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Schuler CF, Lukacs NW, Baker JR. Recent patents in allergy and immunology: Transepidermal water loss for anaphylaxis monitoring. Allergy 2024; 79:765-766. [PMID: 38205722 PMCID: PMC10922900 DOI: 10.1111/all.16017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Affiliation(s)
- Charles F Schuler
- Mary H. Weiser Food Allergy Center, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas W Lukacs
- Mary H. Weiser Food Allergy Center, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pathology, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - James R Baker
- Mary H. Weiser Food Allergy Center, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Nanotechnology Institute for Medicine and the Biomedical Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
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Kim D, Kim W, Kim J, Lee HK, Joo J, Kim B, Allen MG, Lu D, Venkatesh V, Huang Y, Yu KJ, Park YJ, Kim MK, Han S, Won SM. Optimal bilayer composites for temperature-tracking wireless electronics. NANOSCALE 2024. [PMID: 38412042 DOI: 10.1039/d3nr05784d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Modern silicone-based epidermal electronics engineered for body temperature sensing represent a pivotal development in the quest for advancing preventive medicine and enhancing post-surgical monitoring. While these compact and highly flexible electronics empower real-time monitoring in dynamic environments, a noteworthy limitation is the challenge in regulating the infiltration or obstruction of heat from the external environment into the surface layers of these electronics. The study presents a cost-effective temperature sensing solution by embedding wireless electronics in a multi-layered elastomeric composite to meet the dual needs of enhanced thermal insulation for encapsulation in contact with air and improved thermal conductivity for the substrate in contact with the skin. The encapsulating composite benefits from the inclusion of hollow silica microspheres, which reduce the thermal conductivity by 40%, while non-spherical aluminum nitride enhances the thermal conductivity of the substrate by 370%. The addition of particles to the respective composites inevitably leads to an increase in modulus. Two composite elements are engineered to coexist while maintaining a matching low modulus of 3.4 MPa and a stretchability exceeding 30%, all without compromising the optimized thermal properties. Consecutive thermal, electrical, and mechanical characterization confirms the sensor's capacity for precise body temperature monitoring during a single day's lifespan, while also assessing the influence of behavioral factors on body temperature.
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Affiliation(s)
- Doyoung Kim
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, 16419, Korea.
| | - Wooseok Kim
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, 16419, Korea.
| | - Jihwan Kim
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, 16419, Korea.
| | - Hee Kyu Lee
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, 16419, Korea.
| | - Janghoon Joo
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, 16419, Korea.
| | - Bogeun Kim
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, 16419, Korea.
| | - Mark G Allen
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dengyang Lu
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Vishal Venkatesh
- Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yanghang Huang
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ki Jun Yu
- Functional Bio-integrated Electronics and Energy Management Lab, School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Young-Jin Park
- KERI (Korea Electrotechnology Research Institute), 111, Hanggaul-ro, Sangrok-gu, Ansan, 15588, Republic of Korea
| | - Mu Kyung Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Korea
| | - Seungyong Han
- Multiscale Bioinspired Technology Lab, Department of Mechanical Engineering, Ajou University, 206, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499 Republic of Korea
| | - Sang Min Won
- Department of Electrical and Computer Engineering, Sungkyunkwan University, Suwon, 16419, Korea.
