Assessment of IgE-mediated food allergies in children with atopic dermatitis

BACKGROUND: Atopic dermatitis (AD) is an inflammatory disease of the skin, which is characterised by a chronic relapsing course. AIM: The aim of the study was to assign the prevalence of clinically active food allergies among a group of children between 3 months and 7 years of age, with AD. METHODS: Eighty-eight children with AD were screened for specific IgE antibodies to food proteins. All patients with AD and specific IgE antibodies to food proteins were subjected to Oral Food Challenges (OFCs) with the relevant foods. RESULTS: Food-sensitised patients with moderate levels of sIgE had clinically active food allergy to milk (39.28%) and egg (42.34%) on the basis of positive OFCs. High IgE and eosinophilia had a prevalence of almost 80% and 25%, regardless of concomitant food sensitisation and disease severity. CONCLUSIONS: In this study, clinically active food allergies were recognised in 26.13% of children with AD. Nevertheless, no association was confirmed between food sensitisation and AD severity. High IgE and peripheral eosinophilia have not been found more prevalent among children with severe AD nor among children with food sensitisation. Infants and younger children with AD should be screened for an underlying food allergy, regardless of disease severity

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Assessment of IgE-mediated food allergies in children with atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is an inflammatory disease of the skin, which is characterised by a chronic relapsing course. AIM: The aim of the study was to assign the prevalence of clinically active food allergies among a group of children between 3 months and 7 years of age, with AD. METHODS: Eighty-eight children with AD were screened for specific IgE antibodies to food proteins. All patients with AD and specific IgE antibodies to food proteins were subjected to Oral Food Challenges (OFCs) with the relevant foods. RESULTS: Food-sensitised patients with moderate levels of sIgE had clinically active food allergy to milk (39.28%) and egg (42.34%) on the basis of positive OFCs. High IgE and eosinophilia had a prevalence of almost 80% and 25%, regardless of concomitant food sensitisation and disease severity. CONCLUSIONS: In this study, clinically active food allergies were recognised in 26.13% of children with AD. Nevertheless, no association was confirmed between food sensitisation and AD severity. High IgE and peripheral eosinophilia have not been found more prevalent among children with severe AD nor among children with food sensitisation. Infants and younger children with AD should be screened for an underlying food allergy, regardless of disease severity.

Home intravenous antibiotic therapy in children with cystic fibrosis: clinical outcome, quality of life and economic benefit.

BACKGROUND: Pediatric home care has improved therapeutic options for children with chronic disease. Home intravenous (IV) antibiotic treatment against Pseudomonas aeruginosa (PsA) in cystic fibrosis (CF) patients has offered increased flexibility to these patients and family life. A prospective clinical study was conducted to compare safety, efficacy, and cost benefits of home versus hospital IV antibiotic treatment among CF children and adolescents. METHOD: The clinical outcome, quality of life, and cost benefits of home versus hospital antibiotic treatment were assessed. The clinical outcome was evaluated with Forced Expiratory Volume in one second (FEV1) and weight gain before and one month after antibiotic treatment, while the Quality of life was evaluated using the DISABKIDS questionnaire. Cost analysis was performed to calculate cost benefits from home IV treatment. RESULTS: Thirty-five stable patients with CF (mean age: 12.6 ± 7 years, 56 % male, mean FEV1: 83.5 ± 26 %), colonized with PsA, were treated with IV antibiotics for two weeks either in the hospital (15 patients), or at home (20 patients) under supervision by a home care nurse. Lung function (FEV1) and weight improved significantly in both groups (ΔFEV1% =7.7 ± 6.1, p <0.001; ΔWeight =1.2 ± 0.8, p <0.001). Hospital treatment did not show a better clinical outcome, compared to home treatment (ΔFEV1, p =0.606; ΔWeight, p =0.608). Both improvements in the quality of life and economical savings were substantial (p <0.001) regarding patients treated at home. Also, patients treated at home did not report any significant side effects or complications. CONCLUSIONS: Home IV antibiotic therapy monitored by a home care nurse, is a safe, efficient, and cost-saving therapeutic option in CF. Hippokratia 2016, 20(4): 279-283.

