乌鲁木齐地区喘息患儿发生支气管哮喘的危险因素

目的 探讨乌鲁木齐地区喘息患儿发生支气管哮喘(哮喘)的危险因素.方法 对2008年1 -12月在新疆医科大学第五附属医院门诊及住院的300例喘息患儿的临床资料进行统计.用统一的调查表调查其年龄、性别、湿疹、变应性鼻炎、食物过敏、家族过敏史/哮喘史、运动相关性喘息等.出院后通过门诊或电话进行随访.采用 Logistic回归分析方法对各因素与哮喘发生的关系及相关程度进行分析.结果 随访2a,275例获得随访;25例失访.275例喘息患儿在随访期内86例(31.2％)发生哮喘.Logistic回归分析发现湿疹、变应性鼻炎、家族过敏史/哮喘史、运动相关性喘息、反复下呼吸道感染( LRTI)、外周血嗜酸性粒细胞(EOS)增高与喘息患儿发生哮喘有关(湿疹:OR=2.376,95％ CI0.098～0.935,P=0.039;变应性鼻炎:OR=1.052,95％ CI2.267 ～14.283,P =0.024;家族过敏史/哮喘史:OR=1.886,95％CI1.004～3.542,P =0.048;运动相关性喘息:OR=1.881,95％ CI2.267 ～18.983,P =0.001;LRTI:OR=5.341,95％ CI1.676～ 10.983,P =0.016;外周血EOS增高:OR=3.915,95％ CI1.459～ 10.501,P=0.002).结论 个人过敏史(湿疹和变应性鼻炎)、家族过敏史/哮喘史、运动相关性喘息、LRTI、外周血EOS增高是乌鲁木齐地区喘息患儿发生哮喘的危险因素.     

北京地区学龄儿童变应性鼻炎相关因素分析

目的 了解北京城区学龄儿童变应性鼻炎的主要变应原、伴发结膜炎的情况及其与气道高反应的关系.方法 2006年和2007年8-9月在首都儿科研究所耳鼻喉科门诊就诊的100例6～14岁的变应性鼻炎患儿为病例组,小学健康儿童(无变态反应性疾病)30名为正常对照组,进行问卷调查及吸入变应原皮肤点刺试验(skin prick test,SPT);随机选取病例组中53例鼻炎患儿和对照组30名儿童做乙酰甲胆碱气道激发试验(methacholine bronchial provocation test,Mth BPT).结果 ①变应性鼻炎组中螨、霉菌、艾蒿、猫狗毛、夏秋季花粉、葎草SPT阳性率较高,分别为55%、39%、36%、34%、31%、27%、22%.②变应性鼻炎组中各年龄组螨SPT阳性率差异无统计学意义,而艾蒿和夏秋季花粉随年龄增加SPT阳性率明显增JJ玎(x2=7.51,6.29,P均＜0.05).③变应性鼻炎合并结膜炎患儿为65%.合并结膜炎组患儿变应原阳性数量高于单纯变应件鼻炎组,差异有统计学意义(t=3.06,P＜0.05).④变应性鼻炎症状越重,变应原阳性数幂越多(r=0.21,P=0.04),越可能合并变应件结膜炎(r=0.31,P=0.002).⑤变应性鼻炎组53例患儿乙酰甲且日碱气道激发试验阳性率为77%,正常对照组儿童为16.7%,两组差异有统计学意义(x2=28.56,P＜0.0001).变应性鼻炎组激发试验阳性的发生概率是正常对照组的17.08倍(95%可信区间5.38～54.26).结论 北京城区儿童8-9月变应性鼻炎就诊高峰和花粉变应原有关,其中艾蒿、夏秋季花粉和年龄有相关性.变应性鼻炎合并结膜炎发病率高,应注重结膜炎的诊断和治疗.变应性鼻炎儿童气道反应性增加,应对其积极治疗,减缓和预防哮喘的发生.     