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Krzych-Fałta E, Czerwińska ME, Białek S, Furmańczyk K, Samoliński B, Grodner B, Sybilski A, Nowicka G, Wojas O. Methodological Principles of Nasal Food Challenge. Nutrients 2023; 15:3816. [PMID: 37686848 PMCID: PMC10489609 DOI: 10.3390/nu15173816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Thanks to their valuable assessment possibilities (subjective complaints and changes in nasal patency during the examination), nasal provocation tests may serve as an alternative tool for oral food challenges in the future. However, this test requires successive attempts to regulate its methodology in order to develop a standardized lyophilisate form and determine the threshold dose for a positive result. The study objective was to present the methodological foundation for nasal food allergen provocation tests induced by freeze-dried powdered chicken egg whites. A control group of 25 individuals with no history of allergy to chicken eggs or any other allergy was included in the study. Optical rhinometry and visual analog scales were used to assess the response of nasal mucosa to local allergen challenges. Minor variations in nasal flows, as measured by optical rhinometry, were observed in the provocation tests. The mean optical density measurements (as measured regardless of the allergen dose used) varied from positive to negative values and vice versa, e.g., amounting to 0.018 OD (standard deviation 0.095) at 15 min and -0.011 OD (standard deviation 0.090) at 30 min. No significant differences were observed concerning the perceived nasal discomfort using the visual analog scale. Due to the absence of nasal mucosal reactivity, nasal challenge is an excellent methodological tool for implementing food allergen tests.
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Affiliation(s)
- Edyta Krzych-Fałta
- Department of Basic Nursing, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Monika E. Czerwińska
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.E.C.); (B.G.); (G.N.)
| | - Sławomir Białek
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.E.C.); (B.G.); (G.N.)
| | - Konrad Furmańczyk
- Institute of Information Technology, Warsaw University of Life Sciences, 02-776 Warsaw, Poland;
| | - Bolesław Samoliński
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland; (B.S.); (O.W.)
| | - Błażej Grodner
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.E.C.); (B.G.); (G.N.)
| | - Adam Sybilski
- 2nd Department of Pediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Grażyna Nowicka
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.E.C.); (B.G.); (G.N.)
| | - Oksana Wojas
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland; (B.S.); (O.W.)
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Schuler CF, O’Shea KM, Troost JP, Kaul B, Launius CM, Cannon J, Manthei DM, Freigeh GE, Sanders GM, Hogan SP, Lukacs NW, Baker JR. Transepidermal water loss rises before food anaphylaxis and predicts food challenge outcomes. J Clin Invest 2023; 133:e168965. [PMID: 37402149 PMCID: PMC10425212 DOI: 10.1172/jci168965] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUNDFood allergy (FA) is a growing health problem requiring physiologic confirmation via the oral food challenge (OFC). Many OFCs result in clinical anaphylaxis, causing discomfort and risk while limiting OFC utility. Transepidermal water loss (TEWL) measurement provides a potential solution to detect food anaphylaxis in real time prior to clinical symptoms. We evaluated whether TEWL changes during an OFC could predict anaphylaxis onset.METHODSPhysicians and nurses blinded to the TEWL results conducted and adjudicated the results of all 209 OFCs in this study. A study coordinator measured TEWL throughout the OFC and had no input on the OFC conduct. TEWL was measured 2 ways in 2 separate groups. First, TEWL was measured using static, discrete measurements. Second, TEWL was measured using continuous monitoring. Participants who consented provided blood samples before and after the OFCs for biomarker analyses.RESULTSTEWL rose significantly (2.93 g/m2/h) during reactions and did not rise during nonreacting OFCs (-1.00 g/m2/h). Systemic increases in tryptase and IL-3 were also detected during reactions, providing supporting biochemical evidence of anaphylaxis. The TEWL rise occurred 48 minutes earlier than clinically evident anaphylaxis. Continuous monitoring detected a significant rise in TEWL that presaged positive OFCs, but no rise was seen in the OFCs that resulted in no reaction, providing high predictive specificity (96%) for anaphylaxis against nonreactions 38 minutes prior to anaphylaxis onset.CONCLUSIONSDuring OFCs, a TEWL rise anticipated a positive clinical challenge. TEWL presents a monitoring modality that may predict food anaphylaxis and facilitate improvements in OFC safety and tolerability.
