Eosinophilic esophagitis as a side-effect of allergen immunotherapy: protocol for a systematic review and meta-analysis.

Summary: Background. Sensitization to food and airborne allergens is common in the majority of patients with eosinophilic esophagitis (EoE). Although there is not a direct cause-effect relationship of IgE-mediated allergy with the pathogenesis of EoE, there is a growing evidence that oral desensitization to food and sublingual immunotherapy (SLIT) may induce the development of EoE as an adverse effect. As part of the 'EoE and Allergen Immunotherapy (AIT)' Task Force funded by the European Academy of Allergy and Clinical Immunology (EAACI), a systematic approach will be followed to review the evidence from the published scientific literature on the development of EoE in children and adults under any type of AIT. Methods. This systematic review will be carried out following the PRISMA statement guidelines. Studies will be assessed for inclusion in the review according to the Population-Interventions-Comparators-Outcomes (PICO) criteria. Results. Expected outcomes will provide evidence on the AIT-EoE development connection. Conclusions. The findings from this review will be used as a reference to provide useful guidelines for physicians treating patients with EoE and/or are practicing AIT.

Allergy to strawberry in children from the Mediterranean area: is it really allergy?

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Impact Of "eHealth" in Allergic Diseases and Allergic Patients.

The emergence of new technology enables allergists and patients to compile data and receive feedback regarding key symptoms, risk behavior, and/or management. The term "eHealth" refers to a diverse group of tools that use computerized technologies to improve both the efficacy and the efficiency of the health care industry. eHealth comprises a variety of technologies, as follows: mobile devices (mHealth) in medical care, including electronic diaries, wearable sensors, and adherence monitoring; health informatics (eg, electronic health records, computerized physician order entry, clinical decision support); telemedicine, which is the use of information and communication technologies for the management of diseases and medical education; social media platforms, and the analysis of information acquired through these platforms using "big data" technologies. In this review, we summarize the latest findings on the use of eHealth technology and the relevance of eHealth to allergic conditions.

Anaphylaxis related to passive second-hand exposure to cannabis sativa cigarette smoke in adolescents

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Impact of "eHealth" in allergic diseases and allergic patients

The emergence of new technology enables allergists and patients to compile data and receive feedback regarding key symptoms, risk behavior, and/or management. The term "eHealth" refers to a diverse group of tools that use computerized technologies to improve both the efficacy and the efficiency of the health care industry. eHealth comprises a variety of technologies, as follows: mobile devices (mHealth) in medical care, including electronic diaries, wearable sensors, and adherence monitoring; health informatics (eg, electronic health records, computerized physician order entry, clinical decision support); telemedicine, which is the use of information and communication technologies for the management of diseases and medical education; social media platforms, and the analysis of information acquired through these platforms using "big data" technologies.In this review, we summarize the latest findings on the use of eHealth technology and the relevance of eHealth to allergic conditions

La aparición de nuevas tecnologías conlleva para los alergólogos y los pacientes la posibilidad de recopilar datos y recibir información directa sobre los síntomas clave de las enfermedades, los comportamientos de riesgo y/o su manejo. El término "eHealth", o salud electrónica, se refiere a un grupo diverso de herramientas que utilizan tecnologías informáticas para mejorar la eficacia y la eficiencia de la industria de la salud. La "eHealth" comprende varias tecnologías, como el uso de dispositivos móviles aplicados a la salud ("mHealth"), incluyendo diarios electrónicos, sensores ponibles o monitorización de la adherencia terapéutica; la informática biomédica (por ejemplo, la historia clínica electrónica, la prescripción electrónica o los sistemas de ayuda a las decisiones clínicas); la telemedicina, que es el uso de las tecnologías de la información y la comunicación para el manejo de enfermedades y de educación sanitaria; las plataformas de redes sociales, y el análisis de la información adquirida a través de estas plataformas, usando técnicas de "big data" o inteligencia de datos. En esta revisión, resumimos la evidencia que rodea al uso de tecnologías "eHealth" y su relevancia para las enfermedades alérgicas

Social Media as a Tool for the Management of Food Allergy in Children.

