Prognosis of food-induced anaphylaxis in children: A single-center real-life study

Background: Food allergies are known to resolve over time, but there is little information on the natural history of food-induced anaphylaxis (FIA). Objective: This study aimed to evaluate the natural history of FIA in children and determine the factors that affect prognosis. Methods: Children with FIA who were followed up for at least 3 years, between 2010 and 2020, were included. Patients' families were contacted by telephone to question their child's tolerance status and invite them for reevaluation if uncertain. The patients were grouped as tolerant or persistent according to parent reports or reevaluation results. Logistic regression analysis was performed to determine the factors that affected persistence. Results: The study included 185 patients (62.2% boys) with 243 anaphylactic reactions to various foods. Fifty-eight patients (31%) gained tolerance within a 3-year follow-up period. Tolerance rates were higher in patients with FIA to milk (40%) and egg (43.9%) compared with to tree nuts (18.8%), legumes (5.6%), and/or seafood (11.1%) (p < 0.001). In a multivariate analysis, risk factors for persistent FIA were multiple food anaphylaxis (odds ratio [OR] 3.755 [95% confidence interval {CI}, 1.134‐12.431]; p = 0.030), total IgE > 100 kU/L (OR 5.786 [95% CI, 2.065‐16.207]; p = 0.001), and skin-prick test wheal size > 10 mm (OR 4.569 [95% CI, 1.395‐14.964]; p = 0 .012) at presentation. Conclusion: Approximately a third of the patients with FIA developed tolerance within 3 years. Clinicians should remember that children with food allergies, even anaphylaxis, may develop tolerance over time. Regular follow up and reevaluation of tolerance status are necessary to avoid unnecessary elimination.

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Spontaneous dyskinesia and parkinsonism in never-medicated, chronically ill patients with schizophrenia: 18-month follow-up

The British Journal of Psychiatry ◽

10.1192/bjp.181.2.135 ◽

2002 ◽

Vol 181 (2) ◽

pp. 135-137 ◽

Cited By ~ 15

Author(s):

R. G. McCreadie ◽

R. Padmavati ◽

R. Thara ◽

T. N. Srinivasan

Keyword(s):

Natural History ◽

Disease Process ◽

Chronically Ill ◽

Abnormal Involuntary Movements ◽

Syndrome Scale ◽

History Of ◽

Chronically Ill Patients ◽

Negative Syndrome ◽

Over Time

BackgroundSpontaneous dyskinesia and parkinsonism have been reported in never-medicated patients with schizophrenia but there has been no previous study of the natural history of these conditions.AimsTo determine the prevalence of spontaneous dyskinesia and parkinsonism in a group of never-medicated, chronically ill patients with schizophrenia on two occasions separated by an 18-month interval.MethodDyskinesia was assessed by the Abnormal Involuntary Movements Scale using Schooler and Kane criteria for its presence; parkinsonism by the Simpson and Angus scale; and mental state by the Positive and Negative Syndrome Scale for schizophrenia.ResultsThirty-seven patients were examined on two occasions. Nine (24%) had dyskinesia on both occasions, 12 (33%) on one occasion and 16 (43%) on neither occasion. Twenty-one (57%) had dyskinesia on at least one occasion. Thirteen patients (35%) had parkinsonism on at least one occasion.ConclusionsSpontaneous dyskinesia and parkinsonism fluctuate over time. The former was found on at least one occasion in the majority of patients. It is an integral part ofthe schizophrenic disease process.

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Prevalence and natural history of arachnoid cysts in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.2.peds09464 ◽

2010 ◽

Vol 5 (6) ◽

pp. 578-585 ◽

Cited By ~ 139

Author(s):

Wajd N. Al-Holou ◽

Andrew Y. Yew ◽

Zackary E. Boomsaad ◽

Hugh J. L. Garton ◽

Karin M. Muraszko ◽

...

