Diagnosis and natural course of allergy to cooked potatoes in children

BACKGROUND: Allergy to heat stable potato proteins can cause severe allergic disease in children. OBJECTIVE: To study diagnostic criteria for allergy to cooked potatoes and to describe its clinical characteristics and natural history. METHODS: Thirty-six children, aged 4-36 months, with atopic symptoms and having a positive potato-CAP and/or skin prick test (SPT) were included. Potato allergy was documented by means of provocation, or elimination and reintroduction or an unequivocal clinical history. Potato-CAP and SPT with a commercial extract were evaluated for diagnostic performance. RESULTS: Presenting symptoms in children with proven potato allergy (n = 17) were eczema (16 of 17), gastrointestinal complaints (eight of 17), urticaria and/or angioedema (five of 17), wheezing/rhinitis (three of 17) and anaphylaxis (two of 17). Fifteen children had previously diagnosed cow's milk protein allergy and were egg-sensitized. Potato-CAP at cut-off >2 kU/l provided a 100% sensitivity and a 62.5% specificity for diagnosis of potato allergy, while a SPT score >/= 3 had a 100% sensitivity and a score >/= 4 had a 100% specificity. Tolerance to cooked potato was achieved in 80% of subjects at age 16-102 months. Of 12 subjects having reached the age of 3 years during the study, 10 were re-evaluated at age 3-6 years: seven of 10 subjects had developed clinical pollen allergy, compared with four of 18 atopic controls (P < 0.05). CONCLUSIONS: Potato-CAP and SPT at specific cut-off are valuable tools in the diagnosis of allergy to cooked potato. Most children with potato allergy develop tolerance at mean age of 4 years. Allergy to cooked potatoes is a risk factor for the development of pollen allergy.     

Food allergy is a matter of geography after all: sesame as a major cause of severe IgE-mediated food allergic reactions among infants and young children in Israel

OBJECTIVE: To determine the prevalence, importance, and the order of frequency of IgE-mediated food allergens among infants and young children in Israel. STUDY DESIGN AND PATIENTS: In a cross-sectional study, the prevalence of IgE-mediated food allergy was investigated in 9070 infants and young children (0-2 years) who were followed-up at 23 Family Health Centers (FHCs) in central Israel. Patients with suspected IgE-mediated food allergic reactions, were recruited for further evaluation (detailed questionnaire and skin-prick test (SPT)). RESULTS: We identified 150 out of 9070 (1.7%) patients with suspected IgE-mediated food allergy. Among them, 102/150 (67%) [59 males, 43 females; mean age 10.3 months] completed a detailed questionnaire and underwent SPT. Evaluation revealed 131 positive SPTs in 78/102 (76.5%) patients. Twenty-seven positive SPTs in 18 patients were considered clinically irrelevant based on previous consumption of the relevant foods without clinical symptoms. Thus, there were 104 relevant positive SPTs in 78 patients. The overall prevalence of clinically relevant IgE-mediated food allergic reactions among these patients is estimated to be 1.2% (104/9070). The most common food allergens were egg, cow's milk, and sesame. Anaphylaxis was the presenting symptom in 14/78 (18%) including six sesame-induced cases. A history of other atopic diseases was reported in 27 (35%) patients. In addition, 22 (28%) had a history of atopy in first-degree family members. CONCLUSIONS: We found sesame to be a major cause of IgE-mediated food allergy in Israel. In fact, it is second only to cow's milk as a cause of anaphylaxis. We recommend that testing for food allergens be tailored to each community based on local experience and should include sesame in appropriate populations.     

Dietary antioxidant intake, allergic sensitization and allergic diseases in young children

Background:  Allergic diseases have risen in prevalence over recent decades. The aetiology remains unclear but is likely to be a result of changing lifestyle and/or environment. A reduction in antioxidant intake, consequent to reduced intake of fresh fruits and vegetables, has been suggested as a possible cause.
Objective:  To investigate whether dietary antioxidant intake at age 5 was related to atopy at 5 and 8 years of age amongst children in an unselected birth cohort.
Methods:  Children were followed from birth. Parents completed a validated respiratory questionnaire and children were  skin prick tested at 5 and 8 years of age. Serum IgE levels were measured at age 5. At age 5, antioxidant intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). A nutrient analysis program computed nutrient intake, and frequency counts of foods high in the antioxidant vitamins A, C and E were assessed.
Results:  Eight hundred and sixty-one children completed both the respiratory and FFQ. Beta-carotene intake was associated with reduced risk of allergic sensitization at age 5 [0.80 (0.68–0.93)] and 8 [0.81 (0.70–0.94)]. In addition, beta-carotene intake was negatively associated with total IgE levels ( P  = 0.002). Vitamin E intake was associated with an increased risk of allergic sensitization [1.19 (1.02–1.39)], only at age 5. There was no association between antioxidant intakes and wheeze or eczema.
Conclusion:  Increased beta-carotene intake was associated with a reduced risk of allergic sensitization and lower IgE levels, in  5- and 8-year-old children. Dietary antioxidants may play a role in the development of allergic sensitization.     

