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Microelements and vitamins are believed to have immunomodulatory effects. The aim of the study was to establish the role of antioxidants (vitamins A, E, D) and microelements such as copper (Cu), selenium (Se), and zinc (Zn) levels in allergic diseases in schoolchildren. The study uses a cohort of 80 children (40 with and 40 without allergy/asthma diagnosis) aged 9 to 12 years recruited for the Polish Mother and Child Cohort Study. At nine to twelve years old, the children were tested for microelement and vitamin content and health status (including skin-prick test and spirometry, urine cotinine level). Demographic data were collected from mothers by an allergist. The risk of asthma occurrence was found to be significantly related to the levels of Cu and Zn. The level of Cu was also particularly closely associated with allergic rhinitis and was indicated as a significant predictor of food allergy. The levels of Cu and Zn, and poor nutritional status in general, can influence the immune system and may be considered risk factors for developing asthma, allergic rhinitis and food allergy.

Introduction Omalizumab has been successfully used as a supplementary therapy to improve asthma control in children aged ≥ 6 years with moderate or severe persistent allergic asthma. Aim To evaluate effectiveness ofomalizumab in children and adolescents with uncontrolled allergic asthma. Material and methods Seventeen children and adolescents aged 8-16, treated with omalizumab from 2011 until now, were enrolled into the retrospective, open, uncontrolled, observational study. The effectiveness of therapy, asthma control, quality of life, exacerbation rate, corticosteroid use, were assessed after 16, 52 and 104 weeks of treatment and after omalizumab cessation. Results The response to treatment was assessed as excellent (9 patients) and good (6 patients), according to global evaluation of treatment effectiveness (GETE). A statistically significant decrease in use of oral corticosteroids (OCS) and leukotriene receptor antagonists (LTRAs) was observed. The doses of inhaled corticosteroids (ICS) decreased significantly (the mean dose of ICS converted to a dose of budesonide before treatment was 1503.53 μg/day versus 903.53 μg after discontinuation). The mean asthma control questionnaire (ACQ) value decreased from 2.10 to 0.84 points and the mean mini asthma quality of life questionnaire (miniAQLQ) outcome increased from 4.37 to 6.1 points. The mean number of exacerbations decreased from 5.59 to 0.53 per year. Conclusions Our results are supportive of the existing evidence that omalizumab therapy improves asthma control, reduces OCS and ICS use, decreases exacerbations in children and adolescents with severe/moderate uncontrolled allergic asthma.

Exercise may trigger bronchoconstriction, especially in a group of athletes in whom bronchospasm during exercise is reported to occur more frequently than in nonathletes. The aim of this study was to determine the prevalence and environmental risk factors contributing to exercise-induced bronchoconstriction (EIB) in adolescent athletes. A prospective study was conducted among a group of 101 adolescent athletes who underwent spirometry, exercise challenge, fractional exhaled nitric oxide (FeNO) measurements, and allergy assessment. The study group was divided into three subgroups of athletes based on the most common sports environments: swimmers, “indoor” athletes, and “outdoor” athletes. The clinical evaluation demonstrated a high frequency of EIB in the study group. Moreover, a large proportion of the athletes in whom EIB was observed reported no pre-existing symptoms suggestive of bronchospasm or asthma. Among patients without a previous diagnosis of asthma, clinical evaluation confirmed 22% with positive exercise challenges, compared with 77% of adolescents with negative test results. Moreover, among the athletes with a history of asthma, 39% had positive exercise challenges. Both EIB and asthma are common conditions that affect adolescent athletes. Physicians should pay particular attention to this group, as the symptoms can lead to under- and overdiagnosis.

Background: Interventions to help parents quit smoking may yield important benefits for children with asthma. Children’s exposure to environmental tobacco smoke can be measured by reporting of an adult in the household and testing the child’s biomarker, e.g., cotinine. Objective: The aim of the study was to assess the effectiveness of “face-to-face” intervention carried out since 2016 in families with children diagnosed with asthma 3 years after beginning the anti-tobacco intervention. Methods: This study was a follow-up to an interventional study that assessed the effectiveness of direct patient education versus educational leaflets alone about parental tobacco smoking. The patients with asthma (ages 4‐17 years) enrolled in our original intervention study conducted in 2016 were under the care of the allergy outpatient clinic. The active group was individually educated about the harmful effects of environmental tobacco smoke on their children. The control group included patients and parents, among whom only leaflets were distributed. After 3 years of ongoing intervention, in patients from both groups, exposure to tobacco smoking was evaluated with a questionnaire addressed to parents and/or caregivers and measurement of cotinine in children’s urine. The forced expiratory volume in the first second of expiration and fractional exhaled nitric oxide levels were measured. Results: Seventy participants completed the study: 37 in the active group and 33 in the control group. In the active group, 27% of the parents quit smoking entirely compared with 9.4% of parents in the control group. In the group of active intervention, a significant decrease in the cotinine level (p < 0 .001) and the number of cigarettes smoked daily were observed (p Conclusion: “Face-to-face” intervention among families with smokers were effective and lowered cotinine levels in children with asthma and the number of cigarettes smoked assessed 3 years after the intervention.

