ABSTRACT
El síndrome de enterocolitis inducido por proteínas de los alimentos (FPIES, por su sigla en inglés) es una reacción alérgica no mediada por inmunoglobulina E (IgE) con síntomas gastrointestinales, como vómitos y diarrea. El diagnóstico se basa en criterios clínicos y en una prueba de provocación para confirmarlo. Es una enfermedad desconocida en las unidades neonatales, debido a la inespecificidad de los síntomas en los recién nacidos. La cifra de metahemoglobina elevada es una opción sencilla de aproximación diagnóstica. Se describe el caso clínico de un recién nacido que ingresa al servicio de urgencias por deshidratación, letargia, vómitos, diarrea y acidosis metabólica grave con elevación de metahemoglobina, con mejora clínica y recuperación total tras el inicio del aporte de fórmula elemental. La sospecha diagnóstica se confirmó tras la prueba de provocación positiva.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated allergic reaction with gastrointestinal symptoms, such as vomiting and diarrhea. FPIES diagnosis is based on clinical criteria and on a food challenge test. It is an unknown disease in neonatal units due to its nonspecific symptoms in newborn infants. An elevated methemoglobin level is a simple way to approach diagnosis. Here we describe a clinical case of a newborn admitted to the emergency department because of dehydration, lethargy, vomiting, diarrhea, severe metabolic acidosis, and a high methemoglobin level. Clinical improvement and complete recovery was achieved after initiation of elemental formula. The diagnostic suspicion was confirmed after a positive challenge test.
Subject(s)
Humans , Infant, Newborn , Acidosis/diagnosis , Acidosis/etiology , Enterocolitis/diagnosis , Enterocolitis/etiology , Food Hypersensitivity/complications , Food Hypersensitivity/diagnosis , Syndrome , Vomiting/etiology , Methemoglobin , Dietary Proteins , Diarrhea/etiologyABSTRACT
Oral allergy syndrome (OAS) is an IgE-mediated hypersensitivity. Patients with pollen allergy will experience oropharyngeal allergy after eating fresh fruits or vegetables containing homologous pathogenesis-related allergen, occasionally accompanied by systemic symptoms, it is a special type of food hypersensitivity in which respiratory allergens and food allergens are similar structurally and lead to the cross-reactivity. At present, there is little research and attention to it in China. To master the definition, epidemiological characteristics, pathological mechanism, diagnosis, prevention and treatment of OAS is very important to the prevention and control of OAS. This article reviews the research progress of OAS, providing reference and prevention basis for clinicians to improve the diagnosis and differential diagnosis of OAS.
Subject(s)
Humans , Pollen , Food Hypersensitivity/diagnosis , Rhinitis, Allergic, Seasonal/therapy , Allergens , Fruit , Cross ReactionsABSTRACT
There are many types in food allergy, and the most common is mediated by IgE. Currently, the diagnosis of food allergy mainly relied on skin prick test and serum specific IgE of allergen extract, which can not identify cross-sensitization. Component-resolved diagnosis (CRD) can identify the major allergen components and cross-components of food allergens, which plays an important role in dietary guidance, prognosis monitoring and diagnosis of special types of IgE-mediated food allergy. This article enumerates clinical characteristics of the IgE-mediated common food allergies, such as milk, egg and seafood allergy, and special type of food allergy, such as cat pork syndrome, oral allergy syndrome, α-gal syndrome and food-dependent exercise-induced anaphylaxis, summarizes the advances of CRD in these types of IgE-mediated food allergy, in order to provide an evidence for the diagnosis, treatment and prevention of IgE-mediated food allergy.
Subject(s)
Humans , Allergens , Immunoglobulin E , Food Hypersensitivity/diagnosis , Skin TestsABSTRACT
Food-dependent, exercise-induced anaphylaxis (FDEIA) is a potentially life-threatening disorder that often occurs with exercise, and patients typically have eaten a specific food within hours before disease onset. This disease is exceedingly rare, with a prevalence of 0.02%. No well-recognized prevention or treatment strategy has been available for FDEIA except avoiding triggers strictly. Here we report an 11-year-old boy with a history of recurrent anaphylaxis of unknown etiology more than 10 times within two years. As the anaphylactic symptoms had not been controlled after traditional treatments, the patient was given subcutaneous injection of dupilumab seven times within 33 weeks. During dupilumab treatments, the patient was exposed to culprit mushrooms plus exercises at least twice a month but without notable anaphylaxis. Thus, Dupilumab may improve the allergic reactions in FDEIA patients.