Use of lung clearance index to assess the response to intravenous treatment in cystic fibrosis.

BACKGROUND: Progressive lung disease is the main cause of clinical deterioration and mortality in cystic fibrosis (CF) patients. Being able to assess the effectiveness of interventions is very significant. OBJECTIVES: To assess the response to intravenous (IV) treatment among CF patients, using forced expired volume in 1(st) second (FEV1) and Lung Clearance Index (LCI) as outcome measures and to compare the effect of IV treatment on lung function and LCI between CF children being treated on a regular basis, or in case of a pulmonary exacerbation. SUBJECTS AND METHODS: Thirty-two CF patients (15 males) with mean age 9.90 (range: 2-23) years, performed spirometry and multiple breath washout (MBW) before and one month after IV antibiotic treatment. Nineteen patients received a course of elective treatment (group A) and 13 received IV antibiotic regimens for an acute exacerbation (group B). RESULTS: Statistically significant differences after treatment were seen in LCI (p≤0.001), and Forced Expiratory Flow (FEF) z-scores (p<0.05). FEV1 did not change significantly after drug intervention. Dividing patients into two groups, only LCI showed significant change (p<0.05), when treatment was administered on a regular basis. Patients being treated for an acute pulmonary exacerbation showed significant improvement in most of the lung function parameters: LCI (p=0.0001), FEV1% (p=0.05), FEV1 z-score (p=0.033) and FEF25-75 (p=0.046). The mean LCI difference was significantly greater in group B compared to group A (p=0.001). CONCLUSION: LCI is more sensitive marker than FEV1 to assess the effect of IV antibiotic treatment among CF children. IV antibiotics are more effective on lung function parameters, when they are administered for an acute exacerbation, than when they are given on a regular basis. Hippokratia 2015, 19 (1): 47-52.

Antioxidant foods consumption and childhood asthma and other allergic diseases: The Greek cohorts of the ISAAC II survey.

BACKGROUND: Antioxidant intake changes have been implicated with the increase in asthma and allergies outcomes, but no clear association has been revealed. In this cross sectional study, the overall effect of antioxidants on asthma and allergic diseases was studied. METHODS: Data from the cohorts of the phase II ISAAC survey (2023 children 9-10 years old) in two metropolitan Greek cities were analysed. Using a semi-quantitative food frequency questionnaire, an Antioxidant Eating Index (AEI, range 0-6) was created with the pro-antioxidant (vegetables, fruits, fresh juice, fish) and the non-antioxidant (meat, burgers) food intake and was evaluated with allergic diseases. Higher values of the score suggest closer to an "antioxidant" and lesser to a "saturated fatty" diet. RESULTS: Prevalence of lifetime and current asthma, current rhinitis and sensitisation were higher in Thessaloniki compared to Athens. The AEI score of the entire cohort was 4.2 ± 1.2 (median 4.0) and was higher in Athens compared to Thessaloniki (4.3 ± 1.2 vs. 4.0 ± 1.2, p=0.001) and in girls than boys (4.3 ± 1.1 vs. 4.0 ± 1.2, p=0.001). AEI was inversely associated with lifetime asthma (OR: 0.87, 95%CI 0.77, 0.99) in either cities independently of other cofounders such as family history, sensitisation, exercise, house smoking, breast feeding, pet or dampness in houses. No association with other allergic disease or sensitisation was detected. CONCLUSION: Antioxidant foods seem to be a non-pharmacological, protective dietary pattern for asthma development in children irrespectively of atopy or heredity; AEI was a rough indicator and the role of antioxidants in allergic diseases is still under consideration.

Comparison in asthma and allergy prevalence in the two major cities in Greece: the ISAAC phase II survey.

