RESUMO
BACKGROUND AND OBJECTIVE: Nut allergy is a growing problem, yet little is known about its onset in children. Objective: To characterize the onset of nut allergy in children in southern Europe. METHODS: The study population comprised consecutive patients up to 14 years of age who visited allergy departments with an initial allergic reaction to peanut, tree nut, or seed. The allergy work-up included a clinical history, food challenge, skin prick testing, determination of whole-extract sIgE, and ImmunoCAP ISAC-112 assay. RESULTS: Of the 271 children included, 260 were first diagnosed with nut allergy at a mean age of 6.5 years and at a mean (SD) of 11.8 (21.2) months after the index reaction. The most common culprit nuts at onset were walnut (36.5%), peanut (28.5%), cashew (10.4%), hazelnut (8.5%), pistachio (5.4%), and almond (5%). Onset of peanut allergy was more frequent in children ≤6 years and walnut in those aged >6 years (P=.032). In 65% of cases, the allergic reaction occurred the first time the patient consumed the nut, and 35% of reactions were anaphylactic. Overall, polysensitization to nuts was detected by skin prick testing in 64.9% of patients, although this rate was lower among walnut-allergic children (54.7%) and peanut-allergic children (54.1%) (P<.0001). Sensitization to 2S albumins was predominant (75%), especially Jug r 1 (52.8%), whereas sensitization to lipid transfer proteins was less relevant (37%). CONCLUSION: In the population we assessed, the onset of nut allergy occurred around 6 years of age, slightly later than that reported in English-speaking countries. Walnut was the main trigger, followed by peanut. 2S albumin storage proteins, especially Jug r 1, were the most relevant allergens. This study will help guide management and may contribute to preventive strategies in pediatric nut allergy.
Assuntos
Juglans , Hipersensibilidade a Noz , Hipersensibilidade a Amendoim , Alérgenos , Arachis , Criança , Humanos , Imunoglobulina E , Hipersensibilidade a Noz/diagnóstico , Hipersensibilidade a Noz/epidemiologia , Nozes , Hipersensibilidade a Amendoim/diagnóstico , Testes CutâneosRESUMO
BACKGROUND: The objectives of this study were to investigate the prevalence of sIgE to galactose-α-1,3-galactose (α-gal) in individuals with acute urticaria or anaphylaxis from different geographical areas of Spain and to evaluate the relevance of demographics and lifestyle as risk factors for this immune response. METHODS: Participants were recruited from allergy departments at 14 Spanish hospitals. Patients aged 18 years or older presenting with urticaria or anaphylaxis were enrolled into one of 2 arms: cases and controls. An interviewer-administered questionnaire collecting demographic data, lifestyle habits, and the presence of cofactors was obtained from each participant. sIgE to α-gal and total IgE were determined using ImmunoCAP. sIgE levels ≥0.35 kU/L were considered a positive result. RESULTS: The study population comprised 160 cases and 126 controls. The median age was 44 years. The overall prevalence of a positive result of sIgE to α-gal was 15.7%; this was higher in cases (26.3%) than in controls (2.4%). The sIgE anti-α-gal positivity rate ranged from 37.68% (rural) to 15.38% (semiurban), and 7.85% (urban). The rates of positivity were 46.32%, (Northern), 0.72% (Center), and 0% (Mediterranean). A positive result for sIgE to α-gal was associated with a history of tick bites, participation in outdoor activities, pet ownership, and ingestion of mammalian meats or innards before the onset of symptoms. Only alcohol consumption could be implicated as a cofactor. CONCLUSION: Sensitization to α-gal in patients with urticaria or anaphylaxis differs considerably between the 3 geographical areas studied and is related to tick bites.
