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1.
Eur J Pediatr ; 182(8): 3419-3431, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37249680

RESUMEN

The "Atopy Patch Test" (APT) has been proposed as a diagnostic tool for food allergies (FA), especially in children with FA-related gastrointestinal symptoms. However, its diagnostic accuracy is debated, and its usefulness is controversial. The aim of this systematic review was to evaluate the APT diagnostic accuracy compared with the diagnostic gold standard, i.e., the oral food challenge (OFC), in children affected by non-IgE mediated gastrointestinal food allergies, including the evaluation in milk allergic subgroup. Both classical non-IgE mediated clinical pictures and food induced motility disorders (FPIMD) were considered. The search was conducted in PubMed and Scopus from January 2000 to June 2022 by two independent researchers. The patient, intervention, comparators, outcome, and study design approach (PICOS) format was used for developing key questions, to address the APT diagnostic accuracy compared with the oral food challenge (OFC). The quality of the studies was assessed by the QUADAS-2 system. The meta-analysis was performed to calculate the pooled sensitivity, specificity, DOR (diagnostic odds ratio), PLR (positive likelihood ratio), and NLR (negative likelihood ratio) with their 95% confidence intervals (CI). Out of the 457 citations initially identified via the search (196 on PubMed and 261 on Scopus), 37 advanced to full-text screening, and 16 studies were identified to be included in the systematic review. Reference lists from relevant retrievals were searched, and one additional article was added. Finally, 17 studies were included in the systematic review. The analysis showed that APT has a high specificity of 94% (95%CI: 0.88-0.97) in the group of patients affected by FPIMD. Data showed a high pooled specificity of 96% (95% CI: 0.89-0.98) and the highest accuracy of APT in patients affected by cow's milk allergy (AUC = 0.93).      Conclusion: APT is effective in identifying causative food in children with food-induced motility disorders.  What is Known: • Atopy patch test could be a useful diagnostic test for diagnosing food allergy, especially in children with food allergy-related gastrointestinal symptoms. What is New: • Atopy patch test may be a useful tool in diagnosing non IgE food allergy, especially in children with food-induced gastrointestinal motility disorders and cow's milk allergy.


Asunto(s)
Hipersensibilidad a los Alimentos , Enfermedades Gastrointestinales , Hipersensibilidad Inmediata , Hipersensibilidad a la Leche , Femenino , Animales , Bovinos , Niño , Humanos , Pruebas del Parche/efectos adversos , Hipersensibilidad a la Leche/complicaciones , Hipersensibilidad a la Leche/diagnóstico , Sensibilidad y Especificidad , Hipersensibilidad a los Alimentos/diagnóstico , Alérgenos , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/etiología
6.
Ital J Pediatr ; 50(1): 194, 2024 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-39334454

RESUMEN

BACKGROUND: Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare complication, which develops within 3-6 weeks after SARS-CoV2 infection. The coronavirus disease 2019 (COVID-19) vaccine was firstly introduced in adults and adolescents and later in patients aged 5-11 years old. Although a reduced incidence of MIS-C and with less severe symptoms has been reported in vaccinated adolescents, there is little knowledge in children younger than 12 years of age. In addition, it is not understood whether MIS-C in vaccinated patients can be triggered by Covid19 vaccination or be secondary to a recent asymptomatic Sars-Cov2 infection. CASE PRESENTATION: We describe the case of a Caucasian 6-year-old girl, one month after double COVID-19 vaccination, who presented fever, acute abdominal pain, rash, pharyngotonsillitis, cheilitis, cervical lymphadenopathy without a prior detected Sars-Cov2 infection. She also had lymphopenia, increase in inflammatory markers, cardiac and pulmonary involvement. Therefore, we dosed both anti Sars-Cov2 Spike and Nucleocapsid antibodies, which were positive and allowed us to confirm the diagnosis of MIS-C. We promptly administered intravenous immunoglobulins and methylprednisone, resulting in the initial regression of fever. During the hospitalization, the child also developed pancreatitis and severe neurological involvement, including irritability, drowsiness, distal tremor, dyskinesia and buccal asymmetry with complete resolution after 2 months. After 3 months from the onset of the symptoms, she reported a transient loss of hair compatible with telogen effluvium. After 12 months of follow-up, she did not show any symptomatic sequelae. CONCLUSIONS: This case raises the question of whether COVID-19 vaccination may be involved in the pathogenesis of MIS-C in children between the ages of 5 and 11 years old.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Síndrome de Respuesta Inflamatoria Sistémica , Humanos , Femenino , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Niño , COVID-19/prevención & control , COVID-19/complicaciones , Vacunas contra la COVID-19/efectos adversos , SARS-CoV-2 , Infecciones Asintomáticas
7.
Curr Opin Allergy Clin Immunol ; 20(2): 149-154, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31985547

