Concomitant Allergic Diseases Research Articles

Frequency of CD4+CD25 + (High) Foxp3+ Regulatory T cells (Tregs) in Peripheral Blood of Pediatric Patients with Autism

Abstract Background Immune system dysfunctions have been observed in autistic spectrum of disorders (ASD). Autoimmunity may have a role in ASD. In addition, skewed cytokine responses, differences in total numbers and frequencies of immune cells and their subsets, neuroinflammation, both adaptive and innate immune dysfunction, altered levels of immunoglobulins and the presence of autoantibodies in some autistic children were reported. Objective To measure the frequency of CD4+CD25 + (High) Foxp3+ Tregs in peripheral blood of children with autism in relation to the disease severity. Patients and Methods This cross-sectional study involved 30 ASD patients were enrolled from the Psychiatry and Development clinic, Children’s Hospital, Ain Shams University, after excluding children with concomitant allergic diseases or infections. Another 30 healthy children were included as a control group. Severity of ASD and associated convulsions or impaired intelligence were demonstrated. The frequency of CD4+CD25 + (High) Foxp3+ Tregs was assessed using flow cytometry. Data collected were coded, tabulated and analyzed using Microsoft Excel software Statistical analysis (SPSS) (version 21, Chicago, IL, USA). Results Thirty patients with primary ASD were recruited, including 24 males (80%) and 6 females (20%) with mean age of 6.62 ± 2.11 years. Mild illness was diagnosed in 20 patients (66.7%) and severe illness was defined in 10 patients (33.3%)%). CD4+CD25 + (High) Foxp3+ Tregs were significantly lower among autistic children compared to healthy control (mean percentage in patients 15.41 ± 32.1%, mean percentage in control 49.2 ± 42.6%, P-value <0.001). The markers were not correlated with disease severity, epilepsy status or IQ level (P = 0.716, 0.729, 0.472, respectively). However,CD4+CD25 + (High) Foxp3+ Tregs were significantly lower among male patients compared to females(Median in males 1.25 (0-96), Median in females 2.25 (1.5-84.2). CD4+CD25 + (High) lymphocytes less than 3.15 cells were found to be 80% sensitive and 73.5% specific for ASD probability (AUC was 0.816). Whereas percentage of FOXP3 less than 2.55% showed 73.3% and 76.7% sensitivity and specificity, respectively (AUC was 0.753). Conclusion CD4+CD25 + (High) FOXP3, the master promotor of Tregs, was detected in lower levels in ASD Egyptian children. A level of expression lower than 2.5% is both sensitive and specific for ASD diagnosis. We recommend considering CD4+CD25 + (High) FOXP3 as a future therapeutic target in children with ASD to achieve early, efficient management.

Fruit allergy and anaphylaxis in children: Culprit fruits and clinical findings.

Background: Fruit allergy usually presents with mild-to-moderate symptoms but serious systemic reactions, e.g., anaphylaxis, may also occur. Objective: This study aimed to examine the clinical and laboratory characteristics of patients with fruit allergy and fruit-induced anaphylaxis. Methods: Patients diagnosed with fruit allergy at Dışkapı Hematology and Oncology Hospital and Bilkent City Hospital between January 2017 and January 2023 were included in the study. The diagnosis of anaphylaxis was made according to the European Allergy and Clinical Immunology Anaphylaxis Guideline. Results: During the study period, skin-prick tests with food allergens were performed on 9432 patients in our clinic, and fruit allergy was detected in 78 patients (0.82%). Five patients with inaccessible medical records were excluded from the study. 40 (54.8%) were boys. The median (interquartile range) age at the onset of symptoms was 72 months (12.5-144 months). Sixty-eight of the patients (93.2%) had a concomitant allergic disease, the most common of which was allergic rhinitis (n = 48 [65.8%]). The 73 patients had a history of reaction to 126 fruits. Twenty-five patients (19.8%) were allergic to multiple fruits. The most common fruit allergen was banana (22/126 [17.4%]), followed by peach (18/126 [14.2%]) and kiwi (17/126 [13.5%]). Mucocutaneous findings were observed most frequently after fruit consumption (120/126 [95.2%]). Anaphylaxis occurred in 17 patients (23.2%) with 21 fruits.The fruits most commonly associated with anaphylaxis were banana (6/21 [28.6%]) and kiwi (6/21 [28.6%]). Conclusion: Fruit allergy generally presents with mild symptoms, e.g., oral allergy syndrome, but severe systemic symptoms, e.g., anaphylaxis, can also be observed. Kiwi and banana are the fruits that most commonly cause anaphylaxis. Although more comprehensive studies are needed to comment on the development of tolerance, especially in patients with anaphylaxis, responsible fruit avoidance is still the most important strategy.

