Mona Kidon

Peanut allergy is an increasing concern in younger children. Available bedside diagnostic tools, i.e., prick tests with commercial extracts or peanut-containing foods have only limited predictive values. In a cohort of preschoolers with both a history of allergic reactions and sensitization to peanut proteins, we aimed to characterize the impact of skin tests with a novel composition of peanuts LPP-MH. Almost one quarter (27/110) of preschool children, with a history of allergic reactions to peanuts and positive standard IgE-mediated tests for peanut allergy, can tolerate the reintroduction of peanut proteins into their diet after resolving their allergy and, thus, can avoid adverse health outcomes associated with the false diagnosis. In the younger age group, a quarter of peanut allergic children, display a relatively high threshold, potentially enabling an easier and safer oral immunotherapy protocol in this window of opportunity in childhood. The use of the novel diagnostic skin ...

Innate immunity is one of two immune defence system arms. It is present at birth and does not require ‘learning’ through exposure to foreign organisms. It activates various mechanisms collectively to eliminate pathogens and hold an infection until the adaptive response are mounted. The innate immune system consists of four elements: the epithelial barrier, cells (e.g. macrophages, NK cells), plasma proteins (e.g. complement) and cytokines. These components act in concert to induce complex processes, as well as recruitment, activation and differentiation of adaptive responses. The innate response is more than just the ‘first line of defence’, as it essentially withholds the vast majority of any intruder, has a complex interplay with the adaptive arm and is crucial for survival of the host. Finally, yet importantly, a myriad of diseases has been linked with innate immune dysregulation. In this mini-review we will shed some light on these conditions, particularly regarding autoinflamma...

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in the pediatric population as antipyretics/analgesics and anti-inflammatory medications. Hypersensitivity (HS) reactions to NSAID in this age group, while similar to adults, have unique diagnostic and management issues. Although slowly accumulating, published data in this age group are still relatively rare and lacking a unifying consensus. This work is a summary of current knowledge and consensus recommendations utilizing both published data and expert opinion from the European Network of Drug Allergy (ENDA) and the Drug Hypersensitivity interest group in the European Academy of Allergy and Clinical Immunology (EAACI). This position paper summarizes diagnostic and management guidelines for children and adolescents with NSAIDs hypersensitivity.

Allergic reactions to drugs are considered rare in the paediatric population. Host genetic and environmental factors influence the reported incidence and characteristics of adverse drug reactions (ADRs), and cause significant variation according to the population described and case definition used. We aimed to define the prevalence and characteristics of reported drug allergies in hospitalised children in Singapore. A retrospective case control study was performed through the hospital's inpatient electronic medical record (EMR) for the period of August 2002 to December 2002. The EMR was used to identify children with a previously reported ADR. The control group was randomly selected from patients hospitalised during the same period. Of the 8437 patients hospitalised during the study period, reports of previous ADRs were found in the records of 222 patients. The mean age of the patients was 7.4 years, range 2 months to 17 years (95 percent confidence interval [CI] 6.3 - 8.4). The...

Symptomatic hypogammaglobulinemia in infancy and childhood (SHIC), may be an early manifestation of a primary immunodeficiency or a maturational delay in the normal production of immunoglobulins (Ig). We aimed to evaluate the natural course of SHIC and correlate in vitro lymphoproliferative and secretory responses with recovery of immunoglobulin values and clinical resolution. Children, older than 1 year of age, referred to our specialist clinic because of recurrent infections and serum immunoglobulin (Ig) levels 2 SD below the mean for age, were followed for a period of 8 years. Patient with any known familial, clinical or laboratory evidence of cellular immunodeficiency or other immunodeficiency syndromes were excluded from this cohort. Evaluation at 6- to 12-months intervals continued up to 1 year after resolution of symptoms. In a subgroup of patients, in vitro lymphocyte proliferation and Ig secretion in response to mitogens was performed. 32 children, 24 (75%) males, 8 (25%) f...

Objective. Nonsteroidal antiinflammatory drugs (NSAIDs), mainly ibuprofen, are used extensively among children as analgesic and antipyretic agents. Our initial survey in the Kendang Kerbau Children's Hospital in Singapore showed NSAIDs to be the second most common adverse drug reaction-causing medications among children of Asian descent. We attempted to characterize the clinical and epidemiologic profile of NSAID reactions in this group of patients.Methods. A retrospective case series from a hospital-based pediatric drug allergy clinic was studied. A diagnosis of NSAID hypersensitivity was made with a modified oral provocation test. Atopy was evaluated clinically and tested with a standard panel of skin-prick tests. We excluded from analysis patients with any unprovoked episodes of urticaria and/or angioedema, patients <1 year of age, and patients who refused a diagnostic challenge test.Results. Between March 1, 2003, and February 28, 2004, 24 patients, including 14 male pati...

