Atopic dermatitis (AD) and food allergy (FA) share similar type 2 inflammation and commonly co‐occur, but the precise proportion of AD patients with FA and vice versa, as well as the effect of AD disease severity on the strength of this association remains uncertain. The aim of this comprehensive systematic review and meta‐analysis was to determine the prevalence and bidirectional associations of AD with food sensitivity (FS), FA and challenge‐proven food allergy (CPFA). We searched PubMed and EMBASE and three independent reviewers performed title/abstract and full‐text review and data extraction. Overall, 557 articles (n = 225,568 individuals with AD, n = 1,128,322 reference individuals; n = 1,357,793 individuals with FS, FA or CPFA, n = 1,244,596 reference individuals) were included in quantitative analyses. The overall pooled prevalence of FS, FA and CPFA in individuals with AD were 48.4% (95% confidence interval: 43.7–53.2), 32.7% (28.8–36.6) and 40.7% (34.1–47.5) respectively. AD prevalence among individuals with FS, FA and CPFA were 51.2% (46.3–56.2), 45.3% (41.4–49.3) and 54.9% (47.0–62.8) respectively. Children with AD had higher pooled FS (49.8% (44.4–55.1)) and FA (31.4% (26.9–36.1)) prevalences than adults with AD (28.6% (13.4–46.8) and 24.1% (12.1–38.7) respectively). Prevalences of FS and FA numerically increased with AD severity. FS, FA and CPFA are common comorbidities of AD and are closely related. Physicians should be attentive to this relationship to optimize management and treatment strategies in patients.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jdv.18919

Prevalence of and association between atopic dermatitis and food sensitivity, food allergy and challenge‐proven food allergy: A systematic review and meta‐analysis

Objective: Recurrent acute rhinosinusitis (RARS) is defined as multiple episodes of acute rhinosinusitis in which the symptoms and signs of infection resolve completely between episodes. Limited data are available on the characteristics and preventive therapy of RARS. This study evaluated the clinical characteristics and predisposing factors of RARS in children as well as the preventive therapy. Methods: Medical records of children with RARS diagnosed between January 2010 and December 2012 were obtained. Demographic data, presenting symptoms, predisposing factors and preventive therapy were reviewed. Results: Ninety-four children with RARS were recruited. The mean age was 7.7±2.6 years, with a mean age of onset of 4.0±1.4 years. Sixty-one patients (64.9%) were boys and 56 patients (59.6%) had family history of atopy. The most common presenting symptom of RARS was purulent nasal discharge (100.0%), followed by nasal congestion (68.1%) and postnasal drainage (31.9%). The most common predisposing factor for RARS was immunoglobulin G subclass deficiency (78.7%), followed by non-allergic rhinitis (64.9%) and allergic rhinitis (35.1%). Sixty-five children (69.1%) received preventive therapy for RARS. The responses to preventive measures were: 80.0% (32/40 patients) to oral antibiotic prophylaxis, 50.0% (11/22 patients) to adenotonsillectomy, 91.7% (11/12 patients) to specific allergen immunotherapy, 27.3% (3/11  patients) to gentamicin nasal irrigation, and 66.7% (4/6 patients) to intravenous immunoglobulin. Conclusion: The most common presenting symptoms of RARS in children were purulent nasal discharge, nasal congestion and postnasal drainage. Children with RARS should be evaluated for the presence of underlying conditions such as immunodeficiency and allergic disease, which led to the appropriate management for these children.

Clinical characteristics of recurrent acute rhinosinusitis in children.

