RESUMEN La alergia a las proteínas de la leche de vaca aparece en los primeros meses de vida y es la alergia alimentaria más frecuente en el lactante y el niño pequeño. Esta investigación tiene como objetivo caracterizar clínica y epidemiológicamente a pacientes con alergia a las proteínas de la leche de vaca. Se realizó un estudio longitudinal, descriptivo, retrospectivo en el hospital infantil Hermanos Cordové del municipio Manzanillo en Granma, Cuba. La población estuvo constituida por los 10 infantes egresados de la institución durante el período 2017-2021. Se estudiaron las variables: edad, sexo, estadía, tiempo de evolución de la enfermedad, lactancia, factores de riesgo, evaluación nutricional. Entre los principales resultados se obtuvieron que predominó el sexo femenino y las edades de uno a seis meses (60 %). El 50 % de niños estaban desnutridos. El 70 % de los pacientes presentaron diarreas como principal síntoma, seguido por las lesiones de piel (60 %). Solo el 20 % recibieron lactancia materna exclusiva hasta los 6 meses de edad. El parto por cesárea fue el factor de riesgo más predominante (50 %). Se concluye que el sexo femenino y las edades de uno a seis meses fueron las más sobresalientes. La diarrea y las lesiones de piel fueron las manifestaciones clínicas más frecuentes de los pacientes con alergia a las proteínas de la leche de vaca. Los lactantes desnutridos, con lactancia artificial y antecedentes de parto por cesárea tienen mayores probabilidades de padecer esta enfermedad.

RESUMO A alergia à proteína do leite de vaca aparece nos primeiros meses de vida e é a alergia alimentar mais comum em lactentes e crianças pequenas. Esta pesquisa tem como objetivo caracterizar clínica e epidemiologicamente pacientes com alergia à proteína do leite de vaca. Foi realizado um estudo longitudinal, descritivo e retrospectivo no Hospital Infantil Hermanos Cordové, no município de Manzanillo, em Granma, Cuba. A população foi composta por 10 crianças que se formaram na instituição no período de 2017 a 2021. As seguintes variáveis foram estudadas: idade, sexo, tempo de internação, tempo de evolução da doença, aleitamento materno, fatores de risco, avaliação nutricional. Dentre os principais resultados, predominaram o sexo feminino e a faixa etária de um a seis meses (60%). 50% das crianças estavam desnutridas. A diarreia foi o principal sintoma de 70% dos pacientes, seguida pelas lesões cutâneas (60%). Apenas 20% foram amamentados exclusivamente até os 6 meses de idade. O parto cesáreo foi o fator de risco mais prevalente (50%). Conclui-se que o sexo feminino e a idade de um a seis meses foram os que mais se destacaram. Diarreia e lesões cutâneas foram as manifestações clínicas mais frequentes dos pacientes com alergia à proteína do leite de vaca. Lactentes desnutridos, lactentes com alimentação com fórmula e história de parto cesáreo são mais propensos a sofrer dessa doença.

ABSTRACT Allergy to cow's milk proteins, appears in the first months of life and is the most common food allergy in infants and young children. This research aims to characterize clinically and epidemiologically patients with allergy to cow's milk proteins. A longitudinal, descriptive, retrospective study was conducted at the Hermanos Cordové Children's Hospital in the municipality of Manzanillo in Granma, Cuba. The population consisted of the 10 children who graduated from the institution during the period 2017-2021. The following variables were studied: age, sex, length of stay, duration of disease progression, breastfeeding, risk factors, nutritional assessment. Among the main results, it was found that the female sex and the ages of one to six months predominated (60 %). The 50 % of children were malnourished. 70 % of patients had diarrhea as the main symptom, followed by skin lesions (60 %). Only 20 % were exclusively breastfed up to 6 months of age. Caesarean section was the most prevalent risk factor (50 %). It is concluded that the female sex and the ages of one to six months were the most outstanding. Diarrhea and skin lesions were the most common clinical manifestations in patients with cow's milk protein allergy. Malnourished infants, breastfed infants and a history of cesarean delivery are more likely to have this disease.

RESUMEN Objetivo. Identificar los países que tienen legislación relacionada con la declaración obligatoria de alergenos alimentarios, alimentos irradiados y transgénicos en el etiquetado nutricional de alimentos envasados. Métodos. Estudio exploratorio en el cual se revisaron los reglamentos sanitarios o normas técnicas de los alimentos de los países de América Latina con el fin de recopilar información sobre la declaración de alergenos, trazas de alergenos, alimentos irradiados y transgénicos. La búsqueda de la información se realizó a través de páginas gubernamentales de los países. Los resultados se presentan de manera descriptiva y narrativa. Resultados. De los 19 países revisados, 89% declara alergenos en su etiquetado nutricional, 76% incorpora la declaración de trazas en su legislación de manera explícita y 82% sigue las recomendaciones del Codex Alimentarius con algunas modificaciones en las categorías de alimentos. Conclusiones. La declaración de alergenos como medida de seguridad alimentaria, así como avanzar en mejorar la rotulación de trazas de alergenos y la disponibilidad universal de epinefrina son los desafíos pendientes de la Región.

