Prevalence of Childhood Allergic Diseases in Central Taiwan over the Past 15 Years

BackgroundThe prevalence of asthma, allergic rhinitis and atopic eczema in children from the developed and developing countries has been increasing.MethodsThree epidemiological surveys of the prevalence of bronchial asthma, allergic rhinitis and atopic eczema in schoolchildren in Taichung, located in central Taiwan, were conducted in 1987, 1994, and 2002. The first questionnaire was used before the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire was developed; the last two surveys were modified using ISAAC questionnaires.ResultsA total of 37,801, 75,960, and 11,580 children were studied in 1987, 1994 and 2002, respectively. The prevalence of allergic diseases had increased in the past two decades. Results indicate that the prevalence of bronchial asthma had risen, from 2.19% in 1987, and 3.54% in 1994, to 6.99% in 2002. Regardless of sex, the prevalence of bronchial asthma decreased with increasing age. The prevalence of allergic rhinitis was 5.1% in 1987, 12.46% in 1987, and 27.59% in 2002, and the prevalence of atopic eczema was 1.10% in 1987, 1.88% in 1994, and 3.35% in 2002.ConclusionThere has been a significant increase in the prevalence of bronchial asthma, allergic rhinitis and atopic dermatitis in Taichung schoolchildren from 1987 to 2002

Preliminary Report on Admission Profiles for Children Under 5 Years Old in Taiwan: Disparities between 2000 and 2009

Background/PurposeData on hospital admissions for children under 5 years old, concerning the admission rate, leading diagnoses, categories of disease, average hospitalization days, costs and between-year differences are scarce. Our study aims to investigate such admission profiles.MethodsFive percent of admission data for children under 5 years old in 2000 and 2009 was collected from the National Health Insurance Research Database in Taiwan. We calculated the admission rate in regards to total admission, the patients' gender, the ten leading diagnoses, the ten most systemic common categories of disease, and the average hospitalization days and costs. The differences of the rates between 2000 and 2009 were evaluated by incidence rate ratios (IRR).ResultsThe admission rate per thousand children (population) was higher in 2009 (172.9) than 2000 (153.1). The ten most common systemic categories of disease were similar in both years. Furthermore, it was observed that the hospitalization days decreased by 3.7% in 2009, while medical expenditures increased by 10.9%.ConclusionsEfforts should be made to decrease the admission rate and hospitalization days in Taiwan to the levels of well-developed countries. Our data may serve as baseline data for future evaluations of child morbidity

Optimization of a PVC Membrane for Reference Field Effect Transistors

For the miniaturization of ISFET sensing systems, the concept of a REFET with low ion sensitivity is proposed to replace the conventional reference electrodes through the arrangement of a quasi reference electrode and a differential readout circuit. In this study, an ion-unblocking membrane was used as the top layer of a REFET. To optimize the REFET performance, the influences of the silylating process, different plasticizers, and the composition of the PVC cocktails were investigated. A low sensitivity (10.4 ± 2.2 mV/pH) and high linearity (99.7 ± 0.3 %) in the range from pH 2.2 to pH 11.6 was obtained for the REFET with a 60 wt.% DNP/(DNP + PVC) membrane. To evaluate the long term stability, the drift coefficient was estimated, and for the best REFET, it was −0.74 mV/h. Two criteria for assessing the lifetime of REFETs were used, namely the increase in pH sensitivity to a value higher than 15 mV/pH and the degradation of linearity below 99 %. For the best REFET, it was approximately 15 days

Early Bronchiolitis Contributes to Preschool Asthma

This study aims to analyze whether bronchiolitis in children younger than one-year-old contributes to subsequent asthma. Medical data were retrieved from the National Health Insurance Research Database of Taiwan. Participants were divided into study (N = 65,559) and control (N = 49,656) groups, depending on whether they had early bronchiolitis. Incidences of asthma, potential comorbidities, and associated medical conditions were compared. The incidence of childhood asthma was significantly higher in the study group (aHR = 1.127, 95% CI: 1.063–1.195). Children with bronchiolitis hospitalization displayed higher asthma risk in the period between two and four years of age. The risk diminished as the children grew up. No relevant synergistic effects were found between bronchiolitis and atopic dermatitis. In conclusion, bronchiolitis before one year of age exhibits predictive value for development of preschool asthma, especially in children with bronchiolitis hospitalizations

Allergic rhinitis, rather than asthma, might be associated with dental caries, periodontitis, and other oral diseases in adults

