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Allergic disorders are increasing prevalence from decades. Often of allergic diseases such as chronic urticaria in some aspects of quality of life of patients affected. Outdoor and indoor allergens can cause aggravation of symptoms in allergic patients. H1-antihistamines have been available for decades and those are over-the-counter drugs. The first generation H1-antihistamines have anticholinergic and sedative effects. Basically, their use (H1 blockers) for the routine management of allergic diseases is not recommended. Second generation H1-antihistamines (bilastine, cetirizine, desloratadine, ebastine, fexofenadine, levocetirizine, loratadine, and rupatadine) have minimally or non-sedating and free of anticholinergic effects. About 10–15% of pregnant women used antihistamine within pregnancy.

Background: Ataxia-telangiectasia is a multi-organ disease. It is due to a mutation of the Exon No. 5 ataxia telangiectasia mutated gene (c.381delA: p.v128fls). Complications including recurrent infections, progressive cerebellar ataxia, and varying degrees of humoral and cellular immunodeficiency arise. Case Presentation: We report a 7-year-old girl patient with A-T who developed acute rheumatic fever. Conclusion: Rheumatoid disorders and or infectious diseases such as acute rheumatic fever could be observed in A-T patient.

Chronic Urticaria (CU) is a skin disorder characterized by wheal and flare with a duration of more than 6 weeks affecting 1%-2% of the population (more common in women). Thirty to 35% of cases of CU have angioedema [1]. The etiology of chronic spontaneous urticarial is not usually clear, 40%-50% are idiopathic and 30%-40% are autoimmune [2, 3]. Quality of life in CU is usually disturbed which has a direct relation with severity [4].

Background: Coronavirus disease 2019 (COVID‐19, the seventh coronavirus) is a new infectious disease that spread worldwide and rapidly became a pandemic. COVID‐19 is rare in children and often asymptomatic. The respiratory system is mainly involved in COVID-19 infection. Objectives: This study aimed to review respiratory manifestations in children with COVID-19. Methods: We searched for studies published from January 2020 to January 2021 in PubMed, Google Scholar, and Scopus in English. The search words were “2019-nCoV,” “novel coronavirus,” “COVID-19,” “SARS-CoV-2,” “severe acute respiratory syndrome coronavirus 2,” “children,” “child,” “infant,” “teenager,” “adolescent,” “pediatric,” and “neonate.” Results: Cough was a common symptom in our study (18.8%-100%, mean=64%). Pneumonia prevalence in children with COVID-19 is 11%-67% (mean=46%). Mild respiratory symptoms (14% - 60%) and severe respiratory distress syndromes (14%) were reported in some studies. Upper respiratory tract infection (URTI) was reported in 4 studies ranging from 11.1% to 34.4% (mean=24.1%). Ground-glass opacities (GGO) was reported in 12.2% to 81% of cases (mean=49.01%). Isolated consolidations were reported in 17% and 58% of patients in two studies. Enhanced lung texture was reported in 1.3% to 50% (mean=20.07%) of patients. Bilateral patchy shadowing was seen in 12.3% to 68% (mean=46.58%) of patients. Conclusions: Cough is the most common manifestation of respiratory system involvement in children with COVID-19. GGO and bilateral patchy involvement are the most common finding on lung CT scans in children with COVID-19.

Background: Diabetic ketoacidosis (DKA) is not the most common acute complication of type 1 diabetes in children and adolescents, but the cerebral edema caused by it is the most common cause of death in children with DKA. Objectives: The purpose of this study was to systematically review the literature to describe the predisposing factors of cerebral edema in pediatric DKA. Methods: Six international databases of Wiley, Medline, Scopus, Web of Science, ProQuest, and Cochrane Library, and three domestic databases, including SID, Magiran, and Iranmedex were searched for relevant studies. Then, articles with inclusion criteria and related to the objectives of this study were reviewed. Results: These studies have identified several risk factors for cerebral edema, some of which are related to the severity of the disease on admission and some are related to treatment. Conclusions: Preventing DKA is the only reliable way to prevent cerebral edema until the causes of this life-threatening complication are fully understood.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus disease that is highly contagious and affects all age groups of children. The incubation period of Coronavirus disease (COVID-19) ranges from 2 to 14 days. Diagnosis of COVID-19 is made by conducting nasal and pharyngeal swabs and analyzing sputum, stool, and blood samples for COVID-19 nucleic acid using reverse-transcription polymerase chain reaction (RT-PCR). A nasal swab is more sensitive and specific than a pharyngeal swab. Lung CT imaging is a confirmation and complimentary method which is more sensitive than RT-PCR analysis. The mortality rate of COVID-19 infection is very low in children. Treatment of COVID-19 is supportive care and home isolation for 2 weeks (1). The disease has now spread to most countries. Clinical manifestations of COVID-19 vary from asymptomatic to a severe form in children (2).

