Severe eczema in infancy can predict asthma development. A prospective study to the age of 10 years.

BACKGROUND: Children with atopic eczema in infancy often develop allergic rhinoconjunctivitis and asthma, but the term "atopic march" has been questioned as the relations between atopic disorders seem more complicated than one condition progressing into another. OBJECTIVE: In this prospective multicenter study we followed children with eczema from infancy to the age of 10 years focusing on sensitization to allergens, severity of eczema and development of allergic airway symptoms at 4.5 and 10 years of age. METHODS: On inclusion, 123 children were examined. Hanifin-Rajka criteria and SCORAD index were used to describe the eczema. Episodes of wheezing were registered, skin prick tests and IgE tests were conducted and questionnaires were filled out. Procedures were repeated at 4.5 and 10 years of age with additional examinations for ARC and asthma. RESULTS: 94 out of 123 completed the entire study. High SCORAD points on inclusion were correlated with the risk of developing ARC, (B = 9.86, P = 0.01) and asthma, (B = 10.17, P = 0.01). For infants with eczema and wheezing at the first visit, the OR for developing asthma was 4.05(P = 0.01). ARC at 4.5 years of age resulted in an OR of 11.28(P = 0.00) for asthma development at 10 years. CONCLUSION: This study indicates that infant eczema with high SCORAD points is associated with an increased risk of asthma at 10 years of age. Children with eczema and wheezing episodes during infancy are more likely to develop asthma than are infants with eczema alone. Eczema in infancy combined with early onset of ARC seems to indicate a more severe allergic disease, which often leads to asthma development. The progression from eczema in infancy to ARC at an early age and asthma later in childhood shown in this study supports the relevance of the term "atopic march", at least in more severe allergic disease.

No effect of probiotics on respiratory allergies: a seven-year follow-up of a randomized controlled trial in infancy.

BACKGROUND: Supplementation with the probiotic Lactobacillus reuteri reduced the incidence of IgE-associated allergic disease in infancy. This treatment might therefore also reduce the risk of asthma and allergic rhinoconjunctivitis in school age. OBJECTIVE: To evaluate whether perinatal and infant supplementation with L. reuteri reduced the prevalence of respiratory allergic disease in school age and to explore whether this supplementation was associated with any long-term side effects. METHODS: A randomized, placebo-controlled trial with oral supplementation with L. reuteri ATCC 55730 (1 × 10(8) CFU) during the last month of gestation and through the first year of life comprising 232 families with allergic disease, of whom 184 completed a 7-yr follow-up. The primary outcomes at 7 yr of age were allergic disease and skin prick test reactivity (ClinicalTrials.gov ID NCT01285830). RESULTS: The prevalence of asthma (15% in the probiotic vs. 16% in placebo group), allergic rhinoconjunctivitis (27% vs. 20%), eczema (21% vs. 19%) and skin prick test reactivity (29% vs. 26%) was similar in the probiotic and placebo group. Growth indices and gastrointestinal symptoms were similar in the two groups. No severe adverse events were reported. CONCLUSION: The effect of L. reuteri on sensitization and IgE-associated eczema in infancy did not lead to a lower prevalence of respiratory allergic disease in school age. Thus, the effect of L. reuteri on the immune system seems to be transient. Administration of L. reuteri during the last weeks of gestation and in infancy was not associated with any long-term side effects.

Oral health in young adults with long-term, controlled asthma.

OBJECTIVE: To study oral health in young adults with long-term, controlled asthma. MATERIAL AND METHODS: Twenty 18- to 24-year-olds with a mean duration of asthma of 13.5 [standard deviation (SD) 5.4] years and 20 matched healthy controls were included. A clinical examination was performed and the prevalences of caries, erosions, gingival inflammation, cervicular fluid and periodontal pockets and the plaque formation rate were registered. The salivary flow rate and the numbers of mutans Streptococci and Lactobacilli in saliva were determined. Plaque pH was measured after a sucrose rinse for up to 40 min at two approximal sites. The participants were interviewed regarding dietary and oral hygiene habits. RESULTS: The mean (SD) DFS, including manifest and initial caries, was 8.6 (10.6) in the asthma group and 4.0 (5.2) in the control group (P = 0.09). Initial caries lesions were more common in the asthma group than in the control group: 6.0 (8.1) and 1.3 (2.0), respectively (P = 0.02). The asthma group had more gingivitis (P = 0.01) and a lower stimulated salivary secretion rate than the controls (P = 0.01). The asthmatics also had a somewhat, although not statistically significant, lower initial pH value in plaque and a more pronounced pH drop compared with the controls. In the asthma group, 65% reported frequent mouthbreathing, compared with 10% of the controls (P = 0.01). No differences were found in tooth-brushing or dietary habits between the groups. CONCLUSION: Young adults with long-term, controlled asthma had more initial caries, more gingival inflammation and a lower stimulated salivary secretion rate than individuals without asthma.

