Clinical Manifestations Of Allergy Research Articles

To Reverse Sensitization By Co-Administration of Bortezomib and Rituximab with Conventional Chemotherapy for Patients Who Developed Neutralizing Hypersensitivity Reactions Against Asparaginase

Background: Acute lymphoblastic leukemia (ALL) patients undergoing Pegylated asparaginase (Peg-asp) or Erwinia-asparaginase (Erw-asp) preparation therapy may experience silent inactivation and allergy to asparaginase (ASP), leading to decreased therapeutic efficacy. How to treat ASP sensitized patients, especially those who are allergic to both Peg-asp and Erw-asp, without compromising the treatment outcome remains a problem for hematologists.This study aims to investigate whether the sensitization to Peg-asp can be reversed through the co-treatment of bortezomib and rituximab with conventional chemotherapy for patients hypersensitive to both Peg-asp and Erw-asp. Method: ALL Patients who developed silent inactivation and allergic reaction to both Peg-asp and Erw-asp enrolled in the study. The study featured 2 courses of combined conventional chemotherapy with rituximab and bortezomib co-treatment. In the second course of desensitization, Peg-asp was re-exposed according to the severity of previous allergic reaction against Peg-asp. For those with silent inactivation or previous allergic reactions of grade ≤ III, a split intramuscular injection was administered (the first dose was given at 1/10th of the required dosage, and then the remaining dose was given at an interval of 2 hours if there was no allergic reaction). Patients with grade IV previous allergic reactions underwent a standard 3-bag desensitization procedure. ASP activity was measured on days 1, 3, 7, 10, 14, and 21 after the first Peg-asp re-challenge. If re-exposure to the first dose did not result in an allergic reaction, a subsequent intramuscular single full dose was administered based on the results of ASP activity monitoring. Primary endpoint: to observe the percentage of allergic reaction on re-exposure and the duration of sustained ASP activity. Result: From August 2020 to May 2023, 10 patients of ALL who developed a neutralizing allergy or silent inactivation to both Peg-asp and Erw-asp preparation were recruited to the study. Among them, six cases were B-ALL, and four were T-ALL. The median age of the participants was 8 years, with seven boys and three girls. Seven children experienced Peg-asp neutralizing allergy or silent inactivation during remission induction, while three children experienced it during the interphase treatment. Eight of them had clinical manifestations of allergy and two had silent inactivation. During the second desensitization course, none of the children showed any allergic reaction after the first re-exposure to Peg-asp. Three children maintained >3 weeks of therapeutic activity after the first Peg-asp re-exposure, while one child maintained 14 days, and three children maintained 10 days. Three children detected Asp activity below 100U/L on day 3 monitoring. After two courses of desensitization, the patients returned to the original chemotherapy regimen. Nine patients (90%) maintained activity above 0.1IU/ML for more than three weeks after subsequent Peg-asp administration. One child developed pancreatitis after the last dose of Peg-asp but recovered soon. Another child experienced silent inactivation and was discontinued from all ASP administration. During desensitization therapy, eight children developed febrile neutropenia. Three were recovered with outpatient antibiotic treatment, while five required hospitalization for 5-7 days. As of July 30, 2023, all ten children survived without any adverse events, with a median follow-up time of 28 months from the start of desensitization therapy. Conclusion： Rituximab and bortezomib co-treatment effectively reverse ASP sensitization and restore the sustained potent activity of Peg-asp. This co-treatment is a safe and promising desensitization therapy after ASP sensitization in ALL patients.

