Allergic Reactions In Children Research Articles

Frequency and Severity of Cow’s Milk Allergy Reactions in Children: A Prospective Audit

Milk ranks as the second most common allergen, following peanuts. Recent studies from Spain and theUSA reports an annual frequency of accidental allergic reactions (AAR) ranging from 34% to 40%. AAR severity is influenced by food allergens and the presence of atopic diseases such as asthma, eczema, hay-fever, and recurrent wheezing. This study aimed to determine the frequency of accidental allergic reactions in children with cow’s milk protein allergy between September 2011 to September 2012. The study design employed is missing. A structured questionnaire was used and the guardians of the patients were guided in answering by the research assistants (Students). The questionnaire was conducted on 62 patients (35 males, 27 females) with a median age of 67 months. The inquiries were about the number and locations of accidental reactions, their severity, other food allergies, and risk factors such as asthma, hay-fever, recurrent wheezing, and eczema. Symptoms were classified as mild, moderate, or severe, and previous and current skin prick test results were recorded. Between 2011 and 2012, the frequency of AAR was found to be 57% (inclusive of adults). Among the children, 37 (60%) experienced 51 accidental reactions in the past year, with 43% classified as mild, 19% as moderate, and 38% as severe. The majority of reactions (60%) occurred at home, and treatment primarily involved the use of Chlorphenamine [Piriton©] (79%). Three anaphylactic reactions occurred and were identified leading to hospitalization and administration of epinephrine. Oral exposure was the primary route (89%), with milk-containing products being the most common allergen sources (51%). The main cause of AAR was attributed to mislabeling and misreading of labels, especially in newly implemented recipes and non-packaged cereal products like homemade croissants sold in cafes and restaurants. Other causes included high levels of peanut traces and hazelnuts in cookies and chocolates. In conclusion, accidental allergic reactions are prevalent in children and are often caused by contamination, mislabeling, recipe changes by companies, misinterpretation by caregivers, and direct milk intake. Risk factors for AAR severity include hay fever, peanut allergy, multiple atopic diseases, and wheal size.

Immunotherapy approaches for managing allergic conditions in children – A narrative review

Allergic reactions in children are a major concern globally. The ever-changing environment, exposure to new and chemically altered compounds, genetically modified food products, variations in hygiene parameters, and most importantly, questionable immunity, together influence the pattern of allergic diseases in children. The most favorable and convenient mode of treatment sought is the use of over-the-counter drugs like antihistamines. However, they tend to lose their efficacy when used over a long period of time. Immunotherapy, for the management of allergic conditions, is considered a gold standard and is still a promising tool. Subcutaneous immunotherapy and sublingual immunotherapy together comprise the two modes of allergen-specific immunotherapy. Each method differs in its mode of administration and role in allergic diseases, in terms of, efficacy and safety measures. The choice between the two is dependent on the type of allergic disease and personal preferences opted either by the specific patient, or by the health-care professional involved in the treatment. The convenience of administration and compliance are also major grounds to consider while opting for the most appropriate mode of treatment. This review hence highlights new advancements in the field of immunotherapy, the efforts to achieve the goals envisioned and literature focusing on better outcomes in managing allergic reactions.

Severe anaphylaxis in children: Definitions, etiology, and preventive approaches

Anaphylaxis is a generalized allergic reaction, and its severe course has a potential risk of fatal outcome. The course of each episode of anaphylaxis is the result of a complex interaction between the patient and some internal and external factors (concomitant diseases, profile and level of sensitization, features of allergen exposure, intercurrent infections, etc.). Currently, the clinical and biological features of severe anaphylaxis are not well characterized; however, arterial hypotension and/or loss of consciousness are usually observed in these patients, possibly without typical symptoms from the skin, whereas the outcome of the disease is associated with the possibility of timely emergency medical care. The lack of generally accepted reliable individual prognostic predictors for determining this group of patients is a serious problem. Very little data are available on subfatal/fatal anaphylaxis in pediatric patients, and approaches to it are often based on clinical experience in other age groups. This article presents a systematization of data in the context of severe and subfatal/fatal anaphylaxis in pediatrics to understand the etiology, risk factors, and markers of severe life-threatening allergic reactions in children and the possibilities of their prevention.

