Real-life data on the effectiveness of extensively hydrolyzed protein-based formula and amino acid-based formula in regaining weight and height in infants on a cow's milk protein elimination diet

OBJECTIVE

To compare the effectiveness of extensively hydrolyzed protein-based formula (EHF) or amino acid-based formula (AAF) in reversing the weight and height deficit in infants on a cow's milk protein elimination diet.

METHODS

Infants from a retrospective cohort who were fed EHF (n = 17) or AAF (n = 16) for at least 2 months on a cow's milk protein elimination diet were included. The weight and height values recorded in the infants' medical records were obtained.

RESULTS

The mean age of the infants at the start of EHF and AAF were 5.8 ± 2.6 and 4.4 ± 2.5 months, respectively (P = 0.061). There was no difference between the groups in terms of the monthly weight gain (373.0 ± 212.2 and 453.1 ± 138.5 g, P = 0.223, respectively, for EHF and AAF), while the monthly increase in height was greater in the group fed with AAF (1.3 ± 0.5 and 1.8 ± 0.6, P = 0.030). A comparison between the difference in the initial z-score and in the oral challenge test of weight-for-age (+0.7 ± 1.2 and +1.3 ± 1.4, P = 0.262, respectively, for the EHF and AAF groups), height-for-age (+0.2 ± 1.1 and +1.2 ± 1.8, P = 0.090), and body mass index (BMI)-for-age (+0.7 ± 1.3 and +0.7 ± 1.5, P = 0.971) did not reveal a statistically significant difference between the groups. Correlation coefficients showed that the greater the initial nutritional deficit, the greater the positive variation between the beginning of each formula and the oral challenge test.

CONCLUSION

EHF and AAF provided similar increases in the weight-for-age, height-for-age, and BMI-for-age z-scores in both groups. The monthly increase in height was greater in infants who received AAF.

Natural Tolerance Development to Peach in a Child with Lipid Transfer Protein Allergy

Non-specific lipid transfer proteins (LTPs), present in multiple plant foods and pollens, are the predominant allergen in peach allergy in the Mediterranean region and may induce life-threatening allergic reactions. Although reasonably studied in adults, LTP allergy has been rarely described in children, and to the best of the author's knowledge, natural tolerance development during childhood to this allergen has not been reported to date. The authors reported the case of a 21 month-old boy who presented urticaria and facial edema 15 minutes after eating a peach. Sensitization to peach LTP was confirmed by skin prick tests and specific IgE. At the age of 32 months, skin prick tests and specific IgE to peach LTP were negative, so a food challenge was performed. The child tolerated one medium-sized peach. Peach and peach-related fruits were reintroduced in the child's diet. The authors discuss the relevance of regular allergy workup and dietary recommendations in children with LTP allergy.

[Inadequate infant diets and false food allergies]

INADEQUATE INFANT DIETS AND FALSE FOOD allergiesthe administration, by families, of more or less extensive avoidance diets of food to their infants has been a growing problem in recent years. Regardless of certain parental beliefs, these diets are also often set up to treat mild digestive disorders or suspected food allergies. In young children, these diets, without cow's milk protein, vegetarians or even vegans or eliminating foods on unsuitable allergological tests, not supervised by health professionals, can lead to nutritional complications which are sometimes serious and life-threatening. It is therefore important to detect possible nutritional deficiencies, to treat them and to resume, after explanations to the family, a diet as little restricted as possible.

Atopic manifestations are underestimated clinical features in various primary immunodeficiency disease phenotypes

BACKGROUND

Atopic manifestations are describedas clinical feature of variousprimary immunodeficiency disease (PID) phenotypes and in particular frequently reported in the combined immune deficiencies. The prevalence of atopic manifestations in other PIDs remains largely unknown.

OBJECTIVE

To evaluate the prevalence of atopic manifestations in other PIDs and to identify in which PIDsatopic manifestations are most common in order to improve patient care.

METHODS

A partner-controlled questionnaire-based study was performed in pediatric and adult PID patients. Subsequently, data of diagnostic tests for atopic manifestations (i.e. diagnostic criteria for AD, spirometry, specific IgE against food and inhalant allergens) were collected in adult patients to confirm patient-reported atopic manifestations.

RESULTS

Forty-seven children and 206 adults with PIDs, and 56 partner-controls completed the questionnaire. Thirty-five (74.5%) pediatric and 164 (79.6%) adult patients reported to have ever experienced one or more atopic manifestations compared with 28 (50.0%) partner-controls. In adult patients vs. partner-controls, prevalence of atopic dermatitis was 49.5% vs. 27.3% (p=0.003), food allergy10.7% vs. 1.9% (p=0.031), asthma 55.7% vs. 14.8% (p<0.001) and allergic rhinitis 49.8% vs. 21.8% (p<0.001).The frequency of current atopic manifestationsreported by patients washigher than the prevalence based on diagnostic tests (atopic dermatitis 11.2%, food allergy 1.9%, asthma 16.4% and allergic rhinitis 11.5%).

