A Systematic Review on the Diagnosis of Pediatric Bacterial Pneumonia: When Gold Is Bronze

In developing countries, pneumonia is one of the leading causes of death in children under five years of age and hence timely and accurate diagnosis is critical. In North America, pneumonia is also a common source of childhood morbidity and occasionally mortality. Clinicians traditionally have used the chest radiograph as the gold standard in the diagnosis of pneumonia, but they are becoming increasingly aware that it is not ideal. Numerous studies have shown that chest radiography findings lack precision in defining the etiology of childhood pneumonia. There is no single test that reliably distinguishes bacterial from non-bacterial causes. These factors have resulted in clinicians historically using a combination of physical signs and chest radiographs as a 'gold standard', though this combination of tests has been shown to be imperfect for diagnosis and assigning treatment. The objectives of this systematic review are to: 1) identify and categorize studies that have used single or multiple tests as a gold standard for assessing accuracy of other tests, and 2) given the 'gold standard' used, determine the accuracy of these other tests for diagnosing childhood bacterial pneumonia.Search strategies were developed using a combination of subject headings and keywords adapted for 18 electronic bibliographic databases from inception to May 2008. Published studies were included if they: 1) included children one month to 18 years of age, 2) provided sufficient data regarding diagnostic accuracy to construct a 2x2 table, and 3) assessed the accuracy of one or more index tests as compared with other test(s) used as a 'gold standard'. The literature search revealed 5,989 references of which 256 were screened for inclusion, resulting in 25 studies that satisfied all inclusion criteria. The studies examined a range of bacterium types and assessed the accuracy of several combinations of diagnostic tests. Eleven different gold standards were studied in the 25 included studies. Criterion validity was calculated for fourteen different index tests using eleven different gold standards. The most common gold standard utilized was blood culture tests used in six studies. Fourteen different tests were measured as index tests. PCT was the most common measured in five studies each with a different gold standard.We have found that studies assessing the diagnostic accuracy of clinical, radiological, and laboratory tests for bacterial childhood pneumonia have used a heterogeneous group of gold standards, and found, at least in part because of this, that index tests have widely different accuracies. These findings highlight the need for identifying a widely accepted gold standard for diagnosis of bacterial pneumonia in children

Lung epithelium as a sentinel and effector system in pneumonia – molecular mechanisms of pathogen recognition and signal transduction

Pneumonia, a common disease caused by a great diversity of infectious agents is responsible for enormous morbidity and mortality worldwide. The bronchial and lung epithelium comprises a large surface between host and environment and is attacked as a primary target during lung infection. Besides acting as a mechanical barrier, recent evidence suggests that the lung epithelium functions as an important sentinel system against pathogens. Equipped with transmembranous and cytosolic pathogen-sensing pattern recognition receptors the epithelium detects invading pathogens. A complex signalling results in epithelial cell activation, which essentially participates in initiation and orchestration of the subsequent innate and adaptive immune response. In this review we summarize recent progress in research focussing on molecular mechanisms of pathogen detection, host cell signal transduction, and subsequent activation of lung epithelial cells by pathogens and their virulence factors and point to open questions. The analysis of lung epithelial function in the host response in pneumonia may pave the way to the development of innovative highly needed therapeutics in pneumonia in addition to antibiotics

A European-Japanese study on peach allergy : IgE to Pru p 7 associates with severity