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Affiliation(s)
- Charles F. Schuler
- Division of Allergy and Clinical Immunology, Department of Internal Medicine
- Mary H. Weiser Food Allergy Center
| | - Kelly M. O’Shea
- Division of Allergy and Clinical Immunology, Department of Internal Medicine
- Mary H. Weiser Food Allergy Center
| | | | | | | | - Jayme Cannon
- Mary H. Weiser Food Allergy Center
- Michigan Nanotechnology Institute for the Biomedical Sciences, and
| | - David M. Manthei
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - George E. Freigeh
- Division of Allergy and Clinical Immunology, Department of Internal Medicine
| | - Georgiana M. Sanders
- Division of Allergy and Clinical Immunology, Department of Internal Medicine
- Mary H. Weiser Food Allergy Center
| | - Simon P. Hogan
- Mary H. Weiser Food Allergy Center
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas W. Lukacs
- Mary H. Weiser Food Allergy Center
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - James R. Baker
- Division of Allergy and Clinical Immunology, Department of Internal Medicine
- Mary H. Weiser Food Allergy Center
- Michigan Nanotechnology Institute for the Biomedical Sciences, and
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Krzych-Fałta E, Wojas O, Samel-Kowalik P, Samoliński B, Sybilski A, Białek S. Oral and nasal provocation test in chicken egg allergy-case report. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:70. [PMID: 37580833 PMCID: PMC10426171 DOI: 10.1186/s13223-023-00829-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/25/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Allergy to chicken egg protein is a common form of food allergy. The most common clinical presentation includes gastrointestinal, skin, and respiratory symptoms. Differential diagnosis, including provocative tests, is critical in diagnosis. CASE DESCRIPTION We present a case of a 21-year-old patient with egg allergy, who underwent a double-blind food provocation test with placebo (evaluating subjective complaints from the gastrointestinal tract) and a titrated nasal provocation test using dry chicken egg content. We assessed the response of the nasal mucosa in the provocation test using the visual analogue scale (VAS), acoustic and optical rhinometry, as well as measurements of nitric oxide concentration in the exhaled air. During the provocation test, we measured the changes in the transverse section of the nasal passages, which were accompanied by subjective complaints measured with the VAS scale, using objective techniques. In the nasal provocation test with a dose of 20 µg of chicken egg protein, we observed an increase in the reactivity of the nasal mucosa and a decrease in the level of nitric oxide in the exhaled air from the upper airways (920 ppb before the provocation test and up to 867 ppb during the early stage of the allergic reaction). During the provocation tests, we recorded typical symptoms associated with the early stage of the allergic reaction; including nasal obstruction (1.2 cm), leakage of watery discharge (0.8 cm) in the food test, and itchy nose (1.1 cm) in the food test vs. the nasal test: 4.6, 2.8, and 3.5 cm, respectively. CONCLUSIONS The nasal mucosa provides convenient conditions for evaluation of the severity of allergy to common food allergens, including chicken egg allergens.
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Affiliation(s)
- E Krzych-Fałta
- Department of Basic of Nursing, Medical University of Warsaw, Warsaw, Poland
| | - O Wojas
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Banacha 1a Str, 02097, Warsaw, Poland.
| | - P Samel-Kowalik
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Banacha 1a Str, 02097, Warsaw, Poland
| | - B Samoliński
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Banacha 1a Str, 02097, Warsaw, Poland
| | - A Sybilski
- Second Department of Pediatrics, Center of Postgraduate Medical Education, Warsaw, Poland
| | - S Białek
- Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, Warsaw, Poland
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Krzych-Fałta E, Wojas O, Samel-Kowalik P, Sybilski AJ, Samoliński B. Nasal mucosal reactivity assessment via a double-blind placebo-controlled food challenge with cow's milk allergens. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:59. [PMID: 35773706 PMCID: PMC9248200 DOI: 10.1186/s13223-022-00700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/20/2022] [Indexed: 11/14/2022]
Abstract
Background Allergies, including food allergies, are a considerable clinical and public-health problem. The introduced preventive measures and differential diagnostics, including oral food challenges, are the gold standard for determining further treatment planning. Case presentation We present a case of an 18-year-old girl with a cow’s milk allergy who underwent an oral food challenge (double blind oral food challenge). Such a challenge may be confounded by inducing a response from other systems and organs, which provides theoretical grounds for the use of other methods of assessing the body’s response to food allergens (response demonstrated by the upper respiratory tract). Based on this idea, in order to assess the degree of mucosal response, we used optical rhinometry as an objective method for nasal patency evaluation, as well as identification of tryptase level in nasal lavage fluid and exfoliative cytology of nasal mucosa. The results of these tests confirmed positive reaction of the nasal mucosa in the course of the oral allergen challenge. Conclusions The observed increase in the nasal mucosal reactivity that accompanies oral food challenges may suggest a potential for using food allergens in nasal allergen provocation testing in order to diagnose food allergies.
