Respiratory disorders and hospitalization rates during the second RSV season in preterm infants who received palivizumab prophylaxis during their first RSV season.

This prospective study evaluated the frequency and severity of respiratory symptoms during the second respiratory syncytial virus (RSV) season in an italian cohort of preterm infants (< or = 35 weeks) who had received palivizumab prophylaxis in their first year of life (October 2004-April 2005) and who had not previously been hospitalized for RSV-induced lower respiratory tract infection (LRTI). infants were evaluated at enrolment (May-September 2005), in October/November 2005 and in April 2006. The occurrence of any respiratory episode, the rate of hospitalization for respiratory-related LRTI, total length of stay in hospital, physician-documented recurrent wheezing (>or = 3 physician-documented episodes of wheezing) and use of airway medication/antibiotics were recorded during follow-up. All infants had prior palivizumab prophylaxis during their first RSV season. In the total evaluable population (n=260), 32.3% of infants experienced at least one respiratory episode, 3.8% required short hospitalization because of LRTI, 8.5% had physician-documented recurrent wheezing, and 48.8% required airway medications/antibiotics during follow-up. in this study the rate of airway morbidity, hospitalization and physician-documented recurrent wheezing during the second RSV season was low among preterm infants who had received prior palivizumab prophylaxis.

Safety and tolerability of ultra-rush induction, less than one hour, of sublingual immunotherapy in children.

BACKGROUND: The safety and tolerability of sublingual immunotherapy (SLIT) has been documented in allergic patients both in the build-up phase as well as during maintenance, but only two studies have evaluated the occurrence of adverse reactions with an ultra-rush regimen of SLIT induction in a mixed paediatric/adult population. Moreover one of these two studies used a chemically modified extract (allergoid). The aim of the present study was to evaluate the occurrence of immediate or late adverse reactions in allergic children after a very fast (40 min) ultra-rush SLIT induction with two different allergen extract solutions. METHODS: We studied 100 children (64 boys, mean age of 9.6 years, range 3.5-16.8), with a history of intermittent/persistent rhinitis and/or intermittent/mild persistent asthma due to inhalant allergens. The ultra-rush build-up phase involved the administration, every 10 min, of increasing doses of the highest-concentration vial of SLIT of two different manufacturers (Anallergo and Stallergènes). RESULTS: All patients completed the treatment, side-effects have been recorded in 19% of the cases: 10% within 1 h after the build-up phase, 7% within 48 h and 2% mixed. A major difference (p = 0.0001) was recorded between Anallergo (6 patients, 8.7%) and Staloral (13 patients, 41.9%), but all the reactions were mild: principally oral symptoms, in 1 case rhinorrhoea and cough, and delayed abdominal pain and diarrhoea in another patient. CONCLUSIONS: No severe adverse reactions were observed with this ultra-rush SLIT induction also in the paediatric age; statistical differences have been documented between the two different extracts.

Use of a specific oral hyposensitization therapy to Dermatophagoides pteronyssinus in children with atopic dermatitis.

The aim of the present study was to evaluate the efficacy of an oral specific hyposensitization therapy in children with atopic dermatitis and positive prick skin tests and/or RAST to Dermatophagoides pteronyssinus (D.pt.). A total of 60 patients, in three different clinical groups, were selected for a three years clinical trial. Group A: children with atopic dermatitis and allergic asthma and/or rhinitis; groups B and C: children with exclusively atopic dermatitis. Groups A and B received specific hyposensitization therapy. Group C was the control group. The clinical evaluation of the dermatological lesions, at the end of our study, didn't show any significant difference among the three groups. Moreover, the onset of respiratory symptoms between the two groups with exclusively atopic dermatitis was similar and not related to the positivity of prick skin tests and/or RAST to seasonal allergens. Our study suggests that specific hyposensitisation therapy with extracts of D.pt., although with no side effects, does not affect the natural history of atopic dermatitis.

[Therapy of allergic rhinitis in childhood]. / Zur Therapie der allergischen Rhinitis im Kindesalter.

Allergic rhinitis is the most common of all allergic disorders. After summarising the clinical features and diagnostic approach with regard to differential diagnosis, we will discuss the therapeutic modalities. As with all long-term therapy measures, it is essential to persuade both the child and the parents to participate in the treatment and to get their co-operation.

Rare syndromes. The Kaufman-McKusick syndrome. A review of the 44 cases reported in the literature.

The Kaufman-McKusick syndrome (MK 23670) is a rare autosomal recessive disorder characterized by the triad of hydrometrocolpos, postaxial polydactyly, and congenital heart disease. Multiple other anomalies have been ascribed to this syndrome. Hydrometrocolpos, especially if unrecognized, may be a serious, life-threatening condition in the newborn girl. Forty-four cases have been so far reported in the literature. A great phenotypic variability occurs in this syndrome, therefore making it very difficult to identify the disorder at its presentation and classify it correctly. We shall hereafter review current data regarding the prominent clinical features, the diagnosis and treatment of this syndrome. Problems in genetic counseling will be discussed.

Double-blind crossover trial with oral sodium cromoglycate in children with atopic dermatitis due to food allergy.

