Lack of bone metabolism side effects after 3 years of nasal topical steroids in children with allergic rhinitis.

This study evaluated the effects on bone mineral status of long-term treatment with intranasal budesonide (INB) spray, using the recommended dose, in pediatric patients with allergic rhinitis (AR). This retrospective, case-control study of 230 prepubertal children with perennial AR, who had used nasal budesonide at a mean daily dose of 100 µg (range, 89-132 µg) for at least 3 years intermittently, was conducted from May 2007 through May 2010. The bone mineral density (BMD) of the lumbar spine was measured by dual-energy X-ray absorptiometry. Levels of serum calcium, phosphorus, alkaline phosphatase (ALP), parathyroid hormone, and osteocalcin were also assessed. The results were compared to sex- and age-matched controls (n = 140), who were newly diagnosed children with AR without any corticosteroid treatment. The 230 study patients (145 boys) were aged from 7 to 11 years. The average age (± SEM) was 8.7 ± 0.7 years; the mean (± SEM) steroid dosage used was 73.5 ± 7.0 µg daily, with 65.2 ± 5.2 g total steroid use during treatment. The 140 control patients (90 boys) were aged from 6 to 11 years. No significant differences were observed in BMD (P > 0.05) between the study and the control groups. Although mean serum ALP level was higher, and cortisol, phosphorus, and osteocalcin levels were lower, in the treatment group, these differences were not statistically significant. The findings suggest that long-term intermittent treatment for 3 years with INB spray, 50 µg twice daily, for children with perennial rhinitis revealed no negative effect on BMD and associated parameters.

Evaluation of nasal fluid ß-defensin 2 levels in children with allergic rhinitis.

AIM: Knowledge about the role of the innate immune system in the pathogenesis of allergic diseases has been expanding in recent years. Defensins are antimicrobial peptides that are components of the innate immune system. Defensins have strong efficacy against bacterial, viral, and fungal infections. Moreover, they have regulatory functions in many physiologic processes such as antitumoral immunity, chemotaxis, inflammation, and wound healing. In this study, we aimed to investigate ß-defensin 2 levels in the nasal fluids of children with allergic rhinitis. MATERIAL AND METHODS: Study and control groups consisted of 28 patients with newly diagnosed allergic rhinitis who were not taking any medication, and 23 healthy children. Skin prick tests were performed on patients with allergic rhinitis and disease severity was assessed using the total symptom score. Nasal fluid samples were obtained using a modified polyurethane sponge absorption method from patients and control subjects. Nasal fluid ß-defensin 2 levels were determined using an enzyme-linked immunosorbent assay (ELISA). RESULTS: The median value of nasal fluid ß-defensin 2 levels were 173.8 pg/mL (interquartile range; 54.8-205.9 pg/mL) in allergic rhinitis group and 241.6 pg/mL (163.5-315.2 pg/mL) in the control group. There was a statistically significant difference between the two groups (p=0.01). Moreover, nasal fluid ß-defensin 2 levels showed a significant negative correlation with total symptom scores (rho= -0.78, p<0.001). CONCLUSIONS: Children with allergic rhinitis have reduced nasal fluid ß-defensin 2 levels compared with controls, and ß-defensin 2 levels were negatively correlated with disease severity. A more definite understanding of the roles of defensins and other antimicrobial peptides in allergic inflammation can open up new horizons in the management and treatment of these common diseases.

Skin sensitization to common allergens in Turkish wheezy children less than 3 years of age.

Infants and small children with asthma are not commonly skin tested, as allergy is not considered to be a major cause of infantile asthma. The aim of this study was to determine the frequency of skin test positivity to various allergens in wheezy children less than 3 years of age. We evaluated 161 patients with infantile asthma (median age 20 months) and 100 healthy controls (median age 18 months). Infantile asthma was defined as three or more episodes of wheezing in a child less than 3 years of age, whose symptoms improved on treatment with beta-agonist and anti-inflammatory agents. All children were skin tested to house dust mites (HDM), pollens, molds, and cow milk extracts using prick technique. One hundred and eighteen (73.3%) children In the patient group tested positive to HDM, 84 (52.1%) to pollens, 37 (22.9%) to molds, and 16 (10%) to cow milk. Sensitization rates to HDM were significantly higher in the patient group than In the healthy controls. Sensitization rates to pollens were not statistically different between the two groups. There was no association between family history of atopy and frequency of sensitization to allergens in the wheezy and control groups. We concluded that skin sensitization to allergens was common In wheezy infants. The prevalence of sensitization to indoor allergens was higher than to outdoor or food allergens.

Autonomic dysfunction and clinical severity of disease in children with allergic rhinitis.

