Trace element levels in children with atopic dermatitis.

BACKGROUND: Trace elements are micronutrients that are present in small amounts in the body and are essential for normal functioning of the immune and antioxidant systems. Inflammation and oxidative stress are major pathogenic mechanisms in the development of atopic dermatitis (AD). The role of micronutrients in AD has been investigated in a limited number of studies, although the results are contradictory. OBJECTIVES: In this study, we examined the levels of iron, copper, and magnesium in serum and the level of zinc in erythrocytes in children with AD. We compared our findings with those of a healthy control group. METHOD: The study population comprised 92 AD patients and 70 controls. We performed a complete blood count and measured levels of iron, copper, and magnesium in serum and levels of zinc in erythrocytes. RESULTS: We found that serum magnesium and erythrocyte zinc levels were lower in children with AD than in the control group; levels of copper and iron did not differ between the groups. The levels of micronutrients studied were not correlated with disease severity. CONCLUSION: Evaluation of zinc and magnesium levels in children with AD could prove useful. The role of micronutrients in the pathogenesis and course of AD warrants further study.

Relationship between hair cadmium levels, indoor ETS exposure and wheezing frequency in children.

BACKGROUND: Cadmium (Cd) is a toxic heavy metal and the components of tobacco and scalp hair effectively reflect a long-term environmental exposure. OBJECTIVE: The aim of this study was to assess the concentration of Cd levels in the hair of children with recurrent wheezing, and to evaluate the predictors of elevated Cd levels with a focus on anthropometric, environmental, and dietary factors. METHODS: In this case-control study, scalp hair was obtained from 65 children with recurrent wheezing (RW) and from 65 healthy children (HC). Hair Cd concentrations were determined by ICP-MS. RESULTS: Median (IQR) hair Cd levels were 0.22 µg/kg (0.10-0.35) in RW group and 0.12 µg/kg (0.04-0.23) in HC group (p = 0.013). Multivariable logistic regression model results showed that being a child with RW (OR = 6.28; p = 0.001), ETS exposure at home (OR=22.56; p < 0.001), and mother's education level (OR = 0.49; p = 0.020), are the major predictor variables for elevated hair Cd levels (cut off >0.17 µg/kg). In RW group, multivariable logistic regression results showed that hair Cd levels of >0.17 µg/kg was significantly predictive of having three or more wheezing episodes in RW group after adjustment for ETS exposure at home (OR = 5.48; p = 0.012). CONCLUSION: We demonstrated that the more children are exposed to ETS at home, the more they are exposed to heavy metals like Cd. Especially children who have had three or more wheezing attacks over the last six months are much more susceptible than the other asthmatic and non-asthmatic children, and Cd exposure aggravates their asthmatic status.

Anaphylaxis in Turkish children: a multi-centre, retrospective, case study.

BACKGROUND: Anaphylaxis is a serious and potentially lethal systemic reaction affecting more than one organ or system. OBJECTIVE: We aimed to describe the demographic characteristics, clinical features, causes, settings, and administered therapy in Turkish children. METHODS: This retrospective, case note study included all children referred to the outpatient clinics of the Pediatric Allergy Departments of the participating study centres from 1 July 1999 to 30 June 2009 for investigation of anaphylaxis or who were seen by us at the moment of the reaction during the same period and who met the clinical criteria of anaphylaxis. RESULTS: Two hundred and twenty-four cases of anaphylaxis were reported in 137 children (88 boys, P = 0.0001). The mean ± SD age at the referral was 7.7 ± 4.2 years (range: 4 months-17 years). Ninety-eight episodes (43.8%) occurred at home. The symptoms were cutaneous in 222 (99.1%) episodes, respiratory in 217 (96.9%), neuro-psychiatric in 118 (52.7%), cardiovascular in 92 (41.1%), and gastrointestinal in 88 (39.3%). Biphasic reaction was reported in seven episodes (3.1%, 95% CI: 1.5-6.3). Death occurred in one case (0.4%, 95% CI: 0.08-2.4). Treatment was available in 158 episodes (70.5%). Of them, 148 (93.7%) received antihistamines, 132 (83.5%) corticosteroids, 51 (32.3%) epinephrine, and 17 (10.8%) beta-2-mimetics. The causative agents were foods in 86 (38.4%) episodes, hymenoptera venom in 84 (37.5%), drugs and medications in 47 (21.0%), and latex in 5 (2.2%). In two episodes (0.9%), the causative agent was unidentified. Allergy to the trigger was known prior to anaphylaxis in 116 (51.8%) episodes. An epinephrine auto-injector had been prescribed for 70 children (51.1%). CONCLUSIONS AND CLINICAL RELEVANCE: Anaphylaxis was seen significantly more in boys. Most of the reactions occurred at home. Foods were the most frequent cause. Epinephrine, the first-line treatment of anaphylaxis, was administered in only a third of the children.

