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Kawahara T, Tezuka J, Ninomiya T, Honjo S, Masumoto N, Nanishi M, Nakayama H, Ohga S. Risk prediction of severe reaction to oral challenge test of cow's milk. Eur J Pediatr 2019; 178:181-188. [PMID: 30377799 DOI: 10.1007/s00431-018-3274-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/14/2018] [Accepted: 10/19/2018] [Indexed: 11/28/2022]
Abstract
Cow's milk is one of the most common food allergens among children. Oral food challenge tests determine the threshold dose of allergens, but have not been standardized. To reduce the severe reactions, we developed a practical model of the test. We studied 111 high-risk patients who underwent a first milk oral food challenge on the risk-stratified dose between 2011 and 2017 for predicting the severe reaction risk. Severe reactions were defined as showing > 3 of Sampson's classification grade. Twenty-eight patients (25%) showed severe reactions without death. Prior to oral food challenge, severe reaction patients experienced milk avoidance (71% vs. 45%, p = 0.02) or bronchial asthma (61% vs. 28%, p = 0.003) more frequently and showed higher milk-specific IgE levels (median 28.3 vs. 7.7 UA/mL, p < 0.0001) than non-severe reaction patients. Multivariate logistic regression analyses established a formula including severe reaction-associated factors; increased levels of milk-specific IgE (odds ratio 11.61, p = 0.001), milk avoidance (odds ratio 3.88, p = 0.02), and bronchial asthma (odds ratio 3.75, p = 0.02). This model had 86% sensitivity and 56% specificity (cut-off 0.25) for risk. Five patients with < 25% probability developed severe reactions, which started in > 3 grade dyspnea up to 20 mL of challenge.Conclusion: This model could effectively reduce the severe reaction development on the first milk oral food challenge test according to the individual needs. What is Known: •Higher levels of milk-specific IgE values, bronchial asthma, and complete milk avoidance are independent risk factors of severe reactions during the cow's milk oral food challenge. What is New: •Statistical analyses of our milk oral food challenge records for 111 patients helped us develop a model formula predicting severe reactions at the first test with high specificity and sensitivity. •This simple risk-stratified protocol is useful for minimizing the adverse events in the first milk challenge.
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Affiliation(s)
- Takahiro Kawahara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
- Division of Pediatrics, National Hospital Organization Fukuoka Higashi Medical Center, 1-1-1 Chidori, Koga city, Fukuoka, 811-3195, Japan
| | - Junichiro Tezuka
- Division of Allergy and Pulmonology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka, 813-0017, Japan.
| | - Takahito Ninomiya
- Division of Pediatrics, National Hospital Organization Fukuoka Hospital, 1-39-1 Yakatabaru Minami-ku, Fukuoka, 811-1394, Japan
| | - Satoshi Honjo
- Division of Pediatrics, National Hospital Organization Fukuoka Hospital, 1-39-1 Yakatabaru Minami-ku, Fukuoka, 811-1394, Japan
| | - Natsuko Masumoto
- Division of Pediatrics, National Hospital Organization Fukuoka Higashi Medical Center, 1-1-1 Chidori, Koga city, Fukuoka, 811-3195, Japan
| | - Makiko Nanishi
- Division of Pediatrics, National Hospital Organization Fukuoka Higashi Medical Center, 1-1-1 Chidori, Koga city, Fukuoka, 811-3195, Japan
| | - Hideki Nakayama
- Division of Pediatrics, National Hospital Organization Kyushu Cancer Center, 1-1-3 Nodame Minami-ku, Fukuoka, 811-1395, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan
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Araújo L, Moreira A, Palmares C, Beltrão M, Fonseca J, Delgado L. Induced sputum in children: success determinants, safety, and cell profiles. J Investig Allergol Clin Immunol 2011; 21:216-221. [PMID: 21548450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Sputum induction is a noninvasive method for the assessment of airway inflammation. OBJECTIVES To evaluate the safety of the procedure and the clinical predictors of successful induction, and to analyze the relationship between sputum cell counts and clinical features in asthmatic and nonasthmatic children. METHODS We reviewed sputum inductions performed in our department between 2006 and 2008 in individuals under 18 years; 34 asthmatic and 