A new score to predict allergic march in patients with IgE-mediated cow milk allergy

Background: Cow milk allergy (CMA) is the most common food allergy in infants. Some patients will express, in the future, other allergic diseases (allergic march). Objective: To evaluate if a new scoring system could determine the risk of developing allergic march. Methods: A retrospective observational cohort study of subjects who were immunoglobulin E (IgE) mediated was conducted. We defined a risk score for atopy (RSA), including clinical and laboratory variables. Three risk groups were defined according to the RSA. We defined as dependent variables atopy (one or more allergic diseases) and atopy+ (two or more allergic diseases). A multivariate logistic regression model was created, which included RSA and the type of formula (high-grade extended hydrolyzed formula [EHF] with Lactobacillus rhamnosus GG (LGG), high-grade EHF without LGG, and other formulas). Results: A total of 211 patients were recruited. When we analyzed the risk of atopy+, we found an increased risk for RSA intermediate-risk (odds ratio [OR 2.08] [95% confidence interval {CI}, 0.95-4.56) and high-risk (OR 24.74 [95% CI, 6.26-97.73]) groups, and a decreased risk for the subjects fed with high-grade EHF (OR 0.42 [95% CI, 0.20-0.87]) and also in those subjects fed with high-grade EHF plus LGG (OR 0.30 [95% CI, 0.09-0.98]). Conclusion: RSA is a simple and useful tool to predict the risk of developing other allergic diseases in patients with IgE-mediated CMA.

Association between Caesarean Delivery and Isolated Doses of Formula Feeding in Cow Milk Allergy

BACKGROUND

Cow milk allergy (CMA) is the most common food allergy in breastfed infants. The aim of this study is to verify whether certain perinatal factors may influence the development of CMA immunoglobulin E (IgE)+.

METHODS

A retrospective, observational study of case and control groups was carried out. Information was collected of patients with CMA IgE+ from our department during the years 1990-2013. Patients of the same age and sex were recruited for the control group. Information on the following variables was collected: sex, age, pregnancy tolerance, duration of pregnancy, type of delivery, isolated doses of formula feeding in hospital (FFH), duration of breastfeeding, and family history of allergy (defined as ≥1 first-degree family member with allergic disease). Statistical analysis was performed using multivariate logistic regression techniques.

RESULTS

A total of 211 cases were included in this study. Multivariate analysis showed an influence of duration of breastfeeding, FFH to be a risk factor (OR 4.94; 95% CI 2.68-9.08), especially in caesarean delivery (OR 11.82; 95% CI 2.64-47.50), and prematurity (OR 0.29; 95% CI 0.09-0.92) to be a protective factor.

CONCLUSIONS

Perinatal factors play a key role in the development of CMA IgE+, with an influence of breastfeeding duration, FFH and caesarean delivery as risk factors and prematurity as a protective factor. While family history had no important role, environmental factors were more decisive.

[Epilepsy in children in Navarre]

BACKGROUND

To estimate the annual incidence rate of epilepsy, as well as the relative distribution of the different epilepsies and epileptic syndromes in children.

MATERIAL AND METHODS

All incident cases of children living in Navarre below 15 years of age with a newly diagnosed epilepsy (years 2003 through 2005) have been registered in a prospective study. Epidemiological and clinical data and complementary studies were collected. ILAE guidelines for epidemiological studies were applied.

RESULTS

One hundred and forty two patients were diagnosed with child epilepsy (18 infants, 47 early children, 39 school children and 38 adolescents). The annual incidence rate was 62.1 cases per 100.000 (95% CI: 61.6-62.6), with a highest incidence rate during the first year of life (103.9 per 100.000). Fifty seven percent of the patients presented focal epilepsies, 41.5% generalized and 1.4% undetermined. In infants, West syndrome (44.4%), epilepsies associated to specific syndromes (27.7%) and focal symptomatic (11.1%) were the most prevalent epileptic syndromes. In early childhood, the main syndromes were focal symptomatic (21.3%) or cryptogenic epilepsies (25.5%). In schoolchildren, focal idiopathic (25.6%) and cryptogenic epilepsies (20.5%). And, in adolescents, focal cryptogenic (21.1%) and idiopathic epilepsies (18.4%).

CONCLUSIONS

The annual incidence rate of child epilepsy in Navarre shows a similar rate as described for other western countries, with the highest incidence rate during the first year of life, diminishing gradually until adolescence. Published data concerning relative frequency of epilepsy and epileptic syndromes are quite discordant. The difficulties in establishing a syndromic diagnosis require the application of uniform criteria in order to obtain valid and comparable epidemiological information.

[Alcohol consumption in pupils of Compulsory Secondary Education]

BACKGROUND

The consumption of addictive substances by adolescents is a growing problem with a considerable social and health impact, with alcohol being the drug of greatest consumption. The aim of this paper is to analyse the consumption of alcohol in pupils attending Compulsory Secondary Education in our health care milieu in order to understand the dimension of the problem in our context.

METHODS

Randomized distribution, stratified by school year, of a semi-quantitative questionnaire on the frequency of consumption of alcoholic drinks. Distributed to 406 pupils in Compulsory Secondary Education: 194 males and 212 females, with ages between 13 and 16 years.

RESULTS

Alcohol consumption increased with school year (p<0.05), with differences existing between the two sexes. From figures for consumption in the 1st year of Compulsory Secondary Education of 27.8% in males and 11.4% in females (p<0.05), figures were reached in the 4th school year of 81.5% in males and 54.7% in females (p<0.05). The regular consumption of alcohol (at least once a week) in males rose from 8.4% (1st school year) to 53.7% (4th school year); and in females from 5.8% (1st school year) to 24.6% (4th school year). In the 4th year of Compulsory Secondary Education, amongst the males who consumed alcohol, 18.2% did so on a daily basis, 47.7% at the weekend, and the remaining 34.1% occasionally; and amongst the females, 6.9% did so on a daily basis, 37.9% at the weekend, and the remaining 55.2% occasionally. In the 4th year of Compulsory Secondary Education, the average quantity of alcohol ingested by the males at the weekend was 130.7 grams, and by the females 98.8 grams. In both sexes, the proportional contribution to the total ingestion of alcohol was in the majority of cases by consumption of spirits (46.1% in males and 55.4% in females) and beer (30.9% in males and 31.6% in females).

CONCLUSIONS

The prevalence of alcohol consumption amongst Secondary School pupils is very high, especially starting in the 3rd year of Compulsory Secondary Education in males and the 4th school year in females. On the completion of studies in Compulsory Secondary Education, there is a generalised consumption of alcohol amongst our adolescents that is mainly circumscribed to the weekend, although there is an important and relevant number of pupils who refer to daily consumption.

[Combination of hydantoins and valproate. Evidence of its teratogenic effect in 4 consecutive gestations]

Four siblings are presented with a malformative syndrome. All were born to an epileptic woman treated with phenytoin and valproic acid. A considerable high fetal pathology is found. Perhaps increased teratogenic effects are related with this pharmacological association not previously described.