Attacks In Children Research Articles

P10-05: The relationship between environmental air pollution, meteorological factors, and emergency service admissions for epileptic attacks in children

P10-05: The relationship between environmental air pollution, meteorological factors, and emergency service admissions for epileptic attacks in children

Wartime panic attacks in children with special educational needs

The study is relevant because it covers the main ways to help during panic attacks in the most vulnerable category of the population of Ukraine, children with special educational needs, in conditions of war and experiencing traumatic events. The purpose of the study is to identify the main methods of psychological assistance during panic attacks in children with special educational needs. The main practice-oriented research methods were observation, conversations, interviews, questionnaires in the process of meetings with children, and the collection of medical history. Based on the results of applying practical research methods, effective, unified step-by-step psychological support for this category of persons was developed. The study describes the main methods of psychological assistance, as the main chosen technique of cognitive behavioural therapy, which should be accompanied by additional communication with parents and teachers to disseminate information, practical skills, and actions in situations of panic attacks in children with special educational needs. The study has an evidence base, is a praxeological writing, and is still being conducted based on educational institutions and rehabilitation centres for children with special educational needs, in particular, those with visual, hearing, intelligence, and speech disorders. The main signs of behaviour and emotional states of children experiencing panic attacks are characterised. It is stated that a panic attack in children with special educational needs occurs from excessive emotional load, exhaustion, traumatic event, stress, and negative dynamics of habitual life. The final result of the study is outlined, namely: the development of a unified protocol of psychological assistance and support for children with special educational needs experiencing panic attacks, their parents, and relatives. At this stage of the study, the results obtained allowed forming effective advice to parents, people who happened to be nearby, and teachers during the onset of a panic attack in a child.

The efficacy of a single-dose anakinra injection during disease attack in pediatric familial Mediterranean fever.

The aim of this retrospective study is to evaluate the efficacy of a single-dose anakinra during familial Mediterranean fever (FMF) attacks and its effect on the duration, severity, and frequency of attacks. The patients with FMF who had disease episode and received a single-dose anakinra during disease episode between December 2020 and May 2022 were included. Demographic characteristics, MEFV gene variants detected, concomitant medical conditions, demographics of recent and previous episodes, laboratory findings and length of hospital stay were recorded. A retrospective analysis of medical records revealed 79 attacks from 68 patients who met inclusion criteria. The patients had a median age of 13 (2.5-25) years. All patients reported that the average duration of their previous episodes lasted longer than 24h. When the recovery time of attacks after subcutaneous anakinra application at the disease attack was examined, it was observed that 4 attacks (5.1%) ended in 10min; 10 attacks (12.7%) in 10-30min; 29 attacks (36.7%) in 30-60min; 28 attacks (35.4%) in 1-4h; 4 attacks (5.1%) in 24h; and 4 attacks (5.1%) ended in more than 24h. There was no patient who did not recover from their attack after a single dose of anakinra. Although the efficacy of a single-dose anakinra administration during FMF attacks in children needs to be confirmed by prospective studies, our results suggest that use of a single-dose anakinra during FMF attacks is effective in reduction of severity and duration of disease attacks.

The Effectiveness of Budesonide in the Treatment of Asthma Attacks in Children: A Systematic Review and Meta-Analysis

The Effectiveness of Budesonide in the Treatment of Asthma Attacks in Children: A Systematic Review and Meta-Analysis

Compare the Efficacy of Ipratropium Bromide with Salbutamol and Salbutamol Alone in Recurrent Wheezes in Children with Asthma Presenting to LRH, Peshawar

