Gabriel R Bouygue - Academia.edu (original) (raw)

Papers by Gabriel R Bouygue

Annals of Allergy Asthma & Immunology, 2002

bjective: Our goals were to analyze some of the similarities and differences in the increase in a... more bjective: Our goals were to analyze some of the similarities and differences in the increase in asthma, hay fever, and atopic sensitization between Europe and the United States and attempt to explain "inner-city asthma" within the framework of the hygiene hypothesis.

Current Opinion in Allergy and Clinical Immunology, 2010

Fatal allergy as a possible consequence of long-term elimination diet. Allergy 2004; 59:668-669. ... more Fatal allergy as a possible consequence of long-term elimination diet. Allergy 2004; 59:668-669. 33 Flinterman AE, Knulst AC, Meijer Y, et al. Acute allergic reactions in children with AEDS after prolonged cow's milk elimination diets. Allergy 2006; 6:370-374.

Allergy and Asthma Proceedings, 2006

When a child presents with an allergic symptom, the general pediatrician needs to discriminate wh... more When a child presents with an allergic symptom, the general pediatrician needs to discriminate which patient has to be sent to the specialist for an allergologic evaluation. If referred, the child will undergo not only skin-prick test, but also more complex specialistic evaluations that we define here as "the march of allergic children." The objective of this article is to overview the clinical evidence about possible diagnostic interventions to avoid unuseful referrals of children reported with allergy from the general to the specialist level. Data sources include PubMed, using a search algorithm selecting for diagnostic studies of respiratory and food allergy in all children to August 2005. Also included are commentaries based on the authors' clinical experience in the allergy unit of a University Hospital in Italy. No study prospectively assessed the rule-out efficacy of clinical history, physical evaluation, and skin-prick test panels on the allergic disease. Three prospective studies on in vitro panels of specific IgE sensitization matched entry criteria. Diverse trial designs and diagnostic criteria precluded meta-analytic methods. The use of in vitro panels proved effective in ruling out the allergic condition in children. The screening efficacy of panels of food and respiratory skin-prick tests remains to be evaluated. With sensitivities and negative predictive values exceeding 90%, in vitro panels can inform the decisions of pediatricians in their capacity as gateway to specialist care. Avoiding the march of allergic children from the GPs to the secondary level is a more realistic goal than preventing the allergic march.

Pediatrics, 2003

Adverse reactions following the ingestion of lactose have been reported in children with cow&... more Adverse reactions following the ingestion of lactose have been reported in children with cow's milk (CM) allergy. Whether this is attributable to the contamination of lactose with CM proteins is unknown. In this paper, we assessed clinical tolerance of lactose derived from CM whey in children hypersensitive to CM from 2 university hospital pediatric departments. Twenty-four children (5 girls and 19 boys, median 25 months old; range: 2-107 months) with immediate CM allergy confirmed at history or during double-blind, placebo-controlled food challenge (DBPCFC) were enrolled. DBPCFC with CM could be conducted in 11 of 24 patients. Children with a history of immediate/delayed reactions to soy formula (SF) were excluded. Clinical tolerance to CM, SF, and SF + lactose was assessed by: 1) skin prick test with casein, lactalbumin, soy commercial allergen preparations, fresh CM, SF, SF and lactose, lactose (Official Pharmacopoeia) in 4 concentrations (0.01%, 0.1%, 1%, 10%); 2) specific serum immunoglobulin E determination by CAP system technology; 3) DBPCFC in 8 incremental doses of SF + lactose and using SF as a placebo to make up a total of 240 mL of reconstituted formula. With a positive cutoff point of > or = 3 mm wheal diameter at SPT, all patients were sensitized to fresh CM, lactalbumin, and/or casein. Twenty-three of 24 patients (95.8%) were SPT-positive to CM formula, 16 of 24 to lactalbumin (66.6%), 14 of 24 to casein (58.3%), and none to SF, SF + lactose, or lactose alone at all dilutions. Complexed immunoglobulin E determinations were positive for CM in 23 of 24 cases and negative in all cases for soy. Challenge with SF + lactose was negative in all cases. Even children hypersensitive to CM are clinically tolerant to lactose and can safely consume foods and drugs with lactose from bovine sources as an ingredient. Lactose exclusion is unwarranted from soy preparations on grounds of potential allergic reactions to CM protein residue.

