Background
Fish is the most common causative food of food protein–induced enterocolitis syndrome (FPIES) in Southern Europe. In children with FPIES, the development of tolerance varies according to ...the culprit food and specifically fish seems to have a poorer prognosis than other solid foods. We sought to evaluate the fish‐FPIES resolution rate in children.
Methods
A descriptive retrospective analysis of children with fish‐FPIES, followed during the last 20 years, was performed. The offending fish, age and symptoms at onset, the coexistence of atopic diseases and FPIES to other foods were registered. All the children included had undergone an oral food challenge (OFC) with the offending fish. We recorded those children that overcame their fish‐FPIES and those that did not outgrow the disease.
Results
Seventy children were enrolled in this study (median age: 9 yo; IQR 6.4‐13.8). Forty‐two (60%) achieved tolerance to the offending fish with a median age of 4 years (IQR: 3‐5). Among children ≤5 yo (n = 40), 35 (87.5%) developed tolerance; among 6‐8yo (n = 14), 40% developed tolerance; and only 12.5% among those ≥9 yo (n = 16) developed tolerance. Twenty‐eight children did not outgrow the disease (median age: 8.9 yo; IQR: 9‐13.8). We did not find any statistical differences regarding the offending fish, presence of single vs multiple fish‐FPIES, symptoms at the beginning, coexistence of other atopic diseases or the coexistence of other FPIES, between the children who overcame the disease and those who did not.
Conclusion
One in five children with FPIES to fish will not overcome the disease during childhood.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy characterized by gastrointestinal symptoms, mainly protracted and delayed vomiting. Diagnosis is based on ...clinical history, and it can be challenging as symptoms are delayed and the causative food is often not very suspicious.
This case report highlights the importance of having a high degree of suspicion to reach a correct diagnosis.
We report an unusual case of FPIES due to zucchini. During the follow-up. Two oral food challenges (OFC) were carried out to evaluate tolerance to the food involved.
The first OFC was positive and in the second the child tolerated the food without problems.
In this case, the OFC was essential to identify the offending food and to verify that the child had overcome the disease.
Delayed Diagnosis Of Egg Allergy Acevedo Matos, Margarita R., MD; Fuentes-Aparicio, Victoria; Infante, Sonsoles ...
Journal of allergy and clinical immunology,
02/2017, Letnik:
139, Številka:
2
Journal Article
Recenzirano
Odprti dostop
The patients in the DD group comprised 5 boys and 1 girl, median age 6.5 years (range: 2-11), most frequent presentation symptom was rejection (100%), followed by itchy mouth (66.7%).
Purpose of Review
Food protein-induced enterocolitis syndrome (FPIES) is considered a rare, non-IgE-mediated food allergy that typically presents in infancy. As there is not a specific biological ...marker of the disease, diagnosis of FPIES is based on typical symptoms that improve once the offending food is removed from the diet. The most common causative foods are cow’s milk, soy, and rice. For years, we have thought that the typical symptoms and the triggering foods were the same around the world.
Recent Findings
The epidemiological data are scarce and variable but recent studies suggests that FPIES is not as rare as it is thought but rather misdiagnosed. The clinical symptoms and the offending foods vary depending on the geographic area. Perhaps because different phenotypes might exist due to dietary habits, race, or ethnicity.
Summary
FPIES symptoms and causative foods are not the same around the world. It is important to know our population in order to reach a correct and early diagnosis of our patients.
Elevated proinflammatory cytokines are associated with greater COVID-19 severity. We aimed to assess safety and efficacy of sarilumab, an interleukin-6 receptor inhibitor, in patients with severe ...(requiring supplemental oxygen by nasal cannula or face mask) or critical (requiring greater supplemental oxygen, mechanical ventilation, or extracorporeal support) COVID-19.
We did a 60-day, randomised, double-blind, placebo-controlled, multinational phase 3 trial at 45 hospitals in Argentina, Brazil, Canada, Chile, France, Germany, Israel, Italy, Japan, Russia, and Spain. We included adults (≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and pneumonia, who required oxygen supplementation or intensive care. Patients were randomly assigned (2:2:1 with permuted blocks of five) to receive intravenous sarilumab 400 mg, sarilumab 200 mg, or placebo. Patients, care providers, outcome assessors, and investigators remained masked to assigned intervention throughout the course of the study. The primary endpoint was time to clinical improvement of two or more points (seven point scale ranging from 1 death to 7 discharged from hospital) in the modified intention-to-treat population. The key secondary endpoint was proportion of patients alive at day 29. Safety outcomes included adverse events and laboratory assessments. This study is registered with ClinicalTrials.gov, NCT04327388; EudraCT, 2020-001162-12; and WHO, U1111-1249-6021.
