Elham Hossny - Academia.edu (original) (raw)

Papers by Elham Hossny

Research paper thumbnail of Double Negative Alpha Beta T Cells in Pediatrics Patients with Hemophagocytic Syndromes

QJM: An International Journal of Medicine, 2020

Introduction Autoimmune lymphoproliferative syndrome (ALPS) and hemophagocytic lymphohistiocytosi... more Introduction Autoimmune lymphoproliferative syndrome (ALPS) and hemophagocytic lymphohistiocytosis (HLH) share clinical and laboratory features including lymphandenpathy, splenomegaly and pancytopenia. We sought to measure αβ double negative T cells (αβ DN T cells) among patients with established diagnosis of HLH and study its relation to disease activity and severity. Methods we conducted a follow-up controlled study, comprising 25 patients fulfilling diagnosis of HLH according to criteria set forward by the pediatric HLH study Group of the Histiocyte Society, in addition to 25 healthy matched controls. Patients were subjected to clinical evaluation and flow cytometric measurement of αβ DN T Cells percentages at presentation and 9 weeks after start of HLH induction treatment. Results In 17 (68%) patients, infection was the trigger of HLH while the trigger was malignancy in three (12%), and rheumatological disorders in two patients (8%). At enrollment, 15 patients (60%) has elvated ...

Research paper thumbnail of Allergy education and training for physicians

World Allergy Organization Journal, 2021

The increasing prevalence of allergic diseases has placed a significant burden on global healthca... more The increasing prevalence of allergic diseases has placed a significant burden on global healthcare and society as whole. This has necessitated a rapid development of "allergy" as a specialist area. However, as allergy is so common and, for most, relatively easy to diagnose and control, all clinicians need to have basic knowledge and competence to manage mild disease and recognize when referral is required.The allergology specialty has not yet been recognized in many countries and even where allergy is fully recognized as a specialty, the approach to training in allergy differs significantly. In the light of recent developments in allergy diagnosis and management, there is an urgent need to harmonize core competences for physicians, as well as the standardization of core principles for medical education and postgraduate training in allergy. All physicians and allied health professionals must appreciate the multidisciplinary team (MDT) approach to allergy, which is key to achieving the highest standards in holistic care. Due to worldwide variation in resources and personnel, some MDT roles will need to be absorbed by the treating physician or other healthcare professionals. We draw particular attention to the role of psychological input for all allergy patients, dietetic input in the case of food allergy and patient education to support all patients in the supported self-management of their condition on a daily basis. A strong appreciation of these multidisciplinary aspects will help physicians provide quality patient-centered care. We consider that harmonization of allergy components within undergraduate curricula is crucial to ensure all physicians develop the appropriate allergy-related knowledge and skills, particularly in light of inconsistencies seen in the primary care management of allergy. This review from the World Allergy Organization (WAO) Education and Training Committee also outlines allergyrelated competences required of physicians working with allergic patients and provides recommendations to promote harmonization of allergy training and practice worldwide.

Research paper thumbnail of A study of club (Clara) cell protein (CC16) expression in a group of atopic asthmatic children

The Egyptian Journal of Pediatric Allergy and Immunology

A study of club (Clara) cell protein (CC16) expression in a group of atopic asthmatic children Or... more A study of club (Clara) cell protein (CC16) expression in a group of atopic asthmatic children Original article Background: The dysregulation of CC16 protein secreted by club cells (Clara cells) was reported in acute respiratory distress syndrome and Chronic obstructive pulmonary disease. We sought to investigate serum and urinary CC16 in asthmatic children in relation to asthma exacerbation and quiescence and correlate it to pulmonary function test results. Methods: This prospective controlled study was conducted in the Pediatric Allergy,

Research paper thumbnail of Sesame seed sensitization in a group of atopic Egyptian children

Egyptian Journal of Pediatric Allergy and Immunology, 2013

Research paper thumbnail of Value of Urinary Ceruloplasmin as a Marker in Juvenile SLE

The Egyptian Journal of Pediatric Allergy and Immunology

There is substantial evidence that lupus nephritis (LN) is primarily related to type-III hypersen... more There is substantial evidence that lupus nephritis (LN) is primarily related to type-III hypersensitivity reactions leading to immune complex deposition at the mesangial, subendothelial, and/or subepithelial space near the renal glomerular basement membrane. The search for a non-invasive urinary marker of lupus nephritis is an appealing point of research. There are few studies that have evaluated the role of urinary ceruloplasmin (CP) as a biomarker for LN. Being expressed at high levels by parietal epithelial cells of Bowman's capsule it could possibly detoxify molecules as they pass through the glomerular filter. CP is a highly effective antioxidant that can prevent oxidative damage to lipids, DNA, and proteins. However, it is unlikely that a single biomarker can replace clinical parameters to monitor disease progression and detect early renal flares.

