Cecilia P. Mikita

Section on allergy and immunology

Founded in 1948, the Section on Allergy and Immunology is dedicated to ensuring that children receive the highest quality of allergy and immunology care. To accomplish its mission, the Section provides a number of educational, training, and research programs and continually advocates for improved allergy and immunology care and services. The Section sponsors educational programs for both pediatric generalists and subspecialists at the American Academy of Pediatrics (AAP) National Conference and Exhibition (NCE) each fall and at the American Academy of Allergy Asthma & Immunology annual meeting each spring. The Section’s other educational endeavors include this annual “Best Articles Relevant to Pediatric Allergy and Immunology” supplement to Pediatrics, Visiting Professor Program, Pediatric Asthma Speaker’s Kit, online continuing medical education course on “asthma gadgets,” electronic quality improvement in practice program on asthma diagnosis and management (Education in Quality Improvement for Pediatric Practice [eQIPP], which meets the American Board of Pediatrics maintenance-ofcertification criteria), school nurse allergy tool kit, and a number of public education materials. The Section is also active in contributing to educational programs and resources such as AAP News, educational brochures, clinical reports, and many other endeavors. To support training and promote research in pediatric allergy and immunology, the Section awards travel grants to residents and training fellows to participate and present cases at the AAP NCE and provides outstanding abstract awards for training fellows and junior faculty for presentation at the American Academy of Allergy Asthma & Immunology annual meeting. In close collaboration with other subspecialty societies, the Section is actively involved with initiatives to improve subspecialty education such as the American Board of Allergy and Immunology maintenance-of-certification requirements. Section members represent the AAP in national and government conferences and provide input on federal legislation on behalf of the AAP. For more information on all AAP allergy and immunology resources and initiatives, visit www.aap.org/sections/allergy. The reviews contained in the 2011 synopsis were written by Fellows of the AAP Section on Allergy and Immunology and fellows in allergy and immunology training programs who contributed reviews with their mentors. The editor selected the journals to be reviewed on the basis of the likelihood that they would contain articles on allergy and immunology that would be of value and interest to the pediatrician. Each journal was assigned to a voluntary reviewer who was responsible for selecting articles and writing reviews of their articles. Only articles of original research were selected for review. Final selection of the articles to be included was made by the editor. The 2010–2011 journals chosen for review were Allergy, American Journal of Asthma & Allergy for Pediatricians, Archives of Pediatric and Adolescent Medicine, American Journal of Medicine, American Journal of Respiratory and Critical Care Medicine, Annals of Allergy, Asthma, and Immunology, Annals of Internal Medicine, Archives of Disease in Childhood, Archives of Internal Medicine, Blood, British Journal of Dermatology, British Medical Journal, Chest, Clinical and Experimental Allergy, Clinical Pharmacology and Therapeutics, Critical Care Medicine, European Journal of Pediatrics, European Respiratory Journal, Immunology, Journal of Allergy and Clinical Immunology, Journal of the American Academy of Dermatology, Journal of the American Medical Association, Journal of Applied Physiology, Journal of Experimental Medicine, Journal of Immunology, Journal of Infectious Diseases, Journal of Pediatric Gastroenterology and Nutrition, Journal of Pediatrics, Journal of Pharmacology and Experimental Therapeutics, Lancet, Nature, New England Journal of Medicine, Pediatrics, Medicine, Pediatric Allergy and Immunology, Pediatric Asthma, Allergy & Immunology, Pediatric Dermatology, Pediatric Infectious Disease Journal, and Science. The editor and the Section on Allergy and Immunology gratefully acknowledge the work of the reviewers and their trainees who assisted. The reviewers were Stuart L. Abramson, MD, PhD, Sugar Land, TX; James R. Banks, MD, Arnold, MD; Theresa A. Bingemann, MD, Rochester,

Allergen Avoidance Does Not Alter Airborne Cat Allergen Levels in Classrooms

Karlsson AS, Renstrom A, Hedren M, Larsson K. Allergy . 2004;59:661–667 To determine if feasible and economically defensible classroom interventions that do not interfere with pet ownership can alter airborne levels of cat allergen. Intermediate-level school classrooms ( n = 25, grades 1–6) in a suburb north of Stockholm, Sweden. Only classrooms with a single group of students using the class during the study period were used. Flooring materials, ventilation, cleaning routines, and room size were similar. The mean number of children per classroom was 25 (range: 18–30), and 21% had cats at home. …

Can we find a possible structural explanation for antibody-dependent enhancement of dengue virus infection resulting in hemorrhagic fever?