RESUMO Objetivo. Identificar os países que têm legislação relacionada à declaração obrigatória de alimentos alergênicos, irradiados e transgênicos na rotulagem nutricional de alimentos embalados. Métodos. Estudo exploratório com revisão dos regulamentos sanitários ou normas técnicas de alimentos dos países da América Latina, a fim de coletar informações sobre a declaração de alimentos alergênicos, traços de alergênicos, alimentos irradiados e transgênicos na rotulagem nutricional. A busca de informações foi realizada por meio dos sites governamentais dos países. Os resultados são apresentados de forma descritiva e narrativa. Resultados. Dos 19 países analisados, 89% declaram alergênicos na rotulagem nutricional, 76% incorporam explicitamente a declaração de traços na legislação e 82% seguem as recomendações do Codex Alimentarius, com algumas modificações nas categorias de alimentos. Conclusões. Entre os desafios pendentes na Região estão a implementação da declaração de alergênicos como medida de segurança alimentar e a melhoria da rotulagem de traços de alergênicos e da disponibilidade universal de epinefrina.

ABSTRACT Objective. Identify countries that have legislation on mandatory declarations of food allergens, irradiated foods, and transgenic foods on the nutritional labels of packaged foods. Methods. Exploratory study reviewing the health regulations and technical standards for foods in Latin American countries in order to gather information on declarations of allergens, trace allergens, irradiated foods, and transgenic foods. The information search was carried out through the countries’ government web pages. Presentation of the results is descriptive and narrative. Results. Of the 19 countries reviewed, 89% require a declaration of allergens on their nutrition labeling, 76% have legislation that explicitly require a statement on trace allergens, and 82% follow Codex Alimentarius recommendations with some modifications of food categories. Conclusions. Three pending challenges in the Region are: requiring statements on allergens as a food safety measure; making progress toward improved labeling of trace allergens; and ensuring universal availability of epinephrine.

ABSTRACT Introduction: Allergic diseases are very common in the pediatric population. Among the frequent causes are aeroallergens from the environment and the identification of these is a great help for diagnosis and treatment. Objectives: To determine the frequency of aeroallergens, through the determination of Immunoglobulin E (IgE) specific to common allergens by the skin sensitivity test in pediatric patients with symptoms of asthma and allergic rhinitis. Materials and Methods: Observational, descriptive, prospective, cross-sectional design, population of patients from 4 to 17 years old with symptoms compatible with asthma and allergic rhinitis who attended a pediatric care center during the study period. It was carried out by means of Skin Puncture Tests (PCP). Results: The mean age of the patients was 8 years, 57% male patients and 43% female. 53% of the patients presented Rhinitis and Asthma, 45% only Rhinitis and 2% only Asthma. 79% of the patients presented a positive allergic sensitization reaction through PCP. Taking into account the sensitization by type of aeroallergens, 64% of the patients had a positive reaction to mites, 19 % to animals 18% to cockroaches, 8% to pollens and 6% to fungi. Conclusion: The vast majority of patients with asthma suffered from concomitant allergic rhinitis and dust mites were the most frequently determined aeroallergens in allergic skin tests in children with asthma and rhinitis in our population.

RESUMEN Introducción: Las enfermedades alérgicas son muy comunes en la población pediátrica. Entre las causas frecuentes se encuentran los aeroalérgenos del ambiente, y la identificación de estos es de gran ayuda tanto para el diagnóstico como para el tratamiento. Objetivos: Determinar la frecuencia de aeroalérgenos, por medio de la determinación de Inmunoglobulina E (IgE) específica a alérgenos comunes por la prueba de sensibilidad cutánea en pacientes pediátricos con síntomas de asma y rinitis alérgica. Materiales y Métodos: Diseño observacional, descriptivo, prospectivo, transversal, población de pacientes de 4 a 17 años con síntomas compatibles con asma y rinitis alérgica que acudieron a un centro asistencial pediátrico en el periodo de estudio. Se realizó por medio de las Pruebas de punción cutánea (PCP). Resultados: La edad media de los pacientes fue de 8 años, 57% pacientes de sexo masculino y 43% de sexo femenino. El 53% de los pacientes presenta rinitis y asma, 45% solo rinitis y el 2% solo asma. El 79% de los pacientes presentó reacción positiva de sensibilización alérgica por medio de la PCP. Teniendo en cuenta la sensibilización por tipo de aeroalérgenos se tuvo que el 64% de los pacientes tuvo reacción positiva a ácaros, 19% a animales 18% a cucarachas, 8% a pólenes y 6% a hongos. Conclusión: La gran mayoría de pacientes con asma padecía rinitis alérgica concomitante y los ácaros del polvo fueron los aeroalérgenos más frecuentemente determinados en las pruebas cutáneas de alergia en niños con asma y rinitis de nuestra población.

Abstract Skin tests, also known as prick tests, in food allergies are restricted to IgE-mediated food allergies, with results that barely indicate sensitization to a certain food and do not necessarily suggest food allergy. The clinical context of the patient is the decisive point before performing any type of food allergy skin test; Contextualizing and relating the patient's clinical picture with the immunological mechanism of IgE-mediated allergies will allow a better selection of the allergy test for each case. Positive tests should be interpreted more carefully, and consider that during early childhood it is common that several patients may have negative specific serum IgE tests in the blood for food allergens compared to those performed on the skin, which are positive. Skin testing can be carried out with standardized strata of foods, but they are not always available for all foods and some are very unstable. Skin tests can even be performed with raw foods, using the prick to prick technique to perform the puncture with fresh foods (especially fruits or vegetables) or other products that are not commercially available. The skin prick test is a test where, after having placed the allergenic extract in drops or with fresh food itself, the puncture must be carried out with a standardized lancet.

