Case Report: Insulin hypersensitivity in youth with type 1 diabetes

OBJECTIVE: Immediate type I, type III, and delayed type IV hypersensitivity reactions to insulin are rare, but potentially serious complications of exogenous insulin administration required for the treatment of type 1 diabetes (T1D). METHODS: We present four cases of insulin hypersensitivity reactions occurring in youth with T1D and a literature review of this topic. RESULTS: Insulin hypersensitivity reactions included types I, III, and IV with presentations ranging from localized urticaria, erythematous nodules, and eczematous plaques to anaphylaxis with respiratory distress. Reactions occurred in youth with newly diagnosed T1D and in those with long-standing T1D who were using both injection and insulin pump therapy. Multidisciplinary care involving pediatric endocrinology and allergy/immunology utilizing trials of many adjunct therapies yielded minimal improvement. Despite the use of various treatments, including antihistamines, topical therapies, immunosuppressant medications, desensitization trials, and intravenous immune globulin, cutaneous reactions, elevated hemoglobin A1c levels, and negative effects on quality of life remain persistent challenges. One patient became one of the youngest pancreas transplant recipients in the world at age 12 years due to uncontrollable symptoms and intolerable adverse effects of attempted therapies. CONCLUSION: Although rare, insulin hypersensitivity reactions negatively affect glycemic control and quality of life. These cases demonstrate the varying severity and presentation of insulin hypersensitivity reactions along with the limited success of various treatment approaches. Given the life-sustaining nature of insulin therapy, further studies are needed to better understand the underlying pathophysiology of insulin hypersensitivity and to develop targeted treatment approaches

Seafood graded oral food challenge outcomes in a pediatric tertiary care center

BACKGROUND: There are sparse data regarding the predictors of positive oral food challenges and reaction severity for seafood in children. OBJECTIVE: Identify clinical characteristics in children with seafood allergy who were most likely to experience a negative oral food challenge (OFC). METHODS: A retrospective chart review was performed for children who had a graded OFC to seafood at a pediatric tertiary care center from 2008 through 2019. RESULTS: Sixty-three (60% male; average age 8 years; range 1-21 years) OFCs were performed, of which 21 were fish and 42 were shellfish. There were 10 (16%) positive OFCs and positive OFC rate was similar between fish (19%) and shellfish (14%). Forty-three children who underwent OFC had a reported history of IgE-mediated symptoms. Five of six children who had a history of anaphylaxis had a negative OFC. There was no difference in positive OFCs due to age, history of atopy, or initial allergic reaction history. The clinical characteristics of the positive OFCs were similar between fish and shellfish. A positive skin prick test to fish or shellfish did not increase the risk of a positive OFC. While the positive OFC rate did not differ for the shellfish food-specific IgE (FSIgE) level, there was a significant difference for fish (median \u3c0.34 kU CONCLUSION: A retrospective study of OFCs to seafood showed that the rate of a positive OFC was low. While seafood allergy is thought to be rarely outgrown, children who have a low FsIgE and/or skin testing can successfully tolerate seafood

Student Recital (May 2, 2014)

Etude No. 62 / Mitchell Peters Nicole Desmarais, timpani Malagueña from Spanish Dances, Op. 21 / Pablo de Sarasate Carla Mason, violin Valse Venezolano No. 2 / Antonio Lauro Michael Cirino, guitar Ballade / Albert Périlhou Nicole Mount, flute Etude No. 8 / Heitor Villa-Lobos Dylan Mowry, guitar Sicilienne and Rigaudon / Fritz Kreisler Tempo di Allegretto and Allegro Megan Polk, violin Cavatine, Op. 144 / Camile Saint-Saëns Cody O’Toole, trombone Concerto No. 1 in A minor / Jean Baptiste Accolaÿ Gail Colombo, violin Das Wohltemperierte Klavier II, BWV 886 / Johann Sebastian Bach Prelude and Fugue in Ab Major Jiaying Zhu, piano Cello Suite No. 1, BWV 1007 / J. S. Bach Prelude Killian Kerrigan, guitar El Colibri / Julio S. Sagreras Brian Picher, guitar Maria Wiegenlied / Max Reger Se Tu M’ami / Giovanni Battista Pergolesi Brooke Speigel, soprano Nocturnal After John Dowland / Benjamin Britten Passacaglia and Theme Jim Davidson, guitar Spring / Ivor Gurney Lied Der Mignon, D. 877, No. 3 / Franz Schubert Mackenzie Leahy, soprano Ma Mère L’oye (Mother Goose Suite) / Maurice Ravel Pavane de la Belle au bois dormant (Lent) Petit Poucet. (Très modéré) Laideronnette, Impératrice des pagodes ( Mouvement de marche) Jiaying Zhu, piano Alexander Heinrich, piano Waltz in Db Major, Op. 64, No. 1 / Frederic Chopin Brenner Campos, piano Three Songs Without Words / Paul Ben-Haim Arioso Ballad Shepardic Melody Colby DeWitt, alto saxophone For You There is No Song / Leslie Adams Deborah / Gene Bone Justine Smigel, sopranohttps://vc.bridgew.edu/student_concerts/1065/thumbnail.jp

Non-suicidal reasons for self-harm: a systematic review of self-reported accounts

Background: Self-harm is a major public health problem yet current healthcare provision is widely regarded as inadequate. One of the barriers to effective healthcare is the lack of a clear understanding of the functions self-harm may serve for the individual. The aim of this review is to identify first-hand accounts of the reasons for self-harm from the individual's perspective. Method: A systematic review of the literature reporting first-hand accounts of the reasons for self-harm other than intent to die. A thematic analysis and ‘best fit' framework synthesis was undertaken to classify the responses. Results: The most widely researched non-suicidal reasons for self-harm were dealing with distress and exerting interpersonal influence. However, many first-hand accounts included reasons such as self-validation, and self-harm to achieve a personal sense of mastery, which suggests individuals thought there were positive or adaptive functions of the act not based only on its social effects. Limitations: Associations with different sub-population characteristics or with the method of harm were not available from most studies included in the analysis. Conclusions: Our review identified a number of themes that are relatively neglected in discussions about self-harm, which we summarised as self-harm as a positive experience and defining the self. These self-reported “positive” reasons may be important in understanding and responding especially to repeated acts of self-harm

What have recent advances in therapy taught us about severe asthma disease mechanisms?

Introduction: Severe asthma still represents a worldwide challenge. The need for further treatment options has stimulated basic and pharmacological research to focus on the immune and inflammatory background of asthma. The new biologic drugs express the considerable advances in the field and besides providing a revolutionary treatment option for severe asthma, contribute themselves to better understand the pathophysiologic mechanisms they address, paving the way to new potential targets. Areas covered: A selective search on PubMed and Medline was performed, including the evidence on immunology of severe asthma published up to May 2019 by focusing on the immunological effects of biologic drugs underlying their clinical outcomes. Expert opinion: The recent pharmacological research in the field of biologics has represented an exceptional opportunity for exploring severe asthma mechanisms. However, some points deserve to be addressed by further investigation. Although in the absence of safety warnings so far, interfering with the immune system may raise some safety concerns, especially in the long-term use. Particularly when interacting with epithelial and innate immunity the selection of candidates probably deserves special caution. Also, whether biologics exert a true disease-modifying effect is not completely clear. As a direct practical implication, the optimal treatment duration is still controversial