Pediatric Allergy and Immunology, 2007

We reviewed current clinical evidence for the use of topical treatments in pediatric rhinosinusit... more We reviewed current clinical evidence for the use of topical treatments in pediatric rhinosinusitis. Repeated Entrez PubMed searches were done using the template algorithm [rhinosinusitis AND (…)] with the settings: [Humans; English; All Child 0–18; Clinical trial; Last 10 yr] for the following comparators: steroid, irrigation, saline, antihistamine, decongestant, antibiotic, antimycotic, fungicide. The authors’ clinical experience in the pediatric allergy unit of a university hospital was also drawn upon. Pediatric studies were retrieved but only one satisfied current evidence-based medicine standards for reporting clinical trials. Studies could not be systematized because of methodological, analytical, and interpretation biases. While saline irrigation, nasal decongestants, steroids, antibiotics, antihistamines and fungicides are all in widespread pediatric use, comparing studies from the literature for evidence of efficacy implied subjective appraisal, except in the case of topical steroids. Evidence for the efficacy of topical treatment for pediatric rhinosinusitis is narrative albeit this modality cannot be excluded from individualized patient protocols on the basis of the clinical literature alone. With the exception of topical steroids, no weighable evidence of effectiveness supports the premise that topical treatments actually serve the purpose for which they are widely prescribed in pediatrics.

Allergy, 2005

Background: Epidemiological surveys identify a 900 000-strong potential paediatric population wh... more Background: Epidemiological surveys identify a 900 000-strong potential paediatric population who may self-report with food allergy in Italy. As the reference test is the double-blind, placebo-controlled food challenge for diagnosis, we carried out a nation-wide questionnaire survey of hospital-based paediatric allergy centres between 1 January and 30 June 2003.Methods: All registered centres received a 27-point questionnaire polling logistics and protocols of oral food challenge. Items polled included medical facilities and personnel, selection of patients, foods tested, blinding, placebo use, evaluation criteria, number of tests and positive outcome rates in 2002.Results: Two hundred and two of 456 responders (44.3%) carried out food challenges (a ratio of one centre to 37 400 children in the general population). 11 728 challenges were performed in 2002 (an average of 58 procedures per centre; range: 1–500) and 3350 procedures were claimed positive (28.6%). Cow's milk was tested by all centres, egg by 77.2%, beef by 19.8% and cereals, peanuts, fish or fruit collectively by 37.6%. Twenty-nine of 202 centres performed blinded tests, 18 of which under double-blinded conditions. In cow's milk challenges, placebos included lyophilized cow's milk capsules, soy formula, extensive whey hydrolysate or extensive casein hydrolysate.Conclusion: Our survey reveals great differences in challenge test criteria, facilities and procedures and that many centres perform relatively few procedures. This argues in favour of greater rationalization in the allocation of tertiary-level resources before procedure standardization can be contemplated in the diagnostic workup of food allergy.

Journal of Allergy and Clinical Immunology, 2003

Asthma is an inflammatory disease characterized by inflammatory cells and their cytokines in airw... more Asthma is an inflammatory disease characterized by inflammatory cells and their cytokines in airway mucosa. The concentration of nitric oxide in exhaled air (eNO) is a reliable marker of airway inflammation and is thus a tool in the assessment of asthma control. 2 Exhaled nitric oxide concentrations are increased in asthmatics, 3,4 but it is not known whether atopy influences bronchial inflammation or the level of eNO.

