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73 Natural history of food hypersensitivity (FH) in children (PTS) with atopic dermatitis (AD)
... Ils rapportent cette donnée au fait que la consommation de fruits à 3.2.2. Chez un enfant antérieurement allergique à un aliment Dans une série de 75 patients porteurs de DA, Sampson et Scanlon [58] ont montré par la réalisation de TPO successifs qu'un enfant porteur d'une AA pouvait acquérir une tolérance orale. Depuis, d'autres auteurs ont cherché à établir des facteurs prédictifs d'acquisition d'une tolérance orale pour le lait et l'oeuf [30,32,59,60], pour l'arachide [34,59,61,62], et pour les fruits à coque [ [63], les guérisons sont peu fréquentes après l'âge de cinq–sept ans, et pratiquement inexistantes après l'âge de 12 ans.Fig. ...
... Dans les études de Sampson et Ho [2] et Sampson [42], le diagnostic d'allergie au soja est porté par la réalisation d'un TPO respectivement dans 93 et 84 % des cas. La tolérance au soja est estimée acquise dans 50 % des cas, après un à deux ans de régime d'éviction chez les enfants porteurs de DA [58]. Perry et al. [59] n'ont pas pu déterminer un taux d'IgE spécifiques ayant une valeur prédictive positive de 95 % d'un TPO négatif. ...
... Enfin, pour Sampson [42], le diagnostic d'allergie à la farine de blé est fondé sur le TPO dans 90 % des cas. Une tolérance peut être acquise [58,59], mais Perry et al. [59] n'ont pas pu déterminer de taux d'IgE spécifiques prédictif d'une tolérance. ...
Oral food challenge (OFC) is the gold standard to diagnose food allergy. The OFC defines also the tolerance to a particular food in a child previously sensitized or allergic. There are significant risks associated with OFC. According to the literature review and for the three major foods implicated in food allergy in children (cow's milk, hen's egg and peanut), this chapter analyzes the indications, taking into account the clinical situation and the results of allergy testing (specific IgE assay, skin prick tests, atopy patch tests), and the contra-indications of OFC.
... Food allergy is increasing and the prevalence of food allergy is estimated to be 6-8% of children and 1-3% of adults [5]. Wheat is an important part of human diet and one of the six most common foods causing allergy [6]. Depending on the route of allergen exposure and the underlying immunologic mechanisms, wheat allergy may appear as classic food allergy affecting the skin, gut, or respiratory tract; exercise-induced anaphylaxis; occupational asthma and rhinitis; or contact urticaria . ...
... Despite the high prevalence of wheat allergy in children, relatively little is known about its natural history. The natural course of only a few patients with wheat allergy has been reported in the literature, and in these studies 25% to 35% of patients became tolerant in a 1-to 2-year period [6]. In the study by Keet et al. [7], 35% of the children who had wheat allergy remained allergic during their teenage years. ...
Wheat is a common cause of food allergy. Wheat-induced anaphylaxis (WIA) and wheat-dependent exercise induced anaphylaxis (WDEIA) are severe forms of immunoglobulin E (IgE) mediated allergic reaction to wheat protein. As the diagnosis of WIA or WDEIA is not easy because of the risk of oral challenge, identification of specific IgE of various wheat proteins is helpful for diagnosis. In Korea, there are only a few reports on WIA in adults. We report six cases of WIA diagnosed on the basis of clinical history and specific IgE of wheat proteins or provocation test. For immunologic evaluation of severe wheat allergy including WIA and WDEIA, it is important to measure specific IgE to each component of wheat including gluten and ω-5 gliadin not just measuring wheat-specific IgE.
... The majority of reactions to foods in infants and young children will be to egg and milk. It has long been established that most children grow out of these allergies (Sampson & Scanlon, 1989 ). However , it is commonly thought that peanut allergy does not resolve, although Skolnick et al. (2001) have shown that peanut allergy may be outgrown in 21 . ...
Currently, the only treatment for any food hypersensitivity (including food allergy) is the dietary avoidance of the causative allergen, using an elimination diet. In addition to being used for the management of food hypersensitivity, an elimination diet may also be used in the diagnosis of food allergy. Dietary exclusion should be managed by a dietitian or other health professional with nutritional expertise to ensure that the exclusion does not lead to a nutritionally-deficient diet. There are three main types of elimination diets: single-food exclusion; multiple-food exclusion; the ‘few-food’ diet, which requires the avoidance of a large number of allergens and therefore concentrates on the foods that can be included rather than the foods that need to be avoided. Any sort of elimination diet is hard to manage. Thus, as well as ensuring that the diet is nutritionally adequate, it is essential that families are given advice and support relevant to their circumstances to aid them in the day-to-day management of the diet, so that it remains varied and enjoyable for food-allergy sufferers. This approach involves advice about which alternative foods are available, provision of ‘free-from’ recipes and guidance on which nutritional supplements are needed to meet their nutritional needs.
... The prevalence of sensitization to one, two, three or ≥ four of seven key allergen sources (egg, cow's milk, peanut, dust mite, cat, ragweed, and ryegrass) was 90%, 75%, 69% and 54% respectively. These allergens included food and aeroallergens relevant to the pathogenesis of AD and symptom flares [19,[25][26][27][28]. ...
Atopic dermatitis (AD) is common in children; however, persistence of AD with or without asthma is less common. Longitudinal studies remain limited in their ability to characterize how IgE antibody responses evolve in AD, and their relationship with asthma.
To use a cross-sectional study design of children with active AD to analyse age-related differences in IgE antibodies and relation to wheeze.
IgE antibodies to food and inhalant allergens were measured in children with active AD (5 months to 15 years of age, n = 66), with and without history of wheeze.
