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Children, Volume 2, Issue 3 (September 2015) – 8 articles , Pages 289-402

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233 KiB  
Review
The Role of Skin Barrier in the Pathogenesis of Food Allergy
by Neema Izadi, Minnelly Luu, Peck Y. Ong and Jonathan S. Tam
Children 2015, 2(3), 382-402; https://doi.org/10.3390/children2030382 - 02 Sep 2015
Cited by 14 | Viewed by 5273
Abstract
Food allergy is a serious public health problem with an increasing prevalence. Current management is limited to food avoidance and emergency treatment. Research into the pathogenesis of food allergy has helped to shape our understanding of how patients become sensitized to an allergen. [...] Read more.
Food allergy is a serious public health problem with an increasing prevalence. Current management is limited to food avoidance and emergency treatment. Research into the pathogenesis of food allergy has helped to shape our understanding of how patients become sensitized to an allergen. Classically, food sensitization was thought to occur through the gastrointestinal tract, but alternative routes of sensitization are being explored, specifically through the skin. Damaged skin barrier may play a crucial role in the development of food sensitization. Better understanding of how patients initially become sensitized may help lead to the development of a safe and effective treatment for food allergies or better prevention strategies. Full article
(This article belongs to the Special Issue Recent Advances in Pediatric Food Allergy)
210 KiB  
Article
Egg Food Challenges are Associated with More Gastrointestinal Reactions
by Malika Gupta, Liron D. Grossmann, Jonathan M. Spergel and Antonella Cianferoni
Children 2015, 2(3), 371-381; https://doi.org/10.3390/children2030371 - 17 Aug 2015
Cited by 15 | Viewed by 5941
Abstract
Egg allergy is a common pediatric allergy, and is usually outgrown by elementary school age. There is, therefore, a need to perform an oral food challenge (OFC) to establish the presence of food allergy to egg. In this study, we conducted a retrospective [...] Read more.
Egg allergy is a common pediatric allergy, and is usually outgrown by elementary school age. There is, therefore, a need to perform an oral food challenge (OFC) to establish the presence of food allergy to egg. In this study, we conducted a retrospective review of 2304 OFCs at a pediatric center and analyzed the severity of reactions during egg OFCs and compared them with other foods. The gastrointestinal system (GI) has been reported as more affected in egg food challenge. This study confirmed that 11% of patients undergoing egg OFC had GI symptoms vs. 7% undergoing food challenges for other foods or compared to milk, peanut and tree nut, individually. However, the involvement of lower respiratory tract was less frequent with egg than observed in peanut and tree nut OFC and similar to observed rate in milk. In conclusion, our study confirmed that OFC to egg causes more GI symptoms and less respiratory symptoms compared to other foods, in particular peanuts and tree nuts. However, 27% of children who failed egg OFC had lower respiratory tract reactions and required the use of epinephrine, similarly to children undergoing milk challenge. Full article
(This article belongs to the Special Issue Recent Advances in Pediatric Food Allergy)
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207 KiB  
Review
Controversies in the Mechanism of Total Parenteral Nutrition Induced Pathology
by Jain Ajay Kumar and Jeffery H. Teckman
Children 2015, 2(3), 358-370; https://doi.org/10.3390/children2030358 - 31 Jul 2015
Cited by 21 | Viewed by 7416
Abstract
Over 30,000 patients are permanently dependent on Total Parenteral Nutrition (TPN) for survival with several folds higher requiring TPN for a prolonged duration. Unfortunately, it can cause potentially fatal complications. TPN infusion results in impairment of gut mucosal integrity, enhanced inflammation, increased cytokine [...] Read more.
