Hyperreactivity In Children Research Articles

Is Birth Method Associated with Sensory Hyperreactivity in Children 3-4 Years in an Upper-Middle-Income Country?

Research has shown that pressure in the vaginal birth process aids the infant's neurophysiological adaption to extrauterine life, including their ability to regulate their responses to diverse sensory stimuli. As pressure is absent in elective caesarean section births, we hypothesised that these children may be at higher risk for developing sensory hyperreactivity (SHR), a sensory modulation difficulty which negatively impacts on the child's engagement in their occupations. This paper reports on a study which investigated associations between birth method and SHR. In this cross-sectional study, 91 children aged three and four years from various language, cultural, and socioeconomic groups were recruited and categorised based on birth method (caesarean section or vaginal birth). Caregivers of each child completed the Short Sensory Profile-2 and a demographic questionnaire. The prevalence of SHR between the birth method groups was compared. The prevalence of SHR was greater in the vaginal birth group (29%) than the caesarean section group (9%). Mothers in the vaginal birth group were younger (p ≤ 0.001), of lower-income level (p = 0.003), and more likely to be single (p = 0.037). During data collection with the vaginal birth group, comprehensibility of certain items in the Short Sensory Profile-2 proved challenging for many caregivers. The statistically significant higher prevalence of SHR in the vaginal birth group supported a null hypothesis. However, the results are questioned due to the challenges related to data collection. Given this, the study supports the need for further investigation of how sociocultural and socioeconomic factors influence the assessment of SHR in the South African context.

CATALASE CRS-262T GENE POLYMORPHISM AND CHANGES IN VENTILATION LUNG CAPACITY IN CHILDREN-RESIDENTS OF RADIOACTIVELY CONTAMINATED TERRITORIES.

to determine the association of catalase С-262Т gene polymorphism with the presence of bronchial hyper-reactivity in children living in radioactively contaminated territories. There were examined school-age children-residents of radioactively contaminated territories (RCT), who did not have clinical signs of respiratory pathology. Catalase (CAT) С-262Т gene deletion polymorphism was studied in the molecular genetic laboratory of the State Institution «Reference Center for Molecular Diagnostic of Public Health Ministry of Ukraine». Determination of the polymorphic variant by the catalase С-262Т gene was performed by Polymerase Chain Reaction (PCR) using specific oligonucleotide primers, followed by Restriction Fragment Length Polymorphism (RFLP) analysis. The CAT С-262Т gene polymorphism in children living in RCT was compared with that in the reference group of practically healthy individuals. Ventilation lung capacity was performed by computer spirometry according to the analysis of the loop «the flow-volume». A pharmacological inhalation test with a bronchodilator that acts on β2-adrenergic receptors of the lungs was used to detect early changes in the ventilatory capacity of the lungs - bronchial hyperreactivity. Comparative analysis showed that in the presence of bronchial hyperreactivity in children living in RCT, the CT genotype was more common than in children without bronchial hyperreactivity, and the frequency of the CC genotype was correspondingly reduced. There was a trend towards a decrease in the frequency of the TT genotype. An analysis of the frequency distribution of allelic variants of the CAT С-262Т gene polymorphism in children living in the RCT revealed a tendency to increase in the frequency of the T-allele and according to the decrease in the frequency of C-allele in the presence of bronchial hyperreactivity.Сonclusions. Thus, among children living in RCT, CT-homozygotes of CAT С-262Т gene polymorphism had bronchial hyperreactivity probably more often than CC-heterozygotes. In the presence of bronchial hyperreactivity, there was a trend towards an increase in the frequency of the T-allele and, accordingly, a decrease in the frequency of the C-allele.

