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Poachanukoon O.,Divisions of Allergy and Immunology | Tangsathapornpong A.,Divisions of Infectious Disease | Tanuchit S.,Thammasat University
Clinical and Experimental Otorhinolaryngology | Year: 2015

Objectives. Cefditoren pivoxil (CDT) has been used in the treatment of rhinosinusitis. However, little is known about the efficacy of this drug at low and high doses. This study was to compare the efficacy and safety of low dose (8–12 mg/kg/day) and high dose (16 20 mg/kg/day) CDT in the treatment of children with uncomplicated acute rhinosinusitis (ARS). Methods. This investigation was a randomized, investigator-blinded, and parallel study, conducted in patients (aged 1–15 years) with a clinical diagnosis of uncomplicated ARS. Two groups of patients randomly received low dose or high dose CDT for 14 days. Patients’ symptoms were assessed quantitatively using a quantitative symptom score (the S5 score). The changes in sinus symptoms and adverse events were provided by patients and their parents/caregivers. The response rate and adverse effects were evaluated at days 7 and 14. The relapse rate was recorded at days 21 and 28. The recurrences of sinus symptoms at day 60 were also assessed. Results. One hundred forty patients were recruited and randomized; 72 received low dose CDT (group I) and 68 received high dose CDT (group II). There were no significant differences in demographic data including sex, age, presenting symptoms, medical history, and X–ray findings between two groups. The responses rate at day 14 in groups I and II were 95.5% and 95.4%, respectively (P>0.99). There were no significant differences between groups in relapse rate at day 28 and no recurrence at day 60 in either group. The most common treatment–related adverse events were diarrhea (4.2% in group I vs. 2.9% in group II) and vomiting (2.8% in group I vs. 10.3% in group II). There was no statistically significant difference in adverse events between groups. Conclusion. Both low and high doses regimens of CDT appeared a similar clinical outcome for treatment in uncomplicated ARS in pediatric patients. © 2015 by Korean Society of Otorhinolaryngology-Head and Neck Surgery.

Alvares M.,Divisions of Allergy and Immunology | Kao L.,Divisions of Allergy and Immunology | Mittal V.,Divisions of Pediatrics | Wuu A.,University of Texas Southwestern Medical Center | And 3 more authors.
Pediatrics | Year: 2013

As food allergies become increasingly prevalent and testing methods to identify 'food allergy' increase in number, the importance of careful diagnosis has become even more critical. Misdiagnosis of food allergy and inappropriate use of unproven testing modalities may lead to a harmful food-elimination diet. This case is an example of an infant who was placed on an overly restrictive elimination diet at the recommendation of her health care providers, resulting in kwashiorkor and acquired acrodermatitis enteropathica. Pediatrics 2013;132:e229-e232. Copyright © 2013 by the American Academy of Pediatrics.

Christianson C.A.,Divisions of Allergy and Immunology | Goplen N.P.,Divisions of Allergy and Immunology | Zafar I.,Divisions of Allergy and Immunology | Irvin C.,Divisions of Allergy and Immunology | And 12 more authors.
Journal of Allergy and Clinical Immunology | Year: 2015

Background: Asthma in a mouse model spontaneously resolves after cessation of allergen exposure. We developed a mouse model in which asthma features persisted for 6 months after cessation of allergen exposure. Objective: We sought to elucidate factors contributing to the persistence of asthma. Methods: We used a combination of immunologic, genetic, microarray, and pharmacologic approaches to dissect the mechanism of asthma persistence. Results: Elimination of T cells though antibody-mediated depletion or lethal irradiation and transplantation of recombination-activating gene (Rag1)-/- bone marrow in mice with chronic asthma resulted in resolution of airway inflammation but not airway hyperreactivity or remodeling. Elimination of T cells and type 2 innate lymphoid cells (ILC2s) through lethal irradiation and transplantation of Rag2-/-γc-/- bone marrow or blockade of IL-33 resulted in resolution of airway inflammation and hyperreactivity. Persistence of asthma required multiple interconnected feedback and feed-forward circuits between ILC2s and epithelial cells. Epithelial IL-33 induced ILC2s, a rich source of IL-13. The latter directly induced epithelial IL-33, establishing a positive feedback circuit. IL-33 autoinduced, generating another feedback circuit. IL-13 upregulated IL-33 receptors and facilitated IL-33 autoinduction, thus establishing a feed-forward circuit. Elimination of any component of these circuits resulted in resolution of chronic asthma. In agreement with the foregoing, IL-33 and ILC2 levels were increased in the airways of asthmatic patients. IL-33 levels correlated with disease severity. Conclusions: We present a critical network of feedback and feed-forward interactions between epithelial cells and ILC2s involved in maintaining chronic asthma. Although T cells contributed to the severity of chronic asthma, they were redundant in maintaining airway hyperreactivity and remodeling. © 2015 American Academy of Allergy, Asthma & Immunology.

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