Use of in vitro and in vivo tests in the diagnosis of food-induced anaphylaxis – a case study

Food allergy is a chronic disease that affects both children and adults. Systemic allergic reactions in children are most commonly caused by foods, especially nuts, milk, and eggs. A conventional diagnostic work-up for allergy typically pinpoints the allergen source, while component-resolved diagnostics is an approach that identifies the allergen molecules responsible for causing anaphylaxis. In some cases, determining the causative agent of anaphylaxis requires the use of various diagnostic tests. In the following paper, we want to highlight the importance of a critical approach to allergy tests results and caution in the diagnosis of idiopathic anaphylaxis. Based on a case report of food-induced anaphylaxis, we discuss the diagnostic methods that can be applied following a negative IgE test result for allergens obtained with a multiplex platform.

Socializing practices of Irish children and adolescents with food allergy: Aprospective study.

Food is an integral part of social activities; because of fear of accidental reaction, children with food allergy (FA) are at risk of exclusion or oversupervision at these events. The extent of adaptive exclusion behaviors is poorly defined. Families attending our service are encouraged to socialize and taught to minimize risk and avoid accidental reactions. The aim of this study was to establish the social practices and eating-out habits of children and adolescents with FA who are already attending an allergy clinic. Irish children, aged 2 to 16 years, with confirmed FA were recruited as part of a parallel prospective observational study titled Recording Accidental Allergic Reactions in Children and Teenagers (ReAACT). Information on social activities and eating out habits was collected prospectively. A total of 531 children were enrolled. The majority attended age-appropriate social activities; 97% of the 5- to 12-year-olds went to birthday parties and 85% visited friends' houses. More nonparticipators had previous anaphylaxis (relative risk [RR]= 1.44; 95% CI= 0.97-2.14; P= .06) and peanut allergy (RR= 1.19; 95% CI= 0.99-1.42; P= .06). Among adolescents, 94% visited friends' homes, but only 12% had been away from home alone. Overall, 523 participants (98.5 %) visited food establishments, whereas 4.6% did not eat out in any food establishment; these participants were significantly more likely to be adolescents (RR= 3.27; 95% CI= 1.65-7.48; P= .0001). Overall, Irish children with FA are "living with allergy." There was a trend toward decreased participation among adolescents. Future interventions should target this group specifically.

Food allergy to cow’s milk proteins and meat

Introduction. Cow’s milk and dairy products are important sources of high-quality animal proteins, calcium, vitamins, and minerals. They are widely used in the diet of preschool and school-age children and contribute to the normal development and resilience of children against the effects of adverse external factors. However, cow’s milk can cause serious allergic reactions in children, even leading to anaphylaxis. Allergy to cow’s milk proteins is one of the common allergic reactions among preschool-age children. Through conducted research, patterns of the natural course of milk allergy over time have been established. In most cases, by the age of 5 years, children develop tolerance to cow’s milk proteins. However, some school-age children may retain heightened sensitivity to them. Sustaining such prolonged milk allergy in a school-age child requires identifying the cause and conducting in-depth examinations for each specific patient. In such cases, valuable information about elevated sensitivity to whole cow’s milk protein and its components is provided by molecular (component-based) diagnostics. This enables the identification of causally significant components (α-lactalbumin, β-lactoglobulin, bovine serum albumin) of milk protein for the purpose of rational diet therapy, considering cross-reactions with beef meat. The presented article summarizes and systematizes literary and proprietary data on allergy to cow’s milk proteins and its components, as well as to beef meat. Understanding the characteristics of allergy to cow’s milk proteins and its components, cross-reacting with beef, will help avoid serious consequences of irrational elimination diets.

Exercise-Induced Allergic Reactions in Children Desensitized to Hen's Eggs and Cow's Milk by Oral Immunotherapy.

Exercise-induced allergic reactions on desensitization (EIARDs) after successful in-hospital rush oral immunotherapy (OIT) for wheat allergy have been reported. However, the incidence rates of EIARDs after rush OIT for egg allergy and milk allergy have not been determined. To determine the frequency of EIARDs and risk factors associated with rush OIT for egg and milk allergy. This retrospective chart review, conducted in January 2020, enrolled 64 and 43 patients who underwent rush OIT for egg and milk allergy, respectively (in 2010 to 2014). In particular, 48 and 32 desensitized patients underwent exercise-provocation tests (Ex-P) after allergen administration (4,400 mg boiled egg white and 6,600 mg cow's milk protein, respectively). The EIARDs were determined by Ex-P or a suspicious event even after passing the Ex-P. Specific IgE levels to egg white, cow's milk, ovomucoid, casein, α-lactalbumin, and β-lactoglobulin were analyzed using ImmunoCAP. At least one episode of EIARD was observed in 10 and 17 patients with egg and milk allergy (21% and 53%), respectively, which persisted for more than 5 years in one patient with egg allergy (2.1%) and 11 patients with milk allergy (34.4%) as of January 2020. We could not find background differences between the EIARD-positive and EIARD-negative groups, except that the egg white-specific IgE/total IgE ratio before rush OIT was significantly higher in patients with egg allergy with EIARD than in those without it. Exercise-induced allergic reactions on desensitization were more frequent and common in patients with milk allergy. Moreover, EIARDs to milk allergy were more likely to persist than those to egg allergy.

