Effectiveness of ongoing face-to-face anti-tobacco intervention in children with asthma.

Background: Interventions to help parents quit smoking may yield important benefits for children with asthma. Children's exposure to environmental tobacco smoke can be measured by reporting of an adult in the household and testing the child's biomarker, e.g., cotinine. Objective: The aim of the study was to assess the effectiveness of "face-to-face" intervention carried out since 2016 in families with children diagnosed with asthma 3 years after beginning the anti-tobacco intervention. Methods: This study was a follow-up to an interventional study that assessed the effectiveness of direct patient education versus educational leaflets alone about parental tobacco smoking. The patients with asthma (ages 4-17 years) enrolled in our original intervention study conducted in 2016 were under the care of the allergy outpatient clinic. The active group was individually educated about the harmful effects of environmental tobacco smoke on their children. The control group included patients and parents, among whom only leaflets were distributed. After 3 years of ongoing intervention, in patients from both groups, exposure to tobacco smoking was evaluated with a questionnaire addressed to parents and/or caregivers and measurement of cotinine in children's urine. The forced expiratory volume in the first second of expiration and fractional exhaled nitric oxide levels were measured. Results: Seventy participants completed the study: 37 in the active group and 33 in the control group. In the active group, 27% of the parents quit smoking entirely compared with 9.4% of parents in the control group. In the group of active intervention, a significant decrease in the cotinine level (p < 0 .001) and the number of cigarettes smoked daily were observed (p < 0.001) 3 years after the active intervention compared with values right after the intervention. In the control group, there were no significant changes in the above-mentioned parameters. Conclusion: "Face-to-face" intervention among families with smokers were effective and lowered cotinine levels in children with asthma and the number of cigarettes smoked assessed 3 years after the intervention.

Early life environmental exposure in relation to new onset and remission of allergic diseases in school children: Polish Mother and Child Cohort Study.

Background: This study was based on data from the Polish Mother and Child Cohort Study. Objective: The aim was to study associations between home environment factors and allergic diseases at 1 year of life and new onset and remission of children's allergy diagnosis at ages 7-9 years. Methods: Children's health status was assessed at ∼12 months of age and then at ages between 7-9 years by using a questionnaire administered to the mothers. Children were assessed by pediatrician/allergists. The patients, who were 7-9 years old, underwent skin-prick tests. Exposure to tobacco smoke was evaluated with a questionnaire addressed to parents and/or caregivers and cotinine measurements were taken of mother's saliva during pregnancy and in children's urine at ages 7-9 years. Incidence and remission were calculated by comparing symptoms in the first year of life with symptoms at 7-9 years. We studied the associations among demographic data, home environment, and new onset and remission of food allergy, atopic dermatitis, and asthma and allergic rhinitis in logistic regression analysis. All associations were adjusted for independent risk factors of dependent variables. Results: Data from 211 participants were included in the analysis. During the first year of life, food allergy was the most common symptom (39%), followed by atopic dermatitis (35%) and asthma (12%). When comparing diagnoses at ages 7-9 years with the first year of life, food allergy had decreased by as much as 18.6%, atopic dermatitis decreased by as much as 23.8%, and asthma decreased by as much as 8%, whereas asthma and allergic rhinitis had increased from 6% to 14.8%. More frequent house cleaning negatively correlated with the new onset of atopic dermatitis and of asthma and allergic rhinitis. Hypersensitivity to seasonal allergens and mites and to any other allergen positively correlated with new onset of food allergy, atopic dermatitis, and asthma and allergic rhinitis. Parental atopy positively correlated with the new onset of asthma and negatively correlated with asthma remission. Conclusion: Analysis of our findings indicated that new onset and/or remission of allergic diseases was linked with hypersensitivity to house-dust mites in children who were polysensitized and with parental atopy. In addition, children who had food allergy, allergic rhinitis, or atopic dermatitis at the age of 1 year had more of a chance developing other atopic disease (except asthma) at ages 7-9 years and less of a chance of having a remission of the disease.

The effect of passive smoking on exhaled nitric oxide in asthmatic children.