Cutaneous mastocytosis and allergic diseases in children: A cross-sectional study

BACKGROUND: Mastocytosis is a heterogeneous group of diseases characterized by abnormal accumulation of clonal mast cells in one or more organs. Comorbidities in patients with mastocytosis include IgE-dependent allergies, psychiatric or psychological disorders, and vitamin D deficiency. Despite the clinical similarities between allergies and mastocytosis, only a few European studies have considered these comorbidities.
 AIM: To analyze the frequency of concomitant-allergic diseases in children with cutaneous mastocytosis.
 MATERIALS AND METHODS: Data of 248 children aged 6 months to 17 years who were diagnosed with cutaneous mastocytosis and received outpatient treatment and observation at the Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology between March 2022 and June 2023 were analyzed. Serum levels of total and allergen-specific IgE were analyzed in children with and without allergic diseases. In addition, a positive history of allergy was analyzed in close relatives of children with cutaneous mastocytosis.
 RESULTS: Every third child (36.7%) with cutaneous mastocytosis had a concomitant allergic disease. Relatives of 27.4% of the examined children had allergic diseases. The process was significantly more often accompanied by allergic diseases in children with mastocytomas than in those with maculopapular cutaneous mastocytosis (χ2=45.46; p=0.001). The level of total IgE was not a statistically significant sign of the presence of allergic diseases in cutaneous mastocytosis (χ2=1.161; p=0.3). Allergen-specific IgE was detected in 47.2% of the children with allergic diseases. Among children without signs of food allergy and pollinosis, asymptomatic low and moderate sensitization to any plant product and birch was detected in 26.5%. Sensitization to respiratory allergens was found in 8% of children with cutaneous mastocytosis without allergic diseases.
 CONCLUSIONS: In Russia, this study demonstrated for the first time a high incidence of allergic diseases in children with cutaneous mastocytosis. The results showed that all clinical forms of mastocytosis in children, including cutaneous mastocytosis, should be subjected to interdisciplinary observation and examination. The timely detection of comorbid allergic diseases contributes to the development of individual techniques for the treatment and prevention of complications and anaphylaxis.

Diagnostic intervention improved health-related quality of life among teenagers with food allergy.

The aim was to examine if a diagnostic intervention set up to assess current food allergy to cow's milk, hen's egg, fish, or wheat among teenagers had an impact on generic and disease specific health-related quality of life (HRQL). The study compared HRQL scoring before and two years after the intervention, and in relation to age matched controls without reported food allergy. The study was performed within the Obstructive Lung Disease in Northern Sweden (OLIN) studies where a cohort study on asthma and allergic diseases among 8-year-old schoolchildren was initiated in 2006. At age 12 years, the 125/2612 (5%) children who reported allergy to cow's milk, hen's egg, fish, or wheat were invited to a diagnostic intervention including clinical examination, blood tests and evaluation by a pediatric allergist. Of 94 participants, 79 completed generic and disease specific HRQL questionnaires. Additionally, a random sample of 200 (62% of invited) children without food allergy from the OLIN cohort answered the generic HRQL questionnaire. The respondents of the HRQL questionnaires were re-examined two years later and 57 teenagers with and 154 without reported allergy participated. There were no significant differences in generic HRQL scores between teenagers with and without reported food allergy at study entry, or after the intervention. Among those with reported food allergy, we found a significant improvement in disease specific HRQL after the intervention (mean values: 3.41 vs 2.80, p<0.001). Teenagers with only food allergy had better disease specific HRQL compared to those with one, two or three concomitant allergic diseases, both before and after the intervention. Children with only food allergy significantly improved their HRQL after the intervention, 1.84 vs. 2.87 (p<0.001) but this association was not seen in children with one other allergic disorder (3.16 vs. 3.65, p = 0.121) or those with two or more allergic disorders (3.72 vs. 3.90, p = 0.148). The diagnostic intervention showed a long-term improvement of disease specific HRQL but not generic HRQL.

Evaluation of accompanying allergic disease in children with proven drug allergies.

Data on the prevalence of allergic diseases in children with proven drug allergies are limited. We aim to evaluate the frequency of allergic comorbidity in children with proven common drug allergies. Children with drug hypersensitivity confirmed by diagnostic allergy tests at our center between January 2010 and December 2020 were screened retrospectively. Patients with the most common drug allergies (due to antibiotics, nonsteroidal antiinflammatory drugs [NSAIDs], and antiepileptic drugs) were selected for analysis. Age, sex, the culprit drug, initial reaction characteristics, diagnostic test results, and the study physician who diagnosed concomitant allergic diseases were noted. A total of 168 patients (boys, 51.2%) with a median age of 12 years (IQR = 8-16.3) were included in the study. The culprit drug was an antibiotic in 63% (n = 106), NSAID in 25% (n = 42) and anticonvulsant in 11.9 % (n = 20) of the patients. Drug hypersensitivity reactions were immediate in 74.4 % (n = 125) and delayed in 25.6 % (n = 43) of the patients. Seventy-five patients (44.6 %) had at least one allergic disease, most commonly rhinitis (27.3 %, n = 46) or asthma (25 %, n = 42). Fifty-five patients underwent skin prick tests with aeroallergens, producing a positive result in 60% (n = 31). The prevalence of allergic disease was not differing according to the culprit drug. The frequency of developing at least one concomitant allergic disease was 47.2% (n = 50/106) for antibiotic hypersensitivity, 52.4% (n = 22/42) for NSAID hypersensitivity, and 15% (n = 3/20) for anticonvulsant hypersensitivity (p < 0.00).Immediate drug hypersensitivity reactions were more frequent in children who had allergic diseases (80 % vs. 64.5 %; p = 0.027). Nearly half (44.6%) of the children with proven drug hypersensitivity had concomitant allergic diseases and immediate reactions were more common in this group. Children evaluated for drug hypersensitivity should be assessed for other allergic diseases.

