Skin prick tests and specific IgE in 10-year-old children: Agreement and association with allergic diseases.

BACKGROUND: Accurate assessment of atopic sensitization is pivotal to clinical practice and research. Skin prick test (SPT) and specific IgE (sIgE) are often used interchangeably. Some studies have suggested a disagreement between these two methods, and little is known about their association with allergic diseases. The aims of our study were to evaluate agreement between SPT and sIgE, and to compare their association with allergic diseases in 10-year-old children. METHODS: Skin prick test, sIgE measurements, and assessment of allergic diseases were performed in children aged 10 years in the Protection against Allergy: STUdy in Rural Environments (PASTURE) cohort. The agreement between SPT and sIgE was assessed by Cohen's kappa coefficient with different cutoff values. RESULTS: Skin prick tests and sIgE were performed in 529 children. The highest agreement (κ=.44) was found with a cutoff value of 3 and 5 mm for SPT, and 3.5 IU/mL for sIgE. The area under the curve (AUC) obtained with SPT was not significantly different from that obtained with sIgE. For asthma and hay fever, SPT (cutoff value at 3 mm) had a significantly higher specificity (P<.0001) than sIgE (cutoff value at 0.35 IU/mL) and the specificity was not different between both tests (P=.1088). CONCLUSION: Skin prick test and sIgE display moderate agreement, but have a similar AUC for allergic diseases. At the cutoff value of 3 mm for SPT and 0.35 IU/mL for sIgE, SPT has a higher specificity for asthma and hay fever than sIgE without difference for sensitivity.

[Hypersensitivity pneumonitis in children]. / Pneumopathie d'hypersensibilité de l'enfant.

Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by an immune response to a variety of antigens to which patients have been previously sensitised. It can occur at any age. In children, it is a rare disease, probably under-diagnosed, with an estimated prevalence of 4 per million. The paediatric forms are not really different from those of adults but present some particularities. Avian exposure is by far the most frequent cause of HP, accounting for nearly two-thirds of cases. Although there is no current recommendation for the diagnosis of HP, it is commonly considered that the diagnosis can be made with confidence on the combination of (1) compatible respiratory symptoms, (2) exposure to a known offending antigen, (3) lymphocytic alveolitis, (4) decreased transfer factor for carbon monoxide or hypoxia on exertion and (5) compatible radiologic features. The treatment is based on antigen avoidance that must be complete and definitive. Corticosteroids can be necessary in severe forms. The prognosis of HP in children is better than in adults, with a full clinical and functional recovery in the majority of cases after complete antigenic withdrawal.

Antipyretic efficacy and safety of a single intravenous administration of 15 mg/kg paracetamol versus 30 mg/kg propacetamol in children with acute fever due to infection.

OBJECTIVES: An intravenous formulation of paracetamol and an intravenous formulation of propacetamol (prodrug of paracetamol) were compared in children with acute fever due to infection in order to determine the antipyretic efficacy and safety during the 6-hour period after administration. METHODS: A total of 67 patients aged 1 month to 12 years and with a rectal body temperature between 38.5 degrees C and 41 degrees C, were randomized to receive either intravenous paracetamol 15 mg/kg (n = 35) or propacetamol 30 mg/kg (n = 32) under double-blind conditions. RESULTS: The non-inferiority of intravenous paracetamol compared to propacetamol was demonstrated (non-inferiority margin = 0.5 degrees C) by the median body temperature reduction of 1.9 degrees C in the intravenous paracetamol group and the reduction of 2.05 degrees C in the propacetamol group. The difference in the incidence of local adverse events was statistically significant (p = 0.0134) with more local adverse events in the propacetamol group (9, 28.1%) than in the intravenous paracetamol group (2, 5.7%). CONCLUSION: This double-blind, randomized, clinical trial demonstrates the non-inferiority of a single administration of 15 mg/kg intravenous paracetamol in comparison to 30 mg/kg propacetamol in terms of body temperature reduction in children aged 1 month to 12 years with acute fever due to infection. It confirms the better local safety of intravenous paracetamol in comparison to propacetamol.

Microbiologic contamination study of nebulizers after aerosol therapy in patients with cystic fibrosis.

BACKGROUND: To evaluate the contamination of delivery systems after an aerosol therapy session in patients with cystic fibrosis who have chronic Pseudomonas aeruginosa infection. METHODS: Fifty-three patients with cystic fibrosis were enrolled in the study from March 1996 to June 1997. All patients were age 7 years or older and had P aeruginosa infection. They also had been treated with recombinant deoxyribonuclease and were capable of producing sputum for culture. RESULTS: Nine devices were excluded for the study. A total of 44 nebulizers were included: 37 from patients with P aeruginosa colonization with a count of 10(6) colony-forming units/mL or more and 7 with a count of between 10(5) colony-forming units/mL and 10(6) colony-forming units/mL. CONCLUSION: This study demonstrates that in the absence of cleaning, nebulizers of patients with cystic fibrosis who are infected with P aeruginosa are likely to be contaminated by a pathogenic flora.

