Allergen sensitization and vitamin D status in young Korean children with urticaria

PURPOSE: Urticaria is a common disorder, with a lifetime incidence of approximately 15%–20% of the general population. It is difficult to differentiate urticaria in children because of the similarity in symptoms between acute and chronic urticaria. There is also a lack of studies between vitamin D known as an important role in the immune system and urticaria in children. The present study aimed to assess the characteristics and allergen sensitization of young children diagnosed with urticaria and to evaluate the relationship between their vitamin D status and urticaria. METHODS: We retrospectively reviewed medical records of 218 children diagnosed as having urticaria at CHA and Myongji Hospitals between April 2013 and December 2014. The results of questionnaires and laboratory tests, including specific IgE and serum 25-hydroxy vitamin D concentrations were obtained. RESULTS: Of 218 patients, 118 (54%) were positive for at least 1 allergen and there was no significant difference in the prevalence of sensitization between the acute and chronic urticaria groups. However, the prevalence of polysensitization and sensitization of house dust mites was significantly higher in the chronic urticaria group than in the acute urticaria group (P=0.011 and P=0.029, respectively). Among the urticaria symptoms, an itching sensation was more associated with insufficient vitamin D status in children with urticaria (P=0.034). CONCLUSION: Our results demonstrated that children with chronic urticaria have a higher prevalence of sensitization to house dust mites and polysensitization. Further studies will need to determine whether the supply of vitamin D can improve itching sensation in urticaria children with an insufficient vitamin D status.

Prediction of Resistance to Standard Intravenous Immunoglobulin Therapy in Kawasaki Disease

BACKGROUND AND OBJECTIVES: Ten to twenty percent of children with Kawasaki disease (KD) do not respond to initial intravenous immunoglobulin (IVIG) treatment. If untreated, approximately 15% to 25% of KD patients have complications. The aim of this study was to find useful predictors of responsiveness to initial IVIG treatment in KD. SUBJECTS AND METHODS: We retrospectively reviewed medical records of 91 children diagnosed with KD at Myong Ji Hospital from March 2012 to April 2014. Before and after (24 hours to 36 hours) IVIG treatment, the following laboratory data were obtained: hemoglobin (Hb) level, white blood cell count, proportion of neutrophil, lymphocyte and eosinophil, platelet count, erythrocyte sedimentation rate (ERS), C-reactive protein (CRP), creatine kinase (CK), creatine kinase MB (CK-MB), and N-terminal pro-brain natriuretic peptide (NT-proBNP). Subjects were then divided into two groups: IVIG-responsive or IVIG-resistant. RESULTS: Of 91 patients, 11 (12%) required retreatment. By univariate analysis, before-IVIG laboratory parameters of white blood cell count, % neutrophil, ERS, CRP, sodium, CK, CK-MB, and NT-proBNP were significantly different between IVIG-responsive and IVIG-resistant patient groups. In the after-IVIG laboratory parameters, Hb level, white blood cell count, % neutrophil, % lymphocyte, CRP, CK, CK-MB, and NT-pro-BNP were significantly different between the two groups. While the mean-differences were not statistically significant, fractional change (FC)-CRP and FC-% neutrophil showed significant difference. By multivariate analysis, FC-CRP was confirmed to be an independent predictor for initial IVIG resistance. CONCLUSION: Fractional change-C-reactive protein might be a useful and important value for predicting initial IVIG resistance in KD patients.

Differences in the Clinical Characteristics of Children with Urinary Tract Infections Based on the Results of 99mTc-Dimercaptosuccinic Acid Renal Scanning

PURPOSE: The 99mTc-Dimercaptosuccinic acid (DMSA) renal scan is used primarily for the diagnosis of renal scarring and acute pyelonephritis in children with urinary tract infections (UTI). This study aimed to evaluate clinical differences based on the positive or negative results of DMSA scans and kidney ultrasonography (US) in pediatric UTI. METHODS: We retrospectively reviewed 142 pediatric patients with UTI who were admitted to Myongji Hospital from January 2004 to December 2012. We performed a comparative analysis of clinical parameters such as age, sex, white blood cell (WBC) count, neutrophil count, blood urea nitrogen (BUN) level, creatinine (Cr) level, C-reactive protein (CRP) level, and durations of hospitalization and fever, grouped by the results of the DMSA scans and kidney US. RESULTS: The mean age of the patients was 33.8+/-48.3 months, and 78 (55%) were male. Fifty-two patients had abnormal DMSA findings, and 71 patients had abormal kidney US findings (test positive groups). In the DMSA scan positive group, there were significant differences in age, WBC counts, neutrophil counts, CRP level, BUN level, Cr level, hospitalization duration, number of abnormal findings on kidney US, and incidence of vesicoureteral reflux (VUR) compared with the scan negative group. The kidney US positive group had significant differences in age, neutrophil count, CRP level, BUN level, Cr level, hospitalization duration, number of abnormal findings on the DMSA scans, and more frequent VUR compared with the US negative group. CONCLUSION: Our data suggest that there were no major differences in clinical parameters based on the results of the DMSA scans compared with kidney US in pediatric UTI. However, as kidney US and DMSA scan were performed to predict VUR, the sensitivity and negative predictive value was increased.