Whereas IgE antibodies to foods persisted at a similar prevalence and titre throughout childhood, IgE antibodies to all aeroallergens rose sharply into adolescence. From birth, the chance of sensitization for any aeroallergen increased for each 12-month increment in age (OR ≥ 1.21, P < 0.01), with the largest effect observed for dust mite (OR = 1.56, P < 0.001). A steeper age-related rise in IgE antibody titre to dust mite, but no other allergen was associated with more severe disease. Despite this, sensitization to cat was more strongly associated with wheeze (OR = 4.5, P < 0.01), and linked to Fel d 1 and Fel d 4, but not Fel d 2. Comparison of cat allergic children with AD to those without, revealed higher IgE levels to Fel d 2 and Fel d 4 (P < 0.05), but not Fel d 1.
Differences in sensitization to cat and dust mite among young children with AD may aid in identifying those at increased risk for disease progression and development of asthma. Early sensitization to cat and risk for wheeze among children with AD may be linked to an increased risk for sensitization to a broader spectrum of allergen components from early life. Collectively, our findings argue for early intervention strategies designed to mitigate skin inflammation in children with AD.
... Until recently, most allergy guidelines recommended strict avoidance of all forms and amounts of allergen for the diet of allergic children. This was partly on the basis of safety and also on the belief that that accidental allergen exposure may delay the onset of tolerance [21]. It is now widely held that this is unlikely to be the case, with a series of publication demonstrating that most apallergy.org ...
This article reviews the recent advances in the diagnosis and management of IgE mediated food allergy in children. It will encompass the emerging technology of component testing; moves to standardization of the allergy food challenge; permissive diets which allow for inclusion of extensively heated food allergens with allergen avoidance; and strategies for accelerating tolerance and food desensitization including the use of adjuvants for specific tolerance induction.
Palacos cement contains peanut oil. The manufacturer's instruction states that its use is contraindicated in patients allergic to peanuts. Awareness of this fact by orthopaedic surgeons was evaluated by postal questionnaire, which showed that 73% of those responding were not aware. However, on the basis of the available evidence in the literature, the clinical relevance of the manufacturer's advice appears dubious.
Association Between Allergic Diseases and Food Allergens Based on Skin Prick Test in Bushehr Province
S. keshvari 1, A. Shirkani 2, R. Tahmasebi 3, AM. Omrani 4,
Sh. Farrokhi 1,2*
1 The Persian Gulf Nuclear Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
2 Department of Immunology, Asthma and Allergy, The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
3 Department of Biostatistics, School of Public Health, Bushehr University of Medical Sciences, Bushehr, Iran 4 Department of Pediatrics, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
(Received 13 Sep, 2015 Accepted 26 Dec, 2015)
Abstract
Background: The Frequency of allergic diseases is growing in recent years. Identification of frequency of food allergens in different areas play an important role in diagnosis and treatment of these diseases. The aim of this study was to determine frequency and association of common food allergens in patients with allergic diseases based on Skin Prick Test in Bushehr province.
Material and Methods: In this descriptive cross-sectional study, 1100 patients were enrolled with allergic diseases which had a sensitivity to at least one allergen. This test was carried out with 21 common food allergens extract.
Results: In all patients, association between the severity of the reaction prick allergy test and severity of allergic diseases with shrimp, cow's Milk and peanuts were (P= 0.01), (P= 0.02) and (P=0.04) respectively. In this study, the frequency of allergic rhinitis, asthma, chronic and acute urticaris and atopic eczema were 54.2%, 23%, 12.4%, 4.1% and 12%, respectively. While the the most common food allergens were peanuts (46.6%), egg yolk (43.1%) and shrimp (42%) respectively.
Conclusion: This study indicated that food allergens such as shrimp, cow's Milk and peanuts have a greater role in severity of allergic diseases and this food allergens showed the highest frequency in patients.
Key words: Allergic diseases, Asthma, Food allergens, Skin prick test
Cite this article as: keshvari S, Shirkani A, Tahmasebi R, Omrani AM, Farrokhi Sh. Association Between Allergic Diseases and Food Allergens
©Iran South Med J. All rights reserved
Background:
Atopic dermatitis (AD) is an inflammatory disease of the skin, which is characterised by a chronic relapsing course.
Aim:
The aim of the study was to assign the prevalence of clinically active food allergies among a group of children between 3 months and 7 years of age, with AD.
Methods:
Eighty-eight children with AD were screened for specific IgE antibodies to food proteins. All patients with AD and specific IgE antibodies to food proteins were subjected to Oral Food Challenges (OFCs) with the relevant foods.
Results:
Food-sensitised patients with moderate levels of sIgE had clinically active food allergy to milk (39.28%) and egg (42.34%) on the basis of positive OFCs. High IgE and eosinophilia had a prevalence of almost 80% and 25%, regardless of concomitant food sensitisation and disease severity.
Conclusions:
In this study, clinically active food allergies were recognised in 26.13% of children with AD. Nevertheless, no association was confirmed between food sensitisation and AD severity. High IgE and peripheral eosinophilia have not been found more prevalent among children with severe AD nor among children with food sensitisation. Infants and younger children with AD should be screened for an underlying food allergy, regardless of disease severity.
Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another. Finally, because patients frequently confuse nonallergic food reactions, such as food intolerance, with food allergies, there is an unfounded belief among the public that food allergy prevalence is higher than it truly is. In response to these concerns, the National Institute of Allergy and Infectious Diseases, working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These Guidelines are intended for use by a wide variety of health care professionals, including family practice physicians, clinical specialists, and nurse practitioners. The Guidelines include a consensus definition for food allergy, discuss comorbid conditions often associated with food allergy, and focus on both IgE-mediated and non-IgE-mediated reactions to food. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. These Guidelines provide 43 concise clinical recommendations and additional guidance on points of current controversy in patient management. They also identify gaps in the current scientific knowledge to be addressed through future research.
