Asunto(s)
Hipersensibilidad a los Alimentos/epidemiología , Salud Global , Adulto , Distribución por Edad , Asma/epidemiología , Causalidad , Niño , Progresión de la Enfermedad , Eccema/epidemiología , Estudios Epidemiológicos , Hipersensibilidad a los Alimentos/etiología , Humanos , Prevalencia , Rinitis/epidemiologíaRESUMEN
In France, about 20% of schoolchildren are suffering from allergic diseases. Food allergy (FA) is steadily increasing for the last 20 years. Actually, 400,000 children are suffering from FA. Prevalence has increased this last decade. Frequency is estimated about 10% and increased twofold within 5 years. In France, the most common food allergens are: hen's egg (35%), peanut (24%), cow's milk (8%), mustard (6%), and fish (4%). Other food allergens as hazelnut, kiwi, wheat, sesame, seafood, and lupin. Cross reactivities to exist between fruits, vegetables pollen, latex and are more and more frequent. Multiple food allergies have recently been described.
Asunto(s)
Hipersensibilidad a los Alimentos/epidemiología , Adolescente , Adulto , Anafilaxia/epidemiología , Anafilaxia/etiología , Niño , Preescolar , Femenino , Francia/epidemiología , Humanos , Incidencia , Masculino , PrevalenciaRESUMEN
Since discovery of IgE in 1967, which was a real revolution in allergy field, new biological methods as Phadiatop for inhalant allergens and RAST fx5 for food allergens, have been used routinely. Both methods are very useful for reliable and cost efficient atopy screening.
Asunto(s)
Alérgenos/inmunología , Dermatitis Atópica/diagnóstico , Inmunoglobulina E/sangre , Prueba de Radioalergoadsorción/métodos , Juego de Reactivos para Diagnóstico , Alérgenos/efectos adversos , Animales , Niño , Preescolar , Dermatitis Atópica/economía , Dermatitis Atópica/etiología , Dermatitis Atópica/inmunología , Europa (Continente) , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/economía , Hipersensibilidad a los Alimentos/etiología , Hipersensibilidad a los Alimentos/inmunología , Historia del Siglo XX , Humanos , Inmunoglobulina E/historia , Inmunoglobulina E/inmunología , Lactante , Hipersensibilidad Respiratoria/diagnóstico , Hipersensibilidad Respiratoria/economía , Hipersensibilidad Respiratoria/etiología , Hipersensibilidad Respiratoria/inmunología , Sensibilidad y Especificidad , Estados UnidosRESUMEN
875 adolescents of both sexes, aged between 12 and 15 years, who had presented with a perennial allergic rhinitis, were included in an open study that was conducted by pediatricians and allergologists on the efficacy of ZYRTEC (CETIRIZINE). There were four evaluations in the study, at Day-10, D 0, D15 and D30 and it was conducted according to the following plan: A first period (D-10 to D 0) to establish the eligibility of the subjects to be tested, and to establish the clinical allergic history, before definitive inclusion at D 0. A second period, of therapy, of 30 days, during which the subjects took a 10 mg tablet of ZYRTEC as a daily dose. Efficacy was evaluated at each visit by scores of intensity of major symptoms (sneezing, nasal discharge, nasal obstruction, nasal pruritus) and secondary symptoms (ocular score ... ) of rhinitis, as well as anterior rhinoscopy. The patients made an auto-evaluation of symptoms at different times. Analysis of the different parameters showed a real efficacy of ZYRTEC, for 30 days of treatment, in young patients. Furthermore, the tolerance of the product is excellent. This study has shown an overall improvement in the symptoms of perennial allergic rhinitis in patients who were treated with ZYRTEC in conditions similar to those of usual medical practice by pediatricians and allergologists.
