Recurrent wheezing and asthma after bocavirus bronchiolitis.

BACKGROUND: Human bocavirus (HBoV) was recently discovered and identified as an important cause of respiratory infection in young children. However, the relationship between HBoV-bronchiolitis and the development of recurrent wheezing has not yet been established. OBJECTIVE: We designed this study in order to describe the mid-term outcome, regarding the development of recurrent wheezing and asthma of HBoV-bronchiolitis patients and to compare it with RSV-bronchiolitis infants. METHODS: We studied 80 children (10 with HBoV and 70 with RSV infection), currently aged ≥4 years and previously hospitalised during the seasons 2004-2009 due to acute bronchiolitis. Epidemiological and clinical data were collected through structured clinical interviews at the follow-up visit. Spirometry and skin prick tests to common food and inhaled allergens were performed. RESULTS: All HBoV-patients developed recurrent wheezing and half of them had asthma at age 5-7 years. Almost 30% required hospital admission for recurrent wheezing. Asthma (odds ratio (OR)=1.28) and current asthma (OR=2.18) were significantly more frequent in children with HBoV-bronchiolitis than in RSV-bronchiolitis. FEV1 values were 99.2±4.8 in HBoV-group vs. 103±11 in RSV-group, p: 0.09. No differences were found with respect to allergic rhinitis, atopic dermatitis, food allergy, proportion of positive prick tests, and family history of atopy or asthma. CONCLUSIONS: Severe HBoV-bronchiolitis in infancy was strongly associated with asthma at 5-7 years.

Human metapneumovirus bronchiolitis in infancy is an important risk factor for asthma at age 5.

BACKGROUND: Human metapneumovirus (hMPV) infection plays an important role in the pediatric respiratory infections. However, little is known about the relationship between hMPV-bronchiolitis and the development of subsequent wheezing. The aim of this study was to evaluate the outcome at third to fifth year after admission for hMPV-bronchiolitis and to compare it with children admitted for respiratory syncytial virus (RSV)-bronchiolitis and with children without lower respiratory disease in the first 2 years of life. METHODS: We studied 55 children (23 hMPV and 32 RSV acute bronchiolitis) aged 3-5 years and hospitalized during the seasons 2000-2005. Thirty-eight children admitted due to acute rotavirus gastroenteritis in the same seasons, and without bronchiolitis during infancy, were also analyzed. Clinical data were collected through structured clinical interviews at the follow-up visit. Skin prick tests to food and inhaled allergens were performed. RESULTS: Asthma was significantly more frequent in children with hMPV-bronchiolitis (odds ratio (OR) = 5.21), RSV-bronchiolitis (OR = 4.68), allergic rhinitis (OR = 1.7), and siblings with atopy (OR = 1.75). In the multivariate analyses, hMPV was the most important risk factor for asthma in preschool years (OR = 15.9), followed by RSV-bronchiolitis (OR = 10.1) and allergic rhinitis (OR = 4.9). No differences were found with respect to allergic rhinitis, atopic dermatitis, food allergy, proportion of positive prick tests, family history of atopy, and asthma. CONCLUSIONS: hMPV-bronchiolitis in infancy was strongly associated with asthma as well as other forms of bronchial obstructive disease at third and fifth year of life. This association is, at least, as strong as the association observed with RSV infections.

Recurrent wheezing and asthma after bocavirus bronchiolitis

BACKGROUND: Human bocavirus (HBoV) was recently discovered and identified as an important cause of respiratory infection in young children. However, the relationship between HBoV-bronchiolitis and the development of recurrent wheezing has not yet been established. OBJECTIVE: We designed this study in order to describe the mid-term outcome, regarding the development of recurrent wheezing and asthma of HBoV-bronchiolitis patients and to compare it with RSV-bronchiolitis infants. METHODS: We studied 80 children (10 with HBoV and 70 with RSV infection), currently aged ≥4 years and previously hospitalised during the seasons 2004-2009 due to acute bronchiolitis. Epidemiological and clinical data were collected through structured clinical interviews at the follow-up visit. Spirometry and skin prick tests to common food and inhaled allergens were performed. RESULTS: All HBoV-patients developed recurrent wheezing and half of them had asthma at age 5-7 years. Almost 30% required hospital admission for recurrent wheezing. Asthma (odds ratio (OR)=1.28) and current asthma (OR=2.18) were significantly more frequent in children with HBoV-bronchiolitis than in RSV-bronchiolitis. FEV1 values were 99.2±4.8 in HBoV-group vs.103±11 in RSV-group, p: 0.09. No differences were found with respect to allergic rhinitis, atopic dermatitis, food allergy, proportion of positive prick tests, and family history of atopy or asthma. CONCLUSIONS: Severe HBoV-bronchiolitis in infancy was strongly associated with asthma at 5-7 years

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Clinical efficacy and tolerance of two year Lolium perenne sublingual immunotherapy.

