Tree Nuts Anaphylaxis in Preschool Age Children

Summary

Introduction. The incidence of food-induced anaphylaxis (FIA) is increasing in young children. Although the commonest culprits are cow's milk and egg, FIA to tree nuts (TNs) have been increasing. Objective. Characterization of children referred to our allergy department due to TNs-induced anaphylaxis (TNs-FIA) during preschool age. Materials and methods. We have retrospectively included 25 children with clinical history of preschool TNs-FIA, proven by allergological work-up. TNs sensitization was assessed by skin prick tests and/or specific IgE. Results. The mean age of the first anaphylactic episode was 3.1±1.2 years. The majority (92%) had an allergic disease (52% asthma). The implicated TNs were cashew (11 children), walnut (8), pine nut (5), hazelnut (2) and almond (1). The reaction occurred after the first known ingestion in 68%. In 92%, symptoms appeared within 30 minutes after exposure. The most frequent clinical symptoms were mucocutaneous (96%), respiratory (80%) and gastrointestinal (52%). Twenty-one children were admitted to the emergency department, although only 48% were treated with epinephrine. An underneath IgE-mediated mechanism was proven in all cases. Immunologic cross-reactivity with other TNs was identified in 84%, and with peanut in 36%. Overall, in our center, TNs-FIA represents 18% of all causes of FIA. Conclusions. In preschool age children with TNs-FIA, cashew and walnut were the commonest implicated nuts. Most reactions occurred briefly after exposure to minimal amounts of TNs, demonstrating the high potency of these allergens. About one-third also had peanut sensitization. Potentially life-threatening TNs allergy can occur early in childhood and adequate management should be undertaken.

Treatment of allergic rhinitis using mobile technology with real-world data: The MASK observational pilot study

BACKGROUND

Large observational implementation studies are needed to triangulate the findings from randomized control trials as they reflect "real-world" everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real-life treatment of allergic rhinitis (AR) using mobile technology.

METHODS

A mobile phone app (Allergy Diary, freely available in Google Play and Apple App stores) collects the data of daily visual analog scales (VAS) for (i) overall allergic symptoms, (ii) nasal, ocular, and asthma symptoms, (iii) work, as well as (iv) medication use using a treatment scroll list including all medications (prescribed and over the counter (OTC)) for rhinitis customized for 15 countries.

RESULTS

A total of 2871 users filled in 17 091 days of VAS in 2015 and 2016. Medications were reported for 9634 days. The assessment of days appeared to be more informative than the course of the treatment as, in real life, patients do not necessarily use treatment on a daily basis; rather, they appear to increase treatment use with the loss of symptom control. The Allergy Diary allowed differentiation between treatments within or between classes (intranasal corticosteroid use containing medications and oral H1-antihistamines). The control of days differed between no [best control], single, or multiple treatments (worst control).

CONCLUSIONS

This study confirms the usefulness of the Allergy Diary in accessing and assessing everyday use and practice in AR. This pilot observational study uses a very simple assessment (VAS) on a mobile phone, shows novel findings, and generates new hypotheses.

Daily allergic multimorbidity in rhinitis using mobile technology: A novel concept of the MASK study

BACKGROUND

Multimorbidity in allergic airway diseases is well known, but no data exist about the daily dynamics of symptoms and their impact on work. To better understand this, we aimed to assess the presence and control of daily allergic multimorbidity (asthma, conjunctivitis, rhinitis) and its impact on work productivity using a mobile technology, the Allergy Diary.

METHODS

We undertook a 1-year prospective observational study in which 4 210 users and 32 585 days were monitored in 19 countries. Five visual analogue scales (VAS) assessed the daily burden of the disease (i.e., global evaluation, nose, eyes, asthma and work). Visual analogue scale levels <20/100 were categorized as "Low" burden and VAS levels ≥50/100 as "High" burden.

RESULTS

Visual analogue scales global measured levels assessing the global control of the allergic disease were significantly associated with allergic multimorbidity. Eight hypothesis-driven patterns were defined based on "Low" and "High" VAS levels. There were <0.2% days of Rhinitis Low and Asthma High or Conjunctivitis High patterns. There were 5.9% days with a Rhinitis High-Asthma Low pattern. There were 1.7% days with a Rhinitis High-Asthma High-Conjunctivitis Low pattern. A novel Rhinitis High-Asthma High-Conjunctivitis High pattern was identified in 2.9% days and had the greatest impact on uncontrolled VAS global measured and impaired work productivity. Work productivity was significantly correlated with VAS global measured levels.

