Astma Kinderen Wetenschap

The Suppressive Role of Streptococcus pneumoniae Colonization in Acute Exacerbations of Childhood Bronchial Asthma.

The Suppressive Role of Streptococcus pneumoniae Colonization in Acute Exacerbations of Childhood Bronchial Asthma.

Int Arch Allergy Immunol. 2019 Dec 10;:1-9

Authors: Kama Y, Kato M, Yamada Y, Koike T, Suzuki K, Enseki M, Tabata H, Hirai K, Mochizuki H

Abstract
INTRODUCTION: Little is known about the association between bacterial infections and exacerbations of bronchial asthma.
OBJECTIVE: To elucidate the effect of bacterial infections on bronchial asthma, we examined pharyngeal bacterial colonization, duration of wheezing, and serum levels of cytokines and chemokines during acute exacerbations of asthma in children.
METHODS: Potential bacterial pathogens were investigated in pharyngeal samples and viruses obtained from nasal secretions of 111 children who were outpatients and/or in patients with acute exacerbations of asthma (mean/median age: 2.8/2.6, respectively). We also measured serum levels of 27 different cytokines/chemokines.
RESULTS: Pharyngeal bacterial cultures were positive in 110 of 111 children. The 3 major bacterial pathogens were Streptococcus pneumoniae (29.7%), Moraxella catarrhalis (11.7%), and Haemophilus influenzae (10.8%). M. catarrhalis was detected more frequently in patients with pneumonia. Furthermore, patients with S. pneumoniae colonization had significantly shorter wheezing episodes than those without it. In contrast, the duration of wheezing did not differ significantly among cases with other bacteria such as M. catarrhalis and H. influenzae. Furthermore, the length of wheezing episode in patients with S. pneumoniae colonization showed significant inverse correlation with peripheral white blood cell count, neutrophil count, and C-reactive protein, while there was no significant correlation between duration of wheezing and these 3 parameters among patients with M. catarrhalis or H. influenza. Among the 27 cytokines/chemokines, only serum tumor necrosis factor (TNF)-α was significantly lower in patients with S. pneumoniae colonization than in those without it.
CONCLUSIONS: These results suggested that pharyngeal S. pneumoniae colonization plays a suppressive role on the pathophysiology during acute exacerbations of asthma.

PMID: 31822014 [PubMed - as supplied by publisher]



The Role of Environmental Factors in the Etiology of Nonsyndromic Orofacial Clefts.

The Role of Environmental Factors in the Etiology of Nonsyndromic Orofacial Clefts.

J Craniofac Surg. 2019 Dec 09;:

Authors: Eshete M, Butali A, Abate F, Hailu T, Hailu A, Degu S, Demissie Y, Gravem PE, Derbew M, Mossey P, Bush T, Deressa W

Abstract
BACKGROUND: Nonsyndromic orofacial clefts (NSOFCs) represent the most common congenital anomalies in the head and neck region. Multiple factors contribute to the occurrence of this anomaly. The etiology of NSOFCs in the Ethiopian population has not been investigated prior to this study.
AIMS OF THE STUDY: To assess the role of maternal environmental factors in the occurrence of NSOFCs in the Ethiopian Population.
METHODS: The authors used unmatched case control study design and evaluated the role of environmental factors to the occurrence of NSOFCs in the Ethiopian population. The participants were recruited from the same institution (Yekatit 12 Hospital Medical College). The authors studied 760 mothers (359 mothers of children born with NSOFCs and 401 mothers of children born without any congenital anomalies). Univariate and multivariate logistic regression analyses were used to calculate relative risk by odds ratio and 95% confidence interval.
RESULTS: Mothers who gave history of bronchial asthma and mothers who were admitted for threatened abortion had a higher risk of delivering a child with NSOFCS P value=0.013; AOR=0.194, 95% CI [0.053-0.712], P value <0.001; AOR= 0.179, 95% CI [0.091-0.352] respectively. Higher number of children with NSOFCs were born to mothers who were exposed to diagnostic X-ray investigation during early pregnancy than those who were not exposed P value 0.048; AOR=0.375, 95% CI [0.142-0.990].
CONCLUSION: Maternal exposure to diagnostic x-ray, maternal chronic illness like bronchial asthma and threatened abortion were found to be associated with the occurrence of NSOFCS in the studied population.

PMID: 31821209 [PubMed - as supplied by publisher]



A Case of Serum Sickness-Like Reaction in an Adult Treated with Omalizumab.
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A Case of Serum Sickness-Like Reaction in an Adult Treated with Omalizumab.

Mil Med. 2019 Dec 09;:

Authors: Weiss SL, Smith DM

Abstract
Omalizumab has been safely used to treat asthma and urticaria. We report a case of serum sickness-like reaction in a patient treated with omalizumab for chronic idiopathic urticaria/angioedema. An adult female experienced episodic urticaria/angioedema without repeatable trigger, ultimately receiving diagnosis of chronic idiopathic urticaria/angioedema. After initial treatment, attempts with escalating cetirizine and montelukast doses were unsuccessful due to sedation; she began treatment with subcutaneous omalizumab 150 mg monthly. Urticaria frequency partially improved after two injections; therefore, the dose was increased to 300 mg after four treatments. Several days after first 300 mg dose, she reported abdominal cramping, fatigue, fever, lymphadenopathy, and arthralgia. Aside from mild thrombocytosis, inflammatory markers were unremarkable, as were evaluations for infection, autoimmunity, and malignancy. Omalizumab was held with eventual improvement in symptoms, which did not return after discontinuation. Omalizumab is a helpful medication in treating atopic conditions, with at least theoretical risk of immune complex formation and tissue deposition causing serum sickness-like reaction. Although early publications showed very low adverse event rates, there have now been reports of serum sickness-like reactions in children and adults treated for asthma and urticaria. Determining true incidence is difficult, given rarity and non-specific nature. Previous reports described symptoms with initiation of medication, reproducible after reintroduction. While it remains to be determined which factors increase risk for serum sickness-like reaction to omalizumab, our report of an urticaria patient who exhibited symptoms with increasing dose contributes insight into the discussion regarding this adverse effect of an otherwise well-tolerated and important medication.

