COmparisoN of TastES of Available NutriTional integrated or non-integrated formulas for infants older than 1 year of age with cow’s milk allergy: A multicenter, prospective, single blind, cross-sectional observational clinical study (CONTEST Study)

Palatability of the infant formulas lacking cow milk protein formulas is reported by parents to be an important drawback. The purpose of this study is to examine decisions made by mothers of infants having cow milk protein allergy, and physicians concerning the palatability of unflavored extensively hydrolyzed formulas and amino acid-based formulas. We conducted a multi-center, randomized, single-blinded, observational taste study involving 149 pediatri-cians from gastroenterology and allergy subspecialties at 14 tertiary healthcare units from different regions of Turkey and involving 94 mothers of infants with cow milk protein allergy. Blinding was performed for seven formulas available in the market, which were the most commonly prescribed for feeding: four AAFs (Neocate-Numil®, Aptamil Pregomin AS-Numil®, Alfamino-Nestle®, Comidagen-Mamma®), one AAF specifically designed to address the growing nutritional and lifestyle needs of children >1 year (Neocate Junior-Numil®), 2 eHFs (Bebelac Pepti Junior-Numil®, Similac Alimentum-Abott®). Considering all three formula characteris-tics, Neocate junior-Numil® ranked as the number 1 product among seven products by moth-ers (63.8%) and physicians (69.8%). The ratings of mothers were significantly higher than the physicians (8.1 points and 6.1 points, respectively; p < 0.001). No difference was found in terms of taste, smell, and appearance for Neocate junior-Numil® between the mothers’ and physicians’ ratings. Since caregivers have responsibility for careful selection of replacement products for infants with cow milk protein allergy, it is noteworthy that increased awareness and confidence in the palatability characteristics of these products should motivate mothers and physicians to comply with replacement treatment in the long term (AU)

Asthma control affects school absence, achievement and quality of school life: a multicenter study

INTRODUCTION AND OBJECTIVES: Asthma may have a detrimental effect on school attendance and achievement. Friend relations, attendance to school activities, quality of life (QOL) of asthmatic children may be negatively affected. The aim of this study was to evaluate factors influencing school functioning for asthmatic school-age children. MATERIALS AND METHODS: From January to May 2019, parents and school-age children who were followed by a diagnosis of asthma for more than one year, from seven pediatric allergy centers, were given a standard questionnaire including questions about child's disease, school performance, absenteeism, home-family-school conditions. A pediatric QOL questionnaire was filled out by children. For evaluating control in the previous year, children who had more than two exacerbations and/or had any exacerbations needing systemic corticosteroids in the previous year were defined as inadequate control. School absence over nine days was taken into account as this has been shown to bring a risk for successful school life. RESULTS: 507 patients were included. Asthma control status was found to be effective on school absence (p < 0.001), on school success (especially math scores) (p < 0.001), on friend relations (p = 0.033), QOL (p < 0.001), attendance to school activities (p < 0.001). Regular follow-up (p < 0.001), regular use of asthma medication (p = 0.014), tobacco smoke exposure (p < 0.001), heating with stove at home (p = 0.01) affected asthma control. School conditions such as crowdedness (p = 0.044), humidity of the class (p = 0.025), knowledge of teacher about child's asthma (p = 0.012) were effective on asthma control independent of home conditions and asthma treatment parameters. CONCLUSION: School interventions are important to improve asthma management

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Asthma control affects school absence, achievement and quality of school life: a multicenter study.

