Clinical and immunological profile of children aged 5-9 years with persistent egg allergy before oral immunotherapy with egg. A multicenter, randomized controlled trial of the Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP).

BACKGROUND: In children with egg protein allergy (EA), the probability of overcoming the allergy decreases with age, and the possibility of suffering severe adverse reactions as a consequence of dietetic transgressions results in worsened quality of life. One treatment option in such cases is oral immunotherapy (OIT) with foods. METHODS: We present a cohort of children with EA scheduled for OIT with pasteurized raw egg white, describing their clinical and allergic characteristics before the start of OIT. RESULTS: The median age was six years, and 93% of the patients also suffered other allergies (58% asthma and 38.6% allergy to more than two food groups). In the last year, 14.8% had suffered a severe reaction due to dietetic transgression with egg. The median IgE specific of egg white titer was 38.5kU/l. A double-blind placebo-controlled food challenge with cooked egg white was performed, and if the test proved positive, it was repeated with pasteurized raw egg white. The mean symptoms-provoking dose was 1.26g and 0.55g for cooked egg white and raw egg white, respectively. An IgE specific of ovomucoid titer of <2.045kU/l differentiated those patients that tolerated cooked egg white. CONCLUSIONS: OIT with egg is regarded as an option in patients with persistent egg allergy. In the previous challenge test, an IgE specific of ovomucoid titer of <2.045kU/l differentiates those patients that tolerate cooked egg white.

Anaphylaxis to hidden potato allergens in a peach and egg allergic boy.

More than 170 foods have been identified as being potentially allergenic. However, a minority of these foods cause the majority of reactions. Sweets are frequently implicated in allergic reactions in children with cow's milk, egg, nuts or fruits allergy, and they are the most relevant foods investigated as responsible allergens. We report an anaphylactic reaction to candies in an egg and peach allergic boy. We performed a study to identify responsible allergens for the reaction. We investigated hidden egg and peach allergens in the candies, but they were not found. Finally, the causative allergen resulted to be a vegetable protein from potato peel. We diagnosed a new allergy in our patient and Sol t 4 was identified as the responsible allergen of the anaphylactic reaction. We conclude that responsible allergens should always be studied and identified in whatever allergic reaction in order to prevent new reactions.

Food allergy in breastfeeding babies. Hidden allergens in human milk.

BACKGORUND: Food allergy is a rare disorder among breastfeeding babies. OBJECTIVE: Our aim was to identify responsible allergens in human milk. METHODS: We studied babies developing allergic symptoms at the time they were breastfeeding. Skin prick tests (SPT) were performed with breast milk and food allergens. Specific IgE was assessed and IgE Immunoblotting experiments with breast milk were carried out to identify food allergens. Clinical evolution was evaluated after a maternal free diet. RESULTS: Five babies had confirmed breast milk allergy. Peanut, white egg and/or cow's milk were demonstrated as the hidden responsible allergens. No baby returned to develop symptoms once mother started a free diet. Three of these babies showed tolerance to other food allergens identified in human milk. CONCLUSION: A maternal free diet should be recommended only if food allergy is confirmed in breastfed babies.

Position document: IgE-mediated cow's milk allergy.

The present document offers an update on the recommendations for managing patients with cow's milk allergy - a disorder that manifests in the first year of life, with an estimated prevalence of 1.6-3% in this paediatric age group. The main causal allergens are the caseins and proteins in lactoserum (beta-lactoglobulin, alpha-lactoalbumin), and the clinical manifestations are highly variable in terms of their presentation and severity. Most allergic reactions affect the skin, followed by the gastrointestinal and respiratory systems, and severe anaphylaxis may occur. The diagnosis of cow's milk allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which constitutes the gold standard for confirming the diagnosis. The most efficient treatment for cow's milk allergy is an elimination diet and the use of adequate substitution formulas. The elimination diet must include milk from other mammals (e.g., sheep, goat, etc.) due to the risk of cross-reactivity with the proteins of cow's milk. Most infants with IgE-mediated cow's milk allergy become tolerant in the first few years of life. In those cases where cow's milk allergy persists, novel treatment options may include oral immunotherapy, although most authors do not currently recommend this technique in routine clinical practice. Enough evidence is not there to confirm the efficacy of elimination diets in the mother and infant for preventing the appearance of cow's milk allergy. Likewise, no benefits have been observed with prebiotic and probiotic dietetic supplements in infants for preventing food allergy.