上海不同地区变应性哮喘及变应性鼻炎患儿的变应原分析

目的分析上海不同地区变应性哮喘和变应性鼻炎患儿的变应原分布特点及意义,为防治儿童变应性呼吸道疾病提供理论依据。方法对2005年9月-2006年12月上海3家医院收治的502例变应性哮喘和变应性鼻炎患儿以及375例成人患者,采用12种德国Allergopharma变应原点刺液进行变应原皮肤点刺试验(SPT)。结果1.儿童组SPT阳性率80.9%,显著低于成人组的98.9%(χ2=69.278P=0.001),<7岁儿童组SPT阳性率低于≥7岁儿童组。2.SPT阳性患儿阳性率最高的变应原为粉尘螨,其次为猫上皮和狗上皮,阳性率分别为92.9%、35.7%和19.0%。3.儿童组中单纯哮喘患儿SPT阳性率的(67.7%),显著低于单纯鼻炎患儿(81.5%)和鼻炎并哮喘患儿(86.5%)(P=0.039,0.001)。4.上海市区患儿SPT阳性率(82.7%),显著高于上海郊区患儿阳性率(72.0%)(χ2=7.443P=0.006)。结论保持居住环境、家居用品清洁,减少尘螨接触,不养猫、狗等宠物,对减少儿童变应性哮喘和变应性鼻炎发病有很大帮助;儿童SPT阳性率受年龄影响;变应性鼻炎患儿在诊断治疗中较哮喘更应警惕变应原的检测和回避。     

缓解期哮喘患儿及其父母血清总免疫球蛋白E水平变化

目的通过检测血清总IgE水平和病史采集,探讨缓解期哮喘患儿及其父母的特应性状态。方法采用PharmaciaUniCAP系统检测15例缓解期哮喘患儿及其父母24例和40例正常对照儿童血清总IgE水平,同时采集各自的湿疹、变应性鼻炎和哮喘发病情况。哮喘患儿完成10种吸入性过敏原皮肤试验。结果哮喘患儿15例中13例(86.7%)有婴幼儿湿疹和(或)变应性鼻炎病史。13例(86.7%)的父亲或母亲有变应性鼻炎和(或)哮喘特应性疾病史。缓解期哮喘患儿血清总lgIgE水平与父母亲和对照组比较有显著性差异(F=68.42P=0)。哮喘患儿血清总lg IgE水平(2.43±0.73)KU/L显著高于正常对照儿童(0.72±0.54)KU/L(q=14.176P<0.01);较一级亲属[(2.05±0.54)KU/L]明显增高(q=2.897P<0.05)。哮喘患儿与有特应性疾病母亲和父亲血清总IgE水平无相关性(P>0.05)。12例(80.0%)哮喘患儿过敏原检测阳性,阳性率最高的为粉尘螨和户尘螨。结论哮喘患儿表现家族特应性群集现象。持续高水平血清总IgE参与特应性疾病的免疫病理过程。     

年幼儿童反复喘息发作的转归及不同表型的危险因素

目的探讨年幼儿童反复喘息发作的转归及不同表型的危险因素。方法选择2013年10月至2014年5月间纳入研究的≤5岁反复喘息的年幼儿童,在时隔3年后进行电话随访。调查患儿入组以来的喘息发作情况、鼻炎、湿疹及父母哮喘史等。根据患儿喘息起始及缓解年龄,将接受调查的患儿分为一过性喘息、持续性喘息和晚发性喘息组,比较三组患儿出生史、鼻炎、湿疹、父母哮喘史、过敏相关指标、喘息起始年龄等的差异。结果在入组的100例≤5岁的年幼儿童中随访到85例,男性66例、女性19例,随访时平均年龄(6.82±1.20)岁。其中14例一过性喘息组患儿的喘息起始年龄早于54例持续性与17例晚发性喘息组患儿,差异有统计学意义(P0.05)。与入组时相比,三组患儿近一年的喘息次数均显著减少,差异有统计学意义(P0.05)。既往鼻炎、近一年伴发鼻炎在三组间的差异均有统计学意义(P0.05),持续性和晚发性喘息组的发生率较高。血清总Ig E、吸入性过敏原检测阳性率以及外周血嗜酸性粒细胞(EOS)百分比在一过性喘息、持续性喘息、晚发性喘息患儿中依次升高,差异均有统计学意义(P0.05)。结论年幼儿童随着年龄增加,其喘息发作显著减少,喘息的转归与过敏、鼻炎、起病年龄等显著相关。     

