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Introduction and objectives. Insect stings are the second trigger of anaphylaxis in children and adolescents, causing a potentially life-threatening reactions. Hence health-related quality of life (HRQoL) is an important issue for Hymenoptera venom allergy (HVA) patients. The aim of this cross-sectional study was to evaluate the impact of HVA on young patients’ HRQoL, including their socio-demographic characteristics. Materials and method. The study sample included 102 patients aged 8–17 (Mean 12.5 years, SD=3.0), who were under diagnosis or venom immunotherapy due to systemic reaction after an insect sting in one of the tertiary referential centers in Poland. They were mostly boys (70%), and mainly from rural areas (63%). HRQoL of studied patients was measured with the Children’s Hymenoptera Venom Allergy Quality of Life Scale, a questionnaire covering 6 dimensions: anxiety, caution, limitations, discomfort, support received from parents and a feeling of safety, each measured from 1 to 5. Independent predictors of HRQoL were estimated using the Generalized Linear Model. Results. In the group of children being dermal reactors, girls reported a higher level of anxiety (B=1.17, 95%CI=(0.30;2.03), p=0.008). In the group of children with grade 2 it was the girls who reported lower anxiety (B=-1.33, 95%CI=(-2.38;-0.29), p=0.013). Boys treated longer than 3 years had their level of anxiety significantly lower than those studied at diagnosis (B=-0.65, 95%CI=(-1.23;-0.07), p=0.028). The feeling of safety was higher in children living in villages than in those living in towns (B=0.30, 95%CI=(0.03;0.56), p=0.031). Conclusions. The gender, treatment duration and stage of anaphylactic reaction influenced level of anxiety. The level of feeling of safety was related to the place of living.

INTRODUCTION Hymenoptera insect stings (ISs) in the head and neck (HN) region are commonly considered to be a risk factor for grade IV systemic reactions (SRs) in patients with Hymenoptera venom allergy (HVA). However, clinical data addressing this issue are scarce. OBJECTIVES The aim of our study was to verify whether ISs in the HN region were related to a higher risk of grade IV SRs in patients with HVA. PATIENTS AND METHODS This retrospective cross‑sectional study included 195 patients aged 2 to 74 years and treated with venom immunotherapy due to at least a grade II SR to ISs. The study sample comprised 109 adults (56%; mean [SD] age, 41.08 [14.62] years; male, 50.5%) and 86 children (mean [SD] age, 9.53 [4.37] years; male, 72.1%; P0.001 for age and P = 0.002 for sex). The IS site was divided into 7 categories. RESULTS The HN region was the most common site for the IS (one‑third of the study group). In the entire study population, the risk of grade IV SRs was numerically, though insignificantly higher for ISs in the trunk (odds ratio [OR], 1.58; 95% CI, 0.42-5.92; P = 0.50) and legs (OR, 1.56; 95% CI, 0.49-5.10; P = 0.45), as compared with the HN region. The HN region showed a similar risk of grade IV SRs when compared with all the other IS sites combined into a single category (OR, 0.87; 95% CI, 0.43-1.75, P = 0.7). CONCLUSIONS ISs in the HN region were not confirmed to be a risk factor for grade IV SRs in patients with HVA, regardless of age and sex.

Introduction and objectives The study aimed at evaluating the impact of Hymenoptera venom allergy (HVA) in children and adolescents, on their parents' QoL, taking into account their socio-demographic characteristics. Material and methods The study sample consisted of 101 parents of children and adolescents aged 9-17 years, with a history of systemic reaction after insect sting who were referred for consultations in the tertiary level allergology department. The mean age of the parents was 39 years (SD=8.1; range 25-65 years); the majority were mothers (68%) and rural inhabitants (62%). QoL in parents of HVA children and adolescents was measured with the Parents of Children with Hymenoptera Venom Allergy Quality of Life Scale, a questionnaire covering 5 dimensions: anxiety, caution, limitations and discomfort, support provided to the child and feeling of safety, each measured on the scale ranging from 1 to 5. Independent predictors of QoL were estimated using the Generalized Linear Model. Results Parents of urban children and adolescents treated with venom immunotherapy (VIT) up to 3 years (B=-1.37, 95CI= (-2.22;-0.53); p=0.001) and of rural children treated for more than 3 years (B=-0.94, 95CI=(-1.55;-0.33); p=0.003) reported lower anxiety than parents studied at diagnosis. In urban parents, individuals studied at VIT beginning reported a lower feeling of safety (B=-0.63, 95CI=(-1.11;-0.15); p=0.010); those studied up to 3 years of treatment reported a higher feeling of safety (B=0.64, 95CI=(0.11;1.16); p=0.018) than those studied at diagnosis. Contrariwise, in rural parents, those studied at the beginning of immunotherapy reported a higher feeling of safety than those studied at diagnosis (B=0.51, 95CI=(0.13;0.88); p=0.008). Conclusions The longest VIT duration in children and adolescents with HVA is related to the decreased anxiety of their parents. Parent's feeling of safety depends on the stage of treatment and place of residence.

