Allergy Test Results Research Articles

Analiza zależności między wywiadem rodzinnym a występowaniem nadwrażliwości na pokarmy u niemowląt karmionych wyłącznie piersią w wieku do 6. miesiąca życia

IntroductionThe literature describes an association between a positive family history of allergic diseases and the incidence of allergies in children. AimThe aim of the study was to evaluate the influence of the family history of allergy on the incidence of hypersensitivity to food in infants exclusively breastfed up to 6 months of age. Materials and methodsThe study involved 106 infants exclusively breastfed up to 6 months of age, in whom due to atopic eczema and/ or symptoms of gastrointestinal tract allergy tests were conducted. The family history includes allergies with immediate family members, parents and siblings. All the patients were diagnosed for IgE-mediated and non-IgE-mediated food allergy. The statistical analysis was performed. ResultsIn infants with positive allergy test results (n=84), 34 patients (40.5%) were affected by the family history of allergic diseases. In the group with IgE-mediated sensitization, family history of allergic diseases affected 50.0%; in children with non-IgE-mediated hypersensitivity to food – 39.7%; in children with the mixed type – 42.9%. In the group of patients who did not show hypersensitivity to the allergens examined, family history of atopy affected 36.4% of infants. In our study, in infants exclusively breastfed up to 6 months of age there was no association between the prevalence of hypersensitivity to food and the family history of atopy. ConclusionOn the basis of own research results and reports of other authors it can be assumed that genetic factors are not significant in the development of non-IgE-mediated hypersensitivity to food in young children.

Occupational sensitization to lactase in the dietary supplement industry

ABSTRACTAerogen lactase exposure carries a risk for the development of allergic asthma and rhinitis; only a few occupationally affected patients have been reported. The authors report the results of allergy testing with employees of a lactase tablets manufacturing plant. The survey involved 13 workers, including a questionnaire, spirometry, basophil activation test (BAT), and skin prick tests (SPTs) with lactase and a panel of common aeroallergens. Furthermore, lactase-specific immunoglobulin E (IgE) antibodies were analyzed. Sensitization to lactase could be proven for 9 workers by SPT and BAT; specific IgE antibodies could be detected in serum samples of all sensitized. However, IgE levels ≥0.35 kU/L were only found in 4 sera. These data confirm that occupational exposure to lactase can induce IgE-mediated respiratory sensitization resulting in allergic diseases. Protective measures should thus be obligatory when working with lactase.

Rapid Molecular Identification and Quantification of Allergenic Pollen By Real-Time PCR

Identifying and quantifying airborne pollen is important for causal assessment of allergic symptoms, for determining which pollens should be tested and for interpreting the results of allergy tests. Present pollen counting methods are time-consuming, require specific expertise and training, and are prone to subjective variability. Our goal is to devise a sensitive, high throughput method of quantifying pollen load in environmental samples. 9 different pure pollen samples, including grass (Paspalum notatum), trees (Morella cerifera, Morus alba, Juniperus ashei, Pinus strobus, Quercus virginiana, Taxodium distichum, Ulmus americana), and ragweed (Ambrosia artemisifolia) were used for analysis (courtesy of Tom Greer PhD, Greer Laboratories). Genomic DNA (gDNA) was extracted from pure pollens using a modification of the DNAzol ES procedure. Primers specific for the 5.8S rRNA genes of the different pollens were designed for quantitative real-time PCR (qPCR) using a SYBRGreen-based PCR assay. Individual gDNA from the pollens was detectable to sub nanogram levels. Individual pollen gDNA was detected in samples consisting of a mixture of all 9 pollen gDNAs. Specific pollens were detected in gDNA extracted from randomly admixed samples of the various pollen samples. The selected primers provided accurate identification in mixed samples with variable efficiency. qPCR detection of the pollen gDNA is sensitive and specific. The current assay can be expanded to include additional species and/or modified to detect pollens native to distinct geographical regions. Actual environmental sample quantification is necessary to prove applicability.