Summary Background: Patients with Immunoglobulin G (IgG) subclass deficiency may suffer from recurrent infections, mainly sino-pulmonary infection. Objective: To determine the epidemiology of IgG subclass deficiency in Thai children at a tertiary care hospital and to compare the differences between children who were diagnosed with IgG subclass deficiency by using low level criteria [less than 2 standard deviation (SD) of normal levels for age] and by using low percentage criteria (proportion of each IgG subclasses/total IgG). Methods: The study was a descriptive study of 55 children up to 15 years old with recurrent infections diagnosed as having IgG subclass deficiency but no acquired or other primary immune deficiencies except for IgA and/or IgM deficiency. Result: Isolated IgG3 subclass deficiency was the most common IgG subclass deficiency (56.4%). IgG3 subclass deficiency, either isolated or combined with other IgG subclass deficiency, was found in 85.5% of the cases. The common age of onset was between birth and five years of age. The most common presenting symptom was recurrent sinusitis (83.6%). Majority of the cases (89.3%) were diagnosed by low percentage criteria while 12.7% were diagnosed by low level criteria. All cases with low levels of IgG subclass antibodies also had low percentages. There were no statistically significant differences in the clinical manifestations and management methods between the children who were diagnosed by low level and low percentage. Conclusion: IgG3 subclass deficiency was the most common IgG subclass deficiency in Thai children. The most common presenting symptom was recurrent sinusitis. Although the diagnosis could be made in the patients with recurrent upper respiratory infection by using low level criteria, but the diagnosis should be considered when the low percentage criteria are met. (Asian Pac J Allergy Immunol 2011;29:332-7)

Immunoglobulin G (IgG) subclass deficiency in Thai children.

In this case-control study the association between the approaches used to feed infants, together with known family and environmental factors, and the occurrence of atopic illness in toddlers between the ages of 4 months to 3 years in Hong Kong was examined. A total of 206 subjects were recruited from April to June of 2014. The results obtained by binary logistic regression indicated that atopy is associated with boys (OR 2.072, CI 1.089-3.941), the maternal use of antibiotics in utero or while breast feeding (OR 2.276, CI 1.151-4.504), the later commencement of mixed feeding (OR 2.497, CI 1.025-6.082), breast feeding exclusively for 3 months (OR 1.972, CI 1.009-3.857), and having a mother who was diagnosed with eczema (OR 4.510, CI 1.764-11.530). Although an exclusive reliance on breast feeding has been shown to be predictive of atopy among toddlers, the positive qualities of breast milk cannot be ignored. A further study of the contents and nutritional values of breast milk is warranted.

https://www.mdpi.com/1660-4601/12/3/2501/pdf

Factors Associated with Atopy in Toddlers: A Case-Control Study

IgG subclass deficiency is a laboratory diagnosis and becomes important with recurrent infections. This study aimed to examine the demographic, clinical, and laboratory results of pediatric cases with IgG subclass deficiency and to improve the understanding of the clinical significance of IgG subclass deficiency.In this study, the clinical and laboratory features of 111 pediatric patients, with at least one whose serum IgG subclasses was measured as lower than 2 standard deviation of healthy aged-matched control values, were evaluated. The clinical and laboratory features of the cases with isolated IgG subclass deficiency (Group 1) and those with low serum levels of any of IgG, IgA, and IgM in addition to the IgG subclass deficiency (Group 2) were compared.A total of 55 (49.54%) and 56 (50.45%) patients were included in Groups 1 and 2, respectively. Among our studied cases, 20 (18.1%) had a history of hospitalization in the neonatal period, 61 (54.95%) had at least one hospitalization due to infection, and 55 (49.54%) had a history of recurrent infection. The frequencies of these three conditions were statistically significantly higher in Group 2 (p < 0.05). The frequencies of infections in the last year in Groups 1 and 2 were 4.4 ± 1.2 and 5.4 ± 1.9, respectively (p < 0.05). As a result of recurrent infections, 43.24% (n = 48) of our patients received antibiotic prophylaxis, and 21.62% (n = 24) had immunoglobulin replacement therapy. Furthermore, the numbers of patients who needed these treatments were higher in Group 2 (p < 0.05).In cases with IgG subclass deficiencies, concomitant main-group immunoglobulin deficiencies may increase the number and severity of infections, leading to hospitalizations, antibiotic prophylaxis, and immunoglobulin therapy. More attention should be paid to cases of immunoglobulin main-group deficiencies in the follow-up of these cases. 

Clinical and laboratory evaluation of Turkish children with IgG subclass deficiency.

