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PURPOSE OF REVIEW: In children, allergic reactions to antibiotic are rare and several recent publications confirmed that they are clearly overdiagnosed, representing a major public health problem. Highlighting the most recent literature, the present review addresses the management of children with a possible antibiotic allergy.

RECENT FINDINGS: In diagnosis of antibiotic allergy, the patient's history is central although not sufficient. In case of suspicion of an allergy, the child should be referred to an allergist in order to perform a complete allergy workup, based on carefully selected diagnostic tests depending on whether an immediate or a nonimmediate reaction is suspected. The antigen challenge test remains the gold standard and has gained in importance, particularly in children presenting a benign rash while taking antibiotic treatment. However, this test potentially exposes individuals to a significant risk of severe reaction and has relevant cost and is time consuming. Several new diagnostic tools are currently under investigation and provide promising results.

SUMMARY: Accurate diagnosis of antibiotic allergy is important not only to prevent serious or even life-threatening reactions, but also to avoid unnecessary drug restriction associated with increased resistance and health costs.

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Chronic persistent airway obstruction has been observed in moderate-to-severe asthmatics despite treatment with inhaled corticosteroids. We investigated which airway changes were associated with this obstruction.

High-resolution computed tomography (HRCT) was performed at study entry and reexamined at the time of follow-up when the FEV1 reached a maximally constant level after treatment for 1 year or more with inhaled corticosteroids. Bronchial wall area and air trapping extent were compared in the recovered group (n = 18) and the persistent airway obstruction group (n = 14).

Bronchial wall area and air trapping of the initial HRCT were similar between the two groups. On follow-up HRCT, air trapping was markedly decreased in the recovered group compared with that on initial HRCT (P = 0.017), whereas bronchial wall area did not change. In the persistent-airway-obstruction group, these two parameters did not change during follow-up. When follow-up HRCT was compared, air trapping was significantly greater in the persistent-airway-obstruction group than in the recovered group (P = 0.003). Difference post-bronchodilator FEV1 value between at initial and 2nd HRCT exam was correlated with difference air trapping value between at initial and 2nd HRCT exam(%) on the follow-up HRCT (P = 0.017). The presence of persistent airflow obstruction were significantly associated with the air trapping % difference between initial and 2nd time (RR = 1.70, P = 0.018).

Persistence of AT could be a main contributing factor to chronic persistent airflow obstruction in asthma.

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PURPOSE OF REVIEW: Even in the era of promising molecular diagnostics for tuberculosis, understanding of the immune response remains urgent and fundamental to combating paediatric tuberculosis, given its paucibacillary nature.

RECENT FINDINGS: Significant advances have been made in unravelling the contributions of previously underappreciated components of the immune response to Mycobacterium tuberculosis. Research into the role of the 'innate' immune system such as neutrophils alongside 'adaptive' cells such as CD4(+), CD8(+), polyfunctional and regulatory T cells has highlighted the complexity of their interactions. Lessons from children with congenital or acquired susceptibility to mycobacterial disease, including HIV, continue to illuminate a broader understanding of the host immune response. The role of vitamin D is becoming apparent and highlights the importance of the environmental and clinical context of patients, especially in high prevalence areas. Several approaches show promise as diagnostic tests and in monitoring treatment response, although distinguishing latent from active disease remains a challenge.

SUMMARY: Research into novel immunological biomarkers, and greater understanding of the complex network of interactions between the innate and adaptive immune systems, is key to understanding why following exposure some children are unaffected, others latently infected and yet another group succumb to disease.

It remains unanswered whether persistent allergic inflammation in nasal mucosa alters bacterial colonization and infection. The aim of this study was to investigate the bacterial flora in the nasal cavity of patients with persistent allergic rhinitis (PAR) and to correlate the bacteriological findings with presence of nasal symptoms, nasal eosinophil and neutrophil counts.

A total of 255 subjects, aged between 6 - 74 years (mean 33.9 years) was randomly selected from a population-based rhinitis survey study in Singapore. All subjects went through a thorough medical history and nasal examinations. Serum specific IgE to a panel of common house dust mites, nasal cytological and microbiological examinations were performed.

PAR was diagnosed in 107 patients and none of them had received previous regular therapy. There is a significant relationship between PAR and eosinophil grades, but not with neutrophil count. No statistically significant difference was found in quantitative and qualitative bacterial flora in nasal cavity between PAR patients and subjects with non-rhinitis or with non-allergic rhinitis. There is a significant inverse correlation between ongoing rhinorrhoea and quantitative bacterial load, and between signs of nasal mucosa (pale and edema) and the presence and type of bacterial pathogens.

In conclusion, our study demonstrates that patients with untreated (or using PRN medicine) PAR do not result in a significant change in bacterial flora in their nasal cavity.