Leguminosas como causa infrecuente de alergia alimentaria en Colombia: reporte de dos casos y revisión de la literatura / Legumes as an infrequent cause of food allergy in Colombia: report of two cases and review of the literature

La alergia alimentaria se ha venido incrementando a nivel mundial, afectando alrededor del 1,5 % a 2,5 % de los adultos y 6 % de los niños, y tiene un gran impacto en la calidad de vida de los pacientes y sus cuidadores, debido a las dietas de restricción. Los alérgenos más prevalentes son la leche, el huevo, el trigo, la soja, los frutos secos, el maní, el pescado y los mariscos. Las leguminosas mejor estudiadas son el maní y la soja; otras leguminosas como las lentejas, garbanzos y arvejas representan la quinta causa de alergia alimentaria en el área mediterránea, en Turquía y en la India, siendo menos prevalentes en otras áreas geográficas. La alergia a las leguminosas es una entidad infrecuente en Colombia, se desconoce la prevalencia en el país. Describimos los primeros dos casos de anafilaxia por lentejas reportados en el país. Ambos pacientes menores de 18 años, con reacciones adversas tras la ingesta de leguminosas, en las cuales se demuestra alergia mediada por IgE a las lentejas y además sensibilización en el primer caso a las arvejas y garbanzos, y en el segundo caso a los frijoles. Diferentes datos sobre la prevalencia se han descrito en varias áreas geográficas, siendo mayor en países con dietas mediterráneas. Las reacciones mediadas por IgE suelen aparecer incluso con el alimento altamente cocido, debido a la termo-estabilidad de las proteínas. La reactividad cruzada más frecuente se relaciona con los garbanzos y las arvejas

Food allergy has been increasing worldwide. Affects around 1.5% to 2.5% of adults and 6% of children, and has a great impact on the quality of life of patients and their caregivers, due to restricted diets. The most prevalent allergens are milk, egg, wheat, soy, tree nuts, peanuts, fish and shellfish. The best studied legumes are peanuts and soybeans; other legumes such as lentils, chickpeas and peas represent the fifth cause of food allergy in the Mediterranean area, Turkey and India, being less prevalent in other geographical areas. Allergy to legumes is not common in Colombia, the prevalence in the country is unknown. We describe the first two cases of legumes anaphylaxis reported in the country. Both patients were under 18 years of age, with adverse reactions after ingesting legumes, in which IgE-mediated allergy was demonstrated; in the first case to lentils, peas and chickpeas, and in the second case, to lentils and beans. Different data on prevalence have been described in various geographical areas, being higher in countries with Mediterranean diets. IgE-mediated reactions usually appear even with highly cooked food, due to the thermo-stability of proteins. The most frequent cross-reactivity is related to chickpeas and peas

Queilitis granulomatosa, a propósito de dos casos / Granulomatous cheilitis, regarding two cases

La queilitis granulomatosa es una entidad granulomatosa no infecciosa, poco frecuente, que se presenta como un aumento de volumen persistente de la región orofacial. El estudio histológico, junto con la exclusión de otras patologías granulomatosas son necesarios para su diagnóstico, especialmente cuando no se presenta con la triada clásica del Síndrome de Merkelsson Rosenthal. Presentamos dos casos de queilitis granulomatosa y una revisión de la literatura disponible.

Granulomatous cheilitis is a rare, non-infectious, granulomatous entity that presents as a persistent swelling of the orofacial region. Histological study together with the exclusion of other granulomatous diseases are necessary for the diagnosis, especially when the presentation is not the classic triad of Merkelsson Rosenthal Syndrome. We present two cases of granulomatous cheilitis and a review of the available literature.

Soy protein: a food allergen frequently used in the preparation of meat products / Proteína de soya: un alergeno alimentario altamente utilizado en la preparación de productos cárnicos

The addition of soy proteins, currently classified as a food allergen, into meat products is a commonly used practice due to its functional properties and low cost. Its addition to meat products can cause health problems for individuals allergic to these proteins. Allergic individuals can be affected by the ingestion of low amounts of the allergen. In Brazil, limits are set for the addition of soy proteins in meat products in order to avoide fraud. Starting in 2015 reporting the name of the added component became mandatory for all food labelling. Some studies have reported that food processing can reduce the allergenicity, either by irreversible removal of allergens or by modifying the allergen structure. However, the technological approach to decrease allergenicity has largely been empirical. This review describes the use of soy protein in meat products and the health risk for allergic individuals and consumers of these products. Finally, appropriate methodologies for the detection and quantification of these proteins must be further explored and established to avoid fraud and to preserve consumer health.