BACKGROUND: Food allergy markedly impairs quality of life, and avoiding the offending food requires extensive patient education. Social media have been proven a useful source of information for other chronic conditions. Our aim was to describe how pediatric patients with food allergy and their families are using social media. METHODS: We performed a cross-sectional study in the pediatric allergy unit of a tertiary hospital. Patients with food allergy were questioned about their disease and their use of social media. The survey was completed by the patients themselves in the case of those aged over 13 years and by parents or guardians in the case of younger patients. RESULTS: We included 193 patients (162 guardians, 31 adolescents). Social media were used by 109 guardians (67.3%) and 29 adolescents (90.3%), of whom 30.3% and 6.9%, respectively, used them for food allergy-related purposes. The most popular websites were Facebook for guardians (52.2%) and YouTube for teenagers (80.6%). Having cow's milk and/or egg allergy was the only feature related to using social media for food allergy. Using social media for information on food allergy did not correlate with the frequency of recent reactions, self-scored knowledge about food allergy, or opinion on evidence-based or alternative therapies for the disease. CONCLUSIONS: Most patients and guardians of patients with food allergy used social media. However, only a small portion accessed used them to increase their knowledge of the disease.

Food protein-induced enterocolitis syndrome by fish: Not necessarily a restricted diet.

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow's milk or soy. Recent researches show that fish is 1 of the most important triggers of FPIES in the Mediterranean countries. Due to the risk of multiple-food FPIES, avoiding foods in the same category or that often occur together may be reasonable. The aim of this study was to evaluate the evolution and follow-up of FPIES related to fish over a period of 20 years. We describe the clinical features of our population, discuss different approaches to oral food challenges, and analyze the possibility of introducing the culprit fish or other nonrelated fish to avoid unnecessary restricted diets.

Social media as a tool for the management of food allergy in children

Background: Food allergy markedly impairs quality of life, and avoiding the offending food requires extensive patient education. Social media have been proven a useful source of information for other chronic conditions. Our aim was to describe how pediatric patients with food allergy and their families are using social media. Methods: We performed a cross-sectional study in the pediatric allergy unit of a tertiary hospital. Patients with food allergy were questioned about their disease and their use of social media. The survey was completed by the patients themselves in the case of those aged over 13 years and by parents or guardians in the case of younger patients. Results: We included 193 patients (162 guardians, 31 adolescents). Social media were used by 109 guardians (67.3%) and 29 adolescents (90.3%), of whom 30.3% and 6.9%, respectively, used them for food allergy-related purposes. The most popular websites were Facebook for guardians (52.2%) and YouTube for teenagers (80.6%). Having cow's milk and/or egg allergy was the only feature related to using social media for food allergy. Using social media for information on food allergy did not correlate with the frequency of recent reactions, self-scored knowledge about food allergy, or opinion on evidence-based or alternative therapies for the disease. Conclusions: Most patients and guardians of patients with food allergy used social media. However, only a small portion accessed used them to increase their knowledge of the disease

Introducción: La alergia alimentaria afecta a la calidad de vida de quienes la sufren. La evitación de los alimentos que la producen exige la educación de los pacientes. Las redes sociales han demostrado ser una fuente útil de información acerca de otras enfermedades crónicas. El objetivo de este estudio fue describir el uso de las redes sociales por parte de los pacientes en edad pediátrica con alergia alimentaria, así como el de sus familias. Métodos: Se realizó un estudio transversal en la Unidad de Alergia Infantil de un hospital de tercer nivel. Se encuestó a pacientes diagnosticados de alergia alimentaria, acerca de su enfermedad, así como de su uso de las redes sociales. La encuesta fue cumplimentada por los propios pacientes a partir de los 13 años de edad, mientras que los tutores lo hicieron en los casos de pacientes menores. Resultados: Se incluyeron 193 pacientes (162 tutores y 31 adolescentes). Las redes sociales eran utilizadas por 109 tutores (67,3%) y 29 adolescentes (90,3%), de los que el 30,3% y el 6,9%, respectivamente, lo hacían en relación con la alergia alimentaria. Las páginas web más frecuentes eran Facebook(TM) en el caso de los tutores (52,2%) y YouTube(TM) entre los adolescentes (80,6%). Ser alérgico a la leche y/o al huevo era la única característica que se relacionó con el uso de redes sociales en relación a la alergia alimentaria. El uso de las redes sociales para informarse acerca de la alergia a los alimentos no se correlacionó con la frecuencia de reacciones, la percepción del conocimiento propio acerca de la alergia alimentaria o la opinión sobre terapias científicas y alternativas para su enfermedad. Conclusiones: La mayoría de los pacientes con alergia alimentaria y sus tutores son usuarios de las redes sociales. Sin embargo, sólo una pequeña porción las utiliza para formarse acerca de su enfermedad

