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A university student with a background of atopy presented to her general practitioner (GP) 2 weeks following an episode of throat tightening and dizziness occurring after touching cashew nut to her lip. She took antihistamine medication immediately and went to sleep, fearing for her life. On waking, she felt astounded to be alive. Her symptoms resolved gradually over the following week. She waited 2 weeks for an appointment with her GP, who referred her to allergy clinic. Eight months later, she was still waiting for her clinic appointment, and was left fearing a future fatal reaction, having been provided with no interim treatment. Not all patients who have severe allergic reactions present to the emergency department. Living with the constant fear of anaphylaxis can be overwhelming for patients and their families, and it can negatively impact mental health. Therefore, we advise early allergy counselling and early EpiPen prescription.

INTRODUCTION: There is considerable research interest in the role of helminth infections in the development of allergic diseases. However, findings from previous studies are mixed. Existing systematic reviews of these studies are outdated. We performed a systematic review of the global literature on the association between helminth infections and development and clinical outcomes of allergic diseases. METHODS: We searched Cochrane Library, MEDLINE, EMBASE, ISI Web of Science, PubMed, Global Index Medicus, Scielo, KoreaMed, Google Scholar, and Lilacs for studies published up to January 2020. We included observational epidemiological studies (cohort, case-control and cross-sectional studies) of children and adults reporting associations between helminth infections and asthma, allergic rhinitis, eczema and atopy. We performed random-effects meta-analysis to summarize the effect estimates. RESULTS: We included 80 studies with 99,967 participants. In the meta-analyses, we did not observe an overall association between helminth infections and allergic diseases. There was, however, evidence that A. lumbricoides infections was associated with an increased risk of bronchial hyperreactivity in children (RR:1.41, 95%CI: 1.17-1.70; I2=50, p for I2=0.09), and was associated with an increased risk of atopy among helminth-infected adults (RR:1.37, 95%CI: 1.18-1.61; I2=52, p for I2=0.02). We found no study that addressed the association between helminth infection and clinical outcomes of allergic diseases. The overall strength of the underlying evidence was low to moderate. CONCLUSION: Helminth infections may increase the risk of bronchial hyperreactivity in children and atopy in adults. Well-designed longitudinal cohorts may help clarify potential causal associations between chronic helminth infections and allergic diseases.

In the present study, twenty atopic dogs were investigated for secondary skin infections using different diagnostic techniques. The majority of dogs were suffering from bacterial infections, especially Staphylococcal infection (90 %). Different commensals on skin like Staphylococcus spp., Aspergillus spp. (50 %), Malassezia spp. (45 %), Demodex spp. (25 %) etc. caused secondary or concurrent infections in many atopic dogs indicating the importance of atopy in recurrent or non-responding dermatitis with those commensal organisms.

Vitamins are essential for cellular growth and nutrition. The bioavailability of vitamins may affect the immune system’s ability to fight cancer. Research efforts investigate the complex interplay of vitamins, immune cells, and cancer cells to improve treatment outcomes. This review explores managing the intake of vitamin A, B, C, D, E, and K to enhance the efficacy of forced-atopy cancer immunotherapy.

Останнім часом істотно зросла роль техногенного впливу на організм людини, що обумовлює поширення алергопатології серед дитячого населення. Серед 318 немовлят з IgE-залежними захворюваннями шкіри зареєстровано максимальний рівень гіперсенсибілізації до харчових алергенів (переважно до протеїнів курячого ембріона (34,48 %) та коров’ячого молока (25 %)) та інгаляційних алергенів (переважно до епідермальних алергенів домашніх тварин (28,7 %) та побутових алергенів (29 %)). Створення гіпосенсибілізуючого ефекту до вищезазначених облігатних алергенів дозволить запобігти розвитку атопії в дітей раннього віку. До алергенів риби, пшениці, бобових, арахісу, моркви, картоплі сенсибілізацію серед 318 дітей піддослідної групи не виявлено, що робить недоцільним елімінацію їх відповідно до загальноприйнятих рекомендацій із профілактики алергічних захворювань у дітей у Запорізькому регіоні.

Objective: to create a model for predicting the risk of upper gastrointestinal diseases in children with bronchial asthma.Material and Methods. The study included 120 children with bronchial asthma, 78 of them had concomitant pathology of the upper gastrointestinal tract. All children underwent general clinical, laboratory and instrumental examination. Based on the analysis of primary medical records (patient’s medical card (F-003/o) and child’s records (F-112)), we have evaluated retrospectively the data of ante-, peri- and postnatal periods, clinical manifestations of atopy and concomitant somatic pathology.Results. In terms of the regression analysis, there were determined risk factors for chronic gastroduodenal pathology in children with bronchial asthma: child’s sex, disease duration, severity of asthma symptoms and level of their control, as well as duration of breastfeeding, food sensitization, H.pylori infection, the presence of digestive pathology in child’s parents. Several models for predicting the risk of chronic diseases of the upper gastrointestinal tract (including destructive ones) in this group of patients were developed, based on clinical and laboratory parameters. These prognostic models have a sufficient level of sensitivity, easy to use and can be recommended for primary care physicians.

The article deals with fermentopathy as one of the possible causes of atopic dermatitis in children. Functional disorders of the digestive organs lead to the absorption of inadequately broken down food components, especially proteins, and thereby to organism sensitization to different types of allergens. Children with atopic dermatitis have the following functional disorders of the digestive organs: reflux, dyskinesia, di­seases of the mucous membrane, cholestasis, relative pancreatic insufficiency, intestinal dysbiosis. The doctor’s task consists in the in-depth examination of these patients, and in the administration of combined therapy for atopic dermatitis in view of the identified changes in the gastrointestinal tract., Статья посвящена ферментопатиям как одной из возможных причин атопического дерматита у детей. Функциональные нарушения органов пищеварения приводят к всасыванию неполноценно расщепленных компонентов пищи, особенно белков, и тем самым способствуют сенсибилизации организма к различным видам аллергенов. При атопическом дерматите у детей встречаются следующие функциональные нарушения органов пищеварения: рефлюксы, дискинезии, заболевания слизистой оболочки, холестаз, относительная панкреатическая недостаточность, дисбиоз кишечника. Задача врача состоит в углубленном обследовании таких пациентов и назначении комплексной терапии атопического дерматита с учетом выявленных изменений со стороны желудочно-кишечного тракта., Стаття присвячена ферментопатіям як однієї з можливих причин атопічного дерматиту в дітей. Функціональні порушення органів травлення призводять до всмоктування неповноцінно розщеплених компонентів їжі, особливо білків, і тим самим сприяють сенсибілізації організму до різних видів алергенів. При атопічному дерматиті в дітей зустрічаються такі функціональні порушення органів травлення, як рефлюкси, дискінезії, захворювання слизової оболонки, холестаз, відносна панкреатична недостатність, дисбіоз кишечника. Завданням лікаря є поглиблене обстеження таких пацієнтів та призначення комплексної терапії атопічного дерматиту з урахуванням виявлених змін з боку органів шлунково-кишкового тракту.