INTRODUCTION AND OBJECTIVES: Asthma may have a detrimental effect on school attendance and achievement. Friend relations, attendance to school activities, quality of life (QOL) of asthmatic children may be negatively affected. The aim of this study was to evaluate factors influencing school functioning for asthmatic school-age children. MATERIALS AND METHODS: From January to May 2019, parents and school-age children who were followed by a diagnosis of asthma for more than one year, from seven pediatric allergy centers, were given a standard questionnaire including questions about child's disease, school performance, absenteeism, home-family-school conditions. A pediatric QOL questionnaire was filled out by children. For evaluating control in the previous year, children who had more than two exacerbations and/or had any exacerbations needing systemic corticosteroids in the previous year were defined as inadequate control. School absence over nine days was taken into account as this has been shown to bring a risk for successful school life. RESULTS: 507 patients were included. Asthma control status was found to be effective on school absence (p < 0.001), on school success (especially math scores) (p < 0.001), on friend relations (p = 0.033), QOL (p < 0.001), attendance to school activities (p < 0.001). Regular follow-up (p < 0.001), regular use of asthma medication (p = 0.014), tobacco smoke exposure (p < 0.001), heating with stove at home (p = 0.01) affected asthma control. School conditions such as crowdedness (p = 0.044), humidity of the class (p = 0.025), knowledge of teacher about child's asthma (p = 0.012) were effective on asthma control independent of home conditions and asthma treatment parameters. CONCLUSION: School interventions are important to improve asthma management.

Diagnosis of atopic dermatitis in children: comparison of the Hanifin-Rajka and the United Kingdom Working Party criteria

BACKGROUND: Atopic dermatitis (AD) is the most common chronic skin disease in childhood. There is no definitive test for diagnosing AD. The Hanifin-Rajka criteria (HRC) and The United Kingdom Working Party criteria (UKC) are the most used in the literature. It is aimed to evaluate the clinical efficacy of HRC and UKC in pediatric age. METHODS: Children diagnosed AD in the pediatric allergy clinic were enrolled. Patients with skin problems other than AD were involved as controls. All participants were evaluated for HRC and UKC at the time of diagnosis. Clinical diagnosis by the pediatric allergist was determined as the gold standard. RESULTS: 200 children with AD and 90 controls were enrolled in the study. Median (interquartile range, IQR) age of AD patients was 13.5 (7-36) months. There was no significant difference in age and sex between groups (p = 0.11 and p = 0.34, respectively). The HRC were superior to the UKC for sensitivity, negative predictive value, kappa and accuracy rate (94% vs. 72%, 84% vs. 60%, 0.68 vs. 0.56 and 87 vs. 78, respectively). On the other hand, specificity and positive predictive value of UKC were better than those of HRC (92% vs. 71% and 95% vs. 88%, respectively). CONCLUSION: HRC seem to be better in diagnosing AD than UKC for young children. Further studies are needed to evaluate comparableness of HRC and UKC for AD in childhood in order to generate an international consensus for clinical trials

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Frequency and clinical features of pollen-food syndrome in children

Background: Pollen-food syndrome (PFS) is an allergic reaction to fresh fruits, vegetables and/or nuts that can occur in patients who are allergic to pollen. The prevalence of PFS in children is not clearly known. Objective: The objective of this study was to determine the frequency and clinical features of PFS in pediatric patients with pollen-induced allergic rhinitis (AR). Method: This study was conducted in the pediatric allergy outpatient clinic of our hospital. Pollen-induced seasonal AR patients who were evaluated for any symptoms appearing after consuming any fresh fruits and vegetables. Results: Six hundred and seventy-two pollen-sensitized patients were included in this study. The symptoms related to PFS were reported in 22 (3.3%) patients. The median age of the patients was 12.3 years and 59% (n = 13) were female. Peach was the most common culprit (22%). There were isolated oropharyngeal symptoms in 20 (91%) patients and anaphylaxis in two (9%) patients with the suspected food. The multiple logistic regression analysis revealed that female gender, history of atopic dermatitis and allergic diseases in the family were the potential risk factors for PFS [Odds ratio 95% CI: 3.367 (1.344-8.435), 5.120 (1.935-13.550), 3.046 (1.239-7.492), respectively]. Conclusion: PFS can be seen in children who are followed up for pollen-induced AR. The symptoms of PFS are usually mild and transient. However, comprehensive evaluation of patients is important since serious systemic reactions such as anaphylaxis can also be observed

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Diagnosis of atopic dermatitis in children: comparison of the Hanifin-Rajka and the United Kingdom Working Party criteria.

