Allergy and desensitization to hymenoptera venom in children

Among 15 children who were stung by hymenoptera, 5 underwent semi-rapid desensitization using the outpatient Molkhou method. This technique was well tolerated; desensitization was stopped when protective IgG levels measured by RIP (radioimmunoprecipitation) reached 50% and skin tests and RASTs became negative. In a comparable series of adults, however, discontinuation of the desensitization was considered only following satisfactory tolerance of an accidental or planned sting. In children, semi-rapid desensitization is very effective and has also been proposed for allergies to air borne allergens such as mites and pollens when increased doses are required to improve protection.     

Allergy to Hymenoptera venom in children. Diagnosis and therapy

We studied 52 children, 3 to 15 years of age, suffering from allergic reactions following Hymenoptera stings. The diagnosis of allergy was based on history, results of skin tests and RAST performed by purified venoms of Apis mellifera, Vespula species and Polistes species. The history of children with multiple stings of the same insect showed an essential favourable prognosis, thus suggesting to submit to specific immunotherapy only children with severe reactions. For these patients it is necessary to perform therapy only in specialized Centres, because of the high frequency of adverse reactions which we observed in 33% of our treated patients.     

Prevention of sports injuries in children

As children around the world become involved in increasingly competitive and more organized sports activities, the frequency and severity of both acute and overuse injuries continues to rise. Over the past year, several important studies have contributed to our knowledge in the prevention of sports injuries in children. Safety guidelines and protective equipment are crucial to minimizing pediatric recreational injuries. Protective headgear, mouth guards, and wrist and shin guards have all been shown to be effective in preventing injuries. Nutrition and nutritional supplements (eg, creatine) for the pediatric athlete have also received greater attention recently. Combined with appropriate physical activity programs, nutrition is essential in battling the increasing epidemic of childhood obesity. Increased attention has also been directed toward specific injuries and injury rates in the female athlete. Specific training for the female pediatric athlete may have a preventive effect in halting the rising injury rates.     

Organized sports for children and preadolescents

Participation in organized sports provides an opportunity for young people to increase their physical activity and develop physical and social skills. However, when the demands and expectations of organized sports exceed the maturation and readiness of the participant, the positive aspects of participation can be negated. The nature of parental or adult involvement can also influence the degree to which participation in organized sports is a positive experience for preadolescents. This updates a previous policy statement on athletics for preadolescents and incorporates guidelines for sports participation for preschool children. Recommendations are offered on how pediatricians can help determine a child's readiness to participate, how risks can be minimized, and how child-oriented goals can be maximized.     

Exercise, training and sports in children with asthma from the sports medicine viewpoint

Asthmatic children can tolerate physical exertion relatively well. They should undergo physical training for social, psychological, educational, and medical reasons. It is important to understand the different effects of different kinds of sport on coordination, flexibility, speed and endurance. Details are described. Swimming is especially recommended for children with an exercise-induced asthma. A high air temperature is favorable. An interval-training is more suitable than a continuous work such as jogging. Postexercise bronchial obstruction can be prevented by prophylactic medication with selective beta-2-sympathomimetica or cromolyn sodium. Details of an endurance-training are described.     

Allergy in day care children: prevalence and environmental risk factors

Aim: To investigate the prevalence of atopic disease among Finnish day care children and the relationship between atopy and environmental factors.
Methods: A cross-sectional study of 594 day care children aged 1–6 years from Helsinki, Finland. Each child's history of atopic diseases and environmental exposure was collected in a questionnaire completed by the parents.
Results: The prevalence of diagnosed asthma was 0.9% for the 1–3-year olds and 5.5% for the 4–6-year olds, atopic eczema/dermatis was 16% in both groups, and allergic rhinitis 5% in the younger group, 9% in the older group. According to multivariable logistic regression models, breastfeeding (exclusive ≥4 months or partial ≥6 months) reduced the risk of atopic diseases (OR = 0.60; CI₉₅ 0.39–0.93, p = 0.021). Atopic diseases were more common in the oldest age group, 5–6-year olds, compared to the youngest, 1–2-year olds (OR = 2.18; CI₉₅ 1.14–4.15, p = 0.018). One parent with atopic disease increased the child's risk (OR = 1.89; CI₉₅ 1.20–2.97, p = 0.006), more so if both parents had a history (OR = 3.17; CI₉₅ 1.48–6.78, p = 0.003).
Conclusion: Our results support the hypothesis that breastfeeding for at least six months may protect against atopic diseases. The child's greater age (5–6 years) and parental history of atopic diseases increased the risk of atopy.     

