Analysis of the filed data of a sample of Egyptian children with bronchial asthma

Background: Identification of the clinical profile of asthma in a community is crucial to the understanding of the growing disease burden. We sought to evaluate the clinical characteristics and management outcome of a sample of asthmatic children from Cairo city and its suburbs. Methods: This retrospective study analyzed the data of 422 consecutively numbered files of asthmatic children from the Pediatric Allergy and Immunology Unit of Ain Shams University Children's Hospital. Data collected included the age at onset, duration of follow up, precipitating factors, feeding history, clinical severity, presence of other allergic diseases and outcome and course of the disease. This is besides the available results of laboratory and imaging studies and the treatment received including the routes and types of therapy. Results: The results revealed that 197 children (46.7%) had bronchial asthma only while 225 (53.3%) had concomitant allergic disorders. Males outnumbered females and urban residents outnumbered suburban and rural residents and all cases belonged to the low and middle social and economic community sectors. A positive family history of allergy in general was evident in about 40% of cases. Viral infection was the most common precipitating factor for exacerbations. Mild and moderate persistent asthma were more frequent than the severe variety (15.10%, 10.20%, and 1.50%). Serum total IgE and peripheral blood eosinophil counts were elevated and atopy was evident in most cases. Inhaled corticosteroid therapy was the most commonly prescribed treatment in the current study but compliance was generally poor. Conclusion: Wider scale multi-center studies in Cairo and other localities of Egypt are needed to outline the profile of childhood asthma in the whole country using a population rather than a referral center-based approach.Keywords: Pediatric asthma, risk factors, asthma grade, asthma triggers, smoking, residenceEgypt J Pediatr Allergy Immunol 2009;7(2):59-6

Plasma concentration of thymus and activation-regulated chemokine in childhood asthma

Background: Thymus and activation-regulated chemokine (TARC) is responsible for trafficking of T helper 2 lymphocytes into sites of allergic inflammation. However, its role in assessing the severity of acute asthma in children is still unclear. Objective: We sought to evaluate plasma TARC as a marker for monitoring asthma exacerbation in terms of asthma attack severity. Methods: Plasma TARC concentration was estimated in 24 asthmatic children aged between 2 and 17 years attending the Pediatric Allergy and Immunology Unit of Children’s Hospital, Ain Shams University, and 23 age and sex-matched healthy children using a sandwich enzyme immunoassay technique. For asthmatic patients, the measurement was performed during and after the resolution of acute asthma attack. In addition, complete hemogram and plasma total IgE were evaluated and peak expiratory flow rate was assessed in asthmatic patients during and after acute asthma exacerbation. Results: Plasma TARC mean concentration was significantly higher during acute asthma (839.2 ± 453.6 pg/ml) than after resolution of symptoms (416.5 ± 324.8 pg/ml) and both were statistically higher than the control value (165.7 ± 135.2 pg/ml). During acute attacks of asthma, plasma TARC level was significantly elevated among patients with severe attacks of wheezing (1336.3 ± 431.2 pg/ml) than in those with moderate (743.8 ± 91.8 pg/ml) and mild (437.5 ± 66.1 pg/ml) attacks and inversely related to PEFR measurements during attacks (r = -98, P < 0.001). Meanwhile, no significant relationship was found between plasma TARC levels and either plasma total IgE levels or the absolute eosinophil count. Neither the history of other atopic symptoms nor family history of atopy influenced plasma TARC levels. A significant reduction in plasma TARC level was observed after treatment with inhaled ß2 agonist drugs either alone or in conjunction with inhaled glucocorticoids. Conclusion: Our findings support the concept that TARC may be implicated in the pathogenesis of asthma. Plasma TARC is a useful marker in monitoring the severity of asthma exacerbation and in assessing the degree of allergic inflammation in the asthmatic airway. This would help physicians to design appropriate therapy in terms of dose and duration of treatment especially among children with quiescent asthma. Future studies should focus on using TARC antagonists as a new approach to asthma immunotherapy.Keywords: bronchial asthma, acute attacks, remission, TARC, atopy, inhaled glucocorticoids, ß2 agonistsEgypt J Pediatr Allergy Immunol 2003; 1(2): 86-9