Helminth infections and allergic diseases: Systematic review and meta-analysis of the global literature

There is considerable research interest in the role of helminth infections in the development of allergic diseases. However, findings from previous studies are mixed. Existing systematic reviews of these studies are outdated. We performed a systematic review of the global literature on the association between helminth infections and development and clinical outcomes of allergic diseases. We searched Cochrane Library, MEDLINE, EMBASE, ISI Web of Science, PubMed, Global Index Medicus, Scielo, KoreaMed, Google Scholar, and Lilacs for studies published up to January 2020. We included observational epidemiological studies (cohort, case-control, and cross-sectional studies) of children and adults reporting associations between helminth infections and asthma, allergic rhinitis, eczema, and atopy. We performed random-effects meta-analysis to summarize the effect estimates. We included 80 studies with 99,967 participants. In the meta-analyses, we did not observe an overall association between helminth infections and allergic diseases. There was, however, evidence that Ascaris lumbricoides infections were associated with an increased risk of bronchial hyperreactivity inchildren (risk ratio, 1.41; 95% CI, 1.17-1.70; I2= 50; P for I2= .09), and were associated with an increased risk of atopy among helminth-infected adults (risk ratio, 1.37; 95% CI, 1.18-1.61; I2= 52; P for I2= .02). We found no study that addressed the association between helminth infection and clinical outcomes of allergic diseases. The overall strength of the underlying evidence was low to moderate. Helminth infections may increase the risk of bronchial hyperreactivity in children and atopy in adults. Well-designed longitudinal cohorts may help clarify potential causal associations between chronic helminth infections and allergic diseases.

Факторы риска у детей с СДВГ в сочетании с соматической патологией

The article presents the results of anamnestic data in 120 children with ADHD with somatic diseases aged 6 to 11 years, in which perinatal lesions of the central nervous system were revealed. These parameters were specific, sensitive and reliable in relation to the development of attention deficit disorder with hyperreactivity in children in combination with somatic diseases.

MOLECULAR GENETIC ASPECTS OF BRONCHIAL HYPERREACTIVITY IN CHILDREN - RESIDENTS OF RADIOACTIVELY CONTAMINATED AREAS.

to determine the relationship between polymorphisms of glutathione S-transferase gene family andbronchial hyperreactivity in children living in radioactively contaminated areas. School age children-residents of radioactively contaminated areas (RCA), without clinicalsigns of respiratory pathology were examined. Molecular genetic studies were carried out by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) for further analysis. The GSTT1, GSTM1 gene deletion polymorphism was investigated using multiplex PCR. PCR and PCR-RFLP analyses were performed in the studyof the GSTP1 gene A313G polymorphism. The ventilation lung capacity was examined by the pneumotachographicmethod according to the analysis of «the flow-volume» loop. The pharmacologic inhalation test with bronchodilator drug, affecting the β2-adrenergic lung receptors was used to detect the early changes in the ventilation lungcapacity - the bronchial hyperreactivity (latent and nonlatent bronchospasm). Molecular genetic studies showed that the GSTM1 gene deletion genotype and the GSTP1 gene A313G polymorphism were found significantly more often in the subgroup of children with bronchial hyperreactivity living inRCA than in children without bronchial hyperreactivity and children of the control group. The frequency of GSTT1deletion polymorphism did not have a statistically significant difference in all subgroups. The GSTM1 gene deletion polymorphism and the GSTP1 gene A313G genotype may be a risk factor fordeveloping bronchial hyperreactivity in children living under adverse environmental conditions, including radioactively contaminated areas.

Methacholine Challenge Test Reveals a High Prevalence of Subclinical Severe Airway Hyper-Reactivity in Children and Yound Adults with Sickle Cell Disease Which Correlates with Higher Sickle Acute Events and Acute Chest

