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Environmental enrichment, besides having a great impact on animal welfare, can also be a potential variable in experimental research. Thus, we investigated whether enrichment of cages with paper tissues or plastic tunnels affects scientific outcome in the well-described mouse model of allergic asthma. BALB/cJ mice were introduced to paper tissues as nesting material, transparent plastic tunnels serving as shelters or kept in non-enriched cages. Afterwards, mice were sensitized to chicken egg ovalbumin (OVA) precipitated in aluminium sulphate and then intranasally challenged with OVA to induce allergic lung inflammation. Mice housed in cages enriched with paper tissues, but not with plastic tunnels, had increased total cell number, eosinophil number and IL-13 concentration in bronchoalveolar lavage fluid in comparison with the non-enriched control group. These results indicate that the effect of environmental enrichment on mice asthma models depends on the type of enrichment used. Therefore, it is important to consider the potential effects of any environmental enrichment on animal welfare and more importantly, on research results in order to standardize and obtain more accurate data from rodent studies.

Using data from the North Carolina School Asthma Survey about the respiratory health of 64,432 adolescents attending public schools in North Carolina and data provided by school employees about the environmental health conditions of the school buildings, we assessed the prevalence of daytime wheezing during the past year among students estimated to be exposed to air pollutants arising from pulp and paper mills located near the schools. Of the schools the students attended, 14% (37/266) were located within 30 miles of one or more pulp and paper mills and odor from the mills was identified by survey respondents for 9 of the 266 schools. The prevalences of daytime wheezing in smokers and nonsmokers with household cigarette smoke exposure were elevated among students attending schools located within 30 miles of a pulp and paper mill, compared to the prevalence among students attending schools located beyond 30 miles (⩽10 miles, prevalence ratio (PR): 1.21, 95% confidence interval (95% CI): 0.99, 1.43; 10–⩽30 miles, PR: 1.06, 95% CI: 0.96, 1.16) and among students attending schools with noticeable odor from a pulp and paper mill (PR: 1.12, 95% CI: 0.93, 1.31). These results indicate a possible association between paper mill location and wheezing symptoms among adolescents and suggest that community-based exposure to pulp and paper mill emissions may have a greater impact on smokers and individuals exposed to cigarette smoke in the home than on nonsmokers without such household exposure.

AIMS A discussion of methodological issues and social media recruitment to a feasibility study to investigate mHealth resources for asthma and pregnancy care. BACKGROUND Pregnant women with asthma are reported to be poorly supported according to an international research. We sought to establish if a mHealth intervention might be feasible and acceptable to them. DESIGN A Phase I or modelling study. METHODS A project team designed an intervention to address UK national guidelines for the management of asthma during pregnancy, using other resources already accessible on the web. This was made available on a project website optimized for mobile phone usage. Links were Tweeted and advertised on Facebook, asking participants to access the project website, which included links to the resources and before- and after-use questionnaires to establish baseline symptom data and participant views of the resources. RESULTS Despite 55,700 Twitter impressions in a 76-day period over winter 2016-2017, this recruitment strategy garnered 402 engagements but only seven respondents for questionnaire 1 and zero respondents for questionnaire 2. CONCLUSIONS We could not recruit to this study despite believing that social media recruitment would be effective and we recommend that social media recruitment be used cautiously. Apparently, we did not sufficiently address the theoretical aspects of communications theory and were not clear enough about our key messages. Publication bias may exist about the non-publication of other failed telemedicine studies using social media; this goes largely unreported in some systematic reviews and may influence researchers' decision-making about social media recruitment.

