Pediatric Allergy and Immunology最新文献

Background: Sesame allergy (SA) is a growing concern because of its association with severe reactions and the limited knowledge of long-term outcomes.

Objective: This retrospective study aimed to identify the risk factors influencing persistent SA (PSA) in children to improve management and select suitable candidates for oral immunotherapy (OIT).

Methods: We analyzed the electronic medical records of 84 children with confirmed SA, as defined by consistent clinical reactions and immunoglobulin E (IgE)-mediated sensitization. Patients were followed for a median (IQR) of 56.5 (46.0-82.5) months.

Results: Most participants were male (72.6%) with concurrent food allergies (71.4%). They experienced a median (IQR) of 3.0 (2.0-3.7) allergic episodes, with 46.4% experiencing at least one anaphylactic reaction. PSA was observed in 82.1% (69/84) of the patients. A larger skin prick test (SPT) wheal size at the first reaction (adjusted OR = 1.79, CI:1.05-3.04; p = .03) and allergic reaction grade≥2 (adjusted OR = 19.93, CI:1.37-289.13; p = .02) were independent risk factors for persistence. A 3-fold increase in the likelihood of persistence was observed in patients with SPT results greater than 6.7 mm at first reaction compared with those with results less than 6.7 mm during follow-up (HR = 3.08; CI:1.17-8.12; p = .02). Patients with sustained or increased SPT wheal size (93% remained allergic) and specific IgE (95% remained allergic) at the final visit were more likely to have PSA, whereas those with decreased levels (37% and 39% developed natural tolerance, respectively) were less likely to have resolved SA.

Conclusions: This study identified novel risk factors for PSA, including SPT wheal size at the first reaction, reaction severity, and sustained sensitization markers. These findings can inform management strategies and the selection of OIT candidates. Further long-term studies are crucial to elucidate the natural history of SA across populations and to evaluate early interventions, such as OIT.

This systematic review updated the available evidence on the effectiveness and safety of probiotics as treatment of food allergy among pediatric patients. We conducted a systematic search for all randomized controlled trials available until March 13, 2024 that evaluated the effectiveness and safety of probiotics for treating pediatric food allergy. Two authors independently conducted the search, screening, and data extraction. Data analysis and synthesis were done using Review Manager 5.4 software. We included 13 articles involving 1608 pediatric patients with food allergy. Probiotics probably has no effect on reducing eczema scores among infants with CMA (MD -1.29 points, 95% CI -4.14, 1.56; moderate certainty of evidence), based on two studies. Probiotics may reduce eczema scores for children with various types of allergy (MD -23.08 points, 95% CI -27.55, -18.61; low certainty of evidence), based on one study. It is uncertain whether probiotics may lead to tolerance acquisition among infants with CMA (RR 0.58, 95% CI 0.34, 1.00) due to very low certainty of evidence. Subgroup analysis based on time period showed significant benefit in inducing tolerance after at least 2 years (RR 0.44, 95% CI 0.29, 0.67; moderate certainty of evidence), suggesting a duration-dependent effect of probiotic usage. Subgroup analysis by probiotic preparation showed significant benefit for the LGG strain (RR 0.41, 95% CI 0.28, 0.62). Probiotics were generally well tolerated by the study participants. Further well-designed RCTs focusing on specific types of food allergy, as well as the use of standardized probiotic strains, outcome measurement, and longer follow-up periods are needed to draw clinically relevant conclusions on the role of probiotics in treating children with food allergy.

Background: We aimed to investigate the association between maternal caffeine intake during pregnancy and asthma in children by 10 years of age.

Methods: We considered 5585 mother-child pairs enrolled in a population-based birth cohort. Consumption of regular and decaffeinated coffee, black and green tea, and cola beverages before and during pregnancy was obtained through face-to-face interviews within 72 h after giving birth, and total caffeine intake (mg/day) was estimated. Medical diagnosis of asthma was assessed and spirometry with bronchodilation was performed at 10 years of age. We used adjusted regression models to estimate the association between the caffeine intake/day during pregnancy with asthma by 10 years of age, and a quadratic relationship was verified between them. Consumption of caffeine before pregnancy, gestational age, maternal years of schooling, maternal self-reported medical diagnosis of asthma, smoking status before and during pregnancy, and children's sex were considered as confounders. We used nonlinear least squares models to estimate the knot point and its respective confidence interval (CI).

Results: A higher intake of caffeine/day decreased the odds of having childhood asthma at 10 years of age (adjusted odds ratio [OR] = 0.60, 95% CI: 0.41; 0.88). The estimated knot point was 92.7 mg of caffeine/day (95% CI: 36.3, 163.3), where the risk was 7.2%, while for no intake (0 mg) the risk was 8.8%.

Conclusion: Maternal caffeine intake up to an estimated intake of approximately 93 mg/day during pregnancy decreased childhood asthma risk by 10 years of age. Nonetheless, further studies are required to confirm our results.

Key message: Maternal caffeine intake during pregnancy up to an estimated intake of approximately 93 mg/day decreased the risk of asthma in children by 10 years of age, but considering caffeine's potential adverse effects on other health outcomes, further studies are needed to explore its link to childhood asthma.

Background: Type 1 regulatory T (Tr1) cells are critical players in maintaining peripheral tolerance, by producing high IL-10 levels in association with inducible T-cell co-stimulator (ICOS) expression. Whether these cells play a role in naturally acquired baked egg tolerance is unknown.

Objectives: Evaluate frequencies of egg-responsive Tr1 and Th2 cells in egg-allergic children that naturally acquired baked egg tolerance (BET) versus non-egg-allergic (NEA) children.

Methods: Peripheral blood mononuclear cells from 70 natural BET and 15 NEA children were stimulated for 7 days with ovalbumin and ovomucoid. By flowcytometry, egg-responsive Tr1 cells were identified by co-expression of CD49b and LAG3, and Th2 cells by expression of CD49b but absence of LAG3. Seven-day cultured supernatant was analyzed for Th1, Th2, Tr1, and Th17 cytokines by MSD.

Results: Natural BET children had a higher percentage of egg-responsive Th2 cells vs. NEA children (6.75% vs. 10.35%, p = .006). No significant difference was found in frequencies of egg-responsive Tr1 cells between NEA and natural BET children (11.40% vs. 12.55%, p = .42), although Tr1-related IL-10 and IL-21 production was higher in BET children. Interestingly, egg-responsive Tr1 cells from NEA children expressed higher ICOS levels vs. natural BET children (97.90 vs. 88.20, p < .0001). Supernatant from natural BET children showed elevated levels of Th2 cytokines IL-5, IL-9 and IL-13 and Th17 cytokine IL-17A.

Conclusion: Natural BET children maintain increased egg-specific Th2 responses, along with comparable proportions of egg-responsive Tr1 cells exhibiting higher IL-10 but lower ICOS expression in comparison with NEA children.