Resumen Las pruebas cutáneas, también conocidas como prick test, en alergia alimentaria están restrictas a las alergias a alimentos mediadas por IgE, con resultados que apenas indican sensibilización a cierto alimento y no necesariamente sugieren alergia alimentaria. El contexto clínico del paciente es el punto decisivo antes de realizar cualquier tipo de prueba cutánea de alergia a alimentos; contextualizar y relacionar el cuadro clínico del paciente con el mecanismo inmunológico de las alergias mediadas por IgE permitirá una mejor selección de la prueba de alergia para cada caso. Las pruebas positivas deben interpretarse con más cuidado, y considerar que durante la infancia precoz es común que varios pacientes pueden tener pruebas IgE séricas especificas negativas en sangre para alérgenos alimentarios comparadas con las realizadas en piel, que resultan positivas. La prueba cutánea puede llevarse a cabo con estratos estandarizados de alimentos, pero no siempre se encuentran disponibles para todos los alimentos y algunos son muy inestables. Incluso pueden realizarse pruebas cutáneas con alimentos in natura, mediante la técnica prick to prick para efectuar la punción con alimentos frescos (especialmente con frutas o vegetales) u otros productos que no estén disponibles comercialmente. El skin prick test es una prueba donde después de haber colocado el extracto alergénico en gotas o con el propio alimento fresco debe llevarse a cabo la punción con una lanceta estandarizada.

Abstract The pollen-food allergy syndrome, also known as oral allergy syndrome, is characterized by local reactions inthe mouth and throat after consuming certain raw plant foods in individuals sensitized to pollen from grass, weeds, and trees. Birch-apple is the prototype of this syndrome, with apple, pear, and plum being the most commonly associated foods. Symptoms are usually limited to the oral cavity but can include systemic reactions, including anaphylaxis. Sensitization to pollen allergens, such as lipid transfer proteins, profilin, and PR-10 proteins, triggers this syndrome. Its prevalence varies by geographic region and the predominant pollen type, affecting between 30% and 60% of food allergies. Diagnosis involves a clinical history, skin tests, and, in ambiguous cases, double-blind, placebo-controlled oral food challenges. Treatment primarily involves avoiding trigger foods.

Resumen El síndrome de alergia a alimentos y pólenes, también conocido como síndrome polen-alimento o síndrome de alergia oral, se caracteriza por una reacción local en la boca y faringe después de ingerir ciertos alimentos vegetales crudos, en individuos sensibilizados al polen de hierbas, malezas y árboles. El abedul-manzana es el prototipo de este síndrome, siendo la manzana, pera y ciruela los alimentos más comúnmente asociados. Los síntomas suelen limitarse a la cavidad oral, pero pueden incluir reacciones sistémicas, incluida la anafilaxia. La sensibilización a alérgenos de polen, como las proteínas de transferencia de lípidos, profilina y proteínas PR-10, desencadena este síndrome. Su prevalencia varía según la región geográfica y el tipo de polen predominante, afectando entre el 30% y el 60% de las alergias alimentarias. El diagnóstico implica historia clínica,pruebas cutáneas y, en casos ambiguos, pruebas de provocación alimentaria oral. El tratamiento consiste principalmente en evitar los alimentos desencadenantes.

Abstract skin tests; Sensitization; IgE-mediated allergy; allergenic extract. After the discovery of IgE, technological advances have provided new laboratory tools for the quantification of allergen-specific IgE antibodies in serum and on the surface of basophils-mast cells. In vitro testing offers numerous advantages: accurate quantitation, lack of drug interference, safety, and long-term storage of samples. Quantitative immunoassays for IgE antibodies can be an adjunct to skin testing. The allergen reagent in solid phase (allergosorbent) or liquid is the main component of the assay that confers specificity to the IgE antibody test. It is the most complex and highly variable reagent in IgE antibody assays. The choice to use diagnostic recombinants on a single rather than multiple platforms is made on a case-by-case basis(considering prior history and clinical profile) and in an allergen-dependent manner. Although most food allergies are limited to a small number of possible triggers, these foods are very complex when evaluating their allergenic potential. The possibility of fractionating the allergen and understanding some of its components as potentially important to define the risk of clinical reaction, cross-reactivity, or persistence of allergy, opened a new era in the field of allergy, called molecular allergy. The identification of the allergenic component responsible for the reactions is an important tool to confirm the information and severity of the symptoms, natural history of the disease, possibility of cross-reactivity and clinical symptoms (allergy markers).

Resumen Después del descubrimiento de la IgE, los avances tecnológicos han proporcionado nuevas herramientas de laboratorio para la cuantificación de anticuerpos IgE específicos de alérgenos en suero y en la superficie de basófilos-mastocitos. Las pruebas in vitro ofrecen numerosas ventajas: cuantificación precisa, falta de interferencia de fármacos, seguridad y almacenamiento a largo plazo de las muestras. Los inmunoensayos cuantitativos para anticuerpos IgE pueden ser un complemento de las pruebas cutáneas. El reactivo de alergeno en fase sólida (alergosorbente) o líquida es el componente principal del ensayo que confiere especificidad a la prueba de anticuerpos IgE. Es el reactivo más complejo y altamente variable en los ensayos de anticuerpos IgE. La elección de utilizar recombinantes de diagnóstico en una única plataforma en lugar de múltiples se realiza caso por caso (considerando el historial previo y el perfil clínico) y de manera dependiente de los alérgenos. Aunque la mayor parte de las alergias alimentarias se limitan a una pequeña cantidad de posibles desencadenantes, estos alimentos son muy complejos al momento de evaluar su potencial alergénico. La posibilidad de fraccionar el alérgeno y entender algunos de sus componentes como potencialmente importantes para definir el riesgo de reacción clínica, reactividad cruzada o persistencia de la alergia, abrió una nueva era en el campo de la alergia, denominada alergia molecular. La identificación del componente alergénico responsable de las reacciones supone una herramienta importante para confirmar la información y gravedad de los síntomas,historia natural de la enfermedad, posibilidad de reactividad cruzada y clínica (marcadores de alergia).

