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Gilaberte Y.,Hospital San Jorge | Gilaberte Y.,Aragon Health science Institute | Sanmartin R.,Hospital San Jorge | Aspiroz C.,Hospital Royo Villanova | And 6 more authors.
Pediatric Dermatology | Year: 2015

The skin of children with atopic dermatitis (AD) is colonized with Staphylococcus aureus more frequently than that of their peers. We investigated the prevalence of skin and nares colonization by S. aureus in children with AD, the virulence genes of the isolates, and their association with allergy, AD severity, and serum vitamin D (25(OH)D). This was an observational, cross-sectional study in a sample of children diagnosed with AD in two settings in Spain. The samples were collected in 2012. Swabs from affected skin and nares were taken for microbiologic culture. The prevalence of S. aureus and presence of 17 staphylococcal virulence genes were studied using polymerase chain reaction. A total of 114 patients with a mean age of 5.7 ± 4.1 (range 3 mos to 14 yrs) were included in the study. Swabs were taken from the skin of 113 individuals with AD and from the nares of 85; 28.3% had S. aureus on the skin, which was significantly associated with positive allergen-specific immunoglobulin E antibodies and higher Scoring Atopic Dermatitis (SCORAD) scores in the multivariate analysis. The presence of virulence factors tsst-1, eta, cna, aur, and sec in cutaneous S. aureus isolates was associated with lower serum levels of 25(OH)D. S. aureus on nasal swabs correlated with its presence on the skin and was associated with lower 25(OH)D levels. In conclusion, S. aureus colonization is associated with allergy and severity in AD, whereas certain virulence genes are associated with lower serum 25(OH)D levels. © 2014 Wiley Periodicals, Inc.


Pascal M.,Mount Sinai School of Medicine | Pascal M.,University of Barcelona | Grishina G.,Mount Sinai School of Medicine | Yang A.C.,University of Sao Paulo | And 7 more authors.
Journal of Allergy and Clinical Immunology: In Practice | Year: 2015

BACKGROUND: The diagnosis of shellfish allergy remains a challenge for clinicians. Several shellfish allergens have been characterized and their IgE epitopes identified. However, the clinical relevance of this sensitization is still not clear. OBJECTIVE: The objective of this study was to identify allergens and epitopes associated with clinical reactivity to shrimp. METHODS: Shrimp-sensitized subjects were recruited and grouped based on the history of shrimp-allergic reactions and challenge outcome. IgE reactivity to recombinant crustacean allergens, and IgE and IgG4 reactivity to peptides were determined. Subjects sensitized to dust mites and/or cockroach without shrimp sensitization or reported allergic reactions, as well as nonatopic individuals, were used as controls. RESULTS: A total of 86 subjects were recruited with a skin prick test to shrimp; 74 reported shrimp-allergic reactions, 58 were allergic (38 positive double-blind placebo-controlled food challenge and 20 recent anaphylaxis), and 16 were tolerant. All subjects without a history of reactions had negative challenges. The individuals with a positive challenge more frequently recognized tropomyosin and sarcoplasmic calcium-binding proteins than those found tolerant by the challenge. Especially a sarcoplasmic-calcium-binding-protein positive test is very likely to result in a positive challenge, though the frequency of recognition is low. Subjects with dust mite and/or cockroach allergy not sensitized to shrimp recognized arginine kinase and hemocyanin. Several epitopes of these allergens may be important in predicting clinical reactivity. CONCLUSION: Tropomyosin and sarcoplasmic-calciumbinding-protein sensitization is associated with clinical reactivity to shrimp. Myosin light chain testing may help in the diagnosis of clinical reactivity. Arginine kinase and hemocyanin appear to be cross-reacting allergens between shrimp and arthropods. Detection of IgE to these allergens and some of their epitopes may be better diagnostic tools in the routine workup of shrimp allergy. © 2015 American Academy of Allergy, Asthma & Immunology.


