Estudi de casos i controls sobre els factors de risc i la gravetat de l'asma en una població escolar / Estudio de casos y controles sobre factores de riesgo y gravedad del asma en una población escolar / Case-control study on risk factors for asthma and its severity in school-aged patients

Fonament: L'asma és la malaltia crònica infantil més freqüent i la seva prevalença continua augmentant. Objectiu: Valorar la influència de factors de risc coneguts de l'asma i la seva gravetat en pacients escolars. Mètode: Estudi observacional prospectiu de casos i controls fet a Consultes Externes d'Al·lergologia Pediàtrica en pacients asmàtics i controls sans. Les dades van ser recollides mitjançant qüestionaris i revisió d'històries clíniques. Posteriorment es va fer una anàlisi estadística per regressió univariant i multivariant. Resultats: Es van incloure 32 individus sans amb una edat mitjana de 10 anys i predomini masculí [59,3% (n=19)] i 107 pacients asmàtics amb una edat mitjana de 9 anys i predomini masculí [62,6% (n=67)]. El 32% (n=34) dels pacients asmàtics va presentar asma persistent i el 9% (n=10) mal control de la malaltia. La sensibilització a àcars de la pols va ser la més prevalent [86% (n=92)]. En l'anàlisi estadística entre els factors de risc estudiats de totes dues poblacions va destacar que l'única diferència significativa eren els antecedents de sibilàncies de repetició abans dels 3 anys (p<0,001). Es van observar associacions estadísticament significatives entre asma persistent i antecedents de sibilàncies virals recurrents (p<0,001), bronquiolitis per virus respiratori sincitial (VRS) (p<0,05) i sensibilització a fongs (p<0,05). Conclusions: L'antecedent de sibilàncies recurrents els tres primers anys de vida és el factor de risc més important per a l'asma escolar. Aquest factor, la bronquiolitis per VRS i la sensibilització a fongs es van relacionar amb l'asma més greu

Fundamento: El asma es la enfermedad crónica infantil más frecuente. En las últimas décadas se ha constatado un aumento de su prevalencia Objetivo. Valorar la influencia de factores de riesgo conocidos del asma y su gravedad en un grupo de pacientes en edad escolar. Método: Estudio observacional prospectivo de casos y controles realizado en Consultas Externas de Alergología Pediátrica en pacientes asmáticos y controles sanos. Los datos fueron recogidos mediante cuestionarios y revisión de historias clínicas. Posteriormente se realizó un análisis estadístico por regresión univariante y multivariante. Resultados: Se incluyeron 32 individuos sanos con una edad media de 10 años y predominio masculino [59,3% (n=19)] y 107 pacientes asmáticos con una edad media de 9 años y predominio masculino [62,6% (n=67)]. El 32% (n=34) de los pacientes asmáticos presentó asma persistente y el 9% (n=10) mal control de la enfermedad. La sensibilización a ácaros del polvo fue la más prevalente [86% (n=92)]. En el análisis estadístico entre los factores de riesgo estudiados de ambas poblaciones destacó que la única diferencia significativa fueron los antecedentes de sibilancias de repetición antes de los 3 años (p<0,001). Se observaron asociaciones estadísticamente significativas entre asma persistente y antecedentes de sibilancias virales recurrentes (p<0,001), bronquiolitis por virus respiratorio sincitial (VRS) (p<0,05) y sensibilización a hongos (p<0,05). Conclusiones: El antecedente de sibilancias recurrentes los tres primeros años de vida es el factor de riesgo más importante para el asma escolar. Este factor, la bronquiolitis por VRS y la sensibilización a hongos se relacionaron con el asma de mayor gravedad

Background: Asthma is the most common chronic disease in childhood. Its prevalence has increased over the last few decades. Objective: The aim of our study was to define the influence of known risk factors for asthma and its severity in a group of school- aged patients. Method: Prospective observational case-control study of asthmatic patients attended in our allergy outpatient department and healthy controls. Data were collected through questionnaires and review of medical records. Subsequently, a statistical analysis was perfor- med by univariate and multivariate regression. Results: Thirty-two healthy individuals, with an average age of 10 years and male predominance [59% (n=19)] and 107 asthmatic children, with an average age of 9 years and male predominance [62.6% (n=67)] were included. Thirty-two percent (n=34) of the asthmatic children presented persistent asthma and 9% (n=10) poor control of the disease. Sensitization to dust mites was the most prevalent [86% (n=92)]. In the statistical analysis between the risk factors studied in both populations, the only significant difference was the history of recurrent wheezing of children aged 3 years or younger (p<0.001). Associations were also observed between severe asthma and a history of frequent viral lower respi-atory tract infections (p<0.001), respiratory syncytial virus (RSV) infection (p<0.05) and sensitization to fungi (p<0.05). Conclusions: The history of recurrent wheezing in the first 3 years of life is the most important risk factor for the presence of asthma in children in school age. This factor, RSV bronchiolitis and sensitization to fungi were related to most severe asthma

Egg oral immunotherapy in children (SEICAP I): Daily or weekly desensitization pattern.

