Olga Dominguez

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.

Tolerance to egg proteins in egg‐sensitized infants without previous consumption

Egg‐sensitized infants who have never eaten egg may react at first ingestion. We sought to determine the association between skin prick test (SPT) and specific IgE (sIgE) to egg proteins (EP) and oral food challenge (OFC) outcomes to find cut‐off points which can diagnose egg allergy.

Asymptomatic LTP sensitisation is common in plant-food allergic children from the Northeast of Spain.

BACKGROUND The sensitisation profile at molecular level in plant-food allergy is complex. Several allergens may be involved, with different potential for severe reactions. lipid transfer proteins (LTP) are considered the most relevant plant-food allergens in adults in Mediterranean countries, but less is known in children. AIM To describe the clinical pattern and sensitisation profile of children with plant-food allergy and LTP sensitisation from Northeast Spain. METHODS Children with history of immediate reaction to plant-food(s), positive skin-prick-test to the culprit plant-food(s) and specific-IgE to plant-food LTPs were analysed. RESULTS 130 children were included. 69.2% (90/130) had reacted to ≥2 taxonomically unrelated plant-foods. Peach, walnut, hazelnut and peanut were most frequently involved. Reactions severity ranged from anaphylaxis (45.4%, 59/130) to oral symptoms only. Sensitisation to a particular plant-food LTP not always caused clinical symptoms with that plant-food; 69% (40/58) and 63% (17/27) of peach- and walnut-tolerant subjects had positive rPru p 3 and nJug r 3 specific IgE, respectively. 65.4% (85/130) of children were also sensitised to storage proteins, which was associated to anaphylaxis and nut allergy. However, 60% of patients without nuts/seeds allergy were sensitised to storage proteins. Specific-IgE levels to LTPs and/or storage proteins were not useful to predict allergy (vs. tolerance) to peach, walnut, peanut or hazelnut. CONCLUSIONS Sensitisation to LTP and/or storage proteins without clear clinical significance is relatively common. Prospective longitudinal studies are required to evaluate the relevance of these silent sensitisations over time. Caution is required when interpreting the results of molecular-based diagnostic tools in clinical practice.

A 10% liquid immunoglobulin preparation for intravenous use (Privigen®) in paediatric patients with primary immunodeficiencies and hypersensitivity to IVIG.

BACKGROUND The objective of this study was to evaluate safety and efficacy of Privigen®, a 10% intravenous immunoglobulin (IVIG), in a particular group of paediatric patients (highly sensitive to previous IVIG infusion) affected with Primary Immunodeficiencies (PID). MATERIAL AND METHODS Patients (n=8) from 3 to 17 years old diagnosed of PID who often suffered from adverse events related to the infusion to previous IVIG were switched to Privigen® in an open protocol. Data were prospectively collected regarding Privigen® administration: infusion, safety and efficacy. In parallel, data on safety and tolerance were retrospectively collected from medical charts regarding the previous 10% IVIG product used. RESULTS 50% of the patients required premedication with previous IVIG. At the end of the study none required premedication with Privigen®. The infusion rate was lower than that recommended by the manufacturer. All patients had suffered through adverse events during previous IVIG infusion being severe in three patients and recurrent in the rest. With Privigen® only three patients suffered from an adverse event (all cases were milder than previous related). Trough levels of IgG remained stable. None suffer from any episode of bacterial infection. CONCLUSION The present work shows that Privigen® was safe in a group of hypersensitive paediatric patients who did not tolerate the administration of a previous 10% liquid IVIG by using a particular infusion protocol slower than recommended. The number of adverse effects was smaller than published, and all cases were mild. No premedication was needed. Privigen® was also effective in this small group.

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

Usefulness of the ratio total IgE / specific IgE (sIgE) to predict tolerance in children allergic to cow's milk proteins (CMP)

Background Cow’s milk (CM) IgE-mediated allergy is the most common food allergy in children. It affects 2 - 3% of the general population. About 80% of children allergic to CMP reach natural tolerance in the third year of life. It remains difficult to decide when it is time to attempt a controlled food challenge (CFC) to reintroduce CM in their diets. Objectives. To evaluate if the ratio total IgE / CM sIgE or total IgE / casein sIgE can be more useful than the single measurement of sIgE to predict tolerance in our patients, and to determine the highest sensitivity cut-off point. Methods Retrospective, observational study. The medical records of 178 patients allergic to CM with CFC performed between January 2010 and December 2011 were reviewed. Clinical data, skin prick tests (SPT), total IgE, CM sIgE and casein sIgE at baseline and at the time of the CFC were recorded. These measures were compared between groups of tolerant and nontolerant patients using the nonparametric Mann-Whitney. ROC curves were performed to evaluate predictive values of tolerance for total IgE, CM sIgE, casein sIgE and ratios (total IgE / CM sIgE; total IgE / casein sIgE).

Allergic reactions due to cow’s milk (CM) doses and triggering factors in 40 CM anaphylactic children during maintenance phase of specific oral tolerance induction (SOTI) treatment to CM in our unit

Results Median age: 10.6 years. Median maintenance period: 1.5 years. CM-IgE before SOTI: 101 KU/L. Median threshold dose at oral food challenge before SOTI: 2.5 ml. Median current daily CM dose: 200 ml. Allergic reactions to CM: 29 children have had reactions, as follows: A) Non anaphylactic reactions: 15 children. 8 children suffer daily from mild symptoms (4, mouth itching; 1, abdominal pain; 1, hives; 2, rhinitis) and 4 children from mild asthma 2-3/week, with no triggers associated. 6 children had 1 to 6 mild respiratory or digestive symptoms related to trigger factors. B) 20 children have suffered from anaphylactic reactions, 50% of which are related to trigger factors. 14 patients had skin and respiratory involvement (rank: 65 to 1 episodes). 3 children had skin and digestive symptoms (rank: 4 to 1 episodes). 3 children, respiratory and digestive (rank:13 to 1 episodes). 7 children received epinephrine (39 doses). Number of children reacting to CM because of the following trigger factors: fasting, 5; exercise, 8 (66 episodes); lying, 12 (16 episodes); tiredness, 3; stress, 3; asthma exacerbation, 4; infection, 6. 9 children reacted to goat’s or sheep’s cheese and 4 to cow’s cheese. 7 children have reduced in 10 to 75% their daily milk doses because of allergic reactions. 2 children withdrew SOTI during the maintenance period due to intense and frequent reactions.