Respiratory Allergy In Children Research Articles

Clinical utility of diagnostic methods in respiratory allergy in pediatric patients.

Respiratory allergy is a single condition which affects upper and lower airways. The diagnose in childhood is essential to prevent the allergy respiratory progression. We aimed to analyze the clinical utility of diagnostic tests to identify rhinitis phenotypes and to differentiate between atopy and respiratory allergy in children. 173 children with a clinical suspicion of allergic rhinitis were prospectively evaluated in our pediatric allergist service. The allergological study included clinical history, physical examination, specific IgE (sIgE), skin prick test (SPT), and nasal allergen challenge (NAC). It identified 4 phenotypes: i) allergic rhinitis (AR): positive NAC, SPT and/or sIgE, ii) local allergic rhinitis (LAR): positive NAC and negative SPT and sIgE, iii) dual allergic rhinitis (DAR): positive NAC to perennial & seasonal allergens, SPT and/or sIgE to seasonal and negative to perennial allergens, and iv) non-allergic rhinitis (NAR): negative study. Most of children were girls, with a family history of rhinitis, non-smokers and an urban habit. The mean age of onset of symptoms was 10 (3.982) years. 45,7% had a diagnosis of AR, 24,9% LAR, 11,6% DAR and 17,9% NAR. Atopy was detected by SPT in 57.3%, by sIgE (54.9%), no patient with negative SPT had positive sIgE. However, 36.5% of allergic patients were not correctly classified by these tests being diagnosed by clinical history+NAC. Clinical history and NAC were the most useful diagnostic methods for correctly diagnose respiratory allergy in children. sIgE did not improve the detection of atopy obtained by SPT, and could be avoided as atopy screening-test.

GLI2 promoter hypermethylation in saliva of children with a respiratory allergy

BackgroundThe prevalence of respiratory allergy in children is increasing. Epigenetic DNA methylation changes are plausible underlying molecular mechanisms.ResultsSaliva samples collected in substudies of two longitudinal birth cohorts in Belgium (FLEHS1 & FLEHS2) were used to discover and confirm DNA methylation signatures that can differentiate individuals with respiratory allergy from healthy subjects. Genome-wide analysis with Illumina Methylation 450K BeadChips revealed 23 differentially methylated gene regions (DMRs) in saliva from 11y old allergic children (N=26) vs. controls (N=20) in FLEHS1. A subset of 7 DMRs was selected for confirmation by iPLEX MassArray analysis. First, iPLEX analysis was performed in the same 46 FLEHS1 samples for analytical confirmation of the findings obtained during the discovery phase. iPLEX results correlated significantly with the 450K array data (P <0.0001) and confirmed 4 out of the 7 DMRs. Aiming for additional biological confirmation, the 7 DMRs were analyzed using iPLEX in a substudy of an independent birth cohort (FLEHS2; N=19 cases vs. 20 controls, aged 5 years). One DMR in the GLI2 promoter region showed a consistent statistically significant hypermethylation in individuals with respiratory allergy across the two birth cohorts and technologies. In addition to its involvement in TGF-β signaling and T-helper differentiation, GLI2 has a regulating role in lung development.ConclusionGLI2 is considered an interesting candidate DNA methylation marker for respiratory allergy.

Allergen-Specific Immunotherapy for Respiratory Allergy in Children: Unmet Needs and Future Goals

Allergen-specific immunotherapy for the treatment of respiratory allergy is currently supported, at least for selected products, by evidence of efficacy and effectiveness in the pediatric age. However, unmet needs remain in terms of administration regimens, duration of treatment, biomarkers, and preventive effects. These knowledge gaps need to be urgently addressed to provide pediatricians and pediatric allergists with more definite recommendations for the use of this treatment in children. This article critically appraises the most relevant debated issues on allergen-specific immunotherapy in children, focusing on allergen standardization procedures, heterogeneity of clinical studies, and regulatory and pharmacoeconomic aspects.