Epidemiologic study of sports injuries in children

From 1981 to 1982, within a one year period, all medically treated childrens' accidents were recorded in the public and private medical facilities of a French health care district near Paris. Sports injuries represented 11% of all injuries, and in children aged 12 years and over, sports areas were the leading site of accidents (24%). Seven hundred thirty-eight sports injuries to children aged 6 years and over were analysed and compared to other types of accidental injuries (home, school and traffic accidents). The overall incidence of sports injuries was estimated to be 1.1% in children aged 6 to 14 years. Out-of-school sports accidents were more frequent among boys, but boys and girls had similar injury rates in school physical education. Most lesions were benign but the fracture rate was 22%. A majority of lesions were located on the upper limb. Most commonly, the mechanism of accident was a forward fall and children were injured without any participation of sports equipment. The hospitalization rate was 11%. Repeated hospital admissions and a long time elapsing between the accident and full recovery were significantly more often observed than in other types of accidents. This might be explained by a higher rate of epiphyseal fractures and internal fixations. Eighteen months after the accident, musculo-skeletal sequelae were observed in 12% of the inpatient children.     

Young children in recreational sports. Participation motivation

More than 20 million children between ages 6 and 16 years participate in nonschool sports programs, with increasingly more programs being established for younger-age children. A questionnaire based on previous research with adolescent athletes was developed to determine participation motivation of 6- to 10-year-old children. Three hundred fourteen boys participating in a basketball program were interviewed privately with this instrument. Of the 12 participation motivation items, "learn to do my best," "learn and improve skills," "have a coach to look up to," and "get stronger and healthier" were most highly rated, whereas "win games" and "become popular" were rated least important. When responses of 6 and 7 year olds were compared with those of 9 and 10 year olds, older children rated "feel part of a team", "have fun and excitement" and "be with and make new friends" higher at a statistically significant level (p less than 0.05). Older children rated "win games" and "become popular" lower at a statistically significant level (p less than 0.05). The authors conclude that young children in this recreational sports program make significant distinctions in their participation motivation and that some aspects of participation that motivate them change as they grow older.     

Plantar pressure measurement in children and youths during sports activities

The aim of this study was to consider whether changes occur in the foot area while under repeated physical stress and if they are age related. In addition it interests what consequences this might have in regard to proper shoe wear. The subjects for this study consisted of 15 children and youths aged between 4 and 16 years. The plantar pressure distribution and vertical ground reaction forces were measured before and after physical exercise. The subjects first ran a given distance wearing sport shoes, had a rest and then ran the same distance barefoot. The results showed marked age related differences after exercise. The pressure values were increased in all of the youths in the middle foot region. In comparison young children always exhibited an unbound gait pattern without any dynamic foot roll during heel strike or toe-off. The forefoot had ground contact from the beginning of the stance phase. To compensate for the lack of dynamic foot roll it is recommended that children wear a shoe with a soft sole and with sufficient space for toe movement. The sports shoe for youths should grip the heel and support the longitudinal arch to prevent an incorrect weight distribution.     

Allergy in children: practical recommendations of the Finnish Allergy Programme 2008-2018 for prevention, diagnosis, and treatment

The Finnish Allergy Programme 2008-2018 is a comprehensive plan intended to reduce the burden of allergies. One basic goal is to increase immunologic tolerance and change attitudes to encourage health instead of medicalizing common and mild allergy symptoms. The main goals can be listed as to: (i) prevent the development of allergic symptoms; (ii) increase tolerance to allergens; (iii) improve diagnostics; (iv) reduce work-related allergies; (v) allocate resources to manage and prevent exacerbations of severe allergies, and (vi) reduce costs caused by allergic diseases. So far, the Allergy Programme has organized 135 educational meetings for healthcare professionals around Finland. These meetings are multidisciplinary meetings gathering together all healthcare professionals working with allergic diseases. Since the start of the program in spring 2008, more than 7000 participants have taken part. Educational material for patient care has been provided on special Web sites/therapeutic portals, which can be accessed by all physicians caring for allergic patients. Local Allergy Working Groups have been created in different parts of Finland. As a part of the Programme, a set of guidelines for child welfare clinics was prepared. Child welfare clinics have a key role in the screening of illnesses and providing advice to families with a symptomatic child. The guidelines aimed to facilitate pattern recognition and clinical decision making for public health nurses and doctors are described in this paper.     