年幼儿童反复喘息发作的转归及不同表型的危险因素#br#

目的探讨年幼儿童反复喘息发作的转归及不同表型的危险因素。方法选择2013年10月至2014年5月间纳入研究的≤5岁反复喘息的年幼儿童,在时隔3年后进行电话随访。调查患儿入组以来的喘息发作情况、鼻炎、湿疹及父母哮喘史等。根据患儿喘息起始及缓解年龄,将接受调查的患儿分为一过性喘息、持续性喘息和晚发性喘息组,比较三组患儿出生史、鼻炎、湿疹、父母哮喘史、过敏相关指标、喘息起始年龄等的差异。结果在入组的100例≤5岁的年幼儿童中随访到85例,男性66例、女性19例,随访时平均年龄(6.82±1.20)岁。其中14例一过性喘息组患儿的喘息起始年龄早于54例持续性与17例晚发性喘息组患儿,差异有统计学意义(P0.05)。与入组时相比,三组患儿近一年的喘息次数均显著减少,差异有统计学意义(P0.05)。既往鼻炎、近一年伴发鼻炎在三组间的差异均有统计学意义(P0.05),持续性和晚发性喘息组的发生率较高。血清总Ig E、吸入性过敏原检测阳性率以及外周血嗜酸性粒细胞(EOS)百分比在一过性喘息、持续性喘息、晚发性喘息患儿中依次升高,差异均有统计学意义(P0.05)。结论年幼儿童随着年龄增加,其喘息发作显著减少,喘息的转归与过敏、鼻炎、起病年龄等显著相关。     

舌下含服粉尘螨滴剂治疗支气管哮喘伴变应性鼻炎的疗效

目的 探讨舌下含服粉尘螨滴剂特异性免疫治疗支气管哮喘(哮喘)伴变应性鼻炎的疗效及安全性.方法 选取516例年龄4～13岁哮喘伴变应性鼻炎患儿.其中291例完成1 a舌下免疫治疗(免疫治疗组),非免疫治疗对照组225例.患儿均完成10种常见变应原皮肤点刺试验,点刺试验结果呈阳性反应.免疫治疗组根据皮肤点刺试验结果分尘螨过敏组80例、尘螨及蟑螂过敏组71例、尘螨及花粉过敏组74例、尘螨及狗毛过敏组66例.应用粉尘螨滴剂进行临床免疫治疗,记录治疗前后哮喘控制问卷(ACQ)评分、鼻炎症状评分、用药情况和不良反应.结果 1.治疗12个月后,免疫治疗组和非免疫治疗对照组ACQ评分分别为(0.28±0.33)分和(1.07±0.68)分,与治疗前[(1.76±0.75)分和(1.55±0.62)分]比较,分别下降了(74.03±37.66)%和(29.32±44.53)%,2组ACQ评分比较差异有统计学意义(Z=-154.109,P<0.000 1).2.治疗12个月,免疫治疗组和非免疫治疗对照组鼻炎症状评分分别为(0.337±0.479)分和(0.560±0.634)分,较治疗前[(0.899±0.667)分和(0.892±0.688)分]分别有70.8%和39.1%的患儿评分级别降低,2组比较差异有统计学意义(χ2=51.949,P<0.000 1).3.治疗12个月,免疫治疗组和非免疫治疗对照组治疗哮喘月均用药评分分别为(20.91±18.03)分 和(85.22±47.84)分,与治疗初始月均用药评分[(113.41±35.02)分和(108.86±35.24)分]比较,分别下降了(75.10±28.80)%和(20.60±39.52)%.4.治疗12个月,免疫治疗组肺功能呼气峰流速(预计值百分比)[(91.38±8.82)%]较治疗前上升(8.84±9.64)%.5.免疫治疗结束,免疫治疗组粉尘螨试验阳性级别降低,与非免疫治疗对照组比较差异有统计学意义(χ2=70.850,P<0.000 1).6.各免疫治疗亚组ACQ评分、月均用药评分和粉尘螨皮试阳性级别降低的差异均无统计学意义.7.与用药相关的皮疹、鼻咽痒和哮喘发作不良反应发生率为24.7%,未出现过敏性休克等严重不良反应.结论 特应性舌下免疫治疗方法安全有效,是治疗儿童哮喘伴变应性鼻炎的重要措施之一.     

