Oral food challenge in children with contact urticaria in reaction to cow's milk.

OBJECTIVE: To evaluate the relationship between the occurrence of contact urticaria in reaction to cow's milk in infants and the diagnosis of cow's milk allergy (CMA) established by supervised oral food challenge. METHODS: In this cross-sectional study, we identified 184 children who had undergone 221 oral food challenge (OFC) at a CMA reference center between July 2015 and August 2019. Of these, 23 (12.5%) had a history of contact urticaria to cow's milk and underwent a total of 30 OFC. Baked cow's milk OFC were excluded, and 21 children were included in the study. All data from clinical history and allergy tests (serum-specific IgE dosages and skin prick test [SPT] with reconstituted cow's milk formula) were recorded on standardized forms. The challenge was conducted with reconstituted cow's milk formula in increasing volumes every 15-20 min. RESULTS: 24 OFC were performed; 13/24 (54.2%) for diagnostic purpose and 11/24 (45.8%) to evaluate cow's milk tolerance. Allergy tests were positive in 14 patients (87.5%). Positive oral challenge outcomes were identified in 7/24. One patient had a late flare of atopic dermatitis and five children presented with immediate urticaria (two generalized urticaria and three perioral urticaria). The median papule diameter was 6.5 mm in patients with a positive OFC and 3.75 mm in the negative group (P = 0.02). CONCLUSION: The occurrence of contact urticaria might be the only manifestation among infants sensitized to cow's milk with tolerance to oral ingestion. Reactions due to oral challenge were related to a larger wheal diameter on the SPT.

Oral food challenge in children with contact urticaria in reaction to cow’s milk

Objective: To evaluate the relationship between the occurrence of contact urticaria in reaction to cow’s milk in infants and the diagnosis of cow’s milk allergy (CMA) established by supervised oral food challenge. Methods: In this cross-sectional study, we identified 184 children who had undergone 221 oral food challenge (OFC) at a CMA reference center between July 2015 and August 2019. Of these, 23 (12.5%) had a history of contact urticaria to cow’s milk and underwent a total of 30 OFC. Baked cow’s milk OFC were excluded, and 21 children were included in the study. All data from clinical history and allergy tests (serum-specific IgE dosages and skin prick test [SPT] with reconstituted cow’s milk formula) were recorded on standardized forms. The challenge was conducted with reconstituted cow’s milk formula in increasing volumes every 15–20 min. Results: 24 OFC were performed; 13/24 (54.2%) for diagnostic purpose and 11/24 (45.8%) to evaluate cow’s milk tolerance. Allergy tests were positive in 14 patients (87.5%). Positive oral challenge outcomes were identified in 7/24. One patient had a late flare of atopic dermatitis and five children presented with immediate urticaria (two generalized urticaria and three perioral urticaria). The median papule diameter was 6.5 mm in patients with a positive OFC and 3.75 mm in the negative group (P = 0.02). Conclusion: The occurrence of contact urticaria might be the only manifestation among infants sensitized to cow’s milk with tolerance to oral ingestion. Reactions due to oral challenge were related to a larger wheal diameter on the SPT (AU)

Efeitos do isolamento social pela pandemia por COVID-19 na rinite infantil / Effects of social distancing during the COVID-19 pandemic on childhood rhinitis

Introdução e objetivo: Devido à pandemia do novo coronavírus, as crianças passaram a ficar mais tempo em casa, e essa mudança implicou diretamente nas manifestações de diversas doenças, inclusive da rinite. A rinite é a inflamação da mucosa causada, principalmente, por alérgenos, ocasionando sintomas como rinorreia, espirros, obstrução nasal, hiperemia conjuntival, prurido nasal e ocular. O objetivo deste estudo é avaliar as consequências do isolamento social nas crianças com rinite, a fim de compreender a modificação da doença nesse período. Métodos: O estudo é observacional transversal, com dados obtidos através de um questionário eletrônico, para pais e/ou responsáveis de crianças entre 5 e 12 anos. Resultados: No total de 116 respostas, 51,7% das crianças eram do sexo masculino, e a mediana de idade foi de 8,5 anos. Em relação à rinite, em 81% dos casos foi relatado melhora ou manutenção do quadro durante o período de isolamento social. Em um quarto da amostra houve piora na qualidade de vida dos pacientes. Os sintomas com maior piora foram espirros e prurido nasal, e o sintoma com maior melhora foi a rinorreia. Os desencadeantes de sintomas mais frequentes foram animais domésticos, tapetes e perfumes. O uso de medicamentos foi relatado em 59,4% dos casos, sendo que em 32,7% não houve prescrição médica. Conclusão: Os resultados encontrados evidenciaram que o isolamento social teve um impacto positivo em relação às manifestações clínicas da rinite na população estudada.

