Apple-dependent exercise-induced anaphylaxis.
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Biomedical subjects
Publications and source records attributed to M T Boyano.
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Two hundred and thirty children with suspected food allergy have been reviewed retrospectively. One hundred and nine fulfilled the following three selection criteria: suggestive anamnesis, presence of specific IgE antibodies (in serum or by skin prick test), and having been reassessed at least once. The major clinical data analyzed were: age of onset, sensitising foods, symptomatology and diagnostic procedures. The results show a mean age of onset for food allergy of 11.5 months, with variations related to the sensitizing food, cow's milk allergy being the earliest in onset time. The most frequent sensitizing foods in this group of patients were eggs, fish and cow's milk. The skin and the gastrointestinal tract have been the most affected shock organs, both together or isolated; respiratory symptoms were an uncommon finding and their isolated presentation as the sole manifestation of food allergy exceptional. The skin prick tests were positive in 99.2 percent of the sensitizations and in 84 percent high levels of specific IgE antibodies were found. Food allergy seems to be a common situation in children, clinical symptomatology is similar to that of the other atopic diseases and the diagnosis is based on the demonstration of specific IgE antibodies against the sensitizing foods.
The evolution of 109 allergic children with 129 IgE-mediated food sensitizations has been evaluated. The follow-up period was from nine months to 14 years. The period up to clinical tolerance was analyzed, together with the influence of two possible prognostic factors: specific IgE antibody levels at the beginning of symptomatology and the sensitizing food. Moreover, when clinical tolerance was achieved, the presence of specific IgE antibodies was again assessed. Probability estimations indicated that 30% of food-allergic children become clinically tolerant before 3 years of evolution, 40% before 6 years, 50% before 9 years and 53% before 12 years. Onset of clinical tolerance varies in dependence with the offending food: clinical tolerance to cow's milk seems to be far earlier and easier to reach than those to egg and fish (p less than 0.001, at 9 years' evolution); allergy to egg disappears also earlier and easier than fish allergy (p less than 0.01). Levels of specific IgE antibodies at the onset of the disease show significant difference (p less than 0.01) between the patients which will become tolerant and those with persistence of clinical sensitivity, being higher in the last group. However, a high number of patients who become clinically tolerant (67.5%) remained positive at skin prick testing or had elevated specific IgE serum antibodies against the offending food.