▪Background: Although increase prevalence of airway hyper-reactivity (AHR) has been detected in children, and even adults with sickle cell disease (SCD) using methacholine provocative challenge test (MCT), AHR was not been found to be associated with clinical asthma.Hence, the clinical implications of AHR in SCD are unknown. Furthermore, AHR studies in SCD patients using MCT lack comparisons with a control population. We recently showed that increased placenta growth factor (PlGF) levels in sickle mice causes AHR by upregulating leukotriene synthesis and inflammation. We therefore designed a prospective study to determine the prevalence of AHR in children and young adults with SCD, and in unaffected siblings living in the same household as a control population, and also determine the biochemical and clinical implications of AHR in SCD.Methods: A total of 67 patients with SCD and 14 unaffected siblings of the patients enrolled on to the study for determining baseline AHR (ClinicalTrials.gov Identifier: NCT00448370). Chief eligibility criteria included a diagnosis of SCD (HbSS, HbSC or HbS b-thalassemia) confirmed by hemoglobin electrophoresis or gene sequencing, ages 5.5 years to 30 years who were able to complete pulmonary function testing and were at baseline/steady state (no acute sickle events 3 weeks prior or acute chest syndrome (ACS) 4 weeks prior). Excluded were patients taking anti-leukotriene medications within 30 days prior, although patients with SCD who had a known history of asthma but not on leukotriene inhibitors were eligible. Patients with chronic transfusions, congenital lung or heart condition, or other medical condition that could affect the pulmonary function testing were also ineligible. Unaffected siblings of the 67 enrolled SCD patients living in the same household were offered enrollment for MCT and those consenting were enrolled.Results: 64 SCD patients and 14 siblings underwent a MCT; 3 of 67 SCD patients had FEV1<70% of predicted at baseline, and therefore, for safety reasons, were not subjected to MCT. The degree of AHR was defined by the provocative concentration of methacholine that resulted in a 20% decline in FEV1 (PC20): no AHR=PC20 >16mg/mL; borderline AHR=PC20 4-16mg/mL; mild AHR=PC20 1-3mg/mL and moderate-severe AHR=PC20 <1mg/mL. All subjects were given a dose of albuterol after completion of MCT. MCT was safe in all subjects, and no AHR or acute sickle events occurred in any subject for three weeks after the MCT. Overall, 25 of 67 (37%) SCD patients had no AHR, 8 of 67 (12%) had borderline AHR (PC20 9±1.4mg/ml), 10 of 67 (15%) had mild AHR (PC20 1.72 ±0.16) and 24 of 67 (36%) had moderate-severe AHR (PC20 0.6 ±0.06). Of unaffected siblings, 10 of 14 (71%) had no AHR, 2 of 14 (14%) had borderline AHR (PC20 10±0.4) and 2 of 14 (14%) had mild AHR (PC20 1.7±0.4). Moderate to severe AHR was only seen in SCD patients and not sibling controls. Severe AHR prevalence was highest in the HbSS group. We analyzed the clinical characteristics of the SCD subjects, including acute sickle episodes, defined as admission for one of the following: pain crises, fever with or without a known source of infection, cough/wheezing/chest pain, impending acute chest syndrome, enlarged and splenic sequestration or priapism. SCD patients with AHR had significantly higher (P<0.05) admissions from acute sickle episodes (2.7±0.1) and acute chest syndrome (1.5±0.15). We next assessed PlGF and leukotriene levels in SCD subjects. PlGF levels were not quantifiable due to presence of hemolysis, which confounds PlGF ELISA. However, we found a trend towards higher (1.3-2 fold) expression of PlGF-induced target genes (VEGF, IL-1β, IL-8, CCL2) in the mononuclear cells of patients with severe AHR; Also, circulating cysteinyl leukotriene D4 levels in their plasma were significantly higher.Conclusions: There was a higher prevalence of mild to severe AHR (51%) in patients with SCD, compared to a 14% prevalence of mild AHR in siblings living in the same household. The higher degree of AHR was associated with increased SCD morbidity - increased rates of admission from ACS and pain crisis, when compared to those with no AHR. AHR was associated with higher leukotrienes and a trend towards higher PlGF target gene induction. Together, our data suggests that AHR may be a biomarker for SCD morbidity, and may also be a therapeutic target, since blockade of PlGF or leukotriene synthesis in patients with severe AHR may reduce SCD morbidity. DisclosuresNo relevant conflicts of interest to declare.

