Han-Ping Wu

First Attack of Acute Urticaria in Pediatric Emergency Department

BACKGROUNDnManagement of a first attack of acute urticaria in children is dependent on the etiology of the disease. Knowledge of the various etiologies of urticaria will help primary physicians to perform appropriate clinical assessments. In this study, we analyzed the etiologies and their prevalence in first-attack acute urticaria in infants, children and adolescents in central Taiwan.nnnMETHODSnThis was a retrospective study of 953 children who were admitted to the emergency department (ED) with a first attack of acute urticaria from January 2000 to December 2006. All patients were followed in the ED or outpatient department until their symptoms subsided. Patient demographics and detailed etiologies of the first attack of acute urticaria were analyzed. Furthermore, the prevalence of various etiologies in different age groups, as well as the etiologic trends of acute urticaria in children during the previous 7 years, was determined.nnnRESULTSnThe most common etiologies of a first attack of acute urticaria in children were various infections (48.4%), foods (23.5%), idiopathic causes (13.2%), and medications (11.5%). Among the three major etiologies above, upper respiratory tract infections (nasopharyngitis), seafood (shrimp) and nonsteroidal anti-inflammatory drugs (ibuprofen) were the most frequent causes. Moreover, the etiologies differed significantly with patient age (p < 0.001). Overall, infections were the major cause in infants (56.5%), whereas food (36.6%) and medications (26.8%) were the most common etiologies in adolescents. The prevalence of various infections dropped as the age of the children increased (56.5% in infants, 51.2% in preschool-aged children, 42.1% in school-aged children and 17.1% in adolescents). The etiologies of foods and medications were more prevalent in adolescents than in younger children.nnnCONCLUSIONnDetailed etiologies of first-attack urticaria in children in central Taiwan were analyzed. Most importantly, we found that there was a decrease in the prevalence of various infections as causative factors as the age of the children increased. The etiologies of foods and medications were more prevalent in adolescents than in younger children.

Induction of IL-10+ CD4+ CD25+ regulatory T cells with decreased NF-κB expression during immunotherapy.

Tsai Y‐G, Chiou Y‐L, Chien J‐W, Wu H‐P, Lin C‐Y. Induction of IL‐10+u2003CD4+u2003CD25+ regulatory T cells with decreased NF‐κB expression during immunotherapy.u2028Pediatr Allergy Immunol 2010: 21: e166–e173.u2028© 2009 The Authorsu2028Journal compilation

Significant factors associated with severity and outcome of an initial episode of acute urticaria in children

Liu T‐H, Lin Y‐R, Yang K‐C, Tsai Y‐G, Fu Y‐C, Wu T‐K, Wu H‐P. Significant factors associated with severity and outcome of an initial episode of acute urticaria in children.u2028Pediatr Allergy Immunol 2010: 21: 1043–1051.u2028© 2010 John Wiley & Sons A/S

Poison exposure and outcome of children admitted to a pediatric emergency department

BackgroundThis paper reports the characteristics, outcomes and clinical features of children with poisoning treated at an emergency department (ED).MethodsThis retrospective study at an emergency department consisted of 140 children with poison exposure who were aged under 18 years. Their characteristics were analyzed in order to understand the differences between accidental and non-accidental poisoning. The poisonous materials were divided into two major categories (pharmaceuticals and non-pharmaceuticals) and their associations with patient outcomes were analyzed. Furthermore, the association was analyzed between the incidence of poison exposure and the season in which the poison exposure occurred.ResultsThe incidence of poison exposure was highest among adolescents and pre-school age children. Nonaccidental poisoning was more common in older girls and accidental poisoning was more common in younger boys (P<0.001). Neurological system agents were the most common cause of poisoning in the pharmaceutical group and cleansing products were the most common cause of poisoning in the non-pharmaceutical group. Neurological and gastrointestinal symptoms were the most common clinical presentations for the pharmaceutical and non-pharmaceutical groups, respectively. Furthermore, poisoning due to cleansing products and analgesics were associated with the longest duration of hospitalization. March was the highest risk month for pediatric poisoning (P=0.018).ConclusionsCleansing products and analgesics were associated with the longest duration of hospitalization and intentional poison was more common in girls.