Frequent Bee Stings May Promote More Severe Allergic Reactions in Children with Large Local Reactions

Frequent Bee Stings May Promote More Severe Allergic Reactions in Children with Large Local Reactions

Real possibilities of using <i>Lactobacillus reuteri</i> B-9448 in clinical practice: A modern approach to old problems (review)

Considering the availability of a large selection of probiotics on the pharmaceutical market warrants that doctors know all the possible biological effects. Lactobacillus reuteri exerts antimicrobial action against pathogenic bacterial species, viruses, and fungi, as well as anti-inflammatory, immunomodulatory, detoxifying effects, acid resistance, and promotion of the restoration of intestinal microbiota. L. reuteri B-9448 is one of the most accessible and effective strains in the formulations of modern probiotics used for the prevention and correction of various conditions and diseases.
 The biologically active additive Reuteri ECOlab, which combines the unique properties of living L. reuteri bacteria, highly active products of their metabolism, and MCT oil, allows the drug to be used in combination therapy of acute diarrhea in children and adults and rotavirus infections, Helicobacter pylori infections, antibiotic-associated diarrhea, functional abdominal pain, and allergic reactions in children. This probiotic can be administered in the form of drops, which makes it convenient, and the formulation is devoid of alcohols, emulsifiers, flavors, preservatives, and dyes, which makes it free of the risk of overdose and hence safe for use.

Platelet-activating factor acetylhydrolase is a biomarker of severe anaphylaxis in children.

There is limited ability to predict the severity of allergic reactions in children. Data derived predominantly from adults have implicated the platelet-activating factor pathway as a potential contributor to severe anaphylaxis. In this study, we sought to prospectively assess involvement of key components of the platelet-activating factor pathway in pediatric patients with anaphylaxis. Forty-six pediatric patients (<18years) presenting with acute anaphylaxis were assessed. Anaphylaxis severity was graded and serum anaphylaxis markers were measured acutely and in 36 children who returned for follow-up >4weeks after their acute presentation. These markers were compared with pediatric laboratory reference sera. Severe anaphylaxis was experienced by 12/46 (26%) and mild-moderate anaphylaxis in 34/46 (74%) children. Platelet-activating factor acetylhydrolase (PAF-AH) activity was inversely associated with severe anaphylaxis: 9/12 children with severe anaphylaxis had reduced PAF-AH activity as compared with 14/34 with mild-moderate anaphylaxis (p < .05). Furthermore, 3/3 children who required intensive care had markedly reduced mean PAF-AH (nmol/ml/min) (13.73, 95%CI: 7.42-20.03) versus 20/23 who required ward/emergency department care (17.81, 95%CI: 16.80-18.83; p < .05). In children with anaphylaxis, PAF-AH during acute anaphylaxis was unchanged relative to the child's basal levels (mean, 17.26, 95%CI: 16.10-18.42 vs 17.50, 95%CI: 16.21-18.78, p = .63) and was lower than healthy pediatric controls (mean 19.21; 95%CI:18.21-20.21; p < .05). Decreased serum PAF-AH activity is a biomarker of severe anaphylaxis. Levels of this enzyme do not change from basal levels during acute anaphylaxis. Our results show that PAF-AH is a biomarker of anaphylaxis severity in children. This key regulatory enzyme may modulate susceptibility to severe anaphylaxis.

Long-term adherence and risk of allergic reactions in children who attained milk oral immunotherapy maintenance

Long-term adherence and risk of allergic reactions in children who attained milk oral immunotherapy maintenance

Association between food additives and prevalence of allergic reactions in children: a systematic review.

