Summary
Background
Anaphylaxis hospitalizations are increasing in many countries, in particular for medication and food triggers in young children. Food‐related anaphylaxis remains an uncommon cause ...of death, but a significant proportion of these are preventable.
Aim
To review published epidemiological data relating to food‐induced anaphylaxis and potential risk factors of fatal and/or near‐fatal anaphylaxis cases, in order to provide strategies to reduce the risk of severe adverse outcomes in food anaphylaxis.
Methods
We identified 32 published studies available in MEDLINE (1966‐2017), EMBASE (1980‐2017), CINAHL (1982‐2017), using known terms and synonyms suggested by librarians and allergy specialists.
Results
Young adults with a history of asthma, previously known food allergy particularly to peanut/tree nuts are at higher risk of fatal anaphylaxis reactions. In some countries, cow's milk and seafood/fish are also becoming common triggers of fatal reactions. Delayed adrenaline injection is associated with fatal outcomes, but timely adrenaline alone may be insufficient. There is still a lack of evidence regarding the real impact of these risk factors and co‐factors (medications and/or alcohol consumption, physical activities, and mast cell disorders).
Conclusions
General strategies should include optimization of the classification and coding for anaphylaxis (new ICD 11 anaphylaxis codes), dissemination of international recommendations on the treatment of anaphylaxis, improvement of the prevention in food and catering areas, and dissemination of specific policies for allergic children in schools. Implementation of these strategies will involve national and international support for ongoing local efforts in relationship with networks of centres of excellence to provide personalized management (which might include immunotherapy) for the most at‐risk patients.
Asthma is one of the most common chronic diseases of childhood. Allergen sensitization and high frequencies of comorbid allergic diseases are characteristic of severe asthma in children. Omalizumab, ...an anti-IgE mAb, is the first targeted biologic therapeutic approved for the treatment of moderate-to-severe persistent allergic asthma (AA) that remains uncontrolled despite high-dose inhaled corticosteroids plus other controller medications. Since its initial licensing for use in adults and adolescents 12 years of age and older, the clinical efficacy, safety, and tolerability of omalizumab have been demonstrated in several published clinical trials in children aged 6 to less than 12 years with moderate-to-severe AA. These studies supported the approval of the pediatric indication (use in children aged ≥6 years) by the European Medicines Agency in 2009 and the US Food and Drug Administration in 2016. After this most recent change in licensing, we review the outcomes from clinical trials in children with persistent AA receiving omalizumab therapy and observational studies from the past 7 years of clinical experience in Europe. Data sources were identified by using PubMed in 2016. Guidelines and management recommendations and materials from the recent US Food and Drug Administration's Pediatric Advisory Committee meeting are also reviewed.
To the Editor: Anaphylaxis-related mortality (AMR) has been estimated at less than 1 per million population from the United States and the United Kingdom.1-3 In these countries, the AMR remained ...stable during the last decade.1-3 In contrast, the incidence of anaphylaxis fatalities increased in Australia from 1997 to 2013.4 The most common triggers of fatal anaphylaxis cases are drugs, insect venoms, and foods, with drugs accounting for most of the fatalities.1-4 In France, comprehensive data from anaphylaxis-related deaths are collected by the National Mortality Center. Advancing age is known to be another risk factor for fatal anaphylaxis.1-3 This is likely explained by underlying comorbidities, such as cardiovascular or cerebrovascular diseases, and also by an increased medication use.1 Fatal anaphylaxis is mostly due to medications, mainly antibiotics, as described in Australia and the United States.2-4 Our data showed a decrease in antibiotic-related fatal cases, especially during the last decade, in line with the decrease of 10.7% in antibiotic consumption reported in France (ANSM report 20136). ...our work is the longest time period study reporting AMR. Appendix Table E1Characteristics of anaphylaxis fatalities by specific cause Characteristic Anaphylaxis Iatrogenicn = 1011 (63%) Insect stingsn = 220 (13.7%) Foodn = 8 (0.5%) Unspecifiedn = 364 (22.7%) Alln = 1603 (100%) Sex, n (%) Men 439 (56.0) 159 (20.3) 6 (0.8) 180 (23.0) 784 (100) Women 572 (69.8) 61 (7.4) 2 (0.2) 184 (22.5) 819 (100) Population Adult 993 (63.5) 217 (13.9) 6 (0.4) 348 (22.3) 1564 (100) Pediatric 18 (46.2) 3 (7.8) 2 (5.1)...