面罩储雾罐经鼻吸入糖皮质激素同步治疗小儿变应性鼻炎并哮喘

目的 探讨采用面罩储雾罐方式给药,经鼻吸入布地奈德(BUD)气雾剂同步治疗小儿变应性鼻炎并哮喘的临床疗效与成本.方法 将72例中～重度变应性鼻炎并轻一中度持续性哮喘的患儿随机分为实验组和对照组,实验组经面罩储雾罐鼻吸入BUD气雾剂400g/d,对照组经口吸入BUD干粉剂400μg/d联合使用BUD鼻喷雾剂256μg/d.进行哮喘和鼻炎的症状评分,监测第1秒时间肺活量(FEV1)、晨起呼气峰流速值(PEF),并进行治疗成本比较.结果 经过12周的临床观察,实验组和对照组的鼻炎症状评分明显下降(F=6.529和7.014,P均<0.01),两组的哮喘症状评分不断减低(F=4.132和4.950,P均<0.01),实验组和对照组的肺通气功能指标PEF(L/min)逐渐升高(F=2.750和3.282,P均<0.05).但两组间的症状评分、FEV1和PEF在入选时与治疗后的多次随访中比较,差异无统计学意义.实验组鼻腔干燥等副反应的发生率(5.6%)低于对照组(19.4%),但差异无统计学意义.平均治疗费用:实验组(244.0±12.8)元,对照组(403.2±17.6)元,差异有统计学意义(P<0.01).结论 面罩式储雾罐经鼻吸入糖皮质激素可同时有效控制小儿变应性鼻炎和哮喘,并有依从性高、副作用少、花费低等优点,适用于轻～中度持续性哮喘合并变应性鼻炎患儿.     

Clara细胞分泌蛋白10基因G38A多态性与5岁以下喘息患儿的相关性

目的探讨5岁以下喘息患儿Clara细胞分泌蛋白10(CC10)基因G38A位点多态性与喘息发病机制的关系。方法随机选取于本院就诊的5岁以下反复喘息患儿120例,分为有特应质高危因素的喘息Ⅰ组(n=67)(湿疹45例,父母或父母一方有哮喘病史13例,变应性鼻炎5例,变应性皮炎4例)和无特应质高危因素的喘息Ⅱ组(n=53);对照组为本院外科近期无感染疾病史、择期进行手术的术前患儿(n=55)。采用PCR-限制性片段长度多态性分析对喘息组和对照组患儿CC10 G38A位点基因型频率和等位基因频率进行检测,比较3组间CC10 G38A位点基因型频率和等位基因频率。结果喘息Ⅰ组、喘息Ⅱ组和对照组3种基因型AA、GA、GG分布频率分别为20.9%、44.8%、34.3%,9.4%、32.1%、58.5%、9.1%、31.0%、60.0%;喘息Ⅰ组和喘息Ⅱ组CC10基因G38A位点基因型频率比较差异有统计学意义(P<0.05);喘息Ⅰ组和对照组CC10基因G38A位点基因型频率比较差异亦具有统计学意义(P<0.05)。喘息Ⅰ组、喘息Ⅱ组和对照组38A和38G等位基因频率分别为43.3%、56.7%,25.5%、74.5%,24.5%、75.5%;喘息Ⅰ组和喘息Ⅱ组、喘息Ⅰ组和对照组比较差异均有统计学意义(Pa<0.05)。结论喘息患儿与哮喘存在相同的基因分布频率,发生哮喘的危险性高;对于CC10基因具有A等位基因的喘息患儿应密切关注。     