Respiratory Allergy in Children Due to Foods with 7 Tables

Respiratory Allergy in Children Due to Foods with 7 Tables

IgE-hypersensitivity to allergens of the fungi Rhizopus Nigricans and Cladosporium Herbarum in childrenwith respiratory allergies

A survey of 111 children diagnosed with respiratory allergies (allergic rhinitis, allergic bronchitis, obstructive bronchitis, recurrent bronchitis, bronchial asthma) aged 1 year to 17 years, of which 58 children have a diagnosis of atopic bronchial asthma of different severity. All children are at risk for the development of fungal sensitization, having a household contact with these allergens. Allergological diagnostics was performed by ELISA using a panel of pediatric and fungal (Rhizopus nigricans and Cladosporium herbarum) biotinylated allergens. As a result of the study revealed that allergens mold Rhizopus nigricans and Cladosporium herbarum are the causal significant factor in the development of respiratory allergies, including asthma, in children at risk. Most often a high level of hypersensivity to Rhizopus nigricans is seen in children aged 2-5 years, Cladosporium herbarum - aged 6-9 years, concomitant to both fungal allergens at the age of 10-17 years. The correlation between the severity of atopic process and degree of sensitization to fungal allergens was not detected. All children with atopic asthma have polyvalent sensitization. Allergens mold Rhizopus nigricans and Cladosporium herbarum must be taken into account in the preparation of a diagnostic panel for children with respiratory allergies at risk. It is necessary to support drug therapy of respiratory allergy in children the activities aimed at elimination of cause significant fungal sensitization everyday surroundings.

Evaluation of IgE responses for a better understanding of the role of airborne fungi in respiratory allergy in children

Evaluation of IgE responses for a better understanding of the role of airborne fungi in respiratory allergy in children

Annual temperature and the prevalence of frequent ear infections in childhood

Objectives The aim of this study was to determine if changes in annual temperature influence the prevalence of frequent otitis media (FOM) and respiratory allergy in children. Methods Annual prevalence data for FOM (defined as 3 or more ear infections per year), respiratory allergy, and seizures (nonrespiratory, control condition) in children were extracted from the National Health Interview Survey for 1998 to 2006. Average US annual temperatures for the same period were recorded from the Environmental Protection Agency. Complex samples logistic regression analyses were performed to identify possible correlations between annual temperature and each of the 3 disease conditions, controlling for age and sex. Results A total of 113 067 children were studied (mean age, 8.6 years; 51.1% girls). Overall prevalences (±95% confidence interval) were 6.3% ± 0.2%, 11.8% ± 0.2%, and 0.7% ± 0.1% for FOM, respiratory allergy, and seizures (nonrespiratory, control condition), respectively. Average annual temperatures ranged from 53.64°F to 55.09°F. Regression analysis found that annual temperature did not influence the prevalence of FOM ( P = .681); male sex and younger age were associated with a higher prevalence of FOM ( P = .025 and P < .001, respectively). Similarly, annual temperature did not influence prevalence of respiratory allergy ( P = .883); male sex and increasing age were associated with a higher prevalence of respiratory allergy (both P < .001). Annual temperature and sex did not influence seizure prevalence; however, increasing age was negatively associated. Conclusions Changes in average annual temperature do not appear to influence the prevalence of otitis media or respiratory allergy. This negative finding suggests that although global warming continues to affect our environment, childhood otolaryngologic disease prevalence may not be directly influenced.