Coronavirus disease 2019 (COVID‐19, the 7th coronavirus) was a pandemic infectious disease with significant morbidity and mortality in the world. The respiratory system is often involved in COVID-19 infection. Underlying disorders such as uncontrolled asthma are a risk factor for COVID-19 infection. For protecting against COVID-19, we need vaccination-associated social care such as facial masks, distance, and sanitizers.

Context: Asthma is a chronic inflammatory respiratory disorder, and nutritional conditions affect allergic diseases such as asthma. This study aims to find the relationship between maternal gestational vitamin D levels and asthma progression and wheezing in children later in life. Objectives: Allergic disorders are common everywhere in the world. Asthma is the most chronic inflammatory respiratory disorder among children. It causes significant morbidity and mortality in children as well as adults. Vitamin D deficiency or insufficiency, is a global problem. Vitamin D has immunological effects, and it may prevent autoimmune diseases. Maternal plasma vitamin D during pregnancy has a different impact on children’s allergic disorders. Evidence Acquisition: This is a review article. We searched databases, including Google Scholar, PubMed, SID, IranDoc, Scopus, until now. The keywords for the search included maternal vitamin D, asthma, wheezing, children, and pediatric. We searched in the mentioned databases until March 2020. Full-text articles in the English language were included in this study. Results: A few articles were found in our search. All of them were cohort studies. They evaluated maternal vitamin D and its outcomes in their children’s asthma and wheezing using questionnaire data and serum samples. After assessing the articles (more than 100), 15 papers were included in our review. Six and four articles showed that higher maternal vitamin D levels reduce children’s asthma and or wheezing, respectively. In contrast, 7 articles showed no association between maternal vitamin D and children’s asthma or wheezing. Vitamin D does not have any serious side effects. Because the articles were heterogenic, a meta-analysis could not be done. Conclusions: Administering vitamin D supplements or food enriched vitamin D during pregnancy has different effects on the prevalence of wheezing and or asthma in children.

Introduction: The Unicameral Bone Cyst (UBC) is a benign osteolytic lesion primarily found in the metaphyseal part of long bones in children. It is important as it can involve growth plate involvement, cause pathological fractures and deformities of the affected limb. We report this case to emphasize that hip area pathologies can be represented with knee pain and discomfort. Case Presentation: The patient was a 9-year-old girl with a bone cyst in the right proximal femur, with functional knee pain and limping. The diagnosis was made after two years of pain in the knee area. As the cyst was symptomatic and the signs of impending pathological fracture were seen, the lesion was managed by curettage and fibular strut allograft and proximal humerus locking plate. Conclusions: The patient has been examined for knee joint problems for a long time, and her femur bone cyst was diagnosed after two years of pain. However, it could become a pathologic fracture or involve the growth plate and stop the limb’s growth, thus affecting the patient’s quality of life. Therefore, in children with chronic knee pain, careful assessment of the hip area is recommended.

Introduction: Acute Generalized Exanthematous Pustulosis (AGEP) is a cutaneous reaction that may appear after using certain medications, such as cephalexin. This disease is characterized by non-follicular sterile pustules, erythematous, urticaria, fever over , and leukocytosis. Cephalexin belongs to the family of β-lactam antibiotics, which are widely used to treat infections. However, cephalexin skin sensitivities have been reported rarely. Herein, in this case, we aimed to report a patient presented with AGEP due to cephalexin usage. Case Presentation: A 12-year-old boy presented with warm skin lesions that gradually appeared on the limbs, trunk, face, and neck after using cephalexin powder on his left leg injury. Because of his symptoms, acetaminophen, fexofenadine hydrochloride, loxoprofen sodium, and ointment, including difluprednate and hydrocortisone, were prescribed. Over time, the patient’s fever subsided, and 8 days later, the symptoms of AGEP, including urticaria, erythematous, and pustules in the neck and trunk, disappeared. Conclusions: Cephalexin is one of the antibiotics that doctors and patients consider when there is a possibility of infection. AGEP is a rare but severe reaction that can manifest as skin rashes in any age and sex following the use of cephalexin, so the patient should be careful when using this antibiotic.