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Affiliation(s)
- Edyta Krzych-Fałta
- Department Basic of Nursing Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Oksana Wojas
- Department of Prevention of Environmental Hazards, Allergology and Immunology Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland.
| | - Piotr Samel-Kowalik
- Department of Prevention of Environmental Hazards, Allergology and Immunology Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Adam J Sybilski
- 2nd Department of Paediatrics, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Paediatrics and Neonatology with Allergology Center, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - Bolesław Samoliński
- Department of Prevention of Environmental Hazards, Allergology and Immunology Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
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Kondziołka J, Wilczyński S, Michalecki Ł. Potential Use of Novel Image and Signal Processing Methods to Develop a Quantitative Assessment of the Severity of Acute Radiation Dermatitis in Breast Cancer Radiotherapy. Clin Cosmet Investig Dermatol 2022; 15:725-733. [PMID: 35497689 PMCID: PMC9041143 DOI: 10.2147/ccid.s354320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022]
Abstract
More than 95% of patients who undergo radiotherapy report symptoms of radiation dermatitis, which is a side effect of this therapy. Erythema, edema, dry and moist desquamation intensify with each fraction of irradiation and can significantly reduce a patient's quality of life. Therefore, an effective skin care procedure is needed for skin that has been exposed to ionizing radiation in order to avoid unplanned treatment interruptions. The methods that are currently used to assess the severity of an acute radiation reaction are based on visual scales (RTOG, EORTC, NCI CTCAE, LENT-SOMA). Because the assessment is made subjectively, the results depend on the researchers, their experience and perceptiveness. Until now, several studies have been carried out to check the possibility of using an objective methods like hyperspectral imaging, thermal imaging, laser Doppler flowmetry, dielectric and electrochemical methods, reflection spectrophotometry and Courage-Khazaka Multi-skin instrument to radiation-induced dermatitis assessment. Unfortunately, due to various limitations that occurred in the research, none of these techniques was successfully implement as alternative for visual assessment. The continuous development of technology enables researchers to access new techniques that might constitute useful diagnostic and cognitive tools. Infrared thermal imaging, hyperspectral imaging and reflectance spectroscopy are examples of the visual techniques that have been used for many years in various fields of medicine, including dermatology and chronic wound or burn care. They provide information on the skin parameters, such as the temperature, concentration and distribution of chromophores (eg, hemoglobin and melanin), saturation or perfusion changes. The aim of this study is to review the available literature on the use of imaging methods in the clinical assessment of skin with lesions of various origins, evaluation of their suitability for the assessment of radiation reaction and consideration the possibility of creating a quantitative scale for assessing severity of acute radiation dermatitis.
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Affiliation(s)
- Joanna Kondziołka
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Sławomir Wilczyński
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Łukasz Michalecki
- University Clinical Center of the Medical University of Silesia, Katowice, Poland
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Peppers BP, Jhaveri D, Van Heeckeren R, Fletcher D, Sutton M, Hostoffer RW, Bonfield T. Stratification of peanut allergic murine model into anaphylaxis severity risk groups using thermography. J Immunol Methods 2018; 459:29-34. [PMID: 29802879 DOI: 10.1016/j.jim.2018.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/31/2018] [Accepted: 05/09/2018] [Indexed: 01/08/2023]
Abstract
Murine models are readily used to investigate mechanisms potentially involved in anaphylaxis. Determining successful sensitization with current methods remain potentially lethal, invasive, expensive and/or cumbersome. Here we describe the use of thermography to read intradermal testing to detect peanut allergic sensitization in the murine model and as a first time sensitive tool for anaphylaxis stratification. The relative wheal size in the thermal image can be used to stratify anaphylaxis severity risk groups prior to a challenge. This screening method is nonlethal, inexpensive, minimally invasive and can be carried out expeditiously.
