Małgorzata Bartkowiak-Emeryk

Five‐grass pollen 300IR SLIT tablets: efficacy and safety in children and adolescents

Halken S, Agertoft L, Seidenberg J, Bauer C‐P, Payot F, Martin‐Muñoz MF, Bartkowiak‐Emeryk M, Vereda A, Jean‐Alphonse S, Melac M, Le Gall M, Wahn U. Five‐grass pollen 300IR SLIT tablets: efficacy and safety in children and adolescents.
Pediatr Allergy Immunol 2010: 21: 970–976.
© 2010 John Wiley & Sons A/S

Sublingual immunotherapy (SLIT)--indications, mechanism, and efficacy: Position paper prepared by the Section of Immunotherapy, Polish Society of Allergy.

SLIT (sublingual immunotherapy,) induces allergen-specific immune tolerance by sublingual administration of a gradually increasing dose of an allergen. The mechanism of SLIT is comparable to those during SCIT (subcutaneous immunotherapy), with the exception of local oral dendritic cells, pre-programmed to elicit tolerance. In the SLIT dose, to achieve the same efficacy as in SCIT, it should be 50-100 times higher with better safety profile. The highest quality evidence supporting the efficacy of SLIT lasting 1-3 years has been provided by the large scale double-blind, placebo-controlled (DBPC) trials for grass pollen extracts, both in children and adults with allergic rhinitis. Current indications for SLIT are allergic rhinitis (and conjunctivitis) in both children and adults sensitized to pollen allergens (trees, grass, Parietaria), house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae), cat fur, as well as mild to moderate controlled atopic asthma in children sensitized to house dust mites. There are positive findings for both asthma and new sensitization prevention. Severe adverse events, including anaphylaxis, are very rare, and no fatalities have been reported. Local adverse reactions develop in up to 70 - 80% of patients. Risk factors for SLIT adverse events have not been clearly identified. Risk factors of non-adherence to treatment might be dependent on the patient, disease treatment, physician-patient relationship, and variables in the health care system organization.

Mechanical bacterial lysate administration prevents exacerbation in allergic asthmatic children-The EOLIA study

Despite progress in asthma management, prevention of asthma exacerbation remains challenging in school‐aged children with allergic asthma. New therapeutic approaches are needed. Previously, a chemical bacterial lysate has been successfully used in preschool children to reduce wheezing attacks. We assessed the effect of Polyvalent Mechanical Bacterial Lysate (PMBL®) Tablet on asthma clinical course and control in 6‐ to 16‐year‐old children with partly controlled or uncontrolled allergic asthma.

Test prowokacji nosowej z alergenem, alergiczne testy skórne oraz poziom alergenowo swoistych IgE w surowicy u dzieci chorych na astmę oskrzelową☆☆☆◊

Summary Introduction The important element in the asthma diagnosis is a confirmation of triggers asthma symptoms allergens. The aim Of this study was to evaluate diagnostic value of an allergic skin prick test and serum allergen-specific IgE level with reference to nasal allergen provocation test (NPT) results in asthmatic children. Material and methods Study was performed in 80 asthmatic children in 3–14 yrs aged. 118 NPTs accompanied by assessments of nasal airflow by rhinospirography, were done. In all subjects, allergic skin prick tests with mites and grasses or trees pollen allergens and serum allergen specific IgE levels with the allergen used in NPT were done. Results Concordance between SPT and TPN results was shown in 59% cases, most often in group with pollen than mites provocation. SPTs sensitivity and specificity in relation to TPN result was 71% and 53%, respectively. Concordance between asIgE level and TPN results was shown in 76% cases. asIgE results sensitivity and specificity in relation to TPN result was 71% and 82%, respectively. Conclusion The usefulness of skin prick test results in allergologic diagnosis of asthma is lesser than serum allergen specific IgE determination, especially in patients with house dust mites allergens hypersensitivity. Nasal provocation test (NPT) with suspected allergen should be performed in asthmatic children with a negative or doubtful skin prick test or serum allergen specific IgE level results.