Alonso Hernandez J.,Hospital Infantil Universitario del Nino Jesus
Pediatria Integral | Year: 2014

Limping is a common reason for consultation in Pediatrics, which should always be considered a pathological finding. The etiological diagnosis should be the goal of our assessment, even though not being always easy for the wide range of conditions in different locations that may manifest as a limp. A detailed knowledge of the most common causes of limp in terms of age and a systematic study of these children, will avoid a delay or misdiagnosis that can have serious consequences on child health. This diagnostic study consists of a complete medical history and a delicate and sometimes difficult examination, including a detailed gait analysis. In some cases, the study will be completed with laboratory tests (usually a blood test and sometimes joint fluid test) and imaging tests (usually radiographs and joint ultrasound). © 2014, Ediciones Ergon SA. All rights reserved.


Alonso Hernandez J.,Hospital Infantil Universitario del Nino Jesus
Pediatria Integral | Year: 2010

The child with a limp is a common reason for consultation, which should always be considered a pathological finding. The etiological diagnosis should be the goal of our assessment, even though not being always easy for the wide range of conditions and locations that may manifest as a limp. A detailed knowledge of the most common causes of limp in terms of age and a systematic study of these children, will avoid a delay or misdiagnosis that can have serious consequences on child health. This diagnostic study consists of a complete medical history and a delicate and sometimes difficult examination, including a detailed gait analysis. In some cases, the study will be completed with laboratory tests (usually a blood test and sometimes joint fluid test) and imaging tests (usually radiographs and joint ultrasound).


Barranco P.,Hospital La Paz Institute for Health Research IdiPAZ | Perez-Frances C.,Hospital Universitario Dr Peset | Quirce S.,Hospital La Paz Institute for Health Research IdiPAZ | Gomez-Torrijos E.,Hospital General Of Ciudad Real | And 6 more authors.
Journal of Investigational Allergology and Clinical Immunology | Year: 2012

Background: The concepts of asthma severity, control, and exacerbation are important in the evaluation of patients and their response to treatment. However, terminology is not standardized, and terms are often used interchangeably. Patients with uncontrolled severe asthma pose a major health care problem. Over the last decade, it has become increasingly clear that, in order to facilitate the development of novel targeted therapies, patients must be further characterized and classified. Objective: To draft a consensus statement on the diagnosis, management, and treatment of severe uncontrolled asthma. The statement is meant to serve as a guideline for health professionals and clinical researchers. Methods: The consensus was led by the Severe Asthma Working Group of the Spanish Society of Allergology and Clinical Immunology Asthma Committee. A review was conducted of the best available scientific evidence (until December 2011) on severe asthma in adults and children. Results: Definitions for severe asthma, level of control, and exacerbation are developed. Different phenotypes and endophenotypes of severe uncontrolled asthma and new specific therapeutic interventions are presented. A systematic algorithm for the evaluation of patients presenting with severe persistent asthma symptoms is proposed. Conclusions: A consensus statement on the diagnosis, management, and treatment of severe uncontrolled asthma is presented. © 2012 Esmon Publicidad.


PubMed | Hospital Infantil del Nino Jesus, Hospital San Jorge, Hospital Infantil Universitario del Nino Jesus, Hospital Royo Villanova and University of La Rioja
Type: Journal Article | Journal: Journal of chemotherapy (Florence, Italy) | Year: 2016

The objective was to analyse the genetic lineages of Staphylococcus aureus recovered from nasal and skin samples of atopic dermatitis (AD) paediatric patients, and to characterize the antimicrobial resistance phenotype-genotype and the immune-evasion-cluster (IEC) type of isolates. Forty S. aureus isolates from 35 patients (skin: 26; nasal samples: 14) were characterized. Isolates were submitted to spa-, agr- and multilocus sequence typing. All S. aureus strains analyzed were methicillin-susceptible (MSSA). High genetic diversity was detected among the 40 MSSA isolates (especially among skin isolates), with detection of 27 different spa-types, 20 sequence-types and 16 clonal complexes (CCs). Lineages CC30 and CC5 were predominant among nasal isolates (71% vs 23% skin). Thirteen different CCs were detected among skin isolates, with detection of clades CC1, CC9 and CC398. Antimicrobial resistance rates detected were higher in skin than in nasal isolates, especially for macrolides, aminoglycosides, lincosamides and mupirocin. MSSA strains were characterized into five IEC-types, being A, B and F the predominant ones. MSSA strains of lineages CC45 and CC5 were detected in almost all cases in AD patients with severe Scoring Atopic Dermatitis (SCORAD) and lineages CC8, and CC30 in those with mild or moderate one. As conclusion, high-clonal-diversity was detected among MSSA from AD patients, especially in skin-isolates. Colonization with S. aureus of some CCs seems more associated with AD severity than other lineages.


