Search

The purpose of this cross-sectional study was to describe the evolution of total IgE and food-specific IgE titers in children seen in consultation for the first time for suspected food allergyPatients and methods. – Nine hundred and twenty five children (455 girls and 470 boys) with a mean age of 8.9 ± 9.1 years (range 15 days–18 years) who were investigated for food allergy in 1997 were included. Their sera were assayed for total IgE and for IgE antibodies specific for six major children’s food allergens (cow’s milk proteins, egg white, peanut, soy, wheat and fish) with the RAST Fx5® Cap System (Pharmacia & Upjohn Diagnostics AB®, Uppsala, Sweden). The results are expressed as a percent of the reference values by age.Results. – Total serum IgE increased significantly with age (r = 0.22, P = 0.0001). The percentage of children with a total IgE level above the normal range for age increased with age, going from 10.3% above the reference value at 0–6 months, reaching 38.2% at 1–2 years and peaking at 56.9% at 4–6 years. It then leveled off at 48.1% at 8–12 years (ns vs. 4–6 yrs) and 41.3% at >12 years (ns). RAST Fx5® values increased in a parallel manner until 4–6 years and then showed a progressive decrease from 6–8 years, differing significantly from total IgE: 31.9% vs. 52.9% (P < 0.01) at 6–8 years, 32.2% vs. 48.1% (P < 0.03) at 8–12 years, and 21.8% vs. 41.3% (P 0.05) at >12 years.Conclusion. – In this large group of children investigated for possible food allergy, an increase with age in the percentage of those with a high total IgE contrasted with the progressive decrease from age 4–6 years in the percentage of those with an elevated RAST Fx5® titer. This finding correlates well with the progressive decrease of clinically important food allergy in the developing child. [Copyright &y& Elsevier]

Background: In case of cow's milk allergy (CMA), pediatric guidelines recommend for children the use of extensively hydrolyzed formulas (eHFs) as elimination diet. According to the American Academy of Pediatrics, the hypoallergenicity of each specific eHF should be tested in subjects with CMA., Methods: A prospective, multicenter trial was performed to assess the tolerance/hypoallergenicity of a thickened casein-based eHF (eHCF, Allernova AR®, United Pharmaceuticals, France) in infants aged <12 months with CMA proven by a double-blind placebo-controlled food challenge. Its efficacy, measured through allergy symptoms monitoring and Cow's Milk-related Symptom Score (CoMiSS) calculation, and safety were evaluated during a 4-month feeding period. Growth z-scores were computed based on WHO anthropometric data., Results: Thirty infants (mean age: 4.8 ± 3.0 months) with CMA proven by a DBPCFC tolerated the eHCF during the 4-month study. The CoMiSS, crying and regurgitation scores significantly decreased by 4.2 ± 4.0, 0.9 ±1.2 and 0.7 ± 1.1 respectively, after 14 days of feeding (p < 0.001). The Scoring Atopic Dermatitis index, of 33.2 ± 14.8 at inclusion in 9 patients, significantly decreased by 15.5 ± 6.7 and 21.1 ± 11.2, after 14 and 45 days of feeding, respectively (p < 0.001). The percentage of infants having normal stool consistency (soft or formed stools) significantly improved from 66.7 % (20/30) at inclusion to 90.0 % (27/30) after 14 days of feeding (p = 0.020). The growth z-scores, negative at study inclusion, significantly improved over the 4-month study. No adverse event was related to the eHCF., Conclusion: The thickened eHCF was tolerated by more than 90 % of included allergic infants with 95 % confidence interval and can therefore be considered as hypoallergenic in accordance with current guidelines. The improvement of growth indices and absence of related adverse events confirmed its safety. Results of this trial back the use of the tested thickened eHCF as an efficient and safe alternative in children with CMA., Trial Registration: ClinicalTrials.gov, number NCT02351531 , registered on 27 January 2015.

Aim: Eosinophilic oesophagitis (EO) is an emerging worldwide disease, closely associated with male gender and allergic disorders. This study investigated the distribution of allergy markers in a cohort of children with EO., Methods: We analysed allergy markers in 91 children (62 males and 29 females) with EO and a control group of 45 age-matched children who had non-EO gastrointestinal allergic symptoms. The markers analysed were serum cow's milk-specific and hen's egg-specific IgE, thymic stromal lymphopoietin (TSLP), thymus-regulated and activation-regulated chemokine (TARC/CCL17) and immunoglobulin free light chain (Ig-fLC)., Results: In the EO group, cow's milk-specific IgE levels were detectable in 41.9% of males and 62.1% of females and hen's egg-specific levels in 25% of males and 26.9% of females. There was no gender difference in increased TSLP or TARC levels. Kappa Ig-fLC were increased in 5.6% of males and 20.8% of females (p = 0.058) and lambda Ig-fLC in 1.9% of males and 33.3% of females (p = 0.000). No gender differences were found in the control group., Conclusion: Our findings suggest that serum TSLP might be a potential marker of EO and TARC of non-EO gastrointestinal food allergies. In EO, serum Ig-fLC appeared higher in females, adding another gender difference to the biology of EO., (©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

