Relationship between rhinitis severity and lung function in children and adolescents without asthma. / [Relación entre grado clínico de rinitis y función pulmonar en niños y adolescentes sin asma.]

Background: The link between upper and lower airways is recognized clinically as a "unique airway". Subclinical spirometric abnormalities have been observed in patients with rhinitis without asthma, which could be proportional to rhinitis severity. Objectives: To investigate possible subclinical alterations in lung function and bronchodilator reversibility in children and adolescents with allergic (AR) and non-allergic rhinitis (NAR) without asthma, according to the clinical grade of rhinitis classified by ARIA (Allergic Rhinitis and Its Impact on Asthma). Methods: In a cross-sectional analytical study, we included patients aged 5 to 18 years with symptoms of AR and NAR without asthma. Spirometry was performed by flow-volume curve and we analyzed the abnormalities in respiratory function and bronchodilator response in relation to clinical grade of rhinitis by ARIA using an adjusted logistic model. Results: We studied 193 patients; 42 (21.7%) had some spirometric abnormalities. Patients with moderate-severe persistent rhinitis had greater impairment of lung function compared to the other grades of rhinitis (p=0.009). This defect was associated with both frequency (p=0.03) and severity of rhinitis (p=0.04) but not with atopic status (p=0.28). A positive bronchodilator response was more frequent in grades moderate-severe of rhinitis than in mild forms (p=0.04). Conclusion: Abnormalities of lung function was more prevalent in moderate-severe persistent rhinitis and was associated with the frequency and severity of rhinitis but not to atopic status. The bronchodilator reversibility was observed in patients with intermittent and persistent moderate-severe rhinitis.

Introducción: Las vías aéreas superior e inferior se comportan como una unidad. Se han observado alteraciones espirométricas subclínicas en pacientes con rinitis, sin asma, que podrían ser proporcionales a la magnitud de la rinitis. Objetivos: Investigar las posibles alteraciones de la función pulmonar y reversibilidad al broncodilatador en niños y adolescentes con rinitis alérgica (RA) y no alérgica (RNA), sin asma, según el grado clínico de rinitis establecido por ARIA (Rinitis Alérgica y su Impacto en Asma). Población y métodos: Estudio transversal analítico. Se incluyeron pacientes entre 5 y 18 años con RA y RNA, sin asma. Se analizó la existencia de anormalidades en la función pulmonar (curva flujo-volumen) y la respuesta broncodilatadora en relación al grado clínico de rinitis por ARIA ajustando un modelo logístico.Resultados: Se estudiaron 193 pacientes; 42 (21,7%) tuvieron al menos un parámetro espirométrico alterado. Los pacientes con rinitis persistente moderada-grave presentaron mayor afectación de la función pulmonar respecto a otros grados de rinitis (p=0,009). El defecto se asoció a la frecuencia (p=0,03) y a la gravedad de la rinitis (p=0,04) pero no con la atopia (p=0,28). La respuesta broncodilatadora positiva fue más frecuente en los grados de rinitis moderada-grave que en los leves (p=0,04). Conclusiones: La alteración de la función pulmonar fue más prevalente en la rinitis persistente moderada-grave y se asoció a la frecuencia y la gravedad de la rinitis pero fue independiente de la condición de atopia. La reversibilidad al broncodilatador se observó en pacientes con rinitis intermitente y persistente moderada-grave.

Inducción de tolerancia en alergia a la proteína de leche de vaca: modelo desde un caso clínico / Tolerance induction in cow' s milk protein allergy: a clinical case model

La prevalencia de la alergia alimentaria en pediatría presenta un incremento en los últimos años; el alimento más frecuentemente involucrado es la leche de vaca. La alergia a proteína de leche de vaca (APLV) afecta la calidad de vida del paciente y su familia porque requiere dieta de exclusión y medicación de rescate por probables reacciones frente a ingesta accidental del alimento. Actualmente se está avanzando en el estudio de la inmunoterapia oral (ITO) con leche de vaca (LV) como alternativa de tratamiento. Algunos estudios demuestran descenso de la IgE específica (IgEs) para LV4, mientras otros autores refieren que no hay cambios posteriores al tratamiento con ITO3.

