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1.
Artículo en Inglés | MEDLINE | ID: mdl-38223991

RESUMEN

Summary: Background. Food allergy (FA) negatively affects health-related quality of life (HR-QoL) of children and caregivers. To date, no questionnaire self-compiling assessing the HR-QoL in pre-school children with FA is available. The aim of this study is to develop and validate a self-administered, rapid and easy questionnaire to evaluate the HR-QoL in children ≥ 7 years with IgE-mediated FA. Methods. A two-center prospective study was conducted including children aged 4-7 years with IgE-mediated FA. The Vitulia questionnaire was administered to study participants at the baseline (T0) and after one month (T1). To assess the feasibility and reliability, the Vitulia questionnaire was compared with other two pre-existing questionnaires: FAQLQ-PF and the KiddyKindl, which were also tested at both T0 and T1. The validation phase aimed to assess the following psychometric properties: convergent validity, internal consistency, discriminant validity and sensitivity to change. Results. One hundred patients (62% male, mean age 5.4 ± 1.2 years) were enrolled. The Vitulia questionnaire showed a good internal consistency along with an excellent reliability and repeatability of the measure. Another noteworthy feature of the questionnaire was its discriminant validity as demonstrated by the ability to provide different scores in subgroups, which have differences in terms of quality of life. On the other hand, the questionnaire seems not be sensitive to changes in health status over time. Conclusions. The Vitulia questionnaire represents a valid tool, quick and easy to interpret, which can be used to assess the quality of life in preschool children with IgE-mediated FA.

2.
Allergy ; 73(4): 765-798, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-28940458

RESUMEN

Allergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side-effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology, and it may have a disease-modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project "EAACI Guidelines on Allergen Immunotherapy." It aims to provide evidence-based clinical recommendations and has been informed by a formal systematic review and meta-analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product-specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short-term benefit. The strongest evidence for long-term benefit is documented for grass AIT (especially for the grass tablets) where long-term benefit is seen. To achieve long-term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long-term benefit and use in children.


Asunto(s)
Conjuntivitis Alérgica/prevención & control , Desensibilización Inmunológica/métodos , Desensibilización Inmunológica/normas , Rinitis Alérgica/prevención & control , Humanos
3.
Allergy ; 73(4): 799-815, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29205393

RESUMEN

Food allergy can result in considerable morbidity, impairment of quality of life, and healthcare expenditure. There is therefore interest in novel strategies for its treatment, particularly food allergen immunotherapy (FA-AIT) through the oral (OIT), sublingual (SLIT), or epicutaneous (EPIT) routes. This Guideline, prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Task Force on Allergen Immunotherapy for IgE-mediated Food Allergy, aims to provide evidence-based recommendations for active treatment of IgE-mediated food allergy with FA-AIT. Immunotherapy relies on the delivery of gradually increasing doses of specific allergen to increase the threshold of reaction while on therapy (also known as desensitization) and ultimately to achieve post-discontinuation effectiveness (also known as tolerance or sustained unresponsiveness). Oral FA-AIT has most frequently been assessed: here, the allergen is either immediately swallowed (OIT) or held under the tongue for a period of time (SLIT). Overall, trials have found substantial benefit for patients undergoing either OIT or SLIT with respect to efficacy during treatment, particularly for cow's milk, hen's egg, and peanut allergies. A benefit post-discontinuation is also suggested, but not confirmed. Adverse events during FA-AIT have been frequently reported, but few subjects discontinue FA-AIT as a result of these. Taking into account the current evidence, FA-AIT should only be performed in research centers or in clinical centers with an extensive experience in FA-AIT. Patients and their families should be provided with information about the use of FA-AIT for IgE-mediated food allergy to allow them to make an informed decision about the therapy.


Asunto(s)
Desensibilización Inmunológica/métodos , Desensibilización Inmunológica/normas , Hipersensibilidad a los Alimentos/prevención & control , Animales , Humanos , Inmunoglobulina E/inmunología
4.
Allergy ; 73(4): 744-764, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-28748641

RESUMEN

Hymenoptera venom allergy is a potentially life-threatening allergic reaction following a honeybee, vespid, or ant sting. Systemic-allergic sting reactions have been reported in up to 7.5% of adults and up to 3.4% of children. They can be mild and restricted to the skin or moderate to severe with a risk of life-threatening anaphylaxis. Patients should carry an emergency kit containing an adrenaline autoinjector, H1 -antihistamines, and corticosteroids depending on the severity of their previous sting reaction(s). The only treatment to prevent further systemic sting reactions is venom immunotherapy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Venom Immunotherapy as part of the EAACI Guidelines on Allergen Immunotherapy initiative. The guideline aims to provide evidence-based recommendations for the use of venom immunotherapy, has been informed by a formal systematic review and meta-analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom-allergic children and adults to prevent further moderate-to-severe systemic sting reactions. Venom immunotherapy is also recommended in adults with only generalized skin reactions as it results in significant improvements in quality of life compared to carrying an adrenaline autoinjector. This guideline aims to give practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence-based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence.