Keyword(s):

Natural History ◽

Mr Imaging ◽

Incidental Finding ◽

Arachnoid Cysts ◽

Consecutive Series ◽

Imaging Characteristics ◽

History Analysis ◽

History Of ◽

Over Time

Object Arachnoid cysts are a frequent finding on intracranial imaging in children. The prevalence and natural history of these cysts are not well defined. The authors studied a large consecutive series of children undergoing MR imaging to better define both the MR imaging–demonstrated prevalence and behavior of these lesions over time. Methods The authors reviewed a consecutive series of 11,738 patients who were 18 years of age or younger and had undergone brain MR imaging at a single institution during an 11-year period. In the patients in whom intracranial arachnoid cysts were identified, clinical and demographic information was recorded and imaging characteristics, such as cyst size and location, were evaluated. Prevalence data were analyzed using univariate and multivariate logistic regression, linear regression, and ANOVA. All patients with sufficient data (repeat MR imaging studies as well as repeated clinical evaluation over at least 5 months) for a natural history analysis were identified. This group was assessed for any change in symptoms or imaging appearance during the follow-up interval. Results Three hundred nine arachnoid cysts (2.6% prevalence rate) were identified. There was an increased prevalence of arachnoid cysts in males (p < 0.000001). One hundred eleven patients met all criteria for inclusion in the natural history analysis. After a mean follow-up of 3.5 years, 11 arachnoid cysts increased in size, 13 decreased, and 87 remained stable. A younger age at presentation was significantly associated with cyst enlargement (p = 0.001) and the need for surgery (p = 0.05). No patient older than 4 years of age at the time of initial diagnosis had cyst enlargement, demonstrated new symptoms, or underwent surgical treatment. Conclusions Arachnoid cysts are a common incidental finding on intracranial imaging in pediatric patients. An older age at the time of presentation is associated with a lack of clinical or imaging changes over time.

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Natural history of untreated syringomyelia in pediatric patients

Neurosurgical FOCUS ◽

10.3171/2011.9.focus11208 ◽

2011 ◽

Vol 31 (6) ◽

pp. E13 ◽

Cited By ~ 23

Author(s):

Ash Singhal ◽

Tim Bowen-Roberts ◽

Paul Steinbok ◽

Doug Cochrane ◽

Angela T. Byrne ◽

...

Keyword(s):

Natural History ◽

Pediatric Patients ◽

Nonoperative Treatment ◽

Motor Deficits ◽

Axial Diameter ◽

History Of ◽

Clinical Changes ◽

Changes Over Time ◽

Over Time

Object The natural history of syringomyelia in pediatric patients remains uncertain. Although symptomatic and operative cases of syringomyelia are well studied, there are fewer articles in the literature on the nonoperative syrinx and its clinical and radiological course. The purpose of this research was to analyze the natural history of untreated syringomyelia in pediatric patients presenting with minimal neurological symptoms. Methods A review of the neurosurgery database at British Columbia's Children's Hospital identified all pediatric patients (< 18 years of age) with syringes identified on MR imaging. Patients were included in this study if they had at least 2 MR images of the spine, at least 1 year apart, while receiving nonoperative treatment. Magnetic resonance imaging was used to determine changes in the size of the syrinx over time. Clinic notes were analyzed to establish demographic and clinical features and to determine any clinical changes over time. Results A total of 17 patients were included in the study. Symptoms at presentation were often mild and included limb numbness (3 cases), headaches (2 cases), mild sensory deficits (2 cases), mild motor deficits (3 cases), and intermittent incontinence (7 cases). The consultant neurosurgeon believed that the syrinx was not contributing to the symptoms in these 17 patients. The syrinx either remained unchanged (7 cases) or diminished in size (8 cases) in a total of 15 patients (88%). In the remaining 2 patients the authors noted an increase in syrinx size, in 1 of whom the clinical course also worsened. Both of these patients had a Chiari malformation and subsequently underwent craniocervical decompression. Overall, the mean change was −0.7 mm of maximal axial diameter (range −2.6 to +2.7 mm). Sixteen patients (94%) exhibited no worsening of symptoms over time. Conclusions Syringomyelia often remains stable in patients receiving nonoperative treatment. However, given that 2 (12%) of 17 syringes in this series enlarged, it is likely appropriate to include periodic imaging in the follow-up of these cases.

