Adaptation and Validation of the Israeli Version of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL).

BACKGROUND: Chronic urticaria (CU) is a common disabling disorder. The CU-Q2oL (Chronic Urticaria Quality of Life Questionnaire) is a specific questionnaire for evaluating quality of life in CU patients. It consists of 23 items divided into six quality-of-life dimensions. It was initially developed in Italy and later validated in other countries. OBJECTIVES: To validate and adapt the CU-Q2oL to the Hebrew language in order to make it suitable for use in Israel. METHODS: The CU-Q2oL questionnaire was translated to Hebrew. A group of 119 CU patients were asked to complete this version, in addition to the Dermatology Life Quality Index (DLQI) and Urticaria Activity Score (UAS) questionnaires. A factorial analysis was performed to identify CU-Q2oL subscales, internal consistency and convergent validity assessment, as well as factors determining quality-of-life scores. RESULTS: The factor analysis identified six scales of the Israeli CU-Q2oL: (i) sleep and concentration, (ii) function and mental status, (iii) embarrassment and clothing limitations, (iv) itching, (v) eating behavior and medication side effects, and (vi) swelling, which accounted for 77% of the data variance. Five scales showed good internal consistency over 0.81. The mean ± SD score of CU-Q2oL in our patients with CIU was 41 ± 21.7. We found a strong positive correlation between the overall scores of CU-Q2oL and DLQI questionnaires (r = 0.8, P < 0.01). Additionally, we found a positive correlation between UAS and both CU-Q2oL and DLQI (r = 0.62, P < 0.01, and r = 0.53, P < 0.01, respectively). CONCLUSIONS: This study demonstrates that the Israeli CU-Q2oL questionnaire is suitable for both clinical use and research in Israel.

The significance of allergic contact urticaria to milk in children with cow's milk allergy.

BACKGROUND: Cow's milk allergy (CMA) is the most common food allergy in infancy. Food allergy is generally triggered through ingestion, but can also be triggered through skin contact. We investigated the incidence and the clinical significance of cow's milk protein (CMP)-induced contact urticaria in individuals with CMA with and without atopic dermatitis (AD). METHODS: A total of 157 children of whom 133 were diagnosed with CMA were participated. The study was based on observational data gathered in the course of patient care, including a skin prick test and a 'finger test', in which cow's milk is applied on the cheek by a physician's finger to detect contact urticaria. RESULTS: Eighty nine of 133 patients (66.9%) had IgE-mediated CMA. Forty of these 89 (44.9%) tested positive in the finger test. Family atopy was higher in those with positive contact urticaria [21/40 (52.5%) vs. 14/49 (28.5%), p = 0.029]. Patients with positive vs. negative CMP contact urticaria had higher incidence of multiple food allergies [20 of 40 (50%) vs. 7/49 (14.3%), p < 0.004]. IgE-mediated CMA patients with AD had statistically higher CMP allergic contact urticaria compared to patients without AD [71% (15/21) vs. 37% (25/68), p = 0.0064]. Children with non-IgE milk allergy and healthy control group did not have contact urticaria to CMP. CONCLUSION: CMP contact urticaria exists only in patients with IgE-mediated CMA. A 'finger test' to CMP should be part of the evaluation of CMA patients, and positivity suggests the potential for multiple food allergies, especially to sesame and egg.

The sensory profile of children with asthma.

AIM: Sensory hypersensitivity is one expression of sensory processing disorders (SPD) and results from the inability to regulate an appropriate response to a sensory input in an adaptive manner. We explored the sensory processing profile of children with asthma, based on reports from parents. METHODS: We studied 86 children between the ages of four and 11 years: 37 diagnosed with asthma and 49 healthy controls. The parents of all participants filled out the Short Sensory Profile (SSP) that measures the child's behavioural reactions to sensory stimuli in daily environments. RESULTS: Sensory processing disorders were more prevalent among children with asthma (F7,71 = 4.16, p = 0.001; ή(2) = 0.29) than among healthy controls and were mainly reflected by hypersensitivity. While about 90% of the healthy children were reported to actively seek sensory stimuli, only 53% of the asthmatic children showed this trend. In the study group, 25.7% of the children's scores reflected abnormal sensory performance, compared with 0% of the controls (χ(2) =21.93; p < 0.001). CONCLUSION: Children with asthma may suffer from SPD. Our finding supports previous reports that suggest that the central nervous system is involved in the pathogenesis of atopic conditions. The sensory profile of children with asthma should be evaluated and treated as required.

Social support during the postpartum period: mothers' views on needs, expectations, and mobilization of support.

Research has indicated that social support is a major buffer of postpartum depression. Yet little is known concerning women's perceptions on social support during the postpartum period. The objective of this study was to explore postpartum women's views and experiences with social support following childbirth. Four focus groups were conducted with an ethnically diverse sample of women (n = 33) in a large urban teaching hospital in New York City. Participants had completed participation in a postpartum depression randomized trial and were 6-12 months postpartum. Data transcripts were reviewed and analyzed for themes. The main themes identified in the focus group discussions were mother's major needs and challenges postpartum, social support expectations and providers of support, how mothers mobilize support, and barriers to mobilizing support. Women across all groups identified receipt of instrumental support as essential to their physical and emotional recovery. Support from partners and families was expected and many women believed this support should be provided without asking. Racial/ethnic differences existed in the way women from different groups mobilized support from their support networks. Instrumental support plays a significant role in meeting women's basic needs during the postpartum period. In addition, women's expectations surrounding support can have an impact on their ability to mobilize support among their social networks. The results of this study suggest that identifying support needs and expectations of new mothers is important for mothers' recovery after childbirth. Future postpartum depression prevention efforts should integrate a strong focus on social support.

Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant.

INTRODUCTION: To investigate whether immunologic factors in breast milk change in response to nursing infants' infection. RESULTS: Total CD45 leukocyte count dropped from 5,655 (median and interquartile range: 1,911; 16,871) in the acute phase to 2,122 (672; 6,819) cells/ml milk after recovery with macrophage count decreasing from 1,220 (236; 3,973) to 300 (122; 945) cells/ml. Tumor necrosis factor-α (TNFα) levels decreased from 3.66 ± 1.68 to 2.91 ± 1.51 pg/ml. The decrease in lactoferrin levels was of borderline statistical significance. Such differences were not recorded in samples of the controls. Interleukin-10 levels decreased in the sick infants' breast milk after recovery, but also in the healthy controls, requiring further investigation. Secretory immunoglobulin A levels did not change significantly in the study or control group. DISCUSSION: During active infection in nursing infants, the total number of white blood cells, specifically the number of macrophages, and TNFα levels increase in their mothers' breast milk. These results may support the dynamic nature of the immune defense provided by breastfeeding sick infants. METHODS: Breast milk from mothers of 31 infants, up to 3 months of age, who were hospitalized with fever, was sampled during active illness and recovery. Milk from mothers of 20 healthy infants served as controls.

The Sesame-Peanut Conundrum in Israel: Reevaluation of Food Allergy Prevalence in Young Children.

BACKGROUND: Food allergies (FAs) are on the rise worldwide. A previous cross-sectional study from 2002 in Israel estimated the prevalence of IgE-mediated FA among young children at 0.85%. Although sesame was found to be a common allergen, peanuts were found to be a rare allergen. OBJECTIVE: To determine the prevalence and distributions of IgE-mediated FAs among young children in Israel compared with previous data. METHODS: A total of 1932 young children (56% males, 44% females) with a mean age of 22.4 months (range, 18-30 months) were sequentially recruited from 15 government family health care centers in north Israel. Parents completed a questionnaire with 2 screening questions for suspected FA. Subjects with suspected FA underwent further evaluation including telephone interview, skin prick tests, and oral food challenge as needed. RESULTS: After analyzing the questionnaires, 146 subjects were suspected to have FA. Seventy-nine subjects were excluded by telephone interview and 13 were excluded on the basis of negative oral food challenge. We identified 54 of 1932 (2.8%) young children with 75 IgE-mediated FAs. Thirty-nine of 54 (72.2%) had allergy to 1 food and 9 (16.6%) to 2 foods. The most common food allergens were cow's milk (1%), eggs (0.88%), sesame (0.93%), tree nuts (0.57%), peanuts (0.2%), and fish (0.2%). CONCLUSIONS: The prevalence of IgE-mediated FA among young children in Israel has increased dramatically from 0.85% to 2.8%. The relative prevalence of the most common food allergens is similar to that identified in 2002, with a high prevalence of sesame FA and low prevalence of peanut FA.

Immunization of pregnant women against pertussis: the effect of timing on antibody avidity.

BACKGROUND: The Centers for Disease Control and Prevention recommend tetanus-diphteria-acellular pertussis (Tdap) immunization during pregnancy, preferably at 27-36 weeks gestation. AIMS: First, to assess the relative avidity index (RAI) of umbilical cord immunoglobulin G (IgG) to pertussis toxin (PT) for newborns of women immunized with Tdap during late pregnancy as compared to unimmunized women. Second, to assess whether there is a preferential period of gestational Tdap immunization that provides the highest RAI of umbilical cord IgG to PT. METHODS: RAI of IgG to PT was assessed via an adapted ELISA using NH4SCN as a dissociating agent. RESULTS: We found that newborns of women immunized with Tdap during late pregnancy (n=52) had higher mean RAI of umbilical cord IgG to PT than those of unimmunized women (n=8), 73.77%±12.08 (95% CI, 70.41-77.13) vs. 50.23%±21.32 (95% CI, 32.41-68.06), p<0.001. Further, the RAI of umbilical cord IgG to PT was significantly higher in newborns of women immunized at 27-30(+6) weeks gestation (n=20) when compared with newborns of women immunized at 31-36 weeks (n=22) and >36 weeks (n=7), 79.53%±5.61 (95% CI, 76.91-82.16) vs. 71.56%±12.58 (95% CI, 65.98-77.14) vs. 63.93%±17.98 (95% CI, 47.31-80.56), p<0.03. CONCLUSION: Gestational Tdap immunization between 27 and 30(+6) weeks resulted in the highest avidity of IgG to PT conveyed at delivery as compared with immunization beyond 31 weeks gestation. Future studies should be conducted to confirm our findings to optimize pertussis-controlling strategies.