Oral immunotherapy for food allergy: A Spanish guideline. Egg and milk immunotherapy Spanish guide (ITEMS GUIDE). Part 2: Maintenance phase of cow milk (CM) and egg oral immunotherapy (OIT), special treatment dosing schedules. Models of dosing schedules of OIT with CM and EGG

Introduction: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. Objectives: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. Methods: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. Results: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. Conclusions: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts (AU)

No disponible

Oral immunotherapy for food allergy: A Spanish guideline. Immunotherapy egg and milk Spanish guide (items guide). Part I: Cow milk and egg oral immunotherapy: Introduction, methodology, rationale, current state, indications contraindications and oral immunotherapy build-up phase

Introduction: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. Objectives: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. Methods: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. Results: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. Conclusions: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts (AU)

No disponible

Oral Immunotherapy for Food Allergy: A Spanish Guideline. Immunotherapy Egg and Milk Spanish Guide (ITEMS Guide). Part I: Cow Milk and Egg Oral Immunotherapy: Introduction, Methodology, Rationale, Current State, Indications, Contraindications, and Oral Immunotherapy Build-up Phase.

BACKGROUND AND OBJECTIVE: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. METHODS: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. RESULTS: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. CONCLUSIONS: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.

Oral immunotherapy for food allergy: A Spanish guideline. Egg and milk immunotherapy Spanish guide (ITEMS GUIDE). Part 2: Maintenance phase of cow milk (CM) and egg oral immunotherapy (OIT), special treatment dosing schedules. Models of dosing schedules of OIT with CM and EGG.

INTRODUCTION: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.

Oral immunotherapy for food allergy: A Spanish guideline. Immunotherapy egg and milk Spanish guide (items guide). Part I: Cow milk and egg oral immunotherapy: Introduction, methodology, rationale, current state, indications contraindications and oral immunotherapy build-up phase.

INTRODUCTION: Cow's milk and egg are the most frequent causes of food allergy in the first years of life. Treatments such as oral immunotherapy (OIT) have been investigated as an alternative to avoidance diets. No clinical practice guides on the management of OIT with milk and egg are currently available. OBJECTIVES: To develop a clinical guide on OIT based on the available scientific evidence and the opinions of experts. METHODS: A review was made of studies published in the period between 1984 and June 2016, Doctoral Theses published in Spain, and summaries of communications at congresses (SEAIC, SEICAP, EAACI, AAAAI), with evaluation of the opinion consensus established by a group of experts pertaining to the scientific societies SEICAP and SEAIC. RESULTS: Recommendations have been established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of suffering adverse reactions. CONCLUSIONS: A clinical practice guide is presented for the management of OIT with milk and egg, based on the opinion consensus of Spanish experts.

Oral Immunotherapy for Food Allergy: A Spanish Guideline. Egg and Milk Immunotherapy Spanish Guide (ITEMS GUIDE). Part II: Maintenance Phase of Cow Milk (CM) and Egg Oral Immunotherapy (OIT), Special Treatment Dosing Schedules. Models of Dosing Schedules of OIT With CM and Egg.

BACKGROUND AND OBJECTIVE: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. METHODS: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. RESULTS: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. CONCLUSIONS: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg.

Oral immunotherapy for food allergy: a Spanish Guideline. Egg and milk immunotherapy Spanish Guide (ITEMS GUIDE). Part II: Maintenance phase of cow milk (CM) and egg oral immunotherapy (OIT), special treatment dosig schedules. Models of dosing Schedules of OIT with CM and egg

Introduction: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. Methods: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. Results: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. Conclusions: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg (AU)

Introducción: El huevo y la leche de vaca son la causa más frecuente de alergia alimentaria en los primeros años de vida. Como alternativa terapéutica a la dieta de eliminación se han investigado otras formas de tratamiento como la inmunoterapia oral (ITO). Actualmente no existen guías de práctica clínica para el manejo de la ITO con leche y huevo. Objetivos: Elaborar una guía clínica para el tratamiento con ITO basada en la evidencia científica disponible y en la opinión de expertos. Métodos: Revisión de estudios publicados desde el año 1984 hasta junio de 2016, tesis doctorales publicadas en España, resúmenes de comunicaciones en congresos (SEAIC, SEICAP, EAACI, AAAAI) y consenso de opinión de un grupo de expertos de las sociedades científicas SEICAP y SEAIC. Resultados: Se establecen recomendaciones acerca de la indicación, requerimientos, aspectos prácticos del tratamiento en las diferentes fases de la ITO, y pautas especiales para pacientes de alto riesgo de reacciones adversas. Conclusiones: Se presenta una guía con las directrices para el manejo en la práctica clínica de la ITO con leche y huevo que aúna la opinión consensuada de expertos españoles (AU)

