What's new in the diagnosis and management of food allergy in children?

This article reviews the recent advances in the diagnosis and management of IgE mediated food allergy in children. It will encompass the emerging technology of component testing; moves to standardization of the allergy food challenge; permissive diets which allow for inclusion of extensively heated food allergens with allergen avoidance; and strategies for accelerating tolerance and food desensitization including the use of adjuvants for specific tolerance induction

The General Practitioner and the Care of the Dying Patient

As far as the general practitioner is concerned, the care of the dying patient can begin at birth, or even earlier. Important aspects of treatment at the deathbed of the aged patient are discussed in broad outline, as are the psychological aspects of terminal illness and the alleviation of pain and discomfort.S. Afr. Med. J., 48, 708 (1974)

Myths, facts and controversies in the diagnosis and management of anaphylaxis

Anaphylaxis is a serious systemic allergic reaction that is rapid in onset and may cause death. Despite numerous national and international guidelines and consensus statements, common misconceptions still persist in terms of diagnosis and appropriate management, both among healthcare professionals and patient/carers. We address some of these misconceptions and highlight the optimal approach for patients who experience potentially life-threatening allergic reactions

Pharmacokinetics of adrenaline autoinjectors.

Anaphylaxis is a medical emergency with adrenaline acknowledged as the first line therapy. It is therefore important that patients have access to self-injectable adrenaline in the community. Manufacturers have been requested by European Medicine Regulators to generate pharmacokinetic data for these autoinjector devices. For the first time, these data provide an insight into how individual devices work in different populations, and how they compare. We undertook a thorough literature search and also accessed grey literature, using searches of medicine regulators' websites and freedom of information requests. The data demonstrate that it takes at least 5-10 minutes to achieve early peak plasma concentration for most devices. The specific autoinjector device seems to be the most important determinant of pharmacokinetics, with different devices giving rise to different plasma adrenaline profiles. Needle length does not seem to be the most important factor; rather, the force and speed of injection (which varies from one device to another) is likely to be of greater importance. In general, peak plasma adrenaline concentration is lower and time-to-peak concentration longer with increased skin-to-muscle depth. However, it is difficult to draw conclusions with the current available data, due to a lack of head-to-head comparisons, small numbers of study participants, and the failure to acknowledge the biphasic nature of intramuscular adrenaline absorption for analysis purposes

Mechanisms of hyperresponsiveness in the human nasal airway: role of kinins and nitrous oxide

Allergic rhinitis is a condition which affects over 15% of the population in the United Kingdom. The pathological process involves two stages - nasal inflammation, and the development of a nasal hyperresponsiveness to allergen and a range of other non-specific stimuli. There is currently little information on the pathological process underlying hyperresponsiveness. This thesis presents an investigation into the potential role of kinins and nitric oxide in causing nasal hyperresponsiveness in man. In the non-allergic subject, platelet activating factor (PAF) can be used to induce a nasal hyperresponsiveness which is similar to that observed in allergic rhinitis. The data obtained suggests that PAF-induced nasal hyperresponsiveness is mediated by an action of kinins at the bradykinin B2 receptor. Experiments in subjects with seasonal allergic rhinitis also imply a similar role for kinins in allergen-induced hyperresponsiveness. Furthermore, the kinins may be involved in the recruitment of inflammatory cells which is seen in the hyperresponsive state. Data is presented which indicates that kinin generation can potentiate inflammatory cell recruitment, both in vitro and in vivo in the human nasal airway. However, application of exogenous bradykinin alone does not cause a nasal hyperresponsiveness, nor an influx of inflammatory cells. While suggestions are made as to the precise role of kinins, the mechanism does not appear to be dependent on subsequent neuropeptide release. Interestingly, modulating the degree of nitric oxide in the human nasal airway can also induce a hyperresponsiveness. The data therefore imply that activation of the bradykinin B2 receptor is necessary in both PAF- and allergen-induced nasal hyperresponsiveness in man. In addition, the generation of kinins may be important in the recruitment of inflammatory cells in allergic rhinitis

Allergic gastroenteritis hospital admission time trends in Australia and New Zealand

AIM: Recent epidemiological studies indicate increases in hospital food allergy-related anaphylaxis admission rates in Australian and New Zealand. The aim of the study was to examine whether non-IgE-mediated food allergy might have increased in parallel. METHODS: We analysed childhood hospital admissions rates by ICD 10 codes for allergic gastroenteritis (AG) and infective gastroenteritis in Australia and New Zealand between June 1998 and July 2014. RESULTS: In Australia, most AG-related admissions (73%) occurred in those aged <1 year and increased by 7.3%/year (95% confidence interval (CI) 5.5-9.3, P < 0.0001) from 6.8 to 26.5/10(5) population. Similar trends were observed for New Zealand; 81% of admissions occurred in those aged <1 year and increased by 9.4%/year (95% CI 5.5-9.3, P < 0.0001) from 7.2 to 30.7/10(5) population. By contrast there were no significant changes in AG-related admission rates in the older patients and infective gastroenteritis admissions fell in both countries in those aged <1 year; Australia by 4.4%/year (95% CI 4.3-4.6, P < 0.0001) and in New Zealand by 5.8%/year (95% CI 5.4-6.2, P < 0.0001). CONCLUSION: We observed a fourfold increase in AG-related admission rates in two countries with known high rates of IgE-mediated food allergy/anaphylaxis. If confirmed by other studies, it will be of interest to determine if factors thought to contribute to the increase in IgE-mediated food allergy might also play a role in non-IgE-mediated gastroenterological food allergy syndromes