Duration of remission of steroid-dependent nephrotic syndrome after cyclosporin and mycophenolate sodium therapy in children with and without clinical manifestation of allergy

BACKGROUND. The problem of steroid-sensitive nephrotic syndrome is the developing of steroid dependency and toxicity.THE AIM: Evaluate duration of remission of steroid-dependent nephrotic syndrome (NS) after cyclosporine and mycophenolate sodium therapy in children with or without clinical manifestation of allergy.PATIENTS AND METHODS. Follow-up study with analysis of onset, clinical course and treatment includes 47 children ((31 boys (66 %) и 16 girls (34 %)) with steroid-dependent NS, 34 (72,3 %) had clinical manifestation of allergy, 13 (27,7 %) didn’t have clinical manifestation of allergy. The efficiency of therapy with cyclosporine in 16 patients and mycophenolate sodium in 27 patients with clinical manifestation of allergy is estimated in comparative study by analysis of 6, 12, 24 month remission rate after treatment. Median duration of remission of NS during 2 years after treatment is estimated. Out of 27 children 8 (29,6 %) had mycophenolate sodium treatment after cyclosporine and took part in both groups.RESULTS. Statistically significant differences in 6, 12, 24 month remission rates after cyclosporine and mycophenolate sodium treatment in children with clinical manifestation of allergy are established. Remission of NS during 6 months after mycophenolate sodium treatment was in 81,5 % (in 22 from 27 patients) unlike of that after cyclosporine – in 40 % (in 6 from 15 patients) in children with clinical manifestation of allergy (р<0,05). Remission of NS during 12 months after mycophenolate sodium treatment was in 55,6 % (in 15 from 27 patients) unlike of that after cyclosporine – 13,3 % (in 2 from 15 patients) (р<0,05) in children with clinical manifestation of allergy. Remission of NS during 24 months after mycophenolate sodium treatment was in 37 % (in 10 from 27 patients) unlike of that after cyclosporine – 6,7 % (in 1 from 15 patients) (р<0,05) in children with clinical manifestation of allergy. Median duration of remission during 2 years after treatment with cyclosporine and mycophenolate sodium in children with clinical manifestation of allergy was 7,0 [2,0-11,0] and 17,0 [6,0-24,0] months, retrospectively, (р<0,05).CONCLUSION. Remission of steroid-dependent NS during 6 months after therapy with mycophenolate sodium and cyclosporine in children was in 81,5 % and 40,0 % respectively, in children with clinical manifestation of allergy. Remission of steroid-dependent NS during 12 months after therapy with mycophenolate sodium and cyclosporine in children was in 55,6 % and 13,3 % respectively, in children with clinical manifestation of allergy. Remission of steroid-dependent NS during 24 months after therapy with mycophenolate sodium and cyclosporine in children was in 37 % and 6,7 % respectively, in children with clinical manifestation of allergy. Median duration of remission during 2 years after treatment with cyclosporine and mycophenolate sodium in children with clinical manifestation of allergy was 7,0 [2,0-11,0] and 17,0 [6,0-24,0] months, retrospectively. As the result of comparative study duration of remission of steroid-dependent NS in children with clinical manifestation of allergy was statistically significantly longer in children after therapy with mycophenolate sodium.

Лабораторні маркери алергічних та токсико-алергічних реакцій на медикаменти у хворих на туберкульоз легень

Abstract. The purpose of the study was to determine the laboratory markers of allergic reactions (AR) and toxic-allergic adverse reactions (TAR) to medications in patients with active pulmonary tuberculosis (TB) to predict their development. Methods and materials. There are the results of examination of 68 patients with TB, average age (38.2 ± 1.8) years, who were divided into 4 groups depending on the presence of adverse reactions to medications. 1A group included 12 patients with clinical signs of allergy (A) and nonelevated indicators of liver function in the blood; 2nd group included 16 people with signs of allergy with the increased liver function indicators that developed during treatment (TAR); 3T group included 25 people with the only elevated liver function indicators (toxic (T) reactions); 4BP group included 15 patients without adverse reactions to medications. All patients were examined with standard clinical, radiological, laboratory, biochemical, microbiological, and immunological methods with subsequent computer statistical processing using ranked data series. Conclusions. There were determined the laboratory markers (lymphocyte coefficient — LC and lymphocyte-hepatic coefficient — LHC) of AR and TAR in patients with TB. Decrease in LC (calculated for CD3+, CD8+) below 1 unit and in LC (for CD4+ or CD19+) below 0.5 unit confirmed an allergic reaction in patients with clinical manifestations of allergy. The absence of LC decrease made it possible to diagnose TAR at the presence of allergy clinical signs in patient. The growth of LC for CD 16+56+ above 1.0 unit was the evidence of toxic reactions. Decrease in LHK (calculated for CD3+, CD4+, CD8+ or CD19+) below 2.5 units is possible to use as a TAR marker.