BACKGROUND: Atopic dermatitis (AD) is the most common chronic skin disease in childhood. There is no definitive test for diagnosing AD. The Hanifin-Rajka criteria (HRC) and The United Kingdom Working Party criteria (UKC) are the most used in the literature. It is aimed to evaluate the clinical efficacy of HRC and UKC in pediatric age. METHODS: Children diagnosed AD in the pediatric allergy clinic were enrolled. Patients with skin problems other than AD were involved as controls. All participants were evaluated for HRC and UKC at the time of diagnosis. Clinical diagnosis by the pediatric allergist was determined as the gold standard. RESULTS: 200 children with AD and 90 controls were enrolled in the study. Median (interquartile range, IQR) age of AD patients was 13.5 (7-36) months. There was no significant difference in age and sex between groups (p=0.11 and p=0.34, respectively). The HRC were superior to the UKC for sensitivity, negative predictive value, kappa and accuracy rate (94% vs. 72%, 84% vs. 60%, 0.68 vs. 0.56 and 87 vs. 78, respectively). On the other hand, specificity and positive predictive value of UKC were better than those of HRC (92% vs. 71% and 95% vs. 88%, respectively). CONCLUSION: HRC seem to be better in diagnosing AD than UKC for young children. Further studies are needed to evaluate comparableness of HRC and UKC for AD in childhood in order to generate an international consensus for clinical trials.

Frequency and clinical features of pollen-food syndrome in children.

BACKGROUND: Pollen-food syndrome (PFS) is an allergic reaction to fresh fruits, vegetables and/or nuts that can occur in patients who are allergic to pollen. The prevalence of PFS in children is not clearly known. OBJECTIVE: The objective of this study was to determine the frequency and clinical features of PFS in pediatric patients with pollen-induced allergic rhinitis (AR). METHOD: This study was conducted in the pediatric allergy outpatient clinic of our hospital. Pollen-induced seasonal AR patients who were evaluated for any symptoms appearing after consuming any fresh fruits and vegetables. RESULTS: Six hundred and seventy-two pollen-sensitized patients were included in this study. The symptoms related to PFS were reported in 22 (3.3%) patients. The median age of the patients was 12.3 years and 59% (n=13) were female. Peach was the most common culprit (22%). There were isolated oropharyngeal symptoms in 20 (91%) patients and anaphylaxis in two (9%) patients with the suspected food. The multiple logistic regression analysis revealed that female gender, history of atopic dermatitis and allergic diseases in the family were the potential risk factors for PFS [Odds ratio 95%CI: 3.367 (1.344-8.435), 5.120 (1.935-13.550), 3.046 (1.239-7.492), respectively]. CONCLUSION: PFS can be seen in children who are followed up for pollen-induced AR. The symptoms of PFS are usually mild and transient. However, comprehensive evaluation of patients is important since serious systemic reactions such as anaphylaxis can also be observed.

Neuronal regeneration in injured rat spinal cord after human dental pulp derived neural crest stem cell transplantation.

OBJECTIVE: This study aimed to analyze the effect of human Dental Pulp-Neural Crest Stem Cells (hDP-NCSCs) delivery on lesion site after spinal cord injury (SCI), and to observe the functional recovery after transplantation. METHODS: Neural Crest Stem Cells (NCSCs) were isolated from human Dental Pulp (hDP). The experimental rat population was divided into four groups (n = 6/24). Their behavioral motility was scored regularly. After 4-weeks, rats were sacrificed, and their spinal cords were examined for Green Fluorescent Protein (GFP) labeled hDP-NCSCs by immunofluorescence (IF) staining. RESULTS: In early post-injury (p.i) period, the ultrastructure of spinal cord tissue was preserved in Group 4. The majority of cells forming the ependymal region around the central canal were found to be hDP-NCSCs. While the grey-and-white-matter around the ependymal region was composed of e.g. GFP cells, with astrocytic-like appearance. The scores showed significant motor recovery in hind limb functions in Group 4. However, no obvious change was observed in other groups. CONCLUSION: Cells e.g., mesenchymal (Vimentin+) which express GFP+ cells in the gray-and-white-matter around the ependymal region could indicate the potential to self-renewal and plasticity. Thus, transplantation of hDP-NCSCs might be an effective strategy to improve functional recovery following spinal cord trauma (Fig. 10, Ref. 32).

