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Real-world data on the range and impact of comorbid health conditions that affect pediatric asthma are scant, especially from developing countries. Lack of data hinders effective diagnosis, treatment, and overall management of these complex cases. We, hereby, describe the common pediatric asthma comorbid conditions in terms of evidence for association, potential mechanisms of impact on asthma control, and treatment benefit. Obesity, upper airway allergies, dysfunctional breathing, multiple sensitizations, depressive disorders, food allergy, and gastro-esophageal reflux are common associations with difficult-to-treat asthma. On the other hand, asthma symptoms and/or management may negatively impact the well-being of children through drug adverse effects, worsening of anaphylaxis symptoms, and disturbing mental health. Awareness of these ailments may be crucial for designing the optimum care for each asthmatic child individually and may ultimately improve the quality of life of patients and their families. A multidisciplinary team of physicians is required to identify and manage such comorbidities aiming to mitigate the over-use of asthma pharmacotherapy. Asthma research should target relevant real-world difficulties encountered at clinical practice and focus on interventions that would mitigate the impact of such comorbidities. Finally, policymakers and global healthcare organizations are urged to recognize pediatric asthma control as a healthcare priority and allocate resources for research and clinical interventions. In other words, global asthma control needs support by compassionate scientific partnership., (© 2024 The Authors.)

Introduction: Early recognition of an anaphylaxis event is crucial for instituting lifesaving management. We sought to explore knowledge and practice towards anaphylaxis in a sample of physicians from ten Egyptian governorates., Methods: An eighteen question-based questionnaire was developed by expert allergists to evaluate the knowledge and practice towards anaphylaxis, based on the World Allergy Organization guidelines for the assessment and management of anaphylaxis. The questionnaires were distributed, and the answered forms collected via emails, and data were tabulated, and analysed., Results: In this cross-sectional study, a total of 242 physicians completed the survey (183 (75.6%) paediatricians, 32 (13.2%) internists, 22 (9.1%) intensivists and five (2.1%) anaesthetists). Only 91 participants (37.6%) identified all the four proposed anaphylaxis clinical scenarios while 70, 45 and 36 identified three, two and one scenario, respectively. Loss of consciousness and abdominal symptoms were not recognised as possible presentations of anaphylaxis by 64.5% and 80.2% of the participants, respectively. Epinephrine was considered the first line treatment by 98 (40.5%), corticosteroids by 77 (31.8%) and antihistamines by 25 (10.3%). 75 (31%) responders identified the right dose of epinephrine while 119 (49.2%) identified the proper route. Concerning practice, 83 physicians (39.2%) used epinephrine for all cases of anaphylaxis, 88 (41.5%) used it for refractory cases only whereas 41 (19.3%) did not use epinephrine at all., Discussion: Our survey shows that the knowledge of Egyptian physicians and their practice towards anaphylaxis are still inadequate. The current situation reinforces the need to disseminate and encourage the adoption of the international guidelines for anaphylaxis diagnosis and treatment., Competing Interests: None of the authors has a conflict of interest in relation to this manuscript., (© 2021 The Authors.)

Food allergy (FA) is currently a significant health care problem in the developing world. Widely varying study populations and methodologies, the use of surrogate markers such as self report or hospitalization rates due to anaphylaxis rather than objective methods, limits robust estimation of FA prevalence in low income settings. Also, allergy is under-recognized as a clinical specialty in the developing world which compromises the chance for accurate diagnosis. In this review, most published data on food allergens from developing or low income countries are displayed. The diagnostic challenges and limitations of treatment options are discussed. It seems that FA is an under-appreciated health care issue in the developing world, and accurate determination of its burden in low-income settings represents an important unmet need. Multicenter surveillance studies, using standardized methodologies, are, therefore, needed to reveal the true extent of the problem and provide epidemiological clues for prevention. Preventive strategies should be tailored to fit local circumstances in different geographic regions. In addition, studying the gene environment interactions and impact of early life microbiota on the expression of FA in developing communities would be worthwhile. Efforts and resources should be directed toward public health education and training of health care providers dealing with food allergic patients., Competing Interests: The authors report no competing interests to declare in relevance to the article., (© 2019 The Authors.)

Background: Primary immunodeficiency diseases are underdiagnosed in developing countries. The aim of this study was to identify primary B- and T-cell immune defects in Egyptian infants and children with clinical criteria indicating primary immunodeficiency disease., Material/methods: We enrolled 100 consecutive infants and children clinically suspected to have primary immunodeficiency disease. Subjects were evaluated with respect to immunodeficiency-related score, complete blood count, erythrocyte sedimentation rate, serum immunoglobulin (Ig) A and tetanus IgG antibody estimation, and Candida and tuberculin intradermal testing. Subjects showing IgA deficiency underwent serum total IgG, IgM, and IgE measurement, and lymphopenic patients underwent lymphocyte subset counting by flow cytometry., Results: Thirty-five subjects showed laboratory evidence of T- and/or B-cell immunodeficiency and showed significantly higher immunodeficiency-related scores, a greater frequency of hospitalization, and were more likely to have no bacillus Calmette-Guérin scar and a negative Candida skin test. Laboratory evaluation revealed evidence of predominant B-cell defects in 19 subjects, T-cell defects in 8, and combined immunodeficiency in 8. An immunodeficiency-related score of > or =6 was associated with 71% of the immune defects, and a score > or =8 was predictive of significant immune derangement. The most helpful screening tests for B-cell defects were those for serum IgA and antitetanus IgG, whereas those for T-cell immunodeficiency were peripheral blood lymphocyte count and Candida sensitivity skin test., Conclusions: Our screening procedures allowed for identification of most of the subjects requiring further evaluation of primary immunodeficiency disease in this study. Widescale screening of neonates and older children for primary immunodeficiency disease is indicated.