RESUMEN
INTRODUCTION: Eosinophilic oesophagitis (EoE) is a chronic clinical-pathological disorder with an immunological basis characterised by symptoms of oesophageal dysfunction and, histologically, eosinophilic inflammation. OBJECTIVE: To evaluate the clinical characteristics and differences in children and adults diagnosed with EoE in a tertiary level hospital. METHOD: Descriptive, retrospective and cross-sectional study. We randomly selected 40 children and 40 adults diagnosed with EoE between 2009 and 2016. The patient characteristics were analysed by means of epidemiological, clinical, diagnostic and therapeutic variables. RESULTS: The average age at diagnosis was 10 years (children) and 34 years (adults), with a higher frequency in males. The majority were sensitised to aeroallergens (77.5% children vs. 82.5% adults) and foods (75% children vs. 82.5% adults). Statistically significant differences were detected in sensitisation to fruits (p=0.007) and grains (p<0.001). Differences were observed in impaction (22.5% children vs. 82.5% adults), dysphagia (42.5% children vs. 77.5% adults) and abdominal pain (25% children vs. 7.5% adults). Endoscopy showed that children had a higher frequency of exudates (92.5%) and adults, trachealisation (50% vs. 5%) and stenosis (17.5% vs. 2.5%). Statistically significant differences were found in treatment with topical corticosteroids (30% children vs. 77.5% adults), with a variable positive response. 77.5% of the patients received elimination diets. CONCLUSIONS: Statistically significant differences were observed between the paediatric and adult populations in the food sensitisation profiles, clinical manifestations, endoscopic findings and treatments received. This is a complex pathology that calls for a multidisciplinary team and would require new non-invasive techniques to facilitate its management.
Asunto(s)
Dolor Abdominal/epidemiología , Trastornos de Deglución/epidemiología , Esofagitis Eosinofílica/inmunología , Mucosa Esofágica/patología , Hipersensibilidad a los Alimentos/inmunología , Dolor Abdominal/inmunología , Administración Tópica , Adolescente , Adulto , Factores de Edad , Alérgenos/inmunología , Niño , Preescolar , Estudios Transversales , Trastornos de Deglución/inmunología , Endoscopía/estadística & datos numéricos , Esofagitis Eosinofílica/complicaciones , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/terapia , Mucosa Esofágica/diagnóstico por imagen , Mucosa Esofágica/inmunología , Femenino , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/patología , Glucocorticoides/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVE: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. METHODS: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. RESULTS: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. CONCLUSIONS: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.
Asunto(s)
Alérgenos/uso terapéutico , Desensibilización Inmunológica/métodos , Hipersensibilidad al Huevo/terapia , Hipersensibilidad a la Leche/terapia , Administración Oral , Humanos , Guías de Práctica Clínica como Asunto , EspañaRESUMEN
INTRODUCTION: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.
Asunto(s)
Alérgenos/uso terapéutico , Desensibilización Inmunológica/métodos , Proteínas del Huevo/uso terapéutico , Hipersensibilidad a los Alimentos/terapia , Proteínas de la Leche/uso terapéutico , Administración Oral , Alérgenos/inmunología , Protocolos Clínicos , Cálculo de Dosificación de Drogas , Proteínas del Huevo/inmunología , Testimonio de Experto , Hipersensibilidad a los Alimentos/inmunología , Humanos , Proteínas de la Leche/inmunología , Guías de Práctica Clínica como Asunto , EspañaRESUMEN
INTRODUCTION: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.
Asunto(s)
Alérgenos/uso terapéutico , Desensibilización Inmunológica/métodos , Hipersensibilidad al Huevo/terapia , Proteínas del Huevo/uso terapéutico , Hipersensibilidad a la Leche/terapia , Proteínas de la Leche/uso terapéutico , Administración Oral , Alérgenos/inmunología , Animales , Bovinos , Contraindicaciones , Hipersensibilidad al Huevo/inmunología , Proteínas del Huevo/inmunología , Testimonio de Experto , Humanos , Tolerancia Inmunológica , Hipersensibilidad a la Leche/inmunología , Proteínas de la Leche/inmunología , Guías de Práctica Clínica como Asunto , EspañaRESUMEN
BACKGROUND AND OBJECTIVE: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. METHODS: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. RESULTS: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. CONCLUSIONS: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.