Clinical and Experimental Allergy, 2010

Background The impact of diet on cow's milk allergy (CMA) duration and whether exposure to residu... more Background The impact of diet on cow's milk allergy (CMA) duration and whether exposure to residual amounts of cow's milk protein influences the onset of tolerance are unknown.Objective To prospectively assess the dietary factors influencing disease duration in a randomized cohort.Methods We randomly switched the formula of symptomatic patients from the Milan Cow's Milk Allergy Cohort to one of three treatment groups according to the quarterly rotation of rice hydrolysate formula, extensively hydrolysed cow's milk formula and soy-based formula. In this intention-to-treat, randomized analysis, a hazard ratio (HR) estimation model was used to analyse dietary impact on disease duration.Results Seventy-two children aged a mean of 14.1±8.6 months at diagnosis were followed up for a median of 26 months. Fifty-one reached tolerance at a mean of 34.1±15.2 months. The mean duration of disease was 40.2±4.8 months with milk hydrolysate, 24.3±3.6 months with rice and 24.3±2.6 months with soy. Dietary choice independently predicted shorter duration of disease [adjusted HRs 3.09 (P=0.007) for rice, 2.54 (P=0.02) for soy, both against milk hydrolysate]. In 50 children not co-sensitized to soy, diet choice impacted the duration of disease more strongly [adjusted HRs 8.02 (P=0.006) for rice, 6.53 (P=0.015) for soy, both against milk hydrolysate].Discussion Patients not exposed to cow's milk protein residue achieve cow's milk tolerance earlier than patients who follow an extensively hydrolysed cow's milk diet. This may be due to residual antigenicity in hydrolysed milks. As the effect of dietary intervention is stronger in patients not sensitized to soy, we infer that when atopic disease has progressed to multiple sensitizations, the elimination of allergenic exposure may not be sufficient to reduce the duration of CMA.Cite this as: L. Terracciano, G. R. Bouygue, T. Sarratud, F. Veglia, A. Martelli and A. Fiocchi, Clinical & Experimental Allergy, 2010 (40) 637–642.

Annals of Allergy Asthma & Immunology, 2002

Objectives: To review the recent literature on the diagnostic accuracy of skin prick tests (SPTs)... more Objectives: To review the recent literature on the diagnostic accuracy of skin prick tests (SPTs) in pediatric food allergy, focusing on adverse reactions to milk and beef. To present data about the test performance characteristics of beef extracts used in SPTs among children with atopic dermatitis (AD) reporting immediate hypersensitivity to beef.

Journal of Allergy and Clinical Immunology, 2001

Background: Latex causes anaphylaxis in specific contexts among children. We present 2 cases that... more Background: Latex causes anaphylaxis in specific contexts among children. We present 2 cases that show that severe reactions may occur in everyday circumstances with latex as a contaminant. Objective: Because 2 cases of severe reactions to latex suggested similar circumstances of exposure, we investigated the immediate environment in which episodes occurred. Methods: A 5-year-old girl presented to our casualty department with anaphylaxis after playing in a ball pit filled with approximately 10-cm diameter plastic balls in an Americanstyle fast-food outlet. Two months later, a 9-year-old boy had severe anaphylaxis followed by an asthma attack with loss of consciousness while playing in the playpen of a different outlet belonging to the same company. Latex sensitization was confirmed in both cases by means of skin prick testing, latex glove skin prick testing, and 1-glove finger testing. Immunoblotting of elutions from a ball, the natural rubber latex foam pit lining, and its polyvinyl chloride sheet were performed. Results: In the girl's immunoblot high levels of IgE specific to Hev b 4, Hev b 7, and Hev b 2 were found. The boy's immunoblot showed positivity to Hev b 7. The polyvinyl chloride ball sample showed a high concentration of specific Hevea species allergen similar to that of the foam layer sample. Conclusion: Severe anaphylaxis can result from contact with latex proteins as a contaminant, rather than as a component, of play area ball pits and therefore outside the reported settings. Emergency health care workers should be aware of this kind of risk. A latex-reduced environment might prevent potentially severe reactions in young customers of fast-food outlets. (J Allergy Clin Immunol 2001;108:298-300.)