吸入变应原sIgE在不同气道过敏性疾病儿童中的分布特征

目的了解不同气道过敏性疾病患儿吸入变应原血清特异性Ig E(slg E)的分布特征。方法应用Uni CAP250变应原定量Ig E检测系统的荧光酶联免疫法,对256例3~14岁气道过敏疾病患儿测定9种常见吸入变应原的血清slg E。256例患儿按临床诊断分为:变应性鼻炎组(简称"鼻炎组",37例)、支气管哮喘组(简称"哮喘组",82例)和变应性鼻炎合并支气管哮喘组(简称"鼻炎并哮喘组",137例)。比较3组患儿9种吸入变应原阳性检出率的分布差异,并比较3组患儿变应原致敏级别和致敏种类数的差异。结果哮喘组、鼻炎组和鼻炎并哮喘组患儿吸入变应原血清s Ig E的阳性检出率分别为57.3%(47/82)、86.5%(32/37)、82.5%(113/137),3组间比较差异有统计学意义(P0.05)。哮喘组、鼻炎组、鼻炎并哮喘组患儿常见变应原均依次为霉菌类(32.9%、54.1%、48.9%)、尘螨类(30.5%、45.9%、46.0%)、花粉类(26.8%、35.1%、32.8%)、宠物类(12.2%、27.0%、18.2%)、蟑螂(9.8%、5.4%、5.8%)。鼻炎组和鼻炎并哮喘组患儿霉菌混合的阳性检出率均高于哮喘组,差异有统计学意义(均P0.0166)。3组患儿9种变应原的致敏级别和致敏种类数比较差异无统计学意义。结论支气管哮喘、变应性鼻炎或二者合并患儿前3位吸入变应原均依次是霉菌类、尘螨类、花粉类;与支气管哮喘相比,霉菌致敏可能与变应性鼻炎关系更密切;这3种常见气道过敏性疾病吸入变应原的致敏分布具有相似性。     

按哮喘预测指数分组治疗在5岁以下喘息儿童中的应用

目的 观察按哮喘预测指数（asthma predictive index, API）分组治疗在5 岁以下喘息儿童中的应用价值。方法 239 例5 岁以下喘息患儿,API 阳性组126 例,API 阴性组113 例,分别随机分为糖皮质激素吸入治疗组（ICS 治疗组）及孟鲁司特钠治疗组（LTRA 治疗组）。治疗开始4 周内2 组所用药物种类和剂量相同,在疾病稳定期（第4 周后）ICS 治疗组仅使用布地奈德混悬液雾化吸入治疗,LTRA 治疗组仅使用孟鲁司特钠口服治疗,评估记录各组患儿不同时间点哮喘症状评分。结果 API 阳性组及阴性组在治疗后的前4 周,ICS和LTRA 2 种方法均有效,哮喘症状评分与治疗前比较差异有统计学意义,但2 个治疗组间比较差异无统计学意义;在治疗24 周时,2 种治疗方法仍有效,但API 阳性组中LTRA 治疗组较ICS 治疗组更有效;在API 阴性组中,LTRA 治疗组与ICS 治疗组疗效比较差异无统计学意义。结论 5 岁以下的儿童喘息,在疾病稳定期,可根据不同的API 分组,选择不同治疗方案,以达到更有效地控制喘息的目的。     

Prevalence and risk factors of asthma and allergic diseases among schoolchildren in Bolu, Turkey

