Oral food challenge in children with contact urticaria in reaction to cow's milk.

OBJECTIVE: To evaluate the relationship between the occurrence of contact urticaria in reaction to cow's milk in infants and the diagnosis of cow's milk allergy (CMA) established by supervised oral food challenge. METHODS: In this cross-sectional study, we identified 184 children who had undergone 221 oral food challenge (OFC) at a CMA reference center between July 2015 and August 2019. Of these, 23 (12.5%) had a history of contact urticaria to cow's milk and underwent a total of 30 OFC. Baked cow's milk OFC were excluded, and 21 children were included in the study. All data from clinical history and allergy tests (serum-specific IgE dosages and skin prick test [SPT] with reconstituted cow's milk formula) were recorded on standardized forms. The challenge was conducted with reconstituted cow's milk formula in increasing volumes every 15-20 min. RESULTS: 24 OFC were performed; 13/24 (54.2%) for diagnostic purpose and 11/24 (45.8%) to evaluate cow's milk tolerance. Allergy tests were positive in 14 patients (87.5%). Positive oral challenge outcomes were identified in 7/24. One patient had a late flare of atopic dermatitis and five children presented with immediate urticaria (two generalized urticaria and three perioral urticaria). The median papule diameter was 6.5 mm in patients with a positive OFC and 3.75 mm in the negative group (P = 0.02). CONCLUSION: The occurrence of contact urticaria might be the only manifestation among infants sensitized to cow's milk with tolerance to oral ingestion. Reactions due to oral challenge were related to a larger wheal diameter on the SPT.

Systematic review on fecal calprotectin in cystic fibrosis.

OBJECTIVES: Fecal calprotectin is an inflammatory marker used for monitoring intestinal diseases. It has been studied as a marker of intestinal inflammation in cystic fibrosis (CF), a multi-systemic genetic disease caused by alterations to the CFTR gene. Manifestations of the disease favor a systemic inflammation not limited to the respiratory tract, therefore, calprotectin is a non-invasive and effective diagnostic method. The aim of the study was to perform a systematic review of the literature with a qualitative synthesis of studies. SOURCES: The articles were selected from PubMed, Web of Science, Scielo and Lilacs. SUMMARY OF THE FINDINGS: Nine studies were selected for that qualitative synthesis, one was a randomized clinical trial, and eight were case-control or cohort designs. Most studies have indicated that calprotectin is a marker of systemic inflammation in CF and not just intestinal inflammation. Calprotectin is an aid in monitoring inflammatory bowel conditions in patients with cystic fibrosis. CONCLUSION: Further studies should be conducted to investigate the role of this marker in the systemic inflammation of CF.

Ocular allergy in children and adolescents.

The association between symptoms of asthma, rhinoconjunctivitis (RC) and allergic conjunctivitis (AC) is frequent, and AC is considered a comorbidity of asthma and allergic rhinitis (AR). Ocular symptoms are often underestimated and undertreated.Differences according to gender were reported, because girls present symptoms more frequently. The development of RC depends on genetic and environmental factors, and recent studies have indicated that gender, family history of atopy, early sensitization, food allergy, and atopic dermatitis are risk factors for allergic RC. There are six well-defined clinical forms of ocular allergy: seasonal AC, perennial AC, vernal keratoconjunctivitis, atopic keratoconjunctivitis, and contact blepharoconjunctivitis.

Intra- and interobserver agreement of histopathological findings in pediatric patients with eosinophilic esophagitis.

OBJECTIVE: To assess intra- and interobserver agreement among non-expert pathologists in identifying features of the eosinophilic esophagitis histologic scoring system (EoEHSS) in pediatric patients. PATIENTS AND METHODS: The authors used 50 slides from patients (aged 1-15 years; 72% male) with EoE. EoEHSS evaluates eosinophilic inflammation and other features including epithelial basal zone hyperplasia, eosinophilic abscesses, eosinophil surface layering, dilated intercellular spaces, surface epithelial alteration, dyskeratotic epithelial cells, and lamina propria fibrosis. Grade and stage of abnormalities are scored using a 4-point scale (0 normal; 3 maximum change). Four pathologists determined EoEHSS findings on two occasions. Intra- and interobserver agreement was assessed using Kappa (κ) statistics and intra-class correlation coefficients. RESULTS: Intra- and interobserver agreement for the identification of eosinophil counts ≥ 15/high power field (HPF) was excellent, however varied when assessing additional features of the EoEHSS. For the more experienced pathologist, agreement for most EoEHSS items and the composite scores was substantial to excellent. For the less experienced pathologists, intraobserver agreement ranged from absent to substantial for individual features and ranged from moderate to substantial for the composite scores. CONCLUSION: Most items of the EoEHSS had substantial to excellent reliability when assessed by a pathologist experienced in the diagnosis of EoE but presented lower repeatability among less experienced pathologists. These findings suggest that specific training of pathologists is required for the identification of EoEHSS characteristics beyond eosinophil count, as these features are considered useful in the evaluation of response to treatment and correlation with clinical manifestations and endoscopic findings.

