Barbara Bendandi

Atopic dermatitis : quality of life of young italian children and their families and correlation with severity score

The aim of this study was to determine the ways in which atopic dermatitis (AD) affects the lives of young Italian children and their families, in terms of quality of life, and correlate it with AD severity and the perception of severity as estimated by the family. The parents of 45 children aged 3–84 months affected by AD were asked to complete two validated questionnaires after clinical examination. The first questionnaire was about the childs quality of life (Infants’ Dermatitis Quality of Life Index); the second regarded the familys quality of life (Dermatitis Family Impact questionnaire). In a further question parents were asked to estimate the severity of the disease of the child. Childrens quality of life appeared slightly‐moderately altered (mean score 10.2) compared with the value of a control group (3.3), and itching, sleep problems and the influence of the disease on the childs mood were the cause of greatest discomfort for the child. Family quality of life appeared moderately altered (mean score 11) compared with the value of the control group (7.4). The greatest problem was the disturbed sleep of the family members. Other important problems were the economic cost for the management of the disease and the tiredness and irritability caused by the disease in parents. Analysis of the responses confirms the incorrect estimation of the severity of the disease perceived by the family. In our opinion, the two questionnaires may be useful in clinical practice to understand better the difficulties suffered by a family with a child affected by AD. They also provide data that may help to improve the clinical approach for the child and the family, and to assess the degree of under‐/overestimation of the disease by the family.

Clinical effectiveness of a silk fabric in the treatment of atopic dermatitis

Background  In children with atopic dermatitis (AD), eczema is easily aggravated by contact with irritant factors (e.g. aggressive detergents, synthetic and woollen clothes, climatic factors).

Does improvement management of atopic dermatitis influence the appearance of respiratory allergic diseases? A follow-up study

BackgroundAtopic dermatitis (AD) is often the prelude to allergic diseases. The aim of this study was 1) to evaluate if an integrated management regime could bring about a change in the evolution of the disease in comparison to the results of a previous study; 2) to determine whether the refinement of allergic investigations allowed to identify more promptly the risk factors of evolution into respiratory allergic diseases.MethodsThe study included 176 children affected by AD and previously evaluated between 1993 and 2002 at the age of 9-16 months, who underwent a telephonic interview by means of a semi-structured, pre-formed questionnaire after a mean follow-up time of 8 years. According to the SCORAD, at first evaluation children had mild AD in 23% of cases, moderate in 62%, severe in 15%.ResultsAD disappeared in 92 cases (52%), asthma appeared in 30 (17%) and rhinoconjunctivitis in 48 (27%). The factors significantly related to the appearance of asthma were: sensitization to food allergens with sIgE > 2 KU/L (cows milk and hens egg; P < 0.05); to inhalant allergens with sIgE > 0.35 KU/L (P < 0.05). Logistic regression analysis showed that inhalant sensitization was positively related to the occurrence of asthma (OR = 4.219). While AD showed similar rates of disappearance to those of our previous study, the incidence of asthma was reduced, at the same follow-up time, from 29% to 15% (P = 0.002), and the incidence of rhinoconjunctivitis from 35% to 24% (P = 0.02).ConclusionComparing the results with those of the previous study, integrated management of AD does not seem to influence its natural course. Nevertheless, the decrease in the percentage of children evolving towards respiratory allergic disease stresses the importance of early diagnosis and improvement management carried out by specialist centers. The presence of allergic sensitization at one year of age might predict the development of respiratory allergy.

Use of the Italian version of the Pediatric Asthma Quality of Life Questionnaire in the daily practice: results of a prospective study