Changes in IL-10 and specific antibodies associated to successful Dermatophagoides pteronyssinus immunotherapy in children during the first year of treatment

Background: Allergen-specific immunotherapy (SIT) is a long-term treatment of respiratory allergy. Objective: To look for early predictors of the effectiveness of Dermatophagoides pteronyssinus SIT. Methods: A prospective multi-centre study was carried out in Spain. Children with D. pteronyssinus rhinitis or asthma were invited to participate. The study was divided into times: T0 (recruitment); T1 (inclusion); T2 a-f (immunotherapy times) and T3 (the end of study). Efficacy of SIT was assessed by clinical scores, visual analogue scales (VAS) and lung function tests. We performed D. pteronyssinus skin tests at T1 and T3, and determined specific serum IgE, IgG4 and IL-10 at T1, T2f and T3.Data were analysed using Mann–Whitney and Kruskal–Wallis tests, compared using Wilcoxon and Chi-square tests, and correlated to Spearman test. All tests had a significance level of 0.05. Results: Thirty-eight children completed the study. At T1 all had rhinitis and 34 also had asthma. At T3, 30 patients had improved, six experienced no changes and two worsened. Improvement was associated to FEV1/FVC and VAS improvement; to a reduction in D. pteronyssinus skin prick test; to a progressive increase in serum levels of D. pteronyssinus IgE, and D. pteronyssinus, Der p1 and Der p2 IgG4. IL-10 levels showed an early increase at T2f (the end of initial build-up immunotherapy phase), and then a reduction at T3 (the end of a year of immunotherapy).Improvement associated to an early increase in IL-10 and was correlated with VAS and specific IgG4 evolution(AU)

Changes in IL-10 and specific antibodies associated to successful Dermatophagoides pteronyssinus immunotherapy in children during the first year of treatment.

BACKGROUND: Allergen-specific immunotherapy (SIT) is a long-term treatment of respiratory allergy. OBJECTIVE: To look for early predictors of the effectiveness of Dermatophagoides pteronyssinus SIT. METHODS: A prospective multi-centre study was carried out in Spain. Children with D. pteronyssinus rhinitis or asthma were invited to participate. The study was divided into times: T0 (recruitment); T1 (inclusion); T2 a-f (immunotherapy times) and T3 (the end of study). Efficacy of SIT was assessed by clinical scores, visual analogue scales (VAS) and lung function tests. We performed D. pteronyssinus skin tests at T1 and T3, and determined specific serum IgE, IgG4 and IL-10 at T1, T2f and T3. Data were analysed using Mann-Whitney and Kruskal-Wallis tests, compared using Wilcoxon and Chi-square tests, and correlated to Spearman test. All tests had a significance level of 0.05. RESULTS: Thirty-eight children completed the study. At T1 all had rhinitis and 34 also had asthma. At T3, 30 patients had improved, six experienced no changes and two worsened. Improvement was associated to FEV1/FVC and VAS improvement; to a reduction in D. pteronyssinus skin prick test; to a progressive increase in serum levels of D. pteronyssinus IgE, and D. pteronyssinus, Der p1 and Der p2 IgG4. IL-10 levels showed an early increase at T2f (the end of initial build-up immunotherapy phase), and then a reduction at T3 (the end of a year of immunotherapy). Improvement associated to an early increase in IL-10 and was correlated with VAS and specific IgG4 evolution.

Bee pollen: a dangerous food for allergic children. Identification of responsible allergens

