Asthma diagnosis in infants and preschool children: a systematic review of clinical guidelines

Background and aim: The definition and diagnosis of asthma are the subject of controversy that is particularly intense in the case of individuals in the first years of life, due to reasons such as the difficulty of performing objective pulmonary function tests or the high frequency with which the symptoms subside in the course of childhood. Since there is no consensus regarding the diagnosis of asthma in preschool children, a systematic review has been carried out. Materials and methods: A systematic search was made of the clinical guidelines published in the last 10 years and containing information referred to the concept or diagnosis of asthma in childhood - including the first years of life (infants and preschool children). A series of key questions were established, and each selected guide was analyzed in search of answers to those questions. The review protocol was registered in the international prospective register of systematic reviews (PROSPERO), with registration number CRD42017074872. Results: Twenty-one clinical guidelines were selected: 10 general guides (children and adults), eight pediatric guides and three guides focusing on preschool children. The immense majority accepted that asthma can be diagnosed from the first years of life, without requiring pulmonary function tests or other complementary techniques. The response to treatment and the exclusion of other alternative diagnoses are key elements for establishing the diagnosis. Only one of the guides denied the possibility of diagnosing asthma in preschool children. Conclusions: There is generalized although not unanimous agreement that asthma can be diagnosed in preschool children

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Asthma diagnosis in infants and preschool children: a systematic review of clinical guidelines.

BACKGROUND AND AIM: The definition and diagnosis of asthma are the subject of controversy that is particularly intense in the case of individuals in the first years of life, due to reasons such as the difficulty of performing objective pulmonary function tests or the high frequency with which the symptoms subside in the course of childhood. Since there is no consensus regarding the diagnosis of asthma in preschool children, a systematic review has been carried out. MATERIALS AND METHODS: A systematic search was made of the clinical guidelines published in the last 10 years and containing information referred to the concept or diagnosis of asthma in childhood - including the first years of life (infants and preschool children). A series of key questions were established, and each selected guide was analyzed in search of answers to those questions. The review protocol was registered in the international prospective register of systematic reviews (PROSPERO), with registration number CRD42017074872. RESULTS: Twenty-one clinical guidelines were selected: 10 general guides (children and adults), eight pediatric guides and three guides focusing on preschool children. The immense majority accepted that asthma can be diagnosed from the first years of life, without requiring pulmonary function tests or other complementary techniques. The response to treatment and the exclusion of other alternative diagnoses are key elements for establishing the diagnosis. Only one of the guides denied the possibility of diagnosing asthma in preschool children. CONCLUSIONS: There is generalized although not unanimous agreement that asthma can be diagnosed in preschool children.

Buceo en la edad pediátrica: fisiología, riesgos y recomendaciones / Scuba diving in children: Physiology, risks and recommendations

INTRODUCCIÓN: El gran auge de la práctica recreativa del buceo en los últimos años, incluyendo a los niños, comporta riesgos y la posibilidad de accidentes. Mientras que las normativas, los requisitos y los riesgos del buceo en adultos están bien fundamentados, la evidencia científica en niños y adolescentes es escasa. Asimismo, las guías y recomendaciones existentes dirigidas a los adultos no pueden ser aplicadas directamente a los niños. MÉTODOS: Estas circunstancias han motivado al Grupo de Técnicas de la Sociedad española de Neumología Pediátrica (SENP) a realizar una búsqueda bibliográfica para revisar y actualizar los conocimientos sobre el buceo en la edad pediátrica. RESULTADOS: Se examinan las adaptaciones fisiológicas del organismo durante la inmersión, así como las características anatómicas y fisiológicas propias de los niños que deben considerarse con relación al submarinismo; se exponen las causas y tipos más frecuentes de accidentes, así como los riesgos de su práctica en niños con distintas patologías; y se detallan los requisitos médicos y psicológicos para el buceo que deben respetarse en la evaluación de niño y adolescentes. CONCLUSIONES: Finalmente, se formulan unas recomendaciones de expertos para la práctica del buceo con aire comprimido en la edad pediátrica

