Food allergy in children with refractory gastroesophageal reflux disease

Yükselen, Ayfer; Çeltik, Coşkun

doi:10.1111/ped.12779

Cited by 21 publications

(22 citation statements)

References 31 publications

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“…A total of 41 eligible studies were included in our meta‐analysis. Firstly, 578 studies were identified by the initial search and supplemented by 7 additional studies which were searched manually.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies were judged to be high or unclear risk of bias in all domains except the index test. In the patient selection domain: (a) high risk of bias: 25 studies; 9,14,16,18,22,24,25,[27][28][29][30]32,36,[38][39][40][41][42][43][44][45][46][47]49,51 (b) unclear risk of bias: 10 studies; 7,15,17,19,21,23,26,35,37,50 (c) low risk of bias: 6 studies. 13,20,31,33,34,48 In the index test domain: (a) high risk of bias: 2 studies; 39,46 (b) unclear risk of bias: 2 studies; 23,50 (c) low risk of bias: 37 studies.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…13,20,31,33,34,48 In the index test domain: (a) high risk of bias: 2 studies; 39,46 (b) unclear risk of bias: 2 studies; 23,50 (c) low risk of bias: 37 studies. In the reference standard domain: (a) high risk of bias: 5 studies; 15,17,21,32,34 (b) unclear risk of bias: 20 studies; 7,14,16,19,[22][23][24][25][27][28][29]35,39,41,43,44,[47][48][49][50] However, the applicability concerns were considered to be low concern in most studies, except 6 studies 16,25,27,32,39,46 to be high concern in the patient selection domain, 3 studies 23,39,50 to be unclear in the index test domain, and 2 studies 27,50 to be unclear in the reference standard domain. Detailed information of QUADAS-2 assessment is represented in Table S2.…”

Section: Quality Assessmentmentioning

confidence: 99%

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The diagnostic value of APT for food allergy in children: a systematic review and meta‐analysis

Luo

Zhang

2019

Pediatric Allergy Immunology

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Background The role of atopy patch test (APT) in the diagnosis of food allergy (FA) remains largely controversial. In our meta‐analysis, we aimed to evaluate the accuracy of APT for diagnosing FA in children. Methods Pubmed, Embase and Cochrane Library were searched for studies regarding the diagnostic value of APT for FA in children compared to oral food challenge (double‐blind placebo‐controlled food challenge and/or open food challenge). The last search was conducted on November 11, 2017. Two reviewers independently screened relevant studies and assessed the quality by QUADAS‐2. Meta‐analysis was performed to calculate the pooled sensitivity, specificity, DOR (diagnostic odds ratio), PLR (positive likelihood ratio), NLR (negative likelihood ratio) with their 95% confidence intervals (CIs). Subgroup analyses were conducted according to different food allergens, atopic dermatitis, gastrointestinal symptoms, and age younger than 3 years. Results Forty‐one studies were included in the meta‐analysis. The pooled sensitivity, specificity, PLR, NLR and DOR were 50.30% (95% CI 48.40%‐52.30%), 86.60% (95% CI 85.30%‐87.80%), 3.405 (95% CI 2.594‐4.470), 0.545 (95% CI 0.469‐0.634) and 7.528 (95% CI 5.507‐11.206), respectively. However, for children with FA‐related gastrointestinal symptoms, the pooled sensitivity and specificity were 57.40% (95% CI 52.10%‐62.50%) and 91.50% (95% CI 88.30%‐94.10%) respectively. Conclusions Our findings suggest that APT is specific but not sensitive for diagnosing FA in children, especially in children with FA‐related gastrointestinal symptoms.

