The prevalence of allergic diseases in an unselected group of 6-year-old children. The DARC birth cohort study

This study determines the prevalence of atopic dermatitis, asthma, rhinoconjunctivitis, food hypersensitivity and urticaria and the frequency of sensitization in children with and without clinical allergic disease. In an ongoing prospective non-interventional birth cohort study of 562 unselected children, 404 children were subjected to interview, clinical examination, lung function measurements and allergy testing at 6 yr of age. Sensitization measured by skin prick test (SPT) and specific immunoglobulin E (S-IgE) was determined for 24 different allergens. The 1-yr period prevalence of atopic dermatitis, asthma and rhinoconjunctivitis was 14.4%, 6.2% and 13.6%. 25.7% of the children suffered from at least one of the three diseases. The frequency of sensitization in children with no disease (controls), any allergic disease, atopic dermatitis, asthma and rhinoconjunctivitis was 17%, 45%, 47%, 56% and 55% (defined as SPT ≥3 mm and/or S-IgE ≥0.35 kU/l for at least one allergen). Symptoms were linked to sensitization for 44% in the asthma group and 42% in the rhinoconjunctivitis group, whereas sensitization could not be linked to worsening of the eczema in any cases of atopic dermatitis. Overlap between the three diseases was significantly more frequent in sensitized children than in non-sensitized (19/46 = 41% vs. 9/58 = 16%, p = 0.004). The prevalence of food hypersensitivity and urticaria was 1.2% and 5.4% respectively. In unselected 6 yr old children, approximately half of the children with atopic dermatitis, asthma or rhinoconjunctivitis are IgE-sensitized. Sensitization tends to link these diseases to each other.     

Dermatologic food allergy

Cutaneous reactions to foods represent one of the most common presentations of food allergy in children. IgE-mediated (urticaria, angioedema, flushing, pruritus), cell-mediated (contact dermatitis, dermatitis herpetiformis), mixed IgE- and cell-mediated (atopic dermatitis), and nonimmune-mediated (irritant contact dermatitis, Frey's syndrome) reactions to foods have all been reported. It is important for the pediatrician to recognize the variety of skin reactions potentially related to food allergy and to consider timely referral to an allergy specialist for further evaluation and definitive diagnosis.     

Sensitization to turnip rape and oilseed rape in children with atopic dermatitis: a case-control study

Turnip rape and oilseed rape 2S albumins are new allergens in children with atopic dermatitis suspected for food allergy. We recently found that 11% (206/1887) of these children had a positive skin prick test to seeds of oilseed rape ( Brassica napus ) and/or turnip rape ( Brassica rapa ). In the present case-control study we examined how the children with atopic dermatitis sensitized to turnip rape and oilseed rape had been breast-fed and whether they had some common sensitization pattern to certain foods or pollens. A total of 64 children with atopic dermatitis and a positive skin prick test to turnip rape and/or oilseed rape (≥5 mm) were examined. Sixty-four age- and sex-matched children with atopic dermatitis but negative skin prick tests to turnip rape and oilseed rape served as case controls. The turnip rape and/or oilseed rape sensitized children with atopic dermatitis had significantly more often positive skin prick tests reactions and IgE antibodies to various foods (cow's milk, egg, wheat, mustard; p < 0.01) and pollens (birch, timothy, mugwort; p < 0.01) than the control children. They had been exclusively breast-fed for a longer period (median 4 months; p < 0.05) and had more often associated asthma (36%) and allergic rhinitis (44%). Children with atopic dermatitis sensitized to oilseed rape and turnip rape had high frequency of associated sensitizations to all foods and pollens tested showing that oilseed plant sensitization affects especially atopic children who have been sensitized to multiple allergens.     