BACKGROUND: Variability in the prevalence of allergic diseases has been detected not only between different countries, but also between cities with similar national and different socio-economic or climatic characteristics. The aim of this study was to determine the prevalence of childhood asthma and allergies and which factors are associated with them, in the two largest Greek cities, Athens and Thessaloniki. METHODS: Two thousand and twenty-three Greek 9-10-year-old schoolchildren from Athens (Central Greece) and Thessaloniki (North Greece, more humid), were included in ISAAC-II study. All participants followed the ISAAC-II protocol by questionnaire, skin prick testing and flexural dermatitis examination. RESULTS: Compared with Athens, the prevalence of current wheezing (8.4% vs. 5.7%, p=0.002), lifetime asthma (11.5% vs. 7.7%, p=0.004), atopic current asthma (3.2% vs. 1.6%, p=0.02), allergic rhinitis (8.2% vs. 5.2%, p=0.007), and hay fever (21.7% vs. 12.5%, p<0.001) were higher in Thessaloniki. The overall sensitisation rate was also higher in Thessaloniki than in Athens (25.2% vs. 16%, p<0.001) with more prevalent sensitising due to the perennial allergens (D. pteronyssinus, D. farinae, Alternaria tenuis) and cat dander. Perennial allergens sensitisation was a risk factor for current asthma in both cities. CONCLUSION: A higher prevalence of asthma symptoms, allergic rhinitis, and sensitisation rate was detected in Greek schoolchildren living in Thessaloniki compared to those in Athens. Allergy to mites and mould was more prevalent in Thessaloniki. The more humid weather of Thessaloniki may be implicated.

International variations in associations of allergic markers and diseases in children: ISAAC Phase Two.

BACKGROUND: Circulating allergen-specific IgE (sIgE) and skin prick tests (SPT) are used to define atopy. Downregulation of local inflammatory responsiveness has been proposed to explain a low prevalence of positive SPTs in less affluent countries. We analysed the association between SPTs, total and allergen-specific IgE and their relationships to allergic symptoms in centres with diverse living conditions. METHODS: Cross-sectional studies of stratified random samples of 8 to 12-year-old children (n = 7461) used the standardized methodology of Phase Two of the International Study of Asthma and Allergies in Childhood (ISAAC). Symptoms of asthma, rhinitis and eczema were ascertained by parental questionnaires. Skin examination, hypertonic saline bronchial challenge, six aeroallergen SPTs and measurements of serum total IgE and sIgE were performed. RESULTS: In nonaffluent countries, a higher proportion of children with positive SPT had no detectable sIgE (range 37-61%) than in affluent countries (0-37%). Total serum IgE was associated with all disease outcomes among children with both positive SPT and sIgE (P < 0.001), but only with self-reported eczema in children with negative SPTs and negative sIgE. CONCLUSIONS: The international pattern of discordance between SPT and sIgE results did not support the downregulation hypothesis. Among children with no evidence of sensitization to common aeroallergens, increased total IgE contributes little to the risk of wheeze and rhinitis in the general population but may play a role in eczema.

Acute respiratory admissions in Thessaloniki, Greece: 14-year follow-up.

BACKGROUND: Acute exacerbations of respiratory diseases are a common cause of hospitalization among infants and children. AIM: To assess the epidemiological characteristics of asthma, bronchiolitis and croup among hospitalized children in Thessaloniki, from 1990 to 2003 included. METHODS: Data from the patient registry with discharge diagnosis "asthma", "bronchiolitis" and "croup" were analyzed retrospectively, in five Paediatric Departments of Thessaloniki. Age and sex of the patients, as well as the month of admission were taken into consideration. RESULTS: A total of 8762 admissions of children (aged 3 months-14 years) with the diagnosis of asthma, "bronchiolitis" and "croup", were identified. Sex distribution was 65.86% males (64.86% bronchiolitis, 65.26% asthma and 70.31% croup). Asthma admissions decreased by 53.65%, croup admissions decreased by 4.73%, while bronchiolitis admissions increased by 25.03%, during the study period. A clear seasonal variation was found in all the three diseases, with the lowest incidence during summer months. Moreover there were two peaks for asthma (one during spring and a second during autumn), one peak for bronchiolitis (during winter early spring) and one peak for croup (during autumn). CONCLUSIONS: Paediatric asthma and croup admissions have declined during the last 14 years, in contrast with bronchiolitis admissions, which showed an increased tendency. More frequent use of inhaled steroids and induction of asthma education programs may have contributed to decreasing asthma admission rates.

