Cow's milk-based beverage consumption in 1- to 4-year-olds and allergic manifestations: an RCT.

BACKGROUND: Nutrients such as docosahexaenoic acid (DHA), prebiotics and ß-glucan have been associated with reduced incidence of respiratory illnesses and allergic manifestations (AM). Our objective was to assess if consumption of a cow's milk-based beverage with these and other nutrients supports respiratory, gastrointestinal, and skin health in otherwise well-nourished, healthy children. METHODS: In this double-blind, randomized, controlled trial, healthy children (1-4 years of age) from two daycare centers in Brazil were fed three servings/day of a cow's milk-based beverage (CMBB; n = 125) containing DHA, the prebiotics polydextrose (PDX) and galactooligosaccharides (GOS), ß-glucan, and other key nutrients, or a control cow's milk-based beverage (control; n = 131) for up to 28 weeks. Occurrence of respiratory infections, diarrheal disease and AM was assessed by study pediatricians and the number of episodes were analyzed with the Cochran-Mantel-Haenszel test and the Andersen-Gill model. RESULTS: The CMBB group had fewer episodes of AM, which included allergic rhinitis or conjunctivitis, wheezing, allergic cough, eczema and urticaria, compared to the control group (p = 0.021). The hazard ratio for increased number of episodes of AM was lower in the CMBB group compared to control (HR, 0.64; 95 % CI 0.47-0.89; p = 0.007). There was no difference in the incidence of respiratory infections and diarrheal disease between groups. CONCLUSION: A cow's milk-based beverage containing DHA, PDX/GOS, and yeast ß-glucan, and supplemented with micronutrients, including zinc, vitamin A and iron, when consumed 3 times/day for 28 weeks by healthy 1- to 4-year-old children was associated with fewer episodes of allergic manifestations in the skin and the respiratory tract. TRIAL REGISTRATION: registration number: NCT01431469.

The influence of gender on clinical and social characteristics of patients at psychosis onset: A report from the Psychosis Incident Cohort Outcome Study (PICOS).

BACKGROUND. This paper examined the hypothesis that males with first-episode psychosis (FEP) experience lower pre-morbid adjustment, greater social disability and more self-perceived needs at illness onset than females(by controlling for duration of untreated psychosis, diagnosis, age and symptoms at onset). Results disconfirming this hypothesis were thought to suggest the potentially mediating role of social context in determining the impact of symptoms and disability on the everyday lives of male patients in the early phase of psychosis. METHOD. A large epidemiologically representative cohort of FEP patients (n=517) was assessed within the Psychosis Incident Cohort Outcome Study (PICOS) framework ­ a multi-site research project examining incident cases of psychosis in Italy's Veneto region. RESULTS. Despite poorer pre-morbid functioning and higher social disability at illness onset, males reported fewer unmet needs in the functioning domain than females did. An analysis of help provided by informal care givers showed that males received more help from their families than females did. This finding led us to disconfirm the second part of the hypothesis and suggest that the impact of poorer social performance and unmet needs on everyday life observed in male patients might be hampered by higher tolerance and more support within the family context.CONCLUSIONS. These findings shed new light on rarely investigated sociocultural and contextual factors that may account for the observed discrepancy between social disability and needs for care in FEP patients. They also point to a need for further research on gender differences, with the ultimate aim of delivering gender-sensitive effective mental health care.

Use of specific IgE in assessing the relevance of fungal and dust mite allergens to atopic dermatitis: a comparison with asthmatic and nonasthmatic control subjects.

BACKGROUND: Although allergens have been implicated as aggravating factors in atopic dermatitis (AD), there is little epidemiologic data on the significance of specific IgE. OBJECTIVE: We sought to compare sensitization to dust mite and fungi between patients with AD and asthmatic and nonasthmatic control subjects. METHODS: Total IgE and specific IgE to Dermatophagoides pteronyssinus, Alternaria alternata, Aspergillus fumigatus, Candida albicans, Malassezia furfur, and Trichophyton rubrum were measured in 73 patients with moderate to severe AD. Total IgE and IgE specific for D pteronyssinus, A alternata, and M furfur were also measured in sera from 156 asthmatic and 212 nonasthmatic control subjects. RESULTS: Positive correlations were found between total IgE and IgE antibodies specific for each of the antigens. IgE specific for M furfur was observed more frequently in adults compared with children with AD (P <.01). AD sera had higher levels of total IgE and a higher prevalence of positive sera to D pteronyssinus (95% vs 42% and 17% for subjects with AD, asthmatic subjects, and nonasthmatic subjects, respectively), M furfur (53% vs 1% and 0.5%), and A alternata (49% vs 29% and 18%). Among the sera from subjects allergic to mites, the contribution of IgE specific for D pteronyssinus to the total IgE levels was similar regardless of the clinical status. CONCLUSIONS: Our results demonstrate that moderate-to-severe AD is strongly associated with sensitization to dust mite andM furfur (odds ratios, 45.6 and 132 vs pooled control sera). These results suggest that both environmental allergens and colonizing fungi contribute to the severity of disease, which is consistent with the view that mite avoidance and antifungal treatment can be beneficial in the treatment of these patients.