La adición de proteínas de soya, actualmente clasificadas como alergeno alimentario, en los productos cárnicos es una práctica comúnmente utilizada debido a sus propiedades funcionales y bajo costo. Su adición en productos cárnicos puede causar problemas de salud en personas alérgicas a estas proteínas. Las personas alérgicas pueden verse afectadas por la ingestión de cantidades diminutas de alérgeno. En Brasil, se establecen límites para la adición de proteínas de soya en los productos cárnicos con el objetivo de evitar el fraude. Solo en 2015 se hizo obligatoria la declaración en la etiqueta de todos los alimentos que indicaban la presencia de sustancias alérgicas, así como el nombre del componente. Algunos estudios se refieren al procesamiento de alimentos para reducir la alergenicidad, ya sea mediante la eliminación irreversible de alergenos o modificando la estructura del alergeno; sin embargo, el enfoque tecnológico hasta ahora para disminuir la alergenicidad ha sido en gran medida empírico. Esta revisión describe el uso de proteína de soya en los productos cárnicos y el riesgo que puede causar para la salud de las personas alérgicas y a los consumidores de estos productos. Finalmente, las metodologías apropiadas para la detección y cuantificación de estas proteínas deben explorarse en profundidad y establecerse para evitar el fraude y preservar la salud de los consumidores.

Characteristics related to fish consumption and the risk of ichthyozoonosis in a Colombian population / Características relacionas al con el consumo de pescado y el riesgo de ictiozoonosis en una población de Colombia

ABSTRACT Objective This study aimed to determine the dietary habits related to fish consumption and the risk factors associated with acquiring an ichthyo-zoonotic disease. Materials and Methods A descriptive, cross-sectional study was carried out by means of a structured survey administered to 150 individuals in the city of Cali, Colombia. Results Epidemiological variables regarding fish consumption and preparation were contrasted with the medical records of the respondents. The median fish consumption in the surveyed population was three times a month, with raw or salted/marinated fish once a month. A positive correlation between fish consumption and allergic conditions was confirmed. There was no infectious or parasitic history associated with the data on fish consumption. Conclusions A relationship between fish consumption and allergies was confirmed. Further research is necessary to establish the possible pathogens associated with hypersensitivity, such as parasites of the Anisakidae family.(AU)

RESUMEN Objetivo Este estudio tuvo como fin determinar los hábitos alimenticios relacionados con el consumo de pescado y los factores de riesgo asociados con la adquisición de una enfermedad ictio-zoonótica. Materiales y Métodos Se realizó un estudio descriptivo de corte transversal mediante una encuesta estructurada a 150 individuos de la ciudad de Cali, Colombia. Resultados Las variables epidemiológicas del consumo y preparación de pescado se relacionaron con la historia clínica de los encuestados. El consumo medio de pescado en los encuestados fue de tres veces al mes, con pescado crudo o salado/marinado una vez al mes. Se confirmó una correlación positiva entre el consumo de pescado y las condiciones alérgicas. No se asociaron antecedentes infecciosos o parasitarios con los datos sobre el consumo de pescado. Conclusión Fue posible confirmar una relación entre el consumo de pescado y las condiciones alérgicas. Se necesita investigación para establecer los posibles patógenos asociados con la hipersensibilidad, como los parásitos de la familia Anisakidae.(AU)

Allergenic Characterization of 27-kDa Glycoprotein, a Novel Heat Stable Allergen, from the Pupa of Silkworm, Bombyx mori

