Evolutionary lung function evaluated by impulse oscillometry in preschoolers with asthma. / Función pulmonar evolutiva evaluada por oscilometría de impulso en prescolares con asma.

INTRODUCTION: Impulse oscillometry (IOS) is useful for measuring lung function in preschool children. Our objec tive was to describe the alterations and evolutionary profile of IOS in asthmatic children under 6 years of age after one year of follow-up. PATIENTS AND METHOD: 62 preschoolers performed IOS at the begin ning of the study and after one year. The proportion of altered IOS and bronchodilator response (BR +) at both times was compared, in addition to sub-analysis according to asthma control and presence of atopy. For the statistical analysis, we used McNemar's %2 and the Student's t-test with a 5% a error. RESULTS: The initial IOS was altered in 80.6% and in 64.5%% after one year (p = 0.04). 77.4% of the children presented BR+ at the beginning of the study and 83.9% after one year. The uncontrolled asthma group presented a significant improvement in the X5 and D5-20 means, but the controlled asthma group did not. In atopic patients, only uncontrolled asthmatics improved X5, AX, and D5-20. CONCLUSION: IOS shows alterations in a high percentage of preschoolers with uncontrolled asthma, which decreases significantly at one year, but remains altered and with BR + in most children. Ad ditional studies are required to identify different preschool asthma phenotypes and their evolution with treatment.

[Dietary pattern, asthma, and atopic and non-atopic wheezing in children and adolescents: SCAALA study, Salvador, Bahia State, Brazil]. / Padrão alimentar, asma e sibilo atópico e não atópico em crianças e adolescentes: estudo SCAALA, Salvador, Bahia, Brasil.

A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.

Padrão alimentar, asma e sibilo atópico e não atópico em crianças e adolescentes: estudo SCAALA, Salvador, Bahia, Brasil / Dietary pattern, asthma, and atopic and non-atopic wheezing in children and adolescents: SCAALA study, Salvador, Bahia State, Brazil / Patrón dietético, asma y sibilancias atópicas y no atópicas en niños y adolescentes: estudio SCAALA, Salvador, Bahía, Brasil

Avaliou-se, em estudo transversal, a influência do padrão alimentar sobre a ocorrência de sibilo e asma atópica e não atópica em 1.168 crianças e adolescentes em Salvador, Bahia, Brasil. Sibilo e sintomas de asma nos últimos 12 meses foram obtidos por meio do questionário ISAAC. Atopia foi definida pela presença de IgE específica a aerolérgenos. Questionário de frequência alimentar foi usado para definir padrões alimentares. Empregou-se regressões logística e logística politômica multivariadas. O consumo de pescados reduziu a ocorrência de sibilo em 27% (IC95%: 0,56-0,94) e asma em 37% (IC95%: 0,47-0,83); asma não atópica em 51% (IC95%: 0,31-0,79) e sibilo não atópico em 38% (IC95%: 0,46-0,83). O maior tercil do padrão alimentar reduziu o sibilo em 27% (IC95%: 0,57-0,95), sibilo atópico em 46% (IC95%: 0,30-0,98), asma em 36% (IC95%: 0,49-0,83) e asma atópica em 50% (IC95%: 0,28-0,89). O consumo de pescados pode conferir efeito protetor para sibilo e asma não atópica e o padrão alimentar para sibilo e asma atópica.

A cross-sectional study was conducted on dietary patterns and their influence on the occurrence of wheezing and atopic and non-atopic asthma in a sample of 1,168 children and adolescents in Salvador, Bahia State, Brazil. Wheezing and asthma symptoms in the previous 12 months were obtained using the ISAAC questionnaire. The presence of aeroallergen-specific IgE was identified. A food frequency questionnaire was used to define dietary patterns. The study applied logistic regression and multinomial polytomous logistic regression. Fish consumption was associated with a 27% reduction in wheezing (95%CI: 0.56-0.94), 37% in asthma (95%CI: 0.47-0.83), 51% in non-atopic asthma (95%CI: 0.31-0.79), and 38% in non-atopic wheezing (95%CI: 0.46-0.83). The highest tertile of dietary patterns reduced wheezing by 27% (95%CI: 0.57-0.95), atopic wheezing by 46% (95%CI: 0.30-0.98), asthma by 36% (95%CI: 0.49-0.83), and atopic asthma by 50% (95%CI: 0.28-0.89). Fish consumption may thus have a protective effect against wheezing and non-atopic asthma and dietary pattern against atopic asthma and wheezing.

