Oral Immunotherapy in Children: Ige-Dependent Food Allergy to Milk or Wheat

Oral Immunotherapy (OIT) is an effective strategy for improving food allergy tolerance. OIT has been introduced as a novel immune-modulating medication for food allergies. Other immunomodulatory approaches, such as sublingual (SLIT) or epicutaneous (EPIT) immunotherapy, may be less effective due to lower frequencies of systemic responses. Wheat and milk have lately been identified as a more prevalent cause of food-induced anaphylaxis than previously thought, particularly in young children worldwide. An immunoglobulin E (IgE)-dependent pathway may be responsible for wheat or milk allergy. The goal of our study was to offer a comprehensive evaluation of the effects of OIT in children with IGE-dependent food allergies to milk or wheat. Keywords related to OIT, food allergy, milk, wheat, and children were searched in MEDLINE, PubMed, Google Scholar, and ScienceDirect databases. Although oral immunotherapy for wheat allergy has recently been proposed, research studies have had encouraging results; despite, more research is still needed to determine the optimum strategy for promoting tolerance in wheat/milk-allergic childre

Food-dependent exercise-induced anaphylaxis due to wheat in a young woman

Food Dependent Exercise-Induced Allergy is a rare condition. However, the occurrence of anaphylaxis is increasing especially in young people. The diagnosis of anaphylaxis is based on clinical criteria and can be supported by laboratory tests such as serum tryptase and positive skin test results for specific IgE to potential triggering allergens. Anaphylaxis prevention needs strict avoidance of confirmed relevant allergen. Food-exercise challenge test may be an acceptable method for diagnosis of Food Dependent Exercise-Induced Allergy and dietary elimination of food is recommended to manage it. In this study, a 32 year-old woman visited the allergy clinic with a history of several episodes of hives since 11 years ago and 3 life-threatening attacks of anaphylaxis during the previous 6 months. The onsets of majority of these attacks were due to physical activity after breakfast. On Blood RAST test, the panel of common food Allergens was used and she had positive test only to wheat flour. On skin prick tests for common food allergens she showed a 6 millimeter wheal with 14 mm flare to Wheat Extract. The rest of allergens were negative. The patient was diagnosed as wheat-dependent exercise-induced, and all foods containing wheat were omitted from her diet. In this report we emphasized on the importance of careful history taking in anaphylaxis diagnosis

Quality of Life in Children with Asthma versus Healthy Children

BACKGROUND: Asthma is the most prevalent chronic disease in the pediatric age group. The disease affects different aspects of the children's lives, such as physical, emotional, social and educational aspects. Thus, more focus has been on the quality of life in these patients rather than the duration of their illness in recent years.AIM: This study examined the different aspects of quality of life in asthmatic children for the first time in this geographic area.METHODS: The study was cross-sectional conducted in 2015-2016. The asthmatic group was 100 patients aged 8 to 12 admitted to the Asthma and Allergy Clinic of Ghaem Hospital (as) in Mashhad with the control group composed of 100 healthy children of the same age and gender. The standard questionnaire pedsQLTM was used for comparing the quality of life of children in the two groups. Statistical analysis was SPSS23 with P-value less than 0.05, which was statistically significant.RESULTS: In each group, 58 patients were boys, and 42 were girls. In a comparison of the quality of life of children, the asthma group with a mean total score of Peds QL 20.99 ± 12.54 compared to the healthy children with a mean total score of Peds QL of 8.8 ± 5.41 had a lower quality of life (P < 0.001). Moreover, regarding various aspects of quality of life asthma group had a lower quality of life in physical performance, emotional performance and performance in school (P < 0.001). Nonetheless, there was no significant difference between the two groups considering social function (P = 0.267). Examining the relationship between Peds QL score of patients with asthma with various variables was indicative of the fact that Peds QL scores were significantly correlated with the gender of the patients, showing better quality of life in the girls (P = 0.001).CONCLUSION: The results indicated that children with asthma have a significantly lower quality of life compared with healthy children of the same age. Also, in examining the different aspects of quality of life, these children had a lower quality of life in physical performance, emotional performance, and performance at school, and were at the level as that of healthy children only in social performance

