Prevalence of and risk factors for atopic dermatitis: A birth cohort study of infants in southeast Turkey.

BACKGROUND: Atopic dermatitis (AD) is most common in the first year of life. The aim of this study was to determine the prevalence of and risk factors for AD in a birth cohort of infants from southeast Turkey. METHODS: Adana Paediatric Allergy Research (ADAPAR) birth cohort study was derived from 1377 infants who were born in Cukurova University, Medical Hospital, Adana, Turkey between February 2010 and February 2011. At birth, a physical examination was performed, cord blood samples were taken, and the mother completed a baseline questionnaire that provided data on gestational conditions, family history of allergic diseases and environmental exposures. Follow-up visits scheduled at 3, 6, and 12 months included an infant physical examination and an extended questionnaire. Skin prick test was performed and food-specific IgE levels were measured at 6 and 12 months. Atopic dermatitis was diagnosed based on confirmatory examination by a physician. RESULTS: Of the 1377 infants enrolled, 59 (4.3%) were diagnosed with AD as of 12 months. Maternal allergic disease (ORs 6.28, 95% CI 1.03-38.30; p=0.046), maternal infection during gestation (ORs 3.73, 95% CI 1.25-11.09; p=0.018), and presence of food allergy (ORs 13.7, 95% CI 3.07-61.0; p=0.001) were identified as risk factors for AD. Breastfeeding and cord blood IgE levels were not identified as risk factors. CONCLUSIONS: In this cohort we found prevalence of AD as 4.3% during the first year of life. Positive family history of atopic diseases, prenatal infections and presence of food allergy are the risk factors for early presentation of AD.

Potential association between allergic diseases and pertussis infection in schoolchildren: results of two cross-sectional studies seven years apart.

BACKGROUND: In this study, we aimed to investigate the relationship between pertussis infections and allergic diseases in two cross-sectional questionnaire-based surveys carried out in 1997 and 2004. We also measured serum level of antibody to B. pertussis. MATERIAL AND METHODS: Two cross-sectional, questionnaire-based surveys were carried out in 1997 (n = 3164) and 2004 (n = 3728). 361 cases and 465 controls were recruited from both surveys. The skin tests were performed using standardised extracts. The level of pertussis specific IgG was measured in 136 allergic and 168 non-allergic children. RESULTS: We found that allergic diseases prevalence was significantly higher in the children suffering from pertussis infections (22.3 % fi rst and 8.8 % second survey) compared to children who did not suffer from pertussis infections (6.6 % fi rst and 4.5 % second survey) (p = 0.001 and p = 0.035, respectively). Asthma prevalence was also significantly higher in children suffering from pertussis infection (37.6 % fi rst and 26.2 % second survey) compared to children who did not suffer from pertussis (7.4 % fi rst and 5.0 % second survey) (p = 0.001 and p = 0.001, respectively). However, the mean serum levels of anti-pertussis IgG were similar in allergic and non-allergic groups (p > 0.05). CONCLUSION: Although pertussis antibody levels in atopic and non-atopic children were similar to each other, pertussis infection still seemed to have a significant effect on the development of atopic diseases.

Indices of lower airway inflammation in children monosensitized to house dust mite after nasal allergen challenge.

