Asymptomatic LTP sensitisation is common in plant-food allergic children from the Northeast of Spain

BACKGROUND: The sensitisation profile at molecular level in plant-food allergy is complex. Several allergens may be involved, with different potential for severe reactions. lipid transfer proteins (LTP) are considered the most relevant plant-food allergens in adults in Mediterranean countries, but less is known in children. AIM: To describe the clinical pattern and sensitisation profile of children with plant-food allergy and LTP sensitisation from Northeast Spain. METHODS: Children with history of immediate reaction to plant-food(s), positive skin-prick-test to the culprit plant-food(s) and specific-IgE to plant-food LTPs were analysed. RESULTS: 130 children were included. 69.2% (90/130) had reacted to ≥2 taxonomically unrelated plant-foods. Peach, walnut, hazelnut and peanut were most frequently involved. Reactions severity ranged from anaphylaxis (45.4%, 59/130) to oral symptoms only. Sensitisation to a particular plant-food LTP not always caused clinical symptoms with that plant-food; 69% (40/58) and 63% (17/27) of peach- and walnut-tolerant subjects had positive rPru p 3 and nJug r 3 specific IgE, respectively. 65.4% (85/130) of children were also sensitised to storage proteins, which was associated to anaphylaxis and nut allergy. However, 60% of patients without nuts/seeds allergy were sensitised to storage proteins. Specific-IgE levels to LTPs and/or storage proteins were not useful to predict allergy (vs. tolerance) to peach, walnut, peanut or hazelnut. CONCLUSIONS: Sensitisation to LTP and/or storage proteins without clear clinical significance is relatively common. Prospective longitudinal studies are required to evaluate the relevance of these silent sensitisations over time. Caution is required when interpreting the results of molecular-based diagnostic tools in clinical practice

No disponible

Prevalence and clinical profile of difficult-to-control severe asthma in children: Results from pneumology and allergy hospital units in Spain

BACKGROUND: Severe asthma is often poorly controlled and its prevalence in Spanish children is unknown. The aim was to determine the prevalence of difficult-to-control severe asthma in children, the agreement of asthma control between physicians and Spanish Guidelines for Asthma Management (GEMA), and the health-related quality of life (HRQoL) for children and parents. METHODS: Observational, cross-sectional, two-phase, multicentre study. In the first phase, all children who attended pneumology and allergy units during a three-month period were classified according to physicians' criteria as patients with: asthma, severe asthma, or difficult-to-control severe asthma. Patients aged 6-14 years with severe asthma (difficult-to-control or controlled) were included in the second phase. RESULTS: 12,376 asthmatic children were screened in the first phase. According to physicians' criteria, 8.8% (95% CI 8.3-9.3%) had severe asthma. Of these, 24.2% (95% CI, 21.7-26.8%) had difficult-to-control severe asthma. 207 patients with severe asthma (mean age 10.8 ± 2.3 years; 61.4% male; mean of 5.5 ± 3.4 years since asthma diagnosis) were included in the second phase. Compared to the patients with controlled asthma, children with difficult-to-control asthma had a higher number of exacerbations, emergency room or unscheduled primary care visits in the previous year (p < 0.0001, all) and poor HRQoL (p < 0.0001, both children and caregivers). 33.3% of patients with controlled asthma according to physicians' criteria were poorly controlled according to GEMA. CONCLUSIONS: Around one in four asthmatic children with severe disease had difficult-to-control asthma, although one third was underestimated by physicians. Children with difficult-to-control severe asthma had a poor HRQoL that also affected their parents

No disponible

X-linked agammaglobulinaemia. Mutation A1246G (R372G)

No disponible

Lymphoma as presentation of common variable immunodeficiency

No disponible

Eosinophilic oesophagitis: clinical manifestations and treatment options. The role of the allergologist

Eosinophilic oesophagitis (EO) is an infrequent disorder that is currently underdiagnosed. It has been described in both adults and in children, and is more prevalent among males. The etiology of EO is not clear, though atopy has been suggested as playing an important role in the development of the disease.The clinical presentation of EO is varied, and a differential diagnosis with other digestive tract disorders is required — particularly gastro-oesophageal reflux. Dysphagia and food bolus impactation within the oesophagus are the most characteristic symptoms. Diagnostic confirmation is obtained from multipleoes ophageal biopsy, with the detection in some sample or samples of over 15 eosinophils per high-magnification microscopic field. An allergological study is needed to evaluate the existence of allergens (perennial or seasonal environment alallergens and food allergens) responsible for the eosinophilic infiltration found at oesophageal level.There is no specific treatment for EO, and topical corticosteroids (swallowed) are currently the pharmacological treatment of choice. Dietary therapy in children with food allergy as the causal factor may prove effective, though the existence of polysensitisation complicates the correct implementation of such treatment. Oesophageal dilatation is reserved for cases with severe dysphagia, and is not without complications. Treatment with anti-IL-5, antileukotrienes, azathioprine, 6-mercaptopurine, anti-IgE,etc., could constitute alternatives to topical corticosteroids, although information is still lacking on their long-term safety and efficacy in the paediatric population