The prevalence of food allergy in paediatrics has increased in recent years; the most frequent food involved is cow's milk1. Allergy to cow's milk protein (CMPA) affects the quality of life of the patient and his or her family because it requires exclusion diet and rescue medication for probable reactions to accidental food intake1. There are currently advances in the study of oral immunotherapy (OIT) with cow's milk (CM). Some studies show a decrease in specific IgE (IgEs) for CM, while other authors refer no changes after treatment with OIT3.

Clinical comparison between patients with selective immunoglobulin A deficiency and other primary immunodeficiencies.

Primary immunodeficiencies (PID) are low-prevalence diseases. There are warning signs that may raise clinical suspicion. The objectives of this study were to describe the clinical characteristics and warning signs of patients with PID and to compare the clinical differences between selective immunoglobulin A (IgA) deficiency and other PIDs. Eighty-nine patients were studied; their median age at the time of diagnosis was 6 years old (4.08-11.67). Fifty-three (59.5%) patients were male. Fifty-four (60.7%) patients had selective IgA deficiency, and 35 (39.3%) had other PIDs. The main clinical manifestations were rhinopharyngitis in 65 (73.03%) patients and atopy in 39 (43.82%). Twenty- four (26.97%) patients showed warning signs, and none had selective IgA deficiency. Patients with other PIDs had a higher incidence of lower respiratory tract infection, sepsis, skin infections, mucocutaneous candidiasis, dental alterations, cardiovascular malformations, angioedema, hospitalizations and death. Ten (28.57%) patients received intravenous gammaglobulin, 15 (42.85%) antibiotic prophylaxis, and 2 (2.24%) antifungal prophylaxis.

Analysis of the flow-volume curve in children and adolescents with allergic rhinitis without asthma.

INTRODUCTION: There is epidemiological, functional and pathologic evidence that relates upper and lower airways, clinically known as a single respiratory tract. Patients with allergic rhinitis without asthma may present subclinical abnormal spirometry parameters. OBJECTIVES: To describe the results of the flow-volume curve in a group of patients with allergic rhinitis without asthma and analyze the possible associations between anthropometric, clinical and biochemical outcome measures with abnormal spirometry results. POPULATION AND METHODS: Observational, descriptive study including children and adolescents aged 6 to 18 years old with symptoms of allergic rhinitis without asthma. Age, gender, body mass index and duration of rhinitis were determined as per the subject's medical record. Allergen skin tests, flow-volume curve spirometry, determination of eosinophil count in blood and in nasal secretions, and total serum IgE were performed. RESULTS: A total of 84 patients were studied; 21 (25%; 95% CI: 15.1-34.8) presented at least one altered spirometry outcome measure. The FEV1/FVC ratio was the most affected outcome measure (10/84; 12%; 95% CI: 4.3-19.4). The multiple logistic regression analysis determined that spirometry alterations were associated with the number of blood eosinophils (OR: 1.00229; 95% CI: 1.00022-1.00436; p= 0.03) and the body mass index (OR: 1.31282; 95% CI: 1.08611-1.58685; p= 0.0049). CONCLUSIONS: Our results showed spirometry alterations in a considerable percentage of children and adolescents with allergic rhinitis without asthma. The blood eosinophil count and the body mass index could be associated with a sub-clinical alteration of pulmonary function.

