Successful desensitization to high dose rituximab for a child with nephrotic syndrome - The first report in the literature.

Rituximab is a chimeric monoclonal antibody, which is mainly used in the treatment of lymphoma and autoimmune disorders, but also has been recently approved for the treatment of nephrotic syndrome. The treatment dose is between 375 mg/m2 and 750 mg/m2. Rituximab has been associated with hypersensitivity reactions, which can be classified either into early and late infusion-associated adverse reactions. Different desensitization protocols have been described in adult patients who require rituximab, however, there is a limited experience in children and in patients with nephrotic syndrome. Additionally, all the published protocols for adults and children are based on the low-dose rituximab desensitization. We report the first case in the literature of desensitization to high-dose rituximab in a child with nephrotic syndrome, suggesting a well-tolerated protocol adjusted on the high dose and the clinical reaction to the drug. This protocol can be used for children with nephrotic syndrome and severe reaction that require 750 mg/m2 of rituximab.

Evaluation of AllergiSense Smartphone Tools for Adrenaline Injection Training.

Anaphylaxis is an increasingly prevalent life-threatening allergic condition that requires people with anaphylaxis and their caregivers to be trained in the avoidance of allergen triggers and in the administration of adrenaline autoinjectors. The prompt and correct administration of autoinjectors in the event of an anaphylactic reaction is a significant challenge in the management of anaphylaxis. Unfortunately, many people do not know how to use autoinjectors and either fail to use them or fail to use them correctly. This is due in part to deficiencies in training and also to the lack of a system encouraging continuous practice with feedback. Assistive smartphone healthcare technologies have demonstrated potential to support the management of chronic conditions such as diabetes and cardiovascular disease, but there have been deficiencies in their evaluation and there has been a lack of application to anaphylaxis. This paper describes AllergiSense, a smartphone app and sensing system for anaphylaxis management, and presents the results of a randomized, controlled, prepost evaluation of AllergiSense injection training and feedback tools with healthy participants. Participants whose training was supplemented with AllergiSense injection feedback achieved significantly better practiced injections with 90.5% performing correct injections compared to only 28.6% in the paper-only control group. In addition, the results provide insights into possible self-efficacy failings in traditional training and the benefits of embedding self-efficacy theory into the technology design process.

Single nut or total nut avoidance in nut allergic children: outcome of nut challenges to guide exclusion diets.

BACKGROUND: Children with diagnosed nut allergy are typically advised by health professionals to exclude all nuts from their diets, irrespective of the outcome of allergy testing, to avoid inadvertent contact through contamination or the possible development of new allergies. METHODS: In our service, as we feel greater diagnostic accuracy prevents dietary risk taking, we provide the facility for children with nut allergy the opportunity of controlled exposure to 'other' nuts irrespective of whether their allergy prick test (PT) results are positive or negative. We performed open food challenges on our paediatric day ward. The challenge food was administered by way of a homemade biscuit containing 8 g of each nut challenged and given in increasing visually measured doses. RESULTS: Over the 5-year period from 2006, we challenged 145 children diagnosed as peanut allergic or tree nut allergic. In those with peanut allergy challenged to tree nuts, none of the 72 with negative PTs to tree nuts reacted on challenge whilst 7 of 22 (31.2%) with positive PTs did. In patients with tree nut allergy challenged to peanuts and/or other tree nuts, 3 of 38 (7.9%) with negative PT results and 5 of 13 (38.4%) with positive PT results reacted. CONCLUSION: Children allergic to peanuts with negative allergy tests to tree nuts had no co-existing allergy, but were at risk of tree nut allergy where PTs were positive. Children with tree nut allergy were at risk of co-existing peanut or other tree nut allergy whether PTs were positive or negative. Oral challenges to clarify allergy status in all nuts show co-existing allergies even in young children and in so doing may reduce anxiety, minimize unnecessary dietary restrictions and prevent later episodes of anaphylaxis through uninformed exposure.