A study of health-related quality of life in pediatric atopic dermatitis

Background: Children of atopic dermatitis (AD) have difficulties in social adaptation and academic achievements. Health related quality of life (HRQOL) is a multidimensional measure not restricted to physical effects of disease or its treatment. Objective: We sought to assess, through validated questionnaire sets, the impact of AD on the HRQOL of children and their parents or caregivers. Methods: This analytical cross-sectional study was conducted on 85 children with physician diagnosed AD recruited from the Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University from May 2018 to December 2019. HRQOL of the patients was assessed using the Children’s Dermatology Life Quality Index (CDLQI) and that of parents/caregivers was assessed using the Family Dermatology Life Quality Index (FDLQI). Results: Analysing the CDLQI revealed that more than half of the studied sample (55.4%) had an extremely affected quality of life (QOL). The most affected physical aspects were itching and pain. There was statistically significant effect of face eczema on QOL of children. We also found that 65.9% of parents/caregivers had a significantly affected QOL score and the most frequently reported problems were emotional distress and treatment burden. The presence of other allergies in the affected child, other sib affection and adverse effects of treatment were the most significant distressing factors on the QOL of parents/caregivers. Poor QOL of children also impacted their parents’ mental and physical health .Conclusion: AD affects the QOL of both children and their guardians in many aspects. There is necessity to pay more attention to the psychological and social aspects in the children with AD and to respect their parents’ psychosocial impact and financial burden within the integrated management plans of AD

Double negative alpha beta T cells in pediatric hemophagocytic syndromes

Introduction: Autoimmune lymphoproliferative syndrome (ALPS) and hemophagocytic lymphohistiocytosis (HLH) share clinical and laboratory features including lymphadenopathy, splenomegaly, and pancytopenia. We sought to measure αβ double negative T cells (αβ DNT) in a group of patients with established diagnosis of HLH in relation to disease activity and severity.Methods: We conducted a follow-up, controlled study that comprised 25 patients with HLH and 25 healthy matched controls. Patients were subjected to clinical evaluation and flowcytometric measurement of αβ DNT Cells at presentation and 9 weeks after start of HLH induction treatment.Results: In 17 (68%) patients, infection was the trigger of HLH while the cause was malignancy in three (12%), and rheumatological disorders in two patients (8%). At enrollment, 15 patients (60%) had αβ DNT cells levels [median (IQR): 1.71 (1.25-2.12)] that were significantly higher than the control values [median (IQR): 0.7 (0.4-0.8)] (p<0.001). The αβ DNT counts of patients were also higher at enrollment as compared to values at the end of week 9 [median (IQR): 0.76 (0.45-1.17)]; p=0.018. Survivors (n=8) and non-survivors (n=17) had comparable levels of αβ DNT cells at enrollment (p=0.861). αβ DNT cell count correlated positively with ALT (p=0.019) and negatively with CD4/CD8 ratios (p=0.023).Conclusion: Elevated αβ DNT cell counts might be related to the HLH process and this implies that mild elevation can exist in HLH and are not specific to ALPS. Wider scale studies with longer periods of follow up are needed to validate the results and properly outline the correlation between both medical conditions.Keywords: Hemophagocytic lymphohistiocytosis, Double negative T cells, mortality, ALP

Health-related quality of life assessment in a group of children with juvenile idiopathic arthritis