AIM: In this study we aimed to detect the prevalence and risk factors of asthma and allergic diseases in children aged between 7 and 14 years old at rural and urban areas of Bolu, Turkey. METHODS: Questionnaire of International Study of Asthma and Allergies in Childhood (ISAAC) phase one and questionnaire including questions about family, demographic, socio-economic characteristics of children were applied to 931 schoolchildren who were selected by randomized sampling. RESULTS: In children, the prevalence of diseases and symptoms were as follows: wheeze ever: 15.5%, asthma: 5.6%, nasal symptoms ever: 41.4%, allergic rhinitis: 23.2%, itchy rash ever: 5.9% and eczema: 5.0%. In multivariate regression analysis, presence of allergic disease in the family was risk factor for wheezing (OR=1.74, 95% CI=1.19-2.76), asthma (OR=2.19, CI=1.06-4.52), allergic rhinitis (OR=2.68, CI=1.80-3.98) and eczema (OR=2.33, CI=1.17-4.65); living in shanties was risk factor for allergic rhinitis (OR=5.26, CI=2.1-13.16); a monthly income below $300 was risk factor for asthma (OR=2.54, CI=1.06-6.08). CONCLUSION: It was detected that the prevalence of allergic rhinitis and its symptoms was more common in schoolchildren living in Bolu. Presence of allergic disease in fathers or mothers and low socio-economic level increase the risk of asthma and other allergic diseases in children.     

孟鲁司特治疗儿童支气管哮喘的临床疗效观察

目的孟鲁司特联合布地奈德气雾剂吸入治疗合并过敏性鼻炎的轻、中度哮喘儿童临床疗效的前瞻性研究。方法将80例合并有过敏性鼻炎的轻、中度哮喘儿童随机分为治疗组和对照组。治疗组在吸入布地奈德气雾剂的同时加用孟鲁司特片,对照组则在吸入布地奈德气雾剂基础上加安慰剂,其余治疗相同。两组布地奈德气雾剂递减至最适有效剂量(无哮喘症状体征,β2激动剂吸入量无增加,呼气峰流速达预计值的80%以上,或变异率小于20%),并进行统计学分析。结果治疗组在加用孟鲁司特前后布地奈德吸入量减少差异有统计学意义(P<0.05),对照组在加用安慰剂前后布地奈德吸入量减少差异有统计学意义(P<0.05),而且两组比较差异亦有统计学意义(P<0.05)。结论孟鲁司特片联合布地奈德气雾剂治疗儿童合并过敏性鼻炎的哮喘,不仅能明显缓解哮喘和鼻炎的症状,还可以减少糖皮质激素、β2激动剂吸入量,取得了满意的疗效且无明显的不良反应。     

Reduced basal salivary cortisol in children with asthma and allergic rhinitis

Aim: Reduced basal cortisol is reported in allergic disease. We investigated if basal salivary cortisol levels were reduced in children with asthma or allergic rhinitis, controlling for inhaled corticosteroids (ICS) use. Methods: Morning and evening saliva of asthmatic children aged 7–12 years (n = 50) and that of controls (n = 52) were sampled. A total of 19 asthmatics and four controls had allergic rhinitis. Healthy children were controls without rhinitis. Of all, 14 asthmatic children used low, and 12 used moderate or high doses of ICS. Cortisol was analysed by radioimmunoassay. Results: Morning salivary cortisol median (95% CI) was lower in asthmatics (8.7 (7.1, 9.7)) compared with that in controls (10.4 (9.6, 11.8); p = 0.006), which was similar for evening cortisol levels. Regression analyses demonstrated that asthmatics using moderate or high doses of ICS had reduced morning salivary cortisol adjusted (for age and gender) odds ratio (aOR) (95% CI) (0.54 (0.37, 0.80); p = 0.002) and reduced evening cortisol aOR (0.09 (0.01, 0.6); p = 0.02) compared with that in healthy children. Asthmatics with rhinitis on no or low doses of ICS had reduced morning cortisol aOR (0.73 (0.56, 0.96); p = 0.02) compared with that in healthy children. Conclusion: Asthmatic children on moderate or high doses of inhaled corticosteroids had reduced salivary cortisol, but co‐morbidity of asthma and rhinitis was also associated with reduced cortisol levels.     

