Atopic dermatitis article
Clinical aspects Diagnosis Objetivos: La alergia a proteínas de leche de vaca PLV por la edad en la que se presenta y el tratamiento que requiere exige un diagnóstico de certeza para evitar etiquetar al lactante de falsamente alérgico sometiéndolo a dietas innecesarias.
Se trata de un estudio multicéntrico realizado en las unidades de alergia de 14 Hospitales infantiles para conocer las características epidemiológicas, clínicas y evolutivas de la alergia a proteínas de leche de vaca APLV.
Material y métodos: Se estudiaron a los niños con sospecha de APLV que acudieron a las consultas de alergia de los hospitales participantes, en el periodo del estudio, atopic dermatitis article a todos ellos una detallada historia clínica, Prick-test con leche de vaca y sus proteínas y determinación de anticuerpos IgE específicos mediante CAP para los mismos alergenos del Prick. Se llevó a cabo la prueba de provocación con leche de vaca de no estar contraindicada según el protocolo diagnóstico.
Se utilizaron dos pautas de provocación distintas una de ellas llevada a cabo en 3 días y la otra en un día. Las dos pautas de provocación utilizadas fueron igualmente seguras. La edad media de la reacción con formula de leche de vaca tuvo lugar a los 3. Conclusiones: El realizar un protocolo diagnóstico adecuado en los niños que consultan por sospecha de CMPA permite descartar la alergia en un alto porcentaje de casos. Distinction is made between allergic hypersensitivity, which is those reactions where an immunological mechanism is detected, and within these IgE-mediated and non-IgE-mediated allergy, depending on their mechanism.
Non-allergic hypersensitivity reactions would be those in which the immunological mechanism is excluded 1. Cow's milk proteins occupy the third place in frequency as a cause of food allergy during infancy, after eggs and fish 2. Although it is not the most frequent cause of food allergy, cow's milk attracts the paediatrician's attention as it is the first food foreign to its species with which the infant comes into contact, after breast feeding or from the first day of life when this is not possible.
Development of sensitization and cow's milk protein allergy CMPA depend on the interaction between genetic predisposition and factors of exposure to cow's milk proteins antigen dose, nature of the antigen, the mother's dietary exposure during pregnancy, transmission of cow's milk proteins CMP through the mother's milk, frequency of atopic dermatitis article, etc 3.
The data provided by the international literature about its incidence are very varied, due to atopic dermatitis article differences, diagnostic methodology, and ages studied, and they range between 0. In one of the most recent prospective studies published internationally and carried out in Denmark by Host et al, an incidence of allergy mediated by IgE to CMP of 1. In a prospective study carried out in the Valencia Region, an incidence of 0. Figures below those observed recently in babies born at Hospital Infantil La Paz over a period of one year, for whom an incidence of at least 1.
atopic dermatitis article
So as to improve our knowledge about this important food allergy, the Food Allergy Committee of the Spanish Society of Clinical Immunology and Paediatric Allergology decided to start up a clinical and diagnostic and monitoring study of infants affected by CMPA. It is a multi-centre study in which the Paediatric Allergy Sections of 14 Hospitals took part.
- Schneider ImreHarangi FerencSebők Béla Clinical and Pathological Aspects of Atopic Dermatitis In the last decades the prevalence of atopic dermatitis has considerably increased all over the world.
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In this study we refer to infants with CMPA. The cases of intolerance to other cow's milk products e. This prospective study set the following objectives: 1. Evaluate various epidemiological factors relating to the appearance of CMPA: history of atopy, age of onset, and type of feeding. Observe how it is presented and what its clinical manifestations are.
Study the value of the skin tests and the determination of milk-specific serum IgE and its fractions in diagnosis, as well as the indication and the usefulness of the challenge test in the diagnosis of immediate hypersensitivity to CMP in the infant.
See whether there are other food sensitizations beef, soy, egg and fish and their clinical relevance. Prospective study of the natural history of CMPA, to see at what age tolerance is established and its possible association with other allergic conditions asthma, rhinitis etc.
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This is the first publication of this work and refers to the first two points of the aims mentioned. Procedures The full past medical history was recorded and a complete haj pikkelysömör otthoni kezels examination performed.
Reactions were read at 15 minutes. A net wheal diameter 3 mm larger than that produced by the negative control was considered positive.
The test was considered positive when a result of 0. Challenge test: Open controlled challenge tests with cow's milk were carried out with a formula of cow's milk adapted to the age of the patient. Two regimens freely chosen by the investigators were used: Regimen A first day: 2 ml, 5 ml,10 ml; second atopic dermatitis article 25 ml, 50 ml; third day: ml and the last dose to complete the quantity equivalent to one normal feed were given at minute intervals. Regimen B in a single day, successive doses of 2 ml, 5ml, 10 ml, 25 ml, 50 ml, ml.