Body mass index in young children and allergic disease: gender differences in a longitudinal study

Background The increase in allergic diseases has occurred in parallel with the obesity epidemic, suggesting a possible association. Objective We investigated the relationship of body mass index (BMI) up to age 8 years with allergic disease within a birth cohort. Methods Children were followed from birth and were reviewed at age 3, 5 and 8 years (n=731; male 406). Parents completed questionnaires; children were weighed, measured, skin prick tested and examined. Results Increasing BMI at 3, 5 and 8 years increased the risk of current wheezing at the corresponding age (odds ratio [95% confidence interval] per standardized deviation score: age 3, 1.26 [1.04–1.53], P=0.02; age 5, 1.33 [1.06–1.67], P=0.02; age 8, 1.27 [1.0–1.62], P=0.05). The effect of BMI on wheeze at age 8 years differed between boys and girls, with a significant positive association in girls, but not in boys (P=0.04 for interaction). The effect of BMI at earlier ages on current or subsequent wheezing did not differ significantly between genders. Increasing BMI significantly increased the risk of physician‐diagnosed eczema at age 5 (1.23 [1.04–1.47], P=0.02) and 8 (1.23 [1.03–1.45], P=0.02), with a significant interaction between gender and BMI at age 5 (P=0.04). There was no association between BMI and sensitization. Being overweight at age 3 years was significantly associated with late‐onset wheeze (3.83 [1.51–9.75], P=0.005), persistent wheeze (4.15 [2.07–8.32], P<0.001) and persistent eczema (1.79 [1.03–3.13], P=0.04) in both boys and girls. Conclusions Being overweight is associated with an increased risk of allergic disease in childhood. However, the strength of the association varies with the gender, age and atopic phenotype. Cite this as: C. S. Murray, D. Canoy, I. Buchan, A. Woodcock, A. Simpson and A. Custovic, Clinical & Experimental Allergy, 2011 (41) 78–85.     

Sensitization, asthma and allergic disease in young soccer players

Background:  The aim of this study was to identify the prevalence of allergic disease in young soccer players compared to age-matched students and to evaluate if this prevalence changes as the intensity of training increases.
Methods:  A modified ECRHS questionnaire was administered to 194 soccer players divided by age as Beginners (8–11 years), Juniors (12–16 years) and Under 21 (17–20 years) to evaluate the prevalence of allergic diseases and symptoms as well as drug consumption. Subjects with a positive personal history of allergic diseases underwent skin prick and/or patch tests. Age-matched students ( n  =   136) were used as a control group.
Results:  The prevalence of allergic diseases was 34.5% in soccer players and 31.6% in control subjects (n.s.). Skin sensitization to inhalant allergens was detected in 14.4% of symptomatic soccer players and in 19.2% of control students (n.s.). Patch tests were positive in 35.7% of soccer players and 23.0% of controls with allergic dermatitis (n.s.). The prevalence of allergic diseases did not significantly change in relation to the intensity of training. Although the relative prevalence of sensitization to perennial allergens and asthma was less frequent in soccer players than in controls, and the occurrence of exercise-induced bronchoconstriction was similar in the two groups, soccer players used twice as many anti-allergic and anti-asthmatic drugs as control students.
Conclusions:  An increasingly intensive training programme is not associated with greater risk of allergic disease in soccer players. Therapy regimens of allergic athletes and exercisers should be monitored more closely to guarantee adequate treatment yet avoid inappropriate drug use and doping practices.     

Breast milk fatty acids and allergic disease in preschool children: the Prevention and Incidence of Asthma and Mite Allergy birth cohort study

