Food protein induced enterocolitis syndrome in adults.

Food protein induced enterocolitis syndrome (FPIES) belongs to a group of IgE-independent food allergies. It is the domain of paediatric patients, but it can also occur in adults. In this disease there is a life-threatening risk resulting from the possibility of a severe course of the disease and the development of hypovolemic shock. The disease was first defined in the mid-1970s. Knowledge about this disease is extremely low, we do not know its exact frequency, and the disease itself usually appears between 2 and 7 months of age. FPIES occurs mainly in formula-fed infants, typically 1-4 weeks after formula introduction, very rarely in breastfed infants, but may also develop in adults.

Tree nut allergy.

From a botanical point of view, a nut is a kind of dry, closed, unbroken, single-seeded fruit, which has a ligneous pericarp made up of several fruiting bodies surrounded by one free semen. The term "allergy to tree nuts" includes allergies to almonds, Brazil nuts, cashew nuts, hazelnuts, chestnuts, macadamia nuts, pecan nuts, pistachios and walnuts. All tree nuts belong to five orders of plants: Rosaceae, Fagales, Sapindales, Ericales and Proteales. Allergies to tree nuts usually start in childhood, but unlike other food allergies, they rarely fade away and generally persist throughout life. They are one of the main causes of serious allergic reactions ending in death in both children and adults. The epidemiology of allergy to nuts is variable and depends mainly on the geographical zone and eating habits. In northern Europe, hazelnut allergy is prevalent, whereas in the USA the most common is allergy to peanuts and, when taking tree nuts into consideration, to walnuts. The diagnosis of allergies to nuts is difficult and requires the use of the most modern research tools including molecular diagnostic techniques.

Expression of IL-17A concentration and effector functions of peripheral blood neutrophils in food allergy hypersensitivity patients.

Lymphocytes Th17 and other types of immune system cells produce IL17. By induction of cytokines and chemokines, the IL17 cytokine is involved in mechanisms of allergic reaction with participation of neutrophil granulocytes. It affects activation, recruitment, and migration of neutrophils to the tissues, regulating inflammatory reaction intensity. Excited neutrophils secrete inter alia elastase and reactive oxygen species (ROS)--significant mediators of inflammation process responsible for tissues damage.The aim of the study was to evaluate the concentrations of serum interleukin 17A, serum neutrophil elastase, and ROS production by neutrophils in patients with food allergy.The study included 30 patients with food allergy diagnosed based on interview, clinical symptoms, positive SPT, placebo controlled double-blind oral provocation trial, and the presence of asIgE in blood serum against selected food allergens using fluoro-immuno-enzymatic method FEIA UNICap 100. The control group consisted of 10 healthy volunteers. The concentrations of IL17A were determined in all patients using ELISA method with eBioscience kits, and elastase using BenderMed Systems kits. Chemiluminescence of non-stimulated neutrophils was evaluated using luminol-dependent kinetic method for 40 min on Luminoskan (Labsystems luminometer).The results of serum IL-17A concentrations and the values of chemiluminescence obtained by non-activated neutrophils, as well as elastase concentrations, were higher in patients with food allergic hypersensitivity compared to healthy volunteers.This study demonstrates a significance of IL-17A and activated neutrophil granulocytes in the course of diseases with food allergic hypersensitivity.

The role and therapeutic effectiveness of Plantago ovata seed husk (psyllium husk) in the prevention and non-pharmacological treatment of gastrointestinal diseases. Part 1. Clinical use of psyllium husk in the treatment of irritable bowel syndrome, ulcerative colitis, and colorectal cancer.

Plantago ovata is a common medicinal plant widely cultivated in tropical regions of the world. The outer seed coat of P. ovata, obtained by cleaning the seeds, contains soluble and insoluble fibre in a ratio of 7:3, making products containing P. ovata husk an ideal source of health-beneficial fibre. The results of clinical trials demonstrate the therapeutic efficacy of psyllium husk for various gastrointestinal disorders. It has also been documented that psyllium ingestion exhibits antioxidant, immunomodulatory, antiproliferative, anticancer, and antiviral effects. Such pleiotropic effects of P. ovata husk are related to the presence in its composition of arabinoxylan, which forms a gel in an aqueous environment, as well as bioactive compounds and their metabolites. This article presents the evidence available in the literature on the therapeutic potential and possible mechanisms of action of psyllium in the treatment of irritable bowel syndrome and ulcerative colitis, and prevention of colorectal cancer.

