The prevalence of food allergy has increased over the last 20-30 years, including cow milk allergy (CMA) which is one of the most common causes of infant food allergy. International allergy experts ...met in 2019 to discuss broad topics in allergy prevention and management of CMA including current challenges and future opportunities. The highlights of the meeting combined with recently published developments are presented here. Primary prevention of CMA should start from pre-pregnancy with a focus on a healthy lifestyle and food diversity to ensure adequate transfer of inhibitory IgG- allergen immune complexes across the placenta especially in mothers with a history of allergic diseases and planned c-section delivery. For non-breastfed infants, there is controversy about the preventive role of partially hydrolyzed formulae (pHF) despite some evidence of health economic benefits among those with a family history of allergy. Clinical management of CMA consists of secondary prevention with a focus on the development of early oral tolerance. The use of extensive Hydrolysate Formulae (eHF) is the nutrition of choice for the majority of non-breastfed infants with CMA; potentially with pre-, probiotics and LCPUFA to support early oral tolerance induction. Future opportunities are, among others, pre- and probiotics supplementation for mothers and high-risk infants for the primary prevention of CMA. A controlled prospective study implementing a step-down milk formulae ladder with various degrees of hydrolysate is proposed for food challenges and early development of oral tolerance. This provides a more precise gradation of milk protein exposure than those currently recommended.
Introduction
Information and communication technologies (ICTs) improve patient‐centered care and are routinely used in Allergic Rhinitis (AR), but patients' preferences and attitudes are unexplored. ...This study examines AR‐related information preferences and ICT use by AR patients.
Methods
A survey‐based cross‐sectional study was carried out in Ecuador from July to September 2019 in seven centers of reference for allergic disease. Participants were 18 years or older, diagnosed with AR and had access to ICT and the Internet. Descriptive and binomial logistic regressions were performed. A value of less than 0.05 was considered statistically significant.
Results
217 patients were included. 47% (n = 102) used ICTs to learn about AR, of which 38.2% (n = 83) found it useful. Most of participants (75%, n = 164) did not think that ICTs reduce their need to see a doctor. Individuals with poorer quality of life were more likely to utilize ICTs to contact their doctor (OR 1.27, 95% CI 1.04–1.55), and more likely to be interested in AR‐related content (OR 1.23, 95% CI 1.00–1.52). Patients with long‐term AR or other allergies were less likely to use ICTs (OR 0.92 and OR 0.40 respectively). Higher education and lower quality of life may increase AR apps adoption (OR 4.82, 95% CI 1.11–21.00). Academic preparation five‐fold increased ICT use for health provider communication (OR 5.29, 95% CI 1.18–23.72). Mild‐persistent AR enhanced the probabilities of using ICTs to share experiences and communicate with other patients (OR 12.59, 95% CI 1.32–120.35).
Conclusions
Our study emphasizes the importance of tailoring digital resources to patient needs by considering factors such as quality of life, education, and specific subgroups within the AR patient population. Additionally, the findings suggest that while ICTs can play a valuable role in patient education and support, they should complement, rather than replace, traditional medical care for many AR patients.
Extensively hydrolyzed formulas (eHFs) are recommended for the dietary management of cow's milk protein allergy (CMPA) in non-exclusively breastfed infants. Studies show that peptide profiles differ ...between eHFs. This short review aims to highlight the variability in peptides and their ability to influence allergenicity and possibly the induction of tolerance by different eHFs. The differences between eHFs are determined by the source of the protein fraction (casein or whey), peptide size-distribution profile and residual
-lactoglobulin which is the most immunogenic and allergenic protein in bovine milk for human infants as it is not present in human breastmilk. These differences occur from the hydrolyzation process which result in variable IgE reactivity against cow's milk allergen epitopes by subjects with CMPA and differences in the Th1, Th2 and pro-inflammatory cytokine responses elicited. They also have different effects on gut barrier integrity. Results suggest that one particular eHF-casein had the least allergenic potential due to its low residual allergenic epitope content and demonstrated the greatest effect on restoring gut barrier integrity by its effects on mucin 5AC, occludin and Zona Occludens-1 in human enterocytes. It also increased the production of the tolerogenic cytokines Il-10 and IFN-
. In addition, recent studies documented promising effects of optional functional ingredients such as pre-, pro- and synbiotics on the management of cow's milk allergy and induction of tolerance, in part
the induction of the production of short chain fatty acids. This review highlights differences in the residual allergenicity, peptide size distribution, presence of optional functional ingredients and overall functionality of several well-characterized eHFs which can impact the management of CMPA and the ability to induce immune tolerance to cow's milk protein.