The prognosis of wheat hypersensitivity in children

The study was aimed to determine the natural history of wheat hypersensitivity, to define risk factors for persistent wheat hypersensitivity, and to evaluate the development of respiratory allergy in children with wheat hypersensitivity. The development and subsequent disappearance of wheat hypersensitivity, clinical findings, skin prick test (SPT) reactivity, and the development of allergic rhinoconjunctivitis and asthma were charted retrospectively in 28 children with wheat hypersensitivity proven by the open oral challenge at the median age of 21 months (range 6 to 75 months). Appearance of skin symptoms during the diagnostic wheat challenge was related to SPT-positive wheat hypersensitivity, while the appearance of gastrointestinal symptoms alone was associated with SPT-negative wheat hypersensitivity (p=0.002). Wheat was tolerated by 59%, 69%, 84%, and 96%, by age 4, 6, 10, and 16, respectively. Sensitization to gliadin with a SPT wheal of >or=5 mm at the time of the diagnostic challenge was associated with a slower course of recovery from wheat hypersensitivity (p=0.019), and a SPT wheal of >or=3 mm to gliadin at any time was associated with the development of asthma (p=0.022). SPT reactivity to wheat was associated with later SPT reactivity to birch pollen (p=0.001), and the development of allergic rhinoconjunctivitis (p=0.001). In conclusion, almost all children with wheat hypersensitivity can tolerate wheat by adolescence. Sensitization to gliadin is associated with a slower achievement of tolerance and an increased risk of asthma.

Quoi de neuf en allergologie pédiatrique en 2007–2008 ? Partie 2 : allergie oculaire et respiratoire (une revue de la littérature internationale de septembre 2007–octobre 2008)

Numerous studies on pathophysiology, epidemiology, (early) diagnosis, prevention and treatment of respiratory allergy in children have been published since October 2007. Parental atopy and/or asthma and bronchial hyperreactivity, gynecological and obstetrical problems during pregnancy, prematurity, maternal exposure to domestic pollutants during pregnancy, passive smoking in utero and during early life, early exposure to high levels of mites and molds, respiratory infections and a personal history of atopy (atopic dermatitis, food allergy, sensitizations detected by means of prick-tests and/or specific IgE determination) are associated with an increased risk of wheezing and asthma. However, these risk factors are dependent on complex interactions with numerous genes and interactions between genes themselves. In wheezing infants, bronchial and blood eosinophilia, bronchial hyperreactivity and severity of bronchiolitis are significant risk factors for asthma in childhood. Ribavirin treatment of respiratory syncytial virus bronchiolitis in infants significantly reduces the risk of asthma in children. The control of asthma exacerbations is better in children treated with inhaled corticosteroids than in children treated with leukotriene receptor antagonists. However, these drugs may be more effective than inhaled corticosteroids in the control of the bronchial eosinophilic inflammation. Sublingual immunotherapy may be as effective as subcutaneous immunotherapy in the prevention of neosensitizations in children sensitized to one or a low number of allergens. However, adherence to sublingual immunotherapy is far from excellent and a new case of severe anaphylactic reaction to sublingual immunotherapy has been reported recently.

Exposure to maternal smoking in the first year of life interferes in breast‐feeding protective effect against the onset of respiratory allergy from birth to 5 yr

The aim of this study was to evaluate the interaction between the exclusive breast-feeding protective effect and the exposure to tobacco smoke at domicile in the first year of life, on the onset of respiratory allergy (asthma and rhinitis) in children until 5 yr of age. This is prospective cohort study, observational, institutional based. Three hundred children born in a public hospital of Salvador-Bahia (Brazil) were followed from birth to 5 yr of age. Data from 268 children at 60 months of life were analyzed. Occurrence of allergic symptoms were studied and correlated with gender, allergic relatives in first degree, exclusive breast-feeding duration, smoking mother, and presence of other smoker at home, considering the first year of life. Exclusive breast-feeding for at least 6 months showed a protection effect against the onset of respiratory allergy in children from birth to 5 yr (p < 0.05); odds ratio (OR): 0.33 (95% CI: 0.18-0.59). Breast-fed children for less then 6 months compared with those breast-fed for 6 months or more, presented a higher risk (OR: 2.34-95% CI: 1.4-3.74) for developing allergic respiratory symptoms just to 5 yr. The protective effect of exclusive prolonged breast-feeding on the onset of respiratory allergy in children from birth until 5 yr was lost when their mothers were smokers (OR: 2.50-95% CI 1.19-5.19). Therefore, the protective effect of breast-feeding in the first year of life on the onset of allergic symptoms until the age of 5 yr was confirmed. This study proposes a confounding effect of maternal smoking on this protection, exposed by a higher risk for present allergic symptoms until the age of 5 yr, in children exclusively breast-fed for 6 months or more, when their mothers smoked.

