Paweł Majak

Efficacy and safety of high-doses sublingual immunotherapy in ultra-rush scheme in children allergic to grass pollen

Background Although sublingual immunotherapy (SLIT) has been used with increasing frequency, the data on the efficacy of SLIT in pediatric asthma are limited.

Comparative effect of pre‐coseasonal and continuous grass sublingual immunotherapy in children

To cite this article: Stelmach I, Kaluzińska‐Parzyszek I, Jerzynska J, Stelmach P, Stelmach W, Majak P. Comparative effect of pre‐coseasonal and continuous grass sublingual immunotherapy in children. Allergy 2012; 67: 312–320.

The effect of oral steroids with and without vitamin D3 on early efficacy of immunotherapy in asthmatic children

Background The possibility of additional strategies to enhance the effectiveness of specific immunotherapy (SIT) is highly attractive.

Combined occurrence of filaggrin mutations and IL‐10 or IL‐13 polymorphisms predisposes to atopic dermatitis

Background:  Although filaggrin mutations are presently believed to play a key role in the development of atopic dermatitis (AD), obviously also immunological factors involved in acquired immune response are important for the development of allergic inflammation.

Effects of montelukast treatment on clinical and inflammatory variables in patients with cystic fibrosis

BACKGROUND In cystic fibrosis (CF), the inflammatory process contributes to progressive lung tissue damage. Cysteinyl leukotrienes have been found in the sputum of patients with CF at high concentrations sufficient to cause potent biological effects. OBJECTIVE To evaluate the effect of anti-inflammatory treatment with montelukast sodium in patients with CF. METHODS Twenty-six patients aged 6 to 18 years were recruited to this 20-week, randomized, double-blind, placebo-controlled, crossover trial. Patients received montelukast or placebo for 8 weeks in addition to their regular CF treatment. Before and after treatment, findings from spirometry, whole-body plethysmography, and the clinical wheezing and cough scales were evaluated. At the same time, serum and sputum samples were obtained for the measurement of eosinophil cationic protein, interleukin 10 (IL-10), IL-8, and myeloperoxidase levels. RESULTS Twenty-three patients completed the study. Compared with placebo use, montelukast treatment significantly improved forced expiratory volume in I second, peak expiratory flow, and forced expiratory flow between 25% and 75% and significantly decreased cough and wheezing scale scores (P < .001 for all). There were no significant changes in vital capacity, thoracic gas volume, airway resistance, and residual volume after treatment. Compared with placebo use, montelukast treatment decreased serum and sputum levels of eosinophil cationic protein and IL-8, decreased sputum levels of myeloperoxidase, and increased serum and sputum levels of IL-10 (P < .001 for all). CONCLUSIONS Montelukast may have measurable anti-inflammatory properties in patients with CF.

Comparison of the long-term efficacy of 3- and 5-year house dust mite allergen immunotherapy

BACKGROUND The recommended duration of specific immunotherapy (SIT) treatment relies on empiric data and is not well documented. OBJECTIVE To detect possible differences in the long-term effectiveness between 3 and 5 years of house dust mite (HDM) SIT in asthmatic children. METHODS We performed a 3-year natural history study of 90 asthmatic children who were sensitive only to HDM. Three groups were recruited: 30 who had completed 3 years of HDM SIT (SIT3), 30 who had completed 5 years of HDM SIT (SIT5), and 30 who had an indication for HDM SIT but whose parents refused HDM SIT. Patients attended an enrollment visit in 2007, after SIT discontinuation, and 3 annual follow-up visits at the clinic. The long-term effectiveness of HDM SIT was primarily assessed via analysis of the reduction in required inhaled corticosteroid dose, forced expiratory volume in 1 second, and asthma remission. RESULTS A total of 84 children completed the study. Both SIT durations produced excellent results; asthma remission in both SIT3 (50%) and SIT5 (54%) groups was significantly higher when compared with control (3.3%). The minimal controlling inhaled corticosteroid dose reduction in SIT5 group (median, 75%) was significantly higher compared with the SIT3 group (median, 50%) after immunotherapy discontinuation; after 3 years without SIT, no differences were found between the SIT5 and SIT3 groups (median, 100% and 94%, respectively). We observed a slightly higher increase in forced expiratory volume in 1 second in the SIT5 group compared with the SIT3 group. CONCLUSION Three years of SIT is an adequate duration for the treatment of childhood asthma associated with HDM allergy because 2 further years of SIT added no clinical benefit.

Cockroach allergy and exposure to cockroach allergen in Polish children with asthma

Background:  Asthma morbidity increases every year, especially among children, and exposure to high levels of indoor allergens is a very important factor. We evaluated the prevalence and exposure to cockroach (CR) allergen in asthmatic children in Poland, and also tested the hypothesis that asthma with allergy to CR is more severe than with allergy to other antigens.

Sexual and Reproductive Health Knowledge in Cystic Fibrosis Female Patients and Their Parents

INTRODUCTION The changing outcomes for young cystic fibrosis (CF) patients means that reproductive health issues have become an integral part of CF management. AIM The aim of this study was to investigate the knowledge and experiences of reproductive and sexual health issues in women with CF and to investigate the knowledge and reproductive health attitudes of their parents. MAIN OUTCOME MEASURES Assessment of reproductive and sexual health knowledge in female CF patients and their parents. METHODS A questionnaire study directed to 120 Polish women with CF aged 16 years and older and their parents. RESULTS Sixty-four patients and their parents responded to the questionnaire. Sixty-eight percent of the patients started sexual intercourse at a mean age of 19.2 years. Eighty-four percent of all sexually active women reported that they did not use any form of contraception. Only 32.8% of women understood the problems connected with their own and male fertility in CF. Popular scientific publications and other CF patients were identified as the most important source of information. Only 23% of parents understood the problems connected with female fertility in CF; 44% of parents thought that man with CF had normal fertility. Seventy-five percent of the women and 40% of the parents felt that sexual health discussions should begin between age 12 and 14 years with a CF doctor and the mother. CONCLUSIONS Our study showed that significant knowledge gaps exist regarding fertility issues in both CF patients and CF parents. Women with CF have some general knowledge about sexual issues but insufficient knowledge to have a safe sexual life. The results helped us to develop the educational program for CF patients.

Montelukast treatment may alter