Oral Immunotherapy With Egg and Milk: Changes in Peripheral Serum Cytokines Are Not Predictive Factors for Severe Adverse Reactions or for the Final Report.

BACKGROUND: Oral immunotherapy (OIT) is a new approach in patients with food allergy. Various immunological mechanisms underlie the reversal of food allergy. In this paper, we study possible changes in peripheral cytokine patterns during OIT. METHODS: Determinations of cytokines in peripheral blood were made in children who had milk or egg allergy and who received OIT. The determinations were made before and after OIT, and again following a final repeat oral challenge a month after a diet excluding the culprit food. RESULTS: No significant changes were registered in the cytokines studied (IL-2, IL-4, IL-6, IL-10, IL-12, IL-17, IFNγ, and TNF) at any of the 3 time points. Similarly, no differences in cytokine pattern were observed between children who had presented anaphylaxis during OIT and those who overcame or did not overcome the final oral challenge. DISCUSSION: Peripheral cytokines do not undergo significant changes during the OIT process. They are not predictors of serious adverse reactions or the final result of the OIT.

Is the Quantification of Antigen-Specific Basophil Activation a Useful Tool for Monitoring Oral Tolerance Induction in Children With Egg Allergy?

OBJECTIVES: To assess modifications in baseline specific IgE- and anti-IgE- and antigen-specific-mediated basophil activation in egg-allergic children. The values were compared before and after the children completed specific oral tolerance induction (SOTI) with egg. PATIENTS AND METHODS: We studied 28 egg-allergic children who completed SOTI with egg. The basophil activation test and specific IgE determinations with egg white, ovalbumin, and ovomucoid were performed in all 28 children. RESULTS: A decrease in antigen-specific activation with egg white, ovalbumin, and ovomucoid was observed only at the 2 lowest concentrations used (5 and 0.05 ng/mL). Baseline activation was higher in patients with multiple food allergies and in those who developed anaphylaxis during SOTI; this activation decreased in both groups after completion of SOTI. A significant decrease was also observed in specific IgE values for egg white, ovalbumin, and ovomucoid after tolerance induction. CONCLUSIONS: Food tolerance induction is a specific process for each food that can be mediated by immunologic changes such as a decrease in specific IgE values and in specific and spontaneous basophil activation.

In vivo and in vitro testing with rAni s 1 can facilitate diagnosis of Anisakis simplex allergy.

BACKGROUND: Traditional diagnostic tests such as skin prick tests (SPT) and specific IgE (slgE) against whole Anisakis simplex extract have low specificity. Consequently, allergy to A simplex is overdiagnosed. OBJECTIVE: Our aim was to compare tests used in component-resolved diagnosis. METHODS: We evaluated 34 patients with allergy to A simplex, 15 patients with acute urticaria who were sensitized to A simplex but had no clinical history of allergy to A simplex, and 10 patients allergic to seafood. SPT, slgE (ELISA and ISAC-I 12), and the basophil activation test (BAT) were performed with A simplex whole extract and the molecular components rAni s 1, rAni s 3, and nPen m 1. Sensitivity and specificity were calculated and compared with different cutoffs. RESULTS: With the A simplex whole extract, SPT, slgE, and BAT yielded specificity values of 72%, 68%, and 70%, respectively, with a cutoff (wheal size) of 11.2 mm, an slgE value of 7.9 kUAIL, and a stimulation index of 1.9. Specificity increased to 100% using the molecular component rAni s 1 with SPT, slgE by ELISA, and ISAC-112. Neither rAni s 3 sensitization nor cross-reactivity with Pen m 1 was observed in patients sensitized to A simplex. CONCLUSION: rAni s 1 is recognized by 100% of our patients and is able to distinguish between patients allergic to A simplex and patients with acute urticaria who are sensitized to A simplex but have no clinical history of allergy to this parasite.

