Arnaldo Cantani

Allergenicity and nutritional adequacy of soy protein formulas

Soy protein formulas are used for different conditions, including cow milk protein allergy, lactose and galactose intolerance, and severe gastroenteritis. Feeding soy protein formulas to normal term infants is associated with normal growth, normal protein nutritional status, and normal bone mineralization. Recent studies of infants fed soy protein formulas exclusively during the first months of life revealed no immunologic abnormality; however, the use of such formulas for management of cow milk protein allergy and for prevention of atopy is controversial. Although in the past decade many studies have stressed soy allergenicity, soy allergenicity has been confirmed by the challenge test in only a few studies. In this article we review the studies dealing with the allergenicity of soy protein formulas. We also present our own data on their use in the prevention and management of cow milk protein allergy.

Month of birth and grass pollen or mite sensitization in children with respiratory allergy: a significant relationship

This report describes a retrospective analysis of the month of birth distribution of 2124 children with respiratory allergy in the Rome district between 1964 and 1985, in comparison with the total live births in the same district over the same period. Of the 2124 children, 1685 had positive skin tests and or RAST only to mites, and 439 only to grass pollen (P < < 0.001). A significant relationship was found between grass or mite sensitization and the month of birth. A high proportion of children born in June‐September had mite allergy (P <0.005), and even higher was that of those born in March‐May with grass sensitivity (P< < 0.005), compared with the total live birth distribution in the Rome district in the same years as the children examined. These results are consistent with the idea that allergy may be associated with a period of susceptibility to sensitization in early infancy.

Natural history of soy allergy and/or intolerance in children, and clinical use of soy-protein formulas

Atopic diseases of infants and children are common, debilitating, chronic and sometimes even life‐threatening. Several well‐conducted studies in high risk babies have demonstrated a significant reduction in the prevalence and severity of atopic diseases with dietary and environmental manipulations. The currently available cows milk (CM) substitutes for infants are soy protein (SP) formulas (SPFs), hydrolyzed formulas (HF), and home‐made meat‐based formulas. Soybeans have been cultivated in Eastern countries for many centuries and were first used to feed US babies with CM allergy (CMA) in 1929. Since then, SPFs containing purified SP, a mixture of vegetable oils, and purified carbohydrate have been developed. From a nutritional point of view, SPFs are adequate, support normal growth, protein status, bone mineralization, are well accepted, and economical.

Systemic reactions to specific immunotherapy in children with respiratory allergy: a prospective study.

The aim of this multi‐centre prospective study was to evaluate the prevalence of systemic reactions to specific immunotherapy in children with allergic asthma and or rhinitis. One thousand and fifty‐six children (653 boys and 403 girls), median age 8.5 years, were enrolled in this three‐year prospective study. All the children were treated with injections of the following allergenic extracts: 689 of house dust mite, 291 of grass, 109 of Parietaria, 13 of Alternaria, 6 of Artemisia and 11 of Olea. Among 1056 treated children, 41 (3, 7%) had systemic reactions: 40 children (3.7%) experienced mild symptoms such as asthma and/or urticaria, and only one shock (0.08%). A total of 47, 247 injections were administered, and the rate of systemic reactions, according to the number of total injections was only 0.08%. According to the allergenic extract, systemic reactions occurred in 29/689 children (4.2%) treated with house dust mites extract (0.09% of the injections), in 9/291 children (3.1%) treated with grass extract (0.07% of the injections) and in 3/109 children (2.8%) treated with Parietaria extract (0.06% of the injections). The prevalence of systemic reactions was significantly higher (p< 0.0001) in the children treated with house dust mite extract in comparison with those treated with pollen extracts. All the systemic reactions appeared within 30 minutes following the administration of the extract and occurred in 37/41 cases (90.2%) with the same dose, previously tolerated. Most reactions were mild, and were readily controlled by immediate emergency treatment. There was no need for hospitalization. The low prevalence of systemic reactions (0.08% of the total injections and 3.7% of the total treated, indicates that specific immunotherapy with inhalant allergens is safe in children with respiratory allergic diseases.;

Immunogenicity of a so‐called hypoallergenic formula in at‐risk babies: two case reports

The clinical and immunologic findings of two breast‐fed babies who experienced anaphylaxis after a feeding with a partially whey hydrolysate formula (PWHF) are reported. Sensitization to this formula seems to have occurred in the first days of life in the Maternity Hospital where the babies were fed the same formula. These two case reports suggest that PWHF may be immunogenic in the IgE system. This data is in agreement with previous studies which showed intact fragments of cows milk (CM) proteins in PWHF.