BACKGROUND: Studies are required before incorporating egg oral immunotherapy (OIT) into clinical practice. The Spanish Society of Pediatric Allergy, Asthma and Clinical Immunology (SEICAP) conducted a multicenter, randomized controlled study assessing the effectiveness and safety of the OIT using pasteurized egg white (PEW) in egg-allergic children. METHODS: One hundred and one egg-allergic children (6-9 years) were randomized for 1 year: 25 to an egg-free-diet (CG) and 76 to OIT (target dose 3.3 g PEW proteins), PI (30% weekly plus 5% daily increments) or PII (only 30% weekly increments) buildup patterns. Egg skin prick test, sIgE and sIgG4 serum levels, PEW double-blind placebo-controlled food challenge (DBPCFC), and dosing adverse reactions (DARs) were evaluated in all patients from inclusion (T0) until completing 1 year of follow-up (T12). At T12, egg-allergic control patients could start OIT. The effectiveness and safety of OIT and the effect of the buildup pattern were analyzed. RESULTS: At T12, 4/25 (16.0%) CG patients passed the PEW DBPCFC vs 64/76 (84.2%) OIT that reached total desensitization (P = 0.000); 12 egg-allergic control patients started OIT. Finally, 72/88 (81.81%) patients reached total desensitization, 96.15% PI vs 75.80% on PII (P = 0.01). Induction period (121.12 ± 91.43, median 98.00 days) was longer in patients on PII buildup pattern, and those with allergic asthma, minor threshold dose, or higher egg sIgE (P < 0.05). Most patients (89.06%) developed DARs: 74.53% were mild; 21.90% moderate; and 3.5% requiring adrenaline-treatment. Moderate reactions and those requiring adrenaline were more frequent in patients with allergic asthma, PII pattern, or higher egg sIgE serum antibody levels (P < 0.05). CONCLUSIONS: PEW OIT is an effective treatment for children with persistent egg allergy. A 30% weekly plus 5% daily increment pattern could be more effective and safer than one with only 30% weekly increments.

Egg OIT in clinical practice (SEICAP II): Maintenance patterns and desensitization state after normalizing the diet.

BACKGROUND: It is unknown which are the most suitable maintenance pattern and egg consumption to maintain the desensitization state after ending the oral immunotherapy (OIT). This multicenter, randomized, controlled trial compared two OIT maintenance patterns with pasteurized egg white (PEW), evaluating the egg consumption effect on the desensitization state after ending the OIT. METHODS: One hundred and one children with confirmed egg allergy were randomized: 25 to an egg-free diet (CG) and 76 to an OIT year with PEW and two maintenance patterns, 38 patients to daily 3.3 g proteins (AG) and 38 to every two days (BG). PEW challenge (DBPCFC), adverse reactions, and immune markers were assessed at baseline, at the end of the OIT, and at 6 and 12 months later on ad libitum egg consumption (T0, T12, T18, and T24). A questionnaire evaluated the egg consumption at T18. RESULTS: At T12, 64 of 76 (84.21%) OIT patients had reached total desensitization (32 AG and 32 BG) vs 4 of 25 (16.00%) CG who passed the PEW DBPCFC. Thirty (93.75%) AG vs 25 (78.12%) BG patients completed an OIT year. At T18, 27 of 29 (93.1%) AG vs 20 of 24 (83.3%) BG passed the PEW DBPCFC, 96% consuming at least two egg servings/week. At T24, 97.43% OIT patients passed the challenge. Most patients had adverse reactions, more frequent in the BG patients; frequency and severity of reactions decreased through the study. PEW skin prick test wheal and sIgE antibody serum levels similarly decreased in AG or BG, but AG patients had greater increase in PEW sIgG4 (P < 0.05). CONCLUSIONS: Daily OIT maintenance achieves better adherence, effectiveness, and safety. Two egg servings/week ensure maintained desensitization after the end of an OIT year.