No disponible

Allergy to quail’s egg without allergy to chicken’s egg. Case report

Introduction: We present a case of quail’s egg allergy without allergy to chicken’s egg. Case: Girl of 10.5 years old who presents anaphylactic reaction after she ate an uncooked quail’s egg. She had eaten boiled quail’s egg before. She eats chicken’s eggs without clinical symptoms. Methods: We made a prick to chicken’s egg and prick-by-prick to uncooked quail’s and raw chicken’s egg. We determined specific IgE to chicken’s egg; electrophoresis and IgE by inmunoblot to eggs from chicken, duck, goose, and quail. Results: We obtained negative results to prick, prick-by-prick and specific IgE to chicken’s egg. Prick-by-prick to quail’s egg was positive. By immunoblotwe recognised a protein in quail’s eggwhite, which is ovotransferrin without any similar bands in other species’ eggs. Conclusions: The protein that we recognised is a specific protein of quail’s egg. These proteins did not cross-react with proteins of chicken’s egg. Cooking may degrade such proteins

No disponible

Risk factors of developing asthma in children with recurrent wheezing in the first three years of life / Factores de riesgo para el desarrollo de asma en niños con dificultad respiratoria recurrente en los tres primeros años de vida

Introduction: recurrent wheezing is a common problem during the first years of life, but it is still difficult to identify which of these children may develop asthma in the future. Objectives: To study risk factors of developing asthma in a group of patients with frequent wheezing during the first three years of life. Material and methods: A prospective study was performed of a group of 60 patients, aged below three, referred to our Hospital for recurrent wheezing. Age, sex, parental and personal history of atopy, clinical features, laboratory tests, evolution and response to treatment were analyzed. Results: 60 patients were enrolled in study. Most of children were boys and have had the first episode of wheezing after the 6 months of life. 63 % had personal history of atopy and 55 % parental history of allergy. The group of atopic children had more wheezing exacerbations and worse evolution than the group of non atopic. They also had more treatment necessities. Conclusions: The identification of young children at high risk of developing asthma could permit an early intervention before irreversible changes in the airway appeared

Introducción: Las sibilancias recurrentes son un problema frecuente en los primeros años de vida. Sin embargo, es aún dificultoso identificar cuáles de estos niños van a desarrollar asma en el futuro. Objetivos: estudiar cuáles son los factores de riesgo de desarrollar asma en un grupo de pacientes con broncoespasmo de repetición durante los primeros tres años de vida. Material y métodos: Estudio prospectivo de 60 pacientes con edad igual o inferior a los 3 años, remitidos a nuestro centro por crisis de broncoespasmo repetidas. Se recoge información acerca de: edad, sexo, antecedentes familiares y personales de atopia, exploración física y pruebas alergológicas. Asimismo, evolución clínica y respuesta al tratamiento. Resultados: De los 60 pacientes implicados en el estudio, la mayor parte eran varones y presentaron el primer episodio de broncoespasmo antes de los 6 meses de vida. El 63% tenían antecedentes personales de atopia y el 55% antecedentes familiares de alergia. Los pacientes atópicos presentaron más crisis de sibilancias y peor evolución a corto plazo que los no atópicos. Asimismo, requirieron más tratamiento de mantenimiento. Conclusiones: La identificación precoz de los niños con elevado riesgo de desarrollar asma permitiría una intervención temprana antes de que se desarrollaran cambios irreversibles en la vía aérea

Recomendaciones para la administración de la vacuna antigripal en pacientes alérgicos al huevo / Recommendations for administration of the influenza vaccine

No disponible

Polysensitization to aeroallergens and food in eosinophilic esophagitis in a pediatric population / Polisensibilización a aeroalergenos y alimentos en la esofagitis eosinofílica en una población pediátrica

There are few studies on eosinophilic esophagitis (EE) in the pediatric population in Europe. We present our data and emphasize the following findings: a) all patients had symptoms of allergic respiratory disease prior to receiving a diagnosis of EE with polysensitization (aeroallergens, food allergens); and b) in contrast with the results of earlier studies, food sensitization in our series most often corresponded to legumes

Hay pocos estudios sobre esofagitis eosinofílica (EE) en la población pediátrica en Europa. Presentamos nuestros datos, destacando los siguientes hallazgos: a) presencia de enfermedad alérgica respiratoria en todos los pacientes previamente diagnosticados de EE, polisensibiizados (aeroalergenos, alimentos); b) sensibilización a alimentos en nuestra serie, la mayoría a legumbres, en contraste con el resultado de estudios anteriores

Seguridad de la vacunación triple vírica en pacientes con alergia al huevo / Safety of MMR immunization in egg-allergic children

No disponible

La leche de cabra no es una alternativa válida en pacientes con alergia a las proteínas de la leche de vaca / Goat´s milk is not valid alternative in patients allergic to cow´s milk proteins

Further reflections on streptococcal pharyngitis (AU)

