Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology

The current systematic review presented and discussed the most recent studies on pediatric chronic cough. In addition, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to a pediatric patient with chronic cough. Several algorithms on chronic cough management have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, from birth until adulthood. Based on our findings, children and adolescents with chronic cough without cough pointers can be safely managed, initially using the watchful waiting approach and, successively, starting empirical treatment based on cough characteristics. Unlike other algorithms that suggest laboratory and instrumental investigations as a first step, this review highlighted the importance of a “wait and see” approach, consisting of parental reassurance and close clinical observation, also due to inter-professional collaboration and communication between general practitioners and specialists that guarantee better patient management, appropriate prescription behavior, and improved patient outcome. Moreover, the neonatal screening program provided by the Italian National Health System, which intercepts several diseases precociously, allowing to treat them in a very early stage, helps and supports a “wait and see” approach. Conversely, in the presence of cough pointers or persistence of cough, the patient should be tested and treated by the specialist. Further investigations and treatments will be based on cough etiology, aiming to intercept the underlying disease, prevent potentially irreversible tissue damage, and improve the general health of patients affected by chronic cough, as well as the quality of life of patients and their family. Further high-quality randomized controlled trials are needed to validate this algorithm’s performance in real clinical practice (AU)

Acute cough in children and adolescents: A systematic review and a practical algorithm by the Italian Society of Pediatric Allergy and Immunology

The current systematic review presented and discussed the most recent studies on acute cough in pediatric age. After that, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to pediatric patients, such as infants, children, and adolescents, with acute cough. An acute cough is usually consequent to upper respiratory tract infections and is self-resolving within a few weeks. However, an acute cough may be bothersome, and therefore remedies are requested, mainly by the parents. An acute cough may significantly affect the quality of life of patients and their family. Several algorithms for the management of acute cough have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, and, also, in accordance to the Italian National Health System, which regularly follows the child from birth to all lifelong. Based on our findings, infants from 6 months, children, and adolescents with acute cough without cough pointers can be safely managed using well-known medications, preferably non-sedative agents, such as levodropropizine and/or natural compounds, including honey, glycerol, and herb-derived components (AU)

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)

Análisis de la seguridad clínica en las unidades de Alergología de la Comunidad Valenciana / Analysis of clinical safety in the Allergy Units of the Valencian Community

La introducción de procedimientos diagnósticos y terapéuticos que implican exposición alergénica conlleva riesgos. Para evaluar la seguridad clínica en las unidades de Alergología de la Comunidad Valenciana se diseñó y distribuyó un cuestionario anónimo, obteniendo respuesta de doce unidades hospitalarias y ocho centros de especialidades. La distribución de prestaciones entre los diversos entornos fue homogénea, así como la utilización de unidades de críticos, urgencias u hospitales de día para técnicas de mayor riesgo. La dotación de instrumentos relacionados con la seguridad es más amplia en las consultas hospitalarias e incluye fuente de oxígeno (91,7%), pulsioxímetro (75,0%) o monitor (8,3%), carro de paradas (91,7%) y desfibrilador (83,33%). El tiempo de respuesta para emergencias está pactado en el 50%. Sistemáticamente se revisa el material para resucitación y se firma consentimiento informado. La seguridad es más limitada en los centros de especialidades. Se deberían establecer las condiciones idóneas de seguridad clínica en Alergología (AU)

The introduction of new diagnostic and therapeutic procedures involving allergen exposure may increase the risk of allergic reactions. We designed and distributed an anonymous questionnaire among the allergy units of the Valencian Community in order to collect information on measures to ensure clinical safety. Twelve hospital outpatient clinics and 8 ambulatory care centres reported similar patterns of activities, including the use of critical care units, emergency rooms or day hospitals for higher risk techniques. The provision of security-related instruments is broader in hospital outpatient clinics and included: oxygen (91.7%), pulse oximeter (75.0%) or vital signs monitor (8.3%), resuscitation material (91.7%) and defibrillator (83.3%). The response time for emergencies is set in 50% of clinics. The resuscitation material is systematically reviewed and informed consent signed. Security is more limited in ambulatory care centres. It is necessary to set down the conditions for clinical safety in allergology (AU)