Análisis de la curva flujo-volumen en niños y adolescentes con rinitis alérgica sin asma / Analysis of the fow-volume curve in children and adolescents with allergic rhinitis without asthma

Introducción. Existen evidencias epidemiológicas, funcionales y patológicas que vinculan las vías aéreas superior e inferior, reconocidas clínicamente como una vía aérea única. Los pacientes con rinitis alérgica sin asma podrían presentar anormalidades espirométricas subclínicas. Objetivos. Describir los resultados de las curvas fujo-volumen en un grupo de pacientes con rinitis alérgica sin asma y analizar las posibles asociaciones entre las variables antropométricas, clínicas y bioquímicas con los resultados anormales de las pruebas espirométricas. Población y métodos. Estudio observacional descriptivo, en el que se incluyeron niños y adolescentes de entre 6 y 18 años con síntomas de rinitis alérgica sin asma. Se estableció la edad, el sexo, el índice de masa corporal y la duración de la rinitis por la historia clínica. Se realizaron pruebas cutáneas con alérgenos, espirometría por curva fujo-volumen, determinación de eosinóflos en la sangre y la secreción nasal, e IgE sérica total. Resultados. Se estudiaron 84 pacientes; 21 (25%; IC 95% 15,1 a 34,8) presentaron alguna variable espirométrica alterada. El índice FEV1/FVC fue el más afectado (10/84; 12% IC 95% 4,3 a 19,4). El análisis de regresión logística múltiple determinó que la alteración espirométrica se asoció con el número de eosinóflos en la sangre (OR 1,00229; IC 95% 1,00022 a 1,00436; p= 0,03) y el índice de masa corporal (OR 1,31282; IC 95% 1,08611 a 1,58685; p= 0,0049). Conclusiones. Los resultados muestran la presencia de alteraciones espirométricas en un importante porcentaje de niños y adolescentes con rinitis alérgica sin asma. El recuento absoluto de eosinóflos en la sangre y el índice de masa corporal estarían asociados a la alteración subclínica de la función pulmonar.

Introduction. There is epidemiological, functional and pathologic evidence that relates upper and lower airways, clinically known as a single respiratory tract. Patients with allergic rhinitis without asthma may present subclinical abnormal spirometry parameters. Objectives. To describe the results of the fow-volume curve in a group of patients with allergic rhinitis without asthma and analyze the possible associations between anthropometric, clinical and biochemical outcome measures with abnormal spirometry results. Population and Methods. Observational, descriptive study including children and adolescents aged 6 to 18 years old with symptoms of allergic rhinitis without asthma. Age, gender, body mass index and duration of rhinitis were determined as per the subject's medical record. Allergen skin tests, fow-volume curve spirometry, determination of eosinophil count in blood and in nasal secretions, and total serum IgE were performed. Results. A total of 84 patients were studied; 21 (25%; 95% CI: 15.1-34.8) presented at least one altered spirometry outcome measure. The FEV1/FVC ratio was the most affected outcome measure (10/84; 12%; 95% CI: 4.3-19.4). The multiple logistic regression analysis determined that spirometry alterations were associated with the number of blood eosinophils (OR: 1.00229; 95% CI: 1.00022-1.00436; p= 0.03) and the body mass index (OR: 1.31282; 95% CI: 1.08611-1.58685; p= 0.0049). Conclusions. Our results showed spirometry alterations in a considerable percentage of children and adolescents with allergic rhinitis without asthma. The blood eosinophil count and the body mass index could be associated with a sub-clinical alteration of pulmonary function.

Análisis de la curva flujo-volumen en niños y adolescentes con rinitis alérgica sin asma / Analysis of the fow-volume curve in children and adolescents with allergic rhinitis without asthma