Local anesthetics (LA) have been used for a wide variety of procedures over the years due to their analgesic effect. These drugs have been seen to cause adverse events in the pediatric population, but an actual allergy must be in question. A case of an apparent hypersensitivity reaction to LA used in the setting of dental procedures in a 14.5-year-old girl with a forgotten history of asthma was reported and medical documentation review was performed. After treatment with LA during several dental procedures, the patient presented the shortness of breath, malaise and fainting, which then resolved spontaneously. After proper history taking, and skin and provocation tests, the patient was diagnosed with bronchial asthma and emotional sensitivity. The patient's recommendation included using an antihistamine and controlling her asthma before the use of LA, and administering the drug in a supine position. It is essential to consider all possible etiologies of an adverse event after using drugs in the pediatric population and to perform proper testing before making the diagnosis of a drug allergy.

Cystic fibrosis patients are characterised by disorders of fat-soluble vitamin absorption and bone metabolism. The aim of this study was to compare the effect of 3-month supplementation with calcitriol and cholecalciferol on calcium–phosphate balance in patients with cystic fibrosis. The study included 23 cystic fibrosis patients aged from 6 to 19 years. It was a crossover, placebo-controlled trial. There were 3 visits during which blood and urine were collected for analysis. The patients were treated with cholecalciferol (1,000 IU/day) or calcitriol (0.5 μg 1,25OHD) and placebo, and then received medications according to the cross-over regimen. The second visit took place after 3 months. The concentration of calcium, phosphate, parathyroid hormone and 25OHD were determined in blood serum; calcium/creatinine index was determined in urine. It was shown that after 3-month supplementation with calcitriol, the phosphate concentration decreased significantly, from 1.48 mmol/L (±SD 0.27 mmol/L) to 1.35 mmol/L (±SD 0.20 mmol/L) (p = 0.021). The calcium concentration increased significantly after 3 months of calcitriol treatment, from 3.50 mg/dL (±SD 2.60 mg/dL) to 4.35 mg/dL (±SD 3.35 mg/dL) (p = 0.001). The level of parathyroid hormone decreased significantly after 3 months of treatment with calcitriol, from 36.54 pg/mL (±SD 17.61 pg/mL) to 29.36 pg/mL (±SD 13.08 pg/mL) (p = 0.019). In the cholecalciferol supplementation group, there were no changes in phosphate, calcium or parathyroid hormone concentrations. Supplementation with either cholecalciferol or calcitriol did not affect serum 25OHD levels. In patients with cystic fibrosis, calcitriol supplementation at a dose of 0.5 μg is safe and has a more beneficial effect on the calcium–phosphate metabolism and bone metabolism than that of cholecalciferol at a daily dose of 1,000 IU.

Objectives The objective of this study was to evaluate the association between breastfeeding duration and child neurodevelopment based on the Polish Mother and Child Cohort Study. Material and Methods The current analysis included 501 mother–child pairs. The analysis evaluating the association between the length of breastfeeding and child neurodevelopment considered the following variables: maternal age and body mass index, weight gain during pregnancy, parental level of education, marital status, socioeconomic status, child gender, birthweight, type of delivery, preterm delivery, pre- and postnatal exposure to tobacco constituents and child day care attendance. Psychomotor development was assessed in 1-year-olds on the Bayley Scales of Infant and Toddler Development . Results The length of breastfeeding correlated positively with maternal age at delivery (ρ = 0.13), maternal and paternal level of education (ρ = 0.2 and ρ = 0.14 respectively), birthweight (ρ = 0.1) and marital status (ρ = 0.16) (p < 0.05). A negative correlation between the length of breastfeeding and maternal smoking status during the first year after delivery (ρ = –0.19) and weight gain during pregnancy (r = –0.1) was observed (p < 0.05). The association between the duration of breastfeeding and child development was not statistically significant in the model with the inclusion of confounding variables. A significant association between language development and maternal level of education (p = 0.004), gender of the child (p = 0.0007) and maternal weight gain during pregnancy (p = 0.01) was found. A negative association between cognitive development and maternal salivary cotinine during pregnancy (p = 0.03) and a negative association between motor development and maternal smoking status during the first year after delivery (p = 0.007) were also found. Conclusions This study found no significant association between the duration of breastfeeding and child development after adjustment for confounders. Int J Occup Med Environ Health. 2019;32(2):175–84

