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Background: Despite nebulized budesonide being identified by the Global Initiative for Asthma report as a viable alternative to inhaled corticosteroids (ICS) delivered by pressurized metered-dose inhalers (pMDIs) with spacers, practical guidance on nebulized corticosteroid use in the pediatric population remains scarce., Objective: To review the current literature and provide practical recommendations for nebulized budesonide use in children aged ≤ 5 years with a diagnosis of asthma., Methods: A group of 15 expert pediatricians in the respiratory and allergy fields in Thailand developed Delphi consensus recommendations on nebulized budesonide use based on their clinical expertise and a review of the published literature. Studies that evaluated the efficacy (effectiveness) and/or safety of nebulized budesonide in children aged ≤ 5 years with asthma were assessed. AR patients., Results: Overall, 24 clinical studies published between 1993 and 2020 met the inclusion criteria for review. Overall, results demonstrated that nebulized budesonide significantly improved symptom control and reduced exacerbations, asthma-related hospitalizations, and the requirement for oral corticosteroids compared with placebo or active controls. Nebulized budesonide was well tolerated, with no severe or drug-related adverse events reported. Following a review of the published evidence and group consensus, a treatment algorithm as per the Thai Pediatric Asthma 2020 Guidelines was proposed, based on the availability of medications in Thailand, to include nebulized budesonide as the initial treatment option alongside ICS delivered by pMDIs with spacers in children aged ≤ 5 years., Conclusions: ThNebulized budesonide is an effective and well-tolerated treatment option in children aged ≤ 5 years with asthma.

Background: 22q11.2 deletion syndrome is one of the most prevalent microdeletion syndromes in humans. The syndrome is characterized by extensive phenotypic variability., Objective: to investigate the clinical characteristics, immunological features, and intellectual status of 22q11.2 deletion syndrome patients at Chiang Mai University Hospital, Thailand., Methods: Patients who had a confirmed diagnosis of 22q11.2 deletion syndrome by fluorescent in situ hybridization (FISH) were enrolled. Data collated and evaluated included that pertaining to history, physical examination, laboratory testing including T-cell, immunoglobulin, calcium, thyroid and parathyroid levels in the blood, cardiac and urological imaging, and intellectual status., Results: 34 patients diagnosed with 22q11.2 deletion syndrome; 18 (53%) were female. The median age of patients was 18.5 months (IQR; 1.5-35.8). Ninety-one percent of patients had characteristic facial features; 94% had a congenital heart defect with tetralogy of Fallot being the most frequent (72%); 88% had hypocalcemia, and 35% had genitourinary tract abnormalities. Recurrence of 22q11.2 deletion syndrome in the family was detected in 18% of cases. Twenty-eight patients (82%) were found to have a low number or percentage of T-cells. Five patients (15%) had low immunoglobulin levels. Intellectual disability (IQ/DQ scores < 70) were found in 20 out of 25 patients who were evaluated (80%), whereas the other five (20%) performed at a level of borderline intellectual function., Conclusions: Tetralogy of Fallot, hypocalcemia, immunologic defect, and cognitive impairment were common in our 22q11.2 deletion syndrome study group. We recommend that all affected patients have a multi-system evaluation by a comprehensive care team.

Allergen-specific immunotherapy (AIT) is the only treatment that modifies the underlying pathophysiology of IgE-mediated allergic diseases. Evidence shows the efficacy in achieving better control of the symptoms and reduction in medication use in patients with allergic rhinoconjunctivitis and/or asthma. It should be used in association with proper pharmacotherapy for at least three years. The benefits are sustained for several years after discontinuation of treatment. Moreover, it may prevent the development of new sensitization and progression of disease from allergic rhinitis to asthma in children. The favorable efficacy of AIT is associate to the appropriate selection of patients, allergen extracts, adherence, and duration of treatment. Safety during AIT is another concerning issue. AIT has an acceptable safety profile if administered under the appropriate circumstances. Future studies investigating the prescription, efficacy, and safety need to be developed. The new application routes, use of adjuvants, modification of allergens, and use of biologics are currently under evaluation. Moreover, there is an urgent need for real-world data in developing countries regarding the cost-effectiveness analysis, and optimization of AIT schedules and products, so that clinical practice and implementation of AIT for respiratory allergic diseases can be effective and safe.

