Evaluation of asthma risk index application in treating early childhood asthma

Abstract Finnish current care guidelines recommend that the treatment of asthma in young children should be based on the number of wheezing episodes and on the assessment of asthma risk profile consisting of two major and three minor criteria, constructed on the basis of the international asthma predictive index. The aim of the present study was to assess whether the current guidelines and risk profile determination are applied in the treatment of asthma in children aged less than three years. In all, 179 children aged 1-35 months were admitted for wheezing during four winter-months from 1 st Nov, 2006 to 28 th Feb. 2007. The data on treatment decisions, and major and minor asthma risk factors were retrospectively collected from patient records. Recorded data sufficient for the retrospective determination of the asthma risk profile were found for 112/179(63 %) children. Data on minor criteria were missing in almost all cases. Most of the children with data not available were first-time wheezers. Twenty-one children (19%) were on maintenance medication at admission. The decision whether or not to start maintenance medication was in line with the current care guidelines in 76/91(84 %) children. In conclusion, the treatment of asthma in young children mostly took place according to the national current care guidelines, though the application of the asthma risk profile was insufficient. The minor criteria of the asthma risk profile are not sufficiently sensible for clinical practice, and therefore need to be up-to-dated

Outcome of oral immunotherapy for persistent cow's milk allergy from 11 years of experience in Finland

Background: The safety and efficacy of long-term milk oral immunotherapy (OIT) in Finnish children with persistent cow's milk allergy (CMA) were evaluated in an open-label, non-randomized study. Methods: During the 11-year study, 296 children aged 5 years or older with immunoglobulin E (IgE)-mediated CMA started milk OIT. Follow-up data were collected at three time points: the post-buildup phase, 1 year thereafter, and at the cross-sectional long-term follow-up between January 2016 and December 2017. Patients were divided according to baseline milk-specific IgE (sIgE) level and by the amount of milk consumption at the long-term follow-up. The high-dose group consumed >= 2 dL of milk daily, while the failure group consumed Results: Out of the initial study group, 244/296 (83%) patients participated in the long-term follow-up. Among these patients, 136/244 (56%) consumed >= 2 dL of milk daily. The median follow-up time was 6.5 years. Of the recorded markers and clinical factors, the baseline milk sIgE level was most associated with maintaining milk OIT (P <0.001). Respiratory symptoms in the post-buildup phase increased the risk of treatment failure (OR 3.5, 95% CI: 1.5-8.1, P = 0.003) and anaphylaxis (OR 14.3, 95% CI: 1.8-114, P = 0.01). Conclusion: More than half of the patients were able to maintain the targeted milk dose in their daily diet. Baseline milk sIgE level and reactivity during the early treatment stage strongly predicted the long-term outcome and safety of milk OIT.Peer reviewe

Exposure to sewage water and the development of allergic manifestations in Finnish children

Background The hygiene hypothesis suggests that a decreased microbial load contributes to an increased risk of allergies. In the Finnish municipality of Nokia, sewage water was accidentally mixed with drinking water for 2 days. We studied the association between exposure and the emergence of allergies in children. Methods Children aged 2-5 years living in the accident area and an age-matched cohort from the control municipality were recruited. Based on the questionnaires, we identified 139 children exposed to the contaminated water and selected age- and sex-matched controls for them (mean age 16.59 months at the time of the accident). Allergic symptoms and diseases were recorded by ISAAC questionnaires and skin prick tests (SPTs) performed 2 and 5 years after the accident. Results SPT positivity at 5 years of follow-up was decreased in the children exposed to the sewage water below 1 year of age (OR 0.311, 95% CI 0.118-0.820; P = 0.019), particularly in children who did not develop gastroenteritis at exposure. In contrast, the children over 1 year of age at the exposure tended more likely to be SPT-positive at 5 years of follow-up (OR 1.997, 95% CI 0.963-4.143; P = 0.070). Conclusions Sewage water exposure during the first year of life, but not later, decreased the risk of IgE sensitization emphasizing the importance of age as a modulator. The modulation of IgE sensitization by the presence of clinical gastroenteritis at the exposure suggests that the nature of microbial load may have importance or alternatively shared host defense mechanisms protect from infection and atopic sensitization.Peer reviewe

Noninvasive cardiorespiratory signals analysis for asthma evolution monitoring in preschool children

