Sensitization to cat and dog components and prediction of symptoms in cat-sensitized children.

BACKGROUND: Sensitization to cat and/or dog allergens during childhood represents a risk factor for the development of allergic diseases later in life. OBJECTIVE: The study investigated the association of patterns of sensitization to cat and dog allergen components with clinical symptoms of allergy to these furry animals among cat-sensitized children. METHODS: The children were evaluated for the presence of bronchial asthma, atopic dermatitis and allergic rhinitis. Their mothers completed a questionnaire on pet exposure at home. Levels of serum IgE cat epitopes Fel d (1, 2, 4), as well as dog components Can f (1, 2, 3, 5) were measured in all the studied children. RESULTS: Respiratory symptoms following exposure to the cat allergen were most common in children with Fel d 2 epitope (p = 0.041). After contact with a dog, respiratory symptoms were most common in children with Can f 1 epitope (p = 0.042), atopic dermatitis in children with sensitization to both Can f 1 (p = 0.009) and Can f 2 (p = 0.002), whereas eye symptoms occurred mostly in children with Can f 3 (p = 0.039). CONCLUSIONS: Molecular diagnosis in patients with pet allergy may help clinicians to predict clinical symptoms and their severity.

Dog keeping at home before and during pregnancy decreased the risk of food allergy in 1-year-old children.

INTRODUCTION: The relationship between allergen exposure to animals in pregnancy and the development of allergic symptoms is not clear. AIM: To evaluate the association between prenatal and postnatal exposure to pet ownership and development of atopic dermatitis, food allergy and wheezing in children at the age of 1 and 2. MATERIAL AND METHODS: The mother-child pairs included in this study were part of the Polish Mother and Child Cohort. Mothers in each trimester of pregnancy and 1 year after childbirth have completed a questionnaire on animal exposure. Children's health status was assessed at around one year and two years of age. RESULTS: Keeping a dog at home before and during pregnancy (every trimester) decreased the risk of food allergy in the first year of life. On the other hand, keeping any animal other than a dog (cat, hamster, guinea pig, rabbit) before pregnancy and during each trimester separately increased the risk of food allergy in the first year of life of children. Keeping a guinea pig in the first trimester of pregnancy increased the risk of wheezing in the first year of life. The analysis did not show any significant associations between keeping animals at home before and during pregnancy and the occurrence of atopic dermatitis in the second year of life. CONCLUSIONS: Keeping a dog at home before and during pregnancy decreased the risk of food allergy in 1-year-old children. This effect was eliminated in case of having a cat, hamster, guinea pig, or rabbit.

Maternal Stress During Pregnancy and Allergic Diseases in Children During the First Year of Life.

BACKGROUND: Many recent studies indicate that prenatal maternal distress increases the risk of allergic diseases in children. The mechanisms that favor it are still unclear. OBJECTIVES: We aimed to assess the association between exposure to different kinds of prenatal stress and the occurrence of atopic dermatitis, food allergy, wheezing, and recurrent respiratory tract infections in children. METHODS: The study population consisted of 370 mother-child pairs from a Polish Mother and Child Cohort (REPRO_PL). The analysis was restricted to the women who worked at least one month during the pregnancy period. Maternal psychological stress during pregnancy was assessed based on the Subjective Work Characteristics Questionnaire, the Perceived Stress Scale, and the Social Readjustment Rating Scale. The presence of atopic dermatitis, food allergy, wheezing, and recurrent respiratory tract infections in children was evaluated by doctors at 12 months of age. RESULTS: In a univariate model, we showed significant association between maternal life stress (according to the Perceived Stress Scale) and stressful life events (according to the Social Readjustment Rating Scale) and infant wheezing (at least 1 episode of wheezing during the first year of life). A multivariate model of logistic regression analysis revealed that maternal stress during pregnancy, described by the Social Readjustment Rating Scale, increased the risk of wheezing in children (OR 1.09, 95% CI 1.01-1.02) independently from other predictors of wheezing previously determined in this cohort, such as the number of infections and maternal smoking. We observed also significant positive association between maternal life stress during pregnancy measured by the Perceived Stress Scale and the risk of recurrent respiratory tract infections in the first year of life, however it was not significant after adjustment for confounding variables. CONCLUSIONS: Maternal stress during pregnancy increases the risk of childhood wheezing. The effects of stress during pregnancy on the onset of allergic diseases in children should be developed and translated into early prevention strategies.