INTRODUCTION: The increase in recreational scuba diving in recent years, including children, involves risks and the possibility of accidents. While legislation, conditions and risks of scuba diving are well documented in adults, scientific evidence in scuba diving by children and adolescents is sparse and isolated. Furthermore, existing guidelines and recommendations for adults cannot be transferred directly to children. METHODS: These circumstances have led to the Group on Techniques of the Spanish Society of Pediatric Pulmonology (SENP) to perform a literature search to review and update the knowledge about scuba diving in children. RESULTS: Physiological adaptations of the body are examined during the dive, as well as the anatomical and physiological characteristics of children that should be taken into account in scuba diving. The most common types of accidents and its causes, as well as the risks of scuba diving practice in children with previous diseases are discussed, along with details of the medical and psychological requirements for scuba diving to be considered in the assessment of child and adolescent. CONCLUSIONS: A list of recommendations for scuba diving with compressed air in children is presented by a group of experts

[Scuba diving in children: Physiology, risks and recommendations]. / Buceo en la edad pediátrica: fisiología, riesgos y recomendaciones.

INTRODUCTION: The increase in recreational scuba diving in recent years, including children, involves risks and the possibility of accidents. While legislation, conditions and risks of scuba diving are well documented in adults, scientific evidence in scuba diving by children and adolescents is sparse and isolated. Furthermore, existing guidelines and recommendations for adults cannot be transferred directly to children. METHODS: These circumstances have led to the Group on Techniques of the Spanish Society of Pediatric Pulmonology (SENP) to perform a literature search to review and update the knowledge about scuba diving in children. RESULTS: Physiological adaptations of the body are examined during the dive, as well as the anatomical and physiological characteristics of children that should be taken into account in scuba diving. The most common types of accidents and its causes, as well as the risks of scuba diving practice in children with previous diseases are discussed, along with details of the medical and psychological requirements for scuba diving to be considered in the assessment of child and adolescent. CONCLUSIONS: A list of recommendations for scuba diving with compressed air in children is presented by a group of experts.

Observational Study of the Safety of a Cluster Schedule for Subcutaneous Immunotherapy in a Pediatric Population

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Diagnosis and treatment of allergic rhinitis in children: Results of the PETRA study

Background: Good control of allergic rhinitis (AR) in children is desirable because it is associated with diseases such as asthma. The aim of this analysis of the PETRA study was to characterize its diagnosis and treatment in Spanish children. Methods: Data were analysed for paediatric patients (age 5-17 years, inclusive) included in the PETRA study, which included consecutive patients with allergic rhinitis attending respiratory specialists throughout Spain. Demographic information, disease characteristics (duration, severity according to the Allergic Rhinitis and its Impact on Asthma [ARIA] classification), diagnostic procedures, treatments and physicians’ attitudes to treatment were recorded. Results: Of the original sample of 1043 patients, 260 children were included (mean age, 11.7 years; 56.2% boys; 61.9% allergic to house dust mites (HDM) and 38.1% allergic to grass pollen). By ARIA classification, 180/260 (69.4%) had persistent AR and 176/280 (63%) had moderate disease. Asthma was reported in 89/161 (55%) with HDM allergy and 44/99 (45%) with grass pollen allergy. Symptomatic treatment was prescribed in 98.5%, although disease control had been no better than poor in 57.3%. Allergen specific immunotherapy was administered to 56.9%, and was used more often for HDM AR. When asked why specific immunotherapy was not prescribed, two-thirds of the investigators preferred a wait-and-see approach, prescribing immunotherapy if symptoms worsened or asthma developed. Conclusions: Paediatric patients treated by specialists for allergic rhinitis have moderate or severe disease. Symptomatic treatment was extensively prescribed but often did not achieve good disease control. Many specialists preferred a wait-and-see approach before prescribing immunotherapy(AU)

Diagnosis and treatment of allergic rhinitis in children: results of the PETRA study.