Vascular rings are congenital defects of great vessels. They cause compression of the trachea or/and the esophagus and therefore result in symptoms like inspiratory stridor, cough, wheezing, recurrent respiratory tract infections or dysphagia. In some cases, the correct diagnosis can be delayed for many years, especially when vascular rings produce less severe symptoms or symptoms mimicking other diseases (most of all asthma). In this article, we would like to emphasis the usefulness of pulmonary function test (spirometry) in the initial diagnosis of vascular rings in school-aged children, as well as the importance of spirometry in evaluating patients with asthma presumption.

Background The direct comparison between children and adults with Hymenoptera venom anaphylaxis (HVA) has never been extensively reported. Severe HVA with IgE-documented mechanism is the recommendation for venom immunotherapy, regardless of age. Objective To determine the differences in the basic diagnostic profile between children and adults with severe HVA and its practical implications. Methods We reviewed the medical records of 91 children and 121 adults. Results Bee venom allergy was exposure dependent, regardless of age ( P P = .01), whereas cardiovascular comorbidities were present almost exclusively in adults ( P = .001). In the bee venom allergic group, specific IgE levels were significantly higher in children (29.5 kU A /L; interquartile range, 11.30-66.30 kU A /L) compared with adults (5.10 kU A /L; interquartile range, 2.03–8.30 kU A /L) ( P P P = .002), as well as in bee ( P = .002) and wasp venom allergic groups ( P = .049). Conclusion The basic diagnostic profile in severe HVA reactors is age dependent. Lower skin test reactivity to culprit venom in children may have practical application in starting the intradermal test procedure with higher venom concentrations.

BACKGROUND The ultrarush protocol is an attractive approach in the buildup phase of venom immunotherapy (VIT-UR). However, the degree of risk of VIT-UR in children remains unknown. The objective of this study was to compare the safety of VIT-UR in children and adults. METHODS We performed a study based on prospectively gathered medical records of children and adults with hymenoptera venom allergy treated with VIT-UR in 3 allergy centers in Poland. RESULTS The study population comprised 134 children (mean [SD] age, 12.6 [3.7] years; males, 70.1%) and 207 adults (mean age, 42.4 [14.0] years; males, 47.8%). The number of children in the subgroups of bee venom (BV) allergy and wasp venom (WV) allergy were comparable, although sensitization to WV was more predominant in the adult group (70.1%). Skin reactivity to both venoms was more common in children than in adults (P < .001); however, children had higher concentrations of total IgE and specific IgE to BV (both P < .001). Systemic allergic reactions (VIT-SARs) occurred in 6.2% of the patients (3.7% in children and 7.7% in adults; nonsignificant). In adults, SARs occurred more frequently in patients treated with BV than WV extracts (21.4% vs 2.6%; P < .001). The same pattern was observed in children (7.2% vs 0%; P = .058). However, VIT-SARs to BV were less frequent in children than in adults (P = .034). Similarly, no significant relationship was noted between children and adults receiving WV VIT (2.6% vs 0%; nonsignificant). The severity of VIT-SAR did not differ between children and adults. CONCLUSIONS VIT-UR is safer in children. Age below 18 is not a risk factor for VIT-SARs.

The purpose of this study was to describe clinical manifestations, laboratory findings and outcome of granulomatosis with polyangiitis (GPA) in pediatric patients living in two regions (Southern and Central) of Poland.Retrospective analysis of patient hospital records from four large hospitals during a period from 1995 to 2013. Patients with confirmed diagnosis of GPA according to American College of Rheumatology (ACR) and EULAR/PRINTO/PRES criteria for GPA were analyzed. All patients were subjected to clinical, laboratory, radiological and immunological assessment.During this 18-year period only 9 children with confirmed diagnosis of GPA (6 girls, 3 boys) were identified. The average age of the disease onset was 12 years (range: 8-16 years). Average delay between first symptoms and diagnosis was approx. 20 months (range: 0-84 months). Organ system involvement at presentation included: kidneys 88.8% (8/9), lungs 77.7% (7/9), ear/nose/ throat 55.5% (5/9), gastrointestinal tract 55.5% (5/9), skin 44.4% (4/9), joints 22.2% (2/9), eyes 11.1% (1/9) and nervous system 11.1% (1/9). In 5 children disease course was progressive (constant progression of sinusitis in one case, end-stage renal disease in two, chronic kidney disease stage IV in one and one child died due to alveolar hemorrhage).The majority of our patients were females. Clinical features of pediatric GPA were similar to those described in adults. None of our patients developed subglottic stenosis and in only 2 children saddle-nose deformity was observed. Although GPA was treated according to contemporary standards care, disease progression was observed in more than a half of children.