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Affiliation(s)
- Brian P Peppers
- Adult and Pediatric Allergy and Immunology Fellowship Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Lake Erie Consortium of Osteopathic Medical Training, Erie, PA, United States.
| | - Devi Jhaveri
- Adult and Pediatric Allergy and Immunology Fellowship Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Allergy/Immunology Associates, Inc, Mayfield Heights, OH, United States
| | - Rolf Van Heeckeren
- Department of Immunology, Case Western Reserve University, Mayfield Heights, OH, United States
| | - David Fletcher
- Department of Immunology, Case Western Reserve University, Mayfield Heights, OH, United States
| | - Morgan Sutton
- Department of Immunology, Case Western Reserve University, Mayfield Heights, OH, United States
| | - Robert W Hostoffer
- Adult and Pediatric Allergy and Immunology Fellowship Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Allergy/Immunology Associates, Inc, Mayfield Heights, OH, United States
| | - Tracey Bonfield
- Department of Immunology, Case Western Reserve University, Mayfield Heights, OH, United States
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Owen R, Ramlakhan S. Infrared thermography in paediatrics: a narrative review of clinical use. BMJ Paediatr Open 2017; 1:e000080. [PMID: 29637119 PMCID: PMC5862192 DOI: 10.1136/bmjpo-2017-000080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/17/2017] [Accepted: 09/05/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Infrared thermography (IRT) has been used in adult medicine for decades, but recent improvements in quality of imaging and increasing computer processing power have allowed for a diversification of clinical applications. The specific usage of IRT in a paediatric population has not been widely explored, so this article aims to summarise the available literature in this area. IRT involves the non-contact, accurate measurement of skin surface temperature to identify temperature changes suggesting disease. IRT could well have unique applications in paediatric medicine. METHODS Electronic searches were performed independently by two authors, using the databases of MEDLINE (via Web of Science), the Cochrane Library, CINAHL (EBSCO) and Scopus, including articles published from 1990 to July 2016. The search strategy that was used aimed to include articles that covered the topics of IRT and children, including studies with participants 18 years old or younger. Articles were screened by title and abstract by two authors. Meta-analysis was not performed due to the marked heterogeneity in applications, study design and outcomes: this is a narrative summary of the available literature. RESULTS IRT has been shown to be an effective additional diagnostic tool in a number of different paediatric specialties, namely in fracture screening, burns assessment and neonatal monitoring. Small measurable skin temperature changes can effectively add to the clinical picture, while computer-tracking systems can be reliably used to focus investigations on particular areas of the body. CONCLUSION Throughout this review of the available literature, there has been a general consensus that this non-invasive, non-irradiating and relatively inexpensive technology may well have a place in the management of paediatric patients in the future.
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Affiliation(s)
- Ruaridh Owen
- Faculty of Medicine, Dentistry and Health, The University of Sheffield, Sheffield, UK
| | - Shammi Ramlakhan
- Emergency Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK.,Department of Clinical Surgical Sciences, University of the West Indies, Trinidad, West Indies
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Agache I, Bilò M, Braunstahl GJ, Delgado L, Demoly P, Eigenmann P, Gevaert P, Gomes E, Hellings P, Horak F, Muraro A, Werfel T, Jutel M. In vivo diagnosis of allergic diseases--allergen provocation tests. Allergy 2015; 70:355-65. [PMID: 25640808 DOI: 10.1111/all.12586] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 12/31/2022]
Abstract
The allergen challenge test has been the mainstay of diagnosis of allergic diseases for a long time since it offers a direct proof of the clinical relevance of a particular allergen for the allergic disease symptoms and severity. Standardisation and availability for daily practice (including safety issues) are still to be refined but most of the challenge tests have safely crossed the border from research tools to diagnostic tests available for daily practice for a well trained clinical staff.
