Oral and nasal provocation test in chicken egg allergy-case report.

INTRODUCTION: Allergy to chicken egg protein is a common form of food allergy. The most common clinical presentation includes gastrointestinal, skin, and respiratory symptoms. Differential diagnosis, including provocative tests, is critical in diagnosis. CASE DESCRIPTION: We present a case of a 21-year-old patient with egg allergy, who underwent a double-blind food provocation test with placebo (evaluating subjective complaints from the gastrointestinal tract) and a titrated nasal provocation test using dry chicken egg content. We assessed the response of the nasal mucosa in the provocation test using the visual analogue scale (VAS), acoustic and optical rhinometry, as well as measurements of nitric oxide concentration in the exhaled air. During the provocation test, we measured the changes in the transverse section of the nasal passages, which were accompanied by subjective complaints measured with the VAS scale, using objective techniques. In the nasal provocation test with a dose of 20 µg of chicken egg protein, we observed an increase in the reactivity of the nasal mucosa and a decrease in the level of nitric oxide in the exhaled air from the upper airways (920 ppb before the provocation test and up to 867 ppb during the early stage of the allergic reaction). During the provocation tests, we recorded typical symptoms associated with the early stage of the allergic reaction; including nasal obstruction (1.2 cm), leakage of watery discharge (0.8 cm) in the food test, and itchy nose (1.1 cm) in the food test vs. the nasal test: 4.6, 2.8, and 3.5 cm, respectively. CONCLUSIONS: The nasal mucosa provides convenient conditions for evaluation of the severity of allergy to common food allergens, including chicken egg allergens.

A case of lymphocytic esophagitis in a woman with multiple allergies.

BACKGROUND: Lymphocytic esophagitis is a newly recognized entity of unknown origin. Dysphagia is defined as difficulty swallowing and represents a common symptom in the general population with a prevalence of approximately 20%. Chronic inflammation of the esophageal wall may manifest itself clinically and endoscopically, mimicking inflammation of another origin. However, little is known about the pathogenesis of the disease, as patients are seldom suspected and rarely diagnosed with lymphocytic esophagitis. CASE PRESENTATION: Here, we present a rare case of lymphocytic esophagitis in a patient with multiple allergies and suspected eosinophilic esophagitis. A 28-year-old woman with polyvalent sensitization to food and inhalant allergens presented with intermittent dysphagia, a sensation of a foreign body in the throat, itchiness of the oral cavity after ingesting certain foods, heartburn, and prolonged chewing time. A skin prick test showed positive results for birch-tree, alder, hazel, and rye pollen, as well as house dust mites. Apart from obesity (BMI 30 kg/m2), multiple pustules and excoriations on the skin, her physical examination was insignificant. Esophagogastroduodenoscopy (EGD) was performed revealing full-length but discrete trachealization of the esophagus. A barium swallow test showed slowing of esophageal peristalsis in the recumbent position. No esophageal pathology was observed. A histopathological analysis of mucosal samples revealed slight hyperplasia of the basal layer of the esophagus, and the stomach showed changes typical of chronic gastritis. CONCLUSIONS: In summary, this clinical case illustrates that lymphocytic esophagitis, as a newly recognized entity, should be considered in the differential diagnosis of chronic dysphagia. Additionally, when treating allergic patients, clinicians should be aware that lymphocytic esophagitis, distinct from eosinophilic esophagitis, should be considered in the diagnosis of patients with atopy and upper gastrointestinal symptoms.

A case of allergy to Silybum marianum (milk thistle) and Eragrostis tef (teff).

BACKGROUND: This paper presents a peculiar first case of an allergy to Silybum marianum (milk thistle) and Eragrostis tef (teff). Both teff and milk thistle have been presented in the literature (both domestic and foreign) in a positive light, the former as a new part of gluten-free diet, and the latter as a treatment for a number of conditions, particularly those of the liver. CASE PRESENTATION: A 29-year-old male presented at our clinic due to an episode of itching and burning in his mouth, swollen tongue, and difficulty swallowing following ingestion of teff flakes. He also reported sneezing, runny nose, watering and burning eyes, and wheezing following inhalation exposure to ground milk thistle. The patient's occupation is associated with exposure to these allergens. The patient underwent comprehensive allergy diagnostic assessments (including skin-prick testing, serum specific IgE levels, Faber test, spirometry, and acoustic rhinometry) and gastroenterological assessments. The diagnosis was established on skin tests with native allergens (milk thistle 16/35, teff flour 22/60, negative control 0/0, histamine 3/5) provided by the patient. There are no commercially available (standardized) tests for milk thistle or teff either in Poland or anywhere else in the world. CONCLUSIONS: Milk thistle is available in the form of dry, finely-ground preparations (which are used as additives to bread, soups, and yoghurts) and extracts (which are used as ingredients in over-the-counter herbal remedies). Teff is a gluten-free cereal whose grains are rich in methionine, calcium, iron, folic acid, and antioxidants. This case report presents milk thistle and teff as potentially new allergens. A literature review revealed no similar allergy cases in Poland or elsewhere in the world.

Effect of indoor air quality on the development of rhinitis in an urban population in Poland.

Background: Indoor air significantly impacts the incidence of rhinitis among residents of urban agglomerations. Objective: To assess the impact of indoor air pollution on rhinitis. Methods: Data were collected by using an European Community Respiratory Health Survey (ECRHS) and International Study of Asthma and Allergies in Childhood (ISAAC) standardized questionnaires (N = 18,617), and medical examinations were carried out (N = 4783) in selected Polish regions. For statistical analysis, the odds ratio (OR) was calculated with a 95% confidence interval to detect factors associated with rhinitis. The Wald test was performed to assess the significance of those factors. A value of p < 0.05 was considered statistically significant. Results: The most important factors associated with allergic rhinitis declared by adults, ages 20­44 years were the following: the age of the buildings (OR 1.34), presence of central heating system (OR 1.19), gas furnace used to heat the house (OR 1.19), solid-fuel stove (OR 1.92), and bottled-gas stove (OR 1.66). More frequent declarations of nonallergic rhinitis in the study group were associated with the use of a central heating system (children ages 6­7 years: OR 1.21; children ages 13­14 years: OR 1.22; and adults, ages 20­44 years: OR 1.27), solid-fuel stove (children ages 6­7 years: OR 2.95; children ages 13­14 years: OR 2.86; adults, ages 20­44 years: OR 2.02), and bottled-gas stove (children ages 6­7 years: OR 1.89; children ages 13­14 years: OR 1.88; adults, ages 20­44 years: OR 2.06). Diagnosed seasonal allergic rhinitis in adults, ages 20­44 years was associated with the year when the building was constructed (1970­1990) (OR 1.93) and the presence of a central heating system (OR 1.85). The year of construction of a building (1946­1969) (OR 4.84) as well as the use of central heating (OR 1.79) were causes of allergies to molds in the group of children ages 6­7 years, whereas sensitization to Dermatophagoides. pteronyssinus (OR 1.62) and Dermatophagoides farinae (OR 1.78) in children ages 6­7-years was associated with the presence of a central heating system. In children ages 13­14 years, the use of a solid-fuel stove was a cause of sensitization to D. farinae (OR 1.62). Conclusion: The age of the building, home heating systems, and pollution emitted by cooking appliances have a significant impact on the incidence of rhinitis. The highlights of the study included the following: (1) the age and condition of the building, the use of heating devices, stoves, and also mold allergens and house-dust mites contributed to a higher incidence of rhinitis, mainly among adults, ages 20­44 years; (2) gas-storage tanks and solid fuels contribute to rhinitis in the group of children ages 6­7 years and children ages 13­14 years.