Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology最新文献

{"title":"Basophil CD63 assay to peanut allergens accurately diagnoses peanut allergy in patient with negative skin prick test and very low specific IgE.","authors":"Tom Marrs, Helen A Brough, Matthew Kwok, Gideon Lack, Alexandra F Santos","doi":"10.1111/pai.13739","DOIUrl":"https://doi.org/10.1111/pai.13739","url":null,"abstract":"To the Editor, Fatal food anaphylaxis commonly occurs amongst patients who had previously only reported mild symptoms.1 An accurate diagnosis of food allergy is crucial. Current diagnostic practice relies on evaluating the strength of clinical history and seeking objective validation from the level of IgE sensitisation, investigated by skin prick test (SPT) or serumspecific IgE (sIgE). However, single timepoint sensitisation assays are usually sensitive but not specific— in particular, black ethnicity has been associated with raised levels of sIgE to peanut that are often clinically irrelevant.2 Oral food challenges (OFCs) are routine in clinical practice, exposing large numbers of patients to further food allergic reactions.3 Functional assays such as the basophil activation test (BAT) can discriminate between sensitisedtolerant and sensitisedallergic patients because it more closely resembles the pathological reaction of effector cells towards the culprit allergen.4,5 We have shown that the BAT is the single most accurate test to diagnose peanut allergy (PA) with enhanced specificity and retained sensitivity when compared to sensitisation tests.6 BAT investigation alongside serum and skin sensitisation testing can reduce the number of children who would be required to undergo OFC testing by two thirds.6 Other clinical presentations may prove of particular relevance. Herein, we report a case with negative SPT and very low allergen sIgE who nevertheless reacted on OFC to roasted peanuts and demonstrated activation of basophils on stimulation with peanut extract, Ara h 1, Ara h 2 and Ara h 6. A 12yearold girl of AfroCaribbean descent presented to our clinic to ascertain whether she needed to avoid nuts. At 4 years of age, she had drunk a freshly made fruit drink containing peanut and developed facial angioedema afterwards, although the exact time course was not remembered. On a second occasion, she developed conjunctivitis when a friend ate peanuts whilst being sat next to her. She had no history of allergic rhinitis. Investigations revealed a negative SPT to peanut (0 mm) and very low sIgE to peanut (0.15 kUA/L) and to Ara h 2 (0.11 kUA/L). SIgE to Ara h 1, Ara h 3, Ara h 8 and Ara h 9 was undetectable. Her baseline tryptase was 3.0 μg/L, and there was no wheal to any of the other eight tree nuts skin tested in clinic. An open incremental OFC was scheduled with the aim to rule out PA. The patient tolerated the first four doses. However, after eating the last open dose totalling a cumulative portion of 32 grams of dry roasted peanuts (8 g of peanut protein), she developed nasal congestion and prominent swelling of her eyelids, brow and lips. She reported subjective difficulty in breathing; however, her voice was clear, her oxygen saturations remained over 98% and there was no increase in her respiratory rate or blood pressure. She was treated with 10 mg of cetirizine followed by 120 mg of fexofenadine and her reaction subsided. She was advised to ","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":" ","pages":"e13739"},"PeriodicalIF":4.4,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39656710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between environmental greenness and the risk of food allergy: A population-based study in Melbourne, Australia.","authors":"Rachel L Peters,&nbsp;David Sutherland,&nbsp;Shyamali C Dharmage,&nbsp;Adrian J Lowe,&nbsp;Kirsten P Perrett,&nbsp;Mimi L K Tang,&nbsp;Kate Lycett,&nbsp;Luke D Knibbs,&nbsp;Jennifer J Koplin,&nbsp;Suzanne Mavoa","doi":"10.1111/pai.13749","DOIUrl":"https://doi.org/10.1111/pai.13749","url":null,"abstract":"<p><strong>Background: </strong>While exposure to environmental greenness in childhood has shown mixed associations with the development of allergic disease, the relationship with food allergy has not been explored. We investigated the association between exposure to environmental greenness and challenge-confirmed food allergy in a large population-based cohort.