Liang-Shiou Ou

Prevalence and severity of symptoms of asthma, rhinitis, and eczema in 13- to 14-year-old children in Taipei, Taiwan

BACKGROUND The prevalence of asthma and allergic diseases in children has increased worldwide. OBJECTIVE To perform the phase 3 survey of the International Study of Asthma and Allergies in Children (ISAAC) to report the time trend of the prevalence and severity of asthma and allergic diseases in children in Taipei. METHODS Two junior high schools in each of the 12 school districts in Taipei were randomly chosen to enter the study. All students aged 13 to 14 years in the chosen schools were invited to participate in written and video questionnaires in Chinese (identical to those of the ISAAC phase 1 survey). The study was performed between December 1, 2001, and January 31, 2002. All data analysis followed the protocol of the ISAAC and then was submitted to the ISAAC International Data Center. RESULTS Of 6653 eligible children from 23 high schools (1 school refused participation), 6381 (95.9%) participated. The prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in the past 12 months in 13- to 14-year-old children increased by 37%, 51%, and 193%, respectively, on written questionnaires during a 7-year period. The severity of asthma symptoms, including more than 4 wheezing attacks in the past 12 months, wheezing that disturbs sleep more than once per week, and wheezing that limited speech in the past 12 months, did not show any significant changes on written questionnaires during the 7 years. CONCLUSION The increasing prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in 13- to 14-year-old children in Taipei in a 7-year period is a significant burden on public health systems in Taiwan.

Associations of Age, Gender, and BMI with Prevalence of Allergic Diseases in Children: PATCH Study

Background. Little is known about the prevalence of allergic diseases in children of different ages. This study aimed to investigate the prevalence of allergic diseases and allergic sensitization in children over a wide age range, with emphasis on the influence of age, gender, and body mass index (BMI). Methods. In a cross-sectional study, we assessed 5351 Taiwanese children aged 4–18 years using an International Study of Asthma and Allergies in Childhood questionnaire, BMI, and total and specific serum immunoglobulin E. Results. Forty-eight percent were currently symptomatic for at least one of three allergic diseases. Prevalence of wheeze ever, current wheeze, and diagnosed asthma were 17.0%, 7.5%, and 9.8%, respectively; analogous features for rhinitis were 47.8%, 44.2%, and 39.8%. Allergic sensitization was very common (57.3%). Half of the children (50.6%) with current wheeze had not been diagnosed with asthma by physicians, whereas undiagnosed rates were 32.3% for rhinitis and 25.3% for eczema. The male-to-female prevalence ratios of current wheeze increased with age from <1 at 4–5 years, peaked at 10–11 years (2.24), then reversed to 0.57 at 16–18 years. Childhood wheezing tended to remit with age, but rhinitis and eczema were more persistent. Total immunoglobulin E levels increased with age until 14–15 years, and declined thereafter. Elevated BMI was associated with greater prevalence of wheezing and eczema, with no evidence of significant effect modification by either gender or age. Multivariate analyses revealed that younger age, boys, and obesity were significantly and independently associated with current wheezing in children (all p < .01). Conclusions. The burden and co-morbidity of childhood allergies are substantial. There are striking age-dependent gender differences in asthma prevalence, exhibiting an inverted U-shaped curve for male-to-female prevalence ratios by age. Obesity is associated with a greater prevalence of asthma in children with no evidence of a significant modulation by either gender or age.

