Cross allergic reactions in infants and toddlers with atopic dermatitis.

PURPOSE: Prevalence and clinical significance of cross sensitization in children up to 3 years old, diagnosed with atopic dermatitis. MATERIAL AND METHOD: The retrospective study included 69 children up to 3 years old with atopic dermatitis. Allergological diagnostics was performed based on skin tests, determination of total IgE concentration and allergen-specific IgE. RESULTS: Cross sensitization was found in 26% of children. Other patients were qualified to the control group. The sensitization to trees pollen and fruits as well as grass pollen and vegetables were the most frequent types of cross allergy. The patient's family history was positive with regard to atopy in 72% of children from the study group vs. 31% of children from the control group. The statistically higher prevalence of allergic rhinitis and bronchial asthma as well as co-existence of sensitization to house dust mite and animal dander were revealed in the study group. The total concentration of IgE, eosinophilia and SCORAD values were statistically higher in the study group. Children with cross sensitization required systemic steroid therapy more frequently. CONCLUSION: In children up to 3 years with atopic dermatitis and sensitization to plant pollen, the role of a pollen-food allergy syndrome must be taken into account in the pathogenesis of the disease. In children with cross sensitization, the course of atopic dermatitis is more severe; the symptoms from the respiratory and digestive system co-exist. The positive family history is a factor, predisposing to the development of cross sensitization in infants and toddlers.

The natural history of cow's milk allergy in north-eastern Poland.

PURPOSE: The rate of cow's milk allergy diminishes with age. There is not enough information concerning geographical trends in persistent cow's milk allergy in children. The objective of the study was to evaluate the prevalence of persistent cow's milk allergy in children previously diagnosed with IgE-mediated cow's milk allergy (CMA). MATERIAL/METHODS: Diagnosis of cow's milk allergy was established by a medical history of symptoms associated with exposure to cow's milk, positive skin prick tests with cow's milk, the presence of milk-specific IgE, and by a positive double- or single-blind placebo-controlled food challenge with milk confirmed by a positive open-controlled milk challenge. A second oral challenge was performed after at least one year of a milk-free diet and children with a positive oral milk rechallenge were diagnosed as having a persistent CMA. RESULTS: Two hundred ninety-one children, 2-14 years of age (mean 5.30±3.16 years, 95% CI, 5.02-5.62 years) completed the study. Persistent CMA was diagnosed in 79 patients (27.1%). Two hundred twelve children (72.9%) outgrew their allergy to cow's milk at a mean age of 5 years after an average time of 16.4±0.8 months on an elimination diet. Eighty percent of children below 3 years of age became milk tolerant. Milk-specific IgE (p=0.018) and history of paternal bronchial asthma and/or rhinitis (p=0.020) were associated with persistence of cow's milk allergy in regression analysis. CONCLUSIONS: An age above 3 years, as well as features of atopy, individual and familial, may be associated with a risk of delayed tolerance to milk in children.

Atopy patch test in the diagnosis of food allergy in children with gastrointestinal symptoms.

PURPOSE: To evaluate the diagnostic accuracy of the atopy patch test (APT) in detection of delayed-type sensitization to different food allergens, in children with digestive symptoms and with/or without cow's milk allergy. MATERIAL AND METHODS: 28 children suspected of food allergy-related gastrointestinal symptoms were underwent diagnostic procedures as skin prick test (SPT), specific immunoglobulin E (sIgE), APT, oral food challenge and then divided into two groups according to the results of oral food challenge: A - 17 children with cow's milk allergy, B - 11 children without cow's milk allergy. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of APT were calculated. RESULTS: A positive challenge response to milk was found in 60,7% of examined children. No statistical difference in the prevalence of positive SPT and sIgE to milk has been found between the groups. The prevalence of positive APT to other food allergens was significantly higher in children with allergy to milk (p<0,005). No statistical difference of positive APT to other food allergens has been found in children with/or without cow's milk allergy. APT sensitivity and specificity in children with cow's milk allergy obtained on 77%/73%; where PPV obtained on 71%. CONCLUSIONS: High sensitivity and specificity of APT confirm its accuracy in diagnostics of delayed-type reactions in children with gastrointestinal symptoms. Combined atopy patch test and oral food challenge is essential for avoidance of unnecessary elimination diet. Delayed-type sensitization to other food allergens is common in children with cow's milk allergy.

Atopy patch test in the diagnosis of food allergy in children with atopic eczema dermatitis syndrome.