Effect of peppermint on pediatrics’ pain under endoscopic examination of the large bowel

Introduction: Colonoscopy is a painful and invasive technique for patients especially for pediatrics. Peppermint has analgesic effect. Therefore, we wish to look at the effect of peppermint essence on the patients&rsquo; satisfaction and pain after colonoscopy. Methods: This clinical trial study was performed on 100 patient&rsquo;s candidate for colonoscopy. Patients were randomly divided into two groups. Control group received no drug. Case group was administrated supermint essence thirty minutes before colonoscopy. A valid questionnaire was filled during the colonoscopy for patient&rsquo;s satisfaction and pain evaluation. Results: The mean value of abdominal pain was 0.527&plusmn;2.500 in control group and 1.625&plusmn;0.491 in case group after treatment (p&lt;0.05). Degree of satisfaction was 8 and 17.6 percent in control and case groups, respectively. Mean value of satisfaction in control group was 1.833&plusmn;0.389 that was significantly different from case group (2.607&plusmn;0.566) (p&lt;0.05). Duration of colonoscopy in control group was significantly higher than the one in case group (p&lt;0.05). Conclusion: Our findings showed that peppermint essence causes an increasing in satisfaction as well as a reduction in pain in patients under the colonoscopy.</p

Presentation of DNA Methyltransferase 3 Beta Mutation with Immune Deficiency and Dilation of Aorta and Esophagus

Background: Immunodeficiency, Centromeric region instability, and Facial anomalies syndrome (ICF) is a rare autosomal recessive disorder with Centromeric instability as a hallmark. Method: In this case report, we describe an Iranian 6-year-old male who was diagnosed with ICF syndrome. He had a history of recurrent infections, hydrocephalus report in pregnancy, failure to thrive, facial anomalies, global developmental delay, and umbilical hernia. Results: The investigation showed esophageal dilatation in barium swallow, ascending aortic dilatation in echocardiography and cutis laxa in skin biopsy. In laboratory data, impaired antibody function was observed. Finally, to find the probable causative genetic variant, a whole exome sequencing was performed. The data analysis using bioinformatics tools revealed c.1592G>A mutation in the exon 15 of DNMT3B. With respect to the diagnosis of ICF syndrome, our patient was treated with intravenous immunoglobulin (IVIG). Conclusion: It is necessary to perform periodic neurologic and ophthalmologic examinations. Echocardiography must be done annually. In addition, the possibility of HSCT should be evaluate

Short-course administration of a traditional herbal mixture ameliorates asthma symptoms of the common cold in children

Objective: Asthma is an increasing chronic respiratory disease affecting over 300 million people worldwide. Several studies have shown that herbal remedies may improve asthma control and reduce asthma symptoms. In this study, the effects of short-course administration of an herbal mixture (ASMATUSTM) in asthmatic children during viral respiratory tract infection, were evaluated. Materials and Methods: Forty-six children (7-12 years old) with intermittent asthma were enrolled in this double-blind randomized clinical trial. At the onset of common cold symptoms, the patients were randomly assigned to daily receive either the herbal mixture (comprised of Matricaria chamomilla, Althaea officinalis, Malva sylvestris, Hyssopus officinalis, Adiantum capillus-veneris, Glycyrrhiza glabra and Ziziphus jujube) or placebo for 5 days. Primary outcomes included day symptoms, night symptoms, and asthma attacks.  Secondary outcomes included Peak Expiratory Flow Rate (PEFR), the need for β-agonist administration, oral prednisolone usage, necessity for re-visit due to uncontrolled or insupportable symptoms, as well as the number of hospital admissions and days absent from school. Results: the herbal mixture significantly decreased the severity of coughs (p=0.049) and nighttime awakenings (p=0.029) in comparison to placebo. There was no significant reduction in wheezing, tachypnea, respiratory distress, PEF rate, absence from school, outpatient visits, asthma exacerbation, oral prednisolone or β-agonist usage and hospitalization. Conclusion: Short-course of herbal mixture this traditional herbal mixture, starting at the onset of signs of a viral respiratory tract infection in children with intermittent asthma, reduced cough and nights awakening. Further studies should be done to determine the most effective herbal admixture, as well as dose and duration of treatment

