Protocol per a l’administració d’immunoteràpia específica amb al·lèrgens en l’atenció primària / Protocol for the administration of allergen-specific immunotherapy in primary care

OBJECTIUS FORMATIUS1. Què és la immunoteràpia específica ambal·lèrgens? Definir les indicacions.2.Conèixer les pautes i els mètodes d’administració.3.Recursos necessaris per a l’administració de laimmunoteràpia. On i com s’ha d’administrar.4.Quines són les possibles reaccions adverses?Com reconèixer-les i tractar-les.IntroduccióL’Organització Mundial de la Salut defineix clínicament la immunoteràpia amb al·èrgens (ITA) coml’administració gradual de quantitats creixents d’unavacuna al·lergènica a un subjecte al·lèrgic fins arribara una dosi que sigui eficaç, millorant els símptomes associats a l’exposició posterior a l’al·lergen causant. (AU)

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.

Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register.

BACKGROUND: The use of intramuscular adrenaline to treat anaphylaxis is suboptimal, despite being the first-line treatment recommended by national and international anaphylaxis guidelines. Fear of potentially severe side effects may be one of the underlying factors. The aim of this study was to assess the incidence and severity of adverse side effects after the use of adrenaline in anaphylaxis, as well as potential risk factors. METHODS: Observational study based on a multicenter online registry of cases of adrenaline administration for suspected anaphylaxis. RESULTS: 277 registered valid cases were included: 138 (51.49%) female, median age 29 years (12-47), and 6 children under 2 years with a median age of 9 months (1-21). Side effects occurred in 58 cases (21.64%), with tremors, palpitations, and anxiety being the most frequent. There was a significant association of developing side effects with older age, higher dose of adrenaline, or use of the intravenous route. Potentially severe adverse effects (high blood pressure, chest discomfort, or ECG alterations) occurred only in 8 cases (2.99%); in these cases, no differences were found according to age or adrenaline dose, but again, intravenous administration was associated with more severe adverse events. CONCLUSION: This study shows that side effects affect less than 1 in 5 patients who receive adrenaline for an anaphylactic reaction, and are usually mild and transient. Therefore, in an emergency situation such as anaphylaxis, restricting adrenaline administration due to potential adverse effects would, in general, not be justified.

Incidència de la hipersensibilitat a llet de vaca en el primer any de vida a la Catalunya Centra / Incidencia de la hipersensibilidad a leche de vaca en el primer año de vida en la Cataluña Central / Incidence of cow's milk allergy in the first year of life in central Catalonia

Fonament: l'al•lèrgia a proteïnes de llet de vaca és l'al•lèrgia alimentària més freqüent en lactants. La prevalença real és difícil d'establir, donada la gran variabilitat metodològica dels estudis publicats. Objectiu: conèixer la incidència durant el primer any de vida de reaccions d'hipersensibilitat, en concret les mediades per IgE, a proteïnes de llet de vaca en una població de lactants que van fer seguiment en àrees bàsiques d'atenció primària de la Catalunya Central. Valorar si existien diferències de reaccions en lactants segons el trimestre de naixement. Mètode: estudi multicèntric, observacional i prospectiu. Àmbit: àrees bàsiques d'atenció primària del Bages i el Solsonès. Es van incloure els nascuts durant el primer i l'últim trimestre del 2012, i se'n va fer el seguiment durant un any. En cas de sospita de reacció d'hipersensibilitat (RHS) al•lèrgica, es van remetre a l'al•lergòleg. Resultats: durant el primer trimestre van néixer 153 infants, i 125 el darrer trimestre. Van completar el seguiment 139 i 119 lactants, respectivament. En el primer grup es va sospitar RHS en 3/124 (2,4%) alimentats amb fórmula artificial (FA). No es va confirmar cap cas mediat per IgE. En el segon grup, van rebre FA 111 lactants. En cinc es va sospitar una RHS (4,5%) i en quatre es va confirmar RHS al•lèrgica: 2/111 mediada per IgE (1,8%) i 2/111 no me-diada per IgE (1,8%). Els dos pacients amb al•lèrgia mediada per IgE van patir reacció en iniciar l'FA. Conclusions: de 235 infants que van rebre FA, es va sospitar RHS en cinc (2,1%), i es va confirmar mecanisme IgE en dos (0,9 %), tots dos nascuts el darrer trimestre

