Pediatric Allergy and Immunology最新文献

Background: Food allergy (FA)-related bullying is common, yet little is known about risk factors for FA-related bullying or the relationship between FA-related bullying and psychosocial wellbeing. This study aimed to (1) identify sociodemographic and clinical factors associated with risk of FA-related bullying in children with FA, and (2) evaluate the psychosocial functioning of children and parents reporting FA-related bullying.

Methods: This was a cross-sectional survey study of children ages 5-17 years with immunoglobulin E (IgE)-mediated FA and their parents, recruited from Boston Children's Hospital (BCH) and through social media outlets. Children and parents with versus without a history of FA-related bullying were compared on sociodemographic and clinical characteristics and FA-related psychosocial outcomes using validated instruments.

Results: In this cohort of 295 child-parent dyads, the median child age was 8.0 years, 53.2% of children were male, and parent respondents were primarily mothers (96.6%). Reported lifetime prevalence of FA-related bullying was 36.6%. FA-related bullying was associated with certain child characteristics, including coming from a household at risk of food insecurity (FI) (12.0% of bullied children v. 2.2% of not bullied children were from food insecure households, p < .001), having coexisting atopic and mental health conditions-particularly anxiety (30.6% of bullied children v. 8.6% of not bullied children carried an anxiety disorder diagnosis, p < .001)-and having a history of more severe FA reactions. FA-related bullying was associated with elevated concerns in child and parental FA-related psychosocial functioning domains.

Conclusion: Pediatricians and allergists should screen for FA-related bullying and offer families appropriate guidance around management of FA-related bullying.

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: Peanut allergy consumes a significant volume of oral food challenges (OFC) in the diagnosis of food allergy. Two-step diagnostic algorithms involving both SPT and Ara h 2 sIgE demonstrate increased accuracy of diagnosis in modelled studies compared to peanut skin prick test (SPT) or sIgE to whole peanut, which should result in fewer OFCs. In 2015, The Royal Children's Hospital, Australia (RCH) implemented a clinical guideline using a two-step algorithm incorporating peanut SPT (3-8 mm) followed by sIgE to Ara h 2 if the clinician is considering a peanut OFC. We aimed to determine the OFC reduction in clinical practice as a result of this two-step diagnostic algorithm compared to using peanut SPT alone and perform a cost comparison between these two approaches.

Methods: We performed an audit of all patients presenting to RCH allergy clinics undertaking assessment of peanut allergy. Adherence to the guideline, the number of OFCs required for diagnosis, and outcomes were determined. Modelled data of the same patient cohort estimated the number of OFCs that would have occurred if using peanut SPT alone. A cost comparison was performed, comparing these two approaches.

Results: Eight thousand, eight hundred and twenty-six patients were included, with 9.2% proceeding to an OFC. Of these, 20.1% had a positive result (any allergic reaction), and anaphylaxis occurred in 1.1%. There was a reduction of 27.8% in OFCs when using the diagnostic algorithm compared to SPT alone. Using the diagnostic algorithm also resulted in a 32.05% cost reduction compared to the SPT-only pathway. Sensitivity analysis demonstrated the number of OFCs gives the greatest impact to the overall cost of diagnosis.

Conclusions: A combined algorithm incorporating peanut SPT followed by sIgE to Ara h 2 resulted in a reduction in patients requiring OFCs and a cost saving in a clinical cohort.

The term "feeding difficulties" (FD) encompasses a range of phenotypes characterized by inadequate food intake and/or inappropriate eating habits for a given age. Eosinophilic esophagitis (EoE) is a chronic, immune-mediated condition often affecting children. It leads to esophageal dysmotility, potentially impacting feeding/eating. However, little is known regarding the true prevalence of feeding/eating difficulties in children with EoE. The main objective of this systematic review was to address this knowledge gap and determine the impact of FD in children with EoE. We searched eight international databases for all published studies from inception until March 2024. All publications were screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses, so a narrative synthesis of quantitative data was performed. A total of 3442 abstracts were assessed, 29 underwent full-text screening. Ten studies met eligibility criteria and were analyzed. Across these, 18 different terms to define FD and 6 diagnostic tools were used. All included papers reported quantitative data on the FD prevalence in children with EoE, ranging from 13% to 75.3%. Concomitant IgE food sensitization/allergy was common (26.2%-88%) but its impact on FD occurrence was unclear. The current literature suggests that FD is prevalent among children with EoE, particularly those with associated IgE-mediated food allergies. However, the heterogeneity of terminologies and diagnostic tools makes drawing conclusions challenging, as it might have impacted outcomes. Further research and guidance on the diagnosis and management of FD in children with EoE are needed to appropriately identify and manage such patients.

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.