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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.

Introduction The usefulness of total specific resistance (sRtot) and interrupter resistance (Rint) as a bronchodilator reversibility test (BT) alternative to forced expiratory volume in 1 s (FEV1) in asthma diagnosis in children has not been established. Aim To compare different applied definitions of airflow obstruction in children measuring response to the bronchodilator by spirometry, plethysmography and the interrupter technique in asthmatic children. Material and methods It was a prospective, real-life, non-interventional study. Children, aged 6-18 with newly diagnosed asthma, able to perform lung function tests were included into the study. Subjects underwent a history taking, physical examination, reversibility test in spirometry, plethysmography, and the interrupter technique. A standard cut-off of 12% from the initial value for reversibility in FEV1 was employed. Improvement in the pre-bronchodilator sRtot and Rint ≥ 25% and ≥ 35% was assessed after administration of salbutamol (400 µg) as well as allergen sensitization were measured. Results We included 135 children diagnosed with asthma into the analysis. All investigated parameters changed statistically significantly due to the bronchodilator administration in the examined patients. The FEV1 was not as useful in diagnostics of asthma as the sRtot and Rint, taking into consideration the fait accompli that all the study participants had aptly been diagnosed as having asthma (p < 0.001). The differences between the sRtot and Rint were not statistically significant (p = 0.215). Conclusions Our results suggest that sRtot and Rint may be useful parameters in BT in clinical practice in the asthma diagnostic process in children.

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.

Background Several studies suggest that early-life exposure to animal allergens constitutes a relevant risk factor for the development of allergic sensitization. Objectives The aim of the present study was to determine the role of interleukin-33 in children sensitive to cat allergen with allergic rhinitis and/or asthma. Methods The study included 51 children aged 5–18 years, both sexes, allergic to cats. Sensitization to cat allergen was confirmed by skin prick tests or specific IgE. Children were evaluated for the presence of bronchial asthma, atopic dermatitis, allergic rhinitis. A questionnaire evaluating the occurrence of allergic symptoms in children after contact with the cat and dog was performed. Mothers completed a questionnaire regarding cat exposure: during pregnancy and having a cat at home. A blood sample was taken from all children to measure the level of IL-33 in the serum. Results Keeping a cat in the home, once in the past, or having a cat in the home during the mother’s pregnancy, revealed a statistically significant relationship with IL-33 levels in the studied patients. Also, daily contact with a cat during pregnancy affected the level of IL-33. Higher levels of IL-33 were shown in people with hypersensitivity to cat and pollen allergens and cat and other animals. In patients with bronchial asthma higher levels of IL-33 were found than in patients without bronchial asthma. Conclusions Increased serum levels of IL-33 is related with keeping cats during pregnancy and in early childhood and can be associated with the development of asthma in children.

Introduction The relationship between allergen exposure to animals in pregnancy and the development of allergic symptoms is not clear. Aim To evaluate the association between prenatal and postnatal exposure to pet ownership and development of atopic dermatitis, food allergy and wheezing in children at the age of 1 and 2. Material and methods The mother-child pairs included in this study were part of the Polish Mother and Child Cohort. Mothers in each trimester of pregnancy and 1 year after childbirth have completed a questionnaire on animal exposure. Children's health status was assessed at around one year and two years of age. Results Keeping a dog at home before and during pregnancy (every trimester) decreased the risk of food allergy in the first year of life. On the other hand, keeping any animal other than a dog (cat, hamster, guinea pig, rabbit) before pregnancy and during each trimester separately increased the risk of food allergy in the first year of life of children. Keeping a guinea pig in the first trimester of pregnancy increased the risk of wheezing in the first year of life. The analysis did not show any significant associations between keeping animals at home before and during pregnancy and the occurrence of atopic dermatitis in the second year of life. Conclusions Keeping a dog at home before and during pregnancy decreased the risk of food allergy in 1-year-old children. This effect was eliminated in case of having a cat, hamster, guinea pig, or rabbit.