The impact of maternal diet during pregnancy on the risk of allergic diseases in childhood is an increasing scientific and public health concern. We evaluated the associations of maternal type of diet and essential elements and vitamins intake during pregnancy with offspring allergic and respiratory outcomes.The study population included 557 mother-child pairs from Polish Mother and Child Cohort (REPRO_PL). Based on the Food Frequency Questionnaire filled in between the 20th-24th week of pregnancy, overall maternal diet was evaluated as the difference between the Prudent Dietary Pattern (PDP) score and Western Dietary Pattern (WDP) score ((PDP-WDP) score) and maternal achievement of dietary recommendations (estimated average requirement, EAR) for essential elements and vitamins was assessed. Children's health examination at age of 1, 2, and 7-9 years covered the following symptoms: infections, wheezing/asthma, food allergy, allergic rhinitis, and atopic dermatitis. At age of 7-9 years, children underwent spirometry and skin-prick tests.Children of the mothers who were not achieving adequate intake of vitamin C during pregnancy had a higher risk of wheezing and having more than two infections within the first two years of life comparing to those who met EAR (OR = 2.6, p = 0.05, and OR = 2.3, p = 0.04, respectively). Inadequate intake of vitamin E during pregnancy was related to a higher risk of atopic dermatitis (OR = 2.7, p = 0.04), whereas inadequate intake of magnesium during pregnancy was associated with the risk of wheezing in the offspring at age of two years (OR = 3.7, p = 0.03). A lower (PDP-WDP) score during pregnancy (indicating unhealthier diet) was associated with a higher risk of infections (OR = 1.5, p = 0.007) but a lower risk of atopic dermatitis (OR = 0.7, p = 0.02) at age of 7-9 years.These results may contribute to the body of evidence for the impact of maternal diet during pregnancy for children's optimal health, however further studies are needed before drawing conclusions and recommendations for clinical practice.

Background: Sensitization to cat and/or dog allergens during childhood represents a risk factor for the development of allergic diseases later in life.Material and Methods: The study investigated the association of patterns of sensitization to cat and dog allergen components with clinical symptoms of allergy to these furry animals among cat-sensitized children. It included 50 children aged 5-17 years who showed sensitization to cat in the skin prick test. They were considered to have cat allergy if they suffered from one or more allergy symptoms when being exposed to contact with a cat. The children were evaluated for the presence of bronchial asthma, atopic dermatitis and allergic rhinitis. Their mothers completed a questionnaire on pet exposure at home. Levels of serum IgE cat epitopes Fel d (1, 2, 4), as well as dog components Can f (1, 2, 3, 5) were measured in all the studied children.Results: Respiratory symptoms following exposure to the cat allergen were most common in children with Fel d 2 epitope (p = 0.041). After contact with a dog, respiratory symptoms were most common in children with Can f 1 epitope (p = 0.042), eczema in children with sensitization to both Can f 1 (p = 0.009) and Can f 2 (p = 0.002), whereas eye symptoms occurred mostly in children with Can f 3 (p = 0.039).Conclusions: Molecular diagnosis in patients with pet allergy may help clinicians to predict clinical symptoms and their severity.

Adolescent athletes are a particular group requiring special medical attention. Recent literature outlines the growing problem of physical inactivity among young people, exploring various dimensions that may explain lack of physical activity, and potentially relevant interventions and strategies. There is growing evidence that physical inactivity predisposes to the development of asthma. Exercise is one of the most common factors triggering cough, dyspnea, and breathing difficulties in otherwise healthy children. This condition is called exercise-induced bronchoconstriction (EIB). Symptoms of EIB include cough, wheezes, chest tightness, and dyspnea during or after physical education lessons. The number of adolescents suffering from EIB is underestimated and many athletes remain undiagnosed and untreated. In this article we argue that complexity of diagnosing EIB is greater for adolescent athletes than it is for adults. The purpose of this review is to draw the attention of the medical community to the problem of EIB and asthma symptoms among adolescent athletes. We performed a meta-analysis of these two topics, consulting PubMed and ClinicalKey for the terms: “adolescent athletes”, “exercise-induced bronchoconstriction” and “asthma in adolescent athletes”. After analysis of the relevant scientific data, the most important facts and issues related to the study group were listed.

Background Environmental chemicals, such as phthalates, phenols, and parabens, may affect children's immune development and contribute to the risk of atopic diseases and asthma. Objective To evaluate the associations between prenatal and childhood phthalate exposure and atopic diseases in children at the age of 9 years. Methods This analysis is restricted to 145 mother-child pairs from the prospective Polish Mother and Child Cohort Study. Phthalate metabolite levels were assessed in the urine samples collected from mothers during the third trimester of pregnancy and from children at age of 2 and 9 years. For the appropriate recognition of children's health status, a questionnaire was administered to the mothers and completed with information from the medical record of each child. The clinical examination was performed by a pediatrician/allergist in the presence of the mother or a relative. Results A higher urine concentration of mono-2-ethyl-5-oxohexyl phthalate increased the risk of food allergy in children at the age of 9 years (odds ratio [OR], 1.75; 95% CI, 1.19-2.57; P = .004) and decreased the risk of atopic dermatitis (OR, 0.49; 95% CI, 0.27-0.87; P = .02). For mono-2-ethyl-5-hydroxyhexyl phthalate, an increased risk of atopic dermatitis was observed (OR, 1.90; 95% CI, 1.18-3.05; P = .008). A higher urine concentration of mono-benzyl phthalate increased the risk of asthma in children (OR, 1.67; 95% CI, 1.08-2.58; P = .02), but the risk of asthma decreased when the concentration of mono-2-ethylhexyl phthalate was higher (OR, 0.64; 95% CI, 10.43-0.97; P = .04). Conclusion Our study has not provided clear evidence of the negative effect of phthalate exposure during pregnancy and within the 9 years after birth on allergic diseases in children.

