Pediatric Allergy and Immunology最新文献

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.

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.

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: 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: 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: Newborns under 6 months of age are at high risk of hospitalization for acute respiratory failure following SARS-CoV-2 infection. Herein, we analyzed neonatal protection against SARS-CoV-2 passively acquired after mother vaccination and/or infection (hybrid immunity).

Methods: We enrolled seventy-eight newborns of immunized mothers against SARS-CoV-2 before or during pregnancy, through vaccination and/or infection. Infants were stratified based on the anamnestic lack (SARS-CoV-2 Vaccinated - SV)/presence (SARS-CoV-2 Infected and Vaccinated - SIV) of COVID-19 maternal infection. SARS-CoV-2-specific Neutralizing Activity (NA) in plasma was assessed by virus neutralization assay (vNTA) against the SARS-CoV-2 Omicron strain at delivery (T0), 3 and 6 months after birth (T3 and T6). Cytokine and chemokine profiles in newborns were also analyzed.

Results: At birth, significantly lower NA was observed in infants of SV compared to that of SIV mothers; NA declined equally in both groups 3 months after delivery. The presence of at least 4 immunizing events in the mother significantly enhances the NA against SARS-CoV-2 in newborns, regardless of the type of immunization (vaccination or hybrid immunity) and of the timing of the last maternal immunization. Finally, cytokines and chemokines plasma levels were high at birth in all newborns, followed by a decline over the subsequent month.

Conclusion: Our findings suggest that, independently of a previous SARS-CoV-2 infection or vaccination, it is reasonable to upgrade the recommendation of a booster dose during pregnancy to a "strongly recommended" status, with a view to conferring protection to newborns in the first months after delivery.