Oral immunotherapy to hake in 8 pediatric patients

No disponible

Primary eosinophilic gastrointestinal disorders in children who have received food oral immunotherapy.

BACKGROUND: Food oral immunotherapy (OIT) involves the administration of the food allergen causing the symptoms, in order to induce tolerance. Primary eosinophilic gastrointestinal disorders (PEGDs) are characterised by an eosinophil-rich inflammation affecting different locations of the digestive tract. We present a series of patients with PEGDs in a group of children following OIT with milk and/or egg. MATERIAL AND METHODS: A prospective study during the period 2006-2014 was performed in paediatric patients subjected to OIT with milk and/or egg. When these children present persistent gastrointestinal symptoms, they are referred to the Paediatric Gastroenterology Unit for evaluation. RESULTS: Primary eosinophilic gastrointestinal disorders were diagnosed in eight of the 128 cases of OIT (6.25%). The time to PEGDs development was variable: two cases showed symptoms during OIT, and the rest with a median time of 29 months (15-48 months). Food treatment discontinuation was not required in four of the five cases of eosinophilic oesophagitis, although food removal was necessary in patients with eosinophilic gastroenteritis. CONCLUSIONS: We report the highest prevalence of PEGDs in children subjected to OIT, and the first cases of eosinophilic gastroenteritis following food OIT. The monitoring of new digestive signs and symptoms after OIT is crucial for the diagnosis of these disorders, and prolonged follow-up is required. The management of such patients and the need or not to eliminate the food should be assessed on an individualised basis, according to the severity of the condition, its evolution and response to different treatment alternatives.

Position document: IgE-mediated cow's milk allergy

The present document offers an update on the recommendations for managing patients with cow's milk allergy - a disorder that manifests in the first year of life, with an estimated prevalence of 1.6-3% in this paediatric age group. The main causal allergens are the caseins and proteins in lactoserum (beta-lactoglobulin, alpha-lactoalbumin), and the clinical manifestations are highly variable in terms of their presentation and severity. Most allergic reactions affect the skin, followed by the gastrointestinal and respiratory systems, and severe anaphylaxis may occur. The diagnosis of cow's milk allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which constitutes the gold standard for confirming the diagnosis. The most efficient treatment for cow's milk allergy is an elimination diet and the use of adequate substitution formulas. The elimination diet must include milk from other mammals (e.g., sheep, goat, etc.) due to the risk of cross-reactivity with the proteins of cow's milk. Most infants with IgE-mediated cow's milk allergy become tolerant in the first few years of life. In those cases where cow's milk allergy persists, novel treatment options may include oral immunotherapy, although most authors do not currently recommend this technique in routine clinical practice. Enough evidence is not there to confirm the efficacy of elimination diets in the mother and infant for preventing the appearance of cow's milk allergy. Likewise, no benefits have been observed with prebiotic and probiotic dietetic supplements in infants for preventing food allergy

No disponible

Documento de consenso sobre la actitud ante un niño con una reacción alérgica tras la vacunación o alergia a componentes vacunales / Consensus position document on the child with an allergic reaction after vaccination or an allergy to vaccine components

Las vacunaciones constituyen una de las principales herramientas de salud pública para el control de las enfermedades inmunoprevenibles. Si un niño es etiquetado de haber presentado una reacción alérgica a una vacuna es probable que se suspendan las siguientes inmunizaciones, con los riesgos que ello conlleva. La tasa de reacciones alérgicas graves es muy baja, oscilando entre 0,5 y 1/100.000 dosis. Las proteínas causantes de las reacciones alérgicas, más que los propios antígenos vacunales, son frecuentemente componentes residuales del proceso de fabricación, como son la gelatina y el huevo, y más raramente las levaduras o el látex. La mayoría de las reacciones son leves y localizadas en el lugar de la inyección, aunque en algunos casos pueden producirse reacciones anafilácticas graves. Si se sospecha que se ha producido una reacción alérgica inmediata a la vacuna, o si debemos vacunar a un niño con alergia a alguno de sus componentes, se deberá realizar un correcto diagnóstico de la posible alergia y conocer los componentes habituales de cada vacuna con el fin de determinar si la vacunación puede continuarse de forma segura