Pharmaceutical Poisoning Exposure and Outcome Analysis in Children Admitted to the Pediatric Emergency Department

BACKGROUNDnPharmaceuticals involved in childhood poisoning vary, and treatment of poison exposure can be a challenge for primary physicians when children are unconscious or histories are lacking. Knowledge of the clinical manifestations and prognosis of poisoning will help primary physicians perform appropriate clinical assessments. In this study, we aim to report on patient characteristics, outcomes, and clinical features of pediatric poisoning in the emergency department.nnnMETHODSnWe retrospectively evaluated the medical records of 87 children younger than 18 years of age and presented to the emergency department with pharmaceutical poisoning (2001-2008). The detailed categories of pharmaceutical were reported, and their associations with patient outcomes were analyzed. Furthermore, children were divided into two groups, based on the reasons for poison exposure (accidental or intentional poisoning). Clinical features and outcomes between accidental or intentional poisoning were analyzed, and the cut-off age for high risk of intentional poisoning was also calculated.nnnRESULTSnAge groups of adolescents (48.3%) and preschool age (32.2%) children were the major representation. Neurologic system agents (48.3%) and analgesics (18.4%) were the most common causes of poisoning. Among the two major agents above, anxiolytic/hypnotic drugs (lorazepam) and acetaminophen were the most frequent causes. Of all children, 70.1% had duration of major symptoms for ≤1 day, and intentional poisoning caused significantly longer duration of hospital stay than accidental poisoning did (p=0.008). Moreover, female gender (p<0.001), older age (p<0.001), and analgesics (p=0.008) were more predominantly associated with intentional poisoning in children, and the cut-off age for high risk of intentional poisoning was over 10.5 years.nnnCONCLUSIONnNeurologic system agents and analgesics were responsible for the majority of cases. Intentional poisoning caused longer hospital length of stay than accidental poisoning, and the factors associated with intentional poisoning were older age, female, and neurologic system agents.

Predictive factors of the duration of a first-attack acute urticaria in children.

PURPOSESnThis studys aim was to determine the predictive factors of the duration of first-attack acute urticaria in children.nnnBASIC PROCEDURESnThe sample included 1075 children admitted to the emergency department with first-attack acute urticaria. Variables comprising the clinical features and past histories of children with duration of disease of 3 days or less, 4 to 7 days, 8 to 14 days, and 15 days or more were compared to determine the predictors of duration of acute urticaria.nnnMAIN FINDINGSnAge, various etiologies, clinical presentations, coexistent pyrexia or angioedema, and personal histories of allergic diseases were significant factors (all P < .05). Among allergic diseases, atopic dermatitis was the most significant predictor of duration of acute urticaria, and those with multiple allergic diseases had longer durations of urticaria (both P < .05). Oral plus injection forms of antihistamine or steroid were related to shorter duration of disease (P < .05).nnnPRINCIPAL CONCLUSIONSnEtiologies and personal allergy history may be the most important predictors of the duration of a first attack of acute urticaria.

Increased risk of major depression subsequent to a first-attack and non-infection caused urticaria in adolescence: a nationwide population-based study