BACKGROUND: Good control of allergic rhinitis (AR) in children is desirable because it is associated with diseases such as asthma. The aim of this analysis of the PETRA study was to characterise its diagnosis and treatment in Spanish children. METHODS: Data were analysed for paediatric patients (age 5-17 years, inclusive) included in the PETRA study, which included consecutive patients with allergic rhinitis attending respiratory specialists throughout Spain. Demographic information, disease characteristics (duration, severity according to the Allergic Rhinitis and its Impact on Asthma [ARIA] classification), diagnostic procedures, treatments and physicians' attitudes to treatment were recorded. RESULTS: Of the original sample of 1043 patients, 260 children were included (mean age, 11.7 years; 56.2% boys; 61.9% allergic to house dust mites (HDM) and 38.1% allergic to grass pollen). By ARIA classification, 180/260 (69.4%) had persistent AR and 176/280 (63%) had moderate disease. Asthma was reported in 89/161 (55%) with HDM allergy and 44/99 (45%) with grass pollen allergy. Symptomatic treatment was prescribed in 98.5%, although disease control had been no better than poor in 57.3%. Allergen specific immunotherapy was administered to 56.9%, and was used more often for HDM AR. When asked why specific immunotherapy was not prescribed, two-thirds of the investigators preferred a wait-and-see approach, prescribing immunotherapy if symptoms worsened or asthma developed. CONCLUSIONS: Paediatric patients treated by specialists for allergic rhinitis have moderate or severe disease. Symptomatic treatment was extensively prescribed but often did not achieve good disease control. Many specialists preferred a wait-and-see approach before prescribing immunotherapy.

Chronic granulomatous disease in pediatric patients: 25 years of experience.

INTRODUCTION: Chronic granulomatous disease (CGD) is an uncommon primary immune deficiency (affecting 1/200,000 newborn infants) caused by a defect in phagocyte production of oxygen metabolites, and resulting in bacterial infections produced by catalase-positive microorganisms and fungal diseases that occasionally may prove fatal. METHODS: A review is made of the clinical records of 13 pediatric patients diagnosed with CGD between 1980 and 2005. RESULTS: All patients were males. The mean age at diagnosis was 36 months. The clinical manifestations at the time of diagnosis comprised the following: Abscesses or abscessified adenopathies 4/13 (Staphylococcus aureus (2), Serratia liquefaciens, S. marcescens and Klebsiella sp.), pneumonia 3/13 (Rhodococcus equi, Salmonella typhimurium plus Pneumocystis jiroveci), osteomyelitis 1/13 (Aspergillus sp.), sepsis 1/13 (S. aureus), urinary infection 1/13 (Klebsiella sp.), severe gastroenteritis 1/13, oral aphthae 1/13 and Crohn-like inflammatory bowel disease 1/13. The diagnosis was initially established by the nitroblue tetrazolium test, and confirmed by flow cytometry 10/13 and genetic techniques (gp91) 9/13. In the course of these disease processes there were 88 infections: abscesses (n = 26), lymphadenitis (n = 12), pneumoniae (n = 10), gastroenteritis (n = 7), sepsis (n = 6), osteomyelitis (n = 3) and others (n = 24). As to the germs isolated, the frequency distribution was as follows (n = 49): Aspergillus sp. (n = 10), Staphylococcus sp. (n = 7), Salmonella sp. (n = 6), Serratia sp. (n = 5), Pseudomonas aeruginosa (n = 4), Klebsiella sp. (n = 4), Proteus sp. (n = 3), Leishmania sp. (n = 2) and others (n = 8). IFN-gamma was administered in 7/13 cases, and itraconazole in 9/13; all received cotrimoxazole. There were four deaths, with one case each of sepsis due to gramnegative bacterial infection; disseminated aspergillosis; visceral leishmaniasis and hemophagocytosis; and post-kidney transplant complications. CONCLUSIONS: Clinical suspicion and flow cytometry are the keys for diagnosis of CGD and detection of carrier relatives. Specific prophylactic measures and medical controls are required to prevent serious infections. IFN-gamma has been used intermittently, though its effectiveness is controversial.

Chronic granulomatous disease in pediatric patients: 25 years of experience / Enfermedad granulomatosa crónica en pediatría: 25 años de experiencia