Abstract In recent times, the primary approach to treating food allergies involved strict avoidance of the triggering allergen. Many considered this approach as lacking true treatment, leaving patients vulnerable to even small amounts or hidden sources of the allergenic food. Desensitization or Oral Tolerance Induction (OTI) is a studied method aiming for a lasting tolerance to the allergen. The ultimate goal is permanent tolerance, where allergic reactions won't reoccur after new exposure to the triggering allergen, following a period of abstinence. The research mainly focuses on allergen-specific immunotherapy, covering three routes: oral, sublingual, and epicutaneous immunotherapy. Milk, egg, and peanuts are the extensively studied foods due to their prevalence in allergies. The oral route is favored for inducing tolerance because ingestion of a food antigen by a non-allergic individual triggers an active immune response without causing an allergic reaction. The paradigm has shifted from recommending avoidance to early consumption strategies to prevent allergies. The period from 4 to 6 months of age is considered immunologically sensitive, where children with risk factors show increased allergic sensitization risk. Implementing these recommendations, considering family and community preferences, may reduce the burden of food allergies and healthcare costs.

Resumen Hasta hace poco, el enfoque principal para tratar las alergias alimentarias implicaba evitar estrictamente el alérgeno desencadenante. Este método a menudo se consideraba insuficiente, lo que dejaba a los pacientes vulnerables a pequeñas cantidades o fuentes ocultas del alérgeno. La desensibilización, o inducción de tolerancia oral, es un método emergente que se está investigando para el tratamiento de las alergias alimentarias. El objetivo final es conseguir una tolerancia permanente, previniendo reacciones alérgicas tras una nueva exposición al alérgeno tras un periodo de abstinencia. La investigación se ha centrado en la inmunoterapia con alérgenos específicos a través de tres vías: oral, sublingual y epicutánea. La leche, el huevo y el maní son los principales alimentos estudiados debido a su prevalencia en las alergias. Se prefiere la inducción oral porque la ingestión de una persona no alérgica induce una respuesta inmune sin desencadenar una reacción alérgica. La atención de pacientes se ha desplazado de evitar el alergeno a ofrecer estrategias de consumo temprano para prevenir las alergias. En este enfoque se considera crucial el rango de edad de 4 a 6 meses. Se necesita investigación continua para evaluar los detalles de la población, los efectos a largo plazo, la viabilidad y la seguridad de estas estrategias.

Abstract Food allergens are capable of producing adverse reactions through multiple mechanisms of an allergicor non-allergic nature, and through different routes of exposure; generally by ingestion or contact, as in protein contact dermatitis or contact urticaria, including inhalation. Food allergy reactions, in turn, can be mediated by immediate hypersensitivity mechanisms, delayed hypersensitivity or mixed immediate-delayed mechanisms. The reference diagnostic method in food allergy is the double-blind placebo-controlled food challenge test (DBPCFC), but skin and serological tests are important in the clinical context. The diagnosis of immediate food allergy depends on well-standardized allergological tests, such as the skin prick test (SPT) or specific IgE dosing, which are ideally tested by food challenge testing. However, the diagnosis of delayed mechanism food allergy and mixed allergies, which combine both immune mechanisms, is more complex. Delayed hypersensitivity reactions are evaluated with the epicutaneous patch test, or patch testing, for the diagnosis of contact dermatitis. The atopy patch test is initially used for the investigation of inflammatory reactions, which may be linked to food allergens in patients with atopic dermatitis. It was later applied in other diseases, whose pathogenesis is mainly mediated by a mechanism of delayed hypersensitivity to protein allergens: eosinophilic esophagitis, enterocolitis induced by food proteins, protein contact dermatitis, contact urticaria, among other disorders.

Resumen Los alergenos alimentarios son capaces de producir reacciones adversas por múltiples mecanismos de naturaleza alérgica o no, y mediante distintas vías de exposición; generalmente por ingestión o por contacto, como en la dermatitis por contacto a proteínas o urticaria por contacto, incluso por inhalación. Las reacciones de alergia alimentaria, a su vez, pueden ser mediadas por mecanismos de hipersensibilidad inmediata, hipersensibilidad retardada o mecanismos mixtos inmediato-retardados. El método diagnóstico de referencia en alergia alimentaria es la prueba de desafío con alimentos a doble ciego controlado con placebo (DBPCFC), pero las pruebas cutáneas y serológicas son importantes en el contexto clínico. El diagnóstico de alergia alimentaria inmediata depende de pruebas alergológicas bien estandarizadas, como la prueba de prick (skin prick test-SPT) o la dosificación de IgE específica, que idealmente se comprueban mediante la prueba de provocación con alimentos. Sin embargo, el diagnóstico de alergia alimentaria de mecanismo retardado y alergias mixtas, que combinan ambos mecanismos inmunes, resulta más complejo. Las reacciones de hipersensibilidad retardada se evalúan con la prueba de parche epicutáneo, o patch testing, para el diagnóstico de las dermatitis por contacto. La prueba de parche de atopia se utiliza, inicialmente, para la investigación de reacciones inflamatorias, que pueden vincularse con alergenos alimentarios en pacientes con dermatitis atópica. Posteriormente fue aplicada en otras enfermedades, cuya patogenia es principalmente mediada por un mecanismo de hipersensibilidad retardada a alérgenos proteicos: esofagitis eosinofílica, enterocolitis inducida por proteínas alimentarias, dermatitis por contacto a proteínas, urticaria por contacto, entre otras alteraciones.

