Trends in folic acid supplementation during pregnancy - the effect on allergy development in children.

INTRODUCTION: The results of some previous studies suggested that maternal folate supplementation during pregnancy may contribute to allergy development in offspring. AIM: This study was performed to examine the influence of maternal folic acid intake prior to and during pregnancy on the development of various types of allergy in children taking into account the timing and dosage of supplemented folate. MATERIAL AND METHODS: The retrospective study was performed between 2010 and 2014 in 307 child-mother pairs (203 allergic children and 104 children without allergy symptoms, aged 2-72 months). Allergy diagnosis was based on medical history, physical examination, positive results of allergic tests: specific IgE and/or skin prick tests and double-blind, placebo-controlled food challenge. The data concerning maternal folate supplementation prior to and during pregnancy were obtained based on a questionnaire. RESULTS: Mothers of allergic children used to take folic acid more frequently in the preconception period (42.9%), in the 1st (94.1%) and the 2nd/3rd (81.3%) trimester of pregnancy than mothers of the healthy ones (30.8%, 82.7% and 55.8%, respectively) (p < 0.05). Maternal intake of folate in a dosage higher than recommended (> 0.4 mg/day) was more often observed in the group of allergic subjects, especially in children with combined sensitization to food and inhalant allergens, than in the control group (p < 0.05). CONCLUSIONS: Our results suggest an impact of maternal folic acid supplementation prior to and during pregnancy on allergy development in children. Further observations are required to establish the role of folate in fetal epigenetic modifications.

Folate status, regulatory T cells and MTHFR C677T polymorphism study in allergic children.

PURPOSE: This study aimed to investigate early-life folate serum concentrations in children with food, inhalant or mixed type allergy. The influence of folate levels on the FoxP3 expression in Treg (regulatory T) cells in the studied children, taking into account the MTHFR (5,10-methylenetetrahydrofolate reductase) genotypes was also analyzed. MATERIAL AND METHODS: The study was performed in 83 allergic children (study group) and 49 healthy children (control group), aged 2-72 months. Medical history of each child was obtained and laboratory tests (serum folic acid concentrations and MTHFR C677T polymorphism) were carried out. The percentage of Treg cells was evaluated in almost a half of the examined subjects (48.5%). RESULTS: Significantly higher serum folate levels in the group of children with food allergy than in those with inhalant allergy was confirmed (P=0.037). In the study group the TT homozygotes were characterized by significantly lower folate concentrations than CC homozygotes (P=0.045). A negative correlation was demonstrated between the FoxP3 expression in CD4+CD25highFoxP3+ peripheral blood lymphocytes and serum folic acid concentrations. The correlation was more pronounced in the group of allergic children and it was statistically significant (r=-0.339, P<0.05). CONCLUSIONS: The results of the study indicate a possibility of some effects of folate status on Treg cells, thus suggesting their potential role in the development and course of allergy in children.

Pre- and postnatal exposure of children to tobacco smoke during the first four years of life--observations of the authors.

INTRODUCTION: Environmental exposure to tobacco smoke is a significant threat for human health, where the higher is its degree, the more immature the human organism is. Therefore, the exposure to Tobacco smoke in foetal life exerts unfavourable effects on developing foetus and may cause early and distant results in children. MATERIAL AND METHODS: The study comprised 318 children in their first four years of life, treated for various medical conditions. The examined children were divided into two groups, Group 1--children exposed to Tobacco smoke--and Group 2--a control group with children from non-smoking families. History data were obtained on the basis of a specially designed questionnaire, used by the doctor in an individual conversation with parent. In each third child from the group 1 cotinine concentration in urine was assayed by the method of high performance liquid chromatography-UV-VIS and the cotinine/creatinine ratio was calculated. RESULTS OF STUDY: Results demonstrated environmental exposure to tobacco smoke in 173 children (Group 1). Out of them 31.2% were the children whose mothers had smoked also during pregnancy (Subgroup A). The other 119 children from Group 1 were accounted to Subgroup B, i.e., children, where other household members had been smoking cigarettes. A comparative group comprised 143 children from non-smoking families. The results demonstrated then that 17% of all the examined children were those, exposed to tobacco smoke effects already in their foetal life, predisposing them to prematurity and low birth weight. Moreover, it was observed that the young age and lower education level of their parents, together with worse housing conditions, may suggest a predisposing character and role of the mentioned factors.