CONCLUSIONS

In a novel approach examining daily symptoms with mobile technology, we found considerable intra-individual variability of allergic multimorbidity including a previously unrecognized extreme pattern of uncontrolled multimorbidity.

The Allergic Rhinitis and its Impact on Asthma (ARIA) score of allergic rhinitis using mobile technology correlates with quality of life: The MASK study

Mobile technology has been used to appraise allergic rhinitis control, but more data are needed. To better assess the importance of mobile technologies in rhinitis control, the ARIA (Allergic Rhinitis and its Impact on Asthma) score ranging from 0 to 4 of the Allergy Diary was compared with EQ-5D (EuroQuol) and WPAI-AS (Work Productivity and Activity Impairment in allergy) in 1288 users in 18 countries. This study showed that quality-of-life data (EQ-5D visual analogue scale and WPA-IS Question 9) are similar in users without rhinitis and in those with mild rhinitis (scores 0-2). Users with a score of 3 or 4 had a significant impairment in quality-of-life questionnaires.

Protocol to cryopreserve and isolate nuclei from adipose tissue without dimethyl sulfoxide

Cryopreservation injuries involve nuclear DNA damage. A protocol for cryopreserving and isolating adipocyte nuclei is proposed. Adipose tissue samples were directly analyzed (NoCRYO-0h), or stored at -196°C for 7 days without 10% dimethyl sulfoxide (DMSO) (CRYO-WO-DMSO) or with DMSO (CRYO-W-DMSO). To determine the effect of DMSO on cryopreservation treatment, adipose tissue samples were stored at 4°C for 24 h with 10% DMSO (NoCRYO-W-DMSO-24h) and without (NoCRYO-WO-DMSO-24h). Samples were processed in isolation buffer, and nuclear integrity was measured by flow cytometry. The coefficient of variation, forward scatter, side scatter, and number of nuclei analyzed were evaluated. Pea (Pisum sativum) was used to measure the amount of DNA. All groups contained similar amounts of DNA to previously reported values and a satisfactory number of nuclei were analyzed. CRYO-W-DMSO presented a higher coefficient of variation (3.19 ± 0.09) compared to NoCRYO-0h (1.85 ± 0.09) and CRYO-WO-DMSO (2.02 ± 0.02). The coefficient of variation was increased in NoCRYO-W-DMSO-24h (3.80 ± 0.01) compared to NoCRYO-WO-DMSO-24h (2.46 ± 0.03). These results relate DMSO presence to DNA damage independently of the cryopreservation process. CRYO-W-DMSO showed increased side scatter (93.46 ± 5.03) compared to NoCRYO-0h (41.13 ± 3.19) and CRYO-WO-DMSO (48.01 ± 2.28), indicating that cryopreservation with DMSO caused chromatin condensation and/or nuclear fragmentation. CRYO-W-DMSO and CRYO-WO-DMSO presented lower forward scatter (186.33 ± 9.33 and 196.89 ± 26.86, respectively) compared to NoCRYO-0h (322.80 ± 3.36), indicating that cryopreservation reduced nuclei size. Thus, a simple method for cryopreservation and isolation of adipocyte nuclei causing less damage to DNA integrity was proposed.

Relevance of the sterilization-induced effects on the properties of different hydroxyapatite nanoparticles and assessment of the osteoblastic cell response

