Clinical relevance of cluster analysis in phenotyping allergic rhinitis in the paediatric population of the Kuyavian-Pomeranian voivodeship, Poland.

Introduction: Allergic rhinitis (AR) is the most common allergic disease in the world, and additionally, its prevalence is successively increasing. Children with AR constitute a heterogeneous group of patients differing both in the course of AR and in the frequency of asthma coexistence. It is possible to identify children with AR at risk of a more severe course of the disease by analysing the potential family, environmental and clinical factors related to the development of the disease; the findings will help identify patients with a higher risk of developing asthma in the future, and who will benefit the most from early allergen-specific immunotherapy. Aim: Evaluation of clinical relevance of cluster analysis in phenotyping AR based on an analysis of selected clinical and environmental factors. Material and methods: The study sample was 80 children (7-17 y.o.) with AR, including 28 children with associated asthma. The effects of AR symptoms on the patients daily functioning, skin prick tests (Allergopharma), allergen-specific IgE for airborne allergens (Biocheck GmbH), total cholesterol, cholesterol high-density lipoprotein (HDL), cholesterol low-density lipoprotein (LDL), triglyceride levels in the blood (ARCHITECTcSystem), FeNO and nNO concentrations (HypAir FeNO Medisoft) and results of methacholine challenge test (Lungtest 1000Ispa) were analysed. Results: Four clusters of patients with AR were extracted, differing in the incidence and severity of AR symptoms and the coincidence of asthma. Most of the children from cluster 1 (n = 24; 85.71%) and cluster 2 (n = 15; 78.95%) had persistent AR, while most of the children from cluster 3 (n = 11; 73.33%) and cluster 4 (n = 14; 77.78%) had intermittent AR. The co-occurrence of asthma was significantly higher in cluster 1 than in other clusters (p = 0.0002). Children in clusters 3 and 4 reported a lower impact of AR symptoms on daily functioning (p = 0.0153). Children in cluster 1 had significantly more often an abnormally high total cholesterol level (p = 0.033) and in cluster 4 significantly more often abnormally high triglyceride levels (p = 0.009) were observed. Patients in cluster 2 were significantly less likely to have abnormal high LDL levels (p = 0.015). Conclusions: Children with AR from the Kuyavian-Pomeranian voivodeship differing in the course of AR, the frequency of coexistence of asthma, and occurrence of lipid parameter abnormalities.

Expression of Matrix Metalloproteinases in the Circulating Immune Cells in Children with Helicobacter pylori Infection-Correlation with Clinical Factors.

H. pylori gastritis is strongly associated with the upregulation of the expression of several matrix metalloproteinases (MMPs) in the gastric mucosa. However, the role of MMP-2 and MMP-9, and their inhibitors (tissue inhibitors of metalloproteinases -TIMPs) produced by immune cells in infected children have not been clearly defined. Moreover, the effects of H. pylori eradication therapy on MMPs and TIMPs production has not been evaluated. A total of 84 children were studied: 24-with newly diagnosed H. pylori gastritis, 25-after H. pylori eradication therapy (17 of them after successful therapy), 24-with H. pylori-negative gastritis, and 11-controls. Plasma levels of MMP-2, MMP-9, TIMP-1, and TIMP-2 by ELISA; MMPs and TIMPs expression in lymphocytes; neutrophils and monocytes in peripheral blood by multiparameter flow cytometry; and mucosal mRNA expression levels of MMPs and TIMP-1 in gastric biopsies by RT-PCR were evaluated. Children with H. pylori-related gastritis showed the following: (1) increased MMP-2 and TIMP-2 plasma levels, (2) increased intracellular expression of MMP-2 in the circulating lymphocytes and neutrophils, (3) low frequencies of circulating TIMP-1+ and TIMP-2+ leukocytes, and (4) high expression of mRNA for MMP-9 along with low expression of mRNA for MMP-2 in the gastric mucosa. Unsuccessful H. pylori eradication was associated with the following: (1) high plasma levels of MMP-9 and TIMP-1, (2) increased pool of TIMP-1+ lymphocytes as well as high expression of MMP-9 in circulating lymphocytes, and (3) high expression of mRNA for MMP-9 in the gastric mucosa. Our data suggest that MMPs are important contributors to stomach remodelling in children with H. pylori-related gastritis. Unsuccessful H. pylori eradication is associated with increased MMP-9 in plasma, circulating lymphocytes, and gastric mucosa.