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Affiliation(s)
- I. Agache
- Transylvania University Brasov; Brasov Romania
| | - M. Bilò
- Internal Medicine; Allergy Unit; Ancona Italy
| | | | - L. Delgado
- Faculty of Medicine; Allergy Division; Porto University; Porto Portugal
| | - P. Demoly
- Allergy; University Hospital of Montpellier; Montpellier France
| | - P. Eigenmann
- Paediatrics; University Hospital Geneva; Geneva Switzerland
| | - P. Gevaert
- Otorhinolaryngology; Ghent University; Ghent Belgium
| | - E. Gomes
- Servico de Imunoalergologia; Hospital Maria Pia; Porto Portugal
| | - P. Hellings
- Department of Orothinolaryngology; University Hospitals Leuven; Leuven Belgium
| | - F. Horak
- Department of Allergy Research; Allergy Center Wien West; Vienna Austria
| | - A. Muraro
- Department of Pediatrics; Referral Centre for Food Allergy; Padua General University Hospital; Padua Italy
| | - T. Werfel
- Dermatology and Allergy; Hannover Medical School; Hannover Austria
| | - M. Jutel
- Department of Clinical Immunology; Wroclaw Medical University; Wroclaw Poland
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11
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van Erp FC, Knulst AC, Meijer Y, Gabriele C, van der Ent CK. Standardized food challenges are subject to variability in interpretation of clinical symptoms. Clin Transl Allergy 2014; 4:43. [PMID: 25493173 PMCID: PMC4260179 DOI: 10.1186/s13601-014-0043-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
Background Food challenge tests are the gold standard in diagnosing food allergy. Guidelines provide scoring systems to classify symptoms during challenge and typically recommend that challenges are considered positive when objective symptoms occur. However, currently no standard criteria for the definition of a positive challenge outcome exists and interpretation of food challenges mainly depends on clinical judgment. This study aims to assess inter- and intra-observer variability in outcomes of routinely performed peanut challenges in children. Methods All complete food challenge score sheets of double blind placebo controlled peanut challenges performed in 2008-2010 in an academic hospital were included. Score sheets were reassessed independently by three clinical experts including double reassessment in a subset of score sheets. Inter- and intra-observer variability was evaluated using kappa statistics. Results We included 191 food challenge score sheets. Inter-observer agreement on overall challenge outcome was moderate (κ = 0.59-0.65) and was fair (κ = 0.31-0.46) on challenges with symptoms. Intra-observer agreement on overall challenge outcome was good (κ = 0.63-0.77) but was moderate (κ = 0.50-0.60) on challenges with symptoms. Subjective symptoms (oral symptoms, abdominal complaints, food aversion) were significantly associated with disagreement between observers. Conclusions We demonstrate that, despite strict adherence to guidelines, there is a considerable amount of variability in reassessment of symptoms recorded on food challenges sheets between and within well trained clinicians, especially when subjective symptoms occur.
