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1.
Artigo em Inglês | MEDLINE | ID: mdl-35390476

RESUMO

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the most rapid response and scale-up in vaccine and therapeutic development in history. We highlight the history of these amazing achievements with a focus on the description of the classification and mechanisms of allergic reactions and adverse events relevant to the allergist and immunologist that have been associated with the SARS-CoV-2 vaccines. Finally, we offer a detailed management approach in the context of a possible allergic reaction. DATA SOURCES: Using defined search strategy, we identified peer-reviewed articles within PubMed that were published between January 1, 2019, and December 4, 2021. STUDY SELECTIONS: All recent articles on COVID-19 published in English were reviewed with focus on the immunogenicity and allergenicity of the current existing COVID-19 vaccines. RESULTS: Following a detailed literature review, we discuss the evolution and development of the new vaccines for SARS-CoV-2. Furthermore, we provide evidence regarding the significance and mechanisms of allergic reactions associated with the vaccines and offer a management approach for those with an increased risk of presenting an allergic or other relevant vaccine reaction. CONCLUSION: The international rollout of COVID-19 vaccination started with reports of immediate allergic reactions. Although we still need to understand the mechanisms of these reactions, we can be reassured that patients with underlying allergic disease will not need to avoid SARS-CoV-2 vaccination. In addition, the vast majority of those with a first-dose reaction will tolerate subsequent doses.

2.
Hum Vaccin Immunother ; : 1-6, 2022 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-35475949

RESUMO

Ethnic minorities account for 8% of the Hong Kong population, most are Filipino and Indonesian domestic helpers taking care of children and the elderly. To understand the COVID-19 vaccination rates and factors associated with vaccine acceptance of ethnic minorities, we performed a cross-sectional questionnaire study recruiting Hong Kong ethnic minorities aged ≥18 years between 1 July and 18 July 2021 in public areas. Demographics, knowledge about COVID-19, vaccination status, intention and reasons to receive the vaccine, and planning to be re-vaccinated were analyzed. Continuous and categorical variables were compared using unpaired t-test and Chi-square test, respectively. Potential confounders were adjusted using multiple logistic regression. 2,012 ethnic minorities participated, with a mean age of 39 years, of which 97.6% were female, 79.5% were Filipino, and 17.5% were Indonesian. 80.6% of participants were categorized as vaccine acceptance, and 69.2% were willing to be re-vaccinated. There were significantly more Filipinos than Indonesians in the vaccine acceptance group (p < .001). Subjects in the vaccine acceptance group were more likely to have higher education (p < .001), a higher COVID-19 knowledge score (p < .001), received information from the Government website (p = .003) and not from their friends or family members (p = .02), and were more confident in judging the accuracy of the information (p < .001). Logistic regression showed the mean knowledge score (ß = 3.07, p < .001) and receiving information from official Government websites (adjusted OR = 1.37, p = .03) were significant factors that positively influenced vaccine acceptance. The Hong Kong Government should improve COVID-19 vaccination acceptance among ethnic minorities through public education using official channels.

3.
Child Abuse Negl ; : 105457, 2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-35033372

RESUMO

BACKGROUND: Children with special educational needs (SEN) are more vulnerable during the COVID-19 pandemic with risk of poor mental wellbeing and child maltreatment. OBJECTIVE: To examine the impact of COVID-19 on the mental health of children with SEN and their maltreatment risk. PARTICIPANTS AND SETTING: 417 children with SEN studying at special schools and 25,427 children with typical development (TD) studying at mainstream schools completed an online survey in April 2020 in Hong Kong during school closures due to COVID-19. METHOD: Emotional/behavioural difficulties, quality of life and parental stress of children with SEN were compared with typically developed children using mixed effect model. Linear regression analyses were performed to explore factors associated with child emotional/behavioural difficulties and parental stress during the pandemic. Chi-square test was performed to detect the differences in maltreatment risk before and during COVID-19. RESULTS: Children with SEN had significantly poorer overall quality of life (68.05 vs 80.65, p < 0.01). 23.5% of children had at least one episode of severe physical assault and 1.9% experienced very severe physical assault during COVID-19. Rates of physical assault increased significantly (59.8% vs. 71.2% p < 0.001) while children with mental disorders had increased risk of severe physical assault comparing to those without mental disorders (RR = 1.58, ꭓ2 = 5.19 p = 0.023). CONCLUSION: Children with SEN had poorer mental health than typically developed children during the COVID-19 pandemic. Maltreatment risk for children with SEN is higher in comparison to pre-COVID-19 era. Surveillance of child maltreatment, continuity of medical and rehabilitation care to support children with SEN are essential during a disease pandemic.