Research paper thumbnail of The role of environmental allergen control in the management of asthma

World Allergy Organization Journal, 2022

Allergen exposure may exacerbate asthma symptoms in sensitized patients. Allergen reduction or av... more Allergen exposure may exacerbate asthma symptoms in sensitized patients. Allergen reduction or avoidance measures have been widely utilized; however, there is ongoing controversy on the effectiveness of specific allergen control measures in the management of children with asthma. Often, allergen avoidance strategies are not recommended by guidelines because they can be complex or burdensome, although individual patients may benefit. Here we explore the potential for intervention against exposure to the major allergens implicated in asthma (ie, house dust mites, indoor molds, rodents, cockroaches, furry pets, and outdoor molds and pollens), and subsequent effects on asthma symptoms. We critically assess the available evidence regarding the clinical benefits of specific environmental control measures for each allergen. Finally, we underscore the need for standardized and multifaceted approaches in research and real-life settings, which would result in the identification of more personalized and beneficial prevention strategies.

Research paper thumbnail of G609(P) Pertussis seroimmunity in mother-neonate pairs in egypt

Archives of Disease in Childhood, 2020

own, and there is much debate over the most suitable treatment type for different conditions. The... more own, and there is much debate over the most suitable treatment type for different conditions. The main objective of the work was to form a regional guideline for common inpatient ENT conditions to help simplify current hospital and general practice protocols. Methods We decided to review the past 5 years of ENT admissions who required hospital admission and antibiotics within our trust. This was completed through populating a list of patients using coded hospital data specifically looking at the different types of conditions, choice of medication, treatment length and where possible culture sensitivities. The aim was to them compare them with local and international protocols. A systematic literature search was completed alongside the work. Results In the 5 year period, 3265 patients were seen as an inpatient under ENT and of those 1103 patients received antibiotics. The most common presentations were acute mastoiditis, tonsillitis, neck abscess (superficial and deep) and acute otitis media and externa infections. The most common antibiotic used was Co-amoxiclav of different concentrations with 1245 courses supplied with Co-amoxiclav 1000/200 being the most common. The next most used was Benzyl-penicillin IV with 189 courses given. Conclusion Certain types of antibiotics are used more commonly within paediatric ENT cases that may not be in line with antimicrobial stewardship. Despite some protocols suggesting other antibiotics as first line, medications that are easier for the patient to take and administered less often are used more commonly despite being more broad-spectrum. Clearer guidelines for ENT doctors, general paediatricians and general practitioners are required to ensure the most appropriate antibiotics are prescribed. Further research is needed to identify which antibiotics are most suitable for specific ENT cases before a national guideline can be drawn up.

Research paper thumbnail of Food allergy across the globe

Journal of Allergy and Clinical Immunology, 2021

The prevalence of food allergy (FA) is increasing in some areas of the globe, highlighting the ne... more The prevalence of food allergy (FA) is increasing in some areas of the globe, highlighting the need for better strategies for prevention, diagnosis, and therapy. In the last few decades, we have made great strides in understanding the causes and mechanisms underlying FAs, prompting guideline updates. Earlier guidelines recommended avoidance of common food allergens during pregnancy and lactation and delaying the introduction of allergenic foods in children aged between 1 and 3 years. Recent guidelines for allergy prevention recommend consumption of a healthy and diverse diet without eliminating or increasing the consumption of allergenic foods during pregnancy or breast-feeding. Early introduction of allergenic foods is recommended by most guidelines for allergy prevention after a period of exclusive breast-feedng (6 months [World Health Organization] or 4 months [European Academy of Allergy and Clinical Immunology]). New diagnostics for FA have been developed with varied availability of these tests in different countries. Finally, the first oral immunotherapy drug for FA was approved by the US Food and Drug Administration and European Medicines Agency in 2020. In this review, we will address the global prevalence of FA, our current understanding of the causes of FA, and the latest guidelines for preventing, diagnosing, and treating FA. We will also discuss similarities and differences between FA guidelines.

Research paper thumbnail of Visual field defect due to Hydroxychloroquine in systemic lupus erythematosus

QJM: An International Journal of Medicine, 2021

Background Hydroxychloroquine (HCQ) is used in the management of a variety of autoimmune disorder... more Background Hydroxychloroquine (HCQ) is used in the management of a variety of autoimmune disorders, with well-established role in dermatology and rheumatology. However, Hydroxychloroquine and chloroquine (CQ) have been associated with irreversible visual loss due to retinal toxicity. Aim of the Work screening for field affection resulting from HCQ therapy in patients with SLE and assessing the diagnostic accuracy of the investigational methods employed. Subjects and Methods This is a cross-sectional controlled study that was carried out on 90 subjects (<18 years old). It included 45 physician diagnosed SLE patients taking HCQ for more than 1 year. A 45 age-matched healthy subjects were enrolled as a control group. Visual field assessment was performed by Central 10-2 visual field testing using automated Humphery perimetry. Results In comparison to the normal field in the control group, 13 out of 45 (29%) of the patients treated with HCQ had visual field defects most commonly in t...