Role of E-selectin and platelet endothelial cell adhesion molecule 1 in gastritis in food allergy patients.

INTRODUCTION: The prevalence of food allergies and other allergic reactions is increasing worldwide, particularly in highly-urbanized populations. Cell adhesion molecules are expressed in response to various pro-inflammatory cytokines. The expression of intercellular adhesion molecule 1 - ICAM-1 (CD54), ICAM-1 (CD106), P-selectin (CD62P), and E-selectin (CD62E) on vascular endothelial cells is induced by such pro-inflammatory cytokines as tumor necrosis factor α (TNF-α) and interleukin-1 (IL-1). AIM: To analyze concentrations of E-selectin and platelet endothelial cell adhesion molecule-1 (PECAM-1) in patients with an allergic type of food sensitivity co-existing with gastritis and to compare them to the values determined in individuals with dyspeptic symptoms not associated with allergic disorders. MATERIAL AND METHODS: The study included 80 patients, among them 50 individuals with food sensitivity confirmed based on compulsory standards, and 30 subjects with dyspeptic symptoms not accompanied by allergic conditions. Venous blood samples were taken from each patient and concentrations of E-selectin and PECAM-1 were determined by means of ELISA. RESULTS: Mean concentrations of sE-selectin and sPECAM-1 in patients with food allergy amounted to 54.0 ±21.6 ng/ml and 132.8 ±31.4 ng/ml, respectively. In individuals without food allergy, mean concentrations of sE-selectin and sPECAM-1 were 57.7 ±17.9 ng/ml and 139.6 ±31.1 ng/ml, respectively. Patients with food allergy and individuals with dyspeptic symptoms not associated with food allergy did not differ significantly in terms of sE-selectin concentrations (Mann-Whitney U-test, p = 0.453028). Similarly, no significant intergroup differences were observed with regard to sPECAM-1 concentrations (Mann-Whitney U-test, p = 0.231054). CONCLUSIONS: Adhesion molecules play an important role in the development of inflammation. This study did not find significant differences in the concentrations of such molecules as sE-selectin and sPECAM-1 between patients with food allergy and gastritis, and subjects in whom gastritis was not accompanied by atopic disorders. A positive correlation between the concentrations of sPECAM-1 and E-selectin was observed in food allergy patients. Consequently, it can be concluded that these molecules participate in the pathogenesis of the inflammatory process independently of the etiopathogenesis of gastritis.

Eosinophilic gastroenteritis - a manifestation of an allergic disease in the gastrointestinal tract? Part 2. Treatment.

Treatment of eosinophilic gastroenteritis (EGE) is mainly empirical and is based on the assessment of symptom severity and the experience of clinicians. Patients with mild disease can be treated symptomatically, while patients with more severe symptoms or malabsorption symptoms require more aggressive therapy. So far, several therapeutic options have been proposed, including the following: dietary treatment, glucocorticosteroids, inhibitors of leukotriene receptors, mast cell stabilizers, immunomodulating drugs, and biological drugs. Unfortunately, there is still a lack of well-designed, prospective. and randomized clinical trials involving large groups of patients with EGE and assessing the effectiveness of individual treatments. More research is needed to compare the efficacy and safety profiles of the various treatments available, and to select the prognostic factors of relapse, which in turn will be extremely important in making decisions about the initial treatment phase and maintenance therapy.

Eosinophilic gastroenteritis - a manifestation of an allergic disease in the gastrointestinal tract? Part 1. Epidemiology and diagnosis.

Eosinophilic gastroenteritis (EGE) is a relatively rare disease, but it should be considered whenever a patient presents with unexplained gastrointestinal symptoms that cannot be explained by parasitic infection or other gastrointestinal diseases characterized by eosinophilic infiltration. A high coexistence of EGE and allergic diseases has been documented. Diagnosis of EGE is based primarily on clinical, endoscopic, and histopathological findings. Glucocorticosteroids and other immunomodulatory drugs are the mainstay of treatment, but currently the greatest hope lies in biological drugs, which are undergoing intensive research. This disease is troublesome for the patient and significantly reduces the quality of life.