Among all allergic diseases in pediatric practice, allergic rhinitis is one of the most common pathologies of the upper respiratory tract. This review deals with the problem of modern principles for the diagnosis and treatment of allergic rhinitis in children based on the analysis of literature sources using electronic databases PubMed, Web of Science, MedLine, the Cochrane Library. Allergic rhinitis is an important medical and social problem of our time the importance of which has increased significantly in recent years. The growing number of people sensitized to pollen, the variety of symptoms and the negative impact on the quality of life of patients make pollen allergy one of the major problems in pediatrics. Despite the development of international national protocols and clinical guidelines, in many countries the control of allergic rhinitis in children remains insufficient. Therefore, it is necessary to take into account the individual characteristics of patients, pay attention to both nasal and extranasal symptoms, consider all pathognomonic diagnostic aspects, because the underdiagnosis of this allergic disease leads to inadequate therapy, complications, more severe atopy and reduced quality of children’s life in general. Recently, there is growing evidence of the need for personalized selection of the most effective therapy for allergic rhinitis in children. In-depth study of the pathogenetic role of circadian molecular clock in children with seasonal allergic rhinitis using informative molecular genetic methods may allow characterizing in detail the mechanism of regulation of allergic inflammation of the upper airway mucosa and evaluating the role of circadian genes in the development of allergic diseases, in particular allergic rhinitis. In the future, these studies may become an alternative to improve control over the course of allergy and the organization of a comprehensive monitoring system, development of new strategies for the treatment and prevention of allergic rhinitis in children., Серед всіх алергічних захворювань у педіатричній практиці алергічний риніт посідає одне з найбільш вагомих місць серед патологій верхніх дихальних шляхів. Даний огляд присвячений проблемі сучасних принципів діагностики та лікування алергічного риніту в дітей на підставі аналізу літературних джерел із використанням електронних баз даних PubMed, Web of Science, MedLine, The Cochrane Library. Алергічний риніт є важливою медико-соціальною проблемою сучасності, значення якого істотно збільшується протягом останніх років. Зростаюче число осіб, сенсибілізованих пилком, різноманітність симптомів та негативний вплив на якість життя пацієнтів роблять алергію на пилок однією з вагомих проблем педіатрії. Незважаючи на розробку міжнародних національних протоколів і клінічних рекомендацій, у багатьох країнах контроль за виявленням алергічного риніту в дітей залишається на недостатньому рівні. Тому необхідно враховувати індивідуальні особливості пацієнтів, звертати увагу як на назальні, так і на екстраназальні симптоми захворювання, враховувати всі патогномонічні діагностичні аспекти, оскільки гіподіагностика даного алергологічного захворювання призводить до неадекватної терапії, розвитку ускладнень, формування більш тяжких форм атопії та зниження якості життя в дітей загалом. Останнім часом з’являється все більше даних про необхідність персоніфікованого підбору найбільш ефективної терапії алергічного риніту в дітей. Поглиблене вивчення патогенетичної ролі циркадіанного молекулярного годинника в дітей із сезонним алергічним ринітом за допомогою інформативних молекулярно-генетичних методів може дозволити детально охарактеризувати механізм регуляції алергічного запалення слизової оболонки верхніх дихальних шляхів й оцінити роль досліджуваних циркадіанних генів у розвитку алергічних захворювань, зокрема алергічного риніту. У подальшому дані дослідження можуть стати альтернативою для покращення контролю за перебігом алергопатології та організації комплексної системи моніторингу, розробки нових стратегій лікування і профілактики алергічного риніту в дітей.

Background Identification of biomarkers associated with immune-mediated diseases in 22q11.2 deletion syndrome is an evolving field. Objectives We sought to use a carefully phenotyped cohort to study immune parameters associated with autoimmunity and atopy in 22q11.2 deletion syndrome to define biomarkers associated with immune-mediated disease in this syndrome. Methods Chart review validated autoimmune disease and atopic condition diagnoses. Laboratory data were extracted for each subcohort and plotted according to age. A random-effects model was used to define statistical significance. Results CD19, CD4, and CD4/45RA lymphocyte populations were not different from the general cohort for patients with atopic conditions. CD4/45RA T cells were significantly lower in the subjects with immune thrombocytopenia compared with the general cohort, and CD4 T-cell counts were lower in patients with autoimmune thyroid disease. Conclusions The mechanisms of autoimmunity in cytopenias may be distinct from those of solid-organ autoimmunity in 22q11.2 deletion syndrome. This study identifies potential biomarkers for risk stratification among commonly obtained laboratory studies.

The prevalence of allergic disease has increased significantly over the past decades. Although allergies are inherently multifactorial and heterogenous; environmental, maternal, and early-life microbial exposures could strongly modify disease risk. The effects of environmental microbiota are illustrated by the "farm effect", showing protection against asthma when children grow up on traditional farms. Recent studies have further revealed an important role for early-life exposure to a microbe-rich environment imposing lung and gut microbiome maturation and immune education, preventing allergic disease in childhood. Advances are made in the field of immunology and microbiome research, which identified entire microbial taxa, as well as specific microbial metabolites and bacterial products associated with reducing disease risk. Here we discuss the cross-talk between the microbiota and the pathogenesis of allergic disease, including bacterial products as lipopolysaccharide and CpG, in the farm effect.

В последние десятилетия документально подтверждена молекулярная и клиническая гетерогенность бронхиальной астмы (БА), определены эндотипы и клинические фенотипы заболевания. Аллергический фенотип БА является наиболее распространенным и связан с выработкой специфических IgE-антител (IgE – иммуноглобулин Е). В России для лечения неконтролируемой аллергической БА в 2007 г. зарегистрирован первый генноинженерный биологический препарат омализумаба. Проведенные доклинические и клинические исследования убедительно продемонстрировали, что включение омализумаба в терапию неконтролируемой аллергической БА позволяет не только значительно улучшить контроль заболевания, снижая частоту обострений, но и уменьшить объем базисной терапии. Особенно важно отметить снижение глюкокортикостероидной нагрузки у пациентов, в том числе сокращение приема системных глюкокортикостероидов, вплоть до их полной отмены. Омализумаб, обладая противоаллергическим и противовоспалительным действием, замедляет процессы ремоделирования стенки дыхательных путей, модифицируя течение БА. В настоящее время в России зарегистрирован и с успехом применяется биоаналог омализумаба – препарат Генолар. Выход на российский рынок биосимиляра омализумаба увеличивает доступность таргетной терапии для пациентов с неконтролируемой БА. Эффективность и безопасность препарата Генолар доказаны в доклинических и клинических исследованиях, результаты которых позволяют говорить об успешном достижении контроля БА и повышении качества жизни пациентов при приеме препарата Генолар., Over the past decades molecular and clinical heterogeneity of asthma has been documented; the endotypes and clinical phenotypes of the disease have been determined. The allergic phenotype of asthma is the most common and characterized by high production of specific immunoglobulin E (IgE) antibodies. The first genetically engineered biological drug omalizumab has been registered for the treatment of uncontrolled allergic asthma in Russia in 2007. Preclinical and clinical trials have convincingly demonstrated that the inclusion of omalizumab into the treatment of uncontrolled allergic asthma allowed significantly improving the disease control, reducing the frequency of exacerbations, as well as decreasing the amount of baseline therapy. It is especially important to emphasize the lowering of glucocorticosteroid load in patients and limiting the intake of systemic glucocorticosteroids up to their complete withdrawal. Antiallergic and anti-inflammatory effects of omalizumab decelerate the remodeling processes of respiratory tract wall by modifying the course of asthma. Currently, Genolar, a biosimilar of omalizumab, is registered and successfully used in Russia. The introduction of omalizumab biosimilar to the Russian market increases the availability of targeted therapy for patients with uncontrolled asthma. The efficacy and safety of Genolar have been demonstrated in preclinical and clinical trials. Their results suggest successful control of asthma and improvement of life quality in patients using Genolar.

Contains fulltext : 294367.pdf (Publisher’s version ) (Open Access) Over 90% of preterm neonates are, often empirically, exposed to antibiotics as a potentially life-saving measure against sepsis. Long-term outcome in association with antibiotic exposure (NABE) has insufficiently been studied after preterm birth. We investigated the association of NABE-duration with early-childhood developmental and health outcomes in preterm-born children and additionally assessed the impact of GA on outcomes. Preterm children (GA < 30 weeks) participating in a multicenter cohort study were approached for follow-up. General expert-reviewed health questionnaires on respiratory, atopic and gastrointestinal symptoms were sent to parents of children > 24 months' corrected age (CA). Growth and developmental assessments (Bayley Scales of Infant and Toddler Development (BSID) III) were part of standard care assessment at 24 months' CA. Uni- and multivariate regressions were performed with NABE (per 5 days) and GA (per week) as independent variables. Odds ratios (OR) for health outcomes were adjusted (aOR) for confounders, where appropriate. Of 1079 infants whose parents were approached, 347 (32%) responded at a mean age of 4.6 years (SD 0.9). In children with NABE (97%), NABE duration decreased by 1.6 days (p < 0.001) per week of gestation. Below-average gross-motor development (BSID-III gross-motor score < 8) was associated with duration of NABE (aOR = 1.28; p = 0.04). The aOR for constipation was 0.81 (p = 0.04) per gestational week. Growth was inversely correlated with GA. Respiratory and atopic symptoms were not associated with NABE, nor GA. We observed that prolonged NABE after preterm birth was associated with below-average gross-motor development at 24 months' CA, while a low GA was associated with lower weight and stature Z-scores and higher odds for constipation.