Studying the activity of matrix metalloproteinases and antibodies to DNA in patients with autoimmune thyroiditis

Background. In autoimmune thyroiditis, in addition to impaired immunological tolerance, a significant role is played by biochemical markers such as matrix metalloproteinases and antibodies to deoxyribonucleic acid (DNA), which can contribute to the pathogenesis of the disease.&#x0D; Aim. Studying the activity of metalloproteinases-3, -7 and the level of antibodies to DNA in patients with autoimmune thyroiditis.&#x0D; Material and methods. In 2019–2021 a non-randomized study in the research laboratory at the Department of Biochemistry of the Azerbaijan Medical University, during which the blood serum of 170 patients with autoimmune thyroiditis, 64 (37.6%) men, average age 39.4±11.2 years and 106 (62.4%) women, average age 37.8±9.05 years, was conducted. Inclusion criteria: men and women aged 18 years and older with a primary diagnosis of “autoimmune thyroiditis” without concomitant allergic or other autoimmune diseases and severe somatic disorders. The control group consisted of 65 people (average age 38.7±10.8 years) without any thyroid disease or autoimmune pathology. Analysis of clinical and laboratory studies with determination of the level of thyroid-stimulating hormone, free thyroxine and free triiodothyronine made it possible to divide patients into two groups: the first group — 74 patients with a subclinical form of the disease; the second group — 96 patients with a manifest form of the disease. In all patients, the activity of metalloproteinases-3 and -7 in the blood serum was determined by enzyme-linked immunosorbent assay, and the content of antibodies to native and denatured DNA was determined by enzyme-linked immunosorbent assay. Intergroup comparisons on quantitative indicators were carried out using the nonparametric Mann–Whitney rank test, taking into account the difference in the distribution of the analyzed indicators from the normal one. Qualitative characteristics were assessed as percentages.&#x0D; Results. The median activity of metalloproteinases-3 and -7 in the total group of patients was 56 (51.0; 59.0) and 4.6 (4.3; 5.2) ng/ml, respectively, which was significantly higher than the control values — 23.0 (16.0; 26.0) and 3.6 (3.4; 4.1) ng/ml, respectively (p=0.0001252 and p=0.00054). There were no statistically significant differences in the level of metalloproteinase-7 in patients with subclinical and manifest thyroiditis (p=0.097), while the median activity of metalloproteinase-3 in the manifest group was 59.0 (56.0; 65.0) ng/ml and it was higher than in patients of the subclinical group by 13.2%. The content of antibodies to native DNA in patients was 4.4 (2.3; 9.9) units/ml, which was statistically significantly higher compared to the control group — 2.6 (1.5; 3.6) units/ml (p 0.001), while no significant differences were found in the levels of antibodies to denatured DNA in patients compared to control values.&#x0D; Conclusion. The worsening of the autoimmune process is accompanied by an increase in the activity of metalloproteinases and antinuclear antibodies.

AIM2 participates in house dust mite (HDM)-induced epithelial dysfunctions and ovalbumin (OVA)-induced allergic asthma in infant mice