Boiled silkworm pupa is a traditional food in Asia, and patients with silkworm pupa food allergy are common in these regions. Still now only one allergen from silkworm, arginine kinase, has been identified. The purpose of this study was to identify novel food allergens in silkworm pupa by analyzing a protein extract after heat treatment. Heat treated extracts were examined by proteomic analysis. A 27-kDa glycoprotein was identified, expressed in Escherichia coli, and purified. IgE reactivity of the recombinant protein was investigated by ELISA. High molecular weight proteins (above 100 kDa) elicited increased IgE binding after heat treatment compared to that before heat treatment. The molecular identities of these proteins, however, could not be determined. IgE reactivity toward a 27-kDa glycoprotein was also increased after heating the protein extract. The recombinant protein was recognized by IgE antibodies from allergic subjects (33.3%). Glycation or aggregation of protein by heating may create new IgE binding epitopes. Heat stable allergens are shown to be important in silkworm allergy. Sensitization to the 27-kDa glycoprotein from silkworm may contribute to elevation of IgE to silkworm.

Protein contact dermatitis - case report / Dermatite de contacto proteinica - relato de caso

Protein contact dermatitis is a skin condition not well known and underdiagnosed by dermatologists, resulting from an IgE-mediated allergic reaction. Clinically it presents as a chronic hand and/or forearms eczema of occupational origin, especially in professionals who work as food handlers. Epicutaneous tests are negative, and to diagnose this condition it is necessary to perform immediate-type allergy tests. The most sensitive and practical is the prick-by-prick test with food that the patient refers to cause intense itching after immediate skin contact. Treatment is symptomatic, and it is mandatory to avoid the responsible allergen, wearing plastic gloves and even sometimes leaving the workplace for symptom resolution.

A dermatite de contacto proteínica é uma condição pouco conhecida e infra-diagnosticada pelos dermatologistas, resultante de uma resposta alérgica de tipo imediato, mediada por IgE. Clinicamente apresenta-se como um eczema crónico em mãos e/ou antebraços de origem ocupacional, sobretudo em profissionais que trabalham manipulando alimentos. As provas epicutâneas são negativas e para realizar o diagnóstico desta condição há que realizar testes alérgicos de tipo imediato, sendo o mais sensível e rápido, o prick-by-prick test com os alimentos que o paciente refere causar-lhe prurido intenso e imediato ao seu contacto. O tratamento é sintomático, sendo necessário evitar o alérgeno responsável, utilizar luvas de plástico e em ocasiões abandonar o posto de trabalho para a sua resolução.

Sesame seed sensitization in a group of atopic Egyptian children

Background: There are no published data on the prevalence of sesame allergy/sensitization in Egypt

Objective: In this pilot study, we thought to estimate the frequency of sesame seed sensitization in a group of atopic Egyptian infants and children

Methods: We consecutively enrolled 90 patients with physician diagnosed allergic disease. The study measurements included clinical evaluation for the site and duration of allergy, history suggestive of sesame seed allergy, and family history of allergy, as well as skin prick testing [SPT] using a commercial sesame extract, and serum sesame specific IgE [SpIgE] estimation

Results: None of the studied patients reported symptoms suggestive of sesame seed allergy. Nevertheless, two children [2.2%] showed positive SPT response to sesame [wheal diameter >/= 3 mm above the negative control]. Only one of them had a wheal diameter which exceeded that of the histamine control. The serum sesame SpIgE exceeded 0.35 IU/ml in all subjects [range = 0.35 - 3.0 IU/ml; median [IQR] = 0.9 [0.6] IU/ml]. Serum sesame SpIgE was significantly increased in patients with history of recurrent urticaria [p=0.03]

Conclusion: Sesame seed sensitization is not uncommon in atopic Egyptian children. It can be associated with any clinical form of allergy and the causal relationship needs meticulous evaluation. Wider scale population-based studies are needed to assess the prevalence of sesame allergy and its clinical correlates in our country

Asociación entre los patrones alimentarios durante el primer año de vida y alergia alimentaria en lactantes / Association of dietary patterns and food allergy in infants during the first year of life

