Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up

Introduction: Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary. Objective: We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA. Materials and methods: The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells). Results: The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4+CD25+CD127/dim regulatory T cells were increased after OIT. Conclusions: OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home

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Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up.

INTRODUCTION: Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary. OBJECTIVE: We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA. MATERIALS AND METHODS: The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells). RESULTS: The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4+CD25+CD127-/dim regulatory T cells were increased after OIT. CONCLUSIONS: OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home.

Desensitization to cyanocobalamin: rush protocol

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Regulatory B cells and allergy: uncovering the link

Regulatory B (Breg) cells are recognized as immunosuppressive cells. During the last few years, several subsets of Breg cells with different phenotypes and suppressive mechanisms have been described in the literature. We review the role of Breg cells in allergy based on an extensive literature search in PubMed. We describe the types and mechanisms of action of B cells and their role in the pathogenesis of several allergic diseases (allergic asthma, allergic rhinitis, food allergy, contact hypersensitivity, and anaphylaxis) (AU)

Los linfocitos reguladores del tipo B (B reg.) juegan un papel importante en el funcionamiento del sistema inmunitario. Durante los últimos años, se han descrito varios subgrupos de linfocitos B reg., con diferentes fenotipos y mecanismos supresores. Nuestro objetivo es recopilar la información existente sobre el papel de los linfocitos B reg. en Alergología, en base a una profunda investigación bibliográfica en PubMed. Describimos los tipos y mecanismos de acción de los linfocitos B y su función en la patogénesis de varias enfermedades alérgicas (asma alérgica, rinitis alérgica, alergia alimentaria, eccema de contacto y anafilaxia) (AU)

Regulatory T and B cells in asthmatic women: variations from pregnancy to postpartum

Background and Objectives: Allergic asthma and rhinitis are common in pregnancy. The immune mechanisms underlying the effects of asthma on pregnancy and vice versa are not completely understood. The aim of this study was to investigate changes in regulatory T and B cells in asthmatic women from late pregnancy to postpartum. Methods: Four groups of women were enrolled for this study: asthmatic (n=23) and healthy (n=43) third trimester-pregnant women and asthmatic (n=33) and healthy (n=35) nonpregnant women. Pregnant women were also evaluated postpartum (>6 weeks after delivery). Blood samples were taken from each woman and flow cytometry was used to characterize circulating regulatory T cells (Tregs) and regulatory B cells (Bregs). Foxp3 expression was assessed in CD4DimCD25Hi Tregs. Results: Tregs did not vary significantly from pregnancy to postpartum in asthmatic or healthy women, but CD24HiCD38Hi Bregs decreased in pregnancy and increased significantly postpartum. Foxp3 expression in Tregs was also impaired during pregnancy in both asthmatic and healthy women, but recovered postpartum. Asthmatic pregnant women had higher Foxp3 expression levels than healthy pregnant women (P=.007), probably due to the use of control medication. Conclusions: Women with controlled asthma showed variations in regulatory cell subsets during pregnancy and postpartum. A similar pattern was observed for Foxp3 expression and CD24HiCD38Hi Bregs during this period, corroborating the interaction between Tregs and Bregs in immune responses. Considering the immunomodulatory potential of these immune mediators, more studies are needed to evaluate their relationship with asthma and rhinitis complications in pregnancy (AU)

Introducción y Objetivos: El asma y la rinitis alérgica son enfermedades comunes durante el embarazo. A pesar de ello, no están completamente esclarecidos los mecanismos inmunológicos del embarazo implicados en el asma y viceversa. Este trabajo tuvo como objetivo el estudiar la evolución de los linfocitos T y B reguladores en mujeres asmáticas embarazadas, desde fases tardías del embarazo hasta después del parto. Métodos: Se incluyeron cuatro grupos de mujeres para este estudio: mujeres embarazadas en su tercer trimestre, asmáticas (n = 24) y sanas (n = 43), y mujeres no embarazadas, asmáticas (n = 33) y sanas (n = 35). Las mujeres embarazadas también fueron evaluadas después del parto (> 6 semanas después del parto). Se tomaron muestras de sangre de cada mujer y se realizó citometría de flujo para caracterizar los linfocitos T y B reguladores circulantes. La expresión de Foxp3 se evaluó en los linfocitos T reguladores CD4DimCD25Hi. Resultados: En las mujeres embarazadas, tanto sanas como asmáticas, los linfocitos T reguladores no oscilaron de manera significativa desde el embarazo hasta después del parto. Sin embargo, en los linfocitos B reguladores CD24HiCD38Hi, se observó una disminución durante el embarazo que aumentó significativamente después del parto. La expresión de Foxp3 en los linfocitos T reguladores también se vio alterada durante el embarazo tanto en las mujeres embarazadas asmáticas como en las sanas, normalizándose en el posparto. No obstante, las mujeres asmáticas embarazadas presentaron niveles de expresión de Foxp3 superiores a los de las mujeres embarazadas sanas (p = 0,007), probablemente debido a la utilización de medicación de control. Conclusiones: Las mujeres con asma controlada, durante el embarazo y después del parto, presentan variaciones en los diferentes subtipos linfocitos reguladores. El similar comportamiento que se observa para la expresión de Foxp3 y los linfocitos B reguladores CD24HiCD38Hi apoya la interacción que se establece en la respuesta inmunitaria, entre los linfocitos T y B reguladores, durante este período. Teniendo en cuenta el potencial inmunomodulador de estos mecanismos, se necesitan más estudios para evaluar su relación con las complicaciones del asma y la rinitis durante el embarazo (AU)

Translation to Portuguese and cultural adaptation of Food Allergy Quality of Life Questionnaire - Parent Form (FAQLQ-PF).

