International consensus guidelines for the diagnosis and management of food protein–induced enterocolitis syndrome: Executive summary—Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology

Food protein-induced enterocolitis (FPIES) is a non-IgE cell- mediated food allergy that can be severe and lead to shock. Despite the potential seriousness of reactions, awareness of FPIES is low; high-quality studies providing insight into the pathophysiology, diagnosis, and management are lacking; and clinical outcomes are poorly established. This consensus document is the result of work done by an international workgroup convened through the Adverse Reactions to Foods Committee of the American Academy of Allergy, Asthma & Immunology and the International FPIES Association advocacy group. These are the first international evidence-based guidelines to improve the diagnosis and management of patients with FPIES. Research on prevalence, pathophysiology, diagnostic markers, and future treatments is necessary to improve the care of patients with FPIES. These guidelines will be updated periodically as more evidence becomes available

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Efficacy of over-the-counter immunostimulants in the prevention of paediatric recurrent acute respiratory tract infections. Criticisms and pitfalls of available metanalyses Summary Preschool children frequently suffer from acute respiratory tract infections (ARTI). Immunostimulants (ISs) are often administered to reduce their impact. This study aimed to establish the efficacy of ISs in the prevention of pediatric ARTI through the analysis of systematic reviews (SRs). We explored Medline database i

Exercise-induced anaphylaxis caused by wheat during specific oral tolerance induction [3]

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Resiliencia

PregradoProfesional en Dirección y producción de medios audiovisuale

Does treatment with proton pump inhibitors for gastroesophageal reflux disease (GERD) improve asthma symptoms in children with asthma and GERD? A systematic review.

OBJECTIVE: To evaluate pediatric studies of the effect on asthma symptoms of treatment with proton pump inhibitors (PPI) used to treat gastroesophageal reflux disease (GERD). METHODS: We entered the MeSH terms "gastroesophageal reflux AND asthma AND children" in the PubMed tool Clinical Queries, selecting "therapy" and "broad, sensitive search." The search ended on April 14, 2008. We included only clinical trials performed in pediatric patients. RESULTS: Four studies were considered to be relevant, although only 1 was a randomized, double-blind, placebo-controlled trial. The 3 nonrandomized trials showed that PPIs benefited patients with asthma. The randomized, double-blind, placebo-controlled trial found that omeprazole did not improve asthma symptoms. An improved (although not statistically significant) score was observed in the quality of life questionnaire in children with a reflux index greater than 10% and in those with more severe asthma treated with omeprazole compared with the placebo group. CONCLUSIONS: Scant data in these studies mean that we cannot make solid recommendations. However, in specific cases, we think that treatment of asthma symptoms with a PPI is valid as long as at least 2 conditions are satisfied: asthma must not respond to standard treatment, and 1 instrumental parameter of GERD severity must be satisfied, that is, a reflux index greater than or equal to 10 must be present

The predictive value of specific immunoglobulin E levels for the first diagnosis of cow's milk allergy. A critical analysis of pediatric literature.

Investigators have tried to identify a level of seric specific immunoglobulin E (IgE) that had a sufficient predictive value to diagnose a food allergy without having will resort to the food challenge. To search in literature, all the studies that have estimated the possibility to identify a level of seric specific cow milk IgE with a positive predictive value (PPV) of 95% for the first diagnosis of cow's milk allergy (CMA) in pediatric age. We have identified six studies, nearly all studies suffer from relevant methodological bias. Proposed cut-off are all different. The studied pediatric populations were highly selected. Also neglecting the methodological bias of the studies and the great difference of value between the proposed cut-off, it always remains to consider that the pre-test probability of having a CMA between the children enrolled in the six studies included in this review is particularly high. The likelihood ratio helps to transfer the results of a study on a diagnostic test just to our population, and it is more realistic rather than to entrust itself to the PPV or the negative predictive value, that are much influenced from the prevalence of the disease in the studied population

Oral desensitization in egg acute food protein-induced enterocolitis syndrome

Objective: Strict avoidance of trigger food is the primary management of food protein-induced enterocolitis syndrome (FPIES). No published data are available on active induction of tolerance with oral desensitization (OD) in FPIES. Case Report: We carried out an OD in a 9 and a half years old boy with persistent acute egg FPIES. OD was performed with increasing doses of raw egg every week, starting with an initial dose of 0.2 ml. The boy presented mild and transient gastrointestinal adverse reactions when the 4 ml dose was reached. He could tolerate a whole raw egg in less than 14 months. Conclusions: Even though randomized controlled clinical trials on patients including various phenotypes of FPIES are needed, our experience is encouraging about the possible efficacy and safety of OD in this food allergy

Retrospective analysis of 222 oral food challenges with a single dose in acute food protein-induced enterocolitis syndrome

Background: The method of performing oral food challenge (OFC) in acute food protein\u2013induced enterocolitis syndrome (FPIES) has not been systematically studied. Therefore, there is a certain variability in the choice of the various centers. Methods: Since 2011, we have been performing OFC for acute FPIES with a single dose of culprit food, a full serving size for age. In case of atypical FPIES (skin prick test, SPT, positive), we applied this protocol only if the description of previous adverse reactions was compatible with that of a classic acute FPIES, if other IgE-mediated food allergies were absent, and if the mean diameter of the wheal evoked by the SPT with the challenged food was 645 mm. We have retrospectively analyzed 222 OFCs from 2011 to 2020. The grading of reactions was carried out according to the International Consensus Guidelines on FPIES of 2017. Results: Forty-eight of 222 OFC (21.6%) failed. The mild reactions were 22 of 48 (45.8%), the moderate ones 22 of 48 (45.8%), and the severe ones 4 of 48 (8.4%) failed OFCs. The tested food processing (in the case of cow milk and chicken egg) did affect neither probability nor severity of the reaction. Patients with positive SPT for the tested food presented four times more severe reactions (2 of 9 failed OFC, 22.2%) than patients with negative SPT (2 of 39 failed OFC, 5.1%) (P =.316). Conclusions: The administration of a single dose in a full serving size for age appears to be a sufficiently safe method for OFC for acute FPIES, with the benefit of saving time. In patients with positive SPT for the tested food, it may be prudent to start with a smaller dose carrying on, in the absence of adverse reactions, with the administration of the full dose after a 4-hour observation