The diagnosis and management of food allergies. Position paper of the Food Allergy Section the Polish Society of Allergology.

The paper concerns the current position of the Polish Society of Allergology Food Allergy Section on the diagnosis and management of food allergies. The aim of this position is to provide evidence-based recommendations on the diagnosis and management of patients with allergic hypersensitivity to foods. This position statement includes a systematic review of studies in three areas, namely, the epidemiology, diagnosis and management of food allergies. While taking into account the specific Polish setting, in this publication we also used the current European Academy of Allergy and Clinical Immunology (EAACI) position paper and other current position statements, including those of the United States National Institute of Allergy and Infectious Diseases (NIAID).

Health-related quality of life in Polish adolescents with Hymenoptera venom allergy treated with venom immunotherapy.

INTRODUCTION: Venom allergy, though rare, may seriously influence health-related quality of life (HRQoL). There is a paucity of research on HRQoL of adolescents and young adults with Hymenoptera venom allergy. The aim was to assess the level of HRQoL and to evaluate its independent predictors in Polish adolescents and young adults treated with venom immunotherapy. MATERIAL AND METHODS: A multicenter cross-sectional study based on the Vespid Allergy Quality of Life Questionnaire (VQLQ) adapted for Polish adolescents was used. The study sample included 87 patients (14-21 years) studied at different stages of venom immunotherapy (VIT). Statistical analysis was done with multivariate linear regression. RESULTS: Anxiety level was higher in patients with 4(th) grade of Mueller's classification (anaphylactic shock) than in those with 3(rd) grade (B = 0.84, 95% CI = 0.07-1.61, p = 0.03). Caution increased along with an increase of anxiety of adolescents treated with VIT (B = 0.54, 95% CI = 0.39-0.68, p < 0.01). Level of limitations increased with increasing caution of adolescents (B = 0.63, 95% CI = 0.35-0.91, p < 0.01). Discomfort increased along with a rise of caution of patients (B = 0.38, 95% CI = 0.22-0.55, p < 0.01). Similarly, it increased with an increase of their feeling of limitations (B = 0.37, 95% CI = 0.23-0.51, p < 0.01). The level of discomfort in adolescents treated with VIT was lower in those who were treated with conventional protocol in comparison to those treated with rush or ultra-rush ones (B = -0.47, 95% CI = -0.90 - -0.03, p = 0.04). CONCLUSIONS: Severity of anaphylactic reaction is an independent determinant of anxiety level in adolescents treated with VIT. The VIT protocol affects HRQoL of treated patients.

[Diagnosis and venom specific immunotherapy (VIT) in allergic children in Poland--how much the current practice follows the international guidelines?]. / Diagnostyka i immunoterapia u dzieci z alergia na jad owadów blonkoskrzydlych (VIT) w Polsce--jak wyglda w praktyce zgodnosc z miedzynarodowymi wytycznymi?

INTRODUCTION: Insect venom allergy requires a high level approach adequate to allergy intensity. In case of severe IgE-mediated sting reactions, in children older than five years, venom immunotherapy is a treatment of choice. AIM: Identification of current practices applied to venom allergic children in Poland and their adherence to the international guidelines. METHOD: Questionnaire survey concerning diagnostic and treatment rules was carried out in 8 centres of pediatric allergology, based on a similar audit conducted in the United Kingdom [Diwakar L. et al. Clin Exp Allergy 2008, 38: 1651]. RESULTS: In 5 centres both RAST and SPT tests were used as the first line of investigation. Subsequently 6 centres performed IDT. In three centres baseline serum tryptase levels were estimated. In case of sensitization to both bee and wasp venom in a child with the history of severe systemic reaction, but uncertain culprit insect, specific venom immunotherapy with both venoms was practised by 2 centres. In systemic reaction and not-detectable IgE in 6 centres child was followed-up in 6-12 months. Antihistamine premedication concerned all children in 7 centres. Six-week interval between booster doses was applied in half of centres. A target dose equal 100 mcg was used in 7 centres. Similarly all centres practiced 3-5 five year period of VIT. CONCLUSIONS: In Poland current practice with venom allergic children was conducted in congruence with most of the recommendations.

[Adaptation of Vespide Allergy Quality of Life Questionnaire for Polish children with venom allergy and for their parents]. / Adaptacja kwestionariuszy jakosci zycia dla dzieci z alergia na jad owadów oraz dla ich rodziców.