Prevalence of atopic dermatitis in infants during the first six months of life: authors' observations.

INTRODUCTION: Atopic dermatitis (AD) is a frequent chronic skin disease in infants. It creates great difficulties, both diagnostic and therapeutic. AIM: To assess the prevalence of atopic dermatitis in infants during the first 6 months of life. MATERIAL AND METHODS: The analysis comprised 2256 children at the age of not more than 6 months, treated at the 2(nd) Department of Paediatrics and Allergology of the Polish Mother's Memorial Hospital in Lodz, Poland, during seven years. Out of all the patients, children with cutaneous changes were isolated, and the location, type and aetiology of changes were assessed. RESULTS: Dermal changes were diagnosed in 471 children, including 391 (17.3% of all the patients) with atopic dermatitis. Out of the children with AD, IgE-dependent allergy was identified in 39.9%. Cow's milk protein was the most frequent sensitising allergen. In 71.6% of the infants, cutaneous changes were disseminated and involved at least two areas of the body. All of them were strongly itching. An applied elimination diet, together with anti-allergic medications in some of the children, provided a clear clinical improvement. CONCLUSIONS: Performed studies demonstrated the prevalence of atopic dermatitis in 17.3% of examined children. The changes in children with AD were disseminated, what was confirmed already at the infantile age. The obtained clinical improvement after the applied therapy indicates a relationship between the observed symptoms and allergic disease.

The usefulness of soluble transferrin receptor (sTfR) in differentiating anemia occurring in young children.

We evaluated the usefulness of soluble transferrin receptor (sTfR) and of the sTfR/log ferritin index(sTfR/logF) in the differentiation of anemia in young children. 96 children, aged 6-36 months, were examined.From these, four groups were distinguished: 1 - (IDA): 33 children with anemia due to iron deficiency; 2 -(IA): 19 children with infectious anemia without iron deficiency; 3 - (IA + ID): 16 children with infectious anemia and iron deficiency; and 4 - a comparator group (CG): 28 healthy children without iron deficiency. The soluble transferrin receptor, hematological indices and iron balance were evaluated and the sTfR/logF was calculated for each examined child. It was proved that the mean values of sTfR and sTfR/logF were substantially higher in children with anemia due to iron deficiency, and in those with infectious anemia and iron deficiency,vs. those with infectious anemia or in healthy children. This suggests that both sTfR and the sTfR/logF are good indicators of iron deficiency and could be useful in the differential diagnostics of anemia, especially in young children.

Infection cases in infants and small children with atopic dermatitis--own observations.

INTRODUCTION: The purpose of the work is to estimate the frequency of occurrence of various infections in infants and small children, aged between 0 and 36 months with atopic dermatitis in the practice of a family doctor. MATERIAL/METHODS: The study has been conducted on the basis of the retrospective analysis of medical documentation of disease among children born in 2005-2008 treated in Outpatient Clinic of the Polish Mother's Memorial Hospital in Lodz. RESULTS: Children suffering from atopic dermatitis are more prone to develop infectious diseases. CONCLUSIONS: Infectious diseases in children with atopic dermatitis are of more chronic nature and more often require antibiotic therapy. Such children often manifest chronic diarrhea and their stool contains Staphylococcus aureus. They are more often hospitalized because of difficulty in setting a diagnosis and applying treatment in outpatient clinics.

Role of selenium and zinc in the pathogenesis of food allergy in infants and young children.

INTRODUCTION: Selenium and zinc are indispensable microelements for normal functioning and development of the human body. They are cofactors of many enzymes of the antioxidative barrier (selenium - glutathione peroxidase; zinc - superoxide dismutase). The aim of the study was to evaluate the importance of selenium and zinc in the pathogenesis of food allergy in small children. MATERIAL AND METHODS: The study was performed in 134 children with food allergy, aged 1 to 36 months. The control group was composed of 36 children at the same age, without clinical symptoms of food intolerance. Each child had estimated serum levels of zinc and selenium. Furthermore, the authors evaluated activity of glutathione peroxidase (GSH-Px) in erythrocyte lysates and serum. Tests were performed twice, before and after 6-month administration of elimination diet. RESULTS: The obtained results showed that children with food allergy had significantly lower concentrations of selenium, zinc and examined enzymes in comparison to children from the control group. Concentration of selenium and zinc as well as activity of examined enzymes increased after application of eliminative diet. CONCLUSIONS: In children with allergy decreased concentrations of selenium and zinc, and lower values of glutathione peroxidase and superoxide dismutase which increased after elimination diet were affirmed. These observations suggest their role in pathogenesis of food allergy. Conducted observations indicate the need to monitor trace elements content in the diet in children with food allergy. The results showed that children with food allergy had a weakened antioxidative barrier.