INTRODUCTION: Childhood asthma is the main public health problem in world, and dramatically has increased in developed as well as developing countries. AIM: To assess prevalence and risk factors for asthma based on ISAAC questionnaire. MATERIAL AND METHODS: It was a cross-sectional school population-based study which was carried out on 1803 school children aged 6-7 and 13-14 in Ahvaz city, Khuzestan, south west of Iran, in 2011. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used as a tool to identify prevalence of asthma. Chi-square (χ(2)) test was then used to identify possible potential risk factors associated with asthma. Logistic regression analysis was then applied to determine the various potential risk factors associated with asthma. Data were entered and analyzed using SPSS (version 17) statistical analysis software. The significant level in this study was considered 0.05. RESULTS: The overall prevalence of asthma among school children was 4.9%, but in males it was 5.5% and in females - 4.3%. Also findings have demonstrated that prevalence of asthma was higher among 13-14 years age group (6.1%) as compared to children aged 6-7 (3.7%). The prevalence of wheeze in the last 12 months, wheeze after exercise and playing was 18.1%, 13.9%, and 8.4% respectively. Prevalence of dry cough at night was reported in 17.6%. Prevalence of asthma was highest in winter (2.6%). CONCLUSIONS: Prevalence of asthma in children was higher in males than females and prevalence of allergic symptoms will be increased with high air pollution. Family history of asthma was a strong risk factor for childhood asthma.

Aspirin-induced asthma (AIA) is a distinct clinical syndrome characterized by severe asthma exacerbations after ingestion of aspirin or other non-steroidal anti-inflammatory drugs. The exact pathomechanism of AIA remains unknown, though ongoing research has shed some light. Recently, more and more attention has been focused on the role of aspirin in the induction of oxidative stress, especially in cancer cell systems. However, it has not excluded the similar action of aspirin in other inflammatory disorders such as asthma. Moreover, increased levels of 8-isoprostanes, reliable biomarkers of oxidative stress in expired breath condensate in steroid-naive patients with AIA compared to AIA patients treated with steroids and healthy volunteers, has been observed. This review is an attempt to cover aspirin-induced oxidative stress action in AIA and to suggest a possible related pathomechanism.

INTRODUCTION: The pathogenesis of asthma remains unclear, especially in cases of the severe disease. AIM: To explore IgE-mediated inhalant sensitization in severe asthma compared with a group of patients with chronic mild disease and evaluate the Th1/Th2 cytokine profiles in asthma by different disease severities. MATERIAL AND METHODS: One hundred and fifty-four patients (age range: 28-69) with severe chronic asthma (study group) and 141 patients with chronic mild disease (control group) diagnosed according to GINA criteria were included in the study. Seventy-eight severe asthmatics and 43 subjects with mild disease were randomly selected for serum Th1/Th2 cytokine level estimation. The groups were matched in terms of age and atopy features (skin prick tests, specific and total serum IgE). RESULTS: Positive skin tests to at least one allergen were observed with comparable frequencies. Sensitization to Dermatophagoides pteronyssinus was the most prevalent positive result in both groups. An earlier onset of asthma together with a greater number of exacerbations was noted in severe asthmatics compared to patients with mild disease. Serum levels of interleukin 4 and 2 (IL-4 and IL-2) were detectable only in severe asthmatics irrespective of atopy features. The levels of interferon γ and tumour necrosis factor α were undetectable in both groups. IL-10 and IL-5 were detected in the serum of only 7 and 12 severe asthmatics, respectively. CONCLUSIONS: The serum level of IL-2 and IL-4 could be perceived as a marker of severe asthma. Neither IL-2 nor IL-4 levels in the serum could differentiate allergic and non-allergic asthma.

Background Allergen immunotherapy (AIT) is an effective treatment for allergic rhinoconjunctivitis (AR) with or without asthma. It is important to note that due to the complex interaction between patient, allergy triggers, symptomatology and vaccines used for AIT, some patients do not respond optimally to the treatment. Furthermore, there are no validated or generally accepted candidate biomarkers that are predictive of the clinical response to AIT. Clinical management of patients receiving AIT and efficacy in randomised controlled trials for drug development could be enhanced by predictive biomarkers. Method The EAACI taskforce reviewed all candidate biomarkers used in clinical trials of AR patients with/without asthma in a literature review. Biomarkers were grouped into seven domains: (i) IgE (total IgE, specific IgE and sIgE/Total IgE ratio), (ii) IgG-subclasses (sIgG1, sIgG4 including SIgE/IgG4 ratio), (iii) Serum inhibitory activity for IgE (IgE-FAB and IgE-BF), (iv) Basophil activation, (v) Cytokines and Chemokines, (vi) Cellular markers (T regulatory cells, B regulatory cells and dendritic cells) and (vii) In vivo biomarkers (including provocation tests?). Results All biomarkers were reviewed in the light of their potential advantages as well as their respective drawbacks. Unmet needs and specific recommendations on all seven domains were addressed. Conclusions It is recommended to explore the use of allergen-specific IgG4 as a biomarker for compliance. sIgE/tIgE and IgE-FAB are considered as potential surrogate candidate biomarkers. Cytokine/chemokines and cellular reponses provided insight into the mechanisms of AIT. More studies for confirmation and interpretation of the possible association with the clinical response to AIT are needed.