Oral immunotherapy for food allergy: a Spanish Guideline. Immunotherapy Egg and Milk Spanish Guide (ITEMS Guide). Part I: cow milk and egg oral immunotherapy: introduction, methodology, rationale, current state, indications, contraindications, and oral immunotherapy build-up phase

Introduction: Cow milk and egg are the most frequent causes of food allergy in the first years of life. Oral immunotherapy (OIT) has been investigated as an alternative to avoidance diets. No clinical practice guidelines on the management of OIT with milk and egg are currently available. Objectives: To develop clinical guidelines for OIT based on available scientific evidence and the opinions of experts. Methods: A review was made of studies published between 1984 and June 2016, doctoral theses published in Spain, summaries of communications at scientific meetings (SEAIC, SEICAP, EAACI, and AAAAI), and the consensus of opinion established by a group of experts from the scientific societies SEICAP and SEAIC. Results: Recommendations were established regarding the indications, requirements and practical aspects of the different phases of OIT, as well as special protocols for patients at high risk of adverse reactions. Conclusions: Clinical practice guidelines based on the consensus reached between Spanish experts are presented for the management of OIT with milk and egg (AU)

Introducción: El huevo y la leche de vaca son la causa más frecuente de alergia alimentaria en los primeros años de vida. Como alternativa terapéutica a la dieta de eliminación se han investigado otras formas de tratamiento como la inmunoterapia oral (ITO). Actualmente no existen guías de práctica clínica para el manejo de la ITO con leche y huevo. Objetivos: Elaborar una guía clínica para el tratamiento con ITO basada en la evidencia científica disponible y en la opinión de expertos. Métodos: Revisión de estudios publicados desde el año 1984 hasta junio de 2016, tesis doctorales publicadas en España, resúmenes de comunicaciones en congresos (SEAIC, SEICAP, EAACI, AAAAI) y consenso de opinión de un grupo de expertos de las sociedades científicas SEICAP y SEAIC. Resultados: Se establecen recomendaciones acerca de la indicación, requerimientos, aspectos prácticos del tratamiento en las diferentes fases de la ITO, y pautas especiales para pacientes de alto riesgo de reacciones adversas. Conclusiones: Se presenta una guía con las directrices para el manejo en la práctica clínica de la ITO con leche y huevo que aúna la opinión consensuada de expertos españoles (AU)

Modificaciones en la composición del fluido crevicular en pacientes en tratamiento ortodóncico / Composition changes in gingival crevicular fluid during orthodontic treatment

El fluido crevicular, exudado inflamatorio que se encuentra en el surco gingival, lo integran distintos constituyentes derivados de la placa microbiológica, células inflamatorias y tejido del hospedador que son marcadores diagnósticos de la destrucción de los tejidos en la enfermedad periodontal. El objetivo de esta revisión es describir las modificaciones que sufre el fluido crevicular como consecuencia de la inflamación de los tejidos periodontales cuando se inicia un tratamiento ortodóncico. Resultados: La aplicación de aparatología ortodóncica induce la liberación y el aumento en el fluido crevicular de distintos mediadores bioquímicos: IL-1 beta, IL-8, factor de necrosis tumoral alfa o prostaglandinaE2 y de neuropéptidos como la sustancia P. Los niveles de fosfatasa ácida y alcalina y lactato deshidrogenasa aumentan también con la inflamación. Conclusión: El análisis de los componentes del fluido crevicular es un método no invasivo válido para el estudio de la respuesta celular del ligamento periodontal durante el tratamiento ortodóncico (AU)

Gingival crevicular fluid, an inflammatory exudate, located in the gingival groove is integrated by different components that come from microbiologic plaque, inflammatory cells and tissue, these parameters are used to diagnose tissue loss in the subject’s periodontal disease. The aim of this review is to describe the changes in crevicular fluid as a result of periodontal tissues´ inflammation as orthodontic treatment begins. Results: A significant release and increment of different biochemical substances (Interleukin-1b, interleukin-8, TNF, prostaglandin E2and neuropeptides such as substance P) is produced as the treatment evolves. Inflamation raises alkaline phosphatase, acid phosphatase and lactate dehydrogenase levels. Conclusion: Crevicular fluid’s analysis is a useful-non-invasive approach to study the periodontal ligament response to orthodontic treatment (AU)

Tratamiento ortodóncico de pacientes con esclerosis múltiple. A propósito de un caso / No disponible