Research paper thumbnail of Pollen Sensitization in Association with Allergic Rhinitis in preschool asthmatic Children

QJM: An International Journal of Medicine, 2021

Background Grass pollens are significant elicitors of IgE-mediated allergic disease in the world ... more Background Grass pollens are significant elicitors of IgE-mediated allergic disease in the world and timothy grass (Phleum pratense) is an important pollen in allergy induction. Objective We sought to determine the rate of pollen sensitization in group of Egyptian asthmatic children with allergic rhinitis using timothy grass pollen as a potential triggering factor for allergic rhinitis. Patients and Methods This analytical cross sectional study was conducted on a group of preschool children following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University during the period from December 2018 to April 2019. We enrolled 52 asthmatic children with concomitant allergic rhinitis sampled in a consecutive manner. They were subjected to skin prick testing for timothy grass pollen, positive histamine control and negative control. Results The study revealed high frequency of timothy grass pollen(TGP) sensitization occurring in 60.3% of patients with co...

Research paper thumbnail of Influence of physical limitation in children with juvenile idiopathic arthritis

QJM: An International Journal of Medicine, 2021

Background Health is a state of complete physical, mental, and social well-being, and not merely ... more Background Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Health-related quality of life (HRQOL) is an important outcome measure in understanding the impact of chronic illness. Aim of the Work We saught to measure the amplitude of physical disability in children with juvenile idiopathic arthritis in relation to HRQOL. Patients and Methods This analytical cross sectional study was conducted on children with JIA following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University in the period from May 2018 to May 2019 The sample included 119 patients who were enrolled consecutively by using The Pediatric Quality of Life Inventory TM Version 4.0 (PedsQLTM). Results Physical problem score showed negative correlation with age, age at onset (years) and disease duration (years). The older the child was and the longer the duration of the illness the more severe was his awarenes...

Research paper thumbnail of ARIA 2016 executive summary: integrated care pathways for predictive medicine across the life cycle

Tuberkuloz ve Toraks, 2017

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health ... more The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization (WHO) workshop in 1999. The initial goals were (i) to propose a new allergic rhinitis classification, (ii) to promote the concept of multi-morbidity in asthma and rhinitis and (iii) to develop guidelines with all stakeholders for global use in all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK (MACVIA (Contre les MAladies Chroniques pour un VIeillissement Actif)-ARIA Sentinel NetworK) uses mobile technology to develop care pathways in order to enable the management of rhinitis and asthma by a multidisciplinary group or by patients themselves. An App (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom

Research paper thumbnail of Serum Fluoride Levels in a Group of Egyptian Infants and Children from Cairo City

Archives of Environmental Health: An International Journal, 2003

In this study, the authors investigated fluoride levels in the serum of infants and children (n =... more In this study, the authors investigated fluoride levels in the serum of infants and children (n = 296) and in the breast milk from nursing mothers (n = 60) in Cairo city. Their goal was to evaluate the necessity and safety of implementing a fluoride supplementation program. The authors used an ion-selective electrode to assay fluoride by direct potentiometry. Also, 2- to 12-yr-old participants underwent clinical dental examinations to detect caries and/or fluorosis. The serum fluoride levels of infants were significantly lower than levels found in preschoolers and school-age children. Serum fluoride correlated positively with age; it was significantly lower during the 1st than 2nd yr of infancy (p = 0.005). Breast or formula feeding did not influence serum fluoride status; the fluoride levels in mothers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; milk reflected the serum levels of their own infants. Dental examinations revealed that 81% of the children had caries, whereas there was no evidence of fluorosis. Serum fluoride levels did not vary with the presence or absence of dental caries and did not correlate with the number of decayed, missing, or filled teeth. Gender did not influence serum fluoride expression, and the percentile values were unrelated to height, weight, or head circumference. These findings suggest the necessity and safety of improving the fluoride consumption levels of infants and children in Cairo city. Wider-scale studies are needed to obtain better insight into the problem.