Food allergy is a health problem with significant negative impact in Quality of Life (QoL). We aimed to translate into Portuguese and culturally adapt to our population the Food Allergy Quality of Life Questionnaire - Parent Form (FAQLQ-PF). Cross-cultural translation was performed according to guidelines. Linguistic validation consisted in 3 steps: forward translation, backward translation and comprehensibility testing. A consensual version was obtained and tested in parents of food allergic children by cognitive debriefing. Twelve questionnaires were fulfilled, all completed in ≤ 15 min. No comments, doubts or suggestions were posed, except for 2 parents regarding a question about the number of food their children had to avoid. Two gave special positive feedback about the utility of FAQLQ-PF. Changes have been included after this pre-test in accordance to doubts and suggestions of participants, and the Portuguese version is now able to be used in clinics and research.

Successful oral tolerance induction to cow’s milk in a child with allergy to extensively hydrolysed formula

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Prevalence of asthma in a Portuguese countryside town: repercussions on absenteeism and self-concept

Background: Childhood asthma represents an increasing health problem and is the leading cause of hospital admission and absenteeism in children with chronic disease. It also compromises quality of life, eventually contributing to disturbances in self-concept. Self-concept is a recent and global perspective of “the self” and relates to skills, self-image and self-esteem. Little information is available on this topic and there are no data from Portuguese countryside towns. Objective: The aim of this study was to determine the prevalence of asthma among all school children in the 5th and 6th grades in a Portuguese countryside town and to establish its possible correlation with absenteeism and self-concept. Methods: In April 2002, two questionnaires were administered in the presence of the researcher to a group of 950 children attending different schools. The children completed the internationally renowned questionnaires: ISAAC and the Self-Concept Scale by Susan Harter. Results: Our sample (n = 818) had a mean age of 11 years (10-15 years) and a male-to-female ratio of 1/1. The cumulative prevalence of asthma was 11.9% and that of active asthma was 8.8%; 63.9% of asthmatics were male and 36.1% were female. The mean age of asthmatics was 11.34 years and 74 % had active symptoms. Comparison of this group of 97 asthmatic children with the remaining children revealed a statistically significant correlation between the presence of asthma and school absenteeism (global: p = 0.04; gymnastics: 0.05). Regarding the Self-Concept Scale a statistically significant association was found between the presence of asthma and school achievement (p = 0.027), physical appearance (p = 0.015), behavior (p < 0.000) and self-esteem (p < 0.000). No statistically significant correlations were found in social acceptance (p = 0.289) or athletic competence (p = 0.085). Asthmatic boys had higher self-concept scores than girls, except in the domain of behavior. Conclusions: Twelve percent of the population studied was asthmatic. In asthmatic children, absenteeism was higher and self-concept was lower for almost all domains, except social acceptance and athletic achievement, probably due to overprotection

Introducción: La asma infantil representa un creciente problema de salud, siendo la causa principal de visitas al hospital y de absentismo en los niños con enfermedades crónicas. También compromete la calidad de vida, contribuyendo al desarrollo de perturbaciones en el auto-concepto. El auto-concepto es una perspectiva reciente y global del “uno mismo” con relación a las capacidades, auto-imagen e auto-estima. Hay poca información con relación a este tema y en el caso de ciudades portuguesas de provincia todavia no existen datos. Objetivo: el objetivo de este estudio fue estudiar la prevalencia del asma en niños del 5.º, 6.º año escolar, en una ciudad portuguesa de provincia, y estabelecer una posible correlación con el absentismo y autoconcepto. Métodos: en el mes de Abril del 2002 se efectuaran dos encuestas a 950 niños de todas las escuelas oficiales y siempre con la presencia del investigador. Los niños respondieron a encuestas de renombre internacional: ISAAC; Self-Concept Scale de Susan Harter. Resultados: La muestra de la encuesta (n = 818) presenta una media de edad de 11 años (10-15 años) y una relación M/F de 1/1. Prevalencia cumulada de asma: 11,9%; Asma activa: 8,8%; 63,9% asmáticos masculinos y 36,1% femeninos. Edad media de los asmáticos: 11,34 años; 74% con síntomas activos. Comparando este grupo de 97 niños con síntomas activos con los demás, se encontró correlación estadística significativa entre la presencia de asma y absentismo (global: p = 0,04; Gimnástica: p = 0,05). En relación a la escala de auto-concepto fue posible encontrar correlación estadística sinificativa entre la presencia del asma y el éxito escolar (p = 0,027), aspecto físico (p = 0,015), comportamiento (p = 0,000) y auto-estima (p = 0,000). No se detectó correlación estadística significativa con relación a la aceptación social (p = 0,289) y resultados deportivos (p = 0,085). Los niños asmáticos del sexo masculino presentan resultados más elevados de auto-concepto que el sexo femenino, con excepción del comportamiento. Conclusiones: en la población estudiada 12% eran asmáticos. Los niños asmáticos presentan mas absentismo y un menor nivel de auto-concepto, con excepción de aceptación social y resultados deportivos, probablemente resultante de un exceso de protección