Pediatric Allergy and Immunology最新文献

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: Recently, partially myristoylated carboxymethyl chitosan (PMCMC) was developed in Japan. To compare the efficacy and safety of PMCMC-containing emulsion and petrolatum, we conducted a randomized controlled trial.

Methods: Eligible patients were children aged 1-<6 years who had mild atopic dermatitis (with Eczema Area and Severity Index [EASI] ≤7.0). Participants were randomly assigned (1:1) to receive PMCMC-containing emulsion or petrolatum. Study treatments were applied to the body twice daily for 8 weeks. The co-primary endpoints were the changes in EASI and total score of Quality of life in Primary Caregivers of children with Atopic Dermatitis (QP-CAD) from baseline to the end of the treatment.

Results: Between February 2020 and August 2022, 80 participants (39, emulsion group; 41, petrolatum group) were enrolled and included in the analysis. The decrease in EASI at the end of the treatment was greater in the emulsion group than in the petrolatum group with the LS mean (SE) change of -0.74 (0.31) in the emulsion group and 0.29 (0.31) in the petrolatum group (difference -1.02, 95% CI -1.90 to -0.15; p = .022). The decrease in total QP-CAD was also greater in the emulsion group than in the petrolatum group with the LS mean (SE) change of -1.63 (1.08) and 1.55 (1.01), respectively (difference -3.18, 95% CI -6.13 to -0.22; p = .035). All adverse events in the emulsion group were mild.

Conclusion: PMCMC-containing emulsion significantly improved disease severity of children and quality of life of caregivers compared with petrolatum.

Trial registration: https://jrct.mhlw.go.jp/-number: jRCTs031190201.

Background: Longitudinal studies on allergic rhinitis (AR) incidence and remission from childhood to adulthood are limited. This study aimed to estimate AR incidence and remission from age 8 to 19 years and to identify related risk factors.

Methods: In 2006, all children in grades 1 and 2 (median age 8 years) in three municipalities in Northern Sweden were invited to participate in a questionnaire survey. The children in two of the municipalities underwent a skin prick test (SPT) for airborne allergens. The protocol was repeated at age 19 years. In total, 2250 participants (91% participation rate) completed the questionnaire, and 1338 underwent SPTs at 8 and 19 years of age.

Results: From age 8 to 19 years, the cumulative incidence of AR was 33.6%, significantly higher among girls than boys (37.4% vs. 29.8%, p < .001). Factors that independently increased the risk of developing AR were sensitisation by age 8 (adjusted odds ratio [aOR] 3.75, 95% confidence interval [CI] 2.68-5.23), sensitisation between 8 and 19 years (aOR 2.57, 95% CI 1.82-3.63), and female sex (aOR 1.71, 95% CI 1.30-2.26). The remission rate was 40.0%, with boys experiencing significantly higher remission than girls (45.4% vs. 32.2%, p = .015). The probability of remission was decreased by sensitisation before (aOR 0.26, 95% CI 0.13-0.53) and after age 8 years (aOR 0.20, 95% CI 0.05-0.77).

Conclusion: This study found a high incidence of AR between age 8 and 19 years, especially among girls, while boys had a higher remission rate. Sensitisation increased the risk of developing AR and decreased the remission rate.

Egg allergy represents a significant and growing health concern, particularly among young children. Consequently, there has been a surge in the development of management strategies to address this issue. While oral immunotherapy presents a promising novel approach, its resource-intensive nature renders it impractical in many countries. This review aims to contrast the traditional method of strict avoidance with emerging, cost-effective alternatives for managing egg allergy at home, such as the gradual introduction via a ladder approach. Studies were identified through the search of medical databases and gray literature, with a focus on studies spanning from 2003 to 2023. Studies were independently screened and appraised by two independent reviewers. One hundred and thirty-four articles were identified. After removing duplicates and screening, 49 underwent full-text review, resulting in 28 included articles. These encompassed various study designs and originated from multiple countries, primarily the USA, Australia and Canada. The interventions mainly focused on managing IgE-mediated egg allergy through graded exposure to denatured/baked egg (n = 20), with an additional six studies exploring allergen avoidance and two studies investigating both management methods. A key observation from this review is the shift in management strategies towards incorporating methods such as graded exposure to denatured/baked egg alongside traditional allergen avoidance methods. Allergen avoidance remains the cornerstone of egg allergy management. However, there is a need for complementary approaches to optimise outcomes for individuals with egg allergy. Factors such as quality of life, including social inclusion and dietary diversity, as well as economic implications are crucial considerations.

