ABSTRACT
BACKGROUND AND OBJECTIVES: Based on previous studies revealing acid-suppression medication as a risk factor for food allergy tolerance induction, we aimed to establish the importance of those findings in patients undergoing oral immunotherapy (OIT). MATERIALS AND METHODS, RESULTS: We describe a case series of four patients who underwent milk OIT with a concomitant use of proton pump inhibitor (PPI) medication and who developed anaphylaxis after a known, previously tolerated dose of milk. CONCLUSIONS: PPIs may act as a cofactor in patients undergoing OIT, triggering adverse reactions, irrespective of the PPI used or the dosage. It would be necessary to separate the administration of drug from food intake.Since OIT is a new form of treatment, long-term adverse events arising from PPI treatment and other possible triggers are still uncertain. Consequently, monitoring of patient must be prolonged over time. Additional investigations on the influence of different drugs in OIT maintenance phase are required.
Subject(s)
Anaphylaxis/etiology , Desensitization, Immunologic/methods , Eosinophilic Esophagitis/therapy , Food Hypersensitivity/therapy , Gastritis/therapy , Proton Pump Inhibitors/adverse effects , Animals , Child , Desensitization, Immunologic/adverse effects , Female , Humans , Male , MilkABSTRACT
INTRODUCTION: Primary meningococcal septic arthritis (PMSA) is an unusual manifestation of meningococcal disease. It is defined as the presence of acute septic arthritis without association with meningitis or the classic meningococcemia and isolation of Neisseria meningitidis in synovial fluid and blood culture. Diagnosis and early treatment, combining antibiotic and joint drainage, are fundamental. CASE PRESENTATION: We present the case of a healthy 17-year-old male who presented with history of an acute onset, painful knee accompanied by fever. N. meningitidis was cultured from the synovial fluid. He was treated with arthroscopic lavage and intravenous ceftriaxone for 2 weeks. He was discharged 7 days after admission receiving outpatient intravenous ceftriaxione for 6 days and was ultimately transitioned to oral ciprofloxacin for 2 weeks thereafter. At the final follow-up visit, he had returned to sports activity with a normal knee joint. LITERATURE REVIEW: We have done an exhaustive literature review in PubMed. Forty-four articles were included, with a total of 46 patients, to which we added ours. We collected the available demographic data, analytical values, culture tests, treatment, and evolution. PURPOSES AND CLINICAL RELEVANCE: This case illustrates an unusual presentation of N. meningitidis infection. Diagnostic suspicion is essential. Joint washing and antibiotics are the mainstays of treatment. Early and proper treatment prevents complications and mortality. Our main objective was to evaluate the diagnostics tools and treatment in PMSA. As a secondary objective, we evaluated the cases with negative cultures in order to evaluate the criteria for the diagnostic suspicion of PMSA.
