SUMMARYBackground: The possibility of inducing oral desensitization in patients with food allergy is still controversial and no standardized programmes are yet available. Aim: To evaluate the safety and efficacy of oral desensitization in patients with allergy induced by the most common food allergens. Methods: Fifty-nine patients with food allergy underwent an oral desensitizing treatment according to standardized protocols. The control group consisted of age-and sex-matched subjects, who followed a strict elimination diet. Specific immunoglobulin E and immunoglobulin G 4 were assessed at baseline and after 6, 12 and 18 months.
The possibility of obtaining oral desensitization in patients with food allergy is still a matter of debate. We decided to evaluate the safety and efficacy of standardized protocols for oral desensitization with the most common food allergens. Forty-two children (ages up to 16 years) diagnosed as affected by food allergy (on the basis of clinical history, skin prick tests, measurement of specific IgE, and double-blind, placebo-controlled food challenge) underwent a sublingual-oral desensitizing treatment according to new standardized protocols. The control group consisted of 10 patients who followed an elimination diet. The treatment was successfully completed by 85.7% of the patients. Specific IgE showed a significant decrease, while specific IgG(4) showed a significant increase, in all treated patients. The immunological modifications observed in our patients lead us to hypothesize that oral tolerance may be mediated by the same mechanisms as those involved in traditional desensitizing treatments for respiratory and insect sting allergy.
We present 12 cases of latex allergy in patients who underwent desensitization by a sublingual exposure protocol. This study provides evidence that a safe therapeutic approach to latex allergy is possible.
Nickel allergy is the most common contact allergy. Some nickel-sensitive patients present systemic (cutaneous and/or digestive) symptoms related to the ingestion of high nickel-content foods, which significantly improve after a specific low nickel-content diet. The etiopathogenetic role of nickel in the genesis of systemic disorders is, furthermore, demonstrated by the relapse of previous contact lesions, appearance of widespread eczema and generalized urticaria-like lesions after oral nickel challenge test. The aim of this study is to investigate the safety and efficacy of a specific oral hyposensitization to nickel in patients with both local contact disorders and systemic symptoms after the ingestion of nickelcontaining foods. Inclusion criteria for the recruitment of these patients were (other than a positive patch test) a benefit higher than 80% from a low nickel-content diet and a positive oral challenge with nickel. Based on the previous experiences, our group adopted a therapeutic protocol by using increasing oral doses of nickel sulfate associated to an elimination diet. Results have been excellent: this treatment has been effective in inducing clinical tolerance to nickel-containing foods, with a low incidence of side effects (gastric pyrosis, itching erythema).Nickel allergy is the most common contact allergy because nickel is present in various dailyuse accessories and utensils (coins, pots and pans, watches, earrings, etc.) and its widespread use favors sensitization (I). The prevalence of nickel allergy has shown a constant rise in industrialized countries, about 10-15% (with peaks up to 20%) in females, and 4-7% in males (2-4). Female predominance is probably due to a more frequent exposure to metal jewellery and to the higher incidence of allergic diseases in women.Nickel allergy is a delayed, cell-mediated hypersensitivity, presenting with local eczematous lesions after skin contact with nickel and it can be diagnosed by patch tests. Some reports in literature describe how the use of dental and orthopedic prostheses may provoke generalized eczema (5-6) and urticaria (7-8) in nickel-allergic patients.Nickel is an essential element in the diet: its daily intake is about 300 ug, and vegetables are the main source (9-11). Some cases have been described of nickel-sensitized patients with cutaneous systemic disorders correlated to the ingestion of high nickel-content foods: generalized eczema (12-13), recurrent vesicular hand eczema (pompholyx) (14-15), itching erythema with mild
In the literature there are several reports dealing with the possibility of a desensitising treatment in food allergy, but there are very few studies concerning the immunological mechanisms of oral desensitisation. We studied the immunological modifications in four children who underwent oral desensitisation with cow milk. Four children with cow milk allergy underwent oral desensitisation according to a standardized protocol. Total IgE, eosinophilic cationic protein in serum, and specific IgE and IgG 4 to a-lactalbumin, to f3-lactoglobulin and to casein were determined at the beginning of the treatment and after 6, 12 and 18 months in the 4 children treated. All the 4 treated patients successfully completed the treatment. SpecificIgE to casein showed a significant reduction (p
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