The prevalence, severity and seasonal variations of asthma, rhinitis and eczema in Taiwanese schoolchildren

The prevalence of asthma is increasing in Taiwan but data remain limited. The aim of this study was to determine the prevalence, severity, demographic and seasonal variations of asthma, rhinitis, and eczema in Taiwan. Using a one‐stage stratified cluster random sampling, first grade (aged 6–8) and eighth grade (aged 13–15) students from Taoyuan, northern Taiwan, were invited to participate in this survey. The results showed a total of 6190 students, 3079 aged 6–8 and 3111 aged 13–15, completed this survey. In general, children aged 6–8 had significantly higher prevalence rates of diagnosed asthma, rhinitis, and eczema than children aged 13–15 (12.2%, 29.8%, and 10.2% vs. 9.6%, 18.3%, and 4.7%, respectively). Similarly, children aged 6–8 had significantly higher proportions of allergic symptoms, except for exercise‐induced wheezing (5.8% vs. 17.8%, p < 0.0001). Among those with allergic disorders, children aged 6–8 presented a greater severity of wheezing attacks in the last 12 months. As regards gender, boys aged 6–8 had a significantly higher proportion of asthma or rhinitis symptoms than girls aged 6–8 but not in children aged 13–15. In children aged 6–8, asthma and rhinitis peaked in winter, especially in December. However, children aged 13–15 had two peaks (winter and summer) for asthma or rhinitis.

Risk factors of mortality for salmonella infection in systemic lupus erythematosus.

OBJECT To investigate the risk factors of mortality for Salmonella infection in patients with systemic lupus erythematosus (SLE). METHODS Between 1995 and 1999 we reviewed 37 cases of Salmonella infection in 31 patients with SLE from a total of 1191 hospitalized patients with SLE at a medical center in Taiwan. Contrasting cases of patients who died with those who survived, we compared clinical and laboratory characteristics of SLE at the time of Salmonella infection, with special attention to potential risk factors (sex, age, complete blood count and differential count, erythrocyte sedimentation rate, C-reactive protein, complements, Salmonella species, infection site, reinfection, SLE presenting with Salmonella infection, associated non-Salmonella infection, etc.). RESULTS The mean age at the onset of SLE in the 8 mortality cases was significantly higher than the 23 cases of survivors (p < 0.05). Other factors significantly related to death included associated infections other than Salmonella species, reinfection of Salmonella species, and cases of SLE presenting with Salmonella infection. Reinfection and SLE presenting with Salmonella infection were the most important risk factors of mortality for SLE with Salmonella infections: relative risk (CI) 84 (4.3-1638.8) and 63 (3.1-1296.5), respectively. CONCLUSION Patients with SLE who are older or have associated infections other than Salmonella have an increased mortality rate when they have concurrent Salmonella infection. Patients with Salmonella infection occurring concurrently with the first presentation of SLE and patients with SLE reinfected with Salmonella species are at higher risk of mortality.

Association between Serum Inflammatory Cytokines and Disease Activity in Juvenile Idiopathic Arthritis

Abstract Circulating interleukin-1β (IL-1β), IL-6, tumour necrosis factor-α (TNF-α), osteocalcin, and conventional parameters of inflammation were examined serially in 14 children with juvenile idiopathic arthritis (JIA) to determine any correlation with the disease activity. Serum IL-1β was undetectable in all JIA patients. Serum IL-6, white blood cell counts, platelet counts, erythrocyte sedimentation rate and C-reactive protein levels were significantly elevated in the active phase of JIA, whereas hemoglobin levels were significantly lower. Osteocalcin levels were decreased and TNF-α increased in active JIA status, but these differences showed no statistical significance. We concluded that inflammatory cytokines play an important role in JIA. Monitoring IL-6 in children with JIA is useful in determining disease activity and response to therapy. These findings confirm earlier reports.

