Sensitization in children with atopic dermatitis: a single center study

PURPOSE: There are few recent data regarding allergic sensitization of atopic dermatitis (AD) in Korea. The aim of this study was to investigate patterns of sensitization according to age and gender in children with AD. METHODS: This retrospective study included 4,661 children with AD from 1998 to 2014. The serum specific IgE (sIgE) levels to egg white (EW), cow's milk (CM), peanut, wheat, soybean, buckwheat, tree nuts, crustaceans, meat, and house dust mites (HDMs) were reviewed. AD was categorized into the extrinsic (ADe) and intrinsic type (ADi) according to the presence or absence of sensitization. The proportion of patients with sIgE to EW or CM greater than the previously reported diagnostic decision point (DDP) was determined. RESULTS: A total of 4,661 children (2,843 boys and 1,818 girls) were collected. We identified 1,857 of 2,663 children (69.7%) with the ADe type and 806 of 2,663 children (30.3%) with the ADi type. The sensitization rates increased with age (P<0.001). EW (59.3%) was the most commonly sensitized food, followed by CM (46.6%), peanut (32.2%), wheat (31.5%), soybean (28.1%), and buckwheat (23.7%). The most commonly sensitized food groups were tree nuts (56.7%) and crustaceans (28.3%). The rate of sensitization to HDMs was 40.1%. In addition, 11.1% and 7.5% of children had levels of sIgE to EW and CM, respectively, higher than the DDP. CONCLUSION: The incidence of ADe among children with AD was 69.7% and increased with age. The most commonly sensitized food allergen was EW, followed by CM and peanut.

Rational Mind and Heuristics in Medical Diagnostic Decision Making.

The medical diagnostic label is the most important process in patient management. The decision process involves the thinking process of the caregiver which operates differently in emergencies and outpatient clinic. The heuristics aspect of the mind is more efficient in dealing with emergencies and the slower analyzing mind in outpatient setting. The heuristic approach is useful in rapid decisions and management of emergencies whereas the slower stepwise approach in outpatient treatment will help in reducing investigations, medical errors and cost of care. The article also gives an evidence based template for predicting the disease process based on positive and negative likelihood ratios.

Adenocarcinoma em mucosa sinonasal expressando PSA e CDX-2: apresentação de um caso com ênfase no processo de decisão diagnóstica quanto à origem do tumor / Adenocarcinoma in sinonasal mucous membrane expressing PSA and CDX-2: report of a case with emphasis on the diagnostic decision process as to the origin of the tumor

Neste relato, aproveitamos um caso pouco usual de adenocarcinoma em mucosa sinonasal para ilustrar o processo de decisão diagnóstica em imuno-histoquímica. Trata-se de paciente do sexo masculino, de 86 anos, apresentando massa intranasal. No estudo imuno-histoquímico, notou-se expressão de antígeno prostático específico (PSA) e do CDX-2, indicando possibilidades diagnósticas divergentes, de metástase de adenocarcinoma prostático ou de adenocarcinoma sinonasal do tipo intestinal (ITAC). A partir desse dilema diagnóstico, buscou-se estabelecer como esses marcadores poderiam ser confrontados em uma decisão diagnóstica, definindo-se as qualidades que um bom marcador imuno-histoquímico deve ter, e como os marcadores utilizados no painel se comparam em relação a essas qualidades e às hipóteses diagnósticas levantadas. Nesse exercício, são desvendados aspectos importantes do processo diagnóstico em patologia.

In this report, we explore an unusual case of adenocarcinoma detected in the sinonasal mucous membrane in order to illustrate the diagnostic decision process in the immunohistochemical diagnosis. The patient is a 86-year-old man with an intranasal mass. In the immunohistochemical study, it was found expression for both PSA and CDX-2, raising the divergent diagnostic possibilities of a prostatic adenocarcinoma metastasis or an intestinal type sinonasal adenocarcinoma. In search for a solution for this diagnostic dilemma, we tried to establish how these immunohistochemical markers could be confronted in a diagnostic decision by defining the qualities that good immunohistochemical markers consist of and how the panel markers may be compared as to these qualities and the diagnostic hypotheses. In this exercise, important aspects of the diagnostic process in pathology are revealed.