Asunto(s)
Desensibilización Inmunológica , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/terapia , Administración Oral , Alérgenos/administración & dosificación , Alérgenos/inmunología , Animales , Desensibilización Inmunológica/efectos adversos , Desensibilización Inmunológica/métodos , Manejo de la Enfermedad , Hipersensibilidad al Huevo/inmunología , Hipersensibilidad al Huevo/terapia , Humanos , Hipersensibilidad a la Leche/inmunología , Hipersensibilidad a la Leche/terapia , EspañaRESUMEN
BACKGROUND: Limited published evidence shows oral desensitization to be a potential intervention option for cow's milk protein (CMPs) allergy. OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of oral desensitization in 2-year-old children with cow's milk allergy, as a treatment alternative to elimination diet. METHODS: A total of 60 children aged 24-36 months with IgE-mediated allergy to CMPs were included in this multi-center study and were randomized into two groups. Thirty children (group A: treatment group) began oral desensitization immediately, whereas the remaining 30 (group B: control group) were kept on a milk-free diet and followed-up for 1 year. RESULTS: After 1-year follow-up period, 90% of the children in group A had become completely tolerant vs. 23% of the children in group B. In group A, cow's milk skin reactivity and serum-specific IgE to milk and casein decreased significantly from the initial assessment, whereas group B showed no significant change after 1 year of follow-up. Twenty-four patients (80%) developed some reaction during the treatment period: 14 children developed moderate reaction (47%) and 10 mild reaction (33%). The most common manifestations were urticaria-angioedema, followed by cough. CONCLUSIONS AND CLINICAL RELEVANCE: In this study, oral desensitization was found to be effective in a significant percentage of 2-year-old children with cow's milk allergy. Oral desensitization appears to be efficacious as an alternative to elimination diet in the treatment of 2-year-old children with cow's milk allergy. The side-effect profile appears acceptable but requires further study.
Asunto(s)
Desensibilización Inmunológica , Hipersensibilidad a la Leche/terapia , Administración Oral , Preescolar , Desensibilización Inmunológica/efectos adversos , Femenino , Humanos , Inmunoglobulina E/sangre , Inmunoglobulina E/inmunología , Masculino , Hipersensibilidad a la Leche/sangre , Hipersensibilidad a la Leche/inmunología , Resultado del TratamientoRESUMEN
INTRODUCTION: Sensitisation to Alternaria is a cause of respiratory disease in Spain, particularly in childhood, but it is also a significant marker of the severity of this disease. Therefore, the use of an aetiological treatment (allergen specific immunotherapy) is essential, and both subjective and objective clinical parameters should be used to follow up this treatment. OBJECTIVE: This open-label, uncontrolled, observational, prospective study was designed in order to study the evolution of these patients on allergen specific immunotherapy therapy in daily clinical practice and to assess the use of different monitoring tools. MATERIAL AND METHODS: A total of 99 patients were included. They were monosensitised to this perennial allergen and treated with subcutaneous allergen specific immunotherapy. After one year of follow-up, these patients were assessed for the presence of symptoms, use of medication, clinical incidents, quality of life and asthma control. RESULTS: After one year of treatment a significant fall was observed in the use of concomitant medication (ß2-agonists: p=0.0278, inhaled corticosteroids: p=0.0007, anti-leukotrienes: p=0.0495), nasal symptoms (p=0.0081), quality of life (PAQLQ, p<0.0001) and asthma control (ACQ, p<0.0001). Twenty-one patients had to attend emergency department due to exacerbation of their allergic disease, and only one of them had to be admitted to hospital. CONCLUSION: respiratory allergic disease due to Alternaria alternata is a disease which is hard to control, and in our daily practice, the use of specific subcutaneous immunotherapy can be of significant benefit in our paediatric patients.