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Affiliation(s)
- Francine C van Erp
- Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, P O Box 85090, 3508 AB Utrecht, The Netherlands
| | - André C Knulst
- Department of (Paediatric) Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Yolanda Meijer
- Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, P O Box 85090, 3508 AB Utrecht, The Netherlands
| | - Carmelo Gabriele
- Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, P O Box 85090, 3508 AB Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Department of Paediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, P O Box 85090, 3508 AB Utrecht, The Netherlands
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Hara Y, Shiraishi A, Yamaguchi M, Kawasaki S, Uno T, Ohashi Y. Evaluation of Allergic Conjunctivitis by Thermography. Ophthalmic Res 2014; 51:161-6. [DOI: 10.1159/000357105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/31/2013] [Indexed: 11/19/2022]
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13
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Standardizing double-blind, placebo-controlled oral food challenges: American Academy of Allergy, Asthma & Immunology-European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol 2013. [PMID: 23195525 DOI: 10.1016/j.jaci.2012.10.017] [Citation(s) in RCA: 503] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Järvinen KM, Sicherer SH. Diagnostic oral food challenges: Procedures and biomarkers. J Immunol Methods 2012; 383:30-8. [DOI: 10.1016/j.jim.2012.02.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 02/15/2012] [Accepted: 02/29/2012] [Indexed: 12/30/2022]
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15
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Clark A, Mangat J, King Y, Islam S, Anagnostou K, Foley L, Deighton J, Ewan P. Thermographic imaging during nasal peanut challenge may be useful in the diagnosis of peanut allergy. Allergy 2012; 67:574-6. [PMID: 22309457 DOI: 10.1111/j.1398-9995.2012.02788.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Double-blinded challenges are widely used for diagnosing food allergy but are time-consuming and cause severe reactions. Outcome relies on subjective interpretation of symptoms, which leads to variations in outcome between observers. Facial thermography combined with nasal peanut challenge was evaluated as a novel objective indicator of clinical allergy. METHODS Sixteen children with positive blinded peanut challenge underwent nasal challenge with 10 μg peanut protein or placebo. Mean skin temperatures were recorded from the mouth and nose using infrared thermography over 18 min. RESULTS The area under curve of nasal skin temperature was significantly elevated after peanut vs placebo (18.2 vs 4.8°Cmin). The maximum increase in temperature was also significantly greater after peanut: mean difference +0.9°C. CONCLUSION This feasibility study shows thermography can detect inflammation caused by nasal challenges whilst employing one thousand-fold less peanut than an oral challenge. This novel technique could be developed to provide a rapid, safe and objective clinical allergy test.
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Affiliation(s)
- A. Clark
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - J. Mangat
- Department of Clinical Engineering/Medical Physics; Cambridge University Hospitals; Cambridge; UK
| | - Y. King
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - S. Islam
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - K. Anagnostou
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - L. Foley
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - J. Deighton
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
| | - P. Ewan
- Department of Allergy; Cambridge University Hospitals; Cambridge; UK
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Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FER, Teach SJ, Yawn BP, Schwaninger JM. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2011; 126:1105-18. [PMID: 21134576 DOI: 10.1016/j.jaci.2010.10.008] [Citation(s) in RCA: 1017] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 10/13/2010] [Indexed: 12/11/2022]
Abstract
Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another. Finally, because patients frequently confuse nonallergic food reactions, such as food intolerance, with food allergies, there is an unfounded belief among the public that food allergy prevalence is higher than it truly is. In response to these concerns, the National Institute of Allergy and Infectious Diseases, working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These Guidelines are intended for use by a wide variety of health care professionals, including family practice physicians, clinical specialists, and nurse practitioners. The Guidelines include a consensus definition for food allergy, discuss comorbid conditions often associated with food allergy, and focus on both IgE-mediated and non-IgE-mediated reactions to food. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. These Guidelines provide 43 concise clinical recommendations and additional guidance on points of current controversy in patient management. They also identify gaps in the current scientific knowledge to be addressed through future research.
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Affiliation(s)
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- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, MA, USA
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Rokita E, Rok T, Tatoń G. Application of thermography for the assessment of allergen-induced skin reactions. Med Phys 2011; 38:765-72. [DOI: 10.1118/1.3533940] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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18
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Boyce JA, Assa'ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FER, Teach SJ, Yawn BP, Schwaninger JM. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010; 126:S1-58. [PMID: 21134576 PMCID: PMC4241964 DOI: 10.1016/j.jaci.2010.10.007] [Citation(s) in RCA: 542] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 10/13/2010] [Indexed: 12/14/2022]
Abstract
Food allergy is an important public health problem that affects children and adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy also may vary from one clinical practice setting to another. Finally, because patients frequently confuse nonallergic food reactions, such as food intolerance, with food allergies, there is an unfounded belief among the public that food allergy prevalence is higher than it truly is. In response to these concerns, the National Institute of Allergy and Infectious Diseases, working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These Guidelines are intended for use by a wide variety of health care professionals, including family practice physicians, clinical specialists, and nurse practitioners. The Guidelines include a consensus definition for food allergy, discuss comorbid conditions often associated with food allergy, and focus on both IgE-mediated and non-IgE-mediated reactions to food. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. These Guidelines provide 43 concise clinical recommendations and additional guidance on points of current controversy in patient management. They also identify gaps in the current scientific knowledge to be addressed through future research.