Cow's milk protein allergy (CMPA) is the leading cause of food allergy in infants and young children. An extensively hydrolyzed formula (eHF) is the first choice of dietary management, however, not ...all of them have similar peptide profiles and degree of hydrolysis. The aim of this retrospective study was to investigate the use of two commercially available infant formulas in the clinical management of CMPA in Mexico in terms of symptoms' resolution and growth trajectories.
Medical records of 79 subjects from four sites in Mexico were included to retrospectively evaluate the trajectory of atopic dermatitis, other symptoms of cow's milk protein allergy and growth outcomes. The study formulas were based on hydrolyzed whey protein (eHF-W) and hydrolyzed casein protein (eHF-C).
Medical records of 79 patients were enrolled, 3 were excluded from analysis based on previous formula consumption. Seventy-six children with confirmed CMPA based on skin prick test and/or serum specific IgE levels were included in the analysis. 82% of patients (
= 65) consumed the eHF-C, reflecting the doctors' preference for formulas with a higher grade of hydrolysis and the high incidence of positive reactions to beta-lactoglobulin amongst subjects. During their first visit to the doctors, 55% of the subjects consuming the casein-based formula and 45% of subjects consuming the whey-based formula presented with mild or moderate dermatological symptoms. Other frequently reported symptoms included respiratory issues, enteropathies and colitis which improved during the consumption of both formulas. All CMPA-related symptoms showed improvement during formula consumption. During the period of retrospective observation, growth significantly improved for both groups.
Consumption of eHF-C and eHF-W effectively improved symptoms' resolution and growth outcomes among children with CMPA in Mexico. More preference was reported towards eHF-C due to its hydrolysate profile and lack of b-lactoglobulin.
The study was registered at ClinicalTrials.gov: NCT04596059.
Rhinitis, sinusitis and allergy del Río-Navarro, Blanca Estela; Ito-Tsuchiya, Fernando Mitsutoshi; Zepeda-Ortega, Benjamin
Revista alergia Mexico (Tecamachalco, Pueblo, Mexico : 1993),
2009 Nov-Dec, 20091101, Volume:
56, Issue:
6
Journal Article
The allergic and infectious diseases of the nasal mucous represent two of the most frequent and chronic upper airways diseases in children and young adults. They are a public health problem of great ...magnitude due to the high prevalence that causes a great welfare pressure in terms of ambulatory consultations, significant deterioration of the quality of life so much for the patient who suffers them, like for the relatives and affect the community for the high socioeconomic costs that these generate. It is indispensable to know the physiopathology to be able to realize in time a suitable diagnosis and with it to offer a treatment adapted to diminish it recurrence.
Acute asthma is characterized by acute air way obstruction episodes presented as short breath, increased coughing, wheezing and difficult breathing, reversible with bronchodilator. It constitutes one ...of the most frequent causes of pediatric ER visits whose diagnosis and treatment is not always adequate. It is necessary to carry out a complete medical history searching for the number of previous attacks, risk factors, associated illnesses, triggers, prior hospitalizations, preventive and maintenance treatment used, along with a complete physical examination. During the management of moderate-severe attacks frequent systematic assessments are required to ensure treatment response. In children above 5 years old, monitoring of expiratory peak flow (EPF) during mild-moderate attacks is recommended. In general, a national consensus to classify and treat acute asthma in emergency services does not exist for which the need to develop a clinical practice guide of diagnosis and management arises.
Urticaria pigmentosa: a current approach Pérez-Elizondo, Antonio David; Zepeda-Ortega, Benjamín; del Pino-Rojas, Gladys Teresa
Revista alergia Mexico (Tecamachalco, Pueblo, Mexico : 1993),
2009 Jul-Aug, 20090701, Volume:
56, Issue:
4
Journal Article
The term urticaria pigmentosa (UP) denotes a heterogeneous group of disorders characterized by abnormal growth and accumulation of mast cells (MC) in the skin. Symptoms result from MC chemical ...mediator's release, pathologic infiltration of neoplastic MC in tissues or both. Multiple molecular, genetic and chromosomal defects seem contribute to an autonomous growth, but somatic c-kit D816V mutation is more frequently found, especially in systemic disease. The aim of this paper is to provide a current overview for a better understanding of the symptoms associated with this disease, to describe its classification, recent advances in its pathophysiology and its treatment.
Anomalies in pulmonary function tests in obese are oriented predominantly to restrictive pathology, not been demonstrated efficiently.
To determine and compare pulmonary function tests (PFT) with ...anthropometric measurements by spirometry and plethysmograph in asthmatic obese (AO) and non-asthmatic obese (NAO) adolescents.
Cross-sectional study, with 86 adolescents. Obesity was defined as body mass index (BMI) greater to 95% percentile according to CDC and asthma, on the basis of the definition and criteria of GINA guidelines. Clinical history was made, doing anthropometric measures and PFT with determination of: forced vital capacity with maximal expiratory effort, forced expiratory volume in the first second, specific resistance and conductance.
