Component resolved diagnostics in peanut sensitized children with and without a history of clinical reaction

2020 ◽  
Vol 41 (5) ◽  
pp. 336-340
Author(s):  
Yasmin Hamzavi Abedi ◽  
Cristina P. Sison ◽  
Punita Ponda
Keyword(s):  
Retrospective Chart Review ◽  
Clinical History ◽  
Specific Ige ◽  
Exact Test ◽  
Ara H 1 ◽  
Sige Level ◽  
History Of ◽  
Laboratory Procedures ◽  
Ige Mediated ◽  
The Relationship

Background: Serum Peanut-specific-IgE (PN-sIgE) and peanut-component-resolved-diagnostics (CRD) are often ordered simultaneously in the evaluation for peanut allergy. Results often guide the plans for peanut oral challenge. However, the clinical utility of CRD at different total PN-sIgE levels is unclear. A commonly used predefined CRD Ara h2 cutoff value in the literature predicting probability of peanut challenge outcomes is 0.35kUA/L. Objective: To examine the utility of CRD in patients with and without a history of clinical reactivity to peanut (PN). Methods: This was a retrospective chart review of 196 children with PN-sIgE and CRD testing, of which, 98 patients had a clinical history of an IgE-mediated reaction when exposed to PN and 98 did not. The Fisher's exact test was used to assess the relationship between CRD and PN-sIgE at different cutoff levels, McNemar test and Gwet’s approach (AC1 statistic) were used to examine agreement between CRD and PN-sIgE, and logistic regression was used to assess differences in the findings between patients with and without reaction history. Results: Ara h 1, 2, 3, or 9 (ARAH) levels ≤0.35 kUA/L were significantly associated with PN-sIgE levels <2 kUA/L rather than ≥2 kUA/L (p < 0.0001). When the ARAH threshold was increased to 1 kUA/L and 2 kUA/L, these thresholds were still significantly associated with PN-sIgE levels of <2, <5, and <14 kUA/L. These findings were not significantly different in patients with and without a history of clinical reactivity. Conclusion: ARAH values correlated with PN-sIgE. Regardless of clinical history, ARAH levels are unlikely to be below 0.35, 1, or 2 kUA/L if the PN-sIgE level is >2 kUA/L. Thus, if possible, practitioners should consider PN-sIgE rather than automatically ordering CRD with PN-sIgE every time. Laboratory procedures that allow automatically and reflexively adding CRD when the PN-sIgE level is ≤5 kUA/L can be helpful. However, further studies are needed in subjects with challenge-proven PN allergy.

Immunotheraphy in Allergic Diseases

2018 ◽  
Vol 24 (11) ◽  
pp. 1174-1194
Author(s):  
Albert Roger ◽  
Maria Basagana ◽  
Aina Teniente-Serra ◽  
Nathalie Depreux ◽  
Yanina Jurgens ◽  
...  
Keyword(s):  
Specific Immunotherapy ◽  
Allergic Diseases ◽  
Specific Ige ◽  
World Population ◽  
Allergen Specific Immunotherapy ◽  
Routes Of Administration ◽  
Disease Modifying Therapy ◽  
History Of ◽  
Ige Mediated ◽  
Special Case

The prevalence of allergic diseases is increasing worldwide. It is estimated that more than 30% of the world population is now affected by one or more allergic conditions and a high proportion of this increase is in young people. The diagnosis of allergy is dependent on a history of symptoms on exposure to an allergen together with the detection of allergen-specific IgE. Accurate diagnosis of allergies opens up therapeutic options. Allergen specific immunotherapy is the only successful disease-modifying therapy for IgE-mediated allergic diseases. New therapeutic strategies have been developed or are currently under clinical trials. Besides new routes of administration, new types of allergens are being developed. The use of adjuvants may amplify the immune response towards tolerance to the antigens. In this review, we analyze different antigen-specific immunotherapies according to administration route, type of antigens and adjuvants, and we address the special case of food allergy.

scholarly journals Analysis of the relationship between occlusal and clinical parameters and the need for incisor reduction in confined horses - a retrospective study