Vaccinations are one of the main public health tools for the control of vaccine-preventable diseases. If a child is labeled to have had an allergic reaction to a vaccine, the next immunizations will probably be suspended in that child, with the risks involved in this decision. The rate of severe allergic reactions is very low, ranging between 0.5-1/100,000 doses. The causes of allergic reactions to vaccines, more than the vaccine itself, are often due to residual protein components in the manufacturing process, such as gelatin or egg, and rarely to yeast or latex. Most of vaccine reactions are mild, localized at the site of injection, but in some circumstances, severe anaphylactic reactions can occur. If an immediate-type allergic reaction is suspected when vaccinating, or a child allergic to some of the vaccine components has to be vaccinated, a correct diagnosis of the possible allergy has to be made. The usual components of each vaccine should be known, in order to determine if vaccination can be performed safely on the child

Position document: IgE-mediated cow's milk allergy.

The present document offers an update on the recommendations for managing patients with cow's milk allergy - a disorder that manifests in the first year of life, with an estimated prevalence of 1.6-3% in this paediatric age group. The main causal allergens are the caseins and proteins in lactoserum (beta-lactoglobulin, alpha-lactoalbumin), and the clinical manifestations are highly variable in terms of their presentation and severity. Most allergic reactions affect the skin, followed by the gastrointestinal and respiratory systems, and severe anaphylaxis may occur. The diagnosis of cow's milk allergy is based on the existence of a suggestive clinical history, a positive allergy study and the subsequent application of controlled exposure testing, which constitutes the gold standard for confirming the diagnosis. The most efficient treatment for cow's milk allergy is an elimination diet and the use of adequate substitution formulas. The elimination diet must include milk from other mammals (e.g., sheep, goat, etc.) due to the risk of cross-reactivity with the proteins of cow's milk. Most infants with IgE-mediated cow's milk allergy become tolerant in the first few years of life. In those cases where cow's milk allergy persists, novel treatment options may include oral immunotherapy, although most authors do not currently recommend this technique in routine clinical practice. Enough evidence is not there to confirm the efficacy of elimination diets in the mother and infant for preventing the appearance of cow's milk allergy. Likewise, no benefits have been observed with prebiotic and probiotic dietetic supplements in infants for preventing food allergy.

[Consensus position document on the child with an allergic reaction after vaccination or an allergy to vaccine components]. / Documento de consenso sobre la actitud ante un niño con una reacción alérgica tras la vacunación o alergia a componentes vacunales.

Vaccinations are one of the main public health tools for the control of vaccine-preventable diseases. If a child is labeled to have had an allergic reaction to a vaccine, the next immunizations will probably be suspended in that child, with the risks involved in this decision. The rate of severe allergic reactions is very low, ranging between 0.5-1/100,000 doses. The causes of allergic reactions to vaccines, more than the vaccine itself, are often due to residual protein components in the manufacturing process, such as gelatin or egg, and rarely to yeast or latex. Most of vaccine reactions are mild, localized at the site of injection, but in some circumstances, severe anaphylactic reactions can occur. If an immediate-type allergic reaction is suspected when vaccinating, or a child allergic to some of the vaccine components has to be vaccinated, a correct diagnosis of the possible allergy has to be made. The usual components of each vaccine should be known, in order to determine if vaccination can be performed safely on the child.

Recommendations for administering the triple viral vaccine and antiinfluenza vaccine in patients with egg allergy.

Actually, food allergy is an emerging pathology; and egg allergy is the most frequent in childhood. The recommendations for measles, mumps and rubella (MMR) and influenza vaccination are increasing each year. This implementation increases the exposure of patients with egg allergy to such vaccines. In Spain, since 2004 the only available vaccine for MMR is grown in cultures of fibroblast from chick embryos; previously, patients with egg allergy were vaccinated with an alternative vaccine cultivated in diploid human cells which is no longer commercialized. Influenza vaccines grow in chick egg and the final product contains egg proteins (large variation in egg protein content has been reported). As controversy exist, the Food Allergy Committee of Spanish Society of Clinical Immunology and Pediatric Allergy decided to report some recommendations for the safe administration of MMR and influenza vaccines in patients with egg allergy. In summary, MMR vaccine is safe for children with egg allergy, only in patients with severe anaphylactic reaction after egg ingestion is recommended the administration in his reference hospital. Influenza vaccine is contraindicated in patients with severe anaphylactic reaction after egg ingestion. The rest can receive influenza vaccine in a 2-dose protocol with a vaccine that contains no more than 1.2 mcg of egg protein for mL.