Predictors of deterioration of lung function in Polish children with cystic fibrosis.

INTRODUCTION: Severity of lung disease varies in patients with the same CFTR genotype. It suggests that other factors affect the severity of cystic fibrosis (CF). The aim of the study was to identify risk factors that determine lung function decline in Polish cystic fibrosis children. MATERIAL AND METHODS: The follow-up time was no less than 5 years of respiratory status observation based on the forced expiratory volume in 1 s value (FEV1). The socio-economic data, perinatal interview, presence of meconium ileus (MI), time of CF diagnosis, initiation of tobramycin inhalation solution (TIS), pancreatic function, sensitization to Aspergillus fumigatus, presence of impaired glucose tolerance (IGT) or diabetes mellitus, chronic bacterial colonization and number of exacerbations and hospitalizations were assessed. RESULTS: The mean age of 61 included children was 13.3 ±7.6 years. Delta F508 homozygosity was detected in 45.9%, 44.3% were delta F508 heterozygous, and 9.8% had other genotypes. FEV1 decline was observed among 20% of patients; the rest of the patients presented stable values of FEV1 during at least 5 years of observation. The most significant predictors related to the decline of FEV1 were presentation of MI (p = 0.0344), IGT (p = 0.0227), number of exacerbations (p = 0.0288), and early Pseudomonas aeruginosa (PA) chronic colonization (p = 0.0165) followed by late TIS initiation after the first detection of PA (p=0.0071). Neither time of diagnosis nor type of CFTR mutation was statistically significant as a predictor of lung deterioration. CONCLUSIONS: The presence of MI, IGT, chronic PA colonization, and number of exacerbations are risk factors for lung function deterioration.

School environmental factors are predictive for exercise-induced symptoms in children.

BACKGROUND: Environmental factors in schools have a significant effect on the exercise-induced bronchoconstriction and symptoms in a general paediatric population. OBJECTIVES: To determine the environmental factors such as atmospheric conditions and the presence of allergens in gymnasiums, that could be predictive of the presence of exercise-induced symptoms/bronchospasm in children during physical education (PE). METHODS: 1370 schoolchildren were enrolled. Children attended 45 min PE lesson with similar exercise intensity. Pulmonary function tests were performed before and after PE lesson. Air temperature, humidity and pressure, samples of dust for allergen exposure in the gymnasiums were taken. Children who reported symptoms induced during PE lesson were invited to the clinic for ETC (exercise treadmill challenge) and atopy measurement. RESULTS: 1033 participants were included into the analysis. Sixty seven(6.5%) children reported dyspnea/cough, and in 94(9.4%) children bronchoconstriction induced during PE lesson was documented. There is a correlation between the results of the ETC and bronchoconstriction after PE (OR: 2.55; 95%CI: 1.07-6.05; p = 0.034). Exposure to higher air pressure and higher humidity independently increase the risk of clinical symptoms reported during or after PE lesson. Exposure to cat's allergens increase the risk of bronchoconstriction (independently from atopy status). We showed significant interaction between presence of asthma and current ICS therapy as a risk of physical inactivity at school (OR: 4; 95%CI: 1.3-12; p < 0.001). CONCLUSION: This study showed an effect of cat allergen and environmental factors (humidity, air pressure) on the appearance of exercise related cough/bronchoconstriction during activity class in a natural environment at school in a large urban population of schoolchildren.

Exhaled nitric oxide correlates with IL-2, MCP-1, PDGF-BB and TIMP-2 in exhaled breath condensate of children with refractory asthma.