One of the faces of facial swelling: Melkersson-Rosenthal syndrome

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Anaphylaxis in Adolescent/Adult Patients Treated in the Emergency Department: Differences Between Initial Impressions and the Definitive Diagnosis.

OBJECTIVES: To contrast the initial suspected etiology of anaphylaxis with the postworkup diagnosis in patients attended at the emergency department (ED) of a tertiary-level hospital in Spain and to investigate the incidence, causes, and management of anaphylaxis. METHODS: We performed an observational study of patients aged more than 15 years who came to the ED with anaphylaxis between 2009 and 2010. All clinical records from the ED were reviewed. We recorded data on clinical management, the etiology proposed by the attending emergency physician, and the cause reported by the patient. The findings were compared with the diagnosis reached after the allergy workup. RESULTS: The incidence of anaphylaxis was 0.08%. The most common manifestation was skin-mucosal symptoms (98.3%). Anaphylaxis was diagnosed in the ED in only 44% of the cases, regardless of severity. Only 39.7% received epinephrine, which was administered more frequently when the ED physician diagnosed anaphylaxis, regardless of severity. A total of 60 patients were subsequently seen at the allergy department. The final etiology differed from the initial suspicion in the ED in 45% of cases. The frequency of anaphylaxis of uncertain origin decreased from 33.3% to 13.3%. After the allergy workup, drugs (41.7%) were considered the main cause of anaphylaxis, followed by food (25%). CONCLUSIONS: The incidence of anaphylaxis (0.08%) was double that estimated in the ED. Anaphylaxis is underdiagnosed. A correct diagnosis conditions the administration of epinephrine, regardless of the severity of symptoms. The real etiology of anaphylaxis should only be proposed after an allergy workup, which is recommended in all cases, as the real cause can differ considerably from the initial impression in the ED.

Allergic reaction to polyethylene glycol in a painter.

We report a case of a male painter who visited our outpatient clinic after developing a distinct skin reaction 15 min after the ingestion of a laxative solution containing polyethylene glycol (PEG) prior to colonoscopy. He described suffering from the same skin reaction when he was previously exposed to paints that contained PEG-4000. An exposure challenge test with pure PEG-4000, simulating his workplace conditions, elicited a generalized urticarial reaction. Allergy to PEG should be considered in painters who develop urticarial or other systemic symptoms after handling PEG-containing products.

Anaphylaxis in adolescent/adult patients treated in the emergency department: differences between initial impressions and the definitive diagnosis

Objectives: To contrast the initial suspected etiology of anaphylaxis with the postworkup diagnosis in patients attended at the emergency department (ED) of a tertiary-level hospital in Spain and to investigate the incidence, causes, and management of anaphylaxis. Methods: We performed an observational study of patients aged more than 15 years who came to the ED with anaphylaxis between 2009 and 2010. All clinical records from the ED were reviewed. We recorded data on clinical management, the etiology proposed by the attending emergency physician, and the cause reported by the patient. The findings were compared with the diagnosis reached after the allergy workup. Results: The incidence of anaphylaxis was 0.08%. The most common manifestation was skin-mucosal symptoms (98.3%). Anaphylaxis was diagnosed in the ED in only 44% of the cases, regardless of severity. Only 39.7% received epinephrine, which was administered more frequently when the ED physician diagnosed anaphylaxis, regardless of severity. A total of 60 patients were subsequently seen at the allergy department. The final etiology differed from the initial suspicion in the ED in 45% of cases. The frequency of anaphylaxis of uncertain origin decreased from 33.3% to 13.3%. After the allergy workup, drugs (41.7%) were considered the main cause of anaphylaxis, followed by food (25%). Conclusions: The incidence of anaphylaxis (0.08%) was double that estimated in the ED. Anaphylaxis is underdiagnosed. A correct diagnosis conditions the administration of epinephrine, regardless of the severity of symptoms. The real etiology of anaphylaxis should only be proposed after an allergy workup, which is recommended in all cases, as the real cause can differ considerably from the initial impression in the ED (AU)

