The effects of grass pollen allergoid immunotherapy on clinical and immunological parameters in children with allergic rhinitis.

Allergoid immunotherapy is a new form of allergen immunotherapy allowing safe administration of high allergen doses. There is limited information on the effects of allergoid immunotherapy in children with allergic rhinitis. To investigate the immunological and clinical effects of allergoid immunotherapy in children with allergic rhinitis due to grass pollen allergy. Children with allergic rhinitis were assigned to allergoid immunotherapy (n = 27) or control (n = 26, no immunotherapy) groups. Children in the immunotherapy group received seven injections of grass pollen allergoid immunotherapy before grass pollen season and continued to receive maintenance immunotherapy for 27 months. All patients were offered a pharmacotherapy regimen to be used on demand during the pollen seasons. Clinical and laboratory parameters were compared between the immunotherapy and control groups. The rhinoconjunctivitis symptom-medication score and asthma symptom score were lower in the immunotherapy group after 1 yr of maintenance immunotherapy (p < 0.01 for both). Skin test reactivity and nasal reactivity as determined by nasal provocation testing for grass pollen were significantly decreased after 1 yr of immunotherapy (p < 0.001 for both). The seasonal increase in bronchial reactivity and nasal lavage eosinophil cationic protein levels were prevented after the first year of immunotherapy (p < 0.05 for both). The seasonal increase in immunoglobulin (Ig)E decreased (p < 0.05) and grass-specific IgG, IgG(1) and IgG(4) increased significantly already at the end of the seven-injection build-up therapy (p < 0.001, for all). Interleukin (IL)-4 levels in the culture supernatants showed a steady decline from baseline at first and second year of immunotherapy (p < 0.001) but remained unchanged in the control group. Allergoid immunotherapy is an effective method in the treatment of grass pollen-induced allergic rhinitis in children and prevents the seasonal increase in bronchial hyper-reactivity. Changes in specific IgE and IgG levels and decreased IL-4 production in peripheral blood mononuclear cell culture supernatants may account for the observed clinical effects.

The relationship between serum selenium levels and frequent wheeze in children.

As an antioxidant, selenium stimulates Th1 immune response against viral infections, and may play a role in the pathogenesis of frequent wheeze due to respiratory viral infections during the first year of life. We investigated the level of selenium in children with frequent wheeze who had no atopic diseases and no family history of atopy to determine whether selenium has an effect on the severity of the diseases. Sixty-one children with frequent wheeze who were in the asymptomatic period and had had no infectious disease for two months and an equal number of age- and sex-matched children, as a control group, without atopy or allergy or systemic diseases were enrolled in the study. In the study group, we determined the levels of serum selenium, total IgE, mixed specific IgE, and total eosinophil count, and we performed epidermal prick tests. Serum selenium levels were (mean and SEM) 61.95 +/- 1.23 microg/L in the study group and 72.71 +/- 1.28 microg/L in the control group (p < 0.001), and there was a negative correlation between the serum selenium levels and number of wheeze attacks during the previous year (r = -0.655; p < 0.001). As a result, selenium may play a role in the progression of respiratory infections during childhood and can be accepted as a risk factor for development of wheezing.

Does specific immunotherapy injection cause an increase in bronchial reactivity?

BACKGROUND: Several well-controlled studies have proven the clinical benefit of specific immunotherapy (SIT) for seasonal allergic rhinitis (AR). However, whether subcutaneous SIT injection could cause a transient increase in bronchial reactivity (BR) remains unknown. OBJECTIVE: To investigate whether subcutaneous SIT injection, either during or outside the pollen season, could cause an increase in BR in children with pollen allergy. METHODS: Twenty-two children (mean age 13.6 +/- 0.7 years) with AR who were receiving maintenance SIT for 15 months were included in the study. Pre-injection BR of the patients was evaluated with methacholine provocation test immediately before maintenance dose of SIT during the peak pollen season and outside the season. The post-injection test was administered 24 hours after SIT injection. RESULTS: There was no difference in FEV1 measures recorded during [98(93-109)%] and outside [102(96-111)%] the pollen season. There was no significant difference between pre- [64(7-64) mg/mL] and post-allergen injection [32(7.5-64) mg/mL] BR outside the pollen season (p = 0.9). A trend towards improvement following allergen injection [64(5.4-64)] as compared to pre-allergen injection [14.6(3.5-64)] was shown during the pollen season (p = 0.053). Although PC20 measures in the pollen season were lower than outside the season, the difference was not significant. The percentage of the patients with bronchial hyperreactivity was 62% during and 43% outside the season. CONCLUSION: SIT injections both during and outside the pollen season cause no increase in BR in children with AR. This calls into question the necessity of empirical dose reduction during the pollen season.

