Exhaled nitric oxide, total serum IgE and allergic sensitization in childhood asthma and allergic rhinitis

Exhaled nitric oxide (eNO) levels are correlated with several markers of atopy and inflammatory activity in the airways, but the relationship between eNO and total serum IgE has not been fully elucidated in the context of allergic sensitization. The aim of this study was to investigate the relationship between eNO, total serum IgE and allergic sensitization in childhood asthma and allergic rhinitis. eNO levels, lung function, skin prick tests and total serum IgE were determined in 109 children (mean age, 10.4 yr) with mild intermittent asthma and in 41 children (mean age, 10.1 yr) with allergic rhinitis; 25 healthy non-atopic children were recruited as controls. eNO levels (median) were significantly higher in patients with asthma (22.7 p.p.b.) and in those with allergic rhinitis (15.3 p.p.b.) than in healthy controls (5.9 p.p.b.). Children with allergic asthma had higher eNO levels than children with allergic rhinitis. A significant positive correlation was found between eNO and total serum IgE (asthma, r = 0.42, p < 0.0001; allergic rhinitis, r = 0.31, p < 0.01), and between eNO and the number of positive skin prick tests (asthma, r = 0.31, p < 0.0001; allergic rhinitis, r = 0.39, p < 0.01). eNO levels were better correlated with total IgE than with the number of positive skin prick tests. This correlation was independent of allergic sensitization. High total serum IgE represents a specific and predictive marker of eNO increase in children with asthma or allergic rhinitis. This finding adds further support to the hypothesis that increased serum IgE could be a marker itself of airway inflammation in patients with allergic disease.     

Occurrence and management of acute respiratory illnesses in early childhood

AIM: Acute respiratory illnesses (ARI) impose massive economic burden on health services. The growing costs, limited benefits of pharmacotherapeutic agents, and alarming rise in antibiotic resistance poses a major health challenge. Analysis of the nature and burden of ARI through well-designed epidemiologic studies will help in the development of a uniform public health approach to identify methods to reduce disease transmission and maximise prevention strategies. The aim of this study was to analyse the nature and magnitude of the burden of ARI encountered by a cohort of children in the first 5 years of life. METHODS: This community-based prospective study of ARI followed a cohort of children from birth until 5 years of age. Information on all episodes of ARI encountered, and their management, was collected through daily symptom diary and fortnightly telephone calls. RESULTS: Four episodes of ARI/year were reported in the first 2 years and 2-3 episodes/year between 2 and 5 years. The majority were upper respiratory infections. 53% had at least one lower respiratory infection in the first year. For the majority, symptoms lasted 1-2 weeks. 53% were treated with antitussives or cough mixtures, 44% with paracetamol and 23% with antibiotics. A total of 46% of the episodes presented to a family physician, with younger children and those with lower respiratory infection more likely to seek attention. CONCLUSION: ARI are common in childhood and although symptoms may last for 4 weeks, the majority resolve spontaneously. Use of medication does not appear to significantly alter the course or duration of symptoms of ARI.     

Parental smoking: asthma and wheezing illnesses in infants and children

Parental smoking has an important impact on asthma and wheezing illnesses in infants and children. In utero exposure is associated with impaired lung growth and wheezing illnesses, particularly in preschool children. Exposure to environmental tobacco smoke is associated with increased wheezing illnesses and increased symptoms in asthmatics. There are no consistent data to confirm an effect of in utero or postnatal cigarette smoke exposure on the prevalence of asthma but there is evidence of increased severity of symptoms. The detrimental effects of parental smoking on lung growth will have an impact on respiratory health throughout life.     

The relationships among immunoglobulin levels,allergic sensitization,and viral respiratory illnesses in early childhood