Subject(s)
Male , Humans , Child , Anaphylaxis/etiology , Food Hypersensitivity/diagnosis , Exercise-Induced Allergies , Antibodies, Monoclonal, Humanized/therapeutic useABSTRACT
El parto prematuro, la cesárea, el uso de antibióticos y la lactancia materna limitada son señalados como responsables en parte del aumento de enfermedades crónicas no transmisibles en niños, como las alergias, principalmente la alergia a la proteína de la leche de vaca (APLV). Quienes desarrollan enfermedades alérgicas muestran diferencias en la composición de su microbiota intestinal durante los primeros meses de vida, en comparación con los que no lo hacen. Las intervenciones tempranas para modular la microbiota intestinal y el sistema inmunológico pueden ser herramientas claves para el abordaje y tratamiento de la APLV. El criterio clínico y el trabajo interdisciplinario de alergólogos, gastroenterólogos, inmunólogos, microbiólogos y nutricionistas le permitirá al pediatra lograr un adecuado diagnóstico y un tratamiento oportuno. En este contexto, el empleo de bióticos (prebióticos, probióticos, sinbióticos y posbióticos) como herramientas nutricionales complementarias tiene un presente con sustento científico y un futuro promisorio para la prevención y tratamiento de estas patologías.
Preterm birth, C-section, antibiotic use, and limited breastfeeding are blamed in part for the increasing incidence of chronic noncommunicable diseases among children, such as allergies, mainly cow's milk protein allergy (CMPA). Those who develop allergic diseases, against those who do not, show differences in the composition of their gut microbiota during the first months of life. Early interventions to modulate the intestinal microbiota and the immune system may be the key tools for the management of CMPA. Clinical judgment and the interdisciplinary work of allergists, gastroenterologists, immunologists, microbiologists, and nutritionists will allow pediatricians to achieve an adequate diagnosis and a timely treatment. In this setting, the use of biotics (prebiotics, probiotics, synbiotics, and postbiotics) as supplementary dietary tools is scientifically supported at present and seems to be very promising for the prevention and treatment of these conditions.
Subject(s)
Humans , Animals , Infant, Newborn , Milk Hypersensitivity , Probiotics/therapeutic use , Premature Birth , Food Hypersensitivity/diagnosis , Food Hypersensitivity/therapy , Cattle , ImmunomodulationABSTRACT
Objective: To translate the food allergy quality of life-parental burden (FAQL-PB) scale into Chinese and test its reliability and validity among the caregivers of children with food allergy. Methods: The caregivers of 222 children with food allergy were enrolled by convenient sampling from October 2020 to October 2021 in the Children's Hospital Affiliated to Chongqing Medical University. The forward-backward translation and cultural adaptation of the original FAQL-PB scale was performed in accordance with Brislin's model. Item analysis was used to select items. The validity of the questionnaire was analyzed with the item-level content validity and the exploratory factors analysis. And the internal consistency coefficient, split-half reliability and test-retest reliability were used to evaluate the reliability of the questionnaire. Results: The Pearson correlation coefficients of the scores between each item and total scale ranged from 0.72 to 0.88 (P<0.01). The item-level content validity index (I-CVI) ranged from 0.83 to 1.00, scale-level content validity index/universal agreement (S-CVI/UA) was 0.94, and scale-level content validity index/average (S-CVI/Ave) was 0.99. Exploratory factor analysis revealed that Chinese version of FAQL-PB scale could be classified into two dimensions: emotional distress and limitations on life, with the accumulative variance contribution rate of 74.08%. The Cronbach's α coefficient, split-half reliability coefficient and test-retest reliability of the Chinese version of FAQL-PB scale were 0.97, 0.98 and 0.71, respectively. Conclusion: The Chinese version of FAQL-PB scale is proved to be reliable and eligible, and can be used as a specific tool to investigate the quality of life in family of children with food hypersensitivity.
Subject(s)
Child , Humans , China , Food Hypersensitivity/diagnosis , Parents/psychology , Quality of Life , Reproducibility of ResultsABSTRACT
A maioria das respostas alérgicas a alimentos é mediada por IgE, que pode ser detectada para fins de diagnóstico da alergia alimentar. No entanto, para isso é necessário que alérgenos purificados estejam disponíveis para a elaboração dos diferentes formatos de ensaio, inclusive por microarray, que se constitui em uma ferramenta bastante útil para análise simultânea, e também para a identificação de reatividade cruzada. A esse respeito, é imprescindível ampliar a plataforma de alérgenos que possam ser empregados para a confecção de microarrays. Atualmente, alguns alimentos que constituem objeto de interesse na clínica em função do número de casos de alergia, e sobre os quais as informações a respeito dos alérgenos são escassas, são: abacaxi, mamão, mandioca e manga. Assim, o objetivo desse trabalho foi clonar, expressar e purificar proteínas potencialmente alergênicas de alimentos de importância regional. Após confirmadas por ensaios imunológicos, essas proteínas foram utilizadas na construção e validação de um microarray através de ensaios com os soros de pacientes alérgicos aos alimentos selecionados. Para atingir esse objetivo, foram selecionadas proteínas potencialmente alergênicas coincidentes, apontadas tanto pela similaridade com espécies taxonomicamente mais próximas, quanto pela técnica 2D Western Blotting acoplada à espectrometria de massas. Dezenove proteínas, sendo 4 de abacaxi, 5 de mamão, 6 de mandioca e 4 de manga, foram expressas em Pichia pastoris, purificadas e impressas em um microarray. Após incubar essas proteínas com os soros dos pacientes alérgicos aos alimentos estudados, 18 proteínas mostraram-se potencialmente alergênicas. Além disso, foi observada reatividade cruzada entre proteínas dos alimentos estudados e também em relação ao látex e outros frutos