Food reactions (FR) are multifactorial and impacted by medical, demographic, environmental, and immunologic factors. We hypothesized that multi-omic analyses of host-microbial factors in saliva would enhance our understanding of FR development. This longitudinal cohort study included 164 infants followed from birth through two years. The infants were identified as FR (n = 34) or non-FR (n = 130) using the Infant Feeding Practice II survey and medical record confirmation. Saliva was collected at six months for the multi-omic assessment of cytokines, mRNAs, microRNAs, and the microbiome/virome. The levels of one miRNA (miR-203b-3p, adj. p = 0.043, V = 2913) and one viral phage (Proteus virus PM135, adj. p = 0.027, V = 2955) were lower among infants that developed FRs. The levels of one bacterial phylum (Cyanobacteria, adj. p = 0.048, V = 1515) were higher among infants that developed FR. Logistical regression models revealed that the addition of multi-omic features (miR-203b-3p, Cyanobacteria, and Proteus virus PM135) improved predictiveness for future FRs in infants (p = 0.005, X2 = 12.9), predicting FRs with 72% accuracy (AUC = 0.81, sensitivity = 72%, specificity = 72%). The multi-omic analysis of saliva may enhance the accurate identification of infants at risk of FRs and provide insights into the host/microbiome interactions that predispose certain infants to FRs.

Introduction The burden of asthma morbidity with co-existing atopy among the racial/ethnic minorities in the socio-economically disadvantaged NYC borough of the Bronx is unusually high. The multidisciplinary Montefiore Asthma Center (MAC) provides guideline-based treatment to this high-risk population through the joint efforts of Allergists/Immunologists, Pulmonologists, and on-site health educators. Methods The objective of this prospective, observational study was to define the demographic and clinical characteristics of severe asthma, evaluate improvement in asthma severity and lung function through the course of treatment at the MAC, and describe the asthma phenotypes of the patients managed at the MAC. Adults with severe asthma receiving treatment at the MAC were followed from their first to their last visit at the MAC. Patient demographics, along with asthma severity and co-existing allergies, were assessed. Possible phenotypes were defined (based on presence or absence of atopy, age at asthma onset, and blood eosinophil counts). Results 227 patients were included in the final analysis, of which 55.5% were Hispanic and 33.9% identified as non-Hispanic Black. Ninety-one percent (91%) of our cohort was found to be atopic and allergic rhinoconjunctivitis (ARC) was the most commonly identified co-existing allergic condition (86.3%). Mean Asthma Control Test (ACT) scores improved from 11.1 (± 4.9) at the initial visit to 14.8 (± 6.1) at the last visit. The spirometric values did not improve despite treatment at MAC. Conclusion A multidisciplinary severe asthma center is an ideal setting to phenotype patients and offer personalized guideline-based management and education to adults with severe asthma.

Study aim Galactose-α-1,3-galactose (alpha-Gal) syndrome is a delayed-type hypersensitivity reaction that occurs after consumption of mammalian meat and mammalian products. Our aim was to analyze patients in our population with alpha-Gal syndrome and to present their results. Materials and methods Our study included 18 patients exhibiting allergic symptoms after consumption of mammalian meat and mammalian products between 2018 and 2019. Retrospective examination of these patients’ files enabled us to examine the duration of onset of their allergic symptoms, the extent of their allergies, and their familial history, blood type, and comorbidities, as well as the existence of atopy, their place of residence and their skin test results. Results While 14 out of 18 patients included in the study have ongoing meat allergy, 4 of them recovered from their allergy. All patients were living in the countryside and had a history of contact with ticks during the hazelnut harvest. The median age was 37.44 ± 11.55 years. Time to onset of symptoms after consumption of red meat was 2.68 ± 2.58 hours. Skin prick tests with cetuximab were positive for 8 of 9 patients agreeing to advanced research, while the patient with a negative test result was in the group that recovered from meat allergy. We nevertheless detected that serum galactose-alpha-1,3-galactose-specific IgE values were positive for all 9 patients. Conclusion The most striking point in our study was that most of our patients were female and that all patients reported a history of contact with ticks at hazelnut harvest.

Respiratory syncytial virus (RSV) infection in infancy is associated with increased risk of asthma, except in those with allergic disease at the time of infection. Using house dust mite allergen, we examined the effect of pre-existing atopy on postviral airway disease using Sendai virus in mice, which models RSV infection in humans. Sendai virus drives postviral airway disease in nonatopic mice; however, pre-existing atopy protected against the development of airway disease. This protection depended upon neutrophils, as depletion of neutrophils at the time of infection restored the susceptibility of atopic mice to postviral airway disease. Associated with development of atopy was an increase in polymorphonuclear neutrophil–dendritic cell hybrid cells that develop in Th2 conditions and demonstrated increased viral uptake. Systemic inhibition of IL-4 reversed atopic protection against postviral airway disease, suggesting that increased virus uptake by neutrophils was IL-4 dependent. Finally, human neutrophils from atopic donors were able to reduce RSV infection of human airway epithelial cells in vitro, suggesting these findings could apply to the human. Collectively our data support the idea that pre-existing atopy derives a protective neutrophil response via potential interaction with IL-4, preventing development of postviral airway disease.

The concept of atopy was initially developed in the first quarter of the 20th century on the basis of clinical observations without any knowledge of pathogenic mechanisms. Atopy involves a collection of comorbidities that share pathogenic features, and atopic comorbidities affect outcomes of concomitant conditions rather than existing synchronously. The clinical importance of understanding the relationship of these conditions is necessary because the treatment of one condition influences the others, and the development of one leads to or precedes the development of another. Environmental influences and multigenetic predispositions result in complex relationships among the atopic conditions sharing a type 2 pathogenesis. The specialty of Allergy and Immunology is devoted to managing the comorbidities of atopy, and better understanding of their connections can improve patient care.

Basophils are key effector cells in atopic diseases, and the signaling sphingolipid Sphigosine-1-phosphate (S1P) is emerging as an important mediator in these conditions. The possible interaction of S1P and basophils and the resulting biological effects have not yet been studied. We hypothesize that S1P influences the function of basophils in atopy and aim to elucidate the modes of interaction. S1P receptor (S1PR) expression in human peripheral blood basophils from atopic and non-atopic patients was assessed through qRT-PCR and flow cytometry analysis. Functional effects of S1P were assessed through a basophil activation test (BAT), calcium flux, apoptosis, and chemotaxis assays. Immunofluorescence staining was performed to visualize intracellular S1P. Human basophils express S1PR1, S1PR2, S1PR3, and S1PR4 on the mRNA level. 0.1 µM S1P have anti-apoptotic, while 10 µM exhibits apoptotic effects on basophils. Basophils from atopic patients show less chemotactic activity in response to S1P than those from healthy donors. Protein expression of S1PR1 is downregulated in atopic patients, and basophils in lesional AD skin possess intracellular S1P. These findings suggest that the interaction of S1P and basophils might be an important factor in the pathophysiology of atopy.