Background:
Nasal polyposis is a common nasal mass with unknown etiology. It has been assumed that allergy predisposes to polyp formation. Our objective was to compare the prevalence of food sensitization in medically resistant chronic rhinosinusitis patients with or without nasal polyposis.
Methods:
One hundred and fifty-five patients who fulfilled the inclusion and exclusion criteria were incorporated into this study. The results of their total serum IgE and food-specific IgE levels were examined.
Results:
The average age was 33 years (± 13) with 96 males and 59 females. The percentage of patients in each group that had a positive result for at least one tested allergen was 84% (88 patients in the sinusitis without polyposis group and 42 patients in nasal polyposis group). Patients without nasal polyposis reacted to an average of 4.6 foodstuffs, whereas patients with nasal polyposis reacted to 4.1. Egg white, sheefish and cherry were the most common type of sensitized food. There were no significant differences in the prevalence, type, number of positive food allergens and class level between the two groups.
Conclusions:
Food sensitization is common in medically resistant chronic rhinosinusitis. Since food sensitization prevalence, type and severity do not significantly differ between the two groups studied, food atopy is unlikely to be a major factor in nasal polyposis pathogenesis.
Background: The prevalence of food allergy is different in different parts of the world. Identification of the most common food allergens is a priority in any population to provide effective preventive and curative measures.
The population of the world is expected to increase by 2.5 billion people in the next 25 years. Food requirements for this growing population are expected to double by the year 2025. In order to feed this growing population, crop yield will have to be increased and some of the increase in yield will be due to genetic engineering of foods. The current allergy assessment process identifies the potential risks associated with the introduced protein as well as the overall allergenic risks associated with a transformed food crop. Additions of new methods to the allergy risk assessment that utilizes sound risk assessment principles will continue to provide assurances of the safety of these products.
Background:
Hen's egg (HE) allergy develops during infancy. We investigated tolerance acquisition in Japanese children allergic to HE aging <6 years.
Methods:
In this retrospective study, 226 children born in 2005 with a history of immediate-type HE allergy underwent an oral food challenge (OFC). Tolerance was defined as no reaction to an OFC with half of whole heated HE or accidental HE consumption at home. Participants were divided into three groups based on age at tolerance acquisition: group I (<3 years) (n = 66), group II (3-6 years) (n = 98), and group III (prolonged allergic groups) (n = 62).
Results:
Tolerance acquisition occurred in 30% (66/226) by 3 years of age, 59% (133/226) by 5 years of age, and 73% (164/226) at 6 years of age. At 3 years, incidences of allergy-related complications (bronchial asthma, p = 0.02; atopic dermatitis, p = 0.04) were higher in the group III than in the group I. Anaphylaxis to any food occurred more frequently in the group III than in the group I (p = 0.03); anaphylaxis to HE was more common in the group III (p = 0.04). Egg white (EW)- and ovomucoid (OM)-specific immunoglobulin E (IgE) levels were higher in the group III than in the group I (p < 0.05).
Conclusions:
The group III experienced HE-related anaphylaxis and complications more frequently and exhibited sustained, high EW- and OM-specific IgE levels.
IgE antibodies formed against an allergen may react with similar proteins originated from a completely different source. Allergens causing cross reactions are responsible for most of the food allergies in the adult population. Exercise-induced allergy following food intake is a rare condition. Many foods consumed 24 hours prior to exercise may lead to exercise-induced anaph-ylaxis. Nevertheless, consuming such food without exercise does not lead to any symptom. Many foods like grains, sea products, fruits and vegetables are related to exercise-induced anaphylaxis. Cross-reactions between fungal spores and cultivated mushroom were reported in a few cases. In this paper, we presented a case with anaphylaxis that developed during exercise following ingestion of cultivated mushrooom in a patient sensitive to fungal spores and mushroom; the case was diagnosed with skin prick test.
The term "allergic march" refers to the history of different atopic manifestations throughout the patient's life. Children with food allergy (FA) are more predisposed to the development of other allergic diseases such as atopic dermatitis (AD), asthma and allergic rhinitis. AlD and FA coexist to a greater extent in patients with early signs of AD, aggressive and persistent symptoms. Meanwhile, FA is a precipitating factor to AlD especially in patients with IgE-mediated FA. Correlation to delayed manifestations of FA may also be found. Epithelial barrier dysfunction, mainly attributed to mutations in the filaggrin gene, has been described as a possible trigger for allergen sensitization by increasing skin permeability. This study describes general characteristics of DA and current research evidence regarding the role of FA in the DA development, management and prevention strategies. Also, the utility of diagnostic tests, treatment and prevention in children with DA and FA are discussed. The restoration of impaired skin barrier to prevent sensitization to antigens may have an important role to prevent the development of allergic diseases, especially respiratory diseases.
Reliable predictors of tolerance to cooked egg in an egg allergic population are not established. We investigated the usefulness of the skin prick test to cooked egg in children with egg allergy.
Cow's milk allergy (CMA) is an immune-based disease that has become an increasing problem. The diagnosis and management of CMA varies from one clinical setting to another and represents a challenge in pediatric practice. In addition, because nonallergic food reactions can be confused with CMA symptoms, there is an overdiagnosis of the disease. In response to these situations, pediatric specialties from recognized institutions throughout Latin America decided to develop a clinical guideline for diagnosis and management of cow's milk allergy. These guidelines include definitions, epidemiology, pathophysiology overview, clinical and evidencebased recommendations for the diagnosis and treatment of CMA. They also include prevention and prognosis sections and identify gaps in the current knowledge to be addressed through future research.
The prevalence of food allergy is rising for unclear reasons, with prevalence estimates in the developed world approaching 10%. Knowledge regarding the natural course of food allergies is important because it can aid the clinician in diagnosing food allergies and in determining when to consider evaluation for food allergy resolution. Many food allergies with onset in early childhood are outgrown later in childhood, although a minority of food allergy persists into adolescence and even adulthood. More research is needed to improve food allergy diagnosis, treatment, and prevention.