During bacterial infections of the respiratory tract, neutrophils (PMN) are recruited to the lung by various mechanisms, including production of interleukin-8 (IL-8) by alveolar macrophages (AM). After fulfilling their defense function, PMN become apoptotic and have to be disposed of by AM to prevent local damage to the lung tissue by oxygen species and proteolytic enzymes. We measured the levels of IL-8 in the bronchoalveolar lavage (BAL) and the ability of AM to engulf senescent PMN in a groups of children with and without recurrent infections of the respiratory tract. The IL-8 level was measured by enzyme-linked immunosorbent assay (ELISA). The phagocytosis of apoptotic neutrophils was evaluated microscopically by the presence of myeloperoxidase positive material in AM before and after 1 h of incubation with senescent PMN. The data show that children suffering from recurrent infections have increased IL-8 in BAL and that their AM have a lower ability to engulf apoptotic PMN in vitro. Furthermore, the proportion of annexin V-binding cells was higher in BAL of children with recurrent infections of the respiratory tract than in normal controls. Pediatr Pulmonol. 1999; 27:167–173. © 1999 Wiley-Liss, Inc.

Rationale Chronic endobronchial inflammation is a hallmark of pediatric asthma and involves the arachidonic acid pathway. Its non-volatile metabolites can be quantified in the exhaled breath condensate (EBC), and single substances have been studied as non-invasive biomarkers for the diagnosis and monitoring of children with asthma. The aim of this study was to compare the content and profile of a wider range of eicosanoids in the EBC between patients and a control group. Materials and Methods EBC was sampled from 33 children (aged 12.4 ± 3.1 years) with stable atopic asthma (26 on inhaled steroid treatment) and 25 healthy controls (11.8 ± 3.2 years). Validated high performance liquid chromatography coupled with a tandem mass spectrometry platform (HPLC-MS2) was used to measure 13 different compounds. In addition, exhaled nitric oxide levels (FeNO) were measured and bronchial hyperresponsiveness (BHR) was assessed by an exercise challenge test in all subjects. An analytical approach was used for multivariate regression modeling of disease status using the most relevant variables. Results The levels of PGEM (P

Hymenoptera venom allergy, although rare in children, by its potential fatalities, leads to many psychosocial consequences, influencing quality of life of children and their parents. Aim of this paper is the estimation of health-related quality of life of venom allergic children treated with specific immunotherapy, and their parents. Assessment of factors influencing health-related quality of life levels was also performed.Sample under study consisted of 73 children: mean age 10.6, SD 2, 4, treated because of Hymenoptera venom allergy in 5 clinical allergy centers in Poland. Data was collected using VQLQ questionnaire adapted for children and their parents. Determinants of quality of life were assessed with multivariate linear and logistic regression models. Analysis were done with SPSS 15 for Windows package.Girls reported higher level of anxiety than boys (B = 0.47; 95% CI = (0.01; 0.94)). Level of caution in children increased along with increase of their anxiety against re-sting (B = 0.49; 95% CI = (0.27; 0.71)). Level of anxiety of children who were under treatment from 6 months to 2 years was lower than level of anxiety of parents of children treated shorter than 6 months (B = -1.21; 95% CI = (-2.16; -0.25)). The lowest level of caution was reported by parents of children aged 10 year or less (B = -0.86; 95% CI = (-1.67; -0.05)), while the highest was reported by parents of children aged 11 years (B = 0.86; 95% CI = (0.20; 1.53)) in comparison to parents of children aged 12 years or more. Parents' caution increased along with increase of their anxiety (B = 0.61; 95% CI = (0.40; 0.83)). Higher level of limitations was imposed by parents of children treated with rush or ultra rush method, in comparison to parents of children treated with conventional method (B = 1.27; 95% CI = (0.21; 2.33)). Levels of quality of life in children and their parents were strongly dependent in the same dimensions.1. Levels of quality of life in particular dimension in children is related to level of the same dimension in parents. 2. Age of children influenced level of caution of their parents. 3. Treatment duration influenced level of anxiety of parents. 4. Safety feeling acquired by parents at the beginning of treatment improves their quality of life in all dimensions.

