Non-IgE-mediated Gastrointestinal Food Allergy in Children: Our Foods and Atopy Patch Test

Abstracts:Background: Food allergy is an increasing health problem in children. Previous studies have reported conflicting results about the diagnostic value of atopy patch test (APT) in food allergies.Objectives: To investigate the accuracy of APT in identifying non-IgE-mediated gastrointestinal food allergy to pasteurized cow's milk, heated cow's milk, white and yolk egg, soy, wheat, walnut, sesame, pistachio, almond, peanut, date and cumin which are popular food ingredients in Iran.Methods: This study was performed on children with GI allergic problems who did not improve after at least 4 weeks of cow's milk protein elimination. Atopic patch test (APT) was performed and the elimination diet was considered according to APT results and after resolving symptoms, introduction of each accused food was done sequentially. Results: 53 children under 7 years old with mean age of 19.6 months underwent APT and the results were verified by open oral food challenge. Sensitivity in the rage of 59%-95%, specifity of 80.7-92.8, positive predictive values of 75-96.4 and negative predictive value of 23-80.7% were calculated depending on the type of food. Compared to the heated raw cow's milk, the pasteurized/homogenized cow's milk reaction was significant. Conclusion: APT can be included in the diagnostic workup of non-IgE-mediated GI allergy because it's safe and has great accuracy. However, several aspects require further investigation especially to enable the standardization of the technique. We should be aware of allegenicity of our foods due to processing and geographic region

Psychometric properties of the 12-item WHODAS applied through phone survey: an experience in PERSIAN Traffic Cohort

Background Due to limited capability to function in post-injury daily life injury, survivors need to be reliably assessed without need to commute more than necessary. The key action is to determine the level of functioning difficulties. Having the opportunity of conducting a national post-crash traffic safety and health cohort study, we aimed to translate into Persian and assess the psychometric properties of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) through phone surveys six month post injury. Methods First, having World Health Organization permission, we tested the translation validity by forward translation, expert panel evaluation, back-translation, pre-testing and cognitive interviewing, and finalizing the Persian WHODAS. Then, through a psychometric study within a national cohort platform, the validity, reliability and applicability of the 12-item WHODAS was assessed through phone surveys. We included data of 255 road traffic injury patients enrolled from the cohort at six-month follow-up. The psychometric assessment (internal consistency reliability and stability reliability) was conducted on test-retest data of 50 patients with an average 7-day time span. An exploratory factor analysis tested the construct validity using extraction method of principal component factor and oblique rotation on data from 255 patients. Regarding the multiple criteria including an eigenvalue > 0.9, Cattell's scree test, cumulative variance, and the theoretical basis, the minimum number of factors were retained. Data were analyzed using STATA statistical software package. Results The respondents were mostly male (81%), employed (71%), educated (87%), and with a mean age of 37.7(14.9). The Persian version had high internal consistency reliability (Cronbach's alpha = 0.93) and excellent stability reliability (ICC = 0.97, 95% CI: 0.92-0.98). An exploratory factor analysis retained four factors defining 86% of all the variance. Factors of Self-care, Mobility, and Cognition were completely retained. Conclusions The brief Pesrian WHODAS 2.0 was highly reliable and valid to be applied through phone interviews post injury

Functional Consequences of Road Traffic Injuries: Preliminary Results from PERSIAN Traffic Cohort (PTC)

Introduction: Traffic injuries are one of the main causes of death worldwide. After decreasing mortality rates and improving the recovery of injured patients, long-term functional consequences need to be addressed. The purpose of this study was to assess the functional outcomes of road traffic injuries and their predictors six months after hospital discharge, based on the preliminary results from PTC.Methods: A cross-sectional study based on PERSIAN Traffic Health and Safety Cohort Study was performed. Data were collected using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) with six domains (cognition, mobility, self-care, getting along with others, life activities, and participation), filled-in by 180 injured adults (age >18 years) at six-month follow-up after hospital discharge during October 2019. These patients were hospitalized after road accidents at two referral trauma centers, (from 23 September 2018 to 20 March 2019).Results: The majority of participants were men (82.7%), (Mean age =38.8). The mean score of WHODAS 2.0 was 17.8) SD=9.1). The highest score was estimated for the self-care dimension 3.3 (SD=1.8), and the lowest score for getting along with others 2.4 (SD=1.2). Age, gender, physiotherapy, injury localization including head and face, spinal cord, and upper extremity were predictors of WHODAS 2.0 score in various dimensions (p<0.05).Conclusion: The current study identified some functional disabilities among patients sustaining road traffic injuries. It is evident from the results that a proportion of patients do not recover six months after the injury and suffer a disability, especially in self-care, mobility, and life activities, which potentially prevent them from returning to normalcy. In addition, age, gender, physiotherapy, injury localization was related to WHODAS 2.0 score

