Antihistamines in pediatric allergy

Histamine is a key mediator in allergic diseases, where it exerts most of its effects through the H1 receptor and to a less extent the H2 receptor. H1-antihistamines provide rapid relief of many of the allergic symptoms and are considered the main stay of treatment of allergic rhinoconjunctivitis and urticaria. H1 antihistamines comprise first generation (old) and second generation (new) H 1 antihistamines with different pharmacological aspects, efficacy and safety profile. Few studies dealt with H1 antihistamines in pediatric population. This review will highlight the characteristics of H1 antihistamines and their indications in pediatric allergic disorders.Egypt J Pediatr Allergy Immunol 2012; 10(1):3-1

Updates on hereditary angioedema in pediatrics

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Resolution of lupus-related left ventricular wall thickening and interstitial lung disease in a child with pulsed steroids and cyclophosphamide

Cardiopulmonary involvement is one of the important manifestations of systemic lupus erythematosus (SLE) that tends to be more common in adults than children with SLE. SLE-related cardiopulmonary affection ranges from subclinical to life threatening condition. Although increased left ventricular mass and interstitial lung disease have been reported in association with SLE, the reversibility of such conditions with treatment of SLE was not sufficiently reported. Herein, we describe a female adolescent with SLE and lupus nephritis class III who presented as well with moderate dyspnea, tachycardia in absence of heart failure and hypertension. She had also productive cough of whitish sputum, no fever and both sputum and blood cultures were negative. Her echocardiography revealed left ventricular wall hypertrophy with preserved systolic function, electrocardiogram showed sinus tachycardia. Her pulmonary function tests revealed mild restrictive pattern and high resolution computed tomography revealed veiling of both lungs with increased attenuation and interstitial nodules with bilateral mild pleural effusion. She received full dose prednisone and intravenous monthly cyclophosphamide in addition to intravenous pulsed methylprednislone. She gradually improved with complete resolution of her cardiopulmonary disease and significant reduction of her proteinuria. In conclusion, cardiopulmonary involvement in relation to SLE could be reversible with adequate treatment leaving

Immunomodulatory effects of food

There is a strong consensus that nutrition plays a role in modulating immune function and that the immune system needs adequate supply of nutrients to function properly. The complexity of the immune system supports this idea because its optimal functioning involves a variety of biological activities including cell division and proliferation, energy metabolism, and production of proteins. The micronutrients most often cited as being important to immune function include vitamins A, C, E, and B6, folate, iron, zinc, and selenium. Other nutrients mentioned as playing a role in immune function include beta-carotene (a precursor to vitamin A), vitamin B12, and vitamin D. On the other hand, over-activation of the immune system can lead to detrimental effects such as chronic inflammation or autoimmune diseases. In persons with allergies, a normally harmless material can be mistaken as an antigen. Some individuals develop an exaggerated immune response to food through developing food allergy which may be IgE mediated, non-IgE mediated, or mixed. This review will highlight the interaction between the immune system and some foods and food components in terms of modulation of immune functions by a variety of mechanisms.Egypt J Pediatr Allergy Immunol 2011;9(1):3-1

Subclinical hypothyroidism among Egyptian children with systemic lupus erythematosus

Background: Thyroid autoimmune diseases have been associated with systemic lupus erythematosus (SLE). Both hypothyroidism and hyperthyroidism are seen, but hypothyroidism is the most common abnormality. Subclinical hypothyroidism (SCH) has been reported among adult lupus patients. SCH is not without risk as it might contribute to a proatherogenic state. Objectives: This study was aimed to assess the frequency of SCH in a group of Egyptian children with SLE and its effects on the serum lipids. Methods: Forty patients with pediatric SLE who regularly follow up at our center were enrolled in this study. They were subjected to routine laboratory investigations of SLE and measurement of serum lipids (serum triglycerides, cholesterol, LDL and HDL) as well as free thyroxine (T4), thyroid stimulating hormone (TSH) and anti-thyroperoxidase antibody (anti-TPO-ab) titre. SLE activity was assessed using the systemic lupus erythematosus disease activity index (SLEDAI). Results: Six patients (15%) were found to have SCH while the remaining 34 patients (85%) had normal thyroid function. Anti-TPO-abs were positive in 4 out of the 6 (66.6 %) SLE patients with SCH and in 20 out of the 34 (58.8%) SLE patients with normal thyroid function. In SLE patients with SCH, TSH correlated positively yet insignificantly with anti-TPO-ab titre and the duration of SLE (p = 0.17, p = 0.12, respectively). There were no statistically significant correlations between the serum lipids of SLE patients with SCH and their thyroid function or anti-TPO-ab titre. Conclusion: SCH is not uncommon among children with SLE. This SCH does not seem to affect serum lipids. However, further longitudinal studies on wider scales are needed to assess the long term effects of SCH in those patients.Keywords: SLE, anti-thyroperoxidase antibodies, subclinical hypothyroidismEgypt J Pediatr Allergy Immunol 2011;9(2):87-9