Oral health in pre-school children with asthma--followed from 3 to 6 years.

OBJECTIVE: The aim of this study was to investigate caries and its determinants in preschool children with and without asthma, followed from 3 to 6 years. METHODS AND SUBJECTS: Caries, plaque, and gingivitis were examined at 3 and 6 years of age in 64 asthmatic children and 50 matched, healthy control children. Furthermore, at 6 years radiographic examination and saliva sampling were conducted. The parents were interviewed about various oral health-related factors. RESULTS: Initial caries increment between 3 and 6 years of age was statistically significant higher for children with asthma compared with children without asthma (P < 0.05). Asthmatic children had more bleeding gingivitis and a higher consumption of sugary drinks than healthy children at 3 years of age (P < 0.05). At both 3 and 6 years of age, the asthmatic children were more frequently mouth breathers than healthy children, only statistically significant for 6-year olds (P < 0.05). CONCLUSION: Preschool children with asthma at 3 years of age run a higher risk of developing caries lesions until 6 years of age compared with children without asthma. Children with asthma have a higher prevalence of bleeding gingivitis, a higher intake of sugary drinks and are more frequently mouth breathers than preschool children without asthma.

Oral health in preschool children with asthma.

OBJECTIVE: The aim of this study was to investigate oral health and its determinants in 3-year-old and 6-year-old children with asthma. METHODS AND SUBJECTS: Caries and gingivitis were examined in 127 asthmatic (all children with asthma in a selected area and born during a specific time period) and 117 matched, healthy control children. The parents were interviewed regarding various oral-health-related factors. RESULTS: The mean dfs (+/- standard deviation) in the 3-year-old with asthma was 1.4 +/- 3.2 compared with 0.5 +/- 1.2 in the controls (P < 0.05). The corresponding figures for the 6-year-old were 2.5 +/- 3.9 and 1.8 +/- 2.8. The 3-year-old asthmatic children had more gingival bleeding than the healthy controls (P < 0.05). There were no significant differences in gingivitis in the 6-year-old children. Asthmatic children reported higher consumption of sugar-containing drinks and were more frequently mouthbreathers than healthy children (P < 0.05). In 3-year-old children with asthma and immigrant background, the mean dfs was higher compared with immigrant children in the control group (P < 0.01). CONCLUSION: The results indicate that preschool children with asthma have higher caries prevalence than healthy children. The factors discriminating for caries in asthmatic children are higher intake of sugary drinks, mouth breathing, and immigrant background.

Probiotics in prevention of IgE-associated eczema: a double-blind, randomized, placebo-controlled trial.

BACKGROUND: An altered microbial exposure may underlie the increase of allergic diseases in affluent societies. Probiotics may alleviate and even prevent eczema in infants. OBJECTIVE: To prevent eczema and sensitization in infants with a family history of allergic disease by oral supplementation with the probiotic Lactobacillus reuteri. METHODS: Double-blind, randomized, placebo-controlled trial, which comprised 232 families with allergic disease, of whom 188 completed the study. The mothers received L reuteri ATCC 55730 (1 x 10(8) colony forming units) daily from gestational week 36 until delivery. Their babies then continued with the same product from birth until 12 months of age and were followed up for another year. Primary outcome was allergic disease, with or without positive skin prick test or circulating IgE to food allergens. RESULTS: The cumulative incidence of eczema was similar, 36% in the treated versus 34% in the placebo group. The L reuteri group had less IgE-associated eczema during the second year, 8% versus 20% (P = .02), however. Skin prick test reactivity was also less common in the treated than in the placebo group, significantly so for infants with mothers with allergies, 14% versus 31% (P = .02). Wheeze and other potentially allergic diseases were not affected. CONCLUSION: Although a preventive effect of probiotics on infant eczema was not confirmed, the treated infants had less IgE-associated eczema at 2 years of age and therefore possibly run a reduced risk to develop later respiratory allergic disease. CLINICAL IMPLICATION: Probiotics may reduce the incidence of IgE-associated eczema in infancy.