Corticosteroids (inhaled and/or intranasal) in the treatment of respiratory allergy in children: safety vs. efficacy

Background Topical administration of Corticosteroids (CS) can reduce the total dose of CS required to treat the patient and minimize side effects. Topical CS is extremely effective and has an excellent safety profile. Nonetheless, care must be taken when multiple sites such as lungs, nose and skin are being treated. CS mechanisms of action on the inflammatory process are complex. The aim of this study is to review such mechanisms and the adverse events secondary to it. Methods Review English database (Embase, Pub-Med, Scielo) searching words: CS, adverse events, inhaled CS, intranasal CS, and children. Results There is a classic mechanism involving a genomic effect of CS and a non-genomic effect, independently of gene transcription process. This mechanism acts by reducing mucosal blood flow in the asthmatic airways. Second-generation topical CS is the treatment of choice in allergic diseases control because of their good anti-inflammatory activity, poor absorption and first-pass hepatic metabolism. When comparing different CS, it is important to compare therapeutically equivalent doses. Although topical CS reduces systemic side effects, local and even systemic side effects can occur. Many factors affect the amount of drug that reaches the lung, including inhaler technique and inhaler type, fine particle dose and particle distribution. Conclusion Most patients with allergic diseases respond to CS treatment, but there is a small subset of them whose response is unsatisfactory even with high doses of CS. They are classified as corticosteroid-resistant asthmatics. Pro-inflammatory cytokines appear to up regulate the expression of GRβ that has been associated with CS resistance.

Allergic Sensitization to Cat as Major Predictor of Incident Respiratory Allergy in Children

Allergic Sensitization to Cat as Major Predictor of Incident Respiratory Allergy in Children

Endotoxin exposure and atopic sensitization in adult pig farmers

Recent studies have reported a low prevalence of atopic sensitization and respiratory allergy in children growing up on farms. We sought to evaluate the dose-response relationship between endotoxin and atopic sensitization in adult farmers and to assess the effect on respiratory health outcomes. Data on endotoxin exposure and serum IgE levels were available for 162 pig farmers from a cross-sectional case-control study, with case selection on the basis of respiratory symptoms. Exposure to endotoxin was modeled in detail, and respiratory health effects were assessed during a medical examination. Exploratory analysis was done by using nonparametric modeling and was followed by classical parametric regression. IgE to one or more common allergens was detected in sera from 28 (17%) farmers. The average (geometric mean) total serum IgE levels was 37 IU/mL (geometric SD, 4 IU/mL). A strong inverse relationship was found between endotoxin and sensitization to common allergens for exposures of 75 ng/m 3 or less, with an odds ratio of 0.03 (95% CI, 0.0-0.34) for a 2-fold increase in endotoxin. For endotoxin exposure of greater than 75 ng/m 3 , the association was weak (odds ratio, 1.2 [95% CI, 0.38-3.6]). No association was found between endotoxin exposure and total serum IgE levels. Endotoxin was associated with increased airway hyperresponsiveness to histamine and lower lung function in sensitized farmers, without evidence of a nonlinear relationship. The prevalence of atopic sensitization in adult pig farmers is low. Endotoxin or related exposures might protect from sensitization, even in an adult working population exposed to high levels of endotoxin, but is a risk factor for increased airway hyperresponsiveness and low lung function.

Sublingual immunotherapy in asthma and rhinoconjunctivitis; systematic review of paediatric literature

Aims: To evaluate the clinical efficacy of sublingual immunotherapy (SLIT) in respiratory allergy in children. Methods: A systematic literature review was conducted. The search was focused on all the double...

