Subject(s)
Dermatitis, Allergic Contact/immunology , Dermatitis, Occupational/immunology , Meat Products/adverse effects , Occupational Exposure/adverse effects , Penicillium/immunology , Adult , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/etiology , Dermatitis, Occupational/diagnosis , Dermatitis, Occupational/etiology , Female , Forearm/pathology , Humans , Meat Products/microbiology , Young AdultABSTRACT
A pediatric consensus report on allergen-specific immunotherapy for children and adolescents is presented for Austria. Products on the market in Austria are presented and categorised according to studies performed on the target population of children and adolescents, their effectiveness and indication. In general, more clinical studies on children and adolescents are mandatory for most of the available allergen-specific immunotherapeutics. In addition, the use of allergen-specific immunotherapy in general should be promoted as the exclusive treatment with long-lasting effects in type I allergies in particular in children.
Subject(s)
Allergens/classification , Allergens/therapeutic use , Desensitization, Immunologic/methods , Desensitization, Immunologic/trends , Hypersensitivity/drug therapy , Adolescent , Austria , Child , Child, Preschool , Female , Humans , MaleSubject(s)
Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adrenergic beta-Agonists/therapeutic use , Asthma/diagnosis , Child , Combined Modality Therapy , Drug Therapy, Combination , Evidence-Based Medicine , Follow-Up Studies , Humans , Leukotriene Antagonists/therapeutic use , Patient Education as Topic , Randomized Controlled Trials as TopicSubject(s)
Allergens/adverse effects , Dermatitis, Allergic Contact/diagnosis , Latex Hypersensitivity/diagnosis , Rubber/adverse effects , Adolescent , Adult , Dermatitis, Allergic Contact/etiology , Dermatitis, Allergic Contact/pathology , Diagnosis, Differential , Female , Humans , Latex Hypersensitivity/etiology , Latex Hypersensitivity/pathology , Male , Middle Aged , Patch Tests , Sports Equipment/adverse effectsABSTRACT
Parents who know they are carriers of a genetically transmitted disease because they gave birth to an affected child are being offered a number of reproductive options in a subsequent pregnancy. We describe the attitudes and motives of parents of children with cystic fibrosis (CF) who were initially determined to use prenatal testing but eventually refused it. Based on our observations and clinical impressions we built a model of change that entails a series of stages and depicts change as a process. This begins with the provision of comprehensive information and emotional support through health professionals (Stage 1). The parents then engage in intense confrontation with the impact of prenatal testing and are exposed to influences from many sides. The repeated comparing of the arguments results in uncertainty and distress (Stage 2). When pregnancy occurs a decision must be made and the process culminates in participating in a life-or-death decision. If the parents cannot cope with that responsibility then a change towards rejection of prenatal diagnosis is likely (Stage 3). This phenomenon seems to be the most decisive factor. A case vignette is used to illustrate this model which may be applicable to many individuals who face major and emotionally fraught decisions.
Subject(s)
Attitude to Health , Cystic Fibrosis/diagnosis , Parents , Prenatal Diagnosis , Adaptation, Psychological , Child , Decision Making , Female , Humans , Pregnancy , Social SupportABSTRACT
Recent publications suggest that long-acting beta-2 agonists (LABAs) increase the risk for death in asthma. The American Food and Drug Administration (FDA) published a relevant alert in 2005. In the currently valid Austrian consensus guidelines for drug therapy of bronchial asthma in children and adolescents, LABAs are only recommended as add-on therapy in those patients whose asthma is not sufficiently controlled by inhaled corticosteroids (ICS) alone. LABAs have no established role in earlier steps of the therapeutic algorithm; consequently, the prescription of ICS-LABA combinations for initial treatment of paediatric asthma is not supported by these consensus treatment guidelines.
Subject(s)
Adrenergic beta-Agonists/adverse effects , Adrenergic beta-Agonists/therapeutic use , Anti-Asthmatic Agents/adverse effects , Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Asthma/mortality , Practice Guidelines as Topic , Austria , Delayed-Action Preparations , Risk Assessment/methods , Risk FactorsSubject(s)
Asthma/diagnosis , Asthma/therapy , Bronchitis, Chronic/diagnosis , Bronchitis, Chronic/therapy , Practice Guidelines as Topic , Practice Patterns, Physicians'/standards , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/therapy , Asthma/complications , Austria , Bronchitis, Chronic/complications , Child, Preschool , Humans , Pulmonary Disease, Chronic Obstructive/etiology , Secondary PreventionSubject(s)
Allergens/adverse effects , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Occupational/diagnosis , Hand Dermatoses/diagnosis , Oils, Volatile/adverse effects , Dermatitis, Allergic Contact/etiology , Dermatitis, Allergic Contact/pathology , Dermatitis, Occupational/etiology , Dermatitis, Occupational/pathology , Diagnosis, Differential , Hand Dermatoses/chemically induced , Hand Dermatoses/pathology , Humans , Male , Middle Aged , Patch TestsABSTRACT
BACKGROUND: Atopic dermatitis has been thought to be associated with a disturbance in n-6 polyunsaturated fatty acid (PUFA) metabolism, but randomized trials investigating the clinical efficacy of oral supplementation with gammalinolenic acid have revealed conflicting results. AIM OF THE STUDY: To re-investigate the proposed linkage between PUFA dysregulation and atopic dermatitis. MATERIALS AND METHODS: Plasma levels of linoleic acid (LA), gammalinolenic acid (GLA), dihomogammalinolenic acid (DGLA) and arachidonic acid (AA) were measured using HPLC in 22 children with atopic dermatitis. Patients were subdivided into those with elevated total serum IgE (group A, n = 15, IgE > +1 SD of age-specific normal values) and those with normal IgE (group B, n = 7) and compared with children suffering from allergic rhinitis/asthma (group C, n = 8) and with non-atopic controls (group D, n = 6). RESULTS: GLA levels were significantly lower (p < 0.05) in eczema patients with elevated IgE (A, 0.19 +/- 0.06%) and in atopic controls (C, 0.23 +/- 0.06%) than in eczema patients with low IgE (B, 0.42 +/- 0.19%) and non-atopic controls (D, 0.43 +/- 0.16%). There were no significant differences between groups for LIN, DGLA and AA, except for lower LIN levels in atopic controls. Correlation of individual LA and GLA values showed significantly steeper regression lines in low-IgE responders (B and D, k(x) = 0.058) than in high-IgE responders (A and C, k(x) = 0.012; p < 0.02), suggesting impaired delta-6-desaturase function in the latter. For the study population as a whole, there was a clear negative correlation between total levels of IgE and GLA (r(s) = -0.64) and a moderate negative correlation between total IgE and AA (r(s) = -0.38). CONCLUSIONS: Dysregulation of n-6 PUFA metabolism is neither consistently found in nor specifically associated with atopic dermatitis but rather appears to be associated with IgE production and atopy in general. The finding of decreased GLA levels in eczema patients with elevated total IgE and in children with allergic rhinitis and asthma but not in eczema patients with normal total IgE questions the proposed pathophysiologic role of fatty acid dysregulation in atopic dermatitis.
