RESUMO
OBJECTIVE: Strict avoidance of trigger food is the primary management of food protein-induced enterocolitis syndrome (FPIES). No published data are available on active induction of tolerance with oral desensitization (OD) in FPIES. CASE REPORT: We carried out an OD in a 9 and a half years old boy with persistent acute egg FPIES. OD was performed with increasing doses of raw egg every week, starting with an initial dose of 0.2 ml. The boy presented mild and transient gastrointestinal adverse reactions when the 4 ml dose was reached. He could tolerate a whole raw egg in less than 14 months. CONCLUSIONS: Even though randomized controlled clinical trials on patients including various phenotypes of FPIES are needed, our experience is encouraging about the possible efficacy and safety of OD in this food allergy.
Assuntos
Dessensibilização Imunológica/métodos , Ingestão de Alimentos/imunologia , Hipersensibilidade a Ovo/dietoterapia , Hipersensibilidade a Ovo/etiologia , Ovos/efeitos adversos , Enterocolite/dietoterapia , Enterocolite/etiologia , Hipersensibilidade a Ovo/imunologia , Enterocolite/imunologia , Humanos , Lactente , Masculino , Síndrome , Resultado do TratamentoRESUMO
With the help of a routine clinical case, we highlighted the difference between two of the best asthma guidelines available at the time regarding therapeutic suggestions for the so-called "third step" for school-age asthmatic children. We have analyzed the scientific evidence that each of the two guidelines brings to support their position. Finally, we have motivatedly solved the clinical scenario. However, the question of disagreement between two guidelines remains unresolved. This can lead to unjustified differences in the management of schoolchildren with persistent asthma
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Assuntos
Humanos , Masculino , Criança , Guias de Prática Clínica como Assunto/normas , Asma/tratamento farmacológico , Antiasmáticos/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Antagonistas de Leucotrienos/uso terapêutico , Corticosteroides/uso terapêuticoRESUMO
With the help of a routine clinical case about delayed urticaria induced by drug, we have analyzed the scientific societies reports published during the last 5 years on this topic. We highlighted the differences between the EAACI consensus and documents on drug allergy, commenting their positions and some of their definitions on delayed urticaria. However, the question of disagreement between definitions of delayed urticaria can generate confusion. It would be beneficial to have more and "official" clearness about this topic because of its important clinical application to our patients
No disponible
Assuntos
Humanos , Feminino , Criança , Urticária/induzido quimicamente , Erupção por Droga/etiologia , Amoxicilina/efeitos adversos , Antibacterianos/efeitos adversos , Hipersensibilidade Tardia/induzido quimicamente , Fatores de Tempo , Testes CutâneosRESUMO
With the help of a routine clinical case about delayed urticaria induced by drug, we have analyzed the scientific societies reports published during the last 5 years on this topic. We highlighted the differences between the EAACI consensus and documents on drug allergy, commenting their positions and some of their definitions on delayed urticaria. However, the question of disagreement between definitions of delayed urticaria can generate confusion. It would be beneficial to have more and "official" clearness about this topic because of its important clinical application to our patients.
Assuntos
Amoxicilina/efeitos adversos , Hipersensibilidade a Drogas/complicações , Urticária/imunologia , Alergia e Imunologia/normas , Criança , Consenso , Hipersensibilidade a Drogas/imunologia , Feminino , Humanos , Fatores de TempoRESUMO
With the help of a routine clinical case, we highlighted the difference between two of the best asthma guidelines available at the time regarding therapeutic suggestions for the so-called "third step" for school-age asthmatic children. We have analyzed the scientific evidence that each of the two guidelines brings to support their position. Finally, we have motivatedly solved the clinical scenario. However, the question of disagreement between two guidelines remains unresolved. This can lead to unjustified differences in the management of schoolchildren with persistent asthma.
