Allergy to quail's egg without allergy to chicken's egg. case report.

INTRODUCTION: We present a case of quail's egg allergy without allergy to chicken's egg. CASE: Girl of 10.5 years old who presents anaphylactic reaction after she ate an uncooked quail's egg. She had eaten boiled quail's egg before. She eats chicken's eggs without clinical symptoms. METHODS: We made a prick to chicken's egg and prick-by-prick to uncooked quail's and raw chicken's egg. We determined specific IgE to chicken's egg; electrophoresis and IgE by immunoblot to eggs from chicken, duck, goose, and quail. RESULTS: We obtained negative results to prick, prick-by-prick and specific IgE to chicken's egg. Prick-by-prick to quail's egg was positive. By immunoblot we recognised a protein in quail's egg white, which is ovotransferrin without any similar bands in other species' eggs. CONCLUSIONS: The protein that we recognised is a specific protein of quail's egg. These proteins did not cross-react with proteins of chicken's egg. Cooking may degrade such proteins.

Risk factors of developing asthma in children with recurrent wheezing in the first three years of life.

INTRODUCTION: recurrent wheezing is a common problem during the first years of life, but it is still difficult to identify which of these children may develop asthma in the future. OBJECTIVES: To study risk factors of developing asthma in a group of patients with frequent wheezing during the first three years of life. MATERIAL AND METHODS: A prospective study was performed of a group of 60 patients, aged below three, referred to our Hospital for recurrent wheezing. Age, sex, parental and personal history of atopy, clinical features, laboratory tests, evolution and response to treatment were analyzed. RESULTS: 60 patients were enrolled in study. Most of children were boys and have had the first episode of wheezing after the 6 months of life. 63 % had personal history of atopy and 55 % parental history of allergy. The group of atopic children had more wheezing exacerbations and worse evolution than the group of non atopic. They also had more treatment necessities. CONCLUSIONS: The identification of young children at high risk of developing asthma could permit an early intervention before irreversible changes in the airway appeared.

Polysensitization to aeroallergens and food in eosinophilic esophagitis in a pediatric population.

There are few studies on eosinophilic esophagitis (EE) in the pediatric population in Europe. We present our data and emphasize the following findings: a) all patients had symptoms of allergic respiratory disease prior to receiving a diagnosis of EE with polysensitization (aeroallergens, food allergens); and b) in contrast with the results of earlier studies, food sensitization in our series most often corresponded to legumes.

Variability of immunodeficiency associated with ataxia telangiectasia and clinical evolution in 12 affected patients.

Ataxia telangiectasia (AT) is an infrequent condition, which is difficult to diagnose in children. The objective was to describe the evolution of all affected patients controlled in our hospital and to highlight the keys for an early diagnosis considering the variability of immunological disorders. The present study is a retrospective review of all patients diagnosed and controlled of AT in our hospital. Twelve patients were found, including two couples of siblings. The most frequent reason for consultation was unstable gait. Seven patients suffered repeated infections, being pneumonia the most frequent cause of infection, followed by sinusitis. One of the patients developed Burkitt's lymphoma, and another patient, Hodgkin's lymphoma, which caused the death of the patient at the age of 11. A couple of siblings aged 17 and 22 years developed insulin-resistant diabetes mellitus. The most frequent immunity disorders were the IgG deficiency and the decrease of T lymphocytes. Seven patients were treated with non-specific gamma-globulin. By the end of the follow-up, 8 patients (ages ranged 7 to 12 years) lost gait. Molecular genetic testing was conducted in patients who are still cared for in our hospital. Clinical suspicion of this entity will lead to an early diagnosis, the treatment of complications, and to provide genetic counselling for the families.

[Indications and utility of allergen provocation testing]. / Indicaciones y rentabilidad de la provocación con alergenos.

Specific bronchial provocation tests have been used to confirm diagnosis, as a laboratory model for the study of asthma, and to evaluate the efficacy of immunotherapy with allergen extracts. However, despite the advances achieved in our knowledge of the etiopathogenic mechanisms of asthma, bronchial provocation tests with allergens have certain methodological limitations. These are due to the difficulty of evaluating these tests as regards which markers of inflammation (exhaled nitric oxide, carbon monoxide, etc.) should be investigated and at what points in the chronology of the asthmatic response. The current parameters used to assess respiratory function (FEV1, mainly) do not seem to be the most ideal nor do their percentage reductions, usually established by use, always serve to identify a bronchospastic and inflammatory response. Furthermore, the allergen doses indicated in the various protocols do not mimic natural exposure to these allergens, thus introducing an important bias in the interpretation of the results. In this sense, another and no less important difficulty is the lack of adequate standardization of the characteristics of the allergens used; the development of recombinant allergens may eliminate this obstacle and improve the reproducibility of the tests. In view of the above, the requirement of a positive bronchial provocation test to a specific allergen in the etiological diagnosis of asthma does not seem reasonable nor does it seem reasonable that specific immunotherapy is not indicated if the test is negative or that evaluation of its efficacy lies in a negative result for a previously positive test. This premise does not take into account the fact that bronchial reactivity is subject to variables that are difficult to control (prior natural exposure to the allergen, for example).

