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Brackel CLH, Noij LCE, Vijverberg SJH, Legghe CL, Maitland-van der Zee AH, van Goudoever JB, Buonsenso D, Munblit D, Sigfrid L, McFarland S, Anmyr L, Ashkenazi-Hoffnung L, Bellinat APN, Dias NLS, Edwards A, Fashina T, Juraški RG, Gonçalves ALN, Hansted E, Herczeg V, Hertting O, Jankauskaite LN, Kaswandani N, Kevalas R, Krivácsy P, Lorenz M, Malone LA, McVoy M, Miller DW, Morrow AK, Nugawela MD, Oliveira CR, Oliveira PRS, Osmanov IM, Overmars IM, Paintsil E, Pinto Pereira SM, Prawira Y, Putri ND, Ramos RCF, Rasche M, Ryd-Rinder M, De Rose C, Samitova E, Jovanović TS, Say D, Scott JT, Shachar-Lavie I, Shafran R, Shmueli E, Snipaitiene A, Stephenson T, Ténai N, Tosif S, Turkalj M, Valentini P, Vasconcelos LRS, Villard L, Vilser D, Hashimoto S, Terheggen-Lagro SWJ. International Care programs for Pediatric Post-COVID Condition (Long COVID) and the way forward. Pediatr Res 2024:10.1038/s41390-023-03015-0. [PMID: 38287106 DOI: 10.1038/s41390-023-03015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/16/2023] [Accepted: 12/15/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Pediatric Post-COVID-Condition (PPCC) clinics treat children despite limited scientific substantiation. By exploring real-life management of children diagnosed with PPCC, the International Post-COVID-Condition in Children Collaboration (IP4C) aimed to provide guidance for future PPCC care. METHODS We performed a cross-sectional international, multicenter study on used PPCC definitions; the organization of PPCC care programs and patients characteristics. We compared aggregated data from PPCC cohorts and identified priorities to improve PPCC care. RESULTS Ten PPCC care programs and six COVID-19 follow-up research cohorts participated. Aggregated data from 584 PPCC patients was analyzed. The most common symptoms included fatigue (71%), headache (55%), concentration difficulties (53%), and brain fog (48%). Severe limitations in daily life were reported in 31% of patients. Most PPCC care programs organized in-person visits with multidisciplinary teams. Diagnostic testing for respiratory and cardiac morbidity was most frequently performed and seldom abnormal. Treatment was often limited to physical therapy and psychological support. CONCLUSIONS We found substantial heterogeneity in both the diagnostics and management of PPCC, possibly explained by scarce scientific evidence and lack of standardized care. We present a list of components which future guidelines should address, and outline priorities concerning PPCC care pathways, research and international collaboration. IMPACT Pediatric Post-COVID Condition (PPCC) Care programs have been initiated in many countries. Children with PPCC in different countries are affected by similar symptoms, limiting many to participate in daily life. There is substantial heterogeneity in diagnostic testing. Access to specific diagnostic tests is required to identify some long-term COVID-19 sequelae. Treatments provided were limited to physical therapy and psychological support. This study emphasizes the need for evidence-based diagnostics and treatment of PPCC. The International Post-COVID Collaboration for Children (IP4C) provides guidance for guideline development and introduces a framework of priorities for PPCC care and research, to improve PPCC outcomes.
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Affiliation(s)
- Caroline L H Brackel
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.
- Department of Pediatrics, Tergooi MC, Hilversum, the Netherlands.