Comparación nutricional de purés infantiles caseros verus industriales / Comparison of nutritional contents between homemade and industrial baby food

Introducción. Los cambios sociales y familiares provocan variacionesen los hábitos alimentarios de los lactantes, con un aumentodel consumo de purés comerciales. Desde nuestro servicio depediatría de atención primaria se planteó si estos productos aportabanuna nutrición adecuada para los niños.Objetivos. El objetivo de nuestro trabajo fue analizar las diferenciasentre el contenido nutricional de los purés infantiles caseros ylos preparados industriales.Material y método. Se elaboraron tres purés estándar caseros (verduracon ternera, fruta y verdura con pescado) y se realizó un análisisnutricional de estos (aporte calórico-energético, carbohidratos,proteínas y lípidos) utilizando las tablas Sandoz y Cesnid. Elsegundo punto fue el análisis nutricional de purés comerciales,según etiquetaje, de tres marcas, con nutrientes similares a los preparadoscaseros. En un tercer punto se realizó la comparación deambos. Una nutricionista diplomada realizó el asesoramiento sobreel estudio.Resultados. Una vez analizados todos los productos se obtuvieronlos siguientes resultados: las preparaciones de verduras con carneo pescado de los potitos industriales presentaban un contenidoenergético inferior, hasta un 40%, en comparación con las preparacionescaseras. En cuanto al contenido lipídico, éste es superior(hasta el 50%) en las preparaciones caseras, pero el porcentaje degrasas saturadas (aterógenas) es muy superior (entre 50-60%) enlos preparados industriales.Las preparaciones de frutas industriales tienen un contenido energéticosuperior (35%). El contenido total de carbohidratos es eldoble que en los preparados caseros. En cuanto al contenido lipídicoy proteico, no se encontraron diferencias.Conclusiones. Los niños alimentados habitualmente con potitosindustriales reciben un aporte de carbohidratos inferior al recomendado,con un exceso de carbohidratos simples...(AU)

Introduction. Social and familial changes lead to alterations inthe feeding habits of infants, with an increase in the use ofcommercial baby foods. Our primary pediatric care unit soughtout to investigate whether those products were able to provideadequate nutrition.Objective. To analyze the differences in nutritional content betweenhomemade and commercial baby food.Method. Three standard homemade purées (beef and vegetables,fruits, and fish and vegetables) were made, and a nutritionalanalysis (caloric and energetic content, carbohydrates, lipids, andproteins) was performed using the Sandoz and Cesnid tables. Wethen analyzed the nutritional content of three equivalent commercialand compared the results of both groups.Results. The energetic content of commercial products of vegetableswith beef or fish was up to 40% inferior to the homemadepurees. The lipid content was higher (up to 50%) in the homemadefood, but the percentage of saturated (aterogenic) fat washigher (50-60%) in the commercial purees. The energetic contentof commercial fruit purees was 35% higher. Likewise, the totalcarbohydrate content was twice than in the homemade products,whereas there were no differences in the lipid and proteincontents.Conclusions. Children fed with commercial baby food receive loweramounts of carbohydrates than recommended, with an excessof simple carbohydrates. Commercial vegetable purees provide alower caloric content. In a complete menu using commercial products,the caloric intake is inverted: more energy is delivered withthe desert than with the main course. Even though the overall lipidintake is lower with commercial products, the aterogenic loadis higher(AU)

Cow's milk protein allergy. A multi-centre study: clinical and epidemiological aspects.

BACKGROUND: Due to the age when it becomes apparent and the treatment needed, cow's milk proteins (CMP) allergy requires an accurate diagnosis to avoid labelling infants falsely as allergic and subjecting them to unnecessary diets. The objective of this multi-centre study carried out at the Allergy Units of 14 Children's Hospitals was to discover the epidemiological, clinical and evolutionary characteristics of cow's milk protein allergy (CMPA). METHODS AND RESULTS: Infants suspected of CMPA who attended allergy clinics at the hospitals taking part during the study period were studied and a detailed clinical history was collected on all of them. Prick tests were done with cow's milk and its proteins and specific IgE anti-bodies were determined by means of CAP with the same allergens as the Prick test. The challenge test with cow's milk was carried out unless contraindicated by the diagnostic protocol. Two different challenge regimens were used: one of them carried out in 3 days and the other in one day. 409 infants with suspected CMPA were included and the diagnostic challenge test was performed on 286 patients (70 %) and not carried out on 123, as it was not indicated according to the protocol. IgE-mediated allergy was confirmed in 234 infants (58 %) and in 15 (4 %) non-IgE-mediated hypersensitivity was diagnosed. The two challenge regimens were equally secure. The average age when the reaction to cow's milk formula took place was 3.5 months (10 days-10 months). The symptoms appeared in the first week of introduction in 95 % of cases and appeared in 60 % with the first feeding with the formula. The most frequent clinical signs were cutaneous in 94 % of cases and the majority of cases appeared within 30 minutes of the feed. 99 % had been breast fed and 44 % had received some cow's milk supplement during the lactation period. Sensitization to egg not given in the feed was noted in 30 % and to beef in 29 %, being well tolerated in all of these. CONCLUSIONS: Carrying out an appropriate diagnostic protocol in infants attending for suspected CMPA allows allergy to be ruled out in a high percentage of cases.