[Food allergy as a cause of constipation in children in the first three years of life - own observations]. / Alergia pokarmowa jako przyczyna zaparc u dzieci w pierwszych trzech latach zycia na podstawie obserwacji wlasnych.

BACKGROUND: Constipation is a frequent cause of seeking paediatric advice and concerns up to 15% of the child population. AIM OF THE STUDY: Estimation of the role of allergy in the etiology of constipation in children during the fi rst three years of life. MATERIAL AND METHODS: Retrospective analysis was performed in 9489 children treated in 2nd Department of Pediatrics and Allergology of the Polish Mother's Memorial Hospital in Lodz in the years 1998- 2008. Among them there was a group of children with constipation diagnosed according to the Rome III Criteria. Anamnesis, course of disease and physical examination performed of each child guided further differential diagnosis Confirmation of food allergy diagnosis was positive result of provocation-elimination challenge with harmful food, and in case of some children additionally increased serum concentrations of allergenspecific IgE antibodies. In children with food allergy elimination diet was implemented. RESULTS: Chronic constipation was diagnosed in 136 children (1.43%). The most frequent cause of constipation in the examined children was allergy to cow's milk proteins, (n=99; 72.8%). The others were: psychogenic factors (n=10; 7.3%), dysbacteriosis of digestive system (n=7; 5.1%), anatomical defects of digestive tract (n=6; 4.4%), disorders of nervous system (n=6; 4.4%), overdose of Vit. D3 (n=3; 2.2%), Down Syndrome (n=2; 1.4%), celiac disease (n=1; 0.7%), abdominal tumour (neuroblastoma) (n=1; 0.7%) and cystic fibrosis (n=1; 0.7%). Clinical improvement after introduction of the elimination diet was observed in all children with food allergy. CONCLUSIONS: 1. In the fi rst three years of life cow milk allergy was the most frequent cause of constipation; 2. Incidence of food allergy as the reason of constipation decreased with age of the examined children.

[The estimation of atopic dermatitis in infants and small children in general practitioner's practice--own observations]. / Ocena czestosci wystepowania atopowego zapalenia skóry u niemowlat i malych dzieci w praktyce lekarza rodzinnego --doswiadczenia wlasne.

PURPOSE: The purpose of the work is to estimate the frequency of atopic dermatitis in general practitioner's practice. MATERIAL AND METHODS: The study has been conducted on the basis of the retrospective analysis of medical documentation of individual history of disease among children born in 2005-2008 treated in an outpatient clinic of the Polish Mother's Memorial Hospital, Lodz, Poland. RESULTS: Infants and small children suffering from atopic dermatitis are abig group (31.8%) in own observations. Many of them have dissemination skin lesions. CONCLUSIONS: Atopic dermatitis becomes a more frequent problem in infants and small children in general practitioner's practice. We observe more and more children with disseminated allergic skin lesions.

Evaluation of TLR4 expression and chosen parameters of oxidative-antioxidative balance in young children with food allergy.

The authors evaluated mRNA TLR4 expression on neutrophils and the chosen parameters of oxidative-antioxidative balance in blood of 35 children with food allergy (17 of them with IgE-dependent allergy and 18 with IgE-independent allergy) and 15 healthy children without any allergy. The age of these children ranged from 1 to 36 months. Children with food allergy in comparison with healthy children were found to have lower mRNA TLR4 expression, higher average value of chemiluminescence (CL) and its increase after stimulation by fMLP, PMA and OZ as well as lower TAS values. Disturbances of oxidative-antioxidative balance were found in children with food allergy. We suggest that natural immunity is involved in the development of food allergy mechanisms. Moreover, chemiluminescence can be used as an additional diagnostic test.

