Chronic urticaria (CU) is associated with debilitating symptoms such as pruritic wheals and/or angioedema, which can significantly affect patients’ sleep, productivity and quality of life. Chronic spontaneous urticaria (CSU) is defined in cases in which no triggering factor is identified. Various guidelines directing the optimal management of CU in the adult population were published and updated over the recent years with the most accepted and widely used being the EAACI/GA 2 LEN/EDF/WAO 2017 guidelines. Meanwhile, guidelines specific to the pediatric population are scarce, mainly due to the fact that high quality evidence is lacking for many treatment options in this age group. The objective of this article is to review and synthesize the existing literature regarding the management of pediatric CSU. Our review highlights evidence supporting the EAACI/GA 2 LEN/EDF/WAO 2017 treatment guidelines with non-sedating second-generation antihistamines (sgAHs) as the mainstay of treatment for pediatric CSU, considering their demonstrated efficacy and reassuring safety profile. Additionally, the use of omalizumab in adolescents is well supported by the current literature. There is limited data available regarding the updosing of sgAHs, omalizumab in children with CSU under 12 years of age and the treatment with cyclosporine and leukotriene receptor antagonists (LTRAs) in pediatric patients of all ages. However, the results from currently available case series and case reports are promising for omalizumab and cyclosporine use in children with CSU, although large and well-designed randomized control trials (RCTs) assessing these treatment options are needed in order to formulate strong recommendations for their use. First-generation antihistamines (fgAHs) remain commonly used in pediatric CSU treatment despite a lack of studies assessing their efficacy and safety in the pediatric population and their widely known inferior safety profile compared to sgAHs.

BackgroundEsophageal cancer can be subdivided into two main histological subtypes with significant variability in their etiology and epidemiology. The incidence of esophageal adenocarcinoma (AC) is increasing across the developed countries, whereas the incidence of esophageal squamous cell carcinoma (SCC) is declining. Several risk factors have been identified in the pathogenesis of each subtype, however, their epidemiologic characteristics and distribution throughout Canada remain poorly understood.MethodsWe performed a retrospective analysis of demographic data across Canada from 1992 to 2010 using two independent population‐based cancer registries. The incidence of esophageal cancer, for each subtype, was examined at the levels of provinces/territories, cities, and postal codes.ResultsA total of 19 790 patients were diagnosed with esophageal cancer in Canada between 1992 and 2010; 74% were males. The average national incidence rate was 33.5 cases per million individuals per year. Incidence of esophageal AC increased over time, with notable high‐incidence rates on the Vancouver Island, the coasts of the Great Lakes, and the coasts of the Northumberland Strait in the Maritimes. The overall incidence of esophageal SCC has decreased. However, high incidence of esophageal SCC was detected in the Vancouver city, rural eastern Québec, and in the Maritimes. We also report clustering for each subtype using postal codes, which sheds light onto new avenues of research for potential environmental etiologies.ConclusionsThis study, for the first time, provides a detailed analysis on the burden of esophageal cancer in Canada, revealing important geographic clustering trends.

Gastric cancer is the 5th most common malignancy worldwide, representing ~5–10% of all new cancer cases. Although its incidence is declining, it is estimated that 1 in 98 Canadians will develop gastric cancer in their lifetime. The epidemiology and distribution of gastric cancer throughout Canada, however, remains poorly understood. A retrospective analysis of demographic data across Canada between 1992 and 2010 was performed using 2 population-based cancer registries. The incidence of gastric cancer was examined at the levels of provinces, cities, and postal codes. In addition, 43,955 patients were diagnosed with gastric cancer in Canada between 1992 and 2010; 66% were male and the average age of diagnosis was 68.4 years. The age-adjusted incidence rate was 5.07 cases per 100,000 individuals per year. The incidence decreased over the study period by 30%. High incidence rates were identified in rural areas of Newfoundland and Labrador, New Brunswick, and Quebec. Our study found a significant association between gastric cancer incidence rates and lower socioeconomic status, as well as Hispanic ethnicity. This is the first study to provide a comprehensive analysis of the incidence of gastric carcinoma in Canada, identifying high-risk populations that may benefit from increased primary and secondary prevention.

Allergic contact dermatitis (ACD) most commonly presents as an eczematous reaction; however, a variety of non-eczematous eruptions have also been reported, including erythema multiforme (EM)-like lesions. 1-3 The pathogenesis of true EM is known to be type III hypersensitivity immune complex-mediated, affecting small vessels in the skin and mucosa. 4 The pathogenesis of EM-like lesions which appear secondary to ACD, however, remains elusive but is hypothesized to be a result of a type IV reaction mediated by T cells, as is the case in eczematous contact dermatitis. 2,5 We herein present a case of ACD in a pediatric patient who subsequently developed an EM-like reaction and discuss this potentially underreported complication to plant-induced contact dermatitis.

rogressive hemifacial atrophy, or Parry-Romberg syndrome, is a rare disorder characterized by gradual, unilateral atrophy of soft tissue in the face within regions innervated by branches of the trigeminal nerve. 1 One widely used classification system, attributed to Iñigo et al., 2 denotes the disease as mild if atrophy is limited to one trigeminal nerve branch, or moderate if it involves two branches. Severe cases are either those involving all three trigeminal nerve branches, or if there exists any bony involvement. 2,3 Degeneration may persist over the course of 2 to 20 years, until spontaneous quiescence, with an earlier age of onset associated with more severe bony involvement and poorer outcomes, especially in pediatric patients. [4][5][6][7] Although treatment with agents such as steroids, methotrexate, antimalarials, and retinoids may be initiated early on during the disease process in an attempt to curb progression, 8 softtissue reconstruction is often necessary for restoration of form and function. 4,9 Although there exists a