Dengue virus infection is one of the most prevalent mosquito-borne illnesses worldwide, affecting as many as 400 million persons annually. Most people experience a self-limited viral illness, but some experience life-threatening disease. Subsequent infection with other dengue virus serotypes increases the risk of development of severe dengue disease with plasma leakage with or without hemorrhage and end organ impairment. Antibody-dependent enhancement of dengue virus infection has been implicated in the development of severe dengue disease, previously referred to as dengue hemorrhagic fever and dengue shock syndrome. We propose a structural explanation for the role of non-neutralizing antibodies in the development of antibody-dependent enhancement of dengue virus infection via complement fixation or binding to Fcγ receptors facilitating entry into target cells.

Can we use DNA triple helices as treatment for systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic disease characterized by a variable clinical course and is associated with the presence of numerous autoantibodies. Autoantibodies against double-stranded DNA are highly specific for SLE and are directly associated with distinct clinical manifestations of the disease, specifically lupus nephritis. Examination of the sequences and the three-dimensional structures of autoantibodies specific for nucleic acids, confirms the presence of positively charged amino acids which could interact with the phosphate groups of self DNA. We hypothesize that DNA triple-helices, which can be constructed using short DNA sequences, may be useful in decreasing the clinical manifestations of SLE by inhibiting anti-dsDNA autoantibodies.

Can we explain the allergenicity of peanuts on the basis of the three-dimensional structure of its allergens and use the information to devise means of eliminating peanut allergy?

Helical bundles are found in all the known structures of peanut allergens. The peptide fragments, which survive gastrointestinal digestion of the allergens and are absorbed intact, are hypothesized to reassociate and form stable helical bundles in the circulation, which could elicit a specific IgE response resulting in peanut allergy. The hypothesis is supported by the finding of a diminished allergenicity of an isoform of the peanut allergen, Ara h 3, which has a major deletion. A very probable consequence of this deletion is the reduced tendency to form a stable helix bundle. The discovery of structurally disrupted isoforms of the other peanut allergens and the breeding of plants that contain only those isoforms could lead to the elimination of peanut allergy.

The Canadian Childhood Asthma Primary Prevention Study: Outcomes at 7 Years of Age

Purpose of the Study. To evaluate the effects of a multifaceted intervention program involving high-risk infants on the development of asthma at 7 years of age. Study Population. Of the original 545 high-risk infants in the Canadian Childhood Asthma Primary Prevention Study, 380 were evaluated at 7 years of age. Infants at high risk for asthma development were defined as those with at least 1 first-degree relative with asthma or 2 first-degree relatives with other immunoglobulin E–mediated allergic diseases. Methods. The initial 545 high-risk infants were randomly assigned before birth to a multifaceted intervention group (n = 279) or the control group (n = 266). The multifaceted intervention program, which was implemented before birth and during the first year of life, included house dust mite–control measures, pet-avoidance measures, avoidance of environmental tobacco smoke, breastfeeding, and/or using partially hydrolyzed whey formula. This study describes the follow-up assessment of 380 subjects at 7 years of age who completed a questionnaire and were evaluated by a pediatric allergist for asthma. Allergy skin testing and methacholine challenge were also performed. Results. A significantly lower number of subjects had pediatric allergist–diagnosed asthma in the intervention group (14.9%) than in the control group (23.0%; adjusted relative risk [RR]: 0.44). The prevalence of asthma, defined as wheeze plus bronchial hyperreactivity (methacholine challenge), was also significantly lower in the intervention group when compared with the control group (12.9% vs 25%, respectively; adjusted RR: 0.39). There was no significant difference in the diagnosis of allergic rhinitis or atopic dermatitis, allergen skin-test reactivity, or bronchial hyperreactivity alone between the 2 groups. Symptoms of wheeze and wheeze apart from colds in the last 12 months were significantly lower in the intervention group compared with the control group. There were no significant differences in nocturnal symptoms, exercise-related symptoms, medication use, emergency visits for wheeze, nasal symptoms, or skin rash. Reviewer Comments. Asthma and allergic diseases likely result from a combination of environmental and genetic factors. This study showed that the prevalence of asthma was decreased after an intervention program implemented early in life. Thus, recommending environmental controls as a safe method to decrease the risk of developing asthma in high-risk patients is reasonable. It is unclear from this study whether a specific environmental control or a combination of interventions is more effective. It is interesting that no difference was noted in the prevalence of allergic rhinitis or atopic dermatitis between the groups, which, theoretically, could also be affected by environmental controls.

