Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2016 revision

BACKGROUND: Allergic rhinitis (AR) affects 10% to 40% of the population. It reduces quality of life and school and work performance and is a frequent reason for office visits in general practice. Medical costs are large, but avoidable costs associated with lost work productivity are even larger than those incurred by asthma. New evidence has accumulated since the last revision of the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines in 2010, prompting its update. OBJECTIVE: We sought to provide a targeted update of the ARIA guidelines. METHODS: The ARIA guideline panel identified new clinical questions and selected questions requiring an update. We performed systematic reviews of health effects and the evidence about patients' values and preferences and resource requirements (up to June 2016). We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence-to-decision frameworks to develop recommendations. RESULTS: The 2016 revision of the ARIA guidelines provides both updated and new recommendations about the pharmacologic treatment of AR. Specifically, it addresses the relative merits of using oral H1-antihistamines, intranasal H1-antihistamines, intranasal corticosteroids, and leukotriene receptor antagonists either alone or in combination. The ARIA guideline panel provides specific recommendations for the choice of treatment and the rationale for the choice and discusses specific considerations that clinicians and patients might want to review to choose the management most appropriate for an individual patient. CONCLUSIONS: Appropriate treatment of AR might improve patients' quality of life and school and work productivity. ARIA recommendations support patients, their caregivers, and health care providers in choosing the optimal treatment.

World Allergy Organization-McMaster University Guidelines for allergic disease prevention (GLAD-P): vitamin D

BACKGROUND: The prevalence of allergic diseases is approximately 10 % in infants whose parents and siblings do not have allergic diseases and 20-30 % in those with an allergic first-degree relative. Vitamin D is involved in the regulation of the immune system and it may play a role in the development, severity and course of asthma and other allergic diseases. OBJECTIVE: The World Allergy Organization (WAO) convened a guideline panel to develop evidence-based recommendations addressing the use of vitamin D in primary prevention of allergic diseases. METHODS: Our WAO guideline panel identified the most relevant clinical questions and performed a systematic review of randomized controlled trials and non-randomized studies (NRS), specifically cohort and case-control studies, of vitamin D supplementation for the prevention of allergic diseases. We also reviewed the evidence about values and preferences, and resource requirements (up to January 2015, with an update on January 30, 2016). We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. RESULTS: Having reviewed the currently available evidence, the WAO guideline panel found no support for the hypothesis that vitamin D supplementation reduces the risk of developing allergic diseases in children. The WAO guideline panel suggest not using vitamin D in pregnant women, breastfeeding mothers, or healthy term infants as a means of preventing the development of allergic diseases. This recommendation does not apply to those mothers and infants who have other indications for prophylactic or therapeutic use of vitamin D. The panel's recommendations are conditional and supported by very low certainty evidence. CONCLUSIONS: WAO recommendations about vitamin D supplementation for the prevention of allergic diseases support parents, clinicians and other health care professionals in their decisions whether or not to use vitamin D in preventing allergic diseases in healthy, term infants.(AU)

Early manifestations of autism spectrum disorders. Experience of 393 cases in a paediatric neurology.

INTRODUCTION: Autism spectrum disorders are group of conditions characterised by qualitative impairments in social communication, interaction, and imagination, and by a restricted range of interests and typical repetitive behaviours. Frequently, there is a delay in the age of detection, and therefore in starting multidisciplinary evaluations and interventions, which may result in a poorer prognosis and reduced quality of life for both children and parents. The aim of our study was to describe clinical and epidemiological data including the age of detection and main initial complaints present in children with autism disorders referred to a paediatric neurology centre. PATIENTS AND METHODS: A total of 393 medical records of consecutive cases diagnosed with an autism spectrum disorder were reviewed. RESULTS: Autism was diagnosed in 82.1% of the cases, unspecified pervasive disorder in 9.9%, Asperger syndrome in 4.8%, and Rett syndrome in 3%. Sixty percent of autistic children presented with a language disorder as their main complaint. The average age of detection was 4 years. CONCLUSIONS: Compared with other countries, age of detection is delayed. Primary care-based screening and surveillance are required in order to improve prognosis and quality of life of children with an autism spectrum disorder.

[Total white blood cell count, erythrosedimentation rate and C-reactive protein for the detection of serious bacterial infections in 0- to 90-day-old infants with fever without a source]. / Leucocitos en sangre, eritrosedimentación y proteína C reactiva en pacientes de 0 a 90 días de edad con fiebre sin focalización.

INTRODUCTION: Total white blood cell count (WBC), erythrosedimentation rate (ESR) and C-reactive protein (CRP) are frequently used by primary care physicians attending infants < 90 days old with fever without localizing signs to distinguish those with a serious bacterial infection (SBI). The main objective of this study was to obtain the diagnostic values of these parameters in infants with fever. PATIENTS AND METHODS: We analyzed previously healthy infants aged 0 to 90 days old and fever with no source of infection admitted to the emergency room and/or hospitalized. The main outcome measure was the presence or absence of a SBI (urinary tract infection, bacteremia, meningitis, pneumonia, enteritis) and diagnostic values of WBC, ESR and CRP. RESULTS: A total of 103 infants met the inclusion criteria. Of these, 22 infants (21.3%) had a SBI, the most common being urinary tract infection. Absolute neutrophil count (ANC) and WBC had an area under the ROC curve (AUC) of 0.6 (95% CI: 0.46-0.73) and 0.55 (95% CI: 0.44-0.68) respectively. An ANC>or=10,000/microl had a sensitivity and specificity of 9% (95% CI: 1-21) and 92.5% (95% CI: 86-98) respectively. A WBC>or=15,000/microl had a sensitivity and specificity of 13.6% (95% CI: 1-28) and 85% (95% CI: 77-93) respectively. CRP showed an AUC of 0.71 (95% CI: 0.55-0.86) and a best cut-off point of 2 mg/dL (sensitivity 53% [95% CI: 29-76] and specificity of 85% [95% CI: 75-94]). ESR>or=20 mm/hour had an AUC, sensitivity and specificity of 0.53 (95% CI: 0.37-0.7), 38% (95% CI: 16-62) and 75% (95% CI: 65-85) respectively. CONCLUSIONS: None of these parameters alone, commonly used by physicians, is a reliable diagnostic tool to rule out SBI in infants<90 days old with fever without source of infection.

