Hospital admission with neonatal sepsis and development of atopic disease: Is there a link?

The role of suspected or confirmed neonatal sepsis in modifying the risk of atopic disease during childhood was assessed. Children with early-onset neonatal sepsis were identified from a cohort of neonates, hospitalized between 1990 and 1995. Of 196 individuals, 140 were recruited (71.4%). Pre- and postnatal history was ascertained from neonatal medical records. Based on clinical symptoms and a positive blood culture or at least three of initially defined laboratory or bacteriological criteria, they were stratified in either confirmed neonatal sepsis (CS) or suspected sepsis (SS) group. A control group (C) comprised children who were never hospitalized during infancy (n = 696). Primary end-point was the development of atopic dermatitis, bronchial asthma or allergic rhinitis during childhood (mean age 8.4 yr, range 5.7-12.4). CS and SS children had a higher prevalence of atopic dermatitis (CS 15.7%, SS 21.4%) compared with controls (C 5.2%, p < 0.001). Similarly, children with SS (7.1%), but not with CS (4.3%) had significantly more often a doctor's diagnosis of bronchial asthma compared to controls (1.9%, p = 0.02). No difference in the prevalence of allergic rhinitis was observed (CS 4.3%, SS 10%, C 8.3%). After adjusting for parental history of atopic disease and demographic factors, no significant difference for the risk to develop atopic dermatitis, asthma or allergic rhinitis among the groups was calculated in children with normal birth weight (>2500 g). Our data failed to show a possible link between hospital admission with SS and development of atopic disease.     

Allergy march of Chinese children with infantile allergic symptoms: a prospective multi-center study

Background:Allergy march refers to progression of allergic diseases from infantile food allergy to the development of asthma and allergic rhinitis (AR).Evidence come mostly from studies in European countries.This study aimed to investigate allergy march in Chinese children with infantile food protein allergy (FPA) with a special focus on the effect of different formula interventions.Methods:From 2008 to 2010,153 infants diagnosed with FPA were recruited in five tertiary hospitals across China.They were randomly treated with amino-acid-based formula or soy-protein-based formula for a period of 3 months.Long-term follow-up was performed when they reached early school age,using questionnaires,physical examinations,and serum-specific immunoglobulin E.Results:The overall follow-up rate was 73.20％.In patients who reached their early school years,the prevalence of physician-diagnosed AR and asthma were 43.75％ and 23.21％,respectively.Only 40％ of the subjects remained positive for food sensitizations upon follow-up.Twenty-six subjects receiving aeroallergen screening tests in infancy all proved negative,but upon follow-up,65.57％ were sensitized to aeroallergens (P=0.005).No significant difference between the effects of amino-acid-based formula and soy-protein-based formula on children's allergy march was observed.Conclusions:A high proportion (47.32％) of Chinese infants with early allergic symptoms developed respiratory allergies by their early school years.Most food-sensitized infants outgrew their condition several years later,but then aeroallergen sensitization often occurred.Amino-acid-based formula showed no advantages over soy protein-based formula with respect to arresting the allergy march.     

House dust mite allergen reduction and allergy at 4 yr: Follow up of the PIAMA-study

Exposure to high allergen levels in early life is a risk factor for the development of allergy. We previously reported limited effects of mite allergen impermeable mattress covers in the prevention and incidence of asthma and mite allergy (PIAMA) cohort at the age of 1 and 2 yr. We now present the results of follow-up at 4 yr objectives. To examine the effects of early reduction of house dust mite (HDM) allergen exposure by means of mattress covers on the incidence of allergy and asthma symptoms in the PIAMA birth cohort at the age of 4 yr. High-risk children (allergic mother) were prenatally recruited and randomly allocated to three groups; receiving mite allergen impermeable mattress covers (n = 416), placebo covers (n = 394) or no intervention (n = 472). At 4 yr of age, atopy was assessed by questionnaire; specific Immunoglobulin E (IgE) to inhalant and food allergens was measured in serum. Dust samples collected from the children's mattresses were analysed for mite allergens. Dermatophagoides farinae1 allergen (Der f 1) levels in dust were reduced in the active group. However, Dermatophagoides pteronissinus 1 (Der p 1) levels, sensitization and atopic symptoms were similar in all groups. We found no effect of mite allergen impermeable mattress covers on sensitization and atopy at 4 yr. Moreover, the allergen reducing effects of the covers had disappeared for one of the two mite allergens that were measured.     

