ABSTRACT
Hymenoptera venom allergy (HVA) is one of the most frequent causes of anaphylaxis following a bee, vespid or ant sting. Real-life data regarding the management of HVA in children are lacking. To address this unmet need, we carried out a survey defining the current management of HVA in children among pediatric allergists in Italy. Educational investments on the improvement of the management of pediatric patients with HVA are urgently needed, and our analysis represents a relevant instrument in targeting a roadmap with this aim. The time for pediatric allergists to take action has come, and a task force from the Rare Allergic Diseases Commission of the Italian Society of Pediatric Allergy and Immunology is working on the topic to improve pediatricians' knowledge and optimize the care of these patients
No disponible
Subject(s)
Humans , Child , Wasp Venoms/adverse effects , Bee Venoms/adverse effects , Ant Venoms/adverse effects , Hypersensitivity/etiology , Insect Bites and Stings/complications , Hymenoptera , Wasp Venoms/immunology , Bee Venoms/immunology , Ant Venoms/immunology , Hypersensitivity/therapy , Desensitization, Immunologic/methods , ItalyABSTRACT
Hymenoptera venom allergy (HVA) is one of the most frequent causes of anaphylaxis following a bee, vespid or ant sting. Real-life data regarding the management of HVA in children are lacking. To address this unmet need, we carried out a survey defining the current management of HVA in children among pediatric allergists in Italy. Educational investments on the improvement of the management of pediatric patients with HVA are urgently needed, and our analysis represents a relevant instrument in targeting a roadmap with this aim. The time for pediatric allergists to take action has come, and a task force from the Rare Allergic Diseases Commission of the Italian Society of Pediatric Allergy and Immunology is working on the topic to improve pediatricians' knowledge and optimize the care of these patients.
Subject(s)
Allergens/adverse effects , Anaphylaxis/therapy , Arthropod Venoms/adverse effects , Desensitization, Immunologic/statistics & numerical data , Insect Bites and Stings/complications , Allergens/administration & dosage , Allergens/immunology , Allergists/standards , Allergists/statistics & numerical data , Allergy and Immunology/standards , Anaphylaxis/diagnosis , Anaphylaxis/immunology , Animals , Arthropod Venoms/administration & dosage , Arthropod Venoms/immunology , Child , Clinical Competence/standards , Clinical Competence/statistics & numerical data , Desensitization, Immunologic/methods , Desensitization, Immunologic/standards , Health Services Needs and Demand/statistics & numerical data , Humans , Hymenoptera/immunology , Insect Bites and Stings/immunology , Insect Bites and Stings/therapy , Italy , Pediatricians/standards , Pediatricians/statistics & numerical data , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , Surveys and Questionnaires/statistics & numerical dataABSTRACT
Nowadays, the awareness of risks related to infectious diseases has decreased, whereas THE perception of risks related to vaccination is growing. Therefore, it may be difficult for health care providers to convince people of the importance of vaccination and adherence to the immunisation schedule. Selected situations that might raise uncertainties about vaccine recommendations are discussed in order to help health care providers to identify real and perceived contraindications to vaccines, and cases to be referred to specialised pre-vaccination consultation due to an increased risk of adverse events to vaccines (AU)
No disponible
Subject(s)
Humans , Vaccines/adverse effects , Drug-Related Side Effects and Adverse Reactions/epidemiology , Vaccination , Communicable Disease Control/trends , Risk Factors , Practice Patterns, Physicians' , Drug Hypersensitivity/epidemiologyABSTRACT
Nowadays, the awareness of risks related to infectious diseases has decreased, whereas THE perception of risks related to vaccination is growing. Therefore, it may be difficult for health care providers to convince people of the importance of vaccination and adherence to the immunisation schedule. Selected situations that might raise uncertainties about vaccine recommendations are discussed in order to help health care providers to identify real and perceived contraindications to vaccines, and cases to be referred to specialised pre-vaccination consultation due to an increased risk of adverse events to vaccines.
Subject(s)
Anaphylaxis/immunology , Contraindications , Infections/immunology , Vaccination , Vaccines/immunology , Child , Clinical Decision-Making , Health Personnel , Humans , Medical History Taking , Practice Guidelines as Topic , RiskABSTRACT
BACKGROUND: Cow milk (CM) allergy (CMA) affects up to 3% of the paediatric population and recent data suggest that only about 50% will outgrow by age 8. Oral immunotherapy (OIT) is a type of immune-modulating treatment that is able to induce desensitization to food allergens, to increase tolerance threshold, to reduce the risk of anaphylaxis, and to improve the patient's quality of life. The examination of the immunological changes observed during the establishment of food allergy (FA) desensitization in FA patients is a window into the pathogenesis of food allergy and food tolerance development. In this pathway, we have previously found that invariant natural killer T cells (iNKTs) are involved in CM allergy sensitization and now examine their role in OIT. METHODS: In this study, 10 of the 11 children with CM induced anaphylaxis enrolled in a CMA OIT clinical trial and completed the protocol. Peripheral blood iNKTs were quantitatively and qualitatively via flow cytometry characterized ex vivo and after culture with milk lipids before and after completing the OIT protocol. RESULTS: After completing OIT for CM, children were able to reintroduce CM in their diet. For the first time, we demonstrated that OIT induced a significant increase in the peripheral blood iNKT, as well as their switch from a T helper (Th-2; ie IL-4, IL-13) to Th-1 (ie IFN-γ) cytokine profile. CONCLUSIONS AND CLINICAL RELEVANCE: This study confirms the efficacy and safety of CM-OIT as well as the role of iNKT cells in CM allergy.