Recommendations for administering the triple viral vaccine and antiinfluenza vaccine in patients with egg allergy / Recomendaciones para la administración de la vacuna triple vírica y la vacuna anti-influenza en pacientes con alergia al huevo

Actually, food allergy is an emerging pathology; and egg allergy is the most frequent in childhood. The recommendations for measles, mumps and rubella (MMR) and influenza vaccination are increasing each year. This implementation increases the exposure of patients with egg allergy to such vaccines. In Spain, since 2004 the only available vaccine for MMR is grown in cultures of fibroblast from chick embryos; previously, patients with egg allergy were vaccinated with an alternative vaccine cultivated in diploid human cells which is no longer commercialized. Influenza vaccines grow in chick egg and the final product contains egg proteins (large variation in egg protein content has been reported). As controversy exist, the Food Allergy Committee of Spanish Society of Clinical Immunology and Pediatric Allergy decided to report some recommendations for the safe administration of MMR and influenza vaccines in patients with egg allergy. In summary, MMR vaccine is safe for children with egg allergy, only in patients with severe anaphylactic reaction after egg ingestion is recommended the administration in his reference hospital. Influenza vaccine is contraindicated in patients with severe anaphylactic reaction after egg ingestion. The rest can receive influenza vaccine in a 2-dose protocol with a vaccine that contains no more than 1.2 mcg of egg protein for mL

En la actualidad, la alergia alimentaria constituye una patología emergente; siendo la alergia al huevo la más frecuente en la infancia. Las recomendaciones para la vacunación de sarampión, parotiditis y rubéola (vacuna triple vírica), así como para la vacuna antigripal, aumentan cada año. El cumplimiento de estas recomendaciones aumenta la exposición de pacientes alérgicos al huevo a dichas vacunas. En España, desde el año 2004 solo se dispone de vacuna triple vírica cultivada en fibroblastos de embrión de pollo; anteriormente, los pacientes alérgicos al huevo se inmunizaban con una vacuna alternativa cultivada en células diploides humanas que no se comercializa actualmente. La vacuna antigripal se cultiva en huevos de gallina y el producto final contiene proteína de huevo (la cantidad en proteína de huevo es muy variable). Dada la existente controversia, el Comité de Alergia Alimentaria de la Sociedad Española de Inmunología Clínica y Alergia Pediátrica ha decidido establecer una serie de recomendaciones para la administración segura de la vacuna triple vírica y la vacuna antigripal en pacientes alérgicos al huevo. En resumen, la vacuna triple vírica es segura para los niños alérgicos al huevo, sólo en los pacientes con reacción anafiláctica grave tras la ingesta de huevo se recomienda su administración en su hospital de referencia. La vacuna antigripal está contraindicada en pacientes con reacción anafiláctica grave tras la ingesta de huevo. El resto pueden vacunarse con una administración fraccionada en 2 dosis y con una vacuna que contenga igual o menos de 1.2 mcg de proteína de huevo por ml

Recomendaciones para la administración de la vacuna antigripal en pacientes alérgicos al huevo / Recommendations for administration of the influenza vaccine

No disponible

Alergia a Anisakis simplex / Anisakis simplex allergy

Introducción: Anisakis simplex es un parásito helminto del pescado y cefalópodos, de distribución mundial, siendo causante de la anisakiasis o parasitación del hombre por la larva viva y/o de cuadros de reacciones alérgicas por hipersensibilidad frente a diferentes proteínas parasitarias. Este trabajo revisa los estudios existentes sobre este parásito, su ciclo biológico, manifestaciones clínicas, métodos diagnósticos y medidas preventivas a adoptar. El ciclo biológico incluye una forma adulta y tres estadios larvarios, siendo el ser humano huésped accidental. Existen tres grupos de moléculas antigénicas: somática, secretora/excretora y de superficie. Se sospecha el diagnóstico relacionando clínica e ingesta de pescado con buena tolerancia al alimento en otras ocasiones. Disponemos de 2 tipos básicos de pruebas diagnósticas: prick test y determinación de Ig E específica (CAP, RAST), con menor sensibilidad que las pruebas cutáneas. La provocación oral controlada con larva muerta del parásito confirma el diagnóstico de alergia clínica. Hay numerosas reacciones cruzadas entre Anisakis y otros parásitos dificultando el diagnóstico y siendo posible causa de la alta prevalencia de sensibilización en España. Conclusiones: La infestación del pescado por Anisakis representa un problema de salud pública. Sospechar alergia en casos de reacciones compatibles relacionadas con la ingesta de distintos tipos de pescado. La mejor forma de prevención es el cocinado o la congelación del pescado. En España el cumplimiento de la normativa de conservación y manipulación del pescado es incompleta (AU)