Objective: Evaluate the effectiveness of Ipratropium Bromide in combination with Salbutamol and Salbutamol alone for the treatment of recurrent wheezes in children with asthma who seek care at LRH, Peshawar. Methods: After the approval from the institution review board, this randomized controlled trial was performed at Department of Pediatrics, LRH, Peshawar, from 7th January 2021 to 7th July 2021. A total of 128 patients who met the inclusion criteria were recruited from the Department of Pediatrics at LRH Peshawar. In Group A, 64 patients were given Ipratropium Bromide in addition to Salbutamol, whereas in Group B, 64 patients were given Salbutamol alone. In group A, children were subjected to salbutamol 2.5 mg thrice a day plus ipratropium bromide 125 ug 8 hourly during the exacerbation episode. In group B, children were subjected to 2.5 mg of salbutamol thrice a day during the exacerbation episode. Patients were contacted three months later to assess progress, and outcomes were recorded using a custom-made proforma. Results: 21.9% of the children were between age 1-2 years, while and 78.1% children were between 3-5 years of Age. Mean age was 4.56±1.357 in both the study groups. 0ver all there were 70.3% male children and 29.7 % were females. In 27.3% of the children duration of the disease was 6 months and 72.7% have more than 6 months. Most of the participated children have weight between 16-20 kg (30.5%), followed by 26.6% have weight more than 30kg, followed by 21.1% have weight between 21-25kg. in 56.2% of the children had a family history of asthma, while 43.8% had no family history of asthma. Group wise distribution of efficacy among 128 children were analyzed as children in Group A (Ipratropium Bromide with Salbutamol) showed 45% decrease number of wheezing episodes and Group B (Salbutamol alone group) showed 51.5% decrease number of wheezing episodes Conclusion: Our research reveals that the addition of ipratropium bromide to salbutamol for the treatment of mild to moderate asthma attacks in children does not improve outcomes over the use of salbutamol alone. Keywords: Efficacy of Ipratropium Bromide with Salbutamol and Salbutamol alone, Recurrent wheezes, Children with asthma

Safety and Effectiveness of Magnesium Sulphate for Severe Acute Asthma Management Among Under-five Children: Systematic Review and Meta-analysis.

Asthma is the common chronic inflammatory disease affecting children. It is usually associated with airway hyper-responsiveness. Globally, the prevalence of asthma among pediatrics population varies from 10% to 30%. Its symptoms range from chronic cough to life-threatening bronchospasm. At emergency department, all patients with acute severe asthma should initially receive oxygen, nebulized β2-agonists, nebulized anticholinergic agent, and corticosteroids. Though bronchodilators act within minutes, corticosteroids may require hours. Magnesium sulphate (MgSO4) was first considered for treating asthma about 60 years ago. Several case reports were published on its usefulness in decreasing admission and endotracheal intubation. So far, evidence is conflicting to fully employ MgSO4 for asthma management in children under five. This systematic review was aimed to evaluate the effectiveness and safety of MgSO4 in the treatment of severe acute asthmatic attacks in children. A systematic and comprehensive search of literature was performed to identify controlled clinical trials conducted on IV and nebulized MgSO4 in pediatric patients with acute asthma. Data generated from three randomized clinical trials were included in the final analysis. In this analysis, intravenous MgSO4 did not improve respiratory function (RR=1.09, 95%CI: 0.81-1.45) and not safer than conventional treatment (RR=0.38, 95%CI: 0.08-1.67). Similarly, use of nebulized MgSO4 showed no significant effect on respiratory function (RR=1.05, 95%CI: 0.68-1.64) and more tolerable (RR=0.31, 95%CI: 0.14-0.68). Intravenous MgSO4 may not be superior to conventional treatment in moderate to severe acute asthma among children and neither have significant adverse effects. Similarly, nebulized MgSO4 showed no significant effect on respiratory function in moderate to severe acute asthma in children under five but it seems a safer alternative.