5.
Ann Rheum Dis ; 81(3): 406-415, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34789453

RESUMO

OBJECTIVES: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, delayed hypersensitivity reaction (DHR). We observed DRESS to inhibitors of interleukin 1 (IL-1) or IL-6 in a small group of patients with Still's disease with atypical lung disease. We sought to characterise features of patients with Still's disease with DRESS compared with drug-tolerant Still's controls. We analysed human leucocyte antigen (HLA) alleles for association to inhibitor-related DHR, including in a small Kawasaki disease (KD) cohort. METHODS: In a case/control study, we collected a multicentre series of patients with Still's disease with features of inhibitor-related DRESS (n=66) and drug-tolerant Still's controls (n=65). We retrospectively analysed clinical data from all Still's subjects and typed 94/131 for HLA. European Still's-DRESS cases were ancestry matched to International Childhood Arthritis Genetics Consortium paediatric Still's cases (n=550) and compared for HLA allele frequencies. HLA association also was analysed using Still's-DRESS cases (n=64) compared with drug-tolerant Still's controls (n=30). KD subjects (n=19) were similarly studied. RESULTS: Still's-DRESS features included eosinophilia (89%), AST-ALT elevation (75%) and non-evanescent rash (95%; 88% involving face). Macrophage activation syndrome during treatment was frequent in Still's-DRESS (64%) versus drug-tolerant Still's (3%; p=1.2×10-14). We found striking enrichment for HLA-DRB1*15 haplotypes in Still's-DRESS cases versus INCHARGE Still's controls (p=7.5×10-13) and versus self-identified, ancestry-matched Still's controls (p=6.3×10-10). In the KD cohort, DRB1*15:01 was present only in those with suspected anakinra reactions. CONCLUSIONS: DRESS-type reactions occur among patients treated with IL-1/IL-6 inhibitors and strongly associate with common HLA-DRB1*15 haplotypes. Consideration of preprescription HLA typing and vigilance for serious reactions to these drugs are warranted.


Assuntos
Antirreumáticos/efeitos adversos , Cadeias HLA-DRB1/genética , Hipersensibilidade Tardia/genética , Doença de Still de Início Tardio/tratamento farmacológico , Doença de Still de Início Tardio/genética , Adulto , Alelos , Estudos de Casos e Controles , Síndrome de Hipersensibilidade a Medicamentos/genética , Síndrome de Hipersensibilidade a Medicamentos/imunologia , Tolerância a Medicamentos/genética , Feminino , Cadeias HLA-DRB1/imunologia , Haplótipos , Humanos , Hipersensibilidade Tardia/imunologia , Interleucina-1/antagonistas & inibidores , Interleucina-6/antagonistas & inibidores , Masculino , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Síndrome de Linfonodos Mucocutâneos/genética , Estudos Retrospectivos , Doença de Still de Início Tardio/imunologia
6.
J Hematol Oncol ; 14(1): 182, 2021 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-34717720