Research paper thumbnail of Increased plasma eotaxin in atopic dermatitis and acute urticaria in infants and children

Allergy, 2001

Background: The previously reported eotaxin overexpression in the lesional skin of atopic dermati... more Background: The previously reported eotaxin overexpression in the lesional skin of atopic dermatitis (AD) led us to the assumption that circulating levels of eotaxin may be elevated too. We sought to investigate the plasma expression of eotaxin in children with skin allergy in relation to clinical activity and type of lesions. Methods: Plasma eotaxin was assayed in 78 infants and children, of whom 16 had AD, 19 had acute urticaria (AU), and 43 were healthy matched subjects. Seven children in the group of AU were resampled for plasma eotaxin after clinical remission. Results: The plasma eotaxin levels in AD (median=158 pg/ml, mean [SD]=168 [61] pg/ml) were significantly higher than the control values (median=60 pg/ml, mean [SD]=59.5 [18.5] pg/ml). Not only did patients with AU demonstrate elevated plasma eotaxin levels (median=126 pg/ml, mean [SD]=124 [33] pg/ml), but also a significant decline occurred on follow-up. The coexistence of angioedema with AU did not cause any further increase in plasma eotaxin expression. Plasma eotaxin levels were significantly higher in AD than in AU, probably reflecting the chronic nature of eczematous AD lesions. The plasma eotaxin levels did not correlate with serum total IgE, peripheral blood absolute eosinophil count, or age of the patients. However, there was a positive correlation between age and plasma eotaxin in the control group. Conclusions: Our findings imply that circulating levels of eotaxin increase in AD and during flares of AU, probably to serve in the recruitment and activation of eosinophils. It may also represent a biomarker of lesional activity.

Research paper thumbnail of Impact of COVID-19 on children with rheumatic diseases: a retrospective cohort analysis

The Egyptian Journal of Pediatric Allergy and Immunology

Impact of COVID-19 on children with rheumatic diseases: a retrospective cohort analysis Original ... more Impact of COVID-19 on children with rheumatic diseases: a retrospective cohort analysis Original article Background: Data concerning impact of COVID-19 on children with rheumatic disorders in developing countries are limited. Methods: We conducted a retrospective analysis, examining the medical records of 49 children (15 males, 34 females) with rheumatologic disorders who got infected with SARS-CoV2. They were recruited, over a period of 17 months, from the Children's Hospitals of Ain Shams, Mansoura and Assiut Universities in Egypt. Data recorded were the type and duration of rheumatologic, antirheumatic treatment received, and COVID-19 presentation including severity, and outcome. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), lactate dehydrogenase enzyme (LDH), serum ferritin, and Ddimer levels were recorded. Results: Our series included 25 SLE, 16 JIA, two polyarteritis nodosa, two dermatomyositis, two mixed connective tissue disease, one systemic sclerosis, and one HSP patients. They had median (IQR) age of 13 (10-14) years. Twenty-nine (59.2%) patients had active disease flare. Fortyone (83.7%) patients were on corticosteroids, and 35 (71.4%) were on add-on immunosuppressives. Twenty-nine patients were hospitalized with median (IQR) admission duration of 25 (14-38) days. They included 8 mild/asymptomatic, 4 moderate, 6 severe, and 11 critical COVID-19 cases. Seven cases with critical COVID-19 passed away with mortality rate of 14.3 %. The deceased cases had higher neutrophil/lymphocyte ratio (p=0.003), higher CRP levels (p= 0.041) and higher D-dimer (p=0.001) and ferritin levels (0.002) as compared to survivors. Conclusion: Although reported to be milder in children, COVID-19 seems to have higher mortality among children with rheumatic disorders compared to rates reported in the general population. We could not find evidence for the impact of immunosuppressive treatment on COVID-19 related mortality, yet our findings need to be validated by wider scale prospective studies .

Research paper thumbnail of Use of intravenous immunoglobulin in human disease: A review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology

Journal of Allergy and Clinical Immunology, 2006

Human immunoglobulin prepared for intravenous administration (IGIV) has a number of important use... more Human immunoglobulin prepared for intravenous administration (IGIV) has a number of important uses in the treatment of disease. Some of these are in diseases for which acceptable treatment alternatives do not exist. In this review we have evaluated the evidence underlying a wide variety of IGIV uses and make specific recommendations on the basis of these data. Given the potential risks and inherent scarcity of IGIV, careful consideration of the indications for and administration of IGIV is warranted.

Research paper thumbnail of Research Priorities in Pediatric Asthma: Results of a Global Survey of Multiple Stakeholder Groups by the Pediatric Asthma in Real Life (PeARL) Think Tank

The Journal of Allergy and Clinical Immunology: In Practice, 2020

Research paper thumbnail of The Pediatric Allergy and Immunology Unit of Ain Shams University in times of SARS-CoV-2 pandemic: approach and challenges

The Egyptian Journal of Pediatric Allergy and Immunology, Oct 3, 2020

Research paper thumbnail of Additional file 4: Table S4. of Particularities of allergy in the Tropics

Food Sensitization in Children Living in the Tropics and Subtropics. (DOCX 30Â kb)

Research paper thumbnail of Additional file 3: Table S3. of Particularities of allergy in the Tropics

Allergen sensitization and asthma symptoms. (DOCX 25Â kb)