Possin ME, Morgan S, DaSilva DF, Tisler C, Pappas TE, Roberg KA, Anderson E, Evans MD, Gangnon R, Lemanske RF, Gern JE. The relationships among immunoglobulin levels, allergic sensitization, and viral respiratory illnesses in early childhood.
Pediatr Allergy Immunol 2010: 21: 990–996.
© 2010 John Wiley & Sons A/S IgE plays an essential role in type I allergy, however, there is less information about the relationship between other immunoglobulins (IgA and IgG) and atopic phenotypes in early childhood. We hypothesized that levels of circulating IgA in early childhood would be inversely related to the number of respiratory infections and the risk of becoming sensitized to allergens. Immunoglobulin levels were analyzed (ELISA) in plasma samples (IgG, IgA), and in nasal secretions (IgA) from children participating in a high‐risk birth cohort study. Samples were available from 264 children at age 2 yr and 257 children at age 4 yr, and results were compared to rates of respiratory illnesses, allergic sensitization, atopic dermatitis (AD), and asthma. Children who were sensitized to allergens had higher rather than lower levels of circulating IgA. A subgroup analysis showed that IgA levels were increased in relationship to foods sensitization (58 vs. 50 mg/dl, p = 0.003) but not aeroallergen sensitization (52 vs. 53 mg/dl, p = 0.11). IgA levels in the plasma correlated with levels of IgE levels (r_s =0.19, p = 0.003). Levels of IgE, but not IgG or IgA, were positively correlated with rates of respiratory illnesses, AD, and the risk of developing asthma. Finally, there were no significant relationships between IgA in nasal secretions and infectious outcomes. In conclusion, low‐normal concentrations of plasma IgA are associated with a reduced prevalence of allergic sensitization in infancy. Further, levels of IgA and IgG in plasma within the range of normal, and IgA in nasal secretions, do not appear to influence the risk of subsequent respiratory illnesses. Further studies to define relationships between IgA and allergic sensitization are likely to provide new insights into the pathogenesis of allergic diseases in infancy.     

Relationship of parental smoking to wheezing and nonwheezing lower respiratory tract illnesses in infancy. Group Health Medical Associates

The relationship between parental smoking and lower respiratory tract illness (LRI) was studied in a large cohort of infants followed prospectively from birth. Illnesses were diagnosed by physicians using agreed-on criteria, and parental smoking histories were obtained by questionnaire. The LRIs were differentiated into wheezing and nonwheezing episodes, and the age at first illness of either type was evaluated in relation to smoking by parents. The odds of having an LRI were significantly higher in children whose mothers smoked (odds ratio 1.52; confidence interval 1.07 to 2.15). The odds were higher if the mother smoked a pack of cigarettes or more per day and if the child stayed home rather than attending day care (odds ratio 2.8; confidence interval 1.43 to 5.5). Logistic regression indicated that the LRI rate was significantly elevated both in children exposed to heavy maternal smoke in the absence of day care, and in those who use day care but were not exposed to maternal smoking of a pack or more per day. These findings could not be attributed to other confounding variables. Neither paternal smoking nor smoking by other household members was consistently related to the LRI rate. The relationship of maternal smoking to LRI rate was evident for both wheezing and nonwheezing illnesses. Maternal smoking of a pack or more per day was also related to an early age at first LRI, for both wheezing (p less than 0.05) and nonwheezing (p less than 0.002) illnesses. In sum, maternal smoking is associated with a higher rate of LRIs in the first year, particularly when mothers smoked a pack or more per day and when the child did not use day care.     

Association of higher adiposity and wheezing in infants with lower respiratory illnesses

Aim: The incidences of asthma and obesity have been steadily increasing over the past two decades, with several studies showing a relationship between these conditions. We investigated the influence of higher weight for height (WFH) Z‐score on wheezing in infants with lower respiratory tract infections (LRTI). Methods: We reviewed the medical charts of all infants younger than l year of age who were admitted with the first episode of LRTI between 2000 and 2008. Subjects were classified into six groups according to WFH Z‐score. Results: Wheezing was more frequent in infants with higher WFH Z‐scores. Especially, wheezing infants aged 3–6 months and 6–9 months had significantly higher WFH Z‐scores than had their non‐wheezing counterparts (p = 0.05 and p < 0.01 respectively). Multivariate logistic regression showed that age (OR = 0.76, p < 0.001), male gender (OR = 1.61, p = 0.005) and WFH Z‐score (OR = 1.12, p = 0.007) were independently associated with wheezing. Conclusion: In this study we could show that a higher WFH Z‐score was independently associated with wheezing in infancy. Attainment of appropriate weight for age may reduce the risk of wheezing in infants with respiratory diseases.     