Background The association between asthma (AS), allergic rhinitis (AR) and oral diseases remains inconclusive in adults. AS and AR often coexist. However, studies that investigate AS, AR together and their association with oral diseases are scarce. Methods Data from 22,898 men and 28,541 women, aged 21 to 25 years, were collected from a national database in Taiwan. Five common oral diseases: dental caries, periodontitis, pulpitis, gingivitis, and stomatitis/aphthae were studied. Differences in the incidence of the five oral diseases in AR vs. non-AR, and AS vs. non-AS groups were compared. The incidence of the five oral diseases in men/ women, urban/country citizen, and high/low income groups was studied. The frequencies of clinical visits and impact of topical steroid use between the groups were also studied. The confounding factors included sex, socioeconomic status, urbanization, dentofacial anomalies, disease of salivary flow, diabetes mellitus, and esophageal reflux. Results The incidence and the frequencies of clinical visits for all five oral diseases were higher in those with AR than in the non-AR group after adjusting for confounding factors and AS. Similar observation was made for the AS group, without adjusting for AR. However, if AR was included for adjustment, no relationship was found between AS and oral diseases. In the AR group, those with higher incomes, and country residents had a high risk of developing oral disease. Intranasal steroids, rather than inhaled steroids, were also associated with oral diseases. Conclusion AR, rather than AS, may be associated with oral diseases in young adults

Uric Acid Levels Can Predict Metabolic Syndrome and Hypertension in Adolescents: A 10-Year Longitudinal Study.

The relationships between uric acid and chronic disease risk factors such as metabolic syndrome, type 2 diabetes mellitus, and hypertension have been studied in adults. However, whether these relationships exist in adolescents is unknown. We randomly selected 8,005 subjects who were between 10 to 15 years old at baseline. Measurements of uric acid were used to predict the future occurrence of metabolic syndrome, hypertension, and type 2 diabetes. In total, 5,748 adolescents were enrolled and followed for a median of 7.2 years. Using cutoff points of uric acid for males and females (7.3 and 6.2 mg/dl, respectively), a high level of uric acid was either the second or third best predictor for hypertension in both genders (hazard ratio: 2.920 for males, 5.222 for females; p<0.05). However, uric acid levels failed to predict type 2 diabetes mellitus, and only predicted metabolic syndrome in males (hazard ratio: 1.658; p<0.05). The same results were found in multivariate adjusted analysis. In conclusion, a high level of uric acid indicated a higher likelihood of developing hypertension in both genders and metabolic syndrome in males after 10 years of follow-up. However, uric acid levels did not affect the occurrence of type 2 diabetes in both genders

Comparison of Mometasone Furoate Monohydrate (Nasonex) and Fluticasone Propionate (Flixonase) Nasal Sprays in the Treatment of Dust Mite-sensitive Children with Perennial Allergic Rhinitis

Various studies have investigated the efficacies of mometasone furoate monohydrate (MFM) and fluticasone propionate (FP) nasal sprays for adults. However, research on their effectiveness for children is limited. This study compares the efficacies of MFM and FP nasal sprays in pediatric patients with perennial-allergic rhinitis. Materials and methods: For this study, 94 perennial allergic rhinitis patients aged 6–12 years were randomly assigned to two treatment groups: an MFM group and an FP group. Treatment was provided for 4 weeks. The effects of the two agents were compared using the Pediatric Rhinoconjunctivitis Quality of Life Questionnaire and total symptom scores (TSSs). Nasal-peak expiratory flow rates and eosinophil percentage in nasal smears were also compared between the two groups. Results: Patients in the MFM group exhibited significant improvement in their TSS (t = −2.65, p < 0.05). A detailed TSS analysis showed MFM to be more effective for relieving nasal symptoms, whereas FP was more effective for relieving non-nasal symptoms. Patient questionnaire scores suggested a significant reduction in symptoms for both the MFM (t = −7.23, p < 0.01) and FP (t = −5.43, p < 0.01) groups. The flow rate test results indicated significant improvements in the MFM group (t = 2.27, p < 0.05). Conclusion: Following the 4-week therapy, MFM provided greater improvement compared to FP for symptoms of childhood perennial-allergic rhinitis. Based on their TSSs, the MFM group experienced more effective relief of nasal symptoms, whereas the FP group experienced more effective relief of non-nasal symptoms

Hylan G-F 20 Has Better Pain Relief and Cost-effectiveness than Sodium Hyaluronate in Treating Early Osteoarthritic Knees in Taiwan