Introducción. Existen evidencias epidemiológicas, funcionales y patológicas que vinculan las vías aéreas superior e inferior, reconocidas clínicamente como una vía aérea única. Los pacientes con rinitis alérgica sin asma podrían presentar anormalidades espirométricas subclínicas. Objetivos. Describir los resultados de las curvas fujo-volumen en un grupo de pacientes con rinitis alérgica sin asma y analizar las posibles asociaciones entre las variables antropométricas, clínicas y bioquímicas con los resultados anormales de las pruebas espirométricas. Población y métodos. Estudio observacional descriptivo, en el que se incluyeron niños y adolescentes de entre 6 y 18 años con síntomas de rinitis alérgica sin asma. Se estableció la edad, el sexo, el índice de masa corporal y la duración de la rinitis por la historia clínica. Se realizaron pruebas cutáneas con alérgenos, espirometría por curva fujo-volumen, determinación de eosinóflos en la sangre y la secreción nasal, e IgE sérica total. Resultados. Se estudiaron 84 pacientes; 21 (25%; IC 95% 15,1 a 34,8) presentaron alguna variable espirométrica alterada. El índice FEV1/FVC fue el más afectado (10/84; 12% IC 95% 4,3 a 19,4). El análisis de regresión logística múltiple determinó que la alteración espirométrica se asoció con el número de eosinóflos en la sangre (OR 1,00229; IC 95% 1,00022 a 1,00436; p= 0,03) y el índice de masa corporal (OR 1,31282; IC 95% 1,08611 a 1,58685; p= 0,0049). Conclusiones. Los resultados muestran la presencia de alteraciones espirométricas en un importante porcentaje de niños y adolescentes con rinitis alérgica sin asma. El recuento absoluto de eosinóflos en la sangre y el índice de masa corporal estarían asociados a la alteración subclínica de la función pulmonar.(AU)

Introduction. There is epidemiological, functional and pathologic evidence that relates upper and lower airways, clinically known as a single respiratory tract. Patients with allergic rhinitis without asthma may present subclinical abnormal spirometry parameters. Objectives. To describe the results of the fow-volume curve in a group of patients with allergic rhinitis without asthma and analyze the possible associations between anthropometric, clinical and biochemical outcome measures with abnormal spirometry results. Population and Methods. Observational, descriptive study including children and adolescents aged 6 to 18 years old with symptoms of allergic rhinitis without asthma. Age, gender, body mass index and duration of rhinitis were determined as per the subjects medical record. Allergen skin tests, fow-volume curve spirometry, determination of eosinophil count in blood and in nasal secretions, and total serum IgE were performed. Results. A total of 84 patients were studied; 21 (25%; 95% CI: 15.1-34.8) presented at least one altered spirometry outcome measure. The FEV1/FVC ratio was the most affected outcome measure (10/84; 12%; 95% CI: 4.3-19.4). The multiple logistic regression analysis determined that spirometry alterations were associated with the number of blood eosinophils (OR: 1.00229; 95% CI: 1.00022-1.00436; p= 0.03) and the body mass index (OR: 1.31282; 95% CI: 1.08611-1.58685; p= 0.0049). Conclusions. Our results showed spirometry alterations in a considerable percentage of children and adolescents with allergic rhinitis without asthma. The blood eosinophil count and the body mass index could be associated with a sub-clinical alteration of pulmonary function.(AU)

Analysis of the flow-volume curve in children and adolescents with allergic rhinitis without asthma. / Analysis of the flow-volume curve in children and adolescents with allergic rhinitis without asthma.

INTRODUCTION: There is epidemiological, functional and pathologic evidence that relates upper and lower airways, clinically known as a single respiratory tract. Patients with allergic rhinitis without asthma may present subclinical abnormal spirometry parameters. OBJECTIVES: To describe the results of the flow-volume curve in a group of patients with allergic rhinitis without asthma and analyze the possible associations between anthropometric, clinical and biochemical outcome measures with abnormal spirometry results. POPULATION AND METHODS: Observational, descriptive study including children and adolescents aged 6 to 18 years old with symptoms of allergic rhinitis without asthma. Age, gender, body mass index and duration of rhinitis were determined as per the subjects medical record. Allergen skin tests, flow-volume curve spirometry, determination of eosinophil count in blood and in nasal secretions, and total serum IgE were performed. RESULTS: A total of 84 patients were studied; 21 (25

; 95

CI: 15.1-34.8) presented at least one altered spirometry outcome measure. The FEV1/FVC ratio was the most affected outcome measure (10/84; 12

; 95

CI: 4.3-19.4). The multiple logistic regression analysis determined that spirometry alterations were associated with the number of blood eosinophils (OR: 1.00229; 95

CI: 1.00022-1.00436; p= 0.03) and the body mass index (OR: 1.31282; 95

CI: 1.08611-1.58685; p= 0.0049). CONCLUSIONS: Our results showed spirometry alterations in a considerable percentage of children and adolescents with allergic rhinitis without asthma. The blood eosinophil count and the body mass index could be associated with a sub-clinical alteration of pulmonary function.