La Esclerosis Múltiple es una enfermedad de causa desconocida que afecta fundamentalmente a adultos jóvenes, su diagnóstico sigue siendo clínico pero la aparición de nuevos tratamientos hace necesario el apoyo de pruebas complementarias con las que el ortodoncista tiene que estar familiarizado puesto que cada vez es más frecuente que estos pacientes soliciten tratamientos de ortodoncia (AU)

Multiple sclerosis is an unknown origin disease affecting mostly young people, diagnostic was based almost entirely on clinical findings but with the apparition of the news treatments makes necessary the support of complementary test, with which the orthodontic doctor has to be acquainted since every time it is more frequent than this patients request orthodontic treatments (AU)

Enfermedades periodontales durante el embarazo y suasociación con parto prematuro y bajo peso alnacimiento. Evidencias y controversias / Periodontal diseases in pregnancy and its association with preterm delivery and low birth weight. Evidence and controversies

Aunque el embarazo implica cambios fisiológicos que en general no suponen un riesgo por sí mismos para la salud tanto de la madre como del niño, durante este periodo las infecciones de diversa índole pueden poner en riesgo el curso normal del mismo e incluso comprometer la salud del neonato, siendo los partos prematuros y el bajo peso al nacimiento las patologías que con más frecuencia se asocian con las infecciones. Entre estas infecciones comienza a tener cierta relevancia, desde hace ya algunos años la enfermedad periodontal. Esta revisión bibliográfica recoge las conclusiones de distintas publicaciones sobre la relación entre enfermedad periodontal, los partos prematuros y el bajo peso al nacimiento, encontrándose resultados variables (AU)

Pregnancy involves physiological changes which, although not meaning a risk in itself for either the mother’s or the baby’s health, may lead to the development of new pathologies, including periodontal disease. This bibliographical revision compiles the conclusions drawn by different publications about the relationship between periodontal disease and low-weight preterm births, highlighting variable results (AU)

Cold urticaria and celiac disease.

Cold urticaria can be associated with blood and thyroid disorders, drugs, or infections. Celiac disease is an autoimmune enteropathy caused by permanent gluten intolerance. It is often associated with other autoimmune diseases, such as chronic idiopathic urticaria. Nevertheless, association with cold urticaria has not yet been described. A boy aged 3 years 8 months presented local urticaria-angioedema when exposed to cold temperatures. An ice cube test was positive and iron deficiency anemia was demonstrated. He later developed legume intolerance, rhinoconjunctivitis related to pollen sensitization, and asthma. Due to persistence of cold urticaria symptoms and refractory anemia, a test for immunoglobulin A autoantibodies to tissue transglutaminase and an intestinal biopsy were performed. Results of both tests were compatible with celiac disease.A study of human leukocyte antigen indicated a high risk phenotype (HLA, DR6/DR7; DQA 0501, 0201; DQB 0301, 0201). After 7 months of a gluten-free diet, the boy's anemia resolved and he is free of symptoms when exposed to cold. This is a first description of the possibility of an association between celiac disease and cold urticaria. A poor course of cold urticaria in the absence of evidence of another underlying condition should lead to suspicion of celiac disease.

Hipersensibilidad a alimentos y dermatitis atópica / Hypersensitivity to foods and atopic dermatitis

Las enfermedades atópicas aparcen en las primeras décadas de la vida y están directamente ligadas a la maduración del sistema inmune. La dermatitis atópica (DA) es la primera manifestación de estas enfermedades en el individuo atópico, es frecuente en la infancia y alcanza su prevalencia más alta durante los tres primeros años de vida. Se trata de una enfermedad en aumento que ha duplicado su prevalencia en las tres últimas décadas en los países industrializados. Aunque el eccema se suele considerar un problema menos, distintas investigaciones demuestran que puede causar importantes alteraciones en la vida de los niños y suponer un coste nada despreciable para las familias y los sistemas de salud. Un tercio de los niños con DA tienen IgE específica para algún alimento y otros muestran pruebas del parche positivas frente a estos alergenos. Muchos padres y pediatras asumen que la sensibilización a alimentos es la causa de eccema, un enfoque que impide un apropiado tratamiento de la piel y tiene consecuencias negativas que incluyen pruebas innecesarias, carencias nutricionales y costes económicos. La cuestión es si la IgE específica o las pruebas del parche positivas frente a alimentos tienen un papel etiológico en la aparición del eccema. Cuando estas pruebas son negativas tienen un alto valor predictivo, descartando a los alimentos como alergenos sospechosos. Sin embargo, las pruebas positivas a menudo no se correlacionan con síntomas clínicos. El efecto causal de cada unos de estos alimento sen el desarrollo del eccema debe ser comprobado mediante prueba de provocación controlada y dieta de eliminación. La evitación de los alimentos implicados en las pruebas de provocación controlada debe conducir a una mejoría clínica. En este artículo se revisan la patogénesis y el tratamiento de la dermatitis atópica y se concluye la participación etiológica de la alergia a alimentos debe ser comprobada mediante pruebas de provocación controlada en cada paciente antes de instaurar una dieta de eliminación prolongada