BACKGROUND: Better understanding of the association between early life lipid intakes and the development of allergic diseases is needed. OBJECTIVE: We prospectively studied breast milk content of n-6, n-3, and trans fatty acids in relation to allergic symptoms at the ages of 1 and 4 years. METHODS: Fatty acid content was determined in breast milk samples of 265 (158 allergic and 107 nonallergic) mothers of children participating in the Prevention and Incidence of Asthma and Mite Allergy study. Outcome variables studied were parental reported eczema at age 1 year, eczema at age 4 years, asthma at age 4 years, and, in a subgroup of 133 children, sensitization at age 4 years. RESULTS: In children of mothers with allergy, breast milk n-3 long chain polyunsaturated fatty acids and the ratio between n-3 and n-6 long chain polyunsaturated fatty acids were inversely associated with asthma and with persistent symptoms (eczema at age 1 year and eczema at age 4 years and/or asthma at age 4 years), but no associations between breast milk fatty acids and sensitization were observed. In children of mothers with allergy, also trans fatty acids tended to be inversely associated with allergic symptoms. In children of mothers without allergy, no associations between breast milk fatty acids and allergic symptoms were observed, but alpha-linolenic acid (18:3n-3) was positively associated with sensitization. CONCLUSION: In susceptible infants, the risk to develop allergic symptoms, but not the risk of sensitization, was modified by intake of n-3 long chain polyunsaturated fatty acids through breast milk.     

Antistreptolysin levels in normal infants and young children

A modified method of estimating the antistreptolysin O titre (A.S.O.) is described. The A.S.O. of 279 sera from normal children under 5 years of age is recorded, together with that of 40 children over 5 years of age. The results show a range much lower than that found in adults and older children and are discussed with respect to estimations made in children with proven infections. The significance of these findings is discussed.     

Objective assessments of allergic and nonallergic rhinitis in young children

Background:  Allergic and nonallergic rhinitis are common childhood disorders.
Objective:  To study nasal eosinophilia and nasal airway patency in young children with allergic and nonallergic rhinitis to assess the pathology behind such diagnoses.
Methods:  We investigated 255 children at six years of age from the Copenhagen Prospective Study on Asthma in Childhood birth cohort assessing rhinitis history, specific immunoglobulin E relevant to rhinitis symptoms, nasal eosinophilia and nasal airway patency by acoustic rhinometry before and after decongestion. Associations were studied in a multivariate graphical model corrected for gender, height and nasal steroid usage.
Results:  Allergic rhinitis was significantly and directly associated with irreversible nasal airway obstruction (reduced decongested nasal airway patency) ( P  =   0.004), whereas nonallergic rhinitis was not. Both allergic rhinitis ( P  =   0.000) and nonallergic rhinitis ( P  =   0.014) were directly and significantly associated with nasal eosinophilia, but this association was stronger for allergic rhinitis.
Conclusion:  Allergic rhinitis and nonallergic rhinitis are of different pathologies as suggested from their different associations not only to allergy but importantly also to irreversible nasal airway obstruction and eosinophilic inflammation. Allergic rhinitis was significantly associated with nasal eosinophilia and irreversible nasal airway obstruction suggesting chronic inflammation and structural remodeling of the nasal mucosa in children at the age of 6 years. Nonallergic rhinitis exhibited no change in the nasal airway patency, but some nasal mucosal eosinophilia albeit less than children with allergic rhinitis.     

Influenza and the rates of hospitalization for respiratory disease among infants and young children

BACKGROUND: Young children may be at increased risk for serious complications from influenzavirus infection. However, in population-based studies it has been difficult to separate the effects of influenzavirus from those of respiratory syncytial virus. Respiratory syncytial virus often circulates with influenzaviruses and is the most frequent cause of hospitalization for lower respiratory tract infections in infants and young children. We studied the rates of hospitalization for acute respiratory-disease among infants and children during periods when the circulation of influenzaviruses predominated over the circulation of respiratory syncytial virus. METHODS: For each season from October to May during the period from 1992 to 1997, we used local viral surveillance data to define periods in Washington State and northern California when the circulation of influenzaviruses predominated over that of respiratory syncytial virus. We calculated the rates of hospitalization for acute respiratory disease, excess rates attributable to influenzavirus, and incidence-rate ratios for all infants and children younger than 18 years of age who were enrolled in either the Kaiser Permanente Medical Care Program of Northern California or the Group Health Cooperative of Puget Sound. RESULTS: The rates of hospitalization for acute respiratory disease among children who did not have conditions that put them at high risk for complications of influenza (e.g., asthma, cardiovascular diseases, or premature birth) and who were younger than two years of age were 231 per 100,000 person-months at Northern California Kaiser sites (from 1993 to 1997) and 193 per 100,000 person-months at Group Health Cooperative sites (from 1992 to 1997). These rates were approximately 12 times as high as the rates among children without high-risk conditions who were 5 to 17 years of age (19 per 100,000 person-months at Northern California Kaiser sites and 16 per 100,000 person-months at Group Health Cooperative sites) and approached the rates among children with chronic health conditions who were 5 to 17 years of age (386 per 100,000 person-months and 216 per 100,000 person-months, respectively). CONCLUSIONS: Infants and young children without chronic or serious medical conditions are at increased risk for hospitalization during influenza seasons. Routine influenza vaccination should be considered in these children.