Tolerance induction in food allergy

Alergia pokarmowa to choroba obarczona ryzykiem wystąpienia reakcji anafilaktycznych, łącznie ze zgonem, o narastającej częstości występowania. Stale poszukuje się nowych metod jej leczenia i prewencji. Takie nadzieje stwarza indukcja tolerancji, czyli procesu, który ulega zaburzeniu w jej przebiegu. W pierwszej części artykułu omówione są metody indukcji tolerancji w prewencji pierwotnej alergii pokarmowej, takie jak: ekspozycja na alergeny, karmienie piersią, znaczenie składników dietetycznych i mikrobiomu. W drugiej części omówiono znaczenie immunoterapii w indukcji tolerancji u pacjentów z już rozwiniętą alergią pokarmową i porównano ją do standardowych metod leczenia, jaką jest dieta eliminacyjna. Czytelnik znajdzie tu informacje na temat metod, wskazań, przeciwwskazań, patomechanizmu, skuteczności, bezpieczeństwa oraz nowych metod odczulania.Food allergy is a disease with a risk of anaphylactic reactions, including death, with an increasing incidence. New methods of treatment and prevention are constantly being studied. Such hopes are created by the induction of tolerance, which is a process that is disturbed in patients with food allergy. In the first part of the article, methods of tolerance induction in primary food allergy prevention are discussed, such as exposure to allergens, breastfeeding, the importance of dietary factors and microbiome. The second part discusses the importance of immunotherapy in the induction of tolerance in patients with already developed food allergy and compared it to standard treatment method, which is the elimination diet. The reader will find information about methods, indications, contraindications, pathomechanism, effectiveness, safety and a new methods of desensitizatio

The use of basophil activation test in the diagnosis and monitoring of food allergies in children

Test aktywacji bazofili (ang. Basophil Activation Test, BAT) jest badaniem czynnościowym, określanym niekiedy mianem „doustnej próby prowokacji w probówce”. Choć diagnostyka komponentowa przyczyniła się do istotnego wzrostu czułości i swoistości badań diagnostycznych, to żadna z aktualnie stosowanych metod nie pozwala na zróżnicowanie pomiędzy pacjentami uczulonymi, ale tolerującymi alergen a pacjentami uczulonymi z objawami alergii. W związku z tym badanie to ma zastosowanie kliniczne w diagnostyce i monitorowaniu chorób alergicznych m.in. alergii pokarmowej. Test ten może służyć również jako dodatkowe narzędzie do przewidywania ciężkości reakcji klinicznej oraz oceny progu reaktywności w alergii na pokarmy. BAT cechuje się bardzo dużą czułością i swoistością. Wprowadzenie BAT do codziennego użytku klinicznego wymagałoby standaryzacji procedur laboratoryjnych i sposobu analizy danych oraz klinicznej walidacji testu. Badania z zastosowaniem BAT wymagają kontynuacji, przede wszystkim celem ustalenia jego miejsca w algorytmach diagnostycznych chorób alergicznych.Basophil Activation Test (BAT) is a functional test, sometimes referred as “oral test tube challenge”. Although component-resolved diagnosis contributed to a significant increase in the sensitivity and specificity of diagnostic tests, none of the currently used methods allows for differentiation between allergic but allergen tolerant patients and patients with symptoms of allergy. Therefore, BAT has clinical application in the diagnosis and monitoring of allergic diseases, including food allergy. This test can also serve as an additional tool for predicting the severity of a clinical reaction and assessing the threshold of reactivity in food allergies. BAT is characterized by very high sensitivity and specificity. The introduction of BAT for everyday clinical use would require the standardization of laboratory procedures and methods of data analysis and clinical validation of the test. Research using BAT requires continuation, primarily to determine its place in diagnostic algorithms

Introduction of Complementary Foods and the Risk of Sensitization and Allergy in Children up to Three Years of Age