Exposure to organic dusts may cause airways inflammation in a large proportion of exposed persons. Most studies have relied on questionnaires and spirometry for diagnosis. To assess the possibility of determining the presence of inflammation using clinical diagnostic procedures, a study was undertaken among workers in a paper industry. Participants were 83 workers and 44 controls. Airborne endotoxin and (1-->3)-beta-D-glucan levels at the worksites were determined. The effects of this exposure were evaluated using a questionnaire, spirometry and measurements of airway responsiveness (methacholine) and levels of eosinophil cationic protein (ECP), myeloperoxidase (MPO), and C-reactive protein (CRP) in serum. The workers had a decreased baseline forced expiratory volume in one second (FEV1) and an increased airway responsiveness compared with controls. The concentrations of ECP and MPO were elevated compared with controls. There was a relation between exposure to endotoxin and (1-->3)-beta-D-glucan and airway responsiveness as well as ECP levels, when controlling for age, sex, smoking habits, atopy and asthma. The results suggest an increased prevalence of subjective respiratory symptoms, and an increased airway responsiveness among exposed workers. There was also a relationship between the serum concentration of eosinophil cationic protein and airway responsiveness. Taken together, the results suggest the presence of airways inflammation in the workers.

In recent years non-allergic rhinitis has received a lot of interest; in particular the different phenotypes, endotypes, the impact on quality of life and the potential role of IgE in local allergic rhinitis (LAR). The prevalence of LAR reported in the literature has been extremely variable (0-100%); Hamizan’s review in this issue explains many of these discrepancies. The overall prevalence of IgE in nasal secretion was found to be 10.2 (7.4-13.4) %. However, where there is history of an identifiable aeroallergen which triggered nasal symptoms or seasonality of symptoms, the prevalence is 19.8 (14.5- 25.6) %. On the other hand, patients who lacked a suggestive allergy history and had negative systemic allergy tests had zero probability of detectable nasal serum IgE (0 (0-3.1) %). This useful review highlights history taking as a simple method to filter potential LAR patients from the general NAR population. This is important because LAR patients significantly differ from other phenotypes of NAR, not only in terms of symptoms, but also the likelihood of developing asthma and susceptibility to treatment.

Long-term birth cohort studies are essential to understanding the life course and childhood predictors of allergy and the complex interplay between genes and the environment (including lifestyle and socioeconomic determinants). Over 100 cohorts focusing on asthma and allergy have been initiated in the world over the past 30 years. Since 2004, several research initiatives funded under the EU Framework Program for Research and Technological Development FP6-FP7 have attempted to identify, compare, and evaluate pooling data from existing European birth cohorts (GA(2)LEN: Global Allergy and European Network, FP6; ENRIECO: Environmental Health Risks in European Birth Cohorts, FP7; CHICOS: Developing a Child Cohort Research Strategy for Europe, FP7; MeDALL: Mechanisms of the Development of ALLergy, FP7). However, there is a general lack of knowledge about these initiatives and their potentials. The aim of this paper is to review current and past EU-funded projects in order to make a summary of their goals and achievements and to suggest future research needs of these European birth cohort networks.