Objective: Allergen sensitization and high rates of concomitant allergic diseases are characteristic of severe pediatric asthma. The present study was aimed to explore the mechanism of allergic asthma via bioinformatics and experiment investigation. Methods: The GSE27011 dataset contained the expression profiles of normal and pediatric asthma white blood cells was downloaded for analyzing the different expression genes and function enrichment. The allergic asthma model in infant mice was established by ovalbumin (OVA) stimulation. The cellular model was established by house dust mite (HDM)-stimulation in human bronchial epithelial cells. The absent in melanoma 2 (AIM2) knockdown was achieved by intranasal lentivirus injection or cell infection. The bronchoalveolar lavage fluid (BALF) was collected for cell counting and ELISA assessment of cytokines. Lung tissues were collected for HE staining and immunohistochemical (IHC) staining. Real-time PCR and immunoblotting were used for the determination of key gene expressions in mouse and cell models. Results: upregulation of AIM2 gene expression was observed in pediatric asthma patients based on GSE27011 and OVA-induced infant mouse allergic asthma model. AIM2 knockdown ameliorated OVA caused elevation in airway hyper-responsiveness (AHR), elevation in cell quantities (eosinophils, neutrophils, lymphocytes), and levels of cytokines (IL-4, IL-13, TNF-α, and OVA-specific IgE) in BALF. Moreover, AIM2 knockdown relieved OVA-caused histopathological alterations in mouse lungs, up-regulation of AIM2 levels, and NOD1 and receptor-interacting protein 2 (RIP2) protein levels, as well as p65 phosphorylation. In the cell model, AIM2 knockdown partially ameliorated HDM-induced epithelial dysfunctions by promoting cell viability, down-regulating inflammatory cytokines levels, and decreasing the protein levels of AIM2, NOD1, RIP2, and phosphorylated p65. Conclusion: AIM2 participates in HDM-induced epithelial dysfunctions and OVA-induced allergic asthma progression. AIM2 could be a promising target for pediatric allergic asthma treatment regimens, which warrants further in vivo investigations.

Comorbid Inducible Urticaria Is Linked to Non-Autoimmune Chronic Spontaneous Urticaria: CURE Insights

Patients with chronic spontaneous urticaria (CSU) can have comorbid inducible urticaria (CIndU). How comorbid CIndU affects patients and their CSU is largely unclear. To compare patients with CSU with and without comorbid CIndUs for differences in demographic features, clinical characteristics, and laboratory markers. We analyzed 708 patients with CSU of our Urticaria Center of Reference and Excellence enrolled in CURE, the chronic urticaria registry. CURE data collected until October 2022 were used to compare patients with and without comorbid CIndU for their demographic characteristics, disease onset, activity, impact, and control, as well as concomitant allergic and autoimmune diseases and laboratory parameters associated with autoimmune CSU. Of 708 patients with CSU, 247 (35%) had comorbid CIndU. Compared with patients with standalone CSU, patients with CSU with comorbid CIndU were significantly younger, had earlier disease onset, longer disease duration, higher impact on quality of life, and a higher rate of concomitant allergic diseases. Moreover, patients with CSU with comorbid CIndU less often had features linked to autoimmune CSU such as angioedema, concomitant autoimmune diseases, eosinopenia, low levels of total IgE, and low total IgE combined with elevated anti-thyroid peroxidase IgG. Autoimmune CSU may be less common in patients with comorbid CIndU than without, and comorbid CIndU may point to autoallergic CSU.

Development of anaphylaxis upon oral food challenge and drug provocation tests in pediatric patients.

Background: The drug provocation test (DPT) and the oral food challenge (OFC) are considered as the criterion standard for the diagnosis of drug hypersensitivity reactions and food allergy. Severe allergic reactions may develop during these tests. Objective: To evaluate the frequency and features of anaphylaxis in pediatric patients undergoing OFCs and DPTs. Method: OFCs and DPTs performed in an open method in the pediatric allergy clinic of our institution between January 2014 and January 2021 were reviewed retrospectively. The characteristics of anaphylaxis that developed during these tests were evaluated. Results: A total of 3631 OFCs and/or DPTs were performed on 2588 pediatric patients. Reactions were recorded in 317 challenges (8.7%), including 42 (1.2%) in the form of anaphylaxis. Of the patients with anaphylaxis, 31 developed anaphylaxis during OFC and 11 during DPT. Anaphylaxis during OFCs was mostly triggered by yogurt (n = 8), hen's egg (n = 6), baked milk (n = 5), and baked egg (n = 4). Cases with anaphylaxis during DPT were recorded mostly with ibuprofen (54.5% [n = 6]). All patients who developed anaphylaxis during OFC had cutaneous manifestations, and 90.3% had respiratory symptoms. Gastrointestinal involvement was present in 32.3% of the patients. During DPT, cutaneous manifestations were observed in 90.9% in the patients who developed anaphylaxis and the respiratory tract was involved in 81.8%. In terms of concomitant allergic diseases, 51.6% of the patients who developed anaphylaxis during OFC had atopic dermatitis and 38.7% had asthma. All the patients with anaphylaxis triggered by nonsteroidal anti-inflammatory drug DPT had asthma. Of the anaphylaxis, 54.8% were mild, 35.7% were moderate, and 9.5% were severe. Severe anaphylaxis was recorded with baked milk (n = 2), baked egg and trimethoprim-sulfamethoxazole (n = 1, each). The patients did not require intensive care, and no death occurred. Conclusion: Anaphylaxis may develop during OFCs and DPTs. These tests should be carried out by experienced allergists in an appropriate setting where emergency equipment and medications, including epinephrine, are readily available.

