Peculiarities of egg allergy in children with bird protein sensitization.

BACKGROUND: Hen's egg is frequently implicated in food allergy in children. Sometimes this allergy is associated with bird protein sensitization. OBJECTIVE: A study was conducted to establish the possible role of bird protein sensitization in the clinical picture and evolution of egg allergy in patients with both egg and bird sensitization. METHODS: Epidemiologic and clinical characteristics and the results of allergic study of 27 patients with both egg and bird allergy were compared with those of a control group of 19 egg-allergic patients without bird protein sensitization. All patients were evaluated clinically each year during the 4 years subsequent to the beginning of the study or until clinical tolerance to egg was achieved. RESULTS: Patients with bird sensitization had more frequent digestive and respiratory symptoms related to egg ingestion compared with the control group. At the end of follow-up. 15% of the bird sensitized patients and 58% of the controls tolerated egg. Egg yolk sensitization was the major sensitization in bird-sensitized patients. CONCLUSION: It is necessary to exclude sensitization to bird proteins in egg-allergic patients, mainly when they show respiratory or digestive symptoms after egg ingestion, the egg allergy persists over a long period of time or egg yolk sensitization is strong.

Analysis of cross-reactivity between sunflower pollen and other pollens of the Compositae family.

The sera of 20 patients with Compositae pollen allergy were investigated for the presence of IgE antibodies reacting against sunflower pollen by means of RAST and immunoblotting studies. Thirteen IgE-binding bands were detected with molecular weights ranging from 14.4 to 94 kd. Two of these bands, with molecular weights of 24 and 25 kd, contained major allergens that reacted strongly with 100% (24 kd) and 95% (25 kd) of the sera, respectively. Cross-reactivity between sunflower and other Compositae pollens (mugwort, marguerite, dandelion, golden rod, and short ragweed) was revealed by RAST and immunoblotting inhibition experiments. Mugwort pollen exhibited the greatest degree of allergenic homology (cross-reactivity) with sunflower pollen, whereas at the other end of the spectrum, short ragweed showed less cross-reactive epitopes.

Sulfite-induced urticaria.

Metabisulfite sensitivity is being described with growing frequency. Sulfites are used in food, drinks, and drugs. Adverse reactions to apparently nontoxic doses have been described. Exposure of sensitive persons to sulfites has produced asthma, and occasionally other adverse reactions in nonasthmatic patients. We present a case of urticaria induced by metabisulfites. During the previous 2 years the patient had suffered episodes of urticaria and angioedema limited to the face, neck, upper thorax, and dysphonia without asthma after the ingestion of food and drinks containing sulfites. Oral challenge with 25 mg of potassium metabisulfite elicited urticaria on the face and neck, nasal itching, rhinorrhea, and dysphonia. Prick and intradermal tests were negative. Two further challenges with the same doses were also positive. One of these was controlled with placebo, 30 minutes after oral administration of 400 mg sodium cromolyn; the second was carried out 90 minutes after oral administration of 5000 micrograms cyanocobalamin. We have been unable to identify a pathogenic mechanism.

[Allergic drug reactions in children]. / Reacciones alérgicas a medicamentos en niños.

We present a retrospective study of allergic drug reactions seen in our pediatric allergy consulting room during the last 6 years. During this time, 840 patients were examined for suspected adverse drug reactions. Drug allergy was confirmed in 72 cases (8.5%). Of these cases, 29 (40.2%) were considered to be IgE mediated, or immediate hypersensitivity reactions. We have not found significant differences with regards to age, sex, atopic family history or atopia between patients with IgE mediated reactions compared to patients with allergic drug reactions of different mechanisms or to patients without drug allergies. Sulfonamides, streptomycin, beta-lactam and analgesics were the drugs most frequently involved in immediate type reactions. Among non-immediate reactions, fixed eruption by sulfonamides and contact dermatitis due to Mercurochrome were the most frequent.

Egg protein sensitization in patients with bird feather allergy.