Anaphylaxis Due to Senna (Cassia angustifolia)

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Tolerance to cephalosporins and carbapenems in penicillin-allergic patients

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Oral immunotherapy with egg and milk: changes in peripheral serum cytokines are not predictive factors for severe adverse reactions or for the final report

Introduction: Oral immunotherapy (OIT) is a new approach in patients with food allergy. Various immunological mechanisms underlie the reversal of food allergy. In this paper, we study possible changes in peripheral cytokine patterns during OIT. Methods: Determinations of cytokines in peripheral blood were made in children who had milk or egg allergy and who received OIT. The determinations were made before and after OIT, and again following a final repeat oral challenge a month after a diet excluding the culprit food. Results: No significant changes were registered in the cytokines studied (IL-2, IL-4, IL-6, IL-10, IL-12, IL-17, IFNγ, and TNF) at any of the 3 time points. Similarly, no differences in cytokine pattern were observed between children who had presented anaphylaxis during OIT and those who overcame or did not overcome the final oral challenge. Discussion: Peripheral cytokines do not undergo significant changes during the OIT process. They are not predictors of serious adverse reactions or the final result of the OIT (AU)

Introducción: Se ha introducido la inmunoterapia oral frente a alimentos como una nueva terapia en pacientes con alergia alimentaria. Diferentes mecanismos inmunológicos han sido descritos en un intento de explicar la reversibilidad de esta situación de alergia alimentaria. En este artículo, estudiamos los posibles cambios en el patrón de citoquinas en sangre periférica a lo largo del proceso de la inmunoterapia oral. Métodos: Se realizó determinación de citokinas en sangre periférica en tantos niños con alergia a leche o huevo que realizaron inmunoterapia oral. Las determinaciones se realizaron tanto de forma previa como tras la finalización de la OIT, así como tras una reprovocación final, un mes después de seguir una dieta exenta del alimento implicado. Resultados: No se registraron cambios significativos en las citokinas estudiadas (IL-2, IL-4, IL-6, IL-10, IL-12, IL-17, IFNγ y TNF) entre ninguna de las tres determinaciones temporales. Tampoco existieron diferencias en el patrón de citokinas entre los niños que habían presentado anafilaxias durante la OIT ni entre los que superaron o no superaron la provocación final. Discusión: Las citokinas periféricas no sufren cambios significativos a lo largo del proceso de OIT. No son factores predictivos de reacciones adversas graves ni del resultado final de la OIT (AU)

Is the quantification of antigen-specific basophil activation a useful tool for monitoring oral tolerance induction in children with egg allergy?

Objectives: To assess modifications in baseline specific IgE- and anti-IgE- and antigen-specific-mediated basophil activation in egg-allergic children. The values were compared before and after the children completed specific oral tolerance induction (SOTI) with egg. Patients and Methods: We studied 28 egg-allergic children who completed SOTI with egg. The basophil activation test and specific IgE determinations with egg white, ovalbumin, and ovomucoid were performed in all 28 children. Results: A decrease in antigen-specific activation with egg white, ovalbumin, and ovomucoid was observed only at the 2 lowest concentrations used (5 and 0.05 ng/mL). Baseline activation was higher in patients with multiple food allergies and in those who developed anaphylaxis during SOTI; this activation decreased in both groups after completion of SOTI. A significant decrease was also observed in specific IgE values for egg white, ovalbumin, and ovomucoid after tolerance induction. Conclusions: Food tolerance induction is a specific process for each food that can be mediated by immunologic changes such as a decrease in specific IgE values and in specific and spontaneous basophil activation (AU)

Objetivos: Valorar los cambios en la IgE específica y en la activación de basófilos basal, mediada por Anti-IgE y antígeno específica en niños con alergia a huevo, antes y después de finalizar el proceso de inducción oral de tolerancia. Métodos: Se estudiaron 28 niños con alergia a huevo que finalizaron una inducción oral de tolerancia con este alimento. En todos ellos se realizó test de activación de basófilos e IgE específica con clara de huevo, ovoalbúmina y ovomucoide. Resultados: Se produjo una reducción en la activación antígeno específica con clara de huevo, ovoalbúmina y ovomucoide únicamente con las dos concentraciones más bajas (5 y 0,05 ng/ml) empleadas. La activación basal era más alta en los pacientes con alergia alimentaria múltiple y en aquellos que desarrollaron anafilaxia en el proceso de inducción de tolerancia, disminuyendo esta activación en ambos grupos tras la finalización del proceso de inducción de tolerancia. Se observó igualmente una reducción significativa en los valores de IgE específica frente a clara de huevo, ovoalbúmina y ovomucoide tras finalizar la inducción de tolerancia. Conclusiones: La inducción de tolerancia con alimentos es un proceso específico para cada alimento que puede estar mediado por cambios inmunológicos como un descenso en los valores de IgE específica, así como en la activación de basófilos tanto específica como espontánea (AU)

