Longitudinal Assessment of Blood Pressure in School-Aged Children: A 3-Year Follow-Up Study.

The purpose of this study was to assess the prevalence of abnormal blood pressure in a population of school children during a 3-year follow-up period and its relationship with obesity. Anthropometric and blood pressure data were collected from a population of Italian school children during three consecutive years. During each year blood pressure measurements were repeated three times, at intervals of 1 week. A total of 564 school-children [311 boys; mean (SD) age 8.8 ± 1.4 years] were recruited. During each year, systolic and diastolic blood pressure decreased from visit 1 to visit 3 (p < 0.001). This was associated with a decline in the percentage of prehypertension/hypertension from visit 1 to visit 3. An abnormal blood pressure value in at least one study visit was found in 8.8-17 % of children, whereas the prevalence of hypertension at all three study visits was between 5.2 and 7.8 %, and that of prehypertension at all three visits was between 2.8 and 3.8 %. High blood pressure was more frequent in obese children. In this population of school children the percentage of prehypertension/hypertension remarkably varied when based on one versus three annual assessments, thus emphasizing the importance of repeated measurement before making a diagnosis of abnormal blood pressure. Adiposity was confirmed to be a determinant of high blood pressure.

Factors associated with different results of allergy tests in children with dust mite-induced atopic dermatitis

BACKGROUND: Atopic dermatitis (AD) is a public health problem, with an increasing prevalence worldwide. AD is a chronic inflammatory disease characterised by skin lesions and severe itching. Immunologically, AD has two forms, IgE-mediated and cell-mediated, but it may also be idiopathic. In the pathogenesis of AD, the gene mutations for filaggrin, a filament-aggregating protein present in the epidermis, are of pivotal importance, but other genetic factors are also operating, including those linked to family atopy. METHODS: We evaluated the role of family atopy, and of the results of the atopy patch test (APT) in parents, in children with mite-induced AD. 64 children, 38 males and 26 females, mean age 4.97 years, were included for the diagnosis of AD and underwent APT and skin prick test (SPT) with dust mite extracts, with evaluation of atopy and result of APT also in parents. RESULTS: A positive family history of atopy was shown for children with positivity to both APT and SPT compared to those with negative or only one positive result to APT or SPT (p = 0.08). Significant associations were found concerning APT results in children and parents. In particular, children of a positive-APT parent had an 18-fold higher risk of APT-positivity in comparison with children of negative-APT parents, while the risk was 6.6-fold higher if APT was positive in father. CONCLUSION: Family atopy and a positive APT in fathers are risk factors to develop cell-mediated AD, as assessed by the APT, in children

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Diagnostic performance of the atopy patch test with inhalant allergens.

BACKGROUND: This study evaluated the diagnostic performance of the atopy patch test (APT) compared with skin prick testing (SPT) and in vitro IgE measurement in a large group of patients with atopic dermatitis (AD) with or without respiratory symptoms (RS). METHODS: The study included 521 patients (292 males, 229 females; age, 0.5-18 years; median age, 6 years) with AD and RS with different clinical presentations: current AD, 47 patients (Group A); current AD and RS, 72 patients (Group B), past AD and RS, 69 patients (Group C); and RS only, 280 patients (Group D). Fifty-three healthy individuals served as controls. All participants underwent the APT, SPT, and CAP/RAST with the most common inhalant allergens. The presence of a control group allowed calculation of specificity and positive and negative predictive values. RESULTS: A significant difference was found for a positive APT versus both SPT and CAP/RAST (P < .0001) but not for SPT versus CAP/RAST. The differences for APT were significant in all group comparisons except group B vs C and group C vs D. In the control group, the APT was positive in 2% of cases (specificity of 96.2%), SPT was positive in 6% of cases (specificity of 88.4%), and CAP/RAST was positive in 4% of cases (specificity of 92.5%). CONCLUSIONS: In young patients sensitized to inhalant allergens with AD in addition to RS, the APT has a superior diagnostic performance to SPT and in vitro IgE measurement.