We retrospectively reviewed the clinical characteristics of twenty patients with IgA and/or IgG subclass deficiency attending a tertiary centre. The median age at diagnosis was 1.21 years and the median duration of follow up was 3.83 years. The most common presenting symptom was recurrent sinopulmonary infections (45%). This was followed by refractory asthma (30%), autoimmunity (15%), and other atopic manifestations (10%). Only one out of twenty patients presented with chronic gastrointestinal disease, which contrasted with the majority of previous literature. Three patients had significant pulmonary complications including bronchiolitis obliterans, bronchiectasis and pulmonary fibrosis. The prevalence of IgA deficiency in Hong Kong Chinese population is yet to be established, though it appears not as prevalent as that in western population.

/pdf/review-of-igg-subclass-and-iga-deficiency-in-a-tertiary-1ttc29s3ft.pdf

Review of IgG Subclass and IgA Deficiency in a Tertiary Center

Background: Despite an increasing body of clinical and laboratory evidence suggesting that food hypersensitivity plays a pathogenic role in Atopic Eczema (AE) in a subset of patients, whether IgE food sensitization has any impact on the clinical severity of AE is not clearly established. Objective: To investigate the association between the severity of eczema and immunoglobulin E mediated food sensitization among atopic eczema children in Hong Kong. Study Design: A retrospective chart review study of total 77 atopic eczema cases (age 0-14 years) was carried out. The eczema severity scores (three item severity scores TIS), skin prick test results (wheal diameters), and food specific immunoglobulin E levels, clinician diagnosed food allergy were recorded as main outcome measures. Immunoglobulin E mediated food sensitization was diagnosed when the skin prick test resulted in a wheal diameter of greater than 3 mm compared with the negative control and serum food specific immunoglobulin E level greater than 0.35 ku/L. Result: Overall IgE food sensitization to at least 1 food by either skin prick test or blood test was 81.8%. Eczema severity by TIS was not correlated with the frequency of immunoglobulin E mediated food sensitizations (p-value=0.1346). More than 60% of children in this study developed eczema before 6 months old and this early onset eczema group was highly associated with egg, cow's milk and fish sensitizations (p-value=0.0179, 0.015, and 0.0468 respectively). A positive association was found between the eczema severity and serum total IgE level (p-value=0.002). Conclusion: IgE food sensitization is very common in this small cohort of Hong Kong children with atopic eczema. Most eczema children with or without clinical history of food reactions have shown positive SPT and CAP-FEIA, or one of the two. Severity of atopic eczema is positively associated with the levels of total IgE. It was not shown that any particular food sensitization was associated with severity of eczema.

/pdf/ige-food-sensitizations-amongst-children-with-atopic-eczema-2olr2xc8c6.pdf

IgE food sensitizations amongst children with Atopic Eczema

The coexistence of juvenile pernicious anaemia, vitiligo and selective IgA deficiency in a Southern Chinese boy stimulated a comprehensive work-up of his immune functions. He was found to have an imbalance of T-helper cell (CD4+) and T-suppressor cell (CD8+) activity, leading to low B cell response in vitro to pokeweed-mitogen in production of IgA. Interleukin 12 production in response to various mitogens was also deficient. These abnormalities persisted despite effective vitamin B12 treatment. We speculate that the defective immunoregulatory environment is an intrinsic defect rather than an acquired phenomenon due to vitamin B12 deficiency, which may play an important role in the pathogenesis of juvenile pernicious anaemia.

/pdf/juvenile-pernicious-anaemia-in-association-with-vitiligo-4uf5wouzg8.pdf

Juvenile Pernicious Anaemia in Association with Vitiligo, Selective IgA Deficiency, Defective Interleukin 12 Production and T Cell Dysfunction

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Review of IgG Subclass and IgA Deficiency in a Tertiary Center

IgE food sensitizations amongst children with Atopic Eczema

Juvenile Pernicious Anaemia in Association with Vitiligo, Selective IgA Deficiency, Defective Interleukin 12 Production and T Cell Dysfunction