O16 Organoleptic assessment of pure odour compounds representative of the metabolic end‐products of oral microbes

We have measured various production rates of volatile compounds in tongue scrape cell suspensions, oral biofilm models and the oral cavity in situ and wish to relate these to equivalent levels of oral malodour as assessed by the human nose. Objectives To assess the relationship between measured concentrations of pure odourants and resultant organoleptic scores (using a defined 0–5 score). Methods Seven odour judges, all with experience of organoleptic assessment, were used in this study for all experiments carried out at a single site (UWE, Bristol). A wide range of pure odourants were prepared at a range of concentrations (from a stock of 0.1 M) and were dispensed as 12 ml volumes into ‘universal’ bottles (24 ml capacity) leaving a headspace of 12 ml. The bottles were secured with rubber‐lined metal caps, labelled with a randomized code and were presented to the odour judges for assessment using the Rosenberg 0–5 scale. The volatile sulphur compounds (H₂S and CH₃SH) were presented as gases with dilutions being prepared through a dynamic gas flow rig (using oxygen free nitrogen as the diluent) and presented to the odour judges at a flow rate of 200 ml min^?1. Group means of determinations for each odourant were plotted against log10 of the concentration. Linear regression analysis was used to measure the gradient, 95% CI, and the scatter of the points around the gradient (R² value). Results Organoleptic scores were proportional to the log10 concentration of odourant. Detection thresholds (expressed as mol dm^‐3) were skatole (7.2 × 10^?13) < methyl mercaptan (1.0 × 10^?11) < trimethylamine (1.8 × 10^?11) < butyrate (2.3 × 10^?10) < hydrogen sulphide (6.4 × 10^?10) < putrescine (9.1 × 10^?10) < dimethyldisulphide (5.9 × 10^?8). Hydrogen sulphide showed highest olfactory power whilst putrescine was the lowest. Conclusions The olfactory response is exponential in nature. For any single compound, its contribution to malodour depends on: odour (olfactory) power, threshold (of detection) and volatility in addition to the concentration. It is now possible to relate production rates of VC's in models to typical levels of oral malodour perceived by the human nose.     

The inability of Streptococcus mutans and Lactobacillus acidophilus to form a biofilm in vitro on dentine pretreated with ozone

Background: The use of ozone therapy in the treatment of dental caries is equivocal. The aim of this study was to use an in vitro model to determine the effects of prior ozone application to dentine on biofilm formation and to measure any associated reduction in bacteria viability. Methods: Twenty dentine discs were bonded to the bases of 5 mL polycarbonate screw top vials. Ten dentine discs were infused with ozone for 40 seconds, 10 samples remained untreated as a control. The vials were filled with nutrient medium, sterilized and placed into the outflow from a continuous chemostat culture of Streptococcus mutans and Lactobacillus acidophilus for four weeks. At the conclusion of the experiment bacterial growth was monitored by taking optical density readings of the growth medium in each vial and the outer surface of the dentine specimens were examined by scanning electron microscopy as shown by SEM analysis. Results: Ozone infusion prevented biofilm formation on all the treated samples while there was substantial biofilm present on the control specimens. While the average optical density of the control specimens was almost twice that of the ozone infused dentine (0.710 for the control with a SD of 0.288 and 0.446 for the ozonated samples with a SD of 0.371), the results were not significant (p > 0.05). Conclusions: This preliminary study has shown that the infusion of ozone into non‐carious dentine prevented biofilm formation in vitro from S. mutans and L. acidophilus over a four‐week period. The possibility exists that ozone treatment may alter the surface wettability of dentine through reaction with organic constituents.     

Use of influenza vaccines in children with an egg allergy

Children are at increased risk of morbidity from influenza. Influenza vaccines are grown in eggs, leading to a minute amount of egg protein in their composition. Recent research and new practice parameters spurred by the 2009 global influenza pandemic have challenged the need to withhold influenza vaccine from patients with an egg allergy. The available data suggest that anaphylaxis from influenza vaccines is exceptionally rare, even in patients with an egg allergy. Reported allergic reactions to trivalent inactivated influenza vaccine and pH1N1 influenza vaccines have been rare; when reactions occurred, they have not caused anaphylaxis. This position statement reviews the available evidence on influenza vaccine/egg allergy-related anaphylaxis, and recommends protocols to safely administer the trivalent inactivated influenza vaccine in lower- and higher-risk children with an egg allergy.     

Management of childhood asthma in Western Australia

Aims:   The study aimed to determine how childhood asthma is managed in Western Australia by general practitioners (GPs) and specialist paediatricians.
Methods:   A questionnaire survey was sent to 992 GPs and specialist paediatricians, asking about practice and preferences regarding maintenance management of childhood asthma and treatment of acute asthma. Questions about asthma in infants, pre-school and school-aged children were asked separately.
Results:   The overall response rate was 24.7%, with 188/878 (21.4%) of GPs and 44/62 (71.0%) of paediatricians returning the questionnaire. The decision to start maintenance therapy was generally based on symptom frequency and severity. The first choice for maintenance treatment in all age groups was inhaled corticosteroids (ICS). The second most common treatment varied according to age group, with short-acting β₂-agonist (SBA) preferred for infants, montelukast or short-acting β₂-agonist for pre-schoolers and combination therapy (ICS + long action β₂-agonist) for school-aged children. Objective monitoring of lung function with peak flow or spirometry, was used by 40% of GPs and 59% of paediatricians. Acute asthma was primarily managed with inhaled salbutamol and oral corticosteroids. There were few differences in treatment choice between GPs and paediatricians. Many GPs indicated that they did not treat asthma in infants without specialist consultation.
Conclusions:   These data show good compliance by the minority of GPs responding to the survey and by paediatricians practising in Western Australia with current Australian asthma management guidelines. Major differences in treatment preferences between the groups were not detected.     

Early introduction of allergenic foods for the prevention of food allergy from an Asian perspective—An Asia Pacific Association of Pediatric Allergy,Respirology & Immunology (APAPARI) consensus statement

Emerging evidence for the early introduction of allergenic foods for the prevention of food allergies, such as peanut allergy in Western populations, has led to the recent publication of guidelines in the USA and Europe recommending early peanut introduction for high‐risk infants with severe eczema or egg allergy. Peanut allergy is, however, much less prevalent in Asia compared to the West. Varying patterns of food allergy are seen even within Asian countries—such as a predominance of wheat allergy in Japan and Thailand and shellfish allergy in Singapore and the Philippines. Customs and traditions, such as diet and infant feeding practices, also differ between Asian populations. Hence, there are unique challenges in adapting guidelines on early allergenic food introduction to the Asian setting. In this paper, we review the evidence and discuss the possible approaches to guide the timely introduction of allergenic food in high‐risk infants in Asia.