Pakit Vichyanond

International consensus on (ICON) pediatric asthma

Asthma is the most common chronic lower respiratory disease in childhood throughout the world. Several guidelines and/or consensus documents are available to support medical decisions on pediatric asthma. Although there is no doubt that the use of common systematic approaches for management can considerably improve outcomes, dissemination and implementation of these are still major challenges. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), recently formed by the EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus on (ICON) Pediatric Asthma. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences, thus providing a concise reference. The principles of pediatric asthma management are generally accepted. Overall, the treatment goal is disease control. To achieve this, patients and their parents should be educated to optimally manage the disease, in collaboration with healthcare professionals. Identification and avoidance of triggers is also of significant importance. Assessment and monitoring should be performed regularly to re‐evaluate and fine‐tune treatment. Pharmacotherapy is the cornerstone of treatment. The optimal use of medication can, in most cases, help patients control symptoms and reduce the risk for future morbidity. The management of exacerbations is a major consideration, independent of chronic treatment. There is a trend toward considering phenotype‐specific treatment choices; however, this goal has not yet been achieved.

Periplaneta americana arginine kinase as a major cockroach allergen among Thai patients with major cockroach allergies.

Periplaneta americana is the predominant cockroach (CR) species and a major source of indoor allergens in Thailand. Nevertheless, data on the nature and molecular characteristics of its allergenic components are rare. We conducted this study to identify and characterize the P. americana allergenic protein. A random heptapeptide phage display library and monoclonal antibody (MAb) specific to a the P. americana component previously shown to be an allergenic molecule were used to identify the MAb-bound mimotope and its phylogenic distribution. Two-dimensional gel electrophoresis, liquid chromatography, mass spectrometry, peptide mass fingerprinting, and BLAST search were used to identify the P. americana protein containing the MAb-specific epitope. We studied the allergenicity of the native protein using sera of CR-allergic Thai patients in immunoassays. The mimotope peptide that bound to the MAb specific to P. americana was LTPCRNK. The peptide has an 83–100% identity with proteins of Anopheles gambiae, notch homolog scalloped wings of Lucilia cuprina, delta protein of Apis mellifera; neu5Ac synthase and tyrosine phosphatase of Drosophila melanogaster, and a putative protein of Drosophila pseudoobscura. This finding implies that the mimotope-containing molecule of P. americana is a pan-insect protein. The MAb-bound protein of P. americana was shown to be arginine kinase that reacted to IgE in the sera of all of the CR-allergic Thai patients by immunoblotting, implying its high allergenicity. In conclusion, our results revealed that P. americana arginine kinase is a pan-insect protein and a major CR allergen for CR-allergic Thai patients.

Milk-induced pulmonary disease in infants (Heiner syndrome).

Heiner syndrome (HS) is a food hypersensitivity pulmonary disease that affects primarily infants, and is mostly caused by cows milk (CM). Only a few reports have been published, which may be due to its misdiagnosis. We review here a series of eight cases. When first diagnosed they were 4–29 months of age. They were fed CM from birth and their chronic respiratory symptoms began at age 1–9 months. The symptoms were in the form of cough in seven, wheezing in three, hemoptysis in two, nasal congestion in three, dyspnea in one, recurrent otitis media (OM) in three, recurrent fever in four, anorexia, vomiting, colic or diarrhea in five, hematochezia in one, and failure to thrive (FTT) in two. All had radiologic evidence of pulmonary infiltrates. High titers of precipitating antibodies to CM proteins were demonstrated in six of six and milk‐specific immunoglobulin E (IgE) was positive in one of two. Pulmonary hemosiderosis (PH) was confirmed in one patient who showed iron‐laden macrophages (ILM) in the bronchoalveolar lavage (BAL), gastric washing, and open lung biopsy. Additional findings, in a descending frequency, were eosinophilia, anemia, and elevated level of total IgM, IgE or IgA. Milk elimination resulted in remarkable improvement in symptoms within days and clearing of the pulmonary infiltrate within weeks. Parents consented to milk challenge in only three cases, all of whom developed recurrence of symptoms. After 2 yr of milk avoidance in one patient, milk challenge was tolerated for 2 months, and then the patient developed symptoms, serum milk precipitins, pulmonary infiltrate, and ILM. The HS should be suspected in young children with chronic pulmonary disease of obscure cause. The diagnosis is supported with a positive milk precipitin test and improvement on a trial of milk elimination. Severe cases may be complicated with PH, which should be suspected in the presence of anemia or hemoptysis and be confirmed with the demonstration of ILM.

Genetic polymorphisms of major house dust mite allergens

Background Polymorphic sequence substitutions in the major mite allergens can markedly affect immunoglobulin E binding and T cell responses, but there are few studies on environmental isolates from Dermatophagoides pteronyssinus and none for D. farinae.

