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RESUMEN Introducción: Las alergias alimentarias constituyen una patología cada vez más frecuente en la infancia. Es importante conocer sus características para su prevención y mejor abordaje terapéutico. Objetivo: Determinar la frecuencia, las características clínicas y los tipos de alimentos desencadenantes de las alergias alimentarias más frecuentes, en pacientes pediátricos en un consultorio de referencia, entre marzo 2016-marzo de 2019. Materiales y Métodos: estudio transversal, descriptivo, observacional con datos secundarios de fichas clínicas de pacientes de menores de 18 años. Se estudiaron edad, sexo, manifestaciones clínicas y tipo de alergeno alimentario desencadenante, detectado por RAST. Resultados: La mediana de edad de diagnóstico fue de 10 meses, fueron lactantes 52(73%) pacientes, 10(14%) fueron prescolares y el resto escolares y adolescentes; 43(60%) fueron varones. Las lesiones cutáneas estuvieron presentes (aisladas o combinadas con otros síntomas) en 46 casos (64%); los síntomas respiratorios en 38 casos (53%); gastrointestinales en 30 casos (42,2%). La leche fue el alergeno alimentario detectado en 52 (73%) pacientes, el huevo en 33 (46%), el trigo en 7(9,8%), la soja en 6(8,5%), el gluten en 5(7%); las golosinas, el maní, el maíz y los embutidos en 2 (2,8%) niños y finalmente la sandía, el tomate y los condimentos en 1(1,4%) caso. Se registró un único alérgeno en 46 casos (64,7%), dos alérgenos en 16 casos (22,5%), tres alérgenos en 5 casos (7%), y más de tres alérgenos en 4 casos (5,6%). Conclusiones: Los lactantes son los más afectados por las alergias alimentarias siendo más prevalentes los síntomas cutáneos y digestivos. La proteína de leche de vaca es el alergeno más frecuente seguido por el huevo.

ABSTRACT Introduction: Food allergies are an increasingly frequent pathology in childhood. In order to prevent them and to offer a better therapeutic approach, it is important to characterize them. Objective: To determine the frequency, clinical characteristics and types of foods that trigger the most frequent food allergies, in pediatric patients at a referral clinic, between March 2016-March 2019. Materials and Methods: This was a cross-sectional, descriptive, observational study with secondary data from clinical records of patients under 18 years of age. Age, sex, clinical manifestations and type of triggering food allergen, detected by RAST, were studied. Results: The median age of diagnosis was 10 months, 52 (73%) patients were infants, 10 (14%) were preschool and the rest were schoolchildren and adolescents; 43 (60%) were male. Skin lesions were present (isolated or combined with other symptoms) in 46 cases (64%); respiratory symptoms in 38 cases (53%); gastrointestinal in 30 cases (42.2%). Milk was the food allergen detected in 52 (73%) patients, egg in 33 (46%), wheat in 7 (9.8%), soy in 6 (8.5%), gluten in 5 (7%); sweets, peanuts, corn and sausages in 2 (2.8%) children and finally watermelon, tomato and condiments in 1 (1.4%) case. A single allergen was recorded in 46 cases (64.7%), two allergens in 16 cases (22.5%), three allergens in 5 cases (7%), and more than three allergens in 4 cases (5.6%). Conclusions: Infants are the most affected by food allergies, skin and digestive symptoms are more prevalent. Cow's milk protein is the most common allergen followed by eggs.

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Background and objectives: The epidemiology of food allergy (FA) and food-dependent anaphylaxis remains unknown in Colombia. Our aim was to estimate by parent-report the prevalence of FA and food-dependent anaphylaxis in a Colombian population of schoolchildren. Materials and methods: A printed questionnaire was sent to parents of schoolchildren aged 5-12 years old from Medellín, Colombia in order to collect FA-related data. Results: Nine hundred and sixty-nine (969) parents returned the questionnaire with valid responses (response rate, 52.5%). The estimated prevalence rates (95% CI) were: adverse food reactions 12.79% (10.76-15.07), "perceived FA, ever" 10.93% (9.08-13.08), "physician-diagnosed FA, ever" 4.33% (3.14-5.81), "immediate-type FA, ever" 6.81% (5.30-8.58), "immediate-type FA, current" 3.30% (2.26-4.63), and food-dependent anaphylaxis 1.85% (1.10-2.92). The most frequently reported food allergens were milk (1.44%), fruits (0.41%), meat (0.41%), and peanut (0.3%). Sixty-one percent of "food-dependent anaphylaxis" cases sought medical attention, but only eleven percent of the cases reported the prescription of an epinephrine autoinjector. Conclusions: FA and food-dependent anaphylaxis are not uncommon among schoolchildren from Colombia. The prescription of epinephrine autoinjectors should be encouraged among health personnel for the optimal management of suspected cases of food-dependent anaphylaxis.