Documento de consenso de la Sociedad Española de Infectología Pediátrica, Sociedad Española de Inmunología Clínica y Alergia Pediátricas, Asociación Española de Pediatría de Atención Primaria y Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria sobre antibioterapia en alergia a penicilina o amoxicilina / Spanish Society of Pediatric Infectious Diseases, Spanish Society of Paediatric Clinical Immunology and Allergy, Spanish Association of Paediatric Primary Care, and the Spanish Society of Extra-hospital Paediatrics and Primary Health Care consensus document on antibiotic treatment in penicillin or amoxicillin allergy

La sospecha de alergia a antibióticos betalactámicos, especialmente penicilina y sobre todo amoxicilina, suponen el motivo de consulta más frecuente en las Unidades de Alergia Infantil. En este documento de consenso se describe la clínica y los criterios diagnósticos de las reacciones alérgicas, así como el tratamiento antibiótico alternativo de las infecciones más habituales en pediatría, para los pacientes con sospecha diagnóstica o confirmación de la alergia

The suspected allergy to beta-lactam antibiotics, especially penicillin and amoxicillin, is the most frequent reason for consultation in Child Allergy Units. In this consensus document, the clinical and diagnostic criteria of allergic reactions are described, as well as alternative antibiotic treatment for the most common infections diagnosed in paediatrics for patients with known or suspected allergy

Specific allergen immunotherapy for the treatment of allergic asthma: a review of current evidence

Asthma is frequently associated with atopy, characterized by the production of specific immunoglobulin E in response to environmental allergens. Currently, two types of allergen immunotherapy (AIT) are used in clinical practice: subcutaneous and sublingual immunotherapy, both accepted as key components of the therapeutic repertoire for allergic rhinitis and conjunctivitis. However, their role in asthma remains controversial. The present document is aimed at providing the clinicians with a review of the evidence on the use of AIT in asthma, focusing on the most relevant aspects of its mechanism of action, its efficacy, and existing data on safety, tolerability, and cost-effectivity, both in pediatric and adult populations. A systematic search of MEDLINE, Cochrane, and Clinical Trials databases from 2000 to April of 2016 was carried out by a panel of experts from the Spanish Allergy and Clinical Immunology Scientific Society. Relevant studies prior to the year 2000 included in ulterior systematic reviews were also considered. More than 4000 articles were identified during the search and 241 were selected to retrieve available evidence on AIT, which was graded according to the Oxford classification. All the group members reviewed the resulting text until the final version reached the consensual agreement. A summary of recommendations on the more relevant topics are proposed. The role of AIT as a valuable therapeutic strategy for prevention of exacerbation and progressive decline in lung function is highlighted. Future research should include specific tools for asthma evaluation when assessing AIT effectiveness in asthmatic patients (AU)

El asma se asocia frecuentemente con alergia, entendida ésta como la producción de IgE específica frente a alérgenos ambientales. Actualmente, existen dos tipos de inmunoterapia específica con alérgenos (ITE) para la práctica clínica habitual: subcutánea y sublingual, ambas indicadas en el tratamiento de la rinitis y la conjuntivitis alérgicas. Sin embargo, su papel en el asma resulta todavía controvertido. Este documento pretende ofrecer al clínico una revisión de la evidencia del uso de ITE en asma, centrándose en aspectos más relevantes como su mecanismo de acción, eficacia, seguridad, tolerabilidad y coste-eficacia, tanto en población adulta como pediátrica. Un panel de expertos de la Sociedad Española de Alergología e Inmunología Clínica, llevó a cabo una búsqueda sistemática en las bases de datos MEDLINE, Cochrane y Clinica Trials, desde 2000 a abril de 2016. También se revisaron algunos estudios anteriores al 2000, incluidos en revisiones sistemáticas posteriores. Se identificaron más de 4000 artículos en la búsqueda y se seleccionaron 241 para documentar la evidencia disponible y graduarla según la clasificación Oxford. Todos los miembros del panel revisaron el texto resultante hasta la versión final, alcanzando un acuerdo de consenso y se propusieron recomendaciones para los aspectos más relevantes. Se señala específicamente que la ITE resulta potencialmente valorable en la prevención de las exacerbaciones y el declive progresivo de la función pulmonar, aunque se necesitan nuevos estudios que incluyan variables específicas de evaluación de asma para verificar la eficacia de la ITE en esta patología (AU)