Allergy,total serum immunoglobulin E,and airflow in children and adolescents in TENOR

Haselkorn T, Szefler SJ, Simons FER, Zeiger RS, Mink DR, Chipps BE, Borish L, Wong DA, for the TENOR Study Group. Allergy, total serum immunoglobulin E, and airflow in children and adolescents in TENOR.
Pediatr Allergy Immunol 2010: 21: 1157–1165.
© 2010 John Wiley & Sons A/S In children and adolescents with difficult‐to‐treat asthma, few data exist characterizing the relationships between basic patient characteristics (e.g., age, sex) and atopic indicators in asthma. These associations were examined in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR), an observational study of a large cohort of patients with severe or difficult‐to‐treat asthma. To characterize allergy patterns and the relationship between total serum immunoglobulin E (IgE) and airflow in young patients with severe or difficult‐to‐treat asthma. A total of 1261 patients from the TENOR study were stratified into four age groups at baseline (6–8, 9–11, 12–14, and 15–17 yr). The objective was to characterize allergy patterns and the relationship between total serum immunoglobulin E (IgE) and ratio of pre‐bronchodilator forced expiratory volume in 1 second to forced vital capacity (FEV₁/FVC) in young patients with severe or difficult‐to‐treat asthma. The chi‐square test for categorical variables and analysis of variance for continuous variables were used to identify significant differences among age groups. Multivariable linear regression was used to evaluate the association between IgE and FEV₁/FVC. Allergic rhinitis was reported in approximately two‐thirds of patients. Up to 25% of patients had atopic dermatitis, which differed across age groups in boys (p < 0.05). Positive allergen skin test rate differed across age groups in boys (p < 0.05). Rates of asthma triggers were higher and differed across age groups in girls (p < 0.05), particularly around menarche (12–14 yr). IgE levels were higher in boys and differed across age groups in boys (p < 0.01) and girls (p < 0.05). IgE was associated with a lower FEV₁/FVC after adjusting for age and sex (p < 0.01). Severe or difficult‐to‐treat asthma in children and adolescents is characterized by high frequencies of comorbid allergic diseases, allergen sensitization, and high IgE levels. This burden is amplified by the association of more airflow limitation with higher IgE levels, suggesting the need for allergy evaluations.     

Accommodation in school children with music or sports activities

The accommodation of 324 school children aged 10 to 16 years was studied before and after a 12-minute reading session. One hundred and twenty children (81 girls and 39 boys) were wind instrument players in school bands, 93 children (48 girls and 45 boys) trained in an individual sport, and 111 children (65 girls and 46 boys) having no such activities were studied as a control group. At the end of the reading session, decreased accommodation (7 diopters or less) was found in 19 (15.8%) of the musicians, in six (6.5%) of the athletes, and in six (5.4%) of the control group. The difference was significant between the musicians and the control group, but not significant between the athletes and the control group. The majority of the children with low accommodation were girls; there was only one boy with decreased accommodation in each of the three groups.     

Introduction to the minisymposium on sports imaging in children

Injuries of children participating in gymnastics are seen less often than in more popular sports. Patterns of injury are predictable based upon sex, age and level of intensity of training and competition. More injuries are seen in girls than in boys, and the great majority of early adolescents who compete have wrist pain. Some otherwise quiescent congenital spine anomalies may be uncovered by the stress of gymnastics maneuvers and present with low back pain. In addition to diagnosis of injuries, imaging can be used to guide analgesic and anti-inflammatory therapy in some injured athletes. Parents whose children wish to participate in gymnastics should understand that fewer injuries occur in the child enjoying recreational gymnastics than in competing gymnasts. More gymnastics injuries are found in very competitive athletes training at higher levels.