Assuntos
Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto/normas , Administração por Inalação , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Fatores Etários , Criança , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Medicina Baseada em Evidências/métodos , Glucocorticoides/administração & dosagem , Humanos , Antagonistas de Leucotrienos/administração & dosagem , Masculino , Resultado do TratamentoRESUMO
Background: Some studies have showed that seasonality is an important determinant of vitamin D (vitD) status. Objective: We evaluated whether there are differences in individual trends of serum vitD level over one year in asthmatic and rhinitic children. Materials and methods: Ninety-two asthmatic and rhinitic paediatric patients were followed up for one year and their serum vitD level was detected at three-month intervals, once in each season. Results: We observed higher vitD levels at the end of summer and lower at the end of winter. However, the individual seasonal trend was very variable and unpredictable. If it is true that in a given season the majority of patients followed one direction (increase or decrease of serum vitD levels), nevertheless a substantial percentage behaved differently and unpredictably. For example, at the end of spring, 70% of patients showed an increase in serum vitD levels, but 30% showed a decrease. In addition, five individuals had a value ≥ 50 ng/ml in September and showed serum vitD levels ≥ 30ng/ml throughout the year; 16 patients presented vitD value ≥ 40 ng/ml in September and always had ≥ 20 ng/ml in the other months. Conclusions: The wide and unpredictable variability of the individual trend of serum vitD levels should be taken into account before deciding whether or not a drug supplementation is appropriate
No disponible
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Asma/metabolismo , Rinite Alérgica/metabolismo , Estações do Ano , Vitamina D/sangue , Variação Biológica da População , Suplementos Nutricionais , SeguimentosRESUMO
Background: Children with IgE-mediated cow's milk allergy (IgE-CMA) with gastrointestinal symptoms tolerate yogurt at 100%. Yogurt tolerance in children with IgE-CMA with urticaria and anaphylaxis was 7%. Methods: We enrolled children with IgE-CMA with cutaneous, respiratory, gastrointestinal and anaphylactic symptoms. All performed prick by prick (PbP) and oral food challenge (OFC) with yogurt. Some children performed also an OFC with CM mixed with wheat flour and baked, baked liquid CM, parmesan. Results: 34 children were enrolled, 31/34 (91%) with systemic adverse reaction after ingestion of CM (systemic CMA), 3/34 (9%) with isolated contact urticaria (ICU CMA). PbP with yogurt was negative only in one patient. OFC with yogurt was passed (that is, the OFC was negative) by 20/31 (64%) of the children with systemic CMA. 10/11 (91%) of the patients who failed OFC (that is, the OFC was positive) with yogurt were positive to SPT with casein vs. 8/20 (40%) of the patients who passed it (p = 0.018). None of the 19 children who passed OFC with yogurt failed all OFC with processed CM forms other than yogurt that tested vs. 4/8 among those who failed OFC with yogurt (p = 0.006). The rub test with yogurt was negative in 1/3 (33%) of the patients with ICU CMA. Conclusions: The results of our study are placed alongside others already present in the literature and concerning other methods of processing CM proteins and help to reduce the dietary restrictions of the majority of children with systemic IgE-CMA
No disponible
Assuntos
Humanos , Animais , Masculino , Feminino , Lactente , Pré-Escolar , Gatos , Imunoglobulina E/metabolismo , Hipersensibilidade a Leite/imunologia , Iogurte , Administração Oral , Alérgenos/imunologia , Caseínas/imunologia , Tolerância Imunológica , Testes CutâneosRESUMO
Background: Few studies on the age of resolution of Food Protein Induced Enterocolitis Syndrome (FPIES) induced by solid foods are available. In particular, for FPIES induced by egg, the mean age of tolerance acquisition reported in the literature ranges from 42 to 63 months. Objective: We have assessed whether the age of tolerance acquisition in acute egg FPIES varies depending on whether the egg is cooked or raw. Methods: We conducted a retrospective and multicentric study of children with diagnosis of acute egg FPIES seen in 10 Italian allergy units between July 2003 and October 2017. The collected data regarded sex, presence of other allergic diseases, age of onset of symptoms, kind and severity of symptoms, cooking technique of the ingested egg, outcome of the allergy test, age of tolerance acquisition. Results: Sixty-one children with acute egg FPIES were enrolled, 34 (56%) males and 27 (44%) females. Tolerance to cooked egg has been demonstrated by 47/61 (77%) children at a mean age of 30.2 months. For 32 of them, tolerance to raw egg has been demonstrated at a mean age of 43.9 months. No episodes of severe adverse reaction after baked egg ingestion have been recorded. Conclusions: It is possible to perform an OFC with baked egg, to verify the possible acquisition of tolerance, at about 30 months of life in children with acute egg FPIES
No disponible