Potentially inappropriate prescription in patients with a history of allergy to Beta-lactam antibiotics: a health care challenge

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Diagnòstic molecular en al·lergologia pediàtrica. Implicacions diagnòstiques i terapèutiques / Diagnóstico molecular en alergología pediátrica. Implicaciones diagnósticas y terapéuticas / Component-resolved diagnostic in pediatric allergy. Diagnostic and therapeutic implications

Fonament: els extractes obtinguts a partir de les fonts al•lergògenes completes sovint són barreges mal definides d'al•lèrgens principals, al•lèrgens de reactivitat encreuada i material no al•lergogen. Quan són utilitzades en els mètodes diagnòstics de sensibilització al•lèrgica (tant in vivocom in vitro), sovint no permeten un diagnòstic precís de l'al•lergen responsable de la simptomatologia, especialment en els pacients sensibilitzats a més d'una font al•lergògena. Els avenços en la caracterització d'al•lèrgens (biologia molecular i tècniques de DNA recombinant) han permès que disposem de noves eines diagnòstiques, com els al•lèrgens recombinants i els al•lèrgens purificats. Objectiu: revisar si la utilització d'al•lèrgens recombinants i al•lèrgens purificats pot millorar l'eficàcia dels mètodes diagnòstics convencionals utilitzats fins ara en al•lergologia pediàtrica. Mètode: revisió bibliogràfica fins al desembre del 2014. Es revisen els articles en què s'ha avaluat la utilitat del diagnòstic molecular en població al•lèrgica pediàtrica. Resultats: la utilització d'al•lèrgens recombinants i al•lèrgens purificats millora l'eficàcia dels mètodes diagnòstics convencionals, ja que ens permet definir les sensibilitzacions genuïnes i les que són conseqüència dels fenòmens de reac tivitat encreuada amb més precisió diagnòstica. Amb l'apli cació del diagnòstic molecular s'espera aconseguir una millor tipificació de la patologia al•lèrgica de la població pediàtrica polisensibilitzada i amb patologia al•lèrgica complexa. Conclusions: el diagnòstic al•lergològic molecular pot ser una eina molt útil per prendre decisions clíniques apropiades i a temps per als pacients, i oferir als metges la possi-bilitat d'individualitzar les accions terapèutiques

Fundamento. Los extractos obtenidos a partir de las fuentes alergénicas completas a menudo son mezclas mal definidas de alérgenos principales, alérgenos de reactividad cruzada y material no alergénico. Cuando se utilizan en los métodos diagnósticos de sensibilización alergénica (tanto in vivo como in vitro), a menudo no permiten un diagnóstico preciso del alérgeno responsable de la sintomatología, especialmente en los pacientes sensibilizados a más de una fuente alergénica. Los avances en la caracterización de los alérgenos (biología molecular y técnicas de DNA recombinante) han permitido que dispongamos de nuevas herramientas diagnósticas, como los alérgenos recombinantes y los alérgenos purificados. Objetivo. Revisar si la utilización de alérgenos recombinantes y alérgenos purificados puede mejorar la eficacia de los métodos diagnósticos convencionales utilizados en alergología pediátrica hasta ahora. Método. Revisión bibliográfica hasta diciembre de 2014. Se revisan los artículos en los que se evaluó la utilidad del diagnóstico molecular en población alérgica pediátrica. Resultados. La utilización de alérgenos recombinantes y alérgenos purificados mejora la eficacia de los métodos diagnósticos convencionales, ya que nos permite definir las sensibilizaciones genuinas y las que son consecuencia de los fenómenos de reactividad cruzada con una mayor precisión diagnóstica. Con la aplicación del diagnóstico molecular se espera conseguir una mayor tipificación de la patología alérgica de la población pediátrica polisensibilizada y con patología alérgica compleja. Conclusiones. El diagnóstico molecular puede ser una herramienta muy útil a la hora de establecer decisiones clínicas apropiadas y a tiempo para nuestros pacientes alérgicos, y ofrecer a los médicos la posibilidad de individualizar las mejores acciones terapéuticas (AU)