INTRODUCTION: There is evidence that parameters obtained from exhaled breath condensate (EBC) reflect changes in the level of the airway lining fluid. The telation between exhaled nitric oxide (NO) and EBC inflammatory markers has not been analyzed in the context of the inflammatory profile in the airways in asthmatic children. AIM: To show the cytokine profile in EBC of children with severe/refractory asthma as well as correlations between the fractional exhaled NO (FeNO) level and cytokine concentrations. MATERIAL AND METHODS: The study population consisted of eight children aged 8 to 17 years with IgE-dependent, severe/refractory asthma with a duration of at least 2 years. This was an observational study, the first consecutive eight patients with asthma symptoms on the day of the study visit, when EBC samples were obtained. RESULTS: The inter-subject variability of study cytokines ranged from 8.6 to 54.6. Cytokines with coefficient of variation < 20% were: interferon-γ, interleukins IL-2, IL-7, IL-15, IL-16, monokine induced by interferon γ (MIG) and tumor necrosis factor α. We showed a significant positive correlation between the FeNO level and crucial mediators in asthma development and progression (IL-2, MCP-1), and potent markers of airway remodeling (PDGFBB, TIMP-2). All correlations between two different variables were controlled for the effects of age, forced expiratory volume in 1 s and number of asthma exacerbations during last 12 months. CONCLUSIONS: The profiling of cytokine expression in EBC can be reproducibly performed in children with severe/refractory asthma. When treating asthma in children, the FeNO level should be monitored as a prevention strategy of the progression of the remodeling leading to refractory/severe asthma. Exhaled breath condensate may be a useful tool to phenotype asthma via a non-invasive approach.

Do children with stable asthma benefit from addition of montelukast to inhaled corticosteroids: randomized, placebo controlled trial.

BACKGROUND: To determine the effects of montelukast added to maintenance inhaled steroids (ICS) therapy during the school year in children with stable asthma on the ICS use, frequency of exacerbations, lung function, asthma symptoms, fractional exhaled nitric oxide (FeNO) level and exercise-induced bronchoconstriction (EIB). METHODS: Seventy six asthmatic children aged 6-14 years, allergic to house dust mites were randomized to a double-blinded trial comparing montelukast therapy to a matching placebo. We studied following end-points: the reduction in the ICS dose, the frequency of exacerbations, lung function, asthma control test score, and the change from baseline in FEV1 during a standardized exercise treadmill challenge. ICS dose was adjusted in a stepwise fashion to determine the lowest dose necessary to control asthma symptoms. RESULTS: We showed that children with baseline value of FeNO above 31 ppb and well controlled asthma symptoms on low doses of ICS, benefit the most from additive therapy with montelukast; their cumulative ICS dose is lower than in children treated with ICS only. Also, the addition of montelukast to regular treatment in asthmatic children resulted in a significant reduction in the frequency of exacerbations and EIB protection. CONCLUSION: It is reasonable to add montelukast to ICS therapy in asthmatic children during the school year, to lower cumulative ICS dose in children with well controlled asthma symptoms, as well as to reduce number of exacerbations, and to achieve better control of EIB. TRIAL REGISTRATION: NCT01266772.

Prevalence of exercise-induced cough in schoolchildren: a pilot study.

