Dietary exposures and allergy prevention in high-risk infants

Infants at high risk for developing a food allergy have either an atopic condition (such as eczema) themselves or an immediate family member with such a condition. Breastfeeding should be promoted and supported regardless of issues pertaining to food allergy prevention, but for infants whose mothers cannot or choose not to breastfeed, using a specific formula (i.e., hydrolyzed formula) is not recommended to prevent food allergies. When cow’s milk protein formula has been introduced in an infant’s diet, make sure that regular ingestion (as little as 10 mL daily) is maintained to prevent loss of tolerance. For high-risk infants, there is compelling evidence that introducing allergenic foods early—at around 6 months, but not before 4 months of age—can prevent common food allergies, and allergies to peanut and egg in particular. Once an allergenic food has been introduced, regular ingestion (e.g., a few times a week) is important to maintain tolerance. Common allergenic foods can be introduced without pausing for days between new foods, and the risk for a severe reaction at first exposure in infancy is extremely low. Pre-emptive in-office screening before introducing allergenic foods is not recommended. No recommendations can be made at this time about the role of maternal dietary modification during pregnancy or lactation, or about supplementing with vitamin D, omega 3, or pre- or probiotics as means to prevent food allergy.

Viral Induced Effects on a Vulnerable Epithelium; Lessons Learned From Paediatric Asthma and Eosinophilic Oesophagitis

The epithelium is integral to the protection of many different biological systems and for the maintenance of biochemical homeostasis. Emerging evidence suggests that particular children have epithelial vulnerabilities leading to dysregulated barrier function and integrity, that resultantly contributes to disease pathogenesis. These epithelial vulnerabilities likely develop in utero or in early life due to various genetic, epigenetic and environmental factors. Although various epithelia are uniquely structured with specific function, prevalent allergic-type epithelial diseases in children potentially have common or parallel disease processes. These include inflammation and immune response dysregulation stemming from atypical epithelial barrier function and integrity. Two diseases where aetiology and pathogenesis are potentially linked to epithelial vulnerabilities include Paediatric Asthma and Eosinophilic Oesophagitis (EoE). For example, rhinovirus C (RV-C) is a known risk factor for paediatric asthma development and is known to disrupt respiratory epithelial barrier function causing acute inflammation. In addition, EoE, a prevalent atopic condition of the oesophageal epithelium, is characterised by similar innate immune and epithelial responses to viral injury. This review examines the current literature and identifies the gaps in the field defining viral-induced effects on a vulnerable respiratory epithelium and resulting chronic inflammation, drawing from knowledge generated in acute wheezing illness, paediatric asthma and EoE. Besides highlighting the importance of epithelial structure and barrier function in allergic disease pathogenesis regardless of specific epithelial sub-types, this review focuses on the importance of examining other parallel allergic-type disease processes that may uncover commonalities driving disease pathogenesis. This in turn may be beneficial in the development of common therapeutics for current clinical management and disease prevention in the future.

Meatal Stenosis and Atopic Condition: A Pilot Study Demonstrating a Possible Unidentified Etiology

Meatal stenosis (MS) is known as one of the most frequent complications of circumcision. In the present study, we aimed to find any possible relationship between MS and allergic disorders. A total of 36 children with a mean±SD age of 5.84±2.03 years were referred with MS and an atopic background even in themselves or in one of their family members (Group A). There were also age-matched controls with a mean±SD age of 5.70±2.17 years who were referred to our center with allergic symptoms and no urinary complaints (Group B, n=17). The RIDA qLine allergy and allergy explorer (ALEX) tests were performed for all patients to find possible allergen sensitization. Laboratory findings revealed that IgE-sensitization to the main food and aeroallergens in Group A (with the chief complaint of MS in whom a mild atopic condition was found during concise medical history taking) were very similar to the control group with no significant difference (except for ryegrass which was higher in the control group). Although total IgE level was considerably higher in group B compared to group A, food sensitization to cow’s milk and ß-lactoglobulin was higher in asthmatic patients of group A compared to the controls. It seems that not all patients with MS should be considered as a complication of circumcision and undergo a surgical procedure for correction of the stenosis. Further investigations are required to determine the role of concise medical history taking and proper treatment of the allergic disorder to reduce failed surgical attempts in atopic boys with MS.

Wheezing-Related Relevant Factors and the Role of Viral Bronchiolitis

Bronchiolitis is a virus-associated infection of the lower respiratory tract exhibiting signs and symptoms of airway obstruction. Respiratory Syncytial Virus (RSV) is responsible in most cases; however, different rhinoviruses have also been implicated. Specific viruses and time until the first infection, severity of the respiratory condition, and atopic status have a determinant role in the recurrence of wheezing and asthma development. Genetics, lung function, atopic condition, the role of microbiota and environment, pollution, and obesity are considered in the present review. Emergency room visits and hospitalizations because of severe wheezing and smoking during pregnancy among others were identified as risk factors for significant morbidity in our population. Approaching determinant conditions like genetics, allergy, antiviral immunity, and environmental exposures such as farm vs. urban and viral virulence provides an opportunity to minimize morbidity of viral illness and asthma in children.

