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Atopic dermatitis is a chronic skin disorder in which the skin becomes dry, itchy and thickened.  Even though it is very common in children, its exact causes are not well-known.  Because water is a known skin irritant and the skin of infants are very sensitive, it has been thought that hard water, that is water that contains high calcium carbonate, may be a risk factor.  In this month’s issue of JACI, Engebretsen and colleagues investigate whether early exposure to hard domestic water is associated with the prevalence of atopic dermatitis ( J Allergy Clin Immunol 2017; 139(5): 1568-1574 ). To do this, they looked at the Danish National Birth Cohort study which collected nearly 100,000 children born between 1996 and 2002.  Out of these, the mothers of 55,092 children completed an interview at 6 and 18 months to get more information on atopic dermatitis.  What the authors found was that hard water is associated with a higher incidence of atopic dermatitis.  T...

Asthma is a disease in which the airways of the lung become very sensitive to certain triggers, leading to spasms, in turn causing shortness of breath, coughing and wheezing.  The ultimate cause of asthma is unclear, but it has been shown in previous studies that there is remodeling of the airways in severe asthma. Airway smooth muscle (ASM) increases, along with fibrosis, infiltration of new blood vessels, and growth of cells that line the airways.   Recently, a procedure called bronchial thermoplasty (BT) has been developed, in which an endoscope is inserted into the airways.  This endoscope then delivers a temperature-controlled radio frequency to the airway wall.  In this month’s issue of JACI, Pretolani and colleagues look at bronchial thermoplasty and its effect on various clinical and histopathological findings ( J Allergy Clin Immunol 2017; 139(4): 1176-1185 ). In order to do this, they recruited 15 patients with severe uncontrolled asthma that did not r...

The immune system is complex, composed of numerous cells, proteins, and other components.  Among them, the T-cells are essential in fighting off infectious agents and regulating the functions of the immune system.  People with reduced or dysfunctional T-cells can have life-threatening complications, and may require interventions like hematopoietic stem cell transplant (HSCT), gene therapy, or enzyme replacement. If a T cell deficiency is severe (severe combined immunodeficiency, SCID), these treatment decisions are clear. However, in patients with moderate T cell deficiency (profound combined immunodeficiency, P-CID), prognosis is unclear and transplant decisions are difficult. These patients have so far received little attention.  In this month’s issue of JACI, Speckmann and colleagues report the first 51 P-CID patients  enrolled in a long-term prospective study ( J Allergy Clin Immunol 2017; 139(4): 1302-1310 ). The patients suffer from heterogenous T cell deficien...

Food allergy is the leading cause of anaphylaxis, a serious and life-threatening systemic allergic reaction, among American children today.  Although it can be managed by avoidance and supportive management, there are few options for disease modification.  Oral immunotherapy (OIT) whereby increasing doses of an allergen are given, has been a promising investigational treatment, but the high rates of adverse reactions and intolerance of symptoms lead to high drop-out rates. In this month’s issue of JACI, MacGinnitie et al look at the use of omalizumab, an anti-IgE medication used in asthma, in helping to facilitate OIT ( J Allergy Clin Immunol 2017; 139(3): 873-881 ) . To do this, they randomized 37 participants to receive either omalizumab or a placebo for 19 weeks, in addition to oral immunotherapy.  Neither the patients nor the researchers knew the assignment of the groups.  6 weeks after stopping the omalizumab, it was found that a majority (79%) of the omalizuma...

Obesity and asthma are two of the most common childhood chronic diseases, seen in 25% and 10% of children, respectively.  There are increasing lines of evidence suggesting that they may be inter-dependent : fat may be the source of proinflammatory mediators and may change the mechanics of lung function.  However, not all fat is considered equal.  The android distribution of fat along the abdomen, compared to gynoid distribution along the hips, is more closely associated with a variety of cardiometabolic diseases.  Similarly, visceral fat, situated just above the guts in the belly, is considered a marker of inflammatory status, compared to more superficial subcutaneous fat deposits.  In this month’s issue of JACI, den Dekker and colleagues discuss the effect of body fat mass distribution on asthma and airway function in children ( J Allergy Clin Immunol 2017; 139(3): 810-816 ). To do this, they looked at the medical histories and physical characteristics of 6178 ...

Food allergy is a huge problem affecting 3 to 8% of school-age children.  So far, avoidance and supportive management have been the mainstays of therapy, but this is rapidly changing with studies showing the efficacy of oral immunotherapy (OIT), especially for peanut allergies.  In peanut OIT, gradually increasing doses of peanut are given as part of the buildup, with steady doses given during maintenance.  The hope is to desensitize the immune system so that reactions are not as severe.  In this month’s issue of JACI, Virkud and colleagues discuss the safety of oral immunotherapy to peanut by examining 104 patients from 3 peanut OIT trials ( J Allergy Clin Immunol 2017; 139(3): 882-888 ).  They look at the past medical history, parental reports, daily symptom diaries, and relationship to dose escalations to determine the risks and predictors of adverse effects (AEs).  The rate of AEs was high, with 80% experiencing at least 1 episode, and over 90% of these...

Severe Combined Immunodeficiency (SCID) is a set of fatal immune disorders in which infants are born without proper functioning immune systems needed to fight off infections.  Fortunately, in recent years, there has been a push in several states for newborn screening (NBS) for early identification and life-saving treatment of these children.  In this month’s issue of JACI, Dorsey and colleagues describe the protocol that they use in California, which has successfully identified 32 SCID patients and 46 non-SCID patients with decreased levels of T-cells ( J Allergy Clin Immunol 2017; 139(3): 733-742 ). Newborn screening is performed by measuring TRECs (T-cell receptor excision circles) which are formed upon gene rearrangement of the T-cell receptor.  Peripheral blood count with differential and flow cytometry is the first follow up testing to determine the number of lymphocytes. This is followed by functional lymphocyte testing. If SCID is suspected, then children are place...