Allergologia et Immunopathologia

Youth tobacco use in Latin America: What is the real extent of the problem? Publication date: Available online 30 March 2019 Source: Allergologia et Immunopathologia Author(s): M. Urrutia-Pereira, D. Solé, H.J. Chong Neto, H. Badellino, V. Acosta, R.L. Castro-Almarales, M.G. León, M.M. Avalos, C.C. Fernández, J.C. Sisul-Alvariza, V.J. Oliano, P.N. Rinelli Abstract Introduction Cigarette consumption among teenagers is one of the most critical health-related risk behaviors. Method Prospective study carried out in seven sites of five Latin American countries (Argentina [Cordoba, N = 958, Corrientes, N = 1013], Brazil [Curitiba, N = 650; Uruguaiana, N = 997], Cuba [Havana, N = 1004], Mexico [Veracruz, N = 991] and Paraguay [Ciudad del Este, N = 868]) with public-school adolescents (aged 12–19 years). Respondents were asked to answer the California Student Tobacco Survey. Results 6550 adolescents took part in the survey (average age: 14 years). 38.5% (N = 2517) "tried smoking" and 37.5% started smoking before the age of 12. Sixty-one percent of adolescents think that cigarettes are easily accessible; 41.7% considered that smokers have more friends; 88% indicated knowledge of the harms of smoking one to five cigarettes per day; 58.9% would smoke new cigarette types with less harmful substances; 27.8% have already used e-cigarettes; 28% have smoked hookah. Fifty-seven point five percent have been, in the past seven days, in the same room with someone who was smoking a cigarette; and 30.5% indicated that there were not any no-smoking rules inside their homes. Identifiable risk factors were (logistic regression analysis): smoking cigarettes offered by friends, smoking cigarettes with less harmful substances, knowing what a hookah is, being in the same room with a smoker in the past week. Identifiable protective factors against tobacco use were: knowing the health risks caused by smoking hookah and to have their own room. Conclusion Youth tobacco use in Latin America is a major public health concern, and tobacco control measures are highly needed.

The unpredictability of seasonal variations in serum vitamin D levels in children with asthma and/or rhinitis Publication date: Available online 30 March 2019 Source: Allergologia et Immunopathologia Author(s): S. Miceli Sopo, G. Cerchiara, G. Bersani, S. Monaco, A. Romano, A. Poscia Abstract Background Some studies have showed that seasonality is an important determinant of vitamin D (vitD) status. Objective We evaluated whether there are differences in individual trends of serum vitD level over one year in asthmatic and rhinitic children. Materials and methods Ninety-two asthmatic and rhinitic paediatric patients were followed up for one year and their serum vitD level was detected at three-month intervals, once in each season. Results We observed higher vitD levels at the end of summer and lower at the end of winter. However, the individual seasonal trend was very variable and unpredictable. If it is true that in a given season the majority of patients followed one direction (increase or decrease of serum vitD levels), nevertheless a substantial percentage behaved differently and unpredictably. For example, at the end of spring, 70% of patients showed an increase in serum vitD levels, but 30% showed a decrease. In addition, five individuals had a value ≥50 ng/ml in September and showed serum vitD levels ≥30 ng/ml throughout the year; 16 patients presented vitD value ≥40 ng/ml in September and always had ≥20 ng/ml in the other months. Conclusions The wide and unpredictable variability of the individual trend of serum vitD levels should be taken into account before deciding whether or not a drug supplementation is appropriate.

