Fluticasone in mild to moderate atopic dermatitis relapse: A randomized controlled trial.

BACKGROUND: The long-term efficacy of corticosteroids to prevent atopic dermatitis (AD) relapses has partially been addressed in children. This study compared an intermittent dosing regimen of fluticasone propionate (FP) cream 0.05% with its vehicle base in reducing the risk of relapse in children with stabilized AD. METHODS: A randomized controlled, multicentric, double-blind trial was conducted. Children (2-10 years) with mild/moderate AD (exclusion criteria: >30% affected body surface area and/or head) were enrolled into an Open-label Stabilization Phase (OSP) of up to 2 weeks on twice daily FP. Those who achieved treatment success entered the Double-blind Maintenance Phase (DMP). They were randomly allocated to receive FP or vehicle twice-weekly on consecutive days for 16 weeks. The primary study endpoint was relapse rate; time to relapse and severity of disease were also studied. Kaplan-Meier estimates were calculated. RESULTS: Fifty-four patients (29 girls) entered the OSP (23 mild AD) and 49 (26 girls) continued into the DMP. Mean age was 5.5 (SD: 2.8) and 5.1 (SD: 2.3) yrs for FP and vehicle groups, respectively. Four patients withdrew from the DMP (two in every group). Patients treated with FP twice weekly had a 2.7 fold lower risk of experiencing a relapse than patients treated with vehicle (relative risk 2.72, SD: 1.28; p=0.034). FP was also superior to vehicle for delaying time to relapse. Both treatment therapies were well tolerated. CONCLUSION: This long-term study shows that twice weekly FP provides an effective maintenance treatment to control the risk of relapse in children with AD.

Knowledge of asthma and anaphylaxis among teachers in Spanish schools.

INTRODUCTION: Allergic diseases affect 15-20% of the paediatric population in the industrialised world. Most educational centres in Spain do not have health professionals among their staff, and the teachers are in charge of child care in school. The advisability of specific training of the teaching staff should be considered, with the introduction of concrete intervention plans in the event of life-threatening emergencies in schools. MATERIAL AND METHODS: Evaluation of the training needs constitutes the first step in planning an educational project. In this regard, the Health Education Group of the Spanish Society of Clinical Immunology, Allergology and Paediatric Asthma (Grupo de Educación Sanitaria de la Sociedad Española de Inmunología Clínica, Alergología y Asma Pediátrica [SEICAAP]) assessed the knowledge of teachers in five Spanish Autonomous Communities, using a self-administered questionnaire specifically developed for this study. The data obtained were analysed using the SPSS statistical package. RESULTS: A total of 2479 teachers completed the questionnaire. Most of them claimed to know what asthma is, and almost one half considered that they would know how to act in the event of an asthma attack. This proportion was higher among physical education teachers. Most would not know how to act in the case of anaphylaxis or be able to administer the required medication. In general, the teachers expressed interest in receiving training and in having an interventional protocol applicable to situations of this kind. DISCUSSION: It is important to know what the training requirements are in order to develop plans for intervention in the event of an emergency in school. Teachers admit a lack of knowledge on how to deal with these disorders, but express a wish to receive training.

Leukotriene B4 and 8-isoprostane in exhaled breath condensate of children with episodic and persistent asthma.

BACKGROUND: Leukotrienes and isoprostanes are biomarkers of airway inflammation and oxidative stress that can be detected in exhaled breath condensate (EBC). The aim of this study was to evaluate leukotriene B4 (LTB4) and 8-isoprostane levels in EBC of healthy and asthmatic children with episodic and moderate persistent asthma. METHODS: EBC was collected from 62 children aged 6 to 14 years: 22 healthy children, 30 patients with episodic asthma, and 10 patients with moderate persistent asthma, without preventive treatment at the time of enrolment. RESULTS: LTB concentrations were higher in children with asthma than in healthy controls (50.7 pg/mL vs. 13.68 pg/mL, P < .011). The same was true for children with moderate persistent asthma compared to children with episodic asthma (146.9 pg/mL vs. 18.85 pg/mL, P < .0001), children with moderate persistent asthma compared to healthy controls (146.9 pg/mL vs. 13.68 pg/mL, P < .0001), and children with episodic asthma compared to healthy controls (P, nonsignificant). EBC concentrations of 8-isoprostane were higher in asthmatic than in healthy children (18.3 pg/mL vs. 6.59 pg/mL, P < .026). They were also increased in children with moderate persistent asthma compared to those with episodic asthma (36.25 pg/mL and 12.28 pg/mL, P < .012), and in children with moderate persistent asthma and episodic asthma compared to healthy controls (36.25 pg/mL vs. 6.59 pg/mL [P < .0001] and 12.28 pg/mL versus 6.59 pg/mL [P < .0001], respectively). CONCLUSION: LTB4 and 8-isoprostane concentrations were increased in asthmatic children compared to healthy individuals, with differences detected for 2 degrees of asthma severity. Our findings suggest that EBC is a noninvasive method for airway inflammation and oxidative stress assessment.

Epidemiologic, clinical and socioeconomic factors of atopic dermatitis in Spain: Alergológica-2005.