The relationship between lipid parameters and the course of allergic rhinitis in children.

Introduction: A possible mechanism in the pathogenesis of allergic rhinitis (AR) is hypercholesterolemia, which may shift the balance between Th1- and Th2-dependent immune responses towards the latter. Aim: To assess the prevalence of lipid metabolism abnormalities in children with AR and their influence on the clinical course of AR. Material and methods: The study sample comprised 80 children (7-17 y.o.) with AR, including 28 with associated asthma, and 40 healthy children. Total blood cholesterol, HDL, LDL and triglyceride levels were evaluated (ARCHITECTcSystem). Skin prick tests (Allergopharma) for airborne allergens and a methacholine challenge test (Lungtest 1000, Ispa) were performed. Allergen-specific IgE for airborne allergens (Biocheck GmbH), FeNO and nNO concentrations (HypAir FeNO Medisoft) were measured. Results: Children with AR were significantly more likely to have normal HDL levels than the control group (n = 70; 87.5% vs. n = 27; 67.50%; p = 0.03). No significant differences were observed between these two groups regarding total cholesterol, LDL or triglyceride levels (p > 0.05). Abnormally high total cholesterol levels were associated with a higher risk of sensitisation to D. pteronyssinus (n = 18; 72%, p = 0.023). Children with normal levels of total cholesterol and normal triglyceride values were less likely to be sensitized to dog dander (n = 43; 78.18%, p = 0.049) (n = 42; 72.41%, p = 0.042). No significant correlations were observed between lipid parameters and the clinical course of AR, FeNO concentrations, nNO concentrations and bronchial hyperreactivity in children with AR (p > 0.05). Conclusions: Children with AR are as likely to demonstrate dyslipidaemia as the general population. However, the presence of lipid abnormalities in this group may increase the likelihood of sensitization to perennial allergens.

A foreign body in the mediastinum as a cause of chronic cough in a 10-year-old child with asthma.

Introduction: Chronic cough is a common problem faced by pediatricians, with a reported prevalence of 20% among preschoolers. It is also the most frequent symptom of asthma. Many causes of chronic cough may also be possible causes of asthma exacerbations.Case study: We describe a 10-year-old boy with asthma, which was admitted to the hospital with a persistent dry cough for five months. Initially, he was treated as an exacerbation of asthma; however, a subsequent chest X-ray identified a wire during the next hospitalization. Although the wire was not found during bronchoscopy, a CT scan located the wire in the mediastinum.Results: The patient required urgent thoracic surgery, ending with the extraction of a 3 cm-long metallic wire. The history revealed that he had choked on a pizza shortly before the onset of coughing: it is most likely that the foreign body had been aspirated, and that it may have originated from a metal brush used to clean the oven. However, it is difficult to determine whether the wire was originally aspirated into the airways or into the gastrointestinal tract; from the latter, it would have perforated either the bronchus or esophagus and migrated to the mediastinum.Conclusion: The symptoms associated with aspiration or ingestion of a foreign body in the upper aerodigestive tract can simulate other pediatric diseases, such as asthma, and delay the correct diagnosis. Our findings demonstrate that chronic cough in children with asthma is not always a result of exacerbation. Precise interviewing and correct interpretation of basic diagnostic testing may be key for setting an accurate diagnosis.

Chubby Infant - Should One Worry? An Infant with Primary lymphedema - Mini Review and Case Report.