Subject(s)
Dermatitis, Atopic/blood , Fatty Acids, Unsaturated/blood , Immunoglobulin E/blood , Risk Assessment/methods , Asthma/blood , Asthma/diagnosis , Asthma/epidemiology , Biomarkers/blood , Child , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/epidemiology , Female , Humans , Male , Prevalence , Prognosis , Rhinitis, Allergic, Perennial/blood , Rhinitis, Allergic, Perennial/diagnosis , Rhinitis, Allergic, Perennial/epidemiology , Risk FactorsSubject(s)
Adolescent Medicine , Asthma/drug therapy , Pediatrics , Pulmonary Medicine , Societies, Medical , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Adrenergic beta-Agonists/administration & dosage , Adrenergic beta-Agonists/therapeutic use , Adult , Age Factors , Anti-Asthmatic Agents/administration & dosage , Anti-Asthmatic Agents/therapeutic use , Austria , Bronchodilator Agents/administration & dosage , Bronchodilator Agents/therapeutic use , Child , Drug Therapy, Combination , Humans , Leukotriene Antagonists/administration & dosage , Leukotriene Antagonists/therapeutic use , Practice Guidelines as Topic , Theophylline/administration & dosage , Theophylline/therapeutic use , Time FactorsSubject(s)
Aid to Families with Dependent Children/legislation & jurisprudence , Disability Evaluation , Disabled Children/legislation & jurisprudence , Eligibility Determination/legislation & jurisprudence , Pulmonary Disease, Chronic Obstructive/diagnosis , Adolescent , Austria , Child , Child, Preschool , Humans , Infant , Pulmonary Disease, Chronic Obstructive/etiology , Pulmonary Disease, Chronic Obstructive/therapyABSTRACT
Patch testing was done on 2776 consecutive patients (76.5% female) with a locally revised standard series of 34 contact allergens and the results analyzed for age- and gender-specific differences. At least one positive epicutaneous test reaction occurred in 48.9% of patients. Nickel (20.9%), ethylmercuric chloride (13.2%), thimerosal (11.8%), fragrance mix (9.3%), metallic mercury (8.9%), palladium (5.8%), balsam of Peru (3.8%), copper (3.7%), cobalt (3.3%), and chromium (2.3%) were the 10 most important sensitizers. The following tested allergens with sensitization rates of more than 1% were not part of the usual standard series: ethylmercuric chloride, metallic mercury, copper, propolis (1.3%), propylene glycol (1.0%). Reactions to nickel, cobalt, and palladium, but not to chromium, were significantly more abundant in females (p < 0.002, chi-squared test). The overall sensitization rate was highest in children less than 10 years old (62%) and decreased steadily, to be lowest among patients more than 70 years old (34.9%). The rate of positive reactions to nickel and thimerosal decreased with age, while fragrance mix and metallic mercury stayed at the same level through all age groups.
Subject(s)
Allergens , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/epidemiology , Immunization/methods , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Austria/epidemiology , Child , Child, Preschool , Dermatitis, Allergic Contact/immunology , Female , Humans , Incidence , Male , Metals/pharmacology , Middle Aged , Nickel/pharmacology , Patch Tests/methods , Perfume/pharmacology , Registries , Retrospective Studies , Risk Factors , Sex DistributionABSTRACT
Improved care for patients with cystic fibrosis (CF) has led to their improved survival. We analyzed retrospectively whether improvements in lung function (LF) could be detected in our CF patients over the decade 1980-1990. In 72 patients, 153 LF measurements were performed in their first year of life (1980-1991), and then 189 LF measurements were performed again in 60 of those patients during their sixth year of life (1987-1997). Regression analysis was performed on LF parameters at age 6 years. When adjusting for weight, height, gender, and LF in the first year of life, the date of subsequent measurement was positively associated with FEV(1) (P < 0.01) and MEF(50%) (P < 0.05) and negatively with FRC(pleth) (P < 0.05). The proposed model predicts a child's FEV(1) at age 6 to be 75% of predicted if born in 1980, but 108% of predicted when born in 1990. Improved CF care is the most likely explanation for this observation.