RESUMO
BACKGROUND: In Spain, IgE-mediated cow's milk protein allergy (CMPA) affects approximately 0.69% of infants. Molecular diagnosis may be useful for monitoring natural spontaneous tolerance development in CMPA. The aim of this study was to retrospectively analyse a cohort of paediatric patients with IgE-mediated CMPA who were avoiding milk products awaiting natural tolerance and determine the relationship between disease persistence and major cow's milk allergens. METHODS: A retrospective chart review of 200 patients diagnosed with IgE-mediated CMPA between 2011 and 2020 was conducted. Patients strictly avoided milk products until an oral food challenge was performed. The main outcome was the introduction of liquid milk following a negative oral food challenge and its correlation with IgE and SPT measurements of milk components at diagnosis. Secondary outcomes included the rate of allergic reactions and anaphylaxis during the treatment period and its correlation with IgE and SPT measurements. RESULTS: Of the 200 charts analysed, 122 patients had a negative oral food challenge to milk (61.0%) (95% confidence interval (CI): 54.1-67.5) following a period of strict avoidance of milk. Higher levels of component-specific IgE, especially casein, were associated with failure in the oral food challenge (p = 0.02). Allergic reactions were experienced by 106 children (53%), of which 34 (17%; 95% CI: 12.4-22.8) had anaphylactic reactions. The risk of anaphylaxis was not predicted by raised IgE levels. CONCLUSIONS: While a large proportion of children acquired natural tolerance to cow's milk following a period of strict avoidance, IgE-mediated CMPA persisted in many children. Casein IgE levels at diagnosis were raised in those who failed to achieve natural tolerance. Allergic reactions to milk, including anaphylaxis, occurred commonly, but this was not predicted by raised IgE levels or SPT measurements.
RESUMO
El eccema herpeticum es una infección cutánea causada por el virus del herpes simple que se presenta en pacientes con antecedentes de dermatitis atópica. Cursa con erupción vesiculosa localizada o generalizada y su curso suele ser leve, aunque puede presentar complicaciones graves. El diagnóstico es fundamentalmente clínico y el inicio precoz de aciclovir reduce la duración de la enfermedad y previene posibles complicaciones. Se presenta el caso clínico de un paciente con esta entidad, que no precisó ingreso (AU)
Eczema herpeticum is a skin infection caused by the herpes simplex virus that occurs in patients with a history of atopic dermatitis. It presents with a localized or generalized vesicular eruption and its course is usually mild, although it can present serious complications. The diagnosis is fundamentally clinical and the early administration of acyclovir reduces the duration of the disease and prevents possible complications. We present the clinical case of a patient with this entity, who did not require admission. (AU)
