Rationale. We sought to evaluate the impact of having an allergist at a food allergy support group (FASG) on the relationship between parents and their child&#39;s allergist. Methods. Ninety-eight online surveys were sent to parents who attend a FASG affiliated with our institution. Responses were analyzed looking for reasons for attending the support group and comfort with having an allergist present at the meetings. The main objective of this study was to evaluate the impact of having an allergist at the food allergy support group on the relationship between parents and their child&#39;s allergist. Results. The FASG decreased anxiety about food allergies for 77.7&#37; of those who responded. Most (71.4&#37;) felt the FASG improved their child&#39;s quality of life. Greater than 90&#37; felt comfortable having an allergist at the support group meeting, and 64.3&#37; felt that talking to an allergist at the FASG made it easier to speak with their child&#39;s allergist. Conclusions. FASG meetings appear to be a good way for families of children with food allergies to learn more about food allergies, improve quality of life, and increase comfort in communicating with a child&#39;s allergist.

Ashika Sharma

Tracy Prematta

Tracy Fausnight

A Pediatric Food Allergy Support Group Can Improve Parent and Physician Communication: Results of a Parent Survey

Objectives. This paper reviews the relationship between anxiety and anaphylaxis in children and youth, and principles for managing anxiety in the anaphylactic child and his or her parents. Methods. A review of the medical literature (Medline) was done using the keywords “anxiety,” “anaphylaxis,” and “allergy,” limited to children and adolescents. Findings were organized into categories used in the treatment of childhood anxiety disorders, then applied to managing anxiety in the anaphylactic child. Results. Twenty-four relevant papers were identified. These varied widely in methodology. Findings emphasized included the need to distinguish anxiety-related and organic symptoms, ameliorate the anxiety-related impact of anaphylaxis on quality of life, and address parental anxiety about the child. Conclusion. Children with anaphylaxis can function well despite anxiety, but the physical, cognitive, and behavioral aspects of anxiety associated with anaphylactic risk must be addressed, and parents must be involved in care in constructive ways.

Katharina Manassis

Managing Anxiety Related to Anaphylaxis in Childhood: A Systematic Review

Eosinophilic esophagitis (EoE) is a relatively uncommon allergic disease. Presenting with variable gastrointestinal symptoms, the definitive diagnosis is made after esophageal visualization and histological confirmation of excessive esophageal eosinophils. The scientific discovery of the pathophysiology of EoE has been aided by its relationship to other common and well-recognized allergic diseases. Similarities and important differences have emerged to distinguish EoE as a significant pediatric allergic disease with unique medical care requirements.

Russell J. Hopp

Eosinophilic Esophagitis in Pediatrics:  The Worst of all Possible Allergy Worlds?

Recurrent airway inflammations in children are an important clinical problem in pediatric practice. An essential challenge is differentiation between allergic background and immune deficiency, which is a difficult task taking into consideration individual predisposition to atopy, immune system maturation in the early childhood, as well as exposition to environmental allergens and microbial antigens. In this paper relationship between selected elements of innate and adaptive immunity, such as pattern-recognition receptors, complement  components, dendritic cells, as well as immunoglobulins, and regulatory T lymph cells has been discussed. Particular attention has been paid to these mechanisms of the immune response which, depending on settings and timing of activation, predispose to allergy or contribute to tolerogenic phenotype. In the context of multifactorial conditioning of the innate and adaptive immunity governing the ultimate response and associations between allergy and immune deficiencies, these phenomena should be considered as pathogenetically not precluding, but as an overlapping syndrome.

Aleksandra Szczawinska-Poplonyk

An Overlapping Syndrome of Allergy and Immune Deficiency in Children

Intestinal epithelial barrier plays a critical role in the maintenance of gut homeostasis by limiting the penetration of luminal bacteria and dietary allergens, yet allowing antigen sampling for the generation of tolerance. Undigested proteins normally do not gain access to the lamina propria due to physical exclusion by tight junctions at the cell-cell contact sites and intracellular degradation by lysosomal enzymes in enterocytes. An intriguing question then arises: how do macromolecular food antigens cross the epithelial barrier? This review discusses the epithelial barrier dysfunction in sensitized intestine with special emphasis on the molecular mechanism of the enhanced transcytotic rates of allergens. The sensitization phase of allergy is characterized by antigen-induced cross-linking of IgE bound to high affinity Fc&#x03B5;RI on mast cell surface, leading to anaphylactic responses. Recent studies have demonstrated that prior to mast cell activation, food allergens are transported in large quantity across the epithelium and are protected from lysosomal degradation by binding to cell surface IgE and low-affinity receptor CD23/Fc&#x03B5;RII. Improved immunotherapies are currently under study including anti-IgE and anti-CD23 antibodies for the management of atopic disorders.