Food additives contain synthetic and natural chemical compounds and are one of the causes of food allergies. In this regard, it is necessary to recognize the food additives that are of special interest for children. In this survey, the relation between food additives and allergic reactions and attention-deficit hyperactivity disorders in children was studied. The research studies with keywords "allergic reactions", "hypersensitivity", "food additives" and "children" were searched in PubMed, Scopus, Science Direct, Web of Science, and SID databases, from 1984 to 2020. Three hundred twenty-seven studies were obtained and only seven articles were finally selected according to exclusion and inclusion criteria. In the final review, seven articles were selected to investigate the relationship between food additives and hypersensitivity reactions. Some clinical factors such as urticaria, eczema, rhinitis andgastrointestinal symptoms and the prevalence of laboratory evidence in atopic children are due to increased exposure to food additives including artificial colors and sweeteners, preservatives, and monosodium glutamate. Clinical signs and laboratory evidence prove a significant association between some food additives and allergenic adverse reactions. It was also found that food additives such as artificial colors and sweeteners, preservatives, and monosodium glutamate are responsible for most cases of hypersensitivity in children, and the prevalence of hypersensitivity to food additives was estimated to be about 1.2% based on data extracted from studies.

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

Separating Fact from Fiction in the Diagnosis and Management of Food Allergy

A severity grading system of food-induced acute allergic reactions to avoid the delay of epinephrine administration

BackgroundSubstantial discrepancies among anaphylaxis severity scores may delay epinephrine administration. ObjectiveThe study aims to develop a transparent severity grading system of food-induced acute allergic reactions with a decision model for epinephrine use. MethodsThe natural course of 315 acute food-induced allergic reactions in children hospitalized at the Allergology department between May 2016 and July 2019 owing to follow-up treatment and allergy diagnostics was evaluated. The severity of episodes was classified according to the 5 most accepted grading systems. The interrater reliability of classification between anaphylaxis severity scores was assessed. All symptoms were grouped into a heat map according to their real-life incidence and clinical relevance. Based on the heat map analysis, a severity grading system of food-induced acute allergic reactions in children with the epinephrine administration decision model was created. ResultsData from 259 food-induced anaphylaxis episodes in 157 children were included in the analysis. Comparing the grading systems, we observed a 24.7% to 70.2% disagreement between severity scores. The heat map illustrated a strong association between 29 symptoms and their categorization. A new severity grading system was developed and a 2-stage decision model was proposed: “epinephrine yes” (any rapidly progressing symptoms, even mild ones or from 1 organ system; any symptoms from more than 1 organ system; or every grade of anaphylaxis), and “epinephrine available and prepared to use” (nonprogressing mild systemic allergic reaction from 1 system area only; no anaphylaxis). ConclusionA new severity grading system of food-induced acute allergic reactions in children could serve as a clinical tool for health care professionals to avoid epinephrine administration delay.

Real World Adoption of FDA-approved Peanut Oral Immunotherapy with Palforzia

Oral immunotherapy with Palforzia (POIT) is the first FDA-approved therapy for food allergy, aimed to mitigate accidental allergic reactions in children and adolescents with peanut allergy (PA). Given the novelty of the therapy, it is unknown what percentage of patients and families will pursue this option versus continued strict avoidance.

Markers showing allergic reactions in children caused by aerogenic exposure to manganese and nickel compounds

High prevalence of allergic diseases among children and their close relation with quality of the environment require new approaches to organizing diagnostic and prevention activities. Our research objects were 247 children attending pre-school children facilities (PSCF). It was detected that children who permanently lived and/or attended a pre-school facility for not less than three years under long-term chemical aerogenic exposure to manganese and nickel compounds in low doses (0.17–0.23 MPC average daily) had contents of these metals in their blood that were 1.9–2.0 times higher than the same parameter in children from the reference group and 1.7–2.1 times higher than background level in the region. Pre-school children with their biological media being contaminated with nickel and manganese compounds suffered from atopic dermatitis, allergic rhinitis, and bronchial asthma 1.3–4.5 times more frequently (0.23R20.73; 59.2F388.1; р≤0.001). Allergic diseases associated with aerogenic exposure to chemicals with sensitizing power have certain pathogenetic peculiarities such as active overall inflammatory reaction; sensitization in 54–86% children (the parameter is 1.5–4.3 times higher than in the reference group); cellular metabolism disorder; depletion of antioxidant protection resources in 72% children; deficient activity of phagocytic and humoral section in immunity (1.2 times lower than in the reference group); cytokine regulation disorders (2.4–2.5 time difference); reduced expression of a receptor that induces activation apoptosis; stronger sympathetic influence on heart rate modulation in 26.0% children. Basing on statistical analysis and model making, we determined markers that showed occurring allergic reactions caused by aerogenic exposure to manganese and nickel compounds. These markers are targets for prevention activities; they include growth in allergic pathologies prevalence; these pathologies occurring together with chronic inflammatory-proliferative diseases and disorders in the vegetative nervous system; increased contents of leukocytes, eosinophils, and immunoglobulin E specific to nickel in blood; a decrease in phagocyte number and contents of IgM, IgА in blood serum (0.07≤R2≤0.74; 19.3≤F≤713.2; р≤0.0001).