The majority of allergic reactions to foods is IgE-mediated, which can be detected for the diagnosis of food allergy. However, purified allergens are necessary to produce different kinds of allergy tests, including microarray, which is a useful tool for simultaneous analysis, as well as for the identification of cross-reactivity. In this respect, it is essential to expand the platform of allergens to include them on microarrays. Nowadays, some foods that are object of interest in the clinical area in Brazil and it is necessary a further evaluation about their potential allergens, since there is a limited information about them, are: pineapple, papaya, cassava and mango. Therefore, the aim of this study was cloning, expressing and purifying potentially allergenic proteins of important Brazilian foods. After confirmed by immunological tests, these proteins were used in microarray production and validation by assays with sera from allergic patients to the selected foods. Achieving this goal, matching potentially allergenic proteins were selected, which were identified by comparison among taxonomically closer species (in silico) and 2D Western Blotting coupled with Mass Spectrometry. Nineteen proteins: 4 from pineapple, 5 from papaya, 6 from cassava and 4 from mango were expressed in Pichia pastoris, purified and printed on a microarray. After incubating those proteins with sera from allergic patients to the selected foods, 18 proteins were detected as potentially allergenic. In addition, cross-reactivity was observed among the proteins from the studied foods, and also regarding to the latex and other fruits
Subject(s)
Humans , Male , Female , Allergens/analysis , Cloning, Organism/instrumentation , Microarray Analysis/classification , Food , Food Hypersensitivity/diagnosis , Mass Spectrometry/methods , Blotting, Western/methods , Validation Study , Fruit/adverse effects , Hypersensitivity/complicationsABSTRACT
Introducción: Las alergias alimentarias afectan, mayoritariamente, a los niños en los primeros años de vida. Existen escasos datos epidemiológicos en nuestro país.Objetivos: Determinar los agentes causales, describir la prevalencia y características de los pacientes con alergia alimentaria en una población pediátrica argentina.Pacientes y métodos: Estudio retrospectivo observacional, de corte transversal, de pacientes menores de 18 años. Resultados: Se incluyeron 321 pacientes; se confirmó alergia alimentaria en un 64 % (207) de los casos. El 53 % (109) presentó mecanismo mediado por inmunoglobulina E; el 68 % (140), alergia a las proteínas de la leche de vaca; el 20 % (41), alergia al huevo, y el 12 % (24), anafilaxia como manifestación clínica. La prevalencia global de alergia alimentaria fue del 0,87 % (IC 95 %: 0,7-0,9).Conclusiones: La prevalencia global de alergia alimentaria fue del 0,87 %. La leche de vaca resultó el principal alérgeno incluso en adolescentes.
Introduction: Food allergies affect mostly children in their first years of life. Epidemiological data obtained in Argentina are scarce. Objectives: To determine offending foods and describe the prevalence and characteristics of patients with food allergy in an Argentine pediatric population. Patients and methods: Observational, retrospective, cross-sectional study on patients younger than 18 years. Results:A total of 321 patients were included; food allergy was confirmed in 64 % (207) of cases. An immunoglobulin E-mediated mechanism was observed in 53 % (109); cow's milk protein allergy, in 68 % (140); egg allergy, in 20 % (41); and anaphylaxis as clinical manifestation, in 12 % (24). The overall prevalence of food allergy was 0.87 % (95 % confidence interval: 0.7-0.9). Conclusions: The overall prevalence of food allergy was 0.87 %. Cow's milk was the main allergen, even among adolescents
Subject(s)
Humans , Male , Female , Child , Adolescent , Food Hypersensitivity/diagnosis , Immunoglobulin E/immunology , Epidemiologic Studies , Cross-Sectional Studies , Retrospective Studies , Milk HypersensitivityABSTRACT
Abstract Objective: To evaluate the psychometric properties of the Brazilian version of health-related quality-of-life questionnaires of children with food allergy and their parents. Methods: The translation and cultural adaptation processes were previously performed, according to the method proposed by the World Health Organization. After this stage, the questionnaires were applied to 201 parents of children under 6 years of age with food allergy. The assessment of the psychometric properties included: evaluation of the internal consistency by Cronbach's alpha coefficient; of the reproducibility by the intraclass correlation coefficient between test and retest; and of the construct, using Spearman's correlation coefficient, comparing the obtained scores with those of generic questionnaires that evaluate health-related quality of life. Results: The means of the obtained scores were 2.44 and 3.35, for the children and their parents, respectively. Cronbach's alpha coefficients were 0.85 and 0.91, respectively, which showed good internal consistency of the tools. The intraclass correlation coefficients between test and retest were 0.87 and 0.84 for children and their parents, respectively, showing good reproducibility for both questionnaires. The correlation between the specific and the generic questionnaires was significant (−0.27 for the children, −0.64 for their parents, p < 0.05). Conclusions: The specific questionnaires to evaluate the health-related quality of life of children with food allergy and of their parents were satisfactorily validated to be used in Brazil.