ADAMTS13 phenotype in plasma from normal individuals and patients with thrombotic thrombocytopenic purpura.

The activity of ADAMTS13, the von Willebrand factor cleaving protease, is deficient in patients with thrombotic thrombocytopenic purpura (TTP). In the present study, the phenotype of ADAMTS13 in TTP and in normal plasma was demonstrated by immunoblotting. Normal plasma (n = 20) revealed a single band at 190 kD under reducing conditions using a polyclonal antibody, and a single band at 150 kD under non-reducing conditions using a monoclonal antibody. ADAMTS13 was not detected in the plasma from patients with congenital TTP (n = 5) by either antibody, whereas patients with acquired TTP (n = 2) presented the normal phenotype. Following immunoadsorption of immunoglobulins, the ADAMTS13 band was removed from the plasma of the patients with acquired TTP, but not from that of normal individuals. This indicates that ADAMTS13 is complexed with immunoglobulin in these patients. The lack of ADAMTS13 expression in the plasma from patients with hereditary TTP may indicate defective synthesis, impaired cellular secretion, or enhanced degradation in the circulation. This study differentiated between normal and TTP plasma, as well as between congenital and acquired TTP. This method may, therefore, be used as a complement in the diagnosis of TTP.

A new model for low-dose food challenge in children with allergy to milk or egg.

BACKGROUND: Atopic eczema and food allergy are common in early childhood. Children seem to gradually develop tolerance to milk and egg, and it is a relief for families when their child can tolerate small amounts of these basic foods, even if larger doses may still cause symptoms. AIM: To develop a model for low-dose oral food challenge, facilitating re-/introduction of milk or egg. METHODS: In 39 children sensitized to milk and/or egg, we performed 52 challenges using a new standardized model for low-dose oral food challenge. The recipes were validated for blinding with sensorial tests. RESULTS: Four children challenged to milk had a positive challenge outcome. There were no significant differences with respect to family history, associated atopic manifestations, nutritional supply, eczema severity, or skin-prick test compared with the non-reacting children, but total and specific IgE values were significantly higher. All but two of the non-reacting children were able to introduce milk and egg into their diet without problems. CONCLUSION: We report recipes and a protocol to be used for standardized open and double-blind placebo-controlled low-dose food challenge in young children, enabling the introduction of small amounts of egg and milk into the diet during tolerance development.

Significant improvement of eczema with skin care and food elimination in small children.

AIM: To evaluate common methods of investigation and treatment in children younger than 2 y of age with eczema, with or without sensitization to food allergens. METHODS: One hundred and twenty-three children younger than 2 y of age with eczema and suspected food allergy were included in this prospective study. The children underwent skin-prick test with cow's milk, fresh hen's egg white and wheat. Specific IgE to milk and egg white was analysed. The eczema extent and severity was estimated with SCORAD before and after treatment. Children with a positive skin-prick test were instructed to exclude that food item from their diet. All children were treated with emollients and topical steroids when needed. RESULTS: Sixty-two of the children were skin-prick positive to at least one of the allergens; 62% had mild, 30% moderate and 8% severe eczema at their first visit. After treatment, 90% had mild, 10% moderate and 0% severe eczema. Forty-six per cent of the children had circulating IgE antibodies to milk or egg white. Ten per cent had specific IgE but negative skin-prick test to the same allergen. This subgroup improved their eczema significantly without elimination diet. CONCLUSION: The conventional treatments for children with eczema, i.e. skin care and food elimination, are effective. The beneficial effect of skin care as the first step should not be neglected, and it may not be necessary to eliminate food allergens to relieve skin symptoms in all food-sensitized children with eczema.