Linda Chia-Hui Yu

Intestinal Epithelial Barrier Dysfunction in Food Hypersensitivity

Aspirin-exacerbated respiratory disease (AERD) refers to the development of bronchoconstriction in asthmatics following the exposure to aspirin or other nonsteroidal anti-inflammatory drugs. The key pathogenic mechanisms associated with AERD are the overproduction of cysteinyl leukotrienes (CysLTs) and increased CysLTR1 expression in the airway mucosa and decreased lipoxin and PGE2 synthesis. Genetic studies have suggested a role for variability of genes in disease susceptibility and the response to medication. Potential genetic biomarkers contributing to the AERD phenotype include HLA-DPB1, LTC4S, ALOX5, CYSLT, PGE2, TBXA2R, TBX21, MS4A2, IL10, ACE, IL13, KIF3A, SLC22A2, CEP68, PTGER, and CRTH2 and a four-locus SNP set composed of B2ADR, CCR3, CysLTR1, and FCER1B. Future areas of investigation need to focus on comprehensive approaches to identifying biomarkers for early diagnosis.

Nami Shrestha Palikhe

Seung-Hyun Kim

Hyun Jung Jin

Eui-Kyung Hwang

Young Hee Nam

Hae-Sim Park

Genetic Mechanisms in Aspirin-Exacerbated Respiratory Disease

Background &#x26; Objective. Ultrarush induction for specific venom immunotherapy has been shown to be reliable and efficacious in adults. In this study its safety and tolerance in children was evaluated. 
Methods. Retrospective analysis of 102 ultrarush desensitizations carried out between 1997 and 2005 in 94 children, aged 4 to 15 years. Diagnosis and selection for immunotherapy were according to recommendations of the European Academy of Allergy and Clinical Immunology. Systemic adverse reactions (SARs) were described using the classification of H. L. Mueller. 
Results. All patients reached the cumulative dose of 111.1&#x2009;&#x3bc;g hymenoptera venom within 210 minutes. Six patients (6&#x25;) had allergic reactions grade I; 2 patients (2&#x25;) grade II and 5 patients (5&#x25;) grade III. Three patients (3&#x25;) showed unclassified reactions. SARs did not occur in the 15 patients aged 4 to 8 years and they were significantly more frequent in girls (29&#x25;) compared with boys (12&#x25;) (<svg style="vertical-align:-0.17555pt;width:63.962502px;" id="M1" height="10.9125" version="1.1" viewBox="0 0 63.962502 10.9125" width="63.962502" xmlns="http://www.w3.org/2000/svg">
	<g transform="matrix(1.25,0,0,-1.25,0,10.9125)">
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				<tspan style="font-size: 12.50px; " x="29.182001" y="0">.</tspan>
				<tspan style="font-size: 12.50px; " x="32.307751" y="0">0</tspan>
				<tspan style="font-size: 12.50px; " x="38.559254" y="0">3</tspan>
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</svg>, multivariant analysis) and in bee venom extract treated patients (20&#x25;) compared to those treated with wasp venom extract (8&#x25;) (OR 0.33, 95&#x25; Cl 0.07&#x2013;1.25). 
Conclusion. Initiation of specific immunotherapy by ultrarush regimen is safe and well tolerated in children and should be considered for treating children with allergy to hymenoptera venom.

Alice K&#246;hli-Wiesner

Lisbeth Stahlberger

Christian Bieli

Tamar Stricker

Roger Lauener

Induction of Specific Immunotherapy with Hymenoptera Venoms Using Ultrarush Regimen in Children: Safety and Tolerance

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Journal of Allergy