Demographic and medical factors affecting short-term changes in subjective evaluation of asthma control in adolescents

Introduction Asthma control is an important measure of disease stabilization, which is linked to the treatment and lifestyle recommendations. Aim To assess the impact of selected factors on asthma control in adolescents, as assessed using the Asthma Control Test (ACT™). Material and methods The prospective study included 100 asthma patients aged between 12 and 19. Asthma was assessed in three consecutive follow-up visits spaced 3 months apart, using the standardized ACT™ questionnaire. Results Asthma was fully controlled (ACT score = 25 points) in more than half of the patients in all follow-up visits (53.0%, 54.0%, and 56.0%, respectively). More than one third of the participants scored between 20 and 24 points (37.0% vs. 39.0% vs. 40.0%). A minority of patients had uncontrolled asthma (scores below 20), and the group consistently diminished in subsequent visits (10% vs. 7% vs. 4%). Uncontrolled asthma was found significantly more often in female patients (33.33%; p < 0.001) and those living in rural areas (20.59%; p < 0.01). Treatment with a combination of inhaled corticosteroids (ICS) and LABAs was associated with worse asthma control (14.81%; p < 0.05). Better asthma control was found in patients with a family history of allergies (73.85% vs. 75.38% vs. 78.46%; p < 0.001) and in those with concurrent allergies (66.67% vs. 68.00% vs. 70.67%; p < 0.001). Conclusions Asthma control in adolescents differs by sex and residence. Concurrent allergies and family history of allergies improve asthma self-control in adolescents.

Asthma Control Test (ACT) or Asthma Control Questionnaire (ACQ)? - validity and responsiveness in children

Introduction: The monitoring of a child with asthma consists of a very important analysis of disease control, which determine further action. For the few years now there were simple standardized asthma control tests available in daily practice. However, there are no studies verifying their usefulness in various age groups. Aim of the study: The aim of the study was to compare the compatibility and usability of ACQ and ACT testing in children of different age groups. Material and methods: Between 2014-2015 we conducted a prospective randomized trial which lasted 9 months and included a group of 100 children aged 6-17 years with persistent IgE-mediated asthma. The degree of asthma control was estimated when turned on, after 3 and after 9 months, using age-appropriate ACQ and ACT questionnaires and also based on a clinical assessment by a physician. Results: In the group of children ≥ 11 years of there was strong correlation in the diagnosis of uncontrolled asthma using both tests (p Conclusions: On the basis of this study we can conclude that in children ≥ 11 years of age, both tests ACT and ACQ have equal use, in children younger reliable information about the degree of asthma control can provide ACQ.

197 The Effectiveness of two Different Methods of Salbutamol Nebulization in Children with Asthma

Background Short acting beta-2 agonists (SABA) inhalation is commonly used in bronchodilatatory test, which is still an important research tool in the diagnosis of respiratory diseases with bronchial obstruction. Bronchodilatatory effect of SABA depends primarily on the degree of patency of the airway, the type and dose of SABA, as well as the type of inhaler and inhalation technique. The aim of the study was to evaluate the spirometric effectiveness of 2 different methods of salbutamol nebulization in asthmatic children. Methods The study group included 132 children aged 6 to 18 years (mean: 11.7), 91 (69%) boys and 41 (31%) girls with partly controlled asthma treated in the Allergy or Pulmonology Outpatient Clinics in Childrens University Hospital in Lublin. The study was randomized and single blind design. Patients were randomly assigned to one of 2 groups. The first group used 2.2 mg of salbutamol (mean calculated dose) in the breath-actuated nebulizer (BAN) (Marine, Medbryt, Poland), while the second one–5 mg salbutamol (constans dose) in the constant-output nebulizer (CON) (Porta-Neb, MEDIC-AID, UK). Flow-volume curve (dynamic spirometry) was measured before and 20 minuts. after drug nebulization (bronchodilatatory test). FEV1 (expiratory volume in first second) and FEF25-75 (forced expiratory flow at 25 to 75% of forced vital capacity) values were analyzed. The change in FEV1 and FEF25-75 after treatment with respect to baseline was calculated. Results The mean baseline value of FEV1 was 67.4% in BAN and 70.5% in CON group and there was no statistical difference between these groups. The significant improvement of measured ventilatory parameters was observed. There was the significant difference in the bronchodilator response to salbutamol between 2 methods of nebulization. The value of FEV1 increased at 16.2% in BAN group and at 12.6% in CON group (P = 0,026). The value of FEF25-75 increased in both groups at 37.7% and 32.7% respectively and there was no statistical difference between these groups. Conclusions We observed greater bronchodilatatory effect of salbutamol inhaled via breath-actuated nebulizer while delivering a double lower dose. 2. Bronchodilatatory test using nebulized salbutamol in breath-actuated nebulizer should be recommended for children.