The relationship between gastro-oesophageal reflux disease and asthma during childhood

BACKGROUND: The relationship between GERD and asthma is complex. It is not yet clear whether GERD is an accompanying finding or a cause of asthma, or even if it is an aggravating factor. The aim of this study was to determine the frequency of asthma and allergic diseases in patients who underwent 24-h pH monitoring for a suspicion of GERD, including a comparison between subjects with and without GERD. METHOD: Subjects who were evaluated by 24 h ambulatory intraoesophageal pH monitoring were investigated for the presence of asthma and allergic disorders. All participants were subjected to a skin prick test and a complete blood count and serum levels of specific IgE. RESULTS: A total of 204 subjects (49.5% male) with a mean age of 7.8 ± 4.3 years were enrolled. A diagnosis of GERD was made in 78 (38.2%) subjects after 24 h pH monitoring. The frequency of asthma in subjects with GERD was 20.5% compared to 25.4% in subjects without GERD (p = 0.424). Subjects with GERD presenting with respiratory symptoms have higher incidence of asthma compared to subjects with GERD presenting with gastrointestinal symptoms (35.3% and 5.3% respectively; p = 0.001). CONCLUSION: Although, patients with and without GERD had comparable frequencies of asthma, our findings suggest that subjects who present with respiratory symptoms suggestive of GERD should also be evaluated for the presence of an underlying asthma

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The relationship between gastro-oesophageal reflux disease and asthma during childhood.

BACKGROUND: The relationship between GERD and asthma is complex. It is not yet clear whether GERD is an accompanying finding or a cause of asthma, or even if it is an aggravating factor. The aim of this study was to determine the frequency of asthma and allergic diseases in patients who underwent 24-h pH monitoring for a suspicion of GERD, including a comparison between subjects with and without GERD. METHOD: Subjects who were evaluated by 24h ambulatory intraoesophageal pH monitoring were investigated for the presence of asthma and allergic disorders. All participants were subjected to a skin prick test and a complete blood count and serum levels of specific IgE. RESULTS: A total of 204 subjects (49.5% male) with a mean age of 7.8±4.3 years were enrolled. A diagnosis of GERD was made in 78 (38.2%) subjects after 24h pH monitoring. The frequency of asthma in subjects with GERD was 20.5% compared to 25.4% in subjects without GERD (p=0.424). Subjects with GERD presenting with respiratory symptoms have higher incidence of asthma compared to subjects with GERD presenting with gastrointestinal symptoms (35.3% and 5.3% respectively; p=0.001). CONCLUSION: Although, patients with and without GERD had comparable frequencies of asthma, our findings suggest that subjects who present with respiratory symptoms suggestive of GERD should also be evaluated for the presence of an underlying asthma.

Similar prevalence, different spectrum: IgE-mediated food allergy among Turkish adolescents

Background: Scarcity of reliable data on food allergy prevalence exists in Turkey. We aimed to assess reported and confirmed IgE-mediated food allergy prevalence, and define the spectrum of allergenic food. Methods: We prospectively evaluated the ISAAC Phase II study population for food allergy. Participants that reported experiencing food allergy symptom in the last year and/or were skin prick test positive for a predefined list of food allergens, were interviewed via telephone, and those considered as having food allergy were invited to undergo clinical investigation, including challenge tests. Results: A total of 6963 questionnaires were available. Parental reported food allergy prevalence and skin prick sensitisation rate were 20.2 ± 0.9% and 5.9 ± 0.6%. According to the above-defined criteria, 1162 children (symptom positive n = 909, skin prick test positive n = 301, both positive n = 48) were selected and 813 (70.0%) were interviewed via telephone. Out of 152 adolescents reporting a current complaint, 87 accepted clinical investigation. There were 12 food allergies diagnosed in nine adolescents, with food allergy prevalence of 0.16 ± 0.11%. The most common foods involved in allergic reactions were walnut (n = 3) and beef meat (n = 2), followed by hen's egg (n = 1), peanut (n = 1), spinach (n = 1), kiwi (n = 1), cheese (n = 1), hazelnut (n = 1) and peach (n = 1). Conclusions: While parental reported food allergy prevalence was within the range reported previously, confirmed IgE-mediated food allergy prevalence among adolescents was at least 0.16%, and the spectrum of foods involved in allergy differed from Western countries, implying environmental factors may play a role (AU)