Egg hypersensitivity and measles-mumps-rubella vaccine administration

Because reports have described egg-sensitive individuals in whom anaphylaxis developed after measles vaccination, current recommendations include delaying administration of egg-derived vaccines until skin testing can be performed. Specifically, the 1988 Red Book recommends skin testing via scratch, prick, or puncture with 1:10 dilution of the vaccine and, if the result is negative, intradermal testing is suggested. The purpose of this study was to evaluate the likelihood of reaction to measles-mumps-rubella (MMR) vaccine in patients with documented egg sensitivity and to delineate the efficacy of skin-prick testing (SPT) to MMR as a predictor of hypersensitivity to the vaccine. Egg sensitivity was documented by initial SPT to egg and then, if possible, double-blind placebo-controlled food challenge (DBPCFC). Patients with a positive DBPCFC to egg or a history of anaphylactic egg sensitivity had a SPT with the MMR vaccine and then were given the MMR vaccine. Additionally, children with atopic dermatitis who had been previously proven egg sensitive via DBPCFCs were evaluated retrospectively for sensitivity to the MMR vaccine. Sixteen children with a history of egg sensitivity underwent SPT to egg, with a positive result 3 mm greater than the negative control found in 12 patients. Eight of these children had a positive DBPCFC to egg. The SPT to MMR vaccine was negative in all 16 children; vaccine administration followed with no resultant systemic problems. Three children had a local reaction at the site of injection. Twelve additional children with atopic dermatitis and egg sensitivity were reviewed. Each child had a positive SPT and DBPCFC to egg.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sensitization to turnip rape and oilseed rape in children with atopic dermatitis: a case-control study.

Turnip rape and oilseed rape 2S albumins are new allergens in children with atopic dermatitis suspected for food allergy. We recently found that 11% (206/1887) of these children had a positive skin prick test to seeds of oilseed rape (Brassica napus) and/or turnip rape (Brassica rapa). In the present case-control study we examined how the children with atopic dermatitis sensitized to turnip rape and oilseed rape had been breast-fed and whether they had some common sensitization pattern to certain foods or pollens. A total of 64 children with atopic dermatitis and a positive skin prick test to turnip rape and/or oilseed rape (>or=5 mm) were examined. Sixty-four age- and sex-matched children with atopic dermatitis but negative skin prick tests to turnip rape and oilseed rape served as case controls. The turnip rape and/or oilseed rape sensitized children with atopic dermatitis had significantly more often positive skin prick tests reactions and IgE antibodies to various foods (cow's milk, egg, wheat, mustard; p < 0.01) and pollens (birch, timothy, mugwort; p < 0.01) than the control children. They had been exclusively breast-fed for a longer period (median 4 months; p < 0.05) and had more often associated asthma (36%) and allergic rhinitis (44%). Children with atopic dermatitis sensitized to oilseed rape and turnip rape had high frequency of associated sensitizations to all foods and pollens tested showing that oilseed plant sensitization affects especially atopic children who have been sensitized to multiple allergens.     

Atopy patch testing in children with asthma and rhinitis symptoms allergic to house dust mite

The atopy patch test (APT) is generally used to assess immunoglobulin E (IgE) mediated sensitization to allergens in patients with atopic dermatitis, but its diagnostic role in children with respiratory allergy is still controversial. The aim of the study was to evaluate APT with house dust mite (HDM) in children with asthma and rhinitis symptoms allergic to HDM and its relevance to skin prick test (SPT) diameters and specific IgE levels. The study population consisted of 33 children, aged 8-16 yr (median: 12 yr) with asthma and 30 children with allergic rhinitis in the same age range (median: 11 yr). All patients had positive SPT results and high serum specific IgE levels for Dermatophagoides pteronyssinus APT was performed on back skin of all patients with 200 index of reactivity (IR)/ml of D. pteronyssinus allergen extracts in petrolatum (Stallerpatch) and evaluated at 72 h. Of 63 patients, 16 (25%) showed a positive patch test result. APT with HDM showed 30% (10/33) positivity among the patients with asthma and 20% (6/30) positivity among the patients with allergic rhinitis. APT presented no significant correlation with age, SPT diameter, serum total and specific IgE levels for D. pteronyssinus, nasal provocation test or pulmonary function test results. Patch testing with HDM may partly identify mite sensitive children with respiratory allergy. Positive APT results may imply that delayed hypersensitivity reactions play a role in children with asthma and rhinitis allergic to HDM.     