P343 Eosinophilic inflammation as an indicator of the activity of the course of Inflammatory Bowel Diseases

Abstract Background Eosinophils have been identified as cells that promote immune cell infiltration in inflammatory bowel diseases (IBD). Activation of eosinophils causes degranulation, which can lead to tissue damage due to the release of toxic oxygen radicals, including eosinophilic cationic protein (ECP). The potential role of eosinophils in inflammation and fibrosis in patients with IBD remains relevant. Purpose of the study to study the effect of changes in the level of eosinophilic cationic protein on the activity of the course of inflammatory bowel diseases. Methods The study was conducted from January 2016 to April 2022, among 400 patients with IBD (MC 12 patients, women 8, men 4; UC 150 patients, women 71, men 79; CD 238 patients, women 120, men 118). Patients underwent endoscopy with biopsy sampling for pathomorphological examination, as well as laboratory blood tests (general blood count, h/s CRP, homocysteine, vitamin D, ANCA-parameters, α-THF and IL-1β, IL-4, IL -8, IL-10, IL-18, total protein, albumin, iron, ferritin, eosinophilic cationic protein (ECP), İgE; urinalysis and urinary albumin; fecal analysis and fecal calprotectin and lactoferrin. Results In 250 patients (62.5%) with a poor response to basic therapy, a study was conducted on ECP and in 69 cases (27.6%) the result was positive, the number of positive endoscopic manifestations was 190 (76%), the number of patients with a positive pathological conclusion for the presence of eosinophils in the biopsy material (more than 30-35 eosinophils per field of view) - 95 (38%), the number of patients with concomitant allergic diseases - 14 (5.6% / 20.2%). The level of EPC fluctuated within 29-228 ng/mL (N&amp;lt;24 ng/mL). Indicators for the studied parameters are presented in Table 1. Table 1. Changes in activity in some laboratory, endoscopic and pathological parameters During the follow-up in the group of patients with elevated levels of eosinophilic cationic protein for 6-24 months, some changes occurred: new cases of fibrosis appeared in patients with CD, as well as cases of non-response to basic therapy and, as an outcome, cases of surgical interventions in patients with ulcerative colitis (Diagram 1). Diagram 1. Outcome of patients with elevated EPC levels Conclusion The increase in the level of ECP in the study group of patients was 27.6% and correlated with higher rates both in laboratory and in endoscopic and morphological activity of IBD. The study of the increase in ECP is of interest in the context of the “non-response” marker to basic therapy in IBD and in the search for new targets for treatment.

The significance of component-resolved allergy diagnostics in atopic dermatitis patients when prescribing allergen-specific immunotherapy

The paper presents clinical cases of patients with severe atopic dermatitis with polyvalent sensitization in an adult patient and in a pediatric patient. Standard topical and systemic therapy proved to be an insufficiently effective strategy in these patients. Both patients underwent component-resolved allergy diagnostics, which made it possible to identify the causally significant components of allergens, sensitization to which affects the course of atopic dermatitis. On the basis of the survey, indications for allergen-specific immunotherapy with causally significant allergens were determined. The treatment made it possible to achieve non-drug remission not only of atopic dermatitis but also of concomitant respiratory allergic diseases.&#x0D; The cases demonstrate the efficacy and safety of allergen-specific immunotherapy in patients with proven sensitization to causally significant allergens based on component allergy diagnostics.

DEMOGRAPHICS AND CLINICAL CHARACTERISTICS OF PATIENTS WITH EOSINOPHILIC ESOPHAGITIS: A US-BASED INSURANCE CLAIMS DATA ANALYSIS

<h3>Introduction</h3> Real-world data on demographics and clinical characteristics of patients with eosinophilic esophagitis (EoE) are limited. We described patient characteristics, clinical symptoms, and comorbidities in US patients with newly-diagnosed EoE. <h3>Methods</h3> Retrospective analysis of 2017–2021 US MarketScan Commercial and Medicare administrative claims data including EoE patients with ≥12 months' continuous health plan enrollment pre- and post-first observed EoE diagnosis (index date). Demographic characteristics, clinical symptoms, and comorbidities pre-index in patients with incident (newly diagnosed) EoE were reported overall and stratified by age at EoE index date: <12 years (children), ≥12–17 years (adolescents) and ≥18 years (adults). Statistics were descriptive. <h3>Results</h3> 12,694 patients with incident EoE were identified and included (63.5% male; mean [SD] age 38.2 [16.5] years). The most common symptoms observed pre-index were dysphagia (38.0%), acid reflux (36.5%), and abdominal pain (25.9%). Mean (SD) days from first recorded chest pain and abdominal pain diagnosis to EoE diagnosis were 150.1 (114.6) and 146.3 (114.9), respectively, longer than EoE-specific symptoms such as dysphagia (82 [90.2]). Time from onset of dysphagia to EoE diagnosis was shorter in adults than in children and adolescents. Common comorbidities at index are presented in the <b>Figure</b>. Children and adolescents have a higher frequency of concomitant allergic diseases compared with adults. <h3>Discussion</h3> The presence of concomitant diseases and symptoms such as dysphagia and abdominal pain suggests a high disease burden. Comorbidities, presence of non-specific symptoms, duration of symptoms and patient age should be considered for a timely diagnosis of EoE.