RESUMO

Asparaginase is an important drug to treat childhood haematological malignancies. Data on the association between human leukocyte antigens (HLA) and asparaginase hypersensitivity among Chinese are lacking. We conducted a retrospective study to identify HLA alleles associated with asparaginase hypersensitivity among Chinese children with acute lymphoblastic leukaemia (ALL), mixed phenotype leukaemia and non-Hodgkin lymphoma (NHL), who received asparaginases with HLA typing performed between 2009 and 2019. 107 Chinese patients were analysed. 66.3% (71/107) developed hypersensitivity to at least one of the asparaginases. HLA-B*46:01 (OR 3.8, 95% CI 1.4-10.1, p < 0.01) and DRB1*09:01 (OR 4.3, 95% CI 1.6-11.4, p < 0.01) were significantly associated with L-asparaginase hypersensitivities, which remained significant after adjustment for age, gender and B cell ALL [HLA-B*46:01 (adjusted OR 3.5, 95% 1.3-10.5, p = 0.02) and DRB1*09:01 (OR 4.4, 95% CI 1.6-13.3, p < 0.01)].


Assuntos
Antineoplásicos/efeitos adversos , Asparaginase/efeitos adversos , Hipersensibilidade a Drogas/genética , Antígenos HLA/genética , Alelos , Antineoplásicos/uso terapêutico , Asparaginase/uso terapêutico , Criança , Pré-Escolar , China/epidemiologia , Hipersensibilidade a Drogas/etiologia , Feminino , Predisposição Genética para Doença , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Estudos Retrospectivos
7.
JAMA Netw Open ; 4(5): e218824, 2021 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-33938934

RESUMO

Importance: Schools were closed intermittently across Hong Kong to control the COVID-19 outbreak, which led to significant physical and psychosocial problems among children and youths. Objective: To compare the clinical characteristics and sources of infection among children and youths with COVID-19 during the 3 waves of outbreaks in Hong Kong in 2020. Design, Setting, and Participants: This cross-sectional study involved children and youths aged 18 years or younger with COVID-19 in the 3 waves of outbreaks from January 23 through December 2, 2020. Data were analyzed from December 2020 through January 2021. Main Outcomes and Measures: Demographic characteristics, travel and contact histories, lengths of hospital stay, and symptoms were captured through the central electronic database. Individuals who were infected without recent international travel were defined as having domestic infections. Results: Among 397 children and youths confirmed with COVID-19 infections, the mean (SD) age was 9.95 (5.34) years, 220 individuals (55.4%) were male, and 154 individuals (38.8%) were asymptomatic. There were significantly more individuals who were infected without symptoms in the second wave (59 of 118 individuals [50.0%]) and third wave (94 of 265 individuals [35.5%]) than in the first wave (1 of 14 individuals [7.1%]) (P = .001). Significantly fewer individuals who were infected in the second and third waves, compared with the first wave, had fever (first wave: 10 individuals [71.4%]; second wave: 22 individuals [18.5%]; third wave: 98 individuals [37.0%]; P < .001) or cough (first wave: 6 individuals [42.9%]; second wave: 15 individuals [12.7%]; third wave: 52 individuals [19.6%]; P = .02). Among all individuals, 394 individuals (99.2%) had mild illness. One patient developed chilblains (ie, COVID toes), 1 patient developed multisystem inflammatory syndrome in children, and 1 patient developed post-COVID-19 autoimmune hemolytic anemia. In all 3 waves, 204 patients with COVID-19 (51.4%) had domestic infections. Among these individuals, 186 (91.2%) reported having a contact history with another individual with COVID-19, of which most (183 individuals [90.0%]) were family members. In the third wave, 18 individuals with domestic infections had unknown contact histories. Three schoolmates were confirmed with COVID-19 on the same day and were reported to be close contacts. Conclusions and Relevance: This cross-sectional study found that nearly all children and youths with COVID-19 in Hong Kong had mild illness. These findings suggest that household transmission was the main source of infection for children and youths with domestic infections and that the risk of being infected at school was small.