Between March 28 and July 3, 2020, of 431 patients who were screened, 420 patients were randomly assigned and 416 received placebo (n=84 20%), sarilumab 200 mg (n=159 38%), or sarilumab 400 mg (n=173 42%). At day 29, no significant differences were seen in median time to an improvement of two or more points between placebo (12·0 days 95% CI 9·0 to 15·0) and sarilumab 200 mg (10·0 days 9·0 to 12·0; hazard ratio HR 1·03 95% CI 0·75 to 1·40; log-rank p=0·96) or sarilumab 400 mg (10·0 days 9·0 to 13·0; HR 1·14 95% CI 0·84 to 1·54; log-rank p=0·34), or in proportions of patients alive (77 92% of 84 patients in the placebo group; 143 90% of 159 patients in the sarilumab 200 mg group; difference -1·7 -9·3 to 5·8; p=0·63 vs placebo; and 159 92% of 173 patients in the sarilumab 400 mg group; difference 0·2 -6·9 to 7·4; p=0·85 vs placebo). At day 29, there were numerical, non-significant survival differences between sarilumab 400 mg (88%) and placebo (79%; difference +8·9% 95% CI -7·7 to 25·5; p=0·25) for patients who had critical disease. No unexpected safety signals were seen. The rates of treatment-emergent adverse events were 65% (55 of 84) in the placebo group, 65% (103 of 159) in the sarilumab 200 mg group, and 70% (121 of 173) in the sarilumab 400 mg group, and of those leading to death 11% (nine of 84) were in the placebo group, 11% (17 of 159) were in the sarilumab 200 mg group, and 10% (18 of 173) were in the sarilumab 400 mg group.
This trial did not show efficacy of sarilumab in patients admitted to hospital with COVID-19 and receiving supplemental oxygen. Adequately powered trials of targeted immunomodulatory therapies assessing survival as a primary endpoint are suggested in patients with critical COVID-19.
Sanofi and Regeneron Pharmaceuticals.
Background. Angiogenesis has a key role in several conditions and is regulated by several factors such as the platelet-derived growth factor (PDGF) or the vascular endothelial growth factor (VEGF). ...The goal of this study was to investigate the possible role of PDGF and VEGF in a group of patients with severe food allergy. Methods. We design a prospective longitudinal study (n=30) with patients with persistent cow’s milk proteins (CMP) allergy. After achieving a CMP rush desensitization protocol, a clinical followup including SPT and blood samples to determine sIgE, protein levels, PDGF, and VEGF-A and a panel of the most representative Th1, Th2, Treg, and Th17 cytokines were also monitored. Results. Baseline levels of PDGF and VEGF in the CMP allergic patients (1170 pg/mL and 253 pg/mL) were different compared to those nonallergic CMP control subjects (501 pg/mL and 108 pg/mL). Both PDGF and VEGF were significantly downregulated (P<0.05) 6 months after completion of the CMP desensitization process and remained significantly decreased 12 months later. Conclusion. The present study shows a significant increase of PDGF and VEGF in anaphylaxis suffering children compared to a control group. Interestingly, both VEGF and PDGF were significantly downregulated after completing a full CMP rush IgE desensitization.
Background: Food allergy affects a significant number of children and its prevalence, and persistence is undergoing an important increase in the last years. Specific oral tolerance induction (SOTI) ...is a promising therapy for food allergy. However, little is known about the immune mechanisms implicated in the desensitization to allergens. Our purpose was to study which immune parameters are modified during the process of tolerance achievement with the goal of identifying markers of tolerance induction.
Methods: We performed an extensive immune analysis in 19 allergic children following SOTI with hen’s egg before and after the immunotherapy. Changes in lymphocyte subpopulations and serum cytokines were identified in children with desensitization achievement.
Results: Sixteen children achieved complete tolerance to egg, and the immune analysis reveals that desensitization was accompanied in all the cases by a significant decrease in the percentage and absolute counts of effector‐memory CD4+ T cells (TEM) and a marked increase in the absolute counts of a subset of CD4+CD38+CD45RO− cells. Additionally, we also observed a marked reduction in the plasma levels of different Th1 and Th2 cytokines after tolerance achievement.
Conclusions: Acquisition of tolerance in children after oral immunotherapy is accompanied by a decrease in the TEM population and the increase in a particular subset of CD4+ T cells with a hypo‐proliferative and non‐reactive phenotype. This hypo‐proliferative subset of cells could constitute a marker of the development of oral tolerance, and the study of this subset could contribute to the better understanding of the immune responses in allergic subjects.
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