There is little understanding of the mechanisms by which food allergy (FA) develops into persistent disease, or by which symptoms it regresses. Food allergy is a major health problem in developed countries, where the prevalence reaches up to 6% in children and 3% in the adult population.Children with food allergy remission (FAR) and those without FAR below five years of age, were compared 7-10 years with respect to clinical data and expression of glycoprotein A repetitions predominant (GARP) on peripheral blood mononuclear cells.Forty children with FAR and 40 children without FAR at age 7-10, in whom FA was previously diagnosed at age below five years were evaluated. In this prospective study, demographic and clinical data were taken, patients were classified as atopic based on history and serum specific IgE (sIgE) for a specific allergen. Blood samples were obtained from all patients to assess expression of GARP.We observed higher expression of GARP in children with FAR compared to children without FA (p=0.005); optimal cut-off for GARP prediction of the remission was 20.1%. Children with FAR and food-specific IgE in serum had higher expression of GARP compared to children with low food specific IgE (0.35kU/L). Keeping pets at home decreased, and presence of allergic rhinitis increased ORs for high expression of GARP (hGARP) in our patients.hGARP (20.1%) is related with FAR in school children. Allergic rhinitis, and pets at home modify this effect of GARP. Children with allergic rhinitis have less chance of developing remission despite maintaining immune tolerance (hGARP); quite the opposite case with pets at home.

Background Immunoglobulin replacement has been standard therapy for patients with primary immunodeficiency diseases (PIDD). Intravenous immunoglobin (IVIg) is delivered at the hospital, whereas subcutaneous immunoglobin (SCIg) is used for home-based treatment. The aim of the study was to determine the advantages and disadvantages of IVIg and SCIg in Polish children aged 1-5 years, with PIDD, and the satisfaction of their parents / caregivers regarding immunoglobulin replacement. Methods The research involved parents of 23 children with PIDD, aged 1-5 years. All children were given IVIg therapy and after at least 6 months they were switched towards home SCIg therapy for at least 6 months. A questionnaire assessing advantages and disadvantages of preferred types of treatment and the quality of life of PIDD patients' families' lives was used. Results The research showed that IVIg therapy was better accepted by parents than SCIg therapy (P = 0.034) for the following reasons: It made it possible for the children to receive treatment once per month (60%); it reduced the fear of injecting the children (60%), and it provided better control of the disease through regular visits to the hospital (53.33%). Parents noticed, however, that IVIg had a significant impact on absence at school or work (70%). Parents who preferred SCIg for their children were guided mainly by the smaller number of side effects (40%), and the fact that the treatment did not interfere with parents' work or the children's school (40%). Conclusion The results showed that IVIg therapy was better accepted by parents than SCIg therapy Parents of children with SCIg are less satisfied with their life, and feel anxiety about their children disease, which is related to administering the medicine by themselves.

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.

To date, some studies suggest that passive smoking (PS) may be an important determinant of FeNO levels in children but sill there is a need of investigations using objective methods of PS exposure. The aim of our study was to examine the effect of PS, measured by urine cotinine levels, on FeNO and lung function (FEV1) in allergic and non-allergic asthmatic children. Methods It was a prospective, non-interventional study. 140 children, aged 4–17, newly diagnosed with asthma were recruited into two study groups (exposed group, unexposed group), according to smoking exposure/unexposure based on the questionnaire. There was one study visit. Subjects underwent a medical history (including history of atopy), physical examination, spirometry, FeNO and urinary cotinine measurement. Results 70 individuals had been exposed to tobacco smoke. The patients exposed to tobacco smoke were characterized by statistically significantly higher urine concentration of cotinine, 10,80 ng/mL, than their counterparts who had not been exposed to tobacco smoke, 1,56 ng/mL (P = 0,019). In the group of individuals unexposed to tobacco smoke the mean value of FeNO was 34,99 ppb, while in the group of patient who had been exposed to tobacco smoke, the corresponding mean value was significantly lower, it amounted to 22,41 ppb (P = 0,001) (Table 1). As regards to FEV1 measurements, there were not any statistically significant differences by study groups unexposed/exposed to tobacco smoke (P = 0,179 and P = 0,074, respectively). FeNO levels (ppb) in the studied patients allergic to cat, grass or trees, exposed to tobacco smoke were significantly lower than in those children unexposed to tobacco smoke. Our results suggest a clinically important issue, that FeNO results should be interpreted in the context of environmental tobacco smoke exposure. Additionally allergy to cat dander, grass or tree may be potential confounding factor, which should be taken into consideration.

