Objectives Infants with cow's milk allergy (CMA) are in need of a substitute formula up to 2 years. The are three requisites for a substitute of milk in CMA: tolerability, nutritional adequacy, and cost-effectiveness. We evaluate here the tolerability of a new amino acid-based infant formula for the management of CMA. Methods In a phase III/IV prospective, multicentre, open-label, international study, infants and children with immunoglobulin E-mediated CMA were exposed to a diagnostic double-blinded, placebo-controlled food challenge with a new amino acid formula by Blemil Plus Elemental using Neocate as the placebo. If tolerant to it, the study formula was integrated into the patients' usual daily diet for 7 days. Efficacy on day 7 was assessed in terms of symptoms associated with CMA, amount of formula consumed, nutritional and energy intake, and anthropometric data. Results Thirty children (17 M and 13 F; median age, 1.58; range, 0.08-12.83 years) completed the open challenge and were able to consume the study formula for at least 7 days. No signs or symptoms of allergic reactions were recorded among children assuming either the test or the control formula, with a lower 95% one-sided confidence interval for the proportion of subjects who did not experience allergic reactions above 90%. Sixteen patient under the age of two continued with the optional extension phase. Conclusions The study formula meets the American Academy of Pediatric criteria for hypoallergenicity and is well tolerated in short-term use. During optional phase, growth of the patients was not hindered by the study formula.

To determine the number of early diagnoses of anaphylaxis and its causes during the years 2011 and 2012 in children up to 14 years-old. We performed a retrospective study of all registered diagnoses of anaphylaxis in our unit between 2011 and 2012 in children up to the age of 14. We included all patients who had anaphylaxis in these years, both new patients and follow-up visits. We found 41 patients in total, with an average age of 5 years and 11 months (2 months-14 years). 27 (66%) patients were boys and 14 (34%) patients were girls. In all cases of anaphylaxis, symptoms were due to one or several foods except one, which was due to an antibiotic (amoxicillin). The foods involved were nuts (15,36.6%), egg (8,19.5%), fruits (5,12.2%), LTP syndrome (3,7.3%), cow's milk proteins, vegetables and seafood (2,4.9%) and cereals, fish, goat and sheep milk, potatoes and mushrooms (1, 2.4%). When we reviewed the causes of anaphylaxis by age-group we found that in children under three years the most frequent cause was the egg followed by nuts, in children 3 to 6 years the most frequent cause were nuts and in children 6 to 14 years the causes were more varied. In 18 patients (43%) other allergic diseases were present (food allergy, respiratory allergy, atopic dermatitis and sensitizations without clinical symptoms). The most frequent symptoms were cutaneous symptoms associated with gastrointestinal clinic. The most frequent causes of anaphylaxis in our unit in the pediatric age are nuts and egg. The appearance of anaphylaxis is higher in children younger than 3 years and in males.

The data of the ISAAC project in Spain show a prevalence of childhood asthma ranging from 7.1% to 15.3%, with regional differences; a higher prevalence, 22.6% to 35.8%, is described for rhinitis, and atopic dermatitis is found in 4.1% to 7.6% of children. The prevalence of food allergy is 3%. All children in Spain have the right to be visited in the National Health System. The medical care at the primary level is provided by pediatricians, who have obtained their titles through a 4-yr medical residency training program. The education on pediatric allergy during that period is not compulsory and thus very variable. There are currently 112 certified European pediatric allergists in Spain, who have obtained the accreditation of the European Union of Medical Specialist for proven skills and experience in pediatric allergy. Future specialists in pediatric allergy should obtain their titles through a specific education program to be developed in one of the four accredited training units on pediatric allergy, after obtaining the title on pediatrics. The Spanish Society of Pediatric Allergy and Clinical Immunology (SEICAP) gathers over 350 pediatric allergists and pediatricians working in this field. SEICAP has a growing activity including yearly congresses, continued education courses, elaboration of technical clinical documents and protocols, education of patients, and collaboration with other scientific societies and associations of patients. The official journal of SEICAP is Allergologia et Immunophatologia, published every 2 months since 1972. The web site of SEICAP, http://www.seicap.es, open since 2004, offers information for professionals and extensive information on pediatric allergic and immunologic disorders for the lay public; the web site is receiving 750 daily visits during 2011. The pediatric allergy units are very active in clinical work, procedures as immunotherapy or induction of oral tolerance in food allergy, contribution to scientific literature, and collaboration in international projects.