Atopic diseases appear in the first decade of lige and are directly linked to the maturation of the immune system. Atopic dermatitis (AD) is usually the first manifestation, with the highest prevalence during the first 3 years. Prevalence of this disease has increases by two o three-fold during the past three decades in industrialised countries. While eczema is often seen to be a minor problem, research has shown than it can cause considerable disruption to the lives of children and their career, and can incur significant cost for the family and the healthcare system. Roughly one third of children with AD have specific food igE and some researches detect positive patch tests with these allergens. Most parents and paediatricians assume foods also cause the eczema, a focus that diverts proper skin therapy and has negative outcomes including nutritional deficiency, costly referrals, and unnecessary testing. The question is whether specific food IgE or positive patch test are of pathogenic importance in the causation of lesions of anatomic exzema. Negative skin prick of patch tests or serum allergen specific IgE have a high predictive value for ruling out suspected allergens. However, positive tests often donot correlated with clinical sumptoms and should be confirmed with controlled food challenges and elimination diets. Avoidance of foods implicated in controlled challenges should result in clinical improvement. We review the pathogeneses and treatment of AD and conclude thta the etiologically participation of food allergy could be confirmed in each patient with and adequate food challenge test before begining a diet

[Incidence of allergy to cow's milk protein in the first year of life and its effect on consumption of hydrolyzed formulae]. / Incidencia de alergia a proteínas de leche de vaca en el primer año de vida y su repercusión en el consumo de hidrolizados.

OBJECTIVES: The aims of this study were to determine the incidence of allergy to cow's milk protein in infants and the cost of treatment with hydrolyzed formulae in the Autonomous Community of Madrid. PATIENTS AND METHODS: Infants with suspected adverse reaction to cow's milk protein born between March 1, 2000 and February 28, 2001 within the catchment area covered by the pediatric services of Hospital La Paz were studied. The diagnostic algorithm of allergy to cow's milk protein of our department was used. The theoretical consumption of hydrolyzed formulae in the treatment of allergic infants was calculated and extrapolated to the Community of Madrid. RESULTS: There were 5367 live births in the above-mentioned catchment area. Adverse reaction to cow's milk protein was suspected in 185 infants. Allergy to cow's milk protein was confirmed in 101 (54 %). The incidence of allergy to cow's milk protein was 101/5356 (1.9 %). In the same period there were 57 078 live births in the Autonomous Community of Madrid. The number of infants that might be allergic in one year would be 1084. The cost of hydrolyzed formulae per infant and year would be 1,585.72 Euros. Thus, the cost of hydrolyzed formulae in the 1084 allergic infants would be 1,718,922.9 Euros; in the 923 in whom allergy was ruled out, the cost would be 1,463,621.8 Euros. CONCLUSIONS: The incidence of allergy to cow's milk protein in the first year of life is at least 1.9 %. The correct diagnosis allows us to rule out allergy to cow's milk protein in almost half of the cases, thus avoiding the use of unnecessary substitutive diets involving a high cost.

Incidencia de alergia a proteínas de leche de vaca en el primer año de vida y su repercusión en el consumo de hidrolizados / Iincidence of allergy to cow's milk protein in the first year of life and its effect on consumption of hydrolyzed formulae

Objetivos: Cálculo de la incidencia de alergia a proteínas de leche de vaca (APLV) en el lactante y coste del tratamiento con hidrolizados de leche de vaca en la comunidad de Madrid. Pacientes y métodos Lactantes con sospecha de APLV nacidos entre el 1 de marzo de 2000 y el 28 de febrero de 2001 en el Hospital La Paz pertenecientes a las áreas que atiende el Hospital Infantil. Se les aplicó el algoritmo diagnóstico de APLV del servicio. Se realizó el cálculo teórico del consumo de hidrolizados utilizados en el tratamiento de los APLV y se extrapoló a la comunidad de Madrid. Resultados Nacidos vivos en el Hospital La Paz pertenecientes a las áreas citadas: 5.356 niños. Consultaron por sospecha fundada de APLV: 185 niños. Se diagnosticaron como alérgicos a PLV a 101 (54 per cent). La incidencia calculada de APLV fue de: 101/5.356: 1,9 per cent. Nacidos en la comunidad de Madrid en el mismo período: 57.078 niños. El número de posibles APLV en un año sería de 1.084. El cálculo aproximado de consumo de hidrolizados en el primer año de vida por niño, supone un coste de 1.585,72 3. El gasto de hidrolizados en los 1.084 alérgicos en la comunidad de Madrid sería de 1.718.922,9 3. El gasto de los 923 niños en los que se descartó alergia supondría 1.463.621,8 3.Conclusiones La incidencia de APLV en el primer año de vida en nuestro medio es de, al menos, 1,9 per cent. El diagnóstico correcto permite descartar APLV en casi la mitad de los casos, evitando someter al lactante a dietas innecesarias y que suponen un elevado coste (AU)