Background: Most patients with allergic rhinitis are polysensitized. The efficacy of house dust mite (HDM) allergen immunotherapy (AIT) compared between monosensitized and polysensitized patients remains limited., Objective: To systematically review the efficacy and safety of HDM AIT compared between monosensitized and polysensitized patients with allergic rhinitis., Methods: We searched PubMed/MEDLINE, Scopus, EMBASE, and the Cochrane central register of Controlled Trials (CENTRAL) until June 2022. The primary outcome was the changes from baseline in total nasal symptom score (TNSS). Secondary outcomes were changes from baseline in total medication score (TMS), combined symptom medication score (CSMS), visual analog scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, immunological parameters, and adverse events (AEs)., Results: Of 13 eligible studies, 10 prospective cohorts, 2 retrospective cohorts, and 1 matched cohort, we identified 10 studies for quantitative synthesis. There were 1,113 patients with allergic rhinitis, 566 with HDM monosensitization and 547 with polysensitization to HDM and other allergens. There was no significant difference in the pooled mean changes of the 2 groups in TNSS (SMD -0.05, 95%CI: -0.22 to 0.11, p = 0.532) and VAS (SMD -0.20, 95%CI: -0.42 to 0.01, p = 0.060) with moderate certainty of evidence. The changes in TMS, CSMS, and RQLQ were similar between the 2 groups with very low certainty of evidence. The AEs were mild and comparable between the 2 groups. The immunological indices remained inconsistent and were not predictive of clinical responses., Conclusions: A single HDM AIT similarly improved clinical outcomes in monosensitized and polysensitized patients with allergic rhinitis.

Background: Bee venom (BV) hypersensitivity can be severe and potentially life-threatening. Beekeepers heavily exposed to bee stings and are thus at a high-risk group. The data on bee sting reactions among beekeepers in Thailand is limited., Objective: To determine the prevalence, clinical and immunological characteristics, and the knowledge of BV hypersensitivity in Thai beekeepers., Methods: A self-reported questionnaire survey about BV reactions in beekeepers were conducted. Further blood test for immunological parameters: serum BV-specific IgE (BV sIgE), phospholipase A2-specific IgE (Api m1 sIgE), and BV-specific IgG4 (BV sIgG4) were compared between non-allergic beekeepers, patients with a history of bee sting anaphylaxis and the non-allergic control group., Results: A total of 202 out of 447 questionnaires (response rate 45%) were returned. The median age was 46.7 years. Systemic reactions were documented in 6.4%. Younger than 45 years was found to be a factor associated with systemic reactions (OR, 4.35; 95% CI, 1.16-16.31). The BV sIgE and Api m1 sIgE were significantly higher in the anaphylaxis group (p = 0.001). The median of BV sIgG4 was significantly higher in non-allergic beekeepers (p = 0.001). For the knowledge of BV hypersensitivity, 56.4% recognized that BV hypersensitivity could be fatal but only 6% knew about epinephrine auto-injector device., Conclusions: The prevalence of systemic reactions after stings among Thai beekeepers was not high, which might be due to the tolerance induced by natural exposure via sIgG4. The level of knowledge of BV hypersensitivity among beekeepers was insufficient, more education must be provided.

Background: The study of anaphylaxis in different geographic areas raises the awareness to improve prevention and medical care., Objective: To investigate the incidence, causes, characteristics, and management of anaphylaxis in Chiang Mai, Thailand., Methods: We performed a retrospective review, based on ICD-10 electronic medical records of patients who attended the Out-Patient and Emergency Departments at Chiang Mai University Hospital from January 2007 to December 2016., Results: A total of 441 episodes of anaphylaxis in 433 patients were analyzed. Three-hundred and sixty-two (84%) were adults and 71 (16%) were children. Anaphylaxis was common in the second and third decades of life. The incidence rate for all causes of anaphylaxis was 3.9 episodes per 100,000 out-patient and emergency visits per year. The rate in children was more frequent than in adults. Foods were the most common culprit (47%), followed by insect stings (23%) and drugs (18%). Severe anaphylaxis, defined as the loss of consciousness, hypotension, respiratory failure, or cyanosis were found in 163 events (37%). The time lapses between exposure with an allergen and the onset of symptom less than 30 minutes and triggered by insect stings were significantly associated with severe anaphylaxis. Biphasic reactions occurred in 6 patients (1.4%). Adrenaline injections were prescribed in most of patients (90%). There were no fatality cases in the past 10 years., Conclusions: The incidence of anaphylaxis in our hospital appears more often in children than in adults. The frequency in adults trends to be increasing. Food and insect stings are the common causative agents.