Funding Information: M. Fernández‐Rivas received grants or contracts from Instituto de Salud Carlos III, Spanish Government, Aimmune Therapeutics, Diater, and Novartis; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Aimmune Therapeutics, Ediciones Mayo S.A., Diater, Ga2LEN, HAL Allergy, GSK, MEDSCAPE, NOVARTIS, and EPG Health; is member of the Data Safety Monitoring Board at DBV and advisory board at Aimmune Therapeutics, Novartis, Reacta Healthcare, and SPRIM. B. Ballmer‐Weber received consulting fees from ALK, Allergopharma, Menarini, Sanofi, Novartis, Thermofisher and Aimune and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from ALK, Menarini, Sanofi, Novartis, and Thermofisher. F. De Blay received grants or contract from Aimmune, Stallergenes Greer, GSK, ALK, Chiesi, and Regeneron. Y. Fukutomi received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Thermo Fisher Diagnostics KK. K. Hoffmann‐Sommergruber received funding from Danube Allergy Research Cluster funded by the Country of Lower Austria to (P07) KHS; was Member of the EAACI board until 2022/07. J. Lidholm is employee at Thermo Fisher Scientific. E.N.C Mills received grants or has contracts from Food Standards Agency Patterns and prevalence of adult food allergy (FS101174), European Food Safety Authority (ThRAll; allergenicity prediction [with EuroFIR]) and from Innovate (ML for food allergy); has applied for a patent on oral food challenge meal formulations for diagnosis of food allergy; is member of the Advisory Board of Novartis and Advisory Committee on Novel Foods and Processes; and is shareholder of Reacta Healthcare Ltd. N.G. Papadopoulos received grants or contracts from Capricare, Nestle, Numil, Vianex; received consultancy fees from Abbott, Abbvie, Astra Zeneca, GSK, HAL, Medscape, Menarini/Faes Farma, Mylan, Novartis, Nutricia, OM Pharma, and Regeneron/Sanofi. S. Vieths received royalties or licenses from Schattauer Allergologie Handbuch, Elsevier Nahrungsmittelallergien and Intoleranzen and Karger Food Allergy: Molecular Basis and Clinical Practice; support for attending meetings and/or travel as Associate Editor of the Journal of Allergy and Clinical Immunology. R. van Ree received consulting fees from HAL Allergy, Citeq, Angany, Reacta Healthcare, Mission MightyMe, and Ab Enzymes; received payment of honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from HAL Allergy, Thermo Fisher Scientific and ALK; received payment for expert testimony from AB Enzymes; has stock option at Angany. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: This work was funded by the European Commission under the 6th Framework Programme through EuroPrevall (FP6‐FOOD‐CT‐2005‐514000), and the 7th Framework Programme iFAAM (grant agreement no. 31214). Funding Information: We thank all the patients for their participation in the study. We would like to thank ALK Abello (Madrid, Spain) for their generous gift of SPT reagents. We thank Angelica Ehrenberg, Jonas Östling and Lars Mattsson (Uppsala) for preparing recombinant Cup s 7 and custom ImmunoCAP tests for this study. We acknowledge the support by the 6th and 7th Framework Programmes of the EU, for EuroPrevall (FP6‐FOOD‐CT‐2005‐514000) and iFAAM (Grant agreement no. 312147), respectively. We thank Alejandro Gonzalo Fernández (Hospital Clinico San Carlos, IdISSC, Madrid) for implementing the FASS in the data set. Publisher Copyright: © 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.BACKGROUND: Pru p 3 and Pru p 7 have been implicated as risk factors for severe peach allergy. This study aimed to establish sensitization patterns to five peach components across Europe and in Japan, to explore their relation to pollen and foods and to predict symptom severity. METHODS: In twelve European (EuroPrevall project) and one Japanese outpatient clinic, a standardized clinical evaluation was conducted in 1231 patients who reported symptoms to peach and/or were sensitized to peach. Specific IgE against Pru p 1, 2, 3, 4 and 7 and against Cup s 7 was measured in 474 of them. Univariable and multivariable Lasso regression was applied to identify combinations of parameters predicting severity. RESULTS: Sensitization to Pru p 3 dominated in Southern Europe but was also quite common in Northern and Central Europe. Sensitization to Pru p 7 was low and variable in the European centers but very dominant in Japan. Severity could be predicted by a model combining age of onset of peach allergy, probable mugwort, Parietaria pollen and latex allergy, and sensitization to Japanese cedar pollen, Pru p 4 and Pru p 7 which resulted in an AUC of 0.73 (95% CI 0.73-0.74). Pru p 3 tended to be a risk factor in South Europe only. CONCLUSIONS: Pru p 7 was confirmed as a significant risk factor for severe peach allergy in Europe and Japan. Combining outcomes from clinical and demographic background with serology resulted in a model that could better predict severity than CRD alone.Peer reviewe

Administration of Cisplatin in Three Patients with Carboplatin Hypersensitivity: Is Skin Testing Useful?

Carboplatin is a chemotherapeutic agent approved in the first-line setting of numerous malignancies. Hypersensitivity to carboplatin has been reported in up to 44% of patients receiving this antineoplastic agent, usually occurring after several courses of treatment. The aim of this study was to determine the usefulness of skin tests in ruling out cross-reaction to cisplatin to continue platinum-based chemotherapy in patients who are responsive to these agents. Prick tests and intradermal tests with a series of dilutions of carboplatin and cisplatin were performed on three patients who had exhibited medium and severe hypersensitivity reactions to carboplatin. Prick tests were negative in both the antineoplastic agents. Intradermal tests with carboplatin were positive in all three patients and negative with cisplatin. In all patients, the administration of cisplatin instead of carboplatin was well tolerated without the need of premedication. In conclusion, intradermal skin tests can be a useful tool for detecting a potential cross-reaction between platinum salts. It allows safe administration of a different platinum agent in patients who seem to benefit from platinum-based therapy. Discontinuation of chemotherapy, desensitization protocols and steroid premedication can be avoided. Anti-Cancer Drugs 21: 333-338 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Evaluation and standardisation of different matrices used for double-blind placebo-controlled food challenges to fish

Background: Fish allergens represent one of the most common causes of adverse reactions to food worldwide. Double-blind placebo-controlled food challenges (DBPCFC) are the gold standard for food allergy diagnosis. However, no standardised recipes are available for common food allergens such as fish, and a well trained dietitian is essential for creating and standardising them. The present study aimed to create and standardise recipes for use in DBPCFCs to fish. Methods: Three recipes were prepared. Employing a standardised procedure, a total of 35 panelists evaluated the different matrices using an evaluation form. A paired comparison test was used to estimate total evaluation's outcome. Fish allergic patients were challenged with different fish species blinded with the selected matrix and evaluated the recipe using the same form. Results: From a base recipe and step-by-step modifications, a low fat recipe was selected among other recipes tested, which proved to be appropriate for fish blinding, in terms of taste, odour, appearance and blinding. Patients challenged with the final matrix found it acceptable, no matter which fish type was used. Conclusions: In this pilot study, a recipe with satisfactory organoleptic characteristics was developed and validated for DBPCFC to fish. © 2010 The Authors. Journal compilation © 2010 The British Dietetic Association Ltd