Drug Allergy

Egypt J Pediatr Allergy Immunol 2013; 11(1):3-1

COVID-19 in children: current data and future perspectives

No abstrac

Reliability of candida skin test in the evaluation of T-cell function in infancy

Background: Both standardized and non-standardized candida skin tests are used in clinical practice for functional in-vivo assessment of cellular immunity with variable results and are considered not reliable under the age of 1 year. We sought to investigate the reliability of using manually prepared candida intradermal test in the evaluation of T cell function in infants during their second year of life.Methods: Twenty-five healthy infants were tested with manually prepared intradermal candida test. Cultured lymphocytes were stimulated with phytohemagglutinin (PHA) and gamma interferon (IFN-γ) levels were measured in the culture supernatant of stimulated and non-stimulated samples using ELISA.Results: The enrolled infants were 14 to 24 months old (mean 19.2 ± 3.13 months). They were 17 boys (68 %) and 8 girls (32 %). Candida skin test was positive in 17 out of the 25 infants (68%). All infants showed increased IFN-γ levels after PHA stimulation (mean ± SD: 0.83±0.29 ng/ml) compared to basal levels (mean ± SD = 0.16 ± 0.16 ng/ml). The increase of IFN γ levels after PHA stimulation ranged from 1.54 to 38 folds. Infants with positive and negative candida tests showed comparable results in terms of clinical and immunological assessment except for weight percentiles for age that were higher among candida positive group.Conclusion: Candida intradermal test is a cost-effective simple test for evaluation of T cell function with 70 % sensitivity in healthy infants above the age of one year.Keywords: Candida, IFN-γ, infants, intradermal, lymphocyte proliferation, PHA stimulation, T cell, Tuberculi

The critical level of vitamin D in childhood asthma

Objectives: Studies have suggested a significant link between vitamin D status and asthma. We sought to determine the cutoff level of25 hydroxy (25-OH) vitamin D that is significantly linked to asthma status in children.Methods: Our cross-sectional study comprised 90 asthmatic children, aged 2-18 years. They were evaluated clinically and classified according to asthma severity and control. Asthma control test (ACT) was performed in those aged above 4 years.Pulmonary functions were performed in cooperative children (n=59). Serum 25-OH vitamin D levels were measured by ELISA in all patients.Results: The study comprised 52 boys (57.7%) and 38 girls (42.3%) with mean age 7.03±4.36 years. Thirty-six patients (40%) had mild asthma, 37 (41%) moderate asthma and 17 (19%) had severe asthma. Forty-two patients (46.6%) had controlled asthma; 14 (15.6%) partially controlled and 34 (37.8%) had uncontrolled asthma. ACT score ranged: 11-26, with mean score: 18.9 ± 4.3 SD. Serum 25-OHvitamin D levels ranged between 2-48 ng/ml (mean± SD: 12.2 ± 9 ng/ml); levels were comparable among different grades of asthma severity (f= 1.975, p=0.145), while the uncontrolled asthma group showed the lowest levels (f=8.511, p <0.001). 25-OH vitamin D levels correlated positively with ACT score (r= 0.369, p= <0.001) but not with inhaled steroids doses or any of the pulmonary function parameters. A level of 7.5 ng/ml was associated with partial/completeuncontrol of asthma with 81 % sensitivity and 53 % specificity.Conclusion: 25-OH vitamin D levels below 7.5 ng/ml are associated with poor asthma status in children.Keywords: Asthma, allergy, children, severity, inhaled steroids, 25 hydroxy vitamin D

Double negative alpha beta T cells in pediatric hemophagocytic syndromes

Introduction: Autoimmune lymphoproliferative syndrome (ALPS) and hemophagocytic lymphohistiocytosis (HLH) share clinical and laboratory features including lymphadenopathy, splenomegaly, and pancytopenia. We sought to measure αβ double negative T cells (αβ DNT) in a group of patients with established diagnosis of HLH in relation to disease activity and severity.Methods: We conducted a follow-up, controlled study that comprised 25 patients with HLH and 25 healthy matched controls. Patients were subjected to clinical evaluation and flowcytometric measurement of αβ DNT Cells at presentation and 9 weeks after start of HLH induction treatment.Results: In 17 (68%) patients, infection was the trigger of HLH while the cause was malignancy in three (12%), and rheumatological disorders in two patients (8%). At enrollment, 15 patients (60%) had αβ DNT cells levels [median (IQR): 1.71 (1.25-2.12)] that were significantly higher than the control values [median (IQR): 0.7 (0.4-0.8)] (p<0.001). The αβ DNT counts of patients were also higher at enrollment as compared to values at the end of week 9 [median (IQR): 0.76 (0.45-1.17)]; p=0.018. Survivors (n=8) and non-survivors (n=17) had comparable levels of αβ DNT cells at enrollment (p=0.861). αβ DNT cell count correlated positively with ALT (p=0.019) and negatively with CD4/CD8 ratios (p=0.023).Conclusion: Elevated αβ DNT cell counts might be related to the HLH process and this implies that mild elevation can exist in HLH and are not specific to ALPS. Wider scale studies with longer periods of follow up are needed to validate the results and properly outline the correlation between both medical conditions.Keywords: Hemophagocytic lymphohistiocytosis, Double negative T cells, mortality, ALP

