A retrospective analysis of adenoidal size in children with allergic rhinitis and nonallergic idiopathic rhinitis.

BACKGROUND: Increased incidence of adenoidal tissue enlargement in children with allergic rhinitis (AR) when compared to non-atopic children had been reported. However, data with respect to the comparison of adenoidal size in children with AR and non-allergic idiopathic rhinitis (IR) is still lacking in the literature. OBJECTIVE: We aimed to compare the size of the adenoid in children with AR and with nonallergic IR. METHODS: Adenoid/nasopharynx ratios (ANR) of all children were calculated in both AR and IR patients and the mean ratios were compared. RESULTS: There were 52 patients in the AR group and 56 patients in the nonallergic IR group. Demographic data were similar within the two groups. The mean ANR was 0.59 +/- 0.08 in AR group, whereas it was 0.77 +/- 0.12 in nonallergic IR group. The ANR was very significantly high in the nonallergic IR patients (p = 0.0001). CONCLUSION: Our results suggest that there could be a cellular immune deficiency in allergic children which effects the enlargement of the pharyngeal tonsils. This might be explained with the hypothesis that allergic patients have a deficiency in T-helper 1 cell activity and interferon-gamma production. Larger studies which compare the cytokine profiles of children with AR and with nonallergic IR, will clarify the role of recurrent respiratory infection which is a real problem in clinical practice with allergy.

Aminophylline for treating asthma and chronic obstructive pulmonary disease.

Aminophylline is a complex of theophylline and ethylenediamine. Its main pharmacological action is relaxation of bronchial smooth muscle. Two meta-analyses examining the efficacy of aminophylline in acute asthma attacks in children and in adults have been reported by the Cochrane Collaboration. In the meta-analysis reporting results from studies in children, it was concluded that aminophylline does not add any benefit to standard care. Yet one study, which has the largest patient population, reports that aminophylline improves lung functions within 6-8 h and reduces the risk of intubation. The meta-analysis examining adult studies revealed that there is no outstanding difference between aminophylline and standard therapy in the management of adult acute asthma. In conclusion, aminophylline may be an alternative to intravenous infusion of beta-agonists, heliox or magnesium sulfate administration in children in whom respiratory fatigue begins to develop and intensive-care unit admission and mechanical ventilation seems to be the next treatment in line. However, in adults, it is not recommended for use in the treatment of acute asthma owing to its possible adverse effects.

The role of IL-18 in Th1/Th2 balance in children.

Interleukin (IL)-18 has been identified as a mediator inducing interferon gamma release from type 1 helper (Th1) cells, CD8+ T cells, and natural killer cells, synergizing with IL-12. Several studies report differential roles of IL-18; but little is known about the role of IL-18 in Th1/Th2 balance in children. The aim of this study was to evaluate the role of IL-18 in Th1- and Th2-mediated diseases of children. Serum IL-18 levels were measured in a group of patients with acute asthma exacerbation (n = 24), in a group of patients who had recently been diagnosed as type I insulin-dependent diabetes mellitus (n = 18), and in a group of healthy subjects (n = 20). The groups were compared with respect to IL-18 levels. Significantly lower serum IL-18 levels were found in patients with acute asthma (median, 8.55 pg/mL) and insulin-dependent diabetes mellitus (median, 7.20 pg/mL) than in control subjects (median, 140.10 pg/mL; p < 0.05 and p < 0.001, respectively). We suggest that IL-18 may play an immunoregulatory role in allergic and autoimmune diseases and decreased expression of IL-18 can shift the immune responses to both Th1- and Th2-mediated ways.

Does recurrent sinusitis lead to a sinusitis remodeling of the upper airways in asthmatic children with chronic rhinitis?

