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Pathogenesis, immunology, and immune-targeted management of the multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome (PIMS): EAACI Position Paper.
Feleszko, Wojciech; Okarska-Napierala, Magdalena; Buddingh, Emilie Pauline; Bloomfield, Marketa; Sediva, Anna; Bautista-Rodriguez, Carles; Brough, Helen A; Eigenmann, Philippe A; Eiwegger, Thomas; Eljaszewicz, Andrzej; Eyerich, Stefanie; Gomez-Casado, Cristina; Fraisse, Alain; Janda, Jozef; Jiménez-Saiz, Rodrigo; Kallinich, Tilmann; Krohn, Inge Kortekaas; Mortz, Charlotte G; Riggioni, Carmen; Sastre, Joaquin; Sokolowska, Milena; Strzelczyk, Ziemowit; Untersmayr, Eva; Tramper-Stranders, Gerdien.
  • Feleszko W; Department of Pediatric Pneumology and Allergy, The Medical University of Warsaw, Warsaw, Poland.
  • Okarska-Napierala M; Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland.
  • Buddingh EP; Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands.
  • Bloomfield M; Department of Immunology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic.
  • Sediva A; Department of Pediatrics, 1st Faculty of Medicine, Thomayer University Hospital, Charles University, Prague, Czech Republic.
  • Bautista-Rodriguez C; Department of Immunology, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic.
  • Brough HA; Pediatric Cardiology Services, Royal Brompton Hospital, London, UK.
  • Eigenmann PA; National Heart and Lung Institute, Imperial College London, London, UK.
  • Eiwegger T; Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, St. Thomas' Hospital, King's College London, London, UK.
  • Eljaszewicz A; Children's Allergy Service, Evelina Children's Hospital, Guy's and St.Thomas' Hospital NHS Foundation Trust, London, UK.
  • Eyerich S; Paediatric Allergy Group, Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Guys' Hospital, King's College London, London, UK.
  • Gomez-Casado C; Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland.
  • Fraisse A; Karl Landsteiner University of Health Sciences, Krems, Austria.
  • Janda J; Translational Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
  • Jiménez-Saiz R; Department of Immunology, University of Toronto, Toronto, Ontario, Canada.
  • Kallinich T; Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, St. Pölten, Austria.
  • Krohn IK; Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland.
  • Mortz CG; Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Munich, Germany.
  • Riggioni C; Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
  • Sastre J; Pediatric Cardiology Services, Royal Brompton Hospital, London, UK.
  • Sokolowska M; National Heart and Lung Institute, Imperial College London, London, UK.
  • Strzelczyk Z; Faculty of Science, Charles University, Prague, Czech Republic.
  • Untersmayr E; Department of Immunology, Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-Princesa), Madrid, Spain.
  • Tramper-Stranders G; Department of Immunology and Oncology, Centro Nacional de Biotecnología (CNB-CSIC), Madrid, Spain.
Pediatr Allergy Immunol ; 34(1): e13900, 2023 01.
Article in English | MEDLINE | ID: covidwho-2213793
ABSTRACT
Multisystem inflammatory syndrome in children (MIS-C) is a rare, but severe complication of coronavirus disease 2019 (COVID-19). It develops approximately 4 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and involves hyperinflammation with multisystem injury, commonly progressing to shock. The exact pathomechanism of MIS-C is not known, but immunological dysregulation leading to cytokine storm plays a central role. In response to the emergence of MIS-C, the European Academy of Allergy and Clinical Immunology (EAACI) established a task force (TF) within the Immunology Section in May 2021. With the use of an online Delphi process, TF formulated clinical statements regarding immunological background of MIS-C, diagnosis, treatment, follow-up, and the role of COVID-19 vaccinations. MIS-C case definition is broad, and diagnosis is made based on clinical presentation. The immunological mechanism leading to MIS-C is unclear and depends on activating multiple pathways leading to hyperinflammation. Current management of MIS-C relies on supportive care in combination with immunosuppressive and/or immunomodulatory agents. The most frequently used agents are systemic steroids and intravenous immunoglobulin. Despite good overall short-term outcome, MIS-C patients should be followed-up at regular intervals after discharge, focusing on cardiac disease, organ damage, and inflammatory activity. COVID-19 vaccination is a safe and effective measure to prevent MIS-C. In anticipation of further research, we propose a convenient and clinically practical algorithm for managing MIS-C developed by the Immunology Section of the EAACI.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Diagnostic study / Prognostic study Topics: Vaccines Limits: Child / Humans Language: English Journal: Pediatr Allergy Immunol Journal subject: Allergy and Immunology / Pediatrics Year: 2023 Document Type: Article Affiliation country: Pai.13900

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Cohort study / Diagnostic study / Prognostic study Topics: Vaccines Limits: Child / Humans Language: English Journal: Pediatr Allergy Immunol Journal subject: Allergy and Immunology / Pediatrics Year: 2023 Document Type: Article Affiliation country: Pai.13900