We have studied the hypersensitivity to hen's egg protein and chicken meat in 25 adults with a previous diagnosis of bronchial asthma and rhinoconjunctivitis due to bird feather sensitization. Seventeen of the 25 reported good tolerance to the ingestion of egg and chicken meat. The skin tests were negative to both antigens in 15 of them, and positive for egg in two. All 17 patients had negative RAST to chicken meat and egg protein. The remaining eight patients had intolerance to egg, and three of them also to chicken meat ingestion; in seven of the eight cases allergic to egg, the alimentary intolerance began after the clinical symptoms of bird feather sensitization. In all eight cases the skin tests were positive to egg yolk, and in five of them also to egg white and chicken meat. These patients evidenced specific serum IgE antibodies to egg yolk, four of them to egg white, and seven to chicken meat. These results demonstrate the high frequency (32%) of the association of sensitization to egg proteins, particularly egg yolk, in a selected population of patients with known allergy to bird feathers, thus suggesting that in some patients feather sensitization could trigger or somehow facilitate the later sensitization to egg yolk proteins.

Short-term treatment of asthma with budesonide versus placebo.

The effects of the topical steroid budesonide on bronchial hyperreactivity were evaluated in a patient group (A, n = 17) and a placebo-controlled patient group (B, n = 11). Group A was given budesonide 400 micrograms/12 h for 4 weeks and 200 micrograms/12 h for four more weeks. The drug proved efficient in controlling asthma clinically and improving the spirometric parameters: FVC (p < 0.05), FEF50 (p < 0.05) and FEV1 (p < 0.01). Bronchial hyperreactivity (PD20) decreased moderately in the treatment group (p < 0.1). On the contrary, basal spirometry and PD20 worsened in the control group. Some patients in group A showed peripheric eosinophilia (2/15) or in secretions (9/15), which persisted in one patient at end of treatment. Budesonide was effective in the clinical and spirometric control of asthma. We conclude that for a better assessment of the treatment of bronchial hyperreactivity with budesonide, the drug must be administered for a longer period of time. The differences between this study and previous ones is that the improvement in PD20 can be explained by the different characteristics of the patients selected for this study.

[Asthma and gastroesophageal reflux. Outcome of asthma after longterm medical treatment of the reflux]. / Asma y reflujo gastroesofágico. Resultados del asma con tratamiento médico prolongado del reflujo.

Over one half of the cases of chronic severe childhood asthma, refractory to conventional therapy and without other over aetiology, are associated to gastroesophageal reflux (GER). The aetiopathogenic role of GER in asthma is uncertain, and is only confirmed when therapy of the former induces evident improvement of the latter. We have instituted medical antireflux therapy over two years in 17 patients (17.6%) became asymptomatic after less than three months of therapy, and a further four (23.5%) by the sixth month. Seven patients showed clinical improvement by the third month (41%) and even a greater one by the sixth month, only very slight symptoms persisting thereafter. In three cases (17.6%) there was no improvement after two years of outcome of asthma and the persistence or not of pathological between the outcome of asthma and the persistence or not of pathological 24-hour pHmetry. On the contrary. macroscopic oesophagitis disappeared in the cases of asthma with good outcome, but persisted in all the cases who remained symptomatic. In conclusion, we consider that medical management of GER associated to asthma should be maintained for at least six months (if the clinical course so permits) before considering a surgical indication.

Hypersensitivity to mercuric fluorescein compounds.

The mercurial compounds are known to be a common cause of allergic contact dermatitis. Immediate hypersensitivity is rarely induced by mercurial organic derivatives. However, none of the published cases showed both immediate and delayed hypersensitivity as was the case of one of our two patients. A boy and a woman experienced urticaria and anaphylaxis, respectively after topical application of Merchromine (Merbromine). We were able to demonstrate immediate hypersensitivity in both patients to mercuric fluorescein compounds by skin test and histamine liberation. In addition, the child but not the woman, showed delayed hypersensitivity to mercurial compounds.