Research paper thumbnail of Double Negative Alpha Beta T Cells in Pediatrics Patients with Hemophagocytic Syndromes

QJM: An International Journal of Medicine, 2020

Introduction Autoimmune lymphoproliferative syndrome (ALPS) and hemophagocytic lymphohistiocytosi... more Introduction Autoimmune lymphoproliferative syndrome (ALPS) and hemophagocytic lymphohistiocytosis (HLH) share clinical and laboratory features including lymphandenpathy, splenomegaly and pancytopenia. We sought to measure αβ double negative T cells (αβ DN T cells) among patients with established diagnosis of HLH and study its relation to disease activity and severity. Methods we conducted a follow-up controlled study, comprising 25 patients fulfilling diagnosis of HLH according to criteria set forward by the pediatric HLH study Group of the Histiocyte Society, in addition to 25 healthy matched controls. Patients were subjected to clinical evaluation and flow cytometric measurement of αβ DN T Cells percentages at presentation and 9 weeks after start of HLH induction treatment. Results In 17 (68%) patients, infection was the trigger of HLH while the trigger was malignancy in three (12%), and rheumatological disorders in two patients (8%). At enrollment, 15 patients (60%) has elvated ...

Research paper thumbnail of Allergy education and training for physicians

World Allergy Organization Journal, 2021

The increasing prevalence of allergic diseases has placed a significant burden on global healthca... more The increasing prevalence of allergic diseases has placed a significant burden on global healthcare and society as whole. This has necessitated a rapid development of "allergy" as a specialist area. However, as allergy is so common and, for most, relatively easy to diagnose and control, all clinicians need to have basic knowledge and competence to manage mild disease and recognize when referral is required.The allergology specialty has not yet been recognized in many countries and even where allergy is fully recognized as a specialty, the approach to training in allergy differs significantly. In the light of recent developments in allergy diagnosis and management, there is an urgent need to harmonize core competences for physicians, as well as the standardization of core principles for medical education and postgraduate training in allergy. All physicians and allied health professionals must appreciate the multidisciplinary team (MDT) approach to allergy, which is key to achieving the highest standards in holistic care. Due to worldwide variation in resources and personnel, some MDT roles will need to be absorbed by the treating physician or other healthcare professionals. We draw particular attention to the role of psychological input for all allergy patients, dietetic input in the case of food allergy and patient education to support all patients in the supported self-management of their condition on a daily basis. A strong appreciation of these multidisciplinary aspects will help physicians provide quality patient-centered care. We consider that harmonization of allergy components within undergraduate curricula is crucial to ensure all physicians develop the appropriate allergy-related knowledge and skills, particularly in light of inconsistencies seen in the primary care management of allergy. This review from the World Allergy Organization (WAO) Education and Training Committee also outlines allergyrelated competences required of physicians working with allergic patients and provides recommendations to promote harmonization of allergy training and practice worldwide.

Research paper thumbnail of A study of club (Clara) cell protein (CC16) expression in a group of atopic asthmatic children

The Egyptian Journal of Pediatric Allergy and Immunology

A study of club (Clara) cell protein (CC16) expression in a group of atopic asthmatic children Or... more A study of club (Clara) cell protein (CC16) expression in a group of atopic asthmatic children Original article Background: The dysregulation of CC16 protein secreted by club cells (Clara cells) was reported in acute respiratory distress syndrome and Chronic obstructive pulmonary disease. We sought to investigate serum and urinary CC16 in asthmatic children in relation to asthma exacerbation and quiescence and correlate it to pulmonary function test results. Methods: This prospective controlled study was conducted in the Pediatric Allergy,

Research paper thumbnail of Sesame seed sensitization in a group of atopic Egyptian children

Egyptian Journal of Pediatric Allergy and Immunology, 2013

Research paper thumbnail of Value of Urinary Ceruloplasmin as a Marker in Juvenile SLE

The Egyptian Journal of Pediatric Allergy and Immunology

There is substantial evidence that lupus nephritis (LN) is primarily related to type-III hypersen... more There is substantial evidence that lupus nephritis (LN) is primarily related to type-III hypersensitivity reactions leading to immune complex deposition at the mesangial, subendothelial, and/or subepithelial space near the renal glomerular basement membrane. The search for a non-invasive urinary marker of lupus nephritis is an appealing point of research. There are few studies that have evaluated the role of urinary ceruloplasmin (CP) as a biomarker for LN. Being expressed at high levels by parietal epithelial cells of Bowman's capsule it could possibly detoxify molecules as they pass through the glomerular filter. CP is a highly effective antioxidant that can prevent oxidative damage to lipids, DNA, and proteins. However, it is unlikely that a single biomarker can replace clinical parameters to monitor disease progression and detect early renal flares.