Copyright © 2015 Elsevier Inc. All rights reserved.
Background:
Allergy to hen's egg and meat contributes significantly to the manifestations of food allergy all over the world.
Objectives:
This study was performed to assess the presence of hen's egg and meat specific IgE antibodies among patients investigated for various allergic disorders.
Methods:
This is a retrospective study performed at King Khalid University Hosptial, Riyadh. Data from 421 patients with allergic disorders screened for food specific IgE antibodies between January 2009 and March 2011 were analyzed. Sixty (14.25%) patients including 42 males and 18 females with the mean age (sd) of 7.5 (7.4) years were found to have specific IgE antibodies against hen's egg and chicken meat. There were 56 (93.3%) children and 4 (6.7%) adult patients. Specific IgE antibodies were measured by radioallergosorbent test (RAST) using Pharmacia ImmunoCAP 250 analyzer.
Results:
Atopic dermatitis was the most common (55%) clinical condition. Out of the total 60 patients harboring hen's egg and chicken meat specific IgE antibodies high levels of egg white, yolk and chicken meat specific IgEs were detected in 58 (96.6%), 37 (61.6%) and 6 (10%) patients respectively. Both the egg white and yolk antibodies coexisted in 35 (58.3%) patients.
Conclusion:
Sensitization against hen's egg was higher compared to the chicken meat. Egg white sensitization higher than the egg yolk particularly in Saudi children with food related allergic disorders.
Las características clínicas y de laboratorio de la atopia cutánea pueden relacionarse con la patogenia de las lesiones. La terapéutica de la dermatitis atópica está orientada especialmente a controlar los síntomas. Un manejo orientado a tratar al paciente según sea el mecanismo predominante de la erupción puede lograr mantener la enfermedad inactiva por largos periodos. (1, 2) Son diversas las conductas terapéuticas que pueden emplearse para el tratamiento de la atopia cutánea. En el manejo de la afección se emplean medidas 2 2 generales, técnicas del cuidado de la piel, uso de medidas de prevención y terapias tópicas y / o sistémicas que permitan aminorar las manifestaciones clínicas. (3) Dado que los factores activadores de la enfermedad son diversos, se debe adoptar medidas generales además del empleo de terapia tópica y sistémica según sea la forma de expresión de la dermatitis, así como los factores causales que estén actuando en la etapa de la enfermedad. Las medidas específicas comprenden el uso de emolientes, esteroides tópicos o inhibidores de la calcineurina, fototerapia, inmunosupresores además de otras terapias. Las nuevas posibilidades terapéuticas son las sustancias antiinflamatorias tópicas, agonistas selectivos de de los receptores de glucocorticoides, probióticos, interferón gamma, inhibidores del factor de necrosis tumoral (TNF),inhibición de las células T o B, inhibición de la unión de la IgE entre muchas otras posibilidades. (4 -6) I.-MEDIDAS GENERALES.
OBJECTIVE: To review the main standardization protocols of the open oral food challenge applied to children with suspicion of cow's milk allergy mediated by immunoglobulin E. DATA SOURCE: Medline, Lilacs and SciELO databases were searched for articles published in the last ten years using the following descriptors: "food hypersensitivity", "cow's milk", "cow's milk allergy", "oral food challenge", "children" and "diagnosis". DATA SYNTHESIS: The oral food challenge test is the most reliable method to establish or exclude the diagnosis of food allergy and the open challenge can be the first option when only objective reactions are expected. All medications and equipment needed for emergency treatment should be available. Before being submitted to the test, the patient must follow a diet excluding the suspected food and discontinue the use of medications that may interfere with the results of the test. Usually, it is performed using 8-10g of powdered milk or 100mL of fluid milk, offered in progressive volumes at intervals of ten to 60 minutes. Despite the rigour of the method, there are still situations difficult to interpret. Therefore, well-trained doctors must administer the test, being cautious about their clinical judgment. CONCLUSIONS: Although there are some restrictions in the application of the oral food challenge test with cow's milk in the clinical practice, its implementation in health services could reduce false positive diagnoses of allergies.
Background
Immunoglobulin E (IgE)-mediated food allergy, such as egg white allergy, is common in young children (<3 years old), but not all young children sensitive to egg white present with allergic symptoms. This study investigated the relationship between sensitization to egg white component allergens and clinical manifestations of allergic diseases in young children.
Methods
From March to December 2010, 2256 children with physician-diagnosed allergic diseases were tested for serum levels of egg white, ovalbumin, and ovomucoid-specific IgE in the Pediatric Allergy and Asthma Center of Chang Gung Memorial Hospital. Serum was analyzed for specific IgE antibodies to egg white, ovalbumin, and ovomucoid by ImmunoCAP (Phadia, Uppsala, Sweden). Allergen-specific IgE levels ≥0.35 kUA/L were defined as positive.
Results
There was a significantly higher sensitization rate to egg white and its components in children aged 2–4 years old. The sensitization rate to egg white, ovalbumin, and ovomucoid in this age group was 53.5%, 48.3%, and 37.2%, respectively, and the trend of the sensitization decreased with age (p < 0.001). After adjusting for age, sensitization to egg white and ovalbumin was associated with children with dermatitis [egg white: odds ratio (OR) = 1.28, 95% confidence intervals (CI) = 1.03–1.58, p < 0.05; ovalbumin: OR = 1.30, 95% CI = 1.04–1.62, p < 0.05]. Children with ovomucoid sensitization had no statistically significant risk among different groups in the current study.