Asunto(s)
Cetirizina/uso terapéutico , Rinitis Alérgica Perenne/tratamiento farmacológico , Adolescente , Femenino , Humanos , MasculinoRESUMEN
In this multicenter parallel group randomized trial 254 teenagers, aged 12-15, suffering from perennial allergic rhinitis were investigated. Four evaluations (D-10, D0, D15, D30) were performed according to the following design: a 10-day run-in period (D-10, D0) to determine/establish the patient eligibility and to perform an allergologic checkup. The decision to include the patient was made at D0 according to selection criteria. a 30-day treatment period (D0 to D30). The patient received either cetirizine 10 mg once a day or placebo given in a double blind way according to randomization. Efficacy was assessed at each visit with a nasal symptom score (sneezing, rhinorrhea, obstruction, pruritus) and an ocular symptom score (watery eyes, conjunctival pruritus, red eyes). In addition, an objective evaluation was performed by means of anterior rhinoscopy. Global evaluations by the investigator and the patient on visual analog scales were assessed. Side effects were recorded. At baseline there was no significant difference between the two groups. At day 15 and day 30, all symptoms, subjective as well as objective, were significantly improved in the cetirizine group. Tolerance was good with no significant difference between cetirizine and placebo.
Asunto(s)
Cetirizina/uso terapéutico , Rinitis Alérgica Perenne/tratamiento farmacológico , Adolescente , Método Doble Ciego , Tolerancia a Medicamentos , Femenino , Humanos , Masculino , Factores de TiempoRESUMEN
The efficacy and safety of loratadine and terfenadine in the treatment of 3- to 6-year-old children with seasonal allergic rhinitis were compared in a third-party-blind, randomized, parallel-group study. A total of 96 children were included in the efficacy analysis: 49 children received 5 or 10 mg of loratadine once daily, and 47 received 15 mg of terfenadine twice daily, for 14 days. The mean total score for both nasal and non-nasal symptoms was decreased significantly from baseline at days 3, 7, and 14 in both treatment groups. At endpoint, these scores had improved 73% in each group. There were no statistically significant differences between the two groups in the total symptom scores at any point during the study. Both treatments were effective in relieving individual nasal and nonnasal symptoms. Therapeutic response to treatment was good or excellent in 82% of loratadine-treated children and in 60% of terfenadine-treated children. Few adverse events were reported during the study; all were mild or moderate and were not significantly different between the two treatment groups. There were no reports of sedation or dry mouth in either group. Once-daily treatment with 5 or 10 mg of loratadine was as effective as twice-daily treatment with 15 mg of terfenadine in improving the symptoms of seasonal allergic rhinitis in children 3 to 6 years old. Both treatments were well tolerated.
Asunto(s)
Loratadina/uso terapéutico , Rinitis Alérgica Estacional/tratamiento farmacológico , Terfenadina/uso terapéutico , Química Farmacéutica , Niño , Preescolar , Femenino , Humanos , Loratadina/efectos adversos , Masculino , Suspensiones , Terfenadina/efectos adversosRESUMEN
The intestinal mucosa has a certain degree of "porosity", which allows some molecules and macromolecules that are not subject to active transport, to cross the intestinal wall and enter the blood circulation. This permeability of the intestinal mucosa, which depends mostly on the size of the molecule and the state of the mucosa, can be studied with the assistance of protein macromolecules in an allergy-immunological investigation, or with inert markers, so permitting evaluation of the state of integrity of the small intestine. The markers used are polyethylene glycols (PEG) of various molecular weights, Cr EDTA, the monosaccharide sugars mannitol or rhamnose and the disaccharide sugars lactulose or cellobiose. Study of the intestinal permeability to inert markers allows detection of coeliac or Crohn's disease. It can be repeated, especially at the time of food provocation tests needed in the diagnosis of food intolerances in pediatrics in the enteropathology to cows milk proteins, atopic dermatitis and irritable colon in children.