</p><p><strong>Methods: </strong>The HealthNuts study recruited 5276 12-month-old infants in Melbourne, Australia, who underwent skin prick testing to peanut, egg, and sesame; infants with a detectable wheal underwent food challenges to determine food allergy status. Environmental greenness was estimated using the normalized difference vegetation index (NDVI) for five buffer zones around the infant's home address: at the home, 100 m, 500 m, 800 m, and 1600 m radial distances. Environmental greenness was categorized into 3 tertiles and mixed effects logistic regression models quantified the association between greenness and the risk of food allergy, adjusting for confounding and accounting for clustering at the neighborhood level.</p><p><strong>Results: </strong>NDVI data were available for n = 5097. For most buffer zones, medium and high greenness, compared to low greenness, was associated with an increased risk of peanut allergy (eg, 100 m tertile 2 aOR 1.89 95% CI 1.22-2.95, tertile 3 aOR 1.78 95% CI 1.13-2.82). For egg allergy, the effect sizes were smaller (100 m tertile 2 aOR 1.52 95% CI 1.16-1.97, tertile 3 aOR 1.38 95% CI 1.05-1.82). Socioeconomic status (SES) modified the association between greenness and peanut allergy, but not egg allergy; associations were apparent in the low SES group but not in the high SES group (p for interaction 0.08 at 100 m). Air pollution (PM2.5) also modified the associations between environmental greenness and food allergy, with associations present in high air pollution areas but not low (p for interaction at 100 m 0.05 for peanut and 0.06 for egg allergy.) CONCLUSION: Increased exposure to environmental greenness in the first year of life was associated with an increased risk of food allergy. Increased greenness may correlate with higher pollen levels which may trigger innate immune responses skewing the immune system to the Th2-dependent allergic phenotype; additionally, some pollen and food allergens are cross-reactive. Given the mixed data on greenness and other allergies, the relationship appears complex and may also be influenced by confounding variables outside those that were measured in this study.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":" ","pages":"e13749"},"PeriodicalIF":4.4,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39656716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel AP3B1 mutations in a Hermansky-Pudlak syndrome type2 with neonatal interstitial lung disease.","authors":"Keigo Matsuyuki,&nbsp;Mizuki Ide,&nbsp;Keishirou Houjou,&nbsp;Saho Shima,&nbsp;Seiji Tanaka,&nbsp;Yoriko Watanabe,&nbsp;Hiroyuki Tomino,&nbsp;Tomoko Egashira,&nbsp;Toshimitsu Takayanagi,&nbsp;Katsuya Tashiro,&nbsp;Ken Okamura,&nbsp;Tamio Suzuki,&nbsp;Takayuki Miyamoto,&nbsp;Hirofumi Shibata,&nbsp;Takahiro Yasumi,&nbsp;Ryuta Nishikomori","doi":"10.1111/pai.13748","DOIUrl":"https://doi.org/10.1111/pai.13748","url":null,"abstract":"To the Editor, Hermansky– Pudlak syndrome (HPS) is an inherited disorder characterized by albinism of the oculocutaneous region and hemorrhagic disease. Eleven genes causative of HPS have been identified, and the clinical phenotypes of the condition differ depending on which gene is affected. HPS type 2 (HPS2) is an autosomal recessive inherited disease caused by mutations in AP3B1, resulting in interstitial lung disease (ILD), pulmonary fibrosis (PF), and immunodeficiency.1 Patients with HPS2 also have neutropenia and decreased NK cell cytotoxicity, which can lead to hemophagocytic lymphohistiocytosis (HLH); however, the total number of HPS2 cases reported was less than 40 as of March 2021,1 making it difficult to accurately assess the risk of HLH associated with this disease. In addition, although ILD/PF occurs earlier in HPS2 than in other types of HPS, HPS2 with ILD/PF in the neonatal period has never been reported. Here, we report a case of HPS2 with neonatal ILD/PFharboring mutations in both AP3B1 alleles, one of which is novel. The patient is female, the second child of a nonconsanguineous marriage, and was born at 39 weeks 4 days (birth weight, 3798 g) by spontaneous vaginal delivery. Apgar score was 9 at 1 min; however, respiratory failure