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Food allergy is adverse reaction to certain foods and it arise from a specific immune response, including reactions mediated by immunoglobulin (Ig) E, by cells, or by both. Although individuals of all ages can develop it, the pediatric population is the most affected by it; with a prevalence of 6 to 8 %. In homeostatic conditions, the organism has tolerance and regulation pathways that hinder food components from causing damage or adverse immune reactions. However, under specific conditions such as genetic predisposition, environmental factors, dietary patterns, or premature exposure to certain foods, tolerance is not developed and aberrant and excessive immune responses to food antigens happen. Understanding the complex physiopathological mechanisms that are present during the establishment and evolution of food allergies allows the identification of potential therapeutic targets and the development of more effective therapies aimed to modify the natural course of the allergy and to improve the patients' quality of life. The objective of this review is to give an updated vision of the existing knowledge about predisposition, sensitization pathways, manifestations, and therapies in IgE-mediated food allergies, delving into the molecular and cellular mechanisms of its physiopathology.

La alergia alimentaria es una reacción adversa hacia determinados alimentos, que surge de una respuesta inmune específica, incluyendo reacciones mediadas por inmunoglobulinas (Ig) E, por células o por ambos. Aunque puede desarrollarse en individuos de todas las edades, la población infantil es la más afectada, con una prevalencia de 6 a 8 %. En condiciones de homeostasis, en el organismo existen vías de regulación y de tolerancia que impiden que los componentes de los alimentos originen daño o despierten reacciones inmunológicas adversas. Sin embargo, en condiciones específicas como carga genética predisponente, factores ambientales, patrones dietarios o exposición prematura a ciertos alimentos, no se desarrolla tolerancia y acontecen respuestas inmunológicas excesivas y aberrantes a antígenos alimentarios. La comprensión de los complejos mecanismos fisiopatológicos presentes durante el establecimiento y evolución de la alergia alimentaria permite identificar blancos terapéuticos potenciales y desarrollar terapias más efectivas dirigidas a modificar el curso natural de la alergia y mejorar la calidad de vida de los pacientes. La presente revisión pretende dar una visión actualizada del conocimiento existente sobre la predisposición, vías de sensibilización, manifestaciones y tratamientos de las alergias alimentarias mediadas por IgE, profundizando en los mecanismos moleculares y celulares de su fisiopatología.

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The presence of milk, egg and soy proteins was evaluated in thirteen commercial products, which were premixes to make cream caramel, cake, soy "milanesas", "tortas fritas", pizza, gnocchi and complementary foods. Samples were analysed using SDS-PAGE, immunoblotting and ELISA methods. The electrophoretic method and immunoblotting were useful to confirm the presence of milk, egg and soy proteins in four samples that declared them as ingredients. In other samples, both methods showed negative results for some of these proteins, although they were also declared as ingredients. This suggests that those proteins were not added as ingredients in these products. The ELISA kits detected very low concentration of the allergenic proteins in four products with precautionary phrases and also in five samples that made no reference to them in their labels. ELISA methods are useful to detect cross contamination due to their high sensitivity. The food industry should be responsible for the declaration of milk, egg and soy proteins in their food labels.