Late-onset asthma (LOA) differs from early-onset asthma (EOA) in terms of prognosis and the treatment response because it has a much worse prognosis and a poorer response to standard asthma treatment. This study sought to investigate the characteristics and clinical outcomes of asthma patients with phenotypes distinguished by age at onset and atopy status. We prospectively recruited patients with asthma who were registered in a pay-for-performance program operated by Taiwan’s National Health Insurance Administration (NHIA). These patients received regular outpatient treatment for at least 1 year at every outpatient clinic visit since 2019. Baseline characteristics and clinical outcomes were compared between patients with LOA (≥40 years) and those with EOA (

A history of atopy or allergy has been shown to be protective against the development of glioma, however the effect of atopy on patient outcomes, especially in conjunction with the survival benefit associated with IDH mutation, has not yet been investigated, and is the focus of the study we present here. Low grade glioma (LGG) data from the TCGA was downloaded, along with IDH, TERT, 1p/19q and ATRX mutational status and genetic alterations. History of asthma, eczema, hay fever, animal, or food allergies, as documented in TCGA, was used to determine patient atopy status. Patients with missing variables were excluded from the study. 374 LGG studies were included. Patients with a history of atopy demonstrated longer overall survival (OS) compared to those without (145.3 vs. 81.5 months, p = 00.0195). IDH mutant patients with atopy had longer OS compared those without atopy (158.8 vs. 85 months, p = 0.035). Multivariate cox regression analysis demonstrated that the effects of atopy on survival were independent of IDH and histological grade, (p = 0.002, HR 0.257, 95% 0.109–0.604), (p =

Limited data suggest children with secondary steroid-resistant nephrotic syndrome (secondary SRNS) have increased risk of recurrence post transplantation. There are no data on the association between secondary steroid resistance and risk of transplant loss. Children who received kidney transplantation between 2000 and 2019 for either primary or secondary SRNS in Australia and New Zealand were included. Children presenting with nephrotic syndrome before 12 months were excluded. Data were gathered from chart reviews and ANZDATA. Transplant survival was estimated using the Kaplan–Meier estimator with Cox modelling used to explore predictors of survival. There were seventy children, 38 (55%) male, median age at presentation 4 years (IQR 2–7) and 46 (66%) Caucasian. Median age at transplant was 11 years (IQR 7–15) and 39 (55%) received living donor transplant. Secondary SRNS occurred in 20/70 (29%). For those with secondary SRNS, 18/20 (90%) had recurrence post-transplant, compared to 18/50 (36%) with primary SRNS (p = 0.001). Every child with history of atopy (n = 11) or with hypoalbuminaemia at time of transplant (n = 13) experienced immediate recurrence. For children with secondary SRNS, 8/18 (44%) with post-transplant recurrence had no response to therapy. For children with primary SRNS, 4/18 (22%) with recurrence had no response to therapy (p = 0.3). Overall, 10-year transplant survival was 47% (95%CI 29–77%) for those with secondary SRNS, compared to 71 (95%CI 57–88%) for those with primary SRNS (p = 0.05). Secondary steroid resistance is strongly associated with SRNS recurrence. Atopy and hypoalbuminaemia at transplant may be novel risk factors for recurrence. Further research is needed to assess if secondary steroid resistance is associated with poorer transplant outcomes. “A higher resolution version of the Graphical abstract is available as Supplementary information”.

AIM The potential for immunotherapy to prevent asthma development has become a hot topic. This prompted us to revisit data from an early study that examined allergic sensitisation on bronchial hyperresponsiveness (BHR) in children with and without respiratory symptoms. Unlike previous studies, it used both indirect and direct test methods. METHODS The study was conducted in Kuopio, Finland, in 1994 and 247 children (55.1% boys) with a mean age 10.5 ± 1.7 years were recruited using a school survey: 165 with lower respiratory symptoms and 82 healthy controls. Each child underwent a 6-min free-running test and a methacholine test with a cumulative dose of 4900 µg. All participants underwent skin-prick tests: 127were sensitised and 120 were non-sensitised. RESULTS There were no significant differences in lung function between the sensitised and non-sensitised children. However, sensitisation was associated with BHR which was measured by both the methacholine test (2400 µg versus >4900 µg, p

Background/aim Determining the characteristics and risk factors of severe disease is extremely important to combat atopic dermatitis (AD), which has recently shown increasing prevalence. In this study, we aimed to investigate the clinical characteristics of pediatric patients with AD and identifying the factors associated with the severity of the disease. Materials and methods A total of 304 pediatric patients diagnosed with atopic dermatitis were included in the study. The patients’ age at admission, age at onset of symptoms, the presence of atopy history in their family, eosinophil levels obtained from blood counts were recorded, together with the data of cigarette exposure, and area of residence. Disease severity was determined according to the SCORAD index. Epidermal prick tests (EPT) were applied to all patients. Results There was a negative correlation between the SCORAD score and both age at admission (r = 0.277, p < 0.001) and age at onset of the symptoms (r = –0.474, p < 0.001). Food sensitization rates were higher in individuals with moderate-severe disease (90.7% vs. 23.1%; p < 0.001) and patients with food allergy (FA) had significantly higher SCORAD scores [33 (IQR: 22–44) vs. 14 (IQR: 12–16); p < 0.001]. SCORAD scores of the individuals living in rural areas were higher than the ones living in urban [22 (IQR: 15–39.5) vs. 15 (IQR: 12–22); p < 0.001]. Familial atopy history was more common in patients with moderate-severe disease (66.5% vs. 17.5%; p < 0.001). The SCORAD scores were higher in patients exposed to passive smoking [21 (IQR:14.75–38) vs. 13 (IQR: 12–16); p < 0.001]. The eosinophil count found to be positively correlated with SCORAD scores (r = 0.531, p < 0.001). Conclusion Our findings show that early-onset, food sensitivity, living in rural areas, having familial atopy history and passive cigarette smoke exposure play a role in severe AD. Since it is remarkably correlated with SCORAD scores, eosinophil count can be used as a marker to assess the severity of AD in children.

Objetivo: Determinar la frecuencia de sensibilización alérgica a alimentos y los factores asociados al descontrol del asma en pacientes del Valle del Yaqui. Métodos: Estudio analítico transversal en un hospital de segundo nivel en Ciudad Obregón, México. El control del asma se clasificó según la Global Initiative for Asthma, el estado nutricional con el índice de masa corporal, la sensibilización alimentaria con pruebas de punción cutánea y el resto de las variables a través de pregunta directa o registros médicos. Se determinaron las frecuencias de sensibilización y los factores asociados con el descontrol del asma a través de estadística descriptiva e inferencial; se consideró estadísticamente significativo un valor de p

Having pets in the house during the first years of life has been shown to protect against allergies. However, the result of different studies is heterogeneous. The aim of this study was to evaluate the methylation pattern in cord blood in relation to pet ownership during pregnancy. We investigated the methylation patterns of 96 cord blood samples, participants of the Epigenetic Hallmark of Maternal Atopy and Diet—ELMA project, born to mothers who either owned pets (n = 32) or did not own pets (n = 64) during their pregnancy. DNA from cord blood was analysed using the Infinium methylation EPIC. For statistical analysis, RnBeads software was applied. We found 113 differentially methylated sites (DMs) in the covariate-adjusted analysis (FDR p

Atopic dermatitis is a commonly presenting chronic inflammatory skin disease in children. It is triggered by a variety of irritative and allergic factors. Both genetics and environmental factors play a significant role in development of atopic dermatitis. Atopic Dermatitis may have association with other atopic diseases (IgE mediated) like bronchial asthma, urticaria, allergic rhinitis, food allergies etc. It affects children (10-20%) as well as adults (1-3%), the incidence being highest in early infancy and childhood. There are many homoeopathic medicines that are very effective in management of atopic dermatitis. The lesser indicated homoeopathic medicines for AD include Chrysarobinum, Croton Tig, Rhus venenata, Copaiva, Oleander, Arsenicum iodatum, Primula obconica, Mercurius dulcis and Kali arsenicum.

