The effects of meteorological factors and Alternaria spore concentrations on children sensitised to Alternaria.

BACKGROUND: Alternaria is the most important fungal species belonging to the class Deuteromycetes which causes allergic respiratory diseases. The fungus pattern often shows a pronounced seasonal periodicity and with fluctuations related to meteorological conditions. In this study, we aimed to investigate the effect of outdoor Alternaria spore concentrations on monthly lung function tests, symptoms, and medication scores in children sensitised only to Alternaria. Additionally, we planned to determine the Alternaria spores of the outdoor environment in Adana, with special respect to their relationships with meteorological conditions and their seasonal changes. METHODS: Twenty-five patients with a clinical diagnosis of asthma and/or rhinitis sensitised only to Alternaria were enrolled in the prospective study. Meteorological data and outdoor samples of airborne fungi were obtained between November 2006 and October 2007. RESULTS: The outdoor Alternaria spore concentrations were significantly correlated with the monthly average temperature (r=0.626, p=0.03) and monthly average barometric pressure (r=-0.613, p=0.03). Similarly, the outdoor Alternaria spore concentrations were significantly correlated with mean monthly asthma medication score (r=0.599, p=0.04), value monthly PEF (r=-0.737, p=0.006), value monthly FEF25-75% (r=-0.914, p=0.0001) and, variation in PEF (r=0.901, p=0.0001). CONCLUSIONS: The atmospheric concentration of Alternaria spores are markedly affected by meteorological factors such as air temperatures and barometric pressures. In hypersensitive patients, Alternaria spores can induce decreases in respiratory functions and development of allergic symptoms between May and September, being especially more influential in August.

Life-threatening facial edema due to pine caterpillar mimicking an allergic event / Riesgo vital del edema facial causado por la oruga de la procesionaria del pino, remedando un proceso alérgico

Background: Approximately 150 species of Lepidoptera have been described as causing damage to human skin. One of these species is the pine processionary caterpillar, which is responsible for dermatitis, contact urticaria, ocular lesions and rarely respiratory signs and anaphylactic reactions through IgE-mediated or non-IgE-mediated mechanisms. We report a pediatric case of severe orofacial edema mimicking an allergic reaction after ingestion of a pine processionary caterpillar; urgent airway intubation was required. Case report: A 15-month-old boy was sleeping under a pine tree when his mother noted a pine caterpillar on his tongue. Because of rapidly developing facial swelling and respiratory distress, the infant was first taken to a local hospital where he received intravenous dexamethasone and pheniramine hydrogen maleate. On arrival at our emergency department, diffuse swelling and edema involving the tongue, perioral, nasal and perimandibular regions, and neck was noted, requiring urgent orotracheal intubation. There were no findings of anaphylaxis. The results of skin prick tests and specific IgE to common aero- and food allergens were negative. A skin prick test with extract of pine caterpillar was also negative. Prednisolone and pheniramine hydrogen maleate were administered for 7 days. The child gradually improved and was successfully extubated 4 days later. Conclusion: Although oral contact with a pine processionary caterpillar in the form of ingestion is rare, it may cause significant local reaction and airway compromise mimicking an allergic event. In this situation, early intubation to maintain airway patency is a life-saving measure

Antecedentes: aproximadamente se han descrito 150 especies de lepidopteros causantes de lesiones cutáneas. Uno de estos es la oruga de la procesionaria del pino que es responsable de dermatitis, urticaria de contacto, lesiones oculares y, raramente, síntomas respiratorios y reacciones anafilácticas por mecanismos mediadas o no por IgE. Presentamos un caso pediátrico de edema orofaríngeo grave con el aspecto clínico de una reacción alérgica, que se produjo tras la ingestión de una oruga de procesionaria del pino, siendo necesaria la intubación urgente de vías aéreas. Caso clínico: Cuando un lactante de 15 meses de edad dormía bajo un pino, su madre vio que tenía una oruga en la lengua. Se produjo uns rápida hinchazón facial y distres respiratorio, lo que requirió tratamiento endovenoso urgente en el hospital local, con dexametasona, feniramina y maleato iónico. A llegar al servicio de urgencias, se había desarrollado una hinchazón difusa y edema lingual, perioral, nasal, perimandibular y del cuello, por lo que se le practicó una intubación oro-traqueal. No hubo signos de reacción anafiláctica. El tratamiento con prednisolona, feniramina y maleato prosiguió durante siete días, con mejoría progresiva, pudiendo extubarse cuatro días más tarde. Las pruebas cutáneas y la IgE específica frente a neumoalergenos y alimentos comunes fueron negativas e igual la prueba con extracto de oruga de la procesionaria del pino. Conclusión: aunque el contacto oral con la oruga de la procesionaria del pino por ingestión es un raro incidente, puede causar una importante reacción local y grave afectación respiratoria semejantes a una reacción alérgica La intubación urgente para mantener la permeabilidad de las vías aéreas y las medidas salvadoras oportunas, son condición indispensable

The effects of long term use of inhaled corticosteroids on linear growth, adrenal function and bone mineral density in children

In this study we aimed to investigate the long term effects of inhaled steroids on linear growth, adranal function and bone mineral density. Thirty children with moderate asthma were randomly divided into two groups.Fifteen children (8 boys, 7 girls mean age; 10.6 ± 2.1) were treated with budesonide (group 1), and 15 (9 boys, 6 girls, mean age; 9.6 ± 2.4). with fluticasone propionate (group 2). Control group included 30 children. Anthropometric assesment, symptom and medication scores, pulmonary functions, bone mineral density, serum and urine cortisol levels and ACTH stimulation test were evaluated at the beginning of the study and after one year period. Symptom and medication scores, pulmonary functions improved significantly in both groups (p < 0.05). The mean annual growth was similar in group 1 and 2 and control group. Bone mineral density was comperable with control group at the beginning of the study and after one year. Mean serum cortisol level diminished at the end of the therapy but no significant differences were found between the initial and end values in respect to urine cortisol levels and cortisole/creatinin ratio. Of three groups ACTH stimulation test revealed that there were no significant difference between stdy and control groups. In conclusion, although we did not observed any side effects of inhaled corticosteroids we suggest that children treated with inhaled corticosteroids for a long time should be followed closely with respect to side effects