Abstract The most effective method for diagnosing food allergy is the clinical history, which includes anamnesis and physical examination. The anamnesis must include a directed and detailed questioning, and together with the physical examination, it will provide the necessary data to guide the diagnosis and suggest whether the pathophysiology is mediated or not by IgE, which is relevant for the selection and interpretation of the tests. specific and establish the accurate diagnosis, in addition to evaluating the possibility of distinguishing between the different differential diagnoses. It is important to assess the clinical history, because no in vivo or in vitro test is relevant if it is not confirmed with it. Even if there is a strong history of food allergy detected in the history, positive tests can confirm the diagnosis without the need for oral challenge, thus avoiding the risk and cost of performing it. The expression of food allergy is influenced by non-modifiable risk factors that include sex, race and genetics (familial), and modifiable factors: atopic dermatitis, vitamin D deficiency, diet high in polyunsaturated fats and deficient in antioxidants, consumption of antacid drugs, obesity, increased hygiene, influence of the microbiota, time and route of food exposure (increased risk by delaying oral ingestion of allergens and concomitant environmental exposure of the same that leads to sensitization and allergy).

Resumen El método más efectivo para el diagnóstico de alergia alimentaria es la historia clínica, que comprende la anamnesis y el examen físico. La anamnesis debe incluir el interrogatorio dirigido y detallado, y junto con el examen físico aportarán los datos necesarios para orientar hacia el diagnóstica, y sugerir si la fisiopatología es mediada o no por IgE, lo que es pertinente para la selección e interpretación de las pruebas específicas y establecer el diagnóstico certero, además de evaluar la posibilidad de distinguir entre los distintos diagnósticos diferenciales. Es importante valorar la historia clínica, porque ninguna prueba in vivo o in vitro tienen relevancia de no ser confirmados con la misma. Incluso si existe un fuerte antecedente de alergia alimentaria detectado en la anamnesis, las pruebas positivas pueden confirmar el diagnóstico sin necesidad del desafío oral, y de esta forma evitarse el riesgo y costo de su realización. La expresión de la alergia alimentaria está influenciada por factores de riesgo no modificables que incluyen sexo, raza y genética (familiares), y factores modificables: dermatitis atópica, deficiencia de vitamina D, dieta con alta cantidad de grasas poliinsaturadas y deficiente de antioxidantes, consumo de fármacos antiácidos, obesidad, aumento de la higiene, influencia de la microbiota, tiempo y vía de exposición de los alimentos (mayor riesgo al retrasar la ingestión oral de alérgenos y concomitante exposición ambiental de los mismos que conduce a sensibilización y alergia).

Abstract Food allergy is a common chronic disorder that affects infants, children, adolescents, and adults. The prevalence of food allergy has increased in recent decades throughout the world, not limited to Western countries. Since there is no treatment, this focuses on avoiding allergens, in addition to educating patients and caregivers in the emergency treatment of acute reactions, for example: application of epinephrine. Studies suggest that accidental reactions occur in about 45% of children with food allergies each year, although most reactions are mild or moderate in severity. Hospital admissions for food anaphylaxis vary from 4 to 20 per 100,000 inhabitants; Deaths are rare, with an estimated incidence of 0.03 to 0.3 per million people with food allergy. Death from food anaphylaxis is rare and appears to have remained stable, possibly due to increases in food allergen labeling, diagnostic services, rates of intramuscular epinephrine prescription, and awareness of food allergies. Omalizumab is a drug approved for several disorders (chronic hives or difficult asthma) and may help reduce symptoms associated with food allergy. The relative importance of alternative technologies, management strategies and policies for food allergy varies from one region to another, due to differences in the epidemiology, education, socioeconomic well-being, and cultural preferences of the population.

Resumen La alergia alimentaria es un trastorno crónico frecuente que afecta a lactantes, niños, adolescentes y adultos. La prevalencia de alergia alimentaria se ha incrementado en las últimas décadas en todo el mundo, sin limitarse a los países occidentales. Puesto que no existe ningún tratamiento, éste se centra en evitar los alergenos, además de la educación de pacientes y cuidadores en el tratamiento de urgencia de las reacciones agudas, por ejemplo: aplicación de epinefrina. Los estudios sugieren que las reacciones accidentales ocurren en alrededor del 45% de los niños con alergia alimentaria cada año, aunque la mayor parte de las reacciones son de gravedad leve o moderada. Los ingresos hospitalarios por anafilaxia alimentaria varían de 4 a 20 por cada 100,000 habitantes; las muertes son raras, con una incidencia estimada de 0.03 a 0.3 por cada millón de personas con alergia alimentaria. La muerte por anafilaxia alimentaria es rara y parece haberse mantenido estable, posiblemente por el aumento en el etiquetado de alérgenos alimentarios, los servicios de diagnóstico, las tasas de prescripción de epinefrina intramuscular y la concienciación acerca de alergias alimentarias. Omalizumab es un fármaco aprobado para varias alteraciones (urticaria crónica o asma difícil) y puede ayudar a reducir los síntomas asociados con la alergia alimentaria. La importancia relativa de las tecnologías alternativas, las estrategias de gestión y las políticas para la alergia alimentaria varía de una región a otra, debido a las diferencias en la epidemiología, educación, bienestar socioeconómico y preferencias culturales de la población.