Se evaluó la detección de proteínas de leche, huevo y soja en trece productos comerciales, correspondientes a premezclas para preparar flanes, bizcochuelo, milanesas de soja, tortas fritas, pizza, ñoquis y productos en polvo a base de harinas para niños pequeños. Las muestras fueron analizadas por SDS-PAGE, inmunoblotting y métodos de ELISA. El método electroforético e inmunoblotting resultaron útiles para confirmar la presencia de las proteínas alergénicas en algunas muestras que las declaraban como ingredientes. En cuatro muestras que también declaraban como ingredientes alguna de estas proteínas, tanto con SDS-PAGE como con Inmunoblotting, los resultados fueron negativos, sugiriendo que dichas proteínas no fueron agregadas como ingredientes en dichos alimentos. Los kits de ELISA permitieron la detección de concentraciones muy bajas de estos alérgenos en cuatro productos que presentaban frases de advertencia e incluso en otros cinco que no tenían ninguna declaración de alérgenos. Los métodos de ELISA son útiles para detectar contaminaciones cruzadas, dada su elevada sensibilidad. Se concluye que resulta necesario una declaración responsable de estas proteínas alergénicas, en los rótulos de este tipo de alimentos por parte de los fabricantes.

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Objetivo: Determinar a frequência de anticorpos IgE a alérgenos alimentares em pacientes com doenças alérgicas respiratórias por análise molecular. Método: Este estudo transversal incluiu 101participantes, com idades entre 6-18 anos, com diagnóstico de rinite alérgica (89,1% com asmaassociada), sem história de alergia alimentar. Foi realizada análise de IgE sérica específica por ImmunoCAP ISAC, método que emprega biologia molecular para detecção de IgE a componentes alergênicos, sendo 42 alimentares e provenientes das seguintes fontes: abacaxi, aipo, amendoim,avelã, bacalhau, camarão, carpa, castanha de caju, castanha do Pará, cenoura, gergelim, kiwi, leite de vaca, maçã, ovo, pêssego, soja e trigo. Valores ≥ 0,3 ISU (unidades padronizadas do ISAC) foram considerados positivos. Utilizou-se análise estatística descritiva. Resultados: Vinte e sete (26,7%)pacientes apresentaram IgE específica a pelo menos um dos alérgenos alimentares analisados.Entre os 42 componentes alergênicos testados, 20 (47,6%) foram associados a resposta IgE em pelo menos um dos pacientes. Alérgenos com maior frequência de reatividade IgE foram: camarão(Pen a 1 15,8%, Pen i 1 16,8%, Pen m 1 16,8%) e pêssego (Pru p 3 5,9%). Conclusões: Este estudo demonstrou que a avaliação de alergia alimentar baseada em análise molecular deve considerar vários elementos, particularmente a correlação com os sintomas clínicos, e o conhecimento sobre reatividade cruzada IgE entre alérgenos das mais variadas fontes. Presença de IgE específica a determinado componente alergênico significa sensibilização, e não necessariamente alergia.Diagnóstico incorreto de alergia alimentar pode levar a tratamento inadequado, com dietas restritivas desnecessárias e prejuízo nutricional para os pacientes.

Objective: To determine the frequency of IgE antibodies to food allergens in patients with respiratory allergic diseases using molecular analysis. Method: This cross-sectional study included101 participants aged 6-18 years, diagnosed with allergic rhinitis (89.1% with associated asthma),and with no history of food allergy. Analysis of serum specific IgE was carried out using the ImmunoCAP ISAC method, which applies molecular biology tools to the detection of different allergens, including 42 derived from foods (pineapple, celery, peanut, hazelnut, codfish, shrimp,carp, cashew nut, Brazil nut, carrot, sesame, kiwi, cow’s milk, apple, egg, peach, soy, and wheat).Values ≥ 0.3 ISAC standardized units (ISU) were considered to be positive. Descriptive statistical analysis was used. Results: Twenty seven (26.7%) patients presented specific IgE to at leastone of the food allergens analyzed. Among the 42 allergic components tested, 20 (47.6%) were associated with IgE responses in at least one patient. The allergens with the highest frequencies of IgE reactivity were shrimp (Pen a 1 15.8%, Pen i 1 16.8%, Pen m 1 16.8%) and peach (Pru p 3 5.9%).Conclusions: The present study showed that molecular-based evaluation of food allergies should take several elements into consideration, particularly the correlation with clinical symptoms andthe knowledge available on IgE cross-reactivity among allergens from different sources. Presence of specific IgE to one allergen means sensitization, but not necessarily allergy. Misdiagnosis of food allergies may lead to inappropriate treatment, with unnecessarily restrictive diets which could affect the nutritional status of patients.

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