Asunto(s)
Desensibilización Inmunológica , Hipersensibilidad Respiratoria/tratamiento farmacológico , Adolescente , Alternaria , Antiinflamatorios/uso terapéutico , Antígenos de Plantas/inmunología , Antígenos de Plantas/uso terapéutico , Asma , Niño , Preescolar , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Inyecciones Subcutáneas , Masculino , Calidad de Vida , Hipersensibilidad Respiratoria/inmunología , EspañaRESUMEN
The term food allergy refers to the immune reaction (mediated by IgE or otherwise) that develops in response to the ingestion of a concrete type of food. Among the different potential manifestations of an allergic reaction, those exclusively affecting the gastrointestinal system are described. In recent years, the study of non-IgE-mediated food allergy has grown in relevance. These disorders are almost always of a transient nature, inherent to (though not exclusive of) nursing infants, and with gastrointestinal symptoms that may have variable repercussions upon the nutritional state of the patient. The prevalence of such reactions is not known, though some studies report that up to 60 % of all cases of allergy to cow's milk proteins (CMPs) are due to non-IgE-mediated mechanisms. The latency period between the time of ingestion and the appearance of the first clinical manifestations is greater than in the case of IgE-mediated reactions, and the underlying immunopathological mechanism has not been clearly established although it is accepted that T cell mediation is involved. The gastrointestinal problems derived from these delayed or chronic reactions comprise allergic proctocolitis, enterocolitis and food protein enteropathies. These digestive disorders tend to appear in the first months of life, and are of a progressive and generally self-limiting nature, with resolution at about two years of age. The most commonly implicated food is milk and, in our setting, there have also been reports implicating fish, egg and rice although such reactions can be triggered by any protein introduced into the infant diet. These manifestations disappear after removing the causal protein from the diet. When the causal proteins are CMPs, a highly hydrolysed infant formula is supplied as substitute, and if the latter is not tolerated, an elemental amino acid-based formula is prescribed.
Asunto(s)
Enterocolitis , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/inmunología , Proctocolitis , Proteínas en la Dieta/efectos adversos , Proteínas en la Dieta/inmunología , Enterocolitis/diagnóstico , Enterocolitis/etiología , Enterocolitis/inmunología , Enterocolitis/terapia , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/inmunología , Enfermedades Gastrointestinales/terapia , Humanos , Inmunoglobulina E/inmunología , Lactante , Hipersensibilidad a la Leche/complicaciones , Hipersensibilidad a la Leche/inmunología , Proctocolitis/diagnóstico , Proctocolitis/etiología , Proctocolitis/inmunología , Proctocolitis/terapiaRESUMEN
Authors present a patient who, when three years old, was studied because of weight and psychic retardation. Physical data were as following: weight, 9.9 Kg (less than 93); height, 90 cm (P 10-25); head circumference, 43,5 cm (less than P3); bone age, 2 3/12 years, and the thyroid function, normal. I131 uptake, 43.5% after 24 h. TBI: T3 index, 1.07; T4, 7.7 gamma %. FT4 index, 7.2. Thyroid scan, normal. Diagnosis was: intrauterine dwarfism and iron-deficiency anemia. At 6 6/12 years old, he had measles and at this time his mother noted rapid weight gain, decrease in the grow rate, besides a coarse, cold skin and constipation, that did-not previously exist. Thyroid study showed typical primary hypothyroidism: I131 uptake, 14% after 24 h. TBI: T3 index, 1.2; T4, 1.2 micrograms/100. TSH in the test of TRH of 165 micro U/ml base and 245 maximum. Anti-thyroidal antibodies were negative. In view of the time coincidence, authors speculate that measles virus is perhaps the aetiologic agent of the hypothyroidism either directly or through an autoimmune reaction.