Aim of the study was to assess validity and reliability of adaptations of VQLQ for Polish children with Hymenoptera venom allergy and their parents. Sample under study consisted of 73 children aged up to 14 years, who were treated with specific venom immunotherapy (VIT) in 2008 in centres conducting this procedure in Poland, and their parents. Theoretical validity of the scales was assessed with exploratory factor analysis using principal component analysis method. Reliability of the scales was assessed in terms of internal consistency with Cronbach alpha coefficient. Results of analysis showed that both scales measure 4 dimension of quality of life and reliability of scales measuring particular dimensions is at least acceptable in case of scale for children, and high in case of scale for parents. Both adapted scales are valid and reliable tools measuring quality of life in children with Hymenoptera venom allergy and their parents' quality of life in the face of child's allergy.

Bronchilitis is one of the most common respiratory diseases in infants and early childhood (2 ys of age). The diagnosis is clinical and laboratory tests support only recognition of the severity level of the disease. In most cases, the main reason of inflammation are viruses: RSV, rhinovirus. In the terminal bronchioles, inflammation process includes: edema, necrosis of epithelial cells, production of mucus, and possibly some degree of bronchospasm. For decades, controversy has surrounded the treatment of bronchiolitis. Last published consensuses and reviews indicate that use of bronchodilators, antibiotics, steroids systemic or inhaled, montelukast, ribavirin does not improve the symptoms of disease and is not routinely recommended. Recent studies suggest that nebulized hypertonic saline may substantially modify the course of disease. Moreover, there are no significant or frequent adverse effects noted in this treatment. It is believed that increased hydration of the airway mucus with inhalation of NaCl solutions will be routinely accepted treatment of children with bronchiolitis.

Cilia are evolutionarily conserved structures that play a role in diverse cell types. Motile cilia are involved in the most prominent ciliopathy called primary ciliary dyskinesia (PCD), which combines oto-sino-pulmonary symptoms (impaired mucociliary clearance that is important innate defense mechanism), male infertility and in nearly 50% cases situs inversus. Disease is usually inherited as autosomal recessive disorder, concerning mainly outer and/or inner dynein arms of cilia. Diagnosis of PCD requires the presence of characteristic clinical phenotype and confirmation the diagnosis by either identification of specific defect in electron microscopy or other evidence of abnormal ciliary function. The diagnosis of PCD may be delayed, missed or made incorrectly. The first ERS consensus statement which formulates recommendations regarding diagnostic as well as therapeutic approaches to children with PCD, is a very helpful tool in the management of this patients. We present our own experience with three children with PCD diagnosed in our Department.in children with clinical symptoms suggesting PCD, even with negative screening tests, the estimation of specific cilia defect in electron microscopy is indicated.

Allergic diseases, especially these IgE-dependent, have multifactorial origin, so genetic and environmental factors play role in their development. Increased prevalence of these diseases in last decades indicates that environmental stimuli play the main role, however epigenetic mechanism could not be ruled out. Several studies support the progression from antigen environmental exposure (allergens of house dust mites in most cases) in genetically predisposed children to atopic sensitization and subsequent disease. In some subjects, exposed to high levels of allergens in early childhood, immunomodulation process directs into tolerance. Past primary preventive programs did not show full effectiveness with multifaceted allergen reduction interventions. It indicates complicated interaction of environmental and genetic factors and support idea of further intensive interdisciplinary studies to establish effective prevention strategies.

Insect venom allergy requires a high level approach adequate to allergy intensity. In case of severe IgE-mediated sting reactions, in children older than five years, venom immunotherapy is a treatment of choice.Identification of current practices applied to venom allergic children in Poland and their adherence to the international guidelines.Questionnaire survey concerning diagnostic and treatment rules was carried out in 8 centres of pediatric allergology, based on a similar audit conducted in the United Kingdom [Diwakar L. et al. Clin Exp Allergy 2008, 38: 1651].In 5 centres both RAST and SPT tests were used as the first line of investigation. Subsequently 6 centres performed IDT. In three centres baseline serum tryptase levels were estimated. In case of sensitization to both bee and wasp venom in a child with the history of severe systemic reaction, but uncertain culprit insect, specific venom immunotherapy with both venoms was practised by 2 centres. In systemic reaction and not-detectable IgE in 6 centres child was followed-up in 6-12 months. Antihistamine premedication concerned all children in 7 centres. Six-week interval between booster doses was applied in half of centres. A target dose equal 100 mcg was used in 7 centres. Similarly all centres practiced 3-5 five year period of VIT.In Poland current practice with venom allergic children was conducted in congruence with most of the recommendations.