[Soluble transferrin receptor's value in diagnosis infants and small children iron deficiency]. / Znaczenie rozpuszczalnego receptora transferyny w diagnostyce niedoboru zelaza u niemowlat i malych dzieci.

UNLABELLED: Iron deficiency is the most frequent deficiency in people, especially in infants and small children. To obtain a correct diagnosis there is need to perform complex hematological and biochemical tests. In recent years studies on soluble transferrin receptor (sTfR) as an index of iron deficiency have been carried out, but mainly in adults. THE AIM OF THESE STUDIES: To estimate usefulness of signification sTfR level for iron deficiency anaemia diagnosis in children up to three years. MATERIAL AND METHODS: The study group comprised 98 children aged 6 to 36 month. Depending on haematological and biochemical results 5 groups of examined children were separated: (1) with iron deficiency anaemia, (2) with latent iron deficiency, (3) with iron deficiency and chronic diseases anaemia, (4) with periinfections anaemia and (5) control. In all examined children the level of sTfR were estimated and its specificity, sensitivity and soundness was evaluated. RESULTS: Average levels of sTfR in children with iron deficiency were significantly higher compared to results in groups without iron deficiency. Specificity, sensitivity and soundness of sTfR were higher than 90% in all examined groups. CONCLUSION: An analysis of results showed that sTfR level seems to be a test which results correlate with iron status in infants and small children well.

[The diagnostic difficulties in children with allergic skin changes and parvovirus B19 infection. Own experiences]. / Trudnosci diagnostyczne u dzieci z alergicznymi zmianami skórnymi i zakazeniem parawirusem B19. Doswiadczenia wlasne.

The authors describe two children with similar skin changes, which have been provoked by two different diseases-atopic dermatitis and parvovirosis B19. The authors underline the coexistence of the two diseases in these children, diagnostic difficulties and the need to apply therapeutic management for both.

[The coexistence of atopic dermatitis and psoriasis in a 12 months-old girl]. / Wspólistnienie luszczycy i atopowego zapalenia skóry u 12-miesiecznego dziecka.

The coexistence of atopic dermatitis and psoriasis is especially rare diagnosed disease in small children. Authors present a 12 months-old girl with both of these diseases. It is important to underline that early diagnosis can apply proper coexistence therapy.

[Diagnostic difficulties in differentiation between atopic dermatitis and seborrheic dermatitis in infants]. / Trudnosci diagnostyczne w róznicowaniu atopowego i lojotowego zapalenia skóry u niemowlat.

On the basis of two children with coexistence of atopic and seborrhoeic dermatitis, authors emphasize similarity of clinical symptoms and chronic, recurrent course of these diseases. Atopic dermatitis and seborrheic dermatitis are most common reasons of skin disorders in infants. Location and character of atopic lesions are atypical during infancy. Most often they occur on face and have erythematous-exfoliative and papulovesicular character. Pruritus and anxiety, especially in younger children are often seen. On the contrary seborrhoeic lesions are mostly seen in typical spots, including hairy head skin, where they form characteristic yellow seborrhoeic scales. Usually pruritus is not seen. Authors pay attention to heterogeneous etiopathogenesis of these diseases and underline the importance of early differentiation, which allows application of proper therapy.

[Difficulties in diagnosis of battered child syndrome in infant]. / Trudnosci diagnostyczne u niemowlecia z zespolem maltretowanego (bitego) dziecka.

The diagnosis of battered child syndrome in infants was reached on the basis of the risk factors appraisal in social and family history, combined with clinical and roentgenographic examinations; the difficulties in establishing the diagnosis are presented. Long hospitalisation also revealed that the observed injuries are due to child abuse. The interdisciplinary approach is needed when non-accidental injuries are considered.

[Chemiluminescence of peripheral blood neutrophils in infants and small children with food allergy]. / Chemiluminescencja neutrofilów krwi obwodowej u niemowlat i malych dzieci z alergia pokarmowa.

In this study the activity of neutrophils, measured using the chemiluminescence tests, was estimated in 91 children with food allergy. It was shown that the average chemiluminescence values without as well as after stimulation by FMLP, PMA and NZ were considerably higher in children with allergy in comparison to children from the control group.