Lung abscess is a rare diagnosis in the paediatric population. It most often arises as a complication of bacterial pneumonia; therefore, it is sometimes difficult to distinguish its symptoms from the symptoms of pneumonia. The abscess may be primary (it develops in immunocompetent children) or secondary (when there are favourable factors such as congenital malformations, immunological disorders, infections or neurological diseases). Treatment consists of initiating intravenous antibiotic therapy for 3–4 weeks and continuing it for 5–6 weeks orally to minimise the risk of complications. The purpose of this clinical case report was to draw the attention of general practitioners to the possible occurrence of lung abscess also in immunocompetent children. Attention was drawn to the severity of patient’s condition in the absence of auscultation symptoms. Physician’s experience has an impact on the sensitivity of the assessment of child’s clinical condition.

An important issue in sublingual immunotherapy (SLIT) is how to improve efficacy.To compare the clinical efficacy of SLIT with vitamin D supplementation with placebo in children with allergic rhinitis. Secondary end points included lung function, exhaled nitric oxide concentration, methacholine bronchial provocation test, and serum level of calcifediol (25[OH]D).Fifty children, ages 5-12 years, sensitive to grass pollen, with allergic rhinitis (eight patients had concomitant asthma) participated in a 5-month prospective, randomized, double-blind, placebo-controlled trial. Children received a 5-grass pollen sublingual 300 IR tablet with either vitamin D 1000 IU daily supplementation or placebo.When compared with the placebo group, SLIT plus vitamin D group therapy was more effective in the reduction of nasal symptoms (p = 0.04), asthma symptoms (p = 0.001), and the combined symptom-medication score (p = 0.001); there was no significant difference between the groups in medication and ocular scores. We observed a significant improvement of forced expiratory volume in 1 second (vitamin D group, p = 0.014; placebo group, p = 0.015) and the proportion of a person's vital capacity expired in the first second of forced expiration levels (vitamin D group, p = 0.004; placebo group, p0.001), within both groups, between visits. Fractional exhaled nitric oxide and provocative dose producing a 20% fall in forced expiratory volume in 1 second results did not statistically significantly differentiate the study participants in terms of receiving SLIT along with vitamin D or placebo. We showed a significant increase in calcifediol in the SLIT plus vitamin D group as well as in SLIT plus placebo group.Vitamin D supplementation combined with grass-specific SLIT was more effective in the reduction of nasal and asthma symptoms. Vitamin D supplementation combined with SLIT provides an effective and well-tolerated new immunotherapy modality for treating children with allergic rhinitis. A 5-grass pollen sublingual 300 IR tablet was effective in both studied groups and also in children with comorbid mild asthma.

Background It is considered that farm areas protect young patients from allergy and asthma due to high exposure to endotoxins. Aim To compare CD4+/CD25+ T-regulatory cells and forkhead transcription factor Foxp3 expression in asthmatic children allergic to house dust mites (HDM) living in rural and farm areas. Materials and Methods This was a prospective analysis of 35 children living in farm areas (n = 19) and rural areas (n = 16), aged 8–16, with allergic rhinitis (allergic to dust mites) and newly diagnosed asthma. Surface molecule CD4+CD25+Foxp3+ expression on cultured PBMCs was estimated by flow cytometry using fluorophore-conjugated monoclonal antibodies in each patient. Results Thirty-five children were included into the analysis: 19 children living in farm areas and 16 in rural areas. Within and between-groups (farm area vs. rural area) differences in CD4+/CD25+ and CD4+/CD25+Foxp3+ cell expression did not reach the level of significance. Conclusion The current analysis showed that CD4+/CD25+ and CD4+/CD25+Foxp3+ cell expression was not associated with place of living in asthmatic children sensitive to HDM.

BACKGROUND AND OBJECTIVE We hypothesized that maternal prenatal and children urine metabolite concentration of phthalates would be associated with food allergy and early eczema among inner-city children. The study was based on data from the Polish Mother and Child Cohort. METHODS Prenatal and postnatal exposure to the following phthalates: diethyl phthalate, diisobutyl phthalate, di-n-butyl phthalate, butyl-benzyl phthalate, di(2-ethylhexyl) phthalate, diisononyl phthalate, and di-n-octyl phthalate were determined by measuring phthalate metabolites in the urine collected from the mothers during the third trimester of pregnancy and from their children at age 2 years. Pre- and postnatal observations limited the response rate and final sample size; data from 147 participants were included in the analysis. Children's health status was assessed at 24 months of age by using a questionnaire administered to the mothers. We studied associations between the urine level of phthalates and the presence of food allergy and atopic dermatitis in logistic regression analysis. All associations were adjusted for independent risk factors of dependent variables. Associations with atopic dermatitis were adjusted for the effect of atopy in the family, the father's education, frequency of house cleaning, and breastfeeding; associations with food allergy were adjusted for the presence of pets at home during pregnancy and breastfeeding. RESULTS The prevalence of the outcomes were as follows: atopic dermatitis, 12.2%, and food allergy, 48.9%. We showed that higher urine concentrations of monobenzyl phthalate in mothers during pregnancy increased the risk of food allergy in children during the first 2 years of life (odds ratio 4.17 [95% confidence interval, 1.17-17.89]). There were no associations with children's urine and allergic symptoms. CONCLUSIONS Results of our study indicated awareness of environmental factors that may affect children's health because the phthalates were shown to be risk factors for food allergy in children.