Low salivary secretory IgA levels correlate with hyperreactivity in children with autism

IntroductionAutism is a neurodevelopmental disorder characterized by deficits in communication and social skills as well as stereotypical behaviors. There are multiple lines of evidence, suggesting that the immune system is involved in autism. Since secretory IgA (SIgA) is the predominant antibody isotype in saliva and a marker of mucosal immunity, the aim of the study was to assess if the severity of clinical and behavioral parameters of autistic children was associated with low levels of sIgA in saliva.ObjectivesTo assess possible associations between salivary levels of sIgA and the severity of behavioral outcomes related to autism. In addition, were studied sIgA in saliva of children with autism and the frequency of respiratory tract infections diagnosed in the first 3 years of life.MethodsSaliva samples were obtained from 3–10 years old autistic children and age-matched typically developing Caucasian children from Patagonia, Argentina.ResultsAutistic children with reduced levels of salivary sIgA had a higher incidence of respiratory diseases compared to controls. The reduction in sIgA levels inversely correlated with the severity of the behavioral disorders. The patients with the most severe impairment in autism-related behaviors had the lowest levels of sIgA in the cohort studied.ConclusionsThese findings suggest that sIgA could be an early non-invasive indicator of the dysregulation of the immune system in some children with autism. Clearly, the characterization of immunological parameters has important implications for detection of subgroups of children with ASD, and should be considered when designing therapeutic strategies to treat behavioral impairments of ASD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Serum Clara cell protein and atopic phenotype in children up to 2years of age.

Low value of serum Clara cell protein (CC16) is associated with bronchial hyperreactivity in children. To evaluate the serum CC16 in relation to atopy and previously manifested LRTD. In the population of 163 healthy 5- to 24-month-old children, atopy was determined by Phadiatop-infant (serum-specific IgE≥0.35kUA/L), serum CC16 by ELISA, while data on previously manifested low respiratory tract diseases (LRTD) were collected from the Health Care Center database. In atopic children, serum CC16 negatively correlated with age (r -.281, P=.041, n=53), while in nonatopic children, this correlation was positive (r .200, P=.036, n=110). Atopic ≥8-month-old children with previously manifested LRTD had lower level of CC16 (3.07ng/mL) in relation to atopic children without LRTD at the same age (6.51ng/mL), P=.029 (value of serum CC16≥4.8ng/mL indicates atopic phenotype without LRTD 75% sensitivity, 87.5% specificity). In 8- to 24-month-old children with previously manifested pneumonia, serum CC16 was lower in atopic (2.9ng/mL) in relation to nonatopic children (3.7ng/mL), P=.029 (serum CC16 ≤3.4ng/mL indicating atopy in the group of children with pneumonia, sensitivity 100%, and specificity 77%). Atopic 8- to 24-month-old children with previously manifested pneumonia had lower CC16 in relation to other atopic children in this age (P=.021) (for cutoff CC16≤3.4ng/mL sensitivity 100%, specificity 77%), and also often chronic wheezing (atopic with pneumonia 83.3%, n=5/6 vs atopic without pneumonia 21.4%, n=3/14), P=.018. Low serum CC16 is associated with previously expressed pneumonia and chronic wheezing in atopic children.

IgA modulates respiratory dysfunction as a sequela to pulmonary chlamydial infection as neonates.

Neonatal Chlamydia lung infections are associated with serious sequelae such as asthma and airway hyper-reactivity in children and adults. Our previous studies demonstrated the importance of Th-1 type cytokines, IL-12 and IFN-γ in protection against neonatal pulmonary chlamydial challenge; however, the role of the humoral arm of defense has not been elucidated. We hypothesized that B-cells and IgA, the major mucosal antibody, play a protective role in newborns against development of later life respiratory sequelae to Chlamydia infection. Our studies using neonatal mice revealed that all WT and IgA-deficient (IgA(-/-)) animals survived a sublethal pulmonary Chlamydia muridarum challenge at one day after birth with similar reduction in bacterial burdens over time. In contrast, all B-cell-deficient (μMT) mice succumbed to infection at the same challenge dose correlating to failure to control bacterial burdens in the lungs. Although IgA may not be important for bacterial clearance, we observed IgA(-/-) mice displayed greater respiratory dysfunction 5 weeks post challenge. Specifically, comparative respiratory functional analyses revealed a significant shift upward in P-V loops, and higher dynamic resistance in IgA(-/-) animals. This study provides insight(s) into the protective role of IgA in neonates against pulmonary chlamydial infection induced respiratory pathological sequelae observed later in life.