Efficacy and side effects of beta 2-agonists by inhaled route in acute asthma in children: comparison of salbutamol, terbutaline, and fenoterol.

Thirty-seven separate episodes of acute bronchial asthma were studied in 21 asthmatic children. The bronchodilator, cardiovascular, and tremorigenic responses following administration of salbutamol (SAL), terbutaline (TER) and fenoterol (FEN) by closed-port intermittent nebulization were compared for a period of 8 hr. SAL was used at the maximum dose recommended by the manufacturer and TER and FEN at the average doses commonly used in children. Eleven acute attacks were treated with SAL, 12 with TER, and 14 with FEN. Pulmonary function was evaluated by clinical assessment and by the spirometric indices FEV1 and FEF25-75. Tremor was objectively measured, as well as heart rate (HR), respiratory rate, and blood pressure. The onset of bronchodilating effect occurred at 5 min for all three drugs and there were no differences in intensity and duration of bronchodilation between drugs. All three drugs caused rapid onset of tremor (5 min) and this tended to be more intense with SAL. There was a slight decrease in HR in the TER group, whereas SAL and FEN caused increase in HR, with mean values significantly greater than in the TER group from 5 to 30 min after drug administration. Our results indicate that the three short-acting beta 2-agonists studied are equally effective in treatment of acute bronchospasm by the inhaled route in children, in the doses used. Our findings imply that a dose of SAL twice as great as that commonly used by nebulization in children is equipotent to those usually employed for TER and FEN, as far as therapeutic effect is concerned, but it could generate more intense tremorigenic and tachycardic side effects.

Maximum bronchodilator effect of pirbuterol and procaterol administered as sprays with and without an aerochamber.

OBJECTIVE OF THE STUDY: To determine the maximal bronchodilator dose of procaterol and pirbuterol administered by inhalation with an without an aerochamber (Aerocâmera) to children with acute bronchial asthma attacks. TYPE OF STUDY: Prospective. 18 children (6-15 years of age) with acute bronchial asthma attacks (FEV1 < 80% of the predicted value) received pirbuterol (N = 10) or procaterol (N = 8) by metered-dose inhaler, one puff every 5 minutes, for a total of five doses. During another acute attack, the same patient received the same medication with the aid of a spacer (Aerocâmera). Clinical evaluation and pulmonary function tests were performed 5 minutes after each inhaled dose. RESULTS: For both drugs, maximal bronchodilation was obtained after the second dose. No significant side effects were observed even after procaterol doses of 50 micrograms or pirbuterol doses of 1000 micrograms. The results were unaffected by the use of the spacer. CONCLUSIONS: The doses that induced maximal bronchodilation were 400 micrograms pirbuterol and 20 micrograms procaterol. Although the spacer did not change the results, it is a valuable aid for patients who have difficulty in using the metered-dose inhaler (M.D.I.).

Efficacy and side effects of salbutamol in acute asthma in children: comparison of oral route and two different nebulizer systems.

Thirty-five separate episodes of acute bronchial asthma were studied in 21 asthmatic children. The bronchodilator, cardiovascular, and tremorogenic responses following three modes of administration of salbutamol were compared: open continuous nebulization (ON), closed-port intermittent nebulization (CN), and oral route (OR), for a period of 8 hours. Eleven acute attacks were treated by ON, 11 by CN, and 13 by OR. Pulmonary function was evaluated by clinical assessment and by the spirometric indices FEV1 and FEF25-75. Tremor was objectively measured, as well as heart rate (HR), respiratory rate (RR), and blood pressure (BP). Fastest onset of bronchodilator action, maximal response, and longest duration were seen when the drug was administered by the CN. Onset of tremorogenic effect was registered at 5 minutes when salbutamol was used by CN and ON and at 30 minutes when used by OR. During the first 30 minutes, tremor was significantly greater when salbutamol was used by CN than by OR. There were minor cardiovascular effects, except regarding HR after CN, which was significantly greater than after OR, at 5 and 30 minutes. Our findings indicate the inhaled route as the most effective route for administration of salbutamol to treat acute bronchospasm in children. The use of CN is a good alternative to jet nebulizers, but the greater dose of drug effectively administered by this system can briefly cause more tremor and heart acceleration.