Prenatal latex sensitization in patients with spina bifida: a pilot study.

OBJECT: Patients with spina bifida are particularly vulnerable to developing immunoglobulin E (IgE)-mediated latex sensitization. Even though many risk factors leading to latex allergy in these patients have been described, it is still unclear whether the increased prevalence of latex sensitization is disease associated or due to the procedures used to treat spina bifida. The aim of this study was to assess prenatal latex sensitization in patients with spina bifida by examining IgE levels in umbilical cord blood. METHODS: Patients with spina bifida and matched healthy infants were recruited from the University Medical Center Hamburg-Eppendorf and Children's Hospital Altona. Latex-specific and total IgE were assessed in umbilical cord blood using ImmunoCAP testing to evaluate the degree of prenatal latex sensitization. RESULTS: Twenty-two subjects, 10 with spina bifida and 12 healthy individuals, were included. Subjects were selected after matching for sex, gestational age, weight, parental allergy profile, number of prenatal examinations, and utilization of latex tools during pregnancy (propensity score estimates, p = 0.36). In patients with spina bifida, latex-specific and total IgE levels were significantly higher than those in healthy individuals (p = 0.001). After normalization to total IgE, latex-specific IgE levels were higher, yet not significantly increased (p = 0.085). CONCLUSIONS: Perinatally, there is a significant augmentation of total and latex-specific IgE in patients with spina bifida. After correcting for total IgE, latex-specific IgE was increased, yet not significantly higher than in matched, healthy controls. This pilot study gives novel insights in the immunological reactions related to spina bifida. The increased latex-specific IgE levels could possibly be associated with the occurrence of a latex allergy in the future.

Novopen Echo® for the delivery of insulin: a comparison of usability, functionality and preference among pediatric subjects, their parents, and health care professionals.

BACKGROUND: Despite advances in insulin pen design and functionality, the selection of pens available for children with diabetes is limited. This study assessed the usability, functionality and attitudes towards NovoPen Echo®, a new durable insulin pen designed for pediatric patients that combines a simple memory function with half-increment dosing, versus NovoPen® Junior and HumaPen® Luxura™ HD in pediatric subjects, their parents, and health care professionals (HCPs). METHODS: Pens were evaluated in random order during 1:1 interviews in the three target groups (pediatric subjects, parents, and HCPs) in Germany, France, and Canada. Study participants were asked to prepare each pen, perform injections into foam cushions, and provide feedback via a standardized questionnaire. RESULTS: In total, 205 participants were included in the study. On a scale of 1-6 (1=most favorable; 6=least favorable regarding overall appearance, shape, colors, thickness and length), NovoPen Echo received the most favorable rating for design and overall appearance (mean±standard deviation=1.71±0.79) compared with NovoPen Junior (2.02±0.93) and HumaPen Luxura HD (2.36±1.01). Furthermore, 89% of pediatric subjects and 94% of parents rated the memory function of NovoPen Echo as very easy/easy to use. When asked to rate the pens overall, 80% of participants preferred NovoPen Echo to the other pens (p<0.0001). CONCLUSIONS: The results demonstrate a high overall level of satisfaction with NovoPen Echo among pediatric subjects, parents, and HCPs. The novel design aspects of NovoPen Echo, namely the simple memory function, half-increment units and, ease of use and design, may contribute towards promoting treatment adherence, which is essential in the pediatric setting.

[Type 1 diabetes in children and adolescents--new strategies in management and treatment]. / Typ-1-Diabetes bei Kindern und Jugendlichen. Neue Strategien in Diagnostik und Therapie.

Type 1 diabetes (T1D) is the most common metabolic disease in childhood with an increasing incidence of about 3 to 5% per year, particularly in preschool children. Despite substantial progresses in diabetes research concerning its pathogenesis and etiology in the last decades, there is no strategy for primary prevention in subjects with subclinical signs of diabetes. Nowadays, it is well-known that T1D is caused by partial or total destruction of pancreatic islet cells, resulting in progressive incapacity to produce insulin. This inflammation is of an autoimmune nature, resulting both from environmental and genetic influences. Children with T1D usually have a several day history of typical symptoms such as frequent urination, excessive thirst and weight loss, which appear when about 80% of the pancreatic beta cells are already destroyed. If those symptoms are misinterpreted, the continuing hyperglycaemic metabolism leads to a potential life-threatening condition the diabetic ketoacidosis. Patients with T1D require daily subcutaneous injections of insulin, with the overall aim to mimic the physiological release of insulin during meal-associated and fasting periods (intensive insulin therapy). The most important parameters to evaluate the effectiveness of insulin treatment are blood glucose monitoring and HbA1c. The increased availability of systems for continuous glucose monitoring may help patients to have a better insight into their metabolic conditions. Sensor-based insulin treatment is likely to have a significant impact on paediatric diabetes therapy and education in the future.

NQO1 C609T polymorphism in distinct entities of pediatric hematologic neoplasms.

BACKGROUND AND OBJECTIVES: NAD(P)H:quinone oxidoreductase 1 (NQO1) is an enzyme that protects cells against mutagenicity from free radicals and toxic oxygen metabolites. The gene coding for NQO1 is subject to a genetic polymorphism at nucleotide position 609 (C-->T) of the human NQO1 cDNA. Heterozygous individuals (C/T) have intermediate activity and homozygotes for the variant allele (T/T) are deficient in NQO1 activity. In previous studies, genotypes conferring lower NQO1 activity have been associated with an increased risk of acute leukemia, particularly infant leukemia carrying MLL/AF4 fusion genes. In the present study, we investigated this association in our population and extended the analysis to other subgroups of pediatric hematologic neoplasms characterized by specific fusion genes. DESIGN AND METHODS: We genotyped 138 patients with childhood acute lymphoblastic leukemia (ALL) carrying distinct fusion genes (MLL/AF4=35; BCR/ABL=31; TEL/AML1=72), 71 cases of pediatric sporadic Burkitt's lymphoma and 190 healthy control individuals for the NQO1 C609T polymorphism. RESULTS: When compared to the healthy control group, only children with Burkitt's lymphoma significantly more often had NQO1 genotypes associated with lower NQO1 activity (odds ratio, 1.81; p=0.036), predominantly at a younger age (< 9 years at diagnosis: odds ratio, 3.02; p=0.003). INTERPRETATION AND CONCLUSIONS: Our results suggest that in our population the NQO1 C609T polymorphism does not confer an increased risk of the investigated entities of childhood ALL. However, there may be a modulating role for NQO1 in the pathogenesis of pediatric sporadic Burkitt's lymphoma.