Conclusion
Children aged 2–4 years old have higher sensitivity to egg white, ovalbumin, and ovomucoid. Children with egg white and ovalbumin sensitization have a higher risk for atopic dermatitis, and ovalbumin has a more important contribution. Furthermore, we suggested that in children with atopic dermatitis, if they are aged 2–4 years old and are having egg white and ovalbumin sensitization, avoiding eating raw or slightly heated eggs might have a beneficial effect.
Peanut allergy is often severe, potentially fatal, usually persistent, and appears to have increased in prevalence. An accurate diagnosis is essential because there is a significant burden on quality of life. The tools available for diagnosis include the medical history, skin prick test (SPT), determination of serum peanut-specific IgE antibodies (PN-IgE), and medically supervised oral food challenges. Numerous studies, almost exclusively in children, have correlated clinical outcomes against SPTs and PN-IgE with informative results. The diagnostic utility of SPT and PN-IgE is maximized by considering the degree of positive result and consideration of the medical history (a priori estimation of risk). Emerging tests that evaluate IgE binding to specific proteins in peanut (component testing) add important additional diagnostic information in specific settings. Studies are increasingly focused on how the results of tests considered in combination (or performed serially) may increase diagnostic accuracy. Here, we review the utility of currently available tests and provide suggestions on how to best use them to accurately predict peanut allergy. Still, the physician-supervised oral food challenge remains the most definitive test available.
Atopic dermatitis and contact dermatitis are common dermatologic conditions that may be encountered in the emergency department (ED). Atopic dermatitis is a chronic inflammatory skin disease with an undulating course characterized by remissions and exacerbations. Patients may present to the ED because of chronic disease or acute flares that fail to respond to routine treatments or because of secondary infections. The article reviews the ED management of exacerbations of atopic dermatitis as well as various common skin infections associated with this disorder, including specifically Staphylococcus aureus and eczema herpeticum. Although contact dermatitis can be chronic, patients usually present with acute symptoms. The article discusses the diagnosis and ED management of common types of contact dermatitis, including allergic and irritant chronic dermatitis, photodermatitis, and contact urticaria.
La dermatitis atópica es la dermatosis inflamatoria más frecuente en los niños de los países desarrollados. Existe una clara predisposición genética a padecer laenfermedad, pero su causa exacta no esconocida. Si bien el paciente con unadermatitis atópica puede desarrollar a lo largode su vida hipersensibilidad a un número variable de alergenos ambientales y alimentarios, no está demostrado que estehecho tenga relación alguna con la evolucióndel eccema. Raramente, las investigaciones alergológicas exhaustivas tendrán consecuencias terapéuticas en la dermatitis atópica leve o moderada. El tratamiento adecuado, que no es curativo, puede reducir o eliminar las lesiones del brote en la mayoríade los pacientes.
Patienten mit einer Allergie gegen Birkenpollen sind einem erhöhten Risiko ausgesetzt, bei Verzehr sojahaltiger Nahrungsmittel schwerwiegende anaphylaktische Reaktionen zu erleiden. Grund dafür ist die Strukturhomologie eines Majorallergens des Birkenpollens und eines Strukturproteins im Soja (Gly m 4). Wir berichten über einen 65-jährigen, nicht therapierten Birkenpollenallergiker, der nach Genuss eines sojahaltigen Getränks eine systemische allergische Reaktion erlitt. Die Diagnose konnte mit Hilfe von In-vitro- und Hauttestungen gestellt werden. Birkenpollenallergiker sollten sojahaltige Nahrungsmittel unbedingt meiden.
Immunologic reactions to food, primarily in the form of IgE-mediated hypersensitivity, can result in asthma. Although the exact prevalence is unknown, approximately 6% to 8% of asthmatic children experience food-induced symptoms. Fatal and near-fatal allergic reactions to foods occur primarily in allergic-asthmatics. Food-induced allergic reactions can also increase nonspecific airway reactivity in a subset of allergic asthmatics, potentially contributing to symptoms of chronic asthma. The diagnosis of food-induced asthma and the subsequent identification and elimination of causative foods requires a careful history, laboratory evaluation and, in many cases, confirmation by challenge testing.
Atopic dermatitis is a typical chronic inflammatory skin disease that usually occurs in individuals with a personal or family history of atopy. Children with atopic dermatitis frequently present IgE-mediated food sensitization, the most commonly involved foods being egg and cow’s milk. However, controversy currently surrounds whether food allergy is an etiological factor in atopic dermatitis or whether it is simply an associated factor, accompanying this disease as one more expression of the patient’s atopic predisposition. Approximately 40 % of neonates and small children with moderate-to-severe atopic dermatitis present food allergy confirmed by double-blind provocation tests but this allergy does not seem to be the cause of dermatitis since in many cases onset occurs before the food responsible for allergic sensitization is introduced into the newborn’s diet
Studies of double-blind provocation tests with food in patients with atopic dermatitis demonstrate mainly immediate reactions compatible with an IgE-mediated allergy. These reactions occur between 5 minutes and 2 hours and present mainly cutaneous symptoms (pruritus, erythema, morbilliform exanthema, wheals) and to a lesser extent, digestive manifestations (nausea, vomiting, abdominal pain, diarrhea), as well as respiratory symptoms (wheezing, nasal congestion, sneezing, coughing). However, these reactions do not indicate the development of dermatitis
Some authors believe that responses to the food in provocation tests may also be delayed, appearing mainly in the following 48 hours, and clinically manifested as exacerbation of dermatitis. However, delayed symptoms are difficult to diagnose and attributing these symptoms to a particular foodstuff may not be possible
Delayed reactions have been attributed to a non-IgE-mediated immunological mechanism and patch tests with food have been proposed for their diagnosis. In our experience and in that of other authors, the results of patch tests with cow’s milk do not seem very specific and could be due, at least in part, to the irritant effect of these patches on the reactive skin of children with atopic dermatitis
The involvement of foods in atopic dermatitis will always be difficult to demonstrate given that an exclusion diet is not usually required for its resolution. Food is just one among several possible exacerbating factors and consequently identification of its precise role in the course of the disease is difficult. Further double-blind prospective studies are required to demonstrate the effectiveness of exclusion diets in the treatment of atopic dermatitis
Apart from the controversy surrounding the etiological role of foods, the most important point in atopic dermatitis is to understand that the child is atopic, that is, predisposed to developing sensitivity to environmental allergens; in the first few years of life to foods and subsequently to aeroallergens. Consequently, possible allergic sensitization to foods should be evaluated in children with atopic dermatitis to avoid allergic reactions and to prevent the possible development of allergic respiratory disease later in life
The recent increase in the number of clinical trials demonstrates progress in the treatment of food allergies and confirms the value of oral immunotherapy. This article aims to review recent advances in understanding the subject.