Over 30,000 patients are permanently dependent on Total Parenteral Nutrition (TPN) for survival with several folds higher requiring TPN for a prolonged duration. Unfortunately, it can cause potentially fatal complications. TPN infusion results in impairment of gut mucosal integrity, enhanced inflammation, increased cytokine expression and trans-mucosal bacterial permeation. It also causes endotoxin associated down regulation of bile acid transporters and Parenteral Nutrition Associated Liver Disease (PNALD), which includes steatosis, disrupted glucose metabolism, disrupted lipid metabolism, cholestasis and liver failure. Despite multiple theories, its etiology and pathophysiology remains elusive and is likely multifactorial. An important cause for TPN related pathologies appears to be a disruption in the normal enterohepatic circulation due to a lack of feeding during such therapy. This is further validated by the fact that in clinical settings, once cholestasis sets in, its reversal occurs when a patient is receiving a major portion of calories enterally. There are several other postulated mechanisms including gut bacterial permeation predisposing to endotoxin associated down regulation of bile acid transporters. An additional potential mechanism includes toxicity of the TPN solution itself, such as lipid mediated hepatic toxicity. Prematurity, leading to a poor development of bile acid regulating nuclear receptors and transporters has also been implicated as a causative factor. This review presents the current controversies and research into mechanisms of TPN associated injury. Full article
(This article belongs to the Collection Advances in Pediatric Digestive Diseases)
1262 KiB  
Concept Paper
The Undiagnosed Diseases Program Integrated Collaboration System (UDPICS): One Program’s Experience Developing Custom Software to Support Research for Complex-Disease Families
by Jessica Guzman, Elizabeth Lee, David Draper, Zaheer Valivullah, Guoyun Yu, Murat Sincan, William A. Gahl and David R. Adams
Children 2015, 2(3), 342-357; https://doi.org/10.3390/children2030342 - 31 Jul 2015
Cited by 76 | Viewed by 5952
Abstract
The Undiagnosed Diseases Program (UDP) was started in 2008 with the goals of making diagnoses and facilitating related translational research. The individuals and families seen by the UDP are often unique and medically complex. Approximately 40% of UDP cases are pediatric. The Undiagnosed [...] Read more.
The Undiagnosed Diseases Program (UDP) was started in 2008 with the goals of making diagnoses and facilitating related translational research. The individuals and families seen by the UDP are often unique and medically complex. Approximately 40% of UDP cases are pediatric. The Undiagnosed Diseases Program Integrated Collaboration System (UDPICS) was designed to create a collaborative workspace for researchers, clinicians and families. We describe our progress in developing the system to date, focusing on design rationale, challenges and issues that are likely to be common in the development of similar systems in the future. Full article
(This article belongs to the Collection Development of Medicines for Paediatric and Rare Diseases)
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260 KiB  
Article
Food Allergy Knowledge and Attitudes among School Nurses in an Urban Public School District
by Sarah Twichell, Kathleen Wang, Humaira Robinson, Maria Acebal and Hemant Sharma
Children 2015, 2(3), 330-341; https://doi.org/10.3390/children2030330 - 21 Jul 2015
Cited by 12 | Viewed by 6502
Abstract
Since food allergy knowledge and perceptions may influence prevention and management of school-based reactions, we evaluated them among nurses in an urban school district. All District of Columbia public school nurses were asked to anonymously complete a food allergy knowledge and attitude questionnaire. [...] Read more.
Since food allergy knowledge and perceptions may influence prevention and management of school-based reactions, we evaluated them among nurses in an urban school district. All District of Columbia public school nurses were asked to anonymously complete a food allergy knowledge and attitude questionnaire. Knowledge scores were calculated as percentage of correct responses. Attitude responses were tabulated across five-point Likert scales, ranging from strongly disagree to strongly agree. The knowledge questionnaire was completed by 87% of eligible nurses and the attitude questionnaire by 83%. The mean total knowledge score was 76 ± 13 with domain score highest for symptom recognition and lowest for treatment. Regarding attitudes, most (94%) felt food allergy is a serious health problem, for which schools should have guidelines (94%). Fewer believed that nut-free schools (82%) and allergen-free tables (44%) should be implemented. Negative perceptions of parents were identified as: parents of food-allergic children are overprotective (55%) and make unreasonable requests of schools (15%). Food allergy knowledge deficits and mixed attitudes exist among this sample of urban school nurses, particularly related to management of reactions and perceptions of parents. Food allergy education of school nurses should be targeted to improve their knowledge and attitudes. Full article
(This article belongs to the Special Issue Recent Advances in Pediatric Food Allergy)
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805 KiB  
Article
Cow’s Milk Protein Allergy from Diagnosis to Management: A Very Different Journey for General Practitioners and Parents
by Adriana C. Lozinsky, Rosan Meyer, Katherine Anagnostou, Robert Dziubak, Kate Reeve, Heather Godwin, Adam T. Fox and Neil Shah
Children 2015, 2(3), 317-329; https://doi.org/10.3390/children2030317 - 21 Jul 2015
Cited by 29 | Viewed by 10300
Abstract
Cow’s milk protein allergy (CMPA) is the most common food allergy in infants and can affect a family’s quality of life. The purpose of this paper is to evaluate the knowledge and experience of general practitioners (GPs) in terms of CMPA diagnosis and [...] Read more.