Factors associated with different results of allergy tests in children with dust mite-induced atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a public health problem, with an increasing prevalence worldwide. AD is a chronic inflammatory disease characterised by skin lesions and severe itching. Immunologically, AD has two forms, IgE-mediated and cell-mediated, but it may also be idiopathic. In the pathogenesis of AD, the gene mutations for filaggrin, a filament-aggregating protein present in the epidermis, are of pivotal importance, but other genetic factors are also operating, including those linked to family atopy. METHODS: We evaluated the role of family atopy, and of the results of the atopy patch test (APT) in parents, in children with mite-induced AD. 64 children, 38 males and 26 females, mean age 4.97 years, were included for the diagnosis of AD and underwent APT and skin prick test (SPT) with dust mite extracts, with evaluation of atopy and result of APT also in parents. RESULTS: A positive family history of atopy was shown for children with positivity to both APT and SPT compared to those with negative or only one positive result to APT or SPT (p=0.08). Significant associations were found concerning APT results in children and parents. In particular, children of a positive-APT parent had an 18-fold higher risk of APT-positivity in comparison with children of negative-APT parents, while the risk was 6.6-fold higher if APT was positive in father. CONCLUSION: Family atopy and a positive APT in fathers are risk factors to develop cell-mediated AD, as assessed by the APT, in children.

Diagnostic performance of the atopy patch test with inhalant allergens

Background: This study evaluated the diagnostic performance of the atopy patch test (APT) compared with skin prick testing (SPT) and in vitro IgE measurement in a large group of patients with atopic dermatitis (AD) with or without respiratory symptoms (RS). Methods: The study included 521 patients (292 males, 229 females; age, 0.5-18 years; median age, 6 years) with AD and RS with different clinical presentations: current AD, 47 patients (Group A); current AD and RS, 72 patients (Group B), past AD and RS, 69 patients (Group C); and RS only, 280 patients (Group D). Fifty-three healthy individuals served as controls. All participants underwent the APT, SPT, and CAP/RAST with the most common inhalant allergens. The presence of a control group allowed calculation of specificity and positive and negative predictive values. Results: A significant difference was found for a positive APT versus both SPT and CAP/RAST (P<.0001) but not for SPT versus CAP/RAST. The differences for APT were significant in all group comparisons except group B vs C and group C vs D. In the control group, the APT was positive in 2% of cases (specificity of 96.2%), SPT was positive in 6% of cases (specificity of 88.4%), and CAP/RAST was positive in 4% of cases (specificity of 92.5%). Conclusions: In young patients sensitized to inhalant allergens with AD in addition to RS, the APT has a superior diagnostic performance to SPT and in vitro IgE measurement (AU)

Antecedentes: En este estudio se ha evaluado la capacidad diagnóstica de las pruebas epicutáneas con alérgenos inhalantes comparadas con las pruebas cutáneas en "prick" y con la determinación de IgE específica, en una población pediátrica numerosa de pacientes sensibilizados a inhalantes con dermatitis atópica con o sin síntomas respiratorios asociados. Métodos: En el estudio se incluyeron un total de 521 pacientes (292 varones, 229 mujeres, rango de edad 0,5 a 18 años, mediana 6 años) que presentaban los siguientes cuadros clínicos: dermatitis atópica activa, 47 pacientes (grupo A), dermatitis atópica y síntomas respiratorios activos, 72 pacientes (grupo B), antecedentes de dermatitis atópica y síntomas respiratorio no activos en la actualidad, 69 pacientes (grupo C) y solo síntomas respiratorios activos, 280 pacientes (grupo D); también se incluyeron como controles 53 sujetos sanos. A todos ellos se les realizaron pruebas epicutáneas con inhalantes, pruebas cutáneas en prick y determinación de IgE específica mediante técnica de CAST/RAST con una batería de inhalantes habituales de la zona. Se determinaron la especificidad y los valores predictivos positivos y negativos de la prueba. Resultados: Encontramos diferencia significativas en el rendimiento diagnóstico entre las pruebas epicutáneas con inhalantes tanto frente a las pruebas cutáneas en prick, como frente a la determinación de IgE específica (p< 0,001). No encontramos, por el contrario, diferencias entre las pruebas cutáneas en prick y la determinación de IgE específica. Cuando comparamos los grupos, en el caso de las pruebas epicutáneas con inhalantes todas las diferencias fueron significativas excepto las comparaciones entre el grupo B frente al grupo C y el grupo C frente al grupo D. Las pruebas epicutáneas con inhalantes fueron positivas en el 2% de los controles sanos, las pruebas cutáneas en prick en el 6% y la determinación de IgE específica en el 4%, lo que corresponde a una especificidad del 96,2% para las pruebas epicutáneas, del 88,4% para las pruebas en prick y del 92,5% para la determinación de IgE específica. Conclusiones: En pacientes pediátricos sensibilizados a inhalantes, no solo con dermatitis atópica sino también con síntomas respiratorios, las pruebas epicutáneas tienen una capacidad diagnóstica superior a las pruebas en prick o la determinación de IgE específica (AU)