Short and extended provocation tests have similar negative predictive value in non-immediate hypersensitivity to beta-lactams in children Publication date: Available online 23 March 2019 Source: Allergologia et Immunopathologia Author(s): F.S. Regateiro, I. Rezende, N. Pinto, C. Abreu, P. Carreiro-Martins, E.R. Gomes Abstract Introduction and objectives Drug provocation tests (DPTs) are the gold-standard method to diagnose non-immediate hypersensitivity reactions (NIHSR) to beta-lactam antibiotics (BL) in children. Our aim was to compare the negative predictive value (NPV) of one-day (short) DPT versus 3–7 days (extended) DPT for the diagnosis of NIHSR to BL in paediatric age. A secondary aim was to compare confidence on drug re-exposure after short and extended negative DPTs. Methods The occurrence of HSR on drug re-exposure and drug refusal after negative diagnostic DPTs were evaluated in children/adolescents with a history of NIHSR to BL using a questionnaire performed six months to ten years after DPT. Patients were divided into two groups according to the protocol performed: short DPT vs. extended DPT. Results We enrolled 212 children and adolescents (86 females, 126 males, mean age at DPT 5.52 years, p25 = 3 years, p75 = 7.25 years): 69 tested with short DPT, and 143 with extended DPT. The NPV of both types of DPT together was 95.2%. The NPV of short DPT was 97.5% and the NPV of extended DPT was 93.8% (p = 0.419). After negative DPT, beta-lactams were refused by carers in 14.75% of the children requiring subsequent treatment, 6.98% in the short DPT group and 18.99% in the extended DPT group (p = 0.074). Conclusions In our paediatric sample, prolonging drug administration did not increase the NPV of diagnostic DPT for NIHSR to BL or reduce drug refusal. Altogether, the data here reported suggest that, however intuitive, prolonging DPT is not beneficial in the parameters analysed.

Predictive factors for progression to chronicity or recurrence after the first attack of acute urticaria in preschool-age children Publication date: Available online 21 March 2019 Source: Allergologia et Immunopathologia Author(s): Pinar Gur Cetinkaya, Ozge Soyer, Saliha Esenboga, Umit Murat Sahiner, Ozlem Teksam, Bulent Enis Sekerel Abstract Introduction and objectives Preschool-aged group is frequently affected by urticaria, and infections are the most frequently documented factors that cause acute urticaria in children. This prospective study was designed to investigate the underlying factors of acute urticaria in under five-year-old children and to describe predictive factors for progression to chronicity or recurrence after the first attack. Patients and methods Children younger than five years of age with acute urticaria were recruited between July 2015 and July 2016. Patients (n = 83) were grouped into those below and above two years of age. In order to assess the risk factors for progression to chronicity or recurrence, logistic regression analysis was performed. Results Upper respiratory tract infection was the most common detectable reason for acute urticaria (49.4%). Herpes Simplex Virus type 1 was significantly isolated in the cases with the manifestation of an acute single-episode urticaria (p = 0.042). Angioedema and food allergy were predominantly observed under two years old (p = 0.001, p = 0.006 respectively). A positive relationship was determined between the duration of urticaria and chronicity (r = 0.301, p = 0.006). The absence of atopic dermatitis (OR: 6.95, 95% CI: 1.35–35.67, p = 0.020), negative Herpes virus serology (OR: 4.25, 95% CI: 0.83–21.56, p = 0.040), and unknown etiology (OR: 3.30, 95% CI: 1.12–9.71, p = 0.030) were the independent risk factors for recurrent urticaria. Conclusions Preschool-aged children with acute urticaria should be evaluated for infections at the time of admission. Patients with unknown etiology, negative Herpes virus serology, absence of atopic dermatitis, and long lasting urticaria should be followed up for chronicity and recurrence.

Focus group parental opinions regarding treatment with topical corticosteroids on children with atopic dermatitis Publication date: March–April 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 2 Author(s): S. Veenje, H. Osinga, I. Antonescu, B. Bos, T.W. de Vries Abstract Introduction and objectives Atopic dermatitis is common among children of 0–5 years old. Treatment consists of emollients and topical corticosteroids. Due to corticophobia, however, adherence to topical corticosteroids is low. Our aim was to find factors that influence opinions about topical corticosteroids among parents of children with atopic dermatitis. Methods A qualitative focus group study in secondary care with parents of children with atopic dermatitis. Questions concerned opinions, attitude, sources of information, and the use of topical corticosteroids. Results The parents indicated that they lack knowledge about the working mechanism and side effects of topical corticosteroids. Dermatologists and paediatricians emphasise the beneficial effects, whereas other healthcare workers and lay people often express a negative attitude. Conclusions This study gives a complete overview of factors influencing adherence. Treatment with topical corticosteroids can be improved by better informing parents about the working mechanisms, the use, and how to reduce the dose. Healthcare professionals need to be aware of the consequences of their negative attitude concerning topical corticosteroids.