Serum Allergen-Specific IgE among Pediatric Patients with Primary Immunodeficiency.

Background: Allergy is a clinical condition that reflects a deviated function of the immune system. The purpose of this study was to evaluate serum allergen-specific IgE (sIgE) along with clinical manifestations of allergy in patients with diagnosed primary immunodeficiency (PID). Methods: 72 patients, aged 1–17 years, diagnosed with PID and hospitalized between July 2020 and February 2021 were included in the study. Blood samples were obtained by venipuncture. sIgE (30 allergens), blood eosinophil count, as well as total IgE and IgG were measured and assessed in relation to a detailed medical examination. Results: Serum sIgE was detected in the blood of 50% of the patients in the study group, which significantly correlated (p < 0.0001) with clinical symptoms of allergy. During the period of the study, 61.1% of the patients showed symptoms of allergy, with 77.27% of them having tested positive for sIgE. The total IgE level was elevated in 18.06% of the patients and correlated with clinical symptoms of allergy (p = 0.004). An elevated total IgE level was not observed in children receiving immunoglobulin replacement therapy. Conclusion: The study showed that serum sIgE and total IgE together might be a plausible diagnostic tool for PID patients. However, for patients receiving immunoglobulin replacement therapy, the assessment of total IgE is not useful.

Cow’s milk protein allergy and antihistamines using in infants

Allergy to cow’s milk is a frequent diagnosis in infants and amounts to 2-3%. In most cases, manifestations of allergy to cow’s milk proteins are combined polyorganic in nature with the involvement of two or more systems of the child’s body, more frequent are lesions of the skin and gastrointestinal mucosa. Supporting breastfeeding remains the first task of a pediatrician when observing a child in the first year of life, but if there is a need to appoint and choose from a variety of formulas for supplementary feeding or as a basic diet, there is a difficult question of choosing the right one. Children at risk without clinical manifestations of allergy to cow’s milk proteins should use hypoallergenic preventive formulas based on partially hydrolyzed cow’s milk proteins. In formed clinical manifestations of allergy – formulas based on highly hydrolyzed protein, and in their severe manifestations – on the basis of amino acids. Unfortunately, a significant part of infants have polyvalent sensitization, so even a properly selected formula does not fully eliminate all symptoms. Therefore, in addition to diet correction, antihistamines, both systemic and topical, as well as hormonal topical remedies, emollients, etc., are often used. Pathogenetic treatment for food allergies has not yet been developed, and the only solution we can make, in addition to elimination diets, is to apply symptomatic therapy. A special problem in pediatrics is the lack of drugs, including antihistamines, allowed for use in children under the age of 1 year. At this age, allowed to use only a few: dimetindene, ceirizine, in emergency cases – chloropyramine, starting with the age of 1 month. Optimal forms of administration for infants may be syrup, suspensions, drops, as well as topical forms - lotion, gel, emulsion or cream. Taking into account many years of experience with dimethindene, clinical data on the efficacy and safety of the drug, allow its use in pediatric practice. The drug has good antihistamine activity, antipruritic, anti-edema and antispastic effect, and is able to quickly and firmly relieve symptoms of allergy.

