[Early screening criteria for children at risk of overweight]. / Critères de repérage précoce des enfants à risque de développer un surpoids.

BACKGROUND: Health professionals who monitor the growth of children are also involved in the early detection of overweight. Appropriate tools are required for this purpose. OBJECTIVE: The study sought to identify predictive markers of the development of subsequent overweight using a simple set of criteria. METHODS: A consecutive cohort was composed of 1424 grade 4 children in Aquitaine, France, aged 8-9 years. Body mass index (BMI) was calculated during school health assessments at 8-9 years of age. Data from previous assessments at 3-4 and 5-6 years of age were also collected. RESULTS: Of the 189/1424 children (13.9 %) who were overweight according to the French national cut off for children aged 8-9 years, 67 (33.8 %) were already overweight at 3-4 years and 107 (54.1 %) at 5-6 years. Of the 134 (9.4 %) who were overweight at 5-6 years, 43.3 % were already overweight at 3-4 years and 79.9 % were overweight at 8-9 years. On the other hand, 76 of these 134 children (56.7 %) were not overweight at 3-4 years, so they had become overweight between the two assessments. The combination of the criterion "overweight at 3-4 years or 5-6 years" and "increase in BMI>1kg/m(2) between 3-4 years and 5-6 years" appears to be the best predictor of the risk of overweight at 8-9 years, with good sensitivity (75.3 %) and specificity (87.9 %). CONCLUSION: A predictive tool based on BMI changes between ages 3-4 years and 5-6 years could be used for the early detection of the risk of developing overweight and obesity. The tool is easy to use, especially for health care in schools. Furthermore, the present findings confirm the value of following up and managing children who are already overweight between the ages of 3 and 6 years.

Epicutaneous aeroallergen sensitization in atopic dermatitis infants - determining the role of epidermal barrier impairment.

BACKGROUND: Sensitization to atopens is an early phenomenon that overlaps with the onset of atopic dermatitis (AD) in infancy. Early epidermal barrier impairment may facilitate the epicutaneous penetration of atopens. OBJECTIVE: To correlate transepidermal water loss (TEWL) and aeroallergen sensitization in infants with AD. METHODS: In this cross-sectional study we enrolled 59 AD children and 30 controls aged 3-12 months. Transepidermal water loss in uninvolved skin, specific immunoglobulin E, atopy patch test (APT) and skin prick tests were performed with respect to seven aeroallergens, i.e., Dermatophagoides pteronyssinus, D. farinae, cat, dog, birch pollen, ambrosia, and cockroach. Environmental conditions were assessed by a questionnaire, and the house dust mite (HDM) concentration was determined in dust samples. RESULTS: Eighty-nine percent of AD infants had a positive APT vs one out of eleven controls. AD infants had a significantly higher mean TEWL than controls (27.4 vs 11.1 g/m(2)/h, P < 0001). Children with two or more positive APT had higher TEWL than the others (31.1 vs 19.0 g/m(2)/h, P < 0.025). No correlation was found between indoor APT results and exposure to HDM, cats, and dogs at home. CONCLUSIONS: This study confirms the high prevalence of delayed sensitization to indoor and outdoor aeroallergens in AD infants, and shows that the higher the TEWL, the higher the prevalence of sensitization to aeroallergens. These data are in favor of a major role of a constitutive epidermal barrier impairment in determining early atopen sensitization in infants with AD.

Oat sensitization in children with atopic dermatitis: prevalence, risks and associated factors.

BACKGROUND: Topical treatments of atopic dermatitis (AD) may be responsible for cutaneous allergies. Percutaneous sensitization to oat used in emollients/moisturizers has already been reported. Our objectives were to measure the prevalence of oat sensitization in AD children, to assess its relevance, and to look at related parameters. METHODS: We recruited prospectively children with AD referred for allergy testing between June 2001 and December 2004. Atopy patch tests (APT) and skin prick tests (SPT) to oat proteins (1%, 3% and 5%) and to the European standard series were performed followed by oral food challenge (OFC) and repeated open application test (ROAT) in the oat-sensitized group. RESULTS: About 302 children were enrolled. Oat APT and SPT were positive in 14.6% and 19.2% of cases, respectively. Children under 2 years of age were more likely to have positive APT. In oat-sensitized children, OFC and ROAT were positive in 15.6% (five of 32) and 28% (seven of 25) of cases, respectively. Thirty-two percentage of oat cream users had oat-positive atopy patch test (APT) vs 0% in the nonusers group. CONCLUSIONS: Oat sensitization in AD children seen for allergy testing is higher than expected. It may be the result of repeated applications of cosmetics with oats on a predisposed impaired epidermal barrier. We suggest avoiding topical-containing oat proteins in infants with AD.