Background: Drug allergy is a subtype of Adverse Drug Reaction (ADR) mediated by the immunologic system. Extreme drug allergy is poorly known in children that contribute to hospitalization in our region. Objectives: This research aimed to study major drug hypersensitivity reactions in the north of Iran among the hospitalized children. Methods: This cross-sectional study was conducted at Bou Ali Sina Hospital in the north of Iran. We analyzed the medical files of 140 children admitted to the hospital with drug allergies from 2014 to 2018. The inclusion criteria were based on the DRESS (drug reaction with eosinophilia and systemic symptoms) scoring system, and those who scored more than four were enrolled. Patients with incomplete medical charts were excluded. The sampling methodology was based on the consecutive census method. Results: In the current study, 62 patients were females (44.29%), and 78 were males (55.71%). Ninety-six cases (68.57%) were children under five, and 44 cases (31.43%) were over five years old. Most ADRs were seen in patients from urban areas (58.57%) than in rural areas (41.43%). In 116 children (82.6%), maculopapular rashes were seen. Phenobarbital and cefalexin had the highest levels of drug reactions, including 85 persons (55.19%) and 18 persons (11.69%), respectively. Pruritus, fever, and scaling were the most common symptoms observed in the patients. The most commonly used treatment was antihistamines. Conclusions: The most causative medication inducing ADR was phenobarbital. The maculopapular rash was the most common skin manifestation, and there were no relationships between sex, age, medication type, and type of hypersensitivity reactions.

Background: Exposure to house dust mites is an important cause of asthma among children. The main asthma-causing mites found in homes are Dermatophagoides farinae and Dermatophagoides. pteronyssinus. Der f1 or Der p1 are allergens of the mentioned mites. This study aimed to assess the levels of Der p1, and Der f1 in the homes of families that had a case of childhood asthma in a northern city of Iran and to determine the association between indoor house environment and the level of mites allergens present there. Objectives: This study aimed to evaluate House Dust Mite Allergen Levels of Der p1 and Der f1 in Houses of Asthmatic Children. Methods: Dust samples were collected from bedrooms of 91 homes of families that had cases of childhood asthma. Families filled a questionnaire about demographical characteristics and the indoor condition of their living environment. The levels of Der f1 and Der p1 were measured by enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed in SPSS v. 24 and a P-value less than 0.05 was considered significant. Results: we found that Der p1 was more prevalent than Der f1 among samples. The mean concentration of Der p1 concentration was 271.35 ng/g (9 times greater than the concentration of Der f1). When the indoor environment status was evaluated, it was found that keeping pets and having old carpets are associated with Der f1 (P

Context: Asthma, characterized by airway inflammation, is a common chronic disease of childhood. Cytokines and chemokines could be used in the diagnosis, treatment, and management of asthma severity in children. In this review, we have explained the application of cytokines and chemokines as biomarkers in pediatric asthma. Evidence Acquisition: All related articles were separately searched by two researchers using the following keywords in PubMed, Scopus, and Embase databases: Cytokine biomarkers, chemokines biomarkers, and children asthma. Articles published from 2000 to 2017 were investigated in the research, and 28 articles were included in the final analysis for this review. Results: About cytokines, serum Interleukin 4 (IL-4) level is a marker of the presence of asthma, and IL-13 is a key cytokine involved in the manifestation of asthma symptoms. High IL-13 concentration and number of IL-13+ cells in the bronchial submucosa specimens are characteristic of severe asthma. Serum IL-5 concentration 3.1 times in children with severe asthma. IL-17 is involved in airway obstruction. IFN-γ gene polymorphism (+874A/T) in children elevates susceptibility to asthma. TGFB1 polymorphisms are considered as indicators of asthma severity. IL-26 plays an important role in asthma severity. IP-10 may be a useful inflammatory marker of asthma severity. High periostin level has been identified in pediatric asthma. PDGF level, which is high in asthma patients, plays an important role in bronchial fibrosis. About chemokines, plasma TARC concentration may be a useful biomarker of airway inflammation and asthma severity in children. Studies have supported the association between high serum RANTES levels and severe airway obstruction in children. CXCR4 levels are high in pediatric asthma and are associated with disease severity. Conclusions: A wide range of cytokines and chemokines may play important roles in asthma severity in pediatric patients. Therefore, several studies have recommended the use of multiple molecular biomarkers, such as cytokines, for determining asthma severity in children.