But. – Le but de cette étude transversale était de décrire l'évolution des IgE sériques totales et du Rast F×5® sur la base d'un dosage systématique chez les enfants consultant pour la première fois en allergie alimentaire.
A shift in focus from disease therapy toward disease prevention is occurring in many medical specialties, including dermatology. There are no generally accepted strategies for the prevention of atopic dermatitis. Most research has focused on allergen avoidance and has not produced consistently effective interventions. Immune cell modulation and skin barrier protection are examples of new approaches that hold promise for preventing, or modifying the course of, this common disease.
Establishing the safety of foods derived from genetically modified crops requires a multidisplinary approach using methods adapted from the biochemical, nutritional, toxicological and immunological sciences. The core principle of the process has been articulated as substantial equivalence, which is a comparative evaluation. Concerning potential allergens, it is essential to evaluate newly introduced proteins and when necessary, to evaluate potential changes in endogenous allergens. The incidence of food allergies appears to be on the rise, particularly in developed countries. Since no cure is available for those afflicted with food allergy, disease management is achieved by avoidance of the offending food. As a result, significant weight in the assessment is given to the need for prevention, which in the context of safety assessment, means reducing the likelihood of transferring offending allergens from one food source to another. Genetic engineering of food crops should have little practical consequence for the occurrence, frequency and natural history of food allergy if this evaluation is robust. Essential aspects of the assessment for allergenicity of genetically modified crops are discussed in this article.
Suspected food allergy is commonly encountered. Diagnosis requires skin testing, food-specific immunoglobulin E (IgE), and ultimately a food challenge. Previous studies determined food-specific IgE threshold levels predicting greater than 95% of the patients with a positive food challenge. However, if the food-specific IgE level is less than the threshold, a food challenge is required. Oral food challenges are time consuming, and they subject patients to allergic reactions. The aim of this study was to develop a food challenge risk index (FCRI) to predict positive food challenges. Fifty-five open food challenges were reviewed retrospectively. Skin prick tests, food-specific IgE levels, and time since last reaction were employed to develop a formula. The FCRI = [3 × skin prick test wheal (mm) + 10 × food-specific IgE level - time since last reaction (months)]. The FCRI value was compared to the food challenge results. Threshold levels chosen were 15, 20, and 25 for milk, egg, and peanut, respectively. Comparison of the FCRI to the actual food challenges across all groups revealed a sensitivity of 0.842 and a specificity of 0.861. We have derived a simple and accurate formula that uses readily available clinical data to predict positive food challenges. The FCRI may be used in a prospective fashion to reduce number of food challenges necessary for diagnosis of milk, egg, and peanut allergies in children.
The potential for morbidity and mortality in an ill child with primary immune deficiency (PID) is extremely high. It is estimated that there are more than 500,000 cases of PID in the United States and an incidence of up to 1 in 2000 live births. Although the increased outpatient care of these patients necessitates a standardized approach to maximize emergent treatment, the diversity of these rare diseases and their potential infectious, autoimmune, and malignant sequelae complicate treatment guidelines. We present an overview of the clinical characteristics of primary immune deficiencies and then describe unique aspects of emergent care for these complex patients. Conservative management with empiric antimicrobials, early and aggressive surgical debridement of abscesses, and admission at a tertiary pediatric care center are often indicated. Familiarity with the clinical manifestations of PID and collaboration with a pediatric immunologist are prerequisites for optimal emergent care of these complex patients.
HIV-infected children and youth will continue to be seen in emergency settings. Clinical recognition of patients possibly infected with HIV and the use of rapid HIV testing to identify them are of paramount importance. Effective management of patients known to be infected with HIV requires an understanding of appropriate infection control procedures, an appreciation of risk for opportunistic processes based upon patients' CD4+ T-cell counts, and access to consultation with expert HIV care providers. Finally, effectiveness of and indications for postexposure prophylaxis after occupational and nonoccupational exposures must be appreciated by emergency care providers.
Introduction
Food allergens play an important role at execerbation and supporting of skin's disorders in children with atopic dermatitits. Atopic patch tests seems to be usefull in diagnosis and therapy.
Aim
The aim of study was to assess atopic patch tests with food allergens in children suferring from atopic dermatitits and coexisting food allergy.
Material and methods
80 children with atopic dermatitis aged 6 months–18 years were quallifiled to the study. We used questionnaires, specific IgE assay (UniCAP 100), atopy patch tests with food allergens (Finn Chambers of Chemotechnique Diagnostics), open and double blind placebo food challenges.
Results
46 children (57.5%) have positive results of food allergy in questionnaires. Positive SPT with food allergens were found in 25 children (31.3%). Specific IgE were found in 36 children (45%). Positive results of atopy patch tests were observed with allergens of: cow's milk, eggs, wheat in 18 children (22.5%). Food challenges were done in 55 (68.7%) children suspected of food allergy. In 20 cases (25%) results were positive. The specificity for the APT for milk −87.5%, for egg −91%. The late phase reaction in food challenges was associated with positive results of atopy patch tests (p<0.001).
