• Allergy
• Immune development
• Microbiome
• Sequencing

• Humans
• Asthma/immunology
• Asthma/microbiology
• Gastrointestinal Microbiome/immunology
• Child
• Hypersensitivity/immunology
• Hypersensitivity/microbiology
• Animals
• Infant
• Disease Susceptibility
• Immune System
• Microbiota

• Omalizumab
• food allergy
• threshold value
• treatment

• Child
• Humans
• Allergens/adverse effects
• Asthma/drug therapy
• Double-Blind Method
• Food
• Food Hypersensitivity/complications
• Food Hypersensitivity/drug therapy
• Omalizumab/therapeutic use

• Novartis

• Europe
• epidemiology
• food allergy
• sensitization
• systematic review

• Humans
• Nut Hypersensitivity/diagnosis
• Nut Hypersensitivity/epidemiology
• Prevalence
• Nuts
• Allergens
• Europe/epidemiology
• Corylus/adverse effects
• Prunus dulcis

• DBV Technologies SA

• causal inference
• confounding bias
• directed acyclic graph
• early life
• food allergy

• German Federal Ministry for Education and Research

• Europe
• epidemiology
• food allergy
• sensitization
• systematic review

• Humans
• Food Hypersensitivity/epidemiology
• Prevalence
• Europe/epidemiology
• Clinical Protocols
• Incidence
• Clinical Studies as Topic
• Age Factors
• Child
• Infant, Newborn
• Infant
• Child, Preschool
• Adolescent

• Europe
• epidemiology
• food allergy
• sensitization
• systematic review

Background

Urticaria typically involves the skin and mucosa and is characterized by the development of wheals, angioedema, or both. According to the temporal evolution of the lesions, urticaria is classified as acute (AU) or chronic (CU), depending on whether the episodes last for fewer or more than six weeks, respectively. This study aimed to characterize a group of children and adolescents with urticaria and describe its subtypes, associated comorbidities, treatment, and evolution.

Methodology

This retrospective, observational study included patients aged <18 years who were diagnosed with urticaria in a tertiary teaching hospital in Portugal, and followed up in a Pediatric Allergy Unit, between January 2019 and December 2021.

Results

A total of 43 patients, aged nine months to 16 years were included. Of these, 22 (51%) were males. AU was identified in 12 (28%) cases, chronic spontaneous urticaria in 21 (63%), and physical urticaria (to cold) in four (9%). Autoantibodies were detected in four patients with spontaneous urticaria. In 6% of patients with CU, the episodes were associated with angioedema. Most CU episodes were successfully managed with the recommended or double the recommended dose (48%) of H1 antihistamines. Three patients requiring fourfold higher than the recommended dose of H1 antihistamines remained unresponsive and were started on omalizumab. Associated autoimmune thyroiditis was diagnosed in four patients.

Conclusions

In this cohort of patients, urticaria was equally distributed between the genders and the first-line therapy was second-generation antihistamines, consistent with current guidelines. Universal screening for autoimmune diseases in patients with chronic spontaneous urticaria revealed four cases of thyroiditis, which supports the relevance of this approach when managing CU.

• Allergy
• Epidemiology
• Functional abdominal pain
• Irritable bowel syndrome
• Paediatric gastroenterology

• Asthma
• Birth cohorts
• Case definition
• Children

• Asthma/diagnosis
• Asthma/epidemiology
• Child
• Cohort Studies
• Humans
• Parents
• Prevalence
• Risk Factors

• Acute urticaria
• Angioedema
• Antihistamines
• Chronic urticaria
• Corticosteroids
• Guidelines
• Omalizumab

Heredity and environmental parameters jointly affect allergy development. Here, we used a Swedish prospective cohort to study the influence of heredity and factors usually associated with allergic disease and the development of allergic manifestations in combination with immunoglobulin E (IgE) sensitization at four different time points until 10 years of age.

Parents‐to‐be were characterized concerning allergy and their children (n = 281) were divided based on allergic heredity and followed from birth and clinically examined for IgE‐associated allergic symptoms until 10 years of age. The relation between allergy and early‐life parameters was analyzed by logistic regression. Group‐wise comparisons were made by nonparametrical tests.

Early life eczema and/or asthma in combination with IgE sensitization, was a strong indicator of allergy at a later time point. Further, the early occurrence of multiple allergic symptoms among IgE‐sensitized children predisposed for a more complex allergic phenotype at later ages, independently of allergic heredity. At 10 years of age, allergic children had higher fractional exhaled nitrogen oxide (FeNO) levels, regardless of asthma, and FeNO levels were also influenced by heredity. Birth season was strongly associated with allergy development, but only in children with two allergic parents.

