Contributo originale
Anafilassi da allergia alle proteine del latte vaccino: clinica, storia naturale, challenge e desensibilizzazione orale
FOOD ALLERGY, FROM CHALLENGE TO ORAL DESENSITIZATION
G. LONGO, E. BARBI, R. MENEGHETTI, G. BOROTTO, M. ZERIAL, A. TOMMASINI, A. VENTURA
Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
Gennaio 2004 - pagg. 20 -29
Abstract
Food allergy represents a major problem for children and the first cause of anaphylaxis in
pediatric age. Cow milk and egg are the main offending in Europe both for allergy and
anaphylaxis. Limited evidence from the literature suggests that protracted antigen avoiding
may delay the acquisition of tolerance and that oral desensitization may be effective in children
with food allergy. We describe our experience with oral desensitization in two groups
of children. A group of 30 children with recent very severe episodes underwent to an original
oral desensitization protocol during a 10 days permanence in the ward. Of these, 22 children
reached a normal diet, 5 reached a limited amount of milk (3.5-45 ml), and 3 children
could not proceed with the protocol because of persistent respiratory symptoms. No child experienced
a very severe or life threatening reaction. A second group of 20 children with less
severe allergy underwent to a standardized oral desensitization protocol at home after an
open challenge. In group two, 10 of children reached a normal diet, 7 could tolerate reasonable
amounts of milk, one developed a specific food aversion and 2 failed to proceed with
the protocol. In conclusion, oral desensitization to milk was achieved in a significant percentage
of children with a history of severe reactions or with moderate allergy. Symptomatic
episodes during desensitization were almost the rule but were all easily managed both in
hospital and at home. The cost benefit ratio of this approach in comparison to the actual standard
recommendations is still to be determined.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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2. Eggesbo M, Botten G, Halvorsen R, Magnus P. The prevalence of CMA/CMPI in young children: the validity of parenterally perceived reactions in a population-based study. Allergy 2001; 56: 93-402.
3. Burks AW, Mallory SB, Williams LW, Shirrell MA. Atopic dermatitis: clinical relevance of food hypersensitivity reactions. Pediatrics1988; 113:447-51.
4. Kanny G, Monert-Vautrin DA, Flabbee J, Beaudouin E, Morisset M, Thevenin F. Population study of food allergy in France. J Allergy Clin Immunol 2001;108:133-40.
5. Moneret-Vautrin DA. Cow’s milk allergy. Allerg Immunol 1999;31(6):201-10.
6. Norgaard A, Bindslev-Jensen C. Egg and milk allergy in adults. Allergy 1992;47:503-9.
7. Eigenmann P.A. Future therapeutic options in food allergy. Allergy 2003;58:1217-23.
8. Kemp SF, Lockey RF. Anaphilaxis: A review of causes and mechanisms. J Allergy Clin Immunl 2002;110(3):341-8.
9. Calvani MJr, Miceli Sopo S. Gli alimenti tra allergia e tolleranza. Food allergy and tollerance. RIAIP 2003;17:40-51.
10. Johansson SGO, O’B Hourihane J, Buosquet J, Bruijnzeel-Koomen C, Dreborg S, Haatela T, Kowalski ML, Mygind N, Ring J, Van Cauwenberge P, Van Hage-Hamsten M, Wuthrich B. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001;56:813-24.
11. Sampson HA. Anaphylaxis and emergency treatment. Pediatrics 2003;111 suppl 6:1601-8.
12. Tan BM, Sher MR, Good RA and Bahna SL. Severe food allergies by skin contact. Ann Allergy Asthma Immunology 2001(supple6); 86:583-6.
13. Bahna SL. Exquisite food allergy without eating. Allergy1994;49:129-30.
14. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reaction to food in children and adolescents. N Engl J Med 1992;327:380-4.
15. Gern JE, Yang E, Evrard HM, Sampson HA. Allergic reaction to milk-contaminated ‘non-dairy’ products. N Engl J Med 1991;324: 976-9.
16. Bock SA. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics, 1987;79:683-8.
17. Clark AT, Ewan PW. Food allergy in childhood. Arch Dis Child 2003;88:79-81.
18. Host A. Frequency of cow’s milk allergy in childhood. Ann Allergy Asthma Immunol 2002;89 (suppl 6):33-7.
19. Hill DJ, Hosking CS, Reyes-Benito. Reducing the need for food allergen challenges in young children: a comparison of in vitro with in vivo tests. Clin Exp Allergy 2001;31:1031-5.
20. Hill DJ, Firer MA, Ball G, Hosking CS. Natural history of cow’s milk allergy in children: immunological outcome over 2 years. Clin Exp Allergy 1993;23:124-31.
21. Bindslev-Jensen C. Standardization of double- blind, placebo-controlled food challenges. Allergy 2001;56 suppl 67:75-7.
22. Brujnzeel-Koomen C, Ortolani C, Aas K, Bindslev-Jensen C, Bjorkstén B, Moneret- Vautrin D, Wuthrich B. Adverse reactions to food. Allergy 1995;50:623-35.