The average age was 12.68 years +/- 1.85, 39 were NAO and 47 AO, who had intermittent to persistent asthma, 14 patients received 200 mcg budesonide/day at least 4 weeks previous to the study. The average values in AO and their standard error for anthropometry were: weight: 68.5 +/- 13.6 kg, height: 154.58 +/- 9.1 cm, BMI: 28.27 +/- 3.24 kg/m2, abdominal circumference (AC): 98 +/- 8.85 cm and hip circumference (HC): 100 +/- 8.87 cm, in NAO: weight: 76.1 +/- 14.7 kg, height: 155.7 +/- 7.85 cm, BMI: 31.04 +/- 4.46 kg/m2, AC: 102 +/- 11.05 cm and HC: 103.28 +/- 10.6 cm.
In NAO post-beta2 Raw diminished whereas Sgaw increased. Greater BMI in AO displayed greater FEV1 with statistic significance. Obstructive ventilator pattern mechanics was observed in both groups.
Introduction
Hereditary transthyretin (ATTRv; v for variant) amyloidosis, also known as hATTR amyloidosis, is a progressive and fatal disease associated with rapid deterioration of physical function ...and patients' quality of life (QOL). Vutrisiran, a subcutaneously administered RNA interference (RNAi) therapeutic that reduces hepatic production of transthyretin, was assessed in patients with ATTRv amyloidosis with polyneuropathy in the pivotal HELIOS-A study.
Methods
The phase 3 open-label HELIOS-A study investigated the efficacy and safety of vutrisiran in patients with ATTRv amyloidosis with polyneuropathy, compared with an external placebo group from the APOLLO study of the RNAi therapeutic patisiran. Measures of QOL and physical function were assessed.
Results
At month 18, vutrisiran improved Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QOL-DN) total score (least squares mean difference LSMD in change from baseline CFB: –21.0;
p
= 1.84 × 10
–10
) and Norfolk QOL-DN domain scores, compared with external placebo. This benefit relative to external placebo was evident across all baseline polyneuropathy disability (PND) scores and most pronounced in patients with baseline PND scores I–II. Compared with external placebo, vutrisiran also demonstrated benefit in EuroQoL-Visual Analog Scale (EQ-VAS) score (LSMD in CFB: 13.7; nominal
p
= 2.21 × 10
–7
), 10-m walk test (LSMD in CFB: 0.239 m/s;
p
= 1.21 × 10
–7
), Rasch-built Overall Disability Score (LSMD in CFB: 8.4;
p
= 3.54 × 10
–15
), and modified body mass index (mBMI) (LSMD in CFB: 140.7;
p
= 4.16 × 10
–15
) at month 18. Overall, Norfolk QOL-DN, EQ-VAS, and mBMI improved from pretreatment baseline with vutrisiran, whereas all measures worsened from baseline in the external placebo group. At month 18, Karnofsky Performance Status was stable/improved from baseline in 58.2/13.1% with vutrisiran versus 34.7/8.1% with external placebo.
Conclusion
Vutrisiran treatment provided significant clinical benefits in multiple measures of QOL and physical function in patients with ATTRv amyloidosis with polyneuropathy. Benefits were most pronounced in patients with earlier-stage disease, highlighting the importance of early diagnosis and treatment.
Trial Registration Number
ClinicalTrials.gov: NCT03759379.
Allergic conjunctivitis in children Zepeda Ortega, Benjamín; Rosas Vargas, Miguel Angel; Ito Tsuchiya, Fernando Mitsutoshi ...
Revista alergia Mexico (Tecamachalco, Pueblo, Mexico : 1993),
2007 Mar-Apr, 20070301, Volume:
54, Issue:
2
Journal Article
Allergic conjunctivitis is a group of diseases that are frequent in childhood, associated to several allergic diseases affecting the ocular surface. It is related to type 1 hypersensitivity ...reactions. Two acute disorders: seasonal allergic conjunctivitis and perennial allergic conjunctivitis, exist, as do three chronic diseases: vernal keratoconjunctivitis, atopic keratoconjunctivitis and giant papillary conjunctivitis. The ocular surface inflammation causes itching, tearing, lid and conjunctival edema-redness, and photophobia during the acute phase and can lead to a classic late-phase response (associated to eosinophilia and neutrophilia) in a subset of individuals. As in the case of several chronic allergic diseases, it can remodel the ocular surface tissue. This allergic disease is very frequent. Vernal keratoconjunctivitis could produce corneal lesions and visual illness; however, atopic keratoconjunctivitis does not permanently affect the vision. The aim of this review is to provide a current overview for a better understanding of the symptoms associated to this disease, to describe its classification, recent advances in its physiopathology and its treatment.
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