Food allergy and atopic dermatitis in infancy: an epidemiologic study

Atopic dermatitis is common in infancy. The role of food allergy in atopic dermatitis of infancy is unclear. We examined the relationship between atopic dermatitis and immunoglobulin E (IgE)-mediated food allergy in infancy. A birth cohort of 620 infants with a family history of eczema, asthma, hayfever or immediate food allergy in a parent or sibling: 487 children had complete data including skin prick tests (SPTs) to evaluate IgE-mediated food allergy to cow milk, egg and peanut. Participants were grouped as no atopic dermatitis (Gp 0) or in quartiles of increasing severity of atopic dermatitis (Gps 1-4) quantified by days of topical steroid use as reported monthly. Adverse reactions to foods were recorded. The cumulative prevalence of atopic dermatitis was 28.9% to 12 months (10.3% of the cohort of moderate severity). As atopic dermatitis severity increased so did the prevalence of IgE-mediated food allergy (Gp 0, 40/346 vs. Gp 1, 6/36 vs. Gp 2, 8/35 vs. Gp 3, 12/35 vs. Gp 4, 24/35; chi(2) = 76; p < 10(-6)), and the frequency of reported adverse food allergy reactions (Gp 0, 43/346 vs. Gp 1, 4/36 vs. Gp 2, 8/35, vs. Gp 3, 5/35, vs. Gp 4, 13/35; chi(2) = 17; p = 0.002). The relative risk of an infant with atopic dermatitis having IgE-mediated food allergy is 5.9 for the most severely affected group. Atopic dermatitis is common in infancy. There is a strong association between IgE-mediated food allergy and atopic dermatitis in this age group.     

Advances in pediatric asthma and atopic dermatitis

PURPOSE OF REVIEW: Allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, food allergy, and urticaria are common in general pediatric practice. This review highlights several significant advances in pediatric allergy over the past year, focusing on asthma and atopic dermatitis. RECENT FINDINGS: With increasing options for the treatment of allergic diseases, much work is now focused on methods for individualizing treatments to a patient's phenotype and genotype. Progress over the past year includes the characterization of effects of regular albuterol use in patients with genetic variations in the beta-adrenergic receptor. Maintenance asthma regimens for children in the first years of life are also an ongoing focus. The relation between upper airway allergic inflammation and asthma has continued to accumulate support and now extends to the middle ear. Environmental influences on asthma and interventions have been described, including environmental controls for asthma and the role of air pollution on lung development in children. Finally, concerns have been raised regarding the use of topical immunomodulators in young children with atopic dermatitis. SUMMARY: Progress continues in the care of children with atopic diseases. Attention to treatment with appropriate medications, patient-individualized environmental controls, and extensive education are the keys to successfully treating atopic children. This review highlights several recent advances but is not intended to be a comprehensive review.     

Anaphylactic reaction to lychee in a 12‐year‐old girl: Cross‐reactivity to latex?

There are very few case reports on allergic reactions to lychee in the literature – so far only in adults. We report on a 12-year-old girl who developed swelling of lips, pruritus, generalized urticaria and dyspnea 30 min after eating a raw lychee. A second event occurred after eating a piece of cake covered with a fruit cocktail. All other foods were well tolerated. In infancy the girl had suffered from atopic dermatitis, which disappeared in childhood; for the previous 2 yr she had presented with seasonal allergic rhinoconjunctivitis. Upon oral provocation, she developed restlessness, flush, generalized urticaria and inspiratory stridor 50 min after eating half a lychee. The diagnostic work up showed a clear positive skin prick test to raw lychee and specific immunoglobulin E (IgE) in serum to latex but not to lychee. In the cellular antigen stimulation test (CAST) carried out with lychee extracts in several concentrations, the same positive results could be found confirming an allergic reaction. Cross-reactivity of lychee to latex was shown by inhibition experiments using the UniCAP 100-system. In conclusion, it seems worthwhile considering the rare allergy to lychee in the case of unclear food-allergic reactions and lychee should be added to the list of foods cross-reacting with latex.     