Association of M470V polymorphism of CFTR gene with variability of clinical expression of asthma: Case-report study Publication date: March–April 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 2 Author(s): Imen Wahabi, Sondess Hadj Fredj, Malek Nefzi, Rym Dabboubi, Hajer Siala, Fatma Khalsi, Khedija Bousetta, Taieb Messaoud Abstract Introduction and Objectives Asthma is a complex genetic disorder. Several genes have been found associated with asthma. The cystic fibrosis transmembrane conductance regulator (CFTR) gene is one of them. The aim of this study was to perform a comparative analysis of the genotype and allele frequency distributions of the biallelic marker M470V within the CFTR gene on mutant and wide chromosomes. Patients and methods The molecular approach consists in the genotyping of the M470V marker by the PCR-RFLP technique in 105 asthmatic patients, aged between four months and 17 years, and 105 healthy subjects. Results We found a significant difference in the genotype frequencies between the two studied groups (χ2 = 9.855, P = 0.007). The V/V genotype was over represented in the asthmatic group as compared to the controls (32.38% vs. 16.19%). Whereas, the M/V genotype is more frequent in healthy subjects (40.95% vs. 28.71%). We also noted a significant difference in allelic distribution of M470V with associated diseases (χ2 = 9.610, P = 0.022). Conclusions The present study is the first report on the distribution of the M470V polymorphism in asthmatic Tunisian patients. We noticed that the M470V variant could modulate the clinical phenotype of asthmatic patients. This preliminary study will establish the molecular basis of this disease in Tunisia.

Phenotyping and long-term follow up of patients with hyper IgE syndrome Publication date: March–April 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 2 Author(s): S. Alyasin, H. Esmaeilzadeh, N. Ebrahimi, S.H. Nabavizadeh, S. Kashef, E. Esmaeilzadeh, M. Babaei, R. Amin Abstract Introduction and objectives Long-term follow up of patients with hyper IgE syndrome (HIES), as a primary immunodeficiency disorder, has been poorly investigated. This study describes common clinical and immunological features of patients with HIES in the last 10 years in Shiraz University of Medical Sciences, Shiraz, Iran. Methods and patients In this cross-sectional study, the symptoms and medical records of 18 patients, who were diagnosed with HIES, were observed. Genetic and immunologic study was also performed. Results Eighteen patients with the mean age of 13 years old were investigated. Ten patients were detected to have mutations in DOCK8 gene and autosomal recessive HIES (AR-HIES); and four patients were found with STAT3mutation and autosomal dominant HIES (AD-HIES). So, 14 patients with known genetic results were considered for further data analysis. Food allergy, eczema, viral and skin infections were the major complications of AR-HIES patients. The major clinical complications of AD-HIES patients were pneumonia, skin infections and eczema. Food allergy and viral infection were significantly higher in DOCK8 deficient patients. The most common causes of hospitalization in both AR-HIES and AD-HIES patients were pneumonia, skin infections and sepsis. The most common cause of death was found to be sepsis. Conclusions AD-HIES and AR-HIES cannot be differentiated only based on the clinical presentations. Genetic features are also necessary for better diagnosis. This study, summarizing the clinical, immunological and genetic information of the patients with AD-HIES and AR-HIES, may open a way for better diagnosis and management of HIES.

Microdeletion 22q11.2 syndrome: Does thymus incidental surgical resection affect its immunological profile? Publication date: March–April 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 2 Author(s): E.M. Navarrete-Rodríguez, B.E. Del-Rio-Navarro, D.E. García-Fajardo, G.J. Baay-Guzmán, S.E. Espinosa-Padilla, E.A. Medina-Torres, N.I. Moguel-Molina, M. Sánchez-Curiel-Loyo, N. Nájera-Martínez, J. Navarro-Munguía, N. Reyes-Noriega, N.A. Balderrábano-Saucedo, R. Sánchez-Urbina, C. García Delgado, J.J.L. Sienra-Monge, V.F. Morán-Barroso Abstract Background The del22q11 syndrome patients present immunological abnormalities associated to thymus alterations. Up to 75% of them present cardiopathies and thymus is frequently removed during surgery. The thymectomy per se has a deleterious effect concerning lymphocyte subpopulations, and T cell function. When compared to healthy controls, these patients have higher infections propensity of variable severity. The factors behind these variations are unknown. We compared immunological profiles of del22q11.2 Syndrome patients with and without thymectomy to establish its effect in the immune profile. Methods Forty-six del22q11.2 syndrome patients from 1 to 16 years old, 19 of them with partial or total thymectomy were included. Heart disease type, heart surgery, infections events and thymus resection were identified. Immunoglobulin levels, flow cytometry for lymphocytes subpopulations and TREC levels were determined, and statistical analyses were performed. Results The thymectomy group had a lower lymphocyte index, both regarding total cell count and when comparing age-adjusted Z scores. Also, CD3+, CD4+ and CD8+ lower levels were observed in this group, the lowest count in those patients who had undergone thymus resection during the first year of life. Their TREC level median was 23.6/μL vs 16.1 μL in the non-thymus group (p = 0.22). No differences were identified regarding immunoglobulin levels or infection events frequencies over the previous year. Conclusion Patients with del22q11.2 syndrome subjected to thymus resection present lower lymphocyte and TREC indexes when compared to patients without thymectomy. This situation may be influenced by the age at the surgery and the time elapsed since the procedure.