RESUMO Introdução/enquadramento/objetivos: A “Asma do Padeiro” é um tipo de asma ocupacional frequente na indústria da panificação, relacionada com a inalação de alergénios presentes no ambiente de trabalho. É uma doença que produz elevadas taxas de absentismo e incapacidade temporária (“baixa médica”). Este estudo objetivou agregar informação acerca da presença de alergénios presentes no setor da panificação que podem desencadear asma ocupacional, com o intuito de potenciar a intervenção dos serviços de saúde ocupacional. Metodologia: Foi realizada uma revisão da literatura, onde foram incluídos estudos encontrados nas bases de dados online SciELO.Org, RCAAP, CINAHL, MEDLINE e MedicLatina, com pesquisa realizada entre janeiro e março de 2022, com as palavras-chave “Baker”, “Occupational Asthma” e “Allergens”. Foram definidos como critérios de inclusão os artigos de texto integral publicados nos últimos cinco anos, em inglês, português ou espanhol. A questão protocolar desta revisão é: “Quais os alergénios suscetíveis de desencadear asma ocupacional na área da panificação, bem como os comportamentos preventivos a adotar?”. Conteúdo: A asma do padeiro é um dos tipos mais comuns de asma de origem profissional associada à exposição ao pó da farinha e aos alergénios contidos na mesma. A exposição persistente a alergénios transportados pelo ar pode resultar na iniciação ou agravamento da asma, bem como sintomatologia ocular e/ou nasal. Verifica-se uma forte relação entre asma ocupacional e os trabalhadores expostos ao pó de farinha de cereais, bem como alguns comportamentos adotados pelos trabalhadores da panificação, como fatores de risco. São identificados como principais alergénios aqueles que estão presentes no pó das farinhas de trigo, centeio, cevada, milho, aveia e soja, bem como o ovo, leite, trigo sarraceno, sementes de sésamo, frutos secos e leveduras presentes no fermento, como potenciadores do desenvolvimento de asma ocupacional no setor da panificação. Conclusões: A revisão sobre os alérgenos e asma ocupacional é importante para a saúde dos trabalhadores que inalam continuamente o pó da farinha. É importante a identificação dos alérgenos que causam asma do padeiro, pois pode ajudar a melhorar o diagnóstico e os tratamentos desta doença e programas de prevenção. As intervenções no local de trabalho, através da introdução de medidas preventivas (incluindo proteção individual e coletiva), educação para a saúde e treino adequado dos trabalhadores, destinadas a reduzir a exposição aos alergénios, contribuem para reduzir a incidência de asma ocupacional.

ABSTRACT Introduction/framework/objectives: “Baker’s Asthma” is a common type of occupational asthma in the bakery industry, related to the inhalation of allergens present in the work environment. It is a disease that produces high rates of absenteeism and temporary unfit for duty (sick leave). This study aimed to gather information about the presence of allergens present in the bakery sector that can develop occupational asthma, with the aim of potenciate the intervention by occupational health services. Methodology: A literature review was carried out, including studies found in the online databases SciELO.Org, RCAAP, CINAHL; MEDLINE and MedicLatina, with research carried out between January and March 2022, with the keywords “Baker”, “Occupational Asthma” and “Allergens”. Full text articles published in the last five years, in English, Portuguese or Spanish, were defined as inclusion criteria. The protocol issue of this review is: “What are the allergens likely to trigger occupational asthma in the bakery area, as well as the preventive behaviors to be adopted?”. Results: Baker's asthma is one of the most common types of occupational asthma associated to exposure to flour dust and the allergens contained in it. Persistent exposure to airborne allergens may result in the initiation or worsening of asthma, as well as ocular and/or nasal symptoms. There is a strong relationship between occupational asthma and workers exposed to cereal flour dust, as well as some behaviors adopted by bakery workers as risk factors. The main allergens are those present in the dust of wheat, rye, barley, corn, oat and soy flours, as well as eggs, milk, buckwheat, sesame seeds, nuts and yeasts present in yeast as enhancers of the development of occupational asthma in the bakery sector. Conclusions: The review of allergens and occupational asthma is important for the health of workers who continually inhale flour dust. It is important to identify the allergens that cause baker's asthma, as it can help to improve the diagnosis and treatments of this disease and prevention programs. Workplace interventions, through the introduction of preventive measures (including individual and collective protection), health education and adequate training of workers, aimed at reducing exposure to allergens, contribute to reduce the incidence of occupational asthma.

Resumen Introducción: La normativa existente que obliga a los establecimientos alimentarios a reflejar en el etiquetado la información sobre la presencia de alérgenos de declaración obligatoria no consigue evitar que puedan producirse reacciones adversas accidentales en los consumidores susceptibles. Por ello, en este trabajo se revisa la normativa europea existente en materia de alérgenos y se analizan las causas por las que sigue habiendo alertas sanitarias de alérgenos no declarados, proponiéndose posibles soluciones para solventar este problema. Método: Se ha llevado a cabo una investigación documental desarrollada en cinco etapas. Para ello, se recopiló literatura publicada hasta noviembre de 2022. Resultados: El Reglamento 1169/2011 sobre la información alimentaria facilitada al consumidor establece las normas de etiquetado aplicables a los alérgenos contenidos en los productos. En su artículo 36, una de las informaciones alimentarias voluntarias a incluir es la posible presencia no intencionada en el alimento de sustancias o productos que causen alergias o intolerancias, también conocido como etiquetado precautorio de alérgenos (EPA). Tanto la confusión que existe alrededor del uso del EPA, como la compleja estructura de la cadena alimentaria y, en algunos casos, la formación deficiente del personal, pueden aumentar el riesgo poner en el mercado productos inseguros al alcance de personas susceptibles. Conclusiones: Se considera conveniente intensificar la formación de los trabajadores de cualquier establecimiento alimentario y realizar actos de ejecución que regulen el EPA.

