As soon as possible in IgE-cow's milk allergy immunotherapy.

Oral immunotherapy is a common treatment in cow's milk protein allergy. The Department of Pediatric Allergology at the Children's Hospital of Zaragoza performed a retrospective analysis of 335 infants under 1 year of age diagnosed with IgE-mediated cow's milk and early treated. Clinical evaluation, skin prick test, and serum-specific IgE level control were performed before starting and after finishing treatment. Upon completion of treatment, more than 98% of patients became tolerant to milk and no one presented serious adverse reactions. Nowadays, the remaining non-tolerant patients (1.8%) can take milk or derivatives daily-as prophylaxis-to a certain maximum dose and still remain asymptomatic. After immunotherapy, both positive skin prick tests and a progressive decrease in specific IgE levels were found, as desensitization to milk increased.Conclusion: Oral immunotherapy is a safe and effective treatment against allergy to cow's milk proteins in infants. Such treatment should be offered to the children's families from the first moment of diagnosis. What is known: • Cow's milk proteins are responsible for the earliest IgE-mediated allergic reactions in children. • Oral immunotherapy (OIT) is commonly used as cow's milk allergy treatment and it is proposed at different ages. What is new: • OIT it is an effective and safe method with no severe reactions at early ages. • The number of reaching successful treatments is awesome so we believe that immunity response can be molded at the first months of life, so the probability of success with infants is greater than in older children.

Evolución natural de la pubarquia precoz y posibles patologías asociadas / Natural progression of premature pubarche and underlying diseases

INTRODUCCIÓN: La pubarquia precoz (PP) es generalmente considerada como una enfermedad benigna, pero puede ser el primer signo de una enfermedad subyacente. OBJETIVO: Analizar la etiología y la evolución de parámetros antropométricos, analíticos y de riesgo metabólico, en pacientes con PP. MATERIAL Y MÉTODOS: Estudio retrospectivo, descriptivo y analítico, de 92 pacientes afectos de PP. Se evaluaron medidas antropométricas y analíticas, la edad ósea y marcadores de metabolismo lipídico. RESULTADOS: Muestra de 92 pacientes (67 mujeres y 25 varones) con PP, con una edad media de 7,1 ± 0,6 años las mujeres y 8,3 ± 0,7 los varones. El 7,7% fueron pequeños para la edad gestacional. La edad ósea estaba adelantada (1,2 ± 0,1 años). Veintiún pacientes fueron clasificados como PP idiopática (23%), 60 como adrenarquia precoz idiopática (65%) y 11 como hiperplasia suprarrenal congénita no clásica (12%). La pubertad se mostró adelantada respecto a la media (11 ± 0,9 años en varones versus 9,9 ± 0,8 años en mujeres), así como la edad de la menarquia (11,8 ± 1,1 años), p < 0,001. La talla final alcanzada es próxima a la talla genética. Existe una correlación positiva entre el Z-score del índice de masa corporal, la glucemia y el colesterol LDL, así como una tendencia a la hiperinsulinemia. CONCLUSIONES: El presente estudio demuestra como la PP en la mayoría de los casos supone una patología benigna, no siendo infrecuente la hiperplasia suprarrenal congénita no clásica (12%). Estos pacientes presentaron un adelanto puberal, de la edad ósea y de la menarquia. El crecimiento fue adecuado, alcanzando prácticamente su talla genética. La PP asociada a obesidad presenta alteraciones analíticas de riesgo metabólico

INTRODUCTION: Premature pubarche (PP) is generally thought to be a benign condition, but it can also be the first sign of underlying disease. OBJECTIVE: To analyse the aetiology and the evolution of the anthropometric, analytical and metabolic risk parameters of a group of patients with PP. MATERIAL AND METHODS: A descriptive and analytical retrospective study of 92 patients affected by PP. Anthropometry, analyses, bone age and indicators of lipid metabolism were all evaluated. RESULTS: The sample included 92 patients with PP (67 female and 25 male), with a mean age of 7.1 ± 0.6 for girls and 8.3 ± 0.7 for boys. Small for gestational age was recorded in 7.7%. There was an accelerated bone age (1.20 ± 0.1 years). A total of 21 patients were classified as idiopathic (23%), 60 as idiopathic premature adrenarche (65%), and 11 with non-classic congenital adrenal hyperplasia (12%). Puberty was reached early (11 + 0.9 years old in boys and 9.9 ± 0.8 in girls), as was menstruation age (11.8 + 1.1 years old), P < .001. The stature finally reached was close to their genetic stature. There is a positive correlation between body mass index, blood glucose and LDL cholesterol, as well as a tendency towards hyperinsulinaemia. CONCLUSIONS: The present study shows that PP is a benign condition in the majority of cases, but non-classic congenital adrenal hyperplasia (12%) is not uncommon. Menstruation and puberty started early and bone age was accelerated. Growth was normal, and more or less in line with genetic size. PP associated with obesity is linked with analytical variations of metabolic risks

[Natural progression of premature pubarche and underlying diseases]. / Evolución natural de la pubarquia precoz y posibles patologías asociadas.

INTRODUCTION: Premature pubarche (PP) is generally thought to be a benign condition, but it can also be the first sign of underlying disease. OBJECTIVE: To analyse the aetiology and the evolution of the anthropometric, analytical and metabolic risk parameters of a group of patients with PP. MATERIAL AND METHODS: A descriptive and analytical retrospective study of 92 patients affected by PP. Anthropometry, analyses, bone age and indicators of lipid metabolism were all evaluated. RESULTS: The sample included 92 patients with PP (67 female and 25 male), with a mean age of 7.1±0.6 for girls and 8.3±0.7 for boys. Small for gestational age was recorded in 7.7%. There was an accelerated bone age (1.20±0.1 years). A total of 21 patients were classified as idiopathic (23%), 60 as idiopathic premature adrenarche (65%), and 11 with non-classic congenital adrenal hyperplasia (12%). Puberty was reached early (11+0.9 years old in boys and 9.9±0.8 in girls), as was menstruation age (11.8+1.1 years old), P<.001. The stature finally reached was close to their genetic stature. There is a positive correlation between body mass index, blood glucose and LDL cholesterol, as well as a tendency towards hyperinsulinaemia. CONCLUSIONS: The present study shows that PP is a benign condition in the majority of cases, but non-classic congenital adrenal hyperplasia (12%) is not uncommon. Menstruation and puberty started early and bone age was accelerated. Growth was normal, and more or less in line with genetic size. PP associated with obesity is linked with analytical variations of metabolic risks.