Este estudio transversal se llevó a cabo para estudiar la influencia de los hábitos alimentarios en la aparición del asma y sibilancias atópicas y no atópicas en una muestra de 1.168 niños y adolescentes en Salvador, Bahía, Brasil. Las sibilancias y síntomas de asma en los últimos 12 meses se han obtenido a partir del cuestionario ISAAC. Se identificó la presencia de IgE específica de alérgeno aéreo. Se utilizó un cuestionario de frecuencia de alimentos para definir hábitos alimentarios. Se aplicó la regresión logística y el modelo logístico multinomial. El consumo de pescado redujo las sibilancias en un 27% (IC95%: 0,56-0,94) y el asma en un 37% (IC95%: 0,47-0,83), las sibilancias atópicas en un 51% (IC95%: 0,31-0,79) y no atópicas en un 38% (IC95%: 0,46-0,83). El tercil más alto de los hábitos alimentarios reduce sibilancias en un 27% (IC95%: 0,57-0,95), sibilancias atópicas en un 46% (IC95%: 0,30-0,98), el asma en un 36% (IC95%: 0,49-0,83) y un 50% en el asma atópico (IC95%: 0,28-0,89). El consumo de pescado puede promover un efecto protector, dentro el patrón de dieta, contra sibilancias atópicas y no atópicas y asma.

[Utility of challenge test in immediate hypersensitivity to hydrocortisone sodium succinate]. / Utilidad de la prueba de reto en hipersensibilidad inmediata a succinato sódico de hidrocortisona.

Corticosteroid hypersensitivity is a complex phenomenon in which many factors interact, such as idiosyncrasy, intolerance or allergic reactions. The prevalence of immediate hypersensitivity reactions to corticosteroids is 0.2%-0.5%. Corticosteroids have major therapeutic implications; thus, when hypersensitivity is suspected, in-vitro and/or in-vivo testing can be performed to confirm diagnosis, being the drug challenge the gold standard. After definitive diagnosis, cross-reactivity among the different corticosteroid groups should be considered, to choose wisely if corticosteroid therapy is still required. In Coopman classification, steroids belonging to groups A, B and D2 have high cross-reactivity, however, more studies are needed to determine the degree of cross-reaction among these drugs. This paper presents the case of a woman, in who hypersensitivity to hydrocortisone succinate was confirmed by drug challenge test.

La hipersensibilidad a corticoesteroides es un fenómeno complejo en el que interactúan múltiples factores como idiosincrasia, intolerancia o alergia. La prevalencia de las reacciones de hipersensibilidad inmediata a corticoesteroides es de 0.2 a 0.5%. Debido a la relevancia terapéutica de los esteroides, es importante confirmar el diagnóstico de hipersensibilidad con pruebas in vivo, in vitro, o ambas, el patrón de referencia es la prueba de reto con el fármaco implicado. Una vez realizado el diagnóstico y en caso de que se requiera continuar con el tratamiento con esteroides, deberá considerarse la reactividad cruzada entre los diferentes grupos propuestos en la clasificación de Coopman, en la que los corticoesteroides pertenecientes a los grupos A, B y D2 tienen una elevada reactividad cruzada entre sí; sin embargo, hacen falta más estudios para determinar el grado de reactividad cruzada entre estos fármacos. Comunicamos el caso de una paciente en la que se confirmó el diagnóstico de hipersensibilidad a succinato de hidrocortisona con la prueba de reto.