Respiratory syncytial virus infection and bronchial hyperreactivity in children up to two years of age in correlation with atopy.

Bronchiolitis in early childhood caused by respiratory syncytial virus (RSV) is considered to be important risk factor of the recurrent wheezing and asthma development. The aim of this study was to examine the frequency of RSV infection and atopy in children up to two years of age and to determine their correlation with bronchial hyperreactivity. The study included 175 children aged 5-24 months. The presence of RSV infection was identified by serum levels of IgA and IgG determined by ELISA. Bronchial hyperreactivity (BHR) has been defined as the existence of chronic bronchial disease and/or three or more previous suspected diagnosis of acute bronchial disease. Atopy was confirmed by detection of the specific serum IgE using quantitative multitest Phadiatop infant (cut off 0.35 kUA/L). The children with atopy were more frequently infected with RSV (43.3%) than those without atopy (22.8%; p = 0.02). The higher frequency of RSV infection was found in children with BHR in comparison with those without it but only in the group who also had atopy (77.8% vs. 28.6%, p = 0.018). In the female children, BHR and RSV infection were associated in 62.5% of cases, regardless the atopy. In the male children with atopy, RSV infection was associated with BHR in 83.3% of the cases, while in those without atopy, RSV infection with BHR was found in only 17.4% of the cases. Children up to two years of age with atopy are more frequently infected with RSV (43.3%) than nonatopic children. Every third child with atopy develops BHR and 77.8% of them also have RSV infection. Atopic children are at higher risk for development of BHR when infected with RSV also.

Salivary IgA Correlate with Recurrent Respiratory Infections and Hyperreactivity in Children with Autism

Fil: Furland, Natalia Edith. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Bahia Blanca. Instituto de Investigaciones Bioquimicas de Bahia Blanca. Universidad Nacional del Sur. Instituto de Investigaciones Bioquimicas de Bahia Blanca; Argentina

Ventilation Heterogeneity and Airway Hyperreactivity in Children with Well Controlled Asthma

Rationale: In asthma, airway inflammation, obstruction and reactivity may lead to ventilation heterogeneity; our understanding of this process is limited in asthmatic children. Objectives and Methods: The study’s objective was to measure ventilation heterogeneity, by the lung clearance index (LCI), in children with well controlled asthma and assess the association of LCI with airway reactivity through methacholine challenge tests. LCI and spirometry were measured in 24 children with asthma and 21 healthy controls between 4 and 10 years of age. Sixteen children with asthma and 11 healthy controls also performed methacholine challenge tests. Results: LCI was higher in children with asthma compared to healthy controls (7.58 vs 6.79, p=0.004); no differences in FEV1 or FEF25-75 were noted between groups. Ages were similar (p=0.54); however, the slope of LCI versus age differed between groups (p=0.001). The LCI slope increased with age in asthmatics. Further, higher LCI values were associated with decreasing PC20 (provocative concentration of methacholine to decrease baseline FEV1 by 20%) values in children with asthma (p=0.02), but not healthy controls (p=0.16). Conclusions: Ventilation heterogeneity is present from preschool age in children with well controlled asthma. The relationship between ventilation heterogeneity and airway reactivity suggests that normalizing ventilation heterogeneity may be an important therapeutic target for treating children with asthma.

