Treatment Difficulties in Wheat Oral Immunotherapy and the Predictive Value of Wheat-Specific IgE.

BACKGROUND: Factors associated with wheat oral immunotherapy (OIT) difficulties in patients with IgE-mediated wheat allergy have not been well studied. OBJECTIVE: We aimed to assess factors associated with difficulties in wheat OIT. METHODS: We retrospectively collected data from children under 18 years of age with history of IgE-mediated wheat allergy who underwent wheat OIT. The initial specific IgE (sIgE) of wheat and omega-5-gliadin, wheat skin prick test (SPT) sizes, eliciting doses, and adverse reactions during the OIT were evaluated. RESULTS: A total of 81 children were enrolled, with a mean age of 7.0 ± 2.7 years at the initiation of wheat OIT. The median follow-up duration was 2 years (IQR 1.2 -3.0 years). Difficulties in wheat OIT included patients who experienced frequent reactions (at least grade 2 or exercise-induced reactions) or deviated from the up-dosing protocol, which we defined as 'Complicated cases.' Twenty-six patients (32.1%) were complicated cases. Initial wheat-sIgEs were significantly higher in complicated cases than in noncomplicated cases (median of 192.3 kUA/L (IQR 30.4-590.0) vs 6.9 kUA/L (IQR 1.9-100.0) (p = 0.001)). Initial omega-5-gliadin-sIgEs in the complicated group were also significantly higher, with a median of 15.0 kUA/L (IQR 6.3-69.8) vs 1.6 kUA/L (IQR 0.2-11.4) (p < 0.001). The risk factors for complicated cases include higher omega-5-gliadin-sIgEs and anaphylaxis during the oral food challenge test (aOR 1.035 and 5.684, respectively). CONCLUSION: The initial wheat and omega-5-gliadin-sIgEs were significant risk factors for complicated OIT patients and could be used to monitor these patients carefully during the OIT period.

MetGEMs Toolbox: Metagenome-scale models as integrative toolbox for uncovering metabolic functions and routes of human gut microbiome.

Investigating metabolic functional capability of a human gut microbiome enables the quantification of microbiome changes, which can cause a phenotypic change of host physiology and disease. One possible way to estimate the functional capability of a microbial community is through inferring metagenomic content from 16S rRNA gene sequences. Genome-scale models (GEMs) can be used as scaffold for functional estimation analysis at a systematic level, however up to date, there is no integrative toolbox based on GEMs for uncovering metabolic functions. Here, we developed the MetGEMs (metagenome-scale models) toolbox, an open-source application for inferring metabolic functions from 16S rRNA gene sequences to facilitate the study of the human gut microbiome by the wider scientific community. The developed toolbox was validated using shotgun metagenomic data and shown to be superior in predicting functional composition in human clinical samples compared to existing state-of-the-art tools. Therefore, the MetGEMs toolbox was subsequently applied for annotating putative enzyme functions and metabolic routes related in human disease using atopic dermatitis as a case study.

Feasibility of a 3-step protocol of wheat oral immunotherapy in children with severe wheat allergy.

BACKGROUND: Wheat allergy is not an uncommon event among Thai children. Despite strict avoidance, some patients developed reactions after accidental exposure to minute amount of wheat and thus disturbed their quality of life. Wheat oral immunotherapy (OIT) has been reported to be an alternative treatment for such patients. OBJECTIVE: We designed a new 3-step wheat OIT protocol for treatment of severe wheat allergy in Thai patients. The feasibility of the protocol is evaluated and is reported here in this paper. METHODS: We retrospectively reviewed medical records of 26 patients who had undergone wheat OIT during a 30-month period. The 3-step protocol consisted of an initial phase of double-blind, placebo-controlled food challenge (DBPCFC) and initiation of OIT, a build-up phase, and a maintenance phase. Patient retention in the protocol was the main outcome for this feasibility study. Adverse effects during OIT were recorded. Correlation between serum specific IgE (SpIgE) to wheat and eliciting dose in phase I was determined. RESULTS: Fourteen females and 12 males with a median age of 6 years were studied. Their median age when wheat allergy began was 8 months. Median SpIgE to wheat was high (198 kUA/L). All patients developed reactions during DBPCFC with 17 of 26 patients had moderate to severe reactions required adrenaline injections. Median of eliciting dose of wheat was exceedingly low, i.e., 20 mg of wheat protein. At the end of the study, 23 of 26 patients (88%) were still in the study. Adverse reactions during the build-up phase was frequent (13 patients, 50%), with adrenaline required in 6 occasions. Six patients reached maintenance phase. CONCLUSION: The new 3-step wheat OIT protocol was feasible in these highly wheat-sensitized patients. Despite a high retention rate, a high rate of adverse effects was observed both during DBPCFC and build-up phases.

PREVALENCE AND PREDICTORS OF BACTEREMIA AMONG CHILDREN HOSPITALIZED WITH PNEUMONIA.

National guidelines from many countries recommend obtaining blood culture from children with pneumonia upon hospitalization if the case is moderate to severe. However, etiological, microbes, and health systems vary by country and factors associated with bacteremia may also vary. We aimed to determine the prevalence and identify factors associated with bacteremia among children hospitalized with community-acquired pneumonia (CAP) in Thailand. We conducted a prospective descriptive study. The study population was children aged 60 days to 15 years hospitalized with CAP at King Chulalongkorn Memorial Hospital, Bangkok, Thailand from June 2014 to April 2015. We compared subject with positive and negative blood cultures. One hundred fifty-two children with CAP were recruited. Thirteen cases (8.6%) had a positive blood culture; 7 cases (4.6%) with a positive blood culture were considered contamination, leaving 6 (3.9%) true positive cases. The isolated organisms were Streptococcus pneumoniae, Escherichia coli, and Salmonella group B. Five factors were found to be associated with bacteremia: 1) body temperature >38.5°C [odds ratio (OR) = 9], 2) severe sepsis status (OR = 27), 3) severe respiratory distress requiring mechanical ventilation (OR = 145), 4) leukocytosis >17,000/µl (OR = 6), and 5) patchy infiltration (OR=13). Children hospitalized with community acquired pneumonia have a low rate of bacteremia. The prevalence of subjects in our study with bacteremia was 3.9% and there were 3 clinical and 2 laboratory factors significantly associated with bacteremia. This study shows that hemoculture do not need to be routinely performed in all children hospitalized with CAP.