gradually developed, resulting in endotracheal intubation and mechanical ventilation. At 20 h after birth, a right tension pneumothorax developed, which required thoracentesis, thoracic drainage, and nitric oxide inhalation therapy. Traumatic pneumothorax was less likely because there were no traumatic episodes such as birth injury or chest compression, but pressureinduced pneumothorax due to ventilator management could not be ruled out. Septic workup, including blood and throat swabs, was negative. Respiratory distress syndrome was less likely due to term delivery. A computerized tomography scan at 6 days of age revealed ILD/PF (Figure 1); therefore, we suspected hereditary interstitial lung diseases and tested the SFTPB, SFTPC, ABCA3, FOXF1, NKX2.1, GATA2, CSF2RA, and CSF2RB genes, all of which were negative.2 Since she had albinism, we performed genetic analysis of 22 albinismrelated genes, which revealed two heterozygous variants in AP3B1: c.1122_1123insAG (p. Phe375Serfs*11) and c.2546T&gt;A (p. Leu849Ter)(Figure 2a). The former variant is a novel frameshift mutation, and the latter is a nonsense mutation that was recently reported as the causative mutation in a patient with HPS2 in Japan.3 Neither variant is recorded in the Exome Aggregation Consortium (ExAC, http://exac.broad insti tute.org/) database, and both are considered pathogenic according to ACMG criteria.4 Each parent carried one of the variants; therefore, we diagnosed the patient with HPS2 caused by AP3B1 mutations. The patient also suffered from mitral regurgitation, which did not require additional medication. The patient's respiratory condition improved, and she was discharged from hospital at 190 days of age, with the introduction of","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":" ","pages":"e13748"},"PeriodicalIF":4.4,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39959273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating an online self-help intervention for parents of children with food allergies.","authors":"Naomi Sugunasingha,&nbsp;Fergal W Jones,&nbsp;George du Toit,&nbsp;Christina J Jones","doi":"10.1111/pai.13731","DOIUrl":"https://doi.org/10.1111/pai.13731","url":null,"abstract":"<p><strong>Background: </strong>Parents of children with food allergies (CwFA) experience reduced quality of life (QoL) and may have reduced access to in-person interventions in the COVID-19 pandemic. This trial developed and evaluated an online, self-help, information provision website, aimed at improving QoL in parents of CwFA.</p><p><strong>Methods: </strong>In a single-blinded, randomised controlled trial (RCT), participants were randomised to either receive access to the website or a waiting-list control. At baseline, post-intervention (week 4) and follow-up (week 8), measures of parental food allergy-related QoL, depression, anxiety, stress, intolerance of uncertainty (IU) and self-efficacy were obtained.</p><p><strong>Results: </strong>A total of 205 participants were randomised; 97% were females, 91% white and 78% educated ≥ degree level, with a mean age of 38.95 years (SD = 6.89). 44.9% (n = 92) were retained at follow-up. The arms did not significantly differ on any outcome at any time point. For a sub-group of participants above the clinical cut-off for depression at baseline, the intervention may have improved QoL. Participants reported the website content as useful and accessible, but accessed it infrequently. In baseline data, IU and self-efficacy were significantly associated with QoL.</p><p><strong>Conclusion: </strong>While the COVID-19 pandemic has encouraged greater provision of online interventions, our RCT suggests this particular website is not suitable for this population in general, although future research could examine its efficacy for depressed parents of CwFA, to increase confidence that the sub-group finding was not a Type 1 error. The baseline data suggest IU and self-efficacy remain potential proximal targets for intervention.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":" ","pages":"e13731"},"PeriodicalIF":4.4,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/79/PAI-33-0.PMC9306710.