Eosinophilic esophagitis. What diet? How to treat it? The point of view of a gastroenterologist working in a department of allergology.

Eosinophilic esophagitis (EoE) belongs to a broad group of allergic gastrointestinal diseases. More narrowly, it is classified as an eosinophilic gastrointestinal disease and is its most common representative. Until recently, this disease was extremely rare, but the last 3 decades have seen a rapid increase in its prevalence to such an extent that in some recent studies it has been named the most common esophageal disease after reflux disease. EoE is an interdisciplinary disorder on the borderline between gastrointestinal and allergologic diseases, requiring cooperation of these two branches of medicine in diagnostics and treatment. Despite the development of medical science it remains a poorly known disease, difficult to diagnose and even more difficult to treat. Recent years have seen the emergence of new studies and guidelines, both American and European, that have radically changed our approach to the diagnosis and treatment of EoE.

Clinical utility of immunological methods based on the singleplex and multiplex ImmunoCap systems for diagnosis of shrimp allergy.

BACKGROUND: Levels of specific IgE (sIgE) against allergen components can be assessed using multiplex assays or with highly sensitive, quantitative methods. The aim of this study was to compare the sensitivity and specificity of different immunological methods for diagnosis of shrimp allergy. METHODS: Twenty patients with positive skin prick tests for frozen tiger shrimp were selected for further examination. Blood samples were taken to assess concentrations of sIgE against the house dust mites Dermatophagoides pteronyssinus and D. farinae, shrimp allergen extract, allergen components Der p 1, Der p 2 and Pan a 1 (ImmunoCap), and the ImmunoCap ISAC 112 panel. RESULTS: All patients had elevated levels of sIgE against shrimp and D pteronyssinus. Eight patients were sensitized to Pen m 1, three patients were sensitized to Pen m 2, and two patients were sensitized to Pen m 4 (ISAC). ImmunoCap ISAC detected shrimp sensitization in 50% of patients. There was a strong correlation between concentrations of sIgE against Pen m1 and Der p 10 detected by ImmunoCap. CONCLUSIONS: The singleplex ImmunoCap system remains the reference diagnostic method, but in the case of shrimp allergy ImmunoCap ISAC provided better insight into patient allergen profiles.

Exercise induced anaphylaxis in kiwi allergic patient: case report.

BACKGROUND: An allergy to kiwi is rare in Poland. Most (65-72%) of the patients who are allergic to kiwi report symptoms of an oral allergy syndrome (OAS); however, systemic manifestations (18-28%) have also been reported. CASE REPORT: A 27-year-old male patient, previously not suffering from chronic diseases, exercised in the gym. He began with isometric training and then continued with aerobic exercise on a treadmill. After exercise, he ate 2 kiwi (Actinidia deliciosa) fruits. He experienced a swelling of the lips after eating the fruit, followed by an itchy scalp and a swollen face. Approximately 60 min later, the symptoms worsened: the patient suffered from generalized hives, general weakness and a "rumbling" sensation in ears. The patient's condition improved upon the consumption of antihistamines. However, the swelling of the face persisted for 24 h despite previously eating a kiwi without any side effects. By means of diagnostics based on allergen components, an allergy to grass allergen components, especially timothy grass-Phl p 1, Phl p 2 and Phl p 5, was confirmed. The presence of IgE that is specific for Act d 2 kiwi was also found. The patient had an oral food challenge with kiwi fruit at rest and after exercise provocation test. The challenge was negative at rest and positive after exercise. A food-dependent exercise-induced anaphylaxis gathered with a kiwi sensitization was diagnosed. CONCLUSION: To our knowledge, this case is the first report of a kiwi-allergic patient in whom exercise was a necessary cofactor to induce an anaphylactic reaction.

Selected allergic diseases of the gastrointestinal tract.

