High Prevalence of Response to Proton-pump Inhibitor Treatment in Children With Esophageal Eosinophilia.

OBJECTIVES: Proton-pump inhibitor-responsive esophageal eosinophilia is a newly recognized entity with an unclear prevalence in children, as only retrospective data are available. The aim of this study was to determine the prevalence and clinical features of proton-pump inhibitor-responsive esophageal eosinophilia in children. METHODS: This prospective study enrolled patients with esophageal symptoms and esophageal eosinophilic counts as 15 or more than 15 eos/hpf (eosinophils per high-power field). Children received treatment with esomeprazole 1 mg ·â€Škg per dose twice daily for 8 weeks and the endoscopy was repeated. Complete response to proton-pump inhibitor (PPI) was defined as 5 or less than 5 eos/hpf, and a partial response as >5 and <15 eos/hpf in post-treatment biopsies. RESULTS: Fifty-one children (74.5% boys) were included. Histological response was observed in 35 children (68.6%): 24 children (47%) had a complete response and 11 children (21.6%) had a partial response. Only 16 children (31.4%) were diagnosed with eosinophilic esophagitis (EoE). There were no differences in history of atopy, allergy tests, pH study results, and endoscopic scores. Clinical symptoms were similar, with the exception of food impaction, which was more frequent in children with EoE (56.2% vs 20%, P = 0.01). The mean pretreatment peak eosinophil count was higher in patients with EoE (74.8 ±â€Š36.2 vs 46.3 ±â€Š30.7, P = 0.007). Eleven of the 14 patients (78.6%) on a lower PPI treatment maintenance dose remained in clinicopathologic remission at 1-year follow-up. CONCLUSIONS: A significant proportion of children with esophageal eosinophilia responded to high dose PPI treatment. Clinical, endoscopic, and pH study results were similar, with exception of patients with EoE, who were more likely to experience food impaction and have higher esophageal eosinophil counts.

Impact of Prematurity and Severe Viral Bronchiolitis on Asthma Development at 6-9 Years.

BACKGROUND: Premature birth is associated with increased susceptibility for viral infections and chronic airway morbidity. Preterm children, even moderate and late, may be at risk for short- and long-term respiratory morbidities. OBJECTIVE: Our main goal was to compare the burden of two conditions, severe bronchiolitis and prematurity (early and moderate-late), on asthma development at 6-9 years. PATIENTS AND METHODS: A retrospective cohort of all preterm (<37weeks gestational age) and full-term children hospitalized for bronchiolitis, with current age between 6 and 9 years, was created. A second cohort was made up of preterm children, without admission for bronchiolitis, randomly chosen from the hospital premature births database. Prevalence and risk factors for asthma were analysed. Parents completed the International Study of Asthma and Allergies in Childhood (ISAAC) Questionnaire for asthma symptoms for children 6-7 years. Lung function and aeroallergen sensitization were evaluated. RESULTS: Of the 480 selected children, 399 could be contacted and agreed to participate: 133 preterm and 114 full-term cases with admission for bronchiolitis and 146 preterm control children without admission for bronchiolitis. The frequency of current asthma at 6-9 years was higher in preterm cases (27%) compared with full-term-cases (15%) and preterm controls (14%) (p=0.04). Among hospitalized-bronchiolitis children, prematurity (p=0.04), rhinovirus infection (p=0.03), viral coinfection (p=0.04) and paternal asthma (p=0.003) were risk factors for asthma at 6-9 years. Among premature children, with and without bronchiolitis admission, the risk factors for asthma at 6-9 years were admission for bronchiolitis (p=0.03) and aeroallergen sensitisation (p=0.01). Moderate and late preterm children without admission for bronchiolitis showed similar prevalence of current asthma than full-term ones, previously admitted for bronchiolitis. CONCLUSION: Preterm birth is an important early life risk factor for asthma in childhood. The addition of other risk factors, such as severe bronchiolitis, especially by rhinovirus or viral coinfections, are associated with even higher risk for subsequent asthma.

Human bocavirus detection in nasopharyngeal aspirates of children without clinical symptoms of respiratory infection.

The main objective of our study was to determine the frequency of human bocavirus (HBoV) detection in asymptomatic children and to compare it with that in children hospitalized because of respiratory infection. HBoV was detected in 5% of 116 healthy children versus 17% of 908 hospitalized children. HBoV can be detected in healthy children but with a significantly lower frequency than in ill children.

Efficacy and Safety of Salmeterol/Fluticasone Propionate Combination Delivered by the Diskustrade mark or Pressurised Metered-Dose Inhaler in Children with Asthma.

BACKGROUND AND OBJECTIVE: Salmeterol and fluticasone propionate are well established in the treatment of childhood asthma, and their combination is effective in children aged 4-11 years. Asthma guidelines recommend that the inhaler device best suited to the individual should be used to administer asthma treatment. The aim of this study was to further evaluate the efficacy of salmeterol/fluticasone propionate combination (SFC) delivered by the Diskustrade mark (50/100mug, one inhalation twice daily) and compare it with that observed when SFC is delivered by a chlorofluorocarbon-free pressurised metered-dose inhaler (pMDI) [25/50mug, two inhalations twice daily] in children aged 4-11 years with persistent asthma. PATIENTS AND METHODS: This equivalence study had a multicentre, randomised, double-blind, double-dummy, parallel-group design and comprised asthmatic children aged 4-11 years who required beclometasone (beclomethasone dipropionate)