Claves para el manejo práctico de la tos crónica en pediatría / Keys for practical management of chronic cough in childhood

La tos es un mecanismo defensivo fisiológico que contribuye a liberar a la vía aérea de material extraño y generalmentees consecuencia de procesos breves y autolimitados. La tos crónica, definida, por su persistencia por más de 8 semanas,debe obligar al pediatra clínico a agudizar su ingenio en busca del diagnóstico etiológico.Una cuidadosa historia clínica y un examen físico detallado son los pilares fundamentales del diagnóstico; la indicaciónde estudios complementarios dependerá de los resultados de la valoración clínica inicial.La exacta identificación etiológica de la tos crónica debe ser seguida por un tratamiento específico. El abordaje sintomáticocon antitusivos y mucolíticos es excepcionalmente necesario, generalmente decepcionante y no exento de efectostóxicos. Es imperativo evitar la masiva prescripción de estos fármacos puesto que en la mayoría de los casos propende a laprolongación del síntoma con la consecuente alteración de la calidad de vida de los niños.

Cough is a physiological defense mechanism to help clear excessive secretions and foreign material from the airways andis usually short and therefore self-limiting process. Chronic cough, defined by its persistence for more than 8 weeks, is areal clinical challenge for pediatricians who should focus their efforts in search for etiological diagnosis.A careful medical history and physical examination are the mainstays of diagnosis; the indication of further studiesdepends on the results of initial clinical assessment.The exact etiological identification of chronic cough must be followed by specific treatment. The symptomatic approachwith over the counter medications such as antitussives and mucolytic drugs is exceptionally necessary and generally disappointingbecause they may have toxic effects. Is imperative to avoid the massive prescription of these drugs because in mostcases tends to prolongation of symptoms with a consequent impact on the quality of life of children.

Claves para el manejo práctico de la tos crónica en pediatría / Keys for practical management of chronic cough in childhood

La tos es un mecanismo defensivo fisiológico que contribuye a liberar a la vía aérea de material extraño y generalmentees consecuencia de procesos breves y autolimitados. La tos crónica, definida, por su persistencia por más de 8 semanas,debe obligar al pediatra clínico a agudizar su ingenio en busca del diagnóstico etiológico.Una cuidadosa historia clínica y un examen físico detallado son los pilares fundamentales del diagnóstico; la indicaciónde estudios complementarios dependerá de los resultados de la valoración clínica inicial.La exacta identificación etiológica de la tos crónica debe ser seguida por un tratamiento específico. El abordaje sintomáticocon antitusivos y mucolíticos es excepcionalmente necesario, generalmente decepcionante y no exento de efectostóxicos. Es imperativo evitar la masiva prescripción de estos fármacos puesto que en la mayoría de los casos propende a laprolongación del síntoma con la consecuente alteración de la calidad de vida de los niños. (AU)

Cough is a physiological defense mechanism to help clear excessive secretions and foreign material from the airways andis usually short and therefore self-limiting process. Chronic cough, defined by its persistence for more than 8 weeks, is areal clinical challenge for pediatricians who should focus their efforts in search for etiological diagnosis.A careful medical history and physical examination are the mainstays of diagnosis; the indication of further studiesdepends on the results of initial clinical assessment.The exact etiological identification of chronic cough must be followed by specific treatment. The symptomatic approachwith over the counter medications such as antitussives and mucolytic drugs is exceptionally necessary and generally disappointingbecause they may have toxic effects. Is imperative to avoid the massive prescription of these drugs because in mostcases tends to prolongation of symptoms with a consequent impact on the quality of life of children. (AU)