A survey of management practices in coexistent allergic rhinitis and asthma (Asia-pacific Survey of Physicians on Asthma and allergic Rhinitis): results from Thailand.

BACKGROUND: Underdiagnosis and undertreatment of allergic rhinitis (AR) in patients with asthma can worsen treatment outcomes. There is limited evidence of clinical practices for management of coexistent AR-asthma in Thailand. METHODS: A multicountry, cross-sectional study (Asia-pacific Survey of Physicians on Asthma and allergic Rhinitis) to evaluate physician perceptions and management practices related to AR-asthma overlap in 6 Asian countries was conducted. For Thailand specifically, AR-asthma linkage questionnaires were developed and translated to Thailaland. General physicians (GPs) or pediatricians, randomly selected from hospitals in urban cities, routinely treating >10 asthma patients/month were interviewed. Here we present the results for Thailand. RESULTS: Two hundred physicians (100 GPs and 100 pediatricians), of whom 70% worked in government hospitals, were interviewed. In their experience, 50% of asthma patients had AR and 28% of AR patients had asthma. Among diagnosed asthma patients, 65% of physicians routinely asked for any AR symptoms at every visit. Among diagnosed AR patients, 63% of physicians routinely asked for any asthma symptoms at every visit. In patients with coexisting AR-asthma, 91% of physicians treated both diseases simultaneously, while 6% of physicians treated asthma as a chronic disease but managed AR symptomatically. The most preferred treatment options for patients with AR-asthma were inhaled corticosteroids with intranasal steroids (46% in GPs, 71% in pediatricians). CONCLUSION: The physicians interviewed in Thailand are aware about coexistent asthma-AR. There is a need to increase the awareness further for coexistent AR-asthma and to educate nonspecialist physicians in the proper management of AR-asthma patients.

Allergic rhinitis and immunoglobulin deficiency in preschool children with frequent upper respiratory illness.

BACKGROUND: Frequent upper respiratory illness (URI) is a common problem in preschool children. Allergic rhinitis and immunoglobulin (Ig) deficiency are usually suspected as underlying etiologies. OBJECTIVE: To determine the prevalence of allergic rhinitis and Ig and IgG subclass deficiency in preschool children with frequent URI. METHODS: Two thousand eight hundred and seventy-six questionnaires were distributed to the parents of children aged 3-6 years in 24 kindergartens. Firstly, they determined the frequency of URI in the previous year and secondly the prevalence of rhinitis according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The skin prick test (SPT) was performed and serum Ig and IgG subclasses were measured in children with frequent URI (> or = 10 episodes per year). Allergic rhinitis was diagnosed when the child had had rhinitis in the previous 12 months and positive SPT for at least 1 aeroallergen. RESULTS: Two thousand three hundred and one questionnaires (80.01%) were returned. Ninety-four out of 219 children with frequent URI participated in the study. The prevalence of allergic rhinitis in the participants was 42.55%. Exclusive breastfeeding for at least 6 months had a protective effect, while paternal history of rhinitis was a risk factor. All participants had normal serum IgG, IgA, IgM and IgG subclass levels for age. CONCLUSION: The prevalence of allergic rhinitis in preschool children with frequent URI in our study was 42.55%. Allergic rhinitis should be considered if they have a family history of allergic rhinitis. Immunoglobulin deficiency was not found in our study.

Prevalence of protective antibody against hepatitis B virus in HIV-infected children with immune recovery after highly active antiretroviral therapy.

HIV-infected children had a lower seroconversion rate to hepatitis B immunization and a more rapid antibody decline when compared to healthy children. Whether re-immunization or additional booster dose is necessary after immune recovery remains unknown. This study was conducted to determine the prevalence of hepatitis B virus protective antibody in HIV-infected children with immune recovery after highly active antiretroviral therapy (HAART). Serum hepatitis B viral markers were measured. An antibody level of > or =10 mIU/mL was defined as a protective antibody level. Only one out of 69 children (1%) had a protective antibody level. We concluded that despite the history of hepatitis B immunization and despite evidence of immune recovery after HAART, most HIV-infected children are still susceptible to HBV infection.