Abstract Introduction: Existing regulations requiring food establishments to label on the presence of mandatory declaration allergen fail to prevent accidental adverse reactions from occurring in susceptible consumers. Therefore, this paper reviews the existing European legislation on allergens and analyses the reasons why health alerts for undeclared allergens continue to occur, proposing possible solutions to solve this problem. Method: Documentary research was carried out in five stages. For this purpose, literature published up to November 2022 was collected. Results: Regulation 1169/2011 on the provision of food information to consumers sets out the labelling rules applicable to allergens contained in products. In its article 36, one of the voluntary food information to be included is the possible unintended presence in the food of substances or products causing allergies or intolerances, also known as precautionary allergen labelling (PAL). Confusion surrounding the use of PAL, the complex structure of the food chain and, in some cases, poorly trained staff all can increase the risk of placing unsafe products on the market within the reach of susceptible people. Conclusions: It is considered appropriate to intensify the training of workers in all food establishments the PAL.

ABSTRACT: Allergic dogs are commonly sensitized to food allergens. We evaluated the use of the prick test to diagnose food allergies in dogs with pruritus and the efficacy of an exclusion diet based on the test. The prick test was performed in 10 healthy dogs and 34 dogs with pruritus, of which 25 received an exclusion diet for 60 days and was challenged with positive food on the test. pVAS and CADESI-4 were assessed on days 0, 30, and 60 after re-exposure. As a result, two control group dogs reacted to a single food allergen, milk and wheat. Of the 25 dogs with pruritus that reacted to food allergens, 24 (96%) reacted to more than one food allergen, and only one (4%) reacted to a single food protein: pork. In the test group (n=25), there was a significant improvement of pVAS and CADESI-4 after 30 and 60 days of dietary exclusion, with significant worsening of the scores with food allergen challenge. In conclusion, the prick test can be used for screening food allergens to make an exclusion diet. ABSTRACT 1 3 2 6 CADESI4 CADESI 4 CADESI- 0 reexposure. reexposure re exposure. exposure re-exposure result wheat 96% 96 (96% 4% (4% protein pork n=25, n25 n n=25 , (n=25) challenge conclusion 9 (96 (4 n2 n=2 (n=25 (9 ( n= (n=2 (n= (n

RESUMO: Cães alérgicos são comumente sensibilizados a alérgenos alimentares. Nós avaliamos o uso do teste de puntura para o diagnóstico de alergias alimentares em cães com prurido e a eficácia de uma dieta de exclusão baseada no teste. O teste de puntura foi realizado em 10 cães saudáveis e em 34 cães com prurido, dos quais 25 receberam uma dieta de exclusão por 60 dias e depois desafiados com o alimento que foi positivo no teste. pVAS e CADESI-4 foram realizados nos dias 0, 30, 60 e depois da reexposição. Como resultados, dois cães do grupo controle reagiram a um único alérgeno alimentar, leite e trigo. Dos 25 cães com prurido que reagiram aos alérgenos alimentares, 24 (96%) reagiram a mais de um alérgeno alimentar e apenas um (4%) reagiu a uma única proteína, que foi porco. No grupo teste (n=25), houve uma significativa melhora do pVAS e CADESI-4 depois de 30 e 60 dias de dieta de exclusão, com significante piora dos scores com o desafio alimentar. Como conclusão, o teste de puntura pode ser usado para selecionar alérgenos alimentares para fazer uma dieta de exclusão. RESUMO 1 3 2 6 CADESI4 CADESI 4 CADESI- 0 reexposição resultados trigo 96% 96 (96% 4% (4% proteína porco n=25, n25 n n=25 , (n=25) conclusão 9 (96 (4 n2 n=2 (n=25 (9 ( n= (n=2 (n= (n

Abstract Several studies have been carried out to expand the use of Ricinus communis L. castor bean (Ricinus communis L castor bean.). This oilseed finds appropriate conditions for its development in Brazil, with more than 700 applications. The main allergens of this plant are Ric c1 and Ric c3, that cross-react with various aeroallergens and food allergens such as peanuts, soybeans, corn, and wheat. This study aimed to determine the effect of mutations in Ric c3 amino acid residues known to affect IgE binding and allergy challenges. Based on the Ric c3 structure, B-cell epitopes, and amino acid involved in IgE binding, we produce recombinant mutant protein, mrRic c3, secreted from E. coli. Strategic glutamic acid residues in IgE-biding regions were changed by Leucine. The allergenicity of mrRic c3 was evaluated by determination of IgE, IgG1, and total IgG in immunized Balb/c mice and by degranulation assays of mast cells isolated from Wistar rats. The mrRic c3 presented a percentage of mast cell degranulation close to that seen in the negative control, and the immunization of mice with mrRic c3 presented lower levels of IgE and IgG1 than the group treated with the protein without mutations. The mutant mrRic c3 had an altered structure and reduced ability to stimulate pro-inflammatory responses and bind IgE but retained its ability to induce blocking antibodies. Thus, producing a hypoallergenic mutant allergen (mrRic c3) may be essential in developing new AIT strategies. bean.. bean. . bean.) Brazil 70 applications c crossreact cross react peanuts soybeans corn wheat challenges Bcell B epitopes E coli IgEbiding biding Leucine Balbc Balb rats control proinflammatory pro inflammatory antibodies Thus strategies 7