Asunto(s)
Venenos de Abeja/administración & dosificación , Desensibilización Inmunológica/métodos , Desensibilización Inmunológica/normas , Hipersensibilidad/etiología , Hipersensibilidad/prevención & control , Animales , Venenos de Abeja/inmunología , Humanos
5.
Allergy ; 72(8): 1133-1147, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28058751

RESUMEN

BACKGROUND: The European Academy of Allergy and Clinical Immunology (EAACI) is developing Guidelines for Allergen Immunotherapy (AIT) for IgE-mediated Food Allergy. To inform the development of clinical recommendations, we sought to critically assess evidence on the effectiveness, safety and cost-effectiveness of AIT in the management of food allergy. METHODS: We undertook a systematic review and meta-analysis that involved searching nine international electronic databases for randomized controlled trials (RCTs) and nonrandomized studies (NRS). Eligible studies were independently assessed by two reviewers against predefined eligibility criteria. The quality of studies was assessed using the Cochrane Risk of Bias tool for RCTs and the Cochrane ACROBAT-NRS tool for quasi-RCTs. Random-effects meta-analyses were undertaken, with planned subgroup and sensitivity analyses. RESULTS: We identified 1814 potentially relevant papers from which we selected 31 eligible studies, comprising of 25 RCTs and six NRS, studying a total of 1259 patients. Twenty-five trials evaluated oral immunotherapy (OIT), five studies investigated sublingual immunotherapy, and one study evaluated epicutaneous immunotherapy. The majority of these studies were in children. Twenty-seven studies assessed desensitization, and eight studies investigated sustained unresponsiveness postdiscontinuation of AIT. Meta-analyses demonstrated a substantial benefit in terms of desensitization (risk ratio (RR) = 0.16, 95% CI 0.10, 0.26) and suggested, but did not confirm sustained unresponsiveness (RR = 0.29, 95% CI 0.08, 1.13). Only one study reported on disease-specific quality of life (QoL), which reported no comparative results between OIT and control group. Meta-analyses revealed that the risk of experiencing a systemic adverse reaction was higher in those receiving AIT, with a more marked increase in the risk of local adverse reactions. Sensitivity analysis excluding those studies judged to be at high risk of bias demonstrated the robustness of summary estimates of effectiveness and safety of AIT for food allergy. None of the studies reported data on health economic analyses. CONCLUSIONS: AIT may be effective in raising the threshold of reactivity to a range of foods in children with IgE-mediated food allergy whilst receiving (i.e. desensitization) and post-discontinuation of AIT. It is, however, associated with a modest increased risk in serious systemic adverse reactions and a substantial increase in minor local adverse reactions. More data are needed in relation to adults, long term effects, the impact on QoL and the cost-effectiveness of AIT.


Asunto(s)
Alérgenos/inmunología , Desensibilización Inmunológica , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/terapia , Alimentos/efectos adversos , Inmunoglobulina E/inmunología , Alérgenos/administración & dosificación , Animales , Desensibilización Inmunológica/métodos , Humanos , Oportunidad Relativa , Calidad de Vida , Inmunoterapia Sublingual , Resultado del Tratamiento
8.
Eur Ann Allergy Clin Immunol ; 47(3): 68-76, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25951144