Air pollution is a severe health issue having both morbidity and mortality effects to human beings. Pulp and paper milling characteristically emits many pollutants key among them Particulate Matter (PM) which is a lethal pollutant irrespective of the particulate diameter. Evidence shows that breathing air containing PM aggravates respiratory and cardiac mortality and morbidity, while precipitating adverse respiratory health outcomes such as asthma, lung function decline, lung cancer, and chronic obstructive pulmonary disease. This study sought to provide empirical evidence on health morbidity effects occasioned by PM10 of pulp and paper milling as a single source pollutant to a rural population in a developing country such as Kenya. This evidence includes prevalence of respiratory symptoms and relationship between exposure to pollutant and morbidity (sickness events). This was achieved through observational population-based cohort study. The study found positive association between PM10 concentration and prevalence of respiratory symptoms. The study found that a marginal increase of PM10 occasions a 12% increase in persistent cough prevalence. Similarly, common cold increased by 92% while wheezing increased by 22% all other factors remaining constant. the study concludes that Webuye environs exhibits high prevalence of respiratory diseases. Regarding morbidity effect of ambient air pollution, the study concludes that there is a positive significant relationship between chronic exposure to PM10 and respiratory symptoms.

Since the establishment of the academic society in 1972, Korean allergists have made continuous efforts to elucidate pathogenic mechanisms and therapeutic advances for allergic diseases. The present study aimed to summarize recent progress and explore future prospects of research performance by Korean allergists. We performed a comprehensive bibliometric analysis for research papers published in the Science Citation Index (SCI) or SCI-expanded journals by Korean allergists between 2009 and 2013. Research performance was quantitatively analyzed for the numbers of papers by publication year, research type, and main topic. In addition, the performance was also examined for qualitative indices, such as impact factor and citation number. A total of 1,091 papers were identified. The number of publication increased continuously, with an annual increase rate of 12.3%. Clinical and basic studies were the most frequent types of research, and recently the number of epidemiological studies has increased. By research topic, asthma was the most commonly studied, accounting for 20.9% of the total number of publications. Notably, the amount of rhinitis/rhinosinusitis research has risen steeply in 2013. Qualitative analyses also indicated continuous progress; the median impact factor of published journals increased from 1.918 in 2009 to 2.746 in 2013, yielding an annual increase rate of 7.4%. In conclusion, the present analyses identified a continuous increase in the research performance of Korean allergists over a recent 5 year period (2009-2013), both quantitatively and qualitatively. A more significant contribution is expected in the forthcoming era.

Asthma is one of the most common chronic diseases in the world, affecting over 300 million people. It is an inflammatory disorder characterized by bronchoconstriction and airway hyperresponsiveness, followed by inflammatory manifestations in the respiratory system. The prevalence of asthma is rising and there is a clinical need to develop more effective treatments. While corticosteroids (glucocorticosteroids) remain the mainstay of asthma therapy, they have limitations because of their potentially severe side-effects and the presence of corticosteroid resistance in some patients. This review discusses current strategies in the treatment of asthma and considers new therapeutic regimens of asthma in the drug development pipeline.

BACKGROUND: The Canadian Clinical Practice Guidelines (CPGs) for the management of asthmatic patients were last published in 1999, with updates in 2001 and June 2004. Large disparities exist in the implementation of these guidelines into clinical practice.OBJECTIVE: The present study evaluated the knowlege of Quebec-based primary care physicians regarding the CPGs, as well as patient outcomes before and after introducing physicians to a new clinical tool – a memory aid in the form of a self-inking paper stamp checklist summarizing CPG criteria and guidelines for assessing asthmatic patient control and therapy. The primary objective of the present study was to assess whether the stamp would improve physicians’ knowledge of the CPGs, and as a secondary objective, to assess whether it would decrease patient emergency room visits and hospitalizations.METHODS: A prospective, randomized, controlled study of 104 primary care physicians located in four Quebec regions was conducted. Each physician initially responded to questions on their knowledge of the CPGs, and was then randomly assigned to one of four groups that received information about the CPGs while implementing an intervention (the stamp tool) aimed at supporting their decision-making process at the point of care. Six months later, the physicians were retested, and patient outcomes for approximately one year were obtained from the Régie de l’assurance maladie du Québec.RESULTS: The stamp significantly improved physicians’ knowledge of the CPGs in all Quebec regions tested, and reduced emergency room visits and hospitalizations in patients who were followed for at least one year.CONCLUSION: A paper stamp summarizing CPGs for asthma can be used effectively to increase the knowledge of physicians and to positively affect patient outcomes.