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

It has been proven that outdoor and indoor air pollutants can cause adverse health effects and are able to promote the onset of atopic diseases. The current manuscript is focused on methodological issues. The aim of the study is to determine the effect of air pollution, urban environment, and urban heat islands (UHIs) on the occurrence of respiratory diseases including allergic rhinitis, asthma and wheezing in preschool children. The study group consists of 276 five-year-old children attending randomly selected kindergartens in the urban and rural areas of the Łódź Voivodeship. The questionnaire including data on the child’s state of health and socio-economic data will be filled by the caregivers. The children will undergo skin prick testing and the measurement of volatile organic compounds in exhaled breath. The key components of air pollution – particulate matter (PM) will be measured by personal meters. The PM sampling planned in the study will take 12 h for PM 2.5 and for PM 10 alike. Data on the level of outdoor air pollution will be collected based on the results obtained from air monitoring stations. The impact of air pollution, UHIs and the environment on the respiratory system and the presence of allergies in children, including chronic respiratory diseases, will be assessed. The project results will provide a scientific basis for the development of preventive programs in the population of children in the Łódź Voivodeship, adapted to the real health needs of society. Int J Occup Med Environ Health. 2021;34(4):453–60

Background: MAS study revealed that chronic course of asthma characterised by airway hyper-responsiveness and impairment of lung function at school age is determined by continuing allergic airway inflammation which begin in the first 3 years of life. Respiratory tract infections early in life, childhood allergic comorbidities, exposure to environmental determinants of asthma and active smoking may all contribute to increased risk of allergic disorders. While these correlations have been established, there is little understanding of the immunological mechanisms by which asthma develops into a persistent disease, or by which symptoms regress. Methods: Eighty patients were included into the analysis. Clinical and immunoregulatory predictors of asthma were analyzed. Results: Presence of mAPI criteria as well as the presence of house dust mite-allergy and allergic rhinitis at present, were associated with a reduced prevalence of asthma remission. The presence of increased eosinophil blood count in API (Asthma Predictive Index) criteria was associated with a lower expression of CD25 positive cells. Current presence of HDM-allergy was associated with a higher FeNO level and higher expression of CD25CD71 positive cells. Allergic rhinitis was associated with a higher expression of PPAR and CD25CD71 positive cells; in the same group of patients a lower expression of GARP positive cells were observed. Conclusions: Probability of persistence of childhood asthma was largely determined by the presence of allergic rhinitis and sensitization to HDM. Our results suggest natural remission of clinical symptoms of asthma in children are not fully related to immunoregulation processes. Additionally, API criteria are related to asthma persistence.

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.