The effects of ketogenic diet on beta-hydroxybutyrate, arachidonic acid, and oxidative stress in pediatric epilepsy

The exact mechanism of a ketogenic diet (KD) as a suitable alternative therapeutic approach for drug-resistant epilepsy (DRE) in alleviating seizures is not yet fully understood. The present study aimed to evaluate the role of the KD in reducing oxidative stress (OS) by increasing the ketone body beta-hydroxybutyrate (BHB) and Arachidonic acid (ARA), an essential polyunsaturated fatty acid, as a possible mechanism in relieving seizure attacks in children with DRE. Forty children with refractory epilepsy were included in the present study. The serum levels of BHB, ARA, and OS markers, malondialdehyde (MDA), and 8-hydroxyl-deoxyguanosine (8-OHdG), were evaluated in children with DRE and compared before and after the three months of KD therapy. Thirty-four of 40 included children could complete the three-month KD therapy. Twenty-one (61.76%) patients had more than a 50% reduction in seizure frequency after the KD (responders). The remaining 13 children were considered non-responders to the diet. The serum levels of ARA and BHB significantly (p < 0.05) increased after the KD therapy. The serum levels of OS parameters MDA and 8-OHdG before the diet therapy were significantly (p < 0.05) higher than those after the administration. The serum levels of BHB and MDA after the KD therapy in the responders were respectively higher and lower than those in the non-responders (p < 0.001). Ketogenic diet might reduce brain OS by increasing BHB and ARA. The role of BHB in diminishing OS and seizure might be more remarkable than ARA.

Evaluation of children with syncope

Background Syncope is one of the most prevalent paroxysmal disorders in children and adolescents. It is a transient, self-limited loss of conscious and postural tone that is followed by a full recovery spontaneously and without any neurological consequences. Aim The objective of this internal audit is to assess how much the staff at Assiut University Children Hospital (AUCH) are sticking to the agreed upon unit’s protocol regarding how to deal with children or adolescent with syncopal attacks. Patients and methods This clinical audit was conducted on 150 pediatric patients with syncope who were admitted to Assiut University Children Hospital, Egypt during the period from the start of January 2021 up to the end of June 2022. Data was systematically collected regarding medical history, general, and systematic examination including chest, cardiac, abdominal, and neurological examination. Duration of syncopal attack (minutes), prodrome history, related symptoms (as chest pain or palpitations), and triggers (as hyperventilation, pain, stress, or effort) were all collected. Results The mean age of the studied participants was 11.96 ± 2.47 years (range 1.5–15 years), with slight female sex predominance. The neurocardiogenic causes (vasovagal, VVS) were the main cause for syncopal attacks among our studied cases, followed by neurologic causes in 17.3%. Collectively, we could say that our institution is successfully following the recommended protocol of our institution for the management of syncopal attacks in children and adolescents. Conclusion The recommended protocol of our institution for the management of syncopal attacks in children and adolescents was successfully followed by the staff members at Assiut University Children Hospital.

Parametric frailty models using two-parameter xgamma distribution with an application of survival analysis

When the actual observation measurement is expensive and difficult, an effective approach for estimating the population parameters is applied, such as ranked set sampling. In a survival or time-to-event analysis, a frailty model is a random effects model where the random effect (the frailty) has a multiplicative effect on the hazard. One of the traditional distributions, the Xgamma distribution, is frequently utilized in reliability and regular survival models (frailty-free), but not in frailty models. Due to its inherent flexibility, the Xgamma distribution and its generalizations have become significantly important in survival analysis in recent years. In this study, we attempt to fit two-parameter X-gamma baseline distribution (TPXGD) with parametric frailty models and apply them to the two real-life data sets. The study results revealed that TPXGD with Gamma frailty model is good choice for Kidney infection data and recurrent asthma attack in children. To make studies of time-to-event data with covariates easier, we propose the Two-parameter Xgamma baseline distribution (TPXGD) with frailty models as suitable alternate models.

From trained immunity in allergy to trained immunity-based allergen vaccines.

