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Paediatric pulmonology and allergology
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Arunas Valiulis, Saulius Rocka, Rima Sabaliene. The prevalence of bronchial asthma, allergic rhinitis and atopic dermatitis among school-children of urban and rural areas of Lithuania (ISAAC study) Laimute Vaideliene, Jurgis Bojarskas, Jolanta Kudzyte, Johannes Forster. Changes of allergy symptoms in childhood Nils E.Eriksson, Christian Möller, Ljudmilla Raudla, Jan A.Wihl, Marius Zolubas. Sensitization according to skin prick testing in atopic patients with asthma or rhinitis at 24 allergy clinics in Northern Europe and Asia Jovile Vingraite. Infant feeding and atopic dermatitis James P.Kemp, Robert J.Dockhorn, Gali G.Shapiro, Ha H.Nguyen, Theodore F.Reiss, Beth C.Seidenberg, Barbara Knorr. Montelukast once daily inhibits exercise - induced bronchoconstriction in 6- to 14-year-old children with asthma Inge Axelsson. Acute otitis media in children: to treat or not to treat? Irena Narkeviciute, Indre Tamuliene. Empiric Antimicrobial Therapy in Children with Acute Bronchitis Albinas Naudziunas, Angele Andriuskeviciene, Virginijus Meskinis. Drug-resistant TB in Kaunas Romainiai TB hospital Algimantas Vingras, Jovile Vingraite. Fever in childhood Kjell Reichenberg, Anders G.Broberg. Disease specific quality of life in parents of children with asthma Kjell Reichenberg, Anders G.Broberg. Disease specific quality of life in 7 to 9 year-old asthmatic children National guidelines of allergic rhinitis |
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The prevalence of bronchial asthma, allergic rhinitis and atopic dermatitis among the school-children of urban and rural areas of Lithuania (ISAAC study)
Arunas Valiulis, Saulius Rocka, Rima Sabaliene
Epidemiological ISAAC study (International Study of Asthma and Allergies in Childhood) on bronchial asthma, allergic rhinitis and atopic dermatitis is carried out all over the world. The same study is also performed in Lithuania. Provided with the standard ISAAC questionnaire we obtained the information from the 7971 children, living in Vilnius city (57 000 inhabitants), Utena city (36 000 inhabitants) and rural area of Utena district. The study took place during the 1998-1999 years period. The aim of the study was to analyze the prevalence of the bronchial asthma, allergic rhinitis and atopic dermatitis in the population of the 6-7 and 13-14 years old children living in the city and country land. We revealed, that the prevalence of the bronchial asthma, allergic rhinitis and atopic dermatitis in the rural areas was statistically significant less than in the population of the city children. on the other hand, the prevalence of the bronchial asthma was not significantly different. The less prevalence of the allergic diseases in the group of junior children may be explained with the higher contact with the non-viral infection. But the same prevalence of the bronchial asthma in the elder group may demonstrate, that the preventive mechanisms of the country land may not be sufficient enough for the morbidity in the elder age. Further development work is needed for the objectivisation of influence of the environmental factors on the allergic diseases development in childhood |
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Changes of allergy symptoms in childhood
Laimute Vaideliene, Jurgis Bojarskas, Jolanta Kudzyte, Johanes Forster
International SPACE study data about dynamics and prevention of allergic symptoms in children are presented in this article. It turned out that 22.6% of 5-5.7 years old children had atopic family history. Only 5.6% of children in these families had no symptoms of allergy. At the beginning of the study 12.8% of investigated children had diagnosed asthma, 8.3% suffered from allergic rhinits and 11.9% had eczema. While investigating these children during the last two years, we noticed that the prevalence of all allergic diseases was increasing. Though symptoms of allergic diseases were very common, they were rarely diagnosed officially. Still we noticed the improvement of diagnosing allergic diseases: asthma was diagnosed for 33.3% of wheezing children in 1997 in comparison with 79.4% of diagnosed asthma in 1999. Special booklets and mattress covers were delivered for the intervention group children. Decreased prevalence of allergic clinical symptoms and less sensitization to house dust mites and cats allergens was noticed in intervention group in comparison with control group two years later. |
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Sensitization according to skin prick testing in atopic patients with asthma or rhinitis at 24 allergy clinics in Northern Europe and Asia
Nils E.Eriksson, Christian Möller, Ljudmilla Raudla, Jan A.Wihl, Marius Zolubas