Genu valgum is an angular deformity caused by several reasons, such as congenital syndromes, post-traumatic bone dysplasia, or an idiopathic form. It generates cosmetic problems, difficulties in function, and pain. Manipulating the growth plate by hemiepiphysiodesis with implants helps to achieve the correct alignment. We presented twin girls diagnosed with genu valgum deformity who were suffering from cosmetic problems and pain. We used growth modulation to temporarily arrest the growth plate. This procedure was followed by photographs and after 8 months, the implants were removed without having overcorrection. A brief literature review was also performed concerning the reported cases in the international databases, such as PubMed and Google Scholar on growth modulation for genu valgum deformity in twins. Twin girls with genu valgum deformities underwent hemiepiphysiodesis surgeries. We used reconstruction plates and 3.5 mm non-cannulated screws to fix both the distal femur and proximal tibia to temporarily arrest the growth plate. When we achieved the correct alignment the devices were removed.

Background: Immune thrombocytopenia (ITP) is an autoimmune disorder associated with decreased platelet production and accelerated platelet destruction. An impaired immune system may induce by or be associated with ITP. Objectives: This study aimed to evaluate complement and humoral immune systems in ITP. Methods: We evaluated 30 children (under 19 years old) with acute and chronic ITP referred to a tertiary hospital and compared them with 30 healthy volunteers. We assessed the samples’ CBC with differentiation, serum immunoglobulins (IgG, IgE, IgM, IgA, IgG1, IgG2, IgG3, IgG4) by nephelometry, antistreptolysin O titer by agglutination, CH50, C3, C4 by nephelometry, CD19 by flow cytometry, and anti-tetanus antibody titer by ELISA. Their demographic data were obtained with a questionnaire. Results: Our findings showed that humoral and complement components were normal in both patients and healthy groups. However, based on independent t test results, the mean serum levels of IgM, IgE, IgG1, C3, and tetanus antibody levels were significantly higher in the patient group. Conclusions: Humoral and complementary immunodeficiency in these patients is unlikely. However, more studies with larger sample sizes are needed.

Context: Asthma is a chronic inflammatory disorder of the respiratory system in children. Immunoglobulin E (IgE) has an important role in allergic disorders like asthma. This study aimed to review the association between maternal serum IgE and the incidence of childhood asthma. Evidence Acquisition: Three researchers searched all articles in PubMed, Scopus, Google, and Embase databases related to maternal serum IgE, cord blood IgE, childhood asthma, and its incidence. We used keywords such as “maternal IgE, cord blood IgE, relation, association, childhood asthma, and child allergy”. Results: We found a few related articles on maternal IgE, cord blood IgE, and childhood asthma. In total, we reviewed 11 articles. Parental atopy and allergy are the most important predictive factors for children’s allergies, like asthma. IgE levels were higher in children whose mothers had higher IgE levels. Total IgE level was significantly higher in boys, compared to girls. Conclusions: Increased maternal and cord blood IgE may be a predictive factor for the development of childhood asthma. More data are required to clarify this relationship.

Introduction: Half of all fractures of the elbow and almost 30% of all limb fractures occur in children under the 7 years of age, supracondylar humerus fracture being the most common. Neurological complications associated with supracondylar humerus fractures in children such as Anterior Interosseous Nerve (AIN) syndrome are well known. Cases Presentation: Thirty-three children with humeral supracondylar fracture were admitted to the orthopedic surgery centers at Imam Hospital in Sari, north of Iran from November 2014 to November 2016. Of them, four cases had AIN syndrome. The treatment of fracture involved closed reduction with percutaneous pinning, open reduction, and pin fixation. Conclusions: According to the only motor (no sensory) dysfunction of AIN and by deceiving children using the third finger to flex the second one, underestimation of AIN syndrome in supracondylar fracture of the humerus can be expected. So, the physician should be more careful about physical examination in supracondylar fracture of humerus beside to vascular state.

Context: Atopic dermatitis is a chronic skin disease in children. The prevalence of eczema is up to 30% in the world. Omalizumab (Xolair) is a monoclonal antibody that blocks the serum IgE. The aim of this study is to review the effect of Xolair in children with atopic dermatitis. Evidence Acquisition: The data was searched in PubMed, Scopus, and Embase with keywords: atopic dermatitis, eczema, children, pediatrics, Xolair, and Omalizumab. The inclusion criteria included articles related to use of Xolair in children with atopic dermatitis, under the age of 20 years old, as well a both full text and brief articles. The exclusion criteria were purely adult cases who had taken systemic immunosuppressive drugs and abstract article. There was no time limitation for our search. Results: After evaluating all data and a total of 124 searched articles, we found 8 eligible articles for this review. All of them had severe atopic dermatitis except 2 cases, which had moderate severity. Serum IgE level was increased in all patients. Only one of those studies included a control group. All patients were associated with other allergic disorders such as asthma and allergic rhinitis. Conclusions: Omalizumab (Xolair) is a safe drug, which decreases serum IgE level, scoring atopic dermatitis, as well as clinical manifestations in all of severe atopic dermatitis. However, in order to approve it, we need future clinical trial studies with control group.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus and highly contagious that affects all age groups such as children. Any age, including infancy, could be affected by the pandemic. More than 210 countries have been affected by now.