Knowledge and attitudes of primary care physicians regarding food allergy and anaphylaxis in Turkey

Background: Food allergy, which becomes an important public health problem, can lead to important morbidity and mortality. Patients with food allergies are more likely to first present to their primary care physicians. We aimed to determine the knowledge of primary care physicians with regard to management of food allergies and anaphylaxis. Methods: Primary care physicians were surveyed via a questionnaire aimed to document their knowledge and attitudes about food allergy and anaphylaxis management. Results: A total of 297 participants completed questionnaires, 55.6% of which were female. Participating physicians had a mean of 17.0 ± 6.1 years of experience. Participants answered 47.2% of knowledge-based items correctly. Overall, participants fared poorly with regard to their knowledge on the treatment of food allergies and anaphylaxis. For example while 60.7% knew that a child can die from the milk allergy reaction, only 37.5% were aware that a child with IgE mediated milk allergies cannot eat yoghourts/cheese with milk. Besides, 53.1% of them chose epinephrine as their first treatment of choice in case of anaphylaxis, yet only 16.6% gave the correct answer about its dosage. Nearly a third of participants (36.7%) felt they were knowledgeable enough regarding the management of patients with food allergies, while 98.2% extended their request for future periodic educational meetings on allergic disorders. Conclusion: Knowledge of food allergy and anaphylaxis among primary care physicians was unsatisfactory. Provision or periodic educational programmes should be aimed at improving the standard of practice as acknowledged by the participants (AU)

The effect of oral contraceptives on current wheezing in young women

Background: Emerging evidence suggests that sex steroid hormones may influence respiratory symptoms. The existing literature about the role of oral contraceptive pill (OCP) on respiratory disease is scarce and conflicting especially during the adolescent period. In this study, we aimed to investigate the effect of OCPs on current wheezing among adolescents and young adults. Methods: A questionnaire was administered face-to-face to adolescents and young women by a physician. The questionnaire included ISAAC survey-comprised questions on ever wheezing, current wheezing, allergic diseases, smoking history (active or passive), and family history of allergic diseases and questions on OCP usage status. The effect of OCPs on wheezing was evaluated by logistic regression analysis. Results: A total of 487 subjects aged between 11.3 and 25.6 years participated in the study and 196 (40.2%) reported that they had used OCPs. 7.4% of the participants had physician-diagnosed asthma and 10.3% of them were active smokers. It was detected that OCPs were associated with increased risk for current wheezing (odds ratio, 2.36; 95% CI, 1.25-4.47 adjusted for asthma and current smoker) and this risk was related with the usage during the past year. Conclusion: Young women taking oral contraceptives had a higher rate of current wheezing, suggesting that sex steroids may be of importance for respiratory health (AU)

The effect of oral contraceptives on current wheezing in young women.

BACKGROUND: Emerging evidence suggests that sex steroid hormones may influence respiratory symptoms. The existing literature about the role of oral contraceptive pill (OCP) on respiratory disease is scarce and conflicting especially during the adolescent period. In this study, we aimed to investigate the effect of OCPs on current wheezing among adolescents and young adults. METHODS: A questionnaire was administered face-to-face to adolescents and young women by a physician. The questionnaire included ISAAC survey-comprised questions on ever wheezing, current wheezing, allergic diseases, smoking history (active or passive), and family history of allergic diseases and questions on OCP usage status. The effect of OCPs on wheezing was evaluated by logistic regression analysis. RESULTS: A total of 487 subjects aged between 11.3 and 25.6years participated in the study and 196 (40.2%) reported that they had used OCPs. 7.4% of the participants had physician-diagnosed asthma and 10.3% of them were active smokers. It was detected that OCPs were associated with increased risk for current wheezing (odds ratio, 2.36; 95% CI, 1.25-4.47 adjusted for asthma and current smoker) and this risk was related with the usage during the past year. CONCLUSION: Young women taking oral contraceptives had a higher rate of current wheezing, suggesting that sex steroids may be of importance for respiratory health.