Research paper thumbnail of The role of environmental allergen control in the management of asthma

World Allergy Organization Journal, 2022

Allergen exposure may exacerbate asthma symptoms in sensitized patients. Allergen reduction or av... more Allergen exposure may exacerbate asthma symptoms in sensitized patients. Allergen reduction or avoidance measures have been widely utilized; however, there is ongoing controversy on the effectiveness of specific allergen control measures in the management of children with asthma. Often, allergen avoidance strategies are not recommended by guidelines because they can be complex or burdensome, although individual patients may benefit. Here we explore the potential for intervention against exposure to the major allergens implicated in asthma (ie, house dust mites, indoor molds, rodents, cockroaches, furry pets, and outdoor molds and pollens), and subsequent effects on asthma symptoms. We critically assess the available evidence regarding the clinical benefits of specific environmental control measures for each allergen. Finally, we underscore the need for standardized and multifaceted approaches in research and real-life settings, which would result in the identification of more personalized and beneficial prevention strategies.

Research paper thumbnail of G609(P) Pertussis seroimmunity in mother-neonate pairs in egypt

Archives of Disease in Childhood, 2020

own, and there is much debate over the most suitable treatment type for different conditions. The... more own, and there is much debate over the most suitable treatment type for different conditions. The main objective of the work was to form a regional guideline for common inpatient ENT conditions to help simplify current hospital and general practice protocols. Methods We decided to review the past 5 years of ENT admissions who required hospital admission and antibiotics within our trust. This was completed through populating a list of patients using coded hospital data specifically looking at the different types of conditions, choice of medication, treatment length and where possible culture sensitivities. The aim was to them compare them with local and international protocols. A systematic literature search was completed alongside the work. Results In the 5 year period, 3265 patients were seen as an inpatient under ENT and of those 1103 patients received antibiotics. The most common presentations were acute mastoiditis, tonsillitis, neck abscess (superficial and deep) and acute otitis media and externa infections. The most common antibiotic used was Co-amoxiclav of different concentrations with 1245 courses supplied with Co-amoxiclav 1000/200 being the most common. The next most used was Benzyl-penicillin IV with 189 courses given. Conclusion Certain types of antibiotics are used more commonly within paediatric ENT cases that may not be in line with antimicrobial stewardship. Despite some protocols suggesting other antibiotics as first line, medications that are easier for the patient to take and administered less often are used more commonly despite being more broad-spectrum. Clearer guidelines for ENT doctors, general paediatricians and general practitioners are required to ensure the most appropriate antibiotics are prescribed. Further research is needed to identify which antibiotics are most suitable for specific ENT cases before a national guideline can be drawn up.

Research paper thumbnail of Food allergy across the globe

Journal of Allergy and Clinical Immunology, 2021

The prevalence of food allergy (FA) is increasing in some areas of the globe, highlighting the ne... more The prevalence of food allergy (FA) is increasing in some areas of the globe, highlighting the need for better strategies for prevention, diagnosis, and therapy. In the last few decades, we have made great strides in understanding the causes and mechanisms underlying FAs, prompting guideline updates. Earlier guidelines recommended avoidance of common food allergens during pregnancy and lactation and delaying the introduction of allergenic foods in children aged between 1 and 3 years. Recent guidelines for allergy prevention recommend consumption of a healthy and diverse diet without eliminating or increasing the consumption of allergenic foods during pregnancy or breast-feeding. Early introduction of allergenic foods is recommended by most guidelines for allergy prevention after a period of exclusive breast-feedng (6 months [World Health Organization] or 4 months [European Academy of Allergy and Clinical Immunology]). New diagnostics for FA have been developed with varied availability of these tests in different countries. Finally, the first oral immunotherapy drug for FA was approved by the US Food and Drug Administration and European Medicines Agency in 2020. In this review, we will address the global prevalence of FA, our current understanding of the causes of FA, and the latest guidelines for preventing, diagnosing, and treating FA. We will also discuss similarities and differences between FA guidelines.

Research paper thumbnail of Visual field defect due to Hydroxychloroquine in systemic lupus erythematosus

QJM: An International Journal of Medicine, 2021

Background Hydroxychloroquine (HCQ) is used in the management of a variety of autoimmune disorder... more Background Hydroxychloroquine (HCQ) is used in the management of a variety of autoimmune disorders, with well-established role in dermatology and rheumatology. However, Hydroxychloroquine and chloroquine (CQ) have been associated with irreversible visual loss due to retinal toxicity. Aim of the Work screening for field affection resulting from HCQ therapy in patients with SLE and assessing the diagnostic accuracy of the investigational methods employed. Subjects and Methods This is a cross-sectional controlled study that was carried out on 90 subjects (<18 years old). It included 45 physician diagnosed SLE patients taking HCQ for more than 1 year. A 45 age-matched healthy subjects were enrolled as a control group. Visual field assessment was performed by Central 10-2 visual field testing using automated Humphery perimetry. Results In comparison to the normal field in the control group, 13 out of 45 (29%) of the patients treated with HCQ had visual field defects most commonly in t...