Asunto(s)
Absorción Intestinal , Síndromes de Malabsorción , Antígenos/farmacocinética , Niño , Preescolar , Enfermedades Funcionales del Colon/complicaciones , Dermatitis Atópica/complicaciones , Carbohidratos de la Dieta/farmacocinética , Proteínas en la Dieta/farmacocinética , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/metabolismo , Humanos , Tolerancia Inmunológica , Lactante , Mucosa Intestinal/metabolismo , Síndromes de Malabsorción/complicaciones , Síndromes de Malabsorción/diagnóstico , Síndromes de Malabsorción/metabolismo , Proteínas de la Leche/efectos adversos , Polietilenglicoles/farmacocinéticaRESUMEN
Atopic Dermatitis (A.D.) is a complex disease with a characteristic clinical appearance, a chronically relapsing course, and is usually seen in patients with a family history of atopic diseases (asthma, allergic rhinitis). Intrinsic and extrinsic factors may play a role in the mechanism beyond this disease. Intrinsic factors include immunological and pharmacological abnormalities. Extrinsic factors include: Bacterial agents and viruses, irritating substances. Inhalant allergens as mite house dust, animal danders, pollens, molds and food allergens are considered, now, to be the most sensitizing agents. Furthermore, social and psychosomatic events may activate the cutaneous symptoms. Allergen avoidance is recommended as well for inhalant allergens as for food allergens. Finally, relationship between parents and physician is essential for the improvement of the patient.
Asunto(s)
Dermatitis Atópica/etiología , Ambiente , Alérgenos , Dermatitis Atópica/prevención & control , HumanosRESUMEN
Intestinal permeability was evaluated by measuring the excretion of two orally absorbed (0.1 g/kg of weight) nonmetabolizable markers, mannitol and lactulose. In 39 controls, the lactulose/mannitol urinary ratio (L/M ratio) was 2.45 +/- 1.01% during fasting and remained stable after food ingestion. In 12 children with cow's milk-sensitive enteropathy under an exclusion diet, the L/M ratio was comparable with that of controls during fasting and exhibited a threefold rise during a provocation intestinal permeability test (IPT) with milk. In 28 children with atopic dermatitis (AD), the fasting IPT L/M ratio was significantly higher than in controls (3.60 +/- 3.31%). This rise was related to an increase of lactulose urinary clearance. A provocation IPT with food induced significant L/M ratio changes only in the group in which the food was proved to be responsible for the exacerbation of skin lesions. We concluded that in cow's milk-sensitive enteropathy, an IPT allows a good evaluation of mucosal reactivity to milk, and in AD, permeability changes are present in at least some cases with cutaneous lesions clearly related to food ingestion.
Asunto(s)
Dermatitis Atópica/complicaciones , Hipersensibilidad a los Alimentos/metabolismo , Enfermedades Intestinales/metabolismo , Mucosa Intestinal/metabolismo , Leche/efectos adversos , Adolescente , Animales , Niño , Preescolar , Femenino , Humanos , Lactante , Lactulosa/metabolismo , Masculino , Manitol/metabolismo , Permeabilidad , Prueba de RadioalergoadsorciónRESUMEN
Eighteen children aged 1 month to 12 years 8 months (mean age, 4.9 years) with pH-metry proven gastroesophageal reflux (GOR)-associated chronic respiratory disorders were treated with Motilium, 2 mg/kg/d in four divided doses, for three months. The incidence of each of the respiratory manifestations decreased, and their cumulative score improved significantly at the end of the treatment period. Patient daily self-assessment scores also fell, but not significantly. Twenty-one hour pH recordings showed a significant reduction in the duration of nocturnal episodes below 4 (2.8 +/- 0.9% versus 8.2 +/- 2.6%, p less than 0.05). No side effects were recorded. Domperidone provides satisfactory control of nocturnal GOR and therefore emerges as a valuable agent for the treatment of chronic GOR-associated respiratory disorders in childhood.