PURPOSE: Food allergy has been demonstrated to play an important role in the pathogenesis of atopic eczema dermatitis syndrome (AEDS), affecting often atopic infants and young children. The most commonly offending foods are cow's milk, hen's egg, wheat and soy; implicating immediate (IgE-mediated) and late-phase (T-cells) immunological reactions in the pathogenesis of skin lesions. The diagnostic work-up of suspected immediate food reactions includes skin prick tests (SPT) and the measurement of food-specific antibodies (sIgE). The methodology of atopy patch test (APT) has been reported as a diagnostic tool with high predictive capacity for late-phase clinical reactions in children with atopic dermatitis. Although APT has been introduced into the diagnostic procedure for food allergy, its diagnostic accuracy remains still controversial; especially in older children. The aim of study was to evaluate the diagnostic accuracy of the atopy patch test in the detection of food allergy in correlation with SPT, sIgE and positive oral food challenge to milk, in children suffering from AEDS and to assess the sensitivity and specificity of this method in dependence on the age of investigated children. MATERIAL AND METHODS: 34 children (25 boys, 9 girls) aged 5 months-16 years with suspicion of milk-related AEDS were investigated. These patients were subdivided into 2 age groups: group A--20 children (<3 years), group B--14 children (>3 years). The diagnostic procedures as skin-prick tests and atopy patch test were performed. The specific IgE to cow's milk allergens were also measured. The open and blind diagnostic oral food challenge were performed to verify the results of tests. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive value of APT were calculated in both age groups. RESULTS: A positive challenge response to milk was found in 65.0% of investigated children in group A and in 35.7% in group B. No statistical differences in the prevalence of immediate (p<0.1905) and delayed-type (p<0.409) reactions has been found between age groups. Positive APT to milk were noticed in 55.0% of patients in group A and in 35.7% of children from group B, that has been in correlation with positive delayed-type reactions in oral food challenge in 72.7% and 80.0% in corresponding age groups. Polysensitization to other food allergens confirmed by SPT and/or sIgE was detected in 35.0% of patients younger than 3 years of age and in 50.0% of older children. The prevalence of positive APT to other foods (soy, rice, maize, cereals) was significantly higher (p<0.0073) in the polysensitized children from group A. Sensitivity of SPT/sIgE in children with immediate-type reactions to milk was 100%, specificity 94%. Sensitivity of APT to cow's milk in children with late-phase reactions was 80% in both age groups; specificity 70%/89% with comparable PPV in both groups (73%/80%). Parallel skin testing with combined patch test and evaluation of sIgE enhanced the value of sensitivity to 92% in the group A and specificity to 89% in the group B. For PPV corresponding figures were 85%/80%. CONCLUSIONS: APT was found to be more sensitive and specific method than SPT/sIgE in diagnosing delayed food allergy in children with AEDS. No age correlation between positive results of APT and oral food challenge and higher specificity of APT in older children confirm its accuracy in diagnosing delayed cow's milk allergy in all age groups of children. Combined skin prick and patch testing significantly enhances identification of food allergy in children with AEDS. The outcome of the APT with food does not seem to be influenced by age of children, but because of its variability of sensitivity and specificity, a diagnosis of food allergy should be confirmed by oral food challenge.

Immunoblotting in the diagnosis of cross-reactivity in children allergic to birch.

PURPOSE: The scientific experiments with new immunological methods (immunoblotting, RAST inhibition) and isolation of recombinant allergens suggest structural similarities in the allergenic components responsible for cross-reactions. Immunochemical and molecular biology studies indicate that epitopes of major allergen (Bet v 1, Mal d 1) contain more IgE binding epitopes than minor allergens (Bet v 2, Mal d 2), what explained clinical importance of major birch and apple allergens, but it is individual. The important role in cross-reactivity play also proteins with low molecular weight; a potentially dangerous allergen is lipid transfer protein (LTP) inducing severe systemic reactions in allergic subjects. The recent studies indicate that the IgE cross-reactivity patterns and the clinical relevance is still not clear and that only some of patients with confirmed IgE cross allergy to Bet v 1 and Mal d 1 demonstrated clinical symptoms after ingesting of apple. The aim of study was to establish the pattern of cross-reactivity between major (Bet v 1) and minor (Bet v 2) birch pollen allergens and apple proteins in children allergic to birch using recombinant allergens and immunoblotting method. MATERIAL AND METHODS: The prospective study were carried out on the group of 13 children aged 4-16 years, referred to the IIIrd Department of Paediatrics in Bialystok and outpatient clinic with clinical symptoms of food and inhalant allergy. Inclusion criteria to the study were: allergy to birch pollen recombinant allergens and apple, confirmed by presence of specific IgE in the sera of patients. The allergens from peel and pulp of apple and birch were separated and loaded onto the polyacrylamide electrophoretic gel and than transferred to membranes by Western blotting. Antigen-IgE complex was detected using goat anti-human IgE antibodies labelled with alkaline phosphatase. RESULTS: Only few sera presented strong reactions in immunoblotting to birch pollen proteins with a molecular weight of 17-18 kDa, corresponding to the main birch allergen Bet v 1. Most of sera having positive reaction vs Bet v 1 showed cross-reactivity with Mal d 1. All sera recognized specifically the main allergen of apple peel Mal d 3 with molecular weight < 10 kDa (Lipid Transfer Protein). CONCLUSIONS: Immunoblotting method allows to verification of cross-reactivity recognized by presence of specific IgE. The nature of proteins responsible for sensitization can influence the spectrum of offending foods and the clinical features of allergic reactions.