Introduction and objective: The COVID-19 pandemic required children to spend more time at home, and this change had a direct impact on the manifestations of various diseases, including rhinitis. Rhinitis is inflammation of the nasal mucosa caused mainly by exposure to allergens, resulting in symptoms such as rhinorrhea, sneezing, nasal obstruction, conjunctival hyperemia, and itchy eyes and nose. This study aimed to evaluate the consequences of social distancing in children with rhinitis in order to understand the changes in the disease pattern during the pandemic. Methods: We conducted a cross-sectional observational study with data obtained through an electronic questionnaire answered by parents and/or guardians of children aged 5 to 12 years. Results: From a total of 116 responses, 51.7% of children were male with a median age of 8.5 years. In 81% of cases, rhinitis symptoms improved or remained unchanged during the period of social distancing. In a quarter of the sample, there was a worsening of patients' quality of life. The symptoms with the greatest worsening were sneezing and nasal itching, and the symptom with the greatest improvement was rhinorrhea. The most frequent symptom triggers were pets, carpets, and perfumes. Medication use was reported in 59.4% of cases, with the use of over-the-counter medications in 32.7% of them. Conclusion: The results showed that social distancing had a positive impact on the clinical manifestations of rhinitis in the study population.

Alergia inalatória a insetos / Inhalant allergy to insects

Asma e rinoconjuntivite alérgicas são doenças que apresentam alta prevalência mundial. Os aeroalérgenos estão entre os principais fatores desencadeantes de sintomas em indivíduos sensibilizados. Há centenas de alérgenos inalantes envolvidos neste processo; porém, os provenientes de insetos, embora frequentes, têm sido pouco valorizados na prática clínica. Esta revisão busca demonstrar, a partir de estudos relevantes, a importância deste tema.

Allergic asthma and rhinoconjunctivitis are highly prevalent diseases worldwide. Aeroallergens are among the major triggers of symptoms in sensitized individuals. There are hundreds of inhalant allergens involved in this process; however, the ones from insects, though frequent, have been underestimated in clinical practice. This review seeks to demonstrate, based on relevant studies, the importance of this subject.

Determinação de IgE a alérgenos alimentares por microarray (ImmunoCAP-ISAC) em pacientes com rinite alérgica / Evaluation of IgE antibodies to food allergens in patients with allergic rhinitis using microarray analysis (ImmunoCAP ISAC)

Objetivo: Determinar a frequência de anticorpos IgE a alérgenos alimentares em pacientes com doenças alérgicas respiratórias por análise molecular. Método: Este estudo transversal incluiu 101participantes, com idades entre 6-18 anos, com diagnóstico de rinite alérgica (89,1% com asmaassociada), sem história de alergia alimentar. Foi realizada análise de IgE sérica específica por ImmunoCAP ISAC, método que emprega biologia molecular para detecção de IgE a componentes alergênicos, sendo 42 alimentares e provenientes das seguintes fontes: abacaxi, aipo, amendoim,avelã, bacalhau, camarão, carpa, castanha de caju, castanha do Pará, cenoura, gergelim, kiwi, leite de vaca, maçã, ovo, pêssego, soja e trigo. Valores ≥ 0,3 ISU (unidades padronizadas do ISAC) foram considerados positivos. Utilizou-se análise estatística descritiva. Resultados: Vinte e sete (26,7%)pacientes apresentaram IgE específica a pelo menos um dos alérgenos alimentares analisados.Entre os 42 componentes alergênicos testados, 20 (47,6%) foram associados a resposta IgE em pelo menos um dos pacientes. Alérgenos com maior frequência de reatividade IgE foram: camarão(Pen a 1 15,8%, Pen i 1 16,8%, Pen m 1 16,8%) e pêssego (Pru p 3 5,9%). Conclusões: Este estudo demonstrou que a avaliação de alergia alimentar baseada em análise molecular deve considerar vários elementos, particularmente a correlação com os sintomas clínicos, e o conhecimento sobre reatividade cruzada IgE entre alérgenos das mais variadas fontes. Presença de IgE específica a determinado componente alergênico significa sensibilização, e não necessariamente alergia.Diagnóstico incorreto de alergia alimentar pode levar a tratamento inadequado, com dietas restritivas desnecessárias e prejuízo nutricional para os pacientes.

Objective: To determine the frequency of IgE antibodies to food allergens in patients with respiratory allergic diseases using molecular analysis. Method: This cross-sectional study included101 participants aged 6-18 years, diagnosed with allergic rhinitis (89.1% with associated asthma),and with no history of food allergy. Analysis of serum specific IgE was carried out using the ImmunoCAP ISAC method, which applies molecular biology tools to the detection of different allergens, including 42 derived from foods (pineapple, celery, peanut, hazelnut, codfish, shrimp,carp, cashew nut, Brazil nut, carrot, sesame, kiwi, cow’s milk, apple, egg, peach, soy, and wheat).Values ≥ 0.3 ISAC standardized units (ISU) were considered to be positive. Descriptive statistical analysis was used. Results: Twenty seven (26.7%) patients presented specific IgE to at leastone of the food allergens analyzed. Among the 42 allergic components tested, 20 (47.6%) were associated with IgE responses in at least one patient. The allergens with the highest frequencies of IgE reactivity were shrimp (Pen a 1 15.8%, Pen i 1 16.8%, Pen m 1 16.8%) and peach (Pru p 3 5.9%).Conclusions: The present study showed that molecular-based evaluation of food allergies should take several elements into consideration, particularly the correlation with clinical symptoms andthe knowledge available on IgE cross-reactivity among allergens from different sources. Presence of specific IgE to one allergen means sensitization, but not necessarily allergy. Misdiagnosis of food allergies may lead to inappropriate treatment, with unnecessarily restrictive diets which could affect the nutritional status of patients.