24 nonasthmatic children were included. Sputum induction was performed with 4.5% saline for 5-minute periods with salbutamol pretreatment. The most viscid portions were selected for processing. Inductions which were tolerated for less than 4 minutes or which produced a sample volume of less than 1 mL or a sample with a squamous cell percentage of over 80% were considered unsuccessful. RESULTS Sputum induction was successful in 43 (74%) of the 58 children studied.The total median induction time was 15 minutes (interquartile range, 10-15 minutes). Only 7 individuals (12%) experienced mild symptoms, which were easily reversed with salbutamol inhalation in all cases. The mean (SD) overall PEF variation with induction was -2.5% (7%), with no significant differences between asthmatics and nonasthmatics. Asthmatics had significantly higher total cell counts (P = .007), macrophages (P = .033), and relatively fewer neutrophils (P = .003) than nonasthmatics; metachromatic cells were rare and seen only in asthmatics (P = .026). We found a positive correlation between exhaled nitric oxide and sputum eosinophil count (r = 0.363, P = .017). CONCLUSIONS Sputum induction is a safe, noninvasive, and feasible procedure that allows the direct assessment of airway inflammation in most children.
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Affiliation(s)
- L Araújo
- Hospital S. João EPE, Allergy Division, Porto, Portugal.
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Toosi S, Bystryn JC. Potential role of interleukin-17 in the pathogenesis of bullous pemphigoid. Med Hypotheses 2009; 74:727-8. [PMID: 19945799 DOI: 10.1016/j.mehy.2009.10.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 10/24/2009] [Indexed: 11/17/2022]
Abstract
Bullous pemphigoid is an autoimmune blistering disease of the skin caused by autoantibodies directed against basement membrane zone adhesion molecules. Autoantibodies cannot fully explain several important features of the disease such as the difficulty transferring with the pathogenic autoantibodies, or the presence of heavy lesional infiltration of eosinophils and neutrophils that is necessary for disease production. There is increasing evidence that Th17 cells and the cytokines they release such as interleukin-17 are important regulators of innate and adaptive immune responses in many Th1 and/or Th2 mediated autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, and allergic asthma. There is also evidence that Th17 cells have a role in pathogenesis of blistering skin diseases. Interleukin-17 is important in initiation and maintenance of many autoimmune reactions and it is involved in production of pro-inflammatory cytokines, matrix metalloproteinases, neutrophils, and eosinophils, all of which are important pathogenic factors in bullous pemphigoid. The hypothesis is that interleukin-17 has an important pathogenic role in BP and can describe features of the disease not explained by the autoantibody theory. This cytokine can be assessed in the blister fluid and sera of patients, and can be used as a marker of disease activity and response to therapy. The information obtained could also lead to the development of novel therapeutic strategies for this and other autoimmune blistering diseases.
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Affiliation(s)
- Siavash Toosi
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
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Warmington E. Not allergic to life. Aust Fam Physician 2008; 37:199. [PMID: 18398512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A lot of things have changed over the 3 years since I first wrote for Australian Family Physician; but one thing remains... without prompt medical assistance I will die if I eat a nut.
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Bindslev-Jensen C, Ballmer-Weber BK, Bengtsson U, Blanco C, Ebner C, Hourihane J, Knulst AC, Moneret-Vautrin DA, Nekam K, Niggemann B, Osterballe M, Ortolani C, Ring J, Schnopp C, Werfel T. Standardization of food challenges in patients with immediate reactions to foods--position paper from the European Academy of Allergology and Clinical Immunology. Allergy 2004; 59:690-7. [PMID: 15180754 DOI: 10.1111/j.1398-9995.2004.00466.x] [Citation(s) in RCA: 471] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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