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The Natural History of Food Allergy

PEDIATRICS ◽

10.1542/peds.111.s3.1631 ◽

2003 ◽

Vol 111 (Supplement_3) ◽

pp. 1631-1637 ◽

Cited By ~ 2

Author(s):

Robert A. Wood

Keyword(s):

Food Allergy ◽

Natural History ◽

Food Allergies ◽

Specific Information ◽

Milk Allergy ◽

Tree Nuts ◽

History Of ◽

The Individual ◽

Over Time ◽

Specific Food

The natural history of food allergy refers to the development of food sensitivities as well as the possible loss of the same food sensitivities over time. Most food allergy is acquired in the first 1 to 2 years of life, whereas the loss of food allergy is a far more variable process, depending on both the individual child and the specific food allergy. For example, whereas most milk allergy is outgrown over time, most allergies to peanuts and tree nuts are never lost. In addition, whereas some children may lose their milk allergy in a matter of months, the process may take as long as 8 or 10 years in other children. This review provides an overview of the natural history of food allergy and provides specific information on the natural course of the most common childhood food allergies.

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Hysteria: An Evaluation of Objective Diagnostic Criteria by the Study of Women with Chronic Medical Illnesses

The British Journal of Psychiatry ◽

10.1192/bjp.114.514.1115 ◽

1968 ◽

Vol 114 (514) ◽

pp. 1115-1119 ◽

Cited By ~ 24

Author(s):

Robert A. Woodruff

Keyword(s):

Natural History ◽

Diagnostic Criteria ◽

Significant Advance ◽

Follow Up Study ◽

Clinical Observations ◽

History Of ◽

Neurological Illnesses ◽

The Stability ◽

Over Time

In 1962, Perley and Guze introduced objective criteria for the diagnosis of hysteria (Perley and Guze, 1962). These criteria were essentially a quantification of clinical observations which had appeared in the literature previously, notably in the work of Purtell, Robins and Cohen (1951). The Perley and Guze criteria for the diagnosis of hysteria offered several important advantages. First, they were derived from observations of the natural history of hysteria. They were straightforward and objective, suggesting that they could be used reliably by different clinicians in different places. Second, the criteria were accompanied by a follow-up study which indicated that diagnoses of hysteria made by means of the Perley-Guze criteria would be stable over a six to eight year period in 90 per cent. of cases. Put another way, these criteria selected a population homogeneous in prognosis. The stability of such a population over time is of particular importance. The original Perley-Guze paper and a further study by Gatfield and Guze (1962) both described the prognosis of patients selected by looser criteria. When conversion (pseudoneurologic) symptoms alone were the criteria of diagnosis, patients developed a bewildering array of psychiatric, medical and neurological illnesses within a few short years. In contrast, the Perley-Guze criteria for the diagnosis of hysteria predict prognosis accurately and represent a significant advance in descriptive, clinical psychiatry.

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Progressive Telomere Shortening Is Part of the Natural History of Chronic Lymphocytic Leukemia (CLL) and Impacts Clinical Outcome

Blood ◽

10.1182/blood.v118.21.2845.2845 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2845-2845

Author(s):

Elisa Bernocco ◽

Davide Rossi ◽

Elisa Genuardi ◽

Chiara Lobetti-Bodoni ◽

Roberto Passera ◽

...

Keyword(s):