Clinical features of children with juvenile idiopathic arthritis using the ILAR classification criteria: A community-based cohort study in Taiwan

BACKGROUND/PURPOSE The aim of the study was to describe the clinical features of children affected by juvenile idiopathic arthritis (JIA) under the International League of Associations for Rheumatology-derived classification criteria in a community-based setting. METHODS Consecutive cases of JIA from defined geographic areas of Taiwan were diagnosed and followed in an observational cohort from 1995 to 2010. In addition to the clinical and laboratory data required for the International League of Associations for Rheumatology system, information about the medication and disease activity during the study period was also recorded. RESULTS Out of 292 children with chronic joint pain, 195 were diagnosed as JIA: systemic arthritis (19%), oligoarthritis (persistent 16.4%; extended 6.7%), polyarthritis rheumatoid factor-negative (11.8%), polyarthritis rheumatoid factor-positive (4.6%), psoriatic arthritis (1.5%), enthesitis-related arthritis (ERA; 37.4%), and undifferentiated arthritis (2.6%). Human leukocyte antigen-B27 was positive in 82.2% of patients with ERA. Uveitis was observed in 6.7% of patients. Disease-modifying anti-rheumatic drugs, including biologic medications, were used in 73.3% of children during the observational period. At the last follow-up, 40% of patients experienced a continuously active or relapsing course. CONCLUSION Compared with previous reports on Western populations, a remarkably high prevalence was found in the ERA of the Chinese cohort, but a relatively low rate of uveitis. Ongoing disease activity was evident in a substantial number of children. These results provided a good starting point in understanding the epidemiology of this serious disease in the Chinese population.

Differences in Disease Features Between Childhood-Onset and Adult-Onset Systemic Lupus Erythematosus Patients Presenting with Acute Abdominal Pain

OBJECTIVE Abdominal pain in systemic lupus erythematosus (SLE) patients has rarely been analyzed in pediatric populations. We planned to investigate the potential differences between childhood-onset and adult-onset SLE patients who were hospitalized because of acute abdominal pain. METHODS A retrospective study including 23 childhood-onset SLE patients with 38 admissions and 88 adult-onset SLE patients with 108 admissions from 1999 to 2008 were conducted in our hospital. All of them had the chief complaint of diffuse abdominal pain. RESULTS The etiologies of acute abdominal pain in adult-onset SLE patients were more diverse than childhood-onset SLE patients. The most common cause of acute abdominal pain in SLE patients was lupus mesenteric vasculitis (LMV) (18.5%), followed by acute gastroenteritis (14.4%), pancreatitis (10.3%), appendicitis (7.5%), and cholecystitis (6.2%). Compared with adults, children were admitted more often due to LMV (31.6% versus 13.9%; P = 0.016), had more frequently recurrent episodes (39.1% versus 14.8%; P = 0.009), and were more often treated with immunosuppressive agents (31.6% versus 7.4%; P < 0.001) at the time of admission. The overall case fatality rate of acute abdomen in SLE patients was 9.4%. The extra-gastrointestinal symptoms, laboratory evaluation, disease activity, and organ damage measured by the SLE Disease Activity Index and outcomes were comparable between children and adults. CONCLUSIONS Various etiologies of acute abdominal pain should be considered in SLE patients. LMV is the most common cause of acute abdomen in childhood-onset SLE patients with low mortality and morbidity provided by prompt diagnosis and timely administration of high-dose intravenous corticosteroids after excluding real surgical abdomen.

Pulmonary Hemorrhage Associated with Henoch-Schönlein Purpura in Pediatric Patients: Case Report and Review of the Literature

OBJECTIVES To characterize the clinical characteristics of pediatric patients with pulmonary hemorrhage and Henoch-Schönlein purpura (HSP). METHODS Presentation of a pediatric patient with pulmonary hemorrhage associated with HSP and review of relevant cases based on a PubMed search (1966 to April 2010). RESULTS We identified 17 previously reported pediatric cases with HSP and pulmonary hemorrhage. The most frequent clinical manifestations were rash (17 patients, 100%), proteinuria (14 patients, 82%), and abdominal pain (13 patients, 76%). Six patients (35%) had complete resolution of symptoms; 7 patients (41%) had partial recovery, and 4 patients (23%) died. Nine patients (53%) had acute respiratory failure following intubation and 3 of these patients (33%) died. Five patients were treated with methylprednisolone pulse therapy and 1 was also given low-dose cyclophosphamide treatment, but 2 of these 5 patients (40%) died. Three patients were given cyclophosphamide pulse therapy plus steroid (nonpulse or pulse) therapy, and all survived. Among the 6 nonintubated patients, all were given steroid treatment with or without an immunosuppressant drug, and all survived. In our reported case, plasma exchange appeared to help resolve the pulmonary hemorrhage and crescentic glomerulonephritis that were associated with HSP. CONCLUSIONS For pediatric HSP patients with pulmonary hemorrhage but no respiratory failure, methylprednisolone pulse or nonpulse therapy could be the first-line therapy. In the presence of respiratory failure, cyclophosphamide pulse therapy is suggested. Plasma exchange may be considered for treatment of pulmonary renal syndrome or refractory pulmonary hemorrhage.