As soon as possible in IgE-cow's milk allergy immunotherapy.

Oral immunotherapy is a common treatment in cow's milk protein allergy. The Department of Pediatric Allergology at the Children's Hospital of Zaragozaperformed a retrospective analysis of 335 infants under 1year of age diagnosed with IgE-mediated cow's milk and early treated. Clinical evaluation, skin prick test, and serum-specific IgE level control were performed before starting and after finishing treatment. Upon completion of treatment, more than 98% of patients became tolerant to milk and no one presented serious adverse reactions. Nowadays, the remaining non-tolerant patients (1.8%) can take milk or derivatives daily-as prophylaxis-to a certain maximum dose and still remain asymptomatic. After immunotherapy, both positive skin prick tests and a progressive decrease in specific IgE levels were found, as desensitization to milk increased.Conclusion: Oral immunotherapy is a safe and effective treatment against allergy to cow's milk proteins in infants. Such treatment should be offered to the children's families from the first moment of diagnosis. What is known: • Cow's milk proteins are responsible for the earliest IgE-mediated allergic reactions in children. • Oral immunotherapy (OIT) is commonly used as cow's milk allergy treatment and it is proposed at different ages. What is new: • OIT it is an effective and safe method with no severe reactions at early ages. • The number of reaching successful treatments is awesome so we believe that immunity response can be molded at the first months of life, so the probability of success with infants is greater than in older children.

Organoleptic excipients used in pediatric antibiotics

Taste is a crucial factor that determines the palatability of the oral dosage form and patient compliance. ObjectiveThe aim of this work was to evaluate the organoleptic excipients in oral antibiotics for pediatric use marketed in Brazil. MethodsThe information was obtained from the GuidetoPharmacy, a reference for the pharmaceutical trade. The analysis included dosage forms for oral administration and drugs and their combination with antibacterial action. After this survey, we identified the constitution of the flavoring, sweetening, and coloring agents of each medicine. The results are presented in a descriptive form. ResultsTwelve drugs or associations are distributed in 70medicines. Oral suspension was the most common pharmaceutical dosage form. Sweeteners were sucrose, sodium saccharin, and sodium cyclamate. All the coloring agents observed are synthetic and the most frequent ones were yellow twilight no. 6, yellow tartrazine no. 5, and red ponceau 4R. The presence of two or more types of flavorings per medicine was observed. ConclusionAntibacterials use coloring agents, flavorings, and sweeteners to facilitate the administration of medicines for children, using up to six different substances per formulation. No natural coloring agent was observed, demonstrating an issue to be explored in the future. It is important to note that, although necessary, these excipients are responsible for a high incidence of allergic reactions in children.

Hazardous Medications in Children with Egg, Red Meat, Gelatin, Fish, and Cow's Milk Allergy.

Childhood food allergies are a growing public health problem. Once the offending food allergens have been identified, a strict elimination diet is necessary in treatment or prevention of most of the allergic reactions. Accidental food ingestion can lead to severe anaphylaxis. Food- derived substances can be used in medications at various stages of the manufacturing process. In this review, the possible roles of medications which may contain egg, red meat, gelatin, and fish allergens on allergic reactions in children with food allergy were evaluated.

Identification and mutational analysis of continuous, immunodominant epitopes of the major oyster allergen Crag 1

Shellfish, including oysters, often cause allergic reactions in children and adults. Oysters are inevitably consumed because of its delicacy and nutritional benefit, leading to frequent occurrence of severe clinical symptoms observed in patients with oyster hypersensitivity. We aimed to identify the immunodominant epitopes of oyster tropomyosin and crucial amino acids for IgE binding, which will help us to further understand the immunochemical characteristics of Cra g 1. The potential epitopes were predicted by immunoinformatics tools and the resultant immunodominant epitopes were identified by inhibition ELISA with pooled sera and individual serum from oyster allergic patients. Surprisingly, homologous substitution of multiple amino acids led to obviously decrease affinity of IgE antibodies, but this manner did not abrogate binding completely. Five major linear epitopes were evenly distributed on the surface of homology-based Cra g 1 model and hydrophilic residues appeared to be the most important for IgE binding. These results not only offer a better understanding of the molecular mechanism of interaction between Cra g 1 and oyster-specific IgE but also have significance in clinical diagnosis and immunotherapy.