2014 ◽  
Vol 44 (11) ◽  
pp. 2052-2057
Author(s):  
Luiz Fernando Rapp de Oliveira Pimentel ◽  
André Luis do Valle De Zoppa
Keyword(s):  
Retrospective Study ◽  
Body Condition ◽  
Body Condition Score ◽  
Clinical History ◽  
Clinical Parameters ◽  
Before And After ◽  
Dental Intervention ◽  
Condition Score ◽  
History Of ◽  
The Relationship

The purpose of this retrospective study was to evaluate the relationship between occlusal and clinical parameters and the need for incisor shortening in horses. It was based on the retrospective analysis of the dental charts of 75 confined horses. Body condition score, shape of incisors, presence of dysmastication, excursion to molar contact (EMC) distance before and after cheek teeth occlusal adjustment were evaluated. History of difficult to riding, dysmastication and digestive problems was also considered. The initial measurement of lateral excursion to molar contact (EMC) revealed incisor occlusal surface abnormalities in 45 (60%) horses and long incisors (EMC>15mm) in five (6.6%) horses. Considering clinical examination and history data the need for reduction of incisor length was significant when EMC exceeded 15mm (P<0.0001) and when based on dental shape, clinical history of dysmastication and/or digestive problems or body condition score was also significant (P<0.05). In confined horses, the decision to shorten and align the incisor teeth should be based on observation and history of dysmastication and digestive problems, body condition score, incisors shape and EMC distance. The need for incisor reduction should be determined before dental intervention and reassessed following cheek teeth oclusal adjustment

Celiac Disease and Sensitization to Wheat, Rye, and Barley: Should We Be Concerned?

2020 ◽  
pp. 1-7
Author(s):  
Camila Marques de Valois Lanzarin ◽  
Natalia de Oliveira e Silva ◽  
Maissara Obara Venturieri ◽  
Dirceu Solé ◽  
Ricardo Palmero Oliveira ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Small Bowel ◽  
Case Reports ◽  
Serum Levels ◽  
Specific Ige ◽  
Age At Diagnosis ◽  
Gluten Free ◽  
Small Bowel Biopsy ◽  
History Of ◽  
Ige Mediated

<b><i>Background:</i></b> Concomitance of celiac disease (CD) and IgE-mediated wheat allergy is described in some case reports. The objective was to evaluate the frequency of sensitization to wheat, rye, barley, and malt in children and adolescents with CD. <b><i>Methods:</i></b> Measurement of serum levels of specific IgE to wheat, rye, barley, and malt (ImmunoCAP; sensitization IgE ≥0.35 kUA/L) in CD patients followed in specialized clinics to verify allergy history, general characteristics, small bowel biopsy characteristics, compliance with gluten-free diet (GFD), and occurrence of symptoms in case of noncompliance. <b><i>Results:</i></b> We evaluated 74 patients; the median of age and age at diagnosis of CD were 8.6 years (5.0–12.8) and 3.6 years (1.6–7.0), respectively. Median time of GFD was 3.5 years (1.4–5.8). History of asthma occurred in 17.3% of subjects, allergic rhinitis in 13.5%, and AD in 5.4%. Frequency of sensitization was 4% for wheat, 10.8% for rye, 5.4% for barley, and 2.7% for malt. There was no association between wheat sensitization and age at diagnosis, time of GFD, small bowel biopsy characteristics, allergy history, and gluten consumption. There was no relationship between sensitization to wheat and occurrence of immediate symptoms when not complying with GFD. <b><i>Conclusion:</i></b> In conclusion, the frequency of sensitization to wheat, rye, barley, and malt in CD patients was 4, 10.8, 5.4, and 2.7%, respectively. Therefore, to ensure that cutaneous and respiratory contact with wheat is safe, we advise patients with CD to investigate their sensitivity to wheat, rye, and barley because not all patients with CD are allergic to these cereals.

Therapy Preference and Outcomes of Hydroxyurea for Pediatric Patients with Silent Cerebral Infarcts

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3531-3531
Author(s):  
Tullia Rushton ◽  
Inmaculada Aban ◽  
Daniel Young ◽  
Thomas H. Howard ◽  
Lee Hilliard ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Sample Size ◽  
Research Funding ◽  
Retrospective Chart Review ◽  
Initial Therapy ◽  
Pediatric Radiologist ◽  
Transfusion Therapy ◽  
Exact Test ◽  
Number Of Patients ◽  
History Of