Factor analysis in the Genetics of Asthma International Network family study identifies five major quantitative asthma phenotypes.

BACKGROUND: Asthma is a clinically heterogeneous disease caused by a complex interaction between genetic susceptibility and diverse environmental factors. In common with other complex diseases the lack of a standardized scheme to evaluate the phenotypic variability poses challenges in identifying the contribution of genes and environments to disease expression. OBJECTIVE: To determine the minimum number of sets of features required to characterize subjects with asthma which will be useful in identifying important genetic and environmental contributors. Methods Probands aged 7-35 years with physician diagnosed asthma and symptomatic siblings were identified in 1022 nuclear families from 11 centres in six countries forming the Genetics of Asthma International Network. Factor analysis was used to identify distinct phenotypes from questionnaire, clinical, and laboratory data, including baseline pulmonary function, allergen skin prick test (SPT). RESULTS: Five distinct factors were identified:(1) baseline pulmonary function measures [forced expiratory volume in 1 s (FEV(1)) and forced vital capacity (FVC)], (2) specific allergen sensitization by SPT, (3) self-reported allergies, (4) symptoms characteristic of rhinitis and (5) symptoms characteristic of asthma. Replication in symptomatic siblings was consistent with shared genetic and/or environmental effects, and was robust across age groups, gender, and centres. Cronbach's alpha ranged from 0.719 to 0.983 suggesting acceptable internal scale consistencies. Derived scales were correlated with serum IgE, methacholine PC(20), age and asthma severity (interrupted sleep). IgE correlated with all three atopy-related factors, the strongest with the SPT factor whereas severity only correlated with baseline lung function, and with symptoms characteristic of rhinitis and of asthma. CONCLUSION: In children and adolescents with established asthma, five distinct sets of correlated patient characteristics appear to represent important aspects of the disease. Factor scores as quantitative traits may be better phenotypes in epidemiological and genetic analyses than those categories derived from the presence or absence of combinations of +ve SPTs and/or elevated IgE.

Current devices of respiratory physiotherapy.

In recent years patients with respiratory diseases use various devices, which help the removal of mucus from the airways and the improvement of pulmonary function. The aim of the present study is to determine the effectiveness of the current devices of respiratory physiotherapy, as it comes from the review of literature. The current devices of physiotherapy for patients with respiratory diseases, are presented as an alternative therapy method or a supplemental therapy and they can motivate patients to apply therapy by themselves. These devices seem to increase patients' compliance to daily treatment, because they present many benefits, as independent application, full control of therapy and easy use. These devices are the Positive Expiratory Pressure, the High Frequency Chest Wall Oscillation, the Oral High Frequency Oscillation, the Intrapulmonary Percussive Ventilation, the Incentive Spirometry the Flutter and the Acapella and the Cornet. Current devices seem to be effective in terms of mucus expectoration and pulmonary function improvement, as it is shown by published studies. The choice of the suitable device for each patient is a challenge for the physiotherapist in order to achieve better compliance in daily treatment. More controlled studies are needed due to the fact that the number of published studies is limited.

Assessment of airway inflammation with exhaled NO measurement.

Assessing airway inflammation is important for investigating the underlying mechanisms of many lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, primary ciliary dyskinesia (PCD) and cystic fibrosis. A growing interest has recently directed toward non-invasive methods for the assessment of airway inflammation. Measurement of exhaled nitric oxide in exhaled air is an exciting innovative technique that gives new insights into the pathophysiology of lung disease and asthma in particular, with many potential clinical applications. Careful standardisation of measurement techniques has facilitated the use of this new measurement in paediatric respiratory medicine. Non-invasiveness and instantaneous results potentially make it a suitable instrument for use in children starting from the age of 4, with useful applications both in asthma diagnosis and monitoring.

Results of active cycle of breathing techniques and conventional physiotherapy in mucociliary clearance in children with cystic fibrosis.