The Internet has become an inevitable tool for collecting health and health behavior questionnaires. This study compared the feasibility, presence of score differences, and subjective evaluations by children between Internet and identical paper (asthma/fruit) questionnaires in elementary schools. A randomized crossover design was applied, with children starting with one administration mode before completing (5 minutes later) the other mode. Ten Dutch elementary schools with 270 school children (fifth grade, 10-12 years) were approached to participate. Response was 92%. The Internet mode had significantly less missing/nonunique answers than the paper mode (p.01). The completion times did not differ significantly between the Internet and the paper mode. Except for perceived self-efficacy to eat sufficient fruit (p.05), no differences in the asthma and fruit scores were found when comparing between the 2 modes. All variables showed strong intraclass correlation coefficients (166or= 0.64) between modes. Most items had good to very good agreement (kappa 0.61-0.95). The percentages for global and exact agreement ranged per item from 61.3 to 100. Most children preferred the Internet mode on "general preference" and "ease of use" aspects but rated no preference on "understandability." The majority rated the evaluation aspects of the Internet mode positively. Thus, Internet administration of a health and health behavior questionnaire is feasible at elementary schools, gives comparable responses, and is well accepted and preferred by children compared to the paper version. Therefore, it is recommended to use Internet as a tool in health and health behavior research among children.

SLIT ( sublingual immunotherapy ) induces allergen-specific immune tolerance by sublingual administration of a gradually increasing dose of an allergen. The mechanism of SLIT is comparable to those during SCIT (subcutaneous immunotherapy), with the exception of local oral dendritic cells, pre-programmed to elicit tolerance. In the SLIT dose, to achieve the same efficacy as in SCIT, it should be 50–100 times higher with better safety profile. The highest quality evidence supporting the efficacy of SLIT lasting 1 – 3 years has been provided by the large scale double-blind, placebo-controlled (DBPC) trials for grass pollen extracts, both in children and adults with allergic rhinitis. Current indications for SLIT are allergic rhinitis (and conjunctivitis) in both children and adults sensitized to pollen allergens (trees, grass, Parietaria ), house dust mites ( Dermatophagoides pteronyssinus, Dermatophagoides farinae ), cat fur, as well as mild to moderate controlled atopic asthma in children sensitized to house dust mites. There are positive findings for both asthma and new sensitization prevention. Severe adverse events, including anaphylaxis, are very rare, and no fatalities have been reported. Local adverse reactions develop in up to 70 – 80% of patients. Risk factors for SLIT adverse events have not been clearly identified. Risk factors of non-adherence to treatment might be dependent on the patient, disease treatment, physician-patient relationship, and variables in the health care system organization.

As the overall prevalence of asthma has escalated in the past decades, so has the population of patients with severe asthma. This condition is often difficult to manage due to the relative limitation of effective therapeutic options for the physician and the social and economic burden of the disease on the patient. Management should include an evaluation and elimination of modifiable risk factors such as smoking, allergen exposure, obesity and non-adherence, as well as therapy for co-morbidities like gastro-esophageal reflux disease and obstructive sleep apnea. Current treatment options include conventional agents such as inhalational corticosteroids, long acting β(2) agonists, leukotriene antagonists, and oral corticosteroids. Less conventional treatment options include immunotherapy with methotrexate, cyclosporine and tacrolimus, biological drugs like monoclonal antibodies, tumor necrosis factor-α blockers and oligonucleotides, phosphodiesterase inhibitors, antimicrobials and bronchial thermoplasty.