RESUMEN

PURPOSE OF REVIEW: In allergy, personalized medicine passes through the assessment of molecular allergens sensitization profiles. Such technique may help to better diagnose and treat patients suffering from allergic respiratory diseases. RECENT FINDINGS: Different laboratory tests are available today to assess sensitization to molecular allergens, from singleplex assays, to unspecific, screening multiplex assays, mainly performed through microarrays or macroarrays. It is important to collect both results from specific IgE toward allergen extracts and toward molecular allergens, to collect the most complete information on the patient's profile, and therefore to highlight genuine sensitization, and exclude cross-reaction and sensitization because of pan-allergens. Being able to know the exact molecular sensitization profile of the patient, also helps predicting the possible evolution of the disease, and targeting the most appropriate allergen immunotherapy treatment to prescribe. SUMMARY: Even though a cost-effective analysis of running multiple assays in allergic patients has not been performed yet, such technique proved to be more efficient in detecting the appropriate treatment in each patient and in analyzing the true sensitization profile in patients suffering from allergic rhinitis, conjunctivitis, and asthma.


Asunto(s)
Asma/diagnóstico , Desensibilización Inmunológica/métodos , Pruebas Inmunológicas/métodos , Técnicas de Diagnóstico Molecular/métodos , Rinitis Alérgica/diagnóstico , Alérgenos/administración & dosificación , Alérgenos/inmunología , Asma/inmunología , Asma/terapia , Reacciones Cruzadas , Desensibilización Inmunológica/efectos adversos , Humanos , Inmunoglobulina E/inmunología , Rinitis Alérgica/inmunología , Rinitis Alérgica/terapia , Resultado del Tratamiento
10.
Toxins (Basel) ; 10(10)2018 10 11.
Artículo en Inglés | MEDLINE | ID: mdl-30314315

RESUMEN

Urea at post-dialysis levels induces increased ROS in a number of cell types. The aim of this study was to determine whether urea-induced production of ROS remains elevated after urea is no longer present, and, if it does, to characterize its origin and effects. Human arterial endothelial cells were incubated with 20 mM urea for two days, and then cells were incubated for an additional two days in medium alone. Maximal ROS levels induced by initial urea continued at the same level despite urea being absent. These effects were prevented by either MnSOD expression or by Nox1/4 inhibition with GKT13781. Sustained urea-induced ROS caused a persistent reduction in mtDNA copy number and electron transport chain transcripts, a reduction in transcription of mitochondrial fusion proteins, an increase in mitochondrial fission proteins, and persistent expression of endothelial inflammatory markers. The SOD-catalase mimetic MnTBAP reversed each of these. These results suggest that persistent increases in ROS after cells are no long exposed to urea may play a major role in continued kidney damage and functional decline despite reduction of urea levels after dialysis.


Asunto(s)
Células Endoteliales/efectos de los fármacos , Mitocondrias/efectos de los fármacos , Urea/farmacología , Células Cultivadas , Células Endoteliales/metabolismo , Humanos , Mitocondrias/fisiología , Dinámicas Mitocondriales/efectos de los fármacos , Especies Reactivas de Oxígeno/metabolismo
12.
Pediatr Pulmonol ; 50(5): 511-24, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25604054

RESUMEN

Vascular rings are congenital anomalies that lead to variable degrees of respiratory problems or feeding difficulties by forming a complete or partial ring compressing the trachea, the bronchi, and the esophagus. The clinical diagnosis of vascular rings is often challenging for the pediatrician because the clinical manifestations are heterogeneous and nonspecific. Symptoms can vary from wheezing, stridor, dyspnea, and/or dysphagia to life-threatening conditions; however, they may not be present. The aim of this study is to review the recent literature on this subject and describe new developments in diagnostics and imaging.


Asunto(s)
Trastornos de Deglución/etiología , Disnea/etiología , Ruidos Respiratorios/etiología , Malformaciones Vasculares/complicaciones , Aorta Torácica/anomalías , Aorta Torácica/embriología , Tronco Braquiocefálico/anomalías , Tronco Braquiocefálico/embriología , Bronquios , Esófago , Humanos , Lactante , Presión , Arteria Pulmonar/anomalías , Arteria Pulmonar/embriología , Arteria Subclavia/anomalías , Arteria Subclavia/embriología , Tráquea , Malformaciones Vasculares/diagnóstico , Malformaciones Vasculares/embriología
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