Asunto(s)
Asma/prevención & control , Bronquitis/prevención & control , Tos/prevención & control , Domperidona/uso terapéutico , Reflujo Gastroesofágico/tratamiento farmacológico , Niño , Preescolar , Enfermedad Crónica , Domperidona/administración & dosificación , Reflujo Gastroesofágico/complicaciones , Humanos , Concentración de Iones de Hidrógeno , Lactante , Laringitis/prevención & control , RecurrenciaRESUMEN
The non-sedating antihistamine Astemizole seems to approach all the major characteristics of the ideal histamine H1 antagonist, according to a comprehensive review of 54 clinical trials and clinical use in over 6,500,000 patients worldwide. The following statements concerning Astemizole can now be made: Astemizole is more potent than any other known antihistamine, following Astemizole therapy, H1 blockade is complete in the main target tissues, such as nasal and ocular mucosa, this blockade is also specific, since all histamine-mediated signs and symptoms respond to the drug, this blockade is maintained, since tolerance does not appear during long-term treatment. Astemizole is a non-sedative and non-toxic drug, even during chronic use. Astemizole is very effective in patients with chronic urticaria. Astemizole has well-documented beneficial protective effects on histamine-induced bronchoconstriction.
Asunto(s)
Bencimidazoles/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Astemizol , Asma/tratamiento farmacológico , Bencimidazoles/farmacocinética , Bencimidazoles/farmacología , Antagonistas de los Receptores Histamínicos H1/farmacocinética , Antagonistas de los Receptores Histamínicos H1/farmacología , Humanos , Rinitis Alérgica Perenne/tratamiento farmacológico , Rinitis Alérgica Estacional/tratamiento farmacológico , Urticaria/tratamiento farmacológicoRESUMEN
60 children aged 3 months to 5 years (mean age 2 years) with early onset symptoms (cutaneous, respiratory or gastrointestinal) after ingestion of cow's milk, egg or fish, were investigated with skin prick tests, dosage of total IgE and specific IgE against these 3 food antigens. The case finding criteria used was positive elimination and challenge tests with the offending foods. In those instances in which intolerance to more than one food was suspected, cow's milk, egg and fish were reintroduced separately after remissions of symptoms with food exclusion. Specific IgE (Phadebas RAST) against the offending foods were found in 70% of cases, with early onset symptoms. RAST higher than 0.35 PRU were considered positive. Results showed that specific IgE antibodies in the serum tend to diminish with time: faster with cow's milk than with egg and specially fish. A sample of 15 children out of the 42 patients with positive RAST was followed up during a period of 3 years. 20 of them were treated with Nalcron, five with Ketotifen, and seventeen with both drugs. Eleven children were greatly improved or improved (74%) there was no clinical change in 4 (26%). Three groups can be considered: - One group with normal IgE levels after 2 years with no clinical symptoms/and no relapse after food challenge. - A second group with no symptom or mild symptoms with positive low levels of IgE. - The third group with resisting allergy to foods remains RAST positive. We conclude that frequency of positive RAST against food allergens is relatively high. High concentrations of IgE antibodies are almost exclusively seen in infants with an atopic disease.