A role for measurement of nasal IgE antibodies in diagnosis of Alternaria-induced rhinitis in children

Background: Rhinitis is a very common disease, frequently caused by sensitisation to inhalant allergens. Negative results from skin prick tests (SPT) and in vitro IgE tests generally lead to a diagnosis of non-allergic rhinitis. However, it is possible, as indicated by studies addressed with dust mites or pollens that the production of specific IgE occurs exclusively at nasal level. Methods: We measured specific nasal IgE in children suffering from rhinitis in the periods when Alternaria spores were present in the air. All subjects underwent SPT with a standard panel of aeroallergens (Stallergenes, Milan, Italy) and, in the same session, to nasal IgE test (NT). Nasal provocation test (NPT) with Alternaria was used as reference. Results: Fifty-six subjects were included in the study. Of them, 20 (37.5%) were positive to SPT and 45 (80.3%) were positive to NT. In particular, 11 subjects (19.6%) had a positive SPT and a negative NT; 36 (64.3%) had a negative SPT and a positive NT; and 9 (16.1%) were positive to both tests. Positivity of NT and NPT was observed in 36 patients (69.6%), while positivity of SPT and NPT was observed in 15 patients (26.8%). This difference was highly significant (p<0.0001). Conclusions: These findings suggest that sensitisation to Alternaria is frequently expressed by exclusive production of specific IgE in the nasal mucosa. Thus, measuring nasal IgE in children with rhinitis and negative SPT during the period of presence of Alternaria spores seems helpful to avoid a mistaken diagnosis of non-allergic rhinitis(AU)

A role for measurement of nasal IgE antibodies in diagnosis of Alternaria-induced rhinitis in children.

BACKGROUND: Rhinitis is a very common disease, frequently caused by sensitisation to inhalant allergens. Negative results from skin prick tests (SPT) and in vitro IgE tests generally lead to a diagnosis of non-allergic rhinitis. However, it is possible, as indicated by studies addressed with dust mites or pollens that the production of specific IgE occurs exclusively at nasal level. METHODS: We measured specific nasal IgE in children suffering from rhinitis in the periods when Alternaria spores were present in the air. All subjects underwent SPT with a standard panel of aeroallergens (Stallergenes, Milan, Italy) and, in the same session, to nasal IgE test (NT). Nasal provocation test (NPT) with Alternaria was used as reference. RESULTS: Fifty-six subjects were included in the study. Of them, 20 (37.5%) were positive to SPT and 45 (80.3%) were positive to NT. In particular, 11 subjects (19.6%) had a positive SPT and a negative NT; 36 (64.3%) had a negative SPT and a positive NT; and 9 (16.1%) were positive to both tests. Positivity of NT and NPT was observed in 36 patients (69.6%), while positivity of SPT and NPT was observed in 15 patients (26.8%). This difference was highly significant (p<0.0001). CONCLUSIONS: These findings suggest that sensitisation to Alternaria is frequently expressed by exclusive production of specific IgE in the nasal mucosa. Thus, measuring nasal IgE in children with rhinitis and negative SPT during the period of presence of Alternaria spores seems helpful to avoid a mistaken diagnosis of non-allergic rhinitis.