The influence of early feeding on the risk of atopic diseases has been studied in full-term newborns, not in very low birth weight infants (VLBW). The study evaluated effect of early feeding of VLBW infants with either cow's milk-based formula (CMF) or extensively hydrolyzed milk formula (HF) on incidence of atopic diseases and markers of atopy at 5-7 years of age. This was a follow-up of the randomized, double-blind study evaluating the influence of different enteral feeding protocols on the early morbidity of VLBW infants. In the original study 80 children were randomly allocated into 2 groups receiving during first month of life HF (experimental group) or CMF (control group). At the age of 5-7 years, 62 children among 74 available (84%) with mean birthweight 1124g were evaluated according to standardized ISAAC (International Study of Asthma and Allergies in Childhood) protocol. Total IgE level, specific IgE, lymphocyte CD4 + CCR4 + / CD4 + CXCR3 + ratio and skin prick tests (SPT) were done. Prevalence of obvious allergic diseases was not significantly different between the studied groups (HF: 12/33; CMF: 6/29; RR [relative risk] HF vs CMF: 1.76; 95%CI [confidence interval]: 0.76―4.09). Comparison of atopic status across groups revealed similar rate of positive markers of atopy: IgE (RR: 2.57 95%CI: 0.91―8,08), SPT (RR: 5.13; 95%CI: 0.93―31.6), lymphocyte CD4 + CCR4 + /CD4 + CXCR3 + ratio (OR: 2.32; 95%CI: 0.78―7.53) in the both studied groups. Based on the carried out follow-up study we were unable to confirm the usefulness of hydrolyzed formula in prevention of allergy in an unselected cohort of very low birth weight infants.

Bronchopulmonary dysplasia (BPD) is one of the most common late complications of prematurity. The study aimed to evaluate: 1) somatic development, 2) psychomotor development, 3) parental opinion of health status of the child and 4) prevalence of bronchial hyperreactivity among 5-7 years old children with history of BPD.Case-control study included 56 newborns bornor =32 weeks of gestation with mean birthweight (SD) 1057+/-218g. BPD was defined as at least 28 days of oxygen therapy and oxygen or positive pressure support at 36 weeks postmenstrual age. The control group consisted of newborns matched by sex, birthweight (+/-100g), gestational age (+/-1 weeks) and year of hospitalization. Somatic and psychomotor developments were prospectively evaluated up to age of 5-7 years. Parents were asked to complete two questionnaires: one assessing normal daily activity of the child and the standardized questionnaire used by International Study of Asthma and Allergies In Childhood (ISAAC). Peak expiratory flow rates (PEFR) before and after the inhalation of betamimetic were evaluated.No significant difference in somatic development was found between the study group and the control group. Normal psychomotor development was diagnosed in 11 (39%) children with BPD and in 13(46%) children without BPD. Mild or moderate impairment was diagnosed in 12 (43%) cases and 13 (36%) controls, and severe impairment in 5 (18%) and 2 (7%) children. At the age of 5-7 years children with BPD presented lower IQ as compared to children without BPD (94+/-25 vs. 103+/-16, p= 0.2). Parents of children with BPD more often declared that their child's development is impaired (39% vs. 11%, OR: 4.96; 95%CI: 1.2-20). Wheezing in past history was noted in 18 cases (64%) and only in 10 (35%) children without BPD (OR: 3.24; 95% CI: 1.09-9.67). Mean PEFR did not differ significantly between the studied groups (80.5+/-16.3% vs 84.5+/-15.4%; p=0.4). Moreover, changes of PEFR after a dose of betamimetic were similar in both groups (21% vs. 19%, p=0.7).The intellectual development of children with BPD at the age of 5-7 is worse than in the control group, especially as declared by their parents. Episodes of wheezing in infancy occurred more frequently in the group of children with BPD. However, bronchial hyperreactivity at the age of 5-7 is not significantly more frequent.

Improvement in perinatal care have resulted in significantly increased survival of premature infants. Discontinuation of correct intrauterine lung development and a necessity of oxygen-therapy and/or mechanical ventilation become a reason of bronchopulmonary dysplasia (BPD). In the first period of life the main complaint of these patients is oxygen dependence. Moreover the risk of serious infections of lower respiratory tract (particularly RSV) increases. This becomes the reason of readmission of about 50% prematures with diagnosed BPD in the first year of life. The main problem of these patients is airway obstruction, which very often doesn't respond to brochodilatators. The probable reason of these disturbances is imperfect development of respiratory system and remodelling of respiratory tract. Reduction in lung function (reduced FEV(1), PEF, FVC) persists until adolescence. Acceleration of the decrease in FEV(1)/FVC ratio may suggest that these patients are a risk group of COPD development. The assessment of lung radiography at the age of 11 years of former prematures with diagnosed BPD reveals the presence of persistent emphysematic changes (86% of these children had one or more bubbles). Abnormalities in chest high resolution CT occur in the majority of these patients (in 81.3% of the 10-years-olds group and in 92.5% of 18-year-olds group). Further prospective long-term study of prematures is essential for the establishment of remote prognosis and treatment standards.

