Síndrome de enterocolitis inducido por proteínas de la dieta: reporte de casos / Food protein Induced enterocolitis: two case reports

A propósito de 2 casos clínicos de pacientes con antecedente de enterocolitis neonatal, se presenta el temade síndrome de enterocolitis inducido por proteínas de la dieta. Este es un tipo de alergia alimentaria no mediada por Ig E, de presentación severa, con incidencia y prevalencia desconocidas y cuya sospecha clínica, diagnóstico y manejo oportuno, se anteponen al desarrollo de complicaciones severas que incluso pueden llevar a la muerte.

Two case reports of patients with neonatal enterocolitis present the topic of Food Protein-Induced EnterocolitisSyndrome (FPIES). FPIES is a type of food allergy which is not mediated by IgE and which has a severe presentation.Its incidence and prevalence are unknown. Clinical suspicion, diagnosis, and timely management are important in light of likely development of severe complications which can even lead to death.

Relación entre dermatitis atópica y alergia alimentaria / Relationship between atopic dermatitis and food allergy

La denominada "marcha alérgica" se caracteriza por diferentes manifestaciones atópicas relacionadas y sucesivas a lo largo de la vida del individuo. Los niños que presentan alergia alimentaria (AA) tienen mayor predisposición al desarrollo de otras enfermedades alérgicas entre las cuales destacan dermatitis atópica (DA), asma y rinitis alérgica. La DA y AA coexisten en mayor medida en los pacientes que presentan DA de comienzo precoz, agresiva y persistente. Por su parte, la AlA es un factor precipitante de DA en un subgrupo de pacientes especialmente aquellos con AA mediadas por IgE, y también existiría correlación con las manifestaciones de AA de tipo retardadas. La disfunción en la barrera epitelial principalmente atribuida a mutaciones en el gen de la filagrina se ha descrito como posible desencadenante de la sensibilización a alérgenos por aumento de la permeabilidad cutánea. Se describen las características generales de la DA y evidencias de investigaciones actuales con respecto al rol de la AA sobre el desarrollo de la DA, su manejo y estrategias de prevención. Se discute la utilidad de los exámenes para el diagnóstico y las indicaciones de tratamiento y prevención en el manejo de niños con DA y AA. La restauración de las alteraciones de la barrera cutánea para prevenir la sensibilización antigénica tendría un rol importante para evitar el desarrollo de enfermedades alérgicas especialmente respiratorias.

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.

Utility of penicillin allergy testing in patients presenting with a history of penicillin allergy

BACKGROUND: Current statistics show that approximately 10% of patients claim to be allergic to penicillin yet only 10% of these have demonstrable allergy. The most appropriate and cost-effective antibiotics are sometimes withheld on the basis of patient history of drug allergy. OBJECTIVE: Investigation of IgE hypersensitivity and delayed hypersensitivity in patients with a history of penicillin allergy to a teaching hospital allergy clinic. METHODS: Patients underwent skin prick and intradermal testing (IDT) with major and minor penicillin determinants. Those with negative skin tests were administered a three-day oral challenge. Demographic and clinical details about the reactions were noted. RESULTS: One hundred twenty eight patients underwent testing, of these, one hundred and ten had self-reported histories of penicillin allergy and eighteen were referred because of other antibiotic allergies. Seventeen patients with self-reported penicillin allergy had either positive skin tests or oral challenge results, corresponding to 15% of patients having proven allergy. None reacted on skin prick testing, four reacted to IDT, thirteen reacted to oral challenge (five immediate and eight delayed). Analysis of clinical histories showed that patients with a well-defined history of allergy and a history of anaphylaxis were more likely to have a positive test compared to patients with vague histories. Skin testing proved to be less sensitive than oral challenge. CONCLUSION: A minority of patients presenting with a history of penicillin allergy have evidence of immune-mediated hypersensitivity (17/110, 15%) in this study. Of these, eight out of seventeen (47%) had delayed reactions, demonstrating the usefulness and discriminating power of objective testing, which must include three-day oral challenge. Discriminating factors for immune-mediated allergy from patient history were a clear description of the original reaction and a history of anaphylaxis. Negative allergy testing enables the use of penicillin as first-line treatment when necessary and this can significantly reduce costs of antibiotics.

Oral drug provocation test to generate a list of safe drugs: Experience with 100 patients.