RESUMEN

BACKGROUND: Attempts aimed at inducing food tolerance through oral food desensitization (OFD) for the treatment of IgE-mediated food allergies are increasing. In Italy, a number of allergy centres offer this procedure. OBJECTIVE: To collect information on how these centres are organized, how patients are selected, the methods used to administer OFD and how adverse reactions are managed. METHODS: A questionnaire was e-mailed to all the Italian allergy centres offering OFD. RESULTS: The survey shows a high degree of variability between centres. A correct diagnosis of food allergy is crucial for selecting patients for OFD. In the Italian allergy centres, oral food challenges are mostly open label (84%), but in 16% of cases they are single-blind (8%) or double-blind (8%). A high proportion of allergy centres (83%) offer OFD to children presenting forms of anaphylaxis triggered by traces--or very low doses--of food allergen. The majority of allergy centres (76%) enroll patients over 3 years of age, with 44% enrolling patients above the age of 5. Not-controlled asthma, unreliability of parents in the management of OFD and/or risk of adverse events, are the main reasons for exclusion from the procedure. CONCLUSION: Although OFD may sometimes be successful and may be considered a valid alternative to an elimination diet, further randomized controlled trials are needed, in order to clarify some controversial points, such as the characteristics of the child undergoing OFD, and the methods of food preparation and administration. Moreover, further studies should further investigate OFD safety, efficacy and costs.


Asunto(s)
Alérgenos/administración & dosificación , Desensibilización Inmunológica/métodos , Hipersensibilidad a los Alimentos/terapia , Pautas de la Práctica en Medicina , Administración Oral , Biomarcadores/sangre , Niño , Preescolar , Desensibilización Inmunológica/efectos adversos , Desensibilización Inmunológica/tendencias , Hipersensibilidad a los Alimentos/sangre , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/inmunología , Encuestas de Atención de la Salud , Humanos , Inmunoglobulina E/sangre , Pruebas Inmunológicas , Lactante , Internet , Italia , Pautas de la Práctica en Medicina/tendencias , Valor Predictivo de las Pruebas , Encuestas y Cuestionarios , Resultado del Tratamiento
9.
Int J Immunopathol Pharmacol ; 24(3 Suppl): S27-34, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22014923

RESUMEN

Perioperative anaphylactic as well as anaphylactoid reactions can be elicited by drugs, diagnostic agents, antiseptics, disinfectants and latex. In some individuals, allergic reactions occur in the absence of any evident risk factor. Previous history of specific safe exposure to a product does not permit to exclude the risk of having a reaction. We have systematically reviewed characteristics in the patient's history or clinical parameters that affect the risk of developing reactions during anesthesia. Evidence shows that patients with previous unexplained reaction during anesthesia are at risk for perioperative allergic reactions. An allergic reaction to an agent is associated with previous reaction to a product that is related with the culprit agent. Multiple surgery procedures, professional exposure to latex and allergy to fruit are associated with an increased frequency of latex allergy. It has been shown that in some instances, allergic perioperative reactions may be more common in atopic patients and in females.


Asunto(s)
Hipersensibilidad/epidemiología , Periodo Perioperatorio/estadística & datos numéricos , Anafilaxia , Colorantes/efectos adversos , Medios de Contraste/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Humanos , Hipersensibilidad Inmediata , Hipersensibilidad al Látex/epidemiología , Factores de Riesgo
10.
Int J Immunopathol Pharmacol ; 24(3 Suppl): S101-4, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22014932

RESUMEN

Perioperative allergic reactions manifest in various ways. The majority of systemic reactions occur during anesthesia within minutes of intravenous induction; however, agents which are administered via other routes may cause reactions after more than 15 minutes. Anaphylaxis during anesthesia may present in many different ways and the signs and symptoms, which do not vary from those of anaphylactic reactions in general, may be masked by hypovolemia, light, deep anesthesia or extensive regional blockade. Recommendations for treatment are based on available evidence in the literature. A treatment algorithm is suggested, with emphasis on the incremental titration of adrenaline and fluid therapy as first-line treatment. Increased focus on this subject will hopefully lead to prompt diagnosis and rapid, correct treatment.


Asunto(s)
Anestesia , Hipersensibilidad a las Drogas/terapia , Hipersensibilidad/terapia , Atención Perioperativa , Niño , Hipersensibilidad a las Drogas/tratamiento farmacológico , Epinefrina/administración & dosificación , Epinefrina/uso terapéutico , Humanos , Vasoconstrictores/administración & dosificación , Vasoconstrictores/uso terapéutico
11.
J Biol Regul Homeost Agents ; 25(4): 627-34, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22217994