Allergic eczema/asthma in early life, being born during the autumn/winter, having multiple allergic symptoms and two allergic parents were all strong predictors for having allergic diseases at 5 and 10 years of age. However, the allergic march seems to be independent of heredity, as IgE‐mediated allergies follow the same trajectories in children with and without allergic heredity.

• FeNO
• allergy
• birth season
• childhood
• early predictors of allergy
• lung function
• parental allergy
• prospective cohort

• Age Factors
• Asthma/diagnosis
• Asthma/immunology
• Child
• Child, Preschool
• Eczema/diagnosis
• Eczema/immunology
• Exhalation
• Female
• Humans
• Hypersensitivity/diagnosis
• Hypersensitivity/immunology
• Immunoglobulin E/immunology
• Infant
• Infant, Newborn
• Male
• Nitric Oxide/immunology
• Nitric Oxide/metabolism
• Parents
• Phenotype
• Prospective Studies

• allergic rhinitis
• asthma
• atopic dermatitis
• cohort study
• sensitization

• acute
• angioedema
• chronic physical urticaria
• histopathology
• hives
• inducible urticaria
• testing
• urticaria
• wheals

• Antihistamines
• chronic urticaria
• pediatric

• asthma
• birth cohort
• childhood
• persistent
• predictors
• rhinoconjunctivitis
• sensitization
• transient

• Age
• Epidemiology
• Ethnic groups
• Food allergy
• Geography
• Population
• Prevalence

• atopy
• childhood
• sensitization
• skin prick test
• specific IgE

Rhinoconjunctivitis is a global health problem and one of the most common chronic conditions in children. Development of rhinoconjunctivitis depends on both genetic and environmental factors. Many studies have investigated rhinoconjunctivitis, but only few studies have evaluated the risk factors for non-allergic rhinoconjunctivitis in children finding family history of atopic diseases and gender to be of importance. The aim of this study was to investigate possible risk factors in early life for rhinoconjunctivitis, allergic as well as non-allergic, in adolescence.

The children in the Danish Allergy Research Center cohort were examined eight times from birth to 14 years of age. Visits included questionnaire-based interview, clinical examination, skin prick test and specific IgE. We used univariate and multivariate logistic regression to investigate the relationship between early-life risk factors and the development of rhinoconjunctivitis, allergic as well as non-allergic, in adolescence.

Follow-up rate at 14-years was 66.2%. The prevalence of rhinoconjunctivitis was 32.8%. Family history of atopic diseases (aOR 2.25), atopic dermatitis (aOR 3.24), food allergy (aOR 3.89), early sensitization to inhalant and food allergens (aOR 2.92 and aOR 3.13) and male gender (aOR 1.90) were associated with allergic rhinoconjunctivitis but not with non-allergic rhinoconjunctivitis. Early environmental tobacco exposure was inversely associated with rhinoconjunctivitis (aOR 0.42), allergic (aOR 0.47) as well as non-allergic (aOR 0.43).

Different patterns of associations were revealed when stratifying rhinoconjunctivitis in allergic and non-allergic suggesting that allergic rhinoconjunctivitis and non-allergic-rhinoconjunctivitis are different phenotypes.

• Adolescence
• Birth cohort
• Logistic regression
• Predictors
• Rhinoconjunctivitis
• Risk factor

• Allergy
• asthma
• children
• focus group interviews
• parental experiences

Limited data is available on the prevalence and risk factors of acute and chronic urticaria in children. Our purpose was to determine the prevalence and identify the risk factors of acute and chronic urticaria in Korean children.

This population-based study examined 4,076 children (age 4 to 13 years) who were enrolled in the 2015 prospective Seongnam Atopy Project (SAP 2015) in Korea. The parents completed an urticaria questionnaire that included questions regarding the duration, severity, and triggering factors of urticaria. Blood sampling (n=464) was performed to measure vitamin D, total eosinophil count (TEC), and total IgE levels, and skin prick tests (n=503) were done.

The prevalences of the life-time, acute, and chronic urticaria were 22.5%, 13.9%, and 1.8% (chronic continuous urticaria, 0.7%; and chronic recurrent urticaria, 1.1%), respectively. Acute urticaria was significantly associated with allergic diseases and parental history of allergy (P<0.001), but chronic urticaria was not associated with these clinical factors. There was no significant difference in the 25-hydroxyvitamin D level between subjects with chronic urticaria and controls (P=0.124). Chronic continuous urticaria was associated with living in a new residence (aOR=2.38, 95% CI=1.02-5.54, P=0.044) and belonging to a family with a high income (aOR=4.24, 95% CI=1.24-14.56, P=0.022).