BACKGROUND: There are few available data assessing the united airway disease and its systemic aspects in children. With this study, we aimed to investigate the inflammation markers of upper and lower airways before and after nasal allergen challenge in mite sensitive children with different clinical expression of the allergic disease. METHODS: Four study groups were formed: rhinitis only, without bronchial hyper-responsiveness (R, n = 10), rhinitis with asthma (R + A, n = 22), atopic asymptomatics (AA, n = 8) and nonallergic healthy controls (C, n = 10). Blood eosinophils, nasal and sputum eosinophils, sputum eosinophil cationic protein (ECP) and cys-LTs, and serum ECP levels were measured before and 24 h after nasal allergen challenge. RESULTS: The groups were comparable in terms of age and gender. Cumulative symptom scores recorded during and 1 h after nasal challenge were not significantly different between patients with R, R + A and AA groups. At T(24), the children belonging to R, R + A and AA showed significant increases in nasal eosinophils (P < 0.01, P < 0.001, and P = 0.01, respectively), sputum eosinophils (P = 0.01, P < 0.001, and P < 0.05, respectively) and blood eosinophils (P < 0.01, P < 0.001, and P < 0.05, respectively). Similarly, increases in sputum ECP (P < 0.01, P < 0.001, and P = 0.07, respectively) and sputum cys-LT levels (P = 0.07, P < 0.001, and P < 0.05, respectively) were detected in children belonging to these three groups at T(24). Sputum eosinophils significantly correlated with blood eosinophils (r = 0.54, P < 0.001) and sputum ECP (r = 0.58, P < 0.001) at T(24). CONCLUSIONS: This study showed that nasal allergen challenge increased markers of eosinophilic inflammation in both upper and lower airways of children monosensitized to mites, even before the onset of clinical symptoms.

Specific allergen immunotherapy: effect on immunologic markers and clinical parameters in asthmatic children.

BACKGROUND: Specific allergen immunotherapy (SIT) is the main treatment modality for achieving long-term symptom relief in perennial allergic diseases. OBJECTIVE: The aim of this study was to evaluate the effect of 1 year of house dust mite immunotherapy on the concentrations of 3 immunologic markers: eosinophil cationic protein (ECP), nitric oxide (NO), and monocyte chemoattractant protein 1 (MCP-1). We also compared the effect on asthma symptoms and medication scores, allergen-specific bronchial challenge test, and the skin prick test. METHODS: A total of 31 mite-allergic, asthmatic children (age range, 6-16 years) were enrolled; 19 were treated with SIT and 12 controls who had refused SIT received only drug treatment. Efficacy was evaluated using serum NO, ECP, and MCP-1 levels, and asthma symptom and medication scores, allergen-specific bronchial challenge test, and skin-prick test. The results of the tests were compared at baseline and after 1 year of treatment. RESULTS: Serum NO and ECP levels decreased significantly in the SIT group (P = .01 and P = .018) compared to baseline, whereas control group values remained similar. The serum MCP-1 level decreased significantly in both the SIT and control groups (P = .009 and P = .041, respectively). The SIT group experienced significant improvement in asthma symptoms (P = .001) and medication scores (P = .001) and skin reactivity to Dermatophagoides pteronyssinus (P = .020), whereas the control group did not. The results of bronchial challenge to D pteronyssinus showed a similar pattern at baseline and after 1 year of treatment in both groups. The tolerated allergen concentration increased in both groups (P < .05). Lung function tests, total immunoglobulin (Ig) E and specific IgE to D pteronyssinus and Dermatophagoides farinae did not change after a year of treatment in either group. CONCLUSION: SIT with D pteronyssinus improves immunological and clinical parameters in mite-allergic asthmatic children after 1 year of treatment. The skin prick test may be used as a marker of efficacy of therapy.

Is there any relationship between asthma and asthma attack in children and atypical bacterial infections; Chlamydia pneumoniae, Mycoplasma pneumoniae and Helicobacter pylori.

