ABSTRACT
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Subject(s)
Humans , Male , Female , Child , Food Hypersensitivity/complications , Food Hypersensitivity/diagnosis , Milk Hypersensitivity/diet therapy , Milk Hypersensitivity/diagnosis , Lactose Intolerance/complications , Lactose Intolerance/diagnosis , Milk Hypersensitivity/physiopathologyABSTRACT
Introduction: Food protein-induced enterocolitis syndrome (FPIES) occurs in infants. Typical symptoms include profuse vomiting and/or diarrhea several hours after ingestion of a given food. The disorder is a non-IgE mediated food hypersensitivity. The most frequently involved foods are milk and soy, but some cases of FPIES induced by solid foods have been described. We report 14 patients with FPIES due to fish protein. Material and methods: History and physical examination, skin prick test (SPT) with fish allergens and Anisakis simplex, prick-by-prick test with implicated fish and determination of specific IgE antibodies against fish were performed. In eight children atopy patch test (APT) were also performed. In nine patients an open oral food challenge with the implicated fish was carried out. Results: There were six boys and eight girls, aged from 9 to 12 months at diagnosis, with between two and six reactions to the offending fish proteins before the diagnosis was established. Four patients had a previous history of atopy. Presenting symptoms included diarrhea in two patients, profuse vomiting in six patients, and recurrent vomiting and subsequent diarrhea in three patients. In addition to these symptoms, associated septic appearance, apathy and lethargy were present in the remaining three patients. Onset of symptoms occurred a few minutes after fish ingestion in two patients and from 60 minutes to 6 hours in the 12 remaining patients. SPT to fish were negative in all patients. Serum food-specific IgE antibodies were negative in all patients except one. APT was positive in three patients. Open oral challenge (OC) was performed in nine infants and was positive in all. The patients were followed-up for between 1 and 7 years after diagnosis, and follow-up OC tests were performed after fish had been eliminated from the patients' diet for 3-4 years. Four patients became clinically tolerant to the causal food. Three patients currently tolerate only one type of fish (swordfish). Conclusions: We report 14 patients with FPIES caused by fish protein. The symptoms suggest a form of cell-mediated, non-IgE mediated food hypersensitivity. The gold standard for diagnosis is OC, although caution should be exercised in infants with several reactions or a recent diagnosis. After a period of elimination of the causal food from the diet, tolerance can develop
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Subject(s)
Child , Animals , Humans , Dietary Proteins/adverse effects , Enterocolitis/etiology , Food Hypersensitivity/etiology , Seafood/adverse effects , Diarrhea/etiology , Immunoglobulin E/immunology , Retrospective Studies , Vomiting/etiologyABSTRACT
Contact with the pine processionary caterpillar induces dermatitis, usually located in exposed areas, and, less frequently, ocular lesions through a toxic-irritative mechanism. Recently, the existence of an immediate hypersensitivity mechanism has been demonstrated, mainly in occupationally exposed patients. Objective: To present four patients who experienced allergic reactions (urticaria-angioedema and rhinitis-asthma) after non-occupational exposure to pine processionary caterpillar. Patients and methods: The four patients underwent allergy testing through skin prick tests (SPT), specific IgE detection and SDS-PAGE immunoblotting. One patient also underwent a specific bronchial challenge test with the pine processionary antigen. Results: In all patients, both SPT with the caterpillar extract and specific IgE were positive. Western blotting showed several IgE-binding bands with molecular mass values ranging from 18 to 107 kDa. A shift in the electrophoretic mobility of some of the relevant allergens occurred under the presence of a reductive agent (β -mercaptoethanol). The specific bronchial challenge test with pine processionary antigen performed in one of the patients also produced positive results. Conclusions: The results of this study show an immunologic IgE-mediated immediate hypersensitivity mechanism in these reactions. The processionary caterpillar's airborne urticating hairs or spicules should be considered, at least in some locations, not only as contact and occupational allergens, but also as seasonal aeroallergens (AU)
El contacto con la procesionaria del pino produce cuadros cutáneos, localizados generalmente en zonas expuestas, y, con menos frecuencia, oculares por un mecanismo toxico-irritativo. Recientemente, se ha demostrado un mecanismo de hipersensibilidad inmediata fundamentalmente en trabajadores expuestos ocupacionalmente. Objetivo: Presentar cuatro casos de pacientes que sufrieron reacciones alérgicas (urticaria-angioedema y rinitis-asma bronquial) tras exposición no ocupacional a procesionaria del pino.Material y métodos: En los cuatro pacientes se realizó estudio alergológico mediante pruebas cutáneas en prick, detección de IgE específica y SDSPAGE inmunotransferencia; siendo sometido, además, uno de los enfermos a prueba de provocación bronquial específica. Resultados: En todos los pacientes tanto la prueba cutánea con el extracto de oruga como la detección de IgE específica fueron positivas. En la inmunotransferencia se detectaron varias bandas fijadoras de IgE, con masas moleculares comprendidas entre 18 y 107 kDa. La movilidad electroforética de alguno de los alergenos relevantes se modifica por la presencia de un agente reductor ( Beta-mercaptoetanol). La prueba de provocación bronquial específica con Ag.de procesionaria del pino realizada en uno de los pacientes resultó, igualmente, positiva. Conclusiones: Los resultados del estudio efectuado muestran un mecanismo inmunológico de hipersensibilidad inmediata mediado por IgE en estas reacciones. Las espículas urticantes aerotransportadas de la procesionaria deberían considerarse, al menos en algunas localizaciones, como neumoalergenos estacionales y no sólo desde el punto de vista ocupacional (AU)
Subject(s)
