ABSTRACT
The article summarizes the discussion of the expert meeting on February 16, 2021. The meeting concerned the medical care of patients with cow’s milk allergy (CMA). Experts analyzed the impact of the COVID-19 pandemic on patients’ access to medical services, including the diagnostic process and the possibility of a proper dietary management. The analysis of the National Health Fund data showed the most significant (by 25%) reduction in the number of health care consultations, in 2020 compared to 2019, for the pediatric population and limited access to services provided as a personal advice. The discussion facilitated the development of recommendations for the treatment of children with CMA. The experts recommended to support services in the form of personal medical advice, especially in the case of first-time visits, to limit the forms of telephone counseling / video counseling to monitoring or prolonging therapy, provided that there are no new symptoms and a good response to the previously applied procedure. The need to monitor the child’s diet and to verify the acquisition of allergen tolerance through food provocation was also emphasized. Appropriate management of allergy to cow’s milk proteins may be important to reduce the risk of further diseases (allergic march). The recommendations presented in the article should be useful for daily practice in the pediatrician’s office. © 2021, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.
ABSTRACT
Food-induced anaphylaxis is the most frequent type of anaphylaxis and the most common cause of fatal acute hypersensitivity reactions in children. It typically occurs after accidental food exposure, after inhalation of food allergen, cutaneous contact and controlled oral food challenge. There is no consensus on a universal clinical definition of anaphylaxis or a uniform symptoms severity score. Recent advances in molecular allergology allow, in many cases, the detailed identification of the allergenic molecule responsible for anaphylaxis. Along with the development of precision medicine, new phenotypes and endotypes of anaphylaxis are being defined. The anaphylaxis course is entirely unpredictable, and even initially mild symptoms may herald a potentially fatal reaction. At the same time, a significant proportion of immediate food hypersensitivity episodes are mild and known as systemic allergic reactions. The occurrence and severity of clinical course of food-induced anaphylaxis are influenced by factors related directly to the child, coexisting diseases, the type and the nature of the allergen, or the presence of cofactors. The unpredictable course of anaphylaxis justifies immediate treatment based on rapid intramuscular administration of adrenaline, regardless of severity. Delayed adrenaline administration is associated with higher incidence of severe course and death. Appropriate and prompt treatment of anaphylaxis is even more critical during the COVID-19 pandemic due to difficult access to medical facilities, hence current treatment plans for food-induced anaphylaxis emphasise the need to administer adrenaline immediately after the onset of the first, even mild, but rapidly progressive symptoms and recommend that the patient have at least two adrenaline autoinjectors. © 2021 Medical Communications. All rights reserved.
ABSTRACT
The article presents and summarizes the current state of knowledge about the management and treatment of allergic diseases in children during the SARS-CoV-2 pandemic. Patients with allergic diseases do not show different symptoms of COVID-19. Children with atopy, like most children, undergo this infection mildly. Current recommendations of Polish and international societies recommend continuing the therapy of allergic diseases to minimize the adverse effects of discontinuing treatment. Continuing treatment with inhaled and oral glucocorticosteroids, antihistamines and anti-leukotriene drugs is not a risk factor for SARS-CoV-2 infection and should not be stopped. Effective treatment of allergic rhinitis may have a positive effect on reducing the transmission of the virus. For children with atopic dermatitis it is essential to use barrier preparations to care atopic skin more often to minimize side effects of excessive use of soaps and disinfectant fluids. It is not recommended to start immunotherapy with inhaled allergens during a pandemic. If there are conditions for epidemiologically safe continuation of specific immunotherapy, the sublingual form is preferred. To minimize the risk of transmission of SARS-CoV-2 infection in medical facilities, telemedicine is the preferred method for continuing specialist care.