Early Introduction of Multi-Allergen Mixture for Prevention of Food Allergy: Pilot Study

The incidence and prevalence of food allergy (FA) is increasing. While several studies have established the safety and efficacy of early introduction of single allergens in infants for the prevention of FA, the exact dose, frequency, and number of allergens that can be safely introduced to infants, particularly in those at high or low risk of atopy, are still unclear. This 1-year pilot study evaluated the safety of the early introduction of single foods (milk, egg, or peanut) vs. two foods (milk/egg, egg/peanut, milk/peanut) vs. multiple foods (milk/egg/peanut/cashew/almond/shrimp/walnut/wheat/salmon/hazelnut at low, medium, or high doses) vs. no early introduction in 180 infants between 4–6 months of age. At the end of the study, they were evaluated for plasma biomarkers associated with food reactivity via standardized blood tests. Two to four years after the start of the study, participants were evaluated by standardized food challenges. The serving sizes for the single, double, and low dose mixtures were 300 mg total protein per day. The serving sizes for the medium and high dose mixtures were 900 mg and 3000 mg total protein, respectively. Equal parts of each protein were used for double or mixture foods. All infants were breastfed until at least six months of age. The results demonstrate that infants at either high or low risk for atopy were able to tolerate the early introduction of multiple allergenic foods with no increases in any safety issues, including eczema, FA, or food protein induced enterocolitis. The mixtures of foods at either low, medium, or high doses demonstrated trends for improvement in food challenge reactivity and plasma biomarkers compared to single and double food introductions. The results of this study suggest that the early introduction of foods, particularly simultaneous mixtures of many allergenic foods, may be safe and efficacious for preventing FA and can occur safely. These results need to be confirmed by larger randomized controlled studies.     

Spindle cell rhabdomyosarcoma of the anterior mandible manifesting as a periapical lesion of pulpal origin: Case report

A 25‐year‐old male patient presented with swelling and pain in the mandibular anterior region for the previous 6 months. He had a history of repeated traumatic episodes associated with his lower incisors. A periapical radiograph revealed a radiolucent lesion involving the apices of the lower incisors, whereas cone beam computed tomography revealed a large osteolytic lesion involving all mandibular incisors and loss of labial and lingual cortical plates. Histological, immunohistochemical and bone scan examination of the curetted tissue established a differential diagnosis of spindle cell rhabdomyosarcoma of the anterior mandible. Such rare but life‐threatening oral cancers can be correctly diagnosed and treated only through systematic analysis of clinical findings and examining the diseased tissue with histological and other diagnostic procedures.     

The in vivo function of a noncanonical TRAF2-binding domain in the C-terminus of CD40 in driving B-cell growth and differentiation

The recruitment of tumor necrosis factor receptor-associated factors (TRAFs) 1, 2, 3, 5, and 6 to the CD40 cytoplasmic tail upon CD40 trimerization results in downstream signaling events that ultimately lead to CD40-dependent, thymus-dependent (TD) humoral immune responses. Previously, we have shown signaling through the C-terminal tail of CD40 in the absence of canonical TRAF-binding sites is capable of signaling through an alternative TRAF2-binding site. Here, we demonstrate that B cells from mice harboring CD40 with only the C-terminal tail can activate both canonical and noncanonical NFkappaB signaling pathways. Moreover, while lacking germinal center formation, several hallmarks of humoral immune responses including clonal B-cell activation/expansion, antibody isotype switching, and affinity maturation remain normal. This study demonstrates a new functional domain in CD40 that controls critical aspects of B-cell immunity in an in vivo setting.     

Giant isolated cavernous hemangioma of the stomach

Giant isolate cavernous hemangiomas of the stomach are extremely rare. An eight year old boy with recurrent episodes of massive hematemesis and involvement of both the anterior and posterior walls of the stomach is presented. Awareness of the lesion, a combination of endoscopy and contrast enhanced CT scan are helpful in reaching a diagnosis. Surgical excision is curative.     

Robotic paraesophageal hernia repair: a single-center experience and systematic review

Robotic Surgery is becoming increasingly used in general surgery. The objective of this study is to evaluate the safety, effectiveness and short-term (less than 1 year) outcomes of Robotic Paraesophageal Hernia (RPEH) Surgery using the DaVinci Surgical Robot system (Intuitive Surgical, CA) in a large community hospital. This is a retrospective cohort study of 28 consecutive patients who underwent robotic paraesophageal hernia repair January 2011–March 2013 in this institution. Data and outcomes collected for analysis include patient demographics, operating times, conversion, complications, mortality and recurrence. The mean age of the patients was 68.7 +/? 12.7 years, 82% were females and the mean BMI was 29 +/? 6.3. The mean operative time, including the robot docking time, was 83.6 + 24 min. The average length of hospital stay (LOS) was 2.8 +/? 1.9 days. There were no conversions to open or laparoscopic procedures. Postoperative complications were noted in 3 patients (10.7%), including one mortality (3.4%). One symptomatic recurrence (3.4%) was noted during the 12-month follow-up period. Robotic Paraesophageal repair is a safe (similar rate of complication and mortality to literature for laparoscopic procedure) and an effective (paraeshopageal hernia repaired without high recurrence) procedure with acceptable complication rates even in older patients with high operative risks.     

Vaccines and allergic reactions: The past,the current COVID-19 pandemic,and future perspectives

Vaccines are essential public health tools with a favorable safety profile and prophylactic effectiveness that have historically played significant roles in reducing infectious disease burden in populations, when the majority of individuals are vaccinated. The COVID-19 vaccines are expected to have similar positive impacts on health across the globe. While serious allergic reactions to vaccines are rare, their underlying mechanisms and implications for clinical management should be considered to provide individuals with the safest care possible. In this review, we provide an overview of different types of allergic adverse reactions that can potentially occur after vaccination and individual vaccine components capable of causing the allergic adverse reactions. We present the incidence of allergic adverse reactions during clinical studies and through post-authorization and post-marketing surveillance and provide plausible causes of these reactions based on potential allergenic components present in several common vaccines. Additionally, we review implications for individual diagnosis and management and vaccine manufacturing overall. Finally, we suggest areas for future research.