Assuntos
Alérgenos/imunologia , Anafilaxia/imunologia , Dissacarídeos/imunologia , Hipersensibilidade Alimentar/imunologia , Imunoglobulina E/imunologia , Doenças Transmitidas por Carrapatos/imunologia , Urticária/imunologia , Adulto , Anafilaxia/epidemiologia , Feminino , Hipersensibilidade Alimentar/epidemiologia , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Espanha/epidemiologia , Doenças Transmitidas por Carrapatos/epidemiologia , Urticária/epidemiologiaRESUMO
BACKGROUND: Multiple sensitization is frequent among pollen-allergic patients. The goal of this study was to determine the diagnostic accuracy of the ImmunoCAP ISAC 112 (ISAC112) microarray in allergy to pollen from several taxa and its clinical utility in a Spanish population. METHODS: Specific IgE was determined in 390 pollen-allergic patients using the ISAC112 microarray. Diagnostic accuracy (sensitivity, specificity, predictive values, and area under the ROC curve) was calculated for the diagnosis of allergy to pollen from grass (n=49), cypress (n=75), olive tree (n=33), plane tree (n=63), and pellitory of the wall (n=17) and compared with that of the singleplex ImmunoCAP immunoassay. RESULTS: The sensitivity of the ISAC112 microarray ranged from 68.2% for allergy to plane tree pollen to 93.9% for allergy to grass pollen. The specificity was >90%. The AUC for the diagnosis of allergy to plane tree pollen was 0.798, whereas the AUC for the remaining cases was ≥0.876. The accuracy of ISAC112 was higher than that of ImmunoCAP for plane tree pollen and similar for the remaining pollens. The frequency of sensitization to most species-specific allergenic components and profilins varied between the different geographical regions studied. A total of 73% of pollen-allergic patients were sensitized to species-specific components of more than 1 pollen type. CONCLUSIONS: The ISAC112 microarray is an accurate tool for the diagnosis of allergy to pollen from grass, cypress, olive tree, plane tree, and pellitory of the wall. The features of the ISAC112 microarray are similar or superior (in the case of plane tree pollen) to those of ImmunoCAP. This microarray is particularly useful for the etiologic diagnosis of pollinosis in patients sensitized to multiple pollen species whose pollination periods overlap.
Assuntos
Alérgenos/imunologia , Imunoglobulina E/sangue , Análise em Microsséries/estatística & dados numéricos , Pólen/imunologia , Hipersensibilidade Respiratória/diagnóstico , Hipersensibilidade Respiratória/imunologia , Adulto , Alérgenos/classificação , Área Sob a Curva , Feminino , Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Poaceae/imunologia , Pólen/classificação , Valor Preditivo dos Testes , Profilinas/sangue , Profilinas/genética , Curva ROC , Hipersensibilidade Respiratória/sangue , Hipersensibilidade Respiratória/patologia , Espanha , Especificidade da Espécie , Árvores/imunologiaRESUMO
BACKGROUND: Component-based diagnosis on multiplex platforms is widely used in food allergy but its clinical performance has not been evaluated in nut allergy. OBJECTIVE: To assess the diagnostic performance of a commercial protein microarray in the determination of specific IgE (sIgE) in peanut, hazelnut, and walnut allergy. METHODS: sIgE was measured in 36 peanut-allergic, 36 hazelnut-allergic, and 44 walnut-allergic patients by ISAC 112, and subsequently, sIgE against available components was determined by ImmunoCAP in patients with negative ISAC results. ImmunoCAP was also used to measure sIgE to Ara h 9, Cora 8, and Jug r 3 in a subgroup of lipid transfer protein (LTP)-sensitized nut-allergic patients (positive skin prick test to LTP-enriched extract). sIgE levels by ImmunoCAP were compared with ISAC ranges. RESULTS: Most peanut-, hazelnut-, and walnut-allergic patients were sensitized to the corresponding nut LTP (Ara h 9, 66.7%; Cor a 8, 80.5%; Jug r 3, 84% respectively). However, ISAC did not detect sIgE in 33.3% of peanut-allergic patients, 13.9% of hazelnut-allergic patients, or 13.6% of walnut-allergic patients. sIgE determination by ImmunoCAP detected sensitization to Ara h 9, Cor a 8, and Jug r 3 in, respectively, 61.5% of peanut-allergic patients, 60% of hazelnut-allergic patients, and 88.3% of walnut-allergic patients with negative ISAC results. In the subgroup of peach LTP-sensitized patients, Ara h 9 sIgE was detected in more cases by ImmunoCAP than by ISAC (94.4% vs 72.2%, P < .05). Similar rates of Cora 8 and Jug r 3 sensitization were detected by both techniques. CONCLUSIONS: The diagnostic performance of ISAC was adequate for hazelnut and walnut allergy but not for peanut allergy. sIgE sensitivity against Ara h 9 in ISAC needs to be improved.