BackgroundAsthma is a serious global health problem and its prevalence is increasing, especially among children. It represents a significant social and economic burden, and it can severely affect the health-related quality of life (HRQL) of patients. Among the numerous questionnaires aiming at evaluating asthma HRQL in children, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) has proved to have good measurement properties.The present study was aimed at investigating the possible role of the Italian, self-administered version of the PAQLQ in the routine clinical evaluation of children affected by bronchial asthma.Methods52 Italian children and adolescents (40 males and 12 females), aged 6 to 17 years, affected by allergic asthma, were enrolled. Each patient was evaluated twice, and at each visit asthma control and severity were assessed, spirometry was performed and the patients completed the self-administered version of the PAQLQ.ResultsThe questionnaire was well-accepted and understood by the children. Children showed an overall good quality of life, with mild impairment in the activity and emotional function domains. The PAQLQ showed an overall good correlation with the clinical and functional indexes that are normally evaluated in follow-up visits of asthmatic patients. The PAQLQ appeared to be strongly related to asthma control, both at the first (p < 0.01) and second (p < 0.001) time of the study. The PAQLQ was also seen to decrease with increasing asthma severity. The results suggest a better compliance of the children towards completion of the questionnaire at t1. Finally, the PAQLQ does not appear to discriminate HRQL in patients with good lung function.ConclusionThe Italian version of the PAQLQ is a quick-to-administer aid to clinical activity and can add valuable information to symptom reports, objective measurements and clinical assessment of asthma control and severity in daily clinical practice. Re-administration at each follow-up visit allows HRQL to be monitored over time.

Allergy is not the main trigger of urticaria in children referred to the emergency room

Background  Urticaria is the disease that has the highest impact on quality of life and requires the most visits to the emergency room.

Cytokines Levels in Children Affected by Atopic and Nonatopic Eczema

Patients with atopic eczema present higher serum levels of total IgE and different pattern of cytokines, com- pared to nonatopic eczematous patients. This study aimed to evaluate serum levels of IL-2, IL-4, IL-5, IL-10, IFN� , TNF� in eczematous children in relation to atopic and nonatopic form. We enrolled 45 eczematous children and 12 controls. To- tal IgE and specific IgE against principal food and inhalant allergens were evaluated by UniCap1000 and levels of cytoki- nes by Cytometric Bead Array System. The geometric means of levels of IL-4 were higher in eczematous patients than controls (P=0.036). Serum levels of IL-10 and IFNwere higher in nonatopic eczematous children than in atopic eczema- tous patients and controls (P= 0.004, P= 0.003). Our data confirm that cytokines may play an important role in the patho- genesis of eczema: nonatopic eczema seems to be characterized by increased levels of IL-10 and IFNcompared to atopic form.

Educational and Medical Programme for Young Children Affected by Atopic Dermatitis and for Their Parents

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease particularly prevalent during the first years of life. The chronic course of AD is a serious problem for affected children and their families. Since the condition provokes extreme itching with continuous scratching that often maintains or exacerbates the inflammation of the skin, the behavioural component of the disease is especially problematic. Moreover, the chronic course and the frequent relapses that characterise AD are a particular burden for the children and their caregivers. To improve long-term outcome in the management of childhood AD, it is important to give parents support in dealing with the chronic disease of their child in addition to medical treatment. Objective: The aim of our programme was to inform families of children with AD about the course of the disease, to improve the family management and to offer them an opportunity for a more open and wide medical dialogue. Methods: Our educational programme consisted of six 2-hour group sessions, conducted at weekly intervals. Sessions were managed by a multidisciplinary team composed of a paediatrician-allergist, a psychologist and a dermatologist. The following issues were covered in the sessions: epidemiology, natural history of the disease, diagnostics and treatment, stress management, psychological counselling on sleeping problems and itchingscratching. Results: Parents reported that the programme well improved the quality of life of their family, particularly thanks to better knowledge and understanding of the disease. Discussion: The programme may encourage an active rather than a passive coping style in the families involved. During routine clinical care it is difficult to recognize and deal with all family troubles and doubts, which are for the most part caused by a poor knowledge of the disease.

Food Allergy in Children with Asthma: Prevalence and Correlation with Clinical Severity of Respiratory Disease

Epidemiological evidence suggests that there is a link between asthma and food allergy. The aim of this study was to estimate the prevalence of food allergy in asthmatic children and to evaluate a possible impact of food allergy on asthma severity. The study enrolled 103 asthmatic children (mean age: 11 years). Skin prick-test, dosage of specific IgE to a standardized panel of inhalant and food allergens and spirometric evaluation was made for each patient. Twenty-four (23%) patients presented food allergy, 75 (77%) were sensitized to at least one food. A lower rate of children with con- trolled symptoms was found in children with food allergy and a higher rate of persistent asthma was found in children sensitized to at least 4 foods. In conclusion, food allergy/sensitization should always be investigated in asthmatic children for its association with increasing severity (only in food sensitized patients) and reduced control of asthmatic symptoms.