The influence of hospital-based intravenous immunoglobulin and home-based self-administrated subcutaneous immunoglobulin therapy in young children with primary immunodeficiency diseases on their parents' / caregivers' satisfaction.

BACKGROUND: Immunoglobulin replacement has been standard therapy for patients with primary immunodeficiency diseases (PIDD). Intravenous immunoglobin (IVIg) is delivered at the hospital, whereas subcutaneous immunoglobin (SCIg) is used for home-based treatment. The aim of the study was to determine the advantages and disadvantages of IVIg and SCIg in Polish children aged 1-5 years, with PIDD, and the satisfaction of their parents / caregivers regarding immunoglobulin replacement. METHODS: The research involved parents of 23 children with PIDD, aged 1-5 years. All children were given IVIg therapy and after at least 6 months they were switched towards home SCIg therapy for at least 6 months. A questionnaire assessing advantages and disadvantages of preferred types of treatment and the quality of life of PIDD patients' families' lives was used. RESULTS: The research showed that IVIg therapy was better accepted by parents than SCIg therapy (P = 0.034) for the following reasons: It made it possible for the children to receive treatment once per month (60%); it reduced the fear of injecting the children (60%), and it provided better control of the disease through regular visits to the hospital (53.33%). Parents noticed, however, that IVIg had a significant impact on absence at school or work (70%). Parents who preferred SCIg for their children were guided mainly by the smaller number of side effects (40%), and the fact that the treatment did not interfere with parents' work or the children's school (40%). CONCLUSION: The results showed that IVIg therapy was better accepted by parents than SCIg therapy Parents of children with SCIg are less satisfied with their life, and feel anxiety about their children disease, which is related to administering the medicine by themselves.

Comparison of the long-term efficacy of 3- and 5-year house dust mite allergen immunotherapy.

BACKGROUND: The recommended duration of specific immunotherapy (SIT) treatment relies on empiric data and is not well documented. OBJECTIVE: To detect possible differences in the long-term effectiveness between 3 and 5 years of house dust mite (HDM) SIT in asthmatic children. METHODS: We performed a 3-year natural history study of 90 asthmatic children who were sensitive only to HDM. Three groups were recruited: 30 who had completed 3 years of HDM SIT (SIT3), 30 who had completed 5 years of HDM SIT (SIT5), and 30 who had an indication for HDM SIT but whose parents refused HDM SIT. Patients attended an enrollment visit in 2007, after SIT discontinuation, and 3 annual follow-up visits at the clinic. The long-term effectiveness of HDM SIT was primarily assessed via analysis of the reduction in required inhaled corticosteroid dose, forced expiratory volume in 1 second, and asthma remission. RESULTS: A total of 84 children completed the study. Both SIT durations produced excellent results; asthma remission in both SIT3 (50%) and SIT5 (54%) groups was significantly higher when compared with control (3.3%). The minimal controlling inhaled corticosteroid dose reduction in SIT5 group (median, 75%) was significantly higher compared with the SIT3 group (median, 50%) after immunotherapy discontinuation; after 3 years without SIT, no differences were found between the SIT5 and SIT3 groups (median, 100% and 94%, respectively). We observed a slightly higher increase in forced expiratory volume in 1 second in the SIT5 group compared with the SIT3 group. CONCLUSION: Three years of SIT is an adequate duration for the treatment of childhood asthma associated with HDM allergy because 2 further years of SIT added no clinical benefit.

Tumor necrosis factor inhibitors in pediatric asthma.

Asthma is the most common pulmonary disease in children worldwide. As its prevalence significantly increases from 30% to 50% every 10 years it seems that finding the exact form of treatment is crucial to achieve a long-term-benefit effect. Sometimes it appears hard, especially in case of difficult and severe asthma when a standard therapy is not sufficient. The success of omalizumab inspired further studies which turned the spotlight on other pro-inflammatory cytokines such as TNF-alpha. After the success of anti-TNF-alpha therapy in many other inflammatory diseases such as for instance Crohn's Disease and Rheumatoid Arthritis, there appeared several trials discussing the usage of anti-TNF agents in asthma. The first wave of enthusiasm over positive results in treating asthma patients was blunted by other researches which challenged the benefit of anti-TNF-alpha in asthma. What is more, they warned about serious problems and adverse events related to that kind of treatment. These results hindered further investigation, especially in case of children's population, because of the ambiguity as far as the risks and benefits of the treatment were concerned. Nevertheless, the research on anti-TNF-alpha and asthma underlined a significant polymorphism in asthma phenotypes. It seems likely that a therapy with anti-TNF-alpha should be limited to a small subgroup of patients with a specific phenotype manifested by an increased TNF axis. The purpose of this review article is to discuss some recent patents in anti-TNF-alpha therapy.

