A. L. Boner

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting β2-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

Exhaled nitric oxide and sputum eosinophil markers of inflammation in asthmatic children

Exhaled nitric oxide and eosinophil sputum markers are considered noninvasive ways in which to evaluate airway inflammation in asthma. The aim of this study was to evaluate the relationships between these methods of evaluation in asthmatic children. In a cross-sectional study of 25 mild-moderate asthmatic children (aged 6-13 yrs, 10 patients on inhaled steroids) exhaled NO was measured along with induced sputum by inhalation of hypertonic saline solution. The sputum was processed for eosinophil count and eosinophil cationic protein (ECP) determination. Serum ECP and lung function (forced expiratory volume in one second (FEV1)) were also measured. A significant correlation was observed between exhaled NO and sputum eosinophils (r = 0.438, p = 0.032) as well as between sputum eosinophils and sputum ECP (r = 0.532, p<0.01). No correlation was observed among exhaled NO and serum ECP, sputum ECP, FEV1, respectively. Furthermore no correlation was observed between sputum eosinophil (%) and serum ECP and between sputum eosinophils and FEV1. There was no correlation among the investigated parameters in children treated with inhaled steroids. In conclusion, exhaled NO and sputum eosinophil counts are concordant in evaluating the degree of airway inflammation in patients with mild-to-moderate asthma. However, the association between these two noninvasive markers becomes less in steroid treated patients.

Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children

Backgroundu2002 Vitamin D deficiency could be associated with the prevalence of atopic dermatitis (AD).

Rhinitis in pre‐school children: prevalence, association with allergic diseases and risk factors

Background The aim of our study was to assess the prevalence of rhinitis, sneezing, runny or blocked nose apart from colds in a pre‐school children population and to evaluate the risk factors and relationship with allergic diseases and sensitization.

Benefits of immunotherapy with a standardized Dermatophagoides pteronyssinus extract in asthmatic children: a three‐year prospective study

Background: Although widely practiced for over 80 years, the role of specific immunotherapy (SIT) in pediatric asthma treatment is still controversial. We assessed the effects of a 3‐year period of subcutaneous administration of a standardized preparation of Dermatophagoides pteronyssinus (D pt) on the respiratory health in a group of asthmatic children monosensitized to house dust mite (HDM).

Influence of allergen avoidance at high altitude on serum markers of eosinophil activation in children with allergic asthma.

A cohort of 12 asthmatic children was followed over several months, during which they moved back and forth from an allergen‐free to an allergen‐rich environment at high and low altitude, respectively. The children were treated with non‐steroidal anti‐asthmatic drugs as clinically needed. Histamine PC20‐FEV1 was unaltered during the study period, whereas serum levels of eosinophil cationic protein (ECP) and eosinophil protein X (EPX) showed significant changes when the children were exposed to the offending allergens. The total IgE significantly increased during exposure. The serum levels of myeloperoxidase (MPO) as well as of chemotactic factors for both neutrophils and eosinophils were unaltered during allergen exposure. We conclude that the serum markers of eosinophil activity ECP and EPX are sensitive indices of allergen exposure in asthmatic atopic children.

Transforming growth factor‐β1 and interleukin‐10 in breast milk and development of atopic diseases in infants

Background Precise relationship between breastfeeding and infant allergy is poorly understood.

Exhaled breath condensate eicosanoids and sputum eosinophils in asthmatic children: a pilot study.

Cysteinyl leukotrienes (cys‐LTs), LTB4 and 8‐isoprostane are increased in the exhaled breath condensate (EBC) from asthmatic patients. The aim of this study was to investigate whether the measurement of cys‐LTs, LTB4 and 8‐isoprostane in EBC can reflect the level of airway inflammation assessed by induced sputum in asthmatic children sensitized to house dust mite (HDM) during natural avoidance of HDM allergens. Twelve children were evaluated at the time of admission (T0) and after 3u2003months of stay (T1) at the Istituto Pio XII (Misurina, Italian Dolomites 1756u2003 m). Sputum eosinophil percentage and measurement of cys‐LTs, LTB4 and 8‐isoprostanes in the breath condensate at T0 and T1 were evaluated. Eosinophil percentage in induced sputum was 8.5u2003±u20031.1% at T0 and 3.5u2003±u20030.4% at T1 (pu2003=u20030.011). Neutrophil percentage in sputum was 1.1u2003±u20030.5% at T0 and 1.5u2003±u20031.0% at T1 (ns). Cys‐LTs mean level was 14.24u2003±u20034.53u2003pg/ml at T0 and 4.65u2003±u20030.68u2003pg/ml at T1 (pu2003=u20030.0125). LTB4 level was 2.36u2003±u20030.19u2003pg/ml at T0 and 2.41u2003±u20030.23u2003pg/ml at T1 (ns). 8‐Isoprostane level reduced from 17.47u2003±u20033.18u2003pg/ml at T0 to 7.36u2003±u20033.26u2003pg/ml at T1 (pu2003=u20030.003). This study show that exhaled cys‐LTs and 8‐isoprostane, as well as eosinophil percentage in induced sputum, are reduced after allergen avoidance in asthmatic children suggesting a potential application of EBC for the non‐invasive evaluation of airway inflammation in asthma in allergic asthmatic children.

Mite avoidance can reduce air trapping and airway inflammation in allergic asthmatic children

Background We investigated the effects of prolonged allergen avoidance in 18 house dust mite‐sensitized asthmatic children during a prolonged residential period at a high altitude, allergen‐free environment.

Flunisolide decreases exhaled nitric oxide and nitrotyrosine levels in asthmatic children.

Background. Exhaled nitric oxide (FeNO) has been reported to be elevated in the oxidative stress involved in asthmatic patients, and the reaction of nitric oxide (NO) with superoxide anions results in the formation of nitrotyrosine. The purpose of this study was to investigate the effect of inhaled steroid treatment on nitrotyrosine levels collected by exhaled breath condensate (EBC) and on FeNO. Methods. This was a single-blind placebo-controlled study. The lung function, FeNO, and nitrotyrosine levels were evaluated in 10 asthmatic children. Results. The nitrotyrosine levels were stable during the placebo period (T0 = 1.16 ng/ml versus T1 = 1.05 ng/ml; NS.), whereas they decreased after the treatment with flunisolide (T2 = 1.14 ng/ml versus T3 = 0.88 ng/ml; P < .001). No significant reduction in FeNO levels was observed after placebo treatment (T0 = 38.4 ppb versus T1 = 34.7 ppb, NS.). In contrast, FeNO values decreased significantly being at T3 = 14.9 ppb (T1 versus T3; P = .024). Conclusions. This study shows that corticosteroid treatment reduces nitrotyrosine levels in EBC of asthmatic subjects.