Resumo Objetivo: Avaliar as propriedades psicométricas da versão brasileira dos questionários de qualidade de vida relacionada à saúde de crianças com alergia alimentar e de seus pais. Método: Os processos de tradução e adaptação cultural foram feitos previamente, de acordo com o método proposto pela Organização Mundial da Saúde. Após essa etapa, os questionários foram aplicados a 201 pais de crianças menores de 6 anos com alergia alimentar. A avaliação das propriedades psicométricas incluiu: avaliação da consistência interna, pelo coeficiente alfa de Cronbach; da reprodutibilidade, pelo coeficiente de correlação intraclasse entre teste e reteste; e do constructo, empregou-se o coeficiente de correlação de Spearman, comparando os escores obtidos com os de questionários genéricos que avaliam a qualidade de vida relacionada à saúde. Resultados: As médias dos escores obtidos foram 2,44 e 3,35, para as crianças e seus pais, respectivamente. Os coeficientes alfa de Cronbach foram 0,85 e 0,91, respectivamente, o que demonstrou boa consistência interna dos instrumentos. Os coeficientes de correlação intraclasse entre os testes e os retestes foram 0,87 e 0,84, para crianças e seus pais, respectivamente, demonstraram boa reprodutibilidade para ambos os questionários. A correlação entre os questionários específicos e genéricos foi significante (−0,27 para as crianças; −0,64 para os pais; p < 0,05). Conclusões: Os questionários específicos para avaliar a qualidade de vida relacionada à saúde de crianças com alergia alimentar e de seus pais foram satisfatoriamente validados para uso no Brasil.
Subject(s)
Humans , Child, Preschool , Child , Quality of Life , Food Hypersensitivity/diagnosis , Parents , Psychometrics , Brazil , Surveys and Questionnaires , Reproducibility of ResultsABSTRACT
ABSTRACT Studies linking type of diet and juvenile idiopathic arthritis (JIA) have variable results and are inconsistent. This case shows an evolution which fulfilled the criteria of JIA, but was diagnosed as food allergy. Case: A seven-year old boy had fever, arthralgia, general malaise, headaches, abdominal pain and rashes. These symptoms were diagnosed as fever of unknown origin (FUO) and probable JIA. There was a stabbing pain in the right iliac fossa. An upper and lower endoscopy were performed and nodular ileocolitis was detected. A hypoallergenic diet was prescribed, in addition to mesalazine and oral corticosteroids. The patient was asymptomatic for 2.5 months and then relapsed with all symptoms after consuming dairy. This JIA case shows the diagnostic phases of food allergy: improvement and recurrence of symptoms with the reintroduction of the allergen (oral challenge=gold standard of food allergy). There is evidence that supports the existence of a gut-joint axis, where the luminal content triggers a series of immunologically mediated reactions that can cause systemic diseases such as JIA and other connective tissue diseases. This case report adds reasonable evidence in support of food allergy as a cause of JIA.
RESUMEN Los estudios que relacionan el tipo de dieta y la artritis idiopática juvenil (AIJ) tienen resultados variables y son inconsistentes. Este caso muestra una evolución que cumplió con los criterios de AIJ, pero fue diagnosticada como alergia alimentaria. Caso: Un niño de siete años tenía fiebre, artralgia, malestar general, dolores de cabeza, dolor abdominal y erupciones cutáneas. Estos síntomas fueron diagnosticados como fiebre de origen desconocido (FUO) y probable AIJ. Hubo un dolor punzante en la fosa ilíaca derecha. Se realizó una endoscopia superior e inferior y se detectó ileocolitis nodular. Se prescribió una dieta hipoalergénica, además de mesalazina y corticosteroides orales. El paciente estuvo asintomático durante 2,5 meses y luego recayó con todos los síntomas después de consumir lácteos. Este caso de AIJ muestra las fases diagnósticas de la alergia alimentaria: mejora y recurrencia de los síntomas con la reintroducción del alergeno (desafío oral = estándar de oro de alergia alimentaria). Existe evidencia que respalda la existencia de un eje de la articulación intestinal, donde el contenido luminal desencadena una serie de reacciones inmunológicamente mediadas que pueden causar enfermedades sistémicas como la AIJ y otras enfermedades del tejido conectivo. Este informe del caso agrega evidencia razonable en apoyo de la alergia a los alimentos como causa de AIJ.