RESUMEN

Allergic rhinitis (AR) is characterized by Th2 polarized immune response. Specific immunotherapy modifies this arrangement restoring a physiologic Th1 profile. Sublingual immunotherapy (SLIT) is widely prescribed, but there is no early marker of response. The aim of this study is to investigate possible marker of SLIT effectiveness. Thirty children with mite allergy were studied: 15 were treated with drugs alone, 15 with SLIT and drugs on demand. The study lasted 2 years. Visual analogue scale (VAS) for symptoms and medication score were evaluated. Serum cytokines (IL-2, IL-4, IL-6, IL-8, IL-10, IFN-gamma, MCP-1, and TNF-alpha) were assessed by ELISA before and after 1 and 2 year SLIT. SLIT-treated children obtained a significant improvement of symptoms and a reduction of drug use, whereas children treated with a drug alone did not obtained any change. IL-10 significantly increased, whereas Th2-dependent and pro-inflammatory cytokines significantly decreased. In conclusion, the present study demonstrates that 2-year SLIT is capable of inducing immunologic hyporeactivity to mites.


Asunto(s)
Desensibilización Inmunológica , Hipersensibilidad/terapia , Ácaros/inmunología , Administración Sublingual , Adolescente , Animales , Niño , Citocinas/sangre , Femenino , Humanos , Hipersensibilidad/inmunología , Inmunoglobulina E/sangre , Masculino
12.
Ital J Pediatr ; 47(1): 209, 2021 Oct 18.
Artículo en Inglés | MEDLINE | ID: mdl-34663397

RESUMEN

BACKGROUND: The social consequences of COVID-19 pandemic are universally known. In particular, the pediatric population is dealing with a radical lifestyle change. For some risk categories, such as overweight or obese children, the impact of home confinement has been greater than for others. The increased sedentary life, the wrong diet and social distancing have stopped the chance of losing weight. The aims of this study were to analyse the impact of COVID-19 lockdown on the behavior changes in a obese pediatric population and to explore the correlation between the new lifestyle and the level of parental instruction. METHODS: Data show features of 40 obese and overweight pediatric patients of our Clinic in Messina (Italy). We evaluated weight, height, BMI and other biochemical parameters: total cholesterol, HDL, LDL, triglyceride, transaminases, glycemia and insulinemia. After the lockdown, we contacted all patients in order to get some information about diet, physical activity and sedentary lifestyle changes in correlation to the level of their parents' instruction. Additionally, we also evaluated 20 children twice from a clinical and laboratory perspective. RESULTS: The study showed an increase of daily meals during COVID-19 lockdown (3.2 ± 0.4 vs 5 ± 1, P < 0.001). In particular, children whose parents have primary school diploma ate a greater significant number of meals during the lockdown, compared to those who have parents with secondary school diploma (P = 0.0019). In addition, the 95% of patients did low physical activity during the lockdown and the 97.5% spent more time in sedentary activity. Even if BMI's values don't show significant differences, they have increased after the lockdown. We didn't find any correlation between biochemical parameters before and after the lockdown. CONCLUSION: The lockdown has had bad consequences on good style of life's maintenance in overweight and obese children. The absence of a significant correlation between the worsening of biochemical parameters and the lockdown doesn't allow to exclude any long-term consequences. It's safe to assume that, if the hours spent in sedentary activity and the number of meals don't diminish, there will probably repercussion on the biochemical parameters.


Asunto(s)
COVID-19/epidemiología , Control de Enfermedades Transmisibles/métodos , Ejercicio Físico/fisiología , Estilo de Vida , Sobrepeso/epidemiología , Obesidad Infantil/epidemiología , Cuarentena/métodos , Adolescente , Índice de Masa Corporal , Niño , Preescolar , Comorbilidad , Femenino , Humanos , Italia/epidemiología , Masculino , Pandemias , Obesidad Infantil/fisiopatología , Obesidad Infantil/psicología , Estudios Retrospectivos , SARS-CoV-2
13.
Int J Immunopathol Pharmacol ; 22(4 Suppl): 1-3, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19944001

RESUMEN

The sublingual route of administration of allergen (SLIT) has emerged as an effective treatment. Other non-injective route of administration of vaccines failed their goals; oral immunotherapy (OIT), local nasal immunotherapy (LNIT), local bronchial immunotherapy (LBIT) were reported as too expensive or unsafe or ineffective. Oral regimens were used in the first half of the 20th century but then they lost ground to injection immunotherapy. SLIT is suitable for home treatment and it has not to be regarded not only as a substitute of subcutaneous immunotherapy (SCIT), but also as a complementary or additional therapeutic tool in conventional medical practice. Currently, the balance sheet for SLIT is improving: with the steadily increasing number of patients with IgE mediated disorders, looking for a "cheap, safe and effective therapy" becomes a priority.


