Pablo Rodríguez del Río

Dehydrated egg white: An allergen source for improving efficacy and safety in the diagnosis and treatment for egg allergy

Raw and cooked eggs are used as allergens in oral food challenge (OFC). Raw egg is the best option, as it keeps proteins intact and retains their allergenicity, albeit microbiologically safe manipulation is difficult. Therefore, the use of dehydrated egg white (DEW) could improve the efficacy and safety profile of OFC. The aim of the study was to compare the allergenicity of DEW, a product that undergoes a double heat treatment (pasteurization and drying), with that of raw egg white (REW) and determine the efficacy of DEW in the diagnosis of egg allergy.

Allergy to goat’s and sheep’s milk in a population of cow’s milk–allergic children treated with oral immunotherapy*

To cite this article: Rodríguez del Río P, Sánchez‐García S, Escudero C, Pastor‐Vargas C, Sánchez Hernández JJ, Pérez‐Rangel I, Ibáñez MD. Allergy to goat’s and sheep’s milk in a population of cow’s milk–allergic children treated with oral immunotherapy. Pediatr Allergy Immunol 2012: 23: 128–132.

The European Survey on Adverse Systemic Reactions in Allergen Immunotherapy (EASSI): a paediatric assessment

Safety data on ‘real‐life’ allergen immunotherapy (AIT) in children and adolescents is usually extrapolated from studies in adults.

Efficacy and safety of high-dose rush oral immunotherapy in persistent egg allergic children: A randomized clinical trial

BACKGROUND Egg oral immunotherapy is effective but time consuming. OBJECTIVE To assess the efficacy and safety of egg rush oral immunotherapy (ROIT) with a targeted dose equivalent to a raw egg white. METHODS Thirty-three persistent egg allergic children confirmed by double-blind, placebo-controlled food challenge (DBPCFC) were randomized to receive egg ROIT immediately after randomization (ROIT1 group), or to continue an egg avoidance diet for 5 months after randomization (control group [CG]). A 5-day build-up phase starting with the highest single tolerated dose at baseline DBPCFC was scheduled and several doses administered daily until achieving a dose of approximately 2,808 mg of egg white protein. In the maintenance phase, patients ate an undercooked egg every 48 hours for 5 months. The CG participants who failed the DBPCFC at 5 months began active treatment. Children from the ROIT1 group plus children from the CG who failed a second DBPCFC at 5 months and then received egg ROIT were randomized to the ROIT2 group. Adverse events (AEs) and immune marker evolution were recorded. RESULTS A total of 17 (89%) of 19 children in the ROIT1 group and no CG patients were desensitized at 5 months (P < .001). A total of 31 (97%) of the 32 children in the ROIT2 group completed the build-up phase in a median of 3 days (range, 1-14 days), and 30 (94%) of 32 maintained desensitization at 5 months. From baseline to 5 months of treatment, skin prick test, specific IgE, and specific IgE/IgG4 ratio to egg fractions significantly decreased, whereas specific IgG4 increased. During the build-up phase, AEs occurred in 69% of patients (50% had ≤2 AEs) and 31% of doses (2% severe, 55% gastrointestinal). Lower threshold dose in the DBPCFC and higher egg white and ovalbumin specific IgE levels at baseline revealed an association with a higher rate of AEs. CONCLUSION The proposed 5-day egg ROIT desensitized 94% of the allergic patients, with most AEs being mild or moderate.

Exercise-induced bronchospasm diagnosis in children. Utility of combined lung function tests.

The diagnosis of exercise‐induced asthma or bronchospasm (EIB) is a complex dare in daily clinical practice. The consensus is that if bronchial hyper‐responsiveness (BHR) is demonstrated in a patient with symptoms consistent with EIB, then that patient can be diagnosed with exercise‐induced bronchospasm. The aim of this study was to determine which BHR test is the most efficient to diagnose EIB.

Prospective assessment of diagnostic tests for pediatric penicillin allergy, from clinical history to challenge tests✰,✰✰,✰✰✰