Status of children with cow's milk allergy in infancy by 10 years of age

To assess the development of milk protein tolerance and atopic diseases in children diagnosed for cow's milk allergy (CMA) in infancy, we conducted re-examinations of 56 CMA subjects at the age of 10 y using 204 age-matched controls. The children underwent clinical examinations and skin prick tests (SPT), and their IgE-specific antibodies to milk and five other food allergens were determined. By the age of 10 y, all but four subjects had become tolerant to at least small amounts of milk protein. However, gastrointestinal symptoms relating to more abundant milk consumption were reported by 45% of the study subjects and 15% of the controls (p < 0.001). The incidence figures for asthma, allergic rhinitis and dermatitis, as well as the occurrence of recurrent otitis, were three to four times higher than in the controls. Positive SPTs were seen in two-thirds of the subjects, the figure being highest (83%) in those with dermatitis onset CMA. Seven subjects showed positive titres of IgE-class milk-specific antibodies, and five showed a clinical response. CONCLUSION: This re-examination study showed that CMA in infancy, even when properly treated, has significant clinical consequences by posing special risks for respiratory atopy and persistence of atopic dermatitis as well as positive SPT and recurrent ear infections. However, each of these clinical manifestations seems to have an independent curriculum unrelated to the persistence of CMA itself.     

Allergy testing in childhood: using allergen-specific IgE tests

A variety of triggers can induce common pediatric allergic diseases which include asthma, allergic rhinitis, atopic dermatitis, food allergy, and anaphylaxis. Allergy testing serves to confirm an allergic trigger suspected on the basis of history. Tests for allergen-specific immunoglobulin E (IgE) are performed by in vitro assays or skin tests. The tests are excellent for identifying a sensitized state in which allergen-specific IgE is present, and may identify triggers to be eliminated and help guide immunotherapy treatment. However, a positive test result does not always equate with clinical allergy. Newer enzymatic assays based on anti-IgE antibodies have supplanted the radioallergosorbent test (RAST). This clinical report focuses on allergen-specific IgE testing, emphasizing that the medical history and knowledge of disease characteristics are crucial for rational test selection and interpretation.     

Clinical presentations of food allergy

Food allergies are immune-mediated responses to food proteins. Because of?differences in the underlying immunologic mechanisms, there are varying clinical presentations of food allergy. This article discusses the manifestations of IgE-mediated disorders, including urticaria and angioedema, rhinoconjunctivitis, asthma, gastrointestinal anaphylaxis, generalized anaphylaxis, food-dependent exercise-induced anaphylaxis, and oral allergy syndrome. It also reviews the presentations of mixed IgE- and cell-mediated disorders, including atopic dermatitis and eosinophilic gastrointestinal disorders. Finally,?the manifestations of cell-mediated food allergies are discussed, including?dietary protein-induced proctitis and proctocolitis, food protein-induced enterocolitis syndrome, celiac disease, and food-induced pulmonary hemosiderosis.     

Wheezing requiring hospitalization in early childhood: Predictive factors for asthma in a six-year follow-up

Although asthma is common after wheezing in early childhood, the risk factors for and the prevention of later asthma are poorly understood. During the present follow-up study, a range of possible predictive factors for school-age asthma was evaluated. The study group consisted of 82 children hospitalized for wheezing at age < 2 years in 1992–93. The baseline data were collected on entry to the study. In 1999, the children were re-examined at the median age of 7.2 years. A structured questionnaire was applied to chart the symptoms suggestive of asthma, and the children were examined clinically. An exercise challenge test, as well as skin prick tests (SPT) to common inhalant allergens, was performed. Asthma was present in 33 (40%) children, 30 (91%) having continuous medication for asthma. The significant asthma-predictive factors, present on entry to the study, were blood eosinophilia (p = 0.0008), atopic dermatitis (p = 0.0089), elevated total serum immunoglobulin E (IgE) (p = 0.0452), and a history of earlier episodes of wheezing in infancy (p = 0.0468). SPT positivity in early childhood was also associated with school-age asthma (p = 0.002). In contrast, respiratory syncytial virus (RSV) identification during the index episode of wheezing played a minor role as a predictive factor for asthma. In conclusion, if hospitalization for wheezing occurs in infancy, more than every third child will suffer from asthma at early school age; the risk is significantly increased with recurrent wheezing in infancy and the development of allergic manifestations.     