Survey on the Prevalence of Allergic Rhinitis and its Effect on the Quality of High School Students’ Life

Introduction: Allergic rhinitis (AR) is a common airway disease. In order to study  the  prevalence of  AR in high school students  in  Kerman, the Score for Allergic Rhinitis (SFAR) was used and the quality of life  in  the  students  affected  by  rhinitis was  evaluated using the SF-36 questionnaire.   Materials and Methods: This was a cross-sectional, analytical, descriptive study, based on the SFAR scale. Quality of life in students with AR was evaluated using the SF-36 questionnaire.   Results: From 1511 students who completed the SFAR questionnaire, 291 (52.6%, girls; 47.4%, boys)  had AR. Domestic dust was the most common cause of the disease. The most common symptoms of AR were rhinorrhea (76.6%), epiphora (76.3%), nasal congestion (64.3%), and itching (54.3%). According to the ARYA scale, (Allergic Rhinitis and its Impact on Asthma), 41.9% of students had moderate-to-severe rhinitis and 58.1% had mild rhinitis. A total of 43.1% of patients with moderate-to-severe rhinitis had a persistent condition and 56.9% had an intermediate condition. Results of the SF-36 questionnaire among students with AR showed a significant difference in physical functioning and bodily pain in comparison with healthy students.   Conclusion:  The results of this study show that the prevalence of AR among Kerman high school students is 19.3%. Because of the effect of this disease on the life quality of high school students in terms of both physical functioning and bodily pain, efforts should be made to reduce allergen levels as far as possible

Survey on the Prevalence of Allergic Rhinitis and its Effect on the Quality of High School Students’ Life

Introduction: Allergic rhinitis (AR) is a common airway disease. In order to study  the  prevalence of  AR in high school students  in  Kerman, the Score for Allergic Rhinitis (SFAR) was used and the quality of life  in  the  students  affected  by  rhinitis was  evaluated using the SF-36 questionnaire.   Materials and Methods: This was a cross-sectional, analytical, descriptive study, based on the SFAR scale. Quality of life in students with AR was evaluated using the SF-36 questionnaire.   Results: From 1511 students who completed the SFAR questionnaire, 291 (52.6%, girls; 47.4%, boys)  had AR. Domestic dust was the most common cause of the disease. The most common symptoms of AR were rhinorrhea (76.6%), epiphora (76.3%), nasal congestion (64.3%), and itching (54.3%). According to the ARYA scale, (Allergic Rhinitis and its Impact on Asthma), 41.9% of students had moderate-to-severe rhinitis and 58.1% had mild rhinitis. A total of 43.1% of patients with moderate-to-severe rhinitis had a persistent condition and 56.9% had an intermediate condition. Results of the SF-36 questionnaire among students with AR showed a significant difference in physical functioning and bodily pain in comparison with healthy students.   Conclusion:  The results of this study show that the prevalence of AR among Kerman high school students is 19.3%. Because of the effect of this disease on the life quality of high school students in terms of both physical functioning and bodily pain, efforts should be made to reduce allergen levels as far as possible

Usage Pattern, Satisfaction, Causes of Concern and Related Factors of Metered Dose Inhalers in Children with Asthma, the Parents Perspective

Introduction  Metered Dose Inhalers (MDIs) are the most common drugs for the control of asthma. This study was conducted to evaluate usage patterns, satisfaction with and concerns about MDIs for children with asthma and the related factors from the viewpoints’ of their parents. Materials and methods This cross-sectional study was conducted on children with asthma who referred to asthma and allergy clinics in two teaching hospitals of Kerman University of Medical Sciences in Iran. Results The mean and SD of age of the patients were 7.58±4.01 years. More than 95% of the patients were taking anti-asthmatic drugs at the time of the study. Of the patients who used anti-asthmatic drugs, 86.6% were using MDIs alone or in combination with oral anti-asthmatic drugs. Of patients who took MDIs, 73.7% were using a combination of bronchodilator and corticosteroid, 22% bronchodilator alone, and 2.3% corticosteroids alone. More than 91% of the parents were satisfied and 95.9 % of them were concerned about the usage of MDIs. Dependence to MDIs (90.1%) and high costs of MDIs (81.3%) were the most frequent causes of concern about MDIs usage.   Conclusion  Despite high satisfaction of parents with MDIs for control of asthma in children, concerns of parents about MDIs usage can cause the deprivation of children from these highly effective drugs. Proper education can correct attitudes of patients or parents and decrease their concerns about MDIs usage