Subject(s)
Child , Humans , Male , Arthritis, Juvenile/etiology , Food Hypersensitivity/complications , Food Hypersensitivity/diagnosisABSTRACT
INTRODUCCIÓN: La alergia alimentaria (AA) es una entidad de elevada y creciente prevalencia, pudiendo ser mediada por IgE o inmunidad celular. Puede presentar amplia sintomatología y ser gatillada por múltiples antígenos alimentarios, lo que varía en diversas zonas geográficas. OBJETIVO: Describir las características clínicas de pacientes chilenos con AA IgE-mediada. PACIENTES Y MÉTODO: Revisión retrospectiva de pacientes con AA IgE-mediada atendidos en un centro terciario de salud de Santiago, Chile entre los años 2006 y 2016. Se evaluaron características demográficas, manifestaciones clínicas y alimentos gatillantes. RESULTADOS: Se incluyeron 282 pacientes con diagnóstico de AA IgE-mediada. El 89% debutó con AA antes de los 18 años de edad y de estos, la mayoría antes del año (mediana: 1 año; rango: 1 mes - 55 años). Las manifestaciones clínicas más frecuentes fueron urticaria, angioedema, disnea y vómitos. Un 40% tenía historia compatible con anafilaxia. Los alimentos más frecuentes fueron huevo, leche de vaca, maní, mariscos, nuez, tomate, trigo, palta, pescados y legumbres. Alergia a huevo, leche de vaca y maní fueron más frecuentes en edad pediátrica, mientras que en adultos fueron los mariscos. CONCLUSIONES: Los alimentos causantes de AA IgE-mediada en Chile fueron similares a los descritos en otros países, aunque destaca la elevada frecuencia de alergia a tomate y palta, poco habituales en series internacionales. La incidencia de anafilaxia fue alta, lo que instala la necesidad de contar con autoinyectores de adrenalina a nivel nacional.
BACKGROUND: Food allergy (FA) is an entity of high and growing prevalence, which can be mediated by IgE or cellular immunity. It can have a wide range of symptoms and be triggered by multiple food antigens, which vary in different geographical areas. OBJECTIVES: To describe clinical characteristics of Chilean patients with IgE-mediated FA. Patients and Method: Retrospective review of patients with IgE-mediated FA treated at a tertiary healthcare center in Santiago, Chile, between 2006 and 2016. Demographic characteristics, clinical manifestations, and trigger foods were evaluated. RESULTS: A to tal of 282 patients diagnosed with IgE-mediated FA were included. 89% had FA onset before 18 years of age and most of these before one year of age (median of age: one year; range: one month-55 years). The most common clinical manifestations were hives, angioedema, dyspnea, and vomiting. 40% had symptoms compatible with anaphylaxis. The foods most frequently involved were egg, cow's milk, peanut, shellfish, walnut, tomato, wheat, avocado, fish, and legumes. Egg, cow's milk, and peanut allergies were the most frequent at pediatric age, while seafood allergy was the most frequent among adults. CONCLUSION: Foods causing IgE-mediated FA in Chile were similar to those described in other countries, although the frequency of tomato and avocado allergy, which are unusual in international series, stands out. Anaphylaxis incidence was high, emphasizing the need for epinephrine autoinjec tors in Chile.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Young Adult , Immunoglobulin E/immunology , Food Hypersensitivity/diagnosis , Chile/epidemiology , Retrospective Studies , Food Hypersensitivity/immunology , Food Hypersensitivity/epidemiologyABSTRACT
SUMMARY As the celiac disease (CD), the non-celiac gluten sensitivity (NCGS) has also been associated with several autoimmune manifestations. It is rarely associated with myasthenia gravis (MG). This paper shall introduce the case of a young female patient, initially presenting a peripheral neuropathy framework. During clinical and neurological follow-up, she began to present symptoms of various immune-mediated morbidities. Diseases related to gluten represent a clinical spectrum of manifestations with a trigger in common, the ingestion of gluten. CD is the most well-known and serious disease of the spectrum, also called gluten-sensitive enteropathy. The NCGS is diagnosed from clinical evidence of improvement in symptoms followed by a Gluten Free Diet (GFD) in patients without signs of enteropathy in duodenal biopsy. There are indications that, although rare, with a prevalence of 1 in 5000, myasthenia gravis (MG) may occur more often when CD is also present. Between 13 to 22% of the patients with MG have a second autoimmune disorder. However, it is often associated with dermatomyositis or polymyositis, lupus erythematosussystemic lupus erythematosus, Addison's disease, Guillain-Barré syndrome and juvenile rheumatoid arthritis. Thus, the symptoms of neuromuscular junction involvement may give a diagnostic evidence of this rare association.