Lymphedema is a localized form of tissue swelling, characterized by a progressive accumulation of a tissue fluid in the interstitial compartment as a result of the lymphatic system dysfunction. It is a rare disease in the pediatric population and in the majority of cases it is a consequence of an abnormal formation of the lymphatic system, which is called primary lymphedema. Although its epidemiology is not precise, it is assumed that 1:100 000 children suffer from primary lymphedema. The diagnosis can be made by a proper clinical examination after ruling out secondary causes of lymphedema, particularly in cases with a more asymmetric swelling of the extremities. In this very article we present a case report of an 8-months-old infant with primary lymphedema, who had presented swelling of the extremities from birth and yet no pathology was suspected before. The purpose of this article is to draw attention to the fact that a baby with excessive subcutaneous tissue is not always a healthy, chubby infant with considerable amount of fat tissue.Das Lymphödem ist eine lokalisierte Form des Gewebeödems, die durch eine fortschreitende Ansammlung von Gewebeflüssigkeit im Interstitialraum infolge einer Funktionsstörung des Lymphsystems gekennzeichnet ist. Dies ist eine seltene Erkrankung in der pädiatrischen Bevölkerung und in den meisten Fällen eine Folge der fehlerhaften Bildung des Lymphsystems, das als primäres Lymphödem bezeichnet wird. Obwohl die Epidemiologie nicht genau ist, wird angenommen, dass 1: 100 000 Kinder an einem primären Lymphödem leiden. Die Diagnose kann auf der Grundlage einer geeigneten klinischen Untersuchung gestellt werden, nachdem sekundäre Ursachen für Lymphödeme ausgeschlossen wurden, insbesondere bei asymmetrischeren Ödemen der Gliedmaßen. In diesem Artikel präsentieren wir den Fallbericht eines 8 Monate alten Kindes mit primärem Lymphödem, dessen Ödem der Gliedmaßen seit der Geburt aufgetreten ist, bei dem aber keine Pathologien vermutet wurde. Der Zweck dieses Artikels ist es, die Aufmerksamkeit auf die Tatsache zu lenken, dass ein Kind mit übermäßigem Unterhautgewebe nicht immer ein gesundes, molliges Kind mit übermäßigem Körperfett bedeutet.

The importance of component-resolved diagnostics in IgE-mediated cow's milk allergy.

Cow's milk allergy (CMA) is an increasingly common problem among children and adults that requires the use of appropriate diagnostics to eliminate allergic reactions and prevent unnecessary dietary regimes. The current diagnostics methods are imperfect hence new, more effective methods are still being sought. Component-resolved diagnostics (CRD) is one of them. CRD assesses sensitivity to individual allergen molecules using purified native or recombinant allergens. The present paper reviews the role of CRD in diagnosing CMA, as well as the benefits and limitations of its use, especially in predicting allergy development or acquiring immunotolerance. It examines the possibility of replacing the current gold diagnostic standard with component tests directed against specific milk proteins. In addition, CRD could be helpful in the evaluation of prognosis. However, CRD allows for improvement in clinical management, particularly of polysensitized subjects, there is still no cogent evidence that it offers more efficient CMA diagnostics than existing tests.

Food-induced anaphylaxis in children up to 3-years-old preliminary study.

INTRODUCTION AND OBJECTIVES: The aim of this study was to determine the frequency of food-induced anaphylaxis, analyze the symptoms, and triggering factors in a group of youngest children. Also, the study aims to estimate the frequency of anaphylaxis episodes in children in the Kuyavian-Pomeranian Voivodeship region. METHODS: Retrospective analysis of medical records of 29 children aged 0-3 years that presented symptoms of food-induced anaphylaxis. Medical charts were reviewed using a collection of documents with the clinical data. RESULTS: The frequency of anaphylaxis was determined to be 0.3% of all hospitalized children aged 0-3 years and 1.9% of children suspected of food allergy. The mean age of an anaphylactic reaction was 12±9 months. The most common symptom was mild-moderate urticaria. The respiratory symptoms were significantly more prevalent in toddlers than in infants (p = 0.148). Cardiac symptoms occurred only in the infant group, i.e., in two (11%) infants. As a possible cause of the symptoms, in 18 (62%) cases, parents most often indicated the consumption of milk or milk-rice porridge. Anaphylaxis as the first manifestation of food-allergy was significantly more prevalent in infants than in older children (p = 0.0002). CONCLUSIONS: The incidence of anaphylactic reactions rated at 0.3% of all children hospitalized at this age. The most common symptoms of anaphylactic reaction were skin lesions. The primary cause of allergic reactions was cow's milk after the first exposure at home. Anaphylaxis has different patterns of symptoms depending on the age of the child.