Global systematic review of primary immunodeficiency registries

Introduction During the last 4 decades, registration of patients with primary immunodeficiencies (PID) has played an essential role in different aspects of these diseases worldwide including epidemiological indexes, policymaking, quality controls of care/life, facilitation of genetic studies and clinical trials as well as improving our understanding about the natural history of the disease and the immune system function. However, due to the limitation of sustainable resources supporting these registries, inconsistency in diagnostic criteria and lack of molecular diagnosis as well as difficulties in the documentation and designing any universal platform, the global perspective of these diseases remains unclear. Areas covered Published and unpublished studies from January 1981 to June 2020 were systematically reviewed on PubMed, Web of Science and Scopus. Additionally, the reference list of all studies was hand-searched for additional studies. This effort identified a total of 104614 registered patients and suggests identification of at least 10590 additional PID patients, mainly from countries located in Asia and Africa. Molecular defects in genes known to cause PID were identified and reported in 13852 (13.2% of all registered) patients. Expert opinion Although these data suggest some progress in the identification and documentation of PID patients worldwide, achieving the basic requirement for the global PID burden estimation and registration of undiagnosed patients will require more reinforcement of the progress, involving both improved diagnostic facilities and neonatal screening.Peer reviewe

Probiotics and prebiotics for prevention of viral respiratory tract infections

This chapter introduces the importance of viral upper respiratory tract infections and evidence that probiotics, prebiotics, and synbiotics may reduce not only their incidence, but also their duration and severity. It starts by explaining the importance of viral respiratory infections and the common cold including their prevalence, morbidity, mortality, and cost. The mechanisms of action are discussed next. Later, it represents the clinical trials using probiotics and prebiotics for the prevention of viral infection in different age groups. At the end of the chapter, a summary of latest evidences is presented

Update on Hyper IgE syndrome (HIES)

Hyper IgE Syndrome (HIES) is a rare primary immunodeficiency disease. Most of HIES cases are sporadic. HIES type AD is caused by mutation in signal transducer and activator of transcription-3 (STAT-3). A number of mosaicism HIES has been reported that is associated with intermediate phenotype. Autosomal recessive HIES (AR-HIES) is due to mutation in Dock-8 or cytokine sis 8 and TYK2 or tyrosine kinase 2. The common manifestations are atopic eczema, staphylococcal dermatitis, cellulitis and folliculitis (cold dermal abscesses that are not warm, painful and without redness), recurrent pneumonia and pulmonary abscesses, osteopenia and recurrent bone fracture. The diagnosis of standard HIES is based on clinical suspicion. There is no specific treatment for HIES. The treatment should be based on the prevention of developing infections. Prophylactic antibiotics such as cotrimoxazole and IVIG are administered. Hematopoietic stem cell transplantation was done for all types of HIES, but there is a little information and experience about the long term results of this therapy

Update on Hyper IgE syndrome (HIES)

Hyper IgE Syndrome (HIES) is a rare primary immunodeficiency disease. Most of HIES cases are sporadic. Autosomal dominant HIES is caused by mutation in signal transducer and activator of transcription-3 (STAT-3). A number of mosaicism HIES has been reported that is associated with intermediate phenotype. Autosomal recessive HIES is due to mutation in Dock-8 or cytokine sis 8 and TYK2 or tyrosine kinase 2. The common anifestations are atopic eczema, staphylococcal dermatitis, cellulitis and folliculitis (cold dermal abscesses that are not warm, painful and without redness), recurrent pneumonia and pulmonary abscesses, osteopenia and recurrent bone fracture. The diagnosis of standard HIES is based on clinical suspicion. There is no specific treatment for HIES. The treatment should be based on the prevention of developing infections. Prophylactic antibiotics such as cotrimoxazole and IVIG are administered. Hematopoietic stem cell transplantation was done for all types of HIES, but there is a little information and experience about the long term results of this therapy