Assuntos
Alérgenos/imunologia , Corylus/imunologia , Juglans/imunologia , Hipersensibilidade a Noz/diagnóstico , Nozes/imunologia , Hipersensibilidade a Amendoim/diagnóstico , Proteínas de Plantas/imunologia , Análise Serial de Proteínas , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Testes Intradérmicos , Masculino , Região do Mediterrâneo , Pessoa de Meia-Idade , Hipersensibilidade a Noz/sangue , Hipersensibilidade a Noz/imunologia , Hipersensibilidade a Amendoim/sangue , Hipersensibilidade a Amendoim/imunologia , Valor Preditivo dos Testes , Espanha , Adulto JovemRESUMO
BACKGROUND: Profilins are ubiquitous proteins that act as panallergens in sensitized patients, considered to be mild or incomplete food allergens. The aim of the study was to evaluate the role of profilins as severe food allergens in allergic patients overexposed to grass who were referred for severe food reactions and were sensitized to profilins. METHODS: After a careful in vitro screening, 26 patients were included, classified into two groups, mild (17) and severe reactors (9), based on clinical history and subsequently provoked orally with purified profilin in a double-blind placebo-controlled food challenge setup. RESULTS: A significant number of patients presented severe positive food challenge test reactions at low doses of the allergen profilin. Patients prone to suffer from severe reactions had lower IgG4/IgE ratio to major grass allergens than those who did not. CONCLUSION: Profilins are complete food allergens in food-allergic patient populations that are exposed to high levels of grass pollen. This type of patient constitutes an optimal model to understand the link between respiratory and food allergies. The nature of the observed reactions and the low level of allergen eliciting the reactions suggest that intake through the oral mucosa might constitute a relevant route of exposure to food allergens.
Assuntos
Alérgenos/imunologia , Hipersensibilidade/imunologia , Poaceae/efeitos adversos , Pólen/imunologia , Profilinas/imunologia , Adolescente , Adulto , Alérgenos/administração & dosagem , Citrus sinensis/efeitos adversos , Cucurbitaceae/efeitos adversos , Feminino , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/imunologia , Humanos , Hipersensibilidade/diagnóstico , Imunoglobulina E/imunologia , Imunoglobulina G/imunologia , Solanum lycopersicum/efeitos adversos , Masculino , Pessoa de Meia-Idade , Testes Cutâneos , Adulto JovemRESUMO
BACKGROUND: The aim of the study was to investigate the prevalence of food allergy in patients referred to our Allergy Unit and to evaluate the diagnostic methods used. METHODS: We selected 674 patients referred to the Allergy Unit of our hospital from May 2002 to October 2004. The prevalence of symptoms was determined by a standardized questionnaire, prick-prick test, and serum specific IgE. In a second phase, double-blind oral challenge tests were administered. RESULTS: Food allergy was found in 106 patients (15.7 %): 71 adults (67 %) and 35 children (33 %). The prevalence of food allergen sensitization was 14 % in adults and 20.8 % in children. A total of 89.6 % of the patients experienced symptoms immediately. Only 29.2 % the patients of sought medical attention and adrenaline was administered to five (16.1 %). The foods most frequently involved in allergic reactions were fruits (56.6 %) and tree nuts (22.6 %). The most common symptoms were oral allergy syndrome (46.2 %), urticaria (32.1 %), and anaphylaxis (14.2 %). Combining the results of the questionnaire with those of prick-prick tests in patients whose allergy was confirmed by double-blind, placebo-controlled food challenge (9.1 %) showed a sensitivity of 95.5 %, a negative predictive value of 96 %, a specificity of 75 % and a positive predictive value of 73 %. CONCLUSIONS: 1. The prevalence of food allergy in our sample was 9.1 %. 2. The foods most frequently involved in allergic reactions were fruits and tree nuts. 3. The most common symptoms were oral allergy syndrome, urticaria, and anaphylaxis. 4. Combining our questionnaire with in vivo tests allowed us to diagnose 75-96 % of patients with no food allergy and 95 % of food allergy patients.