Innate immune cells experience long lasting metabolic and epigenetic changes after an encounter with specific stimuli. This facilitates enhanced immune responses upon secondary exposition to both the same and unrelated pathogens, a process termed trained immunity. Trained immunity-based vaccines (TIbV) are vaccines able to induce innate immune memory, thus conferring heterologous protection against a broad range of pathogens. While trained immunity has been well documented in the context of infections and multiple immune-mediated diseases, the role of innate immune memory and its contribution to the initiation and maintenance of chronic allergic diseases remains poorly understood. Over the last years, different studies attempting to uncover the role of trained immunity in allergy have emerged. Exposition to environmental factors impacting allergy development such as allergens or viruses induces the reprogramming of innate immune cells to acquire a more pro-inflammatory phenotype in the context of asthma or food allergy. Several studies have convincingly demonstrated that prevention of viral infections using TIbV contributes to reduce wheezing attacks in children, which represent a high-risk factor for asthma development later in life. Innate immune cells trained with specific stimuli might also acquire anti-inflammatory features and promote tolerance, which may have important implications for chronic inflammatory diseases such as allergies. Recent findings showed that allergoid-mannan conjugates, which are next generation vaccines for allergen-specific immunotherapy (AIT), are able to reprogram monocytes into tolerogenic dendritic cells by mechanisms depending on metabolic and epigenetic rewiring. A better understanding of the underlying mechanisms of trained immunity in allergy will pave the way for the design of novel trained immunity-based allergen vaccines as potential alternative strategies for the prevention and treatment of allergic diseases.

Triggers and clinical changes of childhood primary headache characteristics during COVID-19 pandemic lockdown.

Children with primary headache are particularly vulnerable to the negative impacts of the pandemic due to factors like increased social isolation, disruption of sleep and impairment of healthy diet. We aimed to investigate the clinical changes and triggering factors for childhood primary headaches to demonstrate the impact of the pandemic lockdown. Children aged between 60months and 18years with headache complaint attending the general outpatient clinic between December 2019 and December 2020 were included in the study. Patients were classified according to ICHD-3 regarding clinical and laboratory data. Primary headaches diagnosed before (December 2019-March 2020) and during the pandemic lockdown (April 2020-December 2020) were divided into two groups as migraine and tension-type headache (TTH). Clinical picture and triggering factors were compared between groups to illustrate the effect of the lockdown. The study included 612 subjects, with 463 patients (76%) classified in the primary headache group and 149 (24%) in the secondary headache group. Among the first group, 267 patients (58%) had migraine and 196 patients (42%) had TTH. Comparisons between before and during the pandemic lockdown showed significant increased frequency of TTH, but no difference in the frequency and duration of migraine. Both screen exposure and sleep pattern changes were found to be significantly increased in the TTH group during the pandemic lockdown. We found a significant increase in the attack frequency for TTH patients during the pandemic lockdown. Reduction in screen time is an important strategy in preventing primary headache attacks in children.

Comparison of the Effect of Adding L-Carnitine to Propranolol in the Prevention of Cyclic Vomiting Syndrome Attacks in Children

Background: Cyclic Vomiting Syndrome (CVS) is an idiopathic, complex, multifactorial disorder that is often characterized by recurrent episodes of vomiting and is usually separated by asymptomatic episodes. Prophylaxis should be considered in children with frequent or severe periods. Prevention and treatment of CVS in children is very difficult and no specific and effective treatment has been proven in clinical trials. Propranolol is approved for the prophylaxis of CVS in children of all ages, but its effectiveness has been variable. In this study, we investigated the efficacy and safety of adding L-Carnitine to propranolol therapy in the prevention of pediatric CVS. Methods: 76 children who were diagnosed with CVS were included in this study. They were divided into two equal groups. The first group received high dose of Propranolol and the case group received L-Carnitine with low dose of propranolol for 6 months. Results: CVS attacks’ frequency in both groups of treatment with propranolol alone and in combination with L-Carnitine and propranolol, before and after the treatment was significantly reduced. But there is no significant difference between the two groups 70.6%) vs. 90.9%) (p-value=0.062). There was no significant reduction in the duration days between vomiting attack index in both groups (31.6 % vs.43.2%) (p-value= 0.345). Conclusion: Our research revealed that combination of low dose propranolol with L-Carnitine has comparable efficacy with high dose Propranolol in prophylaxis of CVS.