哮喘患儿特应性形成的研究

目的探讨个体特应性的发生、发展过程及对哮喘发病的影响。方法调查４１０例哮喘儿童的螨皮试情况，并对三个哮喘家系进行常见过敏原皮试和总ＩｇＥ（ＴＩｇＥ）测定，并对该性状与Ｄ１１Ｓ５３３作遗传连锁分析。结果哮喘儿童的螨皮试阳性率及阳性反应程度随年龄增长而增强，至学龄前期渐趋稳定。三个家系３９人中１７例过敏原皮试阳性，１５名哮喘者中１１例阳性（７３３％），过敏原种类上下各代不同，过敏原皮试与Ｄ１１Ｓ５３３之间无连锁。结论人类存在有控制特异性ＩｇＥ基因，呈常染色体显性遗传，其遗传位点与ＴＩｇＥ不同。个体特应性受遗传影响，其对外界抗原起反应的能力随个体发育不断成熟，至学龄前期渐趋稳定。早期反复的呼吸道感染，犹如佐剂促进了特应性发展。对有特应性家族史的个体，在早期应避免接触过敏原，尽可能减少呼吸道感染，以减少哮喘发病。     

Cow's milk allergic children can present sensitisation to probiotics

Aim: To evaluate sensitivity to different probiotics in children with cow's milk allergy.
Methods: Eighty-five patients (age range: 4 months –12 years) presenting atopic dermatitis (AD) were enrolled. Skin prick test (SPT) responses to three different probiotics preparations (Fiorilac®, Dicoflor® and Reuterin®) were evaluated in addition to relevant food allergens.
Results: Thirty-nine patients out of 85 (45.8%) had a positive skin response to prick test for cow's milk (3 with reaction <3 mm). Of the thirty-six patients with a cow's milk weal reaction >3 mm, twenty-eight (77.8%) had a skin response to Fiorilac®, four patients (11%) to Dicoflor® and four (11%) to Reuterin®. The proportion of SPT reaction to all the investigated probiotics preparations was significantly lower than cow's milk (r = 9.406; p = 0.002). A significantly higher sensitization was observed for Fiorilac® versus Dicoflor® (r = 30.916; p < 0.001) and versus Reuterin® (r = 34.133; p < 0.001).
Conclusion: Probiotic use in patients with cow's milk allergy has to be limited to products that do not contain milk. This should be clearly reported in the label. In selected patients, it is advisable to perform a screening SPT with the product to evaluate its potential contamination with milk.     

Advances in pediatric allergy

PURPOSE OF REVIEW: The purpose of this review is to highlight several important findings related to the broad topic of pediatric allergic diseases reported over the past year, focusing primarily on asthma, urticaria, food allergy, and vaccine reactions. RECENT FINDINGS: Progress continues to be made in identifying environmental exposures during the first years of life that are important for the development of atopic diseases, including asthma. Interventions are being sought based on these findings, to prevent the development of atopic diseases. Chronic urticaria in children is difficult to manage and there is little data related specifically to children to guide treatment and education. Two reports of large populations of children with chronic urticaria were reported in the past year; one dealing with chronic idiopathic, urticaria and one with acquired cold urticaria. Food allergy continues to increase in prevalence and improvements in diagnosis and management continue. Finally, a report of vaccine anaphylaxis cases among a large database was reported. SUMMARY: Allergic disorders comprise a major component of pediatric practice. Advances continue in understanding the origins and natural history of these disorders and treatments are now available that allow effective management in most cases. Patient and parent education remains key to prevent unnecessary restrictions on these children and ensure optimal treatment success.     

