Safety of nasal budesonide in the long-term treatment of children with perennial rhinitis.

BACKGROUND: Intranasal budesonide is an efficacious treatment for perennial allergic rhinitis. Long-term effects on safety, particularly in children, need further investigation. OBJECTIVE: To investigate the long-term safety of intranasal budesonide in children. METHODS: In an open trial, 78 children (5-15 years) with perennial rhinitis were treated with intranasal budesonide pressurized metered dose inhaler 200 microg twice daily (delivered daily dose 256 microg) for 12 months; 43 children stayed in the study for 12 additional months and were switched to aqueous suspension (400 microg delivered daily dose) for 6 months. Statural growth, bone age, ophthalmologic and rhinoscopic status, cortisol and biochemical analyses in blood and urine were monitored during the first and second years, and adverse events (AEs) were continuously recorded. RESULTS: No significant effects on statural growth and bone age, compared with reference values, were observed. Morning plasma cortisol and 24-h urinary cortisol were not changed during treatment. Patients reported 195 AEs, most commonly nasal dryness (30%), blood-tinged secretions (21%) and, among non-nasal AEs, headache (13%). Rhinoscopy revealed no signs of mucosal atrophy, ulceration, or candidiasis but some nasal dryness. No treatment-related ophthalmological or biochemical aberrations were found. Reduction of blood eosinophils and nasal symptom scores, compared with pre-treatment values, indicated the efficacy of budesonide treatment. CONCLUSION: Long-term treatment for 1-2 years with intranasal budesonide 256-400 microg daily in children with perennial rhinitis revealed no negative effects on growth or endogenous cortisol production. Local side-effects were mild and patient symptoms decreased.

Allergic disease and the infestation of Enterobius vermicularis in Swedish children 4-10 years of age.

BACKGROUND: The possible association between certain childhood infections and the propensity to develop allergic disease may include intestinal helminth infections. The experiences of such associations derive mainly from studies in tropical areas, and the results are not clear-cut. OBJECTIVE: To explore the association between Enterobius vermicularis and allergic disease in Swedish children 4 to 10 years of age. METHOD: The occurrence of E. vermicularis was examined by perianal tape tests in 70 allergic children recovered from a pediatric register of positive skin-prick tests. A nonallergic control group (n = 102) was gathered from a cohort of children previously examined for the prevalence of E. vermicularis and allergic symptoms. RESULTS: In the allergic group 26 of the 70 cases (37%) had a positive tape-test for E. vermicularis, compared to 23 of the 102 cases (23%) in the nonallergic control group (p = .037). CONCLUSION: The results indicate that E. vermicularis could be more frequent in children with allergic disease as defined by allergic symptoms and a positive skin-prick test compared to nonallergic children, i. e., those without a history of allergic disease. These data, however, do not allow any conclusion on the nature of the possible association between E. vermicularis and allergic disease.

Frequency of patients with acute asthma in relation to ozone, nitrogen dioxide, other pollutants of ambient air and meteorological observations.

OBJECTIVE: To study the association of the daily frequency of registration of patients with acute asthma at the emergency department of a central hospital in the south-west of Sweden with levels of air pollution and meteorological observations. METHODS: A retrospective longitudinal study was made of asthma patients taken from a hospital registry. This information was correlated with measurements of ozone, nitrogen dioxide, sulphur dioxide, toluene, temperature and relative humidity. Patients were from the catchment area of the Central Hospital of Halmstad containing around 120,000 inhabitants. A total of 4127 visits of patients with acute asthma to the emergency department at the Central Hospital of Halmstad were registered during a period of 1247 days from January 1990 to May 1993. The differential optical absorption spectroscopy (DOAS) technique was used to monitor levels of air pollutants over a distance of 1000 m in the central part of the town of Halmstad. Data on temperature, relative humidity, precipitation, wind speed and wind direction for the time period were supplied by the Swedish Meteorological and Hydrological Institute (SMHI). RESULTS: There were many statistically significant correlations between the levels of air pollutants and the meteorological measurements and a strong negative correlation between ozone and nitrogen dioxide. There was a statistically significant effect on asthma visits in children of low temperature and high nitrogen dioxide levels, and on asthma visits in adults of high temperature and high levels of ozone. CONCLUSIONS: There was a different reaction pattern in children and adults with asthma regarding temperature and ozone/nitrogen dioxide. The strong correlations between temperature and air pollution and between the levels of ozone and nitrogen dioxide made the true relation between asthma, air pollution and temperature hard to evaluate statistically.