[Toxoplasmosis and pregnancy: is it possible to simplify the diagnostic procedures?]. / Toxoplasmose et grossesse: une simplification des procédures diagnostiques est-elle possible?

About 1% of all pregnancies in France are complicated by a primary infection with toxoplasmosis. The risk for the fetus being affected increases during the pregnancy but the seriousness of the effect on the fetus becomes less with more advanced pregnancies. Treatment of the mother using Spiramycin have been proven to be efficient, lessening the risk for the fetus being affected. The diagnosis of the fetus being affected rests on a whole bundle of presumptive evidence culled from non-invasive methods and invasive methods which are not without risk. (Direct or over-enthusiastic diagnostic techniques or none at all). We have studied a series of 101 primary infections with toxoplasmosis for which we have not carried out any invasive diagnostic techniques. The long term results in 77 infants show no difference in fetal morbidity and better results as far as mortality are concerned. We therefore propose simplifying the diagnostic approach in cases of primary infection with toxoplasmosis during pregnancy.

[National French guidelines for management of infants with cystic fibrosis]. / Recommandations nationales pour la prise en charge du nourrisson dépisté atteint de mucoviscidose. Consensus de la fédération des centres de ressources et de compétences de la mucoviscidose.

These guidelines aim to standardize the care of infants diagnosed with a typical form of cystic fibrosis (CF) at neonatal screening. They have been implemented by the National Working Group for Neonatal Screening of the French Federation for CF and have been validated using the Delphi methodology by a large group of clinicians involved in the care of CF infants. These guidelines encompass management and organization of care at diagnosis and describe nutritional, digestive, and respiratory monitoring and treatment during the first 2 years of life.

[Choanal atresia and CHARGE syndrome]. / Atrésie des choanes et syndrome CHARGE.

The acronym CHARGE names a syndrome described by Pagon et Graham in 1981, which associates mainly ocular anomalies, i.e. coloboma, and uni or bilateral choanal atresia. We report three observations of children with choanal atresia confirmed by CT scan. One child exhibited all the signs of the CHARGE syndrome including cerebral involvement at autopsy.

[Congenital myotonic dystrophy. Diagnostic difficulties]. / Dystrophie myotonique congénitale. Difficultés diagnostiques.

Congenital myotonic dystrophy is the neonatal form of Steinert myotonia. It is particularly severe when the mother carries the gene. The diagnosis is made after finding the myotonia in the mother. Prenatal diagnosis can be made by researching the Steinert's disease gene by fetal DNA analysis.

[Screening for hepatitis B carriers at the maternity unit of Besançon teaching hospital]. / Dépistage du portage de virus de l'hépatite B à la maternité du CHU de Besançon.

There are more than 280 carriers of the hepatitis B virus worldwide. The risk of chronic carriers, and a fatal outcome due to hepatocarcinoma, is estimated to be about 50% in Asian children contaminated by materno-fetal transmission. Serovaccination of the neonatal infant born to a HBV carrying mother provides protection in nearly 100% of cases. Routine screening for HBV carriers at the Besançon teaching hospital maternity unit led to the vaccination of 1.12% of the babies born in 1990, which corresponds to the current national average.

Some risk factors for cerebral palsy in very premature infants: importance of premature rupture of membranes and monochorionic twin placentation.

OBJECTIVE: To delineate the perinatal risk factors of neurodevelopmental disabilities in very preterm birth applying logistic regression analysis. DESIGN: This prospective, geographically defined collaborative study was carried out in the Franche-Comté region of France. SUBJECTS: From October 1, 1990 to September 30, 1992, perinatal and follow-up data were collected on 203 consecutive live-born singleton or twin non-malformed infants with strictly ascertained gestational ages of less than 33 weeks. MAIN OUTCOME MEASURE: The rate of cerebral palsy and/or severe mental retardation as diagnosed by a family physician or pediatrician with a screening-skill test performed at 2 years of age. RESULTS: 167/171 (98%) survivors were evaluated. Twenty-two of the 167 examined infants (13%) showed signs of cerebral palsy, and 10 of these had severe cerebral palsy or mental retardation. Risk factors for disabilities were selected by a multivariate approach: premature rupture of membranes >/=48 h (OR 4.3, 95% CI 1.6-11.8); monochorionic twin placentation (OR 6.0, 95% CI 1.7-21.3), and respiratory distress syndrome (OR 2.8, 95% CI 1.1-7.1). CONCLUSION: This geographically defined prospective study gives epidemiological data and highly suggests that there is a link between prenatal events (premature rupture of membranes, monochorionic twin placentation), postnatal events (respiratory distress syndrome), and neurological disabilities in former preterm infants.