Histamine skin prick test (SPT) is used as the ‘golden standard’ for positive control in in vivo immediate type hypersensitivity testing. The skin reactivity to histamine can, however, be modulated by a bevy of extraneous factors. We aimed to define whether histamine skin reactivity in atopic children in Singapore is influenced by age, ethnic origin, gender, environmental exposure or specific sensitization patterns. A retrospective analysis of children, with specific aeroallergen sensitization (as measured by at least one allergen‐specific SPT with a wheal size >3 mm compared with the negative control) from the outpatient speciality clinic of the KK Children's Hospital, during 06/2002–06/2003. A total of 315 patients were included, 235 (75%) were males, 252 (80%) were Chinese, age mean was 7.7 yr (range: 2–15). Patients were referred to the SPT with a diagnosis of one or more of: allergic rhinitis 287 (91%), asthma 112 (36%) or atopic dermatitis 60 (19%). The mean histamine r...

Arterial hypertension is associated with increased plasma levels of complement C3, C4, and C-reactive protein (CRP). The aim of the study was to compare these laboratory markers in patients with resistant arterial hypertension (RAH) and controlled arterial hypertension (CAH). Patients with RAH (n = 34), those with CAH (n = 34), and 26 normotensive controls were included. White blood cell count, erythrocyte sedimentation rates, and blood levels of complement components C3, C4, and high-sensitivity C-reactive protein (hs-CRP) were compared among the study groups. In the RAH group, serum C3 (183.9+/-47.5 mg/dL) and hs-CRP (6.9+/-5.8 mg/L) were higher than in the CAH group (C3, 123.1+/-42.3 mg/dL; P < .001, hs-CRP, 4.2+/-4.8; P = .021, respectively). Significant positive correlations between systolic blood pressure and C3 (r = 0.6481; P < .001) and hs-CRP (r = 0.3968; P = .02) were observed in the RAH group. RAH is associated with higher blood levels of C3 and CRP.

T U E S D A Y 983 Rhinitis Questionnaire Items Predict Physician-Diagnosed Allergic Rhinitis in Children H. Kim, L. Levin, G. K. LeMasters, D. I. Bernstein; Department of Medicine, University of Cincinnati, Cincinnati, OH, Department of Environmental Health, University of Cincinnati, Cincinnati, OH. RATIONALE:Questionnaire items used to evaluate allergic rhinitis (AR) in epidemiologic studies of children have not been clinically validated. METHODS: Children from an atopic birth cohort were evaluated at age 7 using medical questionnaires, physical exams, and skin prick tests (SPT) with 15 aeroallergens (AG). Predictor variables included parental questionnaire responses to presence of: 1) rhinitis symptoms without a cold; 2) ocular symptoms; 3) hay fever symptoms; and 4) seasonality of symptoms. The primary outcome was physician diagnosed AR (PDAR) with positive SPT to 15 AG. Odds ratios (OR) for the primary outcome were calculated using logistic regression; 582/764 children in the cohort were analyzed. RESULTS: PDAR and monosensitization was not predicted by any questionnaire items. PDAR and positive SPT to 3 (OR 2.44, p50.05) or 6 (OR511.68, p50.02) AG was best predicted by presence of rhinitis symptoms. Seasonality increased prediction of PDAR and SPT to 3 (OR52.49, p50.03) or 6 (OR517.27, p50.007) AG, but presence of ocular symptoms increased prediction of PDAR with 6 SPT only (OR527.0, p50.002). PDAR and SPT to 2 (OR52.35, p50.03), 5 (OR56.03, p50.006), or 6 (OR58.05, p50.004) AG was best predicted by presence of hay fever. CONCLUSIONS:Use of questionnaire items best predicts AR in children with polysensitization to AGs, and are less useful for predicting AR in monosensitized children. Including seasonality, ocular symptoms, and hay fever can increase prediction of PDAR with polysensitization. 984 Aeroallergen Sensitization in Children with Allergic Rhinitis: Prevalence and Risk Associations W. Loh, W. Chiang, W. Liew, H. Lim, A. Goh, M. I. Kidon, B. Abhilash, H. Tan, Y. Chen, O. Chay; KK Women’s and Children’s Hospital, Paediatric Allergy and Immunology, Singapore, SINGAPORE, KK Women’s and Children’s Hospital, Department of Paediatric Otolaryngology, Singapore, SINGAPORE, Singapore Clinical Research Institute, Biopolis, Singapore, SINGAPORE. RATIONAL: To describe differences between allergic rhinitis (AR) and nonallergic rhinitis (NAR) from a tertiary Paediatric Hospital in Singapore. METHODS: A total of 6600 subjects, 6mths -19years, were referred to Allergy,Ortholaryngology or Pulmonary physicians for skin prick testing for allergen associated allergies. Theywere included if therewas parent reported persistent allergic rhinitis (>4 weeks) or doctor diagnosed allergic rhinitis. All subjectscompletedaquestionnaireandunderwenta standardized inhalantpanel. RESULTS: Themean age of presentation was 7.82 years (range, 0.6 19y) and 64% were male. Of all subjects, 55.3% have asthma, 33.9% allergic dermatitis and 16.1% allergic conjunctivitis. Aerosensitization was documented in a third presenting with AR under age of 2 years. In the AR subjects, 25%were sensitized before the age of 6 years. Therewas no difference in both groups of children with AR or NAR for use of antihistamines (36%), nasal steroids (3.2%) and ventolin (22.4% vs 21.7%). However, NAR was more likely to be treated with Singulaire. AR patients were more likely to require adjunct therapy with inhaled corticosteroids (51.2% vs 43.2% P<0.0001) suggesting lower respiratory airways disease was more significant. Presence of AR predicted for higher risk of admissions for asthma (9.1% vs 6%, P<0.0001). CONCLUSIONS: NAR accounts for 26% of all rhinitis presenting after 6 years old. Males are (OR 1.5 ;CI 1.39 1.77) more likely to demonstrate AR rather than NAR compared with females. In general, subjects with AR more often suffer fromasthmawithmore asthma relatedadmissions anddrugallergy. 985 Chronic Rhinitis in Pediatric Patients: Epidemiologic Analysis of One Cohort E. A. Erwin, R. A. Faust, T. A. E. Platts-Mills, L. Borish; Nationwide Children’s Hospital, Columbus, OH, The Ohio State University, Columbus, OH, University of Virginia Asthma and Allergic Diseases Center, Charlottesville, VA. RATIONALE: Nonallergic rhinitis is a vaguely defined and poorly understoodentity especially amongpediatric patients.Ourobjectivewas to identify clinical features that may distinguish phenotypes of allergic and nonallergic patients and to evaluate the utility of some current diagnostic modalities. METHODS: We reviewed medical records for 151 pediatric patients with chronic rhinitis, evaluated in a multidisciplinary allergy and otolaryngology clinic.Results obtainedby standardhistory, validatedquestionnaire (SN-5), epicutaneous allergy testing, acoustic rhinometry, and sinus CTwere compared. RESULTS:Nasal congestionwas themost commonprimary presenting complaint (62%). Among subjects having a positive allergy test, associated eye symptomsweremore frequent (X, p50.01)…

