Posts by:
Gabriella True

Symptom flares after COVID-19 infection versus vaccination among youth with PANS/PANDAS
LaRusso MD, Abadia CE. Symptom flares after COVID-19 infection versus vaccination among youth with PANS/PANDAS. Allergy Asthma Proc. 2023 Sep 1;44(5):361-367. doi: 10.2500/aap.2023.44.230049. PMID: 37641227; PMCID: PMC10476495.

These results support COVID-19 vaccination for most individuals with PANS/PANDAS given that the frequencies of symptom flares and setbacks after COVID-19 infection were significantly higher than after the COVID-19 vaccine. Nonetheless, further studies are needed to fully assess the risk-benefit balance and to provide a more individualized approach to disease prevention in people with immune vulnerabilities.

The PANDAS/PANS disorders. Is it time for more allergist-immunologists to get involved?
Bellanti JA. The PANDAS/PANS disorders. Is it time for more allergist-immunologists to get involved? Allergy Asthma Proc. 2023 Sep 1;44(5):296-305. doi: 10.2500/aap.2023.44.230029. PMID: 37641225.
Conclusion: The PANDAS/PANS disorders are a continuing burden for growing numbers of patients, health-care providers, and the global health-care systems, and are a particular challenge for the allergist/immunologist who is increasingly being called upon for their management. Because of the importance of immunologic factors in the pathogenesis and treatment of these conditions with anti-inflammatory and immune-modulating treatments, the allergist/immunologist is well poised to offer consultative care.
Efficacy of Antidopaminergic Pharmacotherapy in Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS): A Case Report
Hefelfinger D, Kaufman H, Gilman A, Gebhart R. Efficacy of Antidopaminergic Pharmacotherapy in Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS): A Case Report. Cureus. 2023 Aug 26;15(8):e44164. doi: 10.7759/cureus.44164. PMID: 37753029; PMCID: PMC10519259.

 

The use of antidopaminergic pharmacotherapy to target the induction of D1 and D2 dopamine receptors was efficacious in this patient and warranted additional research. Further studies must determine definitive treatment guidelines and look at biomarkers to aid the diagnosis. This will help in ensuring a timely diagnosis and treatment for patients and will help minimize the likelihood of neuropsychiatric symptoms persisting into adulthood.

The Dysfunctional Mechanisms Throwing Tics: Structural and Functional Changes in Tourette Syndrome
Lamanna J, Ferro M, Spadini S, Racchetti G, Malgaroli A. The Dysfunctional Mechanisms Throwing Tics: Structural and Functional Changes in Tourette Syndrome. Behav Sci (Basel). 2023 Aug 10;13(8):668. doi: 10.3390/bs13080668. PMID: 37622808; PMCID: PMC10451670.
“TS etiology is very complex, with strong genetic influences, repeated streptococcal infections, and also pre and perinatal phenomena [13]. There is accumulating evidence that immune dysregulation contributes to the pathophysiology of OCD, TS, and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). TS patients may, in fact, have a predisposition to autoimmune responses or impaired general immunity; recently, beta-hemolytic streptococcal infections and/or an increase in anti-basal ganglia antibodies have been found in patients with TS. “
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome.
Hoppin, K. M., & Doran, P. R. (2023). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome. In M. M. Perfect, C. A. Riccio, & M. A. Bray (Eds.), Health-related disorders in children and adolescents: A guidebook for educators and service providers (pp. 185–193). American Psychological Association. https://doi.org/10.1037/0000349-022

In the mid-1990s, researchers at the National Institute of Mental Health identified a link between recent streptococcal infection and the development of neuropsychiatric symptoms such as separation anxiety, tics, behavioral regression, rage, restricted eating, and obsessive–compulsive disorder. Research has found that in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS), exposure to an infection or other agent that activates the immune system creates an immune response that goes awry, causing autoantibodies (or immune cells) to attack brain cells instead. PANDAS and PANS are complex neurological disorders, and their medical impact is significant. Educators should be aware that PANDAS and PANS may have a significant impact on a student’s attendance. This chapter discusses etiology, prevalence and incidence, symptoms, and outcomes of PANDAS and PANS. It presents the psychoeducational implications and school-based interventions organized by medical management, cognitive/academic functioning, and social–emotional and behavioral functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

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Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2

Wilpert, NM., de Almeida Marcelino, A.L., Knierim, E. et al. Pediatric de novo movement disorders and ataxia in the context of SARS-CoV-2. J Neurol 270, 4593–4607 (2023). https://doi.org/10.1007/s00415-023-11853-5

Our data suggest that children with de novo movement disorders, and cerebellar inflammation can benefit from immune-modulating therapy, especially methylprednisolone, despite negative results in clinical investigations.

Antihistamines improve cardiovascular manifestations and other symptoms of long-COVID attributed to mast cell activation

Salvucci F, Codella R, Coppola A, et al. Antihistamines improve cardiovascular manifestations and other symptoms of long-COVID attributed to mast cell activation. Front Cardiovasc Med. 2023;10:1202696. doi:10.3389/fcvm.2023.1202696.

Mast cell activation in Long COVID (related work)

  • Observational study evaluating Long COVID patients treated with H1/H2 antihistamines.

  • Reports improvement in fatigue, cognitive symptoms, tachycardia, and other systemic complaints.

  • Supports the hypothesis that mast cell activation contributes to Long COVID symptom persistence.

  • Suggests immune dysregulation—rather than viral persistence—may drive ongoing symptoms in a subset of patients.

PANDAS – a rare but severe disorder associated with streptococcal infections; Awareness is needed, Acta Oto-Laryngologica Case Reports,
Karin Frånlund & Charbél Talani (2023) PANDAS – a rare but severe disorder associated with streptococcal infections; Awareness is needed, Acta Oto-Laryngologica Case Reports, 8:1, 104-107, DOI: 10.1080/23772484.2023.2231146
“We present a case of PANDAS with the aim of raising awareness of its diagnosis. PANDAS is a rare condition with an impact on the patient’s quality of life; thus, awareness is needed. A multidisciplinary team is needed for diagnosis and treatment. Otorhinolaryngologists may play an important role in the well-being of these patients when performing tonsillectomy.”