Allergic status of schoolchildren with food allergy to eggs, milk or wheat in infancy

Although children allergic to eggs, milk or wheat in infancy tend to become tolerant by school age, the allergic status of these children at school age has not been well evaluated. To investigate the allergic status of schoolchildren who avoided eggs, milk or wheat because of an immediate-type allergic reaction at <1-yr-old (food avoiders in infancy), we conducted a large-scale questionnaire-based survey of schoolchildren. A questionnaire on allergic diseases was distributed to the parents of 14,669 schoolchildren aged 7 to 15 yr in 30 schools in Kyoto, Japan. Of these, 13,215 responded (response rate, 90.1%). The rate of 7-yr-old children who were food avoiders in infancy was 5.4%. This rate decreased as the current age of the children increased, down to 3% in 15-yr-old children, indicating that food allergy in infancy tended to become more prevalent over the past 8 yr. Although more than 80% became tolerant to these foods by school age, the prevalence of bronchial asthma, atopic dermatitis, allergic rhinitis and allergic conjunctivitis were significantly higher in this group. Moreover, avoidance of other foods (buckwheat, shellfish, fruits and others) at school age was seen at much higher frequencies than in non-food avoiders in infancy (adjusted odds ratio, 7.7; confidence interval, 5.9–10.2). This risk did not differ significantly between those who did and did not develop tolerance to eggs, milk and wheat by 3 yr old. In conclusion, food avoiders in infancy appear to have a higher risk of not only other allergic diseases ('atopic march') but also allergy to other foods ('food allergen march') at school age, indicating the need for continuous attention to food allergy.     

Prevalence of specific allergic diseases in school children as related to parental atopy

BACKGROUND: Our objective was to investigate the influence of parental allergy on the manifestations and course of allergic disease in children. METHODS AND RESULTS: A total of 15,234 school children aged 6 and 9 years were evaluated by means of questionnaires completed by their parents in a cross-sectional survey conducted in Tokushima, Japan. The prevalence and relative risk ratio (RRR) for parental allergy in children with atopic dermatitis, asthma and allergic rhinitis were 6.4% (RRR 2.5), 3.2% (RRR 2.4) and 15% (RRR 2.4), respectively. The risk of atopic dermatitis was particularly high in children whose parent had atopic dermatitis, with an RRR of 2.8 (father) and 3.7 (mother). Children with a parental history of asthma also had a high risk of that disorder (RRR of father 5.3, mother 6.2). However, the risk of allergic rhinitis was no different in children with a parental history of allergic rhinitis or from children with a parental history of asthma and atopic dermatitis. A history of allergic disease in both parents, especially of asthma and atopic dermatitis, increased the risk of allergic disease in the child. Milder symptoms, such as wheezy bronchitis, in schoolchildren were similarly related with the same hereditary tendency as the identical allergic disease. The disappearance of allergic symptoms with age also related to a hereditary component, being less likely in children with a history of parental allergy than in those without such an atopic history. CONCLUSIONS: The manifestations and course of allergic disease in school children relate to parental allergic disease.     

Testing children for allergies: why,how, who and when

Allergic diseases are common in childhood and can cause a significant morbidity and impaired quality‐of‐life of the children and their families. Adequate allergy testing is the prerequisite for optimal care, including allergen avoidance, pharmacotherapy and immunotherapy. Children with persisting or recurrent or severe symptoms suggestive for allergy should undergo an appropriate diagnostic work‐up, irrespective of their age. Adequate allergy testing may also allow defining allergic trigger in common symptoms. We provide here evidence‐based guidance on when and how to test for allergy in children based on common presenting symptoms suggestive of allergic diseases.     

Pediatric investigation plans for specific immunotherapy: Questionable contributions to childhood health

Allergen‐specific immunotherapy (SIT) is the only disease‐modifying treatment for children, adolescents, and adults with allergic diseases. The EU has a combined system of national and EU‐wide marketing authorization for all medicines. Germany introduced a new therapy allergen ordinance in 2008. Allergen products manufacturers had to apply for marketing authorization application for the major allergen groups (grass group, birch group, mites group, bee/wasp venom). Due to the EU pediatric regulation, in force since 2007, manufacturers had also to submit a pediatric investigation plan (PIP) for each allergen product. We investigated the allergic rhinoconjunctivitis (ARC) standard PIP, developed jointly by the European Medicines Agency (EMA) and the German Paul Ehrlich Institut (PEI). We analyzed the 118 EMA PIP decisions, looked for SIT trials in children in www.clinicaltrials.gov , and further analyzed EMA/EU justifications. The PIPs request a 1‐year dose‐finding study in adults, a 5‐year placebo‐controlled (PC) efficacy & safety (E&S) study in adults, and a 5‐year PC E&S study in children. Fifty‐eight PIP development programs will have to be performed until 2031. But children benefit even more from SIT for ARC than adults. There is no convincing medical/scientific justification for PC E&S studies in children in the relevant EMA documents. The PIP requirement to withhold effective treatment to thousands of children in the placebo group over a 5‐year period raises profound concerns. The EMA justifications are formalistic and lack scientific foundation. A critical academic review of the ARC PIPs and the entire PIP system is urgently needed.