Background: Allergic disorders are prevalent in the world affecting the quality of life. It imposes heavy burden on people and country. Primary prevention of allergic disease is important. The most prevalent allergic or atopic disorders include atopic dermatitis, asthma, allergic rhinitis, and food allergies. Methods: The search was conducted among paper indexed in databases such as PubMed, Google Scholar, and Embase. Results: There are three types of allergy prevention: 1. Primary prevention which prevents the initial immunologic sensitization (i.e. Immunoglobulin E (IgE) development specific to an allergen); 2. Secondary prevention which decreases the development of further disease after sensitization; and 3. Tertiary prevention which reduces disease symptoms after expression. Studies that support maternal avoidance allergenic foods during pregnancy, lactation, or both are not effective in preventing allergic disease. An infant is categorized as "high risk" for allergic disease when s/he has at least one first-degree relative (parent or sibling) with associated allergic disease. Based on recent studies, maternal avoidance of allergenic foods during pregnancy does not reduce the risk of allergic disease in children, regardless of whether the infant is at high risk or not. In contrary, some studies suggest that avoidance may actually increase the risk in offspring. In high-risk families for allergic disorders, exclusive breastfeeding and delayed introduction of solid foods up to 4-6 months is recommended, although, there is no clear evidence. If needed, we can use protein hydrolysate supplementation. IgA in human milk are generally protective against infant gut and avoid the development of food allergy. Serum levels of immunoglobulin G1 (IgG1) and immunoglobulin G4 (IgG4) in infants whose mothers avoid breastfeeding are lower, and these findings are associated with the development of milk allergy in infant. We found no evidence that vitamin D supplementation in pregnant or breastfeeding women who had no other indications for this vitamin can reduce the risk of developing allergic diseases in children and, hence, we suggest against this intervention. Recent studies do not suggest routine supplementation of mothers with vitamin D or omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFAs) during pregnancy or lactation for preventing allergic disease in offspring. Conclusions: Restriction of mother’s or child’s diet is not beneficial when there is no any documented reason or unclear evidences. Exclusive breast-feeding may be benefit in prevention of allergy but not in all cases.

Context: Pediatric nephrolithiasis is a noticeable cause of morbidity among children. Although, nephrolithiasis is a common disease in adults, its incidence has had a rising trend in children. Objectives: Here in, we reviewed the current state regarding evaluation and management of children with nephrolithiasis in the last decade. Data Sources: The current literature regarding incidence and trend, along with diagnostic evaluation and management of children aged less than 18 years old with nephrolithiasis was searched on MEDLINE and Google scholar from January 2005 to March 2016. Study Selection and Data Extraction: The search terms included, “kidney stone OR nephrolithiasis OR urolithiasis and Pediatric OR children”. English language and human studies were included. Expert opinions, editorials and case reports were excluded. Consequently, the authors independently reviewed the abstracts and the papers, which matched the inclusion criteria. Results: From a total of 1050 studies identified through the database search, 71 articles were selected for the review. According to the results of this review, pediatric nephrolithiasis has an increasing rate worldwide. Recent studies in this regard indicated that the number of girls with nephrolithiasis has increased. The change of life style, diet, obesity and metabolic syndrome and popular imaging study along with referral of the patients to pediatric centers could be contributed to this trend. Conclusions: Evaluation of patients, particularly young children, includes metabolic assessment. Stone analysis and 24-urine collection analysis are very helpful for determining underlying diseases. Medical as well as surgical approaches are used to prevent kidney injuries.

Context: Atopic dermatitis is a chronic, relapsing skin disorder that affects all ages including infancy and childhood. There are many proved and unproved treatments for atopic dermatitis. Evidence Acquisition: Data sources of this narrative review included studies about pediatric atopic dermatitis with the following keywords, pediatric, atopic dermatitis, immunity, acute, chronic, pruritic inflammatory skin disorder, infancy, childhood, diagnosis, management and treatment. All of the articles were written in English language with full text on management or treatment. Results: Innate and adaptive immune system involved atopic dermatitis. Major characteristics of atopic dermatitis include pruritus, chronic or relapsing lesions and personal or family history of atopic disease. There is no specific treatment for atopic dermatitis. The treatment included rehydration, emollients, topical steroid, calcineurin inhibitors and immunosuppressant. Crisaborole topical ointment, a PDE4 anti-inflammatory topical agent (phase three of the research) could be effective in atopic dermatitis. Conclusions: Avoidance from trigger factors and emollients are basic treatments of atopic dermatitis.