Clinical value of fractional exhaled nitric oxide level in predicting bronchial hyperreactivity in asthmatic children

Objective To evaluate the clinical value of fractional exhaled nitric oxide (FeNO) level in asthmatic children to predict bronchial hyperresponsiveness by analyzing the correlation between fraction of exhaled nitric oxide and bronchial provocation test. Methods One hundred and fourteen asthma outpatients of Shengjing Hospital were enrolled, FeNO levels, spirometry and bronchial provocation test were measured. Results In the bronchial provocation test, there were 33 positive and 81 negative cases.The positive group had a significantly higher FeNO levels than the negative ones(19.0×10-9 vs.16.0×10-9, P=0.000). By the ROC curve, the best FeNO cut-off value to predict bronchial hyperresponsiveness was 38.5×10-9 with high specificity(92.6%) but relatively low sensitivity(36.4%). There was no relationship between methacholine provocative dose causing a 20% fall in FEV1(PD20-FEV1) and the level of FeNO. Conclusion FeNO level has important predicting value for bronchial hyperreactivity in children with asthma.The level of FeNO >38.5×10-9 has high predictive value in asthmatic children with bronchial hyperreactivity. Key words: Exhaled nitric oxide; Methacholine bronchial provocation test; Asthma; Children

Indicators of the bronchial lability and hyperreactivity in children with bronchial asthma and exercise induced bronchoconstriction

The results of the analysis of the bronchial hyperreactivity indicators in 60 children suffering from asthma with exercise induced bronchoconstriction and without exercise induced bronchospasm are presented in the article. It has been established that higher bronchial lability was typical for children with asthma and exercise induced bronchoconstriction. The bronchial hypersensitivity to inhaled histamine in a concentration less than 0,4 mg/ml with 77 % specificity, 71 % post-test probability and significant odds ratio indicate a phenotype of childhood asthma with exercise induced bronchoconstriction.

Bronchial hyperreactivity in children with antibody deficiencies

BackgroundAntibody deficiency comprises a heterogeneous group of disorders characterised by the body's inability to mount an effective antibody response to pathogens. Although it has been reported that asthma and allergic disease are frequent in antibody deficiencies, there are no data that evaluate and compare bronchial hyperreactivity (BHR) in all groups of antibody deficiencies. In this study, we aimed to evaluate and compare the frequency of BHR in patients with different antibody deficiencies. MethodsThe study was carried out on 113 patients between ages 5 and 18 diagnosed with antibody deficiencies. The patients and their families were questioned on their history of asthma and allergic diseases. Allergic skin prick tests and non-specific bronchial provocation test with methacholine was done for all patients. Complete blood count and serum total IgE levels were measured. ResultsThe mean age of the patients was 10.8±3.8 years and 66.4% were male. Within the study group 41.6% of the patients had selective IgA deficiency, 24.8% had IgG subclass deficiency, 14.2% had partial IgA deficiency, 10.6% had common variable immunodeficiency, 6.2% had transient hypogammaglobulinaemia and 2.7% X-linked agammaglobulinaemia. In total group, 42.5% had bronchial hyperreactivity with methacholine challenge test. BHR was more significant in both patients with selective IgA deficiency and partial IgA deficiency compared to those with IgG subclass deficiency (P=0.041 and P=0.038, respectively). ConclusionBHR was high in antibody deficiencies, especially selective IgA deficiency compared to IgG subclass deficiency.

Immunotherapy – 2082. Long term prevention of asthma and rhinitis in children with atopic dermatitis four year after discontinuation of sublingual immunotherapy

Background Atopic Dermatitis is a disease with high prevalence in Italy (about 15% of the population). As known, Atopic Dermatitis is often associated with respiratory allergy to mite.We previously showed that sublingual immunotherapy (SLIT) to mite has a beneficial clinical effect in patients with allergic extrinsic Atopic Dermatititis (AD). To investigate the long term effects, we performed a 4-year follow up after the termination of SLIT. Methods 46 children with AD, aged 5-16 years and allergic to mite were re-assessed 4 years after discontinuation of a 2-year course of SLIT (or placebo). Methacholine provocation tests were carried out at baseline, after 2 years (when SLIT was stopped) and after 4 years. The development of asthma and rhinitis was assessed by clinical evaluations. Results The children who previously had received SLIT had significantly less asthma after 6 years as evaluated by clinical symptoms: odd ratio 3.73 (0.130 vs 0.511; P=0.02) as compared to the former placebo group. In addition, significantly less patients reported an increase in asthma scores P=0.003. A significant difference in bronchial methacholine responsiveness was found between the two groups (P=0.03), with an overall lower bronchial hyperreactivity in children who previously received active SLIT. Conclusions A 2-year course of SLIT to mite provided a long term clinical effect and prevented the development of asthma in children with allergic extrinsic form of Atopic Dermatitis.

