Gonul Adalioglu

Complementary and alternative medicine in children with asthma

BACKGROUND The popularity of complementary and alternative medicine (CAM), particularly for chronic conditions such as asthma, is growing rapidly, but little is known about its use in asthmatic children. OBJECTIVE To evaluate the extent, characteristics, and possible predictors of CAM use in a group of Turkish children with asthma. METHODS The parents of asthmatic children were invited to participate in a questionnaire-based survey of 13 worldwide and 5 local methods of CAM. Current asthma treatment, asthma exacerbations, emergency admittances and hospitalizations due to exacerbations, and parental education levels were investigated as predictors that influenced the use of CAM. RESULTS Of the 304 asthmatic children (mean +/- SEM age, 10.5 +/- 0.2 years; range, 1-16 years), 49% (n = 150) had used some form of CAM previously, and 38% had used CAM within the previous year. The most popular forms of CAM were quail eggs (79%), herbal medicine (31%), Turkish wild honey (26%), speleotherapy (5%), and royal jelly (5%). The respondents learned about CAM through friends (61%), relatives (25%), the media (9%), and physicians (6%). Age, sex, and mothers and fathers education levels were insignificant between the groups that used and did not use CAM (P = 0.40, P = 0.18, P = 0.15, and P = 0.09, respectively). The use of regular asthma treatment, the use of inhaled corticosteroids, asthma exacerbations, emergency admittances, and treatment score were significantly high in the CAM group (P = 0.006, P = 0.03, P = 0.008, P = 0.02, and P = 0.02, respectively). A significantly high percentage of respondents in the CAM group had considered using CAM for their childs asthma in the future (P = 0.001). CONCLUSIONS Asthmatic children in whom the disease is not well controlled are more likely to use CAM as complementary therapy.

The effect of polymorphisms at the CD14 promoter and the TLR4 gene on asthma phenotypes in Turkish children with asthma

Background:  Endotoxin, with its potential to enhance type 1 immunity, is a significant player in the hygiene hypothesis. The combined effects of the genetic variants of various molecules in the endotoxin response pathway on asthma related phenotypes are largely unknown.

Determinants of atopic sensitization in Turkish school children: effects of pre- and post-natal events and maternal atopy.

Emergence of new environmental risk factors, and/or loss of protective factors of a traditional lifestyle may explain the increase, or variations in prevalence of allergic diseases. The aim of this study was to delineate the prevalence and spectrum of, and to reveal the causal and/or protective factors for atopic sensitization among a heterogenous cohort of Turkish children, for the first time in our country. The study design adhered to International Study of Asthma and Allergies in Childhood (ISAAC) phase II protocol. A self‐administered parental questionnaire about demographic characteristics and detailed risk factors, and skin‐prick test with 13 allergens were employed in a clustered random sample of 8–11‐yr‐old Turkish school children. Atopy was defined as the presence of at least one positive skin reaction to any allergen tested. The association between a total of 78 risk factors and different aspects of atopy were analyzed in 1144 children with multivariate logistic regression analysis. The overall prevalence of atopy was 20.6%. Most common sensitizations were to grass pollens, Dermatophagoides pteronyssinus and Blatella germanica. Day care attendance, high paternal education level, male gender and maternal asthma were significant risk factors for atopy. Breastfeeding more than 6 months (compared with 0–6 months), maternal smoking during pregnancy and a birth weight under 2500 g were inversely related to (or protective factors for) atopic sensitization. Maternal atopic disease had significant effects on risk factors pattern. In children with a maternal atopy history a low birth weight, day care attendance and maternal smoking during the first year of life independently increased the risk of atopic sensitization. Gender, breastfeeding and paternal education did not show any association with atopy in this group of children. A history of measles and low gestational age were significant protective factors for mite sensitization. This study showed that children of atopic mothers showed a different profile of risk factors associated with atopic sensitization, when compared with other children. Prenatal and early childhood events had important associations with atopic sensitization.