Usefulness of Testing for Fecal Calprotectin in Pediatric Gastroenterology Clinical Practice.

Gastrointestinal tract symptoms such as abdominal pain, constipation, diarrhea, and fever are common reasons for which parents take children to the pediatrician. An increasing prevalence of chronic diseases of the gastrointestinal tract and a decrease in the median age of their onset indicate the need to search for new diagnostic methods for differentiating inflammatory bowel diseases (IBDs) from other gastrointestinal tract diseases. An example of a novel biomarker is fecal calprotectin (FC), which is considered a noninvasive and useful marker of intestinal inflammation. This review summarizes currently available information on the use of FC in the diagnosis and monitoring of IBD in children. Additionally, it attempts to determine the course of action depending on the concentration of FC. Application of FC determination within the framework of primary medical care can decrease the number of children unnecessarily referred either to endoscopic or radiologic examination. There is a double advantage of calprotectin screening; for patients, it reduces delays in diagnosis and unnecessary exposure to endoscopy, and for doctors, it reduces pressure on endoscopy testing and facilitates decision-making. We emphasize the role of FC as a noninvasive marker, primarily in patients with IBD, in monitoring disease activity, predicting relapse, monitoring therapy efficacy, and monitoring postoperative relapses.

Difficulties in interpretation of oral food challenge results.

Oral food challenge is the gold standard in diagnosing food allergies; however, many testing protocols are available. The present article illustrates the difficulties associated with interpreting oral challenge tests with the example of a six-year-old boy with allergy to hen's eggs. The symptoms observed on the first day of challenge indicated a negative result; however, the consumption of the cumulative dose resulted in anaphylaxis. The interpretation of the oral food challenge can be complicated. The criteria used to determine a positive or negative result are sometimes ambiguous. An accurate interpretation of the results is key to determining correct management in children with food allergy.

Peanut allergy diagnosis: Moving from basic to more elegant testing.

Peanut allergy (PNA) is an IgE-mediated immune disorder, which merits particular attention due to its impact on the health and quality of life of millions of patients worldwide. PNA tends to develop in early life and resolves in only 20% of peanut-allergic children. It accounts for the majority of severe food-related allergic reactions. An accurate diagnosis of PNA is vital. In this review, we present the approach to the diagnosis of peanut allergy, starting from the history and proceeding to measures of overall sensitization and then to component-resolved diagnostics and oral food challenges as indicated. Additional testing in development includes basophil activation testing and determination of epitopes for peanut-allergic responses. Based on the literature, stepwise approaches and predictive models for diagnosing PNA are also presented.

Correction to: A loss of consciousness in a teenage girl with anorexia nervosa, due to polydipsia: case report and a minireview.

AN was the most frequent cause of hospitalization within all ED and suicide attempt-related hospitalizations were most common among patients with AN [9].

The microbiome and its impact on food allergy and atopic dermatitis in children.

Food allergy (FA) affects 4-10% of children, especially children with atopic dermatitis (AD). During infancy the gut microbiome may determine both the course of FA and tolerance to food allergens. Analogically, the skin microbiome changes in the course of AD. Most studies have associated FA with a lower abundance and diversity of Lactobacillales and Clostridiales, but greater numbers of Enterobacterales, while AD in children has been associated with lower numbers of Staphylococcus epidermidis and S. hominis but an abundance of S. aureus and Streptococcus species. An understanding of the impact of the microbiome on the clinical course of FA and AD may allow for the development of new models of allergy treatment and prevention.

A loss of consciousness in a teenage girl with anorexia nervosa, due to polydipsia: case report and a minireview.