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Dölle S, Hoser D, Rasche C, Loddenkemper C, Maurer M, Zuberbier T, Worm M. Long-term reduction in local inflammation by a lipid raft molecule in atopic dermatitis. Allergy 2010; 65:1158-65. [PMID: 20337610 DOI: 10.1111/j.1398-9995.2010.02341.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The complex pathogenesis of atopic dermatitis (AD) is guided by cell surface receptor-mediated signal transduction regulated in lipid rafts. Miltefosine is a raft-modulating molecule targeting cell membranes. With this controlled clinical study, the clinical and immunomodulatory efficacy of miltefosine was investigated in patients with AD in comparison with a topical corticosteroid treatment. METHODS Sixteen patients with AD were treated topically with miltefosine and hydrocortisone localized on representative AD target lesions for 3 weeks. To assess the clinical efficacy, the three item severity (TIS) score was evaluated before, during and after treatment as well as after 4-week-follow-up period. To study the anti-inflammatory effect of miltefosine on the cellular T cell pattern, skin biopsies were analysed before and after treatment. RESULTS The TIS score dropped in both groups significantly after treatment. A carry-over effect was exclusively seen for miltefosine after discontinuing the treatment. These findings were substantiated by thermographic imaging with a significant decrease in the maximum temperature (T(max)) after miltefosine application (P = 0.034, DeltaT(max) = 1.7 degrees C [2.1-3.9]). Immunohistochemically, a reduction in lesional CD4(+)-infiltrating T cells was observed in both treatments. Moreover, increased FoxP3(+) cells were present in the skin after miltefosine treatment (before 5.4% [1.9-9.8], after 6.2% [3.5-9.5]). CONCLUSION We demonstrate that miltefosine is locally active in patients with AD and led to a sustained clinical improvement in local skin inflammation. Moreover, the increased frequency of FoxP3(+) cells in the skin of patients with AD suggests its immunomodulatory properties.
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Affiliation(s)
- S Dölle
- Charité- Universitätsmedizin Berlin, Department of Dermatology and Allergology, Berlin, Germany
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Affiliation(s)
- Eddie Y-K Ng
- School of Mechanical and Aerospace Engineering, College of Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore
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Abstract
PURPOSE OF REVIEW To give an update about the optimal diagnostic work-up for children with suspected food allergy. RECENT FINDINGS Food allergy has become a very severe health problem not only for many children and parents, but also for the entire medical and paramedical community. The financial and social costs related to these conditions are increasing, but, contemporarily, basic and clinical research are deeply involved in the search of possible solutions to facilitate the management of these patients. SUMMARY Food allergy is defined as an abnormal immunological reaction to food proteins, which causes an adverse clinical reaction. Over 90% of food allergies in childhood are caused by eight foods: cow's milk, hen's egg, soy, peanuts, tree nuts, wheat, fish and shellfish. The evaluation of a child with suspected food allergy includes detailed medical history, physical examination, screening tests and response to elimination diet and to oral food challenge. None of the screening tests, alone or in combination, can definitely diagnose or exclude it. The main principle of food allergy management is avoidance of the offending antigen. An incorrect diagnosis is likely to result in unnecessary dietary restrictions, which, if prolonged, may adversely affect the child's nutritional status and growth.
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Bibliography. Current world literature. Model systems. Curr Opin Allergy Clin Immunol 2008; 8:276-85. [PMID: 18560306 DOI: 10.1097/aci.0b013e328303e104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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