Leucocitos en sangre, eritrosedimentación y proteína C reactiva en pacientes de 0 a 90 días de edad con fiebre sin focalización / Total white blood cell count, erythrosedimentation rate and C-reactive protein for the detection of serious bacterial infections in 0- to 90-day-old infants with fever without a source

Introducción: El clínico usa con frecuencia la cuenta total de leucocitos en sangre, la velocidad de sedimentación globular (VSG) y la proteína C reactiva (PCR) para tratar de detectar infecciones bacterianas serias (IBS) en lactantes con fiebre sin foco aparente. El objetivo es evaluar los valores diagnósticos de estas pruebas en lactantes con fiebre. Pacientes y métodos: Análisis de pacientes de 0 a 90 días de edad, previamente sanos, evaluados por fiebre sin foco. El desenlace de interés fue la presencia o ausencia de una IBS (uroinfección, bacteriemia, neuroinfección, neumonía, enteritis) y su relación con la cuenta de leucocitos, VSG y PCR. Resultados: Cumplieron criterios de inclusión 103 pacientes. De éstos, 22 (21,3 %) presentaron una IBS, siendo la uroinfección la más común. Los neutrófilos totales y los leucocitos resultaron en valores del área bajo la curva de las características operador receptor (abc-ROC) de 0,6 (intervalo de confianza del 95 % [IC 95 %] : 0,46-0,73) y 0,55 (IC 95 %: 0,44-0,68), respectivamente. La sensibilidad y especificidad de la cuenta de neutrófilos ≥ 10.000/μl fue del 9 % (IC 95 %: 1-21) y del 92,5 % (IC 95 %: 86-98), respectivamente, mientras que la cuenta total de leucocitos ≥ 15.000/μl presentó un 13,6 % (IC 95 %: 1-28) y un 85 % (IC 95 %: 77-93), respectivamente. La PCR presentó el abc-ROC de 0,71 (IC 95 %: 0,55-0,86) con punto de corte a 2 mg/dl (sensibilidad del 53 % [IC 95 %: 29-76] y especificidad del 85 % [IC 95 %: 75-94]), mientras que la VSG ≥ 20 mm/h concluyó con abc-ROC de 0,53 (IC 95 %: 0,37-0,7), sensibilidad del 38 % (IC 95 %: 16-62) y especificidad del 75 % (IC 95 %: 65-85). Conclusiones: Ninguno de estos parámetros, comúnmente usados por los clínicos, alcanza valores diagnósticos aceptables para detectar IBS en niños de 0 a 90 días de edad con fiebre (AU)

Introduction: Total white blood cell count (WBC), erythrosedimentation rate (ESR) and C-reactive protein (CRP) are frequently used by primary care physicians attending infants < 90 days old with fever without localizing signs to distinguish those with a serious bacterial infection (SBI). The main objective of this study was to obtain the diagnostic values of these parameters in infants with fever. Patients and methods: We analyzed previously healthy infants aged 0 to 90 days old and fever with no source of infection admitted to the emergency room and/or hospitalized. The main outcome measure was the presence or absence of a SBI (urinary tract infection, bacteremia, meningitis, pneumonia, enteritis) and diagnostic values of WBC, ESR and CRP. Results: A total of 103 infants met the inclusion criteria. Of these, 22 infants (21.3 %) had a SBI, the most common being urinary tract infection. Absolute neutrophil count (ANC) and WBC had an area under the ROC curve (AUC) of 0.6 (95 % CI: 0.46-0.73) and 0.55 (95 % CI: 0.44-0.68) respectively. An ANC ≥ 10,000/μl had a sensitivity and specificity of 9 % (95 % CI: 1-21) and 92.5 % (95 % CI: 86-98) respectively. A WBC ≥ 15,000/μl had a sensitivity and specificity of 13.6 % (95 % CI: 1-28) and 85 % (95 % CI: 77-93) respectively. CRP showed an AUC of 0.71 (95 % CI: 0.55-0.86) and a best cut-off point of 2 mg/dL (sensitivity 53 % [95 % CI: 29-76] and specificity of 85 % [95 % CI: 75-94]). ESR ≥ 20 mm/hour had an AUC, sensitivity and specificity of 0.53 (95 % CI: 0.37-0.7), 38 % (95 % CI: 16-62) and 75 % (95 % CI: 65-85) respectively. Conclusions: None of these parameters alone, commonly used by physicians, is a reliable diagnostic tool to rule out SBI in infants < 90 days old with fever without source of infection (AU)