Despite the continuous increase in the prevalence of asthma in many developing countries, there have been major advances in understanding and managing this disease. The remarkable role of inflammation in asthma is well known. Current asthma guidelines recommend the use of anti-inflammatory drugs and immunotherapy for long-term management of asthma. The management of asthma in children is a challenge because of their inability to express warning signs and seek medical attention in a timely manner. Unlike adults, asthmatic children must rely on their parents or caregivers for the administration of asthma medications. The inability to carry and self-administer asthma drugs may increase the risk of non-compliance. Glucocorticosteroids, the most important drugs for patients with asthma, are associated with an increased level of side effects and compliance issues mostly in children. In an attempt to solve that dilemma, emphasis is being placed on the modification of current management tactics and the introduction of other drugs. This review presents more recent patents for childhood asthma therapies for the management of asthma in children.

Background Exercise is one of the most common triggers of bronchoconstriction and affects up to 80% of children with asthma. Objective The purpose of this randomized, double-blind, placebo-controlled study was to assess the effectiveness of treatment with ciclesonide 160 microgram, either alone, with a higher dose, with a leukotriene receptor antagonist (LTRA), or with a long-acting beta-agonist (LABA) in children with asthma with postexercise-induced symptoms. Methods Eighty adolescents, ages 1218 years, with asthma and postexercise symptoms were enrolled. Children were treated in one of four treatment groups: ciclesonide 160 microgram daily dose (cic 160), ciclesonide 320 microgram daily dose (cic 320), ciclesonide 160 microgram daily dose combined with montelukast (cic + LTRA), or ciclesonide 160 microgram daily combined with formoterol (cic + LABA). The impact of treatment on clinical symptoms, maximum percentage decrease in forced expiratory volume in 1 second after intense exercise effort, fractional exhaled nitric oxide in exhaled breath, and the contribution of inflammatory mediators in exhaled breath condensate were assessed. Results In children with asthma and with postexercise symptoms, 8-week daily administration of ciclesonide 320 microgram, ciclesonide 160 microgram plus LABA, and ciclesonide 160 microgram alone decreased daytime symptoms; decrease in maximal fall in forced expiratory volume in 1 second reached the level of significance in the cic 320, cic + LABA, and cic + LTRA groups. A higher prevalence of positive responses to treatment after addition of an LTRA or LABA to ciclesonide 160 microgram for patients with exercise treadmill challengeinduced clinical symptoms only was revealed. Conclusion Monotherapy with ciclesonide 320 microgram can be as effective as combined therapy in reducing exercise-induced bronchoconstriction. We revealed a higher prevalence of positive responses to treatment after the addition of LTRA or LABA to ciclesonide 160 microgram for patients with exercise treadmill challengeinduced clinical symptoms only. ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov"www.ClinicalTrials.gov/ext-link NCT01798823.

Adverse drug reaction is defined as any harmful, unintended, and undesired effect of a drug that occurs at doses used for treatment, prevention, or diagnoses. Most of these reactions are classified as type A reactions, which by definition are predictable, common, dose-dependent, and caused by known pharmacological actions of the drug, drug toxicity, and side effects. Allergic reactions are qualified as type B reactions independent of dose, affecting a small population, suggesting that individual patient host factors are important. In pediatric population, β-lactam antibiotics are the most common reason for adverse drug reactions, followed by nonsteroidal anti-inflammatory drugs. In this article, we report the case of a child with several anaphylactic reactions to several drugs, including cefuroxime, amoxicillin/clavulanate, clarithromycin, ibuprofen, and budesonide, in a context of suspected Helicobacter pylori infection.

Background It is considered that farm areas protect young patients from allergy and asthma due to high exposure to endotoxins. Allergen immunotherapy (AIT) is the only treatment of allergy modifying the immune response with the potential to change the natural history of allergic diseases. It seems that studies evaluating the efficacy of immunotherapy in large cohorts of allergic patients living in farm areas are needed to understand the influence of environment on immune response during AIT. Aim. To compare the clinical effectiveness of immunotherapy between children living in farm versus urban areas. Materials and methods This was a retrospective analysis of 87 children living in farm area (n = 42) and city area (n = 45), aged 8–16, who completed three years of subcutaneous immunotherapy due to allergic rhinitis/asthma. An AIT efficacy questionnaire has been designed to be filled in by the allergy specialist during a regular immunotherapy visit before and after AIT. Results We observed significantly higher improvement in total score among children from farm area compared to children from city area (p