CONCLUSIONS

Atopic manifestations are prevalent clinicalfeatures in a large spectrum of PIDs and in our cohort frequently present in patients with combined immune deficiencies and predominant antibody deficiencies. Evaluation of atopic manifestations should be considered in patients with PIDs.

Anisakis Allergy: Raising Awareness

INTRODUCTION

Ingestion of Anisakis is a common cause of allergic reactions to seafood in countries in which undercooked/raw seafood is part of gastronomic traditions. Despite current trends for the ingestion of raw/marinated/undercooked fish, the prevalence rate of anisakiasis and allergy to Anisakis is still considered to be low in Portugal. We aimed to review the current pathogenic mechanisms, the clinical and diagnostic approach of Anisakis allergy, and Anisakis-related eviction measures, while raising awareness to this problem.

MATERIAL AND METHODS

Literature search in the MEDLINE and Scopus databases, regarding Anisakis allergy.

CONCLUSION

Assessment of sensitization to Anisakis should be included in the workup study of urticaria/angioedema and anaphylaxis, as there is a rise in consumption of raw and undercooked fish. Ingestion of previously frozen and properly cooked fish appears to be safe for most patients who are allergic to Anisakis.

Prediction of Food Allergens Sensitization Based on History Taking Technique in Young Children

BACKGROUND

The diagnosis of food allergies needs to be confirmed through an oral food challenge (OFC). However, specific immunoglobulin E (sIgE) concentrations analyzed by serological tests are also helpful in determining OFC items and predicting the presence of allergic reactions. Unfortunately, there is a limit to the number of antigens that can be simultaneously evaluated at one time. The purpose of this study was to analyze the possibility of detecting sIgE antibodies against food using clues in self-reported food allergy symptoms.

METHODS

Medical records of 377 patients aged 3 years or younger were collected for egg white-, cow's milk-, walnut- and soybean-sIgE sensitization, and related clinical history. Each clinical history was classified into class 1: direct-isolated intake resulting in anaphylaxis or hives with consistent clincical history; class 2a: class 1 with inconsistency; class 2b: indirect-mixed intake resulting in anaphylaxis or hives regardless of consistency; class 2c: direct/indirect-isolated/mixed intake resulting in itching without hives, vomiting, or diarrhea with consistent clincical history; or class 3: class 2c with inconsistency or asymptomatic to direct, isolated exposure.

RESULTS

The area under the curve (AUC) of class 1 for cow's milk was 0.790, and the accuracy was 78.0%. The AUC of class 1 and 2 for egg white was better than that of class 1 (0.750), and the accuracy rate was 77.6%. The AUCs of class 1 for walnut and soybean were 0.775 and 0.662, respectively.

CONCLUSION

In conclusion, sIgE sensitization to foods could be predicted by the combination of exposure and selfreported symptoms in children under 3 years of age.

Molar-Incisor Hypomineralisation and Allergic March

Background

Molar-incisor hypomineralisation is a disturbance in dental development that involves first permanent molars as well as permanent incisors with a prevalence that ranges from 2.5% to 40%.

Aim

The objective of this study was to investigate the effect of atopic diseases on the development of molar-incisor hypomineralisation.

Material and methods

The study was based on the review of the medical records of a group of 102 children whose age was between eight and 12 years and 11 months and who had previously been diagnosed with MIH.

Results

An association (χ², p≤0.05) has been found between molar-incisor hypomineralisation in children's mouths and the existence of: atopic dermatitis (OR=2.504; 1.54-4.05 CI 95%), food allergies (OR=2.171; 1.03-4.56 CI 95%), allergic rhinitis (OR=0.17; 0.02-1.27 CI 95%), and asthmatic bronchitis/asthma (OR=1.707; 1.05-2.76 CI 95%). When analyzing the pathologies by location, we found that atopic dermatitis, food allergies, allergic rhinitis and asthma were more frequent in children who had (p≤0.05) #12, #11, #21, #22, #36, #31, #41 and #42 affected.

Conclusions

The association between molar-incisor hypomineralisation and the presence of atopic diseases in the first 36 months of life underlines the convenience of approaching this problem from a multidisciplinary perspective.