To date, some studies suggest that passive smoking (PS) may be an important determinant of FeNO levels in children but sill there is a need of investigations using objective methods of PS exposure. The aim of our study was to examine the effect of PS, measured by urine cotinine levels, on FeNO and lung function (FEV1) in allergic and non-allergic asthmatic children. METHODS: It was a prospective, non-interventional study. 140 children, aged 4-17, newly diagnosed with asthma were recruited into two study groups (exposed group, unexposed group), according to smoking exposure/unexposure based on the questionnaire. There was one study visit. Subjects underwent a medical history (including history of atopy), physical examination, spirometry, FeNO and urinary cotinine measurement. RESULTS: 70 individuals had been exposed to tobacco smoke. The patients exposed to tobacco smoke were characterized by statistically significantly higher urine concentration of cotinine, 10,80 ng/mL, than their counterparts who had not been exposed to tobacco smoke, 1,56 ng/mL (P = 0,019). In the group of individuals unexposed to tobacco smoke the mean value of FeNO was 34,99 ppb, while in the group of patient who had been exposed to tobacco smoke, the corresponding mean value was significantly lower, it amounted to 22,41 ppb (P = 0,001) (Table 1). As regards to FEV1 measurements, there were not any statistically significant differences by study groups unexposed/exposed to tobacco smoke (P = 0,179 and P = 0,074, respectively). FeNO levels (ppb) in the studied patients allergic to cat, grass or trees, exposed to tobacco smoke were significantly lower than in those children unexposed to tobacco smoke. Our results suggest a clinically important issue, that FeNO results should be interpreted in the context of environmental tobacco smoke exposure. Additionally allergy to cat dander, grass or tree may be potential confounding factor, which should be taken into consideration.

One-year follow-up of clinical and inflammatory parameters in children allergic to grass pollen receiving high-dose ultrarush sublingual immunotherapy.

BACKGROUND: In a previous double-blind placebo-controlled study, we analyzed a high-dose sublingual immunotherapy (SLIT) ultrarush protocol in asthmatic children monosensitized to grass pollen. In the present open-label study, we assessed the effect of SLIT on symptom score and nonspecific bronchial hyperreactivity in the same cohort followed for 1 subsequent year. METHODS: The study population comprised 35 children who were enrolled in our previous study. Placebo-treated patients were switched to active treatment; therefore, SLIT was administered for a further year to all patients. SLIT was considered effective if it reduced the severity of clinical symptoms and decreased the use of symptomatic medication. The effect of SLIT on nonspecific bronchial hyperreactivity (methacholine challenge test) was also measured. RESULTS: The symptom scores for asthma and rhinitis and medication score remained unchanged in the group who continued SLIT. We also observed further significant improvement in the results of the methacholine challenge test during the third year of treatment. CONCLUSIONS: High-dose ultrarush SLIT reduced the severity of allergic symptoms in the first 2 grass pollen seasons but continuously improved bronchial hyperreactivity in children with asthma, suggesting that SLIT should be continued despite the lack of further improvement in clinical symptoms.

Early exposure to unhygienic conditions and infections is associated with expression of different Toll-like receptors.

BACKGROUND: We have previously shown a lower prevalence of atopy in children living in foster homes than in children living with their parents. OBJECTIVES: In this study, we explored the associations between atopy and expression of Toll-like receptors (TLRs) 2, 4, 7 and 9 in the same groups of children. MATERIAL AND METHODS: We enrolled all the atopic children living in foster homes in Lodz, Poland and carefully selected, on the basis of age, sex, sensitization profile, clinical manifestation of allergy, and treatment, a similar number of nonatopic children living in foster homes, and a similar number of both atopic and nonatopic children living with their parents. Expression of TLRs 2, 4, 7 and 9 was analyzed in all children. RESULTS: Expression of TLR2 in foster care children was significantly higher in nonatopic children than atopic children (P = .047), while that of TLR7 and TLR9 was significantly higher in atopic children than in nonatopic children. Additionally, expression of TLR9 in nonatopic children in foster care was significantly lower than in nonatopic children living with their parents (P = .003).We also found that both groups of nonatopic children had a greater number of features characteristic of foster home children (poor living conditions in the first year of life) than atopic children. CONCLUSION: Our results may suggest that alternative mechanisms might underlie the in vivo regulation of the expression of different TLRs involved in the development of atopy.