Conclusions
Food allergy was confirmed in 25% children with atopic dermatititis. Atopy patch tests with food allergens may be helpfull in diagnosis food allergy in children suffering from atopic dermatititis.
Food allergy plays a pathogenetic role in subset of patient with atopic dermatitis, as proven over the past decade by laboratory and clinical investigations. Likely 40% of infants and young children may present with food allergy, whatever the severity of atopic dermatitis. The identification of the subset of patient with relevant food allergy requires a thorough a clinical history, the appropriate laboratory tests, food allergy being proven in all cases by elimination diets followed by provocation tests. Atopic dermatitis may be cured or largely improved by elimination diets, but the latter need a peculiar education of patient and physicians because the common causal foods involved (egg, milk, wheat, soil, peanut) are ubiquitous in industrial foods and since elimination diets are at risk of nutritional imbalances. Most food allergies resolve following early childhood and atopic dermatitis in older children and adults is largely less related to food allergy.
Asthma remains one of the leading chronic diseases in children and one of the leading reasons for emergency department visits. As our understanding of the underlying pathophysiology continues to improve, so does our armamentarium for the management of acute exacerbations. Combination therapy with multiple agents is showing promise especially for the child with a severe attack. In addition, there seems to be significant benefit in the implementation of inhaled corticosteroids at the time of emergency department discharge.
The prevalence of food allergy is different in various nations. The identification of the most common food allergens is a priority in any population to provide effective preventive and curative measures. The aim of this study is to determine the most common food allergens in Iranian children. One hundred and ninety children with skin, respiratory or gastrointestinal symptoms, which were thought to be due to food allergy, were studied. Total serum IgE and eosinophil count tests were measured in all patients. Allergy to 25 food allergens was determined according to the patient's history, skin prick tests, radioallergosorbent test (RAST) and open food challenge tests. The most common food allergens were cow's milk, tomato, egg white, egg yolk, beef and almond, in decreasing order of frequency. The order of common food allergens in this study was different from other reports that might be due to the different food habits and/or ethnic diversities. Acta Medica Iranica, 41(4): 40-45; 2003
Background
There was a lack of convincing evidence supporting the influence of allergy on the adenotonsillar hypertrophy (ATH). We investigated the presence of specific IgE (sIgE) in the serum and adenotonsillar tissues in children with ATH. MethodsA Pharmacia ImmunoCAP system was used to test sIgE against 31 allergens in the serum in 83 children with ATH before adenotonsillectomy. sIgE against 15 representative allergens were detected in adenotonsillar tissues from 20 of those children. ResultsA total of 51 (61.45%) children had positive serum sIgE. 20 children with ATH had positive sIgE to more than two allergens at both tonsils and adenoids, although half of them were serum sIgE negative. The percentage of subjects with positive sIgE expression in adenoids and tonsils was 50.0% and 42.9%, respectively, among the subjects with positive serum sIgE expression. Of subjects with negative serum sIgE expression, local sIgE was detected in 36.0% of adenoids and 43.8% of tonsils, respectively. The rate of sIgE presence in local tissue (adenoids or tonsils) was significantly higher than that seen in the serum. Conclusion
This study provided evidence that there was an important role for allergic inflammation in the ATH. The inconsistency in sIgE expression between adenotonsillar and serum suggests a role of local atopy in childhood ATH.
Background:
Specific IgE (sIgE) may be used for the diagnosis of cow's milk allergy (CMA) and as a guide to perform food challenge tests in patients with CMA. The effect of genetic variants on the prognosis of food allergy is largely unknown.
Objective:
To examine the performance of sIgE analysis and the utility of the genetic variants of CD14, STAT6, IL13, IL10, SPINK5, and TSLP in predicting the clinical course in children with CMA.
Methods:
Serum sIgE levels of 94 children who underwent open food challenges and 54 children with anaphylaxis due to cow's milk (CM) were retrospectively analyzed between January 2002 and May 2009. The genetic polymorphisms were determined in 72 children.
Results:
A total of 148 children were followed up for a median of 3.5 years, and 42 of the 94 challenge results were positive. The probability curves with 95% decision points were 2.8 kU/L for younger than 1 year, 11.1 for younger than 2 years, 11.7 for younger than 4 years, and 13.7 for younger than 6 years. Sixty-six children outgrew CMA during follow-up. Children with initial an CM sIgE level less than 6 kU/L outgrew CMA earlier than children with an initial CM sIgE level of 6 kU/L or higher (P < .001). The age of tolerance development for CM was significantly higher in children with the GG genotype at rs324015 of the STAT6 gene compared with those with the AA+AG genotype (2 years [range, 1.5-3.9 years] vs 1.2 years [range, 1.0-2.2 years]) (P = .02).
Conclusion:
The decision points of sIgE obtained in different age groups may help to determine the likelihood of clinical reactivity more precisely. The results suggest that sIgE levels and STAT6 gene variants may be important determinants to predict longer persistence of CMA.
There is a paucity of data on the prevalence, natural history and management of food allergy in most of the populous Asian countries, including China.
To determine the point prevalence of self-reported food allergy in Chinese children and teenagers in Hong Kong.
A cross-sectional population-based questionnaire survey targeted at children aged 0-14y was conducted by use of face-to-face interviews and self-administered questionnaires. Information was obtained from the parent as proxy respondent for children aged 10 and below and from both parent and child for children aged 11 to 14. Households were drawn from the Register of Quarters maintained by the Census and Statistics Department by systematic replicated sampling.