Male , Middle Aged , Female , Adult , Humans , Animals , Child , Urticaria , Immunoglobulin E , Insect Proteins , Larva , Moths , Tissue Extracts , Hypersensitivity, Immediate , Spain , Angioedema , Allergens , Animal Structures , Asthma , Dermatitis, Allergic Contact , Skin Tests , Bronchial Provocation Tests , Rhinitis, Allergic, SeasonalABSTRACT
Asthma is one of the most common chronic chilhood disease. Asthmatic children need a self-management educational program, besides the medical treatment and clinical control. Camps are the ideal place to complete the educational program, to get the right control of the disease and to build the child confidence. Madrid Castilla la Mancha Allergy Society organizes every year a summer camp in a town, near Madrid. Fifty-four children stay for one week with certified allergists, fellows-in-training, nurses and cheer-leaders. Fifty-four children from 8 to 14 years old, with moderate to severe asthma participate in the camp. The camp includes educational, athletic and social activities. Campers participate daily in instructive and didactic teaching sessions. We evaluate quality of life with a questionaire filled in the camp and two months later. Results are analysed into two age groups, one between 8-10 years old and the other from 11 to 14 years old. The first group get a good management and improve their vision of the disease, quite the contrary, adolescents face up to a chronic disease with daily treatment, feeling asthma as a restriction of their autonomy. Even so, they identify crisis and learn to control them in an special risky life period. Asthma camps is a good experience for both groups and also for sanitary equipment (AU)
El asma constituye una de las enfermedades crónicas más frecuentes de la infancia. Los niños asmáticos precisan una educación sanitaria integral, que abarca el tratamiento médico, el control clínico y un programa de autocuidados que les ayude a conseguir un control adecuado de la enfermedad. Los campamentos son probablemente el lugar más adecuado para impartir dicho programa de autocuidados. La Sociedad Madrid Castilla la Mancha de Alergología e Inmunología Clínica organiza anualmente un campamento de verano para asmáticos, cuyo emplazamiento es un espacio natural de dicha Comunidad Autónoma. Un grupo de 54niños con edades comprendidas entre 8 y 14 años, con asma persistente moderada o grave participan en el campamento. Los niños conviven una semana con alergólogos, residentes de la especialidad, enfermeras y monitores de tiempo libre. Las actividades diarias van de la educación sanitaria impartida por el equipo médico, a juegos y deportes dirigidos por el equipo de monitores. El interés principal es que el niño asmático se instruya en los autocuidados necesarios para un adecuado desarrollo físico y psíquico. El objetivo de nuestro estudio es evaluar la calidad de vida en niños asmáticos y la repercusión que tiene un programa de autocuidados en dicha calidad de vida. Los niños rellenan un mismo cuestionario en el campamento y 2 meses después analizamos los resultados separando dos grupos de edad, uno entre 8-10 años y el segundo entre 11 y 14 años de edad. Los resultados sugieren que el primer grupo adquiere un buen manejo, mejorando su visión de la enfermedad, por el contrario el grupo de adolescentes se enfrenta a una enfermedad crónica que requiere un tratamiento diario, lo que supone una restricción de su autonomía. No obstante aprenden a identificar y a controlar las crisis en un período con especial riesgo vital. Los campamentos para niños asmáticos son una buena experiencia para ambos grupos de edad al igual que para el equipo sanitario (AU)
Subject(s)
Child , Adolescent , Male , Female , Humans , Camping , Self Care , Patient Education as Topic , Surveys and Questionnaires , Quality of Life , Asthma , Health Knowledge, Attitudes, PracticeABSTRACT
Introducción: La urticaria por frío se desencadena tras exposición a estímulos fríos, como agua, aire o alimentos. Es la tercera forma más frecuente de urticaria física en población pediátrica. Métodos y resultados: Revisamos 12 pacientes con urticaria por frío, analizando distintas variables con los siguientes resultados: edad media de 12 años y 9 meses, más frecuente en niñas, el 67 per cent eran atópicos y el 25 per cent padecían además otras urticarias físicas; en ningún caso había antecedentes familiares de la enfermedad. El 83 per cent presentaba síntomas locales y generales. La prueba de estimulación por frío fue positiva en el 92 per cent. La detección de crioglobulinas y crioaglutininas fue negativa en todos los casos que se investigaron. Sólo en 2 pacientes hubo un proceso infeccioso asociado. La mayoría fueron tratados con cetirizina con un 70 per cent de buenos resultados. La duración media de la enfermedad fue de 3 años y 6 meses y sólo el paciente con la prueba de estimulación por frío negativo permanece asintomático. Conclusiones: La urticaria por frío debe ser inicialmente diagnosticada por la prueba de estimulación por frío y la historia clínica. La cetirizina se ha mostrado eficaz y con menos efectos secundarios que otros antihistamínicos utilizados tradicionalmente. (AU)
Background: Cold urticaria is caused after exposition to cold air, water and food. It is the third more frequent physical urticaria in pediatric population. Methods and results: We reviewed twelve patients, studied different characteristics and obtained following results: mean age is 12 years and 9 months and it is more frequent in female subjects, atopy is present in 67 % of patients, other physical urticaria are present in 25 % and there is not familial inheritance. 83 % of patients have localized and generalized symptoms. Cold stimulation test is positive in 92 %. Cryoglobulins and cold agglutinins are negative in 100 % of patients in which these tests were made. There is infectious disease in only two patients. Cetirizine was used in most of patients and it was succesful in 70 %. Mean duration is 3 years and 6 months. Only patient with negative cold stimulation test remains without symptoms. Conclusions: Cold urticaria must be initially diagnosed by cold stimulation test and clinical history. Cetirizine is effective and cause less adverse effects than other antihistamines traditionally used (AU)