Despite its increasing prevalence, diagnosis of asthma in children remains problematic due to their difficulties in producing repeatable spirometric maneuvers. Moreover, low adherence to inhaled corticosteroids (ICS) treatment could result in permanent airway remodeling. The growing interest in a noninvasive and objective way for monitoring asthma, together with the apparent role of autonomic nervous system (ANS) in its pathogenesis, have attracted interest towards heart rate variability (HRV) and cardiorespiratory coupling (CRC) analyses. In this work, HRV and CRC were analyzed in 70 children who were prescribed ICS treatment due to obstructive bronchitis. They underwent three different electrocardiogram and respiratory signals recordings, during and after treatment period. After treatment completion, they were followed up during 6 months and classified attending to their current asthma status. Vagal activity, as measured from HRV, and CRC, were reduced after treatment in those children at lower risk of asthma, whereas it kept unchanged in those with a worse prognosis. Results suggest that HRV analysis could be useful for the continuous monitoring of ANS anomalies present in asthma, thus contributing to evaluate the evolution of the disease, which is especially challenging in young children

Food allergy in small children carries a risk of essential fatty acid deficiency, as detected by elevated serum mead acid proportion of total fatty acids

Abstract Background Elevated serum Mead acid as a proportion of total fatty acids is an indirect marker of a deficiency of essential fatty acids (EFA). The aim of the study was to evaluate the symptoms and nutrition of food-allergic children with elevated or normal serum Mead acid. Methods Serum fatty acid compositions from 400 children were studied by clinical indications, mostly by suspicion of deficiency of EFA due to inadequate nutrition. A Mead acid level exceeding 0.21% (percentage of total fatty acids) was considered to be a specific sign of an insufficient EFA supply. From a total of 31 children with elevated Mead acid (MEADplus group), 23 (74%) had food allergy. The symptoms and dietary restrictions of this MEADplus group of food allergic children were compared to 54 age-and sex-matched controls with food allergy but normal Mead acid proportions (MEADminus group) before and 6&#160;months after the serum fatty acid determination. Results At the beginning of the 6-month follow-up, 44% of the food allergic children in both MEADplus and MEADminus groups were on an elimination diet. These diets did not differ between the two groups and we were not able to document an association between the severity of elimination diet and elevated Mead acid proportion. However, the MEADplus children were on average more symptomatic than MEADminus children. In the MEADplus group, food allergy presented with skin symptoms in 100% (vs. 70% in the MEADminus group, p&#8201;&lt;&#8201;0.001) and with vomiting or diarrhea in 70% (vs. 44% in the MEADminus group, p&#8201;&lt;&#8201;0.05). Clinical suspicion of malnutrition resulted in increase in the use of vegetable oil and milk-free margarine in both groups from &lt;50% to 65-74% during the follow-up. After 6&#160;months, 64% of the MEADplus children with food allergy had been sent to a control serum fatty acid analysis. Of these children, Mead acid had declined to normal level in 69%, and remained elevated in 31%. Conclusions Severe symptoms of food allergy combined with elimination diets in children may lead to insufficient nutrition presenting with elevated serum Mead acid. Adding of supplementary polyunsaturated fat to the diet should be considered in these children

Long-term changes in milk component immunoglobulins reflect milk oral immunotherapy outcomes in Finnish children

Background Milk oral immunotherapy (OIT) may increase the amount of milk protein that can be ingested without triggering an allergic reaction. It is important to understand why some patients benefit from the treatment while others do not. Objective The aim was to define the differences in the milk allergen component-specific (casein, alpha-lactalbumin, ss-lactoglobulin) immunoglobulin (sIg [sIgE, sIgG4, and sIgA]) levels relative to the long-term outcomes of milk OIT. Methods In this long-term, open-label follow-up study, 286 children started milk OIT between 2005 and 2015. Follow-up data were collected at two points: the post-buildup phase and long term (range 1-11 years, median 6 years). Comparisons of sIg levels were made among three outcome groups of self-reported long-term milk consumption (high-milk dose, low-milk dose, and avoidance). Results A total of 168 (59%) of the 286 patients on OIT participated. Most patients (57%) were in the high-dose group; here, 80% of these patients had a baseline casein sIgE value less than 28 kUA/L, they had the lowest casein sIgE levels at all time (p < .001), their casein sIgG4/IgE levels increased, and long-term casein sIgA was highest compared with the low-dose and avoidance groups (p = .02). Low-milk dose group had the highest casein sIgG4/IgE levels in long term (p = .002). Conclusion The baseline Ig profiles and responses to milk OIT differed depending on long-term milk consumption. Lower casein sIgE levels were associated with better outcome. Milk casein sIgA differed in the long term among high-milk consumers.Peer reviewe