Generally, 15-25% of general population experience urticaria during their life. The prevalence of chronic urticaria is about 0.1-0.3% in children and most often occurs between ages of 6-11 years. There are several causes for development of chronic urticaria. Known etiologies of chronic urticaria in children vary from 21% to 83%. Chronic urticaria caused by infections is more common in children than adults. Diagnosis of chronic urticaria is based on clinical history and physical examination and routine laboratory testing in the absence of a clinical history is rarely helpful. Similar to adults, antihistamines are the first line of treatment. Omalizumab as a biological engineering molecule is a recombinant humanized monoclonal antibody, which targets the CH3 domain of the ε chain of the free IgE. Omalizumab has been used in patients with H1-antihistamine-refractory chronic idiopathic urticaria (CIU). Here in we made a review about possible mechanisms by which omalizumab may be effective in children above 12 years with chronic urticaria, and also focused on its therapeutic effects, onset criteria and possible side effects.

Context: Allergic diseases such as allergic rhinitis (AR) and immune-mediated inflammatory diseases are the most common chronic diseases among children. Although the cause of AR has yet to be clearly identified, genetic and environmental factors are known to play an important role in the development of the disease. Evidence Acquisition: In a more recent classification, AR is categorized as intermittent and permanent. Vitamin D has a known and important role in the absorption of calcium and preservation of bone density. The prevalence of vitamin D deficiency in children is reported to be between 30% and 50% in the world. Vitamin D confers the growth and development of the immune system including the development of regulatory T cells. Results: Two-thirds of the reviewed articles show a correlation between serum levels of vitamin D and allergic diseases, while the reaming ones demonstrate no correlation between vitamin D and AR and some even report a rise in the incidence of AR following the use of vitamin D supplement. Conclusions: It seems that further clinical trials and meta-analytic studies are necessary to confirm this correlation. The present study aimed at reviewing vitamin D deficiency in children with AR.

Asthma is a chronic inflammatory airway disorder and the most common chronic disease among children characterized by frequent and chronic cough, wheezing, and dyspnea. Asthma is defined as an inflammatory process in response to T- Helper 2 cells. Vitamin E as a Lipid soluble vitamin containing 4 isomers α, β, γ, б, with α- tocopherol as the most important isomer is an important defensive agent against epithelial tissue damages caused by antioxidants in human. The results of animal studies showed vitamins C and E cause decreased and modulation of pulmonary responses to oxidant agents such as O3 or NO2. A few studies showed an association between reduced intake of vitamin E by mothers during pregnancy and wheezing in children aged 2 years old. Some studies showed significant declines in serum vitamin E level in asthmatic children compared to non-asthmatic. However, in another study no significant relationship was observed between serum level of vitamin E and risk of asthma. There are controversies on the effect of vitamin E in children with asthma. This study aimed to investigate the role of vitamin E in children with asthma.

Hyper IgE Syndrome (HIES) is a rare primary immunodeficiency disease. Most of HIES cases are sporadic. HIES type AD is caused by mutation in signal transducer and activator of transcription-3 (STAT-3). A number of mosaicism HIES has been reported that is associated with intermediate phenotype. Autosomal recessive HIES (AR-HIES) is due to mutation in Dock-8 or cytokine sis 8 and TYK2 or tyrosine kinase 2. The common manifestations are atopic eczema, staphylococcal dermatitis, cellulitis and folliculitis (cold dermal abscesses that are not warm, painful and without redness), recurrent pneumonia and pulmonary abscesses, osteopenia and recurrent bone fracture. The diagnosis of standard HIES is based on clinical suspicion. There is no specific treatment for HIES. The treatment should be based on the prevention of developing infections. Prophylactic antibiotics such as cotrimoxazole and IVIG are administered. Hematopoietic stem cell transplantation was done for all types of HIES, but there is a little information and experience about the long term results of this therapy.