The relationship between environmental air pollution, meteorological factors, and emergency service admissions for epileptic attacks in children

ObjectiveThe aim of this study is to investigate the relationship between exposure to acute air pollution and meteorological factors on the frequency of epileptic attacks in children. MethodsThis retrospective study was carried using patient files from a children’s hospital in Diyarbakır, one of the largest cities in Turkey. In the present study, the possible relationship between epileptic attacks seen in children over a 10-year period, two air polluting factors (PM10 and SO2), and the meteorological factors (air pressure, humidity, precipitation, wind speed) affecting them were investigated. The effects of different variables on the number of epilepsy patients admitted to the pediatric emergency department were also evaluated through four different models utilizing Poisson Regression Analysis. ResultsAccording to Model 2 and 3, the strongest relationship of the four Poisson Regression models, there was a significantly increased risk of pediatric emergency department admissions for seizures associated with a 10 µm/m3 increase in PM10 (IRR=1.020; 95% CI: 1.018–1.022); IRR= 1.071; 95% CI: 1.050–1.081; respectively) and 10 µm/m3 increase in SO2 (IRR=1.162; 95%CI: 1.151–1.173; IRR=1.092; 95% CI: 1.042–1.120; respectively). In Model 2, a 1 m/s increase in wind speed decrease the risk of daily of epileptic attack admitted to the emergency department and a 1 °C increase in temperature increased the risk of daily of epileptic attack admitted to the emergency department (IRR=0.840; 95% CI; 0.714–0.987; IRR=1.033; 95%CI: 1.007–1.059; respectively). In Model 3, 1% increase in humidity and 1 m/s increase in wind speed increased the number of daily epileptic attack admitted to the emergency department (IRR=1.008; 95%CI: 1.004–1.011; IRR=1.169; 95%CI: 1.056–1.294; respectively). The daily number of epilepsy patients was statistically significantly affected by the autumn (95%CI: 10.017–19.845) and winter (95%CI: −0.279 to 13.292) seasons. ConclusionMeteorological factors and air pollutants affect the number of pediatric patients admitted to the pediatric emergency department with epilepsy attacks.

Impact of integrated care coordination on pediatric asthma hospital presentations.

IntroductionFrequent asthma attacks in children result in unscheduled hospital presentations. Patient centered care coordination can reduce asthma hospital presentations. In 2016, The Sydney Children's Hospitals Network launched the Asthma Follow up Integrated Care Initiative with the aim to reduce pediatric asthma emergency department (ED) presentations by 50% through developing and testing an integrated model of care led by care coordinators (CCs).MethodsThe integrated model of care was developed by a multidisciplinary team at Sydney Children's Hospital Randwick (SCH,R) and implemented in two phases: Phase I and Phase II. Children aged 2–16 years who presented ≥4 times to the ED of the SCH,R in the preceding 12 months were enrolled in Phase I and those who had ≥4 ED presentations and ≥1 hospital admissions with asthma attack were enrolled in Phase II. Phase I included a suite of interventions delivered by CCs including encouraging parents/carers to schedule follow-up visits with GP post-discharge, ensuring parents/carers are provided with standard asthma resource pack, offering referrals to asthma education sessions, sending a letter to the child's GP advising of the child's recent hospital presentation and coordinating asthma education webinar for GPs. In addition, in Phase II CCs sent text messages to parents/carers reminding them to follow-up with the child's GP. We compared the change in ED visits and hospital admissions at baseline (6 months pre-enrolment) and at 6-and 12-months post-enrolment in the program.ResultsDuring December 2016-January 2021, 160 children (99 in Phase I and 61 in Phase II) were enrolled. Compared to baseline at 6- and 12-months post-enrolment, the proportion of children requiring ≥1 asthma ED presentations reduced by 43 and 61% in Phase I and 41 and 66% in Phase II. Similarly, the proportion of children requiring ≥1 asthma hospital admissions at 6- and 12-months post-enrolment reduced by 40 and 47% in Phase I and 62 and 69% in Phase II.ConclusionOur results support that care coordinator led integrated model of asthma care which enables integration of acute and primary care services and provides families with asthma resources and education can reduce asthma hospital presentations in children.