Background. Extracts obtained from complete allergenic sources are usually poorly defined mixtures of major allergens, cross-reactive allergens, and non-allergenic material. The analysis of those extracts seldom allows for a precise diagnosis of the allergen responsible for the symptoms (in vivo or in vitro), especially in patients sensitized to more than one allergenic source. Advances in the characterization of allergens (molecular biology and recombinant DNA techniques) have allowed for the development of new diagnostic tools based on purified and recombinant allergens. Objective. To review the effect that advances in the characterization of purified and recombinant allergens have had in the diagnostics of pediatric allergy. Method. Literature review of manuscripts published until December 2014. Articles evaluating the usefulness of molecular diagnosis in pediatric allergy were reviewed. Results. Advances in the characterization of allergens have facilitated the development of new diagnostic tools based on purified and recombinant allergens that can improve the efficiency of conventional allergy diagnosis methods. The use of recombinant and purified allergens for the study of the allergic sensitization of polysensitized patients and of patients with complex allergic disease may help discern genuine sensitization of the patient from crossreactivity with greater accuracy. Conclusions. The identification of the specific allergen that is sensitizing the patient is an essential requirement for optimal diagnosis and treatment; multiplexed molecular diagnosis can provide very useful information to aid in the management of these children (AU)

Inmunonutrición: metodología y aplicaciones / Immunonutrition: methodology and applications

La Inmunonutrición es una materia emergente e interdisciplinar, ya que abarca distintos aspectos relacionados con la Nutrición, la Inmunidad, la Infección, la Inflamación y la Injuria o daño tisular, lo que se ha denominado como la Nutrición y las 4 'Ies'. En estas interacciones se encuentran implicados los sistemas endocrino, nervioso e inmune, formando parte la microbiota de este último. Actualmente la microbiota intestinal tiene un papel fundamental no solo a nivel del tracto gastrointestinal sino que presenta además un eje de conexión bilateral con el sistema nervioso. Para el estudio de la Inmunonutrición existen diferentes biomarcadores del sistema inmune que proporcionan información acerca del estado nutricional del individuo. Sin embargo, se debe tener en cuenta que no existe un solo parámetro para evaluar la relación causa-efecto de la nutrición sobre el sistema inmunitario, sino que es un conjunto de biomarcadores a tener en cuenta dependiendo de las distintas situaciones nutricionales. Si bien está claro que se trata de una materia multidisciplinar, no solo se deben focalizar los estudios sobre las interacciones entre la nutrición y el sistema inmune de manera aislada, sino sobre otros sistemas del organismo teniendo en cuenta un gran abanico de factores de confusión y determinantes derivados de las condiciones idiosincrásicas de cada individuo, su genética y su estilo de vida. Por todo ello, la Inmunonutrición permite llevar a cabo una serie de estudios basados fundamentalmente en cuatro líneas de investigación: 1) Evaluación de poblaciones supuestamente sanas pero con riesgo de malnutrición (niños, adolescentes, adultos, gestantes, lactantes, personas mayores y deportistas), 2) Estudio de la evolución de pacientes con enfermedades relacionadas con la nutrición y el sistema inmunitario, 3) Estudio de los efectos de nutrientes, compuestos bioactivos y alimentos convencionales y funcionales sobre el sistema inmunitario; 4) Estudio del impacto del estilo de vida sobre el comportamiento del sistema inmunitario, teniendo como determinantes principales la dieta, el comportamiento alimentario, la actividad física, el sedentarismo, la calidad y cantidad de sueño, y como factor clave, el estrés (AU)

Immunonutrition is an emergent and interdisciplinary subject, since it comprises several aspects related to Nutrition, Immunity, Infection, Inflammation, and Injury or tissue damage, what is known as Nutrition and 4 'Is'. Within these interactions the endocrine, nervous and immune systems are involved, microbiota being a part of the last one. Nowadays, gut microbiota has been shown to play an essential role, not only in the gastrointestinal tract but also into the nervous system, because of its bilateral connection. There are several methods to study Immunonutrition, which allow measuring different immunological biomarkers to provide information about the nutritional status. However, it should be taken into account that there is not a single gold standard parameter to evaluate the cause-effect relationship between nutrition and the immune system. On the contrary, a combination of biomarkers have to be assessed depending on the different nutritional situations. Since Immunonutrition is a multidisciplinary matter as mentioned above, the study on the interactions between nutrition and the immune system has not been exclusively focused as such, but bearing in mind other systems of the organisms as well as a wide range of confounding factors and determinants coming from idiosyncratic features, genes and lifestyle of each individual. Therefore, Immunonutrition allows to study the following research fields: 1) Evaluation of nutritional status in presumably healthy people with risk of malnutrition (children, adolescents, adults, pregnant women, elderly, and sportspeople); 2) Assessment of the evolution and progress of patients with nutrition and immune-related diseases, such as food allergies, eating and metabolic disorders; 3) Evaluation of the effects of nutrients, bioactive compounds and both conventional and functional foods on the immune system; 4) Evaluation of impact of lifestyle determinants on the immune system, such as diet, food behaviour, physical activity, sedentariness, sleep quality and quantity, and as a key factor, stress (AU)