PubMed | Mount Desert Island Biological Laboratory, University of Barcelona, Hospital Infantil Universitario del Nino Jesus, Section of Allergy and 2 more.
Type: Controlled Clinical Trial | Journal: The journal of allergy and clinical immunology. In practice | Year: 2015

The diagnosis of shellfish allergy remains a challenge for clinicians. Several shellfish allergens have been characterized and their IgE epitopes identified. However, the clinical relevance of this sensitization is still not clear.The objective of this study was to identify allergens and epitopes associated with clinical reactivity to shrimp.Shrimp-sensitized subjects were recruited and grouped based on the history of shrimp-allergic reactions and challenge outcome. IgE reactivity to recombinant crustacean allergens, and IgE and IgG4 reactivity to peptides were determined. Subjects sensitized to dust mites and/or cockroach without shrimp sensitization or reported allergic reactions, as well as nonatopic individuals, were used as controls.A total of 86 subjects were recruited with a skin prick test to shrimp; 74 reported shrimp-allergic reactions, 58 were allergic (38 positive double-blind placebo-controlled food challenge and 20 recent anaphylaxis), and 16 were tolerant. All subjects without a history of reactions had negative challenges. The individuals with a positive challenge more frequently recognized tropomyosin and sarcoplasmic calcium-binding proteins than those found tolerant by the challenge. Especially a sarcoplasmic-calcium-binding-protein positive test is very likely to result in a positive challenge, though the frequency of recognition is low. Subjects with dust mite and/or cockroach allergy not sensitized to shrimp recognized arginine kinase and hemocyanin. Several epitopes of these allergens may be important in predicting clinical reactivity.Tropomyosin and sarcoplasmic-calcium-binding-protein sensitization is associated with clinical reactivity to shrimp. Myosin light chain testing may help in the diagnosis of clinical reactivity. Arginine kinase and hemocyanin appear to be cross-reacting allergens between shrimp and arthropods. Detection of IgE to these allergens and some of their epitopes may be better diagnostic tools in the routine workup of shrimp allergy.


PubMed | Imperial College London, Great Ormond Street Hospital for Children NHS Trust, Hospital Infantil Universitario del Nino Jesus and Douglas Hospital Research Center
Type: | Journal: European child & adolescent psychiatry | Year: 2016

In this exploratory case-control study, we investigated basal cortisol regulation in 5-16-year-old children, 3-6months following PICU (paediatric intensive care) admission. This was nested within a study of child psychological and cognitive function; 47 children were assessed alongside 56 healthy controls. Saliva samples were collected three times per day (immediately after waking, waking +30min, and waking +12h) over two consecutive weekdays. In addition, data on posttraumatic stress symptoms were ascertained from 33 PICU admitted children using the Impact of Events Scale-8 (IES-8). Primary analysis revealed no significant differences in basal cortisol concentrations between PICU discharged children and healthy controls (p>0.05). Secondary analysis in the PICU group identified a significant positive association between posttraumatic stress symptoms and evening (waking +12h) cortisol concentrations (p=0.004). However, when subject to multivariate analysis, evening cortisol was a modest independent predictor of IES-8 scores, relative to the presence of septic illness and poor pre-morbid health. We conclude that paediatric critical illness does not appear to result in marked perturbations to basal cortisol at 3-6month following discharge. There was evidence of a link between evening cortisol and symptoms of PTSD, but this was not a robust effect and requires further elucidation.