Kimchi is a traditional Korean food, of which its constituent lactic acid bacteria have been reported to possess various physiological activities. However, few studies have investigated the immunological activity of these bacteria or their effect on atopic dermatitis (AD). We investigated whether a mixture of 6 types of lactic acid bacteria strains (LBS) isolated from kimchi has an immunomodulating effect on atopy. Mice with atopic dermatitis were orally administered LSB from kimchi for 8 weeks, and skin moisture content, scratching behavior, T-and B-cell proliferation, Th1/2 cytokines, and serum IgE and histamine levels were measured. In addition, hematoxylin and eosin and toluidine blue staining were con-ducted. Mice receiving LBS from kimchi had increased skin moisture content (164.3%) and T-cell proliferation (more than 4-fold), and decreased number of scratching behaviors (78.2%) and B-cell proliferation (63.7%) compared with the 2,4-dinitrochlorobenzene control group. In addition, LBS increased Th1 type cytokines, decreased Th2 type and pro-inflam-matory cytokines, and decreased blood IgE (70.4%), histamine (67.6%) and mast cell levels. Therefore, it suggests that LBS of kimchi may be helpful in improving AD caused by immunological imbalance.

The article discusses the features of landscape philosophy, as well as the prospects of its practical application to analyze the crises of modern society associated with the scientific and technological revolution, globalization and the massification of culture. The concept of landscape becomes particularly important in connection with the urban turn in philosophy. The analysis given in this article has shown that landscape philosophy explains the negative characteristics of colonial cognition. The interpretation of the concept of space in landscape philosophy is considered. Following S. Goryainov, we consider landscape philosophy as a philosophy of crisis. Our analysis has shown that landscape philosophy contributes to the approbation of models for solving the crisis of language and mind. Landscape philosophy and philosophical anthropology reveal existential problems. The works of M. de Unamuno, M. Scheler, M. Foucault and V. Podoroga were analyzed in this context. The significance of Unamuno's philosophy for the analysis of the role of individual creative space in the contemporary world is revealed. The applicability of Scheler's concept of spirit for the analysis of the problems of landscape philosophy is revealed. It is proved that within the framework of Podoroga's landscape philosophy, the problem of the correlation of politics and political. Using the concepts of utopia, atopia, and heterotopia, various aspects of the crisis of contemporary man man associated with the transformation of the subject's identity, the fragmentation of meanings and significance are studied. Thus, Podoroga's works are valuable for crisis philosophy because they analyze both spatial and political aspects of the crisis of contemporary society. Podoroga's works make it possible to reflect the contradictions of contemporary society, which ensures the prospects of their application for the analysis of changes in the contemporary social space.

Актуальність. Бронхообструктивний синдром (БОС), зокрема його повторний перебіг у дітей раннього віку, є актуальною проблемою сучасної педіатрії. Обтяжений алергологічний анамнез, прояви атопії традиційно розглядаються як фактори ризику повторних епізодів БОС, які, однак, присутні не в усіх випадках. Останнім часом обговорюється можлива роль вітаміну D (VD) у формуванні схильності до повторних епізодів БОС з огляду на його протиінфекційну дію, що забезпечується шляхом активації імунних механізмів. Мета: вивчення рівня забезпеченості VD і особливостей продукції інтерферону гамма (INF-g) та інтерлейкіну-4 (IL-4) у сироватці крові в дітей раннього віку з повторними епізодами БОС. Матеріали та методи. Обстежені 120 дітей віком від 6 місяців до 3 років з клінічним діагнозом «гострий обструктивний бронхіт» (J20), які були розподілені на дві групи (I група — 60 дітей з епізодичним БОС, II група — 60 дітей із повторним БОС). Групу контролю становили 30 клінічно здорових дітей віком від 6 місяців до 3 років. Усім хворим проводили оцінку анамнестичних даних, у тому числі рівня інсоляції, ступеня тяжкості БОС за 12-бальною оціночною шкалою, загальне клінічне обстеження, пульс­оксиметрію, розраховували прогностичний індекс бронхіальної астми (API). Лабораторні дослідження включали визначення на 2–3-й день захворювання концентрації 25-гідроксивітаміну D (25(OH)D) у сироватці крові електрохемілюмінесцентним методом на аналізаторі Cobas e411 (серійний номер 1041-24, виробник Roche Diagnostics GmbH, Німеччина), сироваткових концентрацій IFN-g, IL-4 методом імуноферментного аналізу за допомогою наборів «ІФА-Бест» (виробник «Вектор-Бест», Російська Федерація) та загального кальцію (Са) за загальноприйнятою методикою. При аналізі отриманих даних використовували непараметричні статистичні критерії. Різниця між показниками, що порівнювались, вважалась вірогідною при р < 0,05. Результати. Більшість пацієнтів із повторним перебігом захворювання (56,7 %) мали 4 епізоди БОС за останні 12 місяців. Аналіз анамнестичних показників, у тому числі алергологічного анамнезу, не виявив суттєвих відмінностей між групами (p > 0,05). У 78,3 % пацієнтів II групи був негативний API. Тяжкий перебіг БОС удвічі частіше реєструвався серед дітей II групи порівняно з I групою (23,3 і 10,0 % відповідно, c2 = 4,50, р = 0,034). Середній вміст 25(OH)D у сироватці крові у дітей I групи становив 33,0 (28,19; 41,97) нг/мл; II групи — 13,68 (7,96; 19,51) нг/мл (p < 0,001). Рівень забезпеченості VD у 75 % дітей II групи відповідав критеріям дефіциту, тоді як у I групі даний показник становив 6,6 % (c2 = 57,98, p < 0,001). Виявлено обернену залежність між рівнем VD і частотою (r = –0,27, р = 0,002), та тяжкістю перебігу БОС (r = — 0,24, р = 0,008). Рівень загального Са в сироватці крові в обох групах був у межах нормальних величин. Середній рівень IFN-g у дітей І групи становив 22,69 (8,98; 41,44) пг/мл та ІІ групи — 21,08 (8,57; 37,03) пг/мл, обидва показники були вищими, ніж у групі контролю, — 12,18 (5,31; 12,92) пг/мл (p = 0,016 для обох показників). Ми виявили, що досліджувані групи відрізнялись між собою за рівнем саплементації VD, показник якого становив 60 % у I групі та 5 % — у дітей II групи (p

Background: Asthma is an inflammatory disorder, usually chronic, and is related to the hypersensitivity of the airways to allergens leading to dyspnoea, wheezing, cough and tightness in chest. Increased severity of asthma and poor control has been attributed to lower levels of Vitamin D levels. Materials and Methods: Blood was collected from 78 patients who were diagnosed with asthma and tested for Vitamin D levels eosinophil counts, IgE levels, and regular biochemical tests. All these patients underwent Asthma Control Test, Pulmonary Function tests for FEV1%, FVC%, FEV1/FVC%. Results : The serum eosinophil count, sputum eosinophil count and IgE levels were significantly higher in Vitamin D deficient patients compared to the sufficient patients. The most common severity of asthma among the patients was due to atopy as seen in 53.8% of the patients. In 39.6% of the patients who were Vit D deficient, the asthma was very severe as was the case in 8% of the Vit D sufficient people. The Forced expiratory volume, Forced vital capacity and FEV1/FVC1 was 92.69 ± 0.9 %, 91.3 ± 12.1% and 76.2 ± 8.7 in patients with deficient Vitamin D levels and 97.36 ± 1.1%, 99.1 ± 7.3% and 81.6 ± 13.1 in patients with sufficient Vit D levels respectively. Conclusions: There seems to be a strong association of Vitamin D levels and asthma among patients. High vitamin D levels are beneficial to the lung function and also slow the asthma exacerbations. Keywords: Vitamin D deficiency, Asthma, Exacerbations