Hedgehog allergy: new pet, old allergens

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El consentimiento informado en la especialidad de alergología desde una perspectiva de ciencia, tecnología y sociedad / The Informed consent in allergology from a scientific, technological and social perspective

En este trabajo se realiza una revisión sobre la aplicación del consentimiento informado dentro de la especialidad de alergología desde una perspectiva de ciencia, tecnología y sociedad, tanto en los procedimientos (pruebas cutáneas), las intervenciones terapéuticas (inmunoterapia) y las investigaciones (ensayos clínicos), a partir de los avances que en Cuba se han tenido en los últimos tiempos en relación con la obtención de mejores extractos alergénicos para pruebas, vacunas de alta calidad y nuevos medicamentos, puestos en función del beneficio del paciente alérgico. Se evidencia que al aplicar el consentimiento informado en la especialidad se respetan los preceptos sociales humanistas, al dirigir sus acciones de salud en función de respetar la integridad del enfermo ante posibles riesgos, ofrecer la opción para el uso de la inmunuterapia y respetar su autonomía en la realización de las investigaciones; se proyecta en el beneficio del paciente al lograr mejorías en sus estilos de vida, para alcanzar el control de la enfermedad alérgica, la mejora de la salud y la calidad de vida de los pacientes, potencia además la justicia social al hacer asequible sus servicios a toda la población(AU)

This paper reviews the application of the informed consent within the specialty of allergology in procedures (skin tests), therapeutic interventions (immunotherapy) and research (clinical trials) from a scientific, technological and social perspective, based on the advances achieved in Cuba in recent years to obtain better allergenic extracts for testing, high-quality vaccines and new drugs to benefit the allergic patient. It is demonstrated that when applying the informed consent in this specialty, the humanistic social precepts are respected by directing health actions to respect the integrity of the patients against possible risks, offering the option to use immunotherapy and respecting their autonomy in research. It benefits the patients by improving their lifestyles to control the allergic disease, improve their health and quality of life. Furthermore, it promotes social justice by making available these services to the entire population(AU)

The Effect of Asthma Clinical Guideline for Adults on Inhaled Corticosteroids PrescriptionTrend: A Quasi-Experimental Study

In order to increase inhaled corticosteroid (ICS) use and to reduce hospitalization, emergency department visits and ultimately the economic burden of asthma, "Korean Asthma Management Guideline for Adults 2007" was developed. To assess the guideline effects on physician's ICS prescription for asthma, we conducted segmented regression and multilevel logistic regression using National Health Insurance claims database of outpatient visits from 2003 to 2010. We set each quarter of a year as a time unit and compared ICS prescription between before and after guideline dissemination. A total of 624,309 quarterly visits for asthma was observed. The ICS prescription rate before and after guideline dissemination was 13.3% and 16.4% respectively (P < 0.001). In the segmented regression, there was no significant guideline effect on overall ICS prescription rate. In multilevel logistic regression analyses, the effect of guideline on overall ICS prescription was not significant (odds ratio, 1.03; 95% CI, 1.00-1.06). In subgroup analysis, ICS prescription increased in secondary care hospitals (odds ratio, 1.15; 95% CI, 1.02-1.30) and in general hospitals (odds ratio, 1.10; 95% CI, 1.04-1.16). However, in primary clinics, which covered 81.7% of asthma cases, there was no significant change (odds ratio, 0.98; 95% CI, 0.94-1.02). From the in-depth interview, we could identify that the reimbursement criteria of the Health Insurance Review and Assessment Service and patient's preference for oral drug were barriers for the ICS prescription. The domestic asthma clinical guideline have no significant effect on ICS prescription, especially in primary clinics.