Background: JIA is known to affect the physical and social wellbeing and impact scholastic achievement of children. Health-related quality of life (HRQOL) is an important outcome measure in understanding the impact of chronic illness. Objective: We sought to evaluate the HRQOL of a group of children with juvenile idiopathic arthritis (JIA) to uncover their main problems that might prevent them from leading a normal life . Methods: We consecutively enrolled 119 JIA patients who were classified according to the ILAR criteria into 16 cases with oligoarticular (13.4%), 36 with polyarticular (30.3%) and 67 with systemic JIA (56.3%). They were 62 (52.1%) males and 57 (47.9%) females with a mean age of 7.7 years. Patients were evaluated by the Pediatric Quality of Life Inventory TM Version 4.0 (PedsQLTM) questionnaire. Results: Physical and feeling problem scores were negatively correlated to age, age at onset, diagnostic lag and diseases duration. The learning problem score showed negative correlation with age, age at onset and receival of non-steroidal anti-inflammatory drugs (NSAIDs) pointing to the favorable effect of pain control on the quality of life. Also, learning and social problem scores were positively correlated to the diagnostic lag. Total scores showed negative correlation with age and age at onset. Conclusion: JIA has an important impact on the HRQOL and normal development. Pain control is mandatory for reduction of learning problems via the judicious use of NSAIDs and the delay in diagnosis was associated with unfavorable learning and social outcome

Regulatory natural killer cell expression in atopic childhood asthma

Introduction: Different subsets of natural killer (NK) cells were found to play a role in pathogenesis of allergy. We sought to investigate the expression of regulatory NK cells (CD56+CD16+CD158+) in atopic children with bronchial asthma in order to outline the value of these cells as biomarkers of disease severity and/or control.Methods: A cross sectional controlled study was carried out in the Pediatric Allergy and Immunology Unit, Ain Shams University. The study included 45 atopic children [mean age(SD)= (2.9) years] with bronchial asthma (BA) and/or allergic rhinitis (AR)as well as 40 healthy matched controls. Enrolled subjects underwent complete blood counting and flow cytometric measurement of NK cell (CD16+ CD56+) and regulatory NK cells (CD16+CD56+CD158+).Results: Patients had significantly higher regulatory NK cell percentages [mean (SD)= 41 (52) %] than controls [mean (SD)=15 (7.1)]; p≤0.001. Regulatory NK cell counts and percentages did not vary with the concomitant presence of AR or the degree of asthma control. Regulatory NK cell counts tended to be higher in children with moderate/severe BA compared to those with mild asthma but the difference did not reach statistical significance (U= -1.8, p=0.06). NK cell counts [mean (SD)= 159 (164) cells/μl] and percentages [mean (SD)= 3.7 (3.2) %] were comparable among patients and controls and did not vary with the presence of AR (p= 0.51, 0.95) or with the degree of asthma control. NK cells absolute counts and percentages tended to be higher among patients with moderate/severe compared to mild asthma but the difference did not reach statistical significance.Conclusions: Regulatory NK cells seem to be increased in childhood asthma. We recommend wider scale prospective studies on steroid-naïve subjects involving measurement of cytokines that are secreted by different types of NK cells.Keywords: Natural killer, regulatory, asthma, children, allerg

Health-related quality of life assessment using EQ-5D-Y questionnaire in a group of Egyptian asthmatic children

Background: Asthma, as a common chronic illness, negatively influences children's quality of life. We sought to investigate the health-related quality of life (HRQoL) in a sample of Egyptian asthmatic children. Methods: A cross-sectional study was conducted in the Pediatric Allergy and Immunology Unit of Ain Shams University, including three groups of age and gender-matched children, aged 6-12 years; an asthma group (n=100), non-asthmatic group with respiratory tract infections (n=114), and a healthy control group (n=100). The EQ-5D-Y questionnaire was used to evaluate the HRQoL in each study group. This questionnaire also comprises a visual analogue scale (VAS) which is scored from zero (worst) to 100 (best) as judged by the patient. Results: HRQoL assessment revealed that 86% of the asthmatic children faced problems with their daily activities, 43 % had worries, sadness and unhappiness and 22% had mobility problems (walking around). Thirteen percent of the cases expressed some pain or discomfort due to their disease, while self-care was the least affected (6%). Parameters of mobility, doing usual activities, feeling worried or sad were more frequently affected among the asthmatics in comparison to the other two groups (X2 = 37.02, 46.38, 22.90, respectively with p <0.001). Enrolled asthmatic children showed the lowest values of visual analogue scale (VAS) scores (mean ± SD: 72.2 ± 24.6) in comparison to the infection and healthy control groups (mean ± SD: 84.6 ± 12, 92.8 ± 9.6, respectively; f = 39.03; p value = 0.001). Conclusion:Asthma has a significant adverse impact on HRQoL of children and the EQ-5D-Y questionnaire could be an applicable instrument to measure their quality of life