Forced expiratory flow between 25 and 75% of vital capacity might be a predictive factor for bronchial hyperreactivity in children with allergic rhinitis, asthma, or both

Allergic rhinitis and asthma are closely associated. Bronchial hyperreactivity (BHR) is a pathophysiological characteristic of asthma. Forced expiratory flow between 25 and 75% of vital capacity (FEF(25-75)) has been previously shown to be able to predict BHR in adult patients with allergic rhinitis. Therefore, the aim of this study was (i) to evaluate the presence of BHR in a large group of children with allergic rhinitis, asthma or both and (ii) to confirm whether FEF(25-75) might be related to BHR and may predict BHR also in a pediatric population. Nine hundred fifty children with allergic rhinitis (350), asthma (300), or both (300) were enrolled. Clinical examination, skin-prick test, spirometry, and methacholine challenge were performed in all patients. Severe BHR was quite frequent in allergic children, mainly in asthmatic patients. FEF(25-75) values were significantly related to BHR grade, mainly in children with rhinitis (r = 0.69). Impaired FEF(25-75) values (such as ≤65% of predicted) constituted a relevant predictive factor for severe BHR, mainly in children with rhinitis (odds ratio, 8.9). In conclusion, this pediatric study confirmed that impaired FEF(25-75) values might predict severe BHR in children, mainly in those with allergic rhinitis. Therefore, low FEF(25-75) values could suggest BHR in children.

Effects of Air Quality and Climate Change on Airway Hyperreactivity in Children (A Multi-Centered Study)

The clinical effects of environmental pollution and climate change on respiratory health is a contemporary debate issue. In this study, the sulfur dioxide (SO 2 ), particulate matter (PM 10 ) levels, and climate conditions in the city of Izmir, have been taken together with the patients with asthma or acute bronchiolitis, who admitted to the children’s emergency departments of the four university/education-research hospitals in Izmir. From September 1, 2007 until August 31, 2008, the 22,467 patients who admitted to these centers because of airway hyperreactivity, were of age 3.05±1.57 on the average, and the male/female ratio was 1.7. Among the patients, 79.3% were having acute bronchiolitis, and 20.7% an asthma attack. As SO 2 and PM 10 levels increase, the daily asthma attacks, patients with acute bronchiolitis, and total of patients with hyperactivity, were observed to increase (p<0.001). In addition, the numbers in the following five days after the increase of air pollution rate, were observed to increase statistically significantly (p<0.001). The number of asthma and acute bronchiolitis patients applying to emergency, was negatively correlated with daily average temperature, but positively correlated with relative humidity, actual air pressure, and sea- level pressure levels (p<0.001). Reflecting on the increase of asthma and acute bronchiolitis in developed societies, there is a necessity of effective reliefs such as effectively monitoring the within-city air quality, taking the industrial centers out of the city, promoting public transportation, and preserving the natural life.