Background: Allergy is known to be influenced by both diet and the immune system. In addition, the time of first exposure to food allergens and their type appear to play a particularly important role in the development of allergies. Aim: To determine the influence of the time of exposure, and the type, degree of processing, and frequency of supply of complementary foods and the development of sensitization and allergies in children up to three years of age. Materials and metods: The study was conducted prospectively in two stages. The first stage included 106 children aged 6–18 months, while the second stage included 86 children selected from the first stage, after a further 12 months. A questionnaire based on validated FFQ sheets was created for the purpose of the study. The following were assessed: nutrition in the first year of life (time, type, degree of processing), frequency of supply of complementary foods and allergic symptoms, sIgE concentration against 10 foods and 10 inhalant allergens. Four groups of patients were formed. This paper presents the results of the second stage of the study. Results: For all participants, allergenic products, viz. hen’s egg, milk, peanuts, wheat, soybean, fish, tree nuts and shellfish were typically introduced at an age of 7 to 12 months. During this period, egg white was introduced in 47 (85.5%) children with allergy (p = 0.894), in 29 (82.9%) with allergy and sensitization (p = 1.00), and in 38 (82.6%) children with sensitization alone (p = 0.533). Milk was introduced at 7 to 12 months in 35 (64.8%) children with allergy (p = 0.64), 22 (64.7%) with both allergy and sensitization (p = 0.815), and 26 (57.8%) children with sensitization alone (p = 0.627). For other foods, the time of introduction appeared not to significantly influence the presence of allergies or sensitization. Heat-treated peanuts were introduced significantly more often to children without allergies and without sensitization (n = 9; 56.2%) than those without allergies but with sensitization (n = 6; 54.5%) (p = 0.028). Fish was consumed significantly more often by children with allergies, i.e., 1–3x/week (n = 43; 79.6%) than children without allergies, i.e., 1–3x/month (n = 9; 30%) (p = 0.009). Conclusions: No relationship was observed between the introduction time of complementary foods, including allergenic ones, or their type, and the development of allergies and sensitization in children up to three years of age. The degree of processing and the frequency of supply of products may affect the development of allergies and sensitization

Formulations of Topical Steroids in Eosinophilic Esophagitis—Current Treatment and Emerging Possibilities

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterised by eosinophilic inflammation and esophageal dysfunction symptoms. The recommended first-line treatment options are proton pump inhibitors and swallowed topical steroids (STS). However, current recommendations regarding STS are based on relatively few studies employing various doses and formulations. Our aim was to review the STS formulations currently used in the treatment of eosinophilic esophagitis, to demonstrate in a practical way the variety of exiting application methods, and to present emerging options for STS delivery to the esophagus. After the literature review, we established that the three most commonly used STS formulations include mist from an inhaler, viscous suspensions compounded with vehicles for oral use, and a recently introduced proprietary medication in the form of orodispersible tablets. Several drug delivery technologies with potential use in EoE are under investigation. To ensure optimal adherence, the choice of formulation should be based on efficacy, patient preferences and experience of the clinician, as well as current recommendations. Further studies are needed to compare the efficacy and acceptability of existing STS types, and to develop new, well-tolerated and effective drug formulations

Hypersensitivity reactions during ciclosporin therapy in children with colitis ulcerosa – two case reports

Ciclosporin is an immunosuppressive drug that is used in many fields of medicine, including e.g. gastroenterology in the treatment of inflammatory bowel diseases. Hypersensitivity reactions to cyclosporin medicines are rare and may be related to the drug's additional component - polyethyloxylated castor oil . In this paper, we present a case report of a 10-year-old girl and a 7-year-old boy who were both treated with cyclosporin because of ulcerative colitis. During the course of therapy we observed cutaneous and systemic reactions which may suggest hypersensitivity to the drug. The cases of both allergic and non-allergic hypersensitivity to cyclosporin medicines described in the literature are also presented.Cyklosporyna jako lek immunosupresyjny jest wykorzystywana w wielu dziedzinach medycyny w tym w gastroenterologii w terapii nieswoistych zapaleń jelit. Reakcje nadwrażliwości na preparaty cyklosporyny występują rzadko i mogą mieć związek ze składnikiem dodatkowym leku - polioksyetylowanym olejem rycynowym. W niniejszej pracy przedstawiamy opis przypadków 10-letniej dziewczynki oraz 7-letniego chłopca leczonych w naszej Klinice preparatami cyklosporyny z powodu wrzodziejącego zapalenia jelita grubego. U dzieci w trakcie terapii obserwowano objawy kliniczne, pod postacią reakcji skórnej i ogólnoustrojowej, mogące sugerować nadwrażliwość na lek. Przedstawiono także opisywane w literaturze przypadki zarówno alergicznej, jak i niealergicznej nadwrażliwości na preparaty cyklosporyny