Fundamento. La alergia a proteínas de leche de vaca es la alergia alimentaria más frecuente en lactantes. La prevalencia real es difícil de establecer, dada la gran variabilidad metodológica de los estudios publicados. Objetivo. Conocer la incidencia durante el primer año de vida de reacciones de hipersensibilidad, en concreto las mediadas por IgE, a proteínas de leche de vaca en una población de lactantes que hacen seguimiento en áreas básicas de atención primaria de Cataluña Central. Valorar si existen diferencias según el trimestre de nacimiento. Método. Estudio multicéntrico, observacional y prospectivo. Ámbito: áreas básicas de atención primaria del Bages y el Solsonès. Se incluyeron los recién nacidos durante el primer y el último trimestre de 2012, y se hizo seguimiento durante un año. En caso de sospecha de reacción de hipersensibilidad (RHS) alérgica, se remitieron al alergólogo. Resultados. Durante el primer trimestre nacieron 153 niños, y 125 en el último trimestre. Completaron el seguimiento 139 y 119 lactantes, respectivamente. En el primer grupo se sospechó RHS en 3/124 (2,4%) alimentados con fórmula artificial (FA). No se confirmó ningún caso mediado por IgE. En el segundo grupo, 111 lactantes recibieron FA. En cinco se sospechó una RHS (4,5%) y en cuatro se confirmó RHS alérgica: 2/111 mediada por IgE (1,8%) y 2/111 no mediada por IgE (1,8%). Los dos niños con alergia mediada por IgE sufrieron reacción al iniciar la FA. Conclusiones. De 235 niños que recibieron FA, se sospechó RHS en cinco (2,1%), y se confirmó mecanismo IgE en dos (0,9%), ambos nacidos en el último trimestre (AU)

Background. Cow's milk allergy is the most frequent food allergy in infants; however, given the methodological variability in published studies, its real prevalence is difficult to ascertain. Objective. To determine the incidence of hypersensitivity reactions, specifically those IgE mediated, to cow’s milk proteins in a population of infants seen in primary health care centers in Central Catalonia, and to assess differences in reactions according to the trimester of birth. Method. Multicenter, observational, prospective study conducted in primary healthcare centers of the Bages and Solsones. Infants born during the first and last trimesters of 2012 were included. In case of suspected allergic hypersensitivity reaction (AHR), they were referred to an allergologist for confirmation. Results. 153 infants were born during the first trimester and 125 during the last trimester; full one-year follow-up was completed in 139 and 119 infants, respectively. In the first group, an AHR was suspected in three of 124 (2.4%) children fed with artificial formula (AF). In the second group, 111 infants received AF, and an AHR was suspected in five of them (4.5%). AHR was confirmed in four, with two of them being IgE mediated. Both children with IgE-mediated allergy developed an allergic reaction upon initiation of AF. Conclusions. Of 235 children receiving AF, five (2.1%) had an AHR, which was confirmed to be IgE-mediated in two (0.9%), both born in the last trimester of the year (AU)

Anafilaxia por ingesta de anacardos / Allergic reactions to cashews, an increasing problem

Introducción. El objetivo del trabajo es presentar un caso de reacción alérgica por sensibilización a anacardos. Caso clínico. Presentamos a una paciente de 3 años de edad, la cual sufrió síntomas inmediatos de alergia (urticaria, angioedema, disnea y vómitos) tras la ingesta de anacardos. Reaccions al·lèrgiques per ingesta d’anacards. Una patologia en creixement Agustín Sansosti Viltes 1, 2, Rosa Solé Artigues 1, Catalina Gómez Galán 2, Laia Ferré Ybarz 2, Mariano de la Borbolla 2, Santiago Nevot Falcó 1, 2 1 Hospital Nostra Senyora de Meritxell, Escaldes Engordany, Andorra. 2 Althaia. Hospital Sant Joan de Déu. Manresa (Barcelona) Se realizó prueba de la picadura frente a frutos secos y neumoalergenos habituales en nuestra área, prick by prick con diversos frutos secos con prueba de tolerancia oral, y medición de IgE específica en el suero de la paciente. Las pruebas cutáneas frente a neumoalergenos y frutos secos fueron negativas, excepto para pistacho. El prick by prick y la prueba de tolerancia oral con cacahuete, avellana, almendra, nuez y pipas de girasol también fueron negativos, mientras que el prick by prick con anacardo fue positivo. Además se efectuó prick by prick, IgE específica en suero, y prueba de tolerancia oral con mango, con resultado negativo. La IgE en suero específica frente a anacardo fue de 24,4 kU/ l (clase 4), y la IgE frente a pistacho fue de 21,1 kU/ l, sin efectuar tolerancia oral. Comentarios. Los anacardos pueden provocar reacciones alérgicas severas, y se ha visto que los pacientes con alergia a dicho fruto seco también pueden reaccionar con la ingesta de pistacho, lo cual es el resultado de la reactividad cruzada entre ambos, dado que forman parte de la familia de las anacardiáceas(AU)

Background. The aim of this study is to present a case of allergy due to sensitization to cashew nuts. Care Report. A 3 year-old girl presented with severe allergy symptoms (urticaria, facial edema, dyspnea, and vomiting) after ingestion of cashews. We performed a prick test with nuts and common aeroallergens in our area, and a prick-by-prick test with different nuts combined with oral challenge tests and measurement of specific IgE in the patient’s serum. The prick test to aeroallergens and nuts was negative, except for pistachio. The prick-by-prick and oral challenge tests with peanut, almond, hazelnut, walnut, and sunflower seed were negative, while prick-by-prick test with cashew nut was positive. We also performed prick-by-prick test, specific IgE in serum, and oral challenge with mango, which was negative. The specific serum IgE to cashew nut was 24.4 kU/l (class 4) and specific IgE to pistachio was 21.1 kU/l (class 4), without performing oral challenge. Conclusion. Cashew nuts can cause severe allergic reactions; patients may also be allergic to pistachios, which could be as a result of cross reactivity since both nuts belong to the Anacardiacea family(AU)