Sublingual immunotherapy for treating respiratory allergy: a review on its effectiveness and suitability.

Sublingual immunotherapy (SLIT) was introduced in the treatment of respiratory allergy as an option to subcutaneous immunotherapy (SCIT), which is clinically effective but has the problem of adverse systemic reactions, quite rare but sometimes life-threatening. A large number of trials, globally evaluated in several meta-analyses, demonstrated that SLIT is an efficacious treatment for allergic rhinitis and allergic asthma and has a satisfactory safety profile, severe reactions being extremely rare, though an increased risk is apparent in subjects undergoing SLIT because of previous systemic reactions to SCIT. The suitability of SLIT is ensured by a good compliance, higher than reported for SCIT, the injections being a major factor for noncompliance with the latter, and by its cost-effectiveness performances. In fact, a number of studies showed that SLIT may be very beneficial to the healthcare system, especially after its stopping, when there is no more the cost of the treatment but its efficacy on symptoms persists.

Allergen-specific immunoglobulin E in the skin and nasal mucosa of symptomatic and asymptomatic children sensitized to aeroallergens.

BACKGROUND: Asymptomatic sensitization is confirmed by a positive response to skin prick tests (SPT) with allergens in the absence of clinical symptoms of allergy. This is a common observation for which no convincing explanation has been provided.We investigated the extent to which the presence of specific immunoglobulin (Ig) E in the nasal mucosa accounts for the occurrence of symptoms. METHODS: The study population comprised 192 patients with positive SPT results to aeroallergens: 111 had symptomatic allergic rhinitis and 81 were totally asymptomatic. All patients underwent measurement of nasal specific IgE using a validated technique (nasal IgE test). RESULTS: A family history of atopy was significantly more frequent in symptomatic patients than in asymptomatic patients (P<.0001). The result of the nasal IgE test was positive in 77.5% of symptomatic patients and in only 13.6% of asymptomatic patients (P<.0001). With regard to individual allergens, there was no association between clinical symptoms and a positive response to SPT, although there was a strong association between symptoms and individual allergens tested for nasal IgE. In symptomatic patients, there was only a slight correlation between SPT and nasal tests with allergens. CONCLUSION: These findings suggest that the absence of specific IgE in the nasal mucosa may explain the absence of symptoms in most sensitized subjects and pave the way for further study of the behavior of mucosal IgE in asymptomatic and symptomatic subjects.

Prevalence and risk factors for overweight and obesity in a population of Italian schoolchildren: a longitudinal study.

Prevalence of childhood overweight and obesity have dramatically increased worldwide in the last decades. Overweight and obesity are the result of a complex interaction between genetic and environmental factors. The aim of our longitudinal study was to assess the prevalence of overweight and obesity in a population of Italian schoolchildren followed for 2 years and to identify main risk factors for obesity onset and persistence in childhood. We enrolled 632 children (males /females= 345/287), aged 3 to 8 yr.Weight and height were measured at time 0, 1 (1 yr later), and 2 (2 yr later). Overweight and obesity were defined using body mass index (BMI) (Italian growth charts). Data collected included: birth weight, gestational age,maternal weight gain during pregnancy, breast feeding, parents' BMI, educational level, and occupation type. At time 0, 1, and 2 the prevalence of overweight was 22%, 22%, and 25%, respectively, and the prevalence of obesity was 7%, 8%, and 8%, respectively. During follow-up 62%of children remained normal weight, 24% was always overweight or obese, 9% became overweight, while only 5% of overweight subjects became normal weight. Male gender, maternal weight gain during pregnancy >10 kg, parental overweight/obesity were positively associated with the presence of overweight during the entire follow-up. On the contrary, being small for gestational age at birth was negatively related to persistence of overweight. No influence was found for being breastfed, for parental low educational level, and manual occupation. A large prevalence of overweight/obesity was observed in Italian schoolchildren. Gender, maternal weight gain during pregnancy, and parents' BMI were the strongest predictors of the persistence of child overweight and obesity.