Research paper thumbnail of Pollen Sensitization in Association with Allergic Rhinitis in preschool asthmatic Children

QJM: An International Journal of Medicine, 2021

Background Grass pollens are significant elicitors of IgE-mediated allergic disease in the world ... more Background Grass pollens are significant elicitors of IgE-mediated allergic disease in the world and timothy grass (Phleum pratense) is an important pollen in allergy induction. Objective We sought to determine the rate of pollen sensitization in group of Egyptian asthmatic children with allergic rhinitis using timothy grass pollen as a potential triggering factor for allergic rhinitis. Patients and Methods This analytical cross sectional study was conducted on a group of preschool children following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University during the period from December 2018 to April 2019. We enrolled 52 asthmatic children with concomitant allergic rhinitis sampled in a consecutive manner. They were subjected to skin prick testing for timothy grass pollen, positive histamine control and negative control. Results The study revealed high frequency of timothy grass pollen(TGP) sensitization occurring in 60.3% of patients with co...

Research paper thumbnail of Influence of physical limitation in children with juvenile idiopathic arthritis

QJM: An International Journal of Medicine, 2021

Background Health is a state of complete physical, mental, and social well-being, and not merely ... more Background Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Health-related quality of life (HRQOL) is an important outcome measure in understanding the impact of chronic illness. Aim of the Work We saught to measure the amplitude of physical disability in children with juvenile idiopathic arthritis in relation to HRQOL. Patients and Methods This analytical cross sectional study was conducted on children with JIA following up at the Pediatric Allergy and Immunology Clinic, Children's Hospital, Ain Shams University in the period from May 2018 to May 2019 The sample included 119 patients who were enrolled consecutively by using The Pediatric Quality of Life Inventory TM Version 4.0 (PedsQLTM). Results Physical problem score showed negative correlation with age, age at onset (years) and disease duration (years). The older the child was and the longer the duration of the illness the more severe was his awarenes...

Research paper thumbnail of ARIA 2016 executive summary: integrated care pathways for predictive medicine across the life cycle

Tuberkuloz ve Toraks, 2017

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health ... more The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization (WHO) workshop in 1999. The initial goals were (i) to propose a new allergic rhinitis classification, (ii) to promote the concept of multi-morbidity in asthma and rhinitis and (iii) to develop guidelines with all stakeholders for global use in all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK (MACVIA (Contre les MAladies Chroniques pour un VIeillissement Actif)-ARIA Sentinel NetworK) uses mobile technology to develop care pathways in order to enable the management of rhinitis and asthma by a multidisciplinary group or by patients themselves. An App (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom

Research paper thumbnail of Serum Fluoride Levels in a Group of Egyptian Infants and Children from Cairo City

Archives of Environmental Health: An International Journal, 2003

In this study, the authors investigated fluoride levels in the serum of infants and children (n =... more In this study, the authors investigated fluoride levels in the serum of infants and children (n = 296) and in the breast milk from nursing mothers (n = 60) in Cairo city. Their goal was to evaluate the necessity and safety of implementing a fluoride supplementation program. The authors used an ion-selective electrode to assay fluoride by direct potentiometry. Also, 2- to 12-yr-old participants underwent clinical dental examinations to detect caries and/or fluorosis. The serum fluoride levels of infants were significantly lower than levels found in preschoolers and school-age children. Serum fluoride correlated positively with age; it was significantly lower during the 1st than 2nd yr of infancy (p = 0.005). Breast or formula feeding did not influence serum fluoride status; the fluoride levels in mothers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; milk reflected the serum levels of their own infants. Dental examinations revealed that 81% of the children had caries, whereas there was no evidence of fluorosis. Serum fluoride levels did not vary with the presence or absence of dental caries and did not correlate with the number of decayed, missing, or filled teeth. Gender did not influence serum fluoride expression, and the percentile values were unrelated to height, weight, or head circumference. These findings suggest the necessity and safety of improving the fluoride consumption levels of infants and children in Cairo city. Wider-scale studies are needed to obtain better insight into the problem.