[Food hypersensitivity in infants]. / Hipersensibilidad a alimentos en el lactante.

In a group of 41 infants with immediate, IgE mediated, food hypersensitivity, food anamnesis was specific in 60 per 100 and food challenge positive in 29 out of 34 times. Total serum IgE levels were raised in 80 per 100. In 26 instances symptoms appeared with the first food intake (15 cases) or there was sensitization before ingestion (11 cases); all but three were breast fed. Moreover, breast feeding in patients of the whole group had higher prevalence (p less than 0,001) than in a non-sensitized control group. These results suggest that food hypersensitivity in infants occurs very often without previous antigen intake and it is not always followed by clinical intolerance. Breast milk and/or transplacental antigen passage are probably important ways of sensitization. If so, it seems that minute quantities of antigen may be more fit for sensitization, provided the possible genetic high responsiveness for IgE synthesis in those infants.

[Thymus implant in a case of DiGeorge syndrome (author's transl)]. / Implante de timo en un caso de síndrome de DiGeorge.

A boy with III-IV pharingeal pouch malformative syndrome, hypocalcemia and recurrent infections is presented. The immunological work-up disclosed deficiency in the specific cellular immunity with normal serum immunoglobulin levels. An adult thymus in Millipore diffusion chambers was implanted in the rectus adominalis muscle. One week later clinical and analytical data suggesting immunological reconstitution was recorded. Two years later the patient remains in good health, T and B lymphocyte percentages are normal, being the only immunological abnormality a low serum level of IgG.

Oral disodium cromoglycate in food allergy. An open trial in four patients.

The effect of DSCG olution per os was studied in four infants with immediate hypersensitivity reaction to cow's milk and egg, manifested by digestive and cutaneous symptoms. Previous administration of a 1 per cent DSCG solution by mouth resulted in diminution of both the digestive and cutaneous symptoms associated with allergen challenge. The best time interval between oral DSCG and the allergen challenge was about 30 min. The drug lost effectiveness when the solution was prepared more than a week in advance of its administration. A 2-year follow-up in two of the patients revealed the reappearance of cutaneous and digestive symptoms and, for the first time, the onset of wheezing while continuing to administer the allergens and despite continuous oral DSCG. The characteristics of these cases raise questions about the means of sensitization, and the possible mechanism of action of oral DSCG in the inhibition of non-digestive symptoms. Clinical indications for its use are discussed.

[Nezelof syndrome with secondary immunodeficiency (author's transl)]. / Síndrome de Nezelof con inmunodeficiencia secundaria sobreañadida

A child with recurrent infections is presented. The frequent diarrhea leads to a severe malnutrition. The immunological work-up disclosed: absent IgA and low IgG serum levels, deficient cellular immunity and abnormal neutrophil chemotaxis. The cellular immunity and the neutrophil chemotaxis were improved with the nutritional status. At present the patient shows a partial combined immunodeficiency. The diagnosis of the case as a Nezelof's syndrome is discussed, as well as the addition of a secondary immunodeficiency caused by the recurrent infections and the malnutrition.

[Common variable immunodeficiency (author's transl)]. / Síndrome variable común de inmunodeficiencia. Diagnóstico diferencial con la agammaglobulinemia congénita ligada al sexo

In a boy initially diagnosed as X-linked hypogammaglobulinemia, the later clinical and analytical course and the application of new immunological techniques led to the new diagnosis of common variable immunodeficiency. The patient shows panhypogammaglobulinemia, a scarce number of plasma cells with a normal number of precursors and circulating B lymphocytes with membrane bound immunoglobulins and C3 receptors. Delayed hypersensitivity is absent despite normal amount of circulating T lymphocytes which were able to transform when stimulated by PHA. The anergy seems primary and not related to the clinical malnutrition. The authors make a differential diagnosis between both illnesses as a tentative pathogenetic interpretation of B cell development arrest.