Tomato allergy in children and young adults: cross-reactivity with latex and potato.

BACKGROUND: Several studies have shown that allergy to natural rubber latex is associated with cross-reactivity to certain foods such as tomato and potato. The objective was to investigate the clinical and immunologic differences between a group of patients with clinical allergy to tomato and latex and another which had only clinical allergy to tomato. We also aimed to assess, in vitro, the relationship of tomato and latex allergens, which could explain the cross-reactivity. METHODS: Forty patients with histories of adverse reactions to tomato and IgE-mediated hypersensitivity were enrolled in the study. Tomato, latex, and potato components were analyzed by SDS-PAGE immunoblotting. CAP and immunoblot inhibition were used to study allergen cross-reactivity. RESULTS: Patients from group A had a mean age of 13.2 years, and in group B the mean age was 21.7 years. In group B, 9/10 patients belonged to the latex-fruits syndrome. All patients of both groups tolerated potato. Immunoblotting patterns obtained with patients' sera from pool A showed IgE-binding bands to tomato ranging from 44 to 46 kDa and a triple band at 67 kDa. For latex, there was a strong binding at 44 kDa, and potato showed a strong band of 44 kDa and a 67-kDa triple band. In pool B, the binding to the band of 44 kDa in latex and tomato was more intense than in pool A. In pool A, immunoblot inhibition with potato allergen showed an intense inhibition of the three allergens (potato, latex, and tomato); with latex, inhibition was partial and with tomato, a complete inhibition of tomato and latex was observed, and a partial inhibition of potato. In pool B, the inhibition pattern followed a similar tendency to pool A. The CAP inhibition confirmed the high rate of cross-reactivity between tomato, potato, and latex. CONCLUSIONS: In our study, tomato, potato, and latex showed a common band of 44-46 kDa probably corresponding to patatin. This protein could be implicated in the high cross-reactivity between tomato, latex, and potato observed in the immunoblot and CAP inhibition.

Specific IgE levels in the diagnosis of immediate hypersensitivity to cows' milk protein in the infant.

BACKGROUND: A milk-free diet with substitute formula should be established when immediate symptomatic hypersensitivity to cows' milk protein (CMP) is diagnosed, and therefore an accurate diagnosis is very important. OBJECTIVE: This study aims to find the optimal cutoff values for specific IgE antibody levels that discriminate between allergic and tolerant infants by using cows' milk and its principal proteins as allergens. METHODS: A prospective study was carried out on 170 patients under 1 year old (mean, 4.8 months). These patients were seen consecutively over a 4-year period in our outpatient clinic and for the first time because of a reaction suggesting immediate hypersensitivity after ingestion of cows' milk formula. A clinical history, prick test with cows' milk and its proteins (alpha-lact-albumin, beta-lactoglobulin, and casein), determination of specific IgE antibodies with the CAP system FEIA for the same allergens as for the prick test, and a challenge test according to the diagnostic protocol were performed in all of the children. A study of validity of the prick test (cutoff point, 3 mm) and CAP system by using different cutoff points in the specific IgE values for cows' milk and its proteins were also analyzed. RESULTS: Prevalence of immediate symptomatic hypersensitivity to CMP in this study was 44%. When both the whole milk and its principal milk proteins were used in the prick test, the negative predictive value was very high, and a negative value excluded allergy in 97% of the patients. When the different cutoff points of the specific IgE for milk were analyzed, 2.5 KU(A)/L had a positive predictive value of 90% and 5 KU(A)/L had a positive predictive value of 95%. CONCLUSIONS: When diagnosing immediate hypersensitivity to CMP in infants, negative skin test responses exclude allergy in most of the patients. If the prick test response is positive, specific IgE levels for cows' milk may be helpful. If these values are 2.5 KU(A)/L or greater, the challenge test should not be performed because of its high positive predictive value (90%).