Journal of Allergy and Clinical Immunology, 2010

The 2nd Milan Meeting on Adverse Reactions to Bovine Proteins was the venue for the presentation ... more The 2nd Milan Meeting on Adverse Reactions to Bovine Proteins was the venue for the presentation of the first consensus-based approach to the management of cow's milk allergy. It was also the first time that the Grading of Recommendations, Assessments, Development, and Evaluation approach for formulating guidelines and recommendations was applied to the field of food allergy. In this report we present the contributions in allergen science, epidemiology, natural history, evidence-based diagnosis, and therapy synthesized in the World Allergy Organization Diagnosis and Rationale for Action against Cow's Milk Allergy guidelines and presented during the meeting. A consensus emerged between discussants that cow's milk allergy management should reflect not only basic research but also a newer and better appraisal of the literature in the light of the values and preferences shared by patients and their caregivers in partnership. In the field of diagnosis, atopy patch testing and microarray technology have not yet evolved for use outside the research setting. With foreseeable breakthroughs (eg, immunotherapy and molecular diagnosis) in the offing, the step ahead in leadership can only stem from a worldwide organization implementing consensus-based clinical practice guidelines to diffuse and share clinical knowledge. (J Allergy Clin Immunol

Annals of Allergy Asthma & Immunology, 2008

The prognosis for many children with cow's milk allergy (CMA) is remission within 3 years, and th... more The prognosis for many children with cow's milk allergy (CMA) is remission within 3 years, and the clinical parameters that predict duration of disease have not been measured incrementally.

Allergy, 2004

Abbreviations: AD, atopic dermatitis; AEDS, atopic eczema/dermatitis syndrome; CMA, cow's milk al... more Abbreviations: AD, atopic dermatitis; AEDS, atopic eczema/dermatitis syndrome; CMA, cow's milk allergy; DBPCFC, doubleblind placebo-controlled food challenge; eHF, extensively hydrolysed formula; SPT, skin prick test.

Annals of Allergy Asthma & Immunology, 2004

To review the effects of technological processing on selected foods of relevance to childhood all... more To review the effects of technological processing on selected foods of relevance to childhood allergy from the viewpoints of reduced allergenicity, contamination of processed foods by allergens introduced during processing, and ad hoc technologies to produce reduced hypoallergenic products. We searched the literature (PubMed/MEDLINE) for articles published between January 1994 and April 2004 using the following keywords: food allergy AND process* OR heat* OR cooking OR toleran*. We drew on our collective clinical and biological experience to restrict retrieved studies to those of more frequent relevance to a hospital allergy practice. Comparatively few clinical studies address the modification of allergenicity of food through cooking or processing. Dairy foods are largely unaffected by processing and may be contaminated by, or themselves become, hidden allergens. Hypoallergenic formulas based on milk, soy, or rice and homogenized beef are successful applications of allergenicity reduction via technological processing. Egg, fish, condiments, and vegetables all carry heat-resistant allergens and should also be considered contaminants. Cereals and bakery products are generally well tolerated, but their allergenicity may be enhanced by processing; the case of rice is still open. Peanut allergens are stable, and the evidence is scant that thermal processing affects the allergenicity of soybean and soy hydrolysates. The debate is ongoing about the tolerance of vegetable oils. It is too early to systematize clinical studies based on single procedures. Processing affects antigenicity, but this does not always translate into safety recommendations. Industrial processing is liable to contamination, and monitoring and labeling are industry priorities. Clinicians should evaluate foods by as complete a workup as possible before recommending processed foods.

[

New England Journal of Medicine, 2007

Pathology & Oncology Research, 2005

We refer to the case presented by Yoram Dekel and colleagues in the Vol. 10, No. 4 issue of the J... more We refer to the case presented by Yoram Dekel and colleagues in the Vol. 10, No. 4 issue of the Journal, 1 which sets out prima facie evidence of talc inhalation from "excessive cosmetic use of talc" as prime suspect in a 42year old woman's demise. We would plead that the proximal cause of death is far from established.