Diagnostic value of birch recombinant allergens (rBet v 1, profilin rBet v 2) in children with pollen-related food allergy.

PURPOSE: Pollen-related food allergy to fresh fruits and vegetables is a well-known clinical phenomenon. Bet v 1, the major birch pollen allergen, has been cloned and shows homologies to various food allergens (e.g. hazelnut, apple, celery, tomato). Allergy to profilin Bet v 2 was also described in 10-15% of patients sensitized to birch pollen. Objective of our work was to assess the diagnostic value of recombinant allergens (rBet v 1, rBet v 2) for diagnosis of children sensitized to birch pollen with associated food allergy. MATERIAL AND METHODS: The investigations were carried out on the group of 14 children aged 4-17 years, with a history of allergic reactions and sensitized to birch pollen with associated food allergy. Skin prick tests were performed with natural foods and commercial aeroallergens (Bencard). Sera-specific IgE antibodies to recombinant and other allergens (Pharmacia Upjohn) were measured with a fluoroimmunoenzymatic essay (UniCAP). Oral food challenge tests were performed to confirm adverse food reactions. RESULTS: 64% were sensitized to rBet v 1, 14% to rBet v 2, 7% to both of them. 50% of children with allergy to Bet v 1 had also concomitant allergy to other pollens and food allergy to fruits from family Rosaceae. Patients with positive reaction to Bet v 2 represented allergy to vegetables from family Umbelliferae. The most common form of allergic reactions were: allergic rhinitis in 64%, atopic dermatitis in 36%, oral allergy syndrome in 21% of investigated children. CONCLUSIONS: Use of two recombinant allergens permits the diagnosis of birch pollen sensitization in children with food-pollen related allergy and gives the pattern of possible cross-reactivity between pollen and food allergens in children with allergic diseases.

Effectiveness of Nutramigen and Prosobee in children with cow's milk protein intolerance.

100 children (61 boys and 39 girls) aged between 5 months and 9 years, with diagnosed cow's milk protein intolerance with symptoms of the gastrointestinal tract, skin, respiratory tract and nervous system, were examined. They were treated with an elimination diet (Nutramigen and Prosobee--47% and 53% of children respectively). Total and partial improvements of clinical complaints were observed in 42% and 37% of children respectively.

Clinical trials of Astemizol in children with cow's milk hypersensitivity.

A group of 36 children aged from 1 10/12 to 11 years was the subject of clinical and laboratory examinations. It was found that there is a close relationship between food hypersensitivity to milk and symptoms of the skin (81%), upper (61%) and lower (55%) respiratory tract, digestive tract (47%) and central nervous system (14%). These symptoms occured in isolated or associated forms on the different organs or systems. An elimination diet and pharmacological treatment with Astemizol were used in all children from the investigated group. Complete relief of symptoms was observed in 39% of children; 44% of examined patients had a regression of symptoms of 1 and/or 2 organs. Side effects of treatment with Astemizol were observed in the form of excessive appetite (22%), body weight gain (3%), vomiting (3%), diarrhoea (3%), bleeding from the nose (3%), sleepiness (5%). Due to the good therapeutic effect and insignificant side effects, the supporting pharmacological treatment with Astemizol was found useful in children with hypersensitivity to cow's milk.

The assessment of the therapeutic effectiveness of IRS-19 in allergic children with recurrent or chronic respiratory infections.

The subject of the clinical-laboratory examinations was a group of 36 children aged 1 4/12 - 17 years with recurrent upper (94%) and lower (63%) airway infections, whose condition did not improve after antibiotic therapy, elimination diet and anti-histaminic treatment. In 83% of the examined patients respiratory tract symptoms co-existed with skin (61%), gastrointestinal tract (44%) and OUN (16%) diseases. 75% of examined children, with humoral and/or cellular response disorders, were given an IRS-19 vaccine, which resulted in the regression of the respiratory tract symptoms in 78% of patients. Due to side-effects in the form of high temperature, the treatment was terminated in 14% of children. The obtained therapeutic effects and convenience of administration of the vaccine, justify IRS-19 treatment in children with recurrent lower and upper airway infections, after complex immunological examination.