Association between exercise-induced bronchoconstriction (EIB) and physical activity has not been investigated in a natural school environment in a general pediatric population. Our objective was to determine the prevalence of exercise-induced symptoms (cough, wheeze, chest tightness, dyspnea) and bronchospasm among schoolchildren during physical education (PE). A total of 557 schoolchildren from seven public schools were enrolled. Information regarding demographic characteristic, previously diagnosed asthma was obtained. All children attended 45-minute PE lesson with similar exercise intensity. Pulmonary function tests were performed before and immediately after PE lesson. The diagnosis of EIB was defined as a forced expiratory volume in one second (FEV1) decrease from baseline of more than or equal to 10% with exercise. Cough and dyspnea after exercise were recorded. A total of 557 participants were included into the analysis. After PE lesson, 15.3% children suffered from cough, 0.9% reported dyspnea, and 10.1% had more than 10% fall in FEV1 from baseline. Among all participants, 5.9% had doctors' diagnosed asthma, 4.8% of them were treated with inhaled corticosteroids (ICS). Among children with cough, 21.5% had asthma and 17.6% experienced EIB. Among asthmatics, 48.6% suffered from cough and 18.2% had more than 10% fall in FEV1 from baseline after PE lesson. EIB was not affected by age, gender, body mass index, asthma diagnosis, and ICS use. Only cough (odds ratio: 2.21, 95% confidence interval: 1.16-4.23; p = 0.0161) was independently associated with EIB. This study showed a high prevalence of exercise-induced cough and/or 10% fall in FEV1 during activity lesson in a natural school environment in a large urban population of schoolchildren. Our results call for another studies addressing the impact of environment on exercise-induced symptoms.

Risk factors for the development of atopic dermatitis and early wheeze.

A global assessment of allergic diseases and prenatal and postnatal exposure to various environmental risk factors is needed to enable early prevention of allergic diseases. This study was designed to evaluate an inner-city urban birth cohort to identify early environmental factors associated with atopic dermatitis and food allergy, as well as the incidence of wheezing during the 1st year of life. We evaluated 501 children from the Polish Mother and Child Cohort Study (2007-2011). The children's health, socioeconomic status, and housing conditions were assessed using a questionnaire. Exposure to tobacco was assessed based on questionnaire data and cotinine measurements. Multiple regression analysis showed that parental atopy, higher paternal education, and more frequent house cleaning significantly predicted atopic dermatitis in the 1st year of life; odds ratio (OR) for the variables was 2.7 (95% CI, 1.3-1.57), 2.8 (95% CI, 1.5-5.0), and 1.8 (95% CI, 1.1-2.9), respectively. Keeping a pet at home during pregnancy increased the risk of food allergy (OR, 1.48; 95% CI, 1.02-2.16). Longer breast-feeding decreased the risk of both food allergy (OR, 0.88; 95% CI, 0.82-0.95) and atopic dermatitis (OR, 0.9; 95% CI, 0.8-0.95) in the 1st year of life. Positive association between maternal exposure to increased concentrations of particulate matter 10 and atopic dermatitis in univariate analyses was found. Atopic dermatitis/food allergy and wheezing/inhaled corticosteroid use had distinct risk factors. The risk factor profile of atopic dermatitis/food allergy in early childhood that is defined in this study support the following recommendations: (i) longer breast-feeding, (ii) avoid pets during gestation, (iii) avoid too frequent house cleaning, and (iv) living in an area with decreased traffic density. This study was a part of the clinical trial NCT01861548 registered in www.clinicaltrials.gov.

Predictive value of fractional nitric oxide in asthma diagnosis-subgroup analyses.

BACKGROUND: There are no studies investigating the benefit of using FeNO measurements in correlation with sensitization to perennial and seasonal allergens in children with asthma. OBJECTIVE: To define the group of children with respiratory symptoms in whose FeNO measurement has predictive value for asthma. We assessed the effect of age, allergy profile, atopy, lung function and the presence of allergic rhinitis on interpretation of FeNO levels for clinical applications. METHODS: It was a retrospective, cross-sectional study. We evaluated data from medical documentation of 1767 children with symptoms of allergic diseases such as asthma and/or allergic rhinitis. We included in the analyses subjects who had the following tests done during diagnostic procedures (single measurement): FeNO, spirometry, specific IgE results. All subjects had undergone a minimum 3-years prospective clinical observation after the first FeNO measurement until the later assignment (or not) of an asthma/allergic rhinitis diagnosis. RESULTS: We included 1767 children into the analysis; asthma diagnosis was confirm in 1054 (59.6%) children. We showed that only atopy (OR: 1.9; 95%CI: 1.5-2.4) and presence of allergic rhinitis (OR: 1.6; 95%CI: 1.4-1.9) were independently associated with increased FeNO level. Only among patients with atopy and allergic rhinitis FeNO level (above 23 ppb) was associated with asthma diagnosis. Sensitivity, specificity, positive predictive value and negative predictive value of FeNO >23 ppb for asthma diagnosis were as follows: 0.9(95%CI: 0.68-0.98), 0.52(95%CI: 0.42-0.61), 0.25(95%CI: 0.16-0.37), 0.97(95%CI: 0.88-0.99). CONCLUSION: We showed that in children with atopy and with allergic rhinitis a negative predictive value for asthma diagnosis was very high with the optimal cut-off point of FeNO 23 ppb. Therefore we showed the utility of FeNO measurements to exclude asthma in the subgroup of patients with atopy and allergic rhinitis.

