Pediatric Allergy and Immunology最新文献

Background: Pollen food allergy syndrome (PFAS) primarily presents as oral allergy syndrome (OAS) with occasional systemic symptoms. Few studies have examined the systemic symptoms of PR-10-related PFAS, which are common among pediatric patients in Japan.

Methods: Two surveys were conducted to investigate the possibility of more severe patients in medical institutions and misdiagnoses among school children: one for patients diagnosed with PR-10-related PFAS at medical institutions and another for elementary and junior high school children whose parents completed an online questionnaire. We examined allergenic foods/symptoms, incidence of OAS, and systemic symptoms in PR-10-related PFAS patients allergic to Rosaceae fruits/soybeans.

Results: Among 221 patients with PR-10-related PFAS at medical institutions, 205 and 86 developed allergic symptoms to Rosaceae fruits and soybeans, respectively. The incidence of systemic symptoms was significantly higher in the soybean group (43/86, 50.0%) than in the Rosaceae fruits group (43/205, 21.0%) (p < .001). Among the 29,906 school children, 3309 (11.1%) responded; 202 were children with PR-10-related PFAS, 194 and 29 developed allergic symptoms to Rosaceae fruits and soybeans, respectively. The incidence of systemic symptoms was higher in the soybean group (12/29, 41.4%) than in the Rosaceae fruits group (46/194, 23.7%), although not significantly (p = .067).

Conclusion: Two surveys were conducted targeting patients with confirmed diagnoses and general students. The incidence of systemic symptoms associated with PR-10-related PFAS was similar at 20% for Rosaceae fruits and 40%-50% for soybeans in both surveys. Attention should be given to the potential for systemic symptoms in patients with PR-10-related PFAS.

Background: Severe combined immunodeficiency (SCID) is a fatal but treatable inborn error of immunity (IEI). Newborn screening (NBS) using T-cell receptor excision circles (TREC) has been adopted globally, with very few countries incorporating kappa recombination excision circles (KREC) to also detect early B-cell development disorders, such as X-linked agammaglobulinemia (XLA).

Objective: To evaluate the effectiveness of a 2-year pilot SCID NBS program in the Czech Republic, emphasising the utility of combined TREC/KREC screening.

Methods: Between January 2022 and December 2023, a dual TREC/KREC NBS pilot was conducted across the Czech Republic, alongside spinal muscular atrophy (SMA) screening. Approximately 200,000 newborns were screened using quantitative real-time PCR on dried blood spots collected 48-72 h after birth.

Results: The pilot referred 58 newborns, identifying 21 cases of IEI, including two SCID cases, with an overall incidence of TREC/KREC screenable IEI of 10.5/100,000 newborns. SCID incidence was 1/100,000. KREC screening proved invaluable, detecting 10 cases of congenital agammaglobulinemia including novel non-XLA forms, which increased the estimated incidence of agammaglobulinemia in the Czech Republic sixfold. Over one-third of low KREC results were linked to maternal immunosuppression.

Conclusion: The Czech pilot demonstrated the effectiveness of integrated TREC/KREC NBS in detecting both T- and B-cell immunodeficiencies. As of 2024, SCID and SMA screening are included in the nationwide NBS, with KREC screening significantly improving early detection of B-cell disorders.

Bronchiolitis is one of the leading causes of hospitalization among infants. Established risk factors include young age, prematurity, and exposure to tobacco smoke. Emerging evidence suggests that air pollution may also contribute to the burden of respiratory diseases. However, its link with bronchiolitis hospitalizations remains debated. To address this, we conducted a systematic review and meta-analysis to assess whether exposure to air pollutants is associated with an increased risk of hospitalization for bronchiolitis in infants. A systematic review and meta-analysis were conducted following the PRISMA guidelines. PubMed, Embase, and Web of Science were searched up to May 2024. Eligible studies examined the relationship between air pollutants and bronchiolitis hospitalizations in infants up to 2 years of age. Meta-analyses were performed to estimate the association between pollutant levels and hospitalization risk. Out of 788 identified studies, 23 met the inclusion criteria. Studies were heterogeneous regarding design, adjustment for confounders, and statistical approaches. Particulate matter with diameter ≤2.5 μm (PM_2.5) or ≤10 μm (PM₁₀) and nitrogen dioxide (NO₂) were the most studied pollutants, with positive associations found between short-, medium-, and long-term exposure and increased hospitalization risk. Meta-analyses showed a 2%-9% increase in hospitalization risk for exposure to PM_2.5, PM₁₀, and NO₂; however, statistical significance was reached only for short-term exposure to PM₁₀. In contrast, data on sulfur dioxide, carbon monoxide, ozone, and black carbon were sparse and inconsistent. PM_2.5, PM₁₀, and NO₂ are likely relevant risk factors for an increased risk of hospitalization for bronchiolitis in infants. Further research using a standardized approach is needed to clarify the role of other pollutants in bronchiolitis.

IgE-mediated food allergies are common and can be life-threatening, especially for children. With increasingly rapid advances in immunological technologies, including the ability to profile highly complex immune features from small sample volumes, our understanding of the immune mechanisms that underpin the development of food allergies continues to grow. This also extends to the immune mechanisms associated with the outcomes of oral immunotherapy (OIT). This review focuses on studies within the past 5 years related to immune signatures associated with food allergy in childhood, immune responses that determine reaction severities to offending allergens, immune alterations that occur during OIT in children, and immune effects of adjunct therapies including omalizumab, dupilumab, and abrocitinib. We conclude by providing a perspective on current evidence and directions for future research that will enable new prediction and screening tools and facilitate the development of effective curative strategies.

Background: Local anesthetics (LAs) are widely utilized to provide analgesia in minor surgical interventions. Although patients are frequently referred for suspected LA allergies in clinical practice, confirmed cases of immediate-type hypersensitivity remain rare. This study aims to establish an optimal diagnostic protocol for immediate-type LA allergy in children and to assess the practicality and reliability of an alternative diagnostic approach for hypersensitivity testing of amide-type local anesthetics.

Methods: The medical records of patients diagnosed with suspected immediate-type reactions to LAs administered by pediatric dentists between January 2019 and August 2024 were retrospectively reviewed. All children underwent a skin prick test (SPT), followed if negative by an intradermal test (IDT) at a 1:10 dilution. If intradermal testing was also negative, a subcutaneous provocation test was subsequently performed.

Results: A total of 88 patients (47 boys, 41 girls), with a mean age of 8.5 ± 3.5 years, were included. In most cases (n = 59, 67%), the suspected LA was unidentified. Among the known agents, articaine (n = 18, 20.5%) and lidocaine (n = 11, 12.5%) were the most frequently reported. IDT results were positive in 11 patients (12.5%), with articaine in 8 cases (61.5%), prilocaine in 3 cases (23%), and lidocaine in 2 cases (15.5%). Intradermal testing at a 1:10 dilution demonstrated a high negative predictive value (99%) for immediate-type reactions.

Conclusion: For the diagnosis of immediate-type LA allergy, including cases with a history of anaphylaxis, an IDT at a 1:10 dilution following a negative SPT, followed by subcutaneous provocation, may serve as a time-efficient and reliable diagnostic strategy.