Early intervention with high-dose inhaled corticosteroids for control of acute asthma exacerbations at home and improved outcomes: a randomized controlled trial.

Various studies have examined the efficacy of a temporary increase in the dose of inhaled corticosteroids (ICSs) during acute asthma exacerbations with conflicting results. This study was designed to investigate the efficacy of high-dose ICSs in controlling asthma exacerbations in children. Data were collected on asthmatic children, aged 2-17 years, who were maintained on ICSs. Participants were randomly assigned to a 12-day treatment protocol for acute asthma exacerbation at doses of ICS that were two, four, or eight times their maintenance ICS dose. The primary outcome was the frequency of need to progress to systemic steroid therapy. The secondary outcome was difference in symptom scores among the three treatment groups to determine if one dosing protocol was superior to another. Eighty-two of 197 enrolled patients experienced acute asthma exacerbation and completed the increased dosing protocol. No significant difference in systemic corticosteroid use was detected between patients treated with two, four, or eight times their maintenance dose of ICS, but we observed a trend toward a larger reduction in mean total symptom score with increasing ICS dose at the end of the study. We did not observe a significant difference in need for systemic corticosteroids between doubling the maintenance dose and increasing to four or eight times the dose, but we observed a trend suggesting that higher doses may improve symptoms better than doubling the dose. A more specific design may be needed to provide a more reliable answer to this question.

Prevalence of positive skin prick test results in children with Down syndrome: a case-control study.

BACKGROUND: Because many of the same otologic and nasal problems experienced by children with Down syndrome are also frequent in children with atopic disease, many children with Down syndrome are referred to an allergist for evaluation. OBJECTIVE: To determine the prevalence of positive skin prick test (SPT) reactions to common aeroallergens in children with Down syndrome. METHODS: Using a case-control design, we reviewed the medical records of children with Down syndrome who had undergone SPT. Each case was matched by sex and age with a control who had been evaluated by SPT at an initial visit. RESULTS: Thirty-nine cases and controls were identified. Eighteen percent of cases were found to have at least 1 positive SPT result compared with 54% of controls. This closely approximates the percentage of the general population with at least 1 positive SPT result (54.3%) as reported in the Third National Health and Nutrition Examination Survey. CONCLUSIONS: Given the low prevalence of positive SPT results in children with Down syndrome, it is unlikely that allergic rhinitis will be identified as the cause of many of the chronic rhinitis symptoms that many of these children are referred to an allergy practice to have evaluated. It may be helpful to the parents and to the patients themselves to avoid involving another specialist and appointment because they frequently are involved with many specialists for medical care. A larger study would be helpful in confirming the prevalence of positive SPT results in children with Down syndrome.

Systemic reaction to pneumococcal vaccine: how common in pediatrics?

The 23-valent-polysaccharide pneumococcal vaccine (PPV23) is currently recommended for patients at high risk for invasive disease from Streptococcus pneumoniae. It is also frequently used in the evaluation of patients with suspected immunodeficiency. Reports of systemic adverse reactions are rare. Our objective is to describe a patient with an apparent systemic reaction to PPV23 and review our hospital's 2-year experience with pneumococcal vaccine. Chart review of 173 patients given PPV23 between January 1, 2004 and December 31, 2005 revealed five who had significant adverse reactions, including local cellulitis, fever, and vomiting. Variables considered included age at immunization, indication for PPV23, and prior pneumococcal vaccines. The mean age of all patients given PPV23 during the defined time period was 8.6 years, and the most common indication for vaccination was recurrent infection. Of those patients who had adverse reactions, the mean age was 6.5 years. The time from prior pneumococcal vaccination was a mean of 20 months in children who did not have an adverse reaction. None of the patients who had an adverse reaction had documentation of receiving PPV23 before. Local reactions to PPV23 occur in approximately 50% of recipients, and revaccination of immunocompetent individuals increases the risk for local reaction. Systemic reactions are less common and only occur in approximately 1% of recipients. Our patient had no identifiable risk factors for development of an adverse reaction. Additional studies are indicated to determine whether there are identifiable risk factors for the development of adverse reactions to PPV23.