Food labelling and food-induced anaphylaxis in children. Where are the intersection points?

Anaphylaxis is an acute life-threatening condition affecting several body systems. It might have a rapid onset and lead to a lethal outcome. The major provoking factors for the development of anaphylactic reactions in childhood are food allergens. High hypersensitivity to one food allergen can make it difficult for a family to find a substitution for an allergenic product. Food-induced anaphylactic reaction to quite a number of food allergens is a serious problem for both the physician and the family of an allergic child necessitating organization of appropriate and safe nutrition. In real life, the standard recommendation for the patient – to strictly follow the rules of the elimination diet with exclusion of the causative allergen and all cross-reactive allergens – often becomes unrealizable. There is a serious risk of developing new allergic reactions due to accidental intake of the triggering allergens because of incorrect food labelling by manufacturers. The objective of the work is to present a clinical case report that demonstrates the importance of performing allergy component testing (ImmunoCAP ISAC-112,) for identification of the full spectrum of allergens with subsequent assessment of allergenic molecules as triggering allergens and shows serious difficulties in the elaboration of recommendations on a personalised diet that should be adequate and safe for a child with a history of recurrent episodes of food-induced anaphylaxis.Анафилаксия – острое жизнеугрожающее состояние, затрагивающее несколько систем организма, которое может развиться мгновенно и привести к фатальному исходу. Основными провоцирующими факторами развития анафилактических реакций в детском возрасте являются пищевые аллергены. При выраженной гиперчувствительности к одному пищевому аллергену возникают сложности для семьи в плане замены виновного продукта. Наличие же пищевой анафилаксии к большому числу пищевых аллергенов – это серьезная проблема для врача и семьи пациента по организации полноценного и безопасного питания ребенка. В реальной жизни обязательная рекомендация для пациента – придерживаться жестких правил элиминационной диеты с исключением причинно-значимого аллергена и всех перекрестных с ним аллергенов – зачастую становится просто невыполнимой. Серьезный риск возникновения новых аллергических реакций существует при случайном попадании в организм аллергенов-триггеров из-за неоднозначности маркировки пищевых продуктов при изготовлении этикеток на продуктах питания. Цель работы: представить клинический случай, демонстрирующий важность проведения компонентного аллергологического обследования (ISAC-112, ImmunoCAP) для выявления полного спектра аллергенов с дальнейшей оценкой аллергенных молекул как аллергенов-триггеров и раскрывающий серьезные трудности в разработке рекомендаций по индивидуальной лечебной диете, которая должна быть полноценной и безопасной для ребенка с повторными эпизодами пищевой анафилаксии в анамнезе

АТОПИЧЕСКИЙ ДЕРМАТИТ У ДЕТЕЙ: НАЛИЧИЕ СПЕЦИФИЧЕСКИХ АНТИТЕЛ К СУПЕРАНТИГЕНАМ STAPHYLOCOCCUS AUREUS И ЕГО АНТИБИОТИКОРЕЗИСТЕНТНОСТЬ

Background. Staphylococcus aureus function in atopic dermatitis (AD) children skin is double-handed: an infectious trigger and an allergen. The aim of the study was to evaluate the frequency of S. aureus enterotoxins the IgE in children with infected AD skin and to compare the IgE levels with antibiotic resistance of S. aureus. Methods: specific IgE to S. aureus enterotoxins A and B (ImmunoCap, Phadia AB, Sweden) were detected in the serum of 90 children infected with AD. The IgE levels were compared with the resistance to antibiotics (McNemar test and 95% confidential intervals of related frequencies). Results: specific IgE > 0,35 kUA/l to S. aureus enterotoxin A were found with a frequency of 0,29; to enterotoxin B — 0,36; to at least one of them — 0,43. The number of children with IgE > 0,35 kUA/l and S. aureus resistant to antibiotics was about 1/3 of the number of children with IgE < 0,35 kUA/l and S. aureus sensitive to antibiotics (р < 0,001). S. aureus in children with IgE > 0,35 kUA/l remained sensitive to oxacillin. Conclusion. In children infected with AD S. aureus enterotoxins A or/and B are revealed in 25–50% of cases. Specific IgE levels to S. aureus enterotoxins are similar in antibiotic resistant and antibiotic sensitive S. aureus skin swabs — about 30%. The IgE level to enterotoxins of S. aureus and its antibiotic resistance don't seem to be conditioned by each other.Актуальность. Наличие атопии создает условия для функционирования Staphylococcus aureus не только в качестве триггера инфекционного процесса, но и в качестве аллергена. Цель работы — оценить частоту выявления специфических IgE к энтеротоксинам S. aureus кожи детей с атопическим дерматитом (АтД), осложненным вторичным инфицированием кожи, и сопоставить наличие IgE с антибиотикорезистентностью S. aureus. Пациенты и методы. Обследовано 90 детей с АтД, осложненным вторичным инфицированием кожи. Специфические IgE-антитела к энтеротоксинам А и В  S. aureus определяли иммунохемилюминесцентным методом (ImmunoCap, Phadia AB, Швеция). Оценивали взаимосвязь наличия IgE к энтеротоксинам S. aureus с его антибиотикорезистентностью (критерий МакНемара, 95% доверительные интервалы относительных частот). Результаты. Специфические IgE к энтеротоксину А обнаружены с частотой 0,29, к энтеротоксину В — 0,36, хотя бы к одному из них — 0,43. Количество детей с наличием специфических IgE и устойчивыми к антибиотикам штаммами S. aureus составляло 1/3 количества детей с отсутствием IgE и чувствительными штаммами S. aureus (р < 0,001). Заключение. У детей с АтД, осложненным вторичной инфекцией, энтеротоксины А и/или В S. aureus обнаруживаются в 25–50% наблюдений. Частота выявления IgE к энтеротоксинам S. aureus одинакова у штаммов с различной антибиотикорезистентностью и составляет 30%. Взаимной опосредованности антибиотикорезистентности S. aureus и выработки специфических IgE-антител к его энтеротоксинам не выявлено