Актуальность. Атопический дерматит (АД) — наиболее распространенное атопическое заболевание среди детей, характеризующееся поражением кожи с выраженным зудом. Развитие АД связывают с генетической предрасположенностью, влиянием эпигенетических факторов, которые приводят к нарушению эпидермальной барьерной функции, иммунодисрегуляцией и IgE-опосредованной сенсибилизацией к наиболее распространенным аллергенам. Особое значение исследователи придают не только поляризации Th2-иммунного ответа, но и особенностям работы врожденного звена иммунитета. Целью исследования было изучить особенности иммунного статуса у детей с учетом тяжести течения атопического дерматита. Материалы и методы. Основную группу составили 85 детей в возрасте от 3 месяцев до 3 лет с верифицированным диагнозом АД, группу контроля — 20 детей без проявлений атопии в анамнезе. Для оценки тяжести кожных проявлений использовали шкалу SCORAD. Дети, которые принимали участие в исследовании, были разделены на группы по тяжести АД. Всем детям проводился общий клинический анализ крови. Изучение иммунного статуса у детей основной группы включало типирование лимфоцитарной популяции по CD-маркерам (C3, C4–2, CD3+, CD19–, CD4+, CD8–, CD4–, CD8+, CD3–, CD56+, CD19+, CD14, CD45), измерение уровней IgA, IgM, IgG, IgE, исследование системы комплемента (С3, С4–2), фагоцитарной активности нейтрофилов и пролиферативной активности лимфоцитов проводилось методом проточной цитометрии в ООО «Синэво». Метод иммуноферментного анализа использовался для выявления уровней интерлейкина (ИЛ)-13 (ELISA Kit, Thermo Fisher Scientific, Австрия), исследование проводилось на базе Учебного медико-лабораторного центра Запорожского государственного медицинского университета. Статистическую обработку результатов проводили с помощью официального программного пакета Statistica 13.0. Результаты. У детей с тяжелым течением АД и уровнями ИЛ-13 ниже уровней контрольной группы и групп детей с тяжелым и среднетяжелым течением наблюдалась эозинофилия периферической крови, прирост CD4+, CD8– с одновременным снижением уровней CD4–, CD8+, дисиммуноглобулинемия и низкие уровни С3 по сравнению с другими группами исследования (р < 0,05). Выводы. Полученные результаты позволяют предположить, что у детей тяжелое течение АД было связано с изменениями системы комплемента и низкими уровнями цитотоксических клеток, транзиторной гипогаммаглобулинемией, что, в свою очередь, требует более детального изучения каскадов иммунологических реакций у детей с АД.

AimsTo evaluate the rates of keratoconus progression and associated factors in eyes of children and adolescents.MethodsRetrospective, cohort study of individuals ≤18 years old at the time of keratoconus diagnosis and with at least 6 months of follow-up. Corneal tomography was performed using an Orbscan tomographer (Bausch & Lomb, Rochester, New York, USA) to determine whether progression occurred. Tomographic progression of keratoconus was defined as a change in any of the investigated parameters (keratometry values, KMAX, maximum anterior or posterior elevation, central pachymetry, thinnest pachymetry) beyond the limits of repeatability.Results148 eyes of 106 patients with a mean age of 15.2±2.5 years were studied over a mean follow-up period of 2.9±2.2 years. The overall rate of tomographic progression was 77.0% (114/148 eyes). Eyes that progressed had more advanced disease at presentation with higher anterior curvature (KMAX55.4±6.3 vs 52.2±5.4 dioptres; pConclusionsA high rate of progression was identified in keratoconic eyes of children and adolescents. More advanced disease at initial presentation may increase the risk of further keratoconus progression.

Вступ. Серед алергічних захворювань переважає шкірна патологія. Від атопічного дерматиту страждає до 10 % дитячого населення. Відомий вплив тиреоїдних гормонів на розвиток атопії. Мета дослідження: вивчити особливості функціонального стану гіпофізарно-тиреоїдної системи в дітей з алергодерматозами. Матеріали та методи. Обстежені 72 дитини віком від 7 до 18 років, які розподілені на 4 групи: I — діти, хворі на атопічний дерматит (n = 29), II — на алергійний контактний дерматит (n = 17), III — на простий контактний дерматит (n = 16), IV — практично здорові діти (n = 10). Визначали рівень тироксину, тиреотропного гормона, антитіл до тиреоглобуліну (ТГ). Одержані результати оброблені методом статистичного варіаційного і кореляційного аналізу з використанням програми «Біостат». Результати. Еритема виявлена у 95,2 %, набряк — у 43,5 %, ексудація — у 37,1 %, екскоріація — у 43,5 %, ліхеніфікація — у 56,4 % дітей із загальної групи хворих, що знаходилися під спостереженням. Визначені порушення функції гіпофізарно-тиреоїдної системи на рівні як центральної, так і периферичної ланки. Частота виявлення антитіл до ТГ у дітей I групи була найвищою і перевищувала середні популяційні значення у 3,7 раза (36,7 %; χ2 = 17,5; р < 0,05). Рівень ТГ у всіх обстежених хворих був вірогідно вищим від рівня групи порівняння. У I групі дітей рівень ТГ був у 15 разів вищим від рівня ТГ у дітей групи порівняння, у II — у 12 разів, у III — в 11 разів. Частота виявлення антитіл до ТГ у групі хворих зі стажем хвороби понад 10 років перевищувала середні популяційні значення у 3,2 раза (34,0 %; χ2 = 8,1; р < 0,05). Висновки. У дітей з алергодерматозами відмічаються зміни морфофункціонального стану гіпофізарно-тиреоїдної системи переважно автоімунного характеру. Для аналізу індивідуального прогнозу захворювань і моніторингу ефективності лікувально-профілактичних заходів доцільно визначати біохімічні показники, спрямовані на оцінку гіпофізарно-тиреоїдної системи у дітей з алергодерматозами.

Objectives Geographic tongue is the mucositis of the dorsal surface of the tongue with no definite etiology, although it may be associated with atopic conditions. In this study, the salivary immunoglobulin E (IgE) and eosinophilic cationic protein (ECP) levels were assessed in patients with geographic tongue to examine the relationship between this condition and allergy-related biomarkers. Materials and Methods In this case-control study, unstimulated saliva was collected from 45 geographic tongue patients and 45 controls, and the salivary IgE and ECP levels were assessed. The data were analyzed with SPSS 20.0 using the Mann–Whitney test with a significance level of p < 0.05. Results The salivary IgE level in the case and control groups was 123.76 ± 8.1 and 74.34 ± 6.2 IU/mL, respectively, and the salivary ECP level was 9.4 ± 6.0 and 7.6 ± 3.2 ng/mL, respectively. There was a statistically significant difference between the two groups in terms of salivary IgE (p = 0.007) and ECP (p = 0.001) levels. Conclusion Salivary IgE and ECP levels increase in patients with geographic tongue. They can, therefore, be used for the initial diagnostic workup and to investigate the possible association of geographic tongue with allergic reactions.

Background Vernal keratoconjunctivitis (VKC) is a severe type of allergic conjunctivitis for which treatment strategies are still under debate. Objectives This study sought to conduct a systematic review and meta-analysis to evaluate the efficacy of medical treatments for VKC. Methods The PubMed, Cochrane Library, Embase, and ScienceDirect databases were searched to assess the efficacy of treatments for VKC. Random-effect meta-analyses on changes in clinical scores of symptoms and signs between baseline and after treatment, stratified on treatment classes, were computed. Meta-regressions were searched for potential influencing parameters. Results Included were 45 studies (27 randomized controlled trials and 18 prospective cohort studies), 1749 patients (78% were men; mean age, 11.2 years), and 12 different treatment classes. Mast cell stabilizers (MCSs; usually considered as first-line therapy), cyclosporine, and tacrolimus were the most studied drugs (in three-quarters of studies). Overall, all clinical scores improved. Total symptom and sign score decreased for MCSs (effect size, −3.19; 95% CI, –4.26 to −2.13), cyclosporine (effect size, −2.06; 95% CI, −2.72 to −1.40), and tacrolimus (effect size, −2.39; 95% CI, −3.36 to −1.43). No significant differences were shown depending on treatment classes, concentration, age, sex, baseline activity scores, and atopy. Sensitivity analyses demonstrated similar results. Conclusions This study confirms the efficacy of MCSs in the treatment of VKC. Efficacy of cyclosporine and tacrolimus did not differ, suggesting that tacrolimus is a good alternative to cyclosporine for severe cases of VKC. Further studies are needed to compare other drugs and their precise place in treatment strategy.