BackgroundNon-infection caused urticaria is a common ailment in adolescents. Its symptoms (e.g., unusual rash appearance, limitation of daily activities, and recurrent itching) may contribute to the development of depressive stress in adolescents; the potential link has not been well studied. This study aimed to investigate the risk of major depression after a first-attack and non-infection caused urticaria.MethodsThis study used the Taiwan Longitudinal Health Insurance Database. A total of 5,755 adolescents hospitalized for a first-attack and non-infection caused urticaria from 2005 to 2009 were recruited as the study group, together with 17,265 matched non-urticarial enrollees who comprised the control group. Patients who had any history of urticaria or depression prior to the evaluation period were excluded. Each patient was followed for one year to identify the occurrence of depression. Cox proportional hazards models were generated to compute the risk of major depression, adjusting for the subjects’ sociodemographic characteristics. Depression-free survival curves were also analyzed.ResultsThirty-four (0.6%) adolescents with non-infection caused urticaria and 59 (0.3%) non-urticarial control subjects suffered a new-onset episode of major depression during the study period. The stratified Cox proportional analysis showed that the crude hazard ratio (HR) of depression among adolescents with urticaria was 1.73 times (95% CI, 1.13-2.64) than that of the control subjects without urticaria. Moreover, the HR were higher in physical (HR: 3.39, 95% CI 2.77-11.52) and allergy chronic urticaria (HR: 2.43, 95% CI 3.18-9.78).ConclusionIndividuals who have a non-infection caused urticaria during adolescence are at a higher risk of developing major depression.

The Post-Resuscitative Urinalysis Associate the Survival of Patients with Non-Traumatic Out-of-Hospital Cardiac Arrest

Objective To analyze whether urine output and urinalysis results are predictive of survival and neurologic outcomes in patients with non-traumatic out-of-hospital cardiac arrest (OHCA). Methods Information was obtained from 1,340 patients with non-traumatic OHCA who had achieved a sustained return of spontaneous circulation (ROSC). Factors that were associated with survival in the post-resuscitative period were evaluated. The association between urine output and fluid challenge in the early resuscitative period was analyzed and compared between the survivors and the non-survivors. The results of the initial urinalysis, including the presence of proteinuria and other findings, were used to evaluate the severity of vascular protein leakage and survival. The association between proteinuria and the neurologic outcomes of the survivors was also analyzed. The clinical features of capillary leakage were examined during the post-resuscitative period. Results Of the 1,340 patients, 312 survived. A greater urine output was associated with a higher chance of survival. The initial urine output increased in proportion to the amount of fluid that was administered during early resuscitation in the emergency department for the survivors but not for the non-survivors (p<0.05). In the initial urinalysis, proteinuria was strongly associated with survival, and severe proteinuria indicated significantly poorer neurologic outcomes (p<0.05 for both comparisons). Proteinuria was associated with a risk of developing signs of capillary leakage, including body mass index gain and pitting edema (both p<0.001). Conclusion The severity of proteinuria during the early post-resuscitative period was predictive of survival.

Early Administration of Glutamine Protects Cardiomyocytes from Post-Cardiac Arrest Acidosis

Postcardiac arrest acidosis can decrease survival. Effective medications without adverse side effects are still not well characterized. We aimed to analyze whether early administration of glutamine could improve survival and protect cardiomyocytes from postcardiac arrest acidosis using animal and cell models. Forty Wistar rats with postcardiac arrest acidosis (blood pH < 7.2) were included. They were divided into study (500u2009mg/kg L-alanyl-L-glutamine, n = 20) and control (normal saline, n = 20) groups. Each of the rats received resuscitation. The outcomes were compared between the two groups. In addition, cardiomyocytes derived from human induced pluripotent stem cells were exposed to HBSS with different pH levels (7.3 or 6.5) or to culture medium (control). Apoptosis-related markers and beating function were analyzed. We found that the duration of survival was significantly longer in the study group (p < 0.05). In addition, in pH 6.5 or pH 7.3 HBSS buffer, the expression levels of cell stress (p53) and apoptosis (caspase-3, Bcl-xL) markers were significantly lower in cardiomyocytes treated with 50u2009mM L-glutamine than those without L-glutamine (RT-PCR). L-glutamine also increased the beating function of cardiomyocytes, especially at the lower pH level (6.5). More importantly, glutamine decreased cardiomyocyte apoptosis and increased these cells beating function at a low pH level.