Eczema is a very common disorder that affects children. To find out the national prevalence of eczema in Iranian children, we conducted a systematic review and meta-analysis. We conducted a literature review by using the Google Scholar, PubMed in Medline area, AltaVista, IranMedex and Magiran in August 2013. The search terms included: Prevalence, Eczema, Children, Pediatric, Allergy, ISAAC and Iran. From 156 related articles based on criteria, all the studies performed on children by the International Study of Asthma and Allergies in Childhood protocol that contained eczema manifestations were selected. The required informations from each study included the authors name, date, city, size of population, prevalence of eczema and number of children in elementary school age groups (6-7 years) and junior high school (13-14 years). The information was recorded in designed tables. The extracted data were analyzed by STATA 11. In this study, we analyzed 16 studies including 56,424 children in whom 28,113 were in 6-7 years age group and 28,311 in 13-14 years age group. The pooled prevalence of eczema in children aged 6-7 years and 13-14 years was 5.98% and 6.52%, respectively. This review revealed the prevalence of eczema in Iranian children. This information can be helpful to identify and control eczema symptoms in children suffering from allergic disorders.

Context Atopic dermatitis is a chronic, relapsing skin disorder that affects all ages including infancy and childhood. There are many proved and unproved treatments for atopic dermatitis. Evidence Acquisition Data sources of this narrative review included studies about pediatric atopic dermatitis with the following keywords, pediatric, atopic dermatitis, immunity, acute, chronic, pruritic inflammatory skin disorder, infancy, childhood, diagnosis, management and treatment. All of the articles were written in English language with full text on management or treatment. Results Innate and adaptive immune system involved atopic dermatitis. Major characteristics of atopic dermatitis include pruritus, chronic or relapsing lesions and personal or family history of atopic disease. There is no specific treatment for atopic dermatitis. The treatment included rehydration, emollients, topical steroid, calcineurin inhibitors and immunosuppressant. Crisaborole topical ointment, a PDE4 anti-inflammatory topical agent (phase three of the research) could be effective in atopic dermatitis. Conclusions Avoidance from trigger factors and emollients are basic treatments of atopic dermatitis.

Context Pediatric nephrolithiasis is a noticeable cause of morbidity among children. Although, nephrolithiasis is a common disease in adults, its incidence has had a rising trend in children. Objectives Here in, we reviewed the current state regarding evaluation and management of children with nephrolithiasis in the last decade. Data Sources The current literature regarding incidence and trend, along with diagnostic evaluation and management of children aged less than 18 years old with nephrolithiasis was searched on MEDLINE and Google scholar from January 2005 to March 2016. Study Selection and Data Extraction The search terms included, “kidney stone OR nephrolithiasis OR urolithiasis and Pediatric OR children”. English language and human studies were included. Expert opinions, editorials and case reports were excluded. Consequently, the authors independently reviewed the abstracts and the papers, which matched the inclusion criteria. Results From a total of 1050 studies identified through the database search, 71 articles were selected for the review. According to the results of this review, pediatric nephrolithiasis has an increasing rate worldwide. Recent studies in this regard indicated that the number of girls with nephrolithiasis has increased. The change of life style, diet, obesity and metabolic syndrome and popular imaging study along with referral of the patients to pediatric centers could be contributed to this trend. Conclusions Evaluation of patients, particularly young children, includes metabolic assessment. Stone analysis and 24-urine collection analysis are very helpful for determining underlying diseases. Medical as well as surgical approaches are used to prevent kidney injuries.

Chédiak-Higashi syndrome is a rare autosomal recessive congenital immunodeficiency mainly characterized by a condition called oculo-cutaneous albinism. The affected subjects have light-colored hair, vision problems, blood clotting (coagulation) abnormalities and in adulthood varying neurologic disorders. Recurrent infections, particularly viral infection with other disorders in childhood are usually life threatening. It has demonstrated mutations throughout the CHS1/LYST gene. The nature of the mutation can be a predictor of the severity of the disease. The current therapeutic options are: Antibiotics, chemotherapy and bone marrow transplantation. This review will discuss the clinical and molecular aspects of this syndrome for better understanding of the factors that may cause abnormalities.

Chronic urticaria is defined as a skin disease with central induration (wheal) and erythema formation around it (flare) that appears at least twice a week and remains at least for 6 weeks continually. The incidence of urticaria in children is about 0.1-3%. Most cases of chronic urticaria occur in children between 6-11 years. Autoimmune and allergy immaturity is one of the reasons of lower incidence of chronic urticaria in younger children. Quality of life impairment in children with urticaria has been known to be similar to diseases with severe atopic dermatitis, epilepsy, diabetes mellitus and asthma. There are several causes for chronic urticaria in children in different reports. In most of cases the known etiologic agents are varies from 21 to 83%. Overall, infectious causes of chronic urticaria in children are more common and obvious than other in adults .In most cases, the cause of chronic urticaria are idiopathic or autoimmune. Urticaria severity divided to mild, moderate and severe was based on the number of wheals and severity of pruritus. Diagnosis of chronic urticaria is based on a good history and physical examination. The treatment of chronic urticaria is a patient education that is to remove the triggering and aggravating agents, resolving and treating of the known disease and the use of various medicines based on the history and clinical findings. The first medical therapeutics lines in children are anti-histamines, beta-blocker H1 and new generation of non-sedating agents.