Care of patients with inborn errors of immunity in thirty J Project countries between 2004 and 2021

IntroductionThe J Project (JP) physician education and clinical research collaboration program was started in 2004 and includes by now 32 countries mostly in Eastern and Central Europe (ECE). Until the end of 2021, 344 inborn errors of immunity (IEI)-focused meetings were organized by the JP to raise awareness and facilitate the diagnosis and treatment of patients with IEI.ResultsIn this study, meeting profiles and major diagnostic and treatment parameters were studied. JP center leaders reported patients’ data from 30 countries representing a total population of 506 567 565. Two countries reported patients from JP centers (Konya, Turkey and Cairo University, Egypt). Diagnostic criteria were based on the 2020 update of classification by the IUIS Expert Committee on IEI. The number of JP meetings increased from 6 per year in 2004 and 2005 to 44 and 63 in 2020 and 2021, respectively. The cumulative number of meetings per country varied from 1 to 59 in various countries reflecting partly but not entirely the population of the respective countries. Altogether, 24,879 patients were reported giving an average prevalence of 4.9. Most of the patients had predominantly antibody deficiency (46,32%) followed by patients with combined immunodeficiencies (14.3%). The percentages of patients with bone marrow failure and phenocopies of IEI were less than 1 each. The number of patients was remarkably higher that those reported to the ESID Registry in 13 countries. Immunoglobulin (IgG) substitution was provided to 7,572 patients (5,693 intravenously) and 1,480 patients received hematopoietic stem cell therapy (HSCT). Searching for basic diagnostic parameters revealed the availability of immunochemistry and flow cytometry in 27 and 28 countries, respectively, and targeted gene sequencing and new generation sequencing was available in 21 and 18 countries. The number of IEI centers and experts in the field were 260 and 690, respectively. We found high correlation between the number of IEI centers and patients treated with intravenous IgG (IVIG) (correlation coefficient, cc, 0,916) and with those who were treated with HSCT (cc, 0,905). Similar correlation was found when the number of experts was compared with those treated with HSCT. However, the number of patients treated with subcutaneous Ig (SCIG) only slightly correlated with the number of experts (cc, 0,489) and no correlation was found between the number of centers and patients on SCIG (cc, 0,174).Conclusions1) this is the first study describing major diagnostic and treatment parameters of IEI care in countries of the JP; 2) the data suggest that the JP had tremendous impact on the development of IEI care in ECE; 3) our data help to define major future targets of JP activity in various countries; 4) we suggest that the number of IEI centers and IEI experts closely correlate to the most important treatment parameters; 5) we propose that specialist education among medical professionals plays pivotal role in increasing levels of diagnostics and adequate care of this vulnerable and still highly neglected patient population; 6) this study also provides the basis for further analysis of more specific aspects of IEI care including genetic diagnostics, disease specific prevalence, newborn screening and professional collaboration in JP countries

Development of pediatric allergology: Problems and prospects

The paper presents the results of modern-day studies in allergology and data on the epidemiology of allergic diseases and new approaches to their diagnosis and therapy in children. It considers trends and problems in the development of pediatric allergology

Anaphylaxis in children: problems and solutions

Since the term “anaphylaxis” has been invented, there are multiple changes in the views on both pathophysiology and the diagnostic and therapeutic aspects of this disease. There have been currently adopted a number of international documents containing principles of anaphylaxis verification and treatment. However, the experts’ views differ, and some disagreements and problems of anaphylactic reactions remain relevant, especially in pediatric patients. The article discusses current issues and possible ways of treatment of anaphylaxis in children

ANAPHYLAXIS AND VACCINATION: RISKS AND REALITIES

The article is about the problem of anaphylaxis in the post-vaccination period. Data on the frequency of its prevalence and lethality depending on the type of vaccine are presented. Variants of a clinical picture of anaphylaxis and differential-diagnostic approaches are indicated. The major causal components of vaccines, anaphylaxis inducers, and methods for their identification are mentioned. Therapeutic approaches are analyzed, false myths and contraindications to vaccination are indicated. The experience of carrying out preventive individual measures is generalized