Resumo Vários estudos têm sido realizados para ampliar o uso da mamona Ricinus communis L. (Ricinus communis L), oleaginosa que encontra condições adequadas para seu desenvolvimento no Brasil com mais de 700 aplicações. Os principais alérgenos desta planta são Ric c1 e Ric c3 que apresentam reação cruzada com vários alérgenos dispersos no ar e alérgenos alimentares, como amendoim, soja, milho e trigo. Este estudo teve como objetivo determinar o efeito de mutações nos resíduos de aminoácidos, presentes, em epítopos ligantes de IgE, de Ric c3 envolvidos no desencadeamento de respostas alérgicas. Com base na estrutura de Ric c3, epítopos de células B, e aminoácidos envolvidos na ligação de IgE, produzimos, em E. coli. uma proteína mutante recombinante, denominada mrRic c3. Resíduos estratégicos de ácido glutâmico, presentes nestes epítopos, foram alterados por Leucina. A alergenicidade da proteína mrRic c3 foi avaliada pela determinação dos níveis séricos de IgE, IgG1 e IgG total em camundongos Balb/c imunizados com a proteína mutante e por ensaios de degranulação de mastócitos isolados de ratos Wistar. A proteína mrRic c3 promoveu um percentual de degranulação de mastócitos próximo ao observado no controle negativo e camundongos imunizados com mrRic c3 apresentou níveis de IgE e IgG1 menores que o grupo tratado com a proteína recombinante nativa. A mutante mrRic c3 apresentou estrutura alterada e capacidade reduzida de estimular respostas pró-inflamatórias e de se ligar a IgE, mas manteve sua capacidade de induzir anticorpos bloqueadores. Assim, a produção de um alérgeno mutante hipoalergênico (mrRic c3) pode ser uma etapa essencial no desenvolvimento de novas estratégias para a AIT. L L, , L) 70 aplicações c alimentares amendoim soja trigo alérgicas B produzimos E coli glutâmico Leucina Balbc Balb Wistar nativa próinflamatórias pró inflamatórias bloqueadores Assim AIT 7

Resumen Introducción: La información reciente sobre la prevalencia de sensibilización alérgica (SA) en niños de áreas urbanas de bajos recursos es limitada. Métodos: Se realizó un estudio transversal, aleatorio, a nivel poblacional, para determinar la prevalencia de SA y su relación con asma y rinitis en escolares de bajos recursos en Santiago de Chile. Los padres respondieron un cuestionario estandarizado de síntomas respiratorios y se realizaron pruebas cutáneas (PC) para alérgenos comunes en los niños. Resultados: En los 545 escolares estudiados (media de edad 8.3 ± 0.9 años) la prevalencia de PC positivas fue del 25.5%. La prevalencia actual de asma, rinitis y rinoconjuntivitis fue del 20%, 43.4% y 27.8%, respectivamente. Las PC fueron positivas en el 30.6%, 32.8% y 38.0% de los niños con síntomas actuales de asma, rinitis y rinoconjuntivitis, respectivamente. La rinitis y la rinoconjuntivitis se asociaron significativamente con PC positiva (p < 0.001), pero no el asma. La lactancia materna por al menos cuatro meses protegió significativamente contra SA (razón de momios [RM] 0.48, intervalo de confianza [IC] 95% 0.26-0.78; p = 0.008); ningún otro factor estudiado se asoció con SA. Conclusiones: La prevalencia de SA fue baja; menos del 40% de los niños con síntomas actuales de asma, rinitis o rinoconjuntivitis evidenció SA. La alta prevalencia de asma y rinitis no atópicas concuerda con hallazgos previos en niños de áreas urbanas de bajos ingresos. Otros factores ambientales como la alta carga de infecciones respiratorias y contaminación ambiental podrían ser más importantes que la atopia para el desarrollo de asma y rinitis en escolares de áreas urbanas desfavorecidas.

Abstract Background: Recent information on the prevalence of allergic sensitization (AS) in children from low-income urban areas is limited. Methods: We conducted a cross-sectional, randomized, population-based study to determine the prevalence of AS, and its relationship with asthma and rhinitis in low-income schoolchildren in Santiago, Chile. The parents answered a standardized questionnaire on respiratory symptoms, and a skin prick test (SPT) for common aeroallergens was performed on all children. Results: In the 545 schoolchildren studied (mean age 8.3 ± 0.9 years), the prevalence of positive SPT was 25.5%. The current prevalence of asthma, rhinitis, and rhinoconjunctivitis was 20%, 43.4%, and 27.8%, respectively. SPT was positive in 30.6%, 32.8%, and 38.0% of children with current asthma, rhinitis, and rhinoconjunctivitis, respectively. Positive SPT was significantly associated with rhinitis and rhinoconjunctivitis (p < 0.001) but not with asthma. Breastfeeding for at least 4 months was significantly protective against AS (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.26-0.78; p = 0.008); no other factor studied was associated with AS. Conclusions: The prevalence of AS was low; less than 40% of children with current asthma, rhinitis, or rhinoconjunctivitis symptoms evidenced AS. The prevalence of non-atopic asthma and rhinitis is consistent with previous findings in children from low-income urban areas. Other environmental factors, such as the high burden of respiratory infections and environmental pollution, might be more critical than atopy for developing asthma and rhinitis in schoolchildren from deprived urban areas.