Introduction: Chronic granulomatous disease (CGD) is an uncommon primary immune deficiency (affecting 1/200,000 newborn infants) caused by a defect in phagocyte production of oxygen metabolites, and resulting in bacterial infections produced by catalase-positive microorganisms and fungal diseases that occasionally may prove fatal. Methods: A review is made of the clinical records of 13 pediatric patients diagnosed with CGD between 1980 and 2005. Results: All patients were males. The mean age at diagnosis was 36 months. The clinical manifestations at the time of diagnosis comprised the following: Abscesses or abscessified adenopathies 4/13 (Staphylococcus aureus (2), Serratia liquefaciens, S. marcescens and Klebsiella sp.), pneumonia 3/13 (Rhodococcus equi, Salmonella typhimurium plus Pneumocystis jiroveci), osteomyelitis 1/13 (Aspergillus sp.), sepsis 1/13 (S. aureus), urinary infection 1/13 (Klebsiella sp.), severe gastroenteritis 1/13, oral aphthae 1/13 and Crohn-like inflammatory bowel disease 1/13. The diagnosis was initially established by the nitroblue tetrazolium test, and confirmed by flow cytometry 10/13 and genetic techniques (gp91) 9/13. In the course of these disease processes there were 88 infections: abscesses (n = 26), lymphadenitis (n = 12), pneumoniae (n = 10), gastroenteritis (n = 7), sepsis (n = 6), osteomyelitis (n = 3) and others (n = 24). As to the germs isolated, the frequency distribution was as follows (n = 49): Aspergillus sp. (n = 10), Staphylococcus sp. (n = 7), Salmonella sp. (n = 6), Serratia sp. (n = 5), Pseudomonas aeruginosa (n = 4), Klebsiella sp. (n = 4), Proteus sp. (n = 3), Leishmania sp. (n = 2) and others (n = 8). IFN-ã was administered in 7/13 cases, and itraconazole in 9/13; all received cotrimoxazole. There were four deaths, with one case each of sepsis due to gramnegative bacterial infection; disseminated aspergillosis; visceral leishmaniasis and hemophagocytosis; and post-kidney transplant complications. Conclusions: Clinical suspicion and flow cytometry are the keys for diagnosis of CGD and detection of carrier relatives. Specific prophylactic measures and medical controls are required to prevent serious infections. IFN-gamma has been used intermittently, though its effectiveness is controversial

Introducción: La enfermedad granulomatosa crónica (EGC) es una inmunodeficiencia primaria infrecuente (1/200.000 recién nacidos vivos) por defecto de la producción de metabolitos del oxígeno por los fagocitos, causando infecciones bacterianas por microorganismos catalasa positivos y fúngicas, en ocasiones letales. Métodos: Revisión de historias clínicas de 13 pacientes diagnosticados de EGC en edad pediátrica de 1980 a 2005. Resultados: 100% varones. Edad mediana al diagnóstico: 36 meses. Clínica al diagnóstico: abscesos o adenopatías abscesificadas 4/13 (Staphylococcus aureus (2), Serratia liquefaciens, S. marcescens y Klebsiella sp.), neumonía 3/13 (Rhodococcus equi, Salmonella typhimurium más Pneumocystis jiroveci), osteomielitis 1/13 (Aspergillus sp.), sepsis 1/13 (S. aureus), infección urinaria 1/13 (Klebsiella sp.), gastroenteritis grave 1/13, aftas orales 1/13 y enfermedad inflamatoria intestinal Crohn-like 1/13. Diagnosticados inicialmente por Nitroblue Tetrazolium Test, confirmados por citometría de flujo 10/13 y genéticamente (gp91) 9/13. En su evolución presentaron 88 infecciones: abscesos (26), adenopatías (12), neumonías (10), gastroenteritis (7), sepsis (6), osteomielitis (3) y otras (24). Gérmenes aislados (49): Aspergillus sp. (10), Staphylococcus sp. (7), Salmonella sp. (6), Serratia sp. (5), Pseudomonas aeruginosa (4), Klebsiella sp. (4), Proteus sp. (3), Leishmania sp. (2) y otros (8). Han recibido Interferón Gamma 7/13; itraconazol 9/13 y todos cotrimoxazol. Cuatro fallecidos (1 sepsis por un bacilo gram negativo, 1 aspergilosis diseminada, 1 leishmaniasis visceral y hemofagocitosis, 1 complicaciones post-trasplante renal). Conclusiones: La sospecha clínica y la citometría de flujo son los pilares del diagnóstico en la EGC para el paciente y para la detección de familiares portadores. Debemos establecer una profilaxis específica y controles médicos para prevenir infecciones graves. Se ha usado intermitentemente IFN-gamma, aunque su efectividad es discutida

[Allergic rhinitis and bronchial hyperreactivity]. / Rinitis alérgica e hiperreactividad bronquial.

