Adverse reactions to food additives in children: A retrospective study and a prospective survey.

BACKGROUND: Allergic reactions to food additives are often suspected by families. The aim of this study was to describe oral food challenge (OFC) outcomes in a pediatric cohort with a suspected diagnosis of allergy to food additives (food dyes or sodium benzoate). METHODS: All patients who underwent an open OFC to carmine red, cochineal red, erythrosine, patent blue V, tartrazine, yellow sunset S, and/or sodium benzoate were included. A survey was sent to families after testing to evaluate whether the OFC results had altered feeding behaviors with food additives. RESULTS: Twenty-three patients were included. The main suspected food was candy (n=11/23; 48%). Only one OFC out of 45 was formally positive for the carmine and cochineal red. Subsequently, most OFCs were negative (44/45; 97.8%). Despite the negativity of the challenge, four families out of 14 reported occurrences of supposed allergic reactions to food additives and six out of 15 continued to completely avoid the additive of concern in their children's diet. CONCLUSIONS: Allergies to food additives remain rare. Even if an IgE-mediated allergy was excluded with a negative OFC, families remained suspicious about ready-made products. Health professionals and parents should be reassured about the low risk of food dye intolerance or allergies.

[Allergy to cow's milk protein hydrolysates: apropos of 8 cases]. / L'allergie aux hydrolysats de protéines due lait de vache. A propos de huit cas.

BACKGROUND: The use of extensively hydrolyzed protein formulas is the best alternative for children with cow's milk allergy, though cases of allergies to hydrolyzed proteins have been reported. The aim of this study was to clarify from our experience the diagnostic, evolutive and therapeutic aspects of allergies to extensively hydrolyzed protein formulas. PATIENTS AND METHODS: We report eight cases of allergy to extensively hydrolyzed protein formulas seen between 1985 and 1998. The diagnostic criteria for allergy were either the appearance of immediate anaphylactic reactions after the ingestion of protein hydrolysate or a positive challenge test with the protein hydrolysate. RESULTS: Four children developed immediate anaphylactic symptoms after ingesting protein hydrolysate, and four children demonstrated subacute or chronic gastrointestinal symptoms. All children who developed acute anaphylactic symptoms had positive skin tests and specific IgF, antibodies (RAST) to cow's milk and/or hydrolyzed proteins. Conversely, in the four children with chronic gastrointestinal symptoms, skin tests and specific IgE antibodies were negative in three cases, but intestinal histology was abnormal in all of them when they were fed with a protein hydrolysate; this became normal after excluding the hydrolysate (data available in only two cases). Three children tolerated another protein hydrolysate form (whey vs. casein), four children had a favourable outcome when fed with human milk, and an amino-acid-based formula was successfully used in the most recent case. Nonhydrolyzed cow's milk proteins were tolerated after the age of 18 months in six children. Other atopic symptoms were observed in six children. CONCLUSION: Allergy to cow's milk protein hydrolysate is rare. The diagnosis is usually easy in children who develop acute anaphylactic symptoms, though intestinal histology is generally necessary for the diagnosis of allergy with chronic gastrointestinal symptoms. Treatment is based on the use of either another protein hydrolysate form (whey vs. casein) or an amino-acid-based formula.

[Severe hyponatremia associated with anorexia nervosa: role of inappropriate antidiuretic hormone secretion?]. / Hyponatrémie sévère associée à une anorexie mentale: rôle d'une sécrétion inappropriée d'hormone antidiurétique?

BACKGROUND: Anorexia nervosa may be revealed by hyponatremia or associated with it. This hyponatremia can be due to diuretics or laxatives abuse, potomania or inappropriate secretion of antidiuretic hormone as in the case reported here. CASE REPORT: A 15 year-old girl was admitted for anorexia nervosa. She had secondary amenorrhea and asthenia and had lost 14 kg during the preceding 4 months. Her natremia ranged from 112 to 130 mEq/l with normal urinary sodium excretion, serum hypoosmolality (252 mosm/kg) and inappropriately elevated urinary osmolality (698 mosm/kg). Renal, adrenal and thyroid functions were normal. After water loading, patient remained euvolemic, with a negative free water clearance and an increased plasma ADH level with concomitant hyposmolality. A diagnosis of inappropriate secretion of antidiuretic hormone was made, after excluding other conditions such as potomania, drug abuse, vomiting, tumor and chronic lung disease. CONCLUSIONS: Hyponatremia sometimes seen in anorexia nervosa must lead to the search of inappropriate antidiuretic hormone secretion.

[A review of four cases of Branhamella catarrhalis bacteremia in children]. / A propos de quatre observations de bactériémies à Branhamella catarrhalis chez l'enfant.

Branhamella catarrhalis was recovered from one blood culture each from three infants and one neonate admitted to the Trousseau Hospital (Paris) between 1986 and 1988. Clinical features included fever in every case, otitis in three cases, pneumonia in two cases, diarrhea in one case, and enterocolitis in one case. All the strains were beta-lactamase producers. Outcome was favorable in every case. The antimicrobial agent used was erythromycin in one case, amoxicillin in one case, and a third generation cephalosporin in two cases. We reviewed the pediatric literature for reports of Branhamella catarrhalis infections that seem more frequent or better detected than previously. The high prevalence of ampicillin-resistant strains is pointed out.

