Clinical and Laboratory Characteristics of Patients with Food Allergy: Single-Center Experience

Food Sensitivity in Children Diagnosed with Atopic Dermatitis in The First 2 Years: How Many of These Patients Are Truly Allergic?

Objectives

In this study, it was aimed to examine food sensitivity in patients with atopic dermatitis (AD) and to investigate the frequency of food allergy in patients with food sensitivity.

Methods

Patients aged 0-2 years who were followed up with the diagnosis of AD were included in the study. The characteristics of demographic and clinical and laboratory findings of the patients were recorded retrospectively. Patients were classified as mild, moderate, and severe using the SCORing AD index according to the severity of AD. The presence of food sensitivity was evaluated by skin prick test and serum-specific immunoglobulin (Ig)E results. Food allergy was diagnosed by oral food challenge (OFC) test.

Results

Of the 72 patients included in the study, 62.5% (n=45) were male, and the mean age was 9±4.8 months. When the disease severity was evaluated, it was mild in 40 patients (55.6%); moderate/severe AD was present in 32 patients (44.4%). The frequency of moderate/severe AD was higher in patients who were younger (p=0.01), whose symptoms started in the first 6 months (p=0.03), who had a family history of allergic disease (p=0.001), who breastfed for <6 months (p=0.01), who had a higher median serum total IgE level, and a higher percentage of serum eosinophils (p=0.005 and p=0.01, respectively). Food sensitivity in 45.8% of patients; food allergy was detected in 41.7% of them. The most common sensitivities and allergies were eggs white/yolk and cow's milk, respectively. The rate of food sensitivity was found to be higher in male gender (p=0.03) and breastfed patients (p=0.03), whereas it was similar in patients with mild and moderate/severe AD.

Conclusion

In the investigation of food sensitivity in patients with AD, it is important to evaluate other demographic and clinical characteristics such as gender and breastfeeding, apart from the severity of disease. The OFC test should be performed to confirm the food allergy in patients with food sensitivity before the recommendation of an elimination diet.

Evaluation of the triggers and the treatment models of anaphylaxis in pediatric patients

OBJECTIVE

Anaphylaxis is an acute, life-threatening systemic hypersensitivity reaction. We aimed to evaluate the demographic and clinical characteristics of patients presenting with anaphylaxis, as well as triggers and risk factors, and to determine the rate of adrenaline auto-injector (AAI) usage.

METHODS

The study was planned in the pediatric allergy outpatient clinic over a 1-year period. The data of children diagnosed with anaphylaxis were evaluated retrospectively; demographic characteristics, causes of anaphylaxis, and treatment modalities were recorded in the created study form.

RESULTS

Eighty children (29 females) with a median age of 6.5 years (range: 1 month-17 years) were evaluated. The most common triggers were foods under 2 years of age (73%), and drugs (70%) above 2 years of age. Nearly half of the anaphylaxis episodes (n=41, 51.3%) occurred at home. Cutaneous and respiratory symptoms were the most commonly reported complaints (98.8%). The median age of the patients at the first attack with severe anaphylaxis (n=29, 36.3%) was significantly higher than the rest (p:0.007). The age at onset of the reaction (p:0.006) and occurrence of the reaction in hospital conditions (p<0.001) were determined to be significant risk factors for severe anaphylaxis. Most of them received antihistamines (95.7%) and corticosteroids (91.3%), while 78.3% received adrenaline. Only 9.5% of patients with recurrent episodes of anaphylaxis used AAIs.

CONCLUSION

Foods in infants and drugs in older children were the leading causative allergens of anaphylaxis. The most common clinical manifestations were respiratory and cutaneous symptoms. The older age at onset of the reaction and the occurrence of the reaction in hospital conditions were determined to be significant risk factors for severe anaphylaxis. It was determined that the frequency of AAI use was low among patients and their families.

Effects of Cow's Milk Components, Goat's Milk and Sheep's Milk Sensitivities on Clinical Findings, and Tolerance Development in Cow's Milk Allergy

Objective:

Cow’s milk (CM) contains some proteins capable of causing an allergic reaction in a sensitized individual and one of the most common causes of food allergy in childhood. Most of the patients will develop tolerance by the age of 3. In this study, we aimed to evaluate sensitivity to CM allergen components as well as goat’s milk (GM) and sheep’s milk cross reactions in cow’s milk allergic (CMA) patients and to figure out the risk factors for tolerance non-development.