Effect of nasal triamcinolone acetonide on seasonal variations of bronchial hyperresponsiveness and bronchial inflammation in nonasthmatic children with seasonal allergic rhinitis.

BACKGROUND: Recent evidence suggests that patients with allergic rhinitis have lower airway inflammation and a higher prevalence of bronchial hyperresponsiveness (BHR) regardless of asthma. OBJECTIVE: To investigate markers of lower airway inflammation in nonasthmatic children with seasonal allergic rhinitis (SAR) before and during pollen season and the effect of nasal triamcinolone acetonide on seasonal variations in these parameters. METHODS: Thirty-two nonasthmatic children with SAR in response to grass and/or weed pollens were recruited and separated into 2 groups. Group 1 was treated with triamcinolone acetonide (220 microg once daily) for 6 weeks, and group 2 received no intranasal corticosteroid treatment. Bronchial responsiveness to methacholine [concentration that caused a decrease in forced expiratory volume in 1 second of 20% (PC20)], eosinophil counts in sputum and peripheral blood, and eosinophil cationic protein (ECP) levels in sputum and serum were measured before and during grass pollen season. RESULTS: Twenty-eight patients completed the study. During the pollen season, methacholine PC20 significantly decreased in both groups when compared with the corresponding preseasonal values (P = .01 and P = .003, respectively). The mean percentage of sputum eosinophils increased significantly during the pollen season compared with preseasonal values in group 1 and group 2 (12.7% +/- 2.1% vs 16.5% +/- 2.1%, P = .007, and 11.0% +/- 2.0% vs 20.2% +/- 1.4%, P = .003, respectively). Median [interquartile ranges (IQR)] sputum ECP levels were significantly higher during the pollen season when compared with the preseasonal values in group 1 and group 2 [7.5 microg/L (3.5-36.0 microg/L) vs 35.5 microg/L (13.0-71.7 microg/L), P = .04, and 18.0 microg/L (6.0-36.0 microg/L) vs 69.0 microg/L (39.0-195.0 microg/L), P = .003, respectively], as were the serum ECP levels [6.0 microg/L (2.0-13.0 microg/L) vs 19.0 microg/L (14.0-43.5 microg/L), P = .004, and 6.0 microg/L (3.0-7.0 microg/L) vs 18.0 microg/L (6.0-36.0 microg/L), P = .001, respectively]. Although the mean number of eosinophils in blood increased during the pollen season in both groups, it was only significant in group 2 (70.0 +/- 20.0 vs 161.6 +/- 29.0, P = .02). CONCLUSIONS: Although prophylactic nasal corticosteroid treatment provides significant reduction of nasal symptoms and rescue antihistamine use, there is no significant prevention in the seasonal increase of bronchial inflammation and methacholine BHR.

Complementary and alternative medicine in children with asthma.

BACKGROUND: The popularity of complementary and alternative medicine (CAM), particularly for chronic conditions such as asthma, is growing rapidly, but little is known about its use in asthmatic children. OBJECTIVE: To evaluate the extent, characteristics, and possible predictors of CAM use in a group of Turkish children with asthma. METHODS: The parents of asthmatic children were invited to participate in a questionnaire-based survey of 13 worldwide and 5 local methods of CAM. Current asthma treatment, asthma exacerbations, emergency admittances and hospitalizations due to exacerbations, and parental education levels were investigated as predictors that influenced the use of CAM. RESULTS: Of the 304 asthmatic children (mean +/- SEM age, 10.5 +/- 0.2 years; range, 1-16 years), 49% (n = 150) had used some form of CAM previously, and 38% had used CAM within the previous year. The most popular forms of CAM were quail eggs (79%), herbal medicine (31%), Turkish wild honey (26%), speleotherapy (5%), and royal jelly (5%). The respondents learned about CAM through friends (61%), relatives (25%), the media (9%), and physicians (6%). Age, sex, and mother's and father's education levels were insignificant between the groups that used and did not use CAM (P = 0.40, P = 0.18, P = 0.15, and P = 0.09, respectively). The use of regular asthma treatment, the use of inhaled corticosteroids, asthma exacerbations, emergency admittances, and treatment score were significantly high in the CAM group (P = 0.006, P = 0.03, P = 0.008, P = 0.02, and P = 0.02, respectively). A significantly high percentage of respondents in the CAM group had considered using CAM for their child's asthma in the future (P = 0.001). CONCLUSIONS: Asthmatic children in whom the disease is not well controlled are more likely to use CAM as complementary therapy.