Regulatory natural killer cell expression in atopic childhood asthma

Introduction: Different subsets of natural killer (NK) cells were found to play a role in pathogenesis of allergy. We sought to investigate the expression of regulatory NK cells (CD56+CD16+CD158+) in atopic children with bronchial asthma in order to outline the value of these cells as biomarkers of disease severity and/or control.Methods: A cross sectional controlled study was carried out in the Pediatric Allergy and Immunology Unit, Ain Shams University. The study included 45 atopic children [mean age(SD)= (2.9) years] with bronchial asthma (BA) and/or allergic rhinitis (AR)as well as 40 healthy matched controls. Enrolled subjects underwent complete blood counting and flow cytometric measurement of NK cell (CD16+ CD56+) and regulatory NK cells (CD16+CD56+CD158+).Results: Patients had significantly higher regulatory NK cell percentages [mean (SD)= 41 (52) %] than controls [mean (SD)=15 (7.1)]; p≤0.001. Regulatory NK cell counts and percentages did not vary with the concomitant presence of AR or the degree of asthma control. Regulatory NK cell counts tended to be higher in children with moderate/severe BA compared to those with mild asthma but the difference did not reach statistical significance (U= -1.8, p=0.06). NK cell counts [mean (SD)= 159 (164) cells/μl] and percentages [mean (SD)= 3.7 (3.2) %] were comparable among patients and controls and did not vary with the presence of AR (p= 0.51, 0.95) or with the degree of asthma control. NK cells absolute counts and percentages tended to be higher among patients with moderate/severe compared to mild asthma but the difference did not reach statistical significance.Conclusions: Regulatory NK cells seem to be increased in childhood asthma. We recommend wider scale prospective studies on steroid-naïve subjects involving measurement of cytokines that are secreted by different types of NK cells.Keywords: Natural killer, regulatory, asthma, children, allerg

Health-related quality of life assessment using EQ-5D-Y questionnaire in a group of Egyptian asthmatic children

Background: Asthma, as a common chronic illness, negatively influences children's quality of life. We sought to investigate the health-related quality of life (HRQoL) in a sample of Egyptian asthmatic children. Methods: A cross-sectional study was conducted in the Pediatric Allergy and Immunology Unit of Ain Shams University, including three groups of age and gender-matched children, aged 6-12 years; an asthma group (n=100), non-asthmatic group with respiratory tract infections (n=114), and a healthy control group (n=100). The EQ-5D-Y questionnaire was used to evaluate the HRQoL in each study group. This questionnaire also comprises a visual analogue scale (VAS) which is scored from zero (worst) to 100 (best) as judged by the patient. Results: HRQoL assessment revealed that 86% of the asthmatic children faced problems with their daily activities, 43 % had worries, sadness and unhappiness and 22% had mobility problems (walking around). Thirteen percent of the cases expressed some pain or discomfort due to their disease, while self-care was the least affected (6%). Parameters of mobility, doing usual activities, feeling worried or sad were more frequently affected among the asthmatics in comparison to the other two groups (X2 = 37.02, 46.38, 22.90, respectively with p <0.001). Enrolled asthmatic children showed the lowest values of visual analogue scale (VAS) scores (mean ± SD: 72.2 ± 24.6) in comparison to the infection and healthy control groups (mean ± SD: 84.6 ± 12, 92.8 ± 9.6, respectively; f = 39.03; p value = 0.001). Conclusion:Asthma has a significant adverse impact on HRQoL of children and the EQ-5D-Y questionnaire could be an applicable instrument to measure their quality of life

Neutrophil functions in late preterm neonates with respiratory distress syndrome

Background: Studies that have addressed the effects of respiratory distress syndrome (RDS) on neutrophil function suggested that neutrophil functions other than the generation of the respiratory burst are not impaired. Yet, results have been confusing and in some cases contradictory.Objectives: The aim of this cross-sectional controlled study is to assess neutrophil number and function in late preterm neonates with RDS.Methods: Thirty patients underwent clinical and laboratory evaluation including complete blood counts and tests of neutrophil functions (CD11b, CD62L and Dihydrorhodamine 123 by flowcytometry) in comparison to 15 healthy term controls. RDS was assessed clinically and radiologically (chest x-ray).Results: Fifty percent of patients (12 females and 18 males) had grade II respiratory distress followed by grade III then grade I. DHR, CD 11b and CD62L results were lower among the patients group (mean ± SD: 62.1± 12.23, 63.22 ± 11.41, 15.03 ± 8.7 respectively). There were no significant correlations between neutrophils count, DHR, CD11b and CD62L. Only CD11b was significantly lower with higher grades of RDS.Conclusion: Neonates with RDS show variable affection of neutrophil functions. Further studies are recommended to elucidate the exact mechanisms by which RDS can affect neutrophil functions and whether these effects are associated with increased incidence of infections.Keywords: Neutrophils, function, respiratory distress syndrome, late preterm, innate immunity, infections, adhesion molecule

The Pediatric Allergy and Immunology Unit of Ain Shams University in times of SARS-CoV-2 pandemic: approach and challenges

The Pediatric Allergy and Immunology (PAI) Unit of Ain Shams University, founded in 1988 by Professor Yehia El-Gamal and currently headed by Professor Shereen Reda, is a tertiary referral center for pediatric allergy, primary immunodeficiency, and rheumatology patients in Egypt. It serves more than 1300 patients with different immunological disorders, with an outpatient and inpatient sections and investigational laboratory. With the widespread of the SARS-CoV-2 and its declaration as a "pandemic", and owing to the heterogeneity of the different disorders managed and followed up in the unit, several measures have been taken in order to provide the necessary services for the patients. This service should maintain a rational balance between the need to mitigate the virus spread and to provide the optimum care for those who get infected, when in the meantime keep their original disease morbidity and mortality to the minimum. These measures were taken by the members of the PAI unit with the help of the head management team of Children’s Hospital, Ain Shams University and were subjected to continuous modification based on the evolving situation, emerging information, problems faced and the availability of human and medical resources

2019 ARIA Care pathways for allergic rhinitis – Egypt

No abstrac