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Chronic urticaria is the most common skin diseases, characterized by chronic cutaneous lesions which severely debilitates patients in several aspects of their everyday life. Vitamin D is known to exert several actions in the immune system and to influence function and differentiation of mast cells, central role players in the pathogenesis of chronic idiopathic urticaria. This study was performed to evaluate the relationship between vitamin D levels and susceptibility to chronic idiopathic urticaria. One hundred and fourteen patients with chronic idiopathic urticaria were recruited in this study along with one hundred and eighty seven sex-matched and age-matched healthy volunteers as the control group. For each patient, urticaria activity score was calculated and autologous serum skin test was done. Vitamin D metabolic statue was measured in serum as 25 hydroxyvitamin D using enzyme immunoassay method. Patients with chronic idiopathic urticaria significantly showed lower levels of vitamin D. Vitamin D deficiency was significantly associated with increased susceptibility to chronic idiopathic urticaria. There was a significant positive correlation between vitamin D levels and urticaria activity score. This study showed that patients with chronic idiopathic urticaria had reduced levels of vitamin D, while vitamin D deficiency could increase susceptibility to chronic idiopathic urticaria.

Chronic urticaria (CU) also known as chronic idiopathic urticaria results in a lowered quality of life (QoL). Disease specific questionnaires are necessary to assess QoL in CU patients. Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) is the only available and validated disease specific questionnaire in the assessment of QoL in CU patients originally developed in Italian language. The aim of the current study was to develop the Persian version of the CU-Q2oL with an acceptable reliability and validity. Using the standard methods provided by guidelines, CU-Q2oL was translated into Persian. A total number of 110 patients with confirmed diagnosis of CU were asked to fill the questionnaire. Determination of scales was performed in addition to checking the data for internal consistency and known group validity. Urticaria activity score 7 (UAS-7) was used to assess the severity of the CU in the population study. The 6 dimensional scale of Persian CU-Q2oL was determined using the Exploratory Factor Analysis. About 68% of the variance was explained by these 6 factor structure higher than 59.9% of the original Italian version. All 6 factors showed acceptable internal consistency as measured by Cronbach α coefficient. There was a significant correlation between UAS-7 and total CU-Q2oL score. UAS7 and the presence of angioedema were predictors of CU-Q2oL score. The Persian version of CU-Q2oL was shown to be a valid and reliable tool to be used in the future clinical studies. Cultural considerations must be kept in mind in adoption of CU-Q2oL to other languages.

Background: Urticaria is a common itchy skin condition characterized by swelling and erythema. A variety of treatments is available today. The purpose of this study was to evaluate the clinical effects of probiotic use in patients with chronic resistant urticaria. Methods: This four-way blind randomized clinical trial was conducted between June 2019 and June 2020. Study population consisted of patients with chronic urticaria who did not respond well to first line treatment with antihistamines. For the intervention group, antihistamine (cetirizine) and probiotics (femilact capsule) and for the control group, antihistamine (cetirizine) and placebo were administered twice a day for 8 weeks. The “Urticarial Activity for 7 Days” (UAS7) questionnaire was used to assess urticaria activity and the Dermatology Life Quality Index (DLQI) questionnaire was used to assess the quality of life of patients. Results: Patients’ age range was 7 to 30 years with a mean and standard deviation of 23.6±9.2 years. 31 (81.57%) cases were females and 7 (18.42%) cases were males. Twenty patients were in the intervention group and eighteen patients were in the control group. The mean scores of UAS7 questionnaire were reduced in both groups, but it was more significant in the intervention group (9.6±6.4) compared to the control group (12.7±8.1) at the end of week eight of treatment (P=0.036). Also, there was no significant difference in the quality of life between the two groups after 8 weeks (P=0.805). Conclusion: This study showed that probiotic consumption along with antihistamines significantly improved the activity of urticaria but not the quality of life of patients.

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.

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: 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

BACKGROUND: Asthma is a common chronic inflammatory respiratory disease more common in children. Microbial agents such as viruses are a common trigger of asthma. Coronavirus disease 2019 (COVID-19) is a pandemic disease that could lead to the exacerbation of allergic disorders such as asthma. The aim of this study is to write a narrative review of COVID-19 and asthma condition. METHODS: We searched in Google scholar, PubMed, and Scopus databases with keywords COVID-19, asthma, corticosteroid, and inhaled steroids. RESULTS: We found a few original articles on the combined subject of asthma and COVID-19. More than 50% of our data is expert comments at valid websites such as https://www.AAAAI.org or https://ginasthma.org. The typical treatment recommended in the exacerbation of asthma or chronic obstructive pulmonary disease (COPD) included the use of corticosteroids. The routine use of corticosteroids in patients with COVID-19 without obstructive lung disease is not advised, as it may prolong viral replication. CONCLUSION: Patients with asthma need to continue on their preventive asthma medication, such as inhaled corticosteroids (ICS) in pandemic COVID-19.

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.

Abstract Cohen syndrome (CS) is a rare autosomal recessive disorder. CS includes a range of clinical symptoms including retinal dystrophy and myopia. The new VPS13B mutation could cause CS‐induced neutropenia and petechiae in patients with CS.

Fractional exhaled nitric oxide (FeNO) is a noninvasive marker of inflammation, used for monitoring asthma. The aim of this study was to compare FeNO, asthma control test (ACT), and lung function test (spirometry) in children aged 8-15 years. This observational, cross-sectional study was performed on76 asthmatic children (age, 8-15 years), who were referred to the Department of Immunology and Allergy, Children's Medical Center, Tehran, Iran during 2012-2013. Patients were matched for sex and age. The recruited patients were selected via consecutive sampling. FeNO was measured with a portable electrochemical analyzer and forced spirometry was performed according to the American Thoracic Society (ATS) guidelines. The ACT questionnaire was used and completed for all the patients. The mean FeNO was 28.5±29.1 ppb, and the mean ACT score was 19.8±3.6. FeNO was significantly correlated with forced expiratory volume (FEV1) (r, 0.232; p=0.049) or 25-75% maximum expiratory flow (MEF 25-75) (r, -0.304; p=0.009). FeNO showed no significant correlation with ACT score or FEV1/forced vital capacity (FVC) (p>0.05). Additionally, there was no significant correlation between FeNO and changes in FEV1 and MEF 25-75% before and after the administration of bronchodilators (p>0.05). To improve asthma control, childhood ACT, FeNO, and spirometric tests can be used as complementary tools in clinical practice to detect children with poorly controlled asthma.

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 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.