Pediatric Allergy Immunology and Pulmonology最新文献

Introduction: Intravenous lipid emulsions (ILE) containing soy protein may cause reactions in allergic patients. We present a case report of atopic dermatitis (AD) and soy allergy triggered by intravenous lipid emulsion containing soy in an infant with short bowel syndrome (SBS). Case Report: A 9-month-old female infant with SBS who had been fed total parenteral nutrition (PN) since birth was consulted for severe AD. Laboratory tests revealed eosinophilia, elevated total IgE, and soy-specific IgE was found positive at 3.56 KU/L. Lipid emulsion containing 20% soybean-oil in PN was replaced with soy-free. The patient's AD lesions resolved rapidly. The food provocation test with re-administration of a soy-containing lipid emulsion confirmed the diagnosis of soy allergy by causing recurrence of eczematous lesions. Conclusions: This case demonstrates that ILE can cause soy sensitization and trigger AD without oral exposure. Food allergies should also not be forgotten in patients who receive only PN.

Background: Children with intestinal failure who are receiving parenteral nutrition through a central venous catheter are at risk of developing catheter-related bloodstream infections. For many years, a prophylactic lock with taurolidine has been used to decrease the incidence of these infections and is considered safe in children. Case Presentation: A 1-month-old boy with jejunal atresia was receiving parenteral nutrition through a central venous catheter. Shortly after administration of taurolidine (TauroSept®), he developed circulatory insufficiency and angioedema. His serum tryptase increased, which was suggestive of anaphylaxis (baseline tryptase 6.3 µg/L; 2 h after start of the reaction: 21 µg/L; cutoff criterion for clinically relevant increase: 1.2 × baseline tryptase level + 2). Conclusions: To the best of our knowledge, this is the first case of anaphylaxis in response to TauroSept® in an infant worldwide. Clinicians should be aware of this possible but very rare side effect.

Patients with pathogenic variants of lipopolysaccharide-responsive beige-like anchor protein (LRBA) are known to present with autoimmune diseases, inflammatory bowel disease, lymphoproliferative disorders, allergies, immunodeficiency, and malignancies. This condition, characterized by widespread infections that impact multiple systems, has various radiological findings reported in the literature. These include computed tomography (CT) findings indicating lung involvement and magnetic resonance imaging (MRI) findings showing neurological system involvement. However, F-18 fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) imaging findings in LRBA deficiency have not yet been described in the literature. This report presents multiple organ involvements detected by F-18 FDG PET-CT in a case with an LRBA gene variant. FDG PET-CT findings for diagnostic and primary focus evaluation were reviewed in a 17-year-old male patient with a pathogenic LRBA variant, prompted by multiple hypoechoic nodular appearances identified on abdominal ultrasonography. In this patient, who carried a pathogenic LRBA variant (c.3396-3397delAC, p.D975Yfs*15) and was treated with abatacept for liver involvement, FDG PET-CT revealed a wide range of system involvements. These included the lungs, liver, intestines, bone, bone marrow, and lymph nodes, as well as multiple joints and tendons. In immunodeficiency diseases with such extensive multisystem involvement, whole-body imaging techniques like F-18 FDG PET-CT can serve as valuable tools for physicians to comprehensively assess the disease and formulate effective treatment strategies.

Measles is a highly contagious, vaccine-preventable infectious disease. The incidence of measles has been rising due to a confluence of factors, including international travel and vaccine hesitancy. The purpose of this Pharmacotherapy Update was to examine and appraise preventive measures and treatment options, both pharmacotherapy and supplements, used in measles management. Topics included ribavirin, measles-mumps-rubella vaccine post-exposure prophylaxis, immune globulin, antibiotics, vitamin A, and cod liver oil supplements. Parents, caregivers, and policymakers considering these interventions are recommended to consult with health care providers and seek guidance from professional organizations regarding the effectiveness and safety of these treatments. Vaccination with the measles-mumps-rubella vaccine remains the most effective intervention to prevent measles, and efforts are urgently needed to achieve the requisite 95% vaccination rate to improve public health, confer herd immunity, and eradicate measles.