Interferon gamma: is it a co-player in the pathogenesis of idiopathic nephrotic syndrome

Introduction: Idiopathic nephrotic syndrome (INS), the most common form of NS in childhood, was considered 4 decades ago as a systemic disorder of T cells, mediated through its released cytokines. To date, the exact incriminated cytokine or immunological mediator is not properly defined. Interferon gamma (IFN-γ), a pro-inflammatory cytokine, is thought to have a role in the provocation of the T cell mediated INS relapse, through promotion of T helper1 (Th1) differentiation and suppression of regulatory T cells (Treg). Aim of the study: to evaluate the immunopathogenic role of IFN-γ in children with steroid sensitive idiopathic nephrotic syndrome (SSNS) through monitoring the changes in its levels with disease course. Methods: This study included twenty-five newly diagnosed children with SSINS. They were all given full dose prednisolone, evaluated at initial diagnosis and at full remission as regards the serum level of IFN-γ. Results: Serum levels of IFN-γ were lowermost at time of diagnosis and increased with remission on corticosteroids. Conclusions: this study points to a role for the lower serum IFN-γ at diagnosis, in the immunopathogenesis of INS than at remission and the rise in its serum level might be a marker of remission induction, however this awaits confirmation in larger scale studies. Studies on renal biopsy specimens are needed to determine the exact renal in situ levels and effects of IFN-

A Rare Association Between Leukocyte Adhesion Deficiency Type I and Psoriasis in Humans

The β2 integrins are expressed exclusively on leukocytes and participate in many immune and inflammatory processes. This subfamily comprises four heterodimeric glycoproteins with a common β-subunit, designated β2 (CD18). Spontaneous mutations of the CD18 gene result in leukocyte adhesion deficiency type I (LAD-I). Low level of CD18 expression has also been implicated in the pathogenesis of psoriasis. We here describe a child with recurrent skin infections without pus formation, persistent gingivitis and periodontitis. His blood counts showed persistent leukocytosis (neutrophilia). CD11b expression was defective on neutrophils, while that of CD18 was normal. So, our patient represents a mild variant of LAD-I with possible dysfunctional CD18. Moreover, he developed psoriasis with reduced CD18 expression on CD4+ T-cells. Psoriasiform dermatitis has been described before in association with LAD-I, however, clinically and histologically confirmed psoriasis in association with LAD-I has been described only in CD18 hypomorphic mice. Therefore, our patient represents the first clinically and histopathologically documented association between LAD-I and psoriasis in humans. It lends support to the role of β2 integrins in the etiopathogenesis of psoriasis

Defining criteria for disease activity states in systemic juvenile idiopathic arthritis based on the systemic Juvenile Arthritis Disease Activity Score

Objective To develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MiDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis (sJIA), based on subjective disease state assessment by the treating pediatric rheumatologist. Methods The cutoffs definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, 6 methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, Youden index, 90% specificity, maximum agreement, and ROC curve analysis. Sixty percent of the patients were assigned to the definition cohort and 40% to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. Results The sJADAS10 cutoffs that separated ID from MiDA, MiDA from MoDA, and MoDA from HDA were ≤ 2.9, ≤ 10, and > 20.6. The cutoffs discriminated strongly among different levels of pain, between patients with or without morning stiffness, and between patients whose parents judged their disease status as remission or persistent activity/flare or were satisfied or not satisfied with current illness outcome. Conclusion The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts, and are therefore suitable for use in clinical trials and routine practice