Medline ® Abstracts for References 7-9

of 'Oral food challenges for diagnosis and management of food allergies'

7
TI
Prevalence of IgE-mediated food allergy among children with atopic dermatitis.
AU
Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA
SO
Pediatrics. 1998;101(3):E8.
 
OBJECTIVE: There is a growing body of clinical and laboratory evidence to support the notion that food allergy plays a role in the pathogenesis of atopic dermatitis (AD). However, the incidence of IgE-mediated food allergy in children with AD is not well established.
DESIGN: A prospective study to determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a university-based dermatologist for evaluation of AD.
SETTING: University hospital pediatric dermatology clinic.
PATIENTS: A total of 63 patients with AD were recruited (35 male; 32 white, 24 African-American, 7 Asian).
METHODS: Patients were assigned an AD symptom score (SCORAD) and were screened for food-specific serum IgE antibodies to six foods (milk, egg, wheat, soy, peanut, fish) known to be the most allergenic in children. The levels of food-specific serum IgE were determined by the CAP System fluoroscein-enzyme immunoassay (CAP); patients with a value>/=0.7 kIUa/L were invited for an additional allergy evaluation. Those with CAP values below the cutoff were considered not food allergic. Patients were considered to be allergic if they met one of the following criteria for at least one food: 1) reaction on food challenge; 2) CAP value more than the 95% confidence interval predictive for a reaction; 3) convincing history of an acute significant (hives, respiratory symptoms) reaction after the isolated ingestion of a food to which there was a positive CAP or prick skin test.
RESULTS: A total of 63 patients (median age, 2.8 years; median SCORAD, 41.1) were recruited; 22 had negative CAP values (without a significant difference in age or SCORAD score, compared with the 41 with positive specific IgE values). Further allergy evaluation was offered to the 41 remaining patients; 10 were lost to follow-up and 31 were evaluated further. Of these, 19 underwent a total of 50 food challenges (36 double-blind, placebo-controlled, and 14 open), with 11 patients experiencing 18 positive challenges (94% with skin reactions). Additionally, 6 patients had a convincing history with a predictive level of IgE; 5 had a convincing history with positive, indeterminate levels of IgE; and 1 had predictive levels of IgE (to egg and peanut) without a history of an acute reaction. Overall, 23/63 (37%; 95% confidence interval, 25% to 50%) had clinically significant IgE-mediated food hypersensitivity without a significant difference in age or symptom score between those with or without food allergy.
CONCLUSIONS: Approximately one third of children with refractory, moderate-severe AD have IgE-mediated clinical reactivity to food proteins. The prevalence of food allergy in this population is significantly higher than that in the general population, and an evaluation for food allergy should be considered in these patients.
AD
Department of Pediatrics, University of Geneva, Geneva, Switzerland.
PMID
8
TI
Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management.
AU
Sicherer SH, Sampson HA
SO
J Allergy Clin Immunol. 1999;104(3 Pt 2):S114.
 
Laboratory and clinical investigations over the past two decades have demonstrated that food allergy plays a pathogenic role in a subset of patients, primarily infants and children, with atopic dermatitis (AD). Approximately 40% of infants and young children with moderate to severe AD have food allergy, but identifying this subset of patients and isolating the relevant food allergens requires a high index of suspicion, the use of appropriate laboratory tests, and, in some cases, physician-supervised oral food challenges. Removal of the causal food protein(s) leads to clinical improvement but requires a great deal of education because most of the common causal foods (egg, milk, wheat, soy, peanut, and so forth) are ubiquitous in the food supply, and food elimination diets risk causing nutritional deficits. Fortunately, most food allergies resolve in early childhood, and food allergy is not a common cause for AD in older children and adults.
AD
Department of Pediatrics, Division of Allergy and Immunology, The Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, NY 10029-6574, USA. scott_sicherer@smtplink.mssm.edu
PMID
9
TI
Eosinophilic esophagitis: a 10-year experience in 381 children.
AU
Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, Flick J, Kelly J, Brown-Whitehorn T, Mamula P, Markowitz JE
SO
Clin Gastroenterol Hepatol. 2005;3(12):1198.
 
BACKGROUND& AIMS: Eosinophilic esophagitis (EoE) is a disorder characterized by a severe, isolated eosinophilic infiltration of the esophagus unresponsive to aggressive acid blockade but responsive to the removal of dietary antigens. We present information relating to our 10-year experience in children diagnosed with EoE.
METHODS: We conducted a retrospective study between January 1, 1994, and January 1, 2004, to evaluate all patients diagnosed with EoE. Clinical symptoms, demographic data, endoscopic findings, and the results of various treatment regimens were collected and evaluated.
RESULTS: A total of 381 patients (66% male, age 9.1 +/- 3.1 years) were diagnosed with EoE: 312 presented with symptoms of gastroesophageal reflux; 69 presented with dysphagia. Endoscopically, 68% of patients had a visually abnormal esophagus; 32% had a normal-appearing esophagus despite a severe histologic esophageal eosinophilia. The average number of esophageal eosinophils (per 400 x high power field) proximally and distally were 23.3 +/- 10.5 and 38.7 +/- 13.3, respectively. Corticosteroids significantly improved clinical symptoms and esophageal histology; however, upon their withdrawal, the symptoms and esophageal eosinophilia recurred. Dietary restriction or complete dietary elimination using an amino acid-based formula significantly improved both the clinical symptoms and esophageal histology in 75 and 172 patients, respectively.
CONCLUSIONS: Medications such as corticosteroids are effective; however, upon withdrawal, EoE recurs. The removal of dietary antigens significantly improved clinical symptoms and esophageal histology in 98% of patients.
AD
Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. liacouras@email.chop.edu
PMID