Prevalence of specific allergic diseases in school children as related to parental atopy

BACKGROUND: Our objective was to investigate the influence of parental allergy on the manifestations and course of allergic disease in children. METHODS AND RESULTS: A total of 15,234 school children aged 6 and 9 years were evaluated by means of questionnaires completed by their parents in a cross-sectional survey conducted in Tokushima, Japan. The prevalence and relative risk ratio (RRR) for parental allergy in children with atopic dermatitis, asthma and allergic rhinitis were 6.4% (RRR 2.5), 3.2% (RRR 2.4) and 15% (RRR 2.4), respectively. The risk of atopic dermatitis was particularly high in children whose parent had atopic dermatitis, with an RRR of 2.8 (father) and 3.7 (mother). Children with a parental history of asthma also had a high risk of that disorder (RRR of father 5.3, mother 6.2). However, the risk of allergic rhinitis was no different in children with a parental history of allergic rhinitis or from children with a parental history of asthma and atopic dermatitis. A history of allergic disease in both parents, especially of asthma and atopic dermatitis, increased the risk of allergic disease in the child. Milder symptoms, such as wheezy bronchitis, in schoolchildren were similarly related with the same hereditary tendency as the identical allergic disease. The disappearance of allergic symptoms with age also related to a hereditary component, being less likely in children with a history of parental allergy than in those without such an atopic history. CONCLUSIONS: The manifestations and course of allergic disease in school children relate to parental allergic disease.     

Fungal allergy in children

One hundred and thirty-nine children (85 hoys) from a paediatric allergy clinic were included in a study which aimed to relate disease traits of fungal allergy to measured serum IgE antibodies to fungi. A structured case history was recorded and the children were subject to a panel of skin prick tests which included common inhalant allergens and two fungi, Cladosporium herbarum and Alternoria alternata . Serum IgE antibodies to 16 different fungi were assayed by RAST using the Pharmacia extended panel. Forty-seven of the children were positive to fungal RAST and many of them were positive to multiple fungi. C. herbarum gave the highest frequency of positive results. The best combination of three fungi for detecting fungal sensitization was C. Herbarum, Penicillium notatum and Mucor racemosus . Skin prick test (SPT) failed to uncover fungal sensitization in many children with broad RAST sensitivity. Children with RAST positivity to fungi generally had more severe asthma and more frequently recognised summer and autumn to be a difficult period compared with children without such positivity. In stepwise regression analysis, positive SPT for cat had the best explanatory value for asthma and positive C. herbarum RAST the second best. Children with fungal RAST positivities were not over-represented among cases with allergic rhino-conjunctivitis but there was a strong association to eczema. The latter is possibly explained by concomitant sensitization to fungi colonizing the human skin. It is suggested that the identification of fungal allergy in asthmatic children will help ensure that proper anti-inflammatory treatment is instituted during peak spore periods.     

Atopic features in early childhood autism

BACKGROUND: Autism is a developmental disorder of unknown etiology. Sensitivity to dietary and environmental antigens has been considered in its pathogenesis. AIM: To examine immediate hypersensitivity in early childhood autism. METHODS: We investigated 30 autistic children (23 boys, seven girls 2-4 years old) for atopic history, serum IgG, IgA, IgM, IgE levels, and skin prick tests (SPT) with 12 common antigens. RESULTS: Nine/30 autistic children (30%) and 1/39 (2.5%) age-matched neurological controls from the same hospital had a family history suggestive of atopy (p<0.005). No patient in the autism and 28% in control group had symptoms of respiratory allergy (wheezing or asthma) (p<0.005), and 6/30 (20%) autistic vs. 7/39 (17%) control children had history suggesting other allergic disorders (p=ns). Eleven/23 (47.8%) autistic children had at least one positive skin test, similar to age-matched population controls. Serum IgG, IgA, and IgM levels were within age-appropriate limits. Serum IgE was elevated in four patients (13.3%). Specific IgE levels were negative in four cases with multiple SPT positivity. CONCLUSIONS: This study suggests allergic features based on history, skin tests, and serum IgE levels are not frequent in young autistic children despite family history. This discrepancy between predisposition and manifestation might imply immunological factors or environmental conditions.