PURPOSE: Anorexia nervosa is a chronic disease which may result in various complications. In pediatric clinical practice, it is common to observe complications related to progressive cachexia caused by malnutrition; however, cases of severe complications, like electrolyte disorders, which represent a direct threat to life, due to polydipsia, are rarely observed. The purpose of this study is to highlight that excessive drinking is of primary importance in anorexia nervosa patients, as it can result in severe medical complications, including increased risk of death. METHODS: We report the case of a 13-year-old girl with anorexia nervosa, who was referred to hospital with seizures, disorders of consciousness, and cardiorespiratory failure. RESULTS: The unstable condition of the patient was attributed to hyponatremia (119 mmol/l), decreased serum osmolality (248 mmol/kg), and decreased urine osmolality (95 mmol/kg) caused by polydipsia (water intoxication) and persistent vomiting. The presented girl was drinking large amounts of water prior to a weigh-in to falsify her low body weight. CONCLUSIONS: Polydipsia is a common problem reported by patients with eating disorders, but one which rarely leads to serious clinical complications, due to severe hyponatremia. This case underscores the importance of careful evaluation of fluid intake and the need for regular monitoring of serum electrolytes in patients with anorexia nervosa. All clinicians treating patients with such disease, as well as the parents of sick children, should be familiar with this life-threatening condition. LEVEL IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.

Correction to: A loss of consciousness in a teenage girl with anorexia nervosa, due to polydipsia: case report and a minireview.

The original article can be found online.

Prevalence of allergic diseases in children with inflammatory bowel disease.

INTRODUCTION: There are many similarities between inflammatory bowel disease (IBD) and allergic diseases, including similar epidemiological data, pathomechanism, clinical course and even treatment methods. So far, many studies of IBD comorbidity with other diseases, including allergy, but mainly in adults, have been conducted. AIM: To analyse the prevalence of allergic diseases, i.e. food allergy (FA), cow's milk allergy (CMA), atopic dermatitis (AD), allergic rhinitis (AR) and asthma in children with IBD. MATERIAL AND METHODS: The study included 105 IBD patients from the Department of Paediatrics, Allergology and Gastroenterology of Collegium Medicum in Bydgoszcz and 100 children without IBD from the Outpatient Clinics. The authors applied the validated questionnaire as a study method. RESULTS: At least one allergic disease was found in 26 (43%) IBD children. The allergological diagnosis was made in IBD children more frequently than in the control group (p = 0.04). The difference was more noticeable with regards to skin prick tests (p = 0.02). FA was the most common disease; it was noted in 19 (32%) IBD children; followed by: AD - in 13 (22%), CMA - in 12 (20%), AR - in 10 (17%) and asthma - in 6 (10%) children. The prevalence of allergic diseases in the control and study groups was comparable (p > 0.05). There was no correlation between age of IBD children and allergy (p > 0.05). Asthma was significantly more common in children undergoing biological treatment (p = 0.01). CONCLUSIONS: Children with IBD should be constantly monitored by medical professionals, not only due to the underlying disease but also due to a possible concomitant allergic disease.

Early risk factors for cow's milk allergy in children in the first year of life.

Background: Cow's milk allergy (CMA) is a key form of food allergy (FA). It was shown that the frequency of FA seems to have increased during the past 10-20 years, which led to the thought that FA may have different risk factors. Epigenetic regulations and environmental pre- and postnatal factors play a large role in contributing to allergy. Understanding the risk factors that pertain to the development of FA may help to provide reasonable recommendations for prevention of the disease. Objective: To assess the impact of perinatal and environmental risk factors on the incidence of CMA in children in the first year of life. Methods: The study group consisted of 138 infants with CMA and 101 healthy infants without allergy. CMA was confirmed by an elimination test and oral food challenge. To assess infant, parental, and environmental risk factors, we used a validated questionnaire survey. Results: The incidence of CMA was three times higher in infants with a positive family history for allergy (p < 0.001). An analysis revealed that mothers of children with CMA were fourfold more frequently university educated than mothers of children without allergy (p < 0.0001). The ages of the mothers from the study group were significantly higher than the ages of the mothers from the control group. Children from the study group were breast-fed for a significantly shorter time than children from the control group. The risk of CMA was threefold lower in children who had pets at home (p = 0.0002). The risk of IgE-mediated CMA was twofold higher than the risk of non-IgE-mediated CMA if the family had more children (p = 0.04) and as many as ninefold higher if multiorgan symptoms were detected (p = 0.01). Conclusion: A positive family history of allergy and mother's education increased the risk of CMA in children in the first year of life, whereas having pets at home and a longer period of breast-feeding decreased the risk.