Background Childhood asthma is an important public health problem worldwide. Risk factors for asthma development include allergic sensitization and exposure to animals. Objective To identify which (perennial or seasonal) inhalant allergens are associated with asthma and allergic rhinitis in children. Methods This was a cross-sectional, retrospective study. We evaluated data from medical documentation of 6,000 children (aged 6 - 18 years) with diagnosed asthma and/or allergic rhinitis who had attended our allergy outpatient clinic. Into the analyses we included those subjects who had specific IgE test done during diagnostic procedures to confirm allergen sensitization. Results We included 5,076 children in the analysis. We showed that among seasonal allergens only sensitization to timothy or birch significantly changed the prevalence of allergic rhinitis and asthma diagnosis. Of the perennial allergens, house dust mite or cat were most closely related with both allergic rhinitis and asthma. Results of ROC curve analysis showed that in atopic children the specific IgE level of seasonal allergens did not significantly change the prevalence of asthma diagnosis. Sensitization to more than one perennial allergen significantly increased the prevalence of allergic rhinitis and asthma. Conclusion We showed that sensitization to the seasonal allergens timothy and birch as well as to the perennial allergens house dust mite and cat, is associated with asthma and allergic rhinitis in children. Our study determined the role of multiple perennial indoor allergens in the developement of allergic diseases in children. The identification of the specific allergens makes them potential targets for intervention and prevention strategies.

Introduction Vitamin D deficiency has been proposed as a potential contributing factor in patients with allergic diseases. We compared the clinical and immunological effects of vitamin D supplementation to placebo during the pollen season in children with allergic rhinitis. Material and methods Thirty-eight children aged 5-12, sensitive to grass pollen, participated in a prospective, randomized, double-blind, placebo-controlled trial. Children received either vitamin D 1000 IU daily supplementation or placebo. We studied symptoms/medication score, lung function, exhaled nitric oxide concentration (FENO), methacholine bronchial provocation test and serum level of 25(OH)D, as well as; CD4+CD25+Foxp3+ cells, TLR4, IL-1, IL-6, TNF and the IL-10 and transforming growth factor β1 (TGF-β1) levels in cell culture supernatants. Results Vitamin D therapy was effective in reduction of the symptoms/medication score (p = 0.0371). In vitamin D group an increase in the CD4+CD25+Foxp3+ cells (7.06 vs. 10.5%; p = 0.0013) and serum 25(OH)D concentration (49.6 vs. 96.6 ng/ml; p = 0.0001) and in control group an increase in FENO (15.6 vs. 21 ppb; p = 0.0331) and serum 25(OH)D level were observed (82.9 vs. 100.3 ng/ml; p = 0.0003).We revealed a higher increase from baseline in the percentage of CD4+CD25+Foxp3+ cells in the vitamin D group compared to the control group (p = 0.0058). A significant correlation between CD4+CD25+Foxp3+ cell induction and FENO reduction in the vitamin D group was observed (p = 0.0217). Conclusions Vitamin D 1000 IU as a supplementary treatment of grass pollen allergy in children with allergic rhinitis during the pollen season significantly reduced the symptoms/medication score. The study revealed an immunological effect of vitamin D.

Background Studies indicate that exposure to polycyclic aromatic hydrocarbons (PAH) is associated with adverse respiratory and allergy outcomes. Exposure to PAH may impair the immune function of the foetus and, subsequently, be responsible for an increased susceptibility of children to allergic diseases. Objectives The aim of the present study was to assess the association between mother's exposure to PAH during pregnancy and allergy diseases in their infants. We also assessed the above associations using measured PAH exposure in children's urine during the first two years of life. Methods The current analysis was restricted to 455 mothers and their children from Lodz district. The women were interviewed three times during the pregnancy in order to collect demographic, socio-economic and medical history data. Children's health status was assessed at the age of 10–18 months and repeated at two years of age. The associations between dependent dichotomous variables and urine concentrations of 1-hydroxypyrene (1-HP) were analysed using logistic regression. Results We showed that higher urine concentrations of 1-HP in mothers at 20–24 weeks of pregnancy increased the risk of more frequent respiratory infections ( p = 0.02) in children during their first year of life. Higher 1-HP concentrations in children's urine increased the risk of food allergy ( p = 0.002) in children during their first two years of life. Conclusions This study suggests awareness of environmental factors, which may affect children's health since PAH showed to be a risk factor for airway infections and food allergy in children after adjustment for other risk factors.