Basophils and allergic inflammation.

Basophils were discovered by Paul Ehrlich in 1879 and represent the least abundant granulocyte population in mammals. The relative rarity of basophils and their phenotypic similarities with mast cells resulted in this cell lineage being historically overlooked, both clinically and experimentally. However, recent studies in human subjects and murine systems have shown that basophils perform nonredundant effector functions and significantly contribute to the development and progression of TH2 cytokine-mediated inflammation. Although the potential functions of murine and human basophils have provoked some controversy, recent genetic approaches indicate that basophils can migrate into lymphoid tissues and, in some circumstances, cooperate with other immune cells to promote optimal TH2 cytokine responses in vivo. This article provides a brief historical perspective on basophil-related research and discusses recent studies that have identified previously unappreciated molecules and pathways that regulate basophil development, activation, and function in the context of allergic inflammation. Furthermore, we highlight the unique effector functions of basophils and discuss their contributions to the development and pathogenesis of allergic inflammation in human disease. Finally, we discuss the therapeutic potential of targeting basophils in preventing or alleviating the development and progression of allergic inflammation.

Clinical characteristics and possible phenotypes of an adult severe asthma population.

BACKGROUND: Currently, there are no studies of well-characterized severe asthmatics in Brazil. We aimed to study a population of severe treated asthmatics still uncontrolled to characterize them and define possible phenotypes. METHODS: Descriptive cross-sectional outpatient study of severe asthmatics, evaluating functional and inflammatory markers, health-related quality of life, anxiety and depression symptoms, clinical control status, and characteristics related to atopy, age of asthma onset, induced sputum eosinophil levels, and airflow limitation. We also grouped the subgroups characteristics to identify phenotypes. The study is registered on ClinicalTrial.gov NCT 01089322. RESULTS: From 128 eligible patients with severe/uncontrolled asthma, 74 fulfilled the inclusion criteria. The cohort was comprised of 85% women, frequently with a body mass index higher than 31 kg m(-2), atopy (60%), early-onset disease (50%), sputum eosinophilia (80%), comorbidities, and reduced quality of life. Nonatopics had significant higher asthma onset (19 y.a.) and twice level of induced sputum eosinophil. Late-onset patients had significantly less atopy (57%) and higher levels of induced sputum eosinophils. Non-eosinophilics had lower levels of inflammatory markers. Patients with airflow limitation had more intensive care unit admissions (56%) and 1.5 times more airway resistance. Subgroups characteristics identified a priori four well-characterized phenotypes, with 55% presenting sputum eosinophilia. CONCLUSION: Our data emphasize the high burden of disease, the persistence of inflammation and the existence of clinical possible phenotypes population sharing common features with published cohorts. Despite the necessity of further investigation into pathogenic mechanisms, this study with clinically difficult patient group may help to improve future asthma care.

Bronchial hyperreactivity to methacholine in atopic versus nonatopic asthmatic schoolchildren and preschoolers.