Rhinitis in 10-year-old children and early life risk factors for its development

Aim: To study the prevalence, characteristics of and risk factors for childhood rhinitis. Methods: In a whole population birth cohort study (n = 1456) the prevalence and characteristics of rhinitis among 10-y-old children were examined. At this age 1373 children (94%) completed standardized questionnaires, 1043 (72%) skin-prick testing, 953 (65%) serum inhalant immunoglobulin E antibody screening and 784 (54%) methacholine bronchial challenges. Results: At the age of 10 y the prevalence of hayfever ever was 18.6% and current nasal symptoms (rhinitis) 22.6%. Rhinitis at 10 y was largely seasonal and associated with low morbidity, although 62.7% of cases required pharmacological treatment. Atopy (positive skin test) and other allergic states were associated with rhinitis (p 3 0.001). Wheeze or diagnosed asthma was higher with coexistent rhinitis. Among wheezing children physician-diagnosed asthma (p 3 0.024) and inhaled corticosteroid use (p 3 0.001) were greater with the presence of rhinitis. Significant bronchial hyperresponsiveness (methacholine concentration giving a 20% fall in forced expiratory volume in 1 s 34.0 mg ml 31 ) was greater if rhinitis was present even when the child did not wheeze (p 3 0.001). Risk factor analysis for rhinitis identified the independent significance for atopy (p 3 0.001) and eczema ( p = 0.009) at the age of 4 y plus paternal rhinitis (p 3 0.001), maternal rhinitis ( p = 0.033) and maternal food allergy ( p = 0.016). Conclusion: Rhinitis is common at the age of 10 y, with strong associations with atopy, wheezing, asthma and bronchial hyperresponsiveness. An inherited predisposition towards atopy appears to predominate over environment in the aetiology of this state.     

Montelukast in pediatric asthma management

Leukotriene modifiers (receptor antagonist and biosynthesis inhibitor) represent the first mediator specific therapeutic option for asthma. Montelukast, a leukotriene receptor antagonist is the only such agent approved for use in pediatric patients. Montelukast modifies action of leukotrienes, which are the most potent bronchoconstrictors, by blocking Cysteinyl leukotriene receptors. Systemic drug like mountelukast can reach lower airways and improves the peripheral functions which play a crucial role in the evolution of asthma. Review of existing literature showed that montelukast compared to placebo has proven clinical efficacy in better control of day time asthma symptoms, percentage of symptom free days, need for rescue drugs and improvement in FEV₁. Studies also demonstrated improvement in airway inflammation as indicated by reduction in fractional exhaled nitric oxide, a marker of inflammation. Studies comparing low dose inhaled corticosteroids (ICS) with montelukast are limited in children and conclude that it is not superior to ICS. For moderate to severe persistent asthma, montelukast has been compared with long acting beta agonists (LABA) as an add-on therapy to ICS, montelukast was less efficacious and less cost-effective. It has beneficial effects in exercise induced asthma and aspirin-sensitive asthma. Montelukast has onset of action within one hour. Patient satisfaction and compliance was better with montelukast than inhaled anti-inflammatory agents due to oral, once a day administration. The recommended doses of montelukast in asthma arechildren 1–5 years: 4 mg chewable tablet, children 6–14 years: 5mg chewable tablet, adults: 10 mg tablet; administered once daily. The drug is well tolerated. Based on the presently available data montelukast may be an alternative treatment for mild persistent asthma as monotherapy where ICS cannot be administered. It is also an alternative to LABA as an add-on therapy to ICS for moderate to severe persistent asthma. The other indications for use of montelukast include: allergic rhinitis, exercise induced bronchoconstriction and aspirin-induced asthma.     

Childhood allergic disorders in Samsun, Turkey: discrepancy between reported and diagnosed

Schoolchildren (n = 1310) randomly selected from 32 schools in Samsun, Northern Turkey, were screened using the International Study of Asthma and Allergies in Childhood questionnaire. The prevalence of wheezing and current (last 12 months) wheezing were 21% and 14%, respectively: 2.3% of this group had received the diagnosis of asthma by a physician. Allergic skin rash was described in 17.3% and rhinitis in 44.7%, while 2.6% had been diagnosed with eczema and 10.5%, with allergic rhinitis. Respiratory symptoms were more common among 6-7-yr-old children compared with those aged 13-14 yr, and tended to be more prevalent in urban and coastal regions. The discrepancy between the rate of allergic symptoms and diagnosed allergic disorders may indicate a need for increased public and professional awareness and screening for allergic disorders in this area.