ABSTRACT Asthma is a common chronic inflammatory and complex disease in children with many contributing (including genetic and environmental) factors. This study aims to review the impact of infections in children with asthma. Different websites including Googlescholar, Yahoo, Pubmed, SID.IR, MAGIRAN, IRANDOC, IRANMEDEX ,Embase and Hand searching were searched for pertinent articles with keywords asthma, pediatric, infection, virus, bacteria, and fungus. Out of the results, full articles relevant to pediatric asthma were selected. Acute respiratory infections caused by Chlamydia pneumoniae and Mycoplasma pneumoniae are involved in 5%-30% of wheezing events and asthma attacks. Viral infections were previously found in 24%-34% of asthmatic children, but technological advancements have revealed them to be present in 77%-81% of cases, with rhinovirus found in 47%, Respiratory Syncytial Virusin 21%, and the rest (including influenza, parainfluenza, adenovirus, coronavirus, and enterovirus) accounting for 2%-5% each. Viral respiratory infections are basically the major trigger for asthma symptoms and attacks in children. No causal relationship has been established between asthma and viruses and bacteria.

ABSTRACT The prevalence of asthma is inconsistent in different countries and even in regions of a country. Awareness of this prevalence has favorable impacts on health care system planning. The aim of this literature review and meta-analysis was to estimate the prevalence of pediatric asthma in the Islamic Republic of Iran during two recent decades. A search was done in national (SID, Magiran, Irandoc, Iranmedex) and international databases (PubMed and Google Scholar) to find articles which evaluated asthma prevalence in pediatrics and adolescences, using the international study of asthma and allergies in children written questionnaire. Twenty eight articles between 1992 and 2012 with a total of 96822 participants were found. ‘Asthma ever’ prevalence was 2.7% (95% CI: 1.9 to 3.6) and 3.5% (95% CI: 2.6 to 4.6) in children aged 6-7 and 13-14 years, respectively. ‘Wheezing in the past 12 months’ were 7.6% (5.6 to 9.8) and 10.7% (95%CI: 8.9 to 12.7) in children aged 6-7 and 13-14 years, respectively. The prevalence of asthma had an increasing trend during the last two decades, therefore, the health care system should be alarmed for more meticulous planning and evaluation to control and prevent asthma.

Hyperimmunoglobulin-D syndrome (HIDS) is a rare, autosomal recessively inherited autoinflammatory disease caused by mutations in the mevalonate kinase gene. HIDS usually starts in infancy with recurrent fever episodes lasting three to seven days and recurring every three to six weeks, with only partial symptom decrease in adulthood. Fever is typically accompanied by abdominal pain, vomiting, diarrhea and cervical lymphadenopathy, and sometimes by skin and joint symptoms. Blood leukocytes and serum C-reactive protein (CRP) are elevated during the episode, and in addition, high levels of interleukine-1 (IL-1), IL-6 and tumor necrosis factor (TNF) and respective soluble receptors are measured. Currently, there is no established treatment for HIDS. So far, four children have been successfully treated by TNF-alpha inhibitor (etanercept) and three children with IL-1 receptor antagonist (anakinra). The current study is a narrative review about the updates of HIDS.

Hyper IgE Syndrome (HIES) is a rare primary immunodeficiency disease. Most of HIES cases are sporadic. Autosomal dominant HIES is caused by mutation in signal transducer and activator of transcription-3 (STAT-3). A number of mosaicism HIES has been reported that is associated with intermediate phenotype. Autosomal recessive HIES is due to mutation in Dock-8 or cytokine sis 8 and TYK2 or tyrosine kinase 2. The common anifestations are atopic eczema, staphylococcal dermatitis, cellulitis and folliculitis (cold dermal abscesses that are not warm, painful and without redness), recurrent pneumonia and pulmonary abscesses, osteopenia and recurrent bone fracture. The diagnosis of standard HIES is based on clinical suspicion. There is no specific treatment for HIES. The treatment should be based on the prevention of developing infections. Prophylactic antibiotics such as cotrimoxazole and IVIG are administered. Hematopoietic stem cell transplantation was done for all types of HIES, but there is a little information and experience about the long term results of this therapy.