Desensibilización a levotiroxina: caso clínico / Successful oral desensitization to levothyroxine: report of one case

We report a 39-year-old female who underwent a total thyroidectomy as treatment for a thyroid papillary cancer. She suffered several episodes of mild angioedema in lips and tongue, after using different commercial Levothyroxine formulations, with and without excipients. Given the need to use this drug, the patient was admitted in our hospital and we proceeded to desensitize her with oral Levothyroxine. The patient fasted throughout the whole procedure, was properly monitored and had an adequate peripheral venous access. On the first day of the procedure, a 15-step protocol was performed, first administering placebo and then, compounded formulations of Levothyroxine starting from 0.01 ug, followed by doubling doses every 15 minutes until the cumulative dose of 111.95 ug was completed, corresponding to the daily dose of Levothyroxine her endocrinologist prescribed (112 ug). The patient was monitored at baseline, between each dose and up to 3 hours after the procedure was completed. There were no incidents such as urticaria, angioedema, or others. On the second day, the patient received a single-full dose of 112 ug on an empty stomach. The medication was successfully tolerated and she was discharged. Thereafter, she tolerates daily Levothyroxine.

Asociación entre los patrones alimentarios durante el primer año de vida y alergia alimentaria en lactantes / Association of dietary patterns and food allergy in infants during the first year of life

Introducción. Existe controversia acerca del efecto del patrón alimentario durante el primer año de vida y el desarrollo de alergia alimentaria. El objetivo de este estudio fue evaluar la asociación entre antecedentes familiares de alergia, manifestaciones alérgicas y patrones alimentarios del primer año de vida en lactantes con alergia alimentaria y sin ella. Población y métodos. Se realizó un estudio descriptivo transversal en menores de 2 años (n= 99), distribuidos en dos grupos: alérgico (n= 50) y grupo control (n= 49), pareados por nivel socioeconómico, edad y género. Se definió alergia alimentaria según criterios clínicos internacionalmente aceptados, pruebas cutáneas y de parche, y respuesta a la dieta. Se recolectó información dietaria, clínica y de historia de alergia en los padres. Se calculó tamaño muestral para regresión logística (Freeman) y se utilizaron pruebas de Student, X² y Mann-Withney. El estudio y el consentimiento fueron aprobados por el Comité de Ética del INTA y de la Universidad de Chile. Resultados. El grupo alérgico mostró una prevalencia significativamente mayor (p <0,0001) de historia familiar de alergia (84%) que el grupo control (16%). La diarrea fue la sintomatología más frecuentemente comunicada por las madres de los niños alérgicos durante el primer año de vida. La lactancia artificial se introdujo más tempranamente en el grupo alérgico que en el grupo control 3 contra 6 meses (p <0,03); no hallamos diferencias con respecto a la edad de inicio de la alimentación complementaria. Al realizar la regresión logística, solo la historia familiar de alergia se asoció con un mayor riesgo de presentar alergia alimentaria (OR: 48,2; IC= 14,2-164; p <0,001). Conclusiones. La introducción precoz de formula láctea podría favorecer la presencia de alergia alimentaria en lactantes que presentan frecuentemente antecedentes familiares de alergia.

Introduction. There is controversy about the effect of dietary patterns during the first year of life and the occurrence of food allergy. The objective of this study was to evaluate the association between family history of allergy, allergic manifestations and dietary patterns during the first year of life in infants with and without food allergy. Population and methods. We performed a descriptive cross-sectional study in children under 2 years of age (n= 99), sorted in two groups: allergic group (n= 50) and control group (n= 49), matched by socioeconomic status, age and gender. Food allergy was defned by internationally approved clinical criteria, prick and patch tests, and response to diet. Information on diet, clinical data and history of allergy in the parents were collected. The sample size was estimated for logistic regression (Freeman), and Student X² and Mann-Withney tests were used. The study and consent forms were approved by the Ethics Committee of the Institute of Nutrition and Food Technology (Instituto de Nutrición y Tecnología de los Alimentos, INTA) and the Universidad de Chile. Results. The allergic group showed a significantly higher prevalence (p <0.0001) of family history of allergy (84%) than the control group (16%). Diarrhea was the symptom most frequently reported by the mothers of allergic infants during the frst year of life. Bottle feeding was introduced earlier in the allergic group than in the control group (3 versus 6 months [p < 0.03]); no differences regarding the start age for supplementary feeding was found. When performing logistic regression, only the family history of allergy was associated with a higher risk of food allergy (OR: 48.2; CI= 14.2-164; p < 0.001). Conclusions. The early introduction of milk formula could promote the occurrence of food allergy in infants frequently presenting family history of allergy.