A review of pediatric allergy, asthma and immunology.

A supplement was included in the December 2018 edition of Pediatrics, vol. 142, supplement 4 listing the best articles relevant to pediatric allergy, asthma and immunology. After reviewing these I felt a synopsis of some of the articles would be educational. Thus it would inform our parent readers on the timely topics discussed. Here are the salient concepts from some of the articles included in the supplement:

 

1. Prebiotics for the Prevention of Allergies: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Cuello-Garcia C., et al ClinExp Allergy, 2017..
There is no evidence to support or reject the benefits of prebiotics in the development of allergic diseases in childhood.

 

2. Early Probiotic Supplementation for Eczema and Asthma Prevention: A Randomized Controlled Trial

by Cabana MD, et al PEDIATRICS, 2017.
In a large prospective study there was no association between breastfeedingwith asthma at 7 years of age. But they did find one with the presence of transient early age asthma in infants breast fed less than 6 months.

 

3. Skin Prick Tests and Specific IgE in 10-Year-Old Children: Agreement and Association With Allergic Diseases

by Chauveau A, et al PASTURE Study Group, Allergiy, 2017.
Early probiotic supplementation had no effect on the development of eczema and asthma.

 

4. Anaphylaxis in the Pediatric Emergency Department: Analysis of 133 Cases After an Allergy Workup

by Alvarez-Perea A, et al, J Allergy ClinImmunalPract, 2017.
There is moderate agreement between serum and skin test allergy testing. Yet a reviewer correctly commented that clinical correlation was needed to prevent unnecessary food avoidance. (My clinical experience supports that, particularly in food allergies.)

 

5. Food-Induced Anaphylaxis in Infants and Children

by Samady W. et al, Ann Allergy Asthma Immunol, 2018.
Anaphylaxis as defined by the National Institute of Allergy as acute onset of skin-mucosal tissue AND symptoms of respiratory involvement, or signs of cardiovascular dysfunction or hypotension. (Note: skin involvement alone, i.e. hives, does not indicate anaphylaxis. I mention this because so many parents equate hives alone with anaphylaxis)

The authors also pointed out that food allergies in their experience were the most common cause of anaphylactic reactions.

 

6. Allergen Specificity of Early Peanut Consumption and Effect on Development of Allergic Disease in the Learning Early About Peanut Allergy Study Cohort

by du Toit G, et al Immune Tolerance Network Learning Early About Peanut Allergy study team, J. ALLERGY CLIN IMMUNOL., 2018.
The introduction of peanuts between 6-11 months of age induced the highest rate of tolerance to peanut products. Another article showed the early introduction of peanuts does not provide protection from developing other food allergies.

 

7. Overweight in Childhood and Adolescence: Does It Lead to Airway Hyperresponsiveness in Adulthood?

By Toennesen LL, et al, ASTHMA 2018.

Obese children (ages 7-17 years) did not become asthma burdened adults at a higher rate than non-obese children.

 

8. Association Between Inhaled Corticosteroid Use and Bone Fracture in Children with Asthma

by Gray N. et al JAMA PED. 2018.

The use of inhaled corticosteroids for asthma does not increase the risk of fractures as seen with oral corticosteroid.