BACKGROUND Diagnostic guidelines for penicillin allergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use. OBJECTIVE To assess the accuracy of tools for diagnosis of penicillin allergy in children. METHODS A prospective, multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol that consisted of clinical history, skin tests, serum specific IgE (sIgE), and, regardless of these results, drug provocation tests (DPTs). RESULTS A total of 732 children (mean age, 5.5 years; 51.2% males) completed the allergy workup, including DPTs. Amoxicillin triggered 96.9% of all reactions. None of the patients with an immediate index reaction (IR) developed a reaction on DPT. Penicillin allergy was confirmed in 35 children (4.8%): 6 immediate reactions (17%) and 29 nonimmediate reactions (83%) on the DPT. No severe reactions were recorded. The allergist diagnosis based on the clinical history was not associated with the DPT final outcome. In 30 of 33 allergic patients (91%), the results of all skin tests and sIgE tests were negative. A logistic regression model identified the following to be associated with penicillin allergy: a family history of drug allergy (odds ratio [OR], 3.03; 95% confidence interval [CI], 1.33-6.89; P = .008), an IR lasting more than 3 days vs 24 hours or less (OR, 8.96; 95% CI, 2.01-39.86; P = .004), and an IR treated with corticosteroids (OR, 2.68; 95% CI, 1.30-5.54; P = .007). CONCLUSION Conventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of nonsevere penicillin allergy in children.

Evaluating primary endpoints in peanut immunotherapy clinical trials

Food immunotherapy has been the focus of several allergy research initiatives over the last decade. Although many questions remain unanswered, the evidence suggests that this treatment might be available in the near future outside clinical trials. Additionally, pharmaceutical companies, in light of promising early-stage results, have shown interest in developing commercially available products, thus increasing the likelihood that new immunotherapy treatments will be introduced, especially for peanut allergy. Given this optimistic scenario and given the prospect of rigorously developed products for peanut allergy treatment, each allergist will need to understand the specificities of these treatments and their expected efficacy and adverse event profiles. Thus it is imperative that allergists understand the differences in efficacy between the different management options, as well as how the end points are measured in the relevant literature. However, given the significant heterogeneity detected among food immunotherapy trials, this task might not be as straightforward as desired. This article aims to dissect how primary efficacy end points are defined and assessed to facilitate understanding of the design of these trials and the potential effect that this variation might have on the reported outcomes.

Initial experience with carboplatin desensitization: A case series in a paediatric hospital

For several years, carboplatin has been the most efficacious and safest first-line treatment for paediatric low-grade gliomas (LGGs), although very recently vinblastine has been proven to display a better safety profile with similar efficacy (1). Classically, hypersensitivity reactions to carboplatin appeared in around 27% to 42% of cases (2). These reactions are especially frequent as of the seventh cycle (3) in adults and the ninth in children (4), leading to treatment withdrawal and the use of second-line drugs. This article is protected by copyright. All rights reserved.

Asthma diagnosis and treatment - 1010. Lung function tests in exercise-induced asthma among pediatric population.

Background EIA (Exercise-induced Asthma) can be considered a marker of severity and disease control in asthma. There are several diagnostic tools to evaluate airway hyperresponsiveness in EIA, but it has not been establish the best one. Our objective is to explore bronchial hyperresponsiveness with different lung function measurement techniques among a pediatric population with clinical history suggestive of EIA.

525 Bronchial Hyperresponsiveness in Children with Suggestive Asthma Symptoms.

Background To describe the accuracy of bronchial challenge tests (methacholine and manitol) to measure bronchial hyperresponsiveness in a group of pediatric patients with suggestive symptoms of asthma. Methods We selected 27 patients who attended consecutively to our outpatient clinic complaining of 1 or 2 symptoms of asthma. They showed a normal baseline spirometry and a negative bronchodilator test. All of them underwent unspecific bronchial provocation challenges. Methacholine was performed using the tidal volumen technique and a PC20 ⩽ 8 mg/mL was considered positive. Dry-powder mannitol (Osmohale TM) was administered according to the manufacturers recommendations and the challenge was considered positive if a PD15 ⩽ 635 mg resulted. We performed both tests with an interval of at least 1 week. Asthma drugs were avoided during the 2 weeks previous to every challenge. Skin prick tests (SPT) to the most common aeroallergens were also performed. Results Mean age was 9 (ranged 7–15) years, 18 (66.6%) children were male. Symptoms referred were: 14 (51.8%) cough, 10 (37%) seasonal cough or shortness of breath, 5 (18.51%) cough or shortness of breath due to physical exercise and 1 (3.7%) cough or wheezing related to respiratory infections. SPT were positive in 59.2% of the children. Eighteen (66.6%) out of 27 patients had bronchial hyperresponsiveness, and 10 (37.03%) were non atopic. All patients with a positive response to manitol showed also positivity to methacholine. Mean methacoline PC20 among responders was 0.64 ± 4.08 mg/mL. Manitol was performed in 16 children, and resulted positive in 8 cases (50%) with a mean PD15 of 146.8 ± 246.49 mg. In 2 (25%) out of 8 patients with negative manitol resulted a positive methacholine. Conclusions Methacholine and manitol challenge tests detected bronchial hyperresponsiveness in more than a half of the studied children with suggestive asthma symptoms. Methacoline was more sensitive than manitol.