Anaphylaxis in Omani Patients: A Study from a Tertiary Care Center.

ObjectivesAnaphylaxis is an acute and potentially fatal allergic reaction. No studies have yet been conducted to evaluate the spectrum of anaphylactic reactions among Omani patients. As such, this study aimed to describe the clinical features, causes, investigation, and management of anaphylaxis among patients presenting to a tertiary care center in Oman.MethodsThis retrospective study took place between August 2005 and June 2020 at the allergy and immunology clinic of Sultan Qaboos University Hospital, Muscat, Oman. All patients diagnosed with anaphylaxis during the study period were included. Data were collected from electronic medical records.ResultsOne hundred patients were diagnosed with anaphylaxis during the study period. Of these, 52.0% were male. The mean age was 15.9±16.2 years, with 70.0% aged < 18 years old. The eosinophil count ranged from 0.0–16.9 × 109/L, with a mean of 0.8±2.2 × 109/L and a median of 0.3 (0.1–0.6) × 109/L. Total immunoglobulin (Ig) E levels ranged from 25–8706 kIU/L, with a mean of 935.1±1369.5 kIU/L and a median of 500.4 (186.0–972.5) kIU/L. The majority of patients had a family history of allergies (72.0%), and other had concomitant allergic conditions (66.0%). All were prescribed epinephrine (100%). The most common cause of anaphylaxis was food (65.0%). The second most frequent trigger was insect venom (32.0%). Most patients had one category cause (81.0%); two or more causes were present in 12.0% of patients. Clinical symptoms manifested most frequently as cutaneous (92.0%) and respiratory (85.0%). The majority of patients (87.0%) demonstrated the involvement of more than one bodily system. Mean total IgE levels were significantly higher in patients with concomitant presence of other allergic conditions (1193.8 kIU/L) than patients without another concomitant allergic disease (503.6 kIU/L; p =0.030). In addition, concomitant allergic disease is significantly higher in patients < 18 years of age (75.4%) compared to patients > 18 years of age (45.2%; p =0.010).ConclusionsDue to its life-threatening nature, knowledge of the epidemiology and clinical features of anaphylaxis in different populations is necessary to deliver rapid treatment. This study found that the clinical features of anaphylactic patients in Oman were similar to those reported elsewhere. Further research is needed to determine the true incidence of anaphylaxis in Oman to minimize associated morbidity and mortality.

Atopic dermatitis: clinical phenotypes, persistence and comorbidity

Background. Atopic dermatitis is the most common skin disease among children. Its natural history is heterogeneous with a difference in age of manifestation, localization of lesions, severity, sensitization profiles, presence of comorbid atopic conditions, and longitudinal trajectories of disease progression. The study aimed to assess the impact of factors such as the onset of the disease, atopic family history, presence of concomitant allergic pathology, duration of breastfeeding on the course of the disease and the development of respiratory allergies, and the impact of environmental factors that aggravate the disease. Materials and methods. Children with atopic dermatitis (n = 88) were included in the study from September 2020 to April 2021 in Kyiv, Ukraine. Symptoms of respiratory allergy in the history of patients have been documented as comorbidity. Results. Total of 88 patients at the time of examination presented with manifestations of atopic dermatitis in the form of a rash, dry skin, scaling, itching, lichenization. The disease severity was significantly related to the age of onset: children with early phenotype had more severe disease (OR = 16.261; 2.056–127.911). There was no statistically significant association of early phenotype of atopic dermatitis with the development of concomitant allergic diseases (OR = 1.813; 0.415–7.916). A severe course was observed in the group of children with atopic family history (OR = 2.750; 1.123–6.735). Children with severe atopic dermatitis had a high risk of concomitant respiratory allergy (OR = 5.604; 1.863–16.863). The duration of breastfeeding did not impact the severity of atopic dermatitis (OR = 0.778; 0.119–5.100) and the risk of concomitant atopic diseases (OR = 1.417; 0.444–4.521). The course of atopic dermatitis was influenced by seasonality in 76 children (86.4 %): the condition of the skin deteriorated in the winter. Contact with the animal was associated with exacerbation of atopic dermatitis in 4 (4.5 %) children, food ingestion — in 20 children (25 %), pollen trees and grasses caused exacerbation in 5 children (5.7 %). Conclusions. Children with a severe phenotype of atopic dermatitis are at risk of developing respiratory allergies. Patients with atopic dermatitis who develop symptoms at the age of under 2 years, as well as those with an atopic family history, are at high risk of developing a severe disease phenotype.