General anaesthesia‐induced anaphylaxis: impact of allergy testing on subsequent anaesthesia

Immunoglobulin E-mediated allergy to drugs and substances used during general anaesthesia as well as non-allergic drug hypersensitivity reactions may account for anaesthesia-induced anaphylaxis. As IgE-mediated anaphylaxis is a potentially life-threatening reaction, identification of the culprit allergen is essential to avoid anaphylaxis recurrence during subsequent general anaesthesia. To study whether preventive recommendations derived from allergy testing after intraoperative anaphylaxis were followed in subsequent general anaesthesia. Results of standardized allergy testing after anaesthesia-induced anaphylaxis and outcome of subsequent general anaesthesia were analysed retrospectively. Fifty-three of 107 patients were diagnosed with IgE-mediated allergy to a drug or substance used during general anaesthesia, and 54 patients were test negative. Twenty-eight of 29 allergy patients tolerated subsequent general anaesthesia uneventfully. One patient with cefazolin allergy suffered from anaphylaxis recurrence due to accidental reapplication of cefazolin. Twenty-two of 24 test-negative patients tolerated subsequent general anaesthesia, whereas two patients again developed anaphylaxis despite pre-medication regimens. Our results confirm the practical impact of allergy testing in general anaesthesia-induced anaphylaxis. By identification of the allergen, it is possible to avoid allergic anaphylaxis during subsequent anaesthesia. In most cases, recommended pre-medication seems to prevent the recurrence of non-allergic drug hypersensitivity reactions.

Asthma Trigger Reports Are Associated with Low Quality of Life, Exacerbations, and Emergency Treatments.

Despite the importance of trigger perceptions for asthma diagnosis and management, associations among asthma triggers, affective disorders, and asthma outcome have received little attention. Because anxiety and depression are known to influence patients' health reports, we measured and controlled for these affective disorders in analyzing associations among patient perceptions of asthma triggers and asthma treatment outcomes. Patients from a nationally representative sample of respiratory specialist practices (N = 459) were assessed for clinically significant anxiety and depression and completed questionnaires on asthma triggers, quality of life, and asthma control. Physicians recorded exacerbation and emergency treatment frequencies in the prior year, spirometric lung function, and allergy test results. Hierarchical multiple regressions examined associations among reported trigger factors, anxiety, depression, and asthma outcomes, including quality of life, asthma control, exacerbations, emergencies, and spirometry. Patients across asthma severity levels were well represented. Anxiety and depression were associated with more frequent nonallergic, in particular psychological, triggers. Controlling for demographics, asthma severity, anxiety, and depression, nonallergic asthma triggers (including psychological triggers) explained substantial portions of variance in asthma control (total of 19.5%, odds ratios [ORs] = 2.07-1.37 for individual triggers), asthma-related quality of life (total of 27.5%, ORs = 3.21-1.49), and general quality of life (total of 11.3%, ORs = 1.93-1.55). Psychological triggers were consistently associated with exacerbations and emergency treatments (ORs = 1.96-2.04) over and above other triggers and affective disorders. Spirometric lung function was largely unrelated to perceived asthma triggers. Patients' perceptions of asthma triggers are important determinants of asthma outcomes, which can help identify individuals at risk for suboptimal asthma management.

Utility of Allergy Testing in Patients with Chronic Laryngopharyngeal Symptoms

To determine the utility of allergy evaluation in patients with chronic refractory laryngeal symptoms. Case series with chart review. Tertiary academic medical center. All patients who underwent in vitro allergy testing at a single institution from 2006 to 2010, for a total of 998 patients. Charts of patients who underwent in vitro allergy testing were identified. The charts were reviewed for the primary indication for allergy testing, as categorized into rhinitis complaints, chronic sinusitis, otitis media, and refractory laryngeal symptoms (globus, cough, throat clearing, increased secretions, and hoarseness). Results of allergy tests and comorbid conditions were analyzed and compared among groups. The positive yield of allergy testing in patients with primary laryngeal indications was 51.8%, 63.3% for rhinitis, 60.9% for sinusitis, and 33.3% for otitis media. The odds ratio of having a positive test was not statistically different for patients with laryngeal symptoms, rhinitis, or sinusitis. Patients with chronic laryngeal symptoms and positive allergy testing were most often sensitized to dust mites (63%) and least often sensitized to molds (1.3%). Allergy testing in patients with chronic laryngeal symptoms yields positive results in equivalent proportion to patients with other common presenting symptoms. Dust mites sensitization is the most common sensitization in patients with allergic laryngitis.