Management of asthma in childhood: study protocol of a systematic evidence update by the Paediatric Asthma in Real Life (PeARL) Think Tank

IntroductionClinical recommendations for childhood asthma are often based on data extrapolated from studies conducted in adults, despite significant differences in mechanisms and response to treatments. The Paediatric Asthma in Real Life (PeARL) Think Tank aspires to develop recommendations based on the best available evidence from studies in children. An overview of systematic reviews (SRs) on paediatric asthma maintenance management and an SR of treatments for acute asthma attacks in children, requiring an emergency presentation with/without hospital admission will be conducted.Methods and analysisStandard methodology recommended by Cochrane will be followed. Maintenance pharmacotherapy of childhood asthma will be evaluated in an overview of SRs published after 2005 and including clinical trials or real-life studies. For evaluating pharmacotherapy of acute asthma attacks leading to an emergency presentation with/without hospital admission, we opted to conduct de novo synthesis in the absence of adequate up-to-date published SRs. For the SR of acute asthma pharmacotherapy, we will consider eligible SRs, clinical trials or real-life studies without time restrictions. Our evidence updates will be based on broad searches of Pubmed/Medline and the Cochrane Library. We will use A MeaSurement Tool to Assess systematic Reviews, V.2, Cochrane risk of bias 2 and REal Life EVidence AssessmeNt Tool to evaluate the methodological quality of SRs, controlled clinical trials and real-life studies, respectively. Next, we will further assess interventions for acute severe asthma attacks with positive clinical results in meta-analyses. We will include both controlled clinical trials and observational studies and will assess their quality using the previously mentioned tools. We will employ random effect models for conducting meta-analyses, and Grading of Recommendations Assessment, Development and Evaluation methodology to assess certainty in the body of evidence.Ethics and disseminationEthics approval is not required for SRs. Our findings will be published in peer reviewed journals and will inform clinical recommendations being developed by the PeARL Think Tank.PROSPERO registration numbers CRD42020132990, CRD42020171624.</p

Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multinational cohort

Background The interplay between COVID-19 pandemic and asthma in children is still unclear. We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes.Methods The PeARL multinational cohort included 1,054 children with asthma and 505 non-asthmatic children aged between 4 and 18 years from 25 pediatric departments, from 15 countries globally. We compared the frequency of acute respiratory and febrile presentations during the first wave of the COVID-19 pandemic between groups and with data available from the previous year. In children with asthma, we also compared current and historical disease control.Results During the pandemic, children with asthma experienced fewer upper respiratory tract infections, episodes of pyrexia, emergency visits, hospital admissions, asthma attacks, and hospitalizations due to asthma, in comparison with the preceding year. Sixty-six percent of asthmatic children had improved asthma control while in 33% the improvement exceeded the minimal clinically important difference. Pre-bronchodilatation FEV1 and peak expiratory flow rate were improved during the pandemic. When compared to non-asthmatic controls, children with asthma were not at increased risk of LRTIs, episodes of pyrexia, emergency visits, or hospitalizations during the pandemic. However, an increased risk of URTIs emerged.Conclusion Childhood asthma outcomes, including control, were improved during the first wave of the COVID-19 pandemic, probably because of reduced exposure to asthma triggers and increased treatment adherence. The decreased frequency of acute episodes does not support the notion that childhood asthma may be a risk factor for COVID-19. Furthermore, the potential for improving childhood asthma outcomes through environmental control becomes apparent.</p