The aim of the present study was to evaluate the safety, tolerance and preventive effect on atopic dermatitis of an experimental α-lactalbumin-enriched and symbiotic-supplemented infant formula. A total of ninety-seven non-breastfed term neonates were enrolled into a double-blind, multicentre, randomised controlled trial in which they received experimental (n 48) or standard formula (n 49) for 6 months. The primary outcome was weight at 6 months of age. Secondary outcomes were gastrointestinal tolerance and manifestation of atopic dermatitis. Faecal secretory IgA (SIgA) concentration and microbiota composition of forty-three infants were analysed at 1 and 6 months. Growth was similar in both groups. At 1 month, compared to those in the control group, infants in the experimental group exhibited less crying or agitation, and more quiet behaviour (P=0·03). At 6 months, atopic dermatitis was less frequently observed in the experimental group (P<0·05). Decrease of faecal SIgA concentration between 1 and 6 months was mainly observed in the control group. This decrease was significantly associated with atopic dermatitis (P<0·014) and negatively correlated to the level of colonisation by bifidobacteria (P<0·005). In conclusion, compared to the control formula, the experimental formula guaranteed a similar growth, was better tolerated at 1 month and had a protective effect against the development of atopic dermatitis.

Intestinal bacterial colonisation in pre-term infants is delayed compared with full-term infants, leading to an increased risk of gastrointestinal disease. Modulation of colonisation through dietary supplementation with probiotics or prebiotics could decrease such a risk. The present study evaluated clinical tolerance, the effects on gut microbiota, and inflammatory and immunological mucosal responses to an infant formula adapted for pre-term infants that included in its manufacturing process a fermentation step with two probiotic strains, Bifidobacterium breve C50 and Streptococcus thermophilus 065, inactivated by heat at the end of the process. A total of fifty-eight infants (gestational age: 30-35 weeks), fed either the fermented pre-term formula or a standard pre-term formula, were followed up during their hospital stay. Clinical tolerance, faecal microbiota using a culture and a culture-independent method (temporal temperature gel electrophoresis), faecal calprotectin and secretory IgA were analysed weekly. No difference was observed regarding anthropometric data and digestive tolerance, except for abdominal distension, the incidence of which was lower in infants fed the fermented formula for 2 weeks. Bacterial colonisation was not modified by the type of feeding, particularly for bifidobacteria. Faecal calprotectin was significantly lower in infants fed the fermented formula for 2 weeks, and secretory IgA increased with both mother's milk and the fermented formula. The fermented formula was well tolerated and did not significantly modulate the bacterial colonisation but had benefits on inflammatory and immune markers, which might be related to some features of gastrointestinal tolerance.

Aim: to assess the accuracy and safety of a ready-to-use atopy patch test (HDM-Diallertest, DBV Technologies, Paris) in the diagnosis of sensitization to house-dust mite (HDM) allergens in children with or without atopic dermatitis., Patients and Methods: prospective analysis of a systematic allergic work-up was carried out in 47 children, age 57.4+42 months (mean + SD, range 7 to 176 mo), presenting with isolated or combined atopic dermatitis (AD, n = 28) or other symptoms without AD (control group, n = 19). Children were routinely tested for specific HDM-IgE [against D. pteronyssinus (DPT) and D. farinae (DF)], and skin testing based on HDM (DPT & DF) skin prick test (SPT) and ready-to-use HDM-ATP (HDM-Diallertest), with a reading at 72 hours., Results: 15 children (31.9%) exhibited specific IgE against both DPT and DF, 16 children (34.04%) exhibited positive SPT against DPT and 17 (36.1%) against DF. HDM-Diallertest was positive in 15 cases (31.9%). Among these, 9 exhibited with an eczematous reaction showed an excellent correlation with both SPT and specific IgE for DPT and DF, respectively 93.3%, 97.77%, 90.47%, and 90.47%. The different diagnostic techniques of HDM sensitization neither differ between groups, nor correlated specifically with the different clinical manifestations. No side effect was observed during and after patch testing, except for a local reaction without diffusion outside the local test area., Conclusion: The 3 diagnostic techniques exhibited a comparable level of accuracy for the diagnosis of HDM allergens sensitization. The excellent concordance of the highest class reactions of HDM-Diallertest with the other diagnostic techniques indicates a potential role as a screening tool for the detection of HDM sensitization in infancy.