| | - Lieke C E Noij
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Susanne J H Vijverberg
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Camille L Legghe
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Faculty of Pharmacy, University of Lille, Lille, France
| | - Anke H Maitland-van der Zee
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes B van Goudoever
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniel Munblit
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Louise Sigfrid
- ISARIC Global Support Centre, Pandemic Science Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sammie McFarland
- Long COVID Kids and Friends, Fletcher & Partners, Crown Chambers, Bridge Street, Salisbury, SP1 2LZ, UK
| | - Lena Anmyr
- Medical Unit Social Work, Function Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Liat Ashkenazi-Hoffnung
- Department of Day Hospitalization, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel
| | - Ana P N Bellinat
- Pediatric Intensive Care Unit, Hospital Martagão Gesteira - Children's Hospital, Salvador, Brazil
| | - Nathália L S Dias
- Pediatric Intensive Care Unit, Hospital Martagão Gesteira - Children's Hospital, Salvador, Brazil
| | - Amy Edwards
- Department of Infectious Disease, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Tomini Fashina
- Department of Global Health, Yale University School of Public Health, New Haven, CT, USA
| | - Romana Gjergja Juraški
- Department of Pediatric Neurology, Srebrnjak Children's Hospital, Srebrnjak, Zagreb, Croatia
- Medical School of Osijek, University of Osijek, Osijek, Zagreb, Croatia
| | | | - Edita Hansted
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Vivien Herczeg
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Budapest, Hungary
| | - Olof Hertting
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Lina N Jankauskaite
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Nastiti Kaswandani
- Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rimantas Kevalas
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Péter Krivácsy
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Budapest, Hungary
| | - Michael Lorenz
- Pediatric Pulmonology, Department of Paediatrics, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Laura A Malone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Molly McVoy
- Department of Pediatric Psychiatry, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - David W Miller
- Department of Pediatric Integrative Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Amanda K Morrow
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Carlos R Oliveira
- Department of Pediatrics, Division of Infectious Diseases & Global Health, Yale University School of Medicine, New Haven, CT, USA
| | | | - Ismael M Osmanov
- ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Isabella M Overmars
- Department of Infection and Immunity, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Elijah Paintsil
- Department of Pediatrics, Division of Infectious Diseases & Global Health, Yale University School of Medicine, New Haven, CT, USA
| | | | - Yogi Prawira
- Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nina Dwi Putri
- Department of Child Health, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Marius Rasche
- Pediatric Pulmonology, Department of Paediatrics, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Malin Ryd-Rinder
- Pediatric Emergency Care, Astrid Lindgren Children Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Christina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elmira Samitova
- ZA Bashlyaeva Children's Municipal Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Daniela Say
- Department of Infection and Immunity, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Janet T Scott
- Department of Infectious Disease, MRC-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Iris Shachar-Lavie
- Department of Psychological Medicine, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Einat Shmueli
- Pulmonary Institute, Schneider Children's Medical Center, Petach Tikva, Tel Aviv, Israel
| | - Ausra Snipaitiene
- Department of Pediatrics, Lithuanian University of Health Sciences Hospital KaunoKlinikos, Kaunas, Lithuania
| | - Terence Stephenson
- UCL Great Ormond Street Institute of Child Health, University College Hospital & Great Ormond Street Hospital, London, UK
| | - Nikolett Ténai
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Budapest, Hungary
| | - Shidan Tosif
- Department of General Medicine, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Mirjana Turkalj
- Department of Pulmonology, Allergy and Immunology, Srebrnjak Children's Hospital, Zagreb, Croatia
- Medical School, Catholic University of Croatia, Zagreb, Croatia
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luydson R S Vasconcelos
- Hospital Universitário Oswaldo Cruz, Recife, Pernambuco, Brazil
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation, FIOCRUZ-PE, Recife, Brazil
| | - Li Villard
- Medical Unit Occupational Therapy and Physiotherapy, Function Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Vilser
- Clinic for Pediatric and Adolescent Medicine Neuberg/Ingolstadt AMEOS Hospital Association, Neuberg, Germany
| | - Simone Hashimoto
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Pulmonary Medicine, Amsterdam Institute for Infection and Immunology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Suzanne W J Terheggen-Lagro
- Department of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