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39960164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human milk oligosaccharide profiles and child atopic dermatitis up to 2 years of age: The Ulm SPATZ Health Study.","authors":"Linda P Siziba,&nbsp;Marko Mank,&nbsp;Bernd Stahl,&nbsp;Deborah Kurz,&nbsp;John Gonsalves,&nbsp;Bernadet Blijenberg,&nbsp;Dietrich Rothenbacher,&nbsp;Jon Genuneit","doi":"10.1111/pai.13740","DOIUrl":"https://doi.org/10.1111/pai.13740","url":null,"abstract":"<p><strong>Background: </strong>Human milk oligosaccharides (HMOs) have several biological functions. Yet, very few studies have investigated the effect of HMOs on the development of allergies and even fewer on their specific associations with atopic dermatitis (AD) during early childhood.</p><p><strong>Objective: </strong>This study investigated whether individual HMO concentrations, measured at two time points of lactation, were associated with reported diagnosis of AD in children up to two years of age.</p><p><strong>Method: </strong>Outcome data were available for HMOs measured in human milk samples collected at 6 weeks (n = 534) and 6 months (n = 356) of lactation. Associations of HMOs with AD, ascertained from parents and pediatricians at ages one and two years, were assessed in crude and adjusted logistic regression models.</p><p><strong>Results: </strong>Few associations were statistically significant at the conventional level (p < .05), for example, 6-week Lacto-N-neotetraose with 2-year AD [OR 95%CI: 0.82 (0.66, 1.00)] and 6-month 3'-sialyllactose among non-secretor mothers with 1-year AD [2.59 (1.53, 6.81)]. Importantly, accounting for multiple testing, these and all further associations were not statistically significant (all p > .0031, which is the threshold for statistical significance after correction for multiple testing).</p><p><strong>Conclusion: </strong>Our findings suggest that the intake of different levels (or even absence) of the individual HMOs measured at 6 weeks and 6 months of lactation, in the current study, is not significantly associated with the development of AD in early childhood. Given the exploratory nature of our study and the limited sample size, these results should be interpreted with caution. The specific HMOs for which we show plausible associations at conventional level may warrant further research and investigation.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":" ","pages":"e13740"},"PeriodicalIF":4.4,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39656714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial comments on: \"Worldwide time trends in prevalence of symptoms of rhinoconjunctivitis in children: Global Asthma Network Phase I\".","authors":"Jon Genuneit,&nbsp;Philippe Eigenmann","doi":"10.1111/pai.13729","DOIUrl":"https://doi.org/10.1111/pai.13729","url":null,"abstract":"In the second half of the 20th century, clinical observations led to suspect a strong increase in allergy prevalence in the Westernized world. However, this had to be confirmed by robust epidemiological studies. Among them, the ISAAC initiative provided unique data from around the world for the prevalence of allergic diseases.1 Although respiratory allergies and atopic dermatitis continued to rise in the last decades, but mostly in developing countries, the focus in Europe, North America, and Australasia has been more on food allergy, as these have been sharply increasing in these countries.2,3 In addition, studies were mostly focusing on the development of respiratory diseases in risk populations and crosssectional studies were largely lacking.4 We highlight here as editor's choice the recent study by Strachan and colleagues, which aimed to update trends in prevalence of symptoms of childhood allergic respiratory diseases and compare them with data from 15 to 23 years ago.5 Data of symptoms suggesting allergic rhinitis and conjunctivitis by standardized questionnaires were collected from over 100,000 participants. Centers were located in India, Mexico, and various countries in Africa, SouthEast Asia, and in Europe and South America. Although the authors discovered a substantial heterogeneity between the countries and the regions of the world (between less than 10% and up to 25%), they found overall that the prevalence of symptoms of allergic rhinoconjunctivitis were no longer increasing in