ABSTRACT
OBJECTIVES: An increased frequency of celiac disease (CeD) has been reported in severe Immunoglobulin E (IgE) -mediated food allergy (FA). This observation requires confirmation, and whether CeD affects FA severity and resolution is unknown. The study aims to estimate the prevalence of CeD in patients with FA and to investigate whether CeD affects FA severity and oral tolerance. METHODS: Consecutive patients with FA referred for allergen reintroduction, either to evaluate allergy resolution or to start oral immunotherapy (OIT), were evaluated for CeD and for FA severity. The primary outcome was the prevalence of CeD. Secondary outcomes were the frequency of severe FA and the level of clinical tolerance at study entry and at last follow-up in patients with isolated FA versus patients with FA + CeD. RESULTS: Two hundred twenty-eight patients were included. CeD was confirmed in 15 patients (6.6%) of whom, 8 patients had a previously established diagnosis of CeD and were on a gluten-free diet. Severe FA was observed in 12 patients with FA + CeD (80%) versus 88 patients with FA (42%) ( P = 0.006). At baseline, patients with FA + CeD had significantly higher median allergen-specific IgE levels [61.8 kU/L; interquartile range (IQR) 11.6-279.0] compared to patients with FA (20.3 kU/L; IQR 2.9-72.7) ( P < 0.001). Complete clinical tolerance was observed in 1 of 15 patients (7%) with FA + CeD versus 98 of 205 patients (48%) with FA ( P = 0.002). CONCLUSIONS: CeD is highly prevalent in patients with FA and could affect FA severity and response to OIT. CeD screening should be considered in patients with severe or persistent FA.
Subject(s)
Celiac Disease , Food Hypersensitivity , Humans , Immunoglobulin E , Celiac Disease/complications , Celiac Disease/epidemiology , Desensitization, Immunologic , Administration, Oral , Food Hypersensitivity/complications , Food Hypersensitivity/epidemiology , AllergensABSTRACT
A 3-year-old boy presented with a 5-day history of bullous skin lesions localised mainly in the upper and lower limbs and in the genital region (figure 1). Lesions were not pruritic nor painful and showed a central crust. There was no family history of skin disorders or autoimmune diseases. The child never had fever and his physical examination was otherwise unremarkable.
Subject(s)
Dapsone , Exanthema , Biopsy , Child , Child, Preschool , Exanthema/diagnosis , Exanthema/etiology , Humans , Immunoglobulin A , MaleABSTRACT
A female neonate was born with asymmetric lower limbs, the right leg appearing enlarged, with thickened, reddish-purple skin and ectasic superficial reticulum (figure 1A,B). Limb pulses were present and symmetrical. The girl's family history and prenatal scans were unremarkable. Laboratory findings were within the normal range, except for a mild thrombocytopenia (90 000/µL), which spontaneously resolved during the next few days. A leg X-ray and the Doppler analysis ruled out the presence of calcifications and venous varices, respectively. Ultrasound showed significant skin thickening, with marked dermal hypertrophy and hyperechogenicity. Magnetic resonance showed circumferential thickening of the derma, with mild hypertrophy of some perforating vessels (figure 2). A biopsy of the right thigh showed capillary malformations on histology.
Subject(s)
Klippel-Trenaunay-Weber Syndrome , Vascular Malformations , Capillaries/abnormalities , Female , Humans , Hypertrophy/etiology , Infant, Newborn , Klippel-Trenaunay-Weber Syndrome/complications , Klippel-Trenaunay-Weber Syndrome/diagnosis , Klippel-Trenaunay-Weber Syndrome/pathology , Leg/pathology , Pregnancy , Vascular Malformations/pathologyABSTRACT
Canakinumab is a human monoclonal antibody anti-interleukin-1ß, it is the only biologic drug approved to treat mevalonate kinase deficiency (MKD). Canakinumab injection can trigger several local cutaneous reactions, but also chronic-relapsing skin infections and other manifestations. We report three cases of unusual cutaneous manifestations in patients treated with canakinumab.
Subject(s)
Mevalonate Kinase Deficiency , Skin Diseases , Antibodies, Monoclonal , Antibodies, Monoclonal, Humanized , Humans , Interleukin-1beta , Phosphotransferases (Alcohol Group Acceptor)ABSTRACT
Pulse laser treatment is useful for aesthetic improvement in children with capillary vascular malformation and residual superficial haemangiomas. However, pulse laser treatment is painful, and repeated procedures are usually required to achieve a satisfactory clinical result. Evidence shows that analgesia in children undergoing pulse laser treatment may vary from general anaesthesia to no treatment at all. This report describes our institutional experience with deep sedation in children with capillary vascular malformation, undergoing laser pulse treatment.
Subject(s)
Deep Sedation , Lasers , Skin/blood supply , Vascular Malformations/therapy , Child , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
Subcutaneous granuloma annulare is an inflammatory lesion occurring in otherwise healthy children. We present 3 pediatric patients with different diagnostic-therapeutic paths depending on the ward they were referred to. The lesions regress spontaneously, and medical or surgical treatments are generally not necessary.