Aim: To analyze the results of a systematic survey of biological tests in a symptomatic pediatric population consulting for the exploration of a possible food allergy., Patients and Methods: 406 children included in this study, mean age 3.3+3.2 years (2 months-16 years), 159 girls and 247 boys, had cutaneous tests (Stallergènes, Paris, France), assaying of total and specific IgE, and RAST Fx5 (Pharmacia & Upjohn Diagnostics AB, Uppsala, Sweden). Those children suffering from eczema (34.9%), digestive disorders (26.1%), ORL and pulmonary (8.3%), anaphylactic choc (3.4%) or mixed symptoms (27.3%)., Results: The overall positivity of cutaneous tests, all confused age periods, was 34.1% with the following order: egg white (52%, p < 0.05 vs. other food), peanut (46%), egg yolk (42%), fish (34%), wheat (33%), soy (32%), cow's milk (24%) and rice (17%). It decreased significantly with age only for the egg white, 61% (0-1 year) and 68% (1-2 years) vs 31% (> 6 years), p < 0.05. The positivity of cutaneous tests for egg and peanut was more frequent with eczema than with digestive manifestations (64% vs. 44%, 57.6% vs. 34% and 56% vs. 38.7%, p < 0.05). The title of total IgE increased with age, r 0.5 p 0.001. The positivity of specific food IgE was more frequent at 4-6 years (68%) than at 0-1 year (36%), p < 0.05. It revealed, all confused age periods, the following order: egg white (74%) and peanut (64%), p < 0.05 vs. other food, cow's milk (59%), wheat (55%), soy (45%) and fish (24%). The number of high specific food IgE titers was significantly higher than the number of positive cutaneous tests by order of frequency; egg white, peanut, cow's milk, wheat and soy, p < 0.05; the reverse was observed for fish, p < 0.05. Percentage of subjects combining a high title of specific food IgE and a positive cutaneous test for egg white (39.4%) was significantly higher than the percentage of those combining a high RAST Fx5 title and a positive cutaneous test for at least one of 6 corresponding foods (25.2%), p < 0.05., Conclusion: The positivity of different food cutaneous tests, the rate of total and specific IgE titers and the agreement of the results varied according to age, food and symptoms.

The effect of daily administration of oligofructose (OF) on 7-19 months old healthy children intestinal microflora, intestinal tolerance and well-being was assessed in a double blind placebo controlled study. The study comprised 8 days of observation, 21 days of supplementation, and 15 days of post-supplementation. Exclusion criteria included antibiotic use and intake of other prebiotic and probiotic at any time following enrolment. Faecal flora was analysed by culture methods, and health information was recorded daily. Bifidobacteria, tended to slightly increase with OF supplementation, but not with placebo (p=0.095). Simultaneously, a decrease in potential pathogens, significant for clostridia (p=0.05) but not for staphylococci (p=0.09) was observed in the OF group. These modifications did not persist during the post-supplementation period. OF supplementation were accompanied by less flatulence, diarrhoea, vomiting (p<0.001), and fever (p<0.05) events.

Aim: To analyze the evolution of total and food specific IgE (Rast Fx5) titers in the course of food allergy in children., Patients & Methods: 925 children, mean age 8.9 + 9.1 years (15 days-18 years), 455 girls and 470 boys, investigated for food allergy in year 1997, underwent serum samples assay for total IgE and of Rast Fx5, Cap System, Pharmacia & Upjohn Diagnostics AB, Uppsala, Sweden, a mix test detecting specific IgE to 6 major food allergens in children, cow's milk proteins (CMP), egg white, peanut, soy, wheat and fish and analyzed as a function of reference values by age., Results: Total IgE titers increased significantly with age, r0.22, p0.0001. The percentage of children with a total IgE level above normal range first increased with age, from 10.3 % at 0-6 months, reaching 38.2 % at 1-2 years and peaking at 56.9% at 4-6 years, then leveled off, 48.1% at 8-12 years (ns vs 4-6 years) and 41.3% above 12 years (ns). Detectable Rast Fx5 increased in a parallel manner until age 4-6 years and then exhibited a progressive decrease from age 6-8 years, differing significantly from total IgE: 31.9% vs 52.9%, p0.01 (6-8 years), 32.2% vs 48.1%, p0.03 (8-12 years), 21.8% vs 41.3%, p0.05 (> 12 years)., Conclusion: In these outpatient children investigated for food allergy, the increase with age of the percentage of high total IgE contrasted with the progressive decrease of Rast Fx5 from age 4-6 yr. This biological finding correlates timely with the clinical spontaneous decrease of food allergy in the developing child.