BACKGROUND: Bronchial hyperreactivity (BHR) is a characteristic of bronchial asthma. Patients with allergic rhinitis who do not report symptoms of bronchial asthma on spirometry show BHR, which could indicate the presence of subclinical inflammation of the lower respiratory airway. The aim of this study was to investigate whether the patients diagnosed with allergic rhinitis in our unit without symptoms of bronchial asthma had bronchial hyperreactivity and to determine which allergens caused these symptoms in our patients. METHODS AND RESULTS: We performed a retrospective, observational study of patients diagnosed with allergic rhinitis in our Allergy Unit between August 2000 and December 2001. The patients' medical records were reviewed and data on the following were gathered: demographic information, age, sex, rhinitis symptoms (perennial or seasonal), conjunctivitis, atopic dermatitis, bronchitis, sensitization (specific IgE, skin tests, nasal challenge tests), total IgE levels, spirometry performed through stress test (positive with a decrease of FEV1 > 15 % with stress or an increase of FEV1 of 12 % after bronchodilation) and family history of allergic disease. A total of 135 medical records of patients with allergic rhinitis were reviewed. Of these, 68 did not report symptoms of bronchial asthma (35 men and 33 women aged between 4 and 18 years). Most of our patients (50/68) reported perennial asthma and were sensitized to mites (44/68). In 14/68 spirometry was not performed at diagnosis. Stress test was positive in 13/54 (24 %). All patients who showed bronchial hyperreactivity were sensitized to mites and only one of these reported seasonal rhinitis. CONCLUSIONS: According to the latest guidelines on the treatment and control of allergic rhinitis --The Allergic Rhinitis and its Impact on Asthma Workshop Report-- bronchial asthma and allergic rhinitis are distinct manifestations of a single airway and of the same disease. In view of our results, we recommend systematic evaluation of bronchial hyperreactivity in the study protocol of allergic rhinitis in patients who do not report symptoms of bronchial asthma.

Rinitis alérgica e hiperreactividad bronquial / Allergic rhinitis and bronchial hyperreactivity

Introducción: La hiperreactividad bronquial (HRB)es característica del asma bronquial. Se ha observado que pacientes afectos de rinitis alérgica que no refieren clínica de asma bronquial al realizar una espirometría presentan HRB. Esto podría indicar la presencia de inflamación subclínica de la vía respiratoria inferior. Hemos revisados los pacientes diagnosticados de rinitis alérgica sin clínica de asma bronquial en relación a la hiperreactividad bronquial con el objetivo de determinar si los pacientes diagnosticados, en nuestra unidad, de rinitis alérgica sin clínica de asma bronquial presentan hiperreactividad bronquial y observar que alergenos son los causantes de esta clínica en nuestros pacientes. Métodos y resultados: Estudio retrospectivo, observacional. Población, pacientes diagnosticados de rinitis alérgica en nuestra Unidad de Alergología entre agosto 2000 y diciembre 2001. Se ha procedido a la revisión de las historias clínicas recogiendo los datos siguientes: demográficos, edad, sexo, clínica de rinitis (perenne o estacional), conjuntivitis, dermatitis atópica, bronquitis, sensibilización (IgE específica, pruebas cutáneas, pruebas de provocación nasal), valor de IgE total, espirometría realizada mediante prueba de esfuerzo (positiva con un descenso del FEV1 > 15 por ciento con el esfuerzo ó un ascenso del FEV1 del 12 por ciento tras broncodilatación) y la presencia de antecedentes familiar de patología alérgica. Se han revisado un total de 135 historias clínicas de pacientes afectos de rinitis alérgica. Hemos hallado 68/135 que no referían síntomas de asma bronquial (35 hombres y 33 mujeres) con edades comprendidas entre 4-18 años. La mayoría de nuestros pacientes refieren rinitis perenne(50/68) y están sensibilizados a ácaros (44/68). No se había realizado espirometría en el momento del diagnóstico en 14/68. Presentaron prueba de esfuerzo positiva 13/54 (24 por ciento).Todos los pacientes que mostraron hiperreactividad bronquial estaban sensibilizados a ácaros y sólo uno de ellos refería rinitis estacional. Conclusiones: Según los últimos consensos en el tratamiento y control de la rinitis alérgica -The Allergic Rhinitis and its Impact on Asthma Workshop Report- asma bronquial y rinitis alérgica son distintas manifestaciones de una sola vía aérea y de la misma patología. Con los resultados que hemos obtenido sugerimos la valoración sistemática de la hiperreactividad bronquial en el protocolo de estudio de la rinitis alérgica en pacientes que no refieren clínica de asma bronquial (AU)