A total of 1.8% of children were found to have chronic urticaria. Living in a new residence and belonging to a family with a high income increased the risk of chronic continuous urticaria.

• Acute urticarial
• chronic urticarial
• prevalence
• risk factor, urticaria

• allergic diseases
• asthma
• atopic dermatitis
• comorbidity
• prevalence rhinoconjunctivitis
• sensitization
• skin prick test
• specific IgE

• adolescence
• allergic contact dermatitis
• cohort study
• infancy
• nickel sulfate
• patch test

In industrialized countries atopic diseases have been reported to be less likely in children and adolescents with a migrant background compared to non-migrants. This paper aimed at both examining and comparing prevalence of asthma, allergic rhinoconjunctivitis and atopic dermatitis and allergic sensitization to specific IgE antibodies in children and adolescents with and without a migrant background. Using data of the population-based German Health Interview and Examination Survey for children and adolescents (KiGGS; n = 17,450; 0–17 years), lifetime and 12-month prevalence of atopic diseases and point prevalence of 20 common allergic sensitizations were investigated among migrants compared to non-migrants. Multiple regression models were used to estimate the association of atopic disease and allergic sensitization with migrant background. In multivariate analyses with substantial adjustment we found atopic dermatitis about one-third less often (OR 0.73, 0.57–0.93) in participants with a two-sided migrant background. Statistically significant associations between allergic sensitizations and a two-sided migrant background remained for birch (OR 0.73, 0.58–0.90), soybean (OR 0.72, 0.54–0.96), peanut (OR 0.69, 0.53–0.90), rice (OR 0.64, 0.48–0.87), potato (OR 0.64, 0.48–0.85), and horse dander (OR 0.58, 0.40–0.85). Environmental factors and living conditions might be responsible for the observed differences.

• adolescents
• allergies
• atopic hypersensitivity
• children
• prevalence
• transients and migrants

• allergy
• asthma
• cluster analysis
• eczema
• rhinitis

Cutaneous involvement characterized by urticarial lesions with or without angioedema and itch is commonly observed in routine medical practice. The clinical approach may still remain complex in real life, because several diseases may display similar cutaneous manifestations. Urticaria is a common disease, characterized by the sudden appearance of wheals, with/without angioedema. The term Chronic Urticaria (CU) encompasses a group of conditions with different underlying causes and different mechanisms, but sharing the clinical picture of recurring wheals and/or angioedema for at least 6 weeks. Hereditary Angioedema (HAE) is a rare disorder characterized by recurrent episodes of non-pruritic, non-pitting, subcutaneous or submucosal edema affecting the extremities, face, throat, trunk, genitalia, or bowel, that are referred as “attacks”. HAE is an autosomal dominant disease caused by a deficiency of functional C1 inhibitor, due to a mutation in C1-INH gene (serping 1 gene) characterized by the clonal proliferation of mast cells, leading to their accumulation, and possibly mediator release, in one or more organs. In childhood there are two main forms of mastocytosis, the Systemic and the Cutaneous. The clinical features of skin lesions in urticaria, angioedema and mastocytosis may differ depending on the aetiologic factors, and the underlying pathophysiological mechanisms. The diagnostic process, as stepwise approach in routine clinical practice, is here reviewed for CU, HAE and mastocytosis, resulting in an integrated method for improved management of these cutaneous diseases. Taking into account that usually these conditions have also a relevant impact on the quality of life of children, affecting social activities and behavior, the availability of care pathways could be helpful in disentangle the diagnostic issue achieving the most cost-effective ratio.

• Angioedema
• Children
• Clinical practice
• Diagnosis
• Epidemiology
• Itch
• Management
• Mastocytosis
• Skin
• Urticaria

Atopic dermatitis (AD) is a chronic inflammatory skin disorder which can precede asthma and allergic rhinitis in a disease trajectory known as the atopic march. The pathophysiology of AD includes cutaneous inflammation, disrupted epidermal barrier function, xerosis and propensity to secondary infections. AD had previously been thought to arise from the systemic atopic immune response and therapies are therefore directed towards ameliorating Th2-mediated inflammation. However in recent years the focus has shifted towards primary defects in the skin barrier as an initiating event in AD. Links between loss-of-function variants in the gene encoding filaggrin and disrupted activity of epidermal serine proteases and AD have been reported. Based on these observations, a mechanism has been described by which epidermal barrier dysfunction may lead to inflammation and allergic sensitization. Exogenous and endogenous stressors can further exacerbate inherited barrier abnormalities to promote disease activity. Pathways underlying progression of the atopic march remain unclear, but recent findings implicate thymic stromal lymphopoietin as a factor linking AD to subsequent airway inflammation in asthma. This new appreciation of the epidermis in the development of AD should lead to deployment of more specific strategies to restore barrier function in atopic patients and potentially halt the atopic march.

