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.

Severe delayed skin reactions related to drugs in the paediatric age group: A review of the subject by way of three cases (Stevens-Johnson syndrome, toxic epidermal necrolysis and DRESS).

Severe delayed drug-induced skin reactions in children are not common but potentially serious. This article describes aspects concerning the etiology, pathogenesis and clinical manifestations of these processes; it presents three paediatric cases, namely STS (Steven Johnson Syndrome), TEN (toxic epidermal necrolysis), probably related to amoxicillin/clavulanate and ibuprofen and DRESS (a drug reaction with eosinophilia and systemic symptoms) secondary to phenytoin; and in relation to them, the diagnosis and the treatment of these processes are discussed and reviewed. The AGEP (acute generalised exanthematous pustulosis) is also reviewed. The aetiological diagnosis of severe non-immediate reactions is difficult, and the value of current allergological testing is not well defined in these cases. Diagnosis is based on clinical history, the empirical risk of drugs to trigger SJS/TEN or DRESS, and the in vivo and in vitro testing of the suspect drug. Skin biopsy confirms that the clinical diagnosis and delayed hypersensitivity tests, especially the patch test and the lymphoblastic transformation test (LTT), may be important to confirm the aetiological diagnosis, in our cases emphasising the latter. These diseases can be life threatening (especially DRESS and TEN) and/or have a high rate of major complications or sequelae (SJS/TEN). The three cases described progressed well without sequelae. All were treated with corticosteroids, which is the most currently accepted treatment although the effect has not been clearly demonstrated.

Associations among pollen sensitizations from different botanical species in patients living in the northern area of Madrid.

OBJECTIVE: To determinate the existence of associations among sensitizations to antigens produced by pollen grains of different botanical species as assessed by skin prick tests in patients with respiratory disorders. METHODS: Six hundred twenty nine consecutive patients living in the northern area of Madrid who underwent clinical evaluation because of rhinoconjunctivitis, and/or asthma were studied. All patients were tested with a skin prick test using a battery of inhalants including pollens, dust mites, molds and danders. The exploratory multivariate technique of Multiple Correspondence Analysis was used to compare the homogeneity of sensitizations between groups. Of the 629 patients, 459 (73.0%) had positive skin prick tests to pollen and were selected as the study group. RESULTS: The most prevalent pollen sensitization was to Gramineae pollen (83.7%) followed by Oleaceae sensitisation (75.8%). Multiple Correspondence Analysis revealed the existence of an association among pollen sensitizations, showing that they clustered two groups: sensitizations to Gramineae, Oleaceae, Cupressaceae, Chenopodiaceae, Plantaginaceae (group I), and sensitizations to Betulaceae, Platanaceae, Compositae (group II). Sensitization to Parietaria was not included in any of the sensitization groups and showed an independent behaviour. CONCLUSION: Pollen sensitizations in our area cluster into two association groups which have not previously been reported.

Mastocitosis sistémica y anafilaxia secundaria a picadura de los himenópteros / Systemic mastocytosis and severe hymenoptera sting anaphylaxis

Introducción: La mastocitosis sistémica comprende varias enfermedades caracterizadas por una proliferación anormal de los mastocitos en diversos tejidos del organismo y una producción excesiva de sus mediadores. La mastocitosis sistémica asociada a la anafilaxia recurrente, con o sin una causa precisa, es una forma relativamente frecuente de la enfermedad y está infradiagnosticada en pacientes con anafilaxia secundaria a la picadura de los himenópteros. La eficacia del tratamiento con inmunoterapia específica hiposensibilizante frente al veneno de himenópteros, y su conveniencia o no en pacientes con mastocitosis sistémica, es un tema discutido que genera controversias. Objetivos: 1) Llamar la atención sobre lo importante que es descartar una mastocitosis sistémica indolente en todo paciente que presenta anafilaxia secundaria a la picadura de los himenópteros. 2) Evaluar la posible repercusión de la mastocitosis sistémica en la eficacia y tolerancia de la inmunoterapia específica con veneno de himenópteros en aquellos pacientes con IgE específica frente al veneno. 3) Revisar los trabajos publicados sobre la mastocitosis sistémica y la anafilaxia tras la picadura de los himenópteros. Material y métodos: Pacientes que acudieron a las consultas externas de alergia para el estudio de una reacción anafiláctica tras una picadura de los himenópteros y en los cuales se sospechó la existencia de una mastocitosis sistémica indolente. Se les realizó una anamnesis y una exploración física detalladas y pruebas cutáneas en intradermorreacción (ID) con extractos comerciales disponibles de veneno de avispa (polistes y véspula) y de abeja además de determinaciones de IgE sérica total, IgE específica frente a veneno de la avispa véspula, la avispa polistes y la abeja, determinación de IgG específica y determinación de triptasa sérica basal. Resultados: Presentamos los casos clínicos de 4 pacientes que acudieron a nuestras consultas tras sufrir cuadro de anafilaxia secundaria a la picadura de los himenópteros. Uno de los pacientes presentó resultados negativos en las pruebas cutáneas con el veneno de los himenópteros y las determinaciones de IgE específica y una cifra baja de IgE sérica total. Las pruebas cutáneas de los otros tres pacientes fueron positivas (de un tamaño moderado) con la máxima concentración, con cifras de IgE total y específica bajas y poco significativas. Dos de los pacientes seguían tratamiento con inmunoterapia específica hiposensibilizante bien tolerada. La elevación de las cifras de triptasa sérica basal nos hizo sospechar la existencia de una mastocitosis sistémica indolente. El diagnóstico se ha confirmado en 2 de los 4 pacientes tras una biopsia medular; los otros dos están en estudio. Conclusiones: En casos de shock anafiláctico secundario a la picadura de los himenóptero, especialmente cuando las pruebas cutáneas sean dudosas o incluso negativas y la IgE específica baja o negativa (o en casos de intolerancia a la inmunoterapia hiposensibilizante) siempre hay que considerar el diagnóstico de mastocitosis sistémica. La determinación basal (fuera del episodio agudo) de triptasa sérica debería realizarse en todos los casos de anafilaxia sea cual sea su causa, y sobre todo en la anafilaxia secundaria a la picadura de los himenópteros

