In recent years, we have been observing an increased proportion of atopic diseases in children after solid organ transplantation. The pathogenesis of post-transplantation allergy is not completely understood and probably involves several factors, including immunosuppressive therapy. In this paper we present a case of 3-year old boy, after orthotopic heart transplantation at 6 months of age, with symptoms of food allergy associated with atopic dermatitis and changes in the orofacial area. The mentioned symptoms and elevated levels of total and specific IgE occurred with a year of transplant. Because of failure to achieve remission after typical allergy therapy we suspected that the reason of allergy in this case can be immunosuppressive therapy.
Urticaria is a common pediatric dermatosis characterized by local swelling, pruritus, and skin redness. The primary lesions include wheals and/or angioedema. By definition, acute urticaria lasts up to 6 weeks and usually occurs as a single episode in life. Chronic urticaria lasts over 6 weeks and is uncommon. Urticaria is a heterogenous disease. The development of skin lesions depends on the action of mast cells and other cells of the immune system, and inflammation is common in all forms of urticaria. Autoimmune mechanisms and activation of coagulation and fibrinolysis also play an important role. The etiology usually remains unknown. Urticaria, especially its chronic form, contributes to a significant decrease in quality of life due to prolonged discomfort and the necessity of long-term and sometimes expensive treatment. This article presents an up-to-date review of the literature on the incidence, causes, diagnosis, treatment and prognosis of urticaria in children.
Recurrent respiratory tract infections in children are a common health problem. Exposure to harmful environmental agents and coexistence of chronic diseases affect the severity and rate of infections. Ineffective outpatient treatment is an indication for a more comprehensive diagnostic workup. The aim of the study was to determine the cause of recurrent respiratory tract infections in children. The study group included 130 children aged 3–17 years who were referred for diagnostic investigation to determine the cause of recurrent respiratory tract infections. The eligibility criterion for the study group was the occurrence of 8 or more respiratory tract infections a year in children aged up to 6 years and 5 or more infections a year in children aged 7–17 years. The study group was subdivided into the following age groups: 3–5 years (n = 60), 6–9 years (n = 35), 10–13 years (n = 11) and 14–17 years (n = 24). The presence of potential risk factors for recurrent infection was analysed on the basis of questionnaires. Tests and examinations were also performed in order to exclude allergies, ear, nose and throat disorders and gastroesophageal reflux disease. Selected laboratory values (complete blood count, vitamin D concentration, immunoglobulin levels) were compared with those obtained from 86 healthy children from the control group. The majority of children had risk factors for recurrent respiratory tract infections. Adenoid hypertrophy was diagnosed in 44.6% of children, asthma in 36.9%, vitamin D deficiency in 30.7%, gastroesophageal reflux disease in 16.2% and immunodeficiency in 9.2% of children. Multimorbidity was found in 34.6% of the subjects. In the study group, there were higher vitamin D levels [study group: 25.6 ng/mL (25th percentile = 17; 75th percentile = 33.3), control group: 22.84 ng/mL (25th percentile = 16.3; 75th percentile = 28.7); p < 0.044] and higher leukocyte levels [study group: 7.5 × 103/μL (25th percentile = 5.9; 75th percentile = 9.1), control group: 6.4 × 103/μL (25th percentile = 5.3; 75th percentile = 7.7); p < 0.02]. The results indicate that children with recurrent respiratory tract infections are a heterogeneous group of patients. The youngest children were the largest group (n = 60). In the majority of children, the onset of symptoms was associated with the beginning of nursery/preschool or school attendance. In 1 in 3 children, a combined presence of a few diseases was found which increase susceptibility to recurrent respiratory tract infections.
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