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Background Guidelines recommend regular assessment of asthma control. The Childhood Asthma Control Test (C-ACT) is a clinically validated tool. Aim To evaluate asthma control according to GINA2006, NAEPP, pediatrician's assessment (PA), and C-ACT in asthmatic children visiting their ambulatory pediatrician or tertiary care pediatric pulmonologist. Methods Demographic data, treatment, and number of severe exacerbations during the previous year were collected. Control was assessed using (i) strict GINA 2006 criteria, (ii) GINA without taking into account the exacerbation item, (iii) NAEPP criteria, and (iv) PA. Children and parents filled out the C-ACT. Results Five hundred and twenty-five children completed the survey (mean age: 7.7 years; 28% ≤ 6 years). 78% had a controller treatment. 58% reported ≥ 1 severe exacerbation. C-ACT was ≤ 19 in 29.5%. Control was not achieved in 76.5%, 55%, 40%, and 34% according to GINA 2006 guidelines, NAEPP guidelines, GINA 2006 without exacerbation criteria, and PA, respectively. C-ACT was significantly lower in children ≤ 6 years old (P = 0.002) or with severe exacerbations (P 21 were controlled and 85% of patients with a C-ACT

We studied the sensitivity and specificity of guanine environmental tests in the evaluation of the two mite allergen levels, i.e. 2 μg/g and 10 μg/g of Der p I and Der f I, considered to be risk factors for sensitization or for the development of acute asthma. We examined 239 house-dust samples for Der p I and Der f I levels (ELISA) and guanine contents (semiquantitative guanine test and quantitative assays). All house-dust samples with class 2 or 3 guanine tests contained more than 2 μg/g of Der p I and Der f I. The probability that house-dust samples of class 2 contained more than 10 μg/g of mite allergens was 88%; it was 100% for house-dust samples of class 3. The probability that a house-dust sample of class 0 contained less than 2 μg/g of mite allergen was 87%. For each level of mite allergen, a ROC curve was constructed with the true positive rates and the false positive rates calculated by different cutoffs of guanine concentration. The cutoff point which gave the best compromise between sensitivity (76%) and specificity (89%) was 2100 μg/g for the threshold of 2 μg/g of Der p I and Der f I. For detection of a mite allergen > 10 μg, a guanine content of 3000 μg/g gave the best compromise between sensitivity (86%) and specificity (93%). In conclusion, the guanine test represents a satisfactory environmental test, inexpensive and simple, for predicting mite allergen levels. Semiquantitative and quantitative guanine measurements are more accurate in predicting an exposure level of 10 μg/g than of the level 2 μg/g of Der p I and Der f I.

BACKGROUND: FEV1 is more sensitive than PEF in assessing late asthmatic responses (LAR) after specific inhalation challenges (SIC) with occupational agents. As immediate asthmatic reactions (IAR) mainly involve proximal airways, PEF may, however, be as valid as FEV1. METHODS: Thirty-seven subjects who experienced an immediate fall in FEV1 of > or =20% during SIC with occupational agents and 20 subjects with fall of < or =10% in FEV1 were included. Both FEV1 and PEF were measured in a random order every 10 min for 1 h after exposure. We corrected PEF (PEFc) for inaccuracies of the mini-Wright meters by the Miller equation. RESULTS: Maximum changes in PEFc (30+/-11%) were not significantly different from changes in FEV1 (27+/-5%) (P=0.13). Their timings after exposure were 14+/-11 min and 17+/-17 min, respectively (P=0.4). High sensitivity (92%), specificity (95%), accuracy (93%), and positive predictive value (97%) were found for a 20% fall in PEFc to detect a significant IAR. Results were better and not influenced by meter inaccuracies with a cutoff point of 15% change in noncorrected PEF (PEFnc). An absolute decrease in PEF of 70 l/min gave a good discrimination between reactions with and without an asthmatic response. CONCLUSIONS: PEF is as satisfactory as FEV1 for detecting a significant IAR after exposure to an occupational agent if one considers a cutoff point of 1) 15% fall in PEF 2) 20% fall in PEFc 3) 20% fall and/or 70 l/min decrease in PEFnc.

Background: Serum tryptase level measured by RIA is the main in vitro tool to confirm the diagnosis of anaphylaxis. Methods: Serum tryptase levels were determined by UniCAP-Tryptase fluoroimmunoassay (Pharmacia & Upjohn, Uppsala, Sweden), in 30 consecutive patients who presented at the emergency room with a clinical allergic reaction of less than 6-h duration to assess the value of this method in the diagnosis of anaphylaxis. Anaphylaxis was established by clinical criteria and by immunoallergic study. Baseline tryptase levels were determined 1 month later in 21 patients. The receiver operating curve (ROC) was used to establish the best cutoff point of tryptase levels to confirm the diagnosis of anaphylaxis. Results: Seventeen patients were diagnosed with anaphylaxis. In this group, tryptase levels were higher than in the nonanaphylaxis group, composed mostly of patients with urticaria or angioedema (P8.23 ng/ml by UniCAP-Tryptase fluoroimmunoassay identify anaphylaxis in patients with symptoms of less than 6-h duration. The usefulness of this determination is higher if baseline tryptase levels are available.