Methods:

This is a retrospective cross-sectional study including 66 patients for IgE-mediated CMA with mean age of 38 months. We evaluated the patients in two groups: Group 1 (n=50): Patients who have no tolerance in oral food challenge test; Group 2 (n= 16): Patients who were found tolerant to CM after elimination diet. Cow’s milk-spesific IgE(sIgE), α-lactalbumin(ALA)-sIgE, β-Lactoglobulin(BLG)-sIgE, casein-sIgE, goat’s milk-sIgE, sheep’s milk-sIgE, skin prick tests(SPTs) with CM and GM, eosinophils in peripheral blood were all compared between two groups.

Results:

In the whole group, goat’s milk-sIgE and sheep’s milk-sIgE were positive in 84.8% and ALA-sIgE, BLG-sIgE, casein-sIgE were positive in 69.7%, 62.7%, 77.3% of the patients, respectively. Two groups were similar in terms of age at onset and diagnosis, gender, median elimination period, total IgE levels, cow’s milk-sIgE and eosinophilia (p>0.05). Mean wheal diameters of CM and GM in SPT (p<0.001), goat’s milk-sIgE (p=0.03), sheep’s milk-sIgE (p=0.01) were significantly higher in Group 1. Cow’s milk-sIgE showed a positive correlation with total IgE (p=0.001), eosinophilia percentage (p=0.04), CM wheal diameter in SPT (p=0.001), casein-sIgE (p<0.001), goat’s milk-sIgE (p<0.001), sheep’s milk-sIgE (p<0.001) in Group 1. Patients with respiratory symptoms and history of anaphylaxis had higher cow’s milk-SPT, cow’s milk-sIgE, casein-sIgE, goat’s milk-sIgE, sheep’s milk-sIgE levels(p<0.05). Gastrointestinal and skin symptoms showed no relation with laboratory findings. Any patient with a history of anaphylaxis did not develop tolerance.

Conclusions:

As with cow’s milk-sIgE levels and high induration diameters in SPT; high casein-sIgE, sheep’s milk-sIgE and goat’s milk-sIgE levels are also risk factors for persistence of CMA. Anaphylaxis, as a first reaction, may also be a risk factor. High cow’s milk-sIgE, casein-sIgE, sheep’s milk-sIgE, goat’s milk-sIgE levels are associated with respiratory symptoms.

Reaction frequency to the skin prick test of inhalant and food allergens in children

OBJECTIVE:

When applied by well-trained personnel, skin prick test (SPT) for a variety of inhalant and/or food allergens is a safe procedure although it may rarely cause systemic reaction. In this article, our aim was to evaluate the reactions after SPTs for the past 6 years in Turkish children having various allergic symptoms brought to our clinic.

METHODS:

The results of the SPTs, performed between May 2013 and March 2019, of 12.529 patients whose ages vary from 2 months to 18 years have been retrospectively evaluated.

RESULTS:

The average age of the patients who were included in this study was 6.12±4.38 years and 46.4% of them were female. When the patients were categorized according to the diagnosis, it was observed that 4.858 of them with symptoms suggesting asthma; 2.720 of them having symptoms suggesting allergic rhinitis; 1.795 of them having rashes; 906 of them with atopic dermatitis; 352 of them having symptoms suggesting food allergy and the remaining 1.898 with symptoms suggesting various diagnoses. In this study, which reflects our 6-year experience from the results of 12.529 patients, post-SPT reactions have been observed in 9 out of 12.529 patients (0.07%). They were three females and six males. These reactions were observed in 3 eczemas, 2 urticaria, 2 allergic rhinitis, and 2 suggested diagnosis of asthma patients. Their mean age was 5.9±3.5 years. SPT reactions were mostly seen in our five patients having skin disorder (eczema and rashes). The most frequent symptom of vasovagal reaction was syncope, occuring between 1 and 20 min after SPT, in eight of nine patients.

CONCLUSION:

During our study, any systemic reaction or anaphylaxis to SPT was not observed. The non-systemic reaction (vasovagal reaction) rate was 7/10.000, similar to the literature.