UNLABELLED: Asthma is a chronic inflammatory airway disease characterized by variable airway obstruction and bronchial hyperresponsiveness. There are many factors affecting the development and severity of childhood asthma such as genetic predisposition, atopy, environmental factors, obesity, diet, socioeconomic status, and infectious triggers. In the present study we aimed to investigate the frequency of Mycdoplasma pneumoniae, Chlamydia pneumoniae, and Helicobacter pylori infections in asthmatic children. We investigated also whether there is a relationship between these agents and asthma attacks. MATERIAL AND METHODS: Seventy-nine asthmatic children (46 males, aged 5-15 years) were included in study. The study group was divided into two groups: group 1 consisted of 37 children with asthma attacks and group 2 consisted of 42 children with stable asthma. As a control group we studied 36 healthy children. Pulmonary function tests, skin prick tests for common allergens were performed; serum total IgE, phadiatop, specific IgM and IgG antibody levels (ELISA) for M. pneumoniae, C. pneumoniae and H. pylori were measured in all patients. RESULTS: Mycoplasma IgM and Chlamidia IgM were positive in 8.1% (3 patients) and 18.9% (7 patients) of group 1 patients, respectively. There was a statistically significant difference for Mycoplasma IgM (p = 0.031) and Chlamidia IgM (p = 0.03) between group1 and other two groups. We have not found significant difference for M. pneumoniae IgG, C. pneumoniae IgG and H. pylori IgM and IgG among groups. CONCLUSION: M. Pneumoniae and C. Pneumoniae may play a role in development of asthma exacerbations in childhood. We could not find a relationship between H. Pylori and asthma.

Prevention of new sensitizations by specific immunotherapy in children with rhinitis and/or asthma monosensitized to house dust mite.

BACKGROUND: Previous studies have suggested that single-allergen-specific immunotherapy (SIT) may prevent sensitization to other airborne allergens in monosensitized children. We aimed to assess the prevention of new sensitizations in monosensitized children treated with single-allergen SIT injections in comparison with monosensitized patients given appropriate pharmacologic treatment for their disease. METHODS: A total of 147 children with rhinitis and/or asthma monosensitized to house dust mite were studied; 45 patients underwent SIT with adsorbed extracts and 40 patients underwent SIT with aqueous extracts for 5 years. The control group was comprised of 62 patients given only pharmacologic treatment for at least 5 years. Skin prick tests, medication scores for rhinitis and asthma, and atopy scores according to skin prick tests were evaluated at the beginning and after 5 years of treatment. RESULTS: All groups were comparable in terms of age, sex, and disease characteristics. At the end of 5 years, 64 out of 85 (75.3%) in the SIT group showed no new sensitization, compared to 29 out of 62 children (46.7%) in the control group (P = .002). There were no differences between the SIT subgroups with regard to onset of new sensitization (P = .605). The patients developing new sensitizations had higher atopy scores (P = .002) and medication scores for both rhinitis (P = .008) and asthma (P = .013) in comparison to patients not developing new sensitizations after 5 years of SIT. CONCLUSION: According to our data, SIT has the potential to prevent the onset of new sensitizations in children with rhinitis and/or asthma monosensitized to house dust mite.

Bronchiectasis: still a problem.

The prevalence of bronchiectasis (BR) has decreased significantly in industrialized countries, but is still commonplace in developing countries. We evaluated the causes and clinical features of BR in 23 children (13 boys (57%) and 10 girls (43%), with a mean age of 8.45 +/- 4.02 years). Infection was the major cause of BR in our region. In 8 patients, BR developed after tuberculosis or pneumonia, was associated with immune deficiency syndromes in 4 children, and with asthma in 4. Cystic fibrosis was diagnosed in 4 cases and ciliary dyskinesia in 3. In 10 patients, only one lobe was involved. Bronchiectatic lesions were most commonly found in the left lower lobe and were observed in 7 patients. Multilobar involvement was found in 13 patients. The initial treatment was primarily medical, but in 2 patients whose medical therapy failed, pulmonary resection was carried out. Three patients died from severe pulmonary infection and respiratory failure.

Cytokine levels in serum of patients with juvenile rheumatoid arthritis.