Background: Bronchial hyperreactivity (BHR) is a characteristic of bronchial asthma. Patients with allergic rhinitis who do not report symptoms of bronchial asthma on spirometry show BHR, which could indicate the presence of subclinical inflammation of the lower respiratory airway. The aim of this study was to investigate whether the patients diagnosed with allergic rhinitis in our unit without symptoms of bronchial asthma had bronchial hyperreactivity and to determine which allergens caused these symptoms in our patients. Methods and results: We performed a retrospective, observational study of patients diagnosed with allergic rhinitis in our Allergy Unit between August 2000 and December 2001. The patients' medical records were reviewed and data on the following were gathered: demographic information, age, sex, rhinitis symptoms (perennial or seasonal), conjunctivitis, atopic dermatitis, bronchitis, sensitization (specific IgE, skin tests, nasal challenge tests), total IgE levels, spirometry performed through stress test (positive with a decrease of FEV1 > 15 % with stress or an increase of FEV1 of 12 % after bronchodilation) and family history of allergic disease. A total of 135 medical records of patients with allergic rhinitis were reviewed. Of these, 68 did not report symptoms of bronchial asthma (35 men and 33 women aged between 4 and 18 years). Most of our patients (50/68) reported perennial asthma and were sensitized to mites (44/68). In 14/68 spirometry was not performed at diagnosis. Stress test was positive in 13/54 (24 %). All patients who showed bronchial hyperreactivity were sensitized to mites and only one of these reported seasonal rhinitis. Conclusions: According to the latest guidelines on the treatment and control of allergic rhinitis ­The Allergic Rhinitis and its Impact on Asthma Workshop Report­ bronchial asthma and allergic rhinitis are distinct manifestations of a single airway and of the same disease. In view of our results, we recommend systematic evaluation of bronchial hyperreactivity in the study protocol of allergic rhinitis in patients who do not report symptoms of bronchial asthma (AU)

A prospective and multicenter safety-monitoring study of a short up-dosing schedule of immunotherapy with a mass-units-standardized extract of mites.

A prospective, multicenter pharmacovigilance study was carried out to evaluate the safety of a new 7-dose treatment schedule of subcutaneous immunotherapy as opposed to the conventional 13 doses normally recommended. The study was carried out in 14 centers and included 261 patients (children and adults) with respiratory allergic disease due to sensitization to mites (Dermatophagoides pteronyssinus and/or farinae). A total of 2290 doses were administered under the direct supervision of the participating specialists. One hundred and ten reactions in 63 patients (24.1%) were recorded, representing 4.8% of the total doses administered. Most of the reactions (98) were local. Only 12 were systemic (0.5% of the administered doses) and occurred in 10 patients (3.8% of the sample). Ten reactions reverted quickly with rescue medication. The maintenance dose had to be lowered in one patient and another patient was withdrawn from the study after suffering two asthmatic crises after two consecutive doses. In view of the results obtained, we can conclude that the new schedule shows an acceptable tolerance profile and does not present a greater risk of reactions than the conventional scheme of 13 doses using an identical extract. Moreover, the new schedule represents substantial savings in the number of doses and visits required to reach the maintenance dose.

[Immunotherapy with acarus extract in children under the age of 5 years]. / Inmunoterapia con un extracto de ácaros en niños menores de cinco años.