Asunto(s)
Hipersensibilidad a los Alimentos/inmunología , Prueba de Radioalergoadsorción , Radioinmunoensayo , Hipersensibilidad Respiratoria/inmunología , Preescolar , Femenino , Hipersensibilidad a los Alimentos/dietoterapia , Hipersensibilidad a los Alimentos/metabolismo , Humanos , Lactante , Absorción Intestinal , MasculinoAsunto(s)
Asma/prevención & control , Estaciones del Año , Asma/fisiopatología , Humanos , Factores de RiesgoRESUMEN
Ketotifen, benzocycloheptathiophene, (Zaditen) an orally active, anti-allergic and anti-asthmatic drug in a dose of 1 mg twice daily was given from 2 to 20 months in 20 selected patients with food allergy (FA) or food intolerance (FI). Sixteen children and four adults of which ten had atopic dermatitis (AD), six urticaria or/and angiooedema (two of which with oropharynx pruritus, oedema of the lips and anaphylactic shock), two asthma, and two gastrointestinal disorders. Food allergy was proved by clinical history, exclusion diet positive challenge test, skin prick tests (SPT) total IgE (PRIST) and specific IgE (RAST). Gastrointestinal permeability was measured in 5 out of 20 patients using mannitol and lactulose as probe molecules on three occasions: (1) by ingestion of the markers alone, (2) with concomitant ingestion of the offending food(s), and (3) with previous administration of ketotifen (2 mg) six hours before ingestion of markers and offending food. In all five individuals, food ingestion resulted in a significant rise of lactulose: mannitol urinary ratio and previous administration of ketotifen resulted in a normalization of the mannitol:lactulose urinary ratio. Patients with urticaria and/or angiooedema, gastrointestinal symptoms, asthma, and oropharynx pruritus with oedema of the lips were completely protected. In patients with AD, 70% were greatly improved or improved but 30% remained the same. It is our impression that ketotifen offers a new therapeutic dimension and therapy in FA.
Asunto(s)
Hipersensibilidad a los Alimentos/prevención & control , Cetotifen/uso terapéutico , Adolescente , Adulto , Niño , Dieta , Hipersensibilidad a los Alimentos/fisiopatología , Hipersensibilidad a los Alimentos/terapia , Humanos , Lactante , Mucosa Intestinal/fisiopatología , PermeabilidadRESUMEN
Intestinal permeability to macromolecules was studied by measuring differential urinary elimination of two orally ingested non-metabolizable sugars of different molecular size, mannitol and lactulose. In 25 control children, mannitol and lactulose urinary elimination were 16.30 +/- 5.77% and 0.33 +/- 0.10% of ingested dose, respectively, with a mean lactulose/mannitol (M/M) urinary ratio of 2.73 +/- 0.70%. In 7 celiac children, L/M ratio exhibited a significant rise: 8.53 +/- 2.54% (p less than 0.001). In 7 children with cow's milk sensitive enteropathy under exclusion diet, L/M ratio was normal in fasting condition: 2.63 +/- 1.28% and raised significantly during provocation test with milk: 7.22 +/- 3.88% (p less than 0.01). Intestinal permeability test is a reliable index of villous atrophy and cow's milk sensitive enteropathy.
Asunto(s)
Enfermedad Celíaca/orina , Disacáridos/orina , Absorción Intestinal , Intolerancia a la Lactosa/orina , Lactulosa/orina , Manitol/orina , Enfermedad Celíaca/diagnóstico , Niño , Preescolar , Humanos , Lactante , Intolerancia a la Lactosa/diagnóstico , Lactulosa/metabolismo , Manitol/metabolismoRESUMEN
The authors report a case of Barrett's oesophagus in a child. This observation is characterized by the extent of the lesion which is of three types of metaplasic epithelium usually seen in this disease (fundic, cardial and intestinal tissue); the difficulties in differential diagnosis from uncomplicated hiatal hernia justify radiological and endoscopical examinations with multiple biopsies. The discussion centers on the risk of malignant transformation with its therapeutical consequences and the long term follow-up of such patients.
Asunto(s)
Esófago de Barrett/diagnóstico , Enfermedades del Esófago/diagnóstico , Adolescente , Esófago de Barrett/diagnóstico por imagen , Esófago de Barrett/patología , Diagnóstico Diferencial , Esofagitis Péptica/etiología , Unión Esofagogástrica/cirugía , Esofagoscopía , Hernia Hiatal/diagnóstico , Humanos , Masculino , RadiografíaRESUMEN
Thirty-five children with atopic dermatitis were proven to be allergic to various foods by dietary elimination and challenge, radio-allergosorbent test (RAST) and human basophil degranulation test (HBDT). Oral sodium cromoglycate improved skin lesions in these patients and protected them from the effects of challenge with food allergens. This protective effect of oral sodium cromoglycate may be explained by the blocking of the immune response in the gut wall and of antigen entry.