Astma Kinderen Wetenschap

Neonates colonized with pathogenic bacteria in the airways have a low-grade systemic inflammation.
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Neonates colonized with pathogenic bacteria in the airways have a low-grade systemic inflammation.

Allergy. 2018 Apr 19;:

Authors: Rahman Fink N, Chawes BL, Thorsen J, Stokholm J, Krogfelt K, Schjørring S, Kragh M, Bønnelykke K, Brix S, Bisgaard H

Abstract
BACKGROUND AND OBJECTIVES: The development of childhood asthma is associated with neonatal colonization with pathogenic bacteria in hypopharynx. Furthermore, established asthma is associated with systemic low-grade inflammation. We here report on the association between neonatal colonization with pathogenic bacteria in hypopharynx and the development of systemic low-grade inflammation.
METHODS: Bacterial colonization of the hypopharynx with M. catharralis, H. influenzae and/or S. pneumoniae was assessed in asymptomatic children from the Copenhagen Prospective Studies on Asthma in Childhood2000 (COPSAC2000 ) cohort at age 1 month by culturing technique (N=238) and by quantitative polymerase chain reaction (qPCR) technique (N=249) and in the COPSAC2010 cohort by culturing at age 1 month (N=622) and again at age 3 months (N=613). Systemic low-grade inflammation was determined in both cohorts at age 6 months by measuring plasma levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α) and interleukine-6 (lL-6).
RESULTS: In both cohorts, bacterial colonization was associated with increased levels of hs-CRP: COPSAC2000 , 1 month culturing (geometric mean ratio of colonized/non-colonized [95% CI]), 1.39 [0.97-2.01], p=0.08, 1 month qPCR, 1.55 [1.14-2.10], p<0.01; COPSAC2010 , 1 month, 1.52 [1.23-1.87], p<0.01, and 3 month, 1.57 [1.30-1.90], p<0.01. A multi-parametric principal component analysis incorporating hs-CRP, TNF-α and IL-6 confirmed a systemic inflammatory profile in children colonized with M. catharralis, H. influenzae and/or S. pneumoniae in the hypopharynx compared to non-colonized children (p-values<0.05).
CONCLUSION: The composition of the upper airway microbiome in early life may cause systemic low-grade inflammation. This article is protected by copyright. All rights reserved.

PMID: 29672858 [PubMed - as supplied by publisher]



Obese and Allergic Related Asthma Phenotypes Among Children Across the United States.
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Obese and Allergic Related Asthma Phenotypes Among Children Across the United States.

J Asthma. 2018 Apr 19;:1-26

Authors: Ross MK, Romero T, Sim MS, Szilagyi PG

Abstract
OBJECTIVES: Pediatric asthma is heterogeneous with phenotypes that reflect differing underlying inflammation and pathophysiology. Little is known about the national prevalence of certain obesity and allergy related asthma phenotypes or associated characteristics. We therefore assessed the national prevalence, risk factors, and parent-reported severity of four asthma phenotypes: not-allergic-not-obese, allergic-not-obese, obese-not-allergic, and allergic-and-obese.
METHODS: We analyzed data from the 2007-2008 National Survey of Children's Health (NSCH) of 10-17 year-olds with parent-reported asthma. We described sociodemographic and health risk factors of each phenotype and then applied logistic and ordinal regression models to identify associated risk factors and level of severity of the phenotypes.
RESULTS: Among 4,427 children with asthma in this NSCH cohort, the association between race and phenotype is statistically significant (p<0.0001); white children with asthma were most likely to have allergic-not-obese asthma while black and Hispanic children with asthma were most likely to have the obese-non-allergic phenotype (p<0.001). ADD/ADHD was more likely to be present in allergic-not-obese children (OR 1.50, CI 1.14-1.98, p = 0.004). The phenotype with the highest risk for more severe compared to mild asthma was the obese-and-allergic asthma phenotype (OR 3.34, CI 2.23-5.01, p<0.001).
CONCLUSIONS: Allergic-not-obese asthma comprised half of our studied asthma phenotypes, while obesity-related asthma (with or without allergic components) comprised one-fifth of asthma phenotypes in this cohort representative of the U.S.
POPULATION: Children with both obese and allergic asthma are most likely to have severe asthma. Future management of childhood asthma might consider more tailoring of treatment and management plans based upon different childhood asthma phenotypes.

PMID: 29672178 [PubMed - as supplied by publisher]



Evaluating children with suspected allergic reactions to vaccines for infectious diseases.
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Evaluating children with suspected allergic reactions to vaccines for infectious diseases.