Introducción. Existe controversia acerca del efecto del patrón alimentario durante el primer año de vida y el desarrollo de alergia alimentaria. El objetivo de este estudio fue evaluar la asociación entre antecedentes familiares de alergia, manifestaciones alérgicas y patrones alimentarios del primer año de vida en lactantes con alergia alimentaria y sin ella. Población y métodos. Se realizó un estudio descriptivo transversal en menores de 2 años (n= 99), distribuidos en dos grupos: alérgico (n= 50) y grupo control (n= 49), pareados por nivel socioeconómico, edad y género. Se definió alergia alimentaria según criterios clínicos internacionalmente aceptados, pruebas cutáneas y de parche, y respuesta a la dieta. Se recolectó información dietaria, clínica y de historia de alergia en los padres. Se calculó tamaño muestral para regresión logística (Freeman) y se utilizaron pruebas de Student, X² y Mann-Withney. El estudio y el consentimiento fueron aprobados por el Comité de Ética del INTA y de la Universidad de Chile. Resultados. El grupo alérgico mostró una prevalencia significativamente mayor (p <0,0001) de historia familiar de alergia (84%) que el grupo control (16%). La diarrea fue la sintomatología más frecuentemente comunicada por las madres de los niños alérgicos durante el primer año de vida. La lactancia artificial se introdujo más tempranamente en el grupo alérgico que en el grupo control 3 contra 6 meses (p <0,03); no hallamos diferencias con respecto a la edad de inicio de la alimentación complementaria. Al realizar la regresión logística, solo la historia familiar de alergia se asoció con un mayor riesgo de presentar alergia alimentaria (OR: 48,2; IC= 14,2-164; p <0,001). Conclusiones. La introducción precoz de formula láctea podría favorecer la presencia de alergia alimentaria en lactantes que presentan frecuentemente antecedentes familiares de alergia.

Introduction. There is controversy about the effect of dietary patterns during the first year of life and the occurrence of food allergy. The objective of this study was to evaluate the association between family history of allergy, allergic manifestations and dietary patterns during the first year of life in infants with and without food allergy. Population and methods. We performed a descriptive cross-sectional study in children under 2 years of age (n= 99), sorted in two groups: allergic group (n= 50) and control group (n= 49), matched by socioeconomic status, age and gender. Food allergy was defned by internationally approved clinical criteria, prick and patch tests, and response to diet. Information on diet, clinical data and history of allergy in the parents were collected. The sample size was estimated for logistic regression (Freeman), and Student X² and Mann-Withney tests were used. The study and consent forms were approved by the Ethics Committee of the Institute of Nutrition and Food Technology (Instituto de Nutrición y Tecnología de los Alimentos, INTA) and the Universidad de Chile. Results. The allergic group showed a significantly higher prevalence (p <0.0001) of family history of allergy (84%) than the control group (16%). Diarrhea was the symptom most frequently reported by the mothers of allergic infants during the frst year of life. Bottle feeding was introduced earlier in the allergic group than in the control group (3 versus 6 months [p < 0.03]); no differences regarding the start age for supplementary feeding was found. When performing logistic regression, only the family history of allergy was associated with a higher risk of food allergy (OR: 48.2; CI= 14.2-164; p < 0.001). Conclusions. The early introduction of milk formula could promote the occurrence of food allergy in infants frequently presenting family history of allergy.

Flagellate dermatitis caused by shiitake mushrooms / Dermatite flagelada após a ingestão de fungos shiitake

Shiitake (Lentinus edodes) is the second most consumed mushroom in the world. It has long been known in Asian medicine for its anticarcinogenic, antihypertensive and serum cholesterol level reduction properties. Nevertheless, the consumption of raw or not well-cooked mushrooms may cause skin eruptions which usually occur 24 to 48 hours after ingestion and are characterized by linearly arranged pruritic erythematous papules and plaques. We present a 36-year-old patient that developed typical symptoms 24 hours after consumption of shiitake mushrooms and summarize therapeutic options and particularities of this disease.

Shiitake (Lentinus edodes) é o segundo tipo de cogumelo mais consumido no mundo. Suas propriedades terapêuticas antitumorais, anti-hipertensivas e redutoras dos níveis elevados de colesterol são há muito conhecidas pela população asiática. Após ingestão desse cogumelo, cru ou malcozido, podem desenvolver-se lesões eritematosas lineares, pruriginosas, que surgem após 24 ou 48 horas em todo o corpo. Apresentamos um paciente de 36 anos com anamnese e clínica típicos, e comentamos as alternativas terapêuticas e nuances dessa dermatose.