OBJECTIVE: To analyze the clinical and epidemiologic characteristics of the population with atopic dermatitis (AD) consulting in Allergology services in Spain. MATERIALS AND METHODS: The study was a multi-center, observational, descriptive, cross-sectional epidemiologic study with prospective collection of data on patients consulting for the first time in Allergology services in Spain. By means of a data collection record, personal and specific variables were collected during the calendar year 2005 from a total of 4991 patients with AD. RESULTS: AD was diagnosed in 171 patients (3.4% of patients seen in Allergology services), which represented no significant change with regard to the Alergológica-1992 study. In 72% of cases, AD was associated with other allergic disorders. The mean age of the onset of clinical manifestations of AD was 1 year and 4 months. During the first consultations, the suspected diagnosis of AD was established in 83% of cases. In 58% of cases the cause was considered idiopathic and 42% were associated with sensitization to allergens. In 10% of patients with AD the triggering allergens were foods and in 26% aeroallergens. Most patients (94%) received hydrating skin and drug treatment (anti-histamines 73%, topical corticoids 49%, calcineurin inhibitors 31%). Only 10% of patients followed an exclusion diet. CONCLUSIONS: No significant increase in the demand for AD consultations was observed in comparison with Alergológica-1992. AD was frequently associated with other allergic disorders. In few cases was food involved in the etiology of the disease. In most cases nothing more than topical drug treatment was indicated.

Oral rush desensitization to cow milk. Following of desensitized patients during three years.

We report the induction of tolerance in four patients with severe IgE-mediated cow's milk allergy, with an oral rush desensitization by introducing increasing daily doses of cow's milk (CM) for 5 days under clinical conditions in order to enable the patients to tolerate 200 ml of CM daily. Our results indicate that we can induce clinical tolerance in CM allergy by oral administration of progressive doses of milk. After three years of following, the four patients are taking CM with good tolerance. Specific IgE levels of casein have decreased progressively during these three years until being not detectable in three of the four patients and also a reduction has been observed in the cutaneous skin prick test reactions to CM.

[Exercise test in exercise-induced asthma in children: study of delayed response]. / El test de esfuerzo en el asma inducido por el ejercicio en niños: estudio de la respuesta tardía.

In this study we perform the exercise broncho-provocation test according to a protocol and involving 27 children with allergic asthma to study the prevalence and distinctive traits of the late response in exercise-induced asthma (EIA). At the conclusion of the study, 20 patients (74%) were diagnosed of EIA through some of the tests employed (ergometric bicycle, free run). In the cases where both tests were negative, we reproduced in a controlled manner the exercise reported as asthmogenic on the basis of anamnesis; no positivity was observed for the test in any case. Prevalence of late asthmatic response was 40% (8/20); mean beginning time to this response was 4-6 hours, lasting less than 1 hour and with a mean intensity rate of 26.8% (measured as the percentage of PEFR drop according to the preexercise basal value). The results are discussed, comparing them with those of other authors and with the allergen provocation response pattern; in addition the methods used and therapeutic implications in view of the results are dealt with.

[Standardization of forced spirometry. Analysis of the basal pulmonary function (PEF, FEF2575, FEF50) in a selected group of children]. / Estandarización de la espirometría forzada. Análisis de la función pulmonar basal (PEF, FEF2575, FEF50) en una población infantil de referencia.

This is a study of the ventilatory function (FEF2575, FEF50, PEF) by dry spirometer Vitalograph in 1,566 children of both sexes with ages ranging from 7 to 14 years; 1,156 children (73.6%) were selected as reference population. Height was the biometric parameter with the greatest correlation to the functional variables studied in both sexes, except to PEF in females. Significant differences were observed in functional variables between male and female subjects. Multiple and simple linear regression equations and percentiles tables for each sex are presented.

[Basal pulmonary function studies (FVC, FEV) in a selected child population]. / Estudio de la función pulmonar basal (FVC, FEV1) en una población infantil de referencia.

This is a study of the ventilatory function (FVC, FEV1) by dry spirometer Vitalograph in 1566 children of both sexes with ages ranging from 7 to 14; 1156 children (73.6 per 100) were selected as reference population. Height was the biometric parameter with the greatest correlation to the functional variables studied in both sexes. Significant differences were observed in functional variables between male and female subjects. Multiple and simple linear prediction equations and percentiles tables for each sex are presented. The results of the present study are compared with those of previously published of children.

[Repercussion of risk factors associated with the development of chronic bronchial pathology on pulmonary function in children]. / Estudio de la repercusión de los factores de riesgo asociados al desarrollo de patología bronquial crónica en el funcionalismo pulmonar en una población infantil.

Of a total of 1,566 children, 1,416 of both sexes and aged 7 to 14 were subjected to functional respiratory exploration with a Vitalograph dry spirometer. The impact of tobacco smoke--as active and/or passive smokers--on the spirometric variables (FVC, FEV1, FEF2572, FEF50) evaluated by variance analysis (ANOVA) revealed no significant reductions. Asthma was the single antecedent of respiratory morbidity showing significant reductions in FEF2575, FEF50 among males alone; no significant reductions were observed for any of the other spirometric variables. No significant decreases were found in the spirometric variables on comparing two areas of the same city with the greatest difference in air pollution level.

[Bronchial provocation test with dermatophagoides in the diagnosis of infantile asthma: sensitivity, specificity and reproducibility]. / Estudio del test de provocación bronquial con dermatofagoides en el diagnóstico del asma infantil: sensibilidad, especificidad y reproductibilidad.

The purpose of this study has been to prove if the lung is the target organ of an allergen against which a biological hypersensitivity, by means of skin test and RAST, has been found; comparing score Foucard diagnostic with inhalatory test result. At the same time, checking test specificity and reproductibility. Fourty children, both sexes aged between 6 and 14 years diagnosed of bronchial asthma divided in two groups were studied. First group included 31 children with hypersensitivity to dermatophagoides and second group was control group including 9 children. The test with dermatophagoides was performed in both groups according to Cockcroft method. The parameters which indicated test positivity were 20% fall in FEV1 for early response and 40% fall in PERF for late response. The results obtained show 83.9% positive tests with 80.6% early responses and 45.2% positive late response. The specificity and reproductibility were of 100%.