AIM: The aim of the present study is the comparison of the results of the appliance of two methods of respiratory physiotherapy; the active cycle of breathing techniques in drainage positions and the conventional physiotherapy, regarding their effects on mucociliary clearance in patients with cystic fibrosis. MATERIAL-METHODS: Thirty-five children teenagers and adults with cystic fibrosis, 8-20 years of age, with mean Schwachman score 78,49 took part in the research. All patients had regular physiotherapeutic control and applied systematically physiotherapy. The same children received two methods of respiratory physiotherapy in a 3-month random order, when they came at the outpatients' department of the hospital for their regular check-up. RESULTS: The comparison of the results of the two methods did not show statistical significant difference in sputum quantity, whereas statistical significant difference was noticed in sputum quality after the application of active cycle of breathing techniques. CONCLUSIONS: The application of the active cycle of breathing techniques contributes effectively in the sputum expectoration from the peripheral bronchopulmonary segments and enhances the mucociliary clearance in children with cystic fibrosis.

A critique on the concept of "brain death".

Since the concept of "brain death" was introduced in medical terminology, enough evidence has come to light to show that the concept is based on an unclear and incoherent theory. The "brain death" concept suffers by internal inconsistencies in both the tests-criterion and the criterion-definition relationships. It is also evident that there are residual vegetative functions in "brain dead" patients. Since the content of consciousness is inaccessible in these patients who are in a profound coma, the diagnosis of "brain death" is based on an unproved hypothesis. A critical evaluation of the role and the limitations of the confirmatory tests in the diagnosis of "brain death" is attempted. Finally it is pointed out that a holistic approach to the problem of "brain death" in humans should necessarily include the inspection of the content of consciousness.

An open study to assess the long-term safety of fluticasone propionate in asthmatic children. International Study Group.

This study was conducted to assess the long-term safety of fluticasone propionate 50 micrograms twice daily (100 micrograms/day) or 100 micrograms twice daily (200 micrograms/day) administered via a dry powder inhaler in children aged 4-17 years with moderately severe asthma. A total of 257 patients received open treatment for 12 months. Of these, 110 had not received treatment with fluticasone propionate in any prior study. The remaining 147 patients had completed one of two previous short-term inhaled fluticasone propionate studies. In all, 132 patients (51%) reported 273 adverse events, the pattern of which was as expected in an atopic population with asthma; only 26 (10%) of these reports were considered either certainly, probably or possibly related to study treatment. The events most commonly reported either as a single or multiple diagnosis were: asthma and related events (25%), upper respiratory tract infection (13%), and rhinitis (6%). For most patients who reported a worsening of asthma, additional therapy was all that was required to control symptoms, and they continued in the study. There was a low incidence (2%) of pharmacologically predictable adverse events. Eight patients (3%) withdrew from the study because of an adverse event, five of which events (one each of hypertension, hoarseness and asthma and two of oral candidiasis) were recorded as being possibly or probably drug-related. Sixteen adverse events reported by 15 patients (6%) were classified as serious but none was considered to be related to the study drug. Of these reports 10 ( patients; 4%) were exacerbations of asthma requiring hospital admission; the other six adverse events were unrelated to asthma.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the efficacy and safety of inhaled fluticasone propionate 200 micrograms/day with inhaled beclomethasone dipropionate 400 micrograms/day in mild and moderate asthma.