Hydroxyapatite (Hap) is a calcium phosphate with a chemical formula that closely resembles that of the mineral constituents found in hard tissues, thereby explaining its natural biocompatibility and wide biomedical use. Nanostructured Hap materials appear to present a good performance in bone tissue applications because of their ability to mimic the dimensions of bone components. However, bone cell response to individual nanoparticles and/or nanoparticle aggregates lost from these materials is largely unknown and shows great variability. This work addresses the preparation and characterization of two different Hap nanoparticles and their interaction with osteoblastic cells. Hap particles were produced by a wet chemical synthesis (WCS) at 37°C and by hydrothermal synthesis (HS) at 180°C. As the ultimate in vivo applications require a sterilization step, the synthesized particles were characterized 'as prepared' and after sterilization (autoclaving, 120°C, 20 min). WCS and HS particles differ in their morphological (size and shape) and physicochemical properties. The sterilization modified markedly the shape, size and aggregation state of WCS nanoparticles. Both particles were readily internalized by osteoblastic cells by endocytosis, and showed a low intracellular dissolution rate. Concentrations of WCS and HS particles less than 500 μg ml(-1) did not affect cell proliferation, F-actin cytoskeleton organization and apoptosis rate and increased the gene expression of alkaline phosphatase and BMP-2. The two particles presented some differences in the elicited cell response. In conclusion, WCS and HS particles might exhibit an interesting profile for bone tissue applications. Results suggest the relevance of a proper particle characterization, and the interest of an individual nanoparticle targeted research.

Determination of tocopheryl acetate and ascorbyl tetraisopalmitate in cosmetic formulations by HPLC

A rapid HPLC method was developed for the assay of tocopheryl acetate and ascorbyl tetraisopalmitate in cosmetic formulations. The validated method was applied for quantitative determination of these vitamins in simulated emulsion formulation. Samples were analysed directly on a RP-18 reverse phase column with UV detection at 222 nm. A mixture of methanol and isopropanol (25 : 75 v/v) was used as mobile phase. The retention time of tocopheryl acetate and ascorbyl tetraisopalmitate were 3.0 min and 5.9 min, respectively. Recovery was between 95% and 104%. In addition, the excipients did not interfere in the analysis. The method is simple, reproducible, selective and is suitable for routine analyses of commercial products.

In vitro 3D assay to test angiogenic effects of human CD14+ monocytes seeded on macroporous PLGA/CaP polymers with a CaP nanostructured surface

In this study we present a three-dimensional angiogenesis assay in vitro that allows the evaluation of the influence of Poly(lactic-co-glycolic acid) based implants seeded with VEGF-A165 stimulated/activated human CD14+ monocytes on the attraction and migration of human micro vascular endothelial cells (HMVEC-L). Primary HMEC of the capillary bed were cultured on an extracellular matrix generated by bovine corneal endothelial cells (BCEC). The HMEC layer was covered by an agarose gel, upon which a Poly(lactic-co-glycolic acid)/CaP polymer with a Calcium-Phosphate (CaP) nanostructured surface was placed. This scaffold has already been shown to interact with endothelial cells and endothelial progenitor cells respectively in vivo. It was seeded with angiogenically stimulated (VEGF-A165) human CD14+ monocytes, to get a monocyte/macrophage fraction, which can promote angiogenesis, tissue remodelling and tissue repair due to the secretion of growth factors, cytokines, chemokines and enzymes. The study demonstrated that this assay is suitable to test angiogenic effects by stimulated human CD14+ monocytes on human microvascular endothelial cells influenced by Poly(lactic-co-glycolic acid)/CaP scaffolds with a nanostructured CaP surface. The assay can exclude effects on migration caused by gravity and also allows testing in a physiological environment on an extracellular matrix secreted by endothelial cells.

Epidemiology of rhinitis in Portugal: evaluation of the intermittent and the persistent types

BACKGROUND

The prevalence of rhinitis is rapidly increasing in recent years and has become a major public health problem in developed countries. A new classification of allergic rhinitis has been proposed by the allergic rhinitis and its impact on asthma group. In this study we aimed to evaluate the prevalence of rhinitis, including different rhinitis subtypes and to describe the severity, rate of diagnosis and use of medication in this pathology.

METHODS

A cross-sectional, population-based study including 6,859 questionnaire responses was performed.

