IgE-mediated allergy: a rare cause of chronic spontaneous urticarial with allergen-specific immunotherapy as treatment option - a systematic review with meta-analysis from China.

BACKGROUND: Allergen-specific immunotherapy (SIT) has long been a controversial treatment for chronic urticaria (CU), although SIT has been used in patients with allergic diseases for more than 90 years. OBJECTIVES: To evaluate the efficacy and safety of SIT vs. conventional treatment (CT) in the treatment of CU. METHODS: Systematic searches were conducted without language restrictions in MEDLINE, EMBASE, the Cochrane Library, ISI Web of Knowledge, China National Knowledge Infrastructure, and Chinese Scientific Journals Full Text Database. The primary outcomes were efficacy and quality of life (QOL) and the secondary outcomes were relapse rate and adverse events (AEs). RESULTS: Fourteen studies (1838 patients) were included. None of them was double-blind placebo controlled. Our study demonstrated that SIT seemed to show more clinical efficacy rate (OR 2.39; 95% CI, 1.73-3.30; I(2) = 55%, P = 0.008), more complete recovery rate (OR 2.13; 95% CI, 1.55-2.91; I(2) = 61%, P=0.008) and less relapse rate 2 weeks after treatment (OR 0.38; 95% CI, 0.24-0.61; I(2) = 6%, P=0.20) than CT. Only one study reported improved QOL and no study reported serious AEs after SIT. CONCLUSIONS: Current evidence indicates that IgE-mediated allergy may be causative in a small number of CU patients and specific immunotherapy with these allergens may be beneficial in those patients. However, the number of included studies was small and those qualities were low. So, available evidence is not adequate to draw an affirmative conclusion and larger studies of high quality are needed to provide increasingly convincing data and cases.

Posterior fossa abscesses secondary to dermal sinus associated with dermoid cyst in children.

We report on the rare disease of posterior fossa abscesses secondary to dermal sinus associated with dermoid cyst in 4 pediatric cases seen over a 15-year of period. All children had a small dimple or a pinhole on the skin of the occipital region. On admission they had the signs of increased intracranial pressure, while 3 of them still suffered from signs of meningitis resulting from a bacterial infection through the dermal sinus. CT scan and MR images revealed both the route of the dermal sinus and intracranial lesions. Total resection was successfully achieved before various treatments in all patients without nervous sequelae. In conclusion, a posterior fossa dermoid cyst should be considered in all children with an occipital dermal sinus. Cerebellar abscesses will arise once bacterial infection has occurred through the associated dermal sinus. Radiological studies such as CT scans and MR images can help confirm the diagnosis and locate the lesions. Early neurosurgical interventions including external ventricular drainage, external abscess drainage and primary removal should be planned as soon as possible in accord with the children's condition.

Pregnant and parenting adolescents and their younger sisters: the influence of relationship qualities for younger sister outcomes.

On the basis of social modeling theory and a sibling interaction hypothesis, it was hypothesized that specific relationship qualities between a pregnant or parenting teen and her younger sister would be associated with permissive younger sister outcomes, such as permissive childbearing attitudes and permissive sexual behavior. Results indicated that negative relationship qualities, such as rivalry, competition, and conflict, were more closely related to younger sisters engaging in problem delinquent-like behavior and sexual behavior than were positive relationship qualities, such as warmth and closeness. Additionally, a shared friendship network with the older sister was found to be associated with extensive younger sister problem behavior and sexual behavior. Three potential explanatory processes are discussed.

PIP: Numerous studies have found that the younger sisters of childbearing adolescents have a 2- to 4-fold increased risk of themselves becoming adolescent mothers. This finding is consistent with social modeling and behavioral theories positing that older siblings shape the sexual attitudes and norms of younger family members. The present study hypothesized that specific relationship qualities (positive and negative) between a pregnant or parenting teenager and her younger sister are associated with permissive younger sister outcomes. Enrolled in the study were 80 Black and Mexican-American younger sisters (mean age, 13.9 years) who completed a Sibling Relationship Questionnaire and measures of childbearing attitudes, school and career orientation, problem behaviors, sexual permissiveness, and sexual status. 31% had engaged in sexual intercourse at least once before the survey. Hierarchical multiple regression analyses indicated that high warmth and closeness between sisters was related to positive school and career goals and perceived older ideal ages for life transitions such as first intercourse and childbearing. However, the negative relationship qualities of rivalry, competition, and conflict were even more closely related to the probability that younger sisters would engage in delinquent-type activities and problematic sexual behaviors than positive relationship qualities. In addition, a shared friendship network with the older sister was associated with a substantial increase in behavioral problems in the younger sister. Additional research should be directed toward identifying the pathways of sibling influence.

Changes in body fluid markers in intestinal ischemia.

New Zealand rabbits were assigned randomly to three groups: sham operation, intestinal simple obstruction, and strangulation obstruction. To relate possible changes in the body fluid content of biochemical markers to the strangulation process, subsequent samples of blood and peritoneal fluid, for the determination of levels of creatine kinase (CK), lactic acid (LA), xanthine oxidase (XO), and inorganic phosphate (IP), were obtained at 1-, 2-, 4-, and 6-hour intervals, and intestinal histological specimens were graded blindly. Significant increases in plasma LA (3.93 +/- 0.26 v 2.99 +/- 0.37; P < .05), peritoneal LA (5.03 +/- 1.14 V 3.33 +/- 0.86; P < .05), and CK (940 +/- 146 v 772 +/- 165, P < .05) occurred after 1 hour of ischemic injury. Except for serum CK, all parameters in the blood and peritoneal fluid in group 3 were markedly elevated within 4 hours. The serum CK remained almost unchanged throughout the 6-hour study period. The results suggest that plasma LA, peritoneal LA, and CK are sensitive indicators in the early diagnosis of bowel ischemia; the determination of both serum and peritoneal XO and IP was also helpful for early diagnosis; in contrast, serum CK was not a useful indicator. The value of any biochemical marker as an early diagnostic tool for intestinal ischemia depends not only on its quantity but also on its location and mechanism of release.

Observation on erythrocyte acetylcholinesterase (AChE) in infants and children with Hirschsprung's disease.

In 31 cases of Hirschsprung's disease, the mean value of erythrocyte AChE activity was discovered to be 91.24 +/- 10.24 u/mL, being significantly higher than that from 127 normal children of 73.51 +/- 9.36 u/mL (P less than 0.001); whereas serum ChE mean value of 14.49 +/- 4.04 u/mL showed no difference from normal control (16.89 +/- 8.86 u/mL, P greater than 0.05). In addition, the erythrocyte AChE activity of six newborns with Hirschsprung's disease was also found to be much higher than its own normal control. It was therefore, concluded that this assay may be of supplementary diagnostic significance in diagnosing neonatal Hirschsprung's disease.