Pediatric Allergy and Immunology最新文献

Background: It remains unclear whether phenotyping of type 2-high (T2-high) asthma can distinguish clinical characteristics and lung function trajectories in childhood.

Objective: To explore differences between T2-high and T2-low asthma from birth to age 18 years.

Methods: We included 47 children with asthma and 165 as a control group from the Copenhagen Prospective Studies on Asthma in Childhood₂₀₀₀ mother-child cohort. T2-high and T2-low asthma was defined at age 7 by sensitization to aeroallergens, elevated eosinophilic blood count, and/or elevated fractional nitric oxide. Lung function measurements included whole-body plethysmography, spirometry, exercise test, cold air provocation, and methacholine challenge. Differences in lung function trajectories and traits were analyzed using linear mixed models, Wilcoxon rank-sum test, Fisher's exact test, and Quasi-Poisson regression.

Results: At age 7 years, 47 had asthma (26 T2-high, 21 T2-low). By age 18, 12 (46.2%) with T2-high had persistent asthma whereas 2 (9.2%) with T2-low; OR 8.14 [1.57-42.34]. Specific airway resistance (sRaw) was 12.5% higher through childhood in children with T2-high asthma (estimate 0.53 [0.06; 1.01]); lung function was more reversible (OR 3.37 [1.03-11.00] for spirometry and OR 2.60 [1.17; 5.75] for sRaw), and they had increased airway hyperresponsiveness (AHR) to methacholine (as shown by 41% lower dose required to cause a 20% drop in lung function (estimate -0.70 [-1.18; -0.23])). There was no significant difference in exacerbation rate and other lung function measurements.

Conclusion: Childhood T2-high asthma differs from T2-low asthma in terms of onset, duration, airway resistance, and airway responsiveness.

Background: It is necessary to evaluate the parental ability to achieve nutritional adequacy while avoiding allergens for children with food allergies (FA), yet this area is currently understudies. Our study aimed to develop and validate the Parental Self-Efficacy Scale for Dietary Management of Children with Food Allergies (PSED-FA).

Methods: PSED-FA was developed through a literature review and semi-structured interviews refined by a panel of five allergists and five dietitians, and validated using responses from caregivers of children with FA. The construction of the tool involved exploratory factor analysis (EFA), confirmatory factor analysis for model fit, and evaluation of internal consistency using Cronbach's alpha. Convergent and divergent validity were assessed using the average variance extracted (AVE), maximum shared variance (MSV), and average shared variance (ASV).

Results: Participants included nine focus interview groups, with 114 individuals in the validation group. Egg whites (55.2%), tree nuts (35.2%), and peanuts (22.8%) were the most common allergens. The EFA identified three factors: preparing allergen-free meals, knowledge of nutrition management, and management of food restrictions. The goodness of fit of our model met all the criteria. The tool showed high internal consistency (overall Cronbach's alpha: 0.902) and met the criteria for both convergent (AVE >0.5) and divergent validity (AVE > MSV and ASV).

Conclusion: This study validated a reliable and effective tool for assessing parental self-efficacy in managing the dietary needs of children with FA. This tool can aid health professionals in evaluating parental confidence and identifying areas for improving dietary management in children with FA.

Background: Long-term evidence on maintenance doses of oral immunotherapy (OIT) for anaphylactic cow's milk allergy is insufficient.

Methods: We retrospectively compared the three-year safety, efficacy, and adherence between OIT with a maintenance dose of 200 mL of cow's milk (HOIT, 2009-2013) and 3 mL of cow's milk (LOIT, 2013-2019). Patients aged 6-18 years with a history of anaphylaxis reacting to ≤3 mL of cow's milk during oral food challenge (OFC) were included. Adverse symptoms, OFC negative rate after 2 weeks of avoidance, dropout rate, and immunological changes were compared.

Results: The median ages in the HOIT (n = 78) and LOIT (n = 99) groups were 8.1 and 7.8 years, with milk-specific IgE levels of 56.5 and 49.2 kUA/L, respectively. The percentages of doses triggering symptoms were 20.88%, 13.73%, and 7.31% in the HOIT group and 11.81%, 8.15%, and 6.30% in the LOIT group during years 1, 2, and 3, respectively. After 3 years, 29% of patients in the HOIT group passed the OFC with 200 mL, and 47%, 18%, and 5% of patients in the LOIT group passed the OFC with ≥25 mL, ≥50 mL, and 100 mL of cow's milk, respectively. After 3 years, the dropout rates were 24% and 11% in the HOIT and LOIT groups and milk-specific IgE levels decreased by 88% and 78% in the HOIT and LOIT groups, respectively.