This study was designed to compare the efficacy and safety of a new inhaled corticosteroid, fluticasone propionate at a total daily dose of 200 micrograms, with beclomethasone dipropionate 400 micrograms/day in childhood asthma. A total of 398 asthmatic children (aged 4-19 years) were randomised to receive either fluticasone propionate 200 micrograms daily or beclomethasone dipropionate 400 micrograms daily for six weeks inhaled via a spacer device from a metered dose inhaler. During the study the patients recorded morning and evening peak expiratory flow rate (PEFR), symptom scores, and use of beta 2 agonist rescue medication. In addition, clinic visit PEFR and forced expiratory volume in one second were measured. Safety was assessed by recording all adverse events and by performing routine biochemistry and haematology screens including plasma cortisol concentration before and after treatment. For the purposes of analysis the diary card data were grouped into three periods: week 3 (days 15-21), week 6 (days 36-42), and weeks 1-6 (days 1-42). The results showed no significant difference between treatments on most efficacy parameters. However, there were significant differences in changes from baseline in favour of fluticasone propionate for % predicted morning PEFR both at week 3 (fluticasone propionate 6.1%, beclomethasone dipropionate 3.9%) and at week 6 (fluticasone propionate 8.3%, beclomethasone dipropionate 5. 9%) and % predicted evening PEFR at week 6 (fluticasone propionate 7.3%, beclomethasone dipropionate 4.9% and over weeks 1-6 (fluticasone propionate 5.5%, beclomethasone dipropionate 3.6%. Comparison between groups showed that the group receiving fluticasone propionate had a lower % of days with symptom-free exercise at week 6 (fluticasone propionate 87%, beclomethasone dipropionate 81%) and % days without rescue medication at week 6 (fluticasone propionate 87%, beclomethasone dipropionate 80%) and over weeks 1-6 (fluticasone propionate 80%, beclomethasone dipropionate 73%). Except for a higher incidence of sore throat in the fluticasone propionate group, the two treatments did not differ with regard to safety. There was no evidence of adrenal suppression with either treatment. In conclusion, fluticasone propionate 200 microgram daily ws at least as effective and as well tolerated as beclomethasone dipropionate 400 microgram daily in childhood asthma.

Acceptance of domiciliary theophylline monitoring using dried blood spots.

Filter paper cards incorporating dried blood spots for the measurement of theophylline concentrations were returned by 62 out of 100 asthmatic children sent kits with instructions for their collection. Analysis of the blood spots showed that 37 (61%) of the children who returned them had less than therapeutic blood theophylline concentrations, in 21 (34%) they were therapeutic, and in three (5%) they were potentially toxic. The results indicate that most asthmatic children would comply with requests for home monitoring of theophylline concentrations, and that only one third of children receiving theophylline achieved blood concentrations and that only one third of children receiving theophylline achieved blood concentrations within the therapeutic range.

Free running asthma screening test.

The free running asthma screening test (FRAST) was evaluated in 503 Sheffield schoolchildren aged 6 to 12 years and compared with responses to an asthma questionnaire. The FRAST measured peak expiratory flow rate (PEFR) before and at 1, 5, and 10 minutes after maximum voluntary running for at least 5 minutes in a standardised environment. A fall in PEFR of greater than 15% in at least two postexercise readings was defined as abnormal. Six (1%) children did not do the test and 69 (14%) failed to complete it. Of these, 14 were known asthmatics, 18 were not testable, and 37 were normal when retested. There were 14 abnormal FRAST results among 412 'normal' children who completed the test and 10 of these were subsequently diagnosed asthmatic. None of 14 children with an abnormal FRAST result had been identified as wheezy, chesty, or asthmatic in the questionnaire. In this sample there was, on average, one child in every school class with unrecognised exercise induced bronchospasm. The FRAST is an acceptable, feasible, and cost effective way of identifying such potential asthmatics at school.

Evaluation of nebulisers for bronchial challenge tests.

The reproducibility of the output of seven different nebulisers was tested. Nebulisers with a minimal increase in output at higher flow rates had less variability in the output. The selection of a nebuliser for bronchial provocation tests depends on the intranebuliser variability. Two nebulisers had highly reproducible outputs.

Reduced vital capacity in insulin-dependent diabetes.

Spirometry was performed on 88 children with insulin-dependent diabetes mellitus (IDDM) and 216 healthy controls living in Sheffield. Children with IDDM had significantly lower percentage predicted forced vital capacity (FVC) than did control children or reference norms. There was no evidence that the reduced FVC was confined to a subgroup of children, and there was no correlation with duration of IDDM or glycemic control. A longitudinal study of 27 children with IDDM did not show progressive deterioration in percentage predicted FVC with age. These findings suggest that a tendency toward reduced lung volumes exists in IDDM and may not be a direct result of the metabolic disturbances in the disease.