Laboratory diagnosis of immuno-mediated reactions of hypersensitivity to drugs in patients with pulmonary tuberculosis

To date, there are no unified and standardized laboratory methods for diagnosis allergic reactions to anti-TB drugs.Objective — to optimize the methods of laboratory diagnostics of hypersensitivity reactions to anti-tuberculosis (TB) drugs in patients with pulmonary tuberculosis and to find out their immunological mechanisms.Materials and methods. Clinical and immunological examination was carried out in 39 patients with pulmonary tuberculosis, which were divided into two groups: 1st — with the presence of clinical manifestations of hypersensitivity to anti-TB drugs; 2rd — without visible clinical sings of hypersensitivity. The tests were performed to detect intolerance to first-line anti-TB drugs in vitro: activation of basophiles, determination of serum tryptase, total (IgE) and specific (IgEsp ) immunoglobulin E levels, and erythrocyte sedimentation rate (ESR).Results and discussion. Patients of the 1st group showed increase levels of tryptase, total IgE, specific IgEsp for rifampicin and ethambutol in the blood. Frequency of positive values of ESR for isoniazid was significantly higher in group 1. Correlation between ESR and number of activated basophils and its activated receptors, levels of tryptase and total IgE was observed.Conclusions. The most informative tests in vitro to determine the causative drug in TB patients with clinical manifestations of allergy are: the level of specific IgEsp for rifampicin and ethambutol; erythrocyte sedimentation reaction for isoniazid. The use of basophil activation test is limited in the diagnosis of immuno-mediated allergic reactions to first-line anti-TB drugs

EPIDEMIOLOGICAL ASPECTS OF CCD-POSITIVITY IN PATIENTS WITH CLINICAL MANIFESTATIONS OF ALLERGY IN THE SOUTH-WESTERN REGION OF UKRAINE

Patients with antibodies to CCD, when tested for the presence of specific IgE antibodies to allergen extracts, may exhibit a large number of positive reactions.Objective - to determine the epidemiological aspects of CCD-positivity in patients with clinical manifestations of allergy in the South-Western region of Ukraine.Material and methods. Results of serological examination of 500 patients with allergic manifestations were estimated and antibodies to different carbohydrate determinants using CCD blot determined.Results. It has been shown that antibodies to cross-reactive carbohydrate determinants are detected in 17.8±1.71% of patients with clinical manifestations of allergy. Antibodies to CCD are recorded in 10.71±2.20%, of patients aged 0-10 years, they are significantly higher in patients older than 10 years, on the average 22.00±5.45%. A direct correlation relationship (r=0.88) was determined between the class of reaction to CCD and the number of positive reactions to allergens. In the group of patients with multiple allergen reactions, 73.7±7.14% showed positive reactions to different CCD chains during additional examination on the linear CCD blot. In a separate analysis of CCD-positive patients on the linear CCD-blot, it was shown that antibodies to horse radish peroxidase were significantly higher than to bromelain (p&lt;0.01) and ascorbate oxidase (p&lt;0.05). The same pattern was observed in patients with multiple allergen reactions. Conclusions. The results of the studies indicate that it is necessary to take into account the possibility of non-specific reactions related to cross-reactive carbohydrate determinants and additionally test patients for the presence of antibodies to CCD, especially in the case of multiple reactions to allergens.

Allergic manifestations in autistic children: Relation to disease severity

Etiology of autism has become an area of significant controversy. Allergy may play a role in the pathogenesis of autism wherein allergic immune responses to some proteins (e.g., dietary proteins and latex) may induce the production of brain autoantibodies, which are found in many autistic children. This study was conducted to investigate the frequency of allergic manifestations in autistic children. The relationship between allergy and disease characteristics in terms of disease severity, clinical findings and electroencephalography (EEG) abnormalities was also studied. Fifty autistic children (30 had mild to moderate autism and 20 had severe autism) were studied in comparison to 50 age- and sex- matched children without neuropsychiatric manifestations serving as controls. Clinical evaluation was done with special emphasis on neuropsychiatric assessment and clinical manifestations of allergy. Serum total immunoglobulin E was measured in all studied subjects. In addition, EEG and assessment of mental age were done for all autistic children. Allergic manifestations (bronchial asthma, atopic dermatitis and/or allergic rhinitis) were found in 52% of autistic patients. This frequency was significantly higher than that of controls (10%; P

ALLERGY TO ANTIBIOTICS IN CHILDREN: WHO IS TO BLAME AND WHAT TO DO?