Introduction: Systemic mastocytosis comprises several diseases characterized by an abnormal increased number of mast cells in several tissues and overproduction of mast cells mediators. Systemic mastocytosis associated to recurrent anaphylaxis with or without an specific etiology represents a relatively frequent group of the illness and is overrepresented in patients with Hymenoptera sting anaphylaxis. Efficacy of venom specific immunotherapy, and their therapeutics convenience in patients with systemic mastocitosis, is under discussion and generates controversies. Aims: 1) To draw attention about the importance to rule out an indolent systemic mastocytosis in every patient with anaphylaxis after Hymenotera sting. 2) To assess the possible repercussion of systemic mastocytosis in the venom specific immunotherapy efficacy and tolerance in those patients with positive venom specific IgE 3) To review the reported literature about systemic mastocytosis and Hymenoptera sting anaphylaxis. Material and Methods: Patients who underwent evaluation at our outpatient Allergy consult for study of severe Hymenoptera sting anaphylaxis and in whom an indolent systemic mastocytosis was suspected. A detailed allergic history and physical exploration was recorded. Skin tests (intradermal) were performed with available commercial extracts of wasp (Vespula spp. and Polistes spp.) and bee venom. Measurements of serum total IgE, venom specific IgE and IgG were carried out, and at least, one baseline serum tryptase determination. Results: We report the clinical cases of 4 patients who were studied at our consult after severe Hymenoptera sting anaphylaxis. One of them had negative skin tests to Hymenoptera venoms, with negative venom specific IgE and low serum total IgE. The other three patients had positive skin tests (moderate size) with the maximum venom concentration and low serum total and specific IgE. Two of them were under venom specific immunotherapy with good tolerance. An elevated baseline tryptase level in serum made us to suspect the existence of indolent systemic mastocytosis. Diagnosis was confirmed in two of the patients, after a positive bone marrow biopsy; the other two ones continue under study. Conclusions: In case of anaphylactic shock to Hymenoptera sting, specially when skin tests are doubtful or even negative and specific serum IgE is low or negative (or in cases of intolerance to hyposensitization) the diagnosis of systemic mastocytosis should be always considered. Baseline serum tryptase level determination should be performed routinely in all cases of anaphylaxis whichever the etiology and mainly after anaphylaxis to Hymenoptera sting

[The allergenic significance of legumes]. / La importancia alergénica de las legumbres.

Leguminous are a cheap source of protein that are cultivated practically throughout the world. They are the main source of food in developing countries. In the Mediterranean area and Middle East, the most commonly consumed legumes are lentils and chickpea. In the United States, United Kingdom and south-east Asia, the major legumes involved in food allergy are considered to be peanut and soy bean, respectively. The clinical manifestations of the allergy to legumes are similar for all legumes and range from oral allergy syndrome, urticaria, angioedema, rhinitis and asthmatic crises to anaphylaxis and even death. Legumes have a high degree of immunological cross-reactivity. Severals authors have described cross-reactivity among different legumes and between legumes and various vegetables. The allergenicity of legumes is mainly is mainly related to allergens from the storage proteins of seeds. Vicilins from this group of proteins could be an important common allergen in clinical allergy to legumes. Profilins are considered to be a cause of cross-reactivity among fruits, vegetables and some pollens and are believed to be a panallergen. Other panallergens of increasing importance are lipid transfer proteins. Few studies have assessed the long-term clinical course of allergy to legumes. Novel therapeutic agents are being investigated for the treatment of peanut allergy and these could be applied to other legumes.