A prospective, randomized, double-blind, placebo-controlled multi-centre study on the efficacy and safety of sublingual immunotherapy (SLIT) in children with seasonal allergic rhinoconjunctivitis to grass pollen.

BACKGROUND: Especially in childhood, sublingual immunotherapy (SLIT) could offer advantages over subcutaneous therapy. However, limited data on its efficacy is available. METHODS: In four German centres 97 children (age 3-14 years) with allergic rhinoconjunctivitis to grass pollen were enrolled in a prospective, double-blind trial comparing SLIT (Pangramin SLIT; ALK-SCHERAX, 0.5 microg major allergens, three times per week, 32 months) with placebo. Primary endpoint was a multiple symptom-medication score for changes in seasonal diary entries between the first and third year of the study (SLIT n=39; placebo n=38). RESULTS: The multiple symptom-medication score was significantly reduced by SLIT to 77.3% of the placebo group (P=0.0498). The subsequent analysis of the single endpoints did not reveal significant differences for symptom scores in favour of SLIT (85.1% of placebo group; P=0.22). However, the medication score improved significantly (67.1% of placebo group; P=0.0025). Furthermore, secondary endpoints assessing in vivo immune responses did not differ significantly between the groups. However, retrospective analysis showed some inhomogeneity for clinical and in vitro parameters at the beginning of the study. Allergic side effects with possible relation to the study drug were reported in both groups (SLIT 49%, placebo 27%, P=0.026). CONCLUSION: Our study indicates that SLIT had a positive effect on the reduction of a multiple symptom-medication score, mainly by significantly reducing rescue medication use, but had no significant effect on symptoms alone in children with rhinoconjunctivitis to grass pollen compared with a placebo.

[Traditional medicine in Ethiopia in childhood diseases]. / Traditionelle Medizin in Athiopien bei Erkrankungen im Kindesalter.

Parents of 100 paediatric patients hospitalized in the Gondar College of Medical Sciences were interviewed on their knowledge of and experience with indigenous medicine in the region. The result has provided an orienting review of methods used for common childhood disorders and attitudes towards traditional and modern medicine, resp. and some understanding of ideas of the rural population on the "etiology" of some diseases. Among the methods some are dangerous. Traditional medicine is the primary (and often the only) source of health care for major parts of the population in developing countries. Some knowledge of this system is also necessary for modern style medical staff working in such regions for a variety of reasons. Some of these aspects are discussed.

PIP: The parents and grandparents of 100 pediatric patients hospitalized at the Hospital of the Gondar college of Medical Sciences were interviewed by means of a questionnaire containing personal data, methods of traditional medicine, treatment of 30 widespread diseases and disorders of children, views about probable causes, the diagnosis of the "local healer", and the effectiveness of his treatment. Most of those interviewed came from the Gondar region, and they had an 82% illiteracy rate. 85 of the 100 children had been treated by traditional medicine: 9 experienced improvement, but the condition of 15 worsened as a result. 68% of respondents thought that traditional medicine was more cautious and conservative, 46% cited easy access to it, and 6% the low cost as the reasons for using it. 62% vowed never to use it, though after their hospital experience, still 36% claimed they would turn to the local healer again. Over 80% had uvulectomy done to treat upper respiratory diseases, and circumcision of boys is almost 100% (it is also frequent among girls). Spirits healers are distinguished from local healers: they are Christian Orthodox clergymen who exorcise demons and ghosts. Amulets, arm rings, hair style, eye makeup is supposed to protect from the evil eye. Certain practices are dangerous: application of parts of a plant causing deep necrosis, Embelia shimperi and Hagenia abyssinia used for deforming can be deadly, phlebotomy for meningitis can cause extreme anemia, the use of red-hot iron to treat infections can not only result in scarification but also sepsis. Malnutrition and kwashiorkor is often neglected, as is tuberculosis when the local healer acts. 34 of the 100 patients had TB, 7 of whom had spondylitis. The improvement of hygiene and programs to educate the populace should be implemented.