Allergic reactions to antibiotics are a serious issue of pediatric practice and a difficult problem for pediatricians due to difficulties of diagnostics, interpretation of anamnestic data and subsequent selection of adequate antibacterial therapy. The review describes the main types of allergic reactions to the antibacterial drugs most widely used in children. Special attention is given to drug hypersensitivity development risk factors; clinical manifestations of allergy to antibiotics and peculiarities of allergic reactions to certain drugs are described. The article dwells upon clinical approaches and algorithms of managing patients with presumed intolerance to antibacterial drugs.

Glaucoma therapy and ocular surface disease

To provide an update on clinical and experimental literature for ocular surface effects of glaucoma therapy and to provide practical guidelines for ophthalmologists treating glaucoma patients with ocular surface disease (OSD). Preservatives, notably benzalkonium chloride (BAK), continue to contribute to OSD and demonstrate a variety of toxic ocular effects both in-vitro, and in animal/human studies. Recent literature frequently compares BAK with Polyquad, SofZia, and preservative-free therapies. Some clinical benefit has been demonstrated with newer BAK-free alternatives. BAK-free and preservative-free therapies are becoming available but are not always a feasible alternative. It is important to recognize different clinical manifestations of allergy and chronic inflammation and to discuss options for patients experiencing OSD.

Molecular characterization of wheat allergens specifically recognized by patients suffering from wheat‐induced respiratory allergy

Wheat (Triticum aestivum) is an important allergen source responsible for various clinical manifestations of allergy (i.e. food allergy, pollen allergy, respiratory allergy to flour-Baker's asthma). The objective of this study was the molecular and immunological characterization of new recombinant wheat allergens and to evaluate their usefulness for the diagnosis of allergy to wheat. A T. aestivum cDNA library was constructed and screened with serum IgE from patients suffering from wheat allergy to identify cDNAs coding for new wheat allergens. The allergen-encoding cDNAs were expressed in Escherichia coli and purified to homogeneity. IgE reactivity of recombinant proteins was analysed in RAST-based, non-denaturing dot blot experiments and by ELISA with sera from wheat allergic patients and their allergenic activity was assessed in basophil degranulation experiments. We report the molecular characterization, recombinant expression and purification of five wheat allergens, a thioredoxin h isoform, glutathione transferase, 1-Cys-peroxiredoxin, profilin and dehydrin. Homologous proteins were identified by sequence comparisons in various plants. 1-Cys-peroxiredoxin appeared to be the most relevant of the newly identified wheat allergens according to prevalence of IgE recognition and results from basophil degranulation experiments. It showed IgE cross-reactivity with seed proteins from barley, rye, rice, maize, soy, oat and spelt. 1-Cys-peroxiredoxin, glutathione transferase and dehydrin were mainly recognized by patients with baker's asthma but not wheat-induced food allergy. The characterized recombinant wheat allergens may be useful for the development of serological tests which allow the discrimination of different clinical manifestations of wheat allergy.

Prevention of Allergy in Infants of Allergic Mothers by Probiotic Escherichia coli

R Lodinova-Zadnikova, L Prokesova, I Kocourkova, J Hrdý, J Zizka. Int Arch Allergy Immunol. 2010;153(2):201–206 To study the effect of after-birth oral colonization by a probiotic Escherichia coli strain in infants of allergic mothers to reduce occurrence of allergy later in life. There were 158 term breastfed infants followed from birth, 113 of whom were born to allergic mothers. Allergic mothers selected for the study met criteria that included clinical manifestation of allergy for more than 24 months, positive allergy-test results, and response to allergy treatment. The infants were divided into groups of colonized infants of allergic mothers (56), control infants of allergic mothers (57), and control infants of healthy mothers (45). Infants of allergic mothers …

Are coeliac patients at increased risk of atopic sensitization and allergy?