Objective Improvement in Nasal Congestion and Nasal Hyperreactivity with Use of Nasal Steroids in Persistent Allergic Rhinitis

Our objective was to evaluate the action of topical nasal steroid in nasal congestion and nasal hyper-reactivity in children and adolescents with persistent allergic rhinitis. Twenty atopic children and adolescents (6 to 18 years) with moderate-to-severe persistent allergic rhinitis (PAR) were treated with mometasone furoate (100 microg once a day) for 21 days. At the beginning and end of treatment, the following were recorded: a) nasal symptoms score; b) several parameters of nasal congestion measured by acoustic rhinometry (SRE 2000 Rhinometrics); c) degree of nasal hyper-reactivity to histamine (concentration of histamine necessary to induce at least 100% increase in total nasal resistance during nasal provocation test). Data were compared with those from 20 controls. Compared to controls, PAR patients had significantly higher score of symptoms, as well as higher degree of nasal hyper-reactivity and lower nasal volumes. After treatment, there was a significant decrease in the mean nasal symptoms score (8.0 versus 3.8; p < 0.001) and in the nasal hyper-reactivity (histamine concentration: 0.72 mg/ml versus 2.60 mg/ml; p < 0.001). Congestion improvement was observed by the increase in all acoustic rhinometry parameters. Among all studied volumes, the volume in the segment between 2 and 5 cm showed the highest mean increase (19.8%). Treatment with topical nasal steroid objectively reduced nasal congestion and nasal histamine hyper-reactivity in children and adolescents with PAR.

Can the Use of HEPA Cleaners in Homes of Asthmatic Children and Adolescents Sensitized to Cat and Dog Allergens Decrease Bronchial Hyperresponsiveness and Allergen Contents in Solid Dust?

Sulser C, Schulz G, Wagner P, et al. Int Arch Allergy Immunol. 2009;148(1):23–30PURPOSE OF THE STUDY. Because pet allergies are associated with asthma, the authors investigated whether high-efficiency particulate-arresting (HEPA) filtration had any effect on reducing indoor allergens and bronchial hyperreactivity in children with asthma who were sensitized to cat and dog.STUDY POPULATION. A total of 30 children with asthma (age: 6–17 years) who were sensitized and exposed to cat and/or dog allergen(s) at home completed the study. The children did not have dust mite or mold sensitivities, and those being treated for asthma stayed on treatment throughout this time.METHODS. This was a randomized, controlled trial in which the children were assigned to 1 of 2 groups. For 12 months, 1 group was exposed to HEPA air cleaners that were placed in the living room and bedroom, and the other group was exposed to paper sham filters. Filters were on for >50% of the time. Pulmonary function testing and cold-air challenges were performed at baseline, 6 months, and 12 months into the study. Serum eosinophil cationic protein, specific immunoglobulin E to several aeroallergens, current medications, and clinical symptoms (nighttime awakenings, physical exercise symptoms, breathing limitations, and nasal stuffiness) were assessed. The amounts of cat (Fel d 1) and dog (Can f 1) allergens in the filters and bulk dust samples were also collected.RESULTS. Forced expiratory volume in 1 second at baseline lung function improved in the entire study population (median: 90% at initial visit, 98% at 6 months, and 95% at 12 months; P < .01). However, there was no significant change in eosinophil cationic protein, use of medication, or quality of life for the 2 groups. Although after 12 months there seemed to be a trend for a decrease in change in forced expiratory volume in 1 second after cold-air challenge in the active group (8.1%–5.4%) versus the sham group (4.3%–8.2%), the difference was not statistically significant (P = .336). Active filters retained higher amounts of cat and dog allergens in their main filter devices, compared with sham filters.CONCLUSIONS. Although HEPA air cleaners were able to retain airborne pet allergens, they had no significant effect on bronchial hyperreactivity.REVIEWER COMMENTS. High-efficiency air filtration is often recommended to patients with asthma with known allergenic sensitivities, to reduce exposure to indoor pet allergens (which are ∼5 μm in size). HEPA filtration can filter out particles as small as 0.3 μm with up to 99.97% efficiency. This study did not find a significant effect of HEPA filtration on bronchial hyperreactivity after 1 year of use, but there seemed to be a trend toward improvement in bronchial hyperreactivity. Although this study revealed a very limited role for HEPA use in asthma therapy, future studies should evaluate whether HEPA filtration may help prevent or delay the development of asthma in younger children with atopy who are at increased risk of developing asthma.