23. Niggemann B, Wahn U, Sampson HA. Proposal for standardization of oral food challenge test in infants and children. Pediatr Allergy Immunol 1994:5:11-13.
24. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107(5):891-6.
25. Sporik R, Hill DJ, Hosking CS. Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin Exp Allergy 2000;30:1540-6.
26. Longo G, Poli F, Saletta S. Anafilassi per alimenti. Epidemiologia, storia naturale, challenge. Risultati preliminari. Medico e Bambino 1998;9:21.
27. Hill DJ, Hosking CS, Reyes-Benito LV. Reducing the need for food allergen challenges in young children: a comparison of in vitro with in vivo tests. Clin Exp Allergy 2001; 31:1031-5.
28. Eigenmann PA, Sampson HA. Interpreting skin prick tests in the evaluation of food allergy in children. Pediatr Allergy Immunol 1998;9(4):186-91.
29. Sisherer SH, Morrow EH, Sampson HA. Dose-response in double-blind, placebo-controlled oral food challenges in food challenges in children with atopic dermatitis. J Allergy Clin Immunol 2000;105(3):582-6.
30. Sampson HA. Utility of food specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107:891-6.
31. Garcia-Ara C, Boxano-Martinez T, Diaz-Pena JM, Martin-Munoz F, Reche-Frutos M, Martin-Esteban M. Specific IgE levels in the diagnosis of immediate hypersensitivity to cows’ milk protein in the infant. J Allergy Clin Immunol 2001;107(1):185-90.
32. Sampson HA, Ho DG. Clinical aspects of allergic disease. Relationship between foodspecific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997; 100(4):444-51.
33. Reibel S, Rohn C, Ziegert M, Sommerfeld C, Wahn U, Niggemann B. What safety measures need to be taken in oral food challenges in children? Allergy 2000;55:940-4.
34. Wood RA. The natural history of food allergy. Pediatrics 2003;111(6):1631-8.
35. Sampson HA. Food allergy. J Allergy Clin Immunol 2003;111:s540-7.
36. Numera E, Schiavin D, Roncallo C, Pollastrini E, De Pasquale T, Lombardo C, Bartolozzi F, Buonomo A, Patriarca G. La terapia desensibilizzante specifica per via orale nei pazienti pediatrici con allergia alimentare. RIAIP 2003;17:52-61.
37. Patriarca G, Schiavino D, Nucera E, Schinco G, Milani A, Gasbarrini GB. Food allergy in children: results of a standardized protocol for oral desensitization. Hepato-Gastroenterology 1998;45:52-8.
38. Cantani A. Allergia alimentare. Test di provocazione alimentare. In: Cantarini A. Allergologia ed Immunologia Pediatrica dall’infanzia all’adolescenza. Roma: Verducci Publishers 2000;573-80.
39. Vander Leek TK, Liu AH, Stefansky K, Blacker B, Bock SA. The natural history of peanut allergy in young children and its association with peanut specific-IgE. J Pediatr 2000;137(6):749-54.
40. Arshad SH. Food allergen avoidance in primary prevention of food allergy. Allergy 2001; 56(suppl 67):113-6.
41. Ring J, Behrendt H. Anaphylaxis and anaphylactoid reactions. Classification and pathophysiology. Clin Rev Allergy Immunol 1999;17:387-99.
2. Eggesbo M, Botten G, Halvorsen R, Magnus P. The prevalence of CMA/CMPI in young children: the validity of parenterally perceived reactions in a population-based study. Allergy 2001; 56: 93-402.
3. Burks AW, Mallory SB, Williams LW, Shirrell MA. Atopic dermatitis: clinical relevance of food hypersensitivity reactions. Pediatrics1988; 113:447-51.
4. Kanny G, Monert-Vautrin DA, Flabbee J, Beaudouin E, Morisset M, Thevenin F. Population study of food allergy in France. J Allergy Clin Immunol 2001;108:133-40.
5. Moneret-Vautrin DA. Cow’s milk allergy. Allerg Immunol 1999;31(6):201-10.
6. Norgaard A, Bindslev-Jensen C. Egg and milk allergy in adults. Allergy 1992;47:503-9.
7. Eigenmann P.A. Future therapeutic options in food allergy. Allergy 2003;58:1217-23.
8. Kemp SF, Lockey RF. Anaphilaxis: A review of causes and mechanisms. J Allergy Clin Immunl 2002;110(3):341-8.
9. Calvani MJr, Miceli Sopo S. Gli alimenti tra allergia e tolleranza. Food allergy and tollerance. RIAIP 2003;17:40-51.
10. Johansson SGO, O’B Hourihane J, Buosquet J, Bruijnzeel-Koomen C, Dreborg S, Haatela T, Kowalski ML, Mygind N, Ring J, Van Cauwenberge P, Van Hage-Hamsten M, Wuthrich B. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy 2001;56:813-24.