Summary This paper honours a paediatrician whose career has been patchwork but distinguished, with many facets. It is a light-hearted look at the printed (infinitely preferable to the electronic) word. Although the obvious response is “read everything I have written”, this would only drive down the stores of Prozac. Read the scientific literature of course. The oldie reads to stay one jump ahead on the ward round. Meta-analyses and systematic reviews rely on the judgement of others, so should be regarded with suspicion. Do your own research, and do not rely on the thoughts of other people. Read beyond PubMed. “There is more in Heaven and Earth, Horatio, than is dreamed of in your PubMed” (Shakespeare). Read the giants of the past. Richard Asher has so much to teach. What are the seven sins of medicine, and how many have you committed? Asher is top read of the talk. Learn from the mistakes of the past. Your patient comes first. Read how the medical profession covered up the death of Steve Biko and never compromise with patient safety and your integrity. Finally, remember thou art mortal – read a real book for pleasure. Kindle reading must be like making love to an inflatable doll (not that I have done either). Choose what you relax with; for me, PG Wodehouse, Jane Austen, Billy Bunter and Wisden. Who said and why: ‘Madam, under similar circumstances I would have kicked the Archangel Gabriel!’.

Biologic agents (also termed biologicals or biologics) are therapeutics that are synthesized by living organisms and directed against a specific determinant, for example a cytokine or receptor. In inflammatory and autoimmune diseases, biologicals have revolutionized the treatment of several immune-mediated disorders. Biologicals have also been tested in allergic disorders. These include agents targeting IgE; T helper 2 (Th2)-type and Th2-promoting cytokines, including interleukin-4 (IL-4), IL-5, IL-9, IL-13, IL-31 and thymic stromal lymphopoietin (TSLP); pro-inflammatory cytokines, such as IL-1β, IL-12, IL-17A, IL-17F, IL-23 and tumor necrosis factor-α (TNF); chemokine receptor CCR4; and lymphocyte surface and adhesion molecules, including CD2, CD11a, CD20, CD25, CD52 and OX40 ligand. In this task force paper of the Interest Group on Biologicals of the European Academy of Allergy and Clinical Immunology we review biologicals that are currently available or tested for the use in various allergic and urticarial pathologies, by providing an overview on their state of development, area of use, adverse events, and future research directions.

The links between asthma and rhinitis are well characterized. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines stress the importance of these links and provide guidance for their prevention and treatment. Despite effective treatments being available, too few patients receive appropriate medical care for both diseases. Most patients with rhinitis and asthma consult primary care physicians and therefore these physicians are encouraged to understand and use ARIA guidelines. Patients should also be informed about these guidelines to raise their awareness of optimal care and increase control of the two related diseases. To apply these guidelines, clinicians and patients need to understand how and why the recommendations were made. The goal of the ARIA guidelines is to provide recommendations about the best management options for most patients in most situations. These recommendations should be based on the best available evidence. Making recommendations requires the assessment of the quality of available evidence, deciding on the balance between benefits and downsides, consideration of patients’ values and preferences, and, if applicable, resource implications. Guidelines must be updated as new management options become available or important new evidence emerges. Transparent reporting of guidelines facilitates understanding and acceptance, but implementation strategies need to be improved.

Dr Michael Flindt’s work in Manchester in the late 1960s and his Lancet paper of 1969 (along with its companion paper) proved to be seminal in a number of respects for the emerging field of occupational respiratory allergy [1,2]. First, inhaled occupational dust contaminated with enzymes from Bacillus subtilis (alcalase and maxatase) was shown to be a potent (very potent) cause of asthma, not merely an irritant that triggered symptoms nonspecifically in subjects who were already asthmatic. Secondly, the mechanism was shown to be one of allergy not toxicity. Thirdly, asthmatic reactions were noted in most cases to follow exposure onset after a period of several hours (and often after the work shift was completed), a feature of occupational asthma that had previously done much to disguise the causal nature of ‘asthmagenic’ occupational environments. Fourthly, a close and timely partnership with Professor Jack Pepys at the Brompton Hospital in London proved to be a catalyst for what became an explosion of clinical and laboratory study in industrially developed countries. This showed that asthma of allergic origin has become the principal cause of occupational lung disease in modern society— now responsible for 25–30% of all incident cases [3,4].

