Pediatric Allergy and Immunology最新文献

Background: Acute urticaria usually resolves spontaneously; however, in some cases, it may progress to CSU. We aimed to investigate the underlying factors of AU in children and the clinical and laboratory factors affecting the progression of AU to CSU.

Methods: A prospective analysis was performed in 155 patients under 18 years of age who were diagnosed with AU and treated in our hospital. Factors affecting the transition from acute urticaria to chronic urticaria were analyzed using logistic regression.

Results: Progression of AU to CSU was observed in 9% of patients. The urticaria activity scores of the first week (UAS7) in patients who progressed to CSU were significantly higher than those of patients who did not develop CSU (UAS7: Median 14.5, Min-Max 6-32, p < .001). Additionally, elevated eosinophil levels (Median 3.6%, Min-Max 0-11, p = .006) and the need for more intensive treatments, including parenteral steroids, antihistamines, and additional therapies (42.9% of CU patients, p = .038), were identified as significant risk factors for progression to CSU. In univariate regression analysis, the UAS7 score was found to be statistically significant (OR: 1.131, 95% CI: 1.056-1.212, p < .001). In multivariate analysis, we found that high UAS7 scores (OR: 1.169, 95% CI: 1.072-1.275, p < .001) and the need for combined treatment with additional therapies (OR: 8.240, 95% CI: 1.007-67.441, p = .049) were independent risk factors for progression from AU urticaria to CU.

Conclusion: We found that the severity of urticaria during the first week and the need for additional therapies are important indicators in predicting the risk of chronicity. These findings may help to develop strategies to effectively manage AU in the early stages.

Background: This study aimed to investigate sensitization to eggs and other common allergenic foods, allergic symptoms, and fatty acid status among infants after introducing daily eggs as a complementary food for 6 months.

Methods: This secondary analysis used data from a randomized controlled trial of 500 infants aged 6-9 months in Jouberton, South Africa, who were randomly assigned to receive one egg daily, n = 250 (treatment) or no egg, n = 250 (control) for 6 months. Clinical allergy symptoms were assessed with the Childhood Allergy and Immunology Research questionnaire. Infants were tested with a skin prick test for egg sensitization at baseline and at the end of the study for additional food allergens. The fatty acid composition was analyzed in whole blood at the endpoint.

Results: At the endpoint, egg sensitization was 1.9% in the egg intervention group and 2.0% in the control group (aOR 0.936 [95% CI 0.229, 3.822]; p = .926) and all foods sensitization was 7.5% in the egg intervention group and 12.9% in the control group (aOR 0.515 [0.264, 1.005]; p = .052). There were no reported acute egg-related allergy symptoms at baseline and midpoint in the two groups. The incidence of allergic disease during the study was 7.5% in the egg intervention group and 13.4% in the control group (aOR = 0.545 [95% CI: 0.283, 1.048]; p = .069). The total and long-chain polyunsaturated fatty acid omega-6/omega-3 ratios were higher in the intervention group (β = .173 [0.291, 2.898], p = .021 and β = .198 [0.149, 0.902], p = .007) with no effect on omega-3 fatty acid composition.

Conclusion: Complementary feeding with daily eggs may reduce overall allergic sensitization to common allergenic foods.

Lipid Transfer Protein (LTP) allergy, traditionally more prevalent in adults from Southern Europe, is increasingly recognized in pediatric populations worldwide. This review explores the epidemiology, pathogenesis, clinical manifestations, diagnosis, and management of LTP allergy in children. LTP allergy can present with severe systemic symptoms both in children and adults; in children-only studies, anaphylaxis is reported in up to half of the patients. Moreover, children often display polysensitization to multiple plant-based foods. The prevalence of LTP allergy among children remains under-researched, contributing to diagnostic and clinical practice variability. Key allergenic sources involved include peach (Pru p 3) and other Rosaceae fruits, as well as tree nuts, with cofactors such as physical activity frequently triggering or exacerbating reactions. Advancements in understanding natural tolerance and targeted therapies, along with expanding LTP immunotherapy, offer promising directions for improving the management of this challenging condition in pediatric patients.

Background: Management of celiac disease (CD) requires adherence to a strict gluten-free diet (GFD). However, little is known about how children with CD manage the GFD. This qualitative study sought to gain a comprehensive understanding of how children with CD experience and navigate the GFD, focusing on their dietary preferences, perceptions, and challenges, as well as the impact of these experiences.

Methods: Fifteen children with CD, aged 8-13 years, who had been following the GFD for a minimum of one year, were interviewed with their parents about their management of the GFD. Reflexive thematic analysis was used to analyze the data.

Results: Children described a range of strategies for managing the GFD. While some adopt problem-focused strategies such as planning ahead and carrying gluten-free foods on their person, others exhibit heightened anxiety and persistent doubts, indicating the need for tailored healthcare support. Importantly, the study uncovers socioecological influences, including social roles, communication patterns, and environmental factors, which shape children's beliefs and coping strategies.