Risk Factors and Imaging Biomarkers Associated With Perioperative Stroke in Pediatric Moyamoya Arteriopathy.

Patients with moyamoya arteriopathy are at high risk for developing ischemic stroke in the perioperative period. We sought to evaluate whether preoperative clinical and neuroimaging biomarkers are associated with postoperative stroke and transient ischemic attack in children with moyamoya following revascularization surgery. We performed a retrospective chart review of pediatric patients who underwent revascularization surgery for moyamoya in the last 15 years. Fifty-three patients who underwent 69 surgeries met the inclusion criteria. We recorded clinical predictors of stroke or transient ischemic attack within 7 days following surgery. We used Suzuki stage and Composite Cerebrovascular Stenosis Score to analyze neuroimaging. Significant risk factors for developing postoperative stroke or transient ischemic attack were younger age at surgery (P = .004) and transient ischemic attack less than 1 month prior to surgery (P < .001). Children under 5 and those with recent preoperative ischemic events should be the focus of investigation to evaluate modifiable risk factors and targeted interventions.

Parametric frailty models under two-parameter Lindley distribution with applications to time-to-event analysis

A frailty model is a random effects model in survival or time-to-event analysis, where the random effect (the frailty) has a multiplicative effect on the hazard. Lindley distribution is one of the classical distributions, which is widely used in reliability and ordinary survival models (without frailty) but not in the frailty models. In recent years, Lindley distribution and its generalizations have played an important role in survival analysis due to its natural flexibility. In this study, we attempt to fit parametric frailty models with Two-parameter Lindley baseline distribution (TPLD) and apply them to the two real-life disease data sets of the (i) Recurrent asthma attacks in children’s (Asthma attacks) and (ii) Culling of dairy heifer cow’s (Culling) data. Comparison and assed the model's fitness were done using a minimum value of Akaike's Information Criteria (AIC) and Bayesian Information Criteria (BIC). The study results revealed that TPLD with the Lognormal frailty model is a good choice for Culling data and Lindley with Gamma frailty model is the best for Asthma data. So, we suggest that the Two-parameter Lindley baseline distribution (TPLD) with frailty models are potential alternative models and will facilitate analyses of time-to-event data with covariates.

Preventing unscheduled hospitalisations from asthma: a retrospective cohort study using routine primary and secondary care data in the UK (The PUSH-Asthma Study)—protocol paper

IntroductionAsthma is the most common chronic respiratory disease in children and adults. Asthma results in significant disease-related morbidity, healthcare costs and, in some cases, death. Despite efforts through implementation of...

Research on Strengthening Health Education to Improve Compliance and Reduce the Number of Acute Attacks in Children with Asthma

Research on Strengthening Health Education to Improve Compliance and Reduce the Number of Acute Attacks in Children with Asthma

Treatment guided by fractional exhaled nitric oxide in addition to standard care in 6- to 15-year-olds with asthma: the RAACENO RCT