Subject(s)
Humans , Female , Adult , Ataxia/etiology , Food Hypersensitivity/complications , Glutens/adverse effects , Glutens/immunology , Myasthenia Gravis/etiology , Pyridostigmine Bromide/therapeutic use , Ataxia/diagnosis , Vitamin B 12 Deficiency/complications , Magnetic Resonance Imaging , Neuroimmunomodulation , Cerebellar Diseases/etiology , Cerebellar Diseases/diagnostic imaging , Cholinesterase Inhibitors/therapeutic use , Food Hypersensitivity/diagnosis , Myasthenia Gravis/diagnosisABSTRACT
INTRODUCCIÓN: La alergia alimentaria en adolescentes ha sido asociada ampliamente con ciertos factores de riesgo. El objetivo de esta investigación fué determinar y comparar, entre adolescentes de Cuenca y Santa Isabel, la prevalencia de alergia alimentaria y la asociación con factores de riesgo demográficos, genéticos, medioambientales y clínicos determinados por autoreporte y test cutáneo. MÉTODO: Se realizó un estudio transversal en 1508 adolescentes de Cuenca (n=1008) y Santa Isabel (n=500) entre julio de 2013 y julio de 2014. Para determinar alergia alimentaria y sus factores de riesgo se aplicaron cuestionarios de autoreporte y de necesidades básicas insatisfechas, excepto para sensibilización a aeroalérgenos. Este factor de riesgo fue establecido por test cutáneo. Se emplearon modelos de regresión lineal para determinar las asociaciones entre alergia alimentaria y factores de riesgo. RESULTADOS: La prevalencia de alergia alimentaria (síntomas de alergia alimentaria autoreportada más test cutáneo positivo al menos a un alimento), para 1411 participantes con información completa, fue de 2.34 %; no se observó diferencias estadísticamente significativas entre las áreas de estudio (Cuenca: 2.31 % vs. Santa Isabel: 2.39 %; p: > 0.05). La rinoconjuntivitis fue el único factor de riesgo asociado con la alergia alimentaria. Los adolescentes que reportaron síntomas de rinoconjuntivitis fueron 5.4 % más propensos a presentar alergia alimentaria que reportaron (p: < 0.001). Ninguna otra interacción persistió estadísticamente significativa en el modelo de regresión lineal completo por lo que ningún resultado fue estratificado por cantón. CONCLUSIONES: La alergia alimentaria determinada por auto reporte y test cutáneo fue prevalente en los adolescentes de Cuenca y Santa Isabel. Para este grupo la rinoconjuntivitis fue el único factor de riesgo relacionado con alergia alimentaria, denotando una predisposición genética a presentar enfermedades alérgicas. La rinoconjuntivitis incrementó un 5.4 % la probabilidad de padecer alergia alimentaria para los adolescentes de las regiones estudiadas.
BACKGROUND: Food allergy in adolescents has been widely associated with risk factors. The aimofthis investigation was determined, among adolescents of Cuenca and Santa Isabel, the prevalence of food allergy and its association with reported risk factors determined by self-report and skin prick test. METHODS: A cross-sectional study was developed in 1508 adolescents (n = 1008) of Cuenca and Santa Isabel (n = 500), between July 2013 and July 2014. To define food allergy and risk factors of food allergy self-reported and unsatisfied basic needs questionnaires were applied. Aeroallergen sensitization was determined by skin prick test with aeroallergens. Linear regression models were applied to determine the associations between food allergy and factors risks. RESULTS: The prevalence of food allergy (self-reported allergy symptoms and positive skin prick test to at least one food), for 1411 participants with complete information was 2.34 %. Do not was observed statistically significant differences between the study areas (2.31%Cuenca vs. 2.39%in Santa Isabel; p > 0.05). Rhino-conjunctivitis was the only risk factors associated. Adolescents who self-reported rhino-conjunctivitis were 5.4 % more likely to have food allergy than adolescents who not reported it (p: < 0.001). No other statistically significant interaction persisted in the full linearregression model so result no was stratified by canton. CONCLUSIONS: Food allergy determined by skin testwas prevalentin adolescents ofCuenca and Santa Isabel. Rhinoconjunctivitis forthis group was the only risk factor associated with food allergy, denoting a genetic predisposition to develop allergic diseases. Rhinoconjunctivitis increased 5.4 % chance of developing the food allergy for adolescents in the regions studied.
Subject(s)
Humans , Male , Female , Adolescent , Risk Factors , Food Hypersensitivity/diagnosis , Adolescent Health , Adolescent Nutrition , Rhinitis, Allergic , Diet, Food, and NutritionABSTRACT
No Brasil, chocolate branco é o produto obtido a partir da mistura de manteiga de cacau com outros ingredientes, alguns dos quais podem desencadear reações, sendo denominadas alergênicos. Entre os alergênicos alimentares mais comuns estão a proteína do leite, proteína do ovo, essências, traços de frutas oleaginosas, soja e aditivos alimentares, como corantes e conservantes. O objetivo deste trabalho foi avaliar a presença de componentes potencialmente alergênicos em diferentes marcas de chocolate branco comercializadas na cidade de Caxias do Sul. Foram adquiridas 12 marcas de chocolate branco no comércio de Caxias do Sul. Os critérios para aquisição das marcas foram: ser chocolate branco puro, em embalagens com peso de 40g a 150g, estando dentro do período de validade. Foram analisados os ingredientes de cada marca com o intuito de identificar os aditivos alimentares e os alérgenos potenciais. O estudo mostrou que, das 12 marcas de chocolate branco, 58,33% apresentaram soja, 66,66% glúten e 75% apresentaram algum traço alergênico de contaminantes da produção. Nenhuma marca apresentou ingrediente transgênico ou glutamato monossódico. Os principais elementos traços encontrados foram amendoim, nozes, amêndoas, avelã, castanhas de caju e do Brasil, macadâmia, coco, ovos, pistache, cevada, trigo, derivados de soja e de leite. Percebe-se a importância da observação e leitura atenta dos rótulo de chocolates antes do consumo, especialmente por indivíduos que apresentam sensibilidade a componentes alimentares, pois mesmo os chocolates puros apresentam substâncias capazes de desencadear complicações graves ao sistema imunológico.(AU)