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Culinária/estatística & dados numéricos , Hipersensibilidade a Ovo/dietoterapia , Enterocolite/dietoterapia , Hipersensibilidade a Ovo/epidemiologia , Proteínas do Ovo/imunologia , Enterocolite/epidemiologia , Tolerância Imunológica , Itália/epidemiologia , Estudos Retrospectivos , SíndromeRESUMO
Introduction and objectives: The reproducibility of the adverse reaction increases the suggestiveness of a history of food allergy. However, the positive predictive value (PPV) of multiple adverse reaction episodes for the diagnosis of IgE-mediated food allergy is not known. This evaluation was the objective of our study. Patients and methods: We retrospectively studied 180 children with a history of non-anaphylactic adverse reactions after the ingestion of a food. All children had the prick test positive for the offending food and performed the oral food challenge (OFC) within 12 months after the last adverse reaction episode (ARE). We have evaluated whether increasing the number of ARE increased the probability that the OFC would be positive (failed). Results: 93 patients (52%) presented one ARE, 49 (27%) presented two ARE, 24 (13%) presented three ARE, 14 (8%) patients presented ≥ four ARE. The OFC was positive in 94/180 (52%). The outcome of the OFC was found to be positively correlated with the number of ARE (OR = 1.56; 95% CI = 1.16-2.09; p = 0.003). A PPV = 100% was observed with a number of ARE ≥ five. Conclusions: The number of ARE is an important predictor of the diagnosis of food allergy, although less than we would have imagined. The number of ARE could be used to increase the predictability of the diagnostic tests currently in use, to define clinical prediction rules alternative to OFC and easy to use in clinical practice
No disponible
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Anafilaxia/diagnóstico , Hipersensibilidade Alimentar/diagnóstico , Anafilaxia/epidemiologia , Administração Oral , Alérgenos/imunologia , Alimentos , Hipersensibilidade Alimentar/epidemiologia , Imunização , Imunoglobulina E/metabolismo , Itália/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos RetrospectivosRESUMO
BACKGROUND: Few studies on the age of resolution of Food Protein Induced Enterocolitis Syndrome (FPIES) induced by solid foods are available. In particular, for FPIES induced by egg, the mean age of tolerance acquisition reported in the literature ranges from 42 to 63 months. OBJECTIVE: We have assessed whether the age of tolerance acquisition in acute egg FPIES varies depending on whether the egg is cooked or raw. METHODS: We conducted a retrospective and multicentric study of children with diagnosis of acute egg FPIES seen in 10 Italian allergy units between July 2003 and October 2017. The collected data regarded sex, presence of other allergic diseases, age of onset of symptoms, kind and severity of symptoms, cooking technique of the ingested egg, outcome of the allergy test, age of tolerance acquisition. RESULTS: Sixty-one children with acute egg FPIES were enrolled, 34 (56%) males and 27 (44%) females. Tolerance to cooked egg has been demonstrated by 47/61 (77%) children at a mean age of 30.2 months. For 32 of them, tolerance to raw egg has been demonstrated at a mean age of 43.9 months. No episodes of severe adverse reaction after baked egg ingestion have been recorded. CONCLUSIONS: It is possible to perform an OFC with baked egg, to verify the possible acquisition of tolerance, at about 30 months of life in children with acute egg FPIES.
Assuntos
Culinária/estatística & dados numéricos , Hipersensibilidade a Ovo/dietoterapia , Enterocolite/dietoterapia , Doença Aguda , Alérgenos/imunologia , Criança , Pré-Escolar , Hipersensibilidade a Ovo/epidemiologia , Proteínas do Ovo/imunologia , Enterocolite/epidemiologia , Feminino , Humanos , Tolerância Imunológica , Itália/epidemiologia , Masculino , Estudos Retrospectivos , SíndromeRESUMO
INTRODUCTION AND OBJECTIVES: The reproducibility of the adverse reaction increases the suggestiveness of a history of food allergy. However, the positive predictive value (PPV) of multiple adverse reaction episodes for the diagnosis of IgE-mediated food allergy is not known. This evaluation was the objective of our study. PATIENTS AND METHODS: We retrospectively studied 180 children with a history of non-anaphylactic adverse reactions after the ingestion of a food. All children had the prick test positive for the offending food and performed the oral food challenge (OFC) within 12 months after the last adverse reaction episode (ARE). We have evaluated whether increasing the number of ARE increased the probability that the OFC would be positive (failed). RESULTS: 93 patients (52%) presented one ARE, 49 (27%) presented two ARE, 24 (13%) presented three ARE, 14 (8%) patients presented≥four ARE. The OFC was positive in 94/180 (52%). The outcome of the OFC was found to be positively correlated with the number of ARE (OR=1.56; 95% CI=1.16-2.09; p=0.003). A PPV=100% was observed with a number of ARE≥five. CONCLUSIONS: The number of ARE is an important predictor of the diagnosis of food allergy, although less than we would have imagined. The number of ARE could be used to increase the predictability of the diagnostic tests currently in use, to define clinical prediction rules alternative to OFC and easy to use in clinical practice.