PMID: 31819972 [PubMed - as supplied by publisher]



Severe Atopic Dermatitis In Spain: A Real-Life Observational Study.
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Severe Atopic Dermatitis In Spain: A Real-Life Observational Study.

Ther Clin Risk Manag. 2019;15:1393-1401

Authors: Sicras-Mainar A, Navarro-Artieda R, Armario-Hita JC

Abstract
Objective: To determine the epidemiology and characterize the treatment prescribed for severe atopic dermatitis (AD) in children/adults in usual clinical practice.
Methods: Observational, retrospective study made through review of medical records of Spanish patients aged ≥6 years. Patients diagnosed with severe AD who required care between 2013 and 2017 were included. The study groups were: 6-12 years; 13-18 years; and > 18 years. Patients were followed for 5 years. The main measurements were the prevalence of AD, comorbidity and treatment duration. Statistical significance was established as p <0.05.
Results: We included 2323 patients with severe AD. The overall prevalence was 0.10% (95% CI: 0.09-0.11%) and was 0.39%, 0.23% and 0.07% in the 6-12 years, 13-18 years and >18 years age groups, respectively (p <0.001), the percentage of males was 58%, 48.6% and 39%, respectively, and general comorbidity was 0.1, 0.2 and 0.9 points, respectively (p <0.001).The most frequent comorbidities were asthma in 49.0%, 44.9% and 20.8%, respectively (p <0.001), and anxiety in 79.7%, 65.8% and 67.3%, respectively (p <0.001). Oral corticosteroids were administered in 97.3%, 90.9% and 81.7%, respectively (concomitant-medication). Cyclosporine (45.3%), azathioprine (15.9%) and methotrexate (9.0%) were the most frequently prescribed drugs; biologic agents were administered in 5.8% of patients (for AD).
Conclusion: In AD the presence of comorbidities was significant, especially in the psychological, immunoallergic and cardiovascular areas. Cyclosporine was the most widely used immunosuppressant. There was a degree of variability in the use and duration of the treatments prescribed.

PMID: 31819466 [PubMed]



Influence of residential land cover on childhood allergic and respiratory symptoms and diseases: Evidence from 9 European cohorts.
Related Articles

Influence of residential land cover on childhood allergic and respiratory symptoms and diseases: Evidence from 9 European cohorts.

Environ Res. 2019 Nov 22;:108953

Authors: Parmes E, Pesce G, Sabel CE, Baldacci S, Bono R, Brescianini S, D'Ippolito C, Hanke W, Horvat M, Liedes H, Maio S, Marchetti P, Marcon A, Medda E, Molinier M, Panunzi S, Pärkkä J, Polańska K, Prud'homme J, Ricci P, Snoj Tratnik J, Squillacioti G, Stazi MA, Maesano CN, Annesi-Maesano I

Abstract
INTRODUCTION: Recent research focused on the interaction between land cover and the development of allergic and respiratory disease has provided conflicting results and the underlying mechanisms are not fully understood. In particular, green space, which confers an overall positive impact on general health, may be significantly contributing to adverse respiratory health outcomes. This study evaluates associations between surrounding residential land cover (green, grey, agricultural and blue space), including type of forest cover (deciduous, coniferous and mixed), and childhood allergic and respiratory diseases.
METHODS: Data from 8063 children, aged 3-14 years, were obtained from nine European population-based studies participating in the HEALS project. Land-cover exposures within a 500 m buffer centred on each child's residential address were computed using data from the Coordination of Information on the Environment (CORINE) program. The associations of allergic and respiratory symptoms (wheeze, asthma, allergic rhinitis and eczema) with land coverage were estimated for each study using logistic regression models, adjusted for sex, age, body mass index, maternal education, parental smoking, and parental history of allergy. Finally, the pooled effects across studies were estimated using meta-analyses.
RESULTS: In the pooled analyses, a 10% increase in green space coverage was significantly associated with a 5.9%-13.0% increase in the odds of wheezing, asthma, and allergic rhinitis, but not eczema. A trend of an inverse relationship between agricultural space and respiratory symptoms was observed, but did not reach statistical significance. In secondary analyses, children living in areas with surrounding coniferous forests had significantly greater odds of reporting wheezing, asthma and allergic rhinitis.
CONCLUSION: Our results provide further evidence that exposure to green space is associated with increased respiratory disease in children. Additionally, our findings suggest that coniferous forests might be associated with wheezing, asthma and allergic rhinitis. Additional studies evaluating both the type of green space and its use in relation to respiratory conditions should be conducted in order to clarify the underlying mechanisms behind associated adverse impacts.

PMID: 31818476 [PubMed - as supplied by publisher]



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