Adverse reaction to the sulphite additives

Sulphites are widely used as preservative and antioxidant additives in the food and pharmaceutical industries. Exposure to sulphites has been reported to induce a range of adverse clinical effects in sensitive individuals, ranging from dermatitis, urticaria, flushing, hypotension, abdominal pain and diarrhea to life-threatening anaphylactic and asthmatic reactions. Exposure to the sulphites arises mainly from the consumption of foods and drinks that contain these additives; however exposure may also occur through the use of pharmaceutical products, as well as in occupational settings. Most studies report a prevalence of sulphite sensitivity of 3 to 10% among asthmatic subjects who ingest these additives. However, the severity of these reactions varies, and steroid-dependent asthmatics, those with marked airway hyperresponsiveness, and children with chronic asthma, appear to be at greater risk. Although a number of potential mechanisms have been proposed, the precise mechanisms underlying sulphite sensitivity remain unclear

Relationship between Silent Gastroesophageal Reflux and Food Sensitization in Infants and Young Children with Recurrent Wheezing

It is known that early childhood wheezing associated with sensitization to allergens, including food, has an increased risk of developing asthma later during school age. Gastroesophageal reflux (GER) is well known to be associated with asthma. The purpose of this study was to determine whether there is an association between silent GER and food sensitization in infants and young children with recurrent wheezing. Eighty-five infants or young children with recurrent wheezing, and no gastrointestinal symptoms, underwent 24 hr esophageal pH monitoring, as well as total serum IgE and specific IgE testing for eggs and milk. Among the 85 subjects, 48.2% had significant GER. There was no significant difference in the GER between atopic and non-atopic recurrent wheezers (41.7% and 50.8%, respectively). The sensitization rate to food (eggs or milk) was 12.2% and 20.5% in the GER and non-GER groups, respectively and showed no statistically significant difference between the two groups (P=0.34). In conclusion, about half of infants and young children with recurrent wheezing and no gastrointestinal symptoms have silent GER. The silent GER may not contribute to food sensitization in infants and young children with recurrent wheezing.

Possible links between intestinal permeablity and food processing: a potential therapeutic niche for glutamine

Increased intestinal permeability is a likely cause of various pathologies, such as allergies and metabolic or even cardiovascular disturbances. Intestinal permeability is found in many severe clinical situations and in common disorders such as irritable bowel syndrome. In these conditions, substances that are normally unable to cross the epithelial barrier gain access to the systemic circulation. To illustrate the potential harmfulness of leaky gut, we present an argument based on examples linked to protein or lipid glycation induced by modern food processing. Increased intestinal permeability should be largely improved by dietary addition of compounds, such as glutamine or curcumin, which both have the mechanistic potential to inhibit the inflammation and oxidative stress linked to tight junction opening. This brief review aims to increase physician awareness of this common, albeit largely unrecognized, pathology, which may be easily prevented or improved by means of simple nutritional changes.

Evaluating the Allergic Risk of Genetically Modified Soybean

Genetically modified (GM) soybean (carrying the EPSPS transgene) is the most common GM food in Korea. In order to assess whether genetic modification increases the allergenic risk of soybeans, the allergenicity and IgE-reactive components of wild-type and GM soybean extracts were compared in allergic adults who had been sensitized to soybeans. We enrolled 1,716 adult allergy patients and 40 healthy, non-atopic controls. Skin prick tests and IgE enzyme linked immunosorbent assays (ELISAs) were performed using wild-type and GM soybean extracts, along with other common inhaled allergens. The specificities of serum IgE antibodies from allergic patients and the identities of the IgE-reactive components of the soybean extracts were compared using ELISA inhibition testing, 2-dimensional gel electrophoresis, and IgE immunoblotting. To evaluate the effects of digestive enzymes and heat treatment, the soybean extracts were heated or pre- incubated with or without simulated gastric and intestinal fluids. The IgE sensitization rates to wild-type and GM soybeans were identical (3.8% of allergic adults), and circulating IgE antibodies specific for the two extracts were comparable. The results of the ELISA inhibition test, SDS-PAGE, and IgE immunoblotting showed a similar composition of IgE-binding components within the wild-type and GM extracts, which was confirmed using two-dimensional gel electrophoresis, IgE immunoblotting, and amino acid sequencing. None of the subjects had a positive response to purified EPSPS protein in the skin prick test, ELISA, or IgE immunoblot analysis. These findings suggest that the IgE sensitization rate to GM soybean extracts is identical to that of wild-type soybean extracts in adult allergy patients. In addition, based on both in vivo and in vitro methods, the allergenicity of wild type and GM soybean extracts was identical.