The influence of dietary immunomodulatory factors on development of food allergy in children

In the last few years many studies have been conducted on the role of dietary and environmental factors in the prevention of allergic diseases among children. Many studies have shown that the diet of pregnant women and children in their early postnatal life, rich in antioxidants, vitamin D, and fatty acids is beneficial as it reduces the risk of allergy in their future life. Moreover, there are many reports about the main role of gut microbiota and probiotics in the allergy prevention, what can indicate new ways of procedures in allergic diseases

Fever as the Only First Sign of Crohn’s Disease—Difficulties in Diagnosis during the COVID-19 Pandemic

We present a case of a nine-year-old girl with Crohn’s disease whose only first manifestation was fever. The patient was treated with antibiotics for six weeks by her general practitioner via teleconsultations during the COVID-19 pandemic. However, no significant improvement was observed. Only the appearance of loose stools after six weeks of observation and the lack of effect of previous treatment allowed for targeting of the diagnostic process and an unequivocal recognition of Crohn’s disease. Our aim is to emphasize the difficulties in diagnosis related to the atypical course of the disease, especially in the context of the ongoing COVID-19 pandemic. The described course of Crohn’s disease occurs in a minority of patients; however, this disease should not be overlooked in the differential diagnosis of fever in paediatric patients

Can mild abdominal pain be the only sign of developing Crohn’s disease? A case report

Crohn’s disease is a condition of multifactorial unclear aetiology and increasing incidence. It can involve any fragment of the gastrointestinal tract and considerably deteriorates quality of life. Typical symptoms include: abdominal pain, chronic diarrhoea with mucus and/or blood, palpable, frequently tender resistance in the abdominal cavity, weight loss, weakness, subfebrile/febrile temperature and perianal changes. Approximately 30% of children with this disease manifest symptoms that are not associated with the gastrointestinal tract, such as growth delay, joint pain, ocular changes and skin lesions. A diversified and sometimes atypical clinical course can pose a number of diagnostic difficulties, delay diagnosis and, consequently, increase the risk of complications, which is of particular significance in patients of developmental age. The aim of this paper is to present a patient who, during the diagnosis for Crohn’s disease, presented a disproportion between very few clinical symptoms and considerable severity of inflammatory changes on endoscopy. The shrewd attitude of the first contact physician enabled a rapid diagnosis and implementation of proper treatment.Choroba Leśniowskiego–Crohna jest schorzeniem o nieznanej, wieloczynnikowej etiologii i narastającym trendzie występowania. Dotyczy dowolnego odcinka przewodu pokarmowego i powoduje znaczne obniżenie jakości życia. Do typowych objawów należą: bóle brzucha, przewlekła biegunka z domieszką śluzu i/lub krwi, badalny, często tkliwy opór w jamie brzusznej, utrata masy ciała, osłabienie, stany podgorączkowe/gorączka oraz zmiany okołoodbytnicze. Około 30% dzieci z rozpoznaną chorobą rozwija objawy spoza przewodu pokarmowego, do których zalicza się opóźnienie wzrastania, bóle stawów, zmiany w narządzie wzroku i zmiany skórne. Zróżnicowany i czasami nietypowy przebieg kliniczny może sprawiać wiele trudności diagnostycznych, opóźniać rozpoznanie i w konsekwencji zwiększać ryzyko wystąpienia powikłań, co ma szczególne znaczenie w populacji wieku rozwojowego. Celem pracy jest przedstawienie pacjentki, u której w momencie rozpoznania choroby Leśniowskiego–Crohna zwracała uwagę dysproporcja między skąpymi objawami klinicznymi a znacznym nasileniem zmian zapalnych w badaniu endoskopowym. Wnikliwe podejście lekarza pierwszego kontaktu umożliwiło szybkie ustalenie rozpoznania i wdrożenie odpowiedniego leczenia