El presente estudio tuvo como objetivo investigar los efectos a largo plazo de los esteroides inhalados sobre el crecimiento lineal, la función adrenal y la densidad mineral ósea. Treinta niños con asma moderada se distribuyeron aleatoriamente en dos grupos: 15 de ellos (8 niños y 7 niñas, con una media de edad de 10,6 ± 2,1 años) se trataron con budesonida (grupo 1), y los otros 15 (9 niños y 6 niñas, con una media de edad de 9,6 ± 2,4 años) con propionato de fluticasona (grupo 2). El grupo de control constaba de 30 niños. Se realizó una exploración antropométrica, una puntuación de los síntomas y la medicación, análisis de la función pulmonar, de la densidad mineral ósea y del nivel de cortisol en sangre y orina, así como pruebas de estimulación de ACTH, tanto al principio del estudio como tras un período de un año. La puntuación de los síntomas y la medicación y la función pulmonar mejoraron significativamente en ambos grupos (p < 0,05). El crecimiento medio anual fue similar en los grupos 1, 2 y el de control. La densidad mineral ósea fue comparable con la del grupo de control en el inicio del estudio y al cabo de un año. El nivel medio de cortisol en sangre descendió al final de tratamiento, pero no se observaron diferencias significativas entre los valores iniciales y finales con respecto al nivel de cortisol en la orina y la proporción entre cortisol y creatinina. La prueba de estimulación de ACTH no reveló diferencias significativas entre los grupos de estudio y el de control. En conclusión, aunque no observamos ningún efecto secundario de los corticosteroides inhalados, sugerimos el control meticuloso de los posibles efectos secundarios en los niños tratados con estos fármacos de forma prolongada

Pneumomediastinum and pneumopericardium: unusual and rare complications of asthma in a 4 years old girl.

We describe a 4-year-old girl with asthma who presented with pneumomediastinum, pneumopericardium and subcutaneous emphysema. She was admitted to our hospital with dyspnea, chest pain, palpitation and cough of two days duration. She had attacks of cough, dyspnea and wheezing from two years of age, but she did not have a diagnosis of asthma previously. She was dyspneic and had subcutaneous emphysema in the neck, axilla and thorax. In the skin prick test (Center Lab. USA) she had positive reaction to Dermatophagoides pteronyssinus, Dermatophagoides farinae, mold mix, tree mix and grass mix. Pulmonary function tests could not be performed. In the chest X-ray air was seen in mediastinum and subcutaneous area and the epicardium was surrounded completely with air. She was treated successfully with inhaled salbutamol and budesonide. Radiological signs of pneumopericardium and pneumomediastinum disappeared completely in ten days period. In the light of this case we want to mention that early diagnosis and treatment of asthma should be done to prevent serious complication of asthma.

Pneumomediastinum and pneumopericardium: unusual and rare complications of asthma in a 4 years old girl

We describe a 4-year-old girl with asthma who presented with pneumomediastinum, pneumopericardium and subcutaneous emphysema. She was admitted to our hospital with dyspnea, chest pain, palpitation and cough of two days duration. She had attacks of cough, dyspnea and wheezing from two years of age, but she did not have a diagnosis of asthma previously. She was dyspneic and had subcutaneous emphysema in the neck, axilla and thorax. In the skin prick test (Center Lab. USA) she had positive reaction to Dermatophagoides pteronyssinus, Dermatophagoides farinae, mold mix, tree mix and grass mix. Pulmonary function tests could not be performed. In the chest X-ray air was seen in mediastinum and subcutaneous area and the epicardium was surrounded completely with air. She was treated successfully with inhaled salbutamol and budesonide. Radiological signs of pneumopericardium and pneumomediastinum disappeared completely in ten days period. In the light of this case we want to mention that early diagnosis and treatment of asthma should be done to prevent serious complication of asthma (AU)

Describimos el caso de una niña de 4 años de edad que se presentó con un neumomediastino, neumopericardio y enfisema subcutáneo. Fue ingresada en nuestro hospital con disnea, dolor torácico, palpitación y tos de 2 días de duración. La paciente experimentaba crisis de tos, disnea y sibilancias desde los 2 años de edad, pero previamente no se había establecido un diagnóstico de asma. La paciente se encontraba disneica y se apreció un enfisema subcutáneo en el cuello, axila y tórax. En la prueba de prick test (Center Lab, EE.UU.) presentó una reacción positiva a Dermatophagoides pteronyssinus, Dermatophagoides farinae, una mezcla de mohos, una mezcla de pólenes de árboles y una mezcla de hierbas silvestres. No pudieron llevarse a cabo pruebas de función pulmonar. En la radiografía de tórax se identificó aire en el mediastino y área subcutánea y el pericardio estaba ocupado por completo por aire. Fue tratada satisfactoriamente con salbutamol y budesonida inhalados. Los signos radiológicos de neumopericardio y de neumomedias tino desaparecieron por completo en un período de 10 días. A la luz de este caso, deseamos destacar que para prevenir las complicaciones de gravedad del asma es preciso establecer un diagnóstico precoz de asma e instituir de inmediato un tratamiento (AU)