BACKGROUND: Atopy and bronchial hyperreactivity are factors related to severe and unremitting asthma of childhood; however, the prevalence of these factors could be different according to age of the child. OBJECTIVE: To determine if methacholine bronchial hyperreactivity (BHR) differs between atopic and nonatopic preschoolers and schoolchildren with mild-moderate asthma. METHODS: Data obtained from 340 children with diagnosis of asthma or recurrent wheezing, matched by atopic conditions (positive or negative skin prick test) and age, and who underwent a methacholine bronchial challenge test (by spirometry in schoolchildren and by transcutaneous oxygen pressure [TcP(O2)] in preschoolers) were reviewed. RESULTS: Among 136 schoolchildren (9.07 ± 2.5 years), the prevalence of positive BHR was significantly higher among atopics than nonatopics (75% versus 48.5%, p = .001, respectively), even after controlling for gender and nutritional status (adjusted odds ratio [aOR] = 3.2129, 95% confidence interval [CI]: 1.5-6.8; p = .002). In addition, atopic schoolchildren had lower PC(20) and required a lower threshold dose of methacholine to induce a reaction (0.53 versus 0.82 mg/ml, p = .055 and .5 versus 1 mg/ml, p = .02, respectively) than nonatopics. Nevertheless, basal and predicted forced expiratory volume in one second (FEV1) were similar between groups. In contrast, among 204 preschoolers (4.74 ± 1.1 years), there were no differences in the prevalence of positive BHR between atopics and nonatopics (74.5% versus 72.5%, p = .75, respectively). Furthermore, basal TcP(O2), a higher fall of TcP(O2) and lower threshold doses of methacholine required for induction as measured by TcP(O2) were similar between the atopic and nonatopic preschoolers. CONCLUSIONS: Atopic asthmatic schoolchildren have greater hyperresponsiveness to methacholine than nonatopics (only among those with normal nutritional status). However, atopic and nonatopic asthmatic preschoolers have similar hyperresponsiveness to methacholine. Therefore, factors different from atopy may be responsible for wheeze in younger children.

Increased total and mite-specific immunoglobulin E in patients with aspirin-induced urticaria and angioedema.

BACKGROUND: An increased prevalence of atopy has been observed in patients with intolerance of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). OBJECTIVE: To investigate total and mite-specific immunoglobulin (Ig) E in serum from patients with hypersensitivity to NSAIDs and healthy controls. METHODS: Patients who reacted to 2 or more chemically unrelated NSAIDs with urticaria and angioedema, confirmed by a double-blinded provocation test with aspirin, were skin tested with inhalant allergens. Total and specific IgE to Dermatophagoides pteronyssinus (Dp) and Blomia tropicalis (Bt) in the serum was quantified by enzyme-linked immunosorbent assay (ELISA) in patients and a control group of healthy blood donors. RESULTS: One-hundred-and-fourteen patients and 74 controls were studied. Skin tests were positive in 95 patients (83.3%). Total mean IgE levels were 107.1 (91.3) IU/mL in controls and 161.0 (150.8) IU/mL in patients (P = .006). Mean (SD) levels of IgE to Dp were 0.210 (0.17) optical density (OD) units in controls and 0.473 (0.65) OD units in patients (P = .001). Levels of specific IgE to Bt were 0.230 (0.20) OD units in controls and 0.522 (0.8) OD units in patients (P =.0001). Positive ELISA results for IgE to Dp were found for 29.6% of controls and 70.4% of patients (P =.0001); the corresponding percentages for Bt were 32.4% of controls and 67.6 % of patients (P = .0001). CONCLUSIONS: Cross-reactive patients with NSAID-induced urticaria and angioedema exhibit an increased prevalence of sensitization to Dp and Bt and increased total serum IgE. Further research is necessary to determine the reasons for this association.

Patogenia e inmunoterapia en la sinusitis alérgica fúngica (SAF) / Pathogeny and immunotherapy of allergic fungal sinusitis

Allergic fungal sinusitis is an atopic condition close related to fungus allergens that initiate a chronic inflammation dependent of the IgE system and LTCD4-TH2 cells whose cytokines and chemokines induced the clinical symptoms. Specific immunotherapy is recommended to avoid the recurrences and to improve the benefits of the surgical procedures of the affected sinuses. We suggest that Bipolaris sp Drechslera sp extracts must be included in the skin testing of the atopic patients suffering rhinosinusal symptoms as well as those who reveal intense response to fungal allergens in general.(AU)

Patogenia e inmunoterapia en la sinusitis alérgica fúngica (SAF) / Pathogeny and immunotherapy of allergic fungal sinusitis

Allergic fungal sinusitis is an atopic condition close related to fungus allergens that initiate a chronic inflammation dependent of the IgE system and LTCD4-TH2 cells whose cytokines and chemokines induced the clinical symptoms. Specific immunotherapy is recommended to avoid the recurrences and to improve the benefits of the surgical procedures of the affected sinuses. We suggest that Bipolaris sp Drechslera sp extracts must be included in the skin testing of the atopic patients suffering rhinosinusal symptoms as well as those who reveal intense response to fungal allergens in general.