Clinical symptoms of food allergy may affect not only the digestive tract, but also the respiratory system, skin, or cardiovascular system. They may manifest themselves as gastrointestinal problems, asthma attacks, hives, or anaphylactic shock. Allergic reactions of the gastrointestinal tract may be IgE-independent (oral anaphylaxis syndrome, acute gastrointestinal reactions), mixed (eosinophilic gastrointestinal disorders), or IgE-independent (food-induced enterocolitis, proctitis, or enteropathy). The most serious conditions in which allergic background plays or can play an important role are: oral anaphylaxis syndrome, aphthous stomatitis, reflux disease, acute and chronic allergic reactions of gastric mucosa, irritable bowel syndrome, and eosinophilic gastrointestinal disorders.

Analysis of feline and canine allergen components in patients sensitized to pets.

BACKGROUND: Component resolved allergen diagnosis allows for a precise evaluation of the sensitization profiles of patients sensitized to felines and canines. An accurate interpretation of these results allows better insight into the evolution of a given patients sensitizations, and allows for a more precise evaluation of their prognoses. METHODS: 70 patients (42 women and 28 men, aged 18-65, with the average of 35.5) with a positive feline or canine allergy diagnosis were included in the research group. 30 patients with a negative allergy diagnosis were included in the control group. The total IgE levels of all patients with allergies as well as their allergen-specific IgE to feline and canine allergens were measured. Specific IgE levels to canine (Can f 1, Can f 2, Can f 3, Can f 5) and feline (Fel d 1, Fel d 2, Fel d 4) allergen components were also measured with the use of the ImmunoCap method. RESULTS: Monosensitization for only one canine or feline component was found in 30% of patients. As predicted, the main feline allergen was Fel d 1, which sensitized as many as 93.9% of patients sensitized to felines. Among 65 patients sensitized to at least one feline component, for 30 patients (46.2%) the only sensitizing feline component was Fel d 1. Only 19 patients in that group (63.3%) were not simultaneously sensitized to dogs and 11 (36.7%), the isolated sensitization to feline Fel d 1 notwithstanding, displayed concurrent sensitizations to one of the canine allergen components. Fel d 4 sensitized 49.2% of the research group.64.3% of patients sensitized to canine components had heightened levels of specific IgE to Can f 1. Monosensitization in that group occurred for 32.1% of the patients. Sensitization to Can f 5 was observed among 52.4% of the patients. CONCLUSIONS: Concurrent sensitizations to a few allergic components, not only cross-reactive but also originating in different protein families, are a significant problem for patients sensitized to animals.

[Influence of physical effort on concentration of lactic acid and acid-base equilibrium in patients with mild and moderate bronchial asthma]. / Wplyw wysilku fizycznego na stezenie kwasu mlekowego i równowage kwasowo-zasadowa u chorych na astme oskrzelowa lekka i umiarkowana.

PURPOSE: Estimate influences of standard physical exercise on lactic acid concentration and acid-base equilibrium in patients with mild and moderate bronchial asthma compared with healthy trained persons and do not ones. MATERIAL AND METHODS: In 47 asthmatic patients and 20 healthy persons: 1) bronchial reactivity was investigated; 2) at rest and 1, 5 and 10 min after 8 min exercise (PWC85%max, bicycle ergometer): FEV1, lactic acid concentration (LAC), pH, pO2, pCO2 and HCO3 (in capillary blood) were investigated. Among asthmatic patients: 1) 21 experienced exercise-induced asthma (EIA), 2) 20 reacted to histamine in concentration of 0.125 mg/ml/3', 3) 6 reacted to histamine in concentration of 0.25 mg/ml/3'. In healthy persons, without EIA and reaction to histamine, were: 12 who did not train, and 8 athletes. RESULTS: After exercise LAC increased in all groups (p<0.05); the increase was significantly higher in patients and persons who did not train, then athletes, and did not normalised, in opposite to athletes, however in persons who did not train was significantly lower then in asthmatics. pH and pCO2 did not change significantly in all examined persons, but HCO3 decreased significantly in patients with bronchial hyperactivity and in persons who did not train. Significant increase of pO2 appeared only in healthy persons. CONCLUSION: Physical effort caused significant greater metabolic changes in asthmatic patients then in healthy persons, especially athletes