Evaluación de técnicas inmunológicas in vitro para el diagnóstico de alergias: metanálisis 2000-2012 / Evaluation of techniques in vitro immune to the diagnosis of allergy: Meta-analysis 2000-2012

Fundamentos: Las alergias presentan elevada prevalencia, afectan a todos los grupos etarios, generan impactos negativos sobre los sistemas de salud, educativo y económico. Se desconoce la utilidad diagnóstica de las pruebas de tamización. El objetivo del estudio fue evaluar la validez, el desempeño, la seguridad y la efectividad diagnóstica de las técnicas inmunológicas in vitro para alergias Métodos: Revisión sistemática con metaanálisis. Se aplicó una estrategia de búsqueda de estudios en Pubmed, Sciencedirect y Wiley con los términos de búsqueda activation basophil test, lymphocyte transformation test, especific IgE immunoassay. Período estudiado: 2000-2012. Se determinó la reproducibilidad de la selección, extracción y evaluación de la calidad de los artículos. Se calculó sensibilidad, especificidad, cocientes de probabilidad, valores predictivos, proporción de resultados falsos, exactitud, razón de odds, índice J de Youden y curva ROC con los software Meta-DiSc(es) y Epidat 3.0 Resultados: Se incluyeron 18 estudios con 3.520 individuos, 58% enfermos y 42% sanos. La activación de basófilos presentó sensibilidad del 78% (IC95%:74-81), especificidad 95% (IC95%:83-100), cociente de probabilidad positivo 9,9 (IC95%:6,8-14,4) y negativo de 0,20 (IC95%:0,13-0,30), OR diagnóstica de 70,8 (IC95:40,2-124,8) y un área bajo la curva de 0,97. En la inmunoglobulina E específica la sensibilidad fue 72% (IC95%:69-75), especificidad 90% (IC95%:88-92), cociente de probabilidad positivo 12,9 (IC95%:4,0-41,6) negativo 0,32 (IC95%:0,23-0,43), OR diagnóstica 41,6 (IC95%:11,6-148,9) y área bajo la curva 0,87 Conclusión: Se evidenció que la activación de basófilos y la IgE específica son pruebas útiles en el diagnóstico de alergias (AU)

Background: Allergies have high prevalence, affecting all age groups, generate negative impacts on health, educational and economic systems, and they are unknown the diagnostic utility of screening tests. The objective of the study was to evaluate the validity, performance, safety and diagnostic efficiency of in vitro immunological techniques for allergies, 2000-2012 Methods: Systematic review with meta-analysis. We applied a search strategy studies in PubMed, Sciencedirect and Wiley, with search terms activation basophil test, lymphocyte transformation test, especific IgE immunoassay. We determined the reproducibility of the selection, extraction and quality assessment of articles. We calculated sensitivity, specificity, likelihood ratios, predictive values, proportion of false, accuracy, odds ratio, Youden index J and ROC curve in Meta-DiSc(es) and Epidat 3.0. software Results: We included 18 studies with 3520 individuals, 58% patients and 42% healthy. Activation of basophils showed sensitivity of 78% (95% CI :74-81), specificity 95% (95% CI: 83-100), positive likelihood ratio 9.9 (95% CI: 6.8 to 14.4) and negative of 0.20 (95% CI = 0.13 to 0.30) a diagnostic OR 70.8 (IC95: 40.2 to 124.8) and area under the curve of 0.97. In specific immunoglobulin E sensitivity was 72% (95% CI: 69-75), specificity 90% (95% CI : 88-92), positive likelihood ratio 12.9 (95% CI = 4.0 to 41.6) negative 0.32 (95% CI:0.23-0.43), diagnostic OR 41.6 (95% CI :11.6 to 148.9) and area under the curve 0.87 Conclusion: We showed that activation of basophils and specific IgE are useful tests for diagnosing allergies (AU)

The impact of double-blind placebo-controlled food challenge (DBPCFC) on the socioeconomic cost of food allergy in Europe