The aims of this multi center study were to find the prevalence of sensitization with two insects - RML and cockroaped- in atopic patients in Nordic countries and relate indoor environmental factors to the sensitization with these and other allergens. Furthermore, we wanted to evaluate the cross-sensitization patterns among inhalant allergens and crustaceans. Skin prick tests (SPTs) with common inhalant allergens as well as cockroach, red mosquito larvae (RML) and shrimp were performed on 2113 atopic patients from eight countries. Allergen specific IgE in the sera of 550 patients was determined, using CLA with 16 different inhalant and food allergen extracts. CAP RAST was used for determination of allergen specific IgE against cockroapedon the sera of 50 individuals having positive SPT but negative CLA with cockroach. On sera from 16 selected patients, having strongly positive SPT with the insects, RAST was performed with nine commercially available insect allergens. Positive SPT with cockroaped was found in 19 proc. of the atopic patients and with RML in 9 perc.. Positive CLA with cockroaped was obtained in only 12 perc. of those having positive SPT. Among 50 patients, however, who had strongly positive SPT and negative CLA with cockroach, 28 (56 perc.) had positive CAP RAST with cockroach. The figure for positive CLA with RML among those having positive SPT with RML was 20 perc.. Positive relationships were found between reports of cockroaches at home and sensitization to cockroaches and between contacts with RML used as aquarium fish foods and specific serum IgE against RML as well as with IgE against cockroaches. Correlation was also found between symptoms on exposure to house dust and positive SPTs with DP and DF. Strongly positive correlations were seen between test results (with SPT as well as with IgE) within (but not between) the allergen groups insects/ crustaceans/mites, moulds, mammalians and pollens. A practical conclusion for clinical work is that a positive test result with one insect allergen does not necessarily mean that this unique insect is of clinical importance for the patient. Furthermore, positive test results with crustaceans in a patient sensitized to insects do not necessarily indicate clinically relevant crustacean allergy, and vice versa.
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Infant feeding and atopic dermatitis
Jovile Vingraite
Atopic dermatitis is the most frequent atopic disease in infancy. Main causes are both genetic and environmental factors. The aim of the study was to assess the influence of infant feeding on morbidity with atopic dermatitis. 154 infants were followed for 12 months, 29 (18.8%) developed clinical signs of this disease. Mean age of falling ill was 2.9 months (range 0.5-8.5 months). Significant association was found between development of atopic dermatitis in infancy and atopic history in family members and close relatives (p=0.000005). At the moment of developing clinical signs of atopic dermatitis, 21 (72.4%) infant was still breast-fed, however, only 2 (6.9%) exclusively. Regardless genetic predisposition no preventive measures were applied, duration of breast-feeding was short, conventional cow's milk formulas, solid foods were started early. Preventive measures were started after the development of atopic dermatitis. A half of mothers indicated cow's milk as the most frequent allergenic food for their infants. The shorter was duration of breast-feeding and the earlier was solid food started the more widespread was skin's involvement. In 5 (17.2%) infants the clinical signs of atopic dermatitis cleared before 1 year of age and haven't relapsed after the hypo-allergenic diet was stopped.
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Montelukast once daily inhibits exercise - induced bronchoconstriction in 6- to 14- year-old children with asthma
James P.Kemp, Robert J.Dockhorn, Gail G.Shapiro, Ha H.Nguyen, Theodore F.Reiss, Beth C.Seidenberg, Barbara Knorr
Objective: To determine whether montelukast, a leukotrien receptor antagonist, attenuates exercise - induced bronchoconstriction (EIB) in 6- to 14-year-old children with asthma. Study design: Double-blind, multicenter, 2-period crossover study. Children (n=270 with forced expiratory volume in 1 second (FEV1) > 70% of the predicted value and a fall in FEV1>20% after exercise on 2 occasions. Patients received montelukast (5-mg chewable tablet) of placebo once daily in the evening for 2 days in crossover fashion (at least 4 days between treatment periods). Standardized exercise challenges were performed 20 to 24 hours after the last dose in each period. End points included area above the post exercise percent fall in FEV1 versus time curve (AAC0-60min), maximum percent fall in FEV1 from pre-exercise baseline, and time to recovery of FEV1 to within 5% of pre-exercise baseline. Results: Montelukast significantly reduced AAC0-60min (265 vs. 590 min for montelukast and placebo, respectively, P<.05; ~59% protection relative to placebo) and the maximum percent fall (18% vs. 26% for montelukast and placebo, respectively, P<.05). Montelukast attenuates EIB at the end of the dosing interval in 6- to 14-year-old children with asthma. (J Pediatr 1998:133:424-8, with permission).