Thirty-one children with atopic dermatitis, aged 6 months to 10 years, were selected for this trial. All had historical, clinical, and laboratory evidences that allergy to food was the cause of exacerbations of eczema. Either oral sodium cromoglycate (SCG) or a matching placebo was administered orally for 8 weeks, followed by the alternative treatment for a further 8-week period. During the first 4 weeks of each treatment period, patients remained on an exclusion diet. During the second 4 weeks, the offending food(s) was reintroduced into the diet. The severity of the eczema and the changes in severity as a result of diet or challenge were measured both by the clinician (using body diagrams) and by parents (using a daily diary card). Analysis of the clinician's scoring and the patient's diary card scores demonstrated a statistically significant difference in favour of SCG, especially in the group where the placebo preceded the active treatment. Sodium cromoglycate does seem to reduce the exacerbations of atopic dermatitis caused by food allergens.

Chronic diarrhea due to cow's milk allergy. A 4- to 10-year follow-up study.

There is general agreement that chronic diarrhea due to cow's milk allergy (CMA) resolves with a cow's milk-free diet, and that tolerance to cow's milk is achieved by 2 years of life. We have followed for 4 to 10 years, 41 infants with chronic diarrhea due to CMA, who had at onset of diarrhea RAST and/or skin tests positive to cow's milk. After the diarrhea subsided, the diet was continued for 6 months and, subsequently, cow's milk reintroduction was attempted at 6-month intervals. In contrast to 25/37 children (four cases were lost to follow-up) in whom CMA subsided at a median age of 2 years, 12/37 (32.5%) children did not tolerate cow's milk at a median age of 6 years. In addition, a large proportion of children (27/37 = 73%) suffered during the follow-up period from other atopic manifestations, due either to CMA or to inhalant allergy. Our data suggest that in infants with chronic diarrhea due to CMA, RAST and/or skin tests positive to cow's milk may indicate either the tendency of CMA to persist throughout childhood, or the risk of developing other atopic diseases.

Epidemiology, incidence and clinical aspects of food allergy.

Clinical manifestations of food allergy (FA) include a large variety of symptoms, most of which are gastrointestinal. Among the various clinical conditions, cow's milk protein allergy (CMPA) usually appears during early infancy; therefore, it is predominantly a problem of childhood. As with any type of FA, the diagnosis of CMPA rests mostly on clinical observation rather than on laboratory tests. Our studies confirm that both skin tests and RAST are valuable tools in the diagnosis. In particular, our follow-up study of a group of infants with CMPA demonstrates that the majority of RAST-positive subjects do not tolerate cow's milk after many years, whereas all RAST-negative infants tolerate cow's milk in their second year of life. Accordingly, RAST may be useful either in the diagnosis or in the prognosis of CMPA. It is generally agreed that treatment of FA should center on avoidance diets. This may not be easy in children with multiple allergies. Prophylactic drugs may be very useful. Disodium cromoglycate, for instance, seems to be effective in the prevention of IgE-mediated FA. They may also be needed when symptoms persist, mostly because of lack of compliance with the antigen avoidance diet. Early prophylaxis against FA appears to be best achieved by breast-feeding. Exclusive breast-feeding should be encouraged for as long as possible when there is a family history of allergy.

A three year controlled study in children with pollinosis treated with immunotherapy.

The clinical course of 87 children with pollen induced rhinitis or both rhinitis and asthma was followed in a prospective controlled study over a three year period. All children were treated with specific IT. The long term results have shown that IT was successful in 94% of children with asthma and rhinitis and 90% with rhinitis given more than 80,000 PNU. By contrast, the outcome of 78 selected controls also followed during the same period who did not receive IT was almost exactly the opposite. In addition to demonstrating the clinical effectiveness of IT, the authors stress the relationship among successful results, highest tolerated doses, and larger cumulative dosage which is irrespective of the duration of the therapy. The authors also discuss whether the children in the control group should be injected with placebo solutions or treated with all available medication.

Effectiveness of oral sodium cromoglycate (SCG) in preventing food allergy in children.

The efficacy of oral SCG in preventing food allergy symptoms in children was investigated. Ten children with cow's milk and/or egg IgE-mediated allergy were selected for this study. The subjects were challenged with the offending food before and after a seven-day pre-treatment period with oral SCG (30 mg/kg b.w. per day). Full protection was achieved in six out of eight children with cow's milk allergy and in four of the five children with egg allergy. The mode of action of SCG in the prevention of clinical manifestations of food allergy is discussed.

On the reliability of RAST in childhood food allergy.

144 children, showing adverse reactions to cow's milk and/or egg, were studied retrospectively. The case finding criteria used was positive elimination and challenge tests with the offending food (s). Specific IgE against the offending food(s) were found in 70% of cases, the majority of whom exhibited early-onset symptoms. RAST seems to be a useful laboratory test in food allergy characterized by early-onset symptoms. Likewise, RAST may be a valuable tool when severe reactions following the ingestion of food are suspected, and dangerous challenge tests are to be avoided.

Results of a milk and/or egg free diet in children with atopic dermatitis.

Food allergy plays an important role in the pathogenesis of atopic dermatitis. Exclusion of eggs and milk from the diet of children during the first few months of life has been proven to significantly reduce the severity of eczema in children aged between 2 and 8 years. We studied the efficacy of exclusion of milk and/or egg from the diet of 59 children with severe atopic dermatitis. A detailed personal and family history was obtained. Total and specific IgE levels were determined on one hand, and intracutaneous tests were evaluated on the other. All allergens suspected of being implicated in the genesis of atopic dermatitis were eliminated from the diet. Clinical improvement was observed in 80% of cases after dietary exclusion. The younger children responded best, and the response to diet was not influenced by the severity of the eczema. No relation was observed between the family history of atopy and response to diet. Neither total nor specific IgE titers presented significant differences when the responder groups were compared.