To cite this article: Stelmach I, Podlecka D, Majak P, Jerzynska J, Stelmach R, Janas A, Krakowiak J, Stelmach W. Validity of the Pediatric Asthma Quality of Life Questionnaire in Polish children. Pediatric Allergy Immunology 2011; 22: 660–666. Abstract Background: Although the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was translated for use in Polish asthmatic children, it is necessary to confirm that its validity, reliability, and the accuracy of the responses are not influenced by culture difference. Therefore, the objective of this study was to validate the Polish version of the Pediatric Asthma Quality of Life Questionnaire. Methods: This was a 9-week period cohort study. The patients were interviewed using the PAQLQ on four occasions: at baseline, 1 wk after inclusion, and after 5 and 9 wk. At each clinic visit, lung functions test and NO measurements were performed. Asthma control (according to GINA) was assessed throughout the study. Results: One hundred and one patients completed the study. At all visits, moderate correlations (from r = −0.51 to −0.68) between all PAQLQ domains and the asthma diary were observed. We noticed a significant improvement in the understanding of the questions during the last visit compared to baseline. The gradient of correlation coefficients between the symptoms domain of PAQLQ and asthma diary was observed across study visits. The standards of reliability defined by Cronbach’s α-coefficient (from 0.75 to 0.91) were fulfilled in all domains of the questionnaire, at all visits. We found a higher increase in PAQLQ score in patients who obtained asthma control compared to those who lost control during the study. There was no relation between PAQLQ and FeNO. At all visits, moderate correlations (from r = −0.51 to −0.68) were shown between all PAQLQ domains and the asthma diary. Conclusions: We showed that Polish version of PAQLQ is valid and reliable among our study group. Moreover, as far as clinical practice is concerned, PAQLQ seems to be a useful tool for monitoring asthma in children especially based on the physician’s grading of asthma severity according to GINA guidelines.

Despite the continuous increase in the prevalence of asthma in the most underdeveloped parts of the world, nowadays, we can generally speak of a better understanding and management of this disease. The remarkable role played by the inflammatory process in asthmatic patients is well known. The aim of most asthma guidelines is to suppress inflammatory process with a combination of anti-inflammatory drugs and immunotherapy. The management of asthma in children is a challenge because of their inability to express warning signs and seek medical attention in a timely manner. Unlike adults, asthmatic children must rely on their parents or caregivers for the administration of asthma medications. This inability to carry and self-administer asthma drugs may increase the risk of non-compliance. Glucocorticosteroids, the most important drugs for patients with asthma, are associated with an increased level of side effects and compliance issues mostly in children. In an attempt to solve that dilemma, emphasis is being placed on the modification of current management tactics and the introduction of other drugs. This review presents more recent patent therapies for the management of asthma in children.

Background Environmental factors in schools have a significant effect on the exercise-induced bronchoconstriction and symptoms in a general paediatric population. Objectives To determine the environmental factors such as atmospheric conditions and the presence of allergens in gymnasiums, that could be predictive of the presence of exercise-induced symptoms/bronchospasm in children during physical education (PE). Methods 1370 schoolchildren were enrolled. Children attended 45 min PE lesson with similar exercise intensity. Pulmonary function tests were performed before and after PE lesson. Air temperature, humidity and pressure, samples of dust for allergen exposure in the gymnasiums were taken. Children who reported symptoms induced during PE lesson were invited to the clinic for ETC (exercise treadmill challenge) and atopy measurement. Results 1033 participants were included into the analysis. Sixty seven(6.5%) children reported dyspnea/cough, and in 94(9.4%) children bronchoconstriction induced during PE lesson was documented. There is a correlation between the results of the ETC and bronchoconstriction after PE (OR: 2.55; 95%CI: 1.07–6.05; p = 0.034). Exposure to higher air pressure and higher humidity independently increase the risk of clinical symptoms reported during or after PE lesson. Exposure to cat's allergens increase the risk of bronchoconstriction (independently from atopy status). We showed significant interaction between presence of asthma and current ICS therapy as a risk of physical inactivity at school (OR: 4; 95%CI: 1.3–12; p Conclusion This study showed an effect of cat allergen and environmental factors (humidity, air pressure) on the appearance of exercise related cough/bronchoconstriction during activity class in a natural environment at school in a large urban population of schoolchildren.

Background: The results of our previous study focused on the high prevalence of exercise related bronchoconstriction (EIB) during physical education lesson in a general population of schoolchildren. Objectives: To determine the potential environmental factors (such as humidity, temperature, air pressure, allergen exposure) in schools that could be predictive for the presence of exercise-induced symptoms in children during physical education. Methods: 480 schoolchildren from 5 public schools were enrolled. All children attended 45 minute PE lesson with similar exercise intensity. Pulmonary function tests were performed before and immediately after PE lesson. The diagnosis of EIB was defined as a FEV1 decrease from baseline of ≥ 10% with exercise. All dust samples were prepared for measurements and performed by Indoor Biotechnologies Laboratory (Cardiff, UK) and analyzed using a multiplex assay kit (MARIA). The following allergens were measured: dust mite, cat, mouse, cockroach, mold. Results: 461 participants were included into the analysis. After PE lesson, 16,3% children suffered from cough, 0,9% reported dyspnea and 11,1% had more than 10% fall in FEV1 from baseline. Among all participants, 6,9% had doctors9 diagnosed asthma. EIB was not affected by age, gender, BMI, asthma diagnosis. Only cough (OR: 2.11, 95%CI: 1.06-4.03; p=0.0141) was independently associated with EIB. Atmospheric conditions didn9t significantly differe between schools. All samples taken from gymnasiums had significant levels of cat allergen only (above 0.1 µg/g dust) Conclusion: This study showed that any detectable level of cat allergen may be clinically significant.