Aims. Recent researches have highlighted the role of innate and Th1 immune responses in coeliac disease (CD). However, the immunopathogenesis of CD still needs to be completely clarified. Based on the paradygm of exclusive Th1/Th2 disorders, a low prevalence of atopy and Th2 mediated allergic manifestations would be expected in coeliac patients. Aim of this study was to screen paediatric coeliac patients for atopic sensitization and clinical manifestations of allergy.

Effects of established allergen sensitization on immune and airway responses after secondary allergen sensitization

Spreading of sensitization with clinical manifestation of allergy is often observed in atopic individuals. To investigate the effects of an established primary allergen sensitization on immune responses and airway inflammation/reactivity on secondary allergen sensitization and airway challenges in a murine model. Balb/c mice were primarily sensitized intraperitoneally with ovalbumin or PBS, followed by systemic sensitization and airway challenges with latex extract as a secondary, unrelated allergen. Purely sham-sensitized animals were included as controls. In a second set of experiments, the primary and secondary allergens were switched. Sensitization with ovalbumin before sensitization with latex resulted in increased production of total and latex-specific (Hev b 3-specific) IgE and IgG(1), and enhanced secretion of T(H)2-cytokines by spleen mononuclear cells cultured with mitogen compared with single latex-sensitized mice. Furthermore, airway challenges of double-sensitized mice (ovalbumin + latex) with latex caused a significant increase in airway reactivity compared with purely latex-sensitized and challenged animals. These effects were dependent on dosing and timing of the primary sensitization in relation to the secondary sensitization and independent of the primary allergen used. Primary sensitization boosted systemic T(H)2 immune responses and enhanced the development of airway reactivity after sensitization and airway challenges with a secondary, unrelated allergen. This effect of consecutive priming was dependent on the strength of the primary sensitization but independent of the allergen used. The results explain the increased susceptibility toward sensitization spreading in atopic individuals. Because sensitization spreading is facilitated by primary sensitization, early prevention measurements or immunotherapy should be considered at this stage of monosensitization.

Intestinal microbiota and immunoglobulin E responses in 5‐year‐old Estonian children

Over the last few decades, several studies from different parts of the world have indicated an increasing prevalence of allergic diseases. This has been related to environmental factors, like changes of microbial pressure. Our previous studies have demonstrated differences in the intestinal microbiota between allergic and non-allergic children. To test the hypothesis that the intestinal microbiota and IgE response are related, both in allergic and non-allergic 5-year-old Estonian children. The study group comprised 19 allergic and 19 non-allergic 5-year-old children, selected from a larger group who had been followed from birth. The diagnosis of allergy was based on clinical examination of the children and on data obtained from the questionnaires. The faecal microbiota were quantified by seeding serial dilutions on nine different media for incubation in different environment. The composition of the gut microbiota was expressed both as absolute counts of the various species and their relative share among the total counts of identified microbiota. Bifidobacteria were less commonly detected in children with allergic diseases than in healthy children and clostridia comprised a higher proportion among their gut microbes. Children with specific IgE antibodies to defined allergens had higher counts of clostridia and the counts of clostridia correlated with the level of serum IgE, but only so in allergic children. In non-allergic children, the serum IgE levels showed a positive correlation with the counts of bacteroides. The development of allergic diseases seems to be associated with the composition of the gut microbial ecosystem. High counts of potential pathogens, such as clostridia, are associated with clinical manifestations of allergy and IgE antibody formation.

Atopic dermatitis -- a total genome-scan for susceptibility genes.