Annals of Allergy Asthma & Immunology, 2002

bjective: Our goals were to analyze some of the similarities and differences in the increase in a... more bjective: Our goals were to analyze some of the similarities and differences in the increase in asthma, hay fever, and atopic sensitization between Europe and the United States and attempt to explain "inner-city asthma" within the framework of the hygiene hypothesis.

Current Opinion in Allergy and Clinical Immunology, 2010

Fatal allergy as a possible consequence of long-term elimination diet. Allergy 2004; 59:668-669. ... more Fatal allergy as a possible consequence of long-term elimination diet. Allergy 2004; 59:668-669. 33 Flinterman AE, Knulst AC, Meijer Y, et al. Acute allergic reactions in children with AEDS after prolonged cow's milk elimination diets. Allergy 2006; 6:370-374.

Allergy and Asthma Proceedings, 2006

When a child presents with an allergic symptom, the general pediatrician needs to discriminate wh... more When a child presents with an allergic symptom, the general pediatrician needs to discriminate which patient has to be sent to the specialist for an allergologic evaluation. If referred, the child will undergo not only skin-prick test, but also more complex specialistic evaluations that we define here as "the march of allergic children." The objective of this article is to overview the clinical evidence about possible diagnostic interventions to avoid unuseful referrals of children reported with allergy from the general to the specialist level. Data sources include PubMed, using a search algorithm selecting for diagnostic studies of respiratory and food allergy in all children to August 2005. Also included are commentaries based on the authors' clinical experience in the allergy unit of a University Hospital in Italy. No study prospectively assessed the rule-out efficacy of clinical history, physical evaluation, and skin-prick test panels on the allergic disease. Three prospective studies on in vitro panels of specific IgE sensitization matched entry criteria. Diverse trial designs and diagnostic criteria precluded meta-analytic methods. The use of in vitro panels proved effective in ruling out the allergic condition in children. The screening efficacy of panels of food and respiratory skin-prick tests remains to be evaluated. With sensitivities and negative predictive values exceeding 90%, in vitro panels can inform the decisions of pediatricians in their capacity as gateway to specialist care. Avoiding the march of allergic children from the GPs to the secondary level is a more realistic goal than preventing the allergic march.

Pediatrics, 2003

Adverse reactions following the ingestion of lactose have been reported in children with cow&... more Adverse reactions following the ingestion of lactose have been reported in children with cow's milk (CM) allergy. Whether this is attributable to the contamination of lactose with CM proteins is unknown. In this paper, we assessed clinical tolerance of lactose derived from CM whey in children hypersensitive to CM from 2 university hospital pediatric departments. Twenty-four children (5 girls and 19 boys, median 25 months old; range: 2-107 months) with immediate CM allergy confirmed at history or during double-blind, placebo-controlled food challenge (DBPCFC) were enrolled. DBPCFC with CM could be conducted in 11 of 24 patients. Children with a history of immediate/delayed reactions to soy formula (SF) were excluded. Clinical tolerance to CM, SF, and SF + lactose was assessed by: 1) skin prick test with casein, lactalbumin, soy commercial allergen preparations, fresh CM, SF, SF and lactose, lactose (Official Pharmacopoeia) in 4 concentrations (0.01%, 0.1%, 1%, 10%); 2) specific serum immunoglobulin E determination by CAP system technology; 3) DBPCFC in 8 incremental doses of SF + lactose and using SF as a placebo to make up a total of 240 mL of reconstituted formula. With a positive cutoff point of > or = 3 mm wheal diameter at SPT, all patients were sensitized to fresh CM, lactalbumin, and/or casein. Twenty-three of 24 patients (95.8%) were SPT-positive to CM formula, 16 of 24 to lactalbumin (66.6%), 14 of 24 to casein (58.3%), and none to SF, SF + lactose, or lactose alone at all dilutions. Complexed immunoglobulin E determinations were positive for CM in 23 of 24 cases and negative in all cases for soy. Challenge with SF + lactose was negative in all cases. Even children hypersensitive to CM are clinically tolerant to lactose and can safely consume foods and drugs with lactose from bovine sources as an ingredient. Lactose exclusion is unwarranted from soy preparations on grounds of potential allergic reactions to CM protein residue.