Systemic mastocytosis in a 5-year-old child: successful treatment with disodium cromoglycate

Most clinical signs and symptoms of systemic mastocytosis (SM) are attributed to histamine release. We report here a 5‐year‐old male child with SM, who suffered from the age of 4 months from disseminated skin lesions, vomiting, diarrhoea, abdominal pain, flushing, tachycardia, hypotension, somnolence, and transient blindness, triggered by heat and egg ingestion. Oral disodium cromoglycate (DSCG) or placebo were started in a single blind trial at a dose of 100 mg/kg/day in four divided doses. The child was studied for 21 months during the administration of three courses of DSCG, each of 6 months’ duration, interspersed with three 1‐month courses of placebo. During treatment with DSCG all the systemic manifestations improved, and the histaminaemia decreased. During the placebo periods the symptoms, signs, and histaminaemia recurred.

A double‐blind, placebo‐controlled study to assess the efficacy of nedocromil sodium in the management of childhood grass‐pollen asthma

The aim of this double‐blind placebo‐controlled trial was to assess the efficacy and tolerance of nedocromil sodium at a dose of 4 mg four times daily, in the management of children suffering from grass‐pollen asthma. Thirty‐one children suffering from seasonal asthma (24 boys and seven girls, aged 4–21 yr, mean 11 yr) were enrolled in the study during the 1988 pollen season. Only one child was aged 4 yr, and she was a cooperative girl able to use the metered dose inhaler properly. In addition, in each group there was a patient aged 20 and 21 years, respectively, who had been followed up by us since childhood. Treatments were delivered by pressurized aerosol over a period of 4 weeks following a 1‐week baseline, during which patients were required to show active disease by obtaining a minimum symptom score (almost 2 points of severity score on at least 3 days of the baseline period). The patients were randomly assigned lo both treatment groups, all were taking inhaled or oral bronchodilators, when necessary. Twenty‐nine patients completed the trial, 16 in the nedocromil sodium treatment group and 13 in the placebo group. One child of each group was withdrawn due to treatment failure.

Severe reactions to cow's milk in very young infants at risk of atopy.

Cows milk (CM) allergy (CMA) is a disease of infancy, usually appearing in the first months of life. Symptoms triggered by CM at first introduction are not completely defined. The aim of this study was to investigate the prevalence of severe reaction to CM and clinical manifestation triggered by CM administration in the first few months of life. Particularly sensitizing appears to be the exposure to CM formulas in the neonatal nursery. The little doses of allergens are more sensitizing than larger ones. These data provide clear evidence of the immunological effects of oral antigen administration during the neonatal period. Babies at risk of atopy should receive in their first days colostrum and/or formulas appropriate for atopy prevention. In this prospective study, we evaluated 27 babies in order to ascertain the prevalence of CM-induced severe reactions.

Familial Juvenile Nephronophthisis A Review and Differential Diagnosis

Familial juvenile nephronophthisis (FJN) is a frequent cause of chronic renal failure in children and adolescents. Typically it presents after 6 years of age through adolescence, but may become apparent in early childhood. The clinical presentation is insidious, and the early symptoms of polyuria and polydipsia are often overlooked in the presence of a relatively normal urinalysis and in the absence of proteinuria, azotemia, and hypertension. Thus most patients are not diagnosed until after the onset of renal failure. These children are excellent candidates for properly selected transplantation.

Natural history of IgE-mediated food allergy in fully breast-fed babies

We have studied 21 babies with IgE‐mediated food allergy (FA) sensitized via breast milk. The diagnosis of IgE‐mediated FA was based on the response to elimination diet and challenge tests, and was confirmed by positive RAST and skin tests. The children exhibited immediate symptoms, such as urticaria, angioedema, and asthma. Only 5/21 children developed tolerance to the offending food at the median age of 14 years. The children who failed to develop tolerance still have high levels of IgE antibodies towards the offending food. In conclusion, the results of our long‐term follow‐up study show that the natural history of FA in children sensitized via breast milk may be less optimistic than generally reported.