[Allergies as a target of interest in the era of immunotherapy]

Exacerbated immune system reactions often trigger allergy pathologies, which include asthma, rhinitis, urticaria, food and drug allergies, insect bites, and may sometimes have fatal outcomes. In Mexico, more than 20% of open population, present allergic symptoms with notable increase in the last twenty years, especially in children. The Mexican Institute for Social Security (IMSS, according to its initials in Spanish) provides attention to around 7000 patients per year, mainly due to allergies deriving from therapeutic drugs and certain foods. Pharmacotherapy has been effective in reducing classical allergy symptoms, although treatment does not stop disease progression. In addition, the constant use of drugs represents a remarkable socioeconomic impact. Strategies based on the modification of immune responses in the course of allergic reactions through immunotherapy started more than 100 years ago, and some have provided cure to the disease. On the occasion of the Nobel Prize in Physiology or Medicine 2018, it was awarded to James P. Allison and Tasuku Honjo for their contributions in the regulation of the immune system against cancer, through a new generation of immunotherapy. In this review we analyzed current immunotherapeutic options, including its benefits, limitations and perspectives for the best clinical management of allergies.

Diagnosing Meat Allergy After Tick Bite Without Delay

Galactose-α-1, 3 galactose (α-gal) is a carbohydrate found in mammalian meat. In 2007, it was implicated as a cause of severe hypersensitivity reactions when a study found elevated levels of antibodies directed against this oligosaccharide among patients treated with cetuximab, a monoclonal antibody that contained an α -gal epitope. The majority of these cases were reported in the Southeast United States in a distribution similar to that of Rocky Mountain spotted fever and ehrlichiosis, and that geographic association led researchers to the conclusion that a bite from the Lone Star tick can induce this antibody. Here, we present a case of delayed urticarial angioedema due to a mammalian meat allergy caused by α-gal immunoglobulin E acquired after tick exposures, and the knowledge and patient education required to prevent recurrences. It is estimated that approximately 0.5% to 1.0% of the general population will experience an episode of angioedema in their lifetime, and this case demonstrates why clinicians in areas that are inhabited by ticks, particularly the Lone Star species, should include this cause in their differential.

Sensitivity Comparison of the Skin Prick Test and Serum and Fecal Radio Allergosorbent Test (RAST) in Diagnosis of Food Allergy in Children

BACKGROUND

Diagnosis of food allergy is difficult in children. Food allergies are diagnosed using several methods that include medical histories, clinical examinations, skin prick and serum-specific immunoglobulin E (IgE) tests, radio-allergosorbent test (RAST), food challenge, and supervised elimination diets. In this study we evaluated allergies to cow's milk, egg, peanut, and fish in children with suspected food allergies with skin prick tests and serum and feces RAST.

METHODS

Forty-one children with clinical symptoms of food allergies were enrolled in the study. Skin prick tests and serum and fecal RAST were performed and compared with challenge tests.

RESULTS

The most common sites of food allergy symptoms were gastrointestinal (82.9%) and skin (48.8%). 100% of the patients responded to the challenge tests with cow's milk, egg, peanut, and fish. 65% of the patients tested positive with the skin prick test, 12.1% tested positive with serum RAST, and 29.2% tested positive with fecal RAST.

CONCLUSION

The skin prick test was more sensitive than serum or fecal RAST, and fecal RAST was more than twice as sensitive as serum RAST.

Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child

BACKGROUND

Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta.

OBJECTIVES

To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation, or both, on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2012).

SELECTION CRITERIA

All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of non-dietary aspects of the infant's environment.

DATA COLLECTION AND ANALYSIS

We extracted data from published reports, supplemented by additional information received from the trialists we contacted.

MAIN RESULTS

The evidence from five trials, involving 952 participants, does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Data on allergic rhinitis or conjunctivitis, or both, and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a non-significantly higher risk of preterm birth, and a non-significant reduction in mean birthweight. The evidence from two trials, involving 523 participants, did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk, egg, or peanut antigen at one, two, or seven years. One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity.

AUTHORS' CONCLUSIONS

Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and such a diet may adversely affect maternal or fetal nutrition, or both. Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child's risk of developing atopic eczema, but better trials are needed. Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema, but larger trials are needed.

Natural course of cow's milk allergy in children with atopic dermatitis

Cow's milk is one of the most common food allergens in children with atopic dermatitis (AD). This study was conducted to describe the natural course of cow's milk allergy in children with AD, and to identify factors predictive of outcome. To accomplish this, we reviewed the medical records of 115 children who were diagnosed with AD and cow's milk allergy before 24 months of age to evaluate their clinical characteristics and prognostic factors. During a follow-up period of 24 to 114 months, the median age for tolerance to cow's milk was found to be 67 months. Multivariate analysis using the Cox proportional hazard model revealed that the peak cow's milk-specific IgE level within 24 months after birth was the most important factor for prediction of the outcome of cow's milk allergy. In conclusion, half of the children younger than 24 months of age with AD and cow's milk allergy could tolerate cow's milk at 67 months of age. The peak cow's milk-specific IgE level within the first 24 months of birth is useful to predict the prognosis of cow's milk allergy in children with AD.