BACKGROUND: There is a growing recognition that some patients with long-standing asthma may possess a component of irreversible airflow obstruction due to airway remodeling. The underlying chronic inflammation has been implicated as the cause of this process. In the upper airways, the inflammation presents itself with symptoms of chronic rhinitis, leading to recurrent sinusitis, in some patients. OBJECTIVE: We attempted to determine if any changes that might be considered remodeling had occurred in the nasopharynx and paranasal sinuses of asthmatic children with recurrent sinusitis. METHODS: Computerized-tomography (CT) scanning of the nasopharynx and paranasal sinuses was investigated retrospectively. RESULTS: Sixty-six asthmatic patients with chronic rhinitis and recurrent sinusitis were analyzed in this respect. Their mean age was 7.41 +/- 2.91 years (26 female, 39 male). In 89% (n = 59) of the patients, tomography findings were abnormal. Among these subjects, sinusal-mucosal thickening was present in 75% (n = 44), and concha hypertrophy was present in 51% (n = 30). Adenoid hypertrophy was present in 20% (n = 12), and septum deviation was present in 17% (n = 10). CT findings were normal in 11% (n = 7). CONCLUSION: In most of the asthmatic children having chronic rhinitis and recurrent sinusitis, the upper respiratory tract underwent a series of changes, which might be assessed as remodeling. Thus, tomography of the upper-respiratory tract may provide some useful information about the state of the disease, and to what extent the treatment can relieve symptoms of the sinus disease and the concomitant asthma.

Effects of passive smoking on lung function in children.

BACKGROUND: Passive smoking can have significant effects on lung function with reductions in forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and forced mid-expiratory flow rate (FEF25-75%) of between 5 and 10%. METHODS: Fifty non-smoking children aged 6-15 years, who had no history of asthma or atopy and no parental history of atopy, were assessed with respect to their lung functions (FEV1, FEV1/FVC, FEF25-75%). RESULTS: Thirty-three of these children were being exposed to environmental tobacco smoke inside their homes, while 17 children were not exposed. In the 'passive smoker' group the FEV1, FEV1/FVC and FEF25-75% values were found to be significantly lower than the non-smoker control group's values (P = 0.0080, 0.0228 and 0.0003, respectively). The decrease in FEF25-75% was significantly correlated inversely with the number of cigarettes smoked per day (P = 0.0261). CONCLUSION: There is sufficient evidence to support the notion that environmental tobacco smoke is a serious health burden for children. Considering that recent studies suggest that up to 70% of children grow up in homes with at least one smoker, every effort should be made to reduce these children's exposure to environmental tobacco smoke and to give them a chance to grow up in a more healthy environment.

Which factors predict success after discontinuation of inhaled budesonide therapy in children with asthma?

Urinary eosinophil protein X (UEPX) concentration, lung function, and nonspecific bronchial hyperreactivity were determined in 40 asthmatic children (asymptomatic for 6.4 +/- 3.0 months) (mean age 9.8 +/- 2.9 years) receiving inhaled budesonide, in order to establish whether measurement of these parameters is useful in determining discontinuation of inhaled corticosteroid therapy. After the discontinuation of therapy, patients were asked to come to the Outpatient Clinic if symptoms recurred and did not respond to beta2 mimetic usage in 24 hr. Otherwise they were to be seen 2-3 months later for a follow-up visit. UEPX concentration was determined and spirometry was performed on this visit. While UEPX concentrations had increased (p < 0.0001), FEV1, FEF 25-75 and PEF had decreased significantly 2.3 +/- 0.53 months after the cessation of inhaled budesonide therapy in all children (p = 0.004, p = 0.02, p = 0.02, respectively). Due to clinical deterioration, inhaled corticosteroid therapy had to be restarted in 19 (48%) of the children (Group I), while the remaining 21 (52%) (Group II) continued to be asymptomatic during the 2.3 +/- 0.5 months follow-up period. Although the initial UEPX concentrations, spirometer variables, and methacholine PC20 values of these two groups were not statistically different, the duration of clinical remission before discontinuation of budesonide prophylaxis was significantly longer in group II (p = 0.0037). We concluded that, in determining discontinuation of inhaled corticosteroid prophylaxis, duration of clinical remission seems to be a more useful criterion than measurement of UEPX levels, lung function test, and assessment of bronchial hyperreactivity.