[Allergy to egg proteins in children]. / Alergia a las proteínas del huevo en edad pediátrica.

Food allergy prevalence has increased during the last years, affecting 15-20% of children, in this case, egg allergy affects from 0.5-2.5%. Most of the egg allergic reactions are type I or IgE mediated antibodies against egg proteins. Five major proteins have been identified: ovomucoid (Gal d1), ovoalbumin (Gal d2), ovotransferrin (Gal d3), lysozyme (Gal d4) and albumin (Gal d5). Ovomucoid protein, which is found in the egg white, is heat resistant and enzyme resistant. This protein is the most allergenic and the most common in egg composition. Clinical diagnosis requires a detailed questionnaire. Skin prick test or Ige specific diagnosis are made as first choice. Skin prick tests are quick and useful to determine the presence of IgE specific antibodies to egg. Specific IgE for egg can be measured using standarized IgE studies in vitro, making a quantitative measure. Traditionally with the clinical history a diagnosis can be made. Standarized oral double blinded-placebo controlled challenge continues to be the gold standard for food allergy diagnosis. The identification and elimination of egg proteins from the diet is the primary treatment and the only one validated to this food, but there are more studies needed to stablish protocols for each specific egg allergen before the oral inmunotherapy becomes a routine practice.

La prevalencia de alergia alimentaria se incrementó en los últimos años: afecta de 15 a 20% de la población infantil; específicamente, la alergia al huevo afecta de 0.5 a 2% de población pediátrica. La mayor parte de las reacciones alérgicas al huevo son tipo I; es decir, son mediadas por anticuerpos de tipo IgE dirigidos contra proteínas contenidas en este alimento. Se ha identificado cinco alergenos mayores: ovomucoide (Gal d1), ovoalbúmina (Gal d2), ovotransferrina (Gal d3), lisozima (Gal d4) y albúmina (Gal d5). La mayor concentración de proteínas alergénicas están en la clara del huevo (Gal d1-4), mientras que en la yema de huevo sólo encontramos una (Gal d5). La proteína ovomucoide, que contiene la clara, es resistente al calor y a las enzimas digestivas; se considera la proteína con mayor poder alergénico y la ovoalbúmina es la proteína más abundante. El diagnóstico clínico requiere una detallada anamnesis. Por lo general, se realiza cualquiera de las pruebas (cutáneas o IgE específica) como primera opción. Las pruebas cutáneas son una prueba rápida y útil para determinar la existencia de anticuerpos IgE específicos al huevo. La IgE específica al huevo puede medirse cuantitativamente mediante estudios estandarizados de IgE in vitro. En conjunto con una buena historia clínica, se utilizan para apoyar el diagnóstico clínico. El reto oral estandarizado, doble ciego, controlado con placebo, aún es el patrón de referencia para el diagnóstico de alergia alimentaria. La identificación y eliminación en la dieta de la proteína de huevo responsable de las reacciones alérgicas es el tratamiento primario y el único validado contra la alergia a este alimento, pero se necesitan más estudios para establecer los protocolos para cada alergeno específico del huevo, antes de que la inmunoterapia oral se convierta en una práctica rutinaria.

Aproximación práctica al diagnóstico de la alergia alimentaria / Practical approach to the diagnosis of food allergy

La alergia alimentaria representa la primera expresión clínica de atopia durante la vida, ya sea con manifestaciones gastrointestinales o cutáneas, seguidas de asma y rinitis. A este continuo desarrollo de enfermedades se ha denominado "marcha atópica". Es un problema importante de salud, no sólo para los pacientes sino también incluye al grupo familiar y social. Se define como una respuesta inmunológica anormal ante la ingesta de proteínas alimenticias que ocasionan una reacción clínica adversa. La mayoría de las personas desarrolla tolerancia a los antígenos alimentarios, los cuales constantemente acceden al organismo. Sin embargo, cuando la tolerancia falla, el sistema inmune responde con reacciones de hipersensibilidad. El diagnóstico de la alergia alimentaria todavía es un ejercicio clínico que depende de una historia cuidadosa, de la determinación específica de IgE, pruebas de parche, una apropiada dieta de exclusión y la realización de reto cegado.

Food allergy has become the first clinical expression of atopy, beginning with dermal o gastric manifestations to continue with asthma an rhinitis ("the atopic march"), a very severe health problem not only for many children and parents, but also for the entire medical and paramedical community. Food allergy is defined as an abnormal immunological reaction to food proteins, which causes an adverse clinical reaction. Most of the people become tolerant to many foods; however, these tolerances sometimes fail and become an immunological reaction. The evaluation of a child with suspected food allergy includes detailed medical history, physical examination, screening tests and response to elimination diet and to oral food challenge. None of the screening tests -alone or in combination- can definitely diagnose or exclude it.

Carboplatin hypersensitivity and desensitization in an infant.

Although the reported incidence of carboplatin hypersensitivity is low, it is important to describe it because of its potentially fatal consequences. A 1-year-old Mexican girl weighing 10 kg who had optic nerve glioma was initially scheduled to receive 12 cycles of 600 mg/m2 carboplatin (CBP) as two 300-mg/m2 intravenous infusions administered over 1 hour on 2 different days and a 1-hour intravenous infusion of 1.5 mg/m2 vincristine every 4 weeks. The patient had no history of drug allergies or any type of adverse drug reaction, but she developed itchiness, maculopapular rash, sweating, respiratory distress, and anxiety during the seventh cycle of CBP. According to the algorithm developed by Naranjo et al, the adverse drug reaction was classified as definite secondary to CBP and confirmed by positive skin tests indicating hypersensitivity to the drug. After evaluating the clinical course of the adverse drug reaction and considering the need to continue cancer treatment, a decision was made to desensitize the patient to CBP. The desensitization procedure took 8 hours and was performed during each new chemotherapy cycle until the 12 cycles of chemotherapy were successfully completed. In summary, a case of CBP hypersensitivity in a 1-year-old girl who was successfully desensitized to CBP is reported.

[The role of acupuncture in asthma]. / El papel de la acupuntura en el asma.

Asthma is a chronic inflammatory syndrome of airways, in which different cells and their mediators play a role originating damage clinically expressed by recurrent respiratory symptoms. Current therapy of asthma is focused to reduce airway inflammation, diminishing long-term bronchial hyperactivity and rescue treatment (when required). Unfortunately, the failure of current therapies of asthma has increased the number of patients searching for approximations in complementary and alternative medicine. Scientific evidence is still scarce for establishing that alternative medicine is more effective than placebo in asthma. However, this does not mean that it is ineffective, maybe more multicentric clinical assays are needed, with methodological rigor, to establish final conclusions of efficacy and safety of complementary medicine. Thus, until such results are available, it is better to be skeptical and not to recommend acupuncture for asthma treatment.