OBJECTIVES: The involvement of autonomic imbalance has been reported in the pathogenesis of allergic diseases. PURPOSE: To investigate the association between the clinical severity of childhood allergic rhinitis and autonomic nervous system (ANS) dysfunction, to define whether the severity of disease correlates with ANS activity. METHODS: In this cross-sectional, case-control study, we evaluated the ANS testing by measuring sympathetic skin response (SRR) and heart rate (R-R) interval variation (RRIV) in 55 children with perennial allergic rhinitis (PAR), aged 7-12 yrs without any chronic co-morbidity, and the results were compared with 40 sex- and age-matched control subjects. The patients were divided into two groups according to the severity of allergic rhinitis. RESULTS: There were significant increase in calculated RRIV variables during at rest and deep breathing in children with PAR compared to controls, which reflect parasympathetic nervous system (PNS) activity (p<0.005). The mean amplitude of SSR in patients, which reflect sympathetic nervous system (SNS) activity was smaller compared with the controls, but this difference was not significant (0.61±0.35 µV vs controls 0.94±0.46, p>0.05). Lower RRIV and the prolonged SSR latencies in children with AR were closely correlated with disease severity (r=-0.65, p<0.05, and r=-0.59, p<0.05 respectively). CONCLUSION: Combined use of these two tests, allows separate testing of PNS and SNS function, and are very sensitive methods in assessing of severity of disease in children with PAR.

Autonomic nervous system dysfunction and their relationship with disease severity in children with atopic asthma.

The involvement of autonomic imbalance has been reported in the pathogenesis of allergic diseases. The aim of this study was to investigate the association between the clinical severity of childhood asthma with autonomic nervous system (ANS) dysfunction and to define whether the severity of asthma correlates with ANS activity. In this case-control study, we evaluated the ANS activity by testing heart rate variability (HRV) and sympathetic skin response (SRR) in 77 asthmatic children, age 7-12 yrs, who had no co-morbidity and compared them with 40 gender- and age-matched control subjects. According to the severity of their asthma, study subjects were further divided into three groups: I (mild asthmatics), II (moderate asthmatics), and III (severe asthmatics). Inter-group ANS scale scores differed significantly (p<0.01) between Groups I and III and between Groups II and III. Combined use of HRV and SSR provides a higher degree of sensitivity for assessing disease severity in cases of pediatric asthma.

Evaluation impact of long-term usage of inhaled fluticasone propionate on ocular functions in children with asthma.

OBJECTIVE: Although systemic, topical, and periocular corticosteroid administration have long been associated with ocular side effects, there has been little evidence to suggest that long-term inhaled corticosteroids can cause ocular side effects. The aim of this study was to evaluate the effects of long term treatment inhaled fluticasone propionate spray usage the recommended dose on some ocular functions in pediatric patients with asthma. METHODS: The study group consisted of 266 prepubertal children with asthma who had used inhaled fluticasone propionate spray at 3-6 years intermittently. One hundred and sixty children who were newly diagnosed with asthma without any treatment made up the control group. Schirmer test results, central corneal thickness, visual acuity, intraocular pressure, cataract formation, keratometry and tear break-up time compared between study and control groups. RESULTS: The ages of the 266 study patients (150 male) were between 7 and 11 years. The average age (±SEM) was 8.2±1.7 years, and the mean (±SEM) a daily dose of 323 µg (range 250-450 µg) inhaled fluticasone propionate spray, with 865.2±215 g total steroid use during treatment. Eye functions including cataract formation, corneal ectasia, ocular hypertension or glaucoma, and dry eye were not observed in any of the patients in the study group and were not correlated with total steroid dosage (t=0.150, p=0.384). CONCLUSION: Our findings suggest that long-term intermittent treatment for 3-6 years with inhaled fluticasone propionate spray, as much as average 320 µg daily, in children with asthma seems to be safe for some eye functions.

Psychological stress and family functioning in mothers of children with allergic rhinitis.

OBJECTIVE: Psychiatric symptoms are observed more commonly in mothers of children with allergic disease compared to the general population. In our study, we aimed to compare family functioning and anxiety parameters in mothers of children diagnosed allergic rhinitis and healthy controls. METHODS: Study group consisted of 82 mothers of 7-15 years old children with allergic rhinitis. Control group consisted of 70 mothers of children with no chronic diseases. State-Trait Anxiety Inventory (STAI) and McMaster Family Assessment Device (FAD) scales was obtained from participants. RESULTS: Anxiety scores in mother of children with allergic rhinitis were significantly higher than the ones in the control group (50+/-7.54, 32+/-5.44, p=0.02, respectively). Family assessment scores were higher in mother of children with allergic rhinitis when compared to the control group but did not reach statistical significance (1.89+/-0.12, 1.87+/-0.95, p=0.19, respectively). Smoking status at home and jobless father were found to have a significant impact on the evaluation scale in mothers in the case group. CONCLUSION: Psychiatric symptoms observed in mothers of children with allergic rhinitis might be associated with child disease and the functioning of the entire family rather than features of the mother alone. Having a child with allergic rhinitis does not affect family functions according to the mother's aspect.