Efficacy of Dietary Treatment for Inducing Disease Remission in Eosinophilic Gastroenteritis.

Various dietary interventions have been used to treat patients with eosinophilic gastroenteritis (EGE). Concrete evidence as to the effectiveness of such treatments in inducing disease remission is, however, lacking. The aim of the study was to systematically review the efficacy of dietary therapies in inducing EGE remission. We performed a systematic search for the MEDLINE, EMBASE, and SCOPUS libraries for studies investigating the efficacy of dietary interventions (in both histological and symptomatic remission) for children and adults with EGE and colitis. The search yielded 490 references; 30 were included in the review, with most of these references being "low-quality" individual cases or short case series. No significant publication bias was found. Elemental diets in children were linked to 75.8% of clinical improvement, but few of these patients underwent a histological evaluation. Allergy-testing results have been used scarcely in EGE. Empiric elimination of allergy-associated foods was the most commonly used option. The variable results in terms of symptom relief, however, were scarcely accompanied by histological confirmation. Clinical and methodological heterogeneity hindered the performance of quantitative summaries for the efficacy of dietary therapies in inducing disease remission. Symptomatic improvements reported for dietary treatment in EGE by most of the available literature are questionable because of the lack of objective evaluation of clinical changes and the very limited assessment of histological remission. Because of the relative lack of well-designed, high-quality studies, the unequivocal use of dietary treatment for patients with EGE and colitis cannot be supported. Further research should be undertaken.

Reconciliation of health records following penicillin allergy testing of hospitalized patients

Background Medication errors are common and can lead to substantial morbidity. Similarly, inaccurate medication allergy lists can result in increased costs to the system, unnecessary allergy testing, prescription of inappropriate antibiotics, and allergic reactions. We hypothesized that most inpatients tested for penicillin allergy were not allergic and this information was not documented in the EMR or communicated to general practitioners. Methods We retrospectively reviewed charts of all inpatients seen at a teaching hospital by a consultant allergist in 2012. Data collected included basic demographics, penicillin allergy test results, current allergy status in the EMR, readmission rates, prescribed antibiotics, and discharge summary contents. Results 146 patients were tested for penicillin allergy and 144 (98.6%) were not allergic. Although orders were written in 145 (99.3%) charts to update the allergy status after testing, 32 (22.23%) patients with negative tests were still listed as allergic to penicillin in the EMR. Only 19 (15.2%) discharge summaries notified family physicians of the allergy testing results and discharge summaries were missing for 25 (20%) patients. Further assessment of half the charts revealed that in 41% of cases the negative allergy test resulted in a change of antibiotic to penicillin or its derivative. Of the 60 readmitted patients, 20 (33%) were still listed as allergic to penicillin in the EMR (only one patient tested positive) and 14 (70%) of the 20 patients required antibiotics. 12 of these 14 patients (86%) were prescribed antibiotics in the penicillin family despite their positive allergy status. Conclusions A significant proportion of health records were not amended following antibiotic allergy testing and the new allergy status was not communicated to most general practitioners in the discharge summary. A more efficient and reliable system needs to be implemented to ensure allergy status changes are communicated to all members of the healthcare team.

P46 The Influence Of Age And Gender On Allergy Test Results: Implications For The Use As Biomarkers In Childhood Asthma

Introduction Skin prick tests (SPTs) and measurement of allergen-specific serum (s)IgE are the main diagnostic tools for confirming atopy. Results of both tests are usually reported as dichotomous (sensitised/not sensitised), using arbitrary cut-offs which are the same across different ages and genders (SPT >3 mm, sIgE >0.35 kU/L). We investigated the influence of age and gender on allergy test results as biomarkers of asthma during childhood. Methods Children in a population-based birth cohort (n = 1051) were followed from birth to age 11 years. Information on asthma/wheeze (questionnaires), SPTs and sIgE to inhalant allergens (mite, cat, dog) were collected at ages 3, 5, 8 and 11 years. We investigated the association between quantitative atopy (sum of SPT mean wheal diameters [MWD]/titres of sIgE) and wheeze/asthma across ages and genders. Results There was a significant association between the SPT MWD/sIgE titre and wheeze/asthma at all ages and for both genders. However, the strength of this association was age and gender-dependent. For SPTs, the strength of the association between MWD and asthma increased with increasing age (OR 1.14–1.20, p = 0.002); we observed the opposite pattern for sIgE titre (OR 0.97–0.99, p = 0.04). For any given SPT/sIgE level, boys were significantly more likely to express clinical symptoms, particularly in early life; this difference between males and females appeared to diminish with age, and was no longer significant by age 11 years. Conclusions Age and gender have to be taken into account when interpreting the results of allergy tests (skin tests and IgE measurement) in the context of asthma during childhood.