A total of 7,393 land-based noninstitutionalized children aged 14 and below in Hong Kong were recruited, excluding those with non-Cantonese speaking parents and those living in non-built-up areas. The sample was representative of the 884,300 children in the target population. 352 reported having adverse reactions to foods and the estimated prevalence was 4.8% (95% CI 4.3-5.3%). The estimated prevalence of peanut allergy was 0.3-0.5% (95%CI 0.1 to 0.7%). In terms of relative frequency, shellfish, which was the top allergen, accounted for more than a third of all reactions. The second most common was hen's egg (14.5%), the third cow's milk and dairy products (10.8%) and co-fourth were peanut and combined fruits (8.5%). Out of 352 subjects who reported adverse reactions, 127 (36.1%) had urticaria and or angioedema and 79 (22.4%) had eczema exacerbations. Combined gastrointestinal symptoms accounted for 20.8 % (diarrhoea 12.8%; vomiting 5.4%; abdominal pain 2.6%). Fifty-five (15.6%) had anaphylaxis, and 7 (2%) had respiratory difficulties.
This survey has provided the first population based epidemiological information related to food allergy amongst children and younger teenagers in Hong Kong. The prevalence of food allergy, including that from more common subtypes, like shellfish and peanut, is highly comparable to that of most of the developed nations.
Objective:
There are few studies on the natural history of milk allergy. Most are single-site and not longitudinal, and these have not identified a means for early prediction of outcomes.
Methods:
Children aged 3 to 15 months were enrolled in an observational study with either (1) a convincing history of egg allergy, milk allergy, or both with a positive skin prick test (SPT) response to the trigger food and/or (2) moderate-to-severe atopic dermatitis (AD) and a positive SPT response to milk or egg. Children enrolled with a clinical history of milk allergy were followed longitudinally, and resolution was established by means of successful ingestion.
Results:
The cohort consists of 293 children, of whom 244 were given a diagnosis of milk allergy at baseline. Milk allergy has resolved in 154 (52.6%) subjects at a median age of 63 months and a median age at last follow-up of 66 months. Baseline characteristics that were most predictive of resolution included milk-specific IgE level, milk SPT wheal size, and AD severity (all P < .001). Baseline milk-specific IgG4 level and milk IgE/IgG4 ratio were not predictive of resolution and neither was expression of cytokine-inducible SH2-containing protein, forkhead box protein 3, GATA3, IL-10, IL-4, IFN-γ, or T-bet by using real-time PCR in CD25-selected, casein-stimulated mononuclear cells. A calculator to estimate resolution probabilities using baseline milk IgE level, SPT response, and AD severity was devised for use in the clinical setting.
Conclusions:
In this cohort of infants with milk allergy, approximately one half had resolved over 66 months of follow-up. Baseline milk-specific IgE level, SPT wheal size, and AD severity were all important predictors of the likelihood of resolution.
Atopic dermatitis (AD) is one of the first manifestations of the atopic march. The natural history of food allergies (FA) is closely related to AD. Sensitivity to food is demonstrated with cutaneous tests (prick-tests and atopy patch-tests) or the presence of IgE specific to food. A true allergy to a foodstuff is revealed by oral provocation tests (OPT) or by improvement during an avoidance diet. Ingestion of the food allergen during OPT can provoke an onset of eczema, an immediate reaction (urticaria, oedema) or involve other target organs (digestive disorders, rhinitis, asthma or anaphylactic shock). Seven allergens are responsible for around 90 p. 100 of FA: milk, eggs, wheat, peanuts, nuts, soy and fish. The fundamental knowledge acquired demonstrates the implication of food allergens in the physiopathogenesis of AD. The assessment of the efficacy of avoidance diets is difficult to demonstrate in standardised double-blind studies. Their efficacy is demonstrated compared with the natural history of AD. A diagnostic algorythm of FA during AD is proposed. An avoidance diet can be prescribed on 3 levels: primary, secondary and tertiary prevention. Diagnostic dietetics are aimed at initiating a hypoallergenic diet over a short period of 15 to 21 days when AD is severe and does not permit an allergy assessment. This diet is followed by an allergy assessment and OPT to determine the foodstuff responsible. Therapeutic dietetics consists in initiating an avoidance diet based on the results of the allergy assessment: positive predictive value of specific IgE, positivity of oral provocation tests or the re-introduction of the foodstuff for one week. Preventive dietetics is aimed at preventing the onset of AD: a consensus has been established by the American and European Academies of Paediatrics. In conclusion, present knowledge demonstrates that FA is a triggering factor for AD and that the avoidance diets based on allergy assessments are an essential tool in the treatment of AD. Understanding the triggering mechanisms of oral tolerance will permit the development of strategies for the prevention and cure of food allergies.
The prevalence of atopic dermatitis (AD) in children has considerably increased in industrialised countries over the past 20-30 years. Determination of the interest of supplementary examinations, notably allergological explorations, is fundamental for all the practitioners who manage children suffering from the disease.Allergological tests: when and for who?Children suffering from eczema and describing concomitant manifestations such as urticaria, an oral syndrome or asthma should benefit from allergological tests. The latter are conducted as markers of the progression in the infant (aged under 24 months) presenting with atopic eczema without any concomitant manifestations. Such tests are aimed at defining the prognosis of AD and specifying the risk of progression towards an asthmatic syndrome. Allergological tests are conducted in the case of severe AD of early onset and in the presence of a family history of atopy.Allergological tests: which?They explore immediate and delayed hypersensitivity. They include determination of IgE-dependent sensitivity using cutaneous tests or specific IgE measurements with validated methods. Allergy to food concerns very young children of around 2 years old. The diagnosis of such allergies is based on the efficacy of the eviction and oral provocation test, when there is discordance between the clinical history and the results of the determination of a specific IgE-related sensitivity. Prick-tests are performed to search for contact hypersensitivity, more frequent in older children. They are performed for contact allergens, aero-allergens and foodstuff and are supplemented by interrogation data. The pertinence of such tests remains to be determined.Allergological tests: what for?An allergic factor enhances AD in one child out of two. Evictions adapted to the results of the allergological tests always improve the status of the children. They may even modify the natural history of the disease.
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