Background: Food allergy (FA) is one of the most common chronic conditions in children. Diagnostic delays and errors in FA are relevant problems in clinical practice. Non-invasive and accessible tools for FA diagnosis are highly required. We aimed to develop an easy-to-use clinical score to facilitate the diagnostic approach for pediatric FA (i.e. the NAPFA score).

Methods: Subjects with suspected FA aged 0-14 years were prospectively evaluated at a tertiary center for pediatric allergy, gastroenterology, and nutrition. Upon completing the diagnostic workup, the subjects were diagnosed with FA based on the oral food challenge result, or with other conditions. Bootstrapped multivariable logistic regression was employed to construct two models that estimate the probability of having FA, one (M1) without the results of the allergy screening tests, while the other (M2) including them.

Results: Six hundred and twenty-seven pediatric subjects were included in the study. The median (interquartile interval) age at symptom onset was 8 (3;27) months. M1 employed the following predictors: sex, age at symptoms onset, cesarean delivery, occurrence of atopic dermatitis before FA onset, first degree family members with allergy, symptoms occurrence after ingestion of specific food, and skin, gastrointestinal, respiratory, and systemic symptoms. M2 replaced the occurrence of symptoms after ingestion of specific food with the results of allergy tests. The c-statistic was 0.915 (95% bootstrapped CI: 0.895-0.937) for M1 and 0.977 (95% CI: 0.969-0.992) for M2. Both models demonstrated good internal calibration and a favorable decision analysis curve.

Conclusion: The NAPFA score could be an easy-to-use tool holding the potential to streamline the FA diagnostic process in pediatric age, reducing unnecessary testing, and improving patient outcomes in a variety of healthcare settings. Its external validation will possibly enable a standardized approach for identifying children with FA.

Background: Perioperative hypersensitivity (POH) is rare but potentially life-threatening, and data on POH in children are sparse. This single-center study aimed to describe clinical presentations and allergy investigations in children with suspected POH in Denmark, and to evaluate a risk stratification algorithm used for suspected POH (elevated tryptase, 2 or more organ systems involved and urticaria/angioedema).

Methods: Retrospective data from 70 children who had undergone allergy investigations at the specialized Danish Anaesthesia Allergy Centre were included. Children were divided into a test positive and test negative group based on results from allergy investigations, and the groups were compared. Sensitivities, specificities, positive and negative predictive values were calculated for the risk stratification algorithm for suspected POH and for different combinations of symptoms.

Results: 24% of the children tested positive. The most confirmed allergen was chlorhexidine (n = 3), followed by NMBAs (n = 2) and antibiotics (n = 2). Skin symptoms were most common (94%), and cardiovascular symptoms (CVS) appeared as the first symptom in 50% of the test positive children. CVS were more common in the test positive group. The risk stratification algorithm had a high sensitivity (88%) but a higher sensitivity (94%) was seen in the combination "elevated tryptase or CVS or urticaria/angioedema".

Conclusion: Several different allergens were confirmed in this study, including hidden allergens like chlorhexidine. This emphasizes the need to identify all potential allergens and the need for investigation at a specialized allergy center. More data are needed to make recommendations on the optimal risk stratification algorithm in children with suspected POH.

Background: Various observational studies have suggested that infants and young children who regularly sleep in synthetic bedding materials are more likely to experience wheezing and asthma, while children who use feather duvets and/or feather pillows are less likely to wheeze.

Methods: In Wellington, New Zealand, we conducted a three-armed, parallel, randomised trial of 460 infants who were assigned to use different bedding materials: synthetic, wool or feather bedding in the form of sleepsacks from 3 months of age to 2 years of age to test the hypothesis that children exposed to feather materials are less likely to develop wheezing. Pregnant women were recruited before birth. Parents were unaware of the primary research hypothesis and were told this was a study of child warmth and wheezing. We have reported wheezing (parental and GP), a variety of respiratory health parameters and atopic status at 2 years.