Intra-articular injection of hyaluronan (hyaluronic acid; HA) products is available to treat early osteoarthritis (OA) of the knee in Taiwan. We tested whether HA products with different molecular weights have significantly different effects on clinical efficacy and cost-effectiveness. Methods: Thirty-seven patients with mild to moderate OA of both knees underwent five weekly intra-articular injections of sodium hyaluronate (Artz®) in one knee and three weekly intra-articular injections of chemically cross-linked Hylan G-F 20 (Synvisc®) in the other. Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne's index, and Hospital for Special Surgery (HSS) knee scores were compared initially and at the last injection, and at 8, 12, 16, 20, and 26 weeks after the first injection. Results: VAS, WOMAC, WOMAC-A1 (pain when walking on a flat surface) scores before week 16, HSS scores before week 12, and Lequesne's index scores except at week 26 all showed that HA significantly improved the scores time-dependently. In VAS scores, Synvisc® showed better improvement before week 20, while this effect appeared at week 12 for the WOMAC-A1 scores. The incremental cost-effectiveness ratio of the Taiwan National Health Insurance Program, of the patient, and both of these was lower for Synvisc®, which also reduced the number of additional hospital visits for injections by two. Conclusion: Synvisc® possesses better symptom-modifying ability and cost–utility in treating early OA of the knee in Taiwan

Efficacy of sublingual immunotherapy with high-dose mite extracts in asthma: A multi-center, double-blind, randomized, and placebo-controlled study in Taiwan

SummarySublingual immunotherapy (SLIT) has been recommended as a viable alternative to subcutaneous injection therapy in the treatment of airway allergies, though more data is needed from well-controlled studies for documenting its efficacy in different ethnic populations. Ninety-seven children (age range 6–12 years), mild-to-moderate asthma with a single sensitization to mite allergen, were enrolled from 5 medical centers in Taiwan to evaluate the efficacy and safety of SLIT with standardized mite extracts, which contain Dermatophagoides pteronyssinus (D.p.) and Dermatophagoides farinae (D.f.). Patients were double blinded and randomly assigned to either a SLIT or placebo group. Following 24 weeks of study period, symptom and medication scores, lung function tests, skin prick tests, total serum IgE, and specific IgE to D.p. and D.f. were recorded. The results showed that there was statistically significant difference between these two groups in the analysis of daily (P=0.011), nighttime (P=0.028), and daytime (P=0.009) asthmatic scores after 24 weeks of treatment. Patients receiving SLIT improved their forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), and peak expiratory flow (PEF) as compared to baseline (P=0.042, P=0.048, and P=0.001, respectively). No differences were found in skin prick test, total serum IgE and specific IgE to D.p. and D.f. Tolerance with high-dose SLIT was good with few minor adverse events reported. Our results indicated that a 24-week SLIT is of clinical benefit to mite-sensitive asthmatic children in Taiwan

Integrated OMICs Approach for the Group 1 Protease Mite-Allergen of House Dust Mite <i>Dermatophagoides microceras</i>

House dust mites (HDMs) are one of the most important allergy-causing agents of asthma. In central Taiwan, the prevalence of sensitization to Dermatophagoides microceras (Der m), a particular mite species of HDMs, is approximately 80% and is related to the IgE crossing reactivity of Dermatophagoides pteronyssinus (Der p) and Dermatophagoides farinae (Der f). Integrated OMICs examination was used to identify and characterize the specific group 1 mite-allergic component (Der m 1). De novo draft genomic assembly and comparative genome analysis predicted that the full-length Der m 1 allergen gene is 321 amino acids in silico. Proteomics verified this result, and its recombinant protein production implicated the cysteine protease and α chain of fibrinogen proteolytic activity. In the sensitized mice, pathophysiological features and increased neutrophils accumulation were evident in the lung tissues and BALF with the combination of Der m 1 and 2 inhalation, respectively. Principal component analysis (PCA) of mice cytokines revealed that the cytokine profiles of the allergen-sensitized mice model with combined Der m 1 and 2 were similar to those with Der m 2 alone but differed from those with Der m 1 alone. Regarding the possible sensitizing roles of Der m 1 in the cells, the fibrinogen cleavage products (FCPs) derived from combined Der m 1 and Der m 2 induced the expression of pro-inflammatory cytokines IL-6 and IL-8 in human bronchial epithelium cells. Der m 1 biologically functions as a cysteine protease and contributes to the α chain of fibrinogen digestion in vitro. The combination of Der m 1 and 2 could induce similar cytokines expression patterns to Der m 2 in mice, and the FCPs derived from Der m 1 has a synergistic effect with Der m 2 to induce the expression of pro-inflammatory cytokines in human bronchial epithelium cells