Coma en un lactante por intoxicación con "cannabis" / Coma in an infant due tu "cannabis" poisoning

La intoxicación por cannabis en niños es rara. Presentamos el caso de un lactante de 12 meses de edad que fue llevado al servicio de Urgencias en estado de coma. Finalmente, se demostró que la causa del coma era una intoxicación por cannabis. Se revisan aquí las intoxicaciones comunicadas en la bibliografía médica, así como el manejo de dicha entidad (AU)

Escorbuto asociado a enfermedad celíaca / Scurvy associated with celiac disease

No disponible

Panarteritis nudosa (PAN). Forma cutánea / Cutaneous polyarteritis nodoso

Niña de 10 años con cuadro de mialgias en región gemelar que le dificulta la de ambulación v aparición de un exantema no pruriginoso, con algunos elementos nodulares en región tibial pre y posterior, y lesiones micropapulares en nalgas y muslos, sin afectación palmoplantar, acompañado de mal estado general, astenia y abdominalgia pasajera. A febril. Presentaba una exploración física normal, salvo lo referido, e intensa hiperemia de pilares amigdalinos anteriores. Entre las pruebas complementarias destaca el aislamiento de Streptococcus pyogenes en el frotis faríngeo y ASLO elevado (800 UI), con una biopsia cutánea compatible con panarteritis nudosa. Durante su ingreso recibió tratamiento con penicilina por vía oral durante 10 días negativizándose el frotis faríngeo. Presentó dolor intenso espontáneo y a la palpación en región gemelar que cedió de forma gradual. Las lesiones cutáneas fueron desapareciendo progresivamente dejando áreas residuales de hiperpigmentación. La infección estreptocócica se puede asociar a panarteritis cutánea, que puede evolucionar a panarteritis sistémica, por lo que se debe vigilar estrechamente a estos niños (AU)

Status asthmaticus: is respiratory physiotherapy necessary?

We present the case of a four year-old girl diagnosed of moderate extrinsic asthma that in the course of an episode of asthmatic status, she presented after treatment with respiratory physiotherapy an abrupt worsening of its clinical state, with appearance of a pneumotorax that precised intensive care treatment. The use of respiratory physiotherapy is dissuaded as part of the treatment in the initial phase of acute asthma, being reserved this treatment later in the recovery phase, anytime when a component of hypersecretion exists and the intensity of the bonchoconstriction has diminished (AU)

Se presenta el caso clínico de una niña de cuatro años de edad, diagnosticada de asma extrínseca moderada que en el curso de un estatus asmático, tras la realización de tratamiento con fisioterapia respiratoria, presentó un brusco empeoramiento de su estado clínico con aparición de neumotórax que precisó asistencia intensiva. Se desaconseja la utilización de la fisioterapia respiratoria como parte del tratamiento en la fase aguda inicial de las crisis de asma, reservándose para el período posterior de recuperación siempre y cuando exista un componente secretor importante (AU)

Status asthmaticus: is respiratory physiotherapy necessary?

We present the case of a four year-old girl diagnosed of moderate extrinsic asthma that in the course of an episode of asthmatic status, she presented after treatment with respiratory physiotherapy an abrupt worsening of its clinical state, with appearance of a pneumotorax that precised intensive care treatment. The use of respiratory physiotherapy is dissuaded as part of the treatment in the initial phase of acute asthma, being reserved this treatment later in the recovery phase, anytime when a component of hypersecretion exists and the intensity of the bonchoconstriction has diminished.