Do gender and puberty influence allergic diseases?

Differences between biological sex, gender identity, and their impact on health may have significant implications for the prevention, screening, diagnosis, and treatment of several diseases, including allergies. Asthma, allergic rhinitis (AR), atopic dermatitis (AD), and allergic conjunctivitis (AC) have different prevalences and different risk factors in infancy. Although boys present allergies more often in childhood, it quickly changes during girls' sexual development, leading to lifelong female predominance of allergic diseases. This can be explained by the influence of sexual hormones, different lifestyles adopted by men and women, microbiota diversity, diet distinctions, professional options, and adherence to treatment, among others. Gender-related aspects should become essential parameters in allergology to diagnostic and therapeutic stratification, associated with molecular, genetic, and epigenetic patterns. Longitudinal studies would be interesting to evaluate possible mechanisms underlying these differences in prevalence. Sex- and gender-specific observations beyond 14 years of age are scarce and further allergic multimorbidity studies in different populations, especially in adults, are necessary.

MALDI-TOF: a useful tool for laboratory identification of uncommon glucose non-fermenting Gram-negative bacteria associated with cystic fibrosis.

The predisposition of patients with cystic fibrosis (CF) for recurrent pulmonary infections can result in poor prognosis of the disease. Although the clinical significance in CF of micro-organisms, such as Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa, is well established, the implication of uncommon glucose non-fermenting Gram-negative bacilli (UGNF-GNB) in respiratory samples from CF patients is still unclear. Because of limitations of traditional methods used in most clinical laboratories, the accurate identification of these microbes is a challenge. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) is an alternative tool for efficient identification of bacteria. This was a retrospective study to evaluate different identification methods in a collection of UGNF-GNB isolated from children with CF during a period of three years. The performance of MALDI-TOF was compared to that of 16S rDNA gene sequencing and to a conventional and automated phenotypic identification. The discriminatory power of MALDI-TOF (75.0 % agreement) was superior to automated techniques (67.1 % agreement) and to conventional phenotypical identification (50.0 % agreement). MALDI-TOF also demonstrated high accuracy in identifying Stenotrophomonas maltophilia, Achromobacter xylosoxidans and Chryseobacterium indologenes, but had limited utility in identifying Pandoraea spp. and some species of Acinetobacter and Chryseobacterium (other than C. indologenes). Although MALDI-TOF identified only 75 % of the isolates in comparison with 16S rDNA gene sequencing, the prompt identification and high discriminatory power exhibited by MALDI-TOF make it a useful tool for the characterization of micro-organisms that are difficult to identify using routine methods.

Insulin-like growth factor-1, leptin, body composition, and clinical status interactions in children with cystic fibrosis.

BACKGROUND/AIMS: Children with cystic fibrosis (CF) are of increased risk of reduced fat body mass (FBM) and lean body mass (LBM). Serum concentrations of insulin-like growth factor-1 (IGF-1)and leptin could be markers of LBM and/or FBM depletion. To evaluate the relationships between disease activity, body composition, IGF-1 and leptin concentrations in CF children. METHODS: A cross-sectional study with 26 CF children aged 5.0-15.5 years and 33 healthy controls, mean age 9.4 years. Body composition was evaluated by dual-energy X-ray absorptiometry. Fasting blood samples were analyzed for leptin, IGF-1 and IGFBP-3. RESULTS: FBM standard deviation score (SDS; CF boys -0.02 +/- 0.88 vs. 0.78 +/- 0.65, p < 0.01; CF girls -0.37 +/- 1.15 vs. 0.70 +/- 0.97, p < 0.05), leptin concentration (CF boys 2.07 +/- 0.79 vs. 3.07 +/- 1.28 ng/ml, p < 0.05; CF girls 2.71 +/- 0.86 vs. 5.00 +/- 2.95 ng/ml, p < 0.05) and IGF-1SDS (CF boys -1.43 +/- 1.50 vs. -0.32 +/- 0.88, p < 0.05; CF girls -0.66 +/- 1.66 vs. 0.64 +/- 0.57, p < 0.01) were lower in CF children compared to controls. Shwachman score was the strongest predictor of lean body mass (R = 0.63). Leptin levels explain 60% of the variability in FBM. CONCLUSION: Serum concentrations of IGF-1 and leptin are decreased in children with CF and are associated with clinical conditions and body composition.