Challenge testing in children with allergy to cow's milk proteins.

OBJECTIVES: To evaluate clinical response after challenge testing in infants with allergy to cow's milk proteins at diagnosis and again when these infants were aged 1 year old and had been fed an exclusion diet. MATERIAL AND METHODS: We performed a prospective study of 49 infants aged less than 6 months with a clinical history suggestive of cow's milk protein allergy, positive skin prick test and specific IgE for alpha-lactalbumin, beta-lactoglobulin and casein. In all children challenge test with cow-milk adapted formula was carried out at diagnosis. The same procedures were repeated when the children were aged 1 year but challenge testing was repeated only in children with a negative skin prick test and specific IgE antibodies to cow's milk proteins. RESULTS: At diagnosis, challenge tests produced immediate hypersensitivity reactions in 94% of infants. Late reactivity (i.e., more than 2 hours after challenge) was found in only 6% of infants, all of whom presented dyspepsia. When the infants were aged 1 year, and after results of immunological study were negative, a further challenge test was performed in 24 (49%) of lactating infants included in the study. Of these 24 infants, positive challenge was found in 5 (21%). None of the infants presented immediate symptomatology (clinical features appeared 7 days after the reintroduction of cow's milk proteins). CONCLUSIONS: Ninety-four percent of challenge tests performed at diagnosis provoked immediate reactions. The results of challenge tests after a negative skin prick test in children with normal concentrations of specific IgE were positive in 21% infants, who presented late reactivity (a mean of 7 days after milk ingestion).

Common variable immunodeficiency, insulin-dependent diabetes mellitus and celiac disease.

Common variable immunodeficiency is a disorder characterised by hypogammaglobulinemia with B-lymphocytes in peripheral blood and repeated infections. We report a child with a diagnosis of diabetes mellitus and celiac disease during lactation, and in whom common variable immunodeficiency was diagnosed at the age of 5. During evolution of the disease he presented multiple respiratory infections in spite of substitution therapy with gamma globulins. He presented pulmonary fibrosis with a pulmonary volume reduced, and a spirometric restrictive patron. Immunologically, he presents reduction in CD4 lymphoid population. He expresses the alleles DQ2 A1 0501 and B1 which are strongly associated with susceptibility to insulin-dependent diabetes mellitus and celiac disease, but don't express antigens HLA class II DR3 and DR4 that are more frequent in these entities. The main disease and all the complications had affected his curve pondostatural.

[Round Table: Severe asthma in pediatrics. Concepts and predisposing factors]. / Mesa Redonda: Asma grave en Pediatría. Concepto y factores predisponentes.

Given the clinical and functional characteristics of severe asthma, we will look at the factors that predispose to potentially fatal asthma. They can be divided into three groups: a) factors related to medical care: error of diagnosis of asthma and severity, deficiencies in the treatment prescribed, lack of control of treatment, frequent changes of doctor, lack of diagnostic tools; b) factors related to the patient and the environment: denial of the disease, failure to comply with or abandonment of treatment, underrating the severity of attacks, age (adolescence), coexistence of psychiatric disorder (depression); c) disease-dependent factors: admissions to hospital, need for mechanical ventilation on occasion, increase of symptoms during the last year, need for substantial medication. Adolescence is a critical stage of life in asthma. It implicitly involves a number of risk factors, all of which are age-dependent: refusal to acknowledge the illness, resistance to treatment (in particular as regards continuity and frequency of doses) lack of self-esteem, lack of confidence in the doctor, the beginning of the smoking habit. Another key factor is the coexistence of depression and asthma. In addition to the low self-esteem due to the affective disorder (which will in itself influence any form of treatment) depression is associated with a higher incidence of illnesses --especially infectious illnesses-- which can also aggravate asthma. Anxiety and stressful circumstances in general are factors that negatively affect the illness. Factors that influence the evolution of the illness are the following: factors that influence asthma severity: patient-dependent, sensitivization-dependent, environment-dependent, treatment-dependent, illness-dependent, dependent on respiratory function exploration.