[Usefulness of measurement of nitric oxide in exhaled air in diagnostics and treatment of allergic rhinitis and asthma in children and adolescents].

Nitric oxide is produced by enzymes called nitric oxide synthases. It fulfills many important functions in the human body, but produced in excess amount has a proinflammatory activity. Fractional exhaled nitric oxide measurements are used in the diagnosis and monitoring of eosinophilic inflammation in the lower airways, but should not be used as an independent parameter to make a diagnosis of asthma or for the monitoring of asthma treatment. Evaluation of fractional exhaled nitric oxide concentrations is also used to determine the pathogenesis of symptoms in patients with rhinitis. In addition, they are helpful in detecting and monitoring eosinophilic inflammation in the lower respiratory tract that coexists with inflammation in the upper airways. Fractional exhaled nitric oxide concentrations may be abnormal (lowered or elevated) in other chronic diseases, such as cystic fibrosis, primary ciliary dyskinesia and inflammatory bowel diseases. Many factors, e.g. atopy, genetic polymorphisms of NOS, and the lipid profile affect the fractional exhaled nitric oxide measurement. Nasal nitric oxide measurement is useful in assessing the prevalence and severity of eosinophilic inflammation in the upper respiratory tract.

[Early risk factors for the development of inflammatory bowel disease in the pediatric population of the Kuyavian-Pomeranian Voivodeship].

OBJECTIVE: Introduction: In recent years there has been an increase in the incidence of new cases of inflammatory bowel disease in children, which is why research is underway to determine the likely predisposing factors for the disease. Aim of the study: To assess the prevalence of early risk factors in children with inflammatory bowel disease. PATIENTS AND METHODS: Methods: The study included 60 children with inflammatory bowel disease, aged 2-19 years. Diagnosis was based on the current criteria [ESPGHAN]. A validated self-construction questionnaire was one of the methods used. The control group comprises 60 children without inflammatory bowel disease. RESULTS: Results: The analysis of the delivery route in the study group showed that 14 (23%) of the children were born via Caesarean section, and 46 (77%) by vaginal delivery. In the children born via C-section, the risk of Crohn's disease was insignificantly higher than in the control group. The average breastfeeding time in the study group was insignificantly shorter compared to the control group. Prematurity and exposure to nicotine smoke in the first year of life negligibly increased the risk of ulcerative colitis. The severe course of the disease affected almost half of the children exposed to antibiotics in the 1st year, but it was not a significant difference in comparison to children with a milder course of the disease. CONCLUSION: Conclusions: There were no significant differences in the prevalence of early risk factors in children with inflammatory bowel disease compared to healthy children. The selection of factors that may affect the development of the disease requires further research.

The influence of dietary immunomodulatory factors on development of food allergy in children.

In the last few years many studies have been conducted on the role of dietary and environmental factors in the prevention of allergic diseases among children. Many studies have shown that the diet of pregnant women and children in their early postnatal life, rich in antioxidants, vitamin D, and fatty acids is beneficial as it reduces the risk of allergy in their future life. Moreover, there are many reports about the main role of gut microbiota and probiotics in the allergy prevention, what can indicate new ways of procedures in allergic diseases.

The diagnosis and management of food allergies. Position paper of the Food Allergy Section the Polish Society of Allergology.

The paper concerns the current position of the Polish Society of Allergology Food Allergy Section on the diagnosis and management of food allergies. The aim of this position is to provide evidence-based recommendations on the diagnosis and management of patients with allergic hypersensitivity to foods. This position statement includes a systematic review of studies in three areas, namely, the epidemiology, diagnosis and management of food allergies. While taking into account the specific Polish setting, in this publication we also used the current European Academy of Allergy and Clinical Immunology (EAACI) position paper and other current position statements, including those of the United States National Institute of Allergy and Infectious Diseases (NIAID).