Cow’s milk protein allergy (CMPA) is the most common food allergy in infants and can affect a family’s quality of life. The purpose of this paper is to evaluate the knowledge and experience of general practitioners (GPs) in terms of CMPA diagnosis and management and to explore the views of parents on the current diagnostic process. Two surveys were conducted in June 2014, which collected data from GPs and parents of infants diagnosed with CMPA in the United Kingdom. The questionnaires included quantitative and qualitative questions, which measured self-reported knowledge, management and perceived treatment progression, and the educational needs of GPs. We also explored parents’ experiences of local healthcare support in relation to CMPA. A total of 403 GPs and 300 parents completed the surveys. The main symptoms of CMPA and diagnosis period differed between GPs and parents. Other key points include different perceptions on symptom presentation and improvement, lack of awareness from GPs about current guidelines, and the significant burden on both families and GPs. This is the first study attempting to establish GP and parental experience in diagnosing CMPA. It is notable that the difference can be improved through training, appropriate diagnostic tools and improved communication between physicians and parents. Full article
(This article belongs to the Special Issue Recent Advances in Pediatric Food Allergy)
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336 KiB  
Article
Parental Perception, Prevalence and Primary Care Physicians’ Knowledge on Childhood Food Allergy in Croatia
by Tamara Voskresensky Baricic, Marija Catipovic, Erina L. Cetinic, Vlado Krmek and Ivona Horvat
Children 2015, 2(3), 305-316; https://doi.org/10.3390/children2030305 - 17 Jul 2015
Cited by 12 | Viewed by 5607
Abstract
Food allergy in children is increasing and the perception of food allergy among parents is even more common. In a questionnaire-based study of 702 children aged 6 to 48 months in four primary care settings, the aim was to determine the prevalence of [...] Read more.
Food allergy in children is increasing and the perception of food allergy among parents is even more common. In a questionnaire-based study of 702 children aged 6 to 48 months in four primary care settings, the aim was to determine the prevalence of perception vs. proven food allergy, parental anxiety and general pediatrician knowledge of food allergy. In 95/702 children (13.5%) parentally-reported food was associated reactions. IgE and/or skin prick test (SPT) and/or an open provocation test were performed in 48 (6.8%) and allergy was proven in 38 (5.4%) children. Discrepancy between parental perception and proven allergy is significant (p < 0.001), especially for food other than milk, egg and peanut (p < 0.001). Allergy to milk was the most common. Allergy to peanut was significantly more common in children ≥2 years (p < 0.05). Severe reactions occurred in 5/95 (5.2%) of all children and in 5/38 (13.1%) of allergic children, in 3/5 caused by peanut. Parents of children with proven allergy do not experience high degree of anxiety. The perception of food allergy among general pediatricians is limited, and in children with severe reactions precautionary measures and information to parents were insufficient. Parents and general pediatricians need additional education in food allergy. Full article
(This article belongs to the Special Issue Recent Advances in Pediatric Food Allergy)
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410 KiB  
Review
The Role of Human Milk Immunomodulators in Protecting Against Viral Bronchiolitis and Development of Chronic Wheezing Illness
by Dani-Louise Dixon
Children 2015, 2(3), 289-304; https://doi.org/10.3390/children2030289 - 07 Jul 2015
Cited by 27 | Viewed by 5566
Abstract
Infants who are breastfed are at an immunological advantage when compared with formula fed infants, evidenced by decreased incidence of infections and diminished propensity for long term conditions, including chronic wheeze and/or asthma. Exclusive breastfeeding reduces the duration of hospital admission, risk of [...] Read more.
Infants who are breastfed are at an immunological advantage when compared with formula fed infants, evidenced by decreased incidence of infections and diminished propensity for long term conditions, including chronic wheeze and/or asthma. Exclusive breastfeeding reduces the duration of hospital admission, risk of respiratory failure and requirement for supplemental oxygen in infants hospitalised with bronchiolitis suggesting a potentially protective mechanism. This review examines the evidence and potential pathways for protection by immunomodulatory factors in human milk against the most common viral cause of bronchiolitis, respiratory syncytial virus (RSV), and subsequent recurrent wheeze in infants. Further investigations into the interplay between respiratory virus infections such as RSV and how they affect, and are affected by, human milk immunomodulators is necessary if we are to gain a true understanding of how breastfeeding protects many infants but not all against infections, and how this relates to long-term protection against conditions such as chronic wheezing illness or asthma. Full article
(This article belongs to the Special Issue Viral-Induced Wheezing and Asthma during Childhood)
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