Purpose: Based on the available data, alterations of the antioxidant defense as well as the vitamin status in mothers may affect the prenatal process of lung and immune system development as a pathophysiological background of increased prevalence of allergic diseases. The primary aim of the current study was to assess the associations among cord blood concentrations of zinc (Zn); copper (Cu); selenium (Se); β-carotene; and vitamin A, E, and D, and the occurrence of atopic dermatitis, food allergy, allergic rhinitis, and asthma in early school-age children. Methods: We evaluated 211 children, 7‐9 years old, from the Polish Mother and Child Cohort Study. the women were interviewed during pregnancy to collect demographic and socioeconomic data, and the medical and reproductive history. At delivery, umbilical cord blood plasma was sampled. Seven to nine years after the birth, the child's exposure and health status (including skin-prick test and spirometry for allergy assessment and urine sample for cotinine level) were examined. In the analyses, a multivariable model was applied. Results: Statistically significant relationships were found among Zn; Cu; Se; and vitamin A, E, and D concentrations in cord blood; and the prevalence of food allergy, allergic rhinitis, atopic dermatitis, and asthma in children ages 7‐9 years after adjustment for several confounders. Conclusion: We showed an imbalance in the antioxidant defense system in cord blood, which may lead to the occurrence of allergic diseases later in life. The maternal diet may have substantial potential to modify immune tolerance and, consequently, the development of allergic disease in the offspring.Clinical trial NCT01861548, www.clinicaltrials.gov

Introduction: Polyunsaturated fatty acids (PUFA) supplementation is thought to reduce inflammation in cystic fibrosis. Likewise vitamin D has immunoregulatory properties. The aim of the study was to compare the effect of cholecalciferol supplementation to cholecalciferol with omega-3 supplementation on the inflammatory response of CF patients infected with P.aeruginosa. Methods: This was a double-blind, cross-over trial. Twenty-three CF patients (aged 6 – 19) infected by P. aeruginosa were randomised to received: cholecalciferol 1000IU or cholecalciferol 1000IU and omega – 3 1000 mg daily for three months. The levels of IL-23 and IL-17A in the exhaled breath condensate (EBC), calcium-phosphorus balance and serum lipid balance were measured. Data were analysed using means of Stata/Special Edition, release 14.2. Results: The level of IL-23 in EBC significantly decreased in vitamin D + omega-3 group from 9,39 pg/mL (± SD = 6,40 pg/mL) to 7,33 pg/mL (± SD = 3,88 pg/mL) (p = 0.023); there was no change in vitamin D group (p = 0.630). The blood concentration of 25OHD significantly increased in both groups: in vitamin D group form 24,64 ng/mL (± SD = 8,31 ng/mL) to 29,41 ng/mL (± SD = 7,78 ng/mL) (P < 0,001) and in vitamin D +omega-3 group from 24,31 ng/mL (± SD = 8,28 ng/mL) to 30,67 ng/mL (± SD = 8,01 ng/mL) (P < 0,001). Conclusions: Omega-3 supplementation with cholecalciferol may provide some benefits and modulate the immunity response in airway CF patients with chronic P. aeruginosa infection reflected as reduction of the level of IL-23 in EBC.

Background One of the most important aspects of sublingual immunotherapy (SLIT) is the regimen of administration. Aim To find any differences in symptom-medication scores between the two groups of SLIT tablets and drops, given pre-coseasonally (starting 8 weeks before the pollen season) in children with rhinoconjunctivitis allergy to grass pollen. The secondary outcome were the differences in lung function and induction of T-regulatory forkhead box P3 (FOXP3) positive cells. Methods This was a retrospective, secondary analysis of pooled data obtained from our two prospective randomized placebo controlled trials that involved children who underwent SLIT. Forty-one children, ages 6-18 years, with allergic rhinitis (AR), sensitive to grass pollen, participated in the study. Results Treatment with both tablets and drops significantly reduced all symptoms (nasal, asthma, and ocular) within the groups; there was no significant difference between both groups. When compared with the tablet therapy, there was a trend for drops therapy to be more effective in the reduction of combined symptom-medication score, but the difference was not statistically significant (p = 0.1036); there was no significant difference in asthma and nasal scores. We showed a significant decrease in the fractional exhaled nitric oxide level comparable in both immunotherapy groups. There were no differences between the groups in the induction of CD4+ CD25+ FOXP3+-positive cells in peripheral blood. Conclusions Both protocols showed similar decreases in symptom-medication scores; however, when compared with tablet therapy, there was a trend for drops therapy to be more effective in the reduction of combined symptom-medication score.

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.