Transforming growth factor-beta1 and IL-13 response to allergen predict steroid needs in asthmatic children.

BACKGROUND: The remission of asthma, which is induced during specific immunotherapy (SIT) or appears spontaneously in children is not completely understood and predictors of this phenomenon are still undefined. OBJECTIVE: To assess CD4(+)CD25(+)Foxp3(+) Treg cells and cytokine/proliferation response to allergen-specific stimulation of PBMC as predictors of steroid sparing effect of SIT and steroid dosage needs without SIT during 5 years of follow-up in asthmatic children. METHODS: This is a 5-year long study of 32 asthmatic children, sensitive only to house dust mite (HDM). Eighteen children who had completed 5 years of HDM SIT - SIT group, and 14 children without SIT as a control group were studied. All patients had baseline clinical/immunological assessment; before and after observation the minimum effective ICS dose was defined and lung function was measured. RESULTS: In children from SIT group minimum effective ICS dose was reduced more than in children from control group (median reduction 65% vs. 0%; p<0.001). Among patients in control group asthma severity was reduced after 5 years of observation in those who had at baseline higher TGF-beta1 and lower IL-13 answer to allergen stimulation of PBMC. Better response to 5 years immunotherapy was observed in those who had at baseline higher TGF-beta1 and lower proliferation answer to allergen stimulation of PBMC. CONCLUSION: Similar processes may decide on both, SIT-induced and spontaneously appearing, reduction in asthma severity. Immunotherapy was much more effective than pharmacotherapy in our study. IL-13 overproduction may impede reduction of disease severity in asthmatic children independently from TGF-beta pathway.

Correlation of vitamin D with Foxp3 induction and steroid-sparing effect of immunotherapy in asthmatic children.

BACKGROUND: Vitamin D promotes different toleragenic processes of the immune system; however, its role in allergen specific immunotherapy (SIT) is still undefined. OBJECTIVE: To determine whether the immunologic and clinical effectiveness of allergen SIT depends on the serum level of 25-hydroxyvitamin D (25[OH]D) and its changes during SIT in asthmatic children. METHODS: This is a retrospective secondary analysis of pooled data obtained from our 2 recently published prospective, randomized, placebo-controlled trials on asthmatic children undergoing allergen immunotherapy. Both trials, which assessed the effect of different pharmacologic modulation of SIT effectiveness, were conducted according to the same study protocol. Children from the placebo arms in these trials were treated with immunotherapy only and were included in the present analysis. The study population consisted of 36 children. Data concerning clinical (asthma symptoms score and percent change in minimal daily inhaled corticosteroid dose) and immunologic parameters (including serum level of 25[OH]D) were analyzed in all patients. RESULTS: Patients with a higher serum level of 25(OH)D experienced more significant reduction in asthma symptoms score and steroid-sparing effect of SIT and had higher transforming growth factor â production and higher Foxp3 induction during SIT. Steroid-sparing effect correlated with 25(OH)D serum level at baseline, after 3 months of SIT, and with the changes in serum level of 25(OH)D during the build-up phase of SIT. Better response to SIT was observed among children with an 25(OH)D serum level higher than 30 ng/mL. CONCLUSION: The efficacy of allergen SIT correlates with 25(OH)D serum concentration. It seems that a serum level of 25(OH)D higher than 30 ng/mL facilitates the optimal effect of allergen immunotherapy.