Specific immunotherapy improves asthma related quality of life in childhood

Background: Asthma is the most common chronic illness in childhood and really affects the everyday life of patients who suffer from it. Since asthma is a common disease, there is a great endeavour to achieve the most appropriate treatment option. Despite inhaled corticosteroids and leukotrien receptor antagonists both being routinely used in asthma treatment, specific immunotherapy is still questioned. There are numerous aspects affecting asthma-related quality of life, such as age; seasons; disease control and severity etc, which are well studied -apart from the type of treatment. With this study we aimed to stress the influence of asthma treatment on quality of life. Methods: A total of 102 children, aged 6—18 years, were assigned to classic asthma therapy (n=50) and specific immunotherapy (n=52). The quality of life is assessed using the Standardized Pediatric Asthma Quality of Life Questionnaire (PAQLQ) interviewer-administered Turkish version. Pulmonary function testing was performed on the same day, after the questionnaire was completed. Results: The PAQLQ total scores were significantly higher in the specific immunotherapy group (p<0.001). Apart from emotional function domain scores; symptoms domain and activity limitation domain scores were higher in the specific immunotherapy group. Emotional function domain scores were similar in the two groups (p>0.05). There were no statistically significant differences in pulmonary function testing results between the two groups (p>0.05). There was a linear correlation between FEV1%, FVC level and total and domain scores of PAQLQ with Spearman Correlation tests (AU)

Serum heavy metal and antioxidant element levels of children with recurrent wheezing

Study Objectives: The aim of the study is to investigate the levels of toxic heavy metals related with environmental pollution and trace elements involved in antioxidant system in children suffering from recurrent wheezing. Study Design: One hundred children with recurrent wheezing (at least three recurrences) between the ages from 1 to 6 years took part in the study, and also 116 age- and sex- matched healthy children were involved in the study as a control group. Venous blood samples were collected and serum mercury, lead, aluminium, zinc, selenium, and copper levels were studied using ICP-MS. Results: Serum lead (0.76±0.15 vs. 0.27±0.01, p:0.001) and mercury levels (1.31±0.15 vs 0.71±0.05, p < 0.001) were higher in wheezy group than those acquired from the control group. Serum zinc (69.4±1.65 vs. 78.9±2.78, p:0.005) and selenium (115.6±1.87 vs. 125.4±2.94, p:0.008) levels were lower in wheezy group than those acquired from the control group. Serumz inc levels were found to be correlated with number of ARTIs (rp: -0.332, p: 0.001) and the number of wheezy attacks (rp: -0.776, p < 0.001) during the previous year in the wheezy group. Conclusion: Elevated levels of serum lead and mercury and low levels of zinc and selenium may suggest some disturbances in the antioxidant system in children with recurrent wheezing. This means that children with recurrent wheezing are much more susceptible to environmental pollutants and respiratory tract infections than healthy children and this heavy metal-antioxidant relationship may play a role as a contributing factor in the pathogenesis of recurrent wheezingin children (AU)

Serum heavy metal and antioxidant element levels of children with recurrent wheezing.

STUDY OBJECTIVES: The aim of the study is to investigate the levels of toxic heavy metals related with environmental pollution and trace elements involved in antioxidant system in children suffering from recurrent wheezing. STUDY DESIGN: One hundred children with recurrent wheezing (at least three recurrences) between the ages from 1 to 6 years took part in the study, and also 116 age- and sex- matched healthy children were involved in the study as a control group. Venous blood samples were collected and serum mercury, lead, aluminium, zinc, selenium, and copper levels were studied using ICP-MS. RESULTS: Serum lead (0.76±0.15 vs. 0.27±0.01, p:0.001) and mercury levels (1.31±0.15 vs 0.71±0.05, p<0.001) were higher in wheezy group than those acquired from the control group. Serum zinc (69.4±1.65 vs. 78.9±2.78, p:0.005) and selenium (115.6±1.87 vs. 125.4±2.94, p:0.008) levels were lower in wheezy group than those acquired from the control group. Serum zinc levels were found to be correlated with number of ARTIs (r(p):-0.332, p:0.001) and the number of wheezy attacks (r(p):-0.776, p<0.001) during the previous year in the wheezy group. CONCLUSION: Elevated levels of serum lead and mercury and low levels of zinc and selenium may suggest some disturbances in the antioxidant system in children with recurrent wheezing. This means that children with recurrent wheezing are much more susceptible to environmental pollutants and respiratory tract infections than healthy children and this heavy metal-antioxidant relationship may play a role as a contributing factor in the pathogenesis of recurrent wheezing in children.

Specific immunotherapy improves asthma related quality of life in childhood.

BACKGROUND: Asthma is the most common chronic illness in childhood and really affects the everyday life of patients who suffer from it. Since asthma is a common disease, there is a great endeavour to achieve the most appropriate treatment option. Despite inhaled corticosteroids and leukotrien receptor antagonists both being routinely used in asthma treatment, specific immunotherapy is still questioned. There are numerous aspects affecting asthma-related quality of life, such as age; seasons; disease control and severity etc, which are well studied -apart from the type of treatment. With this study we aimed to stress the influence of asthma treatment on quality of life. METHODS: A total of 102 children, aged 6-18 years, were assigned to classic asthma therapy (n=50) and specific immunotherapy (n=52). The quality of life is assessed using the Standardized Pediatric Asthma Quality of Life Questionnaire (PAQLQ) interviewer-administered Turkish version. Pulmonary function testing was performed on the same day, after the questionnaire was completed. RESULTS: The PAQLQ total scores were significantly higher in the specific immunotherapy group (p<0.001). Apart from emotional function domain scores; symptoms domain and activity limitation domain scores were higher in the specific immunotherapy group. Emotional function domain scores were similar in the two groups (p>0.05). There were no statistically significant differences in pulmonary function testing results between the two groups (p>0.05). There was a linear correlation between FEV1%, FVC level and total and domain scores of PAQLQ with Spearman Correlation tests.