Asunto(s)
Alérgenos/administración & dosificación , Alérgenos/inmunología , Desensibilización Inmunológica/métodos , Vacunas/administración & dosificación , Administración Sublingual , Desensibilización Inmunológica/efectos adversos , Desensibilización Inmunológica/tendencias , Humanos , Hipersensibilidad/terapia
14.
Ital J Pediatr ; 45(1): 145, 2019 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-31744514

RESUMEN

Hexavalent vaccines, protecting against six diseases (diphtheria, tetanus, pertussis [DTaP], poliovirus, hepatitis B virus [HBV], and Haemophilus influenzae type b [Hib], are routinely the standard of care in Europe. The use of combined vaccines allows the reduction of number of injections and side effects, the reduction of costs, and the increase in adherence of the family to the vaccination schedule both in terms of the number of doses and timing. The safety profile, efficacy and effectiveness of hexavalent vaccines have been extensively documented in infants and children born at term, and data are accumulating in preterm infants. Hexavalent vaccines are particularly important for preterm infants, who are at increased risk for severe forms of vaccine preventable diseases. However, immunization delay has been commonly reported in this age group. All the three hexavalent vaccines currently marketed in Italy can be used in preterm infants, and recent data confirm that hexavalent vaccines have a similar or lower incidence of adverse events in preterm compared to full-term infants; this is likely due to a weaker immune system response and reduced ability to induce an inflammatory response in preterm infants. Apnoea episodes are the adverse events that can occur in the most severe preterm infants and / or with history of respiratory distress. The risk of apnoea after vaccination seems to be related to a lower gestational age and a lower birth weight, supporting the hypothesis that it represents an unspecific response of the preterm infant to different procedures. High seroprotection rates have been reported in preterm infants vaccinated with hexavalent vaccine. However, a lower gestational age seems to be associated with lower antibody titres against some vaccine antigens (e.g. HBV, Hib, poliovirus serotype 1, and pertussis), regardless of the type of hexavalent vaccine used. Waiting for large effectiveness studies, hexavalent vaccines should be administered in preterm infants according to the same schedule recommended for infants born at term, considering their chronological age and providing an adequate monitoring for cardio-respiratory events in the 48-72 h after vaccination, especially for infants at risk of recurrence of apnoea.


Asunto(s)
Esquemas de Inmunización , Vacunas Combinadas/administración & dosificación , Vacunas Combinadas/efectos adversos , Factores de Edad , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Italia , Guías de Práctica Clínica como Asunto
15.
Allergy ; 63(12): 1630-2, 2008 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19032236

RESUMEN

The classical description of the atopic march usually refers to the progression from atopic dermatitis towards asthma, but this pathway has been questioned. We assessed in a prospective observation the possible onset of atopic dermatitis in children with asthma alone at baseline, and evaluated retrospectively their characteristics. Seven hundred and forty-five children (360 male, 6-9 years of age) with asthma alone, without food allergy or atopic dermatitis, were followed-up with regular visits for 9 years. 692 children completed the 9-year observation, and 20% of them were found to have developed atopic dermatitis at 9 years. Comparing retrospectively the children who developed AD with the remaining, no significant difference existed at baseline concerning the demographic characteristics and family history. There was a significantly higher proportion ( chi2 = 0.01) of subjects with single sensitization to mites and a significantly lower proportion of polysensitized subjects ( chi2 = 0.01) within the children who developed AD. Sensitization to foods appeared in 9% of children who developed AD and in 3.8% in the other children (NS). According to these observations, the development of a particular allergic disease does not necessarily follow the classical paradigm of the atopic march.


Asunto(s)
Asma/inmunología , Dermatitis Atópica/inmunología , Progresión de la Enfermedad , Asma/fisiopatología , Niño , Dermatitis Atópica/fisiopatología , Femenino , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/fisiopatología , Humanos , Masculino , Estudios Prospectivos , Estudios Retrospectivos
16.
J Investig Allergol Clin Immunol ; 16(5): 308-10, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17039670

RESUMEN

We describe the case of a young woman with asthma and confirmed food allergy to sesame who had 2 severe systemic reactions after the inadvertent ingestion of tahini, a paste made with ground sesame seeds that is not generally known by physicians and patients as a sesame-containing food. A double-blind placebo-controlled food challenge confirmed the allergy to tahini in our patient. As new products and recipes are being introduced from around the world on a regular basis, it is essential that at-risk patients are able to obtain information about allergens used as ingredients and as potential contaminants. This should be applied not only to packaged food but also to freshly made foods, such as those served in restaurants.