Subject(s)
Humans , Food Additives/administration & dosage , Food Hypersensitivity/diagnosis , Chocolate/analysis , Soy Foods/adverse effects , Nutritional Facts , Food Labeling/standards , Glutens/adverse effects , Milk Proteins/adverse effectsABSTRACT
Abstract Objectives: To guide the diagnostic and therapeutic management of severe forms of food allergy. Data sources: Search in the Medline database using the terms "severe food allergy," "anaphylaxis and food allergy," "generalized urticaria and food allergy," and "food protein-induced enterocolitis syndrome" in the last ten years, searching in the title, abstract, or keyword fields. Summary of data: Food allergy can be serious and life-threatening. Milk, eggs, peanuts, nuts, walnuts, wheat, sesame seeds, shrimp, fish, and fruit can precipitate allergic emergencies. The severity of reactions will depend on associated cofactors such as age, drug use at the onset of the reaction, history and persistence of asthma and/or severe allergic rhinitis, history of previous anaphylaxis, exercise, and associated diseases. For generalized urticaria and anaphylaxis, intramuscular epinephrine is the first and fundamental treatment line. For the treatment in acute phase of food-induced enterocolitis syndrome in the emergency setting, prompt hydroelectrolytic replacement, administration of methylprednisolone and ondansetron IV are necessary. It is important to recommend to the patient with food allergy to maintain the exclusion diet, seek specialized follow-up and, in those who have anaphylaxis, to emphasize the need to carry epinephrine. Conclusion: Severe food allergy may occur in the form of anaphylaxis and food-protein-induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment.
Resumo Objetivos: Abordar o manejo diagnóstico e terapêutico das formas graves de alergia alimentar. Fontes dos dados: Busca ativa na base de dados Medline dos termos severe food allergies, anaphylaxis and food allergy e food protein-induced enterocolitis nos últimos dez anos e com busca nos campos título, resumo ou palavra-chave. Síntese dos dados: A alergia alimentar pode ser grave e ameaçadora à vida. Leite, ovo, amendoim, castanha, noz, trigo, gergelim, crustáceo, peixe e frutas podem precipitar emergências alérgicas. A gravidade das reações vai depender de fatores associados, tais como idade, uso de medicamentos no início da reação, persistência de asma e/ou rinite alérgica grave, história de prévia anafilaxia, exercício e doenças intercorrentes. Para anafilaxia, a adrenalina intramuscular é uma indicação bem estabelecida. Para o tratamento da síndrome da enterocolite induzida pela proteína alimentar na fase aguda no setor de emergência, fazem-se necessárias a pronta reposição hidroeletrolítica e a administração de metilprednisolona e odansetrona IV. Importante recomendar ao paciente com o diagnóstico de alergia alimentar grave que mantenha a dieta de exclusão, procure acompanhamento especializado e, naqueles que apresentaram anafilaxia, enfatizar a necessidade de portar adrenalina. Conclusão: Alergia alimentar grave pode se manifestar como anafilaxia ou síndrome da enterocolite induzida por proteína alimentar em fase aguda, as quais, por serem condições cada vez mais presentes e reconhecidas no setor de emergência pediátrica, demandam diagnóstico e tratamento imediatos.
Subject(s)
Humans , Enterocolitis/etiology , Food Hypersensitivity/diagnosis , Food Hypersensitivity/physiopathology , Food Hypersensitivity/therapy , Anaphylaxis/etiology , Syndrome , Severity of Illness Index , Enterocolitis/diagnosis , Enterocolitis/therapy , Anaphylaxis/diagnosis , Anaphylaxis/therapyABSTRACT
Abstract Objectives: To assess the level of fecal calprotectin in preterm neonates with feeding intolerance, as well as to evaluate it as a marker of feeding intolerance and to determine a cut-off level of fecal calprotectin in feeding intolerance. Methods: Analytical, multicenter, case-control study, which was carried out in neonatal intensive care units in Egypt, in a period from August 1, 2014 to March 1, 2015 on 52 preterm neonates. Neonates were classified into two groups; a study group including 26 neonates who met inclusion criteria and a control group including 26 neonates for comparison. Results: Fecal calprotectin levels ranged from 3.9 µg/g to 971.8 µg/g, and there was a significant increase in fecal calprotectin in the study group when compared to the control group (334.3 ± 236.6 µg/g vs. 42.0 ± 38.2 µg/g, respectively) with moderate inverse significant correlation between fecal calprotectin and birth weight. Furthermore, there was moderate, significant correlation between fecal calprotectin and duration of breastfeeding range. On the other hand, there was no correlation between fecal calprotectin and post-natal age, gestational age, or volume of feeding. A cut-off at the 67.0 µg/g level, with 100.0% sensitivity and 76.9% specificity, was considered. Conclusion: Fecal calprotectin level increased significantly in neonates with feeding intolerance; it can be used to detect early cases with necrotizing enterocolitis in neonates, but this subject still needs more investigations on more patients.