Successful oral desensitization in children with cow's milk anaphylaxis: Clinical and laboratory evaluation up to nine-years follow-up Publication date: March–April 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 2 Author(s): M. Alves-Correia, Â. Gaspar, L.-M. Borrego, J. Azevedo, C. Martins, M. Morais-Almeida Abstract Introduction Cow's milk protein allergy (CMPA) is the most common food allergy in children worldwide. Some children have severe and persistent CMPA, with near-fatal reactions after exposure to trace amounts of cow's milk-proteins (CMP). Strict avoidance diet is difficult, negatively affects quality of life and represents a conservative approach. Therefore, different therapeutic strategies are necessary. Objective We aimed to assess long-term efficacy and safety of oral immunotherapy (OIT) in children with severe and long-lasting IgE-mediated CMPA. Materials and methods The authors present four case reports of patients with CMPA who underwent CMP-OIT, that have been under long-term follow-up up to nine years. We provide information about the clinical and laboratory evaluation. Skin prick tests (SPT), specific IgE and IgG4 were performed before, during, and after OIT. Immune profile after OIT was assessed by flow cytometry (lymphocyte subsets, regulatory T and B cells). Results The success rate was 100%, and all patients currently have a free diet with minimal diary ingestion of 200 mL CMP or equivalent. Specific IgE levels and SPT to CMP have progressively decreased, and specific IgG4 levels have increased. CD4+CD25+CD127−/dim regulatory T cells were increased after OIT. Conclusions OIT ensured a clinical tolerance state after up to nine years, confirmed by both clinical and immune profile, allowing a diet without restrictions, with high satisfaction from patients and caregivers. We emphasize that OIT should be performed only by allergy experts in the hospital setting, and that only motivated families should be enrolled, since it is essential to ensure CMP daily intake at home.

Anaphylaxis to beta-lactam antibiotics at pediatric age: Six-year survey Publication date: March–April 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 2 Author(s): J. Azevedo, Â. Gaspar, I. Mota, F. Benito-Garcia, M. Alves-Correia, M. Chambel, M. Morais-Almeida Abstract Introduction Beta-lactams are the most frequently used antibiotics in pediatric age. Anaphylactic reactions may occur and need to be properly studied, but studies in children are scarce. Objective Characterization of case reports of anaphylaxis in children referred to an allergy department with suspected beta-lactams hypersensitivity. Materials and methods Retrospective analysis of all children referred to our Drug Allergy Center with suspected beta-lactams hypersensitivity between January 2011 and December 2016. Description of the drug allergy work-up performed studied according to standardized diagnostic procedures of ENDA/EAACI, including specific-IgE assay, skin prick and intradermal tests and diagnostic/alternative drug challenge tests. Results 146 children with suspected beta-lactams hypersensitivity were studied, and in 21 (14.4%) the diagnosis was confirmed. In all of them, except for three children, an alternative beta-lactam was found. In seven children (33.3% of those with confirmed beta-lactams hypersensitivity) anaphylaxis was confirmed, and all of them described reactions with cutaneous and respiratory or gastrointestinal involvement. The culprit drug was amoxicillin in six and flucloxacillin in one. In this sample, we also performed oral challenge with cefuroxime, being negative in all cases. Almost all cases of confirmed anaphylaxis (six from seven cases) were IgE mediated, with positive skin tests despite negative serum specific-IgE. Conclusions Allergic reactions to beta-lactams, although rare in children, require a detailed clinical history and a specialized drug allergy work-up to allow a correct diagnosis as well as to avoid the possibility of a potential life-threatening reaction and provide alternative drugs.