Background: Bee pollen has been proposed as a food supplement, but it can be a dangerous food for people with allergy. We study an allergic reaction after ingestion of bee pollen in a 4-year-old boy who had developed rhinitis in the last spring and autumn. Methods: We performed a prick-by-prick test with bee pollen and skin prick tests with the most important local pollens, house dust mites, common fungi, and animal danders. The levels of serum tryptase, serum total IgE and specific IgE against bee venom and local pollen extracts were determined. The composition of the bee pollen was analysed and SDS-PAGE immunoblotting and blotting-inhibition were carried out. Results: Prick tests were positive to bee pollen and all local pollens extracts and negative to any other allergen sources. The bee pollen sample contained pollens from Quercus genus, and Asteraceae (Compositae) and Rosaceae families. Total IgE was 435kU/l. Serum specific IgE to bee pollen was 6kU/l and greater than 0.35kU/L against pollens from Artemisia vulgaris, Taraxacum officinalis, Cupressus arizonica, Olea europaea, Platanus acerifolia and Lolium perenne as well as to n Art v 1 and other pollen marker allergens. Tryptase level was 3.5mcg/mL. SDS-PAGE immunoblotting-inhibition points to Asteraceae pollen as the possible cause of the allergic reaction. Conclusion: Foods derived from bees can be dangerous to people with allergy to pollen

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Bee pollen: a dangerous food for allergic children. Identification of responsible allergens.

BACKGROUND: Bee pollen has been proposed as a food supplement, but it can be a dangerous food for people with allergy. We study an allergic reaction after ingestion of bee pollen in a 4-year-old boy who had developed rhinitis in the last spring and autumn. METHODS: We performed a prick-by-prick test with bee pollen and skin prick tests with the most important local pollens, house dust mites, common fungi, and animal danders. The levels of serum tryptase, serum total IgE and specific IgE against bee venom and local pollen extracts were determined. The composition of the bee pollen was analysed and SDS-PAGE immunoblotting and blotting-inhibition were carried out. RESULTS: Prick tests were positive to bee pollen and all local pollens extracts and negative to any other allergen sources. The bee pollen sample contained pollens from Quercus genus, and Asteraceae (Compositae) and Rosaceae families. Total IgE was 435 kU/l. Serum specific IgE to bee pollen was 6 kU/l and greater than 0.35 kU/L against pollens from Artemisia vulgaris, Taraxacum officinalis, Cupressus arizonica, Olea europaea, Platanus acerifolia and Lolium perenne as well as to n Art v 1 and other pollen marker allergens. Tryptase level was 3.5 mcg/mL. SDS-PAGE immunoblotting-inhibition points to Asteraceae pollen as the possible cause of the allergic reaction. CONCLUSION: Foods derived from bees can be dangerous to people with allergy to pollen.

Exercise-induced asthma in asthmatic children. Predisposing factors.

BACKGROUND: Exercise-induced bronchoconstriction (EIB) has a high prevalence in children with asthma, and this is a common problem, even in case of controlled asthma, because of the high levels of physical activity in the childhood. OBJECTIVES: The aim of our study was to identify factors associated with the development of EIB in children with controlled asthma. METHODS: We studied children evaluated for asthma. A personal and familiar history was collected from each patient to estimate asthma severity, precipitating factors, exercise ability, immunotherapy treatment and atopic familiar disorders. Skin prick tests for inhalant allergens, pulmonary function tests (PFTs) and exercise challenge test (ECT) measurements were realized in every patient. We used the Chi Squared test to compare qualitative variables, the Student's-t test for quantitative variables and a logistic regression analysis to estimate the independent effect of the variables. RESULTS: We evaluated 132 asthmatic patients. Eighty-two, 6 to 14 years old (average 110 +/- 36.9 months), were included in the study. Forty one have coughing or wheezing with exercise at least three months ago, in addition to a positive ECT; 9 of these children had solitary EIB (group A), and 32 (group B) had controlled chronic asthma, 27 intermittent and 5 moderately persistent. Forty one controlled asthmatic children, 39 intermittent, 1 mildly persistent and 1 moderately persistent (group C) had a good tolerance for exercise with a negative ECT. No differences were found in familiar history, asthma severity or evolution time in B vs C group. We found that 35 patients (42,68 %) patients were sensitized to indoor allergens: 24 (58,53 %) were patients suffering EIB and 11 (26,8 %) allowed to group C. Precipitating factors of asthma were in group B: respiratory infections in 19 cases, pollen in 20 and in 10 indoor allergens exposure. In group C: 14 patients had asthmatic symptoms with viral respiratory infections, 32 with pollen and 2 with indoor allergens exposure. A patient from group A had allergy rhinitis after exposure to cats. Allergy to indoor allergens demonstrated an direct association to EIB suffering (p = 0,026). Twenty six patients with allergic asthma followed pollen immunotherapy treatment, 7 of group B (33,3 %) and 19 (59,3 %) of group C. This treatment was inversely associated with EIB suffering (p = 0,048). A logistic regression analysis confirmed the independence of both variables as predisposing and protecting factors in EIB suffering. CONCLUSIONS: Allergy to indoor allergens might be considered a risk factor for EIB. Immunotherapy treatment could be a protective factor against the development of EIB in children with allergic asthma.