BACKGROUND: Specific immunotherapy with allergens is the only treatment capacite of modifying the natural course of allergic diseases. Although its effectiveness is higher when started in early stages, WHO guidelines still consider age under 5 years as relative contraindication.A review of a group of 22 children starting immunotherapy before the age of 5 years in a pediatric allergy unit was attempted to assess the effectiveness and safety of this treatment. METHODOLOGY AND RESULTS: Clinical charts of 22 children with house dust mite asthma starting conventional immunotherapy before the age of 5 years were reviewed. In all cases, biologically standardized extracts and conventional subcutaneous schedules have been used and administration was performed in a hospital setting. Effectiveness and safety were evaluated by clinical scores. The average treatment period was 16.95 ( 10.12) months. Systemic reactions (moderate) were observed in 7 children and local reactions in 5. Children treated for more than 1 year (15 patients) showed a decrease in the number of yearly acute exacerbations (from 5.13 to 2.57) and in hospital admissions (from 5 to 2 children). In 10 patients, drug requirements for bronchial asthma were reduced. CONCLUSION: The clinical data if this study suggest that house dust mite specific immunotherapy under hospital control can be begun in young children with good tolerance and clinical improvement.

Inmunoterapia con un extracto de ácaros en niños menores de cinco años

Antecedentes: La inmunoterapia específica con alérgenos es el único tratamiento capaz de modificar el curso natural de las enfermedades alérgicas, siendo más eficaz cuanto más precozmente se inicie. Sin embargo, las recomendaciones de la OMS continúan considerando la edad inferior a 5 años como una contraindicación relativa. Por este motivo se ha revisado un grupo de 22 niños que han iniciado inmunoterapia antes de los 5 años de edad en la unidad de alergia pediátrica hospitalaria. Métodos y resultados: El grupo está formado por 22 niños diagnosticados de asma bronquial con hipersensibilidad a ácaros domésticos que iniciaron la inmunoterapia antes de los 5 años de edad. En todos ellos se utilizaron extractos estandarizados biológicamente siguiendo pauta convencional subcutánea y control hospitalario. La tolerancia y eficacia de inmunoterapia se evaluaron mediante criterios clínicos. La duración media del tratamiento fue de 16,95 ( ñ 10,12) meses. Se observaron reacciones adversas locales en 5 niños y sistémicas moderadas en 7 niños. En los niños que llevaban más de 1 año de tratamiento (15 niños) se observó una reducción del número de crisis anuales (de 5,13 a 2,57) y de los ingresos hospitalarios (5 niños antes y 2 niños después). Los requerimientos de tratamiento farmacológico de alivio disminuyeron en 10 niños. Conclusión: Los datos de este estudio sugieren que la inmunoterapia específica con un extracto de ácaros bajo control hospitalario puede ser iniciada precozmente con buena tolerancia y mejoría clínica (AU)

Background: Specific immunotherapy with allergens is the only treatment capacite of modifying the natural course of allergic diseases. Althought its effectiveness is higher when started in early stages, WHO guidelines still consider age under 5 years as relative contraindication. A review of a group of 22 children starting immunotherapy before the age of 5 years in a pediatric allergy unit was attempted to assess the effectiveness and safety of this treatment. Methodology and results: Clinical charts of 22 children with house dust mite asthma starting conventional immunotherapy before the age of 5 years were reviewed. In all cases, biologically standardized extracts and conventional subcutaneous schedules have been used and administration was performed in a hospital setting. Effectiveness and safety were evaluated by clinical scores. The average treatment period was 16.95 (± 10.12) months. Systemic reactions (moderate) were observed in 7 children and local reactions in 5. Children treated for more than 1 year (15 patients) showed a decrease in the number of yearly acute exacerbations (from 5.13 to 2.57) and in hospital admissions (from 5 to 2 children). In 10 patients, drug requirements for bronchial asthma were reduced. Conclusion: The clinical data if this study suggest that house dust mite specific immunotherapy under hospital control can be begun in young children with good tolerance and clinical improvement (AU)

Home intravenous antibiotics for cystic fibrosis.