BackgroundThe role of fractional exhaled nitric oxide in guiding asthma treatment in children is uncertain.ObjectiveTo compare treatment guided by both fractional exhaled nitric oxide and symptoms (intervention) with treatment guided by symptoms alone (standard care) in children with asthma who are at risk of an asthma exacerbation, in terms of the number of asthma exacerbations over 12 months.DesignThis was a pragmatic, multicentre, randomised controlled trial with embedded cost-effectiveness and qualitative process evaluations. Randomisation (1 : 1) was carried out using a remote web-based system and was minimised on recruitment centre, age, sex and British Thoracic Society treatment step. Clinical teams and participants were not blind to treatment allocation.SettingThe trial took place in 35 hospitals and seven primary care practices in the UK.ParticipantsChildren aged 6–15 years with a diagnosis of asthma who were currently prescribed inhaled corticosteroids and who had one or more parent-/patient-reported asthma exacerbation treated with oral corticosteroids in the 12 months prior to recruitment.InterventionsAsthma treatment guided by symptoms alone (standard care) and asthma treatment guided by symptoms plus fractional exhaled nitric oxide (intervention). Treatment recommendations in both groups were protocolised within a web-based algorithm, incorporating inhaled corticosteroid adherence (objectively measured using an electronic logging device) and current treatment.Main outcome measuresThe primary outcome measure was asthma exacerbations treated with oral corticosteroids in the year post randomisation. Secondary outcomes included time to first exacerbation, number of exacerbations, lung function, fractional exhaled nitric oxide, daily dose of inhaled corticosteroid, asthma control and quality of life.ResultsIn total, 509 eligible participants were recruited and the primary outcome was available for 506 participants. The primary outcome occurred in 123 out of 255 (48.2%) participants in the intervention group and 129 out of 251 (51.4%) participants in the standard-care group (adjusted odds ratio 0.88, 95% confidence interval 0.61 to 1.27). There was algorithm non-compliance on 21% of assessments. Per-protocol and complier-average causal effect analysis did not change the interpretation. This non-statistically significant estimate was consistent across predefined subgroups. There were no differences between the groups in secondary outcomes. There were no serious adverse events or deaths. No meaningful differences in health service costs, direct patient costs or indirect costs to society were identified between the groups. The economic evaluation does not provide evidence to support the cost-effectiveness of the intervention. In the qualitative process evaluation, 15 trial staff and six families were interviewed. Overall, their experiences were positive. The intervention was broadly acceptable, with caveats around clinicians using the algorithm recommendation as a guide and wariness around extreme step ups/downs in treatment in the light of contextual factors not being taken into account by the algorithm.LimitationsPotential limitations included the choice of cut-off point to define uncontrolled asthma and the change in fractional exhaled nitric oxide to trigger a change in treatment. Furthermore, the treatment decisions in the two groups may not have been sufficiently different to create a difference in outcomes.ConclusionsThe RAACENO (Reducing Asthma Attacks in Children using Exhaled Nitric Oxide) trial findings do not support the routine use of fractional exhaled nitric oxide measurements as part of asthma management in a secondary care setting. The potential for other objective markers to guide asthma management in children needs to be evaluated.Trial registrationThis trial was registered as ISRCTN67875351.FundingThis project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and National Institute for Health and Care Research (NIHR) partnership. This will be published in full inEfficacy and Mechanism Evaluation; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.

Food Sensitization Impact on Asthma Attacks in Children According to Age Group

Introduction: The progression of allergy disorders is termed “atopic march.” Having one allergic disorder increases the likelihood of acquiring others. Asthma and food allergies often coexist. There are no thresholds for specific IgE (sIgE) associated with the presence of clinical symptoms. Each allergen shows a particular trend with age. Objective: Our study and analysis aim to identify food sensitization in children with asthma and evaluate its impact on asthma attacks and clinical control. Material and methods: As a part of a bigger study, 56 children (mean age 11.07 years (5.3–17.5), 38 boys, and 18 girls) with bronchial asthma were tested for total IgE and sIgE against food and inhalator allergens. All children performed baseline and post-BD spirometry and were assessed for asthma control. Results: In the studied population of children, sIgE against several food allergens was positive in the same patient. A significant correlation was found between the positive sIgE for milk and soy (p &lt; 0.0001), for milk and egg yolk (p = 0.01), compared to milk and peanuts (p = 0.004), compared to egg yolk and fish (p &lt; 0.0001), compared to egg yolk and casein (p &lt; 0.001), and soy (p &lt; 0.0001). The children who are positive for sIgE antibodies in cats, dogs, Cladosporium, Aspergillus, wormwood from aeroallergens and soy from food allergens have a higher risk of hospitalization for exacerbation of bronchial asthma. (p &lt; 0.05). In the studied population, sensitization to food allergens among asthmatics does not contribute to the number of asthma attacks. Conclusions: Food sensitivity is associated with eczema, while mite sensitization is strongly associated with rhinitis and asthma. Food sensitization is not a risk factor for asthma exacerbation in children older than five years old.