Conclusion: HOIT enables higher dose consumptions. LOIT might be safer and have higher adherence in patients with anaphylactic cow's milk allergy.

Background: Atopic dermatitis (AD) predominantly manifests before age five, with significant phenotype variations across age groups. Despite increasing systemic treatments for pediatric AD, head-to-head comparisons in network meta-analyses focused on children are scarce.

Methods: Through systematic searches of PubMed, Embase, Web of Science, and Cochrane Library up to March 2024, we identified randomized controlled trials (RCTs) evaluating systemic treatments for moderate-to-severe AD in children aged 2-18 years. From 900 screened articles, 8 RCTs (n = 2636) met inclusion criteria, comparing dupilumab, baricitinib, upadacitinib, and abrocitinib versus placebo with standard care. Primary outcome was Eczema Area and Severity Index (EASI) scores at 12-16 weeks.

Results: Upadacitinib demonstrated highest efficacy at both 30 mg (risk difference [RD] 0.62 [0.53, 0.71]) and 15 mg (RD 0.52 [0.42, 0.62]). Dupilumab (weight-based dosing with corticosteroids; RD 0.43 [0.29, 0.57]), abrocitinib (200 mg; RD 0.40 [0.29, 0.50]; 100 mg; RD 0.30 [0.20, 0.41]), and baricitinib (4 mg; RD 0.21 [0.06, 0.35]) also showed significant efficacy over placebo.

Conclusion: This analysis establishes a hierarchy of effectiveness among systemic therapies for pediatric AD, with upadacitinib showing highest efficacy. However, the predominance of adolescent data emphasizes the need for age-stratified studies in younger children and long-term safety assessments.

Background: Atopic eczema often develops in the first year of life, when the composition of the gut microbiota is most plastic as illustrated by the decrease in bifidobacteria after weaning. This may provide the opportunity for microbial stimuli and their environmental determinants to alter the disease course.

Objectives: To determine the role of the genus Bifidobacterium for atopic eczema in early childhood.

Methods: We analysed the bacterial composition in fecal samples of 618 children of the PASTURE ("Protection against Allergy-Study in Rural Environments") birth cohort using 16S rRNA amplicon sequencing of fecal samples collected at 2 and 12 months of age. Atopic eczema was defined as a parent-reported doctor's diagnosis until 2 years, and patterns of rash symptoms were classified by latent class analysis. We applied mediation models to assess direct and microbiota-mediated effects of environmental determinants on atopic eczema.

Results: The Bifidobacterium composition observed at 2 months was inversely related to atopic eczema (OR = 0.68 [0.53-0.87], p = .002) and persistent rash. This association was not seen at 12 months, when the composition of Bifidobacterium amplicon sequence variants (ASVs) was altered. The effect of beneficial ASVs at 2 months (OR = 0.72 [0.57-0.91]) was lost at 12 months (OR = 0.97 [0.76-1.24]), when distinct bifidobacteria tended to be positively related to late-onset rash.

Conclusions: The subgenus composition of Bifidobacterium undergoes substantial changes in the first year of life. The protective effect of Bifidobacterium depends on the ASV composition at the respective age of the infant, highlighting the importance of timing in prevention strategies targeting infant-microbe interactions.

Background: It's often caregivers or healthcare professionals' experiences that are studied in the field of allergy, but the adolescents' perspective is crucial to develop interventions that support them in areas they find most challenging. This study aims to explore adolescents' experience of managing food allergies, particularly how they navigate the transition from parental management to self-management.

Methods: This is an interpretive descriptive qualitative study. Semi-structured interviews were conducted with ten adolescents with food allergies aged 12-16 years. Reflexive thematic analysis was conducted. The Reflexive Thematic Analysis Reporting Guidelines were used.

Results: Four themes were generated, (1) belonging-seeing me, (2) not knowing (3) taking responsibility-"So I guess when I became older, I started having to manage that more myself" and (4) variation in coping strategies. These describe adolescents need for belonging, that their peers acknowledge their food allergies without making them feel like a burden. Adolescents understanding of essential food allergy information was lacking, with some unaware of this lack of knowledge. Adolescents were conscious of the need to take over responsibility from their parents, although this could be difficult. Finally, how adolescents coped with all these aspects of their food allergy could be seen as avoidant due to high anxiety, minimizing of risk, or adaptive, where adolescents are aware of and mitigate risks appropriately, without avoiding life experiences.

Conclusion: Adolescents find the transition of responsibility from their parents difficult. A trusted source of allergy information is required, aimed at adolescents, covering both physical allergy management and psychosocial content.