• Atopic dermatitis
• Eczema
• Filaggrin
• Skin barrier
• Kallikrein
• Thymic stromal lymphopoietin
• Allergic sensitization
• Atopic march

• Europe
• food allergy
• prevalence
• systematic review

In the preschool period, allergic rhinitis (AR) is infrequent and thus under-diagnosed. However, recent works have highlighted the occurrence of AR in toddlers although the causes of AR in this young population remain unknown. The objective of this study was to identify determinants of AR in young children with asthma.

We carried out a case-control study of 227 children with active asthma and enrolled in the Trousseau Asthma Program. AR and other allergic diseases (asthma, food allergy and eczema) were diagnosed by medical doctors using standardized questionnaires. Parental history of AR and asthma, biological markers of atopy (total IgE, blood eosinophilia, allergic sensitization towards food and aeroallergens) and environmental parameters were also collected.

Forty one of the children (18.1%) had AR. By univariate logistic regression analysis, AR was mainly associated with peanut sensitization (OR = 6.75; p = 0.002); food allergy (OR = 4.31; p = 0.026); mold exposure (OR = 3.81 p<0.01) and parental history of AR (OR = 1.42; p = 0.046). Due to the strong link between food allergy and peanut sensitization three models of multivariate logistic regression were performed and confirmed that AR is associated with peanut sensitization but also food allergy and mold exposure. A random forest analysis was also performed to explain AR. The results reinforced the logistic analysis that peanut sensitization and mold exposure were the principal determinants of AR.

These results stress the importance of investigating AR in young children with asthma to potentially diagnose a particularly severe allergic asthmatic phenotype. Moreover, these data evoke the hypothesis that peanut could be an aeroallergen.

• Allergens/immunology
• Asthma/complications
• Asthma/diagnosis
• Case-Control Studies
• Child, Preschool
• Eczema/immunology
• Environment
• Female
• Food Hypersensitivity/immunology
• Humans
• Hypersensitivity, Immediate/complications
• Hypersensitivity, Immediate/immunology
• Infant
• Male
• Multivariate Analysis
• Rhinitis, Allergic/complications
• Rhinitis, Allergic/diagnosis
• Risk Factors
• Surveys and Questionnaires

• EAACI
• children
• food allergy
• guidelines
• primary prevention

The Mushua Innu of Natuashish, Labrador, Canada seem to have a high rate of childhood eczema. Anecdotally this problem seems to be more common now than 20 years ago. There has been speculation that this could be related to food sensitization that may have arisen coincident with a move away from a traditional Innu diet. We undertook to assess the prevalence and severity of pediatric eczema in Natuashish (population 792), and investigate the level of sensitization to common food antigens.

Over a three-month period we performed a population survey of all children in the community from the ages of 2–12 inclusive. The one-year prevalence of eczema was assessed using the United Kingdom Working Party’s diagnostic criteria, and graded on the Nottingham Severity Scale. All children with eczema and twice as many age/sex matched controls were offered complete blood counts, total IgE, and food specific IgE levels for egg white, cow’s milk protein and wheat.

One hundred and eighty two (95% of the eligible children) were assessed. Of the 182 children examined eczema was diagnosed in 30 (16.5%) - 22 females and 8 males. The majority of children with eczema (20/30) were classified as being in the moderate and severe category. Of the 22 with eczema and 40 controls who consented to venipuncture all but 3 had IgE levels above the lab's reference range. Food specific antibody assays showed that 32, 23, and 5 percent of children with eczema were sensitized to egg, milk, and wheat respectively. None of the controls were sensitized.

The children of Natuashish, Labrador have a high rate of eczema, much of it graded as moderate or severe. IgE levels were markedly elevated in children with and without eczema, with average values at least ten-fold higher than other populations. There is no evidence of an unusual amount of sensitization to egg, milk or wheat.

• Europe
• epidemiology
• food allergy
• risk factors
• systematic review

• Allergic diseases
• Clinical examination
• Eczema
• Exposure pathways
• Wheeze

• Denmark
• IgE
• allergy
• asthma
• childhood
• children
• preschool
• prevalence
• sensitization
• skin prick test

• asthma
• birth cohort
• eczema
• food allergy
• prevalence
• recurrent wheezing
• rhinoconjunctivitis
• sensitization

• urticaria
• angioedema