Pediatric Allergy and Immunology, 2007

We reviewed current clinical evidence for the use of topical treatments in pediatric rhinosinusit... more We reviewed current clinical evidence for the use of topical treatments in pediatric rhinosinusitis. Repeated Entrez PubMed searches were done using the template algorithm [rhinosinusitis AND (…)] with the settings: [Humans; English; All Child 0–18; Clinical trial; Last 10 yr] for the following comparators: steroid, irrigation, saline, antihistamine, decongestant, antibiotic, antimycotic, fungicide. The authors’ clinical experience in the pediatric allergy unit of a university hospital was also drawn upon. Pediatric studies were retrieved but only one satisfied current evidence-based medicine standards for reporting clinical trials. Studies could not be systematized because of methodological, analytical, and interpretation biases. While saline irrigation, nasal decongestants, steroids, antibiotics, antihistamines and fungicides are all in widespread pediatric use, comparing studies from the literature for evidence of efficacy implied subjective appraisal, except in the case of topical steroids. Evidence for the efficacy of topical treatment for pediatric rhinosinusitis is narrative albeit this modality cannot be excluded from individualized patient protocols on the basis of the clinical literature alone. With the exception of topical steroids, no weighable evidence of effectiveness supports the premise that topical treatments actually serve the purpose for which they are widely prescribed in pediatrics.

Allergy, 2005

Background: Epidemiological surveys identify a 900 000-strong potential paediatric population wh... more Background: Epidemiological surveys identify a 900 000-strong potential paediatric population who may self-report with food allergy in Italy. As the reference test is the double-blind, placebo-controlled food challenge for diagnosis, we carried out a nation-wide questionnaire survey of hospital-based paediatric allergy centres between 1 January and 30 June 2003.Methods: All registered centres received a 27-point questionnaire polling logistics and protocols of oral food challenge. Items polled included medical facilities and personnel, selection of patients, foods tested, blinding, placebo use, evaluation criteria, number of tests and positive outcome rates in 2002.Results: Two hundred and two of 456 responders (44.3%) carried out food challenges (a ratio of one centre to 37 400 children in the general population). 11 728 challenges were performed in 2002 (an average of 58 procedures per centre; range: 1–500) and 3350 procedures were claimed positive (28.6%). Cow's milk was tested by all centres, egg by 77.2%, beef by 19.8% and cereals, peanuts, fish or fruit collectively by 37.6%. Twenty-nine of 202 centres performed blinded tests, 18 of which under double-blinded conditions. In cow's milk challenges, placebos included lyophilized cow's milk capsules, soy formula, extensive whey hydrolysate or extensive casein hydrolysate.Conclusion: Our survey reveals great differences in challenge test criteria, facilities and procedures and that many centres perform relatively few procedures. This argues in favour of greater rationalization in the allocation of tertiary-level resources before procedure standardization can be contemplated in the diagnostic workup of food allergy.

Journal of Allergy and Clinical Immunology, 2003

Asthma is an inflammatory disease characterized by inflammatory cells and their cytokines in airw... more Asthma is an inflammatory disease characterized by inflammatory cells and their cytokines in airway mucosa. The concentration of nitric oxide in exhaled air (eNO) is a reliable marker of airway inflammation and is thus a tool in the assessment of asthma control. 2 Exhaled nitric oxide concentrations are increased in asthmatics, 3,4 but it is not known whether atopy influences bronchial inflammation or the level of eNO.

