A.M. Plaza

Baseline specific IgE levels are useful to predict safety of oral immunotherapy in egg-allergic children.

Oral immunotherapy (OIT) is a promising treatment for food allergy but dose‐related reactions are common.

Allergic proctocolitis, food-induced enterocolitis: immune mechanisms, diagnosis and treatment

The term food allergy refers to the immune reaction (mediated by IgE or otherwise) that develops in response to the ingestion of a concrete type of food. Among the different potential manifestations of an allergic reaction, those exclusively affecting the gastrointestinal system are described. In recent years, the study of non-IgE-mediated food allergy has grown in relevance. These disorders are almost always of a transient nature, inherent to (though not exclusive of) nursing infants, and with gastrointestinal symptoms that may have variable repercussions upon the nutritional state of the patient. The prevalence of such reactions is not known, though some studies report that up to 60 % of all cases of allergy to cows milk proteins (CMPs) are due to non-IgE-mediated mechanisms. The latency period between the time of ingestion and the appearance of the first clinical manifestations is greater than in the case of IgE-mediated reactions, and the underlying immunopathological mechanism has not been clearly established although it is accepted that T cell mediation is involved. The gastrointestinal problems derived from these delayed or chronic reactions comprise allergic proctocolitis, enterocolitis and food protein enteropathies. These digestive disorders tend to appear in the first months of life, and are of a progressive and generally self-limiting nature, with resolution at about two years of age. The most commonly implicated food is milk and, in our setting, there have also been reports implicating fish, egg and rice although such reactions can be triggered by any protein introduced into the infant diet. These manifestations disappear after removing the causal protein from the diet. When the causal proteins are CMPs, a highly hydrolysed infant formula is supplied as substitute, and if the latter is not tolerated, an elemental amino acid-based formula is prescribed.

Ovalbumin-specific IgE/IgG4 ratio might improve the prediction of cooked and uncooked egg tolerance development in egg-allergic children

Accurate predictors of natural tolerance development to cooked and uncooked egg are needed in egg‐allergic patients.

PFAPA Syndrome: with regard to a case

BACKGROUND PFAPA syndrome (Periodic Fever, Aphtas, Pharyngitis and cervical Adenopathies) is one of the causes of periodic fever in pediatrics and it is characterised by high fever, pharyngitis, cervical adenitis and aphtous stomatitis. Its etiopathogeny is unknown. The diagnosis is clinical and the findings of laboratory are unspecified. One or two doses (1 mg/kg) of oral prednisone are enough for a fast resolution of the clinic. It is a benign syndrome and no sequels have been noticed after its disappearance, usually in four years from its beginning. CLINICAL CASE We present the case of a 10-year-old patient who has been diagnosed of PFAPA syndrome after 3 years and a half of characteristic clinical bouts, with the fulfilment of diagnostic criteria and after having excluded other entities of similar presentation. CONCLUSIONS Periodic episodes of high fever, pharyngitis and cervical adenitis with a bad response to the conventional treatment should alert us to the PFAPA syndrome. The recognition of this entity will help us to improve the diagnostic and therapeutical focusing, lowering also the anxiety that these cases produce.

Serum allergen-specific IgA is not associated with natural or induced tolerance to egg in children.

The role of specific IgA (sIgA) in oral immunotherapy (OIT) and natural tolerance to foods is poorly understood. We aimed to study serum sIgA in induced and natural tolerance to egg. Children aged 5–16 years diagnosed with IgE‐mediated egg allergy were recruited. After egg challenge, patients were classified as transient (TEA) or persistent (PEA) egg‐allergic. PEA children were further divided into oral immunotherapy (PEA‐OIT) or egg avoidance (PEA‐EA). Allergy/tolerance was reassessed 9–12 months later (T1) in PEA‐EA. Serum sIgA to ovalbumin and ovomucoid were determined at inclusion in all patients and repeated in PEA at T1. 21 TEA and 52 PEA children were recruited (28 PEA‐OIT, 24 PEA‐EA). Serum sIgA remained unchanged after OIT. TEA and PEA had similar serum sIgA. No specific trend on serum sIgA was observed in five PEA‐EA who developed natural tolerance over follow‐up. Thus, serum sIgA seems not to be associated with induced or natural egg tolerance.