[Clinical and pharmacokinetic study of imipenem/cilastatin in children and newborn infants]. / Etude clinique et pharmacocinétique de l'imipénème/cilastatine chez l'enfant et le nouveau-né.

Imipenem, a new carbapenem (thienamycin) beta lactam antibiotic which is clinically used in a 1:1 combination with cilastatin, an inhibitor or renal metabolism of imipenem, was evaluated in 25 patients; 11 children and 14 neonates. A mean daily dose of 60 mg/kg was given to children and the dose in neonates was 50 mg/kg. Clinically, 21 patients were cured, two failed to respond to treatment and two were not evaluable. Pharmacokinetic studies were performed in the 11 children and in 10 of the neonates. The mean elimination half-life of imipenem was 0.87 h in children and 2.1 h in neonates. The mean cilastatin elimination half-life was 0.73 h in children and 5.1 h in neonates. This difference in half-life between children and neonates is similar to the one noted between healthy adults and adults with renal insufficiency. No accumulation of imipenem was seen in neonates studied on the first and fifth days of treatment.

[Infective endocarditis in children. Apropos of 13 cases]. / Endocardite infectieuse de l'enfant. A propos de treize observations.

From 1978 through 1987, thirteen pediatric patients aged 14/12 years to 16/12 years were hospitalized for infective endocarditis (IE). Ten cases presented as acute septicemia with modification or development of a murmur and/or heart failure. Three patients had subacute endocarditis. Prior to the endocarditis, ten patients had recognized heart disease, whereas three had no known cardiac abnormality. The organism was recovered in seven cases, from blood cultures in six cases (3 Staphylococcus aureus, 1 group D streptococcus, 1 Staphylococcus albus, and 1 Salmonella typhi) and from a prosthesis in one case (Corynebacterium). Echocardiography confirmed the diagnosis in every patient except the one that had a prosthesis. Although all the patients received parenteral antimicrobial therapy, selected according to bacteriologic data when available, complications developed in every case, including heart failure in nine patients. Three children died, eight underwent valve replacement or repair once the infection was under control, and two have residual valvular disease. This study confirms that, in pediatric patients, the prognosis of IE remains severe despite advances in antimicrobial therapy and the contribution of echocardiography.

[Conservative surgery of rheumatic mitral insufficiency in children. Remote results]. / Chirurgie conservatrice de l'insuffisance mitrale rhumatismale de l'enfant. Résultats à distance.

Between 1977 and 1986, 38 children aged from 3.8 to 16.4 years underwent mitral valvuloplasty for symptomatic mitral valve incompetence of rheumatic origin. Two children (5.3 per cent) died in the immediate post-operative period, and 6 were lost sight of. Among the 30 children followed up for a mean period of 3.3 years, 6 were reoperated upon within 5 months of the valvuloplasty, 5 still present with a significant residual mitral valve incompetence and 9 have satisfactory clinical and echocardiographic results. Survival rate and survival rate without reoperation at 4 years were 93.8 per cent and 76.1 per cent respectively. Factors that correlated with the quality of long-term results were pre-operative left ventricular myocardial fibre shortening rate and surgical technique (poor results were obtained in children who had only one annuloplasty or none).

Pharmacokinetic and clinical evaluation of imipenem/cilastatin in children and neonates.

Imipenem, a new carbapenem (thienamycin) beta-lactam antibiotic which is clinically used in a 1:1 combination with cilastatin, an inhibitor of renal metabolism of imipenem, was evaluated in 25 patients; 11 children and 14 neonates. A mean daily dose of 60 mg/kg was given to children and the dose in neonates was 50 mg/kg. Clinically, 21 patients were cured, two failed to respond to treatment and two were not evaluable. Pharmacokinetic studies were performed in the 11 children and in 10 of the neonates. The mean elimination half-life of imipenem was 0.87 h in children and 2.1 h in neonates. The mean cilastatin elimination half-life was 0.73 h in children and 5.1 h in neonates. This difference in half-life between children and neonates is similar to the one noted between healthy adults and adults with renal insufficiency. No accumulation of imipenem was seen in neonates studied on the first and fifth days of treatment.

[Regressive hypertrophic myocardiopathy in an infant with Recklinghausen's neurofibromatosis]. / Myocardiopathie hypertrophique régressive chez un nourrisson atteint d'une neuro-fibromatose de Recklinghausen.

A case of neonatal hypertrophic cardiomyopathy (HCM) without obstruction is reported. Von Recklinghausen neurofibromatosis in the mother and several relatives and the occurrence of café-au-lait spots in the child at 6 weeks of life led to the association of HCM with this phacomatosis. The spontaneous regression of the myocardial hypertrophy after 6 weeks makes this first report of neonatal HCM in the course of Von Recklinghausen neurofibromatosis peculiar. Several reports in the literature mention the possibility of such a spontaneous regression of HCM or diffuse cardiac tumors, especially in the course of phacomatosis.