Background: Double-blind placebo controlled food challenge (DBPCFC) is the gold standard diagnostic test in food allergy because it minimizes diagnostic bias. Objective: To investigate the potential effect of diagnosis on the socioeconomic costs of food allergy. Methods: A prospective longitudinal cost analysis study was conducted in Spain and Poland within the EuroPrevall project. Food-allergic patients were enrolled into the study and in all cases diagnosis was confirmed through a standardized DBPCFC. Data were collected through a self-administered survey on all aspects of health and social care resource use, costs of living, and costs of leisure activities. Costs were measured before and 6 months after the DBPCFC and reported in international dollars with 2007 as the benchmark year. Results: Forty-two patients were enrolled. Twenty-one patients had a negative DBPCFC and the suspected food was reintroduced into their diet. Comparing total direct costs before and after the DBPCFC, the reactive group spent a significantly higher amount (median increase of $813.1 over baseline), while the tolerant group’s spending decreased by a median of $87.3 (P=.031). The amount of money spent on food 6 months after diagnosis was also significantly higher in the reactive group (P=.040). Finally, a larger, but not statistically significant, decrease in total indirect costs was observed in the tolerant group compared with the reactive group ($538.3 vs $32.3). Conclusion: DBPCFC has an impact on indirect and direct costs of living. The main contribution to this increase was money spent on food (AU)

Introducción: La provocación oral doble ciego controlada con placebo (PODCCP) es prueba diagnóstica "gold standard" en alergia a alimentos. Objetivo: El objetivo de este estudio es investigar el efecto del diagnóstico en los costes socioeconómicos de la alergia a alimentos (AA). Métodos: Estudio prospectivo longitudinal de análisis de costes llevado a cabo en España y Polonia en el contexto de proyecto EuroPrevall. Se seleccionaron pacientes con AA y en todos los casos el diagnóstico fue estandarizado a través de una PODCCP estandarizada. Se utilizaron cuestionarios autoadministrados para recoger datos del uso de recursos sociosanitarios, coste de vida y coste de actividades de ocio. Los costes se midieron en dos puntos, antes y 6 meses después de PODCCP, expresados en dólares internacionales (nivel de costes 2007). Resultados: Se incluyeron 42 pacientes. 21 pacientes tuvieron una PODCCP negativa y se reintrodujo el alimento. Comparando los costes directos antes y después de PODCCP, el gasto en el grupo de pacientes reactivos fue significativamente mayor (mediana de incremento $813,1 a los 6 meses), mientras que en el grupo de pacientes tolerantes disminuyó una mediana de $87,3 (p=0,031). Los pacientes con una provocación positiva gastaron también más dinero en comida a los 6 meses del diagnóstico (p=0,040). Por último, los costes indirectos disminuyeron, aunque de forma no estadísticamente significativa, en el grupo de pacientes tolerantes comparado con los reactivos ($ 538,3 versus $32,3). Conclusión: La PODCCP tiene un impacto en los costes directos e indirectos, en su mayor parte debido al dinero gastado en comida (AU)

Urticaria de contacto por Aloe vera / Contact urticaria by Aloe vera

El Aloe vera es un producto ampliamente usado en alimentación y cosmética. Aunque es considerado una planta medicinal por sus múltiples propiedades, no es un producto inocuo, ya que presenta ciertos componentes irritantes que pueden producir efectos secundarios. La dermatitis alérgica de contacto se presenta entre los mismos. Presentamos el caso de un niño de seis años en el que observamos una urticaria tras la aplicación directa del jugo de la planta de Aloe, con buena respuesta al tratamiento convencional de la urticaria. Tras esta revisión bibliográfica, podemos concluir que no puede recomendarse el uso de Aloe vera para el tratamiento de ninguna patología específica debido a que no existe suficiente evidencia de su eficacia en la práctica clínica (AU)

Aloe vera is a widely used product in the food sector and the cosmetics industry. Although it is considered to be a medicinal plant because of its many properties, it is not an innocuous product as it has certain irritating components which can cause side effects. Allergic contact dermatitis is included among them. We present the case of a six-year-old child who shows urticaria after applying the juice of the Aloe plant directly onto the skin. The patient responded successfully to conventional urticaria treatment. After this literature review we can conclude that the use of Aloe vera cannot be recommended for the treatment of any specific pathology since there is not enough evidence to prove the effectiveness in clinical practice (AU)

Urticaria recurrente asociada a infección por Streptococcus pyogenes / Recurrent urticaria associated with group Streptococcus pyogenes infection