Abstract Introduction: The Silent Infarct Transfusion (SIT) Trial demonstrated that transfusion therapy over three years, as compared to no sickle cell disease (SCD) modifying therapy, reduces the risk of new CNS events, defined as an overt stroke or new or enlarged silent cerebral infarct (SCI), in patients with SCI on screening MRI. Despite the significant reduction in CNS events with transfusion therapy, patients/caregivers may choose to decline chronic transfusion therapy for secondary CNS events. Hydroxyurea is known to decrease complications of SCD, and while its impact on new CNS events in patients with a SCI has not been tested in a randomized trial, it was offered as an alternative for patients who declined transfusion therapy. We evaluated therapy preference for prevention of new CNS events among patients with SCI on screening MRI and three year outcomes of patients with SCI that elected treatment with hydroxyurea at our institution. Methods: We performed a 15-year IRB approved retrospective chart review for all patients with the diagnosis of SCI at Children's of Alabama based on their original MRI report. Ninety-two patients were identified and subsequently confirmed by an additional pediatric radiologist to have suffered a SCI and had no history of a prior overt stroke while 39 patients were excluded because of their history of overt stroke prior to the detection of a SCI. We recorded the patient/caregiver initial preference for therapy and evaluated differences in therapy selection prior to, during, and post SIT Trial. We recommend annual or biennial follow-up MRI exams to evaluate for SCI progression and recorded and reviewed all subsequent MRIs and SCD therapies for overt stroke or new or enlarged SCI. To compare outcomes of hydroxyurea for secondary CNS events to the SIT Trial, we evaluated the 27 patients with SCI that were treated with hydroxyurea (HU) for their SCI and had a subsequent MRI/MRA at least three years after their initial diagnosis of SCI. Descriptive statistics and Fisher's exact test were performed using JMP10. Sample size was calculated for a superiority trial design using a power of 85% and alpha of 5% with PASS version 14. Results: We evaluated patient/caregiver therapy preference for secondary SCI prevention among 54 patients that were not receiving a SCD modifying therapy at the time of their index SCI. We identified a significantly higher number of patients/caregivers who, after discussion with their primary SCD provider about therapeutic options, elected to initiate transfusion or enroll in the SIT Trial prior to and during SIT Trial enrollment but a higher percentage of patients/families that elected to initiate hydroxyurea after enrollment (p=0.04). Three of 36 patients (8%) elected hydroxyurea prior to and during SIT Trial enrollment as compared to 6 of 18 patients (33%) post enrollment. Among 27 participants on HU at the time of their incident SCI finding on MRI, 25 (93%) participants elected to remain on HU while only two (11%) participants elected to change to chronic transfusion therapy. The two patients that switched to transfusion also had MRA abnormalities identified at the time of their incident SCI finding. To evaluate outcomes of HU for secondary SCI prevention, 27 participants were prescribed HU for at least three years and underwent serial MRI evaluations. Three of these 27 participants developed a new SCI. Four participants had an abnormal MRA at the time of their index MRI and five patients developed an abnormal MRA on subsequent studies. The three participants that had an additional SCI had normal MRA examinations. In comparison to the SIT Trial, which identified 2.0 and 4.8 new CNS events per 100 patient years at risk for transfusion and no therapy respectively, we identified 3.7 new CNS events per 100 patient years among patients prescribed hydroxyurea. Combining our results with that of SIT Trial, a sample size of 1100 participants would be required to conduct a trial to show the superiority of transfusion over HU for secondary SCI. Conclusion: While the SIT Trial showed chronic transfusion to be superior to no therapy in preventing new CNS events in patients with SCI, patients and caregivers at our institution prefer hydroxyurea to transfusion for initial therapy to prevent secondary CNS events. A randomized trial to show superiority of transfusion over hydroxyurea for secondary stroke prevention would require a sample size too large to be practical. Disclosures Lebensburger: NHLBI: Research Funding; American Society of Hematology, Scholar Award: Research Funding.

scholarly journals Measles antibody seropositivity among children with allergic diseases: A cross-sectional study in the Japan Environment & Children’s Pilot Study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257721
Author(s):  
Mayako Saito-Abe ◽  
Kiwako Yamamoto-Hanada ◽  
Kensuke Shoji ◽  
Miori Sato ◽  
Makoto Irahara ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pediatric Population ◽  
Clinical History ◽  
Allergic Diseases ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Antibody Positivity ◽  
History Of ◽  
The Relationship