Phadiatop® in the diagnosis of respiratory allergy in children: Allergy Project – PROAL

Phadiatop® in the diagnosis of respiratory allergy in children: Allergy Project – PROAL

Phadiatop® in the diagnosis of respiratory allergy in children: Allergy project – PROAL, Brazil

Rationale Phadiatop® is a respiratory allergy screening test for evaluation of serum IgE antibodies to inhalant allergens. Objectives To evaluate the positivity of Phadiatop® in children from several Brazilian pediatric allergology centers and to compare its results with the presence of serum specific IgE to inhalant and food allergens. Methods Phadiatop® and serum specific IgE levels (RAST) to inhalant and food allergens (UniCAP - Pharmacia®) were determined in 451 atopic children from several pediatric allergy centers and in a non-allergic control group (N=62), distributed in five age groups: <2 years; 2 to 3 years; 3 to 4 years; 4 to 5 years, and 5 to 12 years. Results Phadiatop was positive in 305 atopic children (67.6%) and in 25.8% of controls (p<0.001). Among atopic children the distribution of positive test varied according to age: 10.8% among below 2 years, 15.4% from 2 to 3 years, 22.0% from 3 to 4 years, 19.3% from 4 to 5 years and 35.4% from 5 to 12 years. No concordance between positive RASTs to food allergens and Phadiatop® was observed. The study of the relationship between positive inhaled allergen RASTs and positive Phadiatop® showed best indices with house dust mites ( D. pteronyssinus, D. farinae and Blomia tropicalis). Conclusions Phadiatop® is an useful tool for allergy diagnosis to domestic mites.

Oral and sublingual immunotherapy in paediatric patients.

Sublingual immunotherapy is becoming a routine treatment for respiratory allergy in several countries and it has been validated in international documents. This article will review the available literature on oral and sublingual immunotherapy, discussing the possible use of sublingual immunotherapy in paediatric patients. As oral immunotherapy was found to be poorly effective in clinical trials, its use has been discontinued. In contrast, several controlled studies have shown the efficacy of sublingual immunotherapy in children with allergic asthma and rhinitis, and a postmarketing survey has confirmed its safety. Moreover, new data on the long-lasting efficacy of this treatment and on the absence of local immunological effects have recently been published. The clinical efficacy and the optimal safety profile of sublingual immunotherapy make it a good candidate for treating respiratory allergy in children. Some aspects, such as the dose-response relationship and preventive effect, will be a research challenge for future developments and better definition of indications in children.

The development of respiratory allergy in children with food sensitivity

The development of respiratory allergy in children with food sensitivity

The role of IgE-mediated hypersensitivity in otitis media with effusion

Introduction: The role of immunoglobin (Ig) E-mediated hypersensitivity in otitis media with effusion (OME) has been the subject of much controversy and personal bias. Uncontrolled studies report the incidence of respiratory allergy in children with OME to range from 4% to over 90%. Materials and Methods: Children 1 to 18 years old who had OME requiring a myringotomy and tubes from January 1, 1987, through July 1, 1988, were the subjects of this study. The history of allergic and radioallergosorbent test (RAST) analysis of specific serum IgE levels was undertaken for 26 allergens on 89 children in the study group and 59 children in the control group. Result: The incidence of allergen as diagnosed by RAST score was higher in children with OME than children in the control group ( P > f .05). There was no correlation between positive RAST scores and the number of polyethylene-ventilating (PE) tubes previously placed, history of tonsillectomy, history of adenoidectomy, or the character of the effusion (mucous v serous). Conclusion: Respiratory allergy is a factor involved in the pathogenesis of OME.

Treatment of respiratory allergy in children by oral administration of dust and pollen extracts

1. 1. An unselected group of 402 children suffering from respiratory allergy was treated orally. Of these, the records on 294 were available for satisfactory evaluation of results. Of these, 221 had no treatment save oral therapy with a single antigen. 2. 2. The method, as described, is simple, easy, and rapid and, when successful, to be preferred to hypodermic therapy. 3. 3. The method was successful in more than one-half of those using it. Hypodermic therapy gave satisfactory relief in a large number of those who failed to get relief by the oral method.