Oral immunotherapy (OIT) is an effective treatment for children with persistent food allergy, and has concerns about its safety, including eosinophilic esophagitis (EoE). The aim of this study was to ...evaluate the prevalence of EoE in a large cohort of children who underwent OIT in our center, and to determine if there were any clinical, endoscopic, or histologic differences depending on the food employed for the OIT.
A retrospective study was performed over a 15-year period (2005-2020). Children who underwent cow's milk (CM), egg, and/or peanut OIT and developed EoE were included.
Six hundred and seven OIT were carried out (277 CM-OIT, 322 egg-OIT, and 8 peanut-OIT). Seventeen patients (2.8%) had a confirmed histologic diagnosis of EoE with a higher prevalence for patients who underwent CM-OIT (3.9%) than egg-OIT (2.2%). Symptoms suggestive of EoE and a confirmed diagnosis occurred at median times of 25 and 36 months, respectively, after the build-up phase of the OIT was completed. Choking, abdominal pain, and dysphagia were the most frequent symptoms and lamina propria fibrosis was observed in 41.2% of patients. No significant differences in clinical symptoms, endoscopic, or histologic findings between patients under CM or egg-OIT were found. One-third of patients reported mild symptoms suggestive of EoE before the OIT.
EoE appears to be a rare but important adverse event that can occur even years after OIT. Validated questionnaires to screen EoE before the OIT and in the follow-up of these patients may be the main tool for an early diagnosis.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by delayed and reproducible gastrointestinal symptoms. It is a heterogenous disorder with a wide ...spectrum of clinical phenotypes. The typical symptoms and the triggers vary depending on age at onset and geographic area. The aim of this study was to establish the characteristics of FPIES and its clinical management in Spain. An online cross-sectional survey was completed by members of the Spanish Society of Allergy and Clinical Immunology (SEAIC) and of the Spanish Society of Paediatric Clinical Immunology, Allergy and Asthma (SEICAAP). The survey (online repository text) was created using SurveyMonkey. It was launched in early March 2020 and ended in July 2020. The data were entered into an anonymized database. The survey was completed by 122 physicians.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food hypersensitivity usually due to cow's milk or soy. Among the solid foods, rice is one of the most ...causative foods worldwide, but it varies depending on the geographic area. In the Mediterranean countries, fish is one of the most important triggers of FPIES. There is not a specific biological marker for the disease that allows us to confirm the diagnosis or to predict when tolerance to the offending food has been achieved, so all patients with a FPIES diagnosis undergo an oral food challenge (OFC) at least once. The OFC is a risky procedure and many patients develop severe symptoms.
We sought to evaluate the safety of a new OFC protocol in children with fish-FPIES.
A retrospective study was performed over a 22-year period (1996-2018). We compared two methodologies used in the OFC: Method 1 that consisted in giving several doses during the same day versus Method 2 that consisted in giving a unique dose per day on 2 or three non-consecutive days.
A total of 75 positive OFC with fish done in 40 children were included. Forty-three (57.3%) OFC were performed following Method 1 and 32 (42.7%) with Method 2.The severity of the symptoms of the OFC done with Method 1 was mostly moderate (41.9%) followed by severe (39.5%) and mild (18.6%). The adverse reactions with Method 2 were mostly mild (68.8%) and only 18.8 and 12.5% presented moderate or severe symptoms, respectively.
OFC performed in children with fish-FPIES are risky and many patients develop moderate or severe symptoms after this procedure. We propose a new protocol that has demonstrated to improve safety.
Two hundred consecutive food-allergic patients were surveyed about their SoMe habits and opinion (1 to 5, or unknown) on allergy-related evidence-based (oral immunotherapy, epinephrine, allergen ...immunotherapy, inhaled corticosteroids) and alternative therapies (homeopathy, reiki, acupuncture, osteopathy, naturopathy, Bach flower remedies). No significant differences were found between patients who used SoMe for food allergy and those who used SoMe for non-allergy-related purposes, regarding therapies’ rating or knowledge.
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