Unusual presentation of pilomatricoma: A case report and comprehensive review of the literature

Key Clinical Message Pilomatricoma is a benign proliferative lesion of skin appendages that often affects the head, upper limbs, and lower limbs. The clinical appearance of the lesions is that of asymptomatic nodules measuring less than 3 cm. pathologically, these skin lesions show the presence of basaloid cell islands, eosinophilic cytoplasmic cells without nuclei, as well as hemorrhage and calcification. In this study, we present the case of an 8‐year‐old girl with a 5 × 5 cm skin lesion on the forearm, which lacked the typical firmness associated with pilomatricoma lesions during examination. After biopsy, the lesion was confirmed to be pilomatricoma. Furthermore, we have reviewed studies documenting pilomatricoma lesions with atypical clinical features. Based on reports of different clinical manifestations of pilomatricoma in these studies, we suggest that the clinical diagnosis of pilomatricoma should not be limited to the typical presentation of these lesions. In cases where the lesions exceed 3 cm in size, display cystic characteristics, are painful, or resemble keloids, consideration should also be given to the possibility of pilomatricoma

Prevalence of Primary Immunodeficiency Diseases in Kerman, Southeast of Iran

Objective: Primary immunodeficiency diseases (PID) are rare and heterogeneous congenital diseases leading to increased unusual susceptibility to developing infections and causingsome malignancies and autoimmune diseases. This study was conducted to evaluate the epidemiological characteristics of primary these diseases in patients attending the clinic of immunodeficiency diseases in Kerman.Subjects and Methods: In a case series study from from 2003 to 2014 in our tertiary referral center, 32 patients with primary immunodeficiency disease were included. Data was analyzed by statistical software SPSS-19 . The level of significance was considered

Table_1_Allergic asthma manifestations in human and seropositivity to Toxocara, a soil-transmitted helminth of carnivores: A case-control study and scoping review of the literature.DOCX

Asthma is a common respiratory disease affecting humans. Helminth parasites, including Toxocara species, have been implicated as predisposing factors of asthma. However, various studies present different findings on asthma-Toxocara association. Herein, we investigated the association of asthma manifestations with Toxocara seropositivity in a case-control setting on 248 participants (147 women and 101 men), with 124 healthy individuals as the control group and 124 patients known to have asthma based on the medical records of asthma clinics of Kerman University of Medical Sciences. Consequently, we presented a scoping review of all previous studies carried out on this topic, summarizing current findings and existing knowledge on this issue. Of 248 participants, 31 (12.5%) were Toxocara-seropositive, of which 19 (15.3%) were in the patient group and 12 (9.7%) in the control group. A significant relationship was found between asthma severity and age in Toxocara-seropositive individuals (P < 0.04). We found no significant relationship between asthma and Toxocara seropositivity. We identified 7,724 related records in three major scientific databases, NCBI PubMed, Scopus, and Google Scholar. The review of the literature showed that there are 80 published articles on asthma-Toxocara relationship with contradictory findings. More than half of the studies were performed in only four countries, namely, Brazil, the Netherlands, the United States, and Iran. The study population in 70% of the studies were children, and few studies investigated asthma-Toxocara association in adults. The most common study designs for investigating the association of asthma and Toxocara seropositivity were cross-sectional (35.0%), case-control (27.5%), and animal experimental (12.5%) studies. This study found no significant relationship between asthma manifestations and toxocariasis in a case-control setting. However, a scoping review of the current literature suggests that further experimental and field longitudinal cohort studies are required to elucidate the nature of asthma-Toxocara interaction in humans.</p

Inheritance Pattern and Clinical Aspects of 93 Iranian Patients with Chronic Granulomatous Disease

Chronic granulomatous disease (CGD) is a rare immunodeficiency due to a genetic defect in one of the NADPH-oxidase components. We studied CGD inheritance forms (autosomal recessive (AR) or X-linked (XL)) and AR-CGD subtypes in Iran. Clinical and functional investigations were conducted in 93 Iranian CGD patients from 75 families. Most of the patients were AR-CGD (87.1%). This was related to consanguineous marriages (p = 0.001). The age of onset of symptoms and diagnosis were lower in XL-CGD compared with AR-CGD (p <0.0001 for both). Among AR-CGD patients, p47phox defect was the predominant subtype (55.5%). The most common clinical features in patients were lymphadenopathy (65.6%) and pulmonary involvement (57%). XL-CGD patients were affected more frequently with severe infectious manifestations. Although XL-CGD is the most common type of the disease worldwide, only 12 patients (12.9%) were XL-CGD in our study. The relatively high frequency of AR-CGD is probable due to widely common consanguineous marriages in Iran