Correlation between skin-prick testing, individual specific IgE tests, and a multiallergen IgE assay for allergy detection in patients with chronic rhinitis.

Allergy test results can differ based on the method used. The most common tests include skin-prick testing (SPT) and in vitro tests to detect allergen-specific IgE. This study was designed to assess allergy test results using SPT, individual specific IgE tests, and a multiallergen IgE assay (multiple allergen simultaneous test) in patients with chronic rhinitis and controls. One hundred forty total patients were prospectively enrolled in the study, including 100 patients with chronic rhinitis and 40 control patients without atopy. All eligible patients underwent SPT, serum analysis using individual specific IgE test, and multiple allergen simultaneous test against 10 common allergens. Allergy test results were then compared to identify correlation and interest agreement. There was an 81-97% agreement between SPT and individual specific IgE test in allergen detection and an 80-98% agreement between SPT and multiple allergen simultaneous test. Individual specific IgE test and multiple allergen simultaneous test allergy detection prevalence was generally similar to SPT in patients with chronic rhinitis. All control patients had negative SPT (0/40), but low positive results were found with both individual specific IgE test (5-12.5%) and multiple allergen simultaneous test (2.5-7.5%) to some allergens, especially cockroach, Dermatophagoides farina, and ragweed. Agreement and correlation between individual specific IgE test and multiple allergen simultaneous test were good to excellent for a majority of tested allergens. This study shows good agreement and correlation between SPT with individual specific IgE test and multiple allergen simultaneous test on a majority of the tested allergens for patients with chronic rhinitis. Comparing the two in vitro tests, individual specific IgE test agrees with SPT better than multiple allergen simultaneous test.

Analysis of a database to predict the result of allergy testing in vivo in patients with chronic nasal symptoms.

This article uses the logistic regression model for diagnostic decision making in patients with chronic nasal symptoms. We studied the ability of the logistic regression model, obtained by the evaluation of a database, to detect patients with positive allergy skin-prick test (SPT) and patients with negative SPT. The model developed was validated using the data set obtained from another medical institution. The analysis was performed using a database obtained from a questionnaire administered to the patients with nasal symptoms containing personal data, clinical data, and results of allergy testing (SPT). All variables found to be significantly different between patients with positive and negative SPT (p < 0.05) were selected for the logistic regression models and were analyzed with backward stepwise logistic regression, evaluated with area under the curve of the receiver operating characteristic curve. A second set of patients from another institution was used to prove the model. The accuracy of the model in identifying, over the second set, both patients whose SPT will be positive and negative was high. The model detected 96% of patients with nasal symptoms and positive SPT and classified 94% of those with negative SPT. This study is preliminary to the creation of a software that could help the primary care doctors in a diagnostic decision making process (need of allergy testing) in patients complaining of chronic nasal symptoms.

Comparison of atopic features between children and adults with eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is a clinicopathological diagnosis seen in children as well as adults. Growing evidence suggests that EoE is strongly associated with atopic disorders. Presenting symptoms differ in children and adults and it is not known whether atopic features vary by age. This study was designed to compare atopic features and allergic sensitization between children and adults with EoE. We conducted a retrospective analysis of demographic and clinical data from 50 children (aged 2-18 years) and 50 adults (aged 21-75 years) with a biopsy-proven diagnosis of EoE referred to our allergy clinic. Data regarding patient characteristics, history of atopic diseases, and allergy test results were collected for analysis. The majority of children and adults were white and male patients. When compared with adults, a higher percentage of children had a history of asthma (52% versus 24%; p < 0.05). There was no statistically significant difference between adults and children regarding history of allergic rhinitis, atopic dermatitis, immunoglobulin E-mediated food allergy, and family history of atopy. There was no statistically significant difference between children and adults regarding immediate-type sensitization to foods and aeroallergens. Compared with adults, a higher percentage of children showed a positive reaction to one or more foods on patch testing (62% versus 31%; p = 0.01). A high prevalence of comorbid atopic diseases and sensitizations to food and environmental allergens was seen in both children and adults. Children had a significantly higher rate of asthma and positive patch test to foods compared with adults.