To the Editor : To evaluate alternative modes of immunoglobulin administration, we designed an openlabel observational study to compare the efficacy and safety of hospital-based intravenous immunoglobulin (IVIG) and home-based self-administered subcutaneous immunoglobulin (SCIG) in children with primary immune deficiency diseases (PIDD) switched from IVIG to SCIG. We studied 18 patients, aged 2–18 y, diagnosed with different types of PIDD (Fig. 1). Children were given IVIG therapy at a dose 400 mg/kg every 4 wk (Kiovig® or Octagam®) and were switched towards home SCIG at a weekly dose of 100 mg/kg (Subcuvia®). At enrollment, a retrospective analysis of IVIG replacement therapy within the last 12 mo was performed. At each visit (every 4 wk), the number of respiratory tract infections, the IgG serum levels and the frequency of adverse events were evaluated. The differences in number of infections and IgG serum level between groups were assessed by Mann–Whitney test. Nominal and categorized variables were compared with Chi-square test. Higher serum level of IgG in patients from SCIG group (median; upper-lower quartiles: 9.3; 7.7–11.8) compared with IV group (median; upper-lower quartiles: 6.5; 5.8– 8.5) were shown. The administration of IVIG led to a rapid and high rise in the serum immunoglobulin G concentration followed by a rapid fall over the next few days whereas the IgG serum level during SCIG remained at the stable average level. Less frequent respiratory tract infections in patients from SCIG group (median; upper-lower quartiles: 1.0; 0.75–1.0) compared with IVIG group (median; upper-lower quartiles: 3.0; 1.0–3.25) were observed. The number of episodes of infections in both the groups are shown in Fig. 2 and Table 1. SCIG therapy was better tolerated then IVIG therapy (1 local vs. 9 systemic adverse events per year). Less frequent systemic adverse reactions (0 % in SCIG group vs. 50 % in IVIG group; p 0.0005; Chi-square, df=12.00, 1) were shown. Thus, as found in other studies SCIG therapy is much more effective and safe for children with primary immune

Summary Background There are investigations concluding that reduced vitamin D status in pregnancy, may be a risk factor for the development of allergic outcomes in offspring. However, studies on the relationship between cord levels of 25-hydroxyvitamin D (25[OH]D) and risk of early childhood wheezing and early-onset atopic dermatitis/food allergy are very limited. Objective To assess the associations between cord blood concentration of 25[OH]D and occurrence of the incidence of wheezing, atopic dermatitis, food allergy, during the first two years of life. Methods We evaluated 240 children by the age of 2 years from the Polish Mother and Child Cohort Study. Women were interviewed during pregnancy to collect demographic and socioeconomic data, the medical and reproductive history. At delivery, umbilical cord blood plasma was sampled. The child's health status were examined at approximately 2 years. In the analyses multivariable model was used. Results Data from 190 participants were included into the analysis. The median value and quartile range of 25[OH]D in cord blood [ng/ml] were as follows: 6.33, 4.16–8.53. 25[OH]D in cord blood below lower quartile increases the risk of multi-triggered wheezing (MTW) in children during first 2 years of life (OR: 2.81; 95% CI: 1.13–7.00). Higher cord serum level of 25[OH]D reduces the risk of viral induced wheezing (VIW). The cord serum level of 25[OH]D below median value (OR: 6.06; 95% CI: 1.3–28.3) or below lower quartile (OR: 5.43; 95% CI: 1.66–17.7) increases the risk of VIW. All above effects of vitamin D level in cord blood were corrected for the effects other independent risk factors of wheezing and VIW in this cohort. Conclusions Cord serum 25[OH]D levels were inversely associated with the risk of multi-triggered wheezing, and especially viral-induced wheezing by the age of 2 years, but no association was found with food allergy, atopic dermatitis and frequencies of infections.

Purpose There is little agreement among researchers whether a caregiver’s QOL can be used to detect changes in asthma severity in children. We assessed correlation between QOL in parents and QOL in children with asthma as well as clinical parameters of asthma. We determined whether changes in caregiver’s QOL scores reflect changes in child’s QOL and their asthma control. Methods This was a 9-week period cohort study. One hundred and ten primary caregivers with 110 children were seen in the clinic at enrollment, at week #1, #5 and #9. At each visit, the parents completed the Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ). Results One hundred and one children and 101 caregivers completed the study. We found a significant correlation between asthma diary score in children and QOL in parents (from r = −0.46 to r = −0.53). We also found significant positive correlation between PAQLQ and PACQLQ and significant association between changes in asthma control and PACQLQ score for both domains. We observed significant change in PACQLQ of caregivers whose children obtained asthma control. Conclusions PACQLQ is a useful tool for monitoring asthma in children. The implementation of the PACQLQ would be helpful in involving parents in therapy of their children with asthma.