The effect of Kawasaki disease on childhood allergies - a sibling control study.

OBJECTIVE: Kawasaki disease (KD) is a multisystem inflammatory vasculitis of childhood, with widespread T-helper cell type 1 immune activation. We hypothesize that children who suffered from KD will have a lower risk of developing allergic diseases. STUDY DESIGN: This was a cross-sectional study, recruiting children with a history of KD, together with well sibling controls. All children underwent the standardized core ISAAC questionnaire for allergy, physical examination and skin prick test evaluation. McNemar's test was employed to evaluate the effect of Kawasaki disease on allergy. Multivariable analysis based on mixed-effects logistic regression model was used to adjust for potential confounding effect of age and gender. RESULTS: One hundred and eighty-six children (93 KD sibling pairs) completed the above evaluation. Allergic rhinitis was more common in patients with KD (crude OR 2.40; 95% CI 1.11-5.62, p=0.024) when compared with controls. The effect was further intensified after accounting for the potential confounding effect of age and gender (adjusted OR=2.90; 95% CI 1.27-6.60). Children in whom KD occurred beyond the age of 12 months had more allergic rhinitis (crude OR 4.00, 95% CI 1.29-16.44, p=0.012), 'any' allergies (crude OR 3.75, 95% CI 1.19-15.52, p=0.019) and Blomia tropicalis sensitization (crude OR 2.57, 95% CI 1.02-7.28, p=0.043) when compared with their sibling controls. Interestingly, children in whom KD course resulted in no coronary artery abnormalities have more allergic rhinitis (crude OR 8.50, 95% CI 2.02-75.85, p=0.003) and 'any' allergies (crude OR 5.00, 95% CI 1.41-26.94, p=0.011), when compared with their sibling controls. CONCLUSION: Kawasaki disease may be a risk factor for subsequent allergic diseases. We postulate that KD occurs more frequently in children at risk of immune disequilibrium, with an abnormal inflammatory response initially, and subsequently more allergic manifestations.

Variant angina in a 6-year-old boy.

We describe a case of variant angina and acute inferior myocardial infarction in a previously well 6-year-old boy with a strong family history of ischemic heart disease.

Exercise myocardial perfusion stress testing in children with Kawasaki disease.

AIM: Kawasaki disease is the commonest cause of acquired coronary artery disease in children. Although echocardiography and treadmill stress testing have been the traditional methods of assessing coronary artery abnormalities and detecting myocardial ischaemia, respectively, these are inadequate for assessing perfusion and performance. We studied the safety and utility of exercise myocardial perfusion stress testing in children with previous Kawasaki disease. METHODS: Eleven subjects (median age 12 years; seven male and four female adolescents) with a history of childhood Kawasaki disease underwent 99mTechnetium-Tetrofosmin myocardial perfusion scan using a modified protocol. All had New York Heart Association effort tolerance class 1 and were asymptomatic at time of testing. Eight of 11 subjects had been treated with intravenous immunoglobulin during the acute phase. Six of 11 subjects had transient coronary artery dilatation. One subject with persistently dilated coronary arteries suffered an acute myocardial infarction 6 months after onset of Kawasaki disease but recovered well. Results were compared with clinical and echocardiographic findings. RESULTS: All subjects were able to complete the exercise test. There were no side effects associated with radioisotope injection. Ten of 11 patients, including the one who suffered a myocardial infarction had normal tests. The single subject with an abnormal scan showed a minimal (2%) fixed defect in the left ventricular wall. CONCLUSION: Exercise myocardial perfusion stress is a safe and useful method for the assessment of myocardial perfusion in co-operative children with a history of Kawasaki disease and is a useful addition to conventional methods for coronary risk stratification in such patients.