Changes in passively-sensitized basophil activation to αS1-casein after oral immunotherapy.

INTRODUCTION: Immune response to cow's milk allergen (CMA) has been analyzed mostly using crude milk antigen or a mixture of various caseins. This study aimed to assess the changes in the immunological response against αS1-casein during oral immunotherapy (OIT) and to investigate the mechanism of tolerance. METHODS: We have performed rush OIT to 39 patients with CMA and obtained the serum samples up to 3 years after OIT. Immunoglobulin E (IgE) and IgG4 antibodies specific to highly purified αS1-casein as well as passively-sensitized basophil activation were evaluated using the serial samples. Furthermore, we examined whether basophil activation led by the pre-OIT serum was suppressed by the post-OIT serum, or by the tolerant serum obtained from naturally outgrown patients. RESULTS: Specific IgE to αS1-casein was significantly reduced after OIT. Specific IgG4 (sIgG4) to αS1-casein was also detected in most of the pre-OIT sera, which was not significantly increased after OIT. Activation of passively-sensitized basophils to αS1-casein was significantly reduced after 2 years (14% ± 19%) and 3 years (19% ± 18%) post-OIT compared with pre-OIT (%CD63high basophils; 51% ± 27%). Furthermore, the addition of post-OIT or tolerant serum to pre-OIT serum significantly suppressed the basophil activation. This suppression was abrogated by washing the supernatant after passive sensitization, but not by depleting IgG antibodies from post-OIT or tolerant sera, nor by blocking FcγRIIb using an anti-FcγR antibody. CONCLUSIONS: αS1-casein-sIgG4 plays a minor role in tolerance mechanisms in cases of CMA; humoral factors other than antigen-sIgG4 may be involved.

[ORAL AND SYSTEMIC SYMPTOMS IN CHILDREN WITH FRUIT ALLERGY].

BACKGROUND AND PURPOSE: The principal aim of this study was to clarify the clinical profile of pediatric patients with fruit allergies. SUBJECTS AND METHODS: We assigned 265 pediatric patients with fruit allergies who were receiving outpatient treatment at Aichi Children's Health and Medical Center and 32 who underwent kiwi or banana oral food chal- lenge (OFC) test to an oral symptom group or a systemic symptom group and retrospectively examined their clinical profiles and prognosis from their medical records. RESULTS: The most common cause of fruit allergy was kiwi (139 patients, 21% of all patients). Watermelon had the highest oral symptom induction rate (97%), whereas banana had the highest systemic reaction induction rate (46%). In the oral symptom group, the prevalence of hay fever was 54% and 66% of patients showed aller- gic reaction to multiple fruits. In contrast, in the systemic symptom group, the prevalence of pollen allergies was 24% and 77% of patients showed allergic reaction to a single fruit only. The results revealed that 65% of patients allergic to bananas had infant-onset allergy and seven among 20 patients were confirmed acquisition of tolerability by the OFC test. CONCLUSION: Our data suggest that there is a difference in the clinical profile and disease type between patients with oral symptoms and those with primarily systemic symptoms. It is important to differentiate between these patients for accurate diet guidance, safety management, and prognosis estimation.

Transient renal dysfunction with reversible splenial lesion.

We report the case of a 6-month-old boy with transient renal dysfunction who had an intensified signal in the splenium of the corpus callosum on magnetic resonance imaging. He presented to hospital with fever and sudden disturbance of consciousness. Cerebrospinal fluid analysis did not show pleocytosis. The mild consciousness disturbance disappeared after 30 min, but the splenial signal persisted even after 8 days. Further, renal glucosuria, increased excretion of select amino acids, and abnormal fractional excretion of electrolytes were observed, indicating renal tubular dysfunction. The abnormal urinary findings spontaneously resolved by day 9 of hospitalization. The splenial lesion took 21 days to normalize. There were no signs of neurological complications 2 months later. This case suggests the possibility of renal involvement in splenial lesions.

Hereditary spherocytosis diagnosed with the eosin-5'-maleimide binding test.

We describe three cases of hereditary spherocytosis (HS) diagnosed using the eosin-5'-maleimide (EMA) binding test and discuss the relevance of the EMA binding test. In Japan, this test is not widely used because the prevalence of HS is low. This test is a valuable screening test for the diagnosis of HS.

[Allergic enterocolitis with protein-losing enteropathy in a 5-month-old girl: a case report].

We report the case of a 5-month-old female infant who had allergic enterocolitis with protein-losing enteropathy and had low birth weight. Until the age of 4 months, she was fed only breast milk and did not experience any related problems. When she was 5-months-old, she was admitted to our hospital with the chief complaints of vomiting and diarrhea. She had whole body edema, thoracic and abdominal ascites, and bloody stools. Laboratory examinations showed the presence of hypoalbuminemia, hypogammaglobulinemia, and an elevated CRP level. Subsequently, she was fed an elemental diet with enteral tube feeding, and her condition gradually improved. However, 2 weeks later, her symptoms reappeared, and therefore, she was admitted to the National Center for Child Health and Development. She underwent upper and colon endoscopies and was found out to have multiple inflammatory lesions in the area extending from the cecum to the rectum. The biopsy findings showed features of eosinophilic enterocolitis and she was diagnosed with allergic eosinophilic enterocolitis. Subsequently, an elemental formula that does not include soybean was used for feeding the infant. The symptoms resolved and her condition improved; currently, she is well and is showing normal development. We have reported this case because allergic enterocolitis is becoming a topic of concern.