Last years, in spite of increasing use of sublingual immunotherapy (SLIT), not enough clinical studies have been published and its efficacy ought to be documented still more. For that purpose, 54 patients suffering seasonal rhinoconjunctivitis--with or without asthma--were allocated to either six month preseasonal SLIT with Lolium perenne extract (n = 35) or to a control group (n = 19). In the following year, thirty from previously treated patients and 12 from former control group, received a nine-month pre-coseasonal SLIT. Skin (SPT) and conjunctival (CPT) allergen response were monitorized several times along the study. Either seric antibodies or intraseasonal eosinophil cationic protein (ECP), as symptom, medication scores and peak nasal inspiratory flow (PNIF) were also assessed, fifty-five adverse reactions were recorded (0.7% doses), although only four required treatment. No main changes in CPT, SPT and antibodies were detected. Nevertheless, during the first pollen season, treated patients needed less medication than their control counterparts (p < 0.05). In the second season, the twelve ex-control subjects also required fewer drugs than in the first one (p < 0.01). Moreover, the whole forty-two treated patients showed a lesser intraseasonal ECP than a reference set of grass-allergic individuals (p < 0.05). We conclude that Lolium perenne SLIT is well tolerated and induces fewer drug requirements during pollen season, being eosinophil activation additionally reduced.

Oilseed rape flour: another allergen causing occupational asthma among farmers.

BACKGROUND: Farmers are exposed to a wide variety of sensitizers. Since occupational asthma (OA) can lead to permanent disability, exposure discontinuation is the preferred treatment. When this is not possible, the identification of the causative allergen may allow an alternative therapy. METHODS: We present three farmers diagnosed with OA as a consequence of handling fodder. We carried out skin tests with common and occupational allergens and with oilseed rape (OSR) extract. Total and specific serum IgE levels were measured. The patients underwent the OSR-bronchial provocation test (OSR-BPT). The day before and 24 h after the OSR-BPT, the methacholine (M)-BPT and induced sputum were performed. Eosinophil percentages and ECP levels were measured in the sputum samples. RESULTS: OSR sensitization (skin tests and specific serum IgE) was detected in all the patients. The OSR-BPT elicited early responses in two subjects. Methacholine sensitivity, sputum eosinophils, and sputum ECP levels increased 24 h after the OSR-BPT in all the patients. CONCLUSIONS: We have demonstrated that inhalation of OSR flour causes bronchoconstriction, induces an eosinophilic inflammatory bronchial response, and increases bronchial hyperresponsiveness in sensitized asthmatics. OSR flour contained in animal fodder should be considered another potential cause of OA among farmers.

Sensibilización al látex en dos grupos de riesgo / Late sensibilitation in two risk groups

En la última década se han comunicado un gran número de pacientes alérgicos a la goma, sobre todo en revistas americanas. Sin embargo, no son tan frecuentes los estudios en poblaciones de riesgo. En este trabajo hemos estudiado la hipersensibilidad al látex (HYLAT) en 41 niños: divididos en un grupo que presen taban atopia (A), otro grupo de niños que habían sido sometidos a múltiples intervenciones quirúrgicas (SUR), y un grupo control (CG). A cada paciente se le realizó una detallada historia, pruebas cutáneas con extracto de látex e IgE específica sérica anti-látex y anti-frutas. En el grupo A, 2/13 pacientes tenían HYLAT tanto "in vivo" (intradermorreacción con látex fue positiva) como "in vitro", aunque ambos niños toleraban la exposición a la goma y a las frutas relacionadas. En el grupo SUR, 3/15 pacientes mostraron HYLAT con prick-test y anti-látex IgE positivos (todos eran mielodisplásicos). Una IgE específica anti-látex positiva en niños atópicos sin historia clínica de alergia a la goma, podría significar una reactividad cruzada parcial con los antígenos de las frutas, sin expresión clínica, como en los dos casos del grupo A. Esto implica que la determinación aislada de IgE anti-látex podría ser de poco valor para el despistaje de la alergia a la goma. En base a los resultados obtenidos en el grupo SUR nosotros creemos que es conveniente valorar la alergia al látex en niños con mielodisplasia, hecho que podría ampliarse a niños con múltiples operaciones (AU)

Hipocomplementemia de causa poco habitual / An infrecuent cause of hypocomplementaemia

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