Total serum IgE and outcome in infants with recurrent wheezing

OBJECTIVE—To investigate the relation between total serum IgE at 0.5-3 and 3-6 years, and the risk of allergic sensitisation and persistent wheezing up to 8 years of age.
METHODS—Prospective follow up study of 45 infants with highly recurrent wheezing, no allergic symptoms, and negative skin tests.
RESULTS—In the last follow up year, 15 children still suffered from wheezing. Five wheeze-free and four episodically wheezing children had become sensitised. No association was found between early (0.5-3 years) IgE z scores and the recurrence of wheezing during follow up, or atopic sensitisation. IgE z scores at 3-6 years were significantly higher in children with positive skin tests (p = 0.013), but were still not associated with recurrence of wheezing.
CONCLUSIONS—In subjects with frequent early wheezing and no signs of atopy, early total serum IgE measurements are not predictive of outcome.

     

儿童呼吸道感染性疾病和哮喘诊治的挑战

新型冠状病毒肺炎的暴发流行告诫我们必须关注病毒源性的呼吸道感染,特别是人畜共患的传染病。正视碳青霉烯类耐药细菌感染的严峻性的同时应关注非典型微生物及其感染。我国儿童哮喘的诊断问题尚未完全解决,应从评估哮喘控制水平、注意环境对哮喘发病的影响以及合理使用现有的哮喘治疗药物等诸多方面提高儿童哮喘的防治水平。     

Risk factors for developing wheezing and asthma in childhood.

Wheezing lower respiratory tract illness in infancy and asthma share the clinical findings of wheezing and respiratory distress. Although the link between wheezing lower respiratory tract illness in infancy and the subsequent development of asthma is a limited one, both conditions do share some common risk factors, including exposure to environmental tobacco smoke, difficult living conditions (low socioeconomic class, crowding, allergen exposure), and increased risk in males. The impact of baseline lung function on wheezing lower respiratory tract illness risk is substantial and may be independent of airway reactivity. In contrast, the development of chronic airway inflammation mediated by allergic sensitization plays a central role in the development of persistent asthma. Although the endogenous risks for these two outcomes may be fixed, it is clear that caregivers may help to reduce or eliminate the exogenous risks listed earlier by parental education and improvement of the living conditions of young children.     

Day care center attendance and diarrheal morbidity in Colombia.

This study was designed to determine whether day care center attendance was associated with increased risk of diarrheal disease among poor children in an urban, developing country setting. From July 17 to December 18, 1988, mothers of 493 Colombian children less than 5 years old (241 attendees and 252 nonattendees) were interviewed weekly about diarrheal events during the previous week. The incidence of diarrhea was greater for day care center attendees than for nonattendees (3.2 vs 2.0 episodes per child-year, P < .0005). For children less than 2 years of age, attendees experienced 7.2 episodes/child-year vs 3.5 episodes per child-year for nonattendees (P < .0005). Analyses controlling for water source and availability, excreta disposal, socioeconomic status, and duration of follow-up showed that the increased diarrheal risk was limited to children younger than 3 years of age spending more than 30 hours per week in the centers. In addition, although the risk among attendees of suffering diarrheal episodes of longer duration was fairly constant across levels of socioeconomic status, this risk was inversely proportional to socioeconomic status for nonattendees. In summary, the increase in risk of diarrhea among young, full-time day care attendees was modest, yet important, because diarrhea continues to be a major cause of morbidity and mortality in Colombian children.     

Total serum IgE and outcome in infants with recurrent wheezing.

OBJECTIVE: To investigate the relation between total serum IgE at 0.5-3 and 3-6 years, and the risk of allergic sensitisation and persistent wheezing up to 8 years of age. METHODS: Prospective follow up study of 45 infants with highly recurrent wheezing, no allergic symptoms, and negative skin tests. RESULTS: In the last follow up year, 15 children still suffered from wheezing. Five wheeze-free and four episodically wheezing children had become sensitised. No association was found between early (0.5-3 years) IgE z scores and the recurrence of wheezing during follow up, or atopic sensitisation. IgE z scores at 3-6 years were significantly higher in children with positive skin tests (p = 0.013), but were still not associated with recurrence of wheezing. CONCLUSIONS: In subjects with frequent early wheezing and no signs of atopy, early total serum IgE measurements are not predictive of outcome.     