Subject(s)
Desensitization, Immunologic , Milk Hypersensitivity/immunology , Milk Hypersensitivity/therapy , Milk/immunology , Natural Killer T-Cells/immunology , Adolescent , Animals , Biomarkers , Cattle , Child , Cytokines/metabolism , Desensitization, Immunologic/methods , Female , Humans , Immunization , Immunoglobulin E/blood , Immunoglobulin E/immunology , Immunophenotyping , Male , Milk Hypersensitivity/diagnosis , Natural Killer T-Cells/metabolism , Skin Tests , T-Lymphocyte Subsets/immunology , T-Lymphocyte Subsets/metabolismABSTRACT
When questioned, about 10% of the parents report suspected hypersensitivity to at least one drug in their children. However, only a few of these reactions can be confirmed as allergic after a diagnostic workup. There is still a lack of knowledge on drug hypersensitivity (DH) epidemiology, clinical spectrum, and appropriate diagnostic methods particularly in children. Meanwhile, the tools used for DH management in adults are applied also for children. Whereas this appears generally acceptable, some aspects of DH and management differ with age. Most reactions in children are still attributed to betalactams. Some manifestations, such as nonsteroidal anti-inflammatory drug-associated angioedema and serum sickness-like reactions, are more frequent among young patients as compared to adults. Risk factors such as viral infections are particularly frequent in children, making the diagnosis challenging. The practicability and validity of skin test and other diagnostic procedures need further assessment in children. This study presents an up-to-date review on epidemiology, clinical spectrum, diagnostic tools, and current management of DH in children. A new general algorithm for the study of these reactions in children is proposed. Data are presented focusing on reported differences between pediatric and adult patients, also identifying unmet needs to be addressed in further research.
Subject(s)
Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/epidemiology , Age Factors , Algorithms , Child , Diagnosis, Differential , Disease Management , Drug Hypersensitivity/etiology , Drug Hypersensitivity/therapy , Humans , Incidence , Risk Factors , Skin TestsABSTRACT
BACKGROUND: Eosinophilic esophagitis (EoE) is an atopic disease characterized by eosinophilic inflammation in which dietary antigens (in particular, milk) play a major role. EoE is most likely a mixed IgE and non-IgE food-mediated reaction in which overexpression of Th2 cytokines, particularly IL-13, play a major role; however, the cells responsible for IL-13 overexpression remain elusive. Th2-cytokines are secreted following the ligation of invariant natural killer T cell receptors to sphingolipids (SLs). Sphingolipids (SLs) are presented via the CD1d molecule on the INKTs surface. Cow's milk-derived SL has been shown to activate iNKTs from children with IgE-mediated food allergies to milk (FA-MA) to produce Th2 cytokines. The role of iNKTs and milk-SL in EoE pathogenesis is currently unknown. OBJECTIVE: The aim of this study was to investigate the role of iNKTs and milk-SL in EoE. METHODS: Peripheral blood mononuclear cells (PBMCs) from 10 children with active EoE (EoE-A), 10 children with controlled EoE (EoE-C) and 16 healthy controls (non-EoE) were measured ex vivo and then incubated with α-galactosylceramide (αGal) and milk-SL. INKTs from peripheral blood (PB) and oesophageal biopsies were studied. RESULTS: EoE-A children had significantly fewer peripheral blood iNKTs with a greater Th2-response to αGal and milk-SM compared with iNKTs of EoE-C and non-EoE children. Additionally, EoE-A children had increased iNKT levels in oesophageal biopsies compared with EoE-C children. CONCLUSION: Milk-SLs are able to activate peripheral blood iNKTs in EoE-A children to produce Th2 cytokines. Additionally, iNKT levels are higher at the site of active oesophageal eosinophilic inflammation. CLINICAL RELEVANCE: This study suggests that sphingolipids (SLs) contained in milk may drive the development of EoE by promoting an iNKT-cell-mediated Th2-type cytokine response that facilitates eosinophil-mediated allergic inflammation.
