Oral immunotherapy in severe cow's milk allergic patients treated with omalizumab: Real life survey from a Spanish registry.

BACKGROUND: Oral immunotherapy is a frequent treatment for the management of food allergies, but adverse events (AE) are common. This study assessed the outcome of cow's milk oral immunotherapy (MOIT) in severe cow`s milk-allergic patients treated with omalizumab in a real-life setting. METHODS: OmaBASE was a national, multicenter, open, and observational registry that collected clinical, immunologic, and treatment from patients with food allergy receiving omalizumab. RESULTS: Data derived from 58 patients aged 10.3 years (IQR 6.3-13.2) and median milk-specific IgE 100 kUA /L at the start of omalizumab treatment. Most had experienced anaphylaxis by accidental exposures (70.7%) and had asthma (81.0%). Omalizumab in monotherapy induced tolerance to ≥6000 mg of cow's milk protein (CMP) to 34.8% of patients tested by oral food challenge. Omalizumab combined with MOIT conferred desensitization to ≥6000 mg of CMP to 83.0% of patients. Omalizumab withdrawal triggered more AE (P = .013) and anaphylaxis (P = .001) than no discontinuation. Anaphylaxis was observed in 36.4% of patients who discontinued omalizumab, and more in those with sudden (50.0%) rather than progressive (12.5%) discontinuation. At database closure, 40.5% of patients who had completed follow-up tolerated CMP without omalizumab (7.2% 1500-4500 mg; 33.3% ≥6000 mg). CONCLUSION: Milk oral immunotherapy initiated under omalizumab allows the desensitization of subjects with severe cow's milk allergy even after omalizumab discontinuation. However, discontinuation of omalizumab can lead to severe AE and should be carefully monitored.

Dehydrated egg white: an allergen source for improving efficacy and safety in the diagnosis and treatment for egg allergy.

BACKGROUND: Raw and cooked eggs are used as allergens in oral food challenge (OFC). Raw egg is the best option, as it keeps proteins intact and retains their allergenicity, albeit microbiologically safe manipulation is difficult. Therefore, the use of dehydrated egg white (DEW) could improve the efficacy and safety profile of OFC. The aim of the study was to compare the allergenicity of DEW, a product that undergoes a double heat treatment (pasteurization and drying), with that of raw egg white (REW) and determine the efficacy of DEW in the diagnosis of egg allergy. METHODS: We conducted a prospective study of 40 egg-allergic patients who visited our outpatient clinic. Each patient underwent OFC with DEW and REW to determine the correlation between the tests. DEW and REW extracts were analyzed using SDS-PAGE. We compared the allergenicity of both extracts using IgE immunoblotting with a serum pool from patients with positive OFC results. RESULTS: Ten patients (25%) had positive OFC results with both DEW and REW, and the doses that triggered an allergic reaction in each patient were similar (p > 0.05). All 30 patients (75%) with a negative OFC result with DEW also had negative OFC results with REW. SDS-PAGE and IgE immunoblotting revealed that the protein composition and IgE-binding capacity of both extracts were virtually identical. CONCLUSIONS: This is the first time that it is shown that the allergenicity of commercially available DEW is equivalent to raw egg whites. In vivo and in vitro tests showed that processing of DEW does not affect the allergenicity of egg proteins. DEW is an effective and microbiologically safer source of allergen for the diagnosis of egg allergy. Furthermore, DEW can be used in egg oral immunotherapy.

Glucosylisomaltol, a new indicator of browning reaction in baby cereals and bread.

Glucosylisomaltol is proposed as a new indicator of the browning reaction in baby cereals and bread. The glucosylisomaltol was synthesized from maltose and proline, purified by semipreparative HPLC, and characterized by NMR, high-resolution mass spectrometry, and GC-MS analysis. Analysis of glucosylisomaltol, previously separated from cereals by centrifugation, was carried out by reversed-phase HPLC with UV detection in isocratic elution with water/acetonitrile (95:5). Mean recovery of glucosylisomaltol by the standard addition method was 96.9%. The relative standard deviation and detection limit were 1.56% and 0.14 mg/kg, respectively. This compound was identified in samples by the similarity of the t(R) and UV spectra to those of synthesized glucosylisomaltol. Moreover, the glucosylisomaltol from samples, previously separated by semipreparative HPLC, was acetylated and then separated and confirmed by GC-MS. Glucosylisomaltol was determined in baby cereals stored at 32 and 55 degrees C for 1 year and at 25 and 55 degrees C for 1 month at a water activity of 0.65. The amount of this indicator increased during storage from 0.48 to 7.7 mg/kg. The glucosylisomaltol was also determined in prebaked bread by heating at 190 degrees C for 30 min. The amount of this compound increased from nondetectable to 20.9 mg/kg after 30 min of baking. Glucosylisomaltol is a useful indicator to control the browning reaction during baby cereal storage and the baking of bread.

Loss of o-phthaldialdehyde reactivity during storage of infant cereals.

A fluorimetric method was used to determine the o-phthaldialdehyde (OPA) reactivity of amino groups for the assessment of non-enzymatic browning reactions in products with a prolonged shelf-life. The studies were conducted in four commercial infant cereals: wheat-based '7-cereals' and '8-cereals', and gluten-free 'rice cereal' and 'rice-corn cereal'. The cereals were monitored at 28 degrees C for 4 or 16 weeks, or under high water activity (0.65) conditions at 25 degrees C or 55 degrees C for 1, 2, 3 or 4 weeks. OPA reactivity gradually decreased during storage under all temperature, time and water activity conditions, with especially marked losses under conditions of greatest heat intensity and high water activity. According to the present results, the determination of OPA reactivity offers a simple, rapid and reliable method to evaluate non-enzymatic browning.