If a clinical reaction appeared, the challenge was discontinued, and treatment was provided if necessary. The challenge was considered to be positive when there were skin urticaria, angioedema, or erythematous rashgastrointestinal vomiting or diarrhoearespiratory rhinoconjunctivitis or bronchospasmsor generalized anaphylactic shock manifestations in atopic dermatitis article 2 hours after the intake of the food.
Atopic dermatitis article of symptoms in the first 60 minutes after intake. Less than 3 months since the last clinical reaction. If the infant was still being breast fed, the challenge test was postponed until the start of artificial lactation.
In those patients allergic to cow's milk sensitized to beef Positive skin prick test, CAP system, or both tolerance to this food was studied at the age when its introduction to the diet was indicated by means of an open controlled challenge test with boiled beef up to a total dose equivalent to a normal meal.
All of the challenges were performed at the Allergy Unit of the Atopic dermatitis article, where appropriate medication and resuscitation equipment was directly available. Informed consent atopic dermatitis article previously obtained from the parents. Each patient remained for 3 hours under observation after the last milk dose intake before going back home.
A clear history of immediate hypersensitivity to CMP. Positive skin prick test, CAP-system, or both, to whole cow's milk, α -lactalbumin, β -lactoglobulin or casein. Positive cow's milk challenge test. No cases of bronchospasm or anaphylactic shock arose. Figure 1. NI: Challenge test not indicated; Ps: positive; Ng: negative. Figure 2. Percentage distribution in relation to the age when the first reaction to CMP took place.
- Piros tömítéssel a lábán
- Egy piros folt pattanásokkal jelent meg a karon
- Hogyan lehet örökre megszabadulni a pikkelysömörtől otthon
The average age of the first consultation for allergological study was 5. An average delay of 2. Clinical reaction appeared in the majority of cases within a latency period of 30 minutes after feeding fig. Figure 3. Percentage distribution compared with latency period of the appearance of symptoms after administration of CMP. No patient had a record of anaphylactic shock. All subjects tolerated boiled beef. They all tolerated soy formulae.
The challenge test is contraindicated in the diagnosis of patients with severe anaphylactic reactions and is not necessary in all cases.
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The results of a recently published study by Eggesbo et al indicated that in pre-disposed infants, whose mothers were allergic, caesarean delivery could increase the risk of developing food allergies, which, according to the authors, could be related to the delay in intestinal colonisation of the new-born child A higher percentage of deliveries by caesarean in our study than in the general population 12, was not observed to make us think of the influence of this factor in the appearance of CMP sensitization.
According to the results of our study, which confirm those obtained by other authors 13,14, CMP allergy begins to show clinically during the first year of life and appears after a more or less extended period of breast feeding, in many cases following the first feed with CMP adapted formula and generally in the first week of its being introduced in the diet.
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Sensitization may have occurred during pregnancy or after birth, during the period of breast feeding. During pregnancy, small amounts of food proteins may cross the placenta and reach the foetal circulation to give rise to IgE sensitization in a genetically pre-disposed foetus. However, the tests carried out have failed to show protection against the development of CMP allergy with a diet excluding cow's milk during pregnancy.
In the review of the Cochrane Collaboration carried out inno evidence was shown of reduction in CMP skin test prevalence in the children of mothers who followed an exclusion diet during pregnancy The main advantage of breast feeding in the prevention of food sensitization is based fundamentally on the relative lack of food allergens in human milk.
Clinical and Pathological Aspects of Atopic Dermatitis
However, this is a double-edged weapon, as experimental studies in animals indicate that small quantities of antigen, at microgram to picogram level, can preferentially induce IgE responses 16, whereas larger quantities, at the milligram level, suppress the IgE response and the degree of suppression depends on the dose Experimental studies have shown that oral tolerance to food proteins can be induced The age of the animal and the food allergen dose are critical for atopic dermatitis article to be induced.
The neonatal period appears the optimum time The larger the dose of antigen and its frequency of administration, the more probable it is for tolerance to be achieved and the IgE response suppressed It has been shown that small amounts of cow's milk proteins and other foods such as egg and peanut, can reach the infant via breast feeding The quantity of beta-lactoglobulin contained in a drop of cow's milk has been calculated to correspond to the quantity of beta-lactoglobulin in litres of mother's milk.
But even so, mother's milk contains approximately as much beta-lactoglobulin per drop as the amount of pollen allergen inhaled per day during the hay fever season. Therefore, it is by no means impossible atopic dermatitis article children to become sensitized to cow's milk, even though they are breast fed exclusively