IgE cross-reactivity between Ascaris and domestic mite allergens: the role of tropomyosin and the nematode polyprotein ABA-1.

BACKGROUND: Analysis of cross-reactivity between the nematode Ascaris ssp. and dust mites, two important allergen sources in the tropics, will contribute in understanding their influence on asthma and atopy. The objective of this study was to investigate immunoglobulin E (IgE) cross-reactivity between Ascaris and two domestic mites in the tropics. METHODS: Sera from 24 asthmatic patients were used in ELISA and immunoblotting IgE-binding inhibition assays using Ascaris, Blomia tropicalis and Dermatophagoides pteronyssinus extracts and the recombinants Blo t 10, ABA-1 and Blo t 13 as competitors. Identification of Ascaris allergens was confirmed by mass spectrometry (LC-MS/MS). RESULTS: We detected at least 12 human IgE-binding components in Ascaris extract. Blomia tropicalis and D. pteronyssinus inhibited 83.3% and 79% of IgE-binding to Ascaris, while Ascaris inhibited 58.3% and 79.3% to B. tropicalis and D. pteronyssinus respectively. Mite tropomyosin inhibited 85% of IgE-binding to Ascaris. Affinity-purified human IgE to rBlo t 10 identified an allergen of 40 kDa in Ascaris extract, further confirmed as tropomyosin by LC-MS/MS. We found no evidence of IgE cross-reactivity between rABA-1 and any allergen component in mite extracts, including rBlo t 13. CONCLUSIONS: There is cross-reactivity between Ascaris and mites, determined by several allergens including tropomyosin and glutathione-S-transferase. In addition to its potential impact on asthma pathogenesis, Ascaris infection and mite allergy diagnosis relying on the determination of specific IgE could be affected by this cross-reactivity. ABA-1 has no cross-reactive counterpart in mite extracts, suggesting its usefulness as a more specific marker of Ascaris infection.

Neutrophilic airway inflammation is a main feature of induced sputum in nonatopic asthmatic children.

BACKGROUND: Asthma phenotypes are well described among children. However, there are few studies comparing airway inflammation in different clinical presentations of pediatric asthma. We tested the hypothesis that nonatopic asthma is associated with a predominant noneosinophilic inflammation in the airways, as assessed by induced sputum. The objective of this study was to evaluate the cytological characteristics of induced sputum (IS) in atopic (AA), nonatopic asthmatics (NAA) and nonatopic nonasthmatic children (NANA). METHODS: Of 90 selected children, 77 met eligibility criteria for performing IS and were classified as: AA, n = 28, NAA, n = 29 and NANA, n = 19. Subjects answered to a set of ISAAC-based questions and were skin-tested for common aeroallergens. A defined series of exclusion criteria was applied. RESULTS: Induced sputum was obtained from 54 (70.1%) subjects (21 AA, 20 NAA and 13 NANA). Demographic data and mean FEV(1) were similar in the three groups. The proportion of eosinophils [median, inter quartile range (IQR)] was significantly higher in the sputum of AA [(6.0.)12)] compared with NAAs [0 (2)] and NANAs [0 (1)], P < 0.001. The proportion of children with sputum eosinophilia (eos > 3%) was also significantly higher in AA (71.4%) when compared with NAA (28.6%); none of the NANA had sputum eosinophilia. Nonatopic asthmatic children had significantly higher proportions and absolute number of neutrophils than AA and controls. CONCLUSIONS: The results suggest that nonatopic children present IS with a cell pattern that is predominantly neutrophilic while eosinophilia is the hallmark of airway inflammation in the majority of atopic wheezing children not treated with inhaled steroids.

[Rhinitis, sinusitis and allergy]. / Rinitis, sinusitis y alergia.