Primary ciliary dyskinesia (PCD) is a rare inherited disease that affects the movement of the respiratory cilia. The main clinical manifestations are chronic upper and lower respiratory symptoms and ...recurrent lung infections, particularly bacterial and viral infections. Fungal infections are not usually associated with PCD. Allergic bronchopulmonary aspergillosis (ABPA) is a rare complex immune hypersensitivity reaction to Aspergillus fumigatus reported in patients with asthma and cystic fibrosis. Only three cases of ABPA associated with adult PCD have been described in the literature. Herein, we reported on two cases of ABPA in two boys aged 10 and 13 years with PCD. Both had severe lung disease and chronic Pseudomonas aeruginosa infections. One patient was diagnosed according to the typical clinical features of ABPA, while the other was diagnosed during a scheduled visit with no clinical changes but worsening pulmonary function and radiologic anomalies. The diagnosis of ABPA was confirmed in the two patients who then improved after receiving specific treatment. These two cases were the first to describe the occurrence of ABPA in children with PCD. We recommend that physicians involved in the management of children with PCD be aware of this potential complication.
Congenital diaphragmatic hernia (CDH) is associated with a high incidence of respiratory problems, even after initial hospital discharge. These problems are likely to lead to re-hospitalization ...during infancy, although actual frequency of readmissions is unknown.
We aimed to determine the rate of hospitalization for wheezing in infants with CDH between the time of initial discharge and 24 months of age, and to identify factors associated with readmission.
Data about infants with CDH born in three French reference tertiary centers between January 2009 and March 2013 who were alive at hospital discharge, were extracted from a prospective national database.
Ninety-two children were identified, and 86 were included in the analysis. In total, 116 wheezing episodes requiring a doctor's visit occurred in 50 infants (58%) before 24 months of age. Twenty-two children (26%) were readmitted at least once for wheezing exacerbations. RSV was present in 6 of 15 (40%) of children with available nasal samples at first readmission, and 1 of 5 (20%) at second readmission. Thoracic herniation of the liver, low gestational age, longer initial hospitalization, need for oxygen therapy at home, and eczema were all significantly associated with readmission for wheezing exacerbations. Fifty-three infants (62%) received palivizumab prophylaxis, but there was no association with the overall rate of readmission for wheezing exacerbations or RSV-related hospitalization.
The rate of readmission for wheezing among infants with CDH is high, and significantly influenced by several prenatal and neonatal factors. Palivizumab prophylaxis was not associated with the rate of readmission.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Omalizumab is recommended as an add-on therapy in patients aged ≥6 years with inadequately controlled, moderate-to-severe persistent allergic asthma. The efficacy and safety of omalizumab treatment ...in allergic asthma clinical trials and its effectiveness in the real world have been reported in numerous studies. In this review, we examine clinical evidence in pediatric and adult patients with allergic asthma who received omalizumab treatment for at least 2 years, to assess its effectiveness, durability, and trajectory of response over time as well as safety. We performed a literature search from inception until March 2022 in PubMed using the keywords “omalizumab” and “allergic asthma” to retrieve articles examining the effects of omalizumab in patients with allergic asthma, aged ≥6 years. Only articles that evaluated the effectiveness of omalizumab for at least 2 years were included. Data from case reports were excluded. Our review confirmed the long-term effectiveness and safety of omalizumab, demonstrating reduced rate of exacerbations, improved lung function, asthma control, and quality of life, decreased health care resource utilization, and use of corticosteroids (oral/inhaled) with a favorable safety and tolerability profile for up to 9 years in adult patients with moderate-to-severe allergic asthma. Similar results were also observed in the pediatric population with up to 7.5 years of omalizumab treatment. This review highlights and confirms the sustained clinical benefits of omalizumab over long periods of treatment in pediatric and adult populations with allergic asthma.