Resumo Objetivos Avaliar o nível de calprotectina fecal em neonatos prematuros com intolerância alimentar, além de avaliá-lo como um indicador de intolerância alimentar e determinar um nível de corte da calprotectina fecal na intolerância alimentar. Métodos Estudo caso-controle analítico, feito em um multicentro de unidades de terapia intensiva neonatais no Egito, de 1° de agosto de 2014 a 1° de março de 2015, com 52 neonatos prematuros. Os neonatos foram classificados em dois grupos; um grupo de estudo incluindo 26 neonatos que atenderam aos critérios de inclusão e um grupo de controle incluindo 26 neonatos para comparação. Resultados Os níveis de calprotectina fecal variaram de 3,9 µg/g a 971,8 µg/g e houve um aumento significativo da calprotectina fecal no grupo de estudo quando comparado com o grupo de controle (334,3 ± 236,6 µg/g em comparação com 42,0 ± 38,2 µg/g, respectivamente) com correlação inversa, moderada e significativa entre a calprotectina fecal e o peso ao nascer. Adicionalmente, houve correlação moderada significativa entre a calprotectina fecal e a duração do intervalo de amamentação. Por outro lado, não houve correlação entre a calprotectina fecal e a idade pós-natal, a idade gestacional ou o volume de amamentação. Foi considerado um corte nos níveis de 67,0 µg/g; com sensibilidade de 100,0% e especificidade de 76,9%. Conclusão O nível de calprotectina fecal aumentou significativamente em neonatos com intolerância alimentar e podemos usá-lo para detectar casos precoces com enterocolite necrosante em neonatos, porém ainda são necessárias mais investigações em mais pacientes.’.
Subject(s)
Humans , Male , Female , Infant, Newborn , Leukocyte L1 Antigen Complex/analysis , Feces/chemistry , Food Hypersensitivity/diagnosis , Birth Weight , Breast Feeding , Infant, Premature , Biomarkers/analysis , Case-Control Studies , Sensitivity and Specificity , Gestational Age , Nutritional Support , Leukocyte L1 Antigen Complex/immunology , EgyptABSTRACT
El tratamiento de la alergia alimentaria consiste en educar al paciente para evitar la ingestión y, cuando ello no es posible, emplear, entre otros procedimientos, la inmunoterapia con el alimento causal. El objetivo de esta revisión es presentar evidencias sobre eficacia y seguridad de la inmunoterapia en alergia alimentaria y las vías recomendadas para su aplicación. Se accedió a las bases de datos con los descriptores inmunoterapia, alergia alimentaria, vías, desensibilización, eficacia y seguridad. La inmunoterapia oral (ITO) a partir de leche caliente por microondas fue eficaz con buen perfil de seguridad en niños con alergia a leche de vaca (ALV). La quimotripsina inhibe la formación de ßLg y es un nuevo candidato para la inmunoterapia oral en ALV. La ITO con leche y omalizumab ha demostrado mejoría significativa en las medidas de seguridad, pero no en los resultados de eficacia. ITO en niños con alergia al huevo desarrollan tolerancia disminuyendo el riesgo de reacciones alérgicas. También ha aumentado la tolerancia al huevo sin cocinar. En alergia al maní la ITO indujo desensibilización en niños y dio lugar a un aumento significativo en la tolerancia con buen perfil de seguridad. La coadministración del probiótico Lactobacillus rhamnosus a ITO con maní fue eficaz en la inducción de la falta de respuesta y cambios inmunes sostenidos. Se concluye que la ITO puede ser una vía eficaz y segura para la alergia a la leche, huevo y maní. Los protocolos muestran resultados diferentes en eficacia y seguridad, por lo que se requieren más ensayos clínicos.(AU)
The treatment of food allergy is to educate the patient to avoid ingestion and, when it is not possible, to use, among other procedures, the immunotherapy with the offending food. The objective of this review is to present evidence on efficacy and safety of immunotherapy in food allergy and recommended for implementation pathways. It was accessed databases with describer's immunotherapy, food allergy, pathways, desensitization, efficacy and safety. The OIT from microwave hot milk was effective with good safety profile in children with CM. Chymotrypsin inhibits the formation of ßLg and is a new candidate for oral immunotherapy CM. The OIT with milk and omalizumab has shown significant improvement in security measures, but not in the efficacy results. OIT in children with egg allergy develop tolerance decreasing the risk of allergic reactions. It has also increased tolerance uncooked egg. In peanut allergy desensitization induced OIT in children and resulted in a significant increase in tolerance with good safety profile. The co-administration of probiotic Lactobacillus rhamnosus with peanut OIT was effective in inducing immune unresponsiveness and sustained changes. It is concluded that the OIT can be an effective and safe for allergy to milk, egg and peanut route. Protocols show different results in efficacy and safety so more clinical trials are required.(AU)