Cow's milk protein allergy. A multi-centre study: clinical and epidemiological aspects / Alergia a las proteínas de la leche de vaca. Estudio multicéntrico : aspectos clínicos y epidemiológicos

Background: Due to the age when it becomes apparent and the treatment needed, cow's milk proteins (CMP) allergy requires an accurate diagnosis to avoid labelling infants falsely as allergic and subjecting them to unnecessary diets. The objective of this multi-centre study carried out at the Allergy Units of 14 Children's Hospitals was to discover the epidemiological, clinical and evolutionary characteristics of cow's milk protein allergy (CMPA). Methods and results: Infants suspected of CMPA who attended allergy clinics at the hospitals taking part during the study period were studied and a detailed clinical history was collected on all of them. Prick tests were done with cow's milk and its proteins and specific IgE anti-bodies were determined by means of CAP with the same allergens as the Prick test. The challenge test with cow's milk was carried out unless contraindicated by the diagnostic protocol. Two different challenge regimens were used: one of them carried out in 3 days and the other in one day. 409 infants with suspected CMPA were included and the diagnostic challenge test was performed on 286 patients (70 %) and not carried out on 123, as it was not indicated according to the protocol. IgE-mediated allergy was confirmed in 234 infants (58 %) and in 15 (4 %) non-IgE-mediated hypersensitivity was diagnosed. The two challenge regimens were equally secure. The average age when the reaction to cow's milk formula took place was 3.5 months (10 days-10 months). The symptoms appeared in the first week of introduction in 95 % of cases and appeared in 60 % with the first feeding with the formula. The most frequent clinical signs were cutaneous in 94 % of cases and the majority of cases appeared within 30 minutes of the feed. 99 % had been breast fed and 44 % had received some cow's milk supplement during the lactation period. Sensitization to egg not given in the feed was noted in 30 % and to beef in 29 %, being well tolerated in all of these. Conclusions: Carrying out an appropriate diagnostic protocol in infants attending for suspected CMPA allows allergy to be ruled out in a high percentage of cases

Objetivos: La alergia a proteínas de leche de vaca (PLV)por la edad en la que se presenta y el tratamiento que requiere exige un diagnóstico de certeza para evitar etiquetar al lactante de falsamente alérgico sometiéndolo a dietas innecesarias. Se trata de un estudio multicéntrico realizado en las unidades de alergia de 14 Hospitales infantiles para conocer las características epidemiológicas, clínicas y evolutivas de la alergia a proteínas de leche de vaca (APLV). Material y métodos: Se estudiaron a los niños con sospecha de APLV que acudieron a las consultas de alergia de los hospitales participantes, en el periodo del estudio, realizándoles a todos ellos una detallada historia clínica, Prick-test con leche de vaca y sus proteínas y determinación de anticuerpos IgE específicos mediante CAP para los mismos alergenos del Prick. Se llevó a cabo la prueba de provocación con leche de vaca de no estar contraindicada según el protocolo diagnóstico. Se utilizaron dos pautas de provocación distintas una de ellas llevada a cabo en 3 días y la otra en un día. Resultados: Se incluyeron 409 niños con sospecha de APLV realizándose prueba de provocación diagnóstica en 286 pacientes (70%), no llevándose a cabo en 123 por no estar indicada según el protocolo. Se confirmó alergia IgE mediada en 234 lactantes (58%) y en 15 (4%) se diagnosticó de Hipersensibilidad no IgE mediada. Las dos pautas de provocación utilizadas fueron igualmente seguras. La edad media de la reacción con formula de leche de vaca tuvo lugar a los 3.5 meses (10 días-10 meses). Los síntomas aparecieron en la primera semana de su introducción en el 95% y en el 60% aparecieron con la primera toma de fórmula. Las manifestaciones clínicas más frecuentes fueron las cutáneas en el 94% y se presentaron en la mayoría de los casos en los primeros 30 minutos tras la toma del alimento. El 99% había recibido lactancia materna y el 44% había recibido algún suplemento de leche de vaca durante la lactancia. Se observó sensibilización a huevo no introducido en la alimentación en el 30% y sensibilización a carne de ternera en el 29% siendo bien tolerada en todos ellos. Conclusiones: El realizar un protocolo diagnóstico adecuado en los niños que consultan por sospecha de CMPA permite descartar la alergia en un alto porcentaje de casos