La mayoría de las urticarias crónicas o agudas recidivantes son idiopáticas. Presentamos un caso de urticaria aguda recidivante en una niña de tres años, en la que, tras el estudio realizado, solo se objetivó un valor elevado de anticuerpos antiestreptolisina O (ASLO). La desaparición de la urticaria tras el tratamiento con penicilina G-benzatina intramuscular, junto con la normalización de los ASLO, sugiere que la etiología de esta podría ser las infecciones recurrentes por el Streptococcus pyogenes. Destacar la importancia de incluir en el protocolo diagnóstico de la urticaria la determinación de los ASLO, lo cual permite el diagnóstico y tratamiento precoces de las infecciones por S. pyogenes (AU)

We present a case of relapsing acute urticaria in a three years old girl who after the study only showed a high value of ASLO (antistreptolysin O titer). The disappearance of urticaria after intramuscular penicillin G benzathine treatment, together with the ASLO normalization, suggested that the etiology of this could be recurrent Streptococcal infections. We conclude the importance of including ASLO determination in the diagnostic protocol of urticaria, allowing early diagnosis and treatment of Group A Streptococcus infections (AU)

Factors that increase wheezing risk in nursing infants in the first year of life

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PURPOSE: Juvenile systemic lupus erythematosus (JSLE) is a severe and chronic autoimmune disease of unknown origin. Inflammatory cytokines can play a pivotal role in the pathogenesis of JSLE, while their secretion is under genetic control. The current investigation was performed to analyse the associations of particular single nucleotide polymorphisms (SNPs) of interleukin-2 (IL-2) and interferon-gamma (IFN-γ) genes in a case control study. MATERIALS AND METHODS: The allele, genotype and haplotype frequencies of the polymorphic IL-2 (G/T at −330, rs2069762, and G/T at +166, rs2069763) and IFN-γ (A/T at +874, rs2430561) genes were estimated in 59 patients with JSLE by contrast with 140 healthy controls using polymerase chain reaction with sequence-specific primers method. RESULTS: Results of the analysed data revealed a negative allelic association for JSLE in IL-2 −330/T (P=0.02), as well as a positive allelic association for IL-2 −330/G (P=0.02). IL-2 GG genotype (−330) in the patient group was also significantly overrepresented (P<0.001), while IL-2 GT genotype (−330) was notably decreased in the patients with JSLE (P<0.001). Additionally, the frequency of IL-2 (−330, +166) GT haplotype was significantly higher in the patient group (P<0.001). CONCLUSION: IL-2 cytokine gene polymorphisms could affect individual susceptibility to JSLE and can take on the role of possible genetic markers for vulnerability to JSLE

Awareness of allergic enterocolitis among primary-care paediatricians: A web-based pilot survey

BACKGROUND: Allergic enterocolitis, also known as food protein-induced enterocolitis syndrome (FPIES), is an increasingly reported and potentially severe non-IgE mediated food allergy of the first years of life, which is often misdiagnosed due to its non-specific presenting symptoms and lack of diagnostic guidelines. OBJECTIVE: We sought to determine the knowledge of clinical, diagnostic and therapeutic features of FPIES among Italian primary-care paediatricians. METHODS: A 16-question anonymous web-based survey was sent via email to randomly selected primary care paediatricians working in the north of Italy. RESULTS: There were 194 completed surveys (48.5% response rate). Among respondents, 12.4% declared full understanding of FPIES, 49% limited knowledge, 31.4% had simply heard about FPIES and 7.2% had never heard about it. When presented with clinical anecdotes, 54.1% recognised acute FPIES and 12.9% recognised all chronic FPIES, whereas 10.3% misdiagnosed FPIES as allergic proctocolitis or infantile colic. To diagnose FPIES 55.7% declared to need negative skin prick test or specific-IgE to the trigger food, whereas 56.7% considered necessary a confirmatory oral challenge. Epinephrine was considered the mainstay in treating acute FPIES by 25.8% of respondents. Only 59.8% referred out to an allergist for the long-term reintroduction of the culprit food. Overall, 20.1% reported to care children with FPIES in their practice, with cow's milk formula and fish being the most common triggers; the diagnosis was self-made by the participant in 38.5% of these cases and by an allergist in 48.7%. CONCLUSION: There is a need for promoting awareness of FPIES to minimise delay in diagnosis and unnecessary diagnostic and therapeutic interventions

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