Background The relationship between allergic individuals and their responsiveness to routine vaccines has rarely been investigated. This study examined whether the seroprevalence of measles antibody differed between children with and without allergic diseases in the general pediatric population. Methods The cross-sectional study was performed within a prospective general birth cohort (a pilot study of the Japan Environment & Children’s Pilot Study [JECS]) of children aged 8 years. The clinical history of allergic diseases, measles, and the concentration of measles immunoglobulin G titers in serum enzyme immunoassay were examined. Fisher’s exact tests were used to assess the relationships between the allergic characteristics of the children and their measles antibody positivity rates. Results This study included 162 children. Any allergic disease was reported in 75 (46.3%). The measles antibody positivity rate was 94.7% among children with any allergic diseases and 92.0% among children without allergic diseases. Our results revealed no differences in measles antibody seropositivity between children with allergies and controls. Conclusions Children with allergies mount and maintain a comparable immune response to the measles vaccine.

scholarly journals Adherence to Guideline Recommendations in Patients with Thyroid Nodules

2019 ◽  
Vol 10 (1) ◽  
pp. 1-2
Author(s):  
Rudruidee Karnchanasorn ◽  
Kristine Grdinovac ◽  
Nichole Smith ◽  
Bhairvi Jani ◽  
G. John Chen
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Clinical History ◽  
Daily Practice ◽  
Needle Aspiration ◽  
History Of ◽  
Work Up ◽  
Current Guidelines

Introduction. Thyroid nodules are common and fine-needleaspiration (FNA) biopsy is the standard of care for workupto exclude thyroid cancer. In this study, we examinedthe discrepancy between daily practice and recommendeddiagnostic approach for management of thyroid nodules,based on history taking, laboratory, and imaging studies. Methods. This was a retrospective chart review of 199 patientswho had ultrasound-guided fine needle aspiration(UGFNA) performed at a Midwest academic medicalcenter from January 2010 to December 2011. Thequality measures were selected based on recommended clinicalpractice guidelines, including family history, history of neckradiation, neck symptoms, TSH test, and thyroid ultrasound. Results. The majority of patients were Caucasian females. Familyhistory of thyroid cancer and childhood neck radiation exposurewere documented in 79 subjects (40%) and 76 subjects(38%), respectively. Neck symptoms were documented in mostsubjects, including dysphonia (56.8%), dysphagia (69.9%), anddyspnea (41.2%). Most subjects had a TSH measured and an ultrasoundperformed prior to biopsy (75% and 86%, respectively). Conclusions. It appears there is a gap between current patientcare and clinical practice guidelines for management of thyroidnodules. Clinical history and ultrasound features for risk stratificationof UGFNA were lacking, which could reflect physicians’unfamiliarity with the guidelines. As thyroid nodules are common,enhancing knowledge of the current guidelines could improveappropriate work-up. Further studies are needed to identifyfactors associated with the poor compliance with clinical guidelinesin management of thyroid nodules. KS J Med 2017;10(1):1-2.

scholarly journals Adults with possible food protein-induced enterocolitis syndrome with crustacean ingestion

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Daniel H. Li ◽  
Andrew Wong-Pack ◽  
Andrea Leilani Macikunas ◽  
Harold Kim
Keyword(s):  
Time Course ◽  
Immunoglobulin E ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Food Protein ◽  
Female Predominance ◽  
Adolescents And Adults ◽  
History Of ◽  
Ige Mediated