Hypersensitivity Reactions to Paracetamol in Children: A Study of 25 Cases

Purpose of the Study. Reports of paracetamol (acetaminophen) allergic and nonallergic hypersensitivity reactions are rare. However, urticaria, angioedema, dyspnea, and allergic and nonallergic anaphylactic reactions have been reported in both children and adults in association with paracetamol administration. Most reactions to paracetamol occur in patients with a nonallergic hypersensitivity to nonsteroidal antiinflammatory drugs (NSAIDs). Alternatively, reactions may result from an allergic hypersensitivity to paracetamol, with tolerance of NSAIDs. This study reports an investigation of 25 children with suspected paracetamol hypersensitivity. Study Population. Twenty-five children, aged 8 months to 15 years, with a history of adverse reactions associated with paracetamol administration. In 12 of the 25 children studied, paracetamol adverse reactions were associated with concurrent administration of other medications or biological agents. Methods. Diagnosis of paracetamol hypersensitivity was based on either clinical history or the results of an oral challenge test. Reported reactions included urticaria, angioedema, conjunctivitis, dyspnea, and a maculopapular rash. Oral challenge tests with paracetamol were performed in the hospital setting. Paracetamol dosing was initiated at 1 mg and gradually increased until the appropriate cumulative dose for age and weight was achieved. An oral challenge with acetylsalicylic acid was performed in 1 child with a history highly suggestive of paracetamol hypersensitivity. Results. Paracetamol hypersensitivity was diagnosed in 1 patient (4%) on the basis of clinical history. The child reported accelerated reactions on 2 occasions, including facial angioedema, conjunctivitis, and dyspnea with wheezing, after isolated intake of paracetamol. Oral challenge to acetylsalicylic acid in this patient induced urticaria and angioedema. Oral challenges to paracetamol in the 24 other children studied were tolerated. Conclusions. Results of this study of 25 children with suspected paracetamol hypersensitivity concur with those of previous reports: paracetamol hypersensitivity is rare and is associated with hypersensitivity reactions to antiinflammatory medications. Reviewer Comments. Adverse reactions temporally associated with paracetamol may result from reactions to other medications or the underlying conditions for which these medications have been prescribed. Diagnostic evaluation of suspected paracetamol hypersensitivity is complicated further by the lack of validated, available skin or in vitro testing. Adverse reactions to paracetamol can be both allergic and nonallergic in nature. The results of this study underscore the need for careful evaluation for both paracetamol and NSAID hypersensitivity in children with a history suggestive of adverse reactions to paracetamol.

Parental Management of Asthma Triggers Within a Child’s Environment

Cabana M, Slish K, Lewis D, et al. J Allergy Clin Immunol . 2004;114:352–357 To assess the type and frequency of attempts by families to control environmental precipitants of asthma symptoms and their degree of consistency with current National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines. A nationwide sample of 896 children (ages 2–12 years) with asthma who had used asthma-related health care within the previous 2 years. Patients were selected randomly from the panels of 106 primary care clinicians participating in a trial to evaluate the effect of physician asthma education on health care …