Inflammation is a risk factor for the development of many types of neoplasia, including skin, colon, gastric, and mammary cancers, among others. Chronic pulmonary diseases, such as chronic bronchitis and asthma, predispose to lung neoplasia. We will review the mouse literature examining the role of inflammation in lung neoplasia, focusing specifically on genetic susceptibility, pharmacologic modulation of inflammatory pathways, and both transgenic and knockout mouse models used to assess pro- and anti-inflammatory pathways involved in lung neoplasia. Identification of molecular mechanisms that govern the association between inflammation and pulmonary neoplasia could provide novel preventive, diagnostic, and therapeutic strategies for a disease in which few biomarkers currently exist.

Introduction: The purpose of this study was to determine the serum levels of neopterin and circulating adhesion molecules sICAM-1, sE-selectin and sL-selectin in children with stable asthma in order to investigate their possible role in the pathogenesis of chronic inflammation in asthma. We also compared atopic and non-atopic asthmatic children in order to detect differences between groups, possibly reflecting different mechanisms involved in chronic inflammation of the airways. Material and methods: The study included three groups of children: A, B and C. Group A consisted of 30 children with atopic asthma, group B of 30 children with non-atopic asthma and group C (control group) of 20 healthy children. All asthmatic children had been diagnosed with mild to moderate persistent asthma according to the International Paediatric Asthma Consensus Group Reports and were studied during a stable phase of their disease. The asthmatic children were divided into atopic and non-atopic, as judged by the presence of a positive or negative skin prick test or a positive specific IgE test. Results: There were no differences in serum sICAM-1, sE-selectin or sL-selectin levels between groups A, B and C. Atopic asthmatic children had significantly higher levels of neopterin compared to the non-atopic asthmatics or healthy children (p

Air pollution has wide-ranging and deleterious effects on human health and is a major issue for the global community. The Global Burden of Disease study has described the worldwide impact of air pollution with as many as 3.1 million of 52.8 million all-cause and all-age deaths being attributable to ambient air pollution in the year 2010.1 Moreover, ambient air pollution ranked ninth among the modifiable disease risk factors, being listed above other commonly recognized factors, such as low physical activity, a high-sodium diet, high cholesterol, and drug use. Finally, air pollution accounts for 3.1% of global disability-adjusted life years, an index that measures the time spent in states of reduced health.1 Although it is intuitive that air pollution is an important stimulus for the development and exacerbation of respiratory diseases, such as asthma, chronic obstructive pulmonary disease, and lung cancer, there is generally less public awareness of its substantial impact on cardiovascular disease. Historically, the 1952 Great Smog of London led to an increase in cardiovascular death as well as deaths due to respiratory disease. Subsequent studies in the 1990s, such as the Harvard Six Cities2 and American Cancer Society cohort studies,2,3 established an enduring positive association between long-term exposure to air pollution and total and cardiovascular mortality, mainly due to coronary artery disease.4 In Europe, the first study that supported this association between long-term exposure and mortality was the Netherlands Cohort Study on Diet and Cancer.5 Associations with cardiovascular morbidity and mortality are also seen with short-term (e.g. day-to-day fluctuations) pollutant exposures of residents in large urban areas worldwide, including the United States of America6 …

Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies. Copyright (C) 2012 S. Karger AG, Basel

The German Standing Committee on Vaccination (STIKO) recommends seasonal influenza vaccination for children and adolescents with chronic medical conditions that put them at risk for severe influenza illness. In addition to trivalent inactivated influenza vaccines (TIV), a trivalent live-attenuated influenza vaccine (LAIV) was licensed for children and adolescents aged 2–17 years in the European Union in 2011. Employing the methodology of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group, we examined the evidence for efficacy and safety of LAIV relative to TIV to guide STIKO’s decision on whether LAIV should be preferentially recommended for at-risk children. In our meta-analysis of data from two randomized trials directly comparing LAIV and TIV in children aged ≤ 6 years, the protective efficacy of LAIV against laboratory-confirmed influenza was 53 % [95 % confidence interval (CI): 45–61 %] higher than that of TIV. A similar study in individuals aged 6–17 years showed a 32 % (95 % CI: 3–52 %) higher efficacy of LAIV. The quality of the evidence for a superior protective efficacy of LAIV against all relevant clinical outcomes was rated ‘moderate’ for children aged 2–6 years and ‘low’ for the age group 7–17 years. Regarding safety outcomes, the available data suggest no significant differences between LAIV and TIV. Based on these results, STIKO recommends that LAIV should be used preferentially for influenza vaccination of at-risk children aged 2–6 years. In children and adolescents aged 7–17 years, either LAIV or TIV may be used without specific preference. Possible contraindications and the vaccinee’s and his/her guardians’ preferences should be taken into account.