Objetivos: Contrastar la etiología sospechada de la anafilaxia con el diagnóstico tras el estudio alergológico en la población atendida en el Servicio de Urgencias (SU) de un hospital español de tercer nivel, y determinar incidencia, causas y manejo de la anafilaxia. Métodos: Se realizó un estudio observacional con pacientes mayores de 15 años de edad del SU con anafilaxia, entre 2009 y 2010. Se revisaron las historias clínicas del SU. Se recogieron manejo clínico, impresión etiológica del médico de Urgencias y paciente. Éstos se compararon con el diagnóstico final tras el estudio alergológico. Resultados: La incidencia de anafilaxia fue 0,08%. La manifestación más frecuente fue la cutáneo-mucosa (98,3%). Sólo se diagnosticó de anafilaxia al 44% de los casos, independientemente de la gravedad. El 39,7% recibió adrenalina, más frecuentemente si se diagnosticaban de anafilaxia, independientemente de la gravedad. Un total de 60 pacientes se atendieron posteriormente en Alergología. La etiología final cambió en un 45% del sospechado en el SU. El origen incierto se redujo de un 33.3% a un 13.3%. Tras el estudio alergológico, la causa más frecuente fueron los fármacos (41,7%), seguidos de los alimentos (25%). Conclusiones: La incidencia de anafilaxia, 0,08%, dobló la estimada en el SU. La anafilaxia está infradiagnosticada, mientras que el diagnóstico correcto condiciona la administración de adrenalina, independientemente de la gravedad. La verdadera etiología de la anafilaxia debería considerarse tras el estudio alergológico, que se debería recomendar a todos los pacientes, ya que puede ser diferente de la impresión en el SU (AU)

Pork-cat syndrome as a cause of occupational asthma

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Anaphylaxis Caused by Flaxseed

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Specific oral tolerance induction in paediatric patients with persistent egg allergy

Introduction: Desensitisation or specific oral tolerance induction (SOTI) to food is a new topical-therapeutic approach of food allergy for those children who have not achieved tolerance spontaneously. The objective of this study is to induce clinical tolerance in children with persistent allergy using an oral desensitisation protocol with powdered pasteurised egg. Methods: Seventy-two patients with egg allergy confirmed by open oral challenge test were randomly assigned to SOTI or elimination diet as a control group. Forty children (5–15 years) underwent a SOTI beginning with 1mg and increasing the dosage weekly until a dose of 10g, equivalent to an egg. The control group included 32 patients (4–15 years). Results: The procedure's average duration was 10 weeks (range 4–28 weeks). Three patients were withdrawn from the protocol for persistent gastrointestinal symptoms. During SOTI, 21 children (52.5%) presented symptoms. In eight the symptoms were mild and required no treatment. In the other 13 (61.90%), the reactions were more severe. Seventeen children finished the treatment over a year ago and 20 in the past 6–12 months. Thirty-seven patients (92.5%) in the active group achieved tolerance to egg, versus 21.8% in the control group. We only found statistically significant differences (p<0.05) for skin prick tests with powdered egg at various dilutions and IgG levels with egg white after SOTI. Specific IgE concentration did not change significantly. Conclusions: Our SOTI protocol is a safe, effective treatment for food allergy and of reasonable duration, confirming that tolerance can be induced in children who have not achieved it spontaneously (AU)