Features of patients with anaphylaxis admitted to a university hospital

BACKGROUND Anaphylaxis in hospitalized patients has been infrequently reviewed. There are few studies of anaphylaxis from Asian countries. OBJECTIVE To describe the clinical characteristics of patients with anaphylaxis admitted to Siriraj Hospital. METHODS The medical records of 101 patients admitted with clinical anaphylaxis between January 1, 1999, and December 31, 2004, were reviewed. Data were analyzed using the chi2 test. RESULTS The annual occurrence of anaphylaxis increased from 9.16 per 100,000 admitted persons in 1999 to 55.45 per 100,000 admitted persons in 2004. The case fatality rate was 0.19 per 100,000 admitted persons. The mean +/- SD age was 23.73 +/- 21.84 years. Males experienced more anaphylaxis than females in pediatric patients and vice versa in adult patients. Biphasic anaphylaxis was found in 7% of pediatric and 2% of adult patients. Anaphylaxis occurred in the hospital in 37% of patients. Involved systems were cutaneous (86%), respiratory (80%), cardiovascular (52%), and oral and gastrointestinal (36%). Identifiable causes were drugs (50%), foods (24%), idiopathic (15%), and insect stings/bites (11%). Epinephrine was given to 77% of the patients. CONCLUSIONS We report the clinical characteristics of patients with anaphylaxis admitted to a university hospital. Knowing the clinical features will raise physician awareness of this condition.

IgE antibodies to omega-5 gliadin in children with wheat-induced anaphylaxis.

Background:  Wheat can cause severe immunoglobulin E (IgE)‐mediated systemic reactions including anaphylaxis but knowledge on relevant wheat allergens at the molecular level is scanty.

Time Trends of the Prevalence of Asthma, Rhinitis and Eczema in Thai Children–ISAAC (International Study of Asthma and Allergies in Childhood) Phase Three

Using the same questionnaire as in ISAAC Phase One study conducted in 1995, the ISAAC Phase Three was carried out in Bangkok and Chiang Mai, Thailand, in 2001, among children aged 6–7 and 13–14 years. There was an increase in the prevalence of the three diseases in the younger age group, i.e., current asthma, rhinitis, rhinoconjunctivitis, and flexural eczema. In the older age group, the prevalence of rhinitis and rhinoconjunctivitis increased. There was no change of prevalence of asthma in Bangkok, but prevalence decreased in Chiang Mai. Prevalence of eczema in older children increased in Bangkok, but remained the same in Chiang Mai.

Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients

Jirapongsananuruk O, Pongpreuksa S, Sangacharoenkit P, Visitsunthorn N, Vichyanond P. Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients.
Pediatr Allergy Immunol 2010: 21: 508–514.
© 2009 John Wiley & Sons A/S

Specific allergy to Penaeus monodon (seawater shrimp) or Macrobrachium rosenbergii (freshwater shrimp) in shrimp-allergic children

Background Allergy to specific shrimp species has not been studied systematically by oral challenges. A comparison of allergy to different shrimp species, especially seawater or freshwater varieties treatment, would be useful in testing shrimp‐allergic subjects.

The effect of BCG vaccine at birth on the development of atopy or allergic disease in young children

BACKGROUND Exposure to infectious diseases may reduce the development of asthma or allergy. In particular, the role of the BCG vaccine in modulating asthma or allergy has been a source of speculation. OBJECTIVE To study newborns from 3 international sites to evaluate the prospective effect of BCG vaccine on allergic diseases or atopic development. METHODS Infants were enrolled from newborn and well-infant clinics in Thailand, Argentina, and Turkey. The standard BCG vaccine for each country was given at birth. Parents who consented to have their infant included in the protocol completed an allergy family questionnaire. Infants underwent a standard purified protein derivative (PPD) test at 9 to 12 months of age, and the reaction size was measured. At the age of 2 years, the children returned to be studied. Allergy skin tests to common allergens appropriate to location and age were performed, and the parents completed the International Study of Allergy and Asthma in Childhood questionnaire. The PPD reaction size was compared with the presence of atopy and allergy questionnaire responses. RESULTS A total of 1,704 infants were studied. Statistical significance was found between a negative PPD response vs any positive PPD response and the risk of having an allergic history at the age of 2 years in Turkey (relative risk, 2.11; 95% confidence interval, 1.25-3.55; P = .005) and Thailand (relative risk, 2.16; 95% confidence interval, 1.18-3.94; P = .02) but not Argentina (relative risk, 1.09; 95% confidence interval, 0.70-1.68; P = .70). CONCLUSIONS This study further supports the role of infectious agents in modulating asthma and allergy development.