Challenge testing in children with allergy to cow's milk proteins

Objectives: to evaluate clinical response after challenge testing in infants with allergy to cow's milk proteins at diagnosis and again when these infants were aged 1 year old and had been fed an exclusion diet. Material and methods: we performed a prospective study of 49 infants aged less than 6 months with a clinical history suggestive of cow's milk protein allergy, positive skin prick test and specific IgE for a -lactalbumin, b -lactoglobulin and casein. In all children challenge test with cow-milk adapted formula was carried out at diagnosis. The same procedures were repeated when the children were aged 1 year but challenge testing was repeated only in children with a negative skin prick test and specific IgE antibodies to cow's milk proteins. Results: At diagnosis, challenge tests produced immediate hypersensitivity reactions in 94 % of infants. Late reactivity (i.e., more than 2 hours after challenge) was found in only 6 % of infants, all of whom presented dyspepsia. When the infants were aged 1 year, and after results of immunological study were negative, a further challenge test was performed in 24 (49 %) of lactating infants included in the study. Of these 24 infants, positive challenge was found in 5 (21 %). None of the infants presented immediate symptomatology (clinical features appeared 7 days after the reintroduction of cow's milk proteins). Conclusions: Ninety-four percent of challenge tests performed at diagnosis provoked immediate reactions. The results of challenge tests after a negative skin prick test in children with normal concentrations of specific IgE were positive in 21 % infants, who presented late reactivity (a mean of 7 days after milk ingestion) (AU)

Objetivo: Evaluar la respuesta clínica tras la prueba de provocación, en niños con alergia a proteínas de leche de vaca, efectuada al diagnóstico y tras dieta exenta de proteínas de leche de vaca, al año de edad.Material y métodos: Estudio prospectivo que incluye 49 niños, menores de seis meses de edad, con historia clínica sugestiva de alergia a proteínas de leche de vaca, prick e IgE específica positivos para -lactoalbúmina, -lactoglobulina y caseína a los que se les efectúa una prueba de provocación con leche de vaca adaptada en el momento del diagnóstico. Al año de edad se repite la misma metodología de estudio y se efectúa prueba de provocación sólo a los que presentan prick e IgE específica a proteínas de leche de vaca negativos en ese momento.Resultados: Al diagnóstico el 94 por ciento de las provocaciones tuvieron una respuesta positiva inmediata, únicamente el 6 por ciento presentaron una respuesta positiva tardía (más de dos horas después de la provocación) todas como dispepsia. Al año de edad y tras la negativización del estudio inmunológico se efectuó una nueva prueba de provocación a 24 (49 por ciento) de los lactantes incluidos en el estudio y presentaron prueba de provocación positiva el 21 por ciento de las efectuadas a esta edad (5 de 24), ninguna de ellas presentó sintomatología inmediata, la clínica apareció a los 7 días de estar tomando leche de vaca.Conclusiones: La mayoría (94 por ciento) de provocaciones al diagnóstico presentan una clínica inmediata. Las provocaciones efectuadas tras la negativización de las pruebas de prick e IgE específica que fueron positivas (21 por ciento), lo fueron todas tardíamente (media de 7 días tras la ingesta de leche) (AU)

Alergía a las proteínas de huevo / Allergy to egg proteins

No disponible

No disponible

Common variable immunodeficiency, insulin-dependent diabetes mellitus and celiac disease

Common variable immunodeficiency is a disorder characterised by hypogammaglobulinemia with Blymphocytes in peripheral blood and repeated infections. We report a child with a diagnosis of diabetes mellitus and celiac disease during lactation, and in whom common variable immunodeficiency was diagnosed at the age of 5. During evolution of the disease he presented multiple respiratory infections in spite of substitution therapy with gamma globulins. He presented pulmonary fibrosis with a pulmonary volume reduced, and a spirometric restrictive patron. Immunologically, he presents reduction in CD4 lymphoid population. He expresses the alleles DQ2 A1 0501 and B1 which are strongly associated with susceptibility to insulin - dependent diabetes mellitus and celiac disease, but don’t express antigens HLA class II DR3 and DR4 that are more frequent in these entities. The main disease and all the complications had affected his curve pondostatural (AU)

La inmunodeficiencia común variable es un trastorno caracterizado por hipogammaglobulinemia con linfocitos B en sangre periférica e infecciones de repetición. Describimos un niño diagnosticado a la edad de cinco años de inmunodeficiencia común variable que de lactante se diagnosticó diabetes mellitus y enfermedad celíaca. Ha presentado durante su evolu ción múltiples infecciones respiratorias a pesar de la terapia de sustitución con gammaglobulinas. Inmunológicamente ha presentado disminución de la población linfoide CD4. Expresa los alelos DQ2 A1 0501 y B1 los cuales están fuertemente asociados con susceptibilidad a diabetes mellitus insulinodependiente y enfermedad celíaca, pero no expresa los alelos que más frecuentemente se describen en esta asociación HLA clase II DR3 y DR4. Su crecimiento pondoestatural se ha visto afectado debido a su enfermedad de base y a todas las complicaciones secundarias. (AU)