Comparison of the long-term efficacy of 3- and 5-year house dust mite allergen immunotherapy.

BACKGROUND: The recommended duration of specific immunotherapy (SIT) treatment relies on empiric data and is not well documented. OBJECTIVE: To detect possible differences in the long-term effectiveness between 3 and 5 years of house dust mite (HDM) SIT in asthmatic children. METHODS: We performed a 3-year natural history study of 90 asthmatic children who were sensitive only to HDM. Three groups were recruited: 30 who had completed 3 years of HDM SIT (SIT3), 30 who had completed 5 years of HDM SIT (SIT5), and 30 who had an indication for HDM SIT but whose parents refused HDM SIT. Patients attended an enrollment visit in 2007, after SIT discontinuation, and 3 annual follow-up visits at the clinic. The long-term effectiveness of HDM SIT was primarily assessed via analysis of the reduction in required inhaled corticosteroid dose, forced expiratory volume in 1 second, and asthma remission. RESULTS: A total of 84 children completed the study. Both SIT durations produced excellent results; asthma remission in both SIT3 (50%) and SIT5 (54%) groups was significantly higher when compared with control (3.3%). The minimal controlling inhaled corticosteroid dose reduction in SIT5 group (median, 75%) was significantly higher compared with the SIT3 group (median, 50%) after immunotherapy discontinuation; after 3 years without SIT, no differences were found between the SIT5 and SIT3 groups (median, 100% and 94%, respectively). We observed a slightly higher increase in forced expiratory volume in 1 second in the SIT5 group compared with the SIT3 group. CONCLUSION: Three years of SIT is an adequate duration for the treatment of childhood asthma associated with HDM allergy because 2 further years of SIT added no clinical benefit.

Pediatric asthma caregiver's quality of life questionnaire is a useful tool for monitoring asthma in children.

PURPOSE: There is little agreement among researchers whether a caregiver's QOL can be used to detect changes in asthma severity in children. We assessed correlation between QOL in parents and QOL in children with asthma as well as clinical parameters of asthma. We determined whether changes in caregiver's QOL scores reflect changes in child's QOL and their asthma control. METHODS: This was a 9-week period cohort study. One hundred and ten primary caregivers with 110 children were seen in the clinic at enrollment, at week #1, #5 and #9. At each visit, the parents completed the pediatric asthma caregiver's quality of life questionnaire (PACQLQ). RESULTS: One hundred and one children and 101 caregivers completed the study. We found a significant correlation between asthma diary score in children and QOL in parents (from r = -0.46 to r = -0.53). We also found significant positive correlation between PAQLQ and PACQLQ and significant association between changes in asthma control and PACQLQ score for both domains. We observed significant change in PACQLQ of caregivers whose children obtained asthma control. CONCLUSIONS: PACQLQ is a useful tool for monitoring asthma in children. The implementation of the PACQLQ would be helpful in involving parents in therapy of their children with asthma.

Decreased markers of atopy in children with presumed early exposure to allergens, unhygienic conditions, and infections.

BACKGROUND: Several risk factors for the development of asthma and atopic disease in children have been described. Furthermore, there is consistent evidence that the prevalence of atopy increases with higher socioeconomic status. The knowledge about risk factors and preventive factors for atopy needs to be improved. OBJECTIVE: To compare 2 child populations (foster care and reference children) with different risk and protective factors for the development of atopy. METHODS: The study group consisted of 415 children, living in all 10 community foster homes in Lodz, a large industrial city in Poland. The study was performed from April 2, 2004, to April 30, 2006. The reference group consisted of 500 children, living with their parents at home, recruited from primary care centers. The primary outcome measures were skin prick test results and specific IgE in serum. Secondary outcomes included symptoms of allergic diseases and family history, including life conditions in early childhood. RESULTS: The full analysis set included 408 study children and 402 reference children. Significant differences were observed in the prevalence of atopy between the study and reference groups (11.3% vs 25.9%). We observed more positive skin prick test results in children from the reference group than in study children. To explain this phenomenon, we selected 16 variables that differ in both groups in early life and relate these to atopy. We found that the more cumulative features characteristic of the foster home population (poor living conditions), the lower the risk of atopy. CONCLUSION: Extremely unfavorable environmental circumstances, which are characteristic of the foster home population during early childhood, might prevent from atopy.