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Acute otitis media in children: to treat or not to treat?
Inge Axelsson Mid-Sweden University&Ostersund County Hospital, Sweden
Every day millions of children world-wide take antibiotics against acute otitis media despite the fact that this treatment has not been shown to benefit the otherwise healthy, average AOM patient. Treatment differs greatly between similar, developed countries. These differences do not seem to be based on rational causes but on differences in mentality and culture. An adoptions of Dutch guidelines for AOM in the USA should result in 400.000 fewer US children on antibiotics during one average day! The incidence of severe complications (mastoiditis, meningitis) must be carefully monitored but there is no evidence that these complications are more common in the Netherlands than in the USA. The number of patients who die due to bacteria made antibiotic-resistant by overuse of antibiotics when treating AOM in children is unknown, but is most probably significant (this is never included in "good versus harm" calculations). We know little about what treatment is best for children suffering from AOM in poor countries, but it is probably wise to be more aggressive there and to adapt a freer usage of antibiotics than is advisable in rich countries.
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Empiric Antimicrobial Therapy in Children with Acute Bronchitis
Irena Narkeviciute, Indre Tamuliene
The aim of this study was to ascertain how often and what kind of antibiotics usually are used for the empiric treatment in patients with acute bronchitis. 314 children (69.8%) from 450 were treated with 23 different antibiotics. Antimicrobial agents were prescribed more often for children aged 7-45 years than for younger children. 31.3% of patients received aminopenicillins before hospitalization and 30% received them during hospitalization. Cephalosporins and gentamicin were prescribed more often in outpatient clinics, penicillin and macrolide - in the hospital.
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Drug-resistant TB in Kaunas Romainiai TB hospital
Albinas Naudziunas, Angele Andriuskeviciene, Virginijus Meskinis
7914 tuberculosis (TM positive) patients have been investigated by culture of the sputum in Kaunas Romainiai tuberculosis hospital during 1979-1999. We have revealed that during this period drug resistance of M.tuberculosis to antituberculous drugs have not changed markedly and fluctuated from 46.9 perc. (in 1986) to 85.9 perc. (in 1982). Maximal resistance was to H and fluctuated from 33.85 perc. (in 1996) to 67.4 perc. (in 1986). Big resistance was found to S - from 58.6 perc. (in 1991) to 60.4 perc. (in 1992) and to R - from 47.2 perc. (in 1986) to 56.7 perc. (in 1994). The lowest resistance was to E - from 0.8 perc. (in 1997) to 9.3 perc. (in 1991). Drug resistance to one or two antituberculous drugs ahve not changed during last 20 years, but resistance to one or two antituberculous drugs have raised (1.48 perc. in 1981 and 19.4 perc. in 1991).
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Fever in Childhood
Algimantas Vingras, Jovile Vingraite
Fever is a nonspecific symptom of various diseases. It is also one of the main causes for applying to a physician. Normal armpit temperature is 36.5-37.0OC. Fever is one of defense reactions. It stimulates the defense against infectious agents. Fever does not depend on the surrounding temperature. Fever should be differentiated from hypertermia, when production of heat is higher than its dispersion. Hypertermia depends on the surrounding temperature. Before starting treatment, fever of infectious origin should be differentiated from fever in non-infectious origin. The most troublesome is fever in infants and small children (up to the age of 36 months0, because their ability for localizing infection is often poor. Fever of 38OC in 5-9 perc. of infants up to 3 months of age is a sign of severe bacterial infection. Other indicators of severe disease are burning red cheeks, burning skin, chills (except for small infants), cold hands and feet, tachycardhia, tachypnea. Usually acutely ill children are feverish for less than one week period; dominating other clinical signs and symptoms depend on the site of infection. Fever lasting longer than 8 days is an indication for more thorough investigation in a hospital. Changes in small children, and especially, infants sleep and awake periods, length and quality, also help to evaluate the severity of the illness. Greater changes indicate a more severe illness. Hasty administration of antipyretics does not help to determine the cause for fever.
