Allergic rhinoconjunctivitis due to pediculus humanus capitis

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[Analysis of clinical safety in the units of Allergy of the Valencian Community]. / Análisis de la seguridad clínica en las unidades de Alergología de la Comunidad Valenciana.

The introduction of new diagnostic and therapeutic procedures involving allergen exposure may increase the risk of allergic reactions. We designed and distributed an anonymous questionnaire among the allergy units of the Valencian Community in order to collect information on measures to ensure clinical safety. Twelve hospital outpatient clinics and 8 ambulatory care centres reported similar patterns of activities, including the use of critical care units, emergency rooms or day hospitals for higher risk techniques. The provision of security-related instruments is broader in hospital outpatient clinics and included: oxygen (91.7%), pulse oximeter (75.0%) or vital signs monitor (8.3%), resuscitation material (91.7%) and defibrillator (83.3%). The response time for emergencies is set in 50% of clinics. The resuscitation material is systematically reviewed and informed consent signed. Security is more limited in ambulatory care centres. It is necessary to set down the conditions for clinical safety in allergology. Key words. Allergy. Ambulatory care. Clinical safety. Health services. Hospital outpatient clinic.

Safety and efficacy profile and immunological changes associated with oral immunotherapy for IgE-mediated cow's milk allergy in children: systematic review and meta-analysis.

BACKGROUND: Cow's milk allergy (CMA), one of the main types of childhood allergy, considerably impairs patient quality of life. Allergen avoidance is difficult, and mistakes are common. Therefore, new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA. Our objective was to review current evidence on immunological changes, efficacy, and safety when using OIT as an alternative to an avoidance diet in the treatment of children with IgE-mediated CMA. METHODS: We performed a systematic review and subsequent meta-analysis of all randomized controlled studies published to date in which OIT is used to treat CMA in children.We evaluated immunological effects, acquisition of desensitization, and adverse events. Immunological changes were examined by means of a meta-analysis of individual patient data. RESULTS: Desensitization using OIT to cow's milk is 10.2 times more likely than in non-0IT-treated patients. The decrease in cow's milk-specific IgE levels was found to differ by 8.1 kUA/L between OIT-treated patients and those on an avoidance diet. This difference was not statistically significant (P=.318). Although side effects are common, they usually involve mild reactions that are easy to manage without parenteral epinephrine. CONCLUSION: OIT can be considered safe and effective (in terms of acquiring desensitization) and reasonably safe (mild-to-moderate adverse events, little need for parenteral epinephrine) in patients with CMA. Although OIT leads to changes in cow's milk-specific IgE levels, the differences between OIT-treated and non-0IT-treated patients are not significant. More studies are needed to evaluate other immunological changes that may occur, such as the increase in IgG4 levels.

Safety and efficacy profile and immunological changes associated with oral immunotherapy for IgE-mediated cow's milk allergy in children: systematic review and meta-analysis

Background: Cow's milk allergy (CMA), one of the main types of childhood allergy, considerably impairs patient quality of life. Allergen avoidance is difficult, and mistakes are common. Therefore, new treatment strategies such as oral immunotherapy (OIT) have been sought for patients with CMA. Our objective was to review current evidence on immunological changes, efficacy, and safety when using OIT as an alternative to an avoidance diet in the treatment of children with IgE-mediated CMA. Methods: We performed a systematic review and subsequent meta-analysis of all randomized controlled studies published to date in which OIT is used to treat CMA in children. We evaluated immunological effects, acquisition of desensitization, and adverse events. Immunological changes were examined by means of a meta-analysis of individual patient data. Results: Desensitization using OIT to cow's milk is 10.2 times more likely than in non-OIT-treated patients. The decrease in cow's milk-specific IgE levels was found to differ by 8.1 kUA/L between OIT-treated patients and those on an avoidance diet. This difference was not statistically significant (P=.318). Although side effects are common, they usually involve mild reactions that are easy to manage without parenteral epinephrine. Conclusion: OIT can be considered safe and effective (in terms of acquiring desensitization) and reasonably safe (mild-to-moderate adverse events, little need for parenteral epinephrine) in patients with CMA. Although OIT leads to changes in cow's milk-specific IgE levels, the differences between OIT-treated and non-OIT-treated patients are not significant. More studies are needed to evaluate other immunological changes that may occur, such as the increase in IgG4 levels (AU)

Antecedentes: La alergia a la leche de vaca (LV) es una de las principales causas de alergia en la infancia, que altera la calidad de vida de los pacientes y su familia. La evitación del alérgeno es difícil y pueden producirse reacciones adversas graves por ingesta accidental. Esto ha impulsado a la investigación de nuevas estrategias terapéuticas como es la inmunoterapia oral (ITO) para la alergia a LV. Objetivo: Determinar la evidencia actual acerca de los cambios inmunológicos, la eficacia y seguridad de la ITO como alternativa a la dieta de exclusión en el tratamiento del niño con alergia IgE-mediada a LV. Métodos: Revisión sistemática y posterior meta-análisis de todos los estudios controlados aleatorizados publicados hasta el momento actual en los que se emplea la ITO para el tratamiento de la alergia a la LV en niños, evaluando los cambios inmunológicos, la adquisición de desensibilización y los efectos adversos. Los cambios inmunológicos se evaluaron realizando un meta-análisis de los datos individuales de cada paciente. Resultados: La adquisición de desensibilización empleando la ITO con LV es 10.2 veces más frecuente que en los pacientes no tratados. Se observa una diferencia en el descenso de los niveles de IgE específica frente a LV en los pacientes tratados con ITO y los que llevan a cabo una dieta de evitación de 8.1, que no es estadísticamente significativa (p=0.318). Aunque los efectos secundarios son frecuentes, se trata en la mayoría de las ocasiones de reacciones leves de fácil manejo que no requieren el uso de adrenalina parenteral. Conclusión: Existe evidencia suficiente para poder considerar que la ITO es efectiva (en términos de adquisición de desensibilización) y razonablemente segura (efectos adversos leves-moderados, con escasos requerimientos de adrenalina parenteral) para el tratamiento de la alergia a LV. Produce modificaciones inmunológicas en cuanto a los niveles de IgE específica frente a LV, sin embargo, las diferencias no resultan significativas a corto plazo. Hacen falta más estudios para valorar otras cambios inmunológicos que pueden producirse, como es el incremento de los niveles de IgG4 (AU)