Peculiarities of vascular endothelial growth factor of oral cavity in atopic condition VEGF of oral cavity in atopic condition

Background and aimsVascular endothelial growth factor (VEGF) is regarded as a potent stimulating factor for angiogenesis and vascular permeability and probably is connected with an inflammatory reaction. Our study aimed to determine the effect of VEGF in the inflammatory process in the oral mucosa of experimental animals in the modulation of atopic disease.Materials and methodsAtopic condition was simulated by the ovalbumin model. Obtained specimens of oral mucosa were examined histologically; immunohistochemistry was performed with detection VEGF, CD23, CD20.ResultsMost pronounced changes with twice increased expression activity of VEGF has been detected in the affected areas of the lamina propria and were associated with perivascular inflammatory microinfiltration, but unexpected expression in the epithelial layer has been revealed surround of intraepithelial inflammatory cells mainly. Pronounced correlations have been detected as VEGF and CD23 (r = 0.91), VEGF and CD20 (r = 0.87), CD23 and CD20 (r = 0.89).Discussiondescribed the changes in the tissues of the oral mucosa could be served as a basis for the development of preventive measures in patients with atopic diseases.discussionConclusionsActivation of VEGF is connected with accumulation of inflammatory infiltrate represented by B-lymphocytes, activated macrophages, eosinophils with a correlation in atopic process.

RINITIS ALERGI DI POLIKLINIK THT-KL BLU RSU PROF. DR. R. D. KANDOU MANADO PERIODE JANUARI 2010 – DESEMBER 2012

ABSTRACT: Allergic Rhinitis is an atopic condition which most often occurred. The incidence of allergic rhinitis is estimated at about 10% of the general population. This study aims to know the profile of allergic rhinitis patients in Ear, Nose and Throat – Head and Neck Surgery Department at Prof. Dr. R. D. Kandou General Hospital, Manado period January 2010 – December 2012 by using descriptive retrospective study method. The overall number of objects in this study are 209 patients. The result, distribution by year obtained the highest number of patients in the year 2011 as many as 80 patients of 4.295 visitors (1,86%), age group 21-30 years old had the highest percentage (23,92%). Percentage of patients with allergic rhinitis was higher in woman (56,48%) than men (43,54%), jobs of patients which employees have highest percentage (34,93%), sneezing clinical symptom has highest percentage (39,40%), antihistamine treatment has highest percentage (42.70%). Conclusion, Age group 21-30 years is the most frequent suffer from allergic rhinitis. Woman is more frequent suffer from allergic rhinitis than in men. The job of patients which most frequent to get allergic rhinitis is an employee. Clinical symptoms which are most frequent complained are sneezing, rhinorrhea and nasal congestion. Treatment which most frequent given is antihistamine drug. Keywords: Allergic rhinitis ABSTRAK: Rinitis alergi merupakan keadaan atopi yang paling sering dijumpai. Insiden rinitis alergi diperkirakan menyerang sekitar 10% dari populasi umum. Penelitian ini dilakukan untuk mengetahui profil penderita rinitis alergi di poliklinik THT-KL BLU RSU Prof. Dr. R. D Kandou Periode Januari 2010 – Desember 2012 dengan menggunakan metode retrospektif deskriptif. Keseluruhan jumlah objek penelitian adalah 209 penderita. Hasil penelitian, distribusi menurut tahun didapatkan jumlah penderita tertinggi pada tahun 2011 yaitu sebanyak 80 penderita dari 4.295 pengunjung (1,86%), golongan umur 21-30 tahun memiliki presentase tertinggi (23,92%). Rinitis alergi tinggi pada perempuan (56,48%) dari pada laki-laki (43,54%), pekerjaan terbanyak adalah pegawai (34,93%), gejala klinik bersin sebesar 39,40%, penanganan antihistamin memiliki presentase tertinggi sebesar 42.70%.Kesimpulan, golongan umur 21-30 tahun ialah yang paling sering menderita rinitis alergi. Perempuan lebih sering menderita rinitis alergi daripada laki-laki. Jenis pekerjaan yang paling sering terkena rinitis alergi ialah pegawai. Gejala klinik yang paling sering dikeluhkan yaitu bersin-bersin, rinore dan hidung tersumbat. Penanganan yang paling sering diberikan ialah obat golongan antihistamin. Kata Kunci: Rinitis alergi

Cupping Therapy May be Harmful for Eczema: A PubMed Search

Eczema is a common childhood atopic condition and treatment is with emollients, topical corticosteroids, and avoidance of possible triggers.S. aureuscolonization is a common complication. As there is no immediate cure, many parents seek alternative therapies that claim unproven therapeutic efficacy. We report a girl with long history of treatment noncompliance. After practicing a long period of dietary avoidance and supplementation, the grandparents took her to an alternative medicine practitioner. Following cupping therapy and acupuncture, the child developed blistering and oozing over her back the next day, which rapidly evolved to two large irregular-edge deep ulcers. She was treated with intravenous antibiotics and received multidisciplinary supportive intervention. Using search words of “cupping,” “eczema,” and “atopic dermatitis,” only two reports were found on PubMed. Therapeutic efficacy was claimed but not scientifically documented in these reports. Childhood eczema is an eminently treatable atopic disease. Extreme alternative therapy seems not to be efficacious and may even be associated with serious undesirable sequelae. Physicians should be aware of various alternative treatment modalities and be prepared to offer evidence-based advice to the patients with eczema and their families.