children.","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":" ","pages":"e13729"},"PeriodicalIF":4.4,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39656715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal autoimmune disease and risk of hospitalization for autoimmune disease, allergy, and cancer in offspring.","authors":"Xiaotian Zhao,&nbsp;Philippe Bégin,&nbsp;Harb Kang,&nbsp;Mélanie Henderson,&nbsp;Antoine Lewin,&nbsp;Ga Eun Lee,&nbsp;Jessica Healy-Profitós,&nbsp;Nathalie Auger","doi":"10.1111/pai.13728","DOIUrl":"https://doi.org/10.1111/pai.13728","url":null,"abstract":"<p><strong>Background: </strong>Children whose mothers have autoimmune disease may be at risk of developing immune-mediated disorders. We assessed the association between maternal autoimmune disease and risk of autoimmune disease, allergy, and cancer in offspring.</p><p><strong>Methods: </strong>We analyzed a cohort of 1,011,623 children born in Canada between 2006 and 2019. We identified mothers who had autoimmune diseases and assessed hospitalizations for autoimmune disease, allergy, and cancer in offspring between birth and 14 years of age. We estimated hazard ratios (HR) for the association of maternal autoimmune disease with child hospitalization in adjusted Cox regression models. We used within-sibling analysis to control for genetic and environmental confounders.</p><p><strong>Results: </strong>A total of 20,354 children (2.0%) had mothers with an autoimmune disease. Compared with no autoimmune disease, maternal autoimmune disease was associated with the risk of childhood hospitalization for autoimmune disease (HR 1.96, 95% CI 1.66-2.31) and allergy (HR 1.30, 95% CI 1.21-1.40), but was not significantly associated with cancer (HR 1.31, 95% CI 0.96-1.80). Type 1 diabetes, celiac disease, inflammatory arthritis, and systemic lupus erythematosus were among specific maternal autoimmune diseases most strongly associated with childhood hospitalization for autoimmune disease and allergy. The associations disappeared after controlling for genetic and environmental confounders in the within-sibling analysis.</p><p><strong>Conclusions: </strong>Maternal autoimmune disease is associated with an increased risk of autoimmune disease and allergy hospitalization in offspring, but the relationship appears to be confounded by genetic and environmental factors. Prenatal exposure to immunologic or pharmacologic products is not likely a direct cause of immune-mediated disease in children.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":" ","pages":"e13728"},"PeriodicalIF":4.4,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39959270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective study of disease persistence and lung function trajectories of childhood asthma.","authors":"Man Fung Tang,&nbsp;Agnes Sze Yin Leung,&nbsp;Noelle Anne Ngai,&nbsp;Oi Man Chan,&nbsp;Gary Wing Kin Wong,&nbsp;Ting Fan Leung","doi":"10.1111/pai.13726","DOIUrl":"https://doi.org/10.1111/pai.13726","url":null,"abstract":"<p><strong>Background: </strong>A proportion of asthmatic children outgrow their disease by adulthood, but there are limited data on predictors for asthma persistence. This prospective study characterized the trajectory of spirometric indices and identified predictors for the persistence of childhood asthma.</p><p><strong>Methods: </strong>Chinese asthmatic children aged 6-15 years from pediatric allergy clinic underwent annual visits for ≥5 years and until their adulthood. Pre-bronchodilator spirometry and anti-asthma medications were recorded at baseline and then at least annually. Asthma resolution was defined when patients were free from asthma symptoms and use of anti-asthma drugs for ≥2 years. Logistic regression was used to identify predictors for asthma persistence. Generalized estimating equation was used to analyze longitudinal changes in lung function parameters in relation to asthma persistence.