Frequent baked egg ingestion was not associated with change in rate of decline in egg skin prick test in children with challenge confirmed egg allergy.

BACKGROUND: It is controversial whether egg-allergic children should strictly avoid all forms of egg, or if regular ingestion of baked egg will either delay or hasten the resolution of egg allergy. OBJECTIVE: This is the first study to examine the relationship between frequency of baked egg ingestion and rate of decline in egg skin prick test size in egg-allergic children. METHODOLOGY: This was a retrospective clinical cohort study. All children with challenge-proven egg allergy who attended the Royal Children's Hospital Allergy Department 1996-2005 and had at least two egg skin prick tests performed in this period were included (n = 125). Frequency of baked egg ingestion was assessed by telephone questionnaire as follows: (a) frequent (> once per week), (b) regular (> once every 3 months, up to ≤ once per week) or (c) strict avoidance (≤ once every 3 months). The relationship between frequency of baked egg ingestion and rate of decline in egg skin prick test size was examined by multiple linear regression, adjusting for potential confounders. RESULTS: Mean rate of decline in egg skin prick test size in all children was 0.7 mm/year (95% CI 0.5-1.0 mm/year). There was no evidence (P = 0.57) that the rate of decline in egg skin prick test size differed between children who undertook frequent ingestion (n = 21, mean 0.4 mm/year, 95% CI -0.3-1.2 mm/year), regular ingestion (n = 37, mean 0.9 mm/year, 95% CI 0.4-1.4 mm/year) or strict avoidance (n = 67, mean 0.7 mm/year, 95% CI 0.4-1.1 mm/year) of baked egg. CONCLUSIONS: Compared with strict dietary avoidance, frequent consumption of baked egg was not associated with a different rate of decline in egg skin prick test size in egg-allergic children. CLINICAL RELEVANCE: Given that dietary restrictions can adversely impact on the family, it is reasonable to consider liberalizing baked egg in the diet of egg-allergic children.

Clinical predictors for biphasic reactions in children presenting with anaphylaxis.

BACKGROUND: One of the main reasons for hospital admission once a child has been stabilized following anaphylaxis is to monitor for a biphasic reaction. However, only a small percentage of anaphylactic episodes involve biphasic reactions that would benefit from admission. Identification of predictive factors for a biphasic reaction would assist in determining who may benefit from prolonged observation. OBJECTIVE: To determine predictive factors for biphasic reactions in children presenting with anaphylaxis. METHODS: This was a retrospective study of children presenting with anaphylaxis to a major paediatric emergency department over a 5-year period. RESULTS: There were 95 uniphasic (87%), 12 (11%) biphasic and two protracted reactions (2%). One child with a protracted reaction died. For the management of the primary anaphylactic reaction, children developing biphasic reactions were more likely to have received >1 dose of adrenaline (58% vs. 22%, P=0.01) and/or a fluid bolus (42% vs. 8%, P=0.01) than those experiencing uniphasic reactions. The absence of either factor was strongly predictive of the absence of a biphasic reaction (negative predictive value 99%), but the presence of either factor was poorly predictive of a biphasic reaction (positive predictive value of 32%). All biphasic reactors, in which the second phase was anaphylactic, received either >1 dose of adrenaline and/or a fluid bolus. CONCLUSIONS: Children who received >1 dose of adrenaline and/or a fluid bolus for treatment of their primary anaphylactic reaction were at increased risk of developing a biphasic reaction.

Paediatric anaphylaxis: a 5 year retrospective review.

OBJECTIVE: To describe the demographic characteristics, clinical features, causative agents, settings and administered therapy in children presenting with anaphylaxis. METHODS: This was a retrospective case note study of children presenting with anaphylaxis over a 5-year period to the Emergency Department (ED) at the Royal Children's Hospital, Melbourne. RESULTS: One-hundred and twenty-three cases of anaphylaxis in 117 patients were included. There was one death. The median age of presentation was 2.4 years. Home was the most common setting (48%) and food (85%) the most common trigger. Peanut (18%) and cashew nut (13%) were the most common cause of anaphylaxis. The median time from exposure to anaphylaxis for all identifiable agents was 10 min. The median time from onset to therapy was 40 min. Respiratory features were the principal presenting symptoms (97%). Seventeen per cent of subjects had experienced anaphylaxis previously. CONCLUSIONS: This is the largest study of childhood anaphylaxis reported. Major findings are that most children presenting to the ED with anaphylaxis are first-time anaphylactic reactions and the time to administration of therapy is often significantly delayed. Most reactions occurred in the home. Peanut and cashew nut were the most common causes of anaphylaxis in this study population, suggesting that triggers for anaphylaxis in children have not changed significantly over the last decade.

Estimation of fungal growth using the ergosterol assay: a rapid tool in assessing the microbiological status of grains and feeds.

AIM: To use ergosterol assay as a rapid tool to assess the extent of fungal contamination in grains and feeds. METHODS AND RESULTS: Ergosterol was extracted from moulds and quantified using a modified method based on Seitz et al. (1977). A good correlation coefficient of 0.9998 was obtained for ergosterol standards and a strong correlation (R(2) = 0 x 9645) was established between the ergosterol content and the growth of Aspergillus niger ATCC 24126. This shows that this assay can be used to estimate fungal growth. The ergosterol contents and amount of carbon dioxide produced in both Control and Myco CURB (brand) liquid-treated corns were measured over 36 days. Ergosterol contents of pelleted pig feeds were also determined. In both experiments, the levels of ergosterol in the control samples were significantly higher than those of the mould-inhibitor-treated samples. CONCLUSIONS: A strong positive correlation (Spearman, Rs = 0 x 7241) was observed between the ergosterol content and the degree of fungal growth. Hence, ergosterol assay can be used as a rapid tool to assess the microbiological status of grains and feeds. SIGNIFICANCE AND IMPACT OF THE STUDY: This study affirms that ergosterol assay is a rapid and accurate tool that can be used for the assessment of the feed quality.