Abstract Background Food protein-induced enterocolitis (FPIES), an entity previously thought to only affect children, has been increasingly described in adults. In this study, we report a Canadian cohort of 19 adolescents and adults with recurrent non-immunoglobulin E (IgE)-mediated gastrointestinal symptoms after crustacean ingestion, consistent with FPIES. Methods We conducted a retrospective chart review of patients in an outpatient allergy clinic from January 2005 to May 2020. Electronic records were searched using keywords for crustaceans and for symptoms consistent with FPIES. We included patients with gastrointestinal symptoms specifically to crustaceans on more than one occasion, who were 14 years or older at the time of index reaction. Exclusion criteria included symptoms suggestive of an IgE-mediated anaphylactic reaction or a likely alternative diagnosis. We identified 19 patients for our cohort who met the criteria. Results Our cohort was 68.4% female (13) and 32.6% (6) male. The average age at first reaction to crustaceans was 34 years old with a range of 14–68 years (median = 28 years; IQR = 32 years). Time from ingestion to beginning of symptoms ranged from 3 min to 6.5 h, with an average of 2.8 h (median = 2 h; IQR = 3.25 h). Duration of reaction ranged from less than a minute to over 48 h, with a mean of 9.4 h (median = 4 h; IQR = 7.75 h). Patients had 4.8 reactions on average; however, number of reactions ranged from 2 to 12.5 (median = 3, IQR = 3). All patients identified a “trigger” food in the crustacean group, and 12 subjects identified additional reactions to other seafood. Conclusions This case series will better characterize and advance our understanding of this disease entity in adults. There are key differences in the presentation of FPIES in adults compared to children, namely female predominance, difference in solid food trigger, and unpredictable time course. Future studies are needed to examine the pathophysiology and natural history of adult FPIES. Specific guidelines should be developed for the diagnosis and management in adults. Trial registration: retrospectively registered.

scholarly journals Component-Resolved Diagnostic Study of Egg Allergy in Northern Chinese Children

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Jiayi Zhang ◽  
Yongming Shen ◽  
Junpu Li ◽  
Huiqiang Li ◽  
Ping Si
Keyword(s):  
Local Population ◽  
Clinical History ◽  
Specific Ige ◽  
Egg White ◽  
Diagnostic Study ◽  
Egg Allergy ◽  
Sige Level ◽  
Specific Igg4 ◽  
Specific Igg ◽  
Egg Components

Background. Egg component-specific IgE can be useful to evaluate and diagnose egg allergy, but their prevalence and clinical significance remain unclear in the local population. Previous studies have led to contradictory results regarding the value of specific IgG and specific IgG4 in sensitization. Objective. We aimed to determine the level of specific IgE, IgG, and IgG4 antibodies to the major egg allergens in egg-allergic children. Methods. Children from 6 months to 10 years of age were recruited. Egg allergy was confirmed by either a strong clinical history or an increased egg white-sIgE level. Other allergies were diagnosed by reactivity to other allergens but without egg-related symptoms and history. The serum sIgE, sIgG, and sIgG4 levels to major egg allergenic components (Gal d 1, Gal d 2, Gal d 3, Gal d 4, and Gal d 5), sIgE level to egg white, and tIgE level were determined by light-initiated chemiluminescent assay (LICA), ELISA, or ImmunoCAP. Results. Egg-allergic children had significantly higher levels of sIgE, sIgG, and sIgG4 to egg components than nonallergic children. Gal d 2 was the predominant allergen, and Gal d 2 sIgE level correlated with the egg white-sIgE level. Ratios of sIgE/sIgG4 to egg components were highest before 1 year of age and dropped gradually in the first decade of life. Conclusion. Patterns of sIgE to egg components could distinguish different forms of egg allergy. Ratios of sIgE/sIgG4 could be useful in predicting tolerance in egg-sensitive subjects, but this needs further evaluation and investigation using more accurate models.

A Body of One’s Own: From Self-Cutting to the Cuts of Separation in an Adolescent Suffering From Traumatic Early Abandonments

2021 ◽  
Vol 69 (1) ◽  
pp. 109-135
Author(s):  
Laura Balottin ◽  
Luca Quagelli ◽  
Maria Vittoria Costantini
Keyword(s):  
Young Patient ◽  
Adolescent Girl ◽  
Clinical History ◽  
Traumatic Experiences ◽  
Self And Other ◽  
Complex Process ◽  
History Of ◽  
The Relationship

The treatment of adolescents suffering from early traumatic experiences inescapably involves the encounter with patients’ concrete use of their bodies and actions. The clinical history of an adolescent girl reveals the relationship between traumatic transgenerational abandonments and self-cutting in the transference-countertransference relationship. Initially the patient’s body and actions were the only way to communicate experiences that could not be conveyed in words and represented: the “skin for two” of the original psychosomatic envelope needed to be wounded, cut, broken concretely. The establishment of a boundary between internal and external, self and other, is the result of a complex process with roots in the quality of the encounter with the object. Gradually, in the encounter with the analyst, the young patient may construct a tenuous possibility of differentiation and begin to access the first outline of a representation of loss.

Sign in / Sign up

Export Citation Format

Share Document