喘息婴幼儿鼻咽分泌物嗜酸粒细胞与血清特异性IgE的关系分析

目的 探讨婴幼儿喘息时鼻咽分泌物涂片中嗜酸粒细胞计数及与血清特异性IgE的关系.方法 选择2002-2004年收治的1个月～3岁的喘息及支气管肺炎患儿223例,分为3组,其中反复喘息(包括婴幼儿哮喘和喘息发作≥2次)组76例,毛细支气管炎组65例,支气管肺炎(无喘息症状)组82例.吸取鼻咽分泌物1ml进行嗜酸粒细胞计数,并测定血清特异性IgE的水平.结果 反复喘息组鼻咽分泌物嗜酸粒细胞计数明显高于其他两组,差异有统计学意义(P=0.000);反复喘息组血清食物变应原(fx5E)的阳性检出率及吸入性变应原(Phadiatop)阳性检出率均明显高于其他两组,差异有统计学意义(P=0.000),毛支组和支气管肺炎组之间差异则无统计学意义;血清特异性IgE与鼻咽分泌物嗜酸粒细胞计数之间存在显著正相关;鼻咽分泌物嗜酸粒细胞水平在同时存在喘息和特应性的患儿最高,在既没有喘息也无个人特应性的患儿最低,有喘息或血清IgE一项者介于两组之间.结论 鼻咽分泌物嗜酸粒细胞计数方法操作简单、无创、快速,费用低,且能在一定程度上反映哮喘的病理特征,与血清特异性IgE之间呈正相关,可以在临床进一步推广应用.     

血清Eotaxin、IL-13及总IgE在支气管哮喘患儿中的表达及意义

目的 探讨支气管哮喘(哮喘)患儿Eotaxin、IL-13及总IgE在哮喘发病中的作用及其相互关系.方法 选择30例哮喘儿童及22例健康儿童为研究对象,酶联免疫吸附法检测血清Eotaxin、IL-13,荧光酶联免疫法检测总IgE水平.哮喘息儿同时做肺功能检测.结果 (1)哮喘患儿急性发作期与临床缓解期肺功能各项指标比较...     

Long-term consequences of respiratory syncytial virus acute lower respiratory tract infection in early childhood in Guinea-bissau

AIM: The study aimed to investigate long-term consequences of respiratory syncytial virus (RSV) positive acute lower respiratory tract infection (ALRI) in a low-income country according to severity of the initial infection. DESIGN: The study was a 1:1 matched case-control study of 335 RSV case children and 335 control children. The mean age of RSV ALRI was 0.9 year and at follow-up, 6.8 years. Case children were identified at the hospital and in the community with an antigen and an IgM test to diagnose RSV. Severe RSV infection was defined when a child was treated at the hospital, whereas disease was assumed less severe when a child was diagnosed at home and received no care in the hospital. RESULTS: At follow-up, forced expiratory volume in 1 second (FEV1) and peak flow were significantly lower in case children (odds ratio [OR] = 0.28; 95% confidence interval [CI] 0.10-0.79), the effect being particularly marked for children with severe RSV. Bronchitis at follow-up was reported more frequently among the case children with severe disease. Fewer case children had a positive skin-prick test for local allergens than control children (OR 0.64; 95% CI = 0.44-0.94). Specific IgE for dust mites and cockroach was elevated (52%) in both case and control children. However, specific IgE to peppertree was higher in the case children (OR 2.18; 95% CI = 1.17-4.07). All identified differences were particularly marked for children with severe RSV. CONCLUSION: Severe RSV infection in infancy was associated with decreased lung function in preschool age in Guinea-Bissau. Children with severe RSV disease had more long-term health problems than children with less severe disease.     

白介素-13与哮喘、呼吸道合胞病毒感染后喘息的相关性

白介素-13(IL-13)是一种主要由活化的2型辅助T细胞分泌的多效能细胞因子,可刺激B细胞的增殖和IgE的合成,后者通过与肥大细胞、嗜碱性细胞的作用而诱发支气管哮喘(哮喘)的急性发作.而呼吸道合胞病毒(RSV)在婴幼儿的感染亦可有喘息出现,部分最终演变为哮喘.该文在IL-13和哮喘及RSV感染后喘息之间寻找其相关性,以探讨IL-13基因突变对哮喘及RSV感染后的喘息影响.