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Herczeg V, Garai R, Takács J, Kovács F, Luczay A, Hrapka E, Krivácsy P, Hosszú É, Beniczky NJ, Németh Á, Szilágyi ES, Pécsi A, Szabó Z, Szabó AJ, Tóth-Heyn P. Thyroid disturbances after COVID-19 and the effect of vaccination in children: a prospective tri-center registry analysis. Eur J Pediatr 2023; 182:4443-4455. [PMID: 37488409 PMCID: PMC10587318 DOI: 10.1007/s00431-023-05097-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023]
Abstract
Rapidly evolving clinical data suggest that the novel coronavirus (SARS-CoV-2) and vaccination against COVID-19 might be associated with thyroid disturbances. However, studies remain limited among the pediatric population. Our aim was to assess the prevalence and permanence of thyroid autoimmunity (TA) and dysfunction in children after an acute infection and its potential association with vaccination. A prospective, multicenter registry analysis was performed among 458 children (mean age: 12.4 ± 3,8 years, 45.4% male) with preceding COVID-19. Patient inclusion lasted from 24th March, 2021 to 23rd March, 2022 at three pediatric outpatient facilities at Semmelweis University, Budapest. Primary outcomes were the rate of thyroid disturbances assessed by laboratory parameters (thyroid function tests, antithyroglobulin [ATG] and anti-thyroid peroxidase [ATPO] antibodies) and thyroid ultrasound. TA rate among vaccinated and unvaccinated children was determined. Children with newly diagnosed thyroid alterations were followed up for 12.7 ± 4.3 months. Six children had previous thyroid disease. Out of 452 children, 30 cases (6.6%) of newly diagnosed TA (six of them had abnormal thyroid-stimulating hormone [TSH] levels) and eight cases (1.8%) of isolated TSH elevation were observed. Ultrasound-proven autoimmune thyroiditis (AIT) was 4.0%. No association was found between COVID-19 vaccination and thyroid autoimmunity (χ2(1,N = 452) = 0.138, p = 0.815). Among children with TA, 73.3% had long-lasting alterations. Conclusion: Vaccination had no effect on the prevalence of TA. Until further controlled studies state otherwise, children with preceding COVID-19 might benefit from thyroid screening. What is Known: • Numerous case reports implicate that coronavirus disease-2019 (COVID-19) and vaccination against SARS-CoV-2 can be responsible for thyroid disturbances. • Thyroid alterations discovered during acute COVID-19 tend to cease by time and only incidental thyroid autoimmunity (TA) is diagnosed after COVID-19. In adults, no increase in vaccine-related hyper- or hypothyroidism was found. What is New: • TA rate after COVID-19 vaccination among children was not increased. TA had no role in long COVID syndrome. • We discovered a considerable rate of TA (6.6%) and ultrasound-proven autoimmune thyroiditis (AIT) (4.0%) after SARS-CoV-2 infection, and the majority of these alterations remained positive after 6 months.
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Affiliation(s)
- Vivien Herczeg
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary.
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary.
| | - Réka Garai
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Johanna Takács
- Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Fanni Kovács
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary
| | - Andrea Luczay
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary
| | - Erzsébet Hrapka
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary
| | - Péter Krivácsy
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary
| | - Éva Hosszú
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Nikolett Jusztina Beniczky
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Ágnes Németh
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | | | - Anna Pécsi
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsófia Szabó
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Attila József Szabó
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- ELKH-SE Pediatrics and Nephrology Research Group, Budapest, Hungary
| | - Péter Tóth-Heyn
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Bókay Unit, Bókay János Street 53-54, 1083, Budapest, Hungary
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Reschke F, Lanzinger S, Herczeg V, Prahalad P, Schiaffini R, Mul D, Clapin H, Zabeen B, Pelicand J, Phillip M, Limbert C, Danne T. The COVID-19 Pandemic Affects Seasonality, With Increasing Cases of New-Onset Type 1 Diabetes in Children, From the Worldwide SWEET Registry. Diabetes Care 2022; 45:2594-2601. [PMID: 36166593 DOI: 10.2337/dc22-0278] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. RESEARCH DESIGN AND METHODS We analyzed data on 17,280 cases of T1D diagnosed during 2018-2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models. RESULTS The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1-12.2) in 2018 to 21.7 (20.6-22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2-14.0) in 2018 to 26.7 (25.7-27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5-12.9) to 24.7 (24.0-25.5) for adolescents ages 12-18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018-2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic. CONCLUSIONS The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.
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Affiliation(s)
- Felix Reschke
- Children's Hospital Auf Der Bult, Hannover Medical School, Hannover, Germany.,SWEET e.V., Hannoversche Kinderheilanstalt, Hannover, Germany
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Vivien Herczeg
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Priya Prahalad
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA.,Stanford Diabetes Research Center, Stanford, CA
| | | | - Dick Mul