[Prevalence of atopy and atopic diseases in children living in an orphanage in Lodz area--pilot study]. / Czestosc wystepowania atopii i chorób atopowych u dzieci z lódzkich domów dziecka--badanie pilotazowe.

UNLABELLED: Over the past three decades there has been an increase in the prevelance of allergic diseases, specially among children. THE AIM OF THE STUDY: was to estimate the prevalence of atopy and atopic diseases in children who are living in orphanages in Lodz. MATERIAL AND METHODS: 120 children 5-18 years old living in 2 orphanages were studied. Main outcome measures were history, physical examination, FEV1, skin prick-test results with 18 allergens; peripheral blood eosinophil count, level of total and specific IgE in children with positive skin-test results were secondary and point. RESULTS: Bronchial asthma was diagnosed in 5.83% (6 of 120) patients, seasonal allergic rhinitis was diagnosed in 2.5% (3 of 120) patients and atopic dermatitis was diagnosed in 1.67% (2 of 120) patients. The skin prick-tests were positive in 12.5% children. Mean number of respiratory tracts infection in early childhood was significantly lower in atopic children than in non-atopic children--3.3 +/- 2,3 vs 8.7 +/- 2.5 (p<0.001). Mean total serum IgE concentration value reached upper limit in 26.6% of non-atopic patients and in 32.4% non-atopic children peripheral blood eosinophil count was significantly increased suggesting possible presence of active helminth infection, what might protect against atopy. CONCLUSION: In children living in orphanages we observed the lower prevalence of atopy (12.5%) and atopic diseases than in general population (25.4-40.2%).

[Pregnancy in cystic fibrosis patients--investigational study]. / Ciaza u kobiet chorych na mukowiscydoze--badanie ankietowe.

AIM: The purpose of this study was to investigate the consequences of pregnancy on women with CF and to clarify the impact of the disease on newborn health. METHODS: It was a retrospective study; a postal questionnaire was sent to 12 woman having a registered pregnancy in National Cystic Fibrosis Registry between 1984 and 2004 (2 to 23 years after delivery). RESULTS: There was a 100% response rate. 16 pregnancies have been reported (4 patients had two pregnancies); there were 16 live births of which 11 (69%) were premature, 10 (62%) of newborns had low weight. There was one neonatal death. The mean prepregnancy FEV1 (% predicted) and BMI (kg/m2) were 56,6 +/- 14,8% (range 35-95) and 19,9 +/- 1,5 (range 18-23) respectively. The mean FEV1 during pregnancy was 47,7 +/- 15,1% (range 23-87), mean maternal weight gain during pregnancy was 5,5kg. There was a significant decline in FEV1 during pregnancy (16.6 +/- 6,4%, p<0.05) as compared to prepregnancy values. Two women had diabetes mellitus and two developed gestational diabetes. Mean postpregnancy (12 months after delivery) FEV1 was 54.1 +/- 18.8% (range 22-103) and mean BMI was 18.7 +/- 1.8 kg/m2 (range 15-22). There was a significant postpregnancy decline in FEV1 (6.2 +/- 10.6%, p=0.027) and in BMI (1 +/- 1.14 kg/m2, p<0.01) as compared to prepregnancy values. Microbiological status remains unchanged. 11 patients are alive; one patient died 11 years after delivery. The mean follow up time was 8.5 +/- 3.6 years (range 2-23). CONCLUSIONS: Pregnancy was well tolerated in our population of CF women, although affected the rate of yearly decline in FEV1 and BMI. Increased risk of premature and low newborn weight were observed. All pregnancies in CF women should be planned and monitored by CF team.