Natural History ◽

Conflicts Of Interest ◽

Lymphocytic Leukemia ◽

Kinetic Evaluation ◽

Mutational Status ◽

Number Of Patients ◽

History Of ◽

Telomere Loss ◽

Over Time

Abstract Abstract 2845 Introduction: Telomere length (TL) at diagnosis has been established as an independent outcome predictor in CLL (Rossi et al Leukemia 2009). However data on TL dynamics over time are scant and anedoctal. Aim of this study was to evaluate telomere dynamics in the natural history of CLL. This issue has been here addressed on a series of 88 CLL patients (pts). Methods: 25 pts were assessed for TL at diagnosis and at relapse and 63 pts had two determinations during the “watch and wait” (WW) phase. The series was fully characterized in terms of Binet stage, ALC, CD38, ZAP-70, IGHV mutational status (IGHV-MS), stereotyped receptors, cytogenetics and detailed clinical history. LDH, B2-microglobulin, p53 mutations and CD49d were available in more than 70% of pts. Treatment-free survival (TFS) analysis was performed exclusively in pts undergoing kinetic evaluation during the WW phase. This population had a median follow-up of 73 months and a median TFS of 130 months. TL was analyzed as previously described (Rossi et al Leukemia 2009; Ladetto et al Blood 2004). Median time between TL determinations was 44 months (range 12–231). Telomere loss was calculated in terms of both absolute loss (AL) and yearly loss (YL). Continuous variables were compared by the Mann-Whitney test, while TFS by the stratified Kaplan-Meyer method. Results: Telomeres were shorter at follow-up compared to baseline with a median loss of 651bp (range +493bp, −5874bp; p<0.001) (Fig 1A). AL and YL were greater in cases with higher baseline TL while those with short telomeres at diagnosis had only modest additional erosion (p=ns for pts in the 25th lowest percentile) (Fig 1B). Telomere loss over time was noticeable both in pts assessed at diagnosis and at relapse as well as in those assessed during the WW phase, but clearly inferior in the former subgroup (YL of −61bp, p<0.05 and −210bp, p<0.01, respectively), possibly due to the higher number of patients with short telomeres. AL and YL did not correlate with any available clinical or biological parameter, with the exception of a positive association with IGHV-MS (p<0.05). Pts with baseline TL shorter than the validated cut-off value of 5000bp (Rossi et al Leukemia 2009) were associated to an inferior TFS (median TFS 41 months vs 182 months; p<0.0001) as expected. Moreover also Binet status and IGVH-MS were predictive for TFS in this series. Surprisingly, also an YL above the median value (-210bp) appeared to be predictive for an inferior TFS (median TFS 82 months vs 182 months; p<0.05) (Fig 1C), despite being more common in pts with longer telomeres and VH-mutated IgH genes. Following stratification of pts according to baseline TL (< or > 5000bp), YL was predictive for TFS in both pts subgroups (Fig 1D i.e. baseline TL >5000bp; YL ≥ −210bp vs YL <-210bp: TFS 88 months vs not reached p<0.01. Figure 1E i.e. baseline TL <5000bp; YL ≥-210bp vs TL <210bp: median TFS 36 months vs 50 months, p<0.01). Conclusions: The results of the first systematic analysis on TL dynamics in CLL indicate the following: i) progressive telomere erosion occurs as part of the natural history of CLL; ii) telomere loss is more pronounced when baseline TL is higher; iii) accelerated telomeric loss associates to an inferior TFS. The results described in the present analysis corroborate basic studies suggesting that telomere disruption represents a critical step associated to CLL progression. Disclosures: No relevant conflicts of interest to declare.

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RA06.04: THE DEVELOPMENT AND NATURAL HISTORY OF A HIATA HERNIA

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra06.04 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 30-31

Author(s):

Walaa Abdelmoaty ◽

Christy Dunst ◽

Jarvis Walters ◽

Carmen Tugulan ◽

Huy Doan ◽

...

Keyword(s):

Natural History ◽

Paraesophageal Hernia ◽

Conflicts Of Interest ◽

Initial Development ◽

Intrathoracic Stomach ◽

X Ray ◽

History Of ◽

Upper Gastrointestinal ◽

Over Time

Abstract Background Little is known about the initial development and natural history of a hiatal hernia. Methods A database containing 12,050 upper gastrointestinal (UGI) studies dating from 1991 to 2013 was queried to identify patients that had more than one study a minimum of 5 years apart showing a hernia. The x-ray films or digital images were reviewed and the type and size of any hernia determined. Results There were 56 patients with 133 UGI studies. On initial UGI; 13 patients had no hernia, 35 patients had a sliding hernia (SH), and 8 patients had a paraesophageal hernia (PEH). Follow-up UGI results are shown in the Figure. A third or fourth UGI study was available for 17 patients. Over a median of 41 months, the most recent UGI showed that the majority (78%) of SH increased in size, with 1 changing to PEH. Among patients with PEH, 2 were already completely intrathoracic stomachs and on most recent UGI 4 of the remaining 6 increased in size with 1 turning into complete intrathoracic stomach. Conclusion Most PEHs (77%) started out as a SH. Over time the majority of both SH and PEH increase in size, with many PEH becoming completely intrathoracic stomachs. Given the risks associated with a PEH, patients with SH should be re-evaluated for progression of their hernia. Disclosure All authors have declared no conflicts of interest.

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