</p><p><strong>Results: </strong>181 asthmatic children aged [mean (SD)] 10.0 (2.7) years were followed for [mean (SD)] 12.5 (2.8) years. One third of them outgrew asthma during follow-up. Female was 3.36 times more likely to have persistent asthma. Inhaled corticosteroid (ICS) treatment ever and frequent asthma exacerbation (AE) predicted asthma persistence with respective odds ratios of 3.19 (95% confidence interval [CI] 1.44-7.09) and 3.05 (95% CI 1.39-6.68). Persistent asthma was inversely associated with baseline forced expiratory volume in 1-second (FEV₁ %) with an odds ratio of 0.96 (95% CI 0.93-1.00). Throughout follow-up, patients with persistent asthma had generally lower forced expiratory indices than those with asthma resolution. Children with persistent asthma experienced poorer lung function growth.</p><p><strong>Conclusions: </strong>Female, ICS ever, and frequent AE predicted persistent asthma. Patients with persistent asthma had lower forced expiratory indices and poorer lung function growth into adulthood.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":" ","pages":"e13726"},"PeriodicalIF":4.4,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39959272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The controversy of drug hypersensitivity in patients with cystic fibrosis and review of the literature.","authors":"Gokcen Dilsa Tugcu,&nbsp;Nagehan Emiralioglu,&nbsp;Ebru Yalcin,&nbsp;Umit Murat Sahiner,&nbsp;Deniz Dogru,&nbsp;Bulent Enis Sekerel,&nbsp;Ugur Ozcelik,&nbsp;Nural Kiper,&nbsp;Ozge Soyer","doi":"10.1111/pai.13719","DOIUrl":"https://doi.org/10.1111/pai.13719","url":null,"abstract":"<p><strong>Background: </strong>Cystic fibrosis (CF) is reported to be a risk factor for drug hypersensitivity. However, there are conflicting data about true prevalence of drug hypersensitivity in children with CF.</p><p><strong>Methods: </strong>The suspicious drug hypersensitivity reactions (DHRs) of children with CF were enquired by the European Network for Drug Allergy (ENDA) questionnaire, and skin tests and/or drug provocation tests were performed according to the established guidelines.</p><p><strong>Results: </strong>Two hundred and nineteen children (48.9% boys; median [IQR] age, 8.4 years [4.8-12.4 years]) with cystic fibrosis were included in the study, among which 22 patients with 24 suspected DHRs were evaluated. Most of the suspected DHRs were of non-immediate (n = 16, 66.6%) type, and the offending drugs were amoxicillin-clavulanic acid (n = 7), macrolides (n = 4), trimethoprim-sulfamethoxazole (TMP/SMX) (n = 2), piperacillin-tazobactam (n = 1), pancrelipase (n = 1), and ursodeoxycholic acid (n = 1). Eight (33.3%) of the DHRs were classified as immediate (ceftriaxone [n = 2], ceftazidime [n = 2], meropenem [n = 1], AmBisome [n = 2], and vancomycin [n = 1]). The main clinical presentations were maculopapular eruption (41.6%) and urticaria (37.5%), accompanied by angioedema (8.3%), flushing (12.5%), and vomiting (8.3%). Nine skin tests (with beta-lactam protocol in 6 patients) and 24 DPTs were performed, and none of the skin tests revealed a positive result; however, 2 DPTs with TMP/SMX were positive.</p><p><strong>Conclusion: </strong>Actual drug hypersensitivity was demonstrated in 2 of 219 patients (0.9%) with non-beta-lactam antibiotics. These results conflict with previous researches that showed higher drug hypersensitivity rates but are consistent with some recent studies. Allergological diagnostic workup is mandatory in patients with cystic fibrosis in case of a suspicious DHR.</p>","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":" ","pages":"e13719"},"PeriodicalIF":4.4,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39725126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucosal fixed drug eruption to levetiracetam with early positive patch test on non-lesional skin.","authors":"Nazli Ercan","doi":"10.1111/pai.13723","DOIUrl":"https://doi.org/10.1111/pai.13723","url":null,"abstract":"Levetiracetam (LEV) is a second-generation antiepileptic drug (AED) that\u0000is well tolerated, has a broad spectrum of action, low protein binding,\u0000and minimal hepatic metabolism. The incidence of hypersensitivity to LEV\u0000in children and adults is 0.6%. This is the first reported fixed drug\u0000eruption (FDE) identified using a patch test in a pediatric case\u0000associated with LEV","PeriodicalId":520742,"journal":{"name":"Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology","volume":" ","pages":"e13723"},"PeriodicalIF":4.4,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39959274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}