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, the Netherlands
| | - Helen Clapin
- Department of Diabetes and Endocrinology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Bedowra Zabeen
- Changing Diabetes in Children and Life for a Child, Department of Paediatrics, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders, Dhaka
| | - Julie Pelicand
- Pediatric and Adolescent Diabetes Program, Department of Pediatrics, San Camilo Hospital, San Felipe, Chile.,Medicine School, Universidad de Valparaíso, San Felipe, Chile
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Catarina Limbert
- Unit of Paediatric Endocrinology and Diabetes, Hospital Dona Estefânia, Lisbon, Portugal.,Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Thomas Danne
- Children's Hospital Auf Der Bult, Hannover Medical School, Hannover, Germany.,SWEET e.V., Hannoversche Kinderheilanstalt, Hannover, Germany
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Muzslay E, Hámory E, Herczeg V, Tóth-Heyn P, Körner A, Madácsy L, Luczay A. Transitional elevation of anti-tissue transglutaminase antibodies in children with type 1 diabetes mellitus without coeliac disease. Orv Hetil 2021; 162:1924-1930. [PMID: 34839274 DOI: 10.1556/650.2021.32287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: Az 1-es típusú diabetes mellitus és a coeliakia gyakori társulása jól ismert. Néhány tanulmány beszámol átmeneti antitranszglutamináz-emelkedésről 1-es típusú diabeteses betegekben, akiknél az emelkedett antitestszint gluténmentes diéta bevezetése nélkül normalizálódik. Célkitűzés: Kutatásunk során az átmeneti antitranszglutamináz-emelkedés gyakoriságának meghatározását tűztük ki célul. További célunk volt a coeliakia gyakoriságának megállapítása 1-es típusú diabetesszel gondozott betegeink között. Módszer: A Semmelweis Egyetem I. Gyermekgyógyászati Klinikáján 1-es típusú diabetesszel gondozott betegeket vontuk be vizsgálatunkba (238 lány, 265 fiú, medián [IR] életkor az 1-es típusú diabetes diagnózisakor: 7,83 [4,67-11] év). Vizsgáltuk a jelenség időbeli megjelenését, az emelkedés mértékét, gyakoriságát és az antitest típusát. Leíró statisztikai módszereket és khi-négyzet-próbát alkalmaztunk. Eredmények: A vizsgált populációban a coeliakia gyakorisága 12,52%. Átmeneti antitranszglutamináztiter-emelkedést 48 gyermeknél (10,9%) észleltünk. Összesen 71-szer mértünk átmeneti antitranszglutamináz-emelkedést. A gyermekek közül 34 esetben (70,83%) egyszer fordult elő emelkedést mutató antitest, a többi betegnél 2-8 alkalommal. Gyakrabban tapasztaltunk izolált IgA-típusú emelkedést, mint izolált IgG-típusút (54 vs. 5). Következtetés: Az átmeneti antitranszglutamináz-emelkedés gyakorisága magas, összevethető a valódi coeliakiás csoporttal. Kutatásunk alátámasztja a nemzetközi ajánlást, miszerint mérsékelt mértékű antitranszglutamináz-emelkedés esetén, tünetmentes 1-es típusú diabetesszel gondozott betegben a gluténfogyasztás folytatása és az antitestszintek gyakori kontrollja javasolt. Orv Hetil. 2021; 162(48): 1924-1930. SUMMARY INTRODUCTION The frequent association of type 1 diabetes mellitus with coeliac disease is well known. Development of transitional elevation of anti-tissue transglutaminase antibodies in the diagnosis of type 1 diabetes is reported in some studies. In these cases, the anti-tissue transglutaminase antibodies returned to normal without gluten-free diet. OBJECTIVE Our aim was to assess the frequency of transitional elevation of anti-tissue transglutaminase in our type 1 diabetes patients. We aimed to investigate the prevalence of coeliac disease in patients with type 1 diabetes. METHOD Patients with type 1 diabetes at the Ist Department of Paediatrics, Semmelweis University, were enrolled in the study (238 girls, 265 boys; the median age at the time of type 1 diabetes diagnosis was 7.83 [4.67-11] years). Descriptive statistical analysis was done and the time of appearance, extent, frequency and type of elevated anti-tissue transglutaminase antibodies were examined. RESULTS The proportion of children with diagnosed coeliac disease was 12.52%. We detected transitional anti-tissue transglutaminase elevation in 48 cases (10.9%). Temporarily elevated antibody levels were measured 71 times. In 34 children (70.83%), the temporary elevation occured once, while in the others, antibody levels became positive 2-8 times. The elevation of the IgA antibody was more frequent than the elevation of the IgG antibody (54 vs. 5). CONCLUSION The frequency of temporary elevated anti-tissue transglutaminase levels is considered high. Our study confirms the recommendation that in the case of moderate anti-tissue transglutaminase levels with lack of clinical symptoms, control antibody measurement is necessary with ongoing gluten consumption. Orv Hetil. 2021; 162(48): 1924-1930.
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Affiliation(s)
- Eszter Muzslay
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Budapest, Bókay J. u. 53.,1083
| | - Eszter Hámory
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar, Budapest
| | - Vivien Herczeg
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Budapest, Bókay J. u. 53.,1083
| | - Péter Tóth-Heyn
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Budapest, Bókay J. u. 53.,1083
| | - Anna Körner
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Budapest, Bókay J. u. 53.,1083
| | - László Madácsy
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Budapest, Bókay J. u. 53.,1083
| | - Andrea Luczay
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Budapest, Bókay J. u. 53.,1083
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