Preeti Joshi

Safety of food challenges to extensively heated egg in egg-allergic children: a prospective cohort study

Many children with IgE‐mediated allergy to egg can tolerate egg in baked foods. However, the clinical characteristics and severity of reactions of egg‐allergic children who react to baked egg at open food challenge (OFC) are not well defined.

Baked egg food challenges – clinical utility of skin test to baked egg and ovomucoid in children with egg allergy

Many children with IgE‐mediated egg allergy can tolerate products containing extensively heated (baked) egg. Aside from food challenge, there are no tests which reliably predict tolerance to baked egg in egg‐allergic individuals.

A comparison of IL-2 levels in nasopharyngeal and endotracheal aspirates of babies with respiratory syncytial viral bronchiolitis

BACKGROUND Cytokines such as IL-2 are thought to be important in the pathogenesis of respiratory tract inflammation. Cytokine levels in nasopharyngeal aspirates (NPAs) have been used as a measure of respiratory inflammation in children with viral infections, but it is unclear whether they reflect levels in the lower respiratory tract. OBJECTIVE We sought to assess the correlation between IL-2 levels in the nasopharyngeal and endotracheal secretions of children intubated with respiratory syncytial virus (RSV)-positive bronchiolitis. METHODS NPA and endotracheal aspirates were collected concurrently from intubated infants with RSV-positive bronchiolitis. IL-2 levels were assayed by ELISA, and the results were compared according to collection site. RESULTS Nine paired specimens were collected. IL-2 levels ranged from 31 pg/mL to 8040 pg/mL. No significant difference was found in the geometric mean IL-2 values from the 2 collection sites. The intraclass correlation coefficient between NPA IL-2 levels and endotracheal aspirate IL-2 levels was 0.83. CONCLUSION IL-2 levels in NPAs are comparable with those in the lower respiratory tracts of infants with RSV-positive bronchiolitis. NPA cytokine levels provide a simple and useful means of assessing respiratory tract inflammation.

Safety and clinical predictors of reacting to extensively heated cow's milk challenge in cow's milk-allergic children

BACKGROUND Many children with IgE-mediated allergy to cows milk (CM) can tolerate CM in baked foods. OBJECTIVE To define the clinical characteristics and severity of reactions to baked CM in children with CM allergy (CMA) at an oral food challenge (OFC). METHODS Children with CMA presenting to a tertiary clinic from 2010 through 2013 with complete dietary CM avoidance were offered a baked CM OFC. Challenges were performed with incremental dosages to a total of 1 baked muffin. RESULTS Seventy children with CMA underwent a baked CM OFC. Fifty-one children (73%) passed the OFC and successfully incorporated baked CM into their diet. Nineteen children (27%) reacted to their challenge. Of reactors, 4 (21%) developed anaphylaxis and required intramuscular adrenalin. Predictors of clinical reactivity to baked CM were asthma, asthma requiring preventer therapy, IgE-mediated clinical reactions to more than 3 food groups, and those with a history of CM anaphylaxis. CONCLUSION This study identified factors that were predictors of clinical reactivity to baked CM in this cohort of children with CMA. These risk factors do not represent contradictions to a baked CM challenge but may allow for risk stratification of challenges. Given the potential for anaphylaxis, an OFC to baked CM should be done under medical supervision in those children with CMA who have been strictly avoiding all CM.

Cord blood mononuclear cell cytokine responses in relation to maternal house dust mite allergen exposure

Background Cord blood mononuclear cells have demonstrated specific immune responses to environmental allergens.

Food protein–induced enterocolitis syndrome in Australia: A population-based study, 2012-2014

Background Food protein–induced enterocolitis syndrome (FPIES) is a non–IgE‐mediated gastrointestinal allergic disorder. Large population‐based FPIES studies are lacking. Objective We sought to determine the incidence and clinical characteristics of FPIES in Australian infants. Methods An Australia‐wide survey (2012‐2014) was undertaken through the Australian Paediatric Surveillance Unit, with monthly notification of new cases of acute FPIES in infants aged less than 24 months by 1400 participating pediatricians. Results Two hundred thirty infants with FPIES were identified. The incidence of FPIES in Australian infants (<24 months) was 15.4/100,000/y. Median age of first episode, diagnosis, and notification were 5, 7, and 10 months, respectively. There was no sex predilection. Seven percent of infants had siblings with a history of FPIES, and 5% reacted during exclusive breast‐feeding. Sixty‐eight had a single food trigger (20% had 2 and 12% had ≥3 food triggers). The most common FPIES triggers were rice (45%), cows milk (33%), and egg (12%). Fifty‐one percent of infants reacted on their first known exposure. Infants with FPIES to multiple versus single food groups were younger at the initial episode (4.6 vs 5.8 months [mean], P = .001) and more frequently had FPIES to fruits, vegetables, or both (66% vs 21%, P < .0001). Infants exclusively breast‐fed for more than 4 months had a trend toward lower rates of FPIES to multiple food groups (23% vs 36%, P = .06). Sixty‐four percent of infants with FPIES to multiple foods, which included cows milk, had coassociated FPIES to solid foods. Forty‐two percent of infants with FPIES to fish reacted to other food groups. Conclusions FPIES is not rare, with an estimated incidence of 15.4/100,000/y. Rice is the most common food trigger in Australia. Factors associated with FPIES to multiple foods included early‐onset disease and FPIES to fruits, vegetables, or both.

Egg allergy: An update

Egg allergy is the commonest infant food allergy both in Australia and world‐wide. The clinical presentation of egg allergy is varied – egg is involved in both IgE and non‐IgE‐mediated allergic reactions and has been implicated in conditions such as anaphylaxis, food protein‐induced enterocolitis syndrome, atopic dermatitis and eosinophilic oesophagitis. The clinical presentation, pathophysiology and diagnosis as well as the natural history and management of egg allergy will be discussed. Current theories about primary prevention as well as potential future therapies are presented. Finally, practical information about egg allergy and immunisation is provided.

Salicylate elimination diets in children: is food restriction supported by the evidence?

A review of case notes from our Sydney‐based paediatric allergy services, between 1 January 2003 and 31 December 2011, identified 74 children who had been prescribed diets that eliminated foods containing natural salicylates before attending our clinics. The most common indications for starting the diets were eczema (34/74) and behavioural disturbances (17/74) including attention deficit hyperactivity disorder (ADHD). We could find no peer‐reviewed evidence to support the efficacy of salicylate elimination diets in managing these diseases. We do not prescribe these diets, and in a survey of European and North American food allergy experts, only 1/23 respondents used a similar diet for eczema, with none of the respondents using salicylate elimination to treat ADHD. A high proportion (31/66) of children suffered adverse outcomes, including nutritional deficiencies and food aversion, with four children developing eating disorders. We could find no published evidence to support the safety of these diets in children. While this uncontrolled study does not prove a causal relationship between salicylate elimination diets and harm, the frequency of adverse events appears high, and in the absence of evidence of safety or efficacy, we cannot recommend the use of these diets in children.