Overweight and hypertension: longitudinal study in school-aged children.

AIM: A continuous increase in overweight has been documented in the paediatric population. The increase occurred in many developed and also developing countries. In the United States prevalence of overweight is 21.5% among African-Americans, 21.8% among Hispanics, and 12.3% among non-Hispanic whites; in Europe, from 10% to 20% in Northern Europe and 20% to as high as 36% in parts of Southern Italy (International Obesity Task Force data). The association between overweight and hypertension in children has been reported. This longitudinal study assessed the prevalence of hypertension and the relationships between gender, overweight, and blood pressure. METHODS: School-based screening was performed in 1.563 children (3-16 years). Age, gender, height, weight and blood pressure were registered every year for 3 subsequent years, in the period 1997-2000. Body mass index (BMI, kg/m2) was calculated and overweight was defined as centile corresponding to BMI = or >25 at 18 years. Blood pressure > 95th centile defined hypertension. RESULTS: The prevalence of elevated blood pressure at first, second and third screenings was 35.1%, 33.8% and 23.9% in males, and 41%, 40.2% and 31.2% in females. The relative risk was significant for overweight subjects. CONCLUSIONS: These results confirm an increasing epidemic of cardiovascular risk in children, as evidenced by an increase in the prevalence of overweight and hypertension. This increase in association with other cardiovascular risk factors that include dyslipidemia, insulin resistance, glucose intolerance, type II diabetes mellitus, suggest the necessity of accurate prevention strategies.

[Allergic rhinitis: A challenge diagnosis]. / La rinite allergica: una diagnosi non semplice.

AIM: The allergic rhinitis represents one of the ten major causes of ambulatory check-up. The incidence is between 10% to 25% in the general population and, in Italy, is approximately present in 10% of children and 20% of adolescents. The diagnosis of this disease is related to family anamnesis and the presence of several signs and typical symptoms. Regarding the tests used to detect this disease, cutaneous specific IgE (skin prick test) is used as cute reactivity expression. Using nasal specific IgE dosage we analyzed patients affected by rhinitis and its relationship between positive test, gender and age, the relationship between positive test and disease and the better response to diagnosis between the 2 tests performed (i.e., skin prick test and nasal specific IgE). METHODS: We analyzed 125 subjects enrolled consecutively, age range 48-216 months (median 144 months) that performed skin prick test and nasal specific IgE. RESULTS: Looking at the overall subjects, 51 subjects were positive to skin prick test and nasal specific IgE, 23 subjects were positive to skin prick test, 31 subjects were positive to nasal specific IgE, 20 subjects were negative to both tests. Regarding the relationship between tests positive and symptoms we did not find any significant correlation. CONCLUSIONS: Our data suggests that rhinitis diagnosis is quite difficult to perform and the test used to detect this disease needs to be more accurate and precise. Family anamnesis and clinical signs are fundamental in the diagnosis of allergic rhinitis.

Anaphylaxis to honey in pollinosis to mugwort: a case report.

A case of anaphylaxis to honey in a 19 year old female sensitized to Compositae pollen is described. The patient suffered from summer rhinoconjunctivitis since seven years; in January 2006, ten minutes after eating bread and honey she developed angioedema of the lips and tongue, runny nose, cough, dyspnoea, and collapse, requiring hospitalization and treatment with high dose corticosteroids and anti-histamines. After two weeks, skin prick tests (SPT) with a standard panel of inhalant allergens and prick + prick with a number of kinds of honey were performed. SPTs were positive to mugwort, ragweed, dandelion, and goldenrod. Concerning honey, the prick + prick was positive to "Millefiori" (obtained from bees foraging on Compositae) and also to sunflower, limetree, and gum tree honey, while was negative for other kinds of honey, including the frequently used chestnut honey and acacia honey. The allergenic component responsible of anaphylaxis in this case seems to be a molecule occurring in Compositae pollens, as previously reported for other three reports, but also in pollen from plants of different families. Honey contains a large number of components derived from bees, such as gland secretions and wax, as well as from substances related to their foraging activity, such flower nectar and pollens (1, 2). Honey as a food has been associated to allergic reactions and particularly to anaphylaxis (3-6). Among the pollens, the role of Compositae is somewhat controversial, since its responsibility is clear in some studies (3, 5, 6) but considered negligible in others (7). Here we present the case of a patient sensitized to Compositae pollen who had an anaphylactic reaction to the ingestion of honey obtained from bees foraging on Compositae flowers and was tested with a number of different varieties of honey.

