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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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June 22, 2022 | Volume 13 | Issue 25 |
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The natural history of peanut and egg allergy in children up to age 6 years |
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Peanut and egg allergies are among the most common causes of severe allergic episodes with peanut allergy being the most common cause of food-induced anaphylaxis.
The HealthNuts Cohort of 5,276 children (of whom 156 had peanut allergy and 471 allergic to raw egg) recruited at 1 year of age and followed prospectively to age 6 years, examined the natural history (persistence or resolution) of food allergy in early childhood.
- Factors at age 1 year associated with persistence of peanut allergy include a skinprick test (SPT) >8mm, sensitization to tree nuts and early-onset severe eczema.
- 0.7% of children develop new onset allergy to peanuts (more commonly than for eggs).
- Egg allergy resolves more commonly (89%) than peanut allergy (29%) by age 6 years (prevalence 1.2% and 3.1% respectively).
- Factors at 1 year associated with persistence of egg allergy at 6 years include a SPT >4mm, other (peanut and/or sesame) food sensitization, baked egg allergy and early-onset severe eczema.
“Most egg allergy and nearly 1/3 of peanut allergy resolve naturally by age 6 years”.
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Read the full article at the Journal of Allergy and Clinical Immunology
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Monkeypox (an Orthopoxvirus of the same family as the smallpox virus but very much less lethal) was first discovered in animals in 1958 with the first human cases being documented in 1970.
Endemic in Africa it is uncommonly seen in the rest of the world (recently the first case in Florida was reported in Broward County, > 550 cases have now been seen globally).
Transmission is by droplets or bodily contact.
Clinically, like many viral illnesses, there is an incubation period of 7-14 (21) days followed by flu-like symptoms, fever, muscle pain, unusual lymphadenopathy and a viral exanthem over body, mouth or on the face which progresses 1-3 days after the fever to be more diffuse (particularly on the extremities). The macular rash then evolves to deep-seated vesicles and finally pustules which scab, over a 2-3 week period.
“Once scabs have fallen off, a person is no longer contagious”.
“Currently there are no proven safe treatments for Monkeypox virus infection; controlling an outbreak, smallpox vaccine, antivirals and vaccinia immune globulin (VIG) can be used”.
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WHO’s Science in 5 : Monkeypox - YouTube |
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Persistent neurologic symptoms and cognitive disfunction in non-hospitalized COVID-19 “long haulers” |
“Although SARS-CoV-2 manifests primarily with respiratory tract infection and flu-like symptoms, COVID-19 is now recognized as a multi-organ disease often involving the nervous system”.
36.4%-82.3% of hospitalized COVID-19 patients have neurological manifestations which may persist in the post-acute phase (“long-COVID”) syndrome.
80% of SARS-CoV-2 infected patients however do not require hospitalization with many having a relatively mild illness. Nevertheless, some develop persistent and debilitating symptoms and are known as “long haulers”.
A prospective study of 100 consecutive, non-hospitalized patients (half SARS-CoV-2 tested positive; mean age 43.2 years 70% females) presenting with new neurologic symptoms of COVID-19 to a Neuro-COVID-19 clinic characterized the spectrum of patient-reported neurological manifestation in “long-haulers” (symptoms lasting >6 weeks).
The most frequent neurologic manifestations of COVID-19 “long haulers” include fatigue (85%), brain fog (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%) and myalgias (55%).
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Association of early discharge with likelihood of hospital readmission in the first 4 weeks for vaginally delivered neonates |
“Early postnatal hospital discharge generally refers to the postpartum hospital discharge of mother and newborn within 48 hours. The duration of what is considered “early discharge” however varies between countries from 12-72 hours”. While early discharge of mothers and babies has advantages it may also carry an increased risk for the infant and mother.
A retrospective analysis (from Finland) examined whether hospital readmission rates by 28 days of age are increased when vaginally delivered infants (333,321; gestational age >37 weeks + 0 days) are discharged early (defined as discharged on the day of birth or after one night stay in a maternity unit).
“Early discharge seems to be associated with an increased risk of hospital readmission” (commonest causes are neonatal jaundice and infection).
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Long-term impact of prophylactic antibiotic use before incision vs. after cord clamping on children born by caesarian section (C/S) |
More than 25% of deliveries (more in the US) are born by caesarian section. C/S carries an increases risk of post-partum infection which appears to be reduced by routine provision of prophylactic antibiotics given before incision rather than after cord clamping. Whether giving antibiotics after cord clamping changes childhood outcomes is unknown.
An observational controlled interrupted type series study of records of mother-baby dyads (2006-2018) examined childhood outcomes in children 5 years of age born by C/S when pre-incision prophylactic antibiotic was the standard and compared this to those similarly born when antibiotics were administered post-cord clamping.
During C/S, prophylactic antibiotics administered post cord-clamping carries no increased risk of asthma or eczema during childhood.
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Multivalent 9-O-Acetylated-sialic acid glycoclusters as potent inhibitors for SARS-CoV-2 infection |
An exciting new option for the treatment of SARS-CoV-2 (independent of mutation) comes from a research group in Brussels (Belgium) who further clarifies (by atomic force microscopy) the molecular attachment/binding mechanisms that the SARS-CoV-2 virus utilizes to bind to the host’s nasal epithelium (e.g., angiotensin – converting enzyme 2 receptor, glycans and in particular sialic acids (SA).
SARS-CoV-2 binds specifically to 9-O-Acetylated-SA (AcSA) which can be blocked by AcSA-derived glycoclusters offering a new antiviral mechanism for the treatment of SARS-CoV-2 and its variants. (A complex article with information that may become extraordinarily important as this pandemic with its multiplicity of variants, continues, Ed.).
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Childhood asthma incidence, Early persistent wheeze and Neighborhood socioeconomic factors in the ECHO/CREW Consortium |
A population study comprising 5,809 children in birth cohorts located throughout the US examined the association between neighborhood characteristics at birth, race and ethnicity and the risk of developing childhood wheeze and asthma.
46% of children are reported to wheeze before the age of 2 years and 26% wheeze persistently to age 11 years. Black (Hazard Risk: HR: 47%) and Hispanic children (HR: 29%) are at significantly increased risk for asthma (compared to Whites) which occurs earlier in childhood, as are children born in low-income/ poorer households and/or living in increased density areas.
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REGISTER - LEARN - EARN CME CREDIT |
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Fetal MRI for Problem Solving: Case Examples from the Body
At the completion of this activity, participants are expected to: [1] Understand general definitions, [2] Learn about the International Classification of Function Model, [3] Review the Disability Laws, [4] Understand the role of Pediatric Physical Medicine and Rehabilitation providers.
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