PURPOSE To characterize very asymmetric keratoconus (KC) in terms of clinical demographics and risk factors in the Japanese population. METHODS We retrospectively reviewed the clinical records of patients with very asymmetric KC attending a university hospital. Patients with very asymmetric KC had defined clinical KC in one eye and normal topography in the fellow eye. All patients completed a questionnaire on potential risk factors (family history of KC, atopy, asthma, allergy, heart disease, sleep apnea, Down syndrome, eye rubbing, prone sleep position, and dominant hand). These data were compared with those of patients with clinical or topographic KC in both eyes. Subgroup analysis of very asymmetric KC eyes were performed based on the KC status: mild and severe. RESULTS We retrospectively investigated 66 patients with very asymmetric KC and 505 patients with KC. Patients reported eye rubbing (53%-56%), allergy (62%-63%), and atopy (28%-29%) in both groups. There was no significant difference in terms of risk factors between the two groups. Approximately half of the 66 patients with very asymmetric KC had KC eyes ipsilateral to the dominant hand. Subgroup analysis of very asymmetric KC showed that atopy and asthma were more frequent in the mild KC group than in the severe KC group. Forty-four of 60 patients (73.3%) were using corneal, rigid, gas-permeable contact lenses (corneal GPs) for the KC eye, of which 30 patients (68.2%) were also using a corneal GP for the fellow eye. CONCLUSIONS The patient-reported frequency of eye rubbing, allergy, and atopy were similar between KC and very asymmetric KC. Furthermore, we found no association between hand dominance and KC laterality.

Background Mastocytosis encompasses a heterogeneous group of disorders characterized by accumulation of clonal mast cells (MCs) in the skin and/or internal organs. Patients typically present with a broad variety of recurrent mediator-related clinical symptoms, including severe anaphylaxis. However, not all patients with mastocytosis experience anaphylactic reactions. Objective We sought to identify disease-specific biomarkers in plasma that could be used to predict patients with mastocytosis with increased risk of anaphylaxis. Methods Nineteen patients (≥18 years) and 2 control groups (11 subjects with allergic asthma and 13 healthy volunteers without history of atopy) were recruited. In total, 248 plasma proteins were analyzed by Proximity Extension Assay using Olink Proseek Multiplex panels. Results We identified 4 novel proteins, in addition to tryptase, E-selectin, adrenomedullin, T-cell immunoglobulin, and mucin domain 1, and CUB domain–containing protein 1/CD138 to be significantly increased in patients with mastocytosis compared with both patients with asthma and healthy controls. Furthermore, we investigated whether we could discriminate between patients with mastocytosis with or without anaphylaxis. In addition to tryptase, we identified 3 novel proteins, that is, allergin-1, pregnancy-associated plasma protein-A, and galectin-3, with significantly different levels in patients with mastocytosis with anaphylaxis compared with those without anaphylaxis. Conclusions Newly identified proteomic biomarkers may be used to predict patients with mastocytosis with increased risk of anaphylaxis.

Objective To present an update of birth cohort study designs and their contributions to allergic risk. Data Sources The PubMed database was used to search for relevant articles. Study Selections Peer-reviewed prospective and retrospective studies involving the assessment of allergy using human birth cohorts between 2014 and 2021 were evaluated. Results Parental history of allergic diseases, especially in cases involving both parents, is associated with increased risk of allergy. Exposure to prenatal and postnatal smoking and limited diet diversity were associated with increased allergic burden. The impact of early-life infections and antibiotics on disease development may be associated with the onset of asthma, though this remains debated. Cohort studies also revealed that the mode of delivery and breastfeeding duration affect the odds ratio of asthma and eczema development. Household exposures, including pets, house dust mites, and scented aeroallergens may confer protective effects, whereas high air pollution exposure and low socioeconomic status may be risk enhancing. Exposure to antibiotics during early life may be associated with increased asthma risk, whereas viral infections may lead to disease protection, though the impact of the coronavirus disease 2019 pandemic on allergic risk is yet to be understood. Conclusion Although evaluating the risk of allergic disease development is complex, clinicians can apply these insights on the multifactorial nature of atopy to better understand and potentially mitigate disease development.

Context It has been hypothesized that a mother’s diet during pregnancy may modulate her offspring’s immune system development and lead to development of allergic diseases among offspring. However, the evidence for this is unclear and inconclusive. Objective This systematic review was undertaken to examine the weight of evidence for causality from cohort studies on the association between maternal free sugar intake during pregnancy and development of allergies in offspring. Data Sources Using a systematic search strategy, PubMed, SCOPUS, and Web of Science databases were searched from inception to May 2020. Data Extraction For the reporting of this systematic review, the PRISMA guideline was followed. Studies examining maternal sugar consumption during pregnancy (using self-reported data) and the development of allergic diseases among offspring (infancy to 5 years) were included. Data Analysis The Newcastle–Ottawa Scale quality assessment tool was used to assess the study quality. Meta-analysis was conducted using a random-effects model to synthesize the findings. Of 159 publications identified from the search, 5 articles with 4 unique cohort studies were included in this systematic review. The limited meta-analysis showed that a mother’s increased free sugar intake during pregnancy was associated with an increased risk of developing asthma in offspring (odds ratio 1.07 [95% CI, 1.00 to 1.14; I2 = 0%]). High free sugar intake by the mother during pregnancy was also associated with increased odds of offspring (to age 7.7 years) developing other common allergies, including allergic rhinitis, atopy and eczema, wheeze, and food allergies . Conclusion From the limited evidence, this review suggests that high free sugar consumption during pregnancy may be associated with the development of allergies in offspring. Clinical guidelines and public health policy recommendations for maternal diet in pregnancy should include advice about reducing free sugar intake due to a possible association with allergies in offspring. However, recommendations should be made with caution considering other maternal and fetal risk factors.

Objective: Although there is no consensus regarding the etiology of paranasal mucous retention cysts (MRCs) in the literature, several studies suggest an allergic etiology. This study aimed to investigate a potential association between paranasal MRCs diagnosed with MRI scans and allergic sensitization in the pediatric population. Materials and Methods: A total of 4559 MRI scans were retrospectively evaluated for MRC in patients who presented to the pediatric neurology outpatient clinic with headache complaints. Fifty children with MRI findings conclusive for paranasal MRC and 50 children without such findings were included in the study. All study and control patients were invited for atopy/allergy evaluation. Total IgE measurements, blood eosinophil levels, nasal smear and skin prick tests were performed to evaluate the allergic status of the children. In addition, an allergic rhinitis symptom questionnaire was administered. Results: The mean age was 13.0±2.8 years (median 14 y, range 6-18 y) with a female-to-male ratio of 1.4:1 in the study group. The prevalence of MRC was found to be 1.1% (50 in 4559). The two groups did not differ with regard to the frequency of blood eosinophilia, nasal eosinophilia, serum IgE levels, and allergic rhinitis symptom severity (p>0.05). Positive skin test for at least one of the allergens tested was more common in the MRC group than the controls (40% vs. 16%, p=0.007). Multivariate analysis identified that a positive skin prick test for at least one allergen was a significant independent predictor of MRC (OR, 4.6; 95% CI 1.2-17.0, p=0.023). Conclusion: Our study showed that paranasal MRCs were significantly more frequent in atopic children compared to controls. Additionally, MRCs were found to be strongly associated with allergic sensitization. Keywords: Cysts, allergic rhinitis, children, diagnostic tests, signs and symptoms

INTRODUCTION In spite of difficulties in differentiating asthma from chronic obstructive pulmonary disease (COPD), physicians should strive for accurate diagnosis because outcomes may be different. OBJECTIVES Our aims were to compare the frequency of hospital admissions (HA) between severe asthmatic (SA) and Gold III-IV COPD subjects receiving disease-specific guideline recommended therapy and to depict the frequency of prevalent chronic disorders and the laboratorial profile suggesting allergic and eosinophilic phenotypes. METHODS This cross-sectional study comprises one group of SA subjects and another group of Gold III-IV COPD subjects. Subjects answered standard questionnaires, underwent spirometry, and provided a peripheral blood sample. We validated the HA that have occurred during the preceding year by review of the report emitted by the hospital. We detected comorbidities by review of current pharmacological therapies. RESULTS We enrolled 160 SA and 41 Gold III-IV COPD subjects. As compared with Gold III-IV COPD subjects, SA subjects had lower odds of HA (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.05-0.74) and higher odds of obesity (OR 9.17, 95%CI 2.68-31.37), hypertension (OR 2.54, 95%CI 1.16-5.57), and diabetes mellitus (OR 5.71, 95%CI 1.56-20.85). The frequency of atopic and eosinophilic phenotypes was similar between study groups. CONCLUSIONS Our results demonstrated that Gold III-IV COPD subjects had worse outcomes as compared with SA subjects. We also observed that the frequency of atopy and high peripheral blood eosinophil count were similar between study groups. Finally, we exposed aspects of comorbidities related to asthma and COPD that indicate the need of close monitoring the cardiovascular risk in SA subjects above 40 years of age.