PubMed | Hospital Infantil del Nino Jesus, Hospital San Jorge, Hospital Infantil Universitario del Nino Jesus, Hospital Royo Villanova and University of La Rioja
Type: Journal Article | Journal: Pediatric dermatology | Year: 2015

The skin of children with atopic dermatitis (AD) is colonized with Staphylococcus aureus more frequently than that of their peers. We investigated the prevalence of skin and nares colonization by S.aureus in children with AD, the virulence genes of the isolates, and their association with allergy, AD severity, and serum vitamin D (25(OH)D). This was an observational, cross-sectional study in a sample of children diagnosed with AD in two settings in Spain. The samples were collected in 2012. Swabs from affected skin and nares were taken for microbiologic culture. The prevalence of S.aureus and presence of 17 staphylococcal virulence genes were studied using polymerase chain reaction. A total of 114 patients with a mean age of 5.74.1 (range 3mos to 14yrs) were included in the study. Swabs were taken from the skin of 113 individuals with AD and from the nares of 85; 28.3% had S.aureus on the skin, which was significantly associated with positive allergen-specific immunoglobulin E antibodies and higher Scoring Atopic Dermatitis (SCORAD) scores in the multivariate analysis. The presence of virulence factors tsst-1, eta, cna, aur, and sec in cutaneous S.aureus isolates was associated with lower serum levels of 25(OH)D. S.aureus on nasal swabs correlated with its presence on the skin and was associated with lower 25(OH)D levels. In conclusion, S.aureus colonization is associated with allergy and severity in AD, whereas certain virulence genes are associated with lower serum 25(OH)D levels.


Ayuso R.,Mount Sinai School of Medicine | Sanchez-Garcia S.,Mount Sinai School of Medicine | Sanchez-Garcia S.,Hospital Infantil Universitario del Nino Jesus | Pascal M.,Mount Sinai School of Medicine | And 6 more authors.
Clinical and Experimental Allergy | Year: 2012

Background: Shrimp is a frequent cause of severe allergic reactions world-wide. Due to issues such as cross-reactivity, diagnosis of shrimp allergy is still inaccurate, requiring the need for double-blind, placebo-controlled food challenges (DBPCFC). A better understanding of the relationship between laboratory findings and clinical reactivity is needed. Objective: To determine whether sensitization to certain shrimp allergens or recognition of particular IgE epitopes of those allergens are good biomarkers of clinical reactivity to shrimp. Methods: Thirty-seven consecutive patients were selected with clinical histories of shrimp allergy. Skin prick test, specific IgE determinations, DBPCFC and immunoblot assays to shrimp extract were performed. IgE binding to synthetic overlapping peptides representing the sequence of the four allergens from the Pacific white shrimp (Litopenaeus vannamei) identified to date (Lit v1, Lit v2, Lit v3 and Lit v4) was analysed. Results: Of 37 (46%) patients, 17 had a positive challenge to shrimp (11 children and 6 adults). By microarray, patients with positive challenges showed more intense binding to shrimp peptides than those with negative challenges. Statistically significant differences in terms of the frequency and intensity of IgE binding to some epitopes were observed between the two groups. Diagnostic efficiency was higher for individual epitopes than for proteins. Particularly, efficiency was highest for certain Lit v 1 and Lit v 2 epitopes, followed by Lit v 3 and Lit v 4 epitopes. Conclusion and Clinical Relevance: Patients with positive shrimp challenges present in general more intense and diverse epitope recognition to all four shrimp allergens. IgE antibodies to these shrimp epitopes could be used as biomarkers for prediction of clinical reactivity in subjects with sensitization to shrimp. Patients with positive shrimp challenges show more intense sensitization and more diverse epitope recognition. Several IgE-binding shrimp epitopes could be used as biomarkers for predicting clinical reactivity in subjects with sensitization to shrimp. © 2011 Blackwell Publishing Ltd.

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