Aim of the study was to assess validity and reliability of adaptations of VQLQ for Polish children with Hymenoptera venom allergy and their parents. Sample under study consisted of 73 children aged up to 14 years, who were treated with specific venom immunotherapy (VIT) in 2008 in centres conducting this procedure in Poland, and their parents. Theoretical validity of the scales was assessed with exploratory factor analysis using principal component analysis method. Reliability of the scales was assessed in terms of internal consistency with Cronbach alpha coefficient. Results of analysis showed that both scales measure 4 dimension of quality of life and reliability of scales measuring particular dimensions is at least acceptable in case of scale for children, and high in case of scale for parents. Both adapted scales are valid and reliable tools measuring quality of life in children with Hymenoptera venom allergy and their parents' quality of life in the face of child's allergy.

[Health-related quality of life in children with Hymenoptera venom allergy treated with VIT and quality of life of their parents]. / Jakosc zycia warunkowana stanem zdrowia dzieci z alergia na jad owadów blonkoskrzydlych leczonych VIT oraz jakosc zycia ich rodziców.

UNLABELLED: Hymenoptera venom allergy, although rare in children, by its potential fatalities, leads to many psychosocial consequences, influencing quality of life of children and their parents. Aim of this paper is the estimation of health-related quality of life of venom allergic children treated with specific immunotherapy, and their parents. Assessment of factors influencing health-related quality of life levels was also performed. MATERIAL AND METHODS: Sample under study consisted of 73 children: mean age 10.6, SD 2, 4, treated because of Hymenoptera venom allergy in 5 clinical allergy centers in Poland. Data was collected using VQLQ questionnaire adapted for children and their parents. Determinants of quality of life were assessed with multivariate linear and logistic regression models. Analysis were done with SPSS 15 for Windows package. RESULTS: Girls reported higher level of anxiety than boys (B = 0.47; 95% CI = (0.01; 0.94)). Level of caution in children increased along with increase of their anxiety against re-sting (B = 0.49; 95% CI = (0.27; 0.71)). Level of anxiety of children who were under treatment from 6 months to 2 years was lower than level of anxiety of parents of children treated shorter than 6 months (B = -1.21; 95% CI = (-2.16; -0.25)). The lowest level of caution was reported by parents of children aged 10 year or less (B = -0.86; 95% CI = (-1.67; -0.05)), while the highest was reported by parents of children aged 11 years (B = 0.86; 95% CI = (0.20; 1.53)) in comparison to parents of children aged 12 years or more. Parents' caution increased along with increase of their anxiety (B = 0.61; 95% CI = (0.40; 0.83)). Higher level of limitations was imposed by parents of children treated with rush or ultra rush method, in comparison to parents of children treated with conventional method (B = 1.27; 95% CI = (0.21; 2.33)). Levels of quality of life in children and their parents were strongly dependent in the same dimensions. CONCLUSIONS: 1. Levels of quality of life in particular dimension in children is related to level of the same dimension in parents. 2. Age of children influenced level of caution of their parents. 3. Treatment duration influenced level of anxiety of parents. 4. Safety feeling acquired by parents at the beginning of treatment improves their quality of life in all dimensions.

[The antioxidative-prooxidative balance in children with asthma treated with inhaled corticosteroids and long acting beta2-agonists]. / Równowaga antyoksydacyjno-prooksydacyjna u dzieci z astma leczonych kortykosteroidami wziewnymi i dlugo dzialajacymi beta2-mimetykami.

UNLABELLED: The aim of study was to analyze the effect of treatment with inhaled corticosteroids and long acting beta2-agonists on antioxidative-prooxidative balance in children with asthma. MATERIALS AND METHODS: Twenty children with newly diagnosed asthma before treatment (group 1), fourteen children with diagnosed asthma treated with inhaled corticosteroids and long acting beta2-agonists and 57 healthy children were ioncluded in the study. In all cases plasma protein carbonyls and activity of erythrocyte SOD was assayed. RESULTS: Plasma protein carbonyls in both group I (1,01 nmol/g of protein, SD=0,30) and group II (0,94; SD=0,15) was significantly higher than in group III (0,85; SD=0,24) (I vs III p<0,033; II vs III p<0,031). The highest SOD activity was found in group II (3156,4 U/gHb; SD=976,1) (II vs I p<0,02; II vs III p<0,0001). SOD activity n group I (2435,8, SD=730,2) was higher than in group III (1533,1, SD=703,8) (p<0,0001). CONCLUSIONS: The increase in SOD activity in children with asthma seems to be a response to intensification of oxidative stress. Treatment of asthma with inhaled corticosteroids and long acting beta2-agonists augments antioxidative defense by increase in superoxide dismutase activity.