|Year : 2019 | Volume
| Issue : 1 | Page : 1-2
Infection and allergy
Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung County, Taiwan
|Date of Web Publication||9-May-2019|
Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Song Hsiang, Kaohsiung County 83301
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Yu HR. Infection and allergy. Pediatr Respirol Crit Care Med 2019;3:1-2
This issue brings up three very interesting articles related to pediatric pulmonology and critical care. The first article shows the authors' experience about flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL). The second article provides the data of pertussis from a medical center of Singapore. The third article describes the author's study about CD3/CD46-activated T-regulatory type 1 (Tr1) cells in asthma.
BAL is a diagnostic procedure used for recovering epithelial lining fluid of the alveolar and bronchial airspaces. It is usually performed by injecting prewarmed sterile normal saline through a syringe into the working channel of an FB which has already been wedged into a target bronchus, irrigated, and then suctioned into a sputum trap and sent for investigation. The major application of BAL is the diagnosis of pathogens for pulmonary disease. In general, BAL is performed in the most affected site depending on the radiologically identified involved lobe. The right middle lobe (RML) or lingula is the preferred site in a patient with diffuse infiltration due to easily accessible site with good volume recovered,, whereas the right lower lobe (RLL) is more accessible location for BAL in infants. BAL has also played an important role in the mucus plug removal for persistent and massive atelectasis. In the first article, the authors tried to determine the proper location of BAL in infants and children. They provided evidence showing BAL performed in the right lung and RLL is associated with a higher volume recovered in infants and children. BAL sampling at the RLL and RML was recommended for infants and children with diffuse lung disease.
The incidence of pertussis has been increasing even though pertussis vaccination is included in the standard early childhood immunization programs worldwide., The second article reported a cohort study relevant to children with hospitalization for pertussis in a tertiary maternal-pediatric hospital in Singapore. They found that majority cases were <6 months. Surprisingly, 69.7% had not received pertussis immunization. Thus, they suggested that routine maternal vaccination to confer passive immunity for a newborn baby may be a beneficial strategy. However, the effects of maternal pertussis vaccination are still not consistent. Some reports demonstrated efficient transplacental transfer of maternal antibodies in infants whose mothers were vaccinated with Tdap in pregnancy, with good evidence that this protects against disease in young infants. However, a recent study by Saul et al. showed a three-component acellular maternal vaccination which was effective at preventing severe pertussis but not mild disease. Knowing the prevalence of pertussis in different countries in Asia will be an interesting issue.
Asthma is a common allergic airway disease, with a prevalence of 4%–10% in the general population., The house dust mites (HDMs) are the most important allergens involved in allergic asthma. Many HDM molecules can drive the IgE-dependent allergic response or activate the type 2 helper T immune response, leading to an allergic reaction.,, Lin et al. provided interesting findings of regulatory T (Treg) cells. Treg cells play a central role in protecting against the development of allergic asthma, and interleukin (IL)-10–producing Tr1 cells contribute to the regulation of asthma. Complement regulatory protein CD46 was shown to stimulate the development of IL-10–producing Tr1 cells. Crosslinking of CD46 during CD4+ T-cell priming induces production of large amount of IL-10 and granzyme B. They found that asthmatic patients have decreased IL-10, granzyme B, and CCR 4 expression from CD3/CD46-activated Tr1 cells. Der p-specific immunotherapy enhances the suppressive function of IL-10 in CD46-mediated Tr1 cell from asthmatic patients and suppresses airway inflammation, hence suggesting that manipulation of complement activated Tr1 cells may be a therapeutic strategy for asthma in the future.
We hope readers can enjoy this issue.
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