Accidental allergic reactions in children allergic to cow's milk proteins

Boyano-Martínez, Teresa; García-Ara, Carmen; Pedrosa, María; Díaz-Pena, José María; Quirce, Santiago

doi:10.1016/j.jaci.2008.12.1125

Cited by 123 publications

(98 citation statements)

References 32 publications

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“…5,20,22 In a 1-year retrospective study of 3 year olds with milk allergy (n = 88) in Spain, 40% had 53 reactions, 22 compared with 42.2% over the period of our study. In a retrospective study of 252 Canadian children (mean age 8.1 years) with peanut allergy, an annual rate of 14.3% was observed, 20 compared with 6% in our group.…”

Section: Figurementioning

confidence: 62%

Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

2012

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Infants and children with diagnosed food allergy are at risk for acute, potentially life-threatening symptoms. Limited data are available on the frequency, severity, and circumstances of reactions and caretaker medical response. WHAT THIS STUDY ADDS:This study describes food allergy reaction frequency, circumstances, and response. Pitfalls that may inform improved anticipatory guidance included lack of vigilance, misreading ingredient labels, allergen cross-contact, nonaccidental allergen feeding, and underutilization of epinephrine for severe reactions. abstract OBJECTIVE: To examine circumstances of allergic reactions to foods in a cohort of preschool-aged children. METHODS:We conducted a prospective, 5-site observational study of 512 infants aged 3 to 15 months with documented or likely allergy to milk or egg, and collected data prospectively examining allergic reactions. , with accidental exposures attributed to unintentional ingestion, label-reading errors, and cross-contact. Foods were provided by persons other than parents in 50.6% of reactions. Of 834 reactions to milk, egg, or peanut, 93 (11.2%) were attributed to purposeful exposures to these avoided foods. A higher number of food allergies (P , .0001) and higher foodspecific immunoglobulin E (P , .0001) were associated with reactions. Of the 11.4% of reactions (n = 134) that were severe, 29.9% were treated with epinephrine. Factors resulting in undertreatment included lack of recognition of severity, epinephrine being unavailable, and fears about epinephrine administration. RESULTS:CONCLUSIONS: There was a high frequency of reactions caused by accidental and nonaccidental exposures. Undertreatment of severe reactions with epinephrine was a substantial problem. Areas for improved education include the need for constant vigilance, accurate label reading, avoidance of nonaccidental exposure, prevention of cross-contamination, appropriate epinephrine administration, and education of all caretakers. Pediatrics 2012;130:e25-e32 AUTHORS:

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Section: Figurementioning

confidence: 62%

Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

2012

PEDIATRICS

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“…Thirty-five children developed allergic reactions, and 15% presented with severe symptoms. The risk of presenting with severe symptoms was associated with a high concentration of asIgE and asthma [45].…”

Section: Discussionmentioning

confidence: 99%

Patient characteristics of children with cow’s milk allergy presenting with an allergy to extensively hydrolyzed whey and/or casein formulae used as part of an elimination diet

Nowacki¹

2012

pdia

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A Ad dd dr re es ss s f fo or r c co or rr re es sp po on nd de en nc ce e: : Zygmunt Nowacki MD, PhD, Allergological-Pediatric Practice, Original paper A b s t r a c t I In nt tr ro od du uc ct ti io on n: : In the recent years the number of children with cow's milk protein allergy (CMPA) presenting with allergies to extensively hydrolyzed whey (eHF-W) and casein formulae (eHF-C) respectively has increased. A Ai im m: : To present the patient characteristics of children with CMPA who presented with allergic reactions to eHF-W and/or eHF-C used as part of an elimination diet. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : A retrospective study was carried out for a group of 65 selected from of 359 children (3 to 12 months) affected with CMPA and allergy to eHF. R Re es su ul lt ts s: : 18.1% (65/359) and 7.8% (28/359) from the group presented with allergic reactions to eHF-W and eHF-C, respectively. An allergic reaction to eHF-C occurred in 43% of the patients from the group (28/65). IgE-mediated CMPA presented with one of the following clinical manifestations: atopic dermatitis (AD) 94%, gastrointestinal symptoms (GI) 47%, respiratory symptoms (RS) 44%, anaphylactic reactions (AR) 26%. Non-IgE-mediated CMPA, on the other hand, manifested with: AD 97%, GI 22%, RS 10% .The observations showed that all 31 from the non-IgE mediated CMPA group with GI and AD manifestations presented with symptoms of eHF-C allergy (p = 0.001). In the IgE-mediated CMPA (n = 34) the following factors were statistically significant with relation to eHF-C allergy: CMPA manifesting with GI (p = 0.014) and AD. The occurrence of AR in response to cow's milk protein (CMP) decreased the probability of an eHF-C allergy (p = 0.028) in a statistically significant way. C Co on nc cl lu us si io on ns s: : Children with CMPA who presented with allergies to eHF-W and eHF-C had a higher frequency of clinical manifestation with GI and AD. K Ke ey y w wo or rd ds s: : cow's milk allergy, elimination diet.

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“…20 In a study in 88 children with milk allergy (median age: 32.5 months) followed for 1 year, 53% of reported reactions were mild (defined as cutaneous symptoms [angioedema excluded], rhinitis, or conjunctivitis). 21 A recent Canadian study of accidental exposures to peanut in 1941 children (mean age: 7 years) with confirmed peanut allergy reported that 30% of exposures resulted only in mild symptoms (defined as involving only pruritus, urticaria, flushing, or rhinoconjunctivitis). 22 Therefore, in the event of a mild allergic reaction involving isolated skin symptoms, mild facial or oral symptoms, or mild gastrointestinal tract discomfort, none of which meet the criteria for anaphylaxis, the use of oral antihistamines may be an option.…”

Section: Treatment Pathwaysmentioning

confidence: 99%

Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan

Wang¹,

Sicherer

Allergy

2017

Pediatrics

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Anaphylaxis is a potentially life-threatening, severe allergic reaction. The immediate assessment of patients having an allergic reaction and prompt administration of epinephrine, if criteria for anaphylaxis are met, promote optimal outcomes. National and international guidelines for the management of anaphylaxis, including those for management of allergic reactions at school, as well as several clinical reports from the American Academy of Pediatrics, recommend the provision of written emergency action plans to those at risk of anaphylaxis, in addition to the prescription of epinephrine autoinjectors. This clinical report provides information to help health care providers understand the role of a written, personalized allergy and anaphylaxis emergency plan to enhance the care of children at risk of allergic reactions, including anaphylaxis. This report offers a comprehensive written plan, with advice on individualizing instructions to suit specifi c patient circumstances.

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Accidental allergic reactions in children allergic to cow's milk proteins

Cited by 123 publications

References 32 publications

Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

Allergic Reactions to Foods in Preschool-Aged Children in a Prospective Observational Food Allergy Study

Patient characteristics of children with cow’s milk allergy presenting with an allergy to extensively hydrolyzed whey and/or casein formulae used as part of an elimination diet

Guidance on Completing a Written Allergy and Anaphylaxis Emergency Plan

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