Epidemiologic studies consistently demonstrate strong associations between gastro-esophageal reflux disease (GERD) and bronchial asthma also in children. A significant percentage of patients with GERD may experience extra-esophageal manifestations like cough or bronchspasm, which are typical symptoms of uncontrolled asthma.retrospective analysis of prevalence and severity of GERD in children with atopic bronchial asthma and influence of proton pomp inhibitor (PPI) therapy in management of asthma.The retrospective analysis of children with uncontrolled bronchial asthma between 6 and 18 years of age was performed. Thirty (21 boys) children were evaluated for acidic gastroesophageal reflux using 24-h esophageal pH-monitoring. Age, area of residence, presence and clinical severity of GERD, nocturnal episodes of GERD, pulmonary function parameters were analyzed. The effect of PPI therapy on modification of asthma treatment and lung function was assessed.Acidic gastroesophageal reflux was diagnosed in 17 (56%) children (fraction time of pH4 above 4.2%). Most of those patients (88%) came from urban area. Mean age at diagnosis of GERD was 10.5 years of age. Mild GERD was diagnosed in 13 children, moderate--in 4 children. Nocturnal episodes of reflux were present in 9 children (53%). Differences between lung function parameters (FEV1, FVC, PEF) before and after PPI treatment were not statistically significant, although their mean values were about 10% higher after treatment. PPI therapy allowed reduction of inhaled steroids dose in 24% of children; LABA were withdrawn in 3 children.The association of GERD with atopic asthma in children is common. It seems to be reasonable to perform work up of pathologic GER in children with uncontrolled asthma.

Prevalence of wheezing during infancy and pre-school age among very low birth weight (VLBW) infants is high. There is too little data to determine exactly the cause of wheezing in this group of children--it may result from early neonatal lung injury or increased susceptibility for allergic reactions.Analysis of wheezing episodes up to 5-7 years of age in a group of VLBW infants and recognition of risk factors.A sample of 104 children aged 5-7 years with birth weightor = 1500g was prospectively evaluated. The standardized ISAAC (International Study of Asthma and Allergies in Childhood) protocol was used to evaluate the number and quality of wheezing episodes. Total IgE level, specific IgE, lymphocyte Th1/Th2 ratio and skin prick tests (SPT) were performed. Children were divided into 3 groups: without wheezing, with episodes of wheezing in the history (more than 12 months previously), and with persistent episodes of wheezing.Episodes of wheezing were diagnosed in 52 (50%) cases: 27% of children showed signs of wheezing during 12 previous months and 23% of children reported wheezing only in their past history. Children with persistent wheezing presented more frequently than other groups: positive family history for atopy, allergic rhinitis, and positive allergic laboratory markers. Children with wheezing only during early infancy had bronchopulmonary dysplasia and more severe respiratory distress syndrome after birth.Prevalence of wheezing during infancy and preschool age among VLBW infants is high. Chronic and recurrent episodes of wheezing are more directly related to atopy than derive from neonatal problems.

The aim of study was to assess the prevalence of symptoms and diagnosis of allergic rhinitis (AR) and allergic rhinitis and conjunctivitis (ARC) in school children in 1994/95 and 2001/02.Standardized ISAAC questionnaire was used for assessment population of school children 6-7 yrs of age and 13-14 yrs of age in Kraków and Poznań.The prevalence of AR ever symptoms increased significantly in group 6-7 yrs of age from 28.5% to 33.6% in Kraków and from 13.0% to 31.3% in Poznań. The similar rise was found in group 13-14 yrs of age in Kraków from 26.1% to 41.1%, in Poznań from 19.0% to 39.6%. In both age groups and both centers the number of children with established AR diagnosis increased: in group 6-7 yrs of age in Kraków from 15.3% to 21.1%, in Poznań from 5.0% to 19.5%; in group 13-14 yrs of age in Kraków from 19.7% to 29.9%, in Poznań from 12.0% to 32.6%. Analysis of AR and ARC current symptoms (in the last year) confirmed significant increasing prevalence in both age groups, too.The prevalence of AR and ARC diagnosis and symptoms increased significantly during last 7 years.

