ALLERGY

There are many references to allergic reactions to drugs and in particular to antibiotics on Medline and Pubmed and also to pancreatic extracts.

1976 Warner JO, Taylor BW, Norman AP, Soothill JF. Association of cystic fibrosis and allergy. Arch Dis Child 1976; 51:507-11. [PubMed]
A number of previous studies had shown an increased prevalence of atopy in people with cystic fibrosis. In this study from London this association was confirmed. Immediate skin hypersensitivity was present in 59% of 123 children with CF – a much higher incidence than normal. Also atopy was more frequent in the obligate heterozygotes. Allergic children with CF tended to have a worse respiratory state. The authors suggested that the increase in allergy possibly was related to impaired handling of antigen at mucosal surfaces.
One of many studies on allergy and cystic fibrosis which never seemed to have a great influence on clinical management - other than the reactions to Aspergillus fumigatus.

1977 Sakula A. Bronchial asthma due to allergy to pancreatic extract: a hazard in the treatment of cystic fibrosis. Brit J Dis Chest 1977; 1:295-299. (not abstracted in "Seventies"). [PubMed]
Mother of two children with CF developed allergic respiratory symptoms and severe asthma due to powder released when capsules were opened.

1977 Twarog FJ. Weinstein SF. Khaw KT. Strieder DJ. Colten HR. Hypersensitivity to pancreatic extracts in parents of patients with cystic fibrosis. J Allergy & Clin Immunol 1977; 59:35-40. (not abstracted in "Seventies"). [PubMed]

1986 Ferguson A, Merrett TG, Littlewood JM, Bolderson I. IgE antibodies to foods are not a feature of cystic fibrosis. Human Nutrition - Clinical Nutrition 1986; 40:255-258. [PubMed]
It had been suggested that patients with cystic fibrosis have abnormal immune responses to foods. In collaboration with Dr Anne Ferguson of Edinburgh, we measured IgE antibodies to inhalants and foods (by RAST) in 105 patients with cystic fibrosis aged between eight months and 28 years. Serum IgE was elevated (greater than 180 kU/l) in 21 (20%) patients. In 43, (41%) IgE antibodies were detected in serum. The majority of positive results were with house-dust mite, grass pollen or Aspergillus. Only four of the patients had a positive RAST to a food - one to milk, one to wheat and two to egg. On the basis of high serum IgE or positive RAST results, 44.8 per cent of the patients were atopic and the frequency of atopy was age-related, being higher in patients aged four years or more. However, the presence of food antibodies was unrelated to age.

This study confirms the high prevalence of atopy in patients with cystic fibrosis but unequivocally demonstrates that the presence of IgE antibodies to foods in their serum is rare. Of course, we had previously observed that many children with quite obvious clinical food intolerance (proved by withdrawal and challenge) have neither positive skin tests nor raised IgE levels nor positive RAST to foods (Minford AMB et al. Food intolerance and food allergy in children: a review of 68 cases. Arch Dis Child 1982; 57:742-747). [PubMed]

1987 Lipkin GW. Vickers DW. Allergy in cystic fibrosis nurses to pancreatic extract. Lancet. [PubMed]
Letter reporting allergic reactions in nurses giving pancreatic extracts to children with CF on our ward in Leeds.

1998 Chamarthy, L M. Reinstein, L J. Schnapf, B. Good, R A. Bahna, S L. Desensitization to pancreatic enzyme intolerance in a child with cystic fibrosis. Pediatrics 1998; 102:e13. [PubMed]
At 29 months of age, a girl with CF developed diarrhea with bulky stools and weight loss. A fecal fat 72-hour study revealed a coefficient of absorption of 50%. She was treated with Pancrease MT 16, but had consistent vomiting 1 to 2 hours after administration of enzymes. The vomiting occurred on switching to different pancreatic enzymes preparations i. e. Creon 10, Viokase, and Pancrease MT 16. Vomiting occurred even with small doses of enzymes disguised in food. She had no vomiting on days when enzymes were not given. She was gradually desensitized with small doses of pancrease MT 16 to tolerate one capsule per meal.