Comparison of cryoglobulinemia in children and adults

BACKGROUND/PURPOSE Cryoglobulinemic vasculitis is a systemic vasculitis resulting from circulating immune complex deposition in the small vessels and is characterized by variable clinical features, including purpura, Raynauds syndrome, ulcerations, arthralgia, glomerulonephritis, and peripheral neuropathy. Cryoglobulinemia can also result from hepatitis C virus (HCV) infection. The clinical spectrum and associated or underlying diseases of cryoglobulinemia in different age groups is not well understood. This study investigated the demographic, clinical, serologic features, and associated or underlying diseases in children and adult patients with cryoglobulinemia. METHODS The retrospective study included 114 patients (18 children, 96 adults) who presented with cryoglobulinemia between 2000 and 2010 at the Chang Gung Memorial Hospital. Their medical records were reviewed and serological and virologic assessments were analyzed. RESULTS In this group of patients, children had a significantly higher prevalence of prolonged fever (16.7% vs. 3.13%; p=0.018), arthralgia (66.67% vs. 16.67%; p<0.001), arthritis (66.67% vs. 15.63%; p<0.001) and cutaneous involvement (77.78% vs. 50%; p=0.03) compared with adults. Both the adult and children groups had a greater frequency of hepatitis B virus (HBV) infection (20.8% and 5.6%, respectively), than HCV infection (12.5% and 0%, respectively). CONCLUSIONS Children with cryoglobulinemia had a significantly higher prevalence of prolonged fever, arthralgia, arthritis and cutaneous involvement compared with adults.

Reduced expression of CD69 and adhesion molecules of T lymphocytes in asthmatic children receiving immunotherapy

T lymphocytes play a fundamental role in the initiation and regulation of chronic inflammatory responses in patients with asthma. CD69 is an early marker of T‐cell activation. The levels of intercellular adhesion molecule‐1 (ICAM‐1, CD54) and L‐selectin have been reported to increase in patients with allergic diseases and asthma. The present study was therefore undertaken to investigate the expression of CD69, CD54, and L‐selectin by T lymphocytes of children with asthma, before and after immunotherapy. Eighteen children newly diagnosed with asthma, 11 good and nine poor responders to immunotherapy, and 16 normal subjects, were enrolled in this study. The percentages of CD69+, CD54+, and CD62L+ cells in T lymphocytes were measured by using flow cytometry. The levels of CD69, CD54, and CD62L in serum and culture supernatants were determined by using enzyme‐linked immunosorbent assay (ELISA). The expression of CD69 and CD54 on CD3+ T lymphocytes was significantly higher in children with asthma than in control patients. All the patient groups expressed (spontaneously and following stimulation with phorbol myristate acetate and ionomycin together with mite‐extract proteins) greater amounts of CD69 and CD54 than did control subjects. With long‐term immunotherapy, the percentages of CD69+ and CD54+ T lymphocytes were significantly lower in patients with a good response to immunotherapy. Our results also showed significantly lower serum L‐selectin levels following immunotherapy. In conclusion, successful immunotherapy resulted in decreased expression and production of CD69 and CD54. These results may explain, in part, the clinical efficacy of immunotherapy.