The introduction of inhaled corticosteroids (ICS) has been a milestone in asthma therapy. According to current guidelines ICS are the first line drug in chronic anti-inflammatory therapy. The purpose of first part of this publication is to present updated knowledge on mechanisms of anti-inflammatory action as well as some pharmacokinetics and pharmacodynamics data about commonly used ICS, especially fluticasone propionate (FP) and two others: budesonide (BUD), beclomethasone dipropionate (BDP). Some differences between mentioned drugs have been found concerning systemic activity and safety of therapy. Fluticasone propionate is twice as active as the BUD and BDP. First results of therapy are seen 1-2 week after administration. Fluticasone propionate, more lipophilic than other steroids, has also high glucocorticoid receptor affinity and specificity, high topical anti-inflammatory activity and low systemic bioavailability. Systemic availability of FP depends on absorption from respiratory system. Oral bioavailability can be neglected because of almost total inactivation in liver during first pass. Fluticasone propionate has some features of dissociated steroids which means predominance of transrepression over transactivation--beneficial from safety point of view. Clinical efficacy of FP in chronic asthma therapy in children was confirmed in many studies. It significantly reduces the symptoms and exacerbations of asthma. There is a close correlation between FP use and lung function tests. The therapy with FP decreases bronchial hyperreactivity and the use of systemic steroids and rescue medication. The beneficial action of fluticasone propionate in asthma is due its anti-inflammatory properties within the airways (decreasing levels of direct and indirect markers of airways inflammations are observed).

Inhaled administration of glucocorticoid doesn't mean lack of systemic effects of drug. Bioavailability of steroid depends on oral absorption and absorption from respiratory system. In case of fluticasone propionate (FP) swallowed dose can be neglected because almost total (99%) inactivation in liver during first pass. In second part of paper the most important safety parameters of therapy with FP are discussed, it means; influence on hypothalamic-pituitary-adrenal axis, growth and bone metabolism. Interpretation of potential side effects should differentiate between abnormal value of laboratory test and clinically important symptoms. Adrenal suppression depends on dose of FP and was found even after low dose (about 200 microg per day), but clinical value of this findings is unknown. Prolonged administration of high doses can suppress hypothalamic-pituitary-adrenal axis; exceptionally, it can induce adrenal insufficiency. Recommended doses of FP given 1 to 2 years doesn't cause growth retardation. Long term studies on influence of drug on final height are needed. FP as other inhaled corticosteroids, may transiently alter bone metabolism. Till now there are no evidences that this drug, when prescribed appropriately in standard doses for asthma control, may decrease the bone mineral density or induce osteoporosis and may increase the risk of bone fractures in asthmatic children. Effective asthma control achieved with FP therapy permits normal activity and development of asthmatic children which prevails over exceptionally noticed side effects.

Protein losing enteropathy (PLE) is a gastrointestinal disorder that is associated with excessive loss of plasma protein into the gut resulting from abnormal mucosal permeability. The disease is usually caused by inflammation. The loss of protein in PLE is a nonselective process affecting albumin, globulin and transferrin. Abdominal scintigraphy with human serum albumin marked by Tc99m seems to be an easy and sensitive method for diagnosing PLE. An 4-year-old girl was presented to an outside Pediatric Department due to hypoproteinemia and recurrent pneumonia which had caused several prior hospitalizations. The laboratory tests revealed hypoproteinemia, hypoalbuminemia, low level of IgG, sideropenia, and a decreased level of T lymphocytes. The loss of protein into the gut was confirmed by fecal clearance of alfa-1 antitrypsin. Only nonspecific inflammation was detected by biopsy of the small intestine. These clinical and laboratory findings, quickly decreasing IgG and albumin levels in spite of i.v. supplementation and the lack of proteinuria permitted PLE diagnosis. The abdominal scintigraphy was planned to assess and localise protein losing through GIT and for strategy of possible surgical treatment. Abdominal dynamic scintigraphy was performed immediately after the injection of 300 MBq Tc99m human albumin. 90 images were taken within 180 minutes. Delayed abdominal images were obtained 6 and 24 hours after the tracer injection. Anterior abdominal scintigraphy showed pathological activity of Tc99m-albumin in small bowel in the upper left segment of the abdomen in the 40th minute after injection. Extensive accumulation of albumin was seen in the 160th minute. Delayed images, after 3 and 6 hours, revealed translocation of the tracer into the lower right abdominal segment. The further passage and tracer concentration was detected in ascendant and transverse colon. Based on the laboratory tests and scintigraphic images the girl was suspected to have segmental lymphangiectasia of small intestine and was qualified for laparatomy and, possibly, for surgical resection of the pathologically changed bowel. However, diffuse pathological changes revealed in the guts during the operation, rendered the operation impossible. Tc99m-labelled human serum albumin scintigraphy may be considered the method-of-choice in the diagnosis of protein-losing enteropathy. However, in this test the assessment of the enteropathy dimension is difficult and surgical treatment should be planned with caution.