Similar prevalence, different spectrum: IgE-mediated food allergy among Turkish adolescents.

BACKGROUND: Scarcity of reliable data on food allergy prevalence exists in Turkey. We aimed to assess reported and confirmed IgE-mediated food allergy prevalence, and define the spectrum of allergenic food. METHODS: We prospectively evaluated the ISAAC Phase II study population for food allergy. Participants that reported experiencing food allergy symptom in the last year and/or were skin prick test positive for a predefined list of food allergens, were interviewed via telephone, and those considered as having food allergy were invited to undergo clinical investigation, including challenge tests. RESULTS: A total of 6963 questionnaires were available. Parental reported food allergy prevalence and skin prick sensitisation rate were 20.2 ± 0.9% and 5.9 ± 0.6%. According to the above-defined criteria, 1162 children (symptom positive n=909, skin prick test positive n=301, both positive n=48) were selected and 813 (70.0%) were interviewed via telephone. Out of 152 adolescents reporting a current complaint, 87 accepted clinical investigation. There were 12 food allergies diagnosed in nine adolescents, with food allergy prevalence of 0.16 ± 0.11%. The most common foods involved in allergic reactions were walnut (n=3) and beef meat (n=2), followed by hen's egg (n=1), peanut (n=1), spinach (n=1), kiwi (n=1), cheese (n=1), hazelnut (n=1) and peach (n=1). CONCLUSIONS: While parental reported food allergy prevalence was within the range reported previously, confirmed IgE-mediated food allergy prevalence among adolescents was at least 0.16%, and the spectrum of foods involved in allergy differed from Western countries, implying environmental factors may play a role.

Knowledge and attitudes of primary care physicians regarding food allergy and anaphylaxis in Turkey.

BACKGROUND: Food allergy, which becomes an important public health problem, can lead to important morbidity and mortality. Patients with food allergies are more likely to first present to their primary care physicians. We aimed to determine the knowledge of primary care physicians with regard to management of food allergies and anaphylaxis. METHODS: Primary care physicians were surveyed via a questionnaire aimed to document their knowledge and attitudes about food allergy and anaphylaxis management. RESULTS: A total of 297 participants completed questionnaires, 55.6% of which were female. Participating physicians had a mean of 17.0 ± 6.1 years of experience. Participants answered 47.2% of knowledge-based items correctly. Overall, participants fared poorly with regard to their knowledge on the treatment of food allergies and anaphylaxis. For example while 60.7% knew that a child can die from the milk allergy reaction, only 37.5% were aware that a child with IgE mediated milk allergies cannot eat yoghourts/cheese with milk. Besides, 53.1% of them chose epinephrine as their first treatment of choice in case of anaphylaxis, yet only 16.6% gave the correct answer about its dosage. Nearly a third of participants (36.7%) felt they were knowledgeable enough regarding the management of patients with food allergies, while 98.2% extended their request for future periodic educational meetings on allergic disorders. CONCLUSION: Knowledge of food allergy and anaphylaxis among primary care physicians was unsatisfactory. Provision or periodic educational programmes should be aimed at improving the standard of practice as acknowledged by the participants.

Primary diffuse choroid plexus T-cell lymphoma: case report.

We present here a case of primary choroid plexus T-cell lymphoma with no evidence of immunodeficiency or immunological disease. As ventricular T-cell lymphoma is extremely rare, there is only limited information on the radiological findings of ventricular T-cell lymphoma. In this report, we also include some unusual MRI findings in this case that have never been described before.

Prevalence, burden, and risk factors of atopic eczema in schoolchildren aged 10-11 years: a national multicenter study.