THE IMPORTANCE OF ALLERGIC FACTOR IN THE ETIOPATHOGENESIS OF CHRONIC ADENOIDITIS IN CHILDREN

The article presents the features of the course of chronic adenoiditis in children with allergic rhinitis. Allergic diseases of the upper respiratory tract and pathology of the pharyngeal tonsil today remain one of the most common diseases in pediatric practice and their pathogenetic mechanisms are often interrelated. The choice of treatment mode for this group of children is currently being actively discussed. The aim of the study is scientific-literary and practical consideration of the problem of the influence of an allergic factor on the pathogenesis of nasopharyngeal tonsil hypertrophy as a cause of chronic adenoiditis in children. The study examined 30 children with stage 2 adenoid hypertrophy, including 18 boys and 12 girls. A number of authors insist on the need to prioritize conservative management, while more and more evidence is emerging that there may often be indications for surgery. The prevalence of allergic diseases and adenoid vegetations in childhood has determined the relevance of studying the research problem. It is established that adenoids in allergic rhinitis become a kind of shock organ, on the surface of which inhaled allergens are delayed. It has been determined that in allergic rhinitis removal of adenoids has the ability to improve the general condition of the patient and relieve symptoms (including nasal congestion) and reduce the risk of various chronic pathologies (namely chronic otitis), and in obstructive sleep apnea — reduce the risk of suffocation. The algorithm of management of children with pathology of the pharyngeal tonsil in concomitant allergic diseases, where the first stage it is necessary to recommend treatment by an allergist, and only in the ineffectiveness of conservative therapy to perform surgery. It has been shown that most of the studied children (60–70%) with stage II nasopharyngeal tonsil hypertrophy showed allergic rhinitis and elevated levels of anti-inflammatory cytokines, which indicates the relationship of the disease with inflammatory diseases of the nasopharynx and immune system. It is determined that the problems of correct diagnosis of the causes of inflammation and hypertrophy of the nasopharyngeal tonsil and the strategy, tactics and correctness of their treatment deserve scientific attention.

Evolution of bronchial obstruction pattern in children of presсhool age

Introduction. The diagnosis of asthma presents objective difficulties in children aged less than 5 years. Not all children with recurrent virus-induced obstruction can further develop asthma.Aim. To assess the realization of different clinical and pathogenetic variants of bronchoobstructive syndrome in the child population.Materials and methods. Risk factors of 75 patients with bronchoobstructive syndrome in the first 5 years of life were retrospectively evaluated. 57 patients were surveyed using the “Asthma Prediction Tool” questionnaire. At the end of the follow-up period (one year), cases of bronchial asthma were evaluated.Results. A predictive contribution to the implementation of the recurrent variant of bronchoobstructive syndrome has a burdened hereditary allergic anamnesis (OR=5,4, CI 1,79-16,46, p&lt;0,05) and the presence of atopic dermatitis (OR=7,7, CI 2,73-21,95, p&gt;&lt;0,05). Symptoms of allergic rhinitis in combination with hypertrophy of the Palatine tonsils in 6,06 and 3,45 times, respectively, increase the risk of bronchial asthma (p&gt;&lt;0.05). Conclusion. As a result of research, there are significant factors in the implementation of bronchial asthma such as concomitant allergic diseases in combination with a hereditary background and hypertrophy of the palatine tonsils. The&gt;˂ 0,05) and the presence of atopic dermatitis (OR=7,7, CI 2,73-21,95, p˂ 0,05). Symptoms of allergic rhinitis in combination with hypertrophy of the Palatine tonsils in 6,06 and 3,45 times, respectively, increase the risk of bronchial asthma (p˂ 0.05).Conclusion. As a result of research, there are significant factors in the implementation of bronchial asthma such as concomitant allergic diseases in combination with a hereditary background and hypertrophy of the palatine tonsils. The “Asthma Prediction Tool” questionnaire allows you to predict the development of bronchial asthma in patients with episodic and recurrent bronchial obstruction. The article will be useful for both pediatricians and primary care professionals, as it allows to rationally influence the risks of bronchial asthma formation.

Idiopathic inflammatory demyelining diseases: optimization of early diagnosis, predictors of the course

Objective: to describe the clinical and epidemiological features of idiopathic inflammatory demyelinating diseases and to determine the factors influencing their course. Materials and methods: the study included 803 patients with idiopathic inflammatory demyelinating diseases using patient questionnaires and scales, laboratory and instrumental research methods. Statistical processing of the results was carried out using a point biserial coefficient and programs for analyzing large data arrays and machine learning. Results: a dynamic increase in the prevalence of some forms of idiopathic inflammatory demyelinating diseases was revealed, the difficulties of differential diagnosis of rare forms of demyelination and the need to create a unified version of their classification are reflected. In the studied population, the effectiveness of liquorological examination in the diagnosis of multiple sclerosis in the early stages of the disease was shown. It has been shown that the likelihood of developing highly active multiple sclerosis is influenced by both a genetic factor and concomitant inflammatory, allergic and autoimmune diseases, surgical interventions, dietary habits, childhood infections, and a history of pregnancy. Conclusions: given the complexity of the differential diagnosis of idiopathic inflammatory demyelinating diseases and the appointment of modifying therapy in multiple sclerosis in the early stages, it is necessary to create a combined classification and maintain a common register.