Dermatitis de contacto por tatuajes temporales en niños / Temporary tattoo-induced contact dermatitis in children

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Reacción urticarial generalizada tras la utilización de toallitas limpiadoras / Generalized urticarial reaction after the use of baby wipes

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Esofagitis eosinofílica. ¿Cuándo debemos sospecharla? / Eosinophilic esophagitis. When must we suspect it?

La esofagitis eosinofílica consiste en una inflamacióncrónica del esófago con una rica infiltración eosinófila.Durante años se ha considerado una patologíapoco frecuente causante de disfagia en el niño.Sin embargo, un incremento reciente en el diagnósticode esta enfermedad ha provocado que susciteun novedoso interés y a la vez que se reconsidereel papel inmunológico del esófago. Este artículoes una revisión de las características conocidasde esta enfermedad la cual implica aspectos clínicos,nutricionales, histológicos, endoscópicos, manométricos,e inmunológicos

Eosinophilic esophagitis is a disease characterizedby a marked eosinophilic chronic inflammationof the esophagus. For years it has been considereda rare cause of dysphagia in children but an increaseof its diagnosis in the last years provoked a newinterest and also a revaluation of the immunologicalpaper of the esophagus. This paper is a review ofthe known features of this disease (including clinical,nutritional, histological, endoscopic, manometric andimmunological aspects)

Cow's milk-specific immunoglobulin E levels as predictors of clinical reactivity in the follow-up of the cow's milk allergy infants.

BACKGROUND: IgE-mediated cow's milk proteins (CMPs) allergy shows a tendency to disappear with age. The sooner tolerance is detected, the earlier the substitute diets can be suspended and the quicker family emotional hardship is alleviated. OBJECTIVE: To analyse the specific IgE levels to cow's milk and its proteins, which help to separate tolerant from no tolerant children in the follow-up of infants with allergy to cow's milk. PATIENTS AND METHODS: Sixty-six infants diagnosed with IgE-mediated allergy to CMPs were included in this prospective follow-up study. Periodic reassessments were carried out every 6 months until they were 2-years old and then, annually, until tolerance arose or until the last reassessment in which tolerance had not been achieved. Non-tolerant infants were followed, at least, for a period of 3 years. In each visit, the same skin tests and determination of specific IgE (CAP System FEIA) for milk and its proteins were carried out. The open challenge test was repeated unless a clear transgression to milk, which came to be positive, had taken place within the previous 3 months in each of the follow-up visits. Specific IgE levels to milk and its proteins, in different moments of the follow-up were analysed by means of the receiver-operating characteristic curve to predict clinical reactivity. RESULTS: Throughout the follow-up 45 (68%) infants became tolerant. The follow-up mean for tolerant infants was 21.2 months whereas for non-tolerant infants it was 58 months. The specific IgE levels which were predictors of the clinical reactivity (positive predictive value (PPV)> or =90%), grew as the age of the infants increased: 1.5, 6 and 14 kU(A)/L for milk in the age range 13-18 and 19-24 months and in the third year, respectively. Specific IgE levels to casein: 0.6, 3 and 5 kU(A)/L, respectively, predicted clinical reactivity (PPV> or =90%) in the different analysed moments of the follow-up. The cut-off points: 2.7, 9 and 24 kU(A)/L for milk and 2, 4.2 and 9 kU(A)/L for casein, respectively, predicted clinical reactivity with an accuracy > or =95% corresponding to a specificity of 90%. CONCLUSIONS: Monitorization of specific IgE concentration for milk and casein by means of the CAP system in allergic children to CMPs allows us to predict, to a high degree of probability, clinical reactivity. Age factor must be taken into account to evaluate the specific IgE levels which are predictors of tolerance or clinical reactivity.