Asunto(s)
Hipersensibilidad a los Alimentos/etiología , Sesamum/efectos adversos , Adulto , Femenino , Humanos , Pruebas Cutáneas
18.
Eur Ann Allergy Clin Immunol ; 37(7): 271-2, 2005 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-16285232

RESUMEN

We describe one case of baker's yeast true allergy in a boy with previously diagnosed mite-allergy and atopic dermatitis. At the age of 6, being atopic dermatitis and rhinitis well controlled by drugs, he began to experience generalized urticaria and asthma after eating pizza and bread, but only fresh from the oven. The diagnostic workup revealed single sensitization to baker's yeast (Saccharomyces cerevisiae), and a severe systemic reaction also occurred during the prick-by-prick procedure. After discussing with parents, no special dietary restriction was suggested but the use of autoinjectable adrenaline and on demand salbutamol. A diary of symptoms was recorded by means of a visual-analog scale. During the subsequent 2 years, the severity of symptoms was progressively reduced, and presently urticaria has disappeared. Only cough persists, invariantly after eating just-baked and yeast-containing foods. If bread, pizza and cakes are ate more than one hour after preparation, no symptom occur at all. Baker's yeast is a common component of everyday diet and it usually acts as an allergen only by the inhalatory route. We speculate that the continuous exposure to saccharomyces in foods may have lead to an immunotolerance with a progressive reduction of symptoms, whereas why the allergens is active only in ready-baked foods remains unexplained.


Asunto(s)
Hipersensibilidad a los Alimentos/inmunología , Tolerancia Inmunológica , Saccharomyces cerevisiae/inmunología , Antialérgicos/uso terapéutico , Asma/tratamiento farmacológico , Asma/etiología , Niño , Preescolar , Dermatitis Atópica/complicaciones , Hipersensibilidad a los Alimentos/complicaciones , Humanos , Masculino , Rinitis Alérgica Perenne/complicaciones , Pruebas Cutáneas , Urticaria/tratamiento farmacológico , Urticaria/etiología
19.
Chem Immunol Allergy ; 82: 77-88, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12947994

RESUMEN

Sublingual immunotherapy (SLIT) is the local route of administration of allergen extracts investigated in several controlled clinical trials. In a number of countries, particularly Italy, France and Spain, this has become common in office practice. At variance with subcutaneous immunotherapy, the knowledge of mechanisms of action of SLIT is still at the beginning: some studies, in animal models, provided interesting information: the dendritic cells of oral mucosa act as efficient antigen-presenting cells and produce IL-12, which directs the immune response towards a Th1 profile away from IgE-Th2 profile. Its clinical efficacy (improvement of symptoms and reduction of drug intake) for both asthma and rhinitis has been assessed in detail for the most common allergens: house dust mites, grass pollen, Parietaria, birch pollen and olive tree. SLIT requires further evaluation concerning the treatment of the extrinsic form of atopic dermatitis. The induction of immunologic tolerance rather than immunoreactivity should be worth pursuing due to the immunologic pathway involved in the pathophysiology of atopic dermatitis. The safety profile of SLIT, derived from the clinical trials and postmarketing surveillance studies, turned out to be satisfactory in adults and children. SLIT represents an important step towards an efficacious and safe treatment of patients with allergic respiratory diseases; nevertheless, further studies are necessary to establish it as a viable alternative to subcutaneous immunotherapy.


Asunto(s)
Asma/terapia , Desensibilización Inmunológica/métodos , Eccema/terapia , Administración Sublingual , Desensibilización Inmunológica/efectos adversos , Humanos
20.
Pediatr Pulmonol Suppl ; 18: 163-4, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10093131

RESUMEN

A knowledge of cross-reactions between different allergens can facilitate the diagnosis of allergy. IgE cross-reactivity has been identified between house dust mite and snails. While most patients have mild symptoms, asthma and/or anaphylaxis may occur with these and other cross-reacting foods. It may be worthwhile to include measurement of IgE to some edible invertebrate animals in asthmatics, e.g. in mite allergic asthmatic patients who eat snails.


Asunto(s)
Reacciones Cruzadas , Hipersensibilidad/inmunología , Ácaros/inmunología , Caracoles/inmunología , Animales , Asma/inmunología , Polvo , Hipersensibilidad a los Alimentos/inmunología , Humanos
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