In vivo and in vitro testing with rAni s 1 can facilitate diagnosis of anisakis simplex allergy

Background: Traditional diagnostic tests such as skin prick tests (SPT) and specific IgE (sIgE) against whole Anisakis simplex extract have low specificity. Consequently, allergy to A simplex is overdiagnosed. Objective: Our aim was to compare tests used in component-resolved diagnosis. Methods: We evaluated 34 patients with allergy to A simplex, 15 patients with acute urticaria who were sensitized to A simplex but had no clinical history of allergy to A simplex, and 10 patients allergic to seafood. SPT, sIgE (ELISA and ISAC-112), and the basophil activation test (BAT) were performed with A simplex whole extract and the molecular components rAni s 1, rAni s 3, and nPen m 1. Sensitivity and specificity were calculated and compared with different cutoffs. Results: With the A simplex whole extract, SPT, sIgE, and BAT yielded specificity values of 72%, 68%, and 70%, respectively, with a cutoff (wheal size) of 11.2 mm, an sIgE value of 7.9 kUA/L, and a stimulation index of 1.9. Specificity increased to 100% using the molecular component rAni s 1 with SPT, sIgE by ELISA, and ISAC-112. Neither rAni s 3 sensitization nor cross-reactivity with Pen m 1 was observed in patients sensitized to A simplex. Conclusion: rAni s 1 is recognized by 100% of our patients and is able to distinguish between patients allergic to A simplex and patients with acute urticaria who are sensitized to A simplex but have no clinical history of allergy to this parasite (AU)

Introducción: Las pruebas diagnósticas tradicionales como pruebas cutáneas (PC) e IgE específica (sIgE) con el extracto completo de Anisakis simplex tienen una baja especificidad. Esto conlleva a un sobrediagnóstico de alergia a A simplex. Objetivo: Nuestro objetivo fue comparar diferentes pruebas de diagnóstico basado en componentes moleculares. Métodos: Se estudiaron 34 pacientes con alergia a A simplex, 15 con urticaria aguda sensibilizados a A simplex pero sin historia clínica compatible con alergia a A simplex y 10 alérgicos a mariscos. A todos ellos se les realizaron PC, sIgE mediante ELISA e ISAC-112 y TAB con el extracto completo de A simplex y los componentes moleculares rAni s 1, rAni s 3 y nPen m 1. Se calculó y se comparó la sensibilidad y especificidad de cada prueba con diferentes puntos de corte. Resultados: Las PC, la sIgE y el TAB con el extracto completo de A simplex mostraron una especificidad del 72%, 68% y 70% con un punto de corte de 11,2 mm de tamaño de pápula, 7,9 kUA/L de sIgE y un índice de estimulación de 1,9, respectivamente. La especificidad incrementó al 100% utilizando el componente rAni s 1en PC e sIgE mediante ELISA e ISAC-112. No se observó sensibilización a rAni s 3 ni reactividad cruzada con nPen m 1 en los pacientes sensibilizados a A simplex. Conclusión: el alérgeno rAni s 1 es reconocido por el 100% de nuestros pacientes y nos permite distinguir entre pacientes alérgicos a A simplex y pacientes con urticaria aguda sensibilizados a A simplex sin historia clínica de alergia a éste parásito (AU)

In Vitro Production of Ag-Specific IFN-?? in Patients With Delayed Hypersensitivity to Amoxicillin

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Acute Abdomen in a Patient With Homozygous Type I Hereditary Angioedema: Rapid Improvement in Computed Tomography Scans After C1 Inhibitor Replacement

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