Effect of specific immunotherapy on serum levels of tumor necrosis factor alpha in asthmatic children.

There is no general agreement among investigators regarding the effect of specific immunotherapy (SIT) on T-cell reactivity. The aim of this study was to investigate the serum levels of IL-1beta, IL-6, and TNF-alpha of children with allergic asthma before and after 3 and 12 months of SIT. Additionally, after 12 months of SIT, we investigated the bronchial hyperresponsiveness. The secondary end points were clinical parameters. Thirty-two children with moderate asthma allergic to house-dust mites (study group) and 10 healthy children (control group) participated in this trial. At each visit blood samples were drawn from all asthmatic patients and at the prestudy visit in controls for determination of parameters. All asthmatic patients received SIT. At the second study visit, baseline spirometry and methacholine challenge tests were performed. Serum TNF-alpha during SIT tended to increase after 3 months with respect to baseline, whereas after 12 months of SIT, serum TNF-alpha decreased. The correlation coefficient (r) between the changes in TNF-alpha values between 3 and 12 months of SIT and provocative concentrations of methacholine to cause a 20% fall in FEV(1) (PC20M) after 12 months of SIT was positive (r = 0.76; p < 0.0001); the greater the changes in TNF-alpha level, the higher the PC20. No modification of IL-1beta and IL-6 was observed. Clinical symptoms also improved after 12 months of SIT in children with asthma. In summary, our results showed the variations in serum levels of TNF-alpha during SIT in asthmatic children and confirm anti-inflammatory properties of SIT.

[Reasons for recurrent respiratory tract inflammations in children]. / Przyczyny nawracajacych zakazen ukladu oddechowego u dzieci.

Respiratory tract inflammations are among the most frequent diseases in children. In natural conditions, respiratory tract is constantly prone to environmental pathogens. In fighting the respiratory tract infections both non-specific and specific: humoral and cellular immune mechanisms, related to mucosa-associated lymphoid tissue (MALT), take part. In healthy subjects, the upper respiratory tract is affluent in physiological bacterial flora comprising aerobic and anaerobic bacteria, some of them potentially pathogenic. In periods of reduced immunity they can cause endogenous infections. Contrary to the upper, the lower respiratory ways are physiologically sterile. The imbalance between defense mechanisms and pathogenity of microorganisms can lead to the development of infection. Recurrent respiratory tract inflammations, due to complexity of their causes, are a problem of great importance. Early estimation of the etiology of recurrent inflammations is particularly crucial, as it allows introduction of aimed therapy and prophylactics, thus preventing the child from the development of irreversible pulmonary lesions and impairment of physical development.

[Serum and sputum eosinophil cationic protein levels and clinical status in cystic fibrosis patients]. / Stezenia eozynofilowego bialka kationowego w surowicy i plwocinie a stan kliniczny chorych na mukowiscydoze.

UNLABELLED: Recent studies have emphasied the role of eosinophils and it's metabolites in the pathogenesis of lung disease in cystic fibrosis. This study was designed to assess the relationship between serum and sputum ECP levels and clinical status of cystic fibrosis patients. MATERIAL AND METHODS: 30 patients, aged 6-30 with moderate cystic fibrosis were recruited. Spirometry, weight and high, and Shwachman-Kulczycki score were measured, and serum and sputum samples were obtained for measurements of the eosinophil cationic protein (ECP). RESULTS: We observed significant inverse correlation between sputum ECP levels and BMI (p<0.001) and FEV1 (p<0.001), and not significant inverse correlation between sputum ECP levels Shwachman-Kulczycki score (p=0.057). There was no signifi cant correlation between sputum ECP levels and FEF25/75% and between serum ECP levels and measured clinical parameters. CONCLUSIONS: Results of this study suggest influence of eosinophil inflammation in respiratory tract on clinical status of CF patients.