Atopic dermatitis is one of the most common chronic diseases of childhood and closely related to other clinical manifestations of allergy. The incidence is high and still increasing. The genetic contribution to disease development is substantial and complex. Only recently genetic research has begun to focus on this phenotype, and specific susceptibility genes remain to be found. To identify candidate regions holding genes for atopic dermatitis we performed a genome-scan in Danish affected sib-pair families containing sib-pairs matching a phenotype definition of both clinical atopic dermatitis and confirmed specific allergy. The scan was undertaken using 446 microsatellite markers and non-parametric linkage results were obtained from the MAPMAKER/SIBS computer program. We found evidence of linkage to three candidate regions in chromosomes 3p (MLS=2.14), 4p (MLS=2.00) and 18q (MLS=2.25), one of which has not been reported previously. Eight additional regions showed weaker but positive results.

Immunologische Aspekte bei Multipler Chemikalischer Sensitivität

Immunological alterations are discussed as potential pathomechanisms for multiple chemical sensitivity (MCS) based on the systemic nature of the symptoms, known complex interactions between the immune system and other organ systems, as well as empirical evidence. However, there are theoretical reservations on immunologic mechanisms in MCS and methodological constraints on human trials. Aim of this paper is a critical presentation of immunological concepts of MCS and resulting future research. Clinical manifestations of allergy, pseudoallergy and MC'S are discussed as similar, closely related disorders where environmental exposure causes inflammation. In the case of allergy, foreign proteins bind to IgE on mast cells, which release inflammatory mediators. In pseudoallergy, initiating substances directly induce liberation of inflammatory mediators without involvement of antibodies. For MCS, low molecular weight chemicals may bind to chemoreceptors on sensory nerve fibers to release inflammatory mediators. Some proponents of these theories hold that this variable pattern can be attributed to various factors, including total body burden, adaptation and biochemical individuality. Both allergic and chemical irritant responses may be subjected to conditioning, so that the response may be triggered by other stimuli. However, the lack of consistency in response patterns both between and within individual MCS patients limits the plausibility of this hypothesis. Therefore, no consistent pattern of immune dysfunction can be identified in MCS patients. It is recommended that clinical evaluation never be based on results of isolated in vitro assessment of quantity and function of immune system cellular components without considering all variables which apply to all different assays and without knowing the patient's complete history and physical examination.

Colitis eosinofílica por alergia a proteína de leche de vaca

Eosinophilic colitis is one of the clinical manifestations of allergy to cow's milk during the first year of life. We report a series of 9 infants who, under 9 months of age and while clinically well, presented rectal bleeding of variable magnitude, with or without diarrhea, shortly after a cow's milk-based formula was initiated (n = 6); yet, 3 cases received only breast feeding. Bleeding disappeared in all patients after milk withdrawal from the diet. Challenges were planned after 12 months of treatment; three patients have not yet reached this moment, 3 had a negative challenge at 12, 18 and 28 months of age and are on a complete diet, and 3 are still on cow's milk free diet because ingestion of milk at 12, 18 and 25 months still induced rectal bleeding. This series of patients gathered in 3 years, follows the trend reported in many countries that there is a relative increase of patients diagnosed with allergy conditions early in life.

Primary Prevention of Allergic Sensitisation

Allergic diseases, particularly allergic asthma, are among the most frequent disorders seen in paediatric practice and clinic. Epidemiological data as well as recent immunological studies have largely contributed to the identification of risk factors eventually leading to the clinical manifestation of allergy. Various strategies of primary prevention are being developed and most of them include avoidance of identified or presumed risk factors. Another promising field of research investigates pharmacological approaches in the prevention of allergy, and drugs have been identified which interfere with the pathophysiological pathways. It seems likely that they may play an important role in future primary prevention strategies especially targeting infants at high risk.

Treatment of eosinophilic esophagitis with inhaled corticosteroids.

Treatment of eosinophilic esophagitis with inhaled corticosteroids.