People who live in highly allergenic regions have a greater risk of being sensitized; therefore, these areas have a higher prevalence of mono and polysensitized patients. The aim of the present study was to investigate the allergen sensitization profiles in patients with asthma in an agricultural zone in Mexico.An analytical cross-sectional study was conducted in a secondary care hospital in Obregon City, Mexico. The allergen sensitization pattern profiles were analyzed through a skin prick test (SPT) in 294 patients. Data was collected before SPT: asthma control was classified according to the Global Initiative for Asthma Criteria, nutritional status was assessed with the Body Mass Index (BMI) using Quetelet's index (BMI = weight/heightIn this study, in a group of adults with asthma, the prevalence of sensitization was 77%. The most frequent categories of aeroallergens were in indoors, in zones with weeds and abundant trees. A low proportion of monosensitized patients (2%) was observed. House dust mites were the most common allergens.Our study describes the sensitization pattern among asthma patients. This study will help identify the panel of most common allergens in this region of Mexico, and aid in selection of specific treatment through immunotherapy.

Food allergens appear to play a role in the etiology and deteriorating of atopy in some patients

CARD11 is a multidomain scaffold protein required for normal activation of NF-κB, JNK, and mTOR during Ag receptor signaling. Germline CARD11 mutations cause at least three types of primary immunodeficiency including CARD11 deficiency, B cell expansion with NF-κB and T cell anergy (BENTA), and CARD11-associated atopy with dominant interference of NF-κB signaling (CADINS). CADINS is uniquely caused by heterozygous loss-of-function CARD11 alleles that act as dominant negatives. CADINS patients present with frequent respiratory and skin infections, asthma, allergies, and atopic dermatitis. However, precisely how a heterozygous dominant negative CARD11 allele leads to the development of this CADINS-specific cluster of symptoms remains poorly understood. To address this, we generated mice expressing the CARD11 R30W allele originally identified in patients. We find that CARD11R30W/+ mice exhibit impaired signaling downstream of CARD11 that leads to defects in T, B, and NK cell function and immunodeficiency. CARD11R30W/+ mice develop elevated serum IgE levels with 50% penetrance that becomes more pronounced with age, but do not develop spontaneous atopic dermatitis. CARD11R30W/+ mice display reduced regulatory T cell numbers, but not the Th2 expansion observed in other mice with diminished CARD11 activity. Interestingly, the presence of mixed CARD11 oligomers in CARD11R30W/+ mice causes more severe signaling defects in T cells than in B cells, and specifically impacts IFN-γ production by NK cells, but not NK cell cytotoxicity. Our findings help explain the high susceptibility of CADINS patients to infection and suggest that the development of high serum IgE is not sufficient to induce overt atopic symptoms.

Background: Allergic rhinitis is an IgE antibody mediated, inflammatory disease. The most commonly encountered risk factors for allergic rhinitis are presence of atopy, asthma, eczema, and other allergic illnesses. Identification of aeroallergens helps in patient counseling to modify life style and prevent exposure to triggering factors. Aim of the study: To determine the prevalence of aeroallergens in allergic rhinitis. Materials and Methods: This was a prospective study done in cases of allergic rhinitis over a duration of one year from January 2019 to December 2019. Complete history taking was followed by ENT examination including Rhinoscopy and endoscopy, peripheral smear examination for eosinophils, absolute eosinophil count testing and Skin prick testing with known allergens and serum IgE level testing. Results: A total of 145 cases of allergic rhinitis were studied. The patient age ranged from 11 years to 50 years. The male to female ratio was 0.5:1. Most common allergen causing allergic rhinitis was dust mite which constituted about 44.1% cases. The next common allergen was Mold which accounted for 20.6% cases. Conclusion: We conclude that there are numerous aeroallergens that can cause allergic rhinitis and the most common ones are dust mites, molds, house dust, animal dander, pollen and others. Correct identification of the aeroallergen helps in the proper counseling of the patients so as to prevent exposure to those aeroallergens thereby reducing the episodes and severity of allergic rhinitis. Keywords: Allergic rhinitis, Aeroallergens, IgE antibody, Eosinophilia

Background The occurrence of allergic conditions, for example allergic asthma, rhinitis, and atopic dermatitis, is rising worldwide. These allergic conditions are associated with poor life quality. Vitamin D is proposed to be linked with increased risk and severe forms of allergic diseases. Aims This review article aimed to evaluate the vitamin D level role and polymorphisms of vitamin D receptor gene (VDR) in atopy. Methods & Materials We analyzed publications that were focusing on levels of vitamin D and/or polymorphism analysis of vitamin D receptor gene in allergic asthma, rhinitis, and atopic dermatitis patients. Results We noticed that levels of vitamin D are extensively studied in atopy by many research groups, however, polymorphisms of vitamin D receptor gene and their link with levels of vitamin D lack comprehensive data. There is evidence that vitamin D may be associated with anti‐inflammatory effects in allergic diseases. Some of VDR polymorphisms also may play a role in pathogenesis of these diseases. However, the data from different studies are controversial. Discussion The results of different studies are usually inconsistent, most probably due to populational bias or differences in methodology. Even though, more evidence shows a positive impact of vitamin D on the risk and outcomes of allergic diseases, especially atopic dermatitis, and asthma. Conclusions There is controversial data about the level of vitamin D and its role in atopy; however, more evidence shows a positive impact on the risk and outcomes of allergic diseases., Some evidence suggests that vitamin D is linked with increased risk and more severe forms of allergic diseases. Therefore, this review article aimed to evaluate the role of vitamin D level and vitamin D receptor gene (VDR) polymorphisms in atopy. We found that vitamin D levels in atopy are extensively studied by many research groups, however, vitamin D receptor gene polymorphisms and their link with vitamin D levels lack comprehensive data. Even though, more evidence shows a positive impact on the risk and outcomes of allergic diseases, especially atopic dermatitis and asthma.

Objective Evidence supports the relationship between the skin barrier and allergic conditions. This narrative review evaluates what role the cutaneous barrier may play in the pathogenesis, disease course, and management of allergic rhinitis (AR). Data Sources A literature review of the MEDLINE (PubMed), Embase, Cochrane, and SCOPUS Sciverse databases was conducted to identify available evidence. Reference lists of pertinent papers were searched using a snowball technique. Study Selections Papers published in English from all years until December 2020 were included. Papers that did not address the relationship between AR and the skin and hypothesis papers were excluded. Results The cutaneous barrier shares histologic characteristics with the sinonasal epithelial barrier, which may explain commonalities between AR and atopic dermatitis. A disruption in the epithelial barrier could be a common pathway in the development of multiple allergic conditions. The skin is a common target for the treatment of AR. Available data that look at the relationship between the skin and AR often include other topics such as other atopic disorders and the role of the epithelial barrier. Increased understanding of how the cutaneous barrier affects AR may lead to new innovations in its management. Conclusion The connection between the cutaneous barrier and AR holds possibilities for further investigation, and these may lead to a better understanding and future innovations for all atopic diseases.