Allergy Asthma Proc. 2018 May 01;39(3):177-183

Authors: Franceschini F, Bottau P, Caimmi S, Cardinale F, Crisafulli G, Liotti L, Pellegrini G, Peroni D, Saretta F, Mastrorilli C, Caffarelli C

Abstract
BACKGROUND: Vaccines often contain potentially allergenic material in addition to pathogen-specific immunogens that may induce allergic reactions. Parents and physicians often suspect that adverse reactions to vaccines are allergic in etiology. The concern that some of the substances contained in vaccines may trigger an anaphylactic reaction may lead to a low vaccination adherence with emergence of infectious disease epidemics.
OBJECTIVE: To provide practical suggestions for managing children suspected to have an allergic reaction to a vaccine.
METHODS: Information was obtained from a search of guidelines and relevant studies on allergic reactions to vaccines for infectious diseases.
RESULTS: True allergic reactions elicited by a vaccine are rare. Skin testing to the vaccine and to its components may identify the triggering agent. Graded dosing desensitization is helpful in children sensitized to the offending vaccine.
CONCLUSION: All children with a suspected allergic reaction to a vaccine should be carefully evaluated by routine allergy tests. When it is necessary, further immunization should be given under strict medical surveillance, which ensures that every child can safely complete the vaccination schedule.

PMID: 29669664 [PubMed - in process]



Nonprescription medications for respiratory symptoms: Facts and marketing fictions.
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Nonprescription medications for respiratory symptoms: Facts and marketing fictions.

Allergy Asthma Proc. 2018 May 01;39(3):169-176

Authors: Weinberger M, Hendeles L

Abstract
BACKGROUND: There are many nonprescription (over-the-counter [OTC]) medications available on pharmacy shelves marketed for relief of respiratory symptoms. The number of such medications has been increasing.
OBJECTIVE: This review provides an evidence-based examination of OTC products used for respiratory symptoms.
METHODS: Antihistamines, decongestants, mucolytics, antitussives, and intranasal steroids were selected as the most common OTC medications taken by adults and children for various respiratory symptoms. Controlled clinical trials of efficacy were identified by searching a medical literature data base. Those trials and key publications related to the pharmacokinetics and pharmacodynamics of the products were reviewed.
RESULTS: Comparisons of the various OTC antihistamines' ability to suppress the effects of histamine were related to their clinical benefit. Intranasal corticosteroids are the preferred agents for maintenance therapy of persistent nasal congestion and are highly effective for symptoms of inhalant allergy other than allergic conjunctivitis. The disconnect between marketing claims and evidence was demonstrated for antihistamines and oral alpha-1 adrenergic agonist decongestants. Data for OTC mucolytics and antitussives were insufficient to justify their use based on the evidence.
CONCLUSION: There was little relationship between marketing claims and evidence regarding OTC medications used for respiratory symptoms. Analysis of data supported cetirizine, levocetirizine, and fexofenadine as the most effective of the OTC antihistamines. There were no data that supported the use of oral phenylephrine as a decongestant. Neither OTC mucolytics or antitussives provided sufficient evidence to justify their use.

PMID: 29669663 [PubMed - in process]



Epidemiology of childhood asthma in mainland China (1988-2014): A meta-analysis.
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Epidemiology of childhood asthma in mainland China (1988-2014): A meta-analysis.

Allergy Asthma Proc. 2018 May 01;39(3):15-29

Authors: Guo X, Li Z, Ling W, Long J, Su C, Li J, Liang S, Su L

Abstract
BACKGROUND: After the promotion of the two-child policy in recent years, the population of children in mainland China was bound to have a rapid growth, which would bring great challenges to public health. A number of cross-sectional studies on the epidemic of childhood asthma in mainland China were recently conducted, and varied prevalences were reported. Thus, knowing the epidemiology of childhood asthma in mainland China is of great necessity.
OBJECTIVE: Our study aimed to summarize the pooled prevalence of childhood asthma in mainland China and its time trend, gender difference, regional distribution, and age structure.
METHODS: Studies that reported the prevalence of childhood asthma in mainland China were identified via a systematic data base search through July 1, 2016. Meta-analysis was used to estimate the prevalence of childhood asthma and its subgroups, including gender, age groups, years, and regions. The regional distribution of the prevalence was set by province with the help of a geographic mapping software. The autoregressive integrated moving average model was used to predict the current prevalence of asthma.
RESULTS: A total of 117 studies published from 1988 to 2014 in mainland China with a total sample size of 2,678,696 were included. The overall current prevalence and lifetime prevalence of childhood asthma was 2.112% (95% confidence interval [CI], 1.977-2.247%) and 2.502% (95% CI, 2.166-2.838%), respectively. The difference of the prevalences between male and female patients was significant: odds ratio 1.54 (95% CI, 1.47-1.62) for the current prevalence and odds ratio 1.61 (95% CI, 1.47-1.77) for the lifetime prevalence.
CONCLUSION: The prevalence of childhood asthma in mainland China was low but has been increasing remarkably since 1998. Boys are more likely to have asthma throughout most of their childhood. Preschoolers (3-6 years old) showed a higher prevalence than the other age groups. The current prevalence of childhood asthma probably increased slightly from 2017 to 2019.

PMID: 29669661 [PubMed - in process]



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