Clinical and Experimental Allergy, 2010

Background The impact of diet on cow's milk allergy (CMA) duration and whether exposure to residu... more Background The impact of diet on cow's milk allergy (CMA) duration and whether exposure to residual amounts of cow's milk protein influences the onset of tolerance are unknown.Objective To prospectively assess the dietary factors influencing disease duration in a randomized cohort.Methods We randomly switched the formula of symptomatic patients from the Milan Cow's Milk Allergy Cohort to one of three treatment groups according to the quarterly rotation of rice hydrolysate formula, extensively hydrolysed cow's milk formula and soy-based formula. In this intention-to-treat, randomized analysis, a hazard ratio (HR) estimation model was used to analyse dietary impact on disease duration.Results Seventy-two children aged a mean of 14.1±8.6 months at diagnosis were followed up for a median of 26 months. Fifty-one reached tolerance at a mean of 34.1±15.2 months. The mean duration of disease was 40.2±4.8 months with milk hydrolysate, 24.3±3.6 months with rice and 24.3±2.6 months with soy. Dietary choice independently predicted shorter duration of disease [adjusted HRs 3.09 (P=0.007) for rice, 2.54 (P=0.02) for soy, both against milk hydrolysate]. In 50 children not co-sensitized to soy, diet choice impacted the duration of disease more strongly [adjusted HRs 8.02 (P=0.006) for rice, 6.53 (P=0.015) for soy, both against milk hydrolysate].Discussion Patients not exposed to cow's milk protein residue achieve cow's milk tolerance earlier than patients who follow an extensively hydrolysed cow's milk diet. This may be due to residual antigenicity in hydrolysed milks. As the effect of dietary intervention is stronger in patients not sensitized to soy, we infer that when atopic disease has progressed to multiple sensitizations, the elimination of allergenic exposure may not be sufficient to reduce the duration of CMA.Cite this as: L. Terracciano, G. R. Bouygue, T. Sarratud, F. Veglia, A. Martelli and A. Fiocchi, Clinical & Experimental Allergy, 2010 (40) 637–642.

Annals of Allergy Asthma & Immunology, 2002

Objectives: To review the recent literature on the diagnostic accuracy of skin prick tests (SPTs)... more Objectives: To review the recent literature on the diagnostic accuracy of skin prick tests (SPTs) in pediatric food allergy, focusing on adverse reactions to milk and beef. To present data about the test performance characteristics of beef extracts used in SPTs among children with atopic dermatitis (AD) reporting immediate hypersensitivity to beef.

Journal of Allergy and Clinical Immunology, 2001

Background: Latex causes anaphylaxis in specific contexts among children. We present 2 cases that... more Background: Latex causes anaphylaxis in specific contexts among children. We present 2 cases that show that severe reactions may occur in everyday circumstances with latex as a contaminant. Objective: Because 2 cases of severe reactions to latex suggested similar circumstances of exposure, we investigated the immediate environment in which episodes occurred. Methods: A 5-year-old girl presented to our casualty department with anaphylaxis after playing in a ball pit filled with approximately 10-cm diameter plastic balls in an Americanstyle fast-food outlet. Two months later, a 9-year-old boy had severe anaphylaxis followed by an asthma attack with loss of consciousness while playing in the playpen of a different outlet belonging to the same company. Latex sensitization was confirmed in both cases by means of skin prick testing, latex glove skin prick testing, and 1-glove finger testing. Immunoblotting of elutions from a ball, the natural rubber latex foam pit lining, and its polyvinyl chloride sheet were performed. Results: In the girl's immunoblot high levels of IgE specific to Hev b 4, Hev b 7, and Hev b 2 were found. The boy's immunoblot showed positivity to Hev b 7. The polyvinyl chloride ball sample showed a high concentration of specific Hevea species allergen similar to that of the foam layer sample. Conclusion: Severe anaphylaxis can result from contact with latex proteins as a contaminant, rather than as a component, of play area ball pits and therefore outside the reported settings. Emergency health care workers should be aware of this kind of risk. A latex-reduced environment might prevent potentially severe reactions in young customers of fast-food outlets. (J Allergy Clin Immunol 2001;108:298-300.)