11. Sampson HA. Anaphylaxis and emergency treatment. Pediatrics 2003;111 suppl 6:1601-8.
12. Tan BM, Sher MR, Good RA and Bahna SL. Severe food allergies by skin contact. Ann Allergy Asthma Immunology 2001(supple6); 86:583-6.
13. Bahna SL. Exquisite food allergy without eating. Allergy1994;49:129-30.
14. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reaction to food in children and adolescents. N Engl J Med 1992;327:380-4.
15. Gern JE, Yang E, Evrard HM, Sampson HA. Allergic reaction to milk-contaminated ‘non-dairy’ products. N Engl J Med 1991;324: 976-9.
16. Bock SA. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics, 1987;79:683-8.
17. Clark AT, Ewan PW. Food allergy in childhood. Arch Dis Child 2003;88:79-81.
18. Host A. Frequency of cow’s milk allergy in childhood. Ann Allergy Asthma Immunol 2002;89 (suppl 6):33-7.
19. Hill DJ, Hosking CS, Reyes-Benito. Reducing the need for food allergen challenges in young children: a comparison of in vitro with in vivo tests. Clin Exp Allergy 2001;31:1031-5.
20. Hill DJ, Firer MA, Ball G, Hosking CS. Natural history of cow’s milk allergy in children: immunological outcome over 2 years. Clin Exp Allergy 1993;23:124-31.
21. Bindslev-Jensen C. Standardization of double- blind, placebo-controlled food challenges. Allergy 2001;56 suppl 67:75-7.
22. Brujnzeel-Koomen C, Ortolani C, Aas K, Bindslev-Jensen C, Bjorkstén B, Moneret- Vautrin D, Wuthrich B. Adverse reactions to food. Allergy 1995;50:623-35.
23. Niggemann B, Wahn U, Sampson HA. Proposal for standardization of oral food challenge test in infants and children. Pediatr Allergy Immunol 1994:5:11-13.
24. Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107(5):891-6.
25. Sporik R, Hill DJ, Hosking CS. Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin Exp Allergy 2000;30:1540-6.
26. Longo G, Poli F, Saletta S. Anafilassi per alimenti. Epidemiologia, storia naturale, challenge. Risultati preliminari. Medico e Bambino 1998;9:21.
27. Hill DJ, Hosking CS, Reyes-Benito LV. Reducing the need for food allergen challenges in young children: a comparison of in vitro with in vivo tests. Clin Exp Allergy 2001; 31:1031-5.
28. Eigenmann PA, Sampson HA. Interpreting skin prick tests in the evaluation of food allergy in children. Pediatr Allergy Immunol 1998;9(4):186-91.
29. Sisherer SH, Morrow EH, Sampson HA. Dose-response in double-blind, placebo-controlled oral food challenges in food challenges in children with atopic dermatitis. J Allergy Clin Immunol 2000;105(3):582-6.
30. Sampson HA. Utility of food specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107:891-6.
31. Garcia-Ara C, Boxano-Martinez T, Diaz-Pena JM, Martin-Munoz F, Reche-Frutos M, Martin-Esteban M. Specific IgE levels in the diagnosis of immediate hypersensitivity to cows’ milk protein in the infant. J Allergy Clin Immunol 2001;107(1):185-90.
32. Sampson HA, Ho DG. Clinical aspects of allergic disease. Relationship between foodspecific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997; 100(4):444-51.
33. Reibel S, Rohn C, Ziegert M, Sommerfeld C, Wahn U, Niggemann B. What safety measures need to be taken in oral food challenges in children? Allergy 2000;55:940-4.
34. Wood RA. The natural history of food allergy. Pediatrics 2003;111(6):1631-8.
35. Sampson HA. Food allergy. J Allergy Clin Immunol 2003;111:s540-7.
36. Numera E, Schiavin D, Roncallo C, Pollastrini E, De Pasquale T, Lombardo C, Bartolozzi F, Buonomo A, Patriarca G. La terapia desensibilizzante specifica per via orale nei pazienti pediatrici con allergia alimentare. RIAIP 2003;17:52-61.
37. Patriarca G, Schiavino D, Nucera E, Schinco G, Milani A, Gasbarrini GB. Food allergy in children: results of a standardized protocol for oral desensitization. Hepato-Gastroenterology 1998;45:52-8.
38. Cantani A. Allergia alimentare. Test di provocazione alimentare. In: Cantarini A. Allergologia ed Immunologia Pediatrica dall’infanzia all’adolescenza. Roma: Verducci Publishers 2000;573-80.
39. Vander Leek TK, Liu AH, Stefansky K, Blacker B, Bock SA. The natural history of peanut allergy in young children and its association with peanut specific-IgE. J Pediatr 2000;137(6):749-54.
40. Arshad SH. Food allergen avoidance in primary prevention of food allergy. Allergy 2001; 56(suppl 67):113-6.
41. Ring J, Behrendt H. Anaphylaxis and anaphylactoid reactions. Classification and pathophysiology. Clin Rev Allergy Immunol 1999;17:387-99.