Background: Bronchopulmonary dysplasia (BPD), a common pulmonary condition in infants causing neonatal death, has a complicated pathogenic mechanism. As the new iron-dependent cell death type, ferroptosis can result from lipid peroxidation and exert a critical effect on the pathogenic mechanism of BPD. This study aimed to investigate ferroptosis-related genes with regard to their expression patterns and functional roles in BPD. Methods: Clinical and gene expression data were obtained based on the Gene Expression Omnibus (GEO) database, and the web-based analysis approach GEO2R was used for selecting differentially expressed genes (DEGs). For significant ferroptosis-related DEGs (FDEGs), their bioinformatic functions and molecular interactions were explored using the WEB-based Gene Set Analysis Toolkit (WebGestalt) and Metascape, protein-protein interaction network analysis, and Kyoto Encyclopedia of Genes and Genomes enrichment. In addition, hub FDEG expression levels in BPD were verified through quantitative reverse transcription polymerase chain reaction (RT-qPCR). Results: There were totally 3,673 DEGs detected in BPD infants compared with controls, including 36 FDEGs with upregulation, whereas 13 with downregulation. Functional enrichment analysis revealed the significant activation of biological processes in response to stress and ferroptosis. Through RT-qPCR validation, five hub FDEGs were identified, including mitogen-activated protein kinase 14 (MAPK14), tumor antigen p53 (TP53), signal transducer and activator of transcription 3 (STAT3), toll-like receptor 4 (TLR4), and dual-specificity protein phosphatase 1 (DUSP1). Based on the outcomes of receiver operating characteristic curve analysis, the area under the curve values of these genes were >0.7, revealing that they might be used to identify BPD. Conclusions: The results in this study shed more insights on the diagnosis and mechanism of ferroptosis in BPD. Further research should be carried out to assess its clinical utility.

Background: Oscillation and lung expansion (OLE) therapy delivers both continuous high-frequency oscillation and continuous positive expiratory pressure. This therapy aids in both mobilizing secretions and lung expansion. Objective data about the chronic use of this therapy in the outpatient setting in pediatric patients are limited. Case Presentation: We identified 3 patients in our pediatric pulmonology clinic, each with different underlying conditions, who had used home OLE therapy for at least 1 year and were able to perform spirometry. We compared forced expiratory volume in 1 second (FEV₁) in the year prior to therapy with the following year after starting therapy. Patients A, B, and C had a mean FEV₁ percent predicted improvement in the year after starting therapy of 19.3%, 13.6%, and 30.5%, respectively. Conclusion: Substantial and sustained improvements in lung function were observed with the addition of OLE to standard-of-care therapies. Larger studies are needed to confirm these findings.

Introduction: The aim of this study was to determine the frequency and risk factors of allergic adverse reaction following measles-mumps-rubella (MMR) vaccination in children with egg and/or cow's milk allergies. Methods: Children with cow's milk and/or egg allergy were included. Patients with IgE-mediated cow's milk allergy were subjected to skin tests with MMR vaccines before vaccination. For patients with a positive skin test, administration of an alternative vaccine not containing the suspected excipient was planned. In case an alternative vaccine is not available, the MMR vaccine is planned to be administered with a gradual desensitization protocol. Results: Two hundred two patients (133 male and 69 female) with a mean age of 14.9 ± 11.9 months were evaluated. Of the patients, 126 (62.4%) received Tresivac®, while 76 (37.6%) received Priorix®. Before vaccination, 84 patients underwent skin testing with the vaccine, and the test was positive in 7 patients. Allergic reactions were observed in 12 patients (urticaria in 10 patients, angioedema in 1 patient, and anaphylaxis in 1 patient). Egg white-specific IgE (spIgE) levels were found to be higher in patients with egg-allergy who developed allergic reactions to MMR vaccines. The receiver operating characteristic (ROC) analysis identified a cut-off value of 6.5 kU/L for egg white-spIgE. In patients who developed allergic reactions following alpha-lactalbumin-containing vaccine, egg white-spIgE and cow's milk-spIgE levels were significantly higher compared with those without reactions. In the ROC analysis for predicting allergic reactions following Tresivac® vaccination, the cut-off values were as follows: egg white-spIgE: 6 kU/L, cow's milk-spIgE: 12.5 kU/L. Conclusion: It was determined that the cut-off values for cow's milk and egg white spIgE were found to be significant in identifying children at risk for allergic reactions following MMR vaccination. Children with food allergies who had a family history of atopy were found to have a higher risk of allergic reactions.

Background: The COVID-19 pandemic impacted multiple aspects of care at pediatric long-term care facilities (pLTCFs). This study evaluated the effect of COVID-19 infection control policies on pLTCF resident's respiratory health. Methods: A retrospective study of 76 residents' oxygen, albuterol, hypertonic saline (HTS), and pulmonary hygiene treatment use from January 2019 to December 2022 was completed using de-identified billing data and chart review. Results: There was a statistically significant increase in rate of oxygen use among residents (5.67; 95% CI 3.44-7.8; P < 0.001) during the study period, but at a slower rate than expected by the pre-pandemic trend (-4.89; 95% CI -7.20-2.59; P < 0.001). HTS use decreased during the study period, with a change in the prior trend to downward (-3.43; -5.89-9.68; P = 0.007). There was no significant change in albuterol or pulmonary hygiene treatment. Conclusions: This study demonstrates that patterns of oxygen and HTS use in a pLTCF changed during the COVID-19 pandemic.