Background: In France, updated data on food allergies (FAs) are lacking, despite the need for efficient FA management and prevention. This study aimed to evaluate the prevalence of FAs in children in ...France, describe the most common allergens and determine the prevalence of atopic diseases in children with FAs. Methods: The ELFE study comprises a French nationwide birth cohort, including 18,329 children born in 2011. FAs were assessed by parental reports of food avoidance based on medical advice related to FAs, provided at 2 months and 2, 3.5 and 5.5 years of age. Data regarding FAs were available for 16,400 children. Data were weighted to account for selection and attrition bias. Results: From birth to 5.5 years of age, FAs were reported for 5.94% (95% CI: 5.54–6.34) children. Milk was the most common allergen, followed by egg, peanut, exotic fruits, tree nuts, gluten and fish. Among children with FAs, 20.5% had an allergy to at least two different groups of allergens; 71% reported eczema at least once before 5.5 years of age; 24.4% reported incidence of asthma; and 42.3% reported incidence of allergic rhinitis or conjunctivitis. Conclusion: In France, the prevalence of FAs in children up to 5.5 years of age is approximately 6%. It was demonstrated that 1 in 5 children with allergies had multiple FAs.
Options to achieve oral corticosteroid (OCS)-sparing have been triggering increasing interest since the 1970s because of the side-effects of OCSs, and this has now become achievable with biologics. ...The Société de Pneumologie de Langue Française workshop on OCSs aimed to conduct a comprehensive review of the basics for OCS use in asthma and issue key research questions. Pharmacology and definition of regular use were reviewed by the first working group (WG1). WG2 examined whether regular OCS use is associated with T2 endotype. WG3 reported on the specificities of the paediatric area. Key "research statement proposals" were suggested by WG4. It was found that the benefits of regular OCS use in asthma outside episodes of exacerbations are poorly supported by the existing evidence. However, complete OCS elimination couldn't be achieved in any available studies for all patients and the panel felt that it was too early to conclude that regular OCS use could be declared criminal. Repeated or prolonged need for OCS beyond 1 g·year
should indicate the need for referral to secondary/tertiary care. A strategic sequential plan aiming at reducing overall exposure to OCS in severe asthma was then held as a conclusion of the workshop.
Background
Radiation dose reduction is a primary objective in pediatric populations owing to the well-known risks of radiation-induced cancers. Low-energy photons participate in the radiation dose ...without significantly contributing to image formation. Their suppression by means of tin filtration should decrease the image noise, anticipating a subsequent application to dose saving.
Objective
To investigate the level of noise reduction achievable with tin (Sn) filtration at 100 kVp for chest computed tomography (CT) in comparison with a standard scanning mode at 70 kVp with comparable radiation dose.
Materials and methods
Fifty consecutive children (Group 1) underwent non-contrast chest CT examinations on a third-generation dual-source CT system at tin-filtered 100 kVp and pitch 2. The tube-current time product (mAs) was adjusted to maintain the predicted dose length product (DLP) value at 70 kVp for the respective patient. Each child was then paired by weight and age to a child scanned at 70 kVp on the same CT unit (Group 2); Group 2 patients were consecutive patients, retrospectively selected from our database of children prospectively scanned at 70 kVp. Objective and subjective image quality were compared between the two groups of patients to investigate the overall image quality and level of noise reduction that could be subsequently achievable with tin filtration in clinical practice.
Results
The mean image noise was significantly lower in Group 1 compared to Group 2 when measured in the air (
P
<0.0001) and inside the aorta (
P
<0.001). The mean noise reduction was 21.6% (standard deviation SD 16.1) around the thorax and 12.0% (SD 32.7) inside the thorax. There was no significant difference in subjective image quality of lung and mediastinal images with excellent overall subjective scores in both groups.
Conclusion
At comparable radiation dose, the image noise was found to be reduced by 21.6% compared to the 70-kVp protocol, providing basis for dose reduction without altering image quality in further investigations.
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