Life-threatening anaphylaxis in children with cow's milk allergy during oral immunotherapy and after treatment failure.

BACKGROUND: Oral immunotherapy (OIT) is a promising therapeutic approach for children with persistent IgE-mediated cow's milk allergy (CMA) but data are still limited. OBJECTIVE: To analyze the prevalence of life-threatening anaphylaxis in children with persistent CMA undergoing OIT and to evaluate potential risk factors. METHODS: This is a retrospective cohort study among children with persistent CMA undergoing OIT over a 20-year period, following a specific Oral Tolerance Induction protocol. Adverse reactions during the whole period and data on long-term outcome were registered. Descriptive and nondescriptive statistics were used to describe data. RESULTS: Three hundred forty-two children were evaluated. During OIT, 12 children (3.5%) presented severe anaphylactic reactions that needed an adrenaline injection. None required intubation, intensive care unit (ICU) admission, or showed a fatal outcome. Five of them abandoned OIT, five reached unrestricted diet and the others are still undergoing OIT. As far as outcome is concerned, 51.2% reached an unrestricted diet; 13.5% are at the build-up stage; and 28.0% (97 patients) stopped the OIT. Among these 96 children, 6.3% experienced a severe reaction induced by accidental ingestion of milk with two fatal outcomes. CONCLUSIONS: The risk of life-threatening reactions was nearly two times lower (3.5% vs. 6.3%) among patients assuming milk during OIT than in those who stopped the protocol. A trend in favor of more severe reactions, requiring ICU admission, or fatal, was shown in patients who stopped OIT.

Dental characteristics of the Wolf-Hirschhorn syndrome: a case report.

Little attention in the dental literature has been given to the dental characteristics of patients with the Wolf-Hirschhorn Syndrome (WHS). The syndrome is caused by deletions of the terminal portion of the short arm of chromosome 4. This case report provides information on dental anomalies noted in a child with WHS. The dental findings include agenesis of multiple permanent teeth, particularly premolars and molars, taurodontism, and over-retained primary teeth. This syndrome exhibits variable clinical expressivity, possibly due to the extent and the specific locus of the chromosomal deletion. Further studies are required to obtain a clearer view of the clinical oral/dental manifestations of this syndrome.

Condylomata acuminata in a boy.

BACKGROUND: Human papillomaviruses, or HPV, are etiologic agents of all types of warts, including those associated with sexual transmission. Although previously rare in children, condylomata acuminata in the mouth have been reported for the past 10 to 15 years, and the possibility of sexual abuse needs to be considered. CASE DESCRIPTION: A 4-year-old boy with poor dental health presented with a wartlike mass on his upper lip, as well as two similar penile lesions. The lesions, cauliflowerlike and pedunculated in appearance, were excised, underwent biopsies and were subtyped via in situ hybridization. All of the lesions tested positive for HPV subtypes 6 and 11, which are the subtypes most often associated with anogenital warts (condylomata acuminata). Although both parents reported having genital warts, the specific mode of transmission to the child was not determined. CLINICAL IMPLICATIONS: Cases of oral condylomata acuminata in children need to be treated as possible instances of sexual abuse, and it is incumbent on the dentist to alert the appropriate community agency for follow-up.

Acellular dermal matrix allograft in the treatment of mucogingival defects in children: illustrative case report.

Mucogingival defects can occur in children and are of particular concern when orthodontic treatment is indicated. The rationale for surgical intervention is predicated on the need to repair the mucogingival defect and to establish adequate thickness of attached gingiva. The free gingival graft, usually obtained from the hard palate, is often used to increase the amount of attached gingiva. The prospect of a second surgical site, and its inherent risks and complications, which may include pain, discomfort, and bleeding, is especially undesirable in children. Important to consider is the possibility that a child may not have adequate tissue thickness at the donor site. A case report is presented utilizing the alternative soft tissue graft, Alloderm, to correct a mucogingival defect prior to orthodontic treatment. Adhering to the free gingival autograft technique, an acellular dermal matrix allograft was utilized at the graft site. The patient revealed good post-operative healing, tissue vascularization, and a healthy zone of attached gingiva at the six month follow up visit. Comparable results to the conventional autograft were obtained with less surgical time, surgical sites, and discomfort to the patient.