[Growth curves in pediatrics. Pilot study in a city of south of Italy]. / Valori di crescita in soggetti pediatrici.

AIM: In the past years the body composition assessment in pediatric subjects showed great changes due to the different quality of life and different diet habits. Over-weight and obesity increased tremendously not only in the industrialized societies but also in developing countries. Growth curves developed in the 60s need to be revises in the light of these changes and population specific curves are needed to follow a population with different life style and energy intake. The aim of this study was to evaluate, in a city of South Italy (San Severo), pediatric subjects in order to create growth curves. METHODS: Between May 1999 and October 2000 we evaluated 2,262 subjects: 1,172 (51.8%) males and 1,090 (48.2%) females, age range 6-11 years (mean 8.48 +/- 2.28 years). Height, weight, thoracic circumference and body mass index (BMI) were measured by the same expert operator. RESULTS: Tables and figures for weight, height, thoracic circumferences and BMI at 3 degrees, 50 degrees, 97 degrees centile for age and gender were presented. A comparison between 50 degrees centile for BMI in males and females were also done showing the different development related to gender. CONCLUSIONS: The results obtained underline the importance of an auxologic follow-up of the pediatric subjects in order to evaluate their correct development. The specific growth curves available make it possible to analyze the development of subjects in comparison with the subjects studied for the curves development. Moreover, the importance of the BMI curve and the relationship of the 50 degrees centile in males and females showing the different growth curve related to gender, is underlined.

[Value of skin prick test and atopy patch test in mite-induced respiratory allergy and/or atopic eczema/dermatitis syndrome]. / Confronto tra skin prick test e atopy patch test nella diagnosi di allergia a Dermatophagoides in soggetti con patologia respiratoria e/o dermatite atopica.

AIM: The atopy patch test (APT) was introduced to assess sensitization to inhalant allergens in patients with atopic/eczema dermatitis syndrome (AEDS), but its diagnostic role in subjects with respiratory allergy is scantly investigated. We sought to evaluate the response to APT and to skin prick tests (SPT) with mite extracts in subjects with persistent respiratory symptoms (rhinoconjunctivitis, rhinosinusitis, asthma), with AEDS, and with both the diseases. METHODS: Eighty-nine patients were included in the study, 75 (84.3%) children and 14 (15.7%) adults, 54 (60.7%) males and 35 (39.3%) females (median age 5.4 years). They were divided in 3 groups, respectively formed by 47 (mean age 12.3+/-11.6 years), 15 (mean age 2.2+/-2.5 years), and 27 (mean age 6.2+/-6.3 years) subjects, according to the presence of only respiratory symptoms, only AEDS, or both, and underwent to usual SPT with mite extracts and to APTs done by mite extract in Finn chambers and removed after 48 hours, with readings after 20 minutes and 24 hours. RESULTS: Of the 89 patients, 24 showed a positive SPT and 69 a positive APT; in 17 both SPT and APT were positive, while 13 were negative to the 2 tests. The APT was more frequently positive than SPT not only in the 2 groups with AEDS -- 32/42 (86.5%) vs 8/42 (21.6%) -- but also in the group with only respiratory symptoms -- 37/47 (78.7%) vs 16/47 (34%). CONCLUSION: These results confirm the high value of APT in patients with mite-induced AEDS and suggest that its routine use might improve also the diagnosis of respiratory allergy to house dust mites.