Korkulu Rüya Anafilaksi: Tek Merkez Deneyimi

Amaç: Anafilaksi hızlı ve doğru müdahale edilmediğinde ölümcül olabilen sistemik bir reaksiyondur. Çalışmamızın amacı çocuk alerji polikliniğine anafilaksi nedeni ile başvurmuş olan hastaların demografik özellikleri, klinik seyri ve tetikleyici etkenlerini paylaşmaktır. Gereç ve Yöntem: 2017-2020 yılları arasında anafilaksi tanısı ile çocuk alerji polikliniğinde tetkik edilmiş olan hastaların dosyaları geriye dönük olarak değerlendirildi. Bulgular: Çalışmamıza dahil edilen 57 anafilaksi hastasının yaş ortalaması 7,8±4,5 yıl idi, %56,1’i erkekti. Hastaların %68,4’ü atopik idi, %49,1’inde serum IgE yüksekliği, %36,8’inde eozinofili eşlik etmekteydi. Tetikleyici olduğu belirlenen alerjenler sırasıyla besinler (%40,4), ilaçlar (%35,1) ve venom (%5,3) idi. Hastaların %64,9’unda hafif şiddette anafilaksi gözlendi. Eşlik eden ek alerjik hastalık, astım ve atopi varlığının anafilaksi şiddetini arttırdığı görüldü. Dokuz hastada 2 veya daha fazla anafilaksi atağı gözlenmiş idi. Adrenalin oto-enjektörü reçete edilmiş olan hiçbir hastada atak esnasında oto-enjektör kullanılmamıştı. Sonuç: Anafilaksi erkek çocuklarda daha sık görülmektedir. En sık tetikleyici etken besinlerdir. Astım, eşlik eden alerjik hastalık ve atopi varlığı atak şiddetini arttıran etmenlerdir. Adrenalin oto-enjektörü reçete edilmiş olan hastalarda da kullanılmamaktadır

Specificities of small airways dysfunction development in patients with mild asthma

The study goal was to identify specificities of small airways dysfunction development (SAD) in patients with mild asthma. Material and Methods — The study involved 114 patients with mild asthma. Depending on the condition of their small airways, the patients were split among two groups: Group 1 of 94 patients with asthma without SAD (82.5%); Group 2 of 20 patients with asthma and SAD (17.5%). The control group consisted of 25 volunteers. SAD was diagnosed by the presence of air trapping and hyperinflation. Results — SAD was diagnosed in 17.5% of patients with mild asthma. The development of SAD was observed in 80% of asthma patients with ailment duration of over 5 years and family history of asthma. Obesity was diagnosed 1.7 times more often in patients with SAD compared with those without it. Food allergy, allergic rhinitis, allergic conjunctivitis, urticaria and bronchial obstruction were identified two or more times more often in patients with SAD compared with those without it. Among all patients with mild asthma and SAD, bronchial obstruction was detected in 55% of cases. Conclusion — The development of SAD in the presence of mild asthma is characteristic for patients with ailment duration over 5 years, family history of asthma, obesity, predominant sensitization to food allergens, and concomitant non-pulmonary allergic diseases. Bronchial obstruction is not the obligatory feature of SAD development in presence of mild asthma.

Acute urticaria: differential diagnosis and treatment

Acute urticaria remains one of the most topical pediatric problems. Acute urticaria lasts for up to 6 weeks, during which blisters appear with varying frequency and intensity. In about 40% of cases, urticaria is accompanied by angioedema. The prevalence of acute urticaria is 1 to 5% in the population, and in the child population the frequency of acute urticaria reaches 6.7%. According to recent estimates, 10 to 20% of the population has had an episode of acute urticaria during their lifetime. About 50% of children with acute urticaria have concomitant allergic diseases. The management of children with acute urticaria presents significant diagnostic and therapeutic challenges. Treatment of acute urticaria in children begins with elimination of the significant trigger – appropriate measures are taken (withdrawal of the drug, administration of an elimination diet, therapy of infectious and inflammatory processes). First-line drugs for acute urticaria are H1-antihistamines, and it is recommended to use H1-antihistamines of the II generation. However, if clinical manifestations develop rapidly, if the patient has generalized urticarial rashes, angioedema, gastrointestinal symptoms, parenteral forms of first-generation antihistamines may be used to relieve the acute allergic reaction. Patients who do not respond to treatment with antihistamines may respond to short-term therapy with systemic glucocorticoids, although the efficacy of this treatment has yet to be tested in controlled clinical trials. The prognosis for acute urticaria is favorable – in most cases, acute spontaneous urticaria remains the only episode in the patient’s life. The disease develops into a chronic form in 5% of patients, and other estimates suggest that the symptoms of urticaria persist in 9.5% of children for up to 6 months.