Background: Following a drug eruption, patients and their doctors need to know which drugs can be safely administered for subsequent illnesses. Currently available laboratory tests are unable to answer this question in a clinically meaningful manner. Aims: To describe our use of oral provocation tests to provide a list of safe drugs to patients. Methods: We studied the records of 100 patients who underwent oral provocation testing in our department between 2003 and 2009. All patients were admitted to hospital and drugs were administered under supervision, one drug per day. A dermatologist evaluated all symptoms and signs that developed following drug intake. Results: Sixty nine women and 31 men underwent provocation testing. There were 96 reactions in 61 patients, of which 44 reactions in 34 patients were judged to be true reactions. All reactions could be controlled, with treatment or spontaneously. A list of safe drugs was provided to the patient along with written instructions to avoid any drug(s) that had produced a reaction. Conclusions: Oral provocation tests are safe and effective in providing patients with a list of drugs they can take safely. These tests should preferably be undertaken after admitting the patient to hospital.

A Case of Anaphylaxis to Oral Minocycline

Minocycline is a semisynthetic tetracycline derivative that is often used in the treatment of acne vulgaris. To date, there has been only one case report of anaphylaxis to minocycline. We report here a case of anaphylaxis to oral minocycline. A 56-yr-old woman visited our hospital after three episodes of recurrent anaphylaxis. We performed an oral challenge test, the standard method for diagnosing drug allergies, with minocycline, one of the drugs she had taken previously. She developed urticaria, angioedema, nausea, vomiting, hypotension, and dyspnea within 4 min and was treated with intramuscular epinephrine, intravenous antihistamine and systemic corticosteroid. However, she presented similar symptoms at 50 min and at 110 min. In prescribing oral minocycline, physicians should consider the possibility of serious adverse reactions, such as anaphylaxis.

The Significance of Gastric Juice Analysis for a Positive Challenge by a Standard Oral Challenge Test in Typical Cow's Milk Protein-Induced Enterocolitis

This study was performed to investigate the significance of gastric juice analysis (GJA) as a diagnostic criterion of a positive challenge in a standard oral cow's milk challenge (OCC) to confirm typical cow's milk protein-induced enterocolitis (CMPIE). Data from 16 CMPIE patients (aged 14 to 44 days) were analyzed. A standard OCC was openly executed using 0.15 g/kg of protein. Three symptoms (vomiting, lethargy, and bloody or pus-like stool), and four laboratory findings (GJA [3 hr], changes in peripheral blood absolute neutrophil count [ANC] [6 hr], C-reactive protein [6 hr], and stool smear test for occult blood or leukocytes) were observed after OCC. Before OCC, baseline studies were conducted; a stool smear test, blood sampling, and GJA. Positive OCC results were; vomiting (87.5%) (observed 1-3 hr after OCC), lethargy (62.5%) (1-3 hr), bloody or pus-like stool (43.8%) (6-10 hr), abnormal GJA (93.8%), an ANC rise >3,500 cells/microliter (93.8%), and an abnormal stool smear test (75.0%). A single GJA test after a standard OCC is a sensitive diagnostic criterion of a positive challenge, and may provide an early confirmatory diagnosis of CMPIE. An investigation of positive OCC outcomes helps to find out a diagnostic algorithm of criteria of a positive challenge in CMPIE.

A Case of Fixed Drug Eruption Caused by Acetaminophen in a Child / 소아알레르기및호흡기학회지

Fixed drug eruption (FDE) is an eruption, which recurs at the same site or sites on each administration of the causative drug, and heals with residual hyperpigmentation. FDE is caused by many drugs, barbiturates, tetracyclines, sulfonamide, and phenolphthalein. Salicylate and nonsteroidal anti-inflammatory drugs (NSAIDs) also cause FDE, but acetaminophen does so only rarely. A 9-year-old girl presented with a 3-year-history of symptomatic pigmented macules on her face, abdomen, and extremities. The eruption was first appeared three years ago, which was when she took medicine after she was discharged following suspicions of Kawasaki disease. Thereafter, she had the same eruption on the same sites when she took medicine for common colds including acetaminophen and ibuprofen. The oral challenge provocation test for ibuprofen was negative, whereas for acetaminophen it was positive. We report a rare case of FDE due to acetaminophen with clinical findings and results of oral challenge test.