No abstract

This article focuses on hypersensitivity reactions after inhalation of food particles as primary cause for food allergy. This is an increasingly recognized problem in children. Reactions are commonly diagnosed in children who develop symptoms when the food is ingested. Some children tolerate the food when it is eaten but they experience reactions to airborne food particles such as peanut, cow's milk, and fish. The exposure can be trivial, as in mere smelling or being in the vicinity of the food. Usually, respiratory manifestations include rhinoconjunctivitis, coughing, wheezing, and asthma, but in some cases even anaphylaxis has been observed. Practical approaches concerning diagnosing clinical reactivity including skin tests, serum IgE antibodies, specific provocation tests, and management have been identified. Studies are warranted to establish the accuracy of diagnostic tests as well as incidence, prevalence, and natural history of food allergy through inhalation route.

Exhaled breath condensate (EBC) is being used increasingly to sample airway lining fluid. In asthmatic patients, the concentration of pH in EBC has been found to be decreased and to be related to airway inflammation. The aim of this study was to determine exhaled pH levels during acute asthma exacerbations in relation to pharmacologic treatment in asthmatic children and compare these with control subjects. Twelve asthmatic children with asthma exacerbation and 27 healthy children were enrolled. Clinical observations and pH in EBC before and after standard treatment for asthma attack, based administration of inhaled beta2-agonist, and corticosteroid, according to international Global Initiative for Asthma guidelines, were compared with those in healthy subjects. All children performed skin-prick tests to aeroallergens. Asthmatic children underwent spirometry. Exhaled pH levels were significantly lower in children with asthma exacerbation before treatment (mean ± SD = 7.87 ± 0.66; p = 0.03) but not after treatment (8.11 ± 0.06; p = 0.40) compared with controls (8.12 + 0.19). Intragroup analyses found that condensate pH levels in asthmatic children before treatment were lower, but not significantly, than those after treatment. No correlation was found between pH values and treatment with systemic corticosteroids or lung function. Asthmatic children were atopic in 75% of cases. Levels of pH are decreased in EBC of asthmatic children with exacerbation before treatment. Larger studies are required to determine whether EBC pH levels may be a useful noninvasive biomarker to guide treatment of asthma exacerbations in childhood.

Hypersensitivity reactions during perioperative period are increasing and may be potentially life-threatening. Therefore, major emphasis is given to prevention. We perform a review to examine which measures should be taken to prevent reactions to products used in elective and emergency surgery. Any patient with a history of previous anaphylaxis or severe reaction during anaesthesia should be referred to allergist for detection of the offending compound. However, the identification of the triggering agent is not always feasible because of the low accuracy of diagnostic tests. In these cases and when emergency surgery is required, it should be considered to replace all drugs administered before the onset of the reaction with alternatives. Furthermore, any cross-reacting agent and latex, especially in patients belonging to populations at-risk for latex allergy should be avoided. In susceptible patients, premedication with antihistamines and corticosteroids might reduce the severity of reaction to drugs or contrast material while it is unclear whether pre-treatment decreases incidence of anaphylactic reactions. There is no evidence that premedication prevents allergic reactions to latex. Overall, physicians should not rely on the efficacy of premedication.