Recurrent infections of the respiratory system among children are the most common reason for ambulatory treatment and one of the main causes of hospitalisation. Out of many factors that can be potentially responsible for the recurrent infections in children it is necessary to consider the ones that are connected with the immaturity of the immune system of a child and ones that can disturb the proper functioning of this system. It seems that the most important observations are those pointing at links between recurrent infections of the respiratory tract and the allergic process. The present article describes a case of a boy with recurrent respiratory infections, who was diagnosed towards immune system malfunction and allergies. An echocardiographic examination revealed a major defect of the interatrial septum. This heart condition was treated with cardiac surgery as a result of which infections occur less frequently and do not require the hospitalisation of the patient.

Children who grow up on dairy farms rarely develop asthma or allergies. Researchers suspect a key reason is that the kids breathe in air full of lipopolysaccharides, molecules from the cell wall of bacteria G-, known as endotoxins. Endotoxin-reduced epithelial cell cytokines activate dendritic cells (DCs), thus suppressing type 2 immunity to house dust mites and reducing the overall reactivity of the immune system and later protecting children from asthma. Schuijs et al showed that an enzyme involved in this defense, called A20, is made by the epithelial cells. Loss of the ubiquitin-modifying enzyme A20 abolished the protective effect. Thus, the farming environment protects from allergy by modifying the communication between barrier epithelial cells and DCs through A20 induction. Their study offers new support for the hygiene hypothesis, which posits that zeal for cleanliness and widespread use of antibiotics have purged the environment of microorganisms that once taught a child's developing immune system not to overreact to foreign substances. This paper is a summary of up-to-date information on hygiene hypothesis. The purpose is to review the important recent advances made in how innate immune cells, microbes, and the environment contribute to the expression of allergic disease, emphasizing the allergen-related signals that drive allergic responses.

Mukowiscydoza jest najczęstszą chorobą wrodzoną w populacji kaukaskiej, uwarunkowaną autosomalnie recesywnie. Obecnie coraz więcej rozpoznań nie spełnia wszystkich kryteriów diagnostycznych tej choroby. Atypowa lub nieklasyczna mukowiscydoza charakteryzuje się prawidłowymi lub granicznymi wynikami testów potowych, brakiem niewydolności trzustki lub monosymptomatycznym przebiegiem choroby. Z tego powodu u pacjentów z nietypowymi objawami z dróg oddechowych, przewlekłymi i opornymi na leczenie lekarze powinni mieć na uwadze możliwość rozpoznania mukowiscydozy. Opisano przypadek kliniczny chłopca, u którego w 11. roku życia rozpoznano mukowiscydozę ze współistniejącymi nawracającymi zapaleniami zatok obocznych nosa z towarzyszącymi masywnymi mnogimi polipami. W niniejszym artykule wskazano, że rozpoznanie opornego na leczenie przewlekłego zapalenia zatok obocznych nosa z towarzyszącymi polipami powinno skutkować pogłębieniem diagnostyki, w tym w kierunku mukowiscydozy.

Cat scratch disease is a rare infectious disease caused by the Gram-negative bacterium Bartonella henselae. Most often, it affects children and adolescents. Infection occurs primarily through bites or scratches by a cat, or less commonly a dog, rabbit or guinea pig. It is transmitted also by body lice and cat fleas. It most often occurs in the form of local lymphadenopathy, in individual cases there may be symptoms of generalised disease. The paper presents a case report of an early diagnosed and confirmed by serological tests cat scratch disease in an 8-year-old boy. The symptoms in the form of painful inguinal lymphadenopathy were observed 3 weeks after the boy sustained a cat scratch in the navel area. Except for a slightly accelerated erythrocyte sedimentation rate, the laboratory findings were normal. After 10-day hospitalisation, improvement of the patient’s overall condition and a significant reduction in lymph nodes size were achieved, and the pain was eliminated. Cat scratch disease is correctly diagnosed increasingly often, yet it still frequently poses a diagnostic problem.