Predictive findings of allergic disease in fiberoptic nasolaryngoscopy.

To determine whether findings on fiberoptic nasolaryngoscopy beyond the nasal cavity can aid in diagnosis of atopy. Case control analysis of patients undergoing fiberoptic nasolaryngoscopy and allergy testing at a single academic institution. Patients who underwent flexible nasolaryngoscopy for either laryngeal or nasal symptoms and allergy testing by in vitro methods were divided into an atopic group and a nonatopic control group based on results of allergy testing. Three board-certified otolaryngologists who were blinded to the atopic status and symptoms viewed 88 patient videos and filled out an 8-item endoscopic rating questionnaire for each. Correlation between rater scores, endoscopic findings, and atopic status was calculated using Randolph's multirater kappa values and Mann-Whitney test. Intrarater reliability was moderate to perfect for all physicians on all questions (kappa 0.545-1.0). Inter-rater reliability was slight to fair (kappa 0.143-0.399) for all questions and the overall impression of atopic disease. Abnormalities of the torus tubarius (P = .007) and increased nasopharyngeal secretions (P = .038) were predictive of atopic disease, whereas the presence of an adenoid (P = .08) and impression of atopic disease (P = .15) approached significance. All other endoscopic measures were not predictive of atopic status. Fiberoptic nasolaryngeal findings within the nasopharynx rather than the larynx are predictive of a positive atopic status. 3b.

Possible prevention of food allergies in children with short bowel syndrome: A retrospective pediatric study

summary Background and aims: Short bowel syndrome is the major cause of intestinal failure. Patients often require parenteral nutrition for a variable period of time to survive, but there is no consensus on the optimal feeding formula during the weaning from parenteral nutrition. Aim of this study was to retrospectively analyze the development of food allergy in children with short bowel syndrome weaned with a hydrolyzed or an amino acid-based formula. Methods: Clinical data were recorded for each patient. We also collected results of allergy tests of patients who had allergic reactions. Results: Forty-seven children with intestinal failure (26 males; mean age of 4.53 ± 3.85 years), followedup at the Department of Pediatrics since 2000, were retrospectively evaluated. Thirty-eight of 47 children (80%) had residual bowel < 100 cm requiring a mean duration of 17.36 ± 6.7 months of parenteral nutrition. In this group 22/38 children were weaned from parenteral nutrition with amino acid-based formula and 16 with hydrolyzed formula. Adverse events were reported in 16/38 children and 10 of these, all weaned with hydrolyzed formula, received diagnosis of cow's milk allergy. None of the 22 children weaned with amino acid-based formula developed allergic reactions. Conclusions: Children weaned with hydrolyzed formula have an increased risk of developing cow's milk allergy in comparison to those weaned with amino acid-based formula and its use may have a role in the prevention of food allergies. The reduced length intestinal residual (<100 cm) is a risk factor for the development of allergic reactions.

Factors associated with different results of allergy tests in children with dust mite-induced atopic dermatitis

BackgroundAtopic dermatitis (AD) is a public health problem, with an increasing prevalence worldwide. AD is a chronic inflammatory disease characterised by skin lesions and severe itching. Immunologically, AD has two forms, IgE-mediated and cell-mediated, but it may also be idiopathic. In the pathogenesis of AD, the gene mutations for filaggrin, a filament-aggregating protein present in the epidermis, are of pivotal importance, but other genetic factors are also operating, including those linked to family atopy. MethodsWe evaluated the role of family atopy, and of the results of the atopy patch test (APT) in parents, in children with mite-induced AD.64 children, 38 males and 26 females, mean age 4.97 years, were included for the diagnosis of AD and underwent APT and skin prick test (SPT) with dust mite extracts, with evaluation of atopy and result of APT also in parents. ResultsA positive family history of atopy was shown for children with positivity to both APT and SPT compared to those with negative or only one positive result to APT or SPT (p=0.08). Significant associations were found concerning APT results in children and parents. In particular, children of a positive-APT parent had an 18-fold higher risk of APT-positivity in comparison with children of negative-APT parents, while the risk was 6.6-fold higher if APT was positive in father. ConclusionFamily atopy and a positive APT in fathers are risk factors to develop cell-mediated AD, as assessed by the APT, in children.