RESULTS

The estimated prevalence of rhinitis was 26.1% (48% for intermittent vs 52% for persistent rhinitis). Only about one-third of the rhinitis cases (31.9%) had done skin prick tests (35.3% for persistent rhinitis vs 21.5% for intermittent rhinitis: P < 0.001) or had medication prescribed in the last year (34%), (35.6% for persistent rhinitis vs 20.1% for intermittent rhinitis : P < 0.001). The prevalence of rhinitis was higher in women (28.2 vs 22.2%; P < 0.001). Intermittent/persistent rhinitis showed the following percentages : <or=25 years (65.6 vs 34.5, P = 0.001); 25-65 years (50.2 vs 49.5) >or= 65 years (52.1 vs 47.9). The estimated prevalence of rhino conjunctivitis was 18.4%. In a severity scale from 0 to 10, the mean value was 6.1 points (6.4 for persistent rhinitis vs 4.8 for intermittent rhinitis: P < 0.001).

CONCLUSION

A significant prevalence of rhinitis and rhino conjunctivitis was identified in all age groups. The severity, the frequency and duration of the symptoms which classify the persistent type should be considered to establish a more effective treatment and improve the quality of life of the patients with rhinitis.

Soluble CD30, dehydroepiandrosterone sulfate and dehydroepiandrosterone in atopic and non atopic children

Elevated levels of soluble CD30-sCD30 (possibly related to Th2) are seen in atopy and other diseases. Dehydroepiandrosterone (DHEA) may regulate Th1/Th2 balance. The aim was to study the relationship between the levels of sCD30, DHEAS and DHEA in atopic (A) and non atopic (B) children, to assess immune-endocrine interactions. We studied 36 children (8-15 years), 18 (A) monosensitised to Dermatophagoides Pteronyssinus (Dpt.), and 18 (B) with isolate rhinitis (R) or asthma (BA) and R (33.3%) without differences in age and sex. They were all HIV negative and free from any medication. It was determined sCD30, DHEAS and DHEA. There was no statistically significant differences between A and B for the levels of DHEAS, DHEA suggesting that the role of this regulation in Th2 type is not important in patients with allergic disease in this age group. sCD30: A-mean 121.1U/ml; B-mean 53.9U/ml. This difference is statistically significant-p = 0.02. sCD30 in patients only with R showed also significant differences-p = 0.01. These results could reflect the Th2 profile. There is an overlap of the values (for R < 80 U/ml; for BA + R < 140 U/ml). Due to this only values > 80 U/ml for R and > 140 U/ml for BA + R could be considered discriminating for atopy.

[Nasofacial zygomycosis in the state of Pará: the registration of 2 cases]

Two new cases of nasofacial zygomycosis from the state of Pará, Brazil, are reported. Both cases were treated with ketoconazole and the response to the drug was considered to be good; the patients improved rapidly and the nasal obstruction was the first manifestation to disappear. As five cases have been described in recent years from the state of Pará, this form of zygomycosis can no longer be considered as a rare disease in northern Brazil.

[HIV/tuberculosis co-infection: a request for a better surveillance]

The increasing endemicity of tuberculosis resulting from causes such as immigration, poverty, a declining public health infrastructure and co-infection by HIV/Mycobacterium tuberculosis, is leading to a change in tuberculosis control programmes. One of the main reasons for the resurgence of tuberculosis is HIV infection--the risk of tuberculosis is greater in HIV patients than in the majority of the population as can be seen from numerous research projects. The need for systematic testing for HIV infection in all tuberculosis patients by undertaking confidential HIV tests on admission to a tuberculosis programme is brought out. This measure would increase the number of cases diagnosed and provide data for better surveillance of the co-infection.

Neutralizing antibodies directed against osteopontin inhibit rat carotid neointimal thickening after endothelial denudation

Osteopontin is an arginine-glycine-aspartate-containing acidic glycoprotein with adhesive and migratory activities in vitro. We previously showed that osteopontin was highly expressed in injured rat arteries as well as in human atherosclerotic plaques. In contrast, uninjured blood vessels make very little osteopontin. In this report, we have investigated the role of osteopontin in rat neointima formation using neutralizing antibodies. Rats were treated with either nonimmune or antiosteopontin antibody and subjected to endothelial denudation of the carotid artery by using a balloon catheter. Two weeks after injury, intimal areas and cell numbers were significantly decreased (33% and 31%, respectively) in the antiosteopontin group compared with the nonimmune IgG group. No differences in carotid medial areas or cell numbers were observed. Intimal and medial replication rates, as measured by continuous bromodeoxyuridine infusion during the final week of the experimental protocol, were not significantly different between the two groups. No gross histological changes were noted in the intimas formed in the presence of either neutralizing or nonimmune antibody. In addition, no difference in early carotid medial cell replication rate was observed when antibodies were infused for 4 days after angioplasty. These data demonstrate for the first time a functional role for osteopontin in the process of carotid neointimal thickening in vivo and suggest that osteopontin plays an active role in the remodeling processes important for human atherosclerotic and restenotic lesion development.