Assuntos
Anafilaxia/diagnóstico , Hipersensibilidade Alimentar/diagnóstico , Administração Oral , Alérgenos/imunologia , Anafilaxia/epidemiologia , Criança , Pré-Escolar , Feminino , Alimentos , Hipersensibilidade Alimentar/epidemiologia , Humanos , Imunização , Imunoglobulina E/metabolismo , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos RetrospectivosRESUMO
BACKGROUND: Children with IgE-mediated cow's milk allergy (IgE-CMA) with gastrointestinal symptoms tolerate yogurt at 100%. Yogurt tolerance in children with IgE-CMA with urticaria and anaphylaxis was 7%. METHODS: We enrolled children with IgE-CMA with cutaneous, respiratory, gastrointestinal and anaphylactic symptoms. All performed prick by prick (PbP) and oral food challenge (OFC) with yogurt. Some children performed also an OFC with CM mixed with wheat flour and baked, baked liquid CM, parmesan. RESULTS: 34 children were enrolled, 31/34 (91%) with systemic adverse reaction after ingestion of CM (systemic CMA), 3/34 (9%) with isolated contact urticaria (ICU CMA). PbP with yogurt was negative only in one patient. OFC with yogurt was passed (that is, the OFC was negative) by 20/31 (64%) of the children with systemic CMA. 10/11 (91%) of the patients who failed OFC (that is, the OFC was positive) with yogurt were positive to SPT with casein vs. 8/20 (40%) of the patients who passed it (p=0.018). None of the 19 children who passed OFC with yogurt failed all OFC with processed CM forms other than yogurt that tested vs. 4/8 among those who failed OFC with yogurt (p=0.006). The rub test with yogurt was negative in 1/3 (33%) of the patients with ICU CMA. CONCLUSIONS: The results of our study are placed alongside others already present in the literature and concerning other methods of processing CM proteins and help to reduce the dietary restrictions of the majority of children with systemic IgE-CMA.
Assuntos
Imunoglobulina E/metabolismo , Hipersensibilidade a Leite/imunologia , Iogurte , Administração Oral , Alérgenos/imunologia , Animais , Caseínas/imunologia , Bovinos , Pré-Escolar , Feminino , Humanos , Tolerância Imunológica , Lactente , Masculino , Testes CutâneosRESUMO
Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated gastrointestinal food allergic disorder. Some diagnostic criteria have been published for acute FPIES. Of course, they are not all the same, so the clinician must choose which ones to adopt for his/her clinical practice. We present here a brief review of these criteria and, through two clinical cases, show how the choice of one or the other can change the diagnostic destiny of a child with suspect FPIES
No disponible
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Alérgenos/imunologia , Proteínas Dietéticas do Ovo/imunologia , Proteínas de Peixes/imunologia , Hipersensibilidade Alimentar/diagnóstico , Trato Gastrointestinal/patologia , Doença Aguda , Dietoterapia , Enterocolite , Hipersensibilidade Alimentar/dietoterapia , Tolerância Imunológica , SíndromeRESUMO
Food protein induced enterocolitis syndrome (FPIES) is classified as non-IgE-mediated or cell-mediated food allergy, although there is an atypical phenotype so defined for the presence of specific IgEs. All diagnostic criteria for FPIES include the absence of skin or respiratory symptoms of IgE-mediated type. We present four cases that suggest that specific IgEs may have a pathogenic role, resulting in the existence of different FPIES phenotypes. This could be important from a diagnostic and therapeutic point of view
No disponible
Assuntos
Humanos , Masculino , Feminino , Lactente , Enterocolite/imunologia , Hipersensibilidade Alimentar/imunologia , Urticária/imunologia , Imunidade Celular/imunologia , Imunoglobulina E , SíndromeRESUMO
We describe two case reports presenting some novel information on fish FPIES. Fish FPIES to one fish does not always start at the same time to other fish. Additionally, development of tolerance to the index fish do not necessarily imply tolerance to other reactive fish. This reflects on the best management of children with FPIES fish
No disponible
Assuntos
Humanos , Animais , Masculino , Feminino , Pré-Escolar , Enterocolite/imunologia , Produtos Pesqueiros/efeitos adversos , Peixes/imunologia , Hipersensibilidade Alimentar/etiologia , Hipersensibilidade Alimentar/imunologia , Tolerância Imunológica/imunologiaRESUMO
Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated gastrointestinal food allergic disorder. Some diagnostic criteria have been published for acute FPIES. Of course, they are not all the same, so the clinician must choose which ones to adopt for his/her clinical practice. We present here a brief review of these criteria and, through two clinical cases, show how the choice of one or the other can change the diagnostic destiny of a child with suspect FPIES.