The effect of allergy on prognosis of surgically treated nasal polyposis

This study aims to investigate the effects of allergy existence on prognosis of surgically treated nasal polyposis. This prospective study included 29 patients (22 males, 7 females; mean age 45.9 years; range 21 to 72 years) admitted to our clinic with nasal polyposis between January 2006 and December 2008. Patients were divided into two groups. Group 1 consisted of 11 patients who had positive results in skin prick test or whose positivity of allergy was confirmed by serum-specific immunoglobulin E, as a skin prick test was contraindicated. Group 2 included 18 patients who had negative allergy test results. Endoscopic and radiological evaluations of the patients were done preoperatively. Bilateral endoscopic sinus surgery was applied to all patients. Statistical analysis of pre- and postoperative endoscopic and radiological evaluation findings in group 1 showed a non-significant improvement (p>0.05). Statistical analysis of pre- and postoperative endoscopic and radiological evaluation findings in group 2 demonstrated a significant improvement (p<0.001, p<0.005 respectively). Response to surgical treatment is more limited in nasal polyposis patients with a positive allergy test.

Prospective Study of Peripregnancy Consumption of Peanuts or Tree Nuts by Mothers and the Risk of Peanut or Tree Nut Allergy in Their Offspring

The etiology of the increasing childhood prevalence of peanut or tree nut (P/TN) allergy is unknown. To examine the association between peripregnancy consumption of P/TN by mothers and the risk of P/TN allergy in their offspring. Prospective cohort study. The 10,907 participants in the Growing Up Today Study 2, born between January 1, 1990, and December 31, 1994, are the offspring of women who previously reported their diet during, or shortly before or after, their pregnancy with this child as part of the ongoing Nurses' Health Study II. In 2006, the offspring reported physician-diagnosed food allergy. Mothers were asked to confirm the diagnosis and to provide available medical records and allergy test results. Two board-certified pediatricians, including a board-certified allergist/immunologist, independently reviewed each potential case and assigned a confirmation code (eg, likely food allergy) to each case. Unadjusted and multivariable logistic regression analyses were used to evaluate associations between peripregnancy consumption of P/TN by mothers and incident P/TN allergy in their offspring. Peripregnancy consumption of P/TN. Physician-diagnosed P/TN allergy in offspring. Among 8205 children, we identified 308 cases of food allergy (any food), including 140 cases of P/TN allergy. The incidence of P/TN allergy in the offspring was significantly lower among children of the 8059 nonallergic mothers who consumed more P/TN in their peripregnancy diet (≥ 5 times vs <1 time per month: odds ratio = 0.31; 95% CI, 0.13-0.75; P(trend) = .004). By contrast, a nonsignificant positive association was observed between maternal peripregnancy P/TN consumption and risk of P/TN allergy in the offspring of 146 P/TN-allergic mothers (P(trend) = .12). The interaction between maternal peripregnancy P/TN consumption and maternal P/TN allergy status was statistically significant (P(interaction) = .004). Among mothers without P/TN allergy, higher peripregnancy consumption of P/TN was associated with lower risk of P/TN allergy in their offspring. Our study supports the hypothesis that early allergen exposure increases tolerance and lowers risk of childhood food allergy.