Since 1984, several waves of Ethiopian immigrants have settled in Israel. On arrival they were found to be highly infected with intestinal parasites and to have increased serum immunoglobulin E and eosinophilia. To study serum IgE levels in Ethiopian children growing up in the environment of Israel. We assessed four groups of children of Ethiopian origin: a) adolescents examined on their arrival to Israel (group 1, n=11); b) adolescents born in Ethiopia and living in Israel for more than 7 years (group 2, n=10); c) children of Ethiopian origin born in Israel, without a history of allergy or asthma (group 3, n=15); and d) asthmatic children of Ethiopian origin born in Israel (group 4, n=8). A thorough clinical interview and examination as well as laboratory work up (including serum IgE levels, stool parasites and absolute eosinophil count) were performed. Group 1 (11 newly arrived Ethiopian adolescents) had a mean eosinophil count of 688 cells/ml (0-1739) and a mean serum IgE of 1043...

All beta-lactam use is associated with a certain rate of adverse reactions. Many of these adverse reactions result in an allergy to the beta-lactam being entered into the patient's medical record. Unfortunately, only a small minority of these recorded allergies are clinically significant immunologically mediated drug hypersensitivity. An unconfirmed allergy to beta-lactams is a significant public health risk, because patients so labeled typically do not receive narrow-spectrum penicillins and cephalosporins when clinically indicated. The alternative antibiotics they receive result in poorer clinical outcomes, increased incidence of serious antibiotic-resistant infections, prolonged hospitalizations, and greater health care utilization. There is a wide variation in beta-lactam allergy incidence and prevalence around the world, based in part on the specific beta-lactams used and overused. There is a wide variation in specific protocols used to confirm current tolerance of beta-lac...

An acute anaphylactic reaction after a conventional antipyretic dose of ibuprofen was diagnosed in a child with allergic rhinitis, recurrent idiopathic urticaria, and nonimmunologic cross-reactive hypersensitivity to nonsteroidal antiinflammatory drugs and acetaminophen. The patient reported several previous, mild (isolated cutaneous) hypersensitivity reactions after exposure to acetaminophen or ibuprofen. There was no evidence of an underlying inflammatory disease except as described above. Patients with chronic or recurrent idiopathic urticaria and those with atopic disease represent groups at increased risk of nonsteroidal antiinflammatory drug hypersensitivity. Mild hypersensitivity reactions to acetaminophen and/or ibuprofen may precede subsequent, more-severe adverse reactions. Risks and benefits of continued use of nonsteroidal antiinflammatory drugs in these children should be carefully considered.