Assuntos
Alérgenos/imunologia , Proteínas Dietéticas do Ovo/imunologia , Proteínas de Peixes da Dieta/imunologia , Hipersensibilidade Alimentar/diagnóstico , Trato Gastrointestinal/patologia , Doença Aguda , Pré-Escolar , Dietoterapia , Enterocolite , Feminino , Hipersensibilidade Alimentar/dietoterapia , Humanos , Tolerância Imunológica , Lactente , Masculino , SíndromeRESUMO
Food protein induced enterocolitis syndrome (FPIES) is classified as non-IgE-mediated or cell-mediated food allergy, although there is an atypical phenotype so defined for the presence of specific IgEs. All diagnostic criteria for FPIES include the absence of skin or respiratory symptoms of IgE-mediated type. We present four cases that suggest that specific IgEs may have a pathogenic role, resulting in the existence of different FPIES phenotypes. This could be important from a diagnostic and therapeutic point of view.
Assuntos
Enterocolite/imunologia , Hipersensibilidade Alimentar/imunologia , Urticária/imunologia , Feminino , Humanos , Imunidade Celular/imunologia , Imunoglobulina E , Lactente , Masculino , SíndromeRESUMO
We describe two case reports presenting some novel information on fish FPIES. Fish FPIES to one fish does not always start at the same time to other fish. Additionally, development of tolerance to the index fish do not necessarily imply tolerance to other reactive fish. This reflects on the best management of children with FPIES fish.
Assuntos
Enterocolite/imunologia , Produtos Pesqueiros/efeitos adversos , Peixes/imunologia , Hipersensibilidade Alimentar/etiologia , Animais , Pré-Escolar , Feminino , Hipersensibilidade Alimentar/imunologia , Humanos , Tolerância Imunológica/imunologia , MasculinoRESUMO
Food protein induced enterocolitis syndrome (FPIES) is a food-related gastrointestinal hypersensitivity disorder, probably non-IgE-mediated. Over the years, various diagnostic criteria have been proposed to identify FPIES. In the last few years, there was an increased interest from researchers about FPIES's syndrome, that frequently brought to discover new aspects of this disease. We describe an unusual case of FPIES to egg in a 21-months-old child, because of its clinical characteristics that reflect some aspects of IgE-mediated allergy and other of non IgE-mediated allergy. Although we believe that the most correct diagnosis for our case is FPIES, we think also that this is undoubtedly an atypical form. This is in fact, the first description of a patient who simultaneously has both clinical expressions of IgE-mediated FA that of FPIES. Our case highlights the need to review criteria for FPIES diagnosis.
Assuntos
Proteínas na Dieta/efeitos adversos , Hipersensibilidade a Ovo/diagnóstico , Enterocolite/diagnóstico , Imunoglobulina E/imunologia , Hipersensibilidade a Ovo/etiologia , Enterocolite/etiologia , Humanos , Lactente , Masculino , Testes Cutâneos , SíndromeRESUMO
BACKGROUND: Therapy for moderate to severe acute food protein-induced enterocolitis syndrome (FPIES) typically consists of intravenous fluids and corticosteroids (traditional therapy). Ondansetron has been suggested as an adjunctive treatment. We aimed to evaluate the efficacy of the parenteral (intravenous or intramuscular) ondansetron vs traditional therapy to resolve the symptoms of acute FPIES. METHODS: Cases of FPIES who had a positive oral food challenge (OFC) were retrospectively examined at two major hospitals over a two-year period (Rome, Italy; and Sydney, Australia). The efficacy of therapy, based on the percentage of cases who stopped vomiting, was compared in cases who received parenteral ondansetron and in cases who received traditional therapy or no pharmacological therapy. RESULTS: A total of 66 patients were included: 37 had parenteral ondansetron, 14 were treated with traditional therapy, and 15 did not receive any pharmacological therapy. Nineteen percentage of children treated with ondansetron continued vomiting after the administration of the therapy vs 93% of children who received traditional therapy (P < 0.05, relative risk = 0.2). Children who received ondansetron or no therapy were less likely to require an admission overnight compared with those who received traditional therapy (P < 0.05). CONCLUSIONS: Parenteral ondansetron is significantly more effective than traditional therapy in resolving acute symptoms of FPIES. The relative risk = 0.2 greatly reduces the bias linked to the lack of randomization. These findings suggest an effective treatment for vomiting in positive FPIES OFCs and allow for more confidence in performing OFCs.