Long-term birth cohort studies are essential to understanding the life course and childhood predictors of allergy and the complex interplay between genes and the environment (including lifestyle and socioeconomic determinants). Over 100 cohorts focusing on asthma and allergy have been initiated in the world over the past 30 years. Since 2004, several research initiatives funded under the EU Framework Program for Research and Technological Development FP6-FP7 have attempted to identify, compare, and evaluate pooling data from existing European birth cohorts (GA(2)LEN: Global Allergy and European Network, FP6; ENRIECO: Environmental Health Risks in European Birth Cohorts, FP7; CHICOS: Developing a Child Cohort Research Strategy for Europe, FP7; MeDALL: Mechanisms of the Development of ALLergy, FP7). However, there is a general lack of knowledge about these initiatives and their potentials. The aim of this paper is to review current and past EU-funded projects in order to make a summary of their goals and achievements and to suggest future research needs of these European birth cohort networks.

Long-term birth cohort studies are essential to understanding the life course and childhood predictors of allergy and the complex interplay between genes and the environment (including lifestyle and socioeconomic determinants). Over 100 cohorts focusing on asthma and allergy have been initiated in the world over the past 30 years. Since 2004, several research initiatives funded under the EU Framework Program for Research and Technological Development FP6-FP7 have attempted to identify, compare, and evaluate pooling data from existing European birth cohorts (GA(2)LEN: Global Allergy and European Network, FP6; ENRIECO: Environmental Health Risks in European Birth Cohorts, FP7; CHICOS: Developing a Child Cohort Research Strategy for Europe, FP7; MeDALL: Mechanisms of the Development of ALLergy, FP7). However, there is a general lack of knowledge about these initiatives and their potentials. The aim of this paper is to review current and past EU-funded projects in order to make a summary of their goals and achievements and to suggest future research needs of these European birth cohort networks.

Long-term birth cohort studies are essential to understanding the life course and childhood predictors of allergy and the complex interplay between genes and the environment (including lifestyle and socioeconomic determinants). Over 100 cohorts focusing on asthma and allergy have been initiated in the world over the past 30 years. Since 2004, several research initiatives funded under the EU Framework Program for Research and Technological Development FP6-FP7 have attempted to identify, compare, and evaluate pooling data from existing European birth cohorts (GA(2)LEN: Global Allergy and European Network, FP6; ENRIECO: Environmental Health Risks in European Birth Cohorts, FP7; CHICOS: Developing a Child Cohort Research Strategy for Europe, FP7; MeDALL: Mechanisms of the Development of ALLergy, FP7). However, there is a general lack of knowledge about these initiatives and their potentials. The aim of this paper is to review current and past EU-funded projects in order to make a summary of their goals and achievements and to suggest future research needs of these European birth cohort networks.

Objectives: The aim of this study was to follow a cohort of children in a defined region from birth up to the age of seven for the occurrence of a doctor's diagnosis of asthma in the medical records in primary healthcare and hospital.Methods: In a defined region in Sweden with a population of about 150,000 inhabitants, all children (n=2104) born in the University Hospital in 1990 were recorded. Seven years later, 82% (n=1752) were still living in the region; their medical files at the Department of Paediatrics and all primary healthcare centres in the region were checked for an asthma diagnosis (ICD 9).Results: The results gave a total cumulative asthma incidence of 10.9% among seven-year-old children in the studied region. A significantly (p

Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.