Research paper thumbnail of Increased plasma eotaxin in atopic dermatitis and acute urticaria in infants and children

Allergy, 2001

Background: The previously reported eotaxin overexpression in the lesional skin of atopic dermati... more Background: The previously reported eotaxin overexpression in the lesional skin of atopic dermatitis (AD) led us to the assumption that circulating levels of eotaxin may be elevated too. We sought to investigate the plasma expression of eotaxin in children with skin allergy in relation to clinical activity and type of lesions. Methods: Plasma eotaxin was assayed in 78 infants and children, of whom 16 had AD, 19 had acute urticaria (AU), and 43 were healthy matched subjects. Seven children in the group of AU were resampled for plasma eotaxin after clinical remission. Results: The plasma eotaxin levels in AD (median=158 pg/ml, mean [SD]=168 [61] pg/ml) were significantly higher than the control values (median=60 pg/ml, mean [SD]=59.5 [18.5] pg/ml). Not only did patients with AU demonstrate elevated plasma eotaxin levels (median=126 pg/ml, mean [SD]=124 [33] pg/ml), but also a significant decline occurred on follow-up. The coexistence of angioedema with AU did not cause any further increase in plasma eotaxin expression. Plasma eotaxin levels were significantly higher in AD than in AU, probably reflecting the chronic nature of eczematous AD lesions. The plasma eotaxin levels did not correlate with serum total IgE, peripheral blood absolute eosinophil count, or age of the patients. However, there was a positive correlation between age and plasma eotaxin in the control group. Conclusions: Our findings imply that circulating levels of eotaxin increase in AD and during flares of AU, probably to serve in the recruitment and activation of eosinophils. It may also represent a biomarker of lesional activity.

Research paper thumbnail of Impact of COVID-19 on children with rheumatic diseases: a retrospective cohort analysis

The Egyptian Journal of Pediatric Allergy and Immunology

Impact of COVID-19 on children with rheumatic diseases: a retrospective cohort analysis Original ... more Impact of COVID-19 on children with rheumatic diseases: a retrospective cohort analysis Original article Background: Data concerning impact of COVID-19 on children with rheumatic disorders in developing countries are limited. Methods: We conducted a retrospective analysis, examining the medical records of 49 children (15 males, 34 females) with rheumatologic disorders who got infected with SARS-CoV2. They were recruited, over a period of 17 months, from the Children's Hospitals of Ain Shams, Mansoura and Assiut Universities in Egypt. Data recorded were the type and duration of rheumatologic, antirheumatic treatment received, and COVID-19 presentation including severity, and outcome. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), lactate dehydrogenase enzyme (LDH), serum ferritin, and Ddimer levels were recorded. Results: Our series included 25 SLE, 16 JIA, two polyarteritis nodosa, two dermatomyositis, two mixed connective tissue disease, one systemic sclerosis, and one HSP patients. They had median (IQR) age of 13 (10-14) years. Twenty-nine (59.2%) patients had active disease flare. Fortyone (83.7%) patients were on corticosteroids, and 35 (71.4%) were on add-on immunosuppressives. Twenty-nine patients were hospitalized with median (IQR) admission duration of 25 (14-38) days. They included 8 mild/asymptomatic, 4 moderate, 6 severe, and 11 critical COVID-19 cases. Seven cases with critical COVID-19 passed away with mortality rate of 14.3 %. The deceased cases had higher neutrophil/lymphocyte ratio (p=0.003), higher CRP levels (p= 0.041) and higher D-dimer (p=0.001) and ferritin levels (0.002) as compared to survivors. Conclusion: Although reported to be milder in children, COVID-19 seems to have higher mortality among children with rheumatic disorders compared to rates reported in the general population. We could not find evidence for the impact of immunosuppressive treatment on COVID-19 related mortality, yet our findings need to be validated by wider scale prospective studies .

Research paper thumbnail of Use of intravenous immunoglobulin in human disease: A review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology

Journal of Allergy and Clinical Immunology, 2006

Human immunoglobulin prepared for intravenous administration (IGIV) has a number of important use... more Human immunoglobulin prepared for intravenous administration (IGIV) has a number of important uses in the treatment of disease. Some of these are in diseases for which acceptable treatment alternatives do not exist. In this review we have evaluated the evidence underlying a wide variety of IGIV uses and make specific recommendations on the basis of these data. Given the potential risks and inherent scarcity of IGIV, careful consideration of the indications for and administration of IGIV is warranted.

Research paper thumbnail of Research Priorities in Pediatric Asthma: Results of a Global Survey of Multiple Stakeholder Groups by the Pediatric Asthma in Real Life (PeARL) Think Tank

The Journal of Allergy and Clinical Immunology: In Practice, 2020

Research paper thumbnail of The Pediatric Allergy and Immunology Unit of Ain Shams University in times of SARS-CoV-2 pandemic: approach and challenges

The Egyptian Journal of Pediatric Allergy and Immunology, Oct 3, 2020

Research paper thumbnail of Additional file 4: Table S4. of Particularities of allergy in the Tropics

Food Sensitization in Children Living in the Tropics and Subtropics. (DOCX 30Â kb)

Research paper thumbnail of Additional file 3: Table S3. of Particularities of allergy in the Tropics

Allergen sensitization and asthma symptoms. (DOCX 25Â kb)