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Section: Resultsmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

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The diagnostic value of APT for food allergy in children: a systematic review and meta‐analysis

Luo

Zhang

2019

Pediatric Allergy Immunology

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“…Eosinophilic esophagitis, GERD and other chronic dysfunctional gastrointestinal diseases have recently been revisited as possible expression of atopy/food allergy [ 51 – 55 ]. Actually, levels of total/specific IgE as well as expression rate of allergic diseases slightly higher than in the general population have already been reported in patients with CSU [ 56 – 58 ].…”

Section: Discussionmentioning

confidence: 99%

The overlap syndrome of urticaria and gastroesophageal reflux disease

et al. 2018

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BackgroundOne-quarter of systemic symptoms associated with chronic spontaneous urticaria (CSU) are related to gastrointestinal complaints (GICs).ObjectivesTo investigate the prevalence and features of urticaria-overlapping GICs.MethodsIn this retrospective cross-sectional survey, 1426 consecutive outpatients were observed at our University Department. Only patients suffering from urticaria or GICs with a complete diagnostic work-up including serum total IgE level (Tot-IgE), differential blood count and urticaria activity score (UAS), were evaluated.ResultsAmong different GICs, gastroesophageal reflux disease (GERD) was the most frequent syndrome observed (15.4%; 95%CI: 13.6–17.3). The prevalence of overlap syndrome for urticaria and GERD was 5.9% (95%CI: 4.7–7.2). In urticaria-patients, the prevalence of GERD was four-fold higher than in patients without hives (44% vs. 11%, p<0.001). UAS was significantly higher in urticaria and GERD overlap syndromes vs. isolated urticarias. In patients with GERD or acute/chronic urticaria or overlap syndrome, Tot-IgE and eosinophil blood count (EBC) differed significantly, with a stepwise increase in their values; from the subgroup of patients with GERD only, to that with overlap of CSU to GERD. Prevalence values for urticaria overlapping with GERD were three- and two-fold higher in CSU and in long-duration GERD cases respectively compared to acute urticaria or short-duration GERD cases. Similar to Th2 pathology models, CSU and GERD overlap syndrome was significantly and independently associated with Total-IgE ≥100IU/ml or EBC ≥250/mmc compared to CSU or GERD. Endoscopic/bioptic findings of non-erosive reflux disease (NERD) or Barrett’s esophagus (BE) were more frequent in chronic overlap syndrome than in GERD-patients.ConclusionsGERD was the most frequent GIC in patients with urticaria. Overlap syndrome was more frequent among patients with CSU, where this syndrome was associated with higher values of UAS, Tot-IgE, EBC and frequencies of NERD and BE. These results suggest that overlap syndrome is frequently a chronic syndrome with a Th2-like profile.

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“…Nielsen et al showed that 56% of children with severe GERD were found to have CMPA on double-blind or open challenge [ 15 ]. Subsequently, Yukselen and Celtik studied the frequency of food allergy in children below five years of age with poor response of GERD symptoms to pharmacological treatment and found a prevalence of food allergy of 43% in the study group, with more than a third of patients (38.4%) showing an allergic reaction only to cow’s milk protein [ 16 ]. Previous studies on food allergy (CMPA and immunoglobulin E-dependent allergy) in GERD in children have shown similar results reporting an association between 43% and 48% [ 17 , 18 ].…”

Section: Clinical Presentation Of Gerd In the Pediatric Populationmentioning

confidence: 99%

Gastro-Esophageal Reflux in Children

Rybak

Pesce

Thapar

et al. 2017

IJMS

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Gastro-esophageal reflux (GER) is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD). Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines.

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Food allergy in children with refractory gastroesophageal reflux disease

Abstract: Cow's milk allergy was observed frequently in children resistant to pharmacologic GERD treatment. Combined skin prick and specific IgE tests, APT and oral food challenge is essential for avoidance of unnecessary elimination diet.

Cited by 21 publications

References 31 publications

The diagnostic value of APT for food allergy in children: a systematic review and meta‐analysis

The diagnostic value of APT for food allergy in children: a systematic review and meta‐analysis

The overlap syndrome of urticaria and gastroesophageal reflux disease

Gastro-Esophageal Reflux in Children

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