Fine-needle aspiration biopsy and imprint cytology of small non-cleaved cell (Burkitt's) lymphoma

We reviewed 13 cases of small non-cleaved cell (Burkitt's) lymphoma diagnosed by fine-needle aspiration biopsy (FNAB) and four cases where that diagnosis was made from touch imprints from surgical biopsy specimens. The most common site was intraabdominal. Histologic confirmation was present in 14/17 cases. General microscopic features on smears included high cellularity and an individual cell pattern. Extracellular lymphoglandular bodies were abundant and tingible body macrophages were prominent. Nuclei were intermediate in size and round with a finely dispersed chromatin pattern on May-Grünwald-Giemsa stained smears. Cytoplasm was basophilic and scant with prominent vacuoles. Extracellular vacuoles and vacuoles within lymphoglandular bodies occurred in all patients. Immunocytochemistry performed on 16/17 cases demonstrated a B cell phenotype in 15. Nine cases were kappa light chain positive and six were lambda light chain positive. Flow cytometry performed in five cases demonstrated diploid cells with a high S phase. We conclude that Burkitt's lymphoma can be diagnosed using combined FNAB and immunophenotyping.

[Nasofacial zygomycosis. Report of a case of Para state, Brazil]

A case of nasofacial zygomycosis in a 64-year-old female patient from Barcarena, State of Pará, is reported. This is the second time that the disease is recognized in Northern Brazil. The diagnosis was initially suspected by the direct observation of broad coenocytic hyphae in biopsy specimens of the nasal cavity mucosa. Later, the cause of the disease was confirmed by the mycologial and histopathological findings. Rapid response to the therapy with potassium iodide was achieved, without however a complete resolution of the lesions. The patient still remains under treatment, with itraconazole and iodide.

Malignant melanoma of soft tissue. A report of three cases with diagnosis by fine needle aspiration cytology

A correlated cytologic and histologic study of three cases of malignant melanoma of soft tissue (MMST) is presented. The patients' ages ranged from 21 to 36 years. Two were females and one, male. In two cases fine needle aspiration cytology was done to document local recurrence or metastatic disease and in one to establish a primary diagnosis. The cytologic findings were similar in all cases. The smears were composed of noncohesive tumor cells with monotonous, uniform nuclei, prominent nucleoli and plentiful, light blue cytoplasm. Immunohistochemical studies performed in all cases demonstrated staining positive for S-100 protein. Electron microscopy from two cases showed premelanosomes and melanosomes. These results demonstrate that a precise diagnosis of MMST can be rendered on material obtained by aspiration cytology.

[Application of aspiration cytology in the diagnosis of tumor lesions in children]

Fine needle aspiration cytology (FNAC) became increasingly popular for evaluating of both superficial and deep seated lesions, but its use in children has been limited. We report our recent experience with FNAC in the pediatric group. The study population included 34 males and 12 females and the age ranged between 11 months to 16 years. The aspirated sites were: testis (n = 14), lymph node (n = 12), bone (n = 9), pelvis (n = 2), retroperitoneum (n = 1), soft tissue (n = 6), lung (n = 1) and orbit (n = 1). The aims of FNAC were to diagnose a primary lesion (25 cases) and to document relapse of neoplastic disease (21 cases). Of the 46 aspirates, 28 were diagnosed as malignant, 4 as benign, 2 were inconclusive; in the remaining case the material was considered inadequate. Eleven out of 14 testicular cases were normal. FNAC diagnosis was confirmed either by histology (25 cases) or by the clinical evolution (18 cases). We conclude that FNAC can be considered a major diagnostic tool for the characterization of the tumoral lesions in childhood, both for diagnostic purposes and for evaluation of the progression of neoplasia. It may also provide useful information for guiding the therapeutical strategy.