Daily baked egg intake may accelerate the development of tolerance to raw egg in egg-allergic children

Recent studies suggest that egg-allergic children who tolerate baked egg (BE) are more likely to outgrow egg allergy than children that do not tolerate it. The question to be answered is whether regular ingestion of BE accelerates tolerance to other forms of egg (cooked and raw). Our aim was to determine if daily ingestion of BE would accelerate tolerance to raw egg in BE-tolerant patients compared to patients who tolerate BE at diagnosis but eliminated it from their diet and to patients who didn't tolerate it. We performed a retrospective analysis of all children diagnosed of IgE-mediated egg allergy at the Pediatric Allergy Unit of the Complejo Hospitalario Universitario A Coruña, from 2008 to 2014. Seventy children were included. At diagnosis, 33 patients tolerated BE and kept its daily ingestion, 16 patients tolerated BE and were recommended to avoid it, and 21 patients didn't tolerate it. Patients tolerating BE who kept daily ingestion achieved tolerance to raw egg significantly earlier (p < 0.05) than the other two groups.Conclusion: Our data suggest that daily intake of BE in BE-tolerant children accelerates tolerance to raw egg.What is Known:• It has been suggested that egg-allergic children who consume baked egg (BE) products on a regular bases are more likely to outgrow egg allergy than children that do not tolerate themWhat is New:• Patients who tolerated BE on diagnosis and followed an exclusion diet show a similar evolution than patients who initially did not tolerate BE. Daily ingestion of BE seems to accelerates tolerance to raw egg.

Mild to moderate hypersensitivity reactions to beta-lactams in children: a single-centre retrospective review

OBJECTIVE

Beta-lactam (BL) antibiotics are the most reported drugs in hypersensitivity reactions in children. More than 90% of these children tolerate the suspected drug after diagnostic work-up. Skin tests (STs) show low sensitivity. Our aim was to assess the performance of drug provocation tests (DPTs) without previous ST in mild and moderate delayed reactions and to propose a new DPT protocol.

DESIGN OF THE STUDY

Charts from 213 children under 15 years of age referred for suspected BL allergy from 2011 to 1013 were reviewed. Prick, intradermal and patch tests were performed with major determinant penicilloyl-polylysine, minor determinant mixture, amoxicillin (AMX), cefuroxime, penicillin G and AMX-clavulamate. Children with negative skin tests underwent DPT. After an initial full dose of antibiotic, DPT was carried on for 3 days at home in patients reacting within the first 3 days of treatment. If the reaction took place from day 4 on of treatment, patients took the antibiotic for 5 days.

RESULTS

We included 108 girls and 105 boys. Mean age at the time of reaction was 3.66±3.06 years. 195 patients (91.5%) reacted to one BL. 154 reactions (67.2%) were non-immediate. Mild to moderate skin manifestations were most frequently reported. AMX-clavulanate was the most frequently involved (63.4%). DPT confirmed the diagnosis of drug hypersensitivity in 17 (7.3%) cases. These 17 patients had negative ST.

CONCLUSION

In mild and moderate cases of BL hypersensitivity, diagnosis can be performed by DPT without previous ST.

Plasma mitochondrial DNA levels are inversely associated with HIV-RNA levels and directly with CD4 counts: potential role as a biomarker of HIV replication

Objectives

To evaluate plasma mitochondrial DNA (mtDNA) levels among HIV-infected patients and its potential role as a biomarker of residual viral replication.

Methods

HIV-infected patients on follow-up at a reference hospital in north-west Spain were selected. DNA was isolated from plasma samples and mtDNA levels were assessed using a quantitative real-time PCR assay. HIV-RNA levels and CD4+ cell counts were evaluated in the same blood samples used for plasma mtDNA quantification. Epidemiological and clinical variables were included for the analysis.

Results

A total of 235 HIV-infected patients were included. Mean plasma mtDNA levels were 217 ± 656 copies/μL for naive (31.9%) and 364 ± 939 copies/μL for HIV-infected patients receiving ART and with suppressed viraemia (P = 0.043). Among the latter, mean plasma mtDNA levels were 149 ± 440 copies/μL for those with low-level viraemia (LLV; HIV-RNA 20-200 copies/mL), 265 ± 723 copies/μL for those with detected-not-quantified (DNQ) viraemia (HIV-RNA <20 copies/mL) and 644 ± 1310 copies/μL for those with not-detected (ND) viraemia. Of note, a linear trend (P = 0.006) was observed among virologically suppressed (LLV, DNQ and ND) patients. ND patients had higher mtDNA levels compared with LLV patients (P = 0.057). Moreover, mtDNA levels were inversely associated with HIV-RNA levels (Spearman's rho -0.191, P = 0.003) and directly associated with CD4+ counts (Spearman's rho 0.131, P = 0.046).

Conclusions

Increased plasma mtDNA levels are associated with lower HIV-RNA levels and higher CD4+ cell counts. Among ART-suppressed patients, mtDNA levels were significantly higher in those with complete virological suppression (ND) than in those with LLV. These data suggest that plasma mtDNA levels might serve as a biomarker of residual HIV replication.