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Disease specific quality of life in parents of children with asthma Quality of Life Research 1999;8:561
Kjell Reichenberg, Anders G.Broberg
Nordic School of Public Health and Child & Adolescent Psychiatry Centre. Göteborg. Sweden.
Background: the Paediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ) [Juniper EF., Guyatt GH., Feeny DH., Ferrie PJ., Griffith LE., Townsend M. Measuring quality of life in the parents of children with asthma. Quality of Life Research. 1996;5:27-34] was developed to estimate the impact of a child’s asthma on limitation of caregivers’ normal activities (4 items) and their worries over the disease (9 items). Each item is scored from 1 (maximal impairment) to 7 (no impairment at all). The PACQLQ was recently translated to Swedish, and the purpose of our study was to analyse the relation between PACQLQ-scores and measures of disease severity, disease-specific QoL in children and socio-economic factors. Methods: In a cross-sectional study, 72 7 to 9 year-old children and their families were approached. 61 families participated of which 11 had a child with mild asthma, 40 intermediate and 10 severe according to established criteria. Non-parametric statistics was used for hypothesis testing. Results: Parental grading of symptoms (Spearman’s rho=0.637, p<0.001), the asthma specific quality of life of the child (rho=0.359, p=0.002) and gradings of asthma from medical records (mild asthma median score 6.69, intermediate 6.27 and severe 5.12, p=0.001) were all related to overall PACQLQ. The sex of child, the presence of other diseases related to allergy, peak flow rate (PEFR) and socio-economic level did not affect scores. Lower scores on the emotional domain were seen in parents of children on steroids (p=0.049). The distribution of scores was heavily skewed towards the positive end of the scale, leading to limited power to discriminate among patents of children with mild asthma. -- The instrument had acceptable internal consistency and was well accepted by the parents. Conclusion: The PACQLQ corresponds well with disease severity as perceived by the parents, the child and the physician. PACQLQ can be used in clinical trials and in the development of medical and psycho-social care of asthmatic children. - There is a need to investigate if mothers and fathers of the same asthmatic child experience different QoL and if single parents have the same impairment in QoL as cohabiting parents.
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Disease specific quality of life in 7 to 9 year-old asthmatic children Quality of Life Research 1999:8:664
Kjell Reichenberg, Anders G.Broberg
Nordic School of Public Health and Child & Adolescent Psychiatry Centre. Göteborg. Sweden Background: the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) [Juniper EF. Guyatt GH. Feeny DH. Ferrie PJ. Griffith LE. Townsend M. Measuring quality of life in children with asthma. Quality of Life Research. 1996;5:35-46.] was translated to Swedish. We have validated the instrument and used it to study determinants of disease specific QoL. Methods: In a cross-sectional study 72 7 to 9-year-old children and their families were approached, of which 61 (85%) participated (25 girls). Mean age was 8.7 years. Children’s asthma was graded according to established criteria, 11 children had mild asthma, 40 intermediate and 10 severe. Results: The most common restricted activities during the week preceding the investigation were: running (74%), gymnastics (30%), walking uphill (26%), playing football (20%), and shouting (13%). Parental rating of symptoms (Spearman’s rho = 0.40, one-sided p < .01), per cent of expected PEFR (rho = 0.30, p <. 01), and FEF25-75 (rho = 0.30, p < .05) all correlated with PAQLQ-scores. Scores were also significantly (p < .05) related to physicians’ grading of severity of children’s disease (mild asthma median 5.9, intermediate 5.8 and severe 5.3). Younger children reported lower PAQLQ. So did children of single parents (median 5.30, children of cohabiting parents median 5.91, p < .01). Children’s gender or presence of eczema or rhinoconjunctivitis did not significantly affect scores. Children suffering from food allergy reported less impairment of disease specific QoL. The PAQLQ-instrument was easy to administer, well accepted by the children, and showed acceptable internal consistency. Conclusion: The PAQLQ is valid in the sense that it corresponds well with measures of disease severity, that is spirometry, clinical grading and parental ratings of amount of symptoms. – How is the reported impaired disease specific QoL of children with single parents mediated? Possible differences in: smoking habits, utilisation of preventive health measures, ease of transportation (access to a car) and general domestic burden, matters not included in our study, need further study. |
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September, 2000, Vol. III, No.3 (p. 965-1068)