The allergic and infectious diseases of the nasal mucous represent two of the most frequent and chronic upper airways diseases in children and young adults. They are a public health problem of great magnitude due to the high prevalence that causes a great welfare pressure in terms of ambulatory consultations, significant deterioration of the quality of life so much for the patient who suffers them, like for the relatives and affect the community for the high socioeconomic costs that these generate. It is indispensable to know the physiopathology to be able to realize in time a suitable diagnosis and with it to offer a treatment adapted to diminish it recurrence.

Asthma and lung function in a birth cohort at 6-7 years of age in southern Brazil.

OBJECTIVE: Asthma and respiratory symptoms are common in children, and many studies have shown associations between childhood symptoms and impaired lung function in adult life. The aim of the present study was to investigate the association of various respiratory symptoms with wheezing patterns (persistent, early, and late-onset) and lung function, as well as to determine whether lung function was associated with atopy or with demographic, socioeconomic, environmental, and gestational factors, in a birth cohort at 6-7 years of age. METHODS: The target population consisted of children aged 6-7 years from a birth cohort of 5,304 children born in southern Brazil in 1993. For this follow-up evaluation, 532 of those children were randomly selected, and a sub-sample was submitted to spirometry and skin prick tests. A questionnaire was administered to the parent(s) or legal guardian(s) of each child. RESULTS: Spirometric values were lower in the children with respiratory symptoms or asthma. Mean forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC ratio) was lower in children with any of the following: current wheezing and asthma; asthma ever; four or more episodes of wheezing within the preceding 12 months; sleep disturbance due to wheezing; and exercise-induced wheezing. Persistent wheezing was associated with lower FEV1/FVC ratio. After multiple linear regression, exercise-induced wheezing was also associated with reduced FEV1/FVC ratio. Nonwhite skin color and wheezing severe enough to limit speech were associated with lower FEV1. CONCLUSIONS: Children with persistent wheezing and symptoms of severe asthma have impaired lung function at 6-7 years of age.

Asma e função pulmonar aos 6-7 anos de idade em uma coorte de nascimentos no Sul do Brasil / Asthma and lung function in a birth cohort at 6-7 years of age in southern Brazil

OBJECTIVE: Asthma and respiratory symptoms are common in children, and many studies have shown associations between childhood symptoms and impaired lung function in adult life. The aim of the present study was to investigate the association of various respiratory symptoms with wheezing patterns (persistent, early, and late-onset) and lung function, as well as to determine whether lung function was associated with atopy or with demographic, socioeconomic, environmental, and gestational factors, in a birth cohort at 6-7 years of age. METHODS: The target population consisted of children aged 6-7 years from a birth cohort of 5,304 children born in southern Brazil in 1993. For this follow-up evaluation, 532 of those children were randomly selected, and a sub-sample was submitted to spirometry and skin prick tests. A questionnaire was administered to the parent(s) or legal guardian(s) of each child. RESULTS: Spirometric values were lower in the children with respiratory symptoms or asthma. Mean forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC ratio) was lower in children with any of the following: current wheezing and asthma; asthma ever; four or more episodes of wheezing within the preceding 12 months; sleep disturbance due to wheezing; and exercise-induced wheezing. Persistent wheezing was associated with lower FEV1/FVC ratio. After multiple linear regression, exercise-induced wheezing was also associated with reduced FEV1/FVC ratio. Nonwhite skin color and wheezing severe enough to limit speech were associated with lower FEV1. CONCLUSIONS: Children with persistent wheezing and symptoms of severe asthma have impaired lung function at 6-7 years of age.