Emerging Therapeutic Strategies for Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is recognized as an increasingly common cause of chronic and recurrent esophageal symptoms that significantly impact quality of life and may occasionally result in severe complications in both pediatric and adult patients. The disease is triggered and maintained by exposure to food antigens in most patients, with an additional role proposed for airborne allergens. Different diet-based approaches focused on restricting potentially offending foods have proven to be effective long-term therapies for EoE. Dietary therapy is thus an attractive, yet challenging treatment option that should be considered for all pediatric and adult EoE patients. However, limitations related to food restriction, patient willingness to undergo repeated endoscopies and biopsies, and the variable results of allergy testing imply that dietary management is for the most part currently restricted to highly motivated healthcare providers treating highly motivated patients reluctant to utilize drug-based therapy on a chronic basis. Pharmacological therapies for EoE mainly comprise swallowed topical steroids, especially fluticasone propionate and budesonide, which were originally developed to treat bronchial asthma and are now extensively used "off label" in EoE patients. In fact, topical steroids currently constitute the prevailing therapeutic option and will probably continue to do so in the near future; indeed, several randomized clinical trials are currently underway to test these drugs for approval as the first pharmacological agents for EoE patients. Immunomodulators and several anti-allergic agents must be further assessed as therapeutic alternatives for refractory cases or patients with complications. Endoscopic dilation represents the third pillar in the therapeutic management of EoE patients, since they frequently present reductions in the esophageal caliber as a result of collagen deposition and a progressive fibrous remodeling process promoted by chronic eosinophilic infiltration. Dilation provides at least temporary symptom relief with similar complication rates to esophageal strictures from a different origin. However, although repeated endoscopic dilation has sometimes been used as the sole therapy for EoE, it best constitutes an adjuvant therapy along with dietary or pharmacological-based interventions, especially since dilation has no effect on the underlying esophageal inflammation. Current therapeutic management of EoE varies widely, with physician experience being a major explanatory factor. New evidence from ongoing research on EoE should thus seek to define a common treatment algorithm to optimize EoE patient management.

Influence of atopy and different treatments of asthma on fractional concentration of exhaled nitric oxide in children

Exhaled nitric oxide fraction is a noninvasive surrogate measure of airway infl ammation. Its levels are elevated in asthma patients. The interconnection between asthma inflammation and Exhaled nitric oxide fraction levels and how it is influenced by atopy and diff erent therapeutic options have not yet been resolved. The study included 143 children, mean age 11.27 years, with asthma and positive allergy test results. Patients were treated for 6 weeks with montelukast or with a combination of inhaled corticosteroids and montelukast. Exhaled nitric oxide fraction was measured in all patients before (visit 1) and after treatment with montelukast or combined therapy (montelukast and inhaled corticosteroids) for 6 weeks (visit 2). Exhaled nitric oxide levels were signifi cantly higher in children before than after treatment (mean 37.01±31.40, median 24.00 vs. 30.02±28.71 ppb, median 20.00; p&lt;0.001). The children treated with montelukast for 6 weeks had statistically signifi cant lower values of exhaled nitric oxide fraction. Accordingly, in children with allergic asthma, montelukast has a positive eff ect on airway infl ammation as measured by the nitric oxide level.

Caesarean section and allergic manifestations: insufficient evidence of association found in population-based study of children aged 1 to 4 years

To provide evidence on the association between caesarean section and allergic manifestations in an unselected child population. Research focused on all children aged from one to 4 years (N = 4779), born between April 2001 and March 2005 and living in the province of South Karelia, Finland. They were identified from the nationwide population register. Questionnaire data on 3181 participants were individually merged with allergy test results (skin prick tests, IgE antibodies and open food challenges) from all patient records. Compared with vaginal delivery, the adjusted relative incidence of positive allergy tests (with 95% confidence intervals, CI) in children born by caesarean section was 1.14 (0.79, 1.65) for food, 1.16 (0.66, 2.05) for animals, 0.94 (0.46, 1.92) for pollen and 1.19 (0.87, 1.63) for any allergens. The corresponding adjusted prevalence odds ratios (with 95% CI) of physician-diagnosed allergic manifestations were 1.15 (0.80, 1.63) for food allergy, 0.90 (0.47, 1.59) for pollen allergy or hay fever, 1.00 (0.75, 1.31) for atopic eczema, 0.96 (0.53, 1.65) for asthma and 1.08 (0.85, 1.38) for any allergic manifestation. Insufficient evidence was found in our population for any association between birth by caesarean section and allergic manifestations. Further evidence from unselected populations, with longer follow-up periods, is needed.