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Hipersensibilidade Alimentar/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Alérgenos/efeitos adversos , Anafilaxia/tratamento farmacológico , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Angioedema/epidemiologia , Angioedema/etiologia , Criança , Pré-Escolar , Método Duplo-Cego , Epinefrina/uso terapêutico , Feminino , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/tratamento farmacológico , Hipersensibilidade Alimentar/etiologia , Frutas/efeitos adversos , Humanos , Imunoglobulina E/sangue , Lactente , Masculino , Pessoa de Meia-Idade , Nozes/efeitos adversos , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Sensibilidade e Especificidade , Testes Cutâneos , Espanha/epidemiologia , Estomatite/epidemiologia , Estomatite/etiologia , Inquéritos e Questionários , Urticária/epidemiologia , Urticária/etiologiaAssuntos
Hipersensibilidade Alimentar/etiologia , Frutas/efeitos adversos , Hipersensibilidade Imediata/etiologia , Hipersensibilidade ao Látex/induzido quimicamente , Látex/efeitos adversos , Adulto , Especificidade de Anticorpos/imunologia , Reações Cruzadas/imunologia , Feminino , Humanos , Imunoglobulina E/sangue , Imunoglobulina E/imunologiaRESUMO
There is no literature concerning postburn exercise tolerance among pediatric patients. In an effort to quantify the endurance capabilities of pediatric burn victims, stress testing of 59 patients was carried out with a modified Bruce protocol. This treadmill test consists of eight 3-minute stages with incremental increases in speed and incline. Fifty-nine patients (37 boys and 22 girls) were tested. The mean burn surface area was 46%; an average of 33% consisted of full-thickness burns. The average time since burn injury at which patients were tested was 2.9 +/- 1.9 years. The average age of the patients at the time of test was 11.4 +/- 3.9 years. No differences in exercise tolerance were found among these children irrespective of the presence of inhalation injury, method of excision, or burn size. If these trends continue as more data are accumulated, the long-term prognosis for the child with severe burns will be encouraging.
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Queimaduras/fisiopatologia , Exercício Físico/fisiologia , Queimaduras/reabilitação , Criança , Metabolismo Energético , Teste de Esforço , Feminino , Humanos , Masculino , PrognósticoRESUMO
Ear cartilage heals slowly, and limited vascularity in cartilage precludes use of systemic antibiotics. Iontophoresis electrically induces drugs in solution to migrate into target tissues. Fifteen patients were randomized to receive gentamicin iontophoresis (n = 7) plus dressing changes every 6 hours and cleaning or routine care alone (n = 8) for treatment of ear burns. There were no differences between the groups in incidence of chondritis (43% vs 50%) or cartilage loss (11% vs 16%). However, gentamicin-resistant organisms developed in 29% of the patients who received iontophoresis, but in none of the patients in the control group (p less than 0.05). To identify the etiology of the resistant organisms, 10 New Zealand white rabbits receive 7 cm2 contact burns to each ear. Gentamicin iontophoresis was performed on one ear, and the other ear served as the control. Serum gentamicin levels were always subtherapeutic. Additionally, gentamicin tissue levels in both the treated and control ears were subtherapeutic. Gentamicin iontophoresis appears to offer no additional salutary effects beyond those that are provided by routine care and may encourage the development of antibiotic resistance.
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Queimaduras/tratamento farmacológico , Doenças das Cartilagens/prevenção & controle , Cartilagem da Orelha/lesões , Gentamicinas/uso terapêutico , Iontoforese , Infecção dos Ferimentos/prevenção & controle , Animais , Criança , Gentamicinas/administração & dosagem , Humanos , CoelhosRESUMO
Good results have been achieved in the treatment of patients with burns with new splinting materials and proper splinting techniques. This article focuses on the thermoplastic splinting materials Clinic and Spectrum (Northcoast Medical Inc., San Jose, Calif.) and the comparable thermoplastic products Polyform (Smith & Nephew Rolyan, Inc., Menomonee Falls, Wis.) and Orthoplast (Johnson & Johnson Orthopedics, New Brunswick, N.J.). Qualities such as self-bonding, recyclability, and rigidity were tested for these materials. Splint rigidity was measured by a calibrated hook scale and determined by the force per pound needed to bend the material 20 degrees. Spectrum and Clinic products were judged more economical and, we contend, they are therefore better choices for splinting the thermally injured patient.
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Queimaduras/terapia , Teste de Materiais , Contenções/normas , Humanos , Plásticos , Poliésteres , Polímeros , TerpenosRESUMO
The rehabilitation and reconstruction of patients who survive large burns is an arduous task. To facilitate it we have devised an inventory form to accurately record the somatic abnormalities caused by burns and also the severity and location of burns. This form was used in the assessment of 25 pediatric patients with massive burns. It was found to be a very useful tool that allowed the identification of more specific functional and esthetic deformities than is possible with currently available forms. It also served as a template for the systematic planning of reconstructive procedures.