Hypersensitivity Reactions: An Everyday Occurrence in Pediatric Allergy Clinics

Systemic barrier dysfunction in type 2 inflammation diseases: perspective in the skin, airways, and gastrointestinal tract

The epithelial barrier in different organs is the first line of defense against environmental insults and allergens, with type 2 immunity serving as a protective function. Genetic factors, and biological and chemical insults from the surrounding environment altered regulate epithelial homeostasis through disruption of epithelial tight junction proteins or dilated intercellular spaces. Recent studies suggest that epithelial barrier dysfunction contributes to pathologic alteration in diseases with type 2 immune dysregulation including (but not limited to) atopic dermatitis, prurigo nodularis, asthma, chronic rhinosinusitis with nasal polyps, and eosinophilic esophagitis. In this review, we summarized current understanding of dysfunction of barrier and its interaction with type 2 inflammation across different organs, and discussed the role of epithelial barrier disruption in the pathogenesis of type 2 inflammation. In addition, recent progresses of emerging barrier restorative therapies are reviewed.

The last step to achieve barrier damage control

Heterogeneity characterises inflammatory diseases and different phenotypes and endotypes have been identified. Both innate and adaptive immunity contribute to the immunopathological mechanism of these diseases and barrier damage plays a prominent role triggering type 2 inflammation through the alarmins system, such as anti-Thymic Stromal Lymphopoietin (TSLP). Treatment with anti-TSLP monoclonal antibodies showed efficacy in severe asthma and clinical trials for other eosinophilic diseases are ongoing. The aim of this perspective review is to analyse current advances and future applications of TSLP inhibition to control barrier damage.

Hand Dermatitis among Nurses during the COVID-19 Pandemic: Frequency and Factors

OBJECTIVE

To determine the frequency of hand dermatitis among nurses during the COVID-19 pandemic and factors affecting its prevalence.

METHODS

The research sample consisted of 175 nurses working in state hospitals. Research data were collected via Google survey between September and October 2020. The data were collected using a sociodemographic data collection form, and a self-assessment form was used to determine dermatologic symptoms.

RESULTS

The frequency of hand dermatitis among nurses was 70.9%. A statistically significant difference was found between sex, allergy history, and increased frequency of handwashing and the frequency of hand dermatitis. No significant difference in terms of the frequency of hand dermatitis was found between nurses who provided care to patients who were COVID-19 positive versus nurses who provided care to patients who were COVID-19 negative. However, the frequency of washing hands and using hand disinfectants and hand creams was found to have increased significantly during the COVID-19 pandemic compared to the prepandemic period.

CONCLUSIONS

The frequency of hand dermatitis increased among nurses during the pandemic. The increased frequency of handwashing during the pandemic poses a risk for hand dermatitis among nurses, although this should not discourage nurses from appropriate hygiene.

A compendium and review of pediatric pulmonary function testing assessment opportunities for asthma

OBJECTIVE

Standard spirograms are widely used in the respiratory disease management community to help diagnosis asthma and provide longitudinal information. Surprisingly, basic information obtained on the spirogram, beyond the FEV₁ and change in FEV₁ after bronchodilator is underutilized. We reviewed information on pulmonary function and bronchodilator response in children since 2016. We present here a discussion of other element of the standard spirogram that can be used for pediatric asthma management.Methods: Medline search of pulmonary function, children, adolescents, bronchodilator reversibility, small airway disease, small airway function, asthma, airflow limitation, bronchodilator response. Studies since 2016 that provide information on normal or asthmatic children bronchodilator response, and/or small airway or pulmonary function values after albuterol.

RESULTS

Limited data has been published on FEV₁ bronchodilator response in children since 2016. Other parameters of the pulmonary function test in children have had recent documentation.

CONCLUSIONS

New data on FEV₁ bronchodilator response in normal children is limited since 2016. However, other details of pulmonary function interpretation in asthmatic children has had considerable attention, and are reviewed here.

Allergic Food Sensitization and Disease Manifestation in the Fetus and Infant: A Perspective

Even though allergic disease is identified in the first year of life, it is often in a less forward fashion, with elements of a wait and see approach. If the infant does not have an anaphylactic food reaction, other less dramatic allergic phenomenon is often under-emphasized, waiting for additional concerns. We approached this with a conception to first conduct birthday surveys, attempting to link intrauterine and peri-birth circumstances to affect better allergy recognition in young infants.

Small Airway Disease in Pediatric Asthma: the Who, What, When, Where, Why, and How to Remediate. A Review and Commentary

Asthma affects all portions of the airways. Small airways, however, comprise a substantial component of the conducting lung air flow. In asthma, inflammatory processes can affect the whole respiratory tract, from central to peripheral/small airways. The emphasis in adult and pediatric respiratory disease clinics is to focus on large airway obstruction and reversibility. This information, although valuable, underemphasizes a large portion of the conduction airway of asthmatics. Standard descriptions of asthma management focus on a multiple medication approaches. We particularly focused on the management of asthma in the international guidelines for the Global Initiative for Asthma (GINA). Overall, however, minimal attention is placed on the small airway pool in asthma medical management. We took the opportunity to thoroughly review and present specific data from the adult asthma literature which supported the concept that small airway abnormalities may play a role in the pathogenesis and clinical expression of asthma. Based on the conclusions of the adult asthma literature, we here present a thorough review of the literature as it relates to small airway disease in children with asthma. We used, collectively, individual data sources of data to expand the information available from standard diagnostic techniques, especially spirometry, in the evaluation of small airway disease. As the pharmacological approaches to moderate to severe asthma are advancing rapidly into the realm of biologics, we sought to present potential pharmacological options for small airway dysfunction in pediatrics prior to biological modifier intervention.