Bone mineral status in children with cow milk allergy.

To investigate bone mineral status in children with verified cow milk allergy for more than 4 yr compared with a large reference population of 343 local healthy controls. Whole body bone mineral content (BMC), projected bone area and bone mineral density (BMD) were determined by dual energy x-ray absorptiometry in nine children (8-17 yr old, one girl and eight boys). All children had cow milk allergy for more than 4 yr. All children had asthma and was treated with corticosteroids. BMC and BMD were reduced for age (p < 0.01). Height for age was significantly reduced (p < 0.01), indicating 'short' bones. BMC for bone area was borderline reduced (p = 0.05), indicating reduced bone mineralization. The growth of the children was reduced compared with there parents and siblings (p < 0.01), and the bone age was retarded (mean 1.4 yr, p < 0.01). Calcium consumption calculated from food intake was about 25% of the recommended. All laboratory tests were normal. Short bones were the main reason for reduced BMC and BMD for age in children with cow milk allergy, but a borderline low BMC for bone area indicated reduced bone mineralization of the bones. A supplementation of calcium to children with cow milk allergy is recommended.

Asthma mortality in the Danish child population: risk factors and causes of asthma death.

Child death due to asthma is a rare and potentially preventable event. We investigated possible risk factors for death due to asthma in children and adolescents, as a step towards preventing or minimizing asthma death in this age group, and improving asthma management and care. We reviewed all 108 cases of asthma death in 1-19-year-olds in Denmark, 1973-1994. Copies of death certificates, hospital records, information from general practitioners, and autopsy records were obtained. The information was assessed with particular reference to: features and duration of asthma before death; severity of asthma; time and place of death; long-term and ongoing medical treatment; quality of medical care; circumstances of final illness; and medical treatment during the final episode of asthma. Age groups of 1-4 years, 5-14 years, and 15-19 years were analyzed separately and in aggregate. Death occurred predominantly in the 15-19-year age group. Generally, significantly more patients died in the summer. These patients were more atopic, had fewer asthma symptoms, and did not have regular asthma consultations. Nearly all patients had early-onset asthma. The 1-4-year age group was characterized by severe asthma. Major risk factors (all age groups) were: gradual deterioration during the last month; length of final attack (>3 hr); and delay in seeking medical help during the final attack. None of the children died during their first attack. Nonadherence was most frequent among the 15-19-year-olds. All asthmatic children and young adults should regularly receive medical care and assessment, even if they suffer only a few symptoms. This study underlines the need for ongoing education of the patient's family, the patient, and doctors on long-term management and management of acute attacks. Copies of clearly written individual plans for periods with increasing symptoms should be supplied to the patient/family and, where appropriate, to their general practitioners. The object of these measures is that the patient and parents/family learn to recognize the signs of deterioration and to act on them.

The prevalence of latex sensitisation and allergy in Danish atopic children. Evaluation of diagnostic methods.

BACKGROUND: All over the world natural rubber allergy is reported to be responsible for a wide spectrum of allergic symptoms ranging from mild rhinitis to severe anaphylaxis. AIM: To estimate the prevalence and the clinical significance of latex sensitisation in atopic children seen in a university paediatric outpatient clinic. MATERIALS AND METHODS: During 1997-1998, a total of one hundred atopic children (4-14 years old, 64 boys and 36 girls) were consecutively screened for latex sensitisation by skin prick tests (SPTs) with standard inhalant allergens (ALK) and latex (Stallergenes SA), measurement of specific IgE (CAP System, Pharmacia, and Magic Lite, ALK) and total IgE. A clinical history with attention to surgical history, latex exposure and presence of symptoms possibly due to latex or food allergy was obtained. RESULTS: Five children (5%) had positive SPT to latex. Four (4%) had positive specific IgE to latex but had a negative SPT to latex. Only one patient (1%), who had spina bifida, had a positive SPT together with symptoms which could be related to latex allergy. This patient also had RAST class 4 to latex both with CAP System and Magic Lite. A history of previous surgery was found in only one of the children with positive latex SPT. Latex CAP System was positive in two of the five latex SPT positive patients, and latex Magic Lite in one of the five. In one patient without any symptoms of latex allergy, both SPT and in vitro tests were positive. Another child without symptoms, and with negative SPT, also had positive in vitro results. CONCLUSION: We found that the prevalence of sensitisation to latex was 9% in atopic children, but the prevalence of manifest type 1 latex allergy was only 1%. Latex allergy in atopic children seems to be a small problem in Denmark. How to evaluate the significance of positive in vitro tests and positive latex SPT in patients without symptoms to latex, remains an open question.