We investigated serum levels of interleukin (IL)-1beta, IL-6, IL-8, IL-12 and tumour necrosis factor (TNF)-alpha in JRA patients during both active and inactive phases of the disease. The systemic JRA patients had the highest IL-1beta and IL-6 levels during both active and inactive periods. In the systemic group IL-1beta, IL-6 and IL-12 levels during the active period were elevated compared to the inactive period (p = 0.0173, p = 0.0359 and p = 0.0117, respectively). Levels of these cytokines during the inactive stage were still greater than those of controls. IL-8 and TNF-alpha levels during both active and inactive periods were comparable to controls. IL-1beta correlated strongly with CRP and ESR (p = 0.008 and p = 0.031, respectively). IL-6 correlated significantly with CRP (p = 0.002). IL-12 levels were found to be correlated with ESR and CRP (p = 0.03 and p = 0.04, respectively). In active polyarticular JRA patients, IL-6 levels were elevated compared to the inactive phase, and the control (p = 0.001) IL-12 levels decreased significantly with clinical remission (p = 0.018). There was a strong correlation between 11-12 levels and number of joint with limited motion (p = 0). In oligoarticular JRA patients, IL-12 levels during active period were greater than in the controls and there was a marked decrease in IL-12 levels when the patients entered the inactive phase (p = 0.001) In conclusion, IL-1beta, IL-6 and IL-12 may play an important role in JRA and may be used as a marker of disease activity.

Hereditary angioedema: case report of a family.

Hereditary angioedema (HAE) is a rare disease resulting from deficiency of complement 1 esterase inhibitor (C1-INH). The clinical manifestations of this disease include recurrent attacks of self-limiting edema affecting face, extremities, gastrointestinal system and upper airways. In this report, we present eleven members of a family with HAE. Edema of the extremities was the most common symptom, occurring in ten patients. Three patients experienced severe laryngeal edema that required tracheotomy. Three patients developed facial and scrotal edema. Three patients experienced severe abdominal pain. The mean age at onset of symptoms was 11 years. C1-INH levels were undetectable in two patients and low in nine patients. CH50 was undetectable in all of the patients. C4 level for all patients was low. HAE in our first case, a 10-year-old boy, was diagnosed on the basis of low C1-INH, CH50 and C4, in addition to his familial history. Eleven members of this family, for whom laboratory studies could not be done, had similar symptoms and course. Two patients died as a result of laryngeal edema before establishment of diagnosis. This case report indicates the importance of recognition and early treatment of HAE to prevent a potentially fatal outcome.

Correlation between atopic diseases and tuberculin responses.

BACKGROUND: In recent decades, the prevalence of atopic diseases has risen steadily in developed countries. The reasons for this increase are not clear. It has been hypothesized that a reduction in infections and immunization programs may contribute to the increase in the prevalence of atopic diseases. We investigated the relationship between tuberculin response and atopic disease. METHODS: A total of 538 (73.0%) atopic and 198 (27.0%) nonatopic children vaccinated with BCG were included in the study. All the children included in the study had neither been given BCG nor tuberculin skin-tested in the previous 6 months, nor did they have a condition known to cause anergy. All the children were given five tuberculin units PPD, and PPD indurations were recorded after 48 h. RESULTS: The PPD induration size was 6.8 +/- 5.6 mm (mean +/- SD) in atopic children and 7.4 +/- 5.9 mm in nonatopic children. The difference between the two groups was not significant (P > 0.05). The PPD induration sizes of children with asthma, rhinitis, and atopic dermatitis were found to be similar. The children with atopic dermatitis had lower PPD induration size, but this was not statistically significant (P> 0.05). The rates of negative (< 5 mm skin induration) and intermediate (5-9 mm) responses were 32.6% and 30.5% in atopic children and 30.2% and 32.4% in nonatopic children, respectively. Positive tuberculin responses (PPD > 10 mm) were recorded in 36.9% of atopic children and 37.4% of nonatopic children. Total serum IgE levels of atopic and nonatopic children were 623.35 and 46.78 IU/ml, respectively. There was no correlation between serum total IgE level and PPD induration size (r = - 0.0012, P = 0.737). CONCLUSIONS: We did not find any relationship between tuberculin response and atopy status later in life in BCG-immunized subjects. We need further studies to clarify the effect of BCG on the development of atopy.