Assuntos
Infecções Assintomáticas/epidemiologia , COVID-19 , Busca de Comunicante , SARS-CoV-2/isolamento & purificação , Avaliação de Sintomas , Adolescente , COVID-19/epidemiologia , COVID-19/terapia , COVID-19/transmissão , Criança , Busca de Comunicante/métodos , Busca de Comunicante/estatística & dados numéricos , Estudos Transversais , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Características da Família , Feminino , Hong Kong/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Índice de Gravidade de Doença , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos , Doença Relacionada a Viagens
8.
Front Immunol ; 12: 797919, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34975908

RESUMO

Persistence of protective immunity for SARS-CoV-2 is important against reinfection. Knowledge on SARS-CoV-2 immunity in pediatric patients is currently lacking. We opted to assess the SARS-CoV-2 adaptive immunity in recovered children and adolescents, addressing the pediatrics specific immunity towards COVID-19. Two independent assays were performed to investigate humoral and cellular immunological memory in pediatric convalescent COVID-19 patients. Specifically, RBD IgG, CD4+, and CD8+ T cell responses were identified and quantified in recovered children and adolescents. SARS-CoV-2-specific RBD IgG detected in recovered patients had a half-life of 121.6 days and estimated duration of 7.9 months compared with baseline levels in controls. The specific T cell response was shown to be independent of days after diagnosis. Both CD4+ and CD8+ T cells showed robust responses not only to spike (S) peptides (a main target of vaccine platforms) but were also similarly activated when stimulated by membrane (M) and nuclear (N) peptides. Importantly, we found the differences in the adaptive responses were correlated with the age of the recovered patients. The CD4+ T cell response to SARS-CoV-2 S peptide in children aged <12 years correlated with higher SARS-CoV-2 RBD IgG levels, suggesting the importance of a T cell-dependent humoral response in younger children under 12 years. Both cellular and humoral immunity against SARS-CoV-2 infections can be induced in pediatric patients. Our important findings provide fundamental knowledge on the immune memory responses to SARS-CoV-2 in recovered pediatric patients.


Assuntos
Imunidade Adaptativa/imunologia , Anticorpos Neutralizantes/imunologia , Anticorpos Antivirais/imunologia , COVID-19/imunologia , Convalescença , SARS-CoV-2/imunologia , Adolescente , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD4-Positivos/virologia , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Linfócitos T CD8-Positivos/virologia , COVID-19/virologia , Criança , Pré-Escolar , Feminino , Humanos , Imunidade Humoral/imunologia , Imunoglobulina G/imunologia , Masculino , SARS-CoV-2/metabolismo , SARS-CoV-2/fisiologia , Glicoproteína da Espícula de Coronavírus/imunologia , Glicoproteína da Espícula de Coronavírus/metabolismo
9.
Int J Infect Dis ; 81: 110-113, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30772467

RESUMO

We report the first case of microabscesses detected by polymerase chain reaction (PCR) amplification of nucleic acid from ultrasound-guided aspirated fluid in a three-year old boy with acute lymphoblastic leukemia and febrile neutropenia during induction chemotherapy. Fever persisted despite effective antifungal treatment. The addition of corticosteroid therapy successfully controlled the suspected immune reconstitution inflammatory syndrome (IRIS). This case highlights the utility of PCR and adjunctive corticosteroid in the approach of Candida tropicalis renal microabscesses in leukemic patients undergoing chemotherapy.


Assuntos
Abscesso/tratamento farmacológico , Corticosteroides/uso terapêutico , Antifúngicos/uso terapêutico , Candida tropicalis , Candidíase/tratamento farmacológico , Nefropatias/tratamento farmacológico , Técnicas de Amplificação de Ácido Nucleico/métodos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Pré-Escolar , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Ultrassonografia de Intervenção
10.
Asian Pac J Allergy Immunol ; 37(3): 179-182, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29981563

RESUMO

A seven-year-old girl developed angioedema and a generalized, erythematous rash several hours after receiving lignocaine with adrenaline reproducible on provocative challenge, confirming the first known case of generalized delayed-type hypersensitivity to local anaesthetics with cross-reactivity to bupivacaine but not chloroprocaine.


Assuntos
Anestésicos Locais/efeitos adversos , Reações Cruzadas/imunologia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Tardia/imunologia , Alérgenos/imunologia , Criança , Feminino , Humanos , Pele/patologia
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