Journal of Allergy and Clinical Immunology, 2010

The 2nd Milan Meeting on Adverse Reactions to Bovine Proteins was the venue for the presentation ... more The 2nd Milan Meeting on Adverse Reactions to Bovine Proteins was the venue for the presentation of the first consensus-based approach to the management of cow's milk allergy. It was also the first time that the Grading of Recommendations, Assessments, Development, and Evaluation approach for formulating guidelines and recommendations was applied to the field of food allergy. In this report we present the contributions in allergen science, epidemiology, natural history, evidence-based diagnosis, and therapy synthesized in the World Allergy Organization Diagnosis and Rationale for Action against Cow's Milk Allergy guidelines and presented during the meeting. A consensus emerged between discussants that cow's milk allergy management should reflect not only basic research but also a newer and better appraisal of the literature in the light of the values and preferences shared by patients and their caregivers in partnership. In the field of diagnosis, atopy patch testing and microarray technology have not yet evolved for use outside the research setting. With foreseeable breakthroughs (eg, immunotherapy and molecular diagnosis) in the offing, the step ahead in leadership can only stem from a worldwide organization implementing consensus-based clinical practice guidelines to diffuse and share clinical knowledge. (J Allergy Clin Immunol

Annals of Allergy Asthma & Immunology, 2008

The prognosis for many children with cow's milk allergy (CMA) is remission within 3 years, and th... more The prognosis for many children with cow's milk allergy (CMA) is remission within 3 years, and the clinical parameters that predict duration of disease have not been measured incrementally.

Allergy, 2004

Abbreviations: AD, atopic dermatitis; AEDS, atopic eczema/dermatitis syndrome; CMA, cow's milk al... more Abbreviations: AD, atopic dermatitis; AEDS, atopic eczema/dermatitis syndrome; CMA, cow's milk allergy; DBPCFC, doubleblind placebo-controlled food challenge; eHF, extensively hydrolysed formula; SPT, skin prick test.

Annals of Allergy Asthma & Immunology, 2004

To review the effects of technological processing on selected foods of relevance to childhood all... more To review the effects of technological processing on selected foods of relevance to childhood allergy from the viewpoints of reduced allergenicity, contamination of processed foods by allergens introduced during processing, and ad hoc technologies to produce reduced hypoallergenic products. We searched the literature (PubMed/MEDLINE) for articles published between January 1994 and April 2004 using the following keywords: food allergy AND process* OR heat* OR cooking OR toleran*. We drew on our collective clinical and biological experience to restrict retrieved studies to those of more frequent relevance to a hospital allergy practice. Comparatively few clinical studies address the modification of allergenicity of food through cooking or processing. Dairy foods are largely unaffected by processing and may be contaminated by, or themselves become, hidden allergens. Hypoallergenic formulas based on milk, soy, or rice and homogenized beef are successful applications of allergenicity reduction via technological processing. Egg, fish, condiments, and vegetables all carry heat-resistant allergens and should also be considered contaminants. Cereals and bakery products are generally well tolerated, but their allergenicity may be enhanced by processing; the case of rice is still open. Peanut allergens are stable, and the evidence is scant that thermal processing affects the allergenicity of soybean and soy hydrolysates. The debate is ongoing about the tolerance of vegetable oils. It is too early to systematize clinical studies based on single procedures. Processing affects antigenicity, but this does not always translate into safety recommendations. Industrial processing is liable to contamination, and monitoring and labeling are industry priorities. Clinicians should evaluate foods by as complete a workup as possible before recommending processed foods.

[

New England Journal of Medicine, 2007

Pathology & Oncology Research, 2005

We refer to the case presented by Yoram Dekel and colleagues in the Vol. 10, No. 4 issue of the J... more We refer to the case presented by Yoram Dekel and colleagues in the Vol. 10, No. 4 issue of the Journal, 1 which sets out prima facie evidence of talc inhalation from "excessive cosmetic use of talc" as prime suspect in a 42year old woman's demise. We would plead that the proximal cause of death is far from established.