Reacciones de hipersensibilidad a antiinflamatorios no esteroideos y su tolerancia a fármacos alternativos

INTRODUCTION Hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) are the most common reactions to drugs. The prevalence varies from 0.6 to 5.7% in general population, but there are no data available in children. The aim of this study is to determine the frequency of patients diagnosed with hypersensitivity to NSAIDs, and describe their clinical characteristics, type of hypersensitivity, and tolerance to alternative drugs. METHODS Retrospective study was conducted on children with suspected hypersensitivity to NSAIDs from January 2012 to December 2013. The diagnosis was confirmed by oral drug provocation test (DPT) to the drug involved in the group with a history of one episode, while in the group with a history of more than one episode with the same drug the diagnosis was based on clinical data. Subsequently, a DPT with acetylsalicylic acid (ASA) was done in order to classify hypersensitivity into selective or multiple. In those cases with a positive result, a DPT was performed with alternative drugs. RESULTS Out of a total of 93 children studied, 26 were diagnosed with hypersensitivity to NSAIDs: 7 confirmed by oral DPT, and 19 based on clinical data. Multiple hypersensitivity was diagnosed in 50% of patients. Ibuprofen was involved in all reactions. The most common clinical manifestation was angioedema (44%). Acetaminophen was the best tolerated alternative drug. CONCLUSIONS More than one quarter (28%) of the population studied was diagnosed with hypersensitivity to NSAIDs, and 50% had multiple hypersensitivity. Acetaminophen is a safe alternative in children with hypersensitivity to NSAIDs. Meloxicam may be an alternative in cases that do not tolerate acetaminophen.

Food protein–induced enterocolitis syndrome to fish and egg usually resolves by age 5 years in Spanish children

Food proteineinduced enterocolitis syndrome to fish and egg usually resolves by age 5 years in Spanish children Marta Vazquez-Ortiz, MD, PhD*, Adrianna Machinena, MD*, Olga Dominguez, MD, Montserrat Alvaro, MD, PhD, Katty Calvo-Campoverde, MD, María Teresa Giner, MD, Rosa Jiménez-Feijoo, MD, PhD, Jaime Lozano, MD, Mònica Piquer, MD, Marcia Dias, MD, María del Mar Folqué, MD, and Ana María Plaza, MD, PhD

Otomastoiditis candidiásica y síndrome de hiper Ig E

Resumen Paciente Nina de cinco anos que consulta por otorrea cronica, adenopatias cervicales y celulitis de rodilla Ademas de esas lesiones, en la exploracion fisica se observo la existencia de eccema en cuero cabelludo, cuello, region perineal y umbilical, y la persistencia de la denticion temporal y la definitiva (doble arcada dental) Las pruebas complementarias demostraron niveles de IgE de 23.969 UI/l, IgD 440U/L, IgG 23.000 mg/L, IgA 4.220 mg/L e intradermorreaccion a candidina negativa, siendo normal el resto del estudio inmunologico. La tomografia axial computada (TAC) revelo la existencia de otomastoiditis bilateral. En los cultivos de secrecion otica se aislo Candida albicans. El diagnostico definitivo fue de sindrome de Hiper IgE. La evolucion clinica fue favorable con tratamiento antibiotico y antifungico y esta en control ambulatorio periodico

Hipereosinofilia y angioedema recurrente

Introduction: Among the various causes of eosinophilia are the syndrome first described by Gleich in 1984. This syndrome is characterized by angioedema of the face, neck, extremities and trunk, weight gain, hypereosinophilia (60-70 %), fever, and increased serum IgM levels without involvement of the vital organs. Case report: A 17-year-old non-allergic woman was referred to our hospital for further investigation of recurrent angioedema, initially of the hands and feet and subsequently of the face, with onset 3 years previously. The attacks had become more frequent and severe and had occurred monthly in the previous year. The patient also showed general malaise, without fever. Complementary investigations revealed eosinophils 40.8 %, total count 3,300/mm 3 , and serum IgM levels 343 mg/dl (normal range: 53300 mg/dl). Possible causes of hypereosinophilia and eosinophilic infiltration of vital organs were ruled out. The patient was treated with oral corticosteroids which produced clinical remission and reduction of eosinophil count (1.7 %, total 200/mm 3 ).

Egg Oral Immunotherapy in Children (SEICAP I). Daily or Weekly Desensitization Pattern

Studies are required before incorporating egg oral immunotherapy (OIT) into clinical practice. The Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP) conducted a multicenter, randomized controlled study assessing the effectiveness and safety of the OIT using pasteurized egg white (PEW) in egg‐allergic children.