BACKGROUND: Little is known about the epidemiology of atopic eczema (AE), and studies from the Mediterranean region and the Middle East are limited. OBJECTIVE: We investigated the frequency, burden, and risk factors of AE in a developing country. METHODS: The International Study of Asthma and Allergies in Childhood Phase II questionnaire was used to survey a representative sample of 10 to 11-year-old children in Turkey. Children were examined by allergists, and parents completed standardized questionnaires. RESULTS: Among 6755 children, the prevalence of having eczema during one's lifetime or currently was 17.1% and 8.1%, respectively. The prevalence of visits to the doctor, nocturnal awakening, school absenteeism, and drug usage was 36.3%, 56%, 9.7%, and 28.7%, respectively. Associated factors were current rhinoconjunctivitis (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.99-3.21), current wheezing (OR, 2.10; 95% CI, 1.58-2.79), family history of allergic disease (OR, 1.62; 95% CI, 1.21-2.18), low birth weight (OR, 1.79; 95% CI, 1.08-2.94), and exposure to animals in the first year of life (OR, 1.47; 95% CI, 1.06-2.03). CONCLUSIONS: In a developing Mediterranean country, the prevalence of AE is comparable to that of developed countries in the same region and lower than that observed in developed countries elsewhere. The course of the disease and risk factors of AE probably differ in developing countries.

The effect of CD14 C159T polymorphism on in vitro IgE synthesis and cytokine production by PBMC from children with asthma.

BACKGROUND: Even though the genotype at the promoter region of the CD14 molecule is known to affect the atopic phenotypes, the cellular and molecular basis of this association is largely unknown. OBJECTIVE: To investigate the effect of lipopolysaccharide (LPS) on IgE production and cytokine profile by peripheral blood mononuclear cells (PBMC) obtained from asthmatic children with the TT and the CC genotypes at position -159 of the CD14 gene. METHODS: Peripheral blood mononuclear cells from asthmatic children with alternative genotypes at CD14 C159T locus were stimulated with 2 and 200 ng/ml LPS in vitro. The IgE, IgG and, IgM response was determined by ELISA and Ig έ-germline, IgG, and IgM transcription by real-time PCR. A cluster of cytokines was measured by cytometric bead array. RESULTS: Asthmatic children with the TT genotype but not those with the CC genotype responded with increased IgE synthesis and germline transcription to LPS stimulation. There were no genotype-related differences in IgG and IgM. TT but not the CC genotype was associated with significantly increased interleukin (IL)-4/IL-12 and IL-4/interferon-gamma (IFN-γ) ratios in the culture supernatant. There were no genotype-related differences in IL-1ß, IL-7, IL-10, IL-13, IL-17A, granulocyte colony stimulating factor, granulocyte macrophage colony stimulating factor, monocyte chemotactic protein, and tumor necrosis factor alpha. CONCLUSION: Peripheral blood mononuclear cells from asthmatic children with the TT genotype at position -159 of the CD14 gene make more IgE than those with the CC genotype following LPS stimulation because of increased germline transcription and have an augmented Th2 cytokine profile.

Paediatricians’ perspectives on the use of pneumococcal vaccine in healthy and asthmatic children

Background: Pneumococcal polysaccharide vaccines were developed in recent decades to reduce the burden of pneumococcal diseases. Little is known about paediatricians’ perspectives on the use of pneumococcal vaccine. Objective: We aimed to examine physicians’ self-reported beliefs and attitudes about the pneumococcal vaccine and their daily clinical practice concerning immunisation against pneumococci in healthy and asthmatic children before the introduction of a nationwide vaccination program. Methods: A questionnaire survey was applied to the paediatricians attending a national paediatrics congress in 2008. Results: Of the 265 paediatricians, 167 responded to the questionnaire. Most (74.5%) believed that antimicrobial resistance could be reduced with the use of the vaccine. 88.5% of the paediatricians declared the pneumococcal vaccine to be a safe vaccine and agreed that the polysaccharide conjugate vaccine-7 should be added to the national vaccination programme. Nearly half of the paediatricians believed that asthmatic children vaccinated with pneumococci had fewer and less severe asthma attacks. 40.0% of the responders stated that the pneumococcal vaccine should be reserved for severe asthmatic children. As the duration of experience increases, the number of patients evaluated per week decreases, and the physicians working in the outpatient clinics tend to vaccinate all children. Conclusion: Despite the paediatricians’ belief in the necessity and importance of the pneumococcal vaccine, none of the examined factors influenced their clinical practice. As the asthma guidelines become clearer regarding the effect of pneumococcal diseases in asthmatics, the perspective of paediatricians may evolve towards greater immunisation

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