[Habitual vomiting due to dust mite allergy. A case report].
It has been demonstrated that: a) part of the inhalant allergenic particles we normally breath, adhere to the oropharyngeal mucosa, and eventually progress to the gastrointestinal tract; b) digestive tract mucosa is able to produce specific IgE against aeroallergens even before than respiratory tract mucosa. The case is described of a 5-year-old girl who presented a daily vomiting since she was 6 months. All clinical instrumental and laboratory findings had been unable to reach a definite diagnosis. SPT (inhalants and foods): Dermatoph. pteronyssinus: + (confirmed by RAST). The patient had an immediate, complete recover just following the clinician's instruction for HDM domestic prevention. Symptoms appeared again in response to a NPT performed with Dermatophagoides extract. The positivity of the exclusion-re-exposure test confirmed the diagnosis of HDM-induced gastrointestinal allergic syndrome, so far not described in literature (to my knowledge). Immunological considerations: since it is known that patients allergic to HDM do not usually present a specific IgE-mediated gastrointestinal allergic syndrome, it is suspectable that an immunological tolerance can be instaured toward inhalant allergens as it normally happens toward food allergens. In atopic individuals there is a high expression of ICAM-1, VCAM-1 and other adhesion molecules on the surface of HEV at BALT level. Adhesion molecules expression and immunocompetent cells activation are modulated by several mechanisms among which the cytokine network plays a major role. The author speculates that sensitized lymphocytes may migrate from intestinal to bronchial mucosa, via lymphocytic immunoallergic competence. In the described clinical case this mechanism did not work.
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IIa Divisione di Pediatria, Ospedale Pausilipon, Napoli.
D000818:Animals; D002675:Child, Preschool; D002908:Chronic Disease; D004391:Dust / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008925:Mites / Q000276:immunology*; D012130:Respiratory Hypersensitivity / Q000150:complications* / Q000209:etiology / Q000517:prevention & control; D012882:Skin Tests; D014839:Vomiting / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control
D004391:Dust
Vomito abituale da allergia agli acari della polvere. Considerazioni su di un caso.