BACKGROUND: Recurrent endobronchial infection in cystic fibrosis requires treatment with intravenous antibiotics for several weeks, which is usually administered in hospital, affecting health costs and quality of life for patients and their families. It is not known whether patients receiving intravenous treatment at home have better or equivalent health outcomes, if costs are reduced or if it is preferred than in-hospital treatment. Home treatment requires training to patients and carers and usually needs a few previous days in hospital. OBJECTIVES: To determine whether home intravenous antibiotic therapy in cystic fibrosis is as effective as in-patient intravenous antibiotic therapy and if it is preferred by patients and/or families. SEARCH STRATEGY: References to trials were obtained from the specialist cystic fibrosis trials register held by the editorial base of the Cochrane Cystic Fibrosis and Genetic Disorders Group. Handsearching of the abstracts books of all Spanish Conferences on cystic fibrosis and the last European Conference (Stockholm, 2000) was carried out by authors. SELECTION CRITERIA: Randomised controlled trials where home intravenous antibiotic treatment for patients with cystic fibrosis was compared with in-hospital intravenous antibiotic treatment, including adults and children with cystic fibrosis. All kinds of antibiotics and regimens administered intravenous were included. DATA COLLECTION AND ANALYSIS: Three reviewers independently selected the trials to be included in the review, assessed methodological quality of each trial and extracted data using a standardised form. Because of several limitations, narrative synthesis was used at this stage. MAIN RESULTS: One study was included with 17 patients aged 10 to 41 years with an infective exacerbation by Pseudomonas aeruginosa. All their 31 admissions were analysed as independent events. Outcomes were measured at 21 days of follow-up after initiation of treatment. Home patients had fewer investigations performed than hospital patients (p<0.002) and general activity was higher in the home group. No differences were found for clinical outcomes, adverse events, complications of intravenous lines or line changes or time to next admission. Home patients received less low-dose home maintenance antibiotic. Quality of life measures showed no differences for dyspnoea and emotional state, but fatigue and mastery were worse for home patients, possibly due to a higher general activity and need of support. Personal, family, sleeping and eating disruptions were less important for home than hospital admissions. Home therapy was cheaper for families and the hospital. Indirect costs were not determined. REVIEWER'S CONCLUSIONS: The current evidence is restricted to one small study. It suggests that in the short term home therapy does not harm patients and in general reduces social disruptions. The decision to attempt home treatment should be based on an individual basis and appropriate local resources. More research is urgently required.

[Multicenter drug surveillance of sublingual immunotherapy in allergic patients]. / Estudio multicéntrico de farmacovigilancia de inmunoterapia sublingual en pacientes alérgicos.

A study of pharmacovigilance has been performed in 522 patients suffering from allergic rhinitis and/or asthma. Sensitization was due to pollens and mites in ther majority of cases. The treatment consisted in biologically standardized glycerinated allergenic extracts for specific sublingual immunotherapy (SLIT) and, major allergens were also quantified, depending on the allergenic composition. The aims of the study were to assay the effect of the SLIT in a short-and-medium-term course and to know the adverse reactions most frequently appearing, as well as the unexpected side effects that are only possible to know through the study of a numerous sample of patients. We also evaluated the factors that can modify the tolerance of the treatment, such as the onset of patient's disease and its severity. All the patients had a clinical history of, at least, two years of evolution and positive skin-prick test to the allergen/s cause of their atopic disorder. Exclusion criteria were immunotherapy in the last two years, pregnancy and those situations in which the immunotherapy is contraindicated according to the EAACI requirements. In order to carry out the daily record of the SLIT as well as the possible appearance of symptoms, two diaries were given to each patient. Tolerance was evaluated by the physician at the end of the build-up phase (3 months) and when the maintenance phase finished (5 months later). Total administered doses were 44.021, the final number of patients who registered any adverse reaction in relation with SLIT was 41 (7.9%), with a number of 67 adverse reactions that means a 0.15% over the total administered doses.(ABSTRACT TRUNCATED AT 250 WORDS)

Uniparental inheritance of microsatellite alleles of the cystic fibrosis gene (CFTR): identification of a 50 kilobase deletion.

More than 250 mutations have been detected in the cystic fibrosis (CF) transmembrane regulator (CFTR) gene, most of which are single point mutations or small deletions or insertions of a few nucleotides. Here we report the first large deletion identified in the CFTR gene, which involves 50 kb in two stretches of DNA: one of 10 kb from exon 4 to exon 7, and another of 40 kb, spanning exons 11 to 18. The deletion has been detected via uniparental inheritance of CFTR microsatellite alleles (IVS17BTA and IVS17BCA) in 3 independent CF families. Clinical status of the 3 CF patients, of which two have the delta F508 mutation as the other CF allele, suggests that this mutation is responsible for a severe clinical phenotype, indistinguishable from homozygous delta F508 patients. The deletion detected here suggests that other large, but less complex molecular defects could also exist in the CFTR gene.