Alergia ao látex e à banana em crianças com mielomeningocele na cidade do Rio de Janeiro / Latex and banana allergies in children with myelomeningocele in Rio de Janeiro city

Recentemente, reações de hipersensibilidade do tipo I ao látex foram relatadas com freqüência, principalmente nos indivíduos cujo contato com produtos de látex é íntimo e freqüente. Crianças com mielomeningocele (MMC) são as que mais se sensibilizam ao látex, pelo contato freqüente e precoce com este material. Reações alérgicas cruzadas entre alimentos são conhecidas há anos. Atualmente, a alergia ao látex é freqüentemente associada à alergia a frutas como abacate, banana, kiwi, grapefruit, pêssego, papaia e castanha. OBJETIVOS: O objetivo deste trabalho consistiu em identificar o número de pacientes com MMC e sensibilização clínico-laboratorial à banana e ao látex. MÉTODOS: Questionários foram aplicados a 33 crianças com MMC, e sangue foi colhido de 30 para ser efetuada a dosagem de imunoglobulina E (IgE) específica (RAST Pharmacia) para látex, e de 29 para banana. Foi considerada positiva a IgE específica igual ou superior à classe I. RESULTADOS: Quatro crianças relataram histórias de urticária com látex, e uma criança descreveu urticária e diarréia com banana. 14/30 (46,6 por cento) apresentavam IgE específica para látex positiva, e 4/29 (13,7 por cento) para banana. Nenhum cruzamento de variáveis foi estatisticamente significativo com a sensibilização clínico laboratorial ao látex e à banana. CONCLUSÕES: Identificou-se elevada prevalência de alergia ao látex e à banana no grupo de pacientes com MMC. No Brasil necessitamos de mais estudos para analisar a prevalência de reações alérgicas cruzadas entre alimentos e látex em crianças com MMC.

Common food allergens in Iranian children

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 aim of this study was to determine the most common food allergens in Iranian children. One hundred and ninety children with skin, respiratory or gastrointestinal symptoms, thought to be due to food allergy, were studied. The 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, RASTs [Radioallergosorbent Test] and open food challenge tests. Findings: The most common food allergens were cow's milk, tomato, egg white, egg yolk, beef and almond, respectively. The order of common food allergens in this study was different from other reports; this might be due to the different food habits and /or ethnic diversities

Pattern of sensitization to common environmental allergens amongst atopic Singapore children in the first 3 years of life.

This study was aimed to investigate the sensitization pattern to a range of common allergens in young Singaporean children. A cross-sectional study involving 75 children aged below 3 years was carried out. They presented between December 1995 and April 2000 with symptoms of asthma, rhinitis, eczema, or food allergy. Their levels of allergen-specific serum IgE to a panel of foods (egg white, milk, soy protein, shrimp, wheat and peanut), pet dander, dust mites and cockroaches were measured with Pharmacia CAP System radioallergosorbent test kits. Serum IgE levels greater than 0.35 kU/l represented a positive result. Four children could not be tested with the complete panel because of insufficient serum. The prevalence of sensitization was highest for cow's milk (45.9%) followed by egg white (38.7%), dust mites Dermatophagoides pteronyssinus (31.4%) and Blomia tropicalis (25.5%). Sensitization to ingested allergens was significantly more prevalent in children aged 1 year or younger than in the older children (70.4% of those below 1 year, and 50% of those aged 1-3 years; p < 0.02). Sensitization to inhaled allergens, such as dust mites, was more likely to manifest as respiratory symptoms (allergic rhinitis and asthma), while ingested allergens were associated with gastrointestinal symptoms and eczema (p < 0.001). It was concluded that infants and young children are at high risk of sensitization to common environmental substances. Allergen avoidance is therefore important even in the very young. The prevalence of sensitization to food allergens is higher compared to inhalant allergens in young children.