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The author focuses on the significance of studying drugs meant for children to determine their safety and efficacy in this age group. He highlights that 75-80 percent of all drugs prescribed for young children have never been tested on children. The author further discusses that there is no evidence of efficacy of house dust mite control measures for the treatment of asthma. It is also stated that drug response may vary in newborn, infant, child or adolescent with growth and maturation.

Background: No study has compared allergic sensitization patterns in infants with atopic eczema from different countries. The aim of this study was to investigate the patterns of allergic sensitization in a cohort of infants with atopic eczema participating in a multicentre, international study. Methods: Two thousand one hundred and eighty-four infants (mean age 17.6 months) with atopic eczema from allergic families were screened in 94 centres in 12 countries to participate in a randomized trial for the early prevention of asthma. Clinical history, Severity Scoring of Atopic Dermatitis Index, measurements for total serum IgE and specific IgE antibodies to eight food and inhalant allergens were entered into a database before randomization to treatment. A history of type of feeding in the first weeks of life and exposure to animals was recorded. Results: A total of 52.9% of the infants had raised total IgE, and 55.5% were sensitized to at least one allergen. There was a wide difference in the total IgE values and in the sensitization rates to foods and aeroallergens among infants from different countries. The highest prevalence rates of allergen-sensitized infants were found in Australia (83%), the UK (79%) and Italy (76%). Infants from Belgium and Poland consistently had the lowest sensitization rates. In each country, a characteristic pattern of sensitization was found for aeroallergens (house dust mite > cat > grass pollen > Alternaria), but not for food allergens. Conclusions: In infants with atopic eczema, there is a wide variation in the pattern of allergic sensitization between countries, and data from one country are not necessarily generalizable to other countries. [ABSTRACT FROM AUTHOR]

In 2184 young children aged 13–24 months with atopic dermatitis (SCORAD 5–59) serum IgE antibodies to a standard panel of food and inhalant allergens were assayed. The frequency of positive IgE responses (>0.35 kU/l) increased with greater severity of skin disease. A significant minority of infants had levels of IgE antibody to foods to suggest they were at risk of acute reaction to those foods (7% to hen’s egg, 3% to cow’s milk, 4% to peanut). Our findings indicate that the frequency of positive IgE responses is related to disease severity and suggest that differences in the time course of the development of IgE responses to food, which are at maximum prevalence within the first year of life, while inhalant allergies, are still developing between 1 and 2 yr and beyond. [ABSTRACT FROM AUTHOR]

Background: Retrospective studies provide evidence that rhinitis is associated with more severe asthma. The aim of this study was to evaluate prospectively whether rhinitis is a predictor of increased asthma severity. Methods: Five hundred and fifty-seven patients with severe asthma were enrolled. During 1 year of follow-up, each patient was evaluated every 3 months with a record of emergency room visits and supply of topical corticosteroids for asthma and rhinitis. In the 1 year of follow-up visit, the patients were checked for rhinitis diagnosis, severity and answered questionnaires for asthma symptoms and quality of life. Results: Eighty-two (15%) patients had no rhinitis, 299 (54%) had mild rhinitis and 176 (31%) moderate/severe rhinitis. In logistic regression models, moderate/severe rhinitis was a predictor for any emergency room visit in the follow-up period [3.83 (2.00–7.35)], for the presence of uncontrolled asthma after 1 year of follow-up [12.68 (1.73–92.85)], for <10% improvement of the airway obstruction [2.94 (1.48–5.85)] and <50% reduction in the number of emergency room visits [2.90 (1.02–8.26)] in the year of follow-up. It was also associated with a smaller chance of more than 90% reduction in the number of emergency room visits in the year of follow-up [0.27 (0.12–0.60)]. In a multivariate linear regression model, severity of rhinitis was positively correlated with a score of asthma severity and inversely correlated to an index of quality of life. Conclusions: In a population with severe asthma, moderate/severe rhinitis is a strong predictor for greater severity of asthma. [ABSTRACT FROM AUTHOR]

A group of 20 mite allergic asthmatic children aged 6–12 years old, living in Sao Paulo, Brazil, was studied regarding their degree of sensitization to house dust mites and exposure to mite allergens in their homes. In 18 out of 20 houses at least one dust sample was obtained which contained > 10 μg Der p I/g of dust. The highest levels of Dermatophagoides pteronyssinus allergens, Der p I and Group II, were measured in bedding samples (geometric mean 38.4 and 36.6 μg/g, respectively), followed by bedroom floor, TV room and kitchen. Mite allergen levels in Brazilian houses were as high as those reported to be associated with sensitization and acute attacks of asthma in other parts of the world. In keeping with previous reports that D. farinae is rarely found in Brazil. Der f I was undetectable or found in very low levels (<0.5 μg/g). Levels of cat allergen Fel d I of > 8 μg/g of dust were obtained only in 2 houses only. Cockroach allergen Bla g I was detected in five out of 20 houses. Levels of IgE antibodies to D. pteronyssinus were > 200 RAST U/ml in 19 out of 20 children (geometric mean 1588 RAST U/ml). IgE antibodies to cat, cockroach, A. fumigatus, ragweed and rye grass pollens were undetectable or < 80 RAST U/ml. IgE antibodies to the mite Blomia tropicalis were also measured, and levels > 200 RAST U/ml were observed in 13 out of 20 sera. Immunoabsorption studies demonstrated that the bulk of the IgE antibody to B. tropicalis (64%) was to species-specific allergens and that 36% were cross-reactive with D. pteronyssinus. The implication of our results is that management of children with asthma in Sao Paulo should include skin testing for allergy to both Dermatophagoides and B. tropicalis as well as recommendations about environmental control of house dust mite exposure. [ABSTRACT FROM AUTHOR]