Food allergic reactions in the community: a questionnaire survey of caregivers

PURPOSE: Food allergies are adverse immune reactions to food. Despite their importance, there have only been a few studies conducted on situations that may cause food allergies in Korean children. This study aims to obtain basic data that are necessary to provide information on food allergies to both patients and caregivers. METHODS: In this study, a survey was conducted on 97 caregivers of patients below 18 years old. The patients' situation upon occurrence of food allergy was examined by a questionnaire. RESULTS: Approximately 89.7% of the patients were at 6 years of age or younger. The most common allergens were eggs (37%) and milk (28%) in a total of 163 cases, including multiple responses. Skin symptoms were most common (77.8%). At the time of occurrence, 85% of the patients were with their parents. As for the exposure place, house was 65%, followed by restaurant (16%), nursery (7%), and relative's or neighbor's house (4%). Exclusive of unknown cases, the most common reason of exposure was the caregiver giving the food to the patient for reconfirmation (13.6%). CONCLUSION: It is concluded that the understanding of food allergies based on this research will assist in the management of patients with food allergies.

Accidental ingestion of E-cigarette liquid nicotine in a 15-month-old child: an infant mortality case of nicotine intoxication / 소아과

Electronic cigarettes are novel tobacco products that are frequently used these days. The cartridge contains liquid nicotine and accidental poisoning, even with a small oral dose, endangers children. We present here a mortality case of a 15-month-old child who ingested liquid nicotine mistaking it for cold medicine. When the emergency medical technicians arrived, she was found to have pulseless electrical activity. Spontaneous circulation was restored after approximately 40 minutes of cardiopulmonary resuscitation. The cotinine level in her urine was 1,716 ng/mL. Despite intensive supportive care, severe anoxic brain injury was found on computed tomography and the child ultimately died. This fatality highlights the need for public health efforts to minimize such accidents.

Breastfeeding increases the risk of food sensitization but not affect food allergy symptoms in young children with atopic dermatitis

PURPOSE: Breast-feeding is recommended to prevent allergies, particularly in high-risk infants, but the evidence of protective effects that breast-feeding has on food allergy (FA) remains elusive. The aim of this study was to investigate risk factors of FA and the association between breast-feeding and FA symptoms/food sensitization (FS) in children with atopic dermatitis under 2 years of age. METHODS: We reviewed the medical records of 384 children with atopic dermatitis under 2 years of age who visited our pediatric allergy clinic from March 1, 2009 through December 31, 2014. Symptoms of FA, feeding type, and family history of allergic disease were assessed. Laboratory tests were conducted, including serum total IgE, eosinophil (%), serum 25-hydroxyvitamin D, and specific IgE to egg white, milk, soy, peanut, and wheat. RESULTS: Subjects were divided into 3 groups based on FA symptoms and evidence of sensitization: The FA symptom group (n=240), no symptom group (n=53) and no FS group (n=91). The FA symptom group had a higher log total IgE level (2.0 vs. 1.3, P<0.001) and eosinophil (%) (7.0% vs. 4.7%, P=0.001) than the no FA symptom group. In multivariate analysis, breast-feeding was associated with FS (adjusted odds ratio [aOR], 2.43; 95% confidence intervals [CI], 1.03-5.74) but was not associated with FA symptoms (aOR, 0.65; 95% CI, 0.23-1.83). CONCLUSION: Breast-feeding may increase the risk of FS, but not immediate-type FA symptoms in children with atopic dermatitis.

Human Leukocyte Antigen B27 and Juvenile Idiopathic Arthritis and Classification of Juvenile Spondyloarthropathies by the Assessment of SpondyloArthritis International Society Criteria

OBJECTIVE: We examined the clinical relationship between human leukocyte antigen B27 (HLA-B27) and juvenile idiopathic arthritis (JIA). Additionally, we assessed the usefulness of the Assessment of SpondyloArthritis International Society (ASAS) criteria for diagnosing juvenile spondyloarthropathies (SpA). METHODS: We retrospectively reviewed medical records of 239 patients with JIA classified according to the International League of Associations for Rheumatology (ILAR) classification to analyze the features of the joint involvement site. Results were correlated with the presence of HLA-B27. After that, we classified the 239 JIA patients according to the ASAS criteria to diagnose juvenile SpA. The relationship between the ASAS criteria and a diagnosis of juvenile SpA was analyzed by a chi-squared test. RESULTS: Back pain was associated with HLA-B27 in boys (p=0.002) but not in girls (p=0.616). In both sexes, involvement of the small joints in the lower extremities was highly associated with HLA-B27 (p=0.001 for boys, p=0.021 for girls). In addition, HLA-B27 was associated with enthesitis (p=0.004 for boys, p=0.021 for girls). Eighty-seven (36.4%) patients with JIA fulfilled the ASAS criteria; 2 (0.8%) had axial SpA and 85 (35.6%) had peripheral SpA. HLA-B27 was the most significant factor for diagnosing juvenile SpA (sensitivity 80%, specificity 99.31%, positive likelihood ratio, 116). CONCLUSION: The ILAR criteria have some weaknesses for diagnosing HLA-B27-positive JIA patients in early stages. The use of the ASAS criteria for juvenile patients will enable pediatric rheumatologists to diagnose juvenile SpA patients earlier.