The aim of the study was to assess changes in asthma prevalence between 1994/1995 (study I) and 2001/2002 (study II). Standardized ISAAC questionnaire was used. Randomly assigned population of school children 6-7 and 13-14 yrs of age was surveyed in Kraków and Poznań.The prevalence of wheezing ever increased significantly in group 6-7 yrs of age from 25.5% to 28.6% in Krakow and from 17.3% to 27.6% in Poznań, respectively in study I and study II. The similar rise was found in group 13-14 yrs of age in Krakow from 14.6% to 21.6%, in Poznań from 17.1% to 22.2%. In both age groups and in both centers the number of children with established asthma diagnosis increased: in group 6-7 yrs of age in Krakow from 4.0% to 5.8%, in Poznań from 1.3% to 5.9%; in group 13-14 yrs of age in Krakow from 2.3% to 6.8%, in Poznań from 2.0% to 5.2%. Analysis of current symptoms (in the last year) confirmed increasing prevalence of wheezing, wheezing after exercise and night cough in Poznań in both age group, in Krakow only in older children. In younger children in Kraków significant difference concerned only wheezing after exercise. The most frequent symptom reported by children was nocturnal cough in the last year.The prevalence of the asthma symptoms and established asthma diagnosis increased during last 7 years. However significant number of children presenting asthma symptoms remains still underdiagnosed.

To determine the prevalence of atopy and bronchial hyper-reactivity (BHR) and their relationship with wheezing and diagnosed asthma reported in schoolchildren.In Cracow, 1347 schoolchildren (9.7 +/- 0.7 yrs of age) were surveyed with ISAAC questionnaire. Skin prick tests with 7 aeroallergens and the exercise challenge test for BHR evaluation were carried out. Atopy was established when a positive skin reaction with at least one allergen occurred. The BHR was confirmed in presence of at least 15% decrease of the relative post-exercise peak expiratory flow (D% PEF) or wheezing during or immediately after exercise.Atopy was found in 26.2% of schoolchildren, with a two-fold higher risk in boys/odds ratio (OR) = 2.14; 95% confidence interval (CI) (1.59-2.86)/. In the group of atopic children, wheeze in the last year and diagnosis of asthma occurred significantly more often. The risk of wheeze in last year related to the type of sensitizing allergen and was highest for Der. f./OR = 6.1; 95% CI (3.78-10.16)/, medium for allergens of trees, dog's fur, Der. p., cat's fur and grasses/OR = 5.17; 95% CI (2.27-11.76), OR = 4.36; 95% CI (2.35-8.13), OR = 4.00; 95% CI (3.12-8.01), OR = 3.86; 95% CI (2.18-6.82), OR = 2.58; 95% CI (1.50-4.45), respectively/. In case of Alternaria allergens no correlation with wheeze was observed/OR = 2.71; 95% CI (0.88-8.31)/. BHR was identified in 12.4% of schoolchildren and demonstrated a significant correlation with that reported in the questionnaire: wheeze in the last year/OR = 2.28; 95% CI (1.25-4.14)/, diagnosis of asthma/OR = 2.96; 95% CI (1.38-6.34)/and post-exercise wheeze/OR = 3.17; 95% CI (1.60-6.27)/. Moreover, a significant correlation was demonstrated between atopy and BHR/OR = 1.85; 95% CI (1.22-2.79)/. In the group of children without wheeze in the past and without diagnosis of asthma, BHR was significantly higher in atopic children (positive skin test to in-door allergens) comparing to non-atopic ones, mean D% PEF values were 3.95%, -0.39%, respectively (p. = 0.0014).In children, there is a significant correlation between atopy and BHR, modified by individual history of wheeze or asthma, sex and allergen type.

Background Children who were Aim To determine if ELBW infants are at higher risk for the development of allergic and respiratory symptoms and to establish if there were any specific risk factors for these symptoms. Methods 81 children born with a mean birthweight of 845 g (91% of available cohort) were evaluated at the mean age 6.7 years. The control group included 40 full-term children. The children were examined for clinical signs of allergy, and were subjected to the following tests: serum total IgE, skin prick tests (SPT), exhaled nitric oxide measurement (FeNO) and spirometry. Results ELBW children had wheezing episodes more often (64% vs. 25%; OR (odds ratio): 5.38; 95% CI (confidence interval): 2.14-13.8) and were diagnosed more frequently with asthma (32% vs. 7.5%; OR: 5.83, 95% CI: 1.52-26) than their term born peers. The most important risk factors for wheezing persistence were hospitalization and wheezing episodes in first 24 months of life. Mean serum tIgE level (geometric mean: 32+/−4 vs. 56+/−4 kU/L; p=0.002) was higher and the number of children with positive results of tIgE level (12% vs. 32%; p=0.02) were more frequent in the control group. Children from the control group also more frequently had SPT, however this data was not statistically significant (11% vs. 24%; p=0.09). All of the ELBW had normal FeNO level ( Conclusion ELBW children have more frequent respiratory, but not allergic problems at the age of 6–7 years compared to children born at term. The need for rehospitalization in the first 2 years of life, was a more important risk factor of future respiratory problems at the age of 7 than perinatal factors, the diagnosis of bronchopulmonary dysplasia or allergy.