Results: One hundred and forty-seven infants received a synthetic sleepsack, 150 wool and 144 feather. We have found no significant differences in reported or doctor-diagnosed wheezing or other respiratory health measures by bedding material used. For frequency of wheezing presentation at GP surgery, there was a significant increased rate for children using feather materials compared to synthetic, relative rate 2.00 (95% CI: 1.14, 3.52).

Conclusion: This study does not support earlier observational studies that suggest higher rates of wheezing for children using synthetic bedding or lower rates for feather materials, at least for early childhood wheezing. Our study suggests that the explanation for the observational study findings may lie in selection bias, where the parents of at-risk children avoid feather bedding materials.

Background: Acute bronchiolitis is the leading cause of hospitalization in infants, and air pollutants represent a risk factor for its development. This work aims to investigate the role of air pollution, considering conventional and nonconventional indicators, in the development of bronchiolitis in three urban areas in the Po Valley, Northern Italy.

Methods: This multicentric, observational, retrospective, cohort study included infants under 12 months who were referred to the Pediatric Emergency Department of Bologna, Belluno, and Biella and diagnosed with bronchiolitis from 2016 to 2019. Data on daily ground-level mass concentrations of particulate matter (PM₁₀ and PM_2.5) and gaseous pollutants in the three areas, and additionally of organic carbon (OC) and elemental carbon (EC) in Bologna, were retrieved and assessed for possible relationships with the occurrence of bronchiolitis.

Results: A total of 1316 patients were enrolled. All conventional air quality indicators (NO₂, PM₁₀, and PM_2.5) showed statistically significant associations with the occurrence of referrals due to bronchiolitis. The highest impacts were observed for OC and EC, the carbonaceous components of PM, which were only measured in Bologna. Considering the conventional indicators, the strongest associations were found between 4-week moving average concentrations and weekly hospital admission, and the strongest associations were found considering NO₂ and PM_2.5.

Conclusion: This study indicates that medium-term exposure to higher levels of air pollution increases the risk of the development of bronchiolitis. In particular, the best association results between bronchiolitis admissions and the exposure to the carbonaceous fraction of PM_2.5.

Background: Symptoms of hereditary angioedema (HAE) typically first present during childhood, but the frequency/severity of attacks often increases at puberty. Real-world data on long-term HAE prophylaxis in adolescents are limited. We report pooled data from adolescent patients enrolled in two Phase 4 studies (EMPOWER, ENABLE) evaluating the effectiveness/safety of lanadelumab (monoclonal antibody directed against plasma kallikrein) for the prevention of HAE attacks.

Methods: Adolescent patients (aged 12 to <18 years) with HAE-C1INH enrolled in EMPOWER and ENABLE received open-label lanadelumab 300 mg once every 2 weeks. Effectiveness outcomes were based on patient-reported assessments of on-treatment HAE attacks. Safety was assessed through the recording of treatment-emergent adverse events (TEAEs) and serious adverse events. This analysis categorized patients as "new" or "established" lanadelumab patients.

Results: Thirteen new and seven established patients on lanadelumab were included. The observed monthly attack rate in new patients fell from 3.8 (mean) and 2.8 (median) during the pre-enrollment period to 0.65 (mean) and 0.21 (median) during the cumulative study period after lanadelumab initiation (84.2% and 92.9% reductions, respectively). In established patients, mean (SD) HAE attack rate (as treated) during the overall study period was 0.04 (0.03) attacks/month. Most HAE attacks were of mild/moderate severity. Nine new patients reported 42 TEAEs, mostly mild/moderate in severity, with 3 TEAEs reported as serious. Seven established patients reported 12 TEAEs (all mild/moderate and non-serious). No TEAEs were related to lanadelumab.

Conclusion: These data support lanadelumab's effectiveness/safety in adolescents with HAE, consistent with results from Phase 3 lanadelumab studies in mixed adult/adolescent populations.

Clinical trial identifiers: NCT03845400 (EMPOWER) and NCT04130191 (ENABLE).