1,721,024 research outputs found
Allergen specific immunotherapy, novel drugs and biologicals: hopes from the difficult to treat allergic child.
No full textAllergen-specific immunotherapy, novel drugs and biologicals: hopes from the difficult-to-treat allergic child
No full textIn the last decades, significant progresses have been reached in the management of atopic diseases in childhood. Several approaches have been proposed in patients affected by moderate-to-severe atopic diseases. Severe asthma and atopic dermatitis are poorly known with different underlying phenotypes and endotypes, and they may require further cares with biological therapies. Omalizumab, anti-IgE monoclonal antibody, is effective and safe in patients with atopic diseases, especially uncontrolled asthma and chronic urticaria. Anti-IL-5 drugs including mepolizumab, reslizumab and benralizumab are effective in resistant eosinophilic asthma. In patients with uncontrolled atopic dermatitis, dupilumab is of benefit. Allergen-specific immunotherapy (AIT) represents the only treatment attaining immunologic tolerance and sustaining improvement in symptoms. Both subcutaneous and sublingual immunotherapies are characterized by a short-term and a long-term efficacy, as demonstrated by a reduced immunologic reactivity after discontinuation. Component-resolved diagnosis has been found an essential diagnostic tool potentially able to increase the efficacy of AIT in polysensitized children, establishing a precise AIT prescription for patient genuinely sensitized to allergens. The future care of allergic diseases in childhood requires an individualized approach to achieve a patient-tailored therapy for difficult-to-treat atopic diseases
Primary Prevention of Allergic Diseases: The Role of Early Exposure to Cow's Milk Formula
No full textThe burden of atopic disorders is continuously worsening worldwide, especially in childhood. Therefore, risk factors and preventive measures have been called into question. The age when infants introduce complementary foods, varies greatly according to traditional habits, clinical practice recommendations, and breastfeeding duration. It is still debated the impact of early exposure to cow's milk on the increase of allergic diseases, mainly food allergy, and atopic dermatitis. Many factors may play a role in this potential link, such as genetic variation, parental atopy, infant feeding regimens. Recent evidences suggest that the early introduction of complementary foods (up to 6 months of age), including cow's milk, could prevent the development of food allergies. So, several countries included this new approach into feeding guidelines. Our review will focus on the influence of early exposure to cow's milk formula on the development of allergic diseases. Some trials found that cow's milk supplementation in the first days of life could even increase the development of IgE sensitization and food allergies. Other trials did not show any efficacy on prevention of allergic disorders. Further studies are needed to understand the prospective for allergy prevention related to optimal timing of cow's milk formula introduction
Proteine del latte vaccine nei farmaci somministrati ai bambini allergici al latte vaccino
No full textComponent-resolved diagnosis of hazelnut allergy in children
Full text linkHazelnuts commonly elicit allergic reactions starting from childhood and adolescence, with a rare resolution over time. The definite diagnosis of a hazelnut allergy relies on an oral food challenge. The role of component resolved diagnostics in reducing the need for oral food challenges in the diagnosis of hazelnut allergies is still debated. Therefore, three electronic databases were systematically searched for studies on the diagnostic accuracy of specific-IgE (sIgE) on hazelnut proteins for identifying children with a hazelnut allergy. Studies regarding IgE testing on at least one hazelnut allergen component in children whose final diagnosis was determined by oral food challenges or a suggestive history of serious symptoms due to a hazelnut allergy were included. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Eight studies enrolling 757 children, were identified. Overall, sensitivity, specificity, area under the curve and diagnostic odd ratio of Cor a 1 sIgE were lower than those of Cor a 9 and Cor a 14 sIge. When the test results were positive, the post-test probability of a hazelnut allergy was 34% for Cor a 1 sIgE, 60% for Cor a9 sIgE and 73% for Cor a 14 sIgE. When the test results were negative, the post-test probability of a hazelnut allergy was 55% for Cor a 1 sIgE, 16% for Cor a9 sIgE and 14% for Cor a 14 sIgE. Measurement of IgE levels to Cor a 9 and Cor a 14 might have the potential to improve specificity in detecting clinically tolerant children among hazelnut-sensitized ones, reducing the need to perform oral food challenges
Allergic reactions to cow’s milk proteins in medications in childhood
No full textIntroduction: Cow’s milk is a frequent trigger of allergic reactions in childhood. Cow’s milk proteins can be present in pharmaceutical excipients. Methods: We have analyzed paediatric literature on allergic reactions to cow’s milk proteins in medication, focusing on the different routes of administration (inhaled, parental and oral). Results: Dry-powder inhalers may contain lactose as excipient. Lactose can be rarely contaminated with milk proteins and it may induce allergic reactions in patients with cow’s milk allergy. Case reports have described immediate hypersensitivity reactions to methylprednisolone sodium succinate 40 mg injection, a formulation that contains lactose as excipient. Some cases of anaphylaxis after receiving diphteria-tetanus-pertussis vaccine injection in children allergic to milk have been reported. Cow’s milk proteins can be detected also in oral polio vaccine, certain probiotics and lactulose syrup. Conclusions: We suggest caution in administration of pharmaceuticals containing milk allergens in children allergic to milk. (www.actabiomedica.it)
Allergen-specific immunotherapy for inhalant allergens in children
No full textAllergen-specific immunotherapy (AIT) for aeroallergens consists of the administration of standardized allergen extracts to patients with respiratory IgE-mediated diseases to the same allergen in order to achieve immune tolerance to the allergen and prevent the onset of symptoms. AIT is usually delivered by sublingual (SLIT), subcutaneous (SCIT) route. AIT with one or multiple allergens currently represents the only causal treatment able to change the natural history of allergic airway diseases. Significant progresses have been made in terms of AIT efficacy and safety. SLIT and SCIT have been found to be effective in the treatment of asthma and rhinoconjunctivitis due to inhalant allergens. The route of AIT administration should be selected on availability, cost (dependent from the local health system), tolerability (better for SLIT), patient’s preference (injections are less accepted in young children), and adherence (higher for SCIT beyond pediatric age). However, it should be taken into account that metanalyses on AIT do not consider that effectiveness and safety depend upon the product chosen for treatment. Each product should be separately assessed to avoid generalization on administration routes or age group that may affect the decision
New insights into food protein-induced enterocolitis in children
No full textFood protein-induced enterocolitis syndrome (FPIES) represents a non-IgE-mediated food allergic disorder with delayed gastrointestinal symptoms that may evolve in a medical emergency. Clinically, FPIES can be distinguished into acute and chronic phenotypes. FPIES is mainly diagnosed in infancy however the onset at older ages is being progressively described. The pathogenetic mechanism underlying FPIES remains mainly unexplained, but an alteration of food-specific T-cell response has been proposed. The diagnosis of FPIES is primarily clinical, since there are not available specific biomarkers. Oral food challenge (OFC) is the gold standard for diagnosing FPIES or excluding the onset of tolerance to the triggering food. Management of FPIES includes an acute phase treatment and a maintenance therapy with the strict food avoidance until challenge, in order to prevent new attacks and avoid nutritional alterations. Acute management requires hydration that can be performed orally or intravenously according to clinical status. Long-term management of FPIES is based on the avoidance of the culprit food(s) and supervised introduction of other high-risk foods if never taken before among infants before 12 months of age. There is a compelling need of future achievements in FPIES research for the definition of underlying disease pathogenesis and potential therapeutic point of care
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