OBJETIVO: Asma e sintomas respiratórios são comuns na infância, e vários estudos têm demonstrado sua associação com redução da função pulmonar na vida adulta. O objetivo deste estudo foi investigar a associação de diversos sintomas respiratórios com padrões de sibilância (persistente, precoce e de início tardio) e função pulmonar aos 6-7 anos de idade em uma coorte de nascimentos, além de determinar se a função pulmonar estava associada à atopia ou a fatores demográficos, socioeconômicos, ambientais e gestacionais. MÉTODOS: A populaçãoalvo compreendeu crianças de 6 a 7 anos de idade pertencentes à coorte de 5.304 nascimentos ocorridos em 1993 em Pelotas, no Sul do Brasil. Para esse acompanhamento selecionaram-se aleatoriamente 532 dessas crianças, e uma subamostra foi submetida a espirometria e testes cutâneos de puntura. Aplicou-se um questionário aos pais das crianças ou seus responsáveis. RESULTADOS: Observamos valores espirométricos mais baixos nas crianças com sintomas respiratórios e asma. A média da relação volume expiratório forçado no primeiro segundo/capacidade vital forçada (relação VEF1/CVF) foi menor nas crianças com sibilância atual e asma, asma alguma vez na vida, quatro ou mais episódios de sibilância nos últimos 12 meses, sono perturbado pela sibilância e sibilância após exercícios. Sibilância persistente foi associada a redução da relação VEF1/CVF. Após regressão linear múltipla, sibilância após exercícios também foi associada a redução da relação VEF1/CVF. Cor da pele não-branca e fala prejudicada pela sibilância foram associadas a VEF1 reduzido. CONCLUSÕES: Crianças com sibilância persistente e sintomas de asma grave apresentaram função pulmonar prejudicada aos 6-7 anos de idade.

Clinical, functional, and epidemiological differences between atopic and nonatopic asthmatic children from a tertiary care hospital in a developing country.

BACKGROUND: Differences between children with atopic asthma (AA) and nonatopic asthma (non-AA) have been shown in epidemiologic studies. In developing countries, even when non-AA is more prevalent than AA among schoolchildren, no data are available regarding clinical, functional, and epidemiological differences between these 2 groups. OBJECTIVE: To evaluate differences between Chilean children with AA and non-AA. METHODS: In this cross-sectional study, skin prick tests were performed on all patients (age range, 4-14 years) admitted to our tertiary care hospital with the diagnosis of asthma who were consequently classified as having AA or non-AA. Demographic characteristics, spirometry results, exercise bronchial challenge test results, and eosinophil counts measured in the last 12 months were recorded. RESULTS: Among the 237 asthmatic children, 62.5% had AA. Non-AA children had a significantly earlier onset of asthma and a more frequent history of pneumonia and tobacco consumption at home. Children with AA had higher nasal eosinophilia levels and a higher prevalence of dermatitis and severe exacerbation episodes of asthma in the past year (emergency department consultation and oral corticosteroids courses). Lung function was similar in both groups. After the multivariate analysis, only the number of oral steroid courses was significantly different between the groups and was associated with AA. CONCLUSIONS: In this selected population of asthmatic schoolchildren, the prevalence of non-AA (37.6%) is not negligible, and some differences between AA and non-AA children exist.

Skin test reactivity to aeroallergens in Jamaicans: relationship to asthma.

BACKGROUND: Asthma causes significant morbidity and mortality in the developing world. It is thus important to identify modifiable risk factors. OBJECTIVES: To undertake a cross-sectional study to determine the prevalence of skin test reactivity to aeroallergens in Jamaican children and adults and the relationship of the diagnosis of asthma to the pattern of skin test positivity. METHODS: One hundred and sixty subjects without the sickle cell gene (genotype AA), eighty adults and eighty children, were recruited. Skin testing to seven aeroallergens was undertaken (atopy being diagnosed if there were at least one positive reaction). Asthma status was determined by a questionnaire and/or medical records. RESULTS: Twenty-seven (34%) of the children and forty-one (51%) of the adults were skin test positive to at least one aeroallergen. The most common positive responses in both age groups were to Dermatophagoides farinae, Dermatophagoides pteronyssinus and cockroach mix-(German and American). All adult asthmatics with current symptoms reacted to cockroach allergen. CONCLUSIONS: Appropriate steps to reduce cockroaches and cockroach sensitization might positively impact on asthma morbidity in Jamaica.