The effects of grass pollen allergoid immunotherapy on clinical and immunological parameters in children with allergic rhinitis

Allergoid immunotherapy is a new form of allergen immunotherapy allowing safe administration of high allergen doses. There is limited information on the effects of allergoid immunotherapy in children with allergic rhinitis. To investigate the immunological and clinical effects of allergoid immunotherapy in children with allergic rhinitis due to grass pollen allergy. Children with allergic rhinitis were assigned to allergoid immunotherapy (n = 27) or control (n = 26, no immunotherapy) groups. Children in the immunotherapy group received seven injections of grass pollen allergoid immunotherapy before grass pollen season and continued to receive maintenance immunotherapy for 27 months. All patients were offered a pharmacotherapy regimen to be used on demand during the pollen seasons. Clinical and laboratory parameters were compared between the immunotherapy and control groups. The rhinoconjunctivitis symptom‐medication score and asthma symptom score were lower in the immunotherapy group after 1 yr of maintenance immunotherapy (p < 0.01 for both). Skin test reactivity and nasal reactivity as determined by nasal provocation testing for grass pollen were significantly decreased after 1 yr of immunotherapy (p < 0.001 for both). The seasonal increase in bronchial reactivity and nasal lavage eosinophil cationic protein levels were prevented after the first year of immunotherapy (p < 0.05 for both). The seasonal increase in immunoglobulin (Ig)E decreased (p < 0.05) and grass‐specific IgG, IgG1 and IgG4 increased significantly already at the end of the seven‐injection build‐up therapy (p < 0.001, for all). Interleukin (IL)‐4 levels in the culture supernatants showed a steady decline from baseline at first and second year of immunotherapy (p < 0.001) but remained unchanged in the control group. Allergoid immunotherapy is an effective method in the treatment of grass pollen‐induced allergic rhinitis in children and prevents the seasonal increase in bronchial hyper‐reactivity. Changes in specific IgE and IgG levels and decreased IL‐4 production in peripheral blood mononuclear cell culture supernatants may account for the observed clinical effects.

ALOX5 promoter genotype, asthma severity and LTC4 production by eosinophils

Background:  The number of Sp1–Egr1 binding tandem repeats at the ALOX5 promoter influences gene transcription and may modify the response to anti‐leukotriene treatment. The relationship of ALOX5 variants to asthma severity and leukotriene production by eosinophils is unknown.

Epidemiologic characteristics of rhinitis in Turkish Children: the International Study of Asthma and Allergies in Childhood (ISAAC) phase 2

Rhinitis is a common problem with important comorbidities. In order to search the association between rhinitis, allergic phenotypes and other risk factors in Turkish children, a parental questionnaire about allergic diseases and risk factors, and skin prick test (SPT) with 13 inhalant allergens were performed in a population‐based sample of 2774 children aged 9–11 yr. Bronchoprovocation testing with hypertonic saline (HS)and total IgE analysis were limited to a subsample of 350 children. Rhinitis was defined as a problem with sneezing, rhinorrhea, or nasal congestion when the child did not have a viral respiratory infection. The prevalences of ever rhinitis, current (last 12 months) rhinitis (CR), and ever hay fever were 36.3%, 30.6%, and 8.3%, respectively. SPT positivity rate was 20.4% among children with CR. Current wheezing and flexural dermatitis were significantly associated with CR. CR significantly increased the risk of asthma among both atopic and non‐atopic subjects [odds ratio (OR), 3.98; 95% CI, 1.81–8.76; and OR, 2.79; 95% CI, 1.82–4.26, respectively]. The association between CR and bronchial hyperreactivity (BHR) was not significant. The multiple logistic regression analysis revealed family atopy (OR = 2.25, 95% CI = 1.79–2.83, p < 0.001), current indoor heating with gas stove (OR = 1.78, 95% CI = 1.18–2.64, p = 0.006) and dampness/molds at home during the first year of life (OR = 1.70, 95% CI = 1.25–2.31, p = 0.001) as significant risk factors for CR. Turkish school children showed a high prevalence of rhinitis with a preponderance of non‐atopics. The highly significant association between rhinitis and asthma independent of atopic sensitization emphasize the importance of non‐atopic forms of rhinitis.

Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow's milk allergy

BACKGROUND Information on the utility of atopy patch testing (APT) in the diagnosis of food allergy is derived from studies of children with atopic dermatitis. OBJECTIVE To evaluate the usefulness of APT in the diagnosis of cows milk allergy (CMA) and to determine interleukin 4 and interferon-gamma production by peripheral blood mononuclear cells. METHODS Thirty-seven children (median age, 11 months) with suspected CMA who had a variety of symptoms that involved many organ systems were evaluated using double-blind placebo-controlled food challenges (DBPCFCs), and the performances of milk specific IgE, skin prick testing (SPT), and APT were determined. To search for a possible relationship between the diagnostic tests and the TH1/TH2 immune response, we measured interferon-gamma and interleukin 4 levels in the supernatants of peripheral blood mononuclear cell cultures. RESULTS Seventeen children with positive DBPCFC results and 6 with a history of anaphylaxis were diagnosed as having CMA. The combined use of APT and SPT had a sensitivity of 100% and a negative predictive value of 100% but a specificity of 50% and a positive predictive value of 76%. The addition of milk specific IgE assays to APT and SPT did not improve these values. Pattern of cytokine secretion was not associated with APT positivity or a specific response to DBPCFC. CONCLUSIONS Atopy patch testing may be a useful adjunct to SPT in excluding CMA in children who have allergic manifestations other than atopic dermatitis. However, DBPCFCs are still necessary in the presence of positive test results.

Prevalence of allergic diseases and influencing factors in primary-school children in the Ankara region of Turkey

We have studied the prevalence of atopic disease, by questionnaire, in 3024 primary-school children from three different socioeconomic levels in Ankara. Physical examinations were also performed on these children. The cumulative prevalence of asthma, allergic rhinitis, allergic conjunctivitis, and atopic eczema was 6.9%, 11.7%, 4.6%, and 2.6%, respectively. Allergic rhinitis was more common in children older than 10 years. Most of the symptoms of asthmatic patients began in the first 3 years of life. The cumulative prevalence of allergic diseases was 23.4%. This study has estimated the prevalence of allergic diseases, including asthma, allergic rhinitis, allergic conjunctivitis, and allergic dermatitis, in the Ankara region of Turkey.

Are risk factors of childhood asthma predicting disease persistence in early adulthood different in the developing world

Background:  Predictive factors of childhood asthma for favorable prognosis may differ between populations where a variety of genetic and environmental factors are present.

Do the leukotriene receptor antagonists work in children with grass pollen-induced allergic rhinitis?

Although cysteinyl‐leukotriene receptor antagonists were recently approved for use in allergic rhinitis (AR), there has been no study to date investigating their application in children. The aim was to evaluate whether montelukast provides any benefit in nasal allergen challenge‐induced symptoms in children, and whether it could improve the control provided by an antihistamine during pollen season. Two randomized studies, one a double‐blind, placebo‐controlled, nasal allergen challenge study and one an open‐label, cross‐over, parallel‐group clinical study, were performed in 18 (11.7 ± 0.7 years) and 32 children (10.5 ± 0.5 years), respectively, with grass pollen allergy. In the first study, the effect of a single dose of montelukast and its combination with loratadine were compared with placebo on nasal responses induced by allergen challenge. In the second study, the additive effect of montelukast to loratadine was tested in an open‐label cross‐over clinical study. In the challenge study, early‐phase and late‐phase nasal reactions peaked at 15 min and 4 h after the challenge respectively. During the early phase, combination improved total nasal symptoms (p = 0.004) during the first hour and sneezing (p = 0.012) at 15 min compared with placebo group. During the late phase, montelukast (p = 0.017) and combination (p = 0.011) caused less nasal obstruction at 4 h and combination caused less sneezing at 6 h (p = 0.015). In the clinical trial, montelukast provided protection on seasonal increase in pulmonary symptoms [0 (0, 14) vs. 6.5 (0, 27.7); p = 0.016] and on the decrease in FEF25−75 [−0.09 (−0.34, 0.17) vs. −0.28 (−0.66, 0.02); p = 0.002]. However, there was no improvement in nasal symptoms and flows. Although we showed protection against nasal challenge‐induced congestion with montelukast, we were not able to show the same in the clinical study possibly because of low pollen counts and mildness of the symptoms of the patients with AR. However, montelukast provided better control of pulmonary symptoms and protection from seasonal decrease in lung function, indicating its potential therapeutic benefit in children with AR.