Conclusions: The study underscores the importance of monitoring gluten-related distress, beliefs, and behaviors in children with CD, as well as the broader context of children's lives. To better support children with CD, holistic support may target anxiety to support well-being alongside GFD management.

Background: Perioperative anaphylaxis (PA) is a rare life-threatening complication of anesthesia, with few descriptions of its diagnosis and outcomes in the pediatric population. Many agents can be potential culprits, and drug provocation testing (DPT) to confirm the diagnosis is limited by the nature of anesthetic drugs. PA diagnosis and culprit identification remain a challenge. For patients with limited drug options, desensitization has not been reported. This study evaluated the results of skin and laboratory testing for pediatric patients with PA and provides the protocol and outcome of the first desensitization to cisatracurium, a neuromuscular blocking agent (NMBA).

Methods: Patients ≤18 years old with PA from 2019 to 2024 were included, and medical records were retrospectively reviewed, which comprised serum tryptase levels, results of skin testing (ST), basophil activation testing (BAT), and outcomes.

Results: Eleven patients were included. Tryptase was elevated in seven of 10 (70%) tested patients. ST yielded positive results for nine of 10 (90%), and two of 11 (18.2%) had positive BAT.

Results: A culprit agent was identified in 10 of 11 (91%). The most common drugs were NMBAs (70%) and beta-lactam antibiotics (20%). One patient with a positive DPT to NMBAs and limited alternatives was successfully desensitized to cisatracurium with a 3-bag, 12-step protocol.

Conclusion: The most common drug culprits of PA in children were NMBAs and were identified by ST. Tryptase correlated with PA. BAT served as adjunctive diagnostic tests. Desensitization to cisatracurium was possible.

The spectrum of non-IgE mediated conditions includes well-defined conditions like Food Protein-Induced Enterocolitis Syndrome (FPIES), Eosinophilic Oesophagitis (EoE), Food Protein-Induced Enteropathy, and Food Protein-Induced Allergic Proctocolitis, but also the more controversial food protein-induced dysmotility disorders like food protein-induced gastroesophageal reflux disease (FPGORD) and food protein-induced constipation (FPC). Typically, non-IgE mediated reactions are delayed, with symptom onset from hours to days after exposure to a culprit food. The diagnosis is mostly clinical, and food elimination followed by reintroduction is the primary diagnostic method. Apart from EoE, the diagnosis of these conditions remains challenging, and there is a need to develop specific diagnostic tests. Acute FPIES presents with distinct symptoms, but misdiagnosis is common due to poor recognition. In contrast, some presentations, particularly FPGORD and FPC, overlap with the common, often benign disorders of gut-brain interaction, previously known as functional gastrointestinal disorders. This raises concerns about overdiagnosis and can lead to an unnecessary restrictive diet in infants and breastfeeding mothers. A systematic approach to an elimination diet and the support of a registered dietitian/nutritionist are recommended to ensure nutritional adequacy, suitable alternatives, promote timely introductions when appropriate, support breastfeeding where required as well as prevent nutritional deficiencies and feeding difficulties. This publication aims to provide an update on the spectrum of non-IgE-mediated food allergic conditions and intends to provide clinicians with practical guidance on the diagnosis and management of each condition. The authors acknowledge the need for further research in a range of areas to inform best evidence-based practice.

Background: Higher intakes of flavonoids have been associated with better lung function in adults. The aim of this study was to examine the associations between maternal prenatal intake of flavonoids and offspring asthma and wheeze.

Methods: We conducted a prospective study of Black (62.8%) and White (37.2%) mother-child dyads (N = 906) enrolled in the CANDLE study. We estimated prenatal dietary flavonoid intake using the Block Food Frequency Questionnaire administered during the second trimester and subsequently linked to the United States Department of Agriculture's Provisional Flavonoid Addendum and Proanthocyanidin database. Our primary outcomes included parent report of child current wheeze and asthma (based on diagnosis, symptoms, and/or medication use) at approximately age 4 years. We used multivariable logistic regression to investigate associations between prenatal flavonoid intake and child respiratory outcomes.

Results: Overall, 19.4% and 15.8% of children had current wheeze and asthma, respectively. The highest quartile of prenatal dietary total flavonoid was associated with lower odds of childhood respiratory outcomes, relative to the lowest quartile, for current wheeze (adjusted odds ratios (aOR) [95% confidence intervals (CI)]: 0.58 [0.35, 0.96]) and current asthma (aOR [95% CI]: 0.53 [0.31, 0.91]), respectively, although there was not a clear dose-response. We observed an inverse association between the prenatal intake of proanthocyanidin and offspring current asthma, but no associations for other flavonoid subclasses.

Conclusions: We report a novel finding that children of women with the highest compared to the lowest prenatal intake of total dietary flavonoids had lower odds of current wheeze and asthma at age 4 years.