Skin test reactivity to aeroallergens in Jamaicans: relationship to asthma / Reactividad de la prueba cutánea frente a aeroalérgenos en los jamaicanos: relación con el asma

BACKGROUND: Asthma causes significant morbidity and mortality in the developing world. It is thus important to identify modifiable risk factors. OBJECTIVES: To undertake a cross-sectional study to determine the prevalence of skin test reactivity to aeroallergens in Jamaican children and adults and the relationship of the diagnosis of asthma to the pattern of skin test positivity. METHODS: One hundred and sixty subjects without the sickle cell gene (genotype AA), eighty adults and eighty children, were recruited. Skin testing to seven aeroallergens was undertaken (atopy being diagnosed if there were at least one positive reaction). Asthma status was determined by a questionnaire and/or medical records. RESULTS: Twenty-seven (34) of the children and forty-one (51) of the adults were skin test positive to at least one aeroallergen. The most common positive responses in both age groups were to Dermatophagoides farinae, Dermatophagoides pteronyssinus and cockroach mix-(German and American). All adult asthmatics with current symptoms reacted to cockroach allergen. CONCLUSIONS: Appropriate steps to reduce cockroaches and cockroach sensitization might positively impact on asthma morbidity in Jamaica.

ANTECíENTES: El asma causa morbilidad y mortalidad significativas en el mundo en desarrollo. Por lo tanto, es importante identificar los factores de riesgo modificables. OBJETIVOS: Llevar a cabo un estudio transversal a fin de determinar la prevalencia de la reactividad de la prueba cutánea frente a los aeroalérgenos en niños y adultos jamaicanos, y la relación del diagnóstico del asma con el patrón de positividad de la prueba cutánea. MÉTODOS: Se reclutaron ciento sesenta sujetos AA (sin genes falciformes), ochenta adultos y ochenta niños. Se llevaron a cabo pruebas cutáneas frente a siete aeroalérgenos (diagnosticándose atopia si se producía al menos una reacción positiva). El estatus asmático se determinó mediante encuestas y/o historias clínicas. RESULTADOS: Veintisiete (34%) de los niños y cuarenta y uno (51%) de los adultos, resultaron positivos en la prueba cutánea, al menos a un aeroalérgeno. Las respuestas positivas más comunes en ambos grupos de edad fueron frente a Dermatophagoides farinae, Dermatophagoides pteronyssinus, y mezcla de cucarachas (alemanas y americanas). Todos los asmáticos adultos con síntomas usuales reaccionaron al alérgeno de la cucaracha. CONCLUSIONES: Medidas apropiadas a fin de reducir las cucarachas y la sensibilización a las cucarachas podría tener un impacto positivo en la morbilidad por asma en Jamaica.

Untreated asthma, final height and sitting height/leg length ratio in Chile.

OBJECTIVE: There is uncertainty as to whether asthma has an effect on final height. We investigated using subjective and objective assessments whether untreated asthma is associated with final height, leg length and sitting height to leg length ratio in an area of Chile in which almost no one received asthma treatment. METHODS: We collected data on 1232 males and females aged 22-28 years in a semi-rural area of Chile. Information on asthma was collected using the European Community Respiratory Health Survey (ECRHS) questionnaire. We assessed sensitisation to eight allergens and bronchial hyper-responsiveness (BHR) to methacholine as a dichotomous variable and as a log slope. Information on possible confounders in terms of smoking, birth weight, number of siblings and socio-economic factors such as household possessions, car ownership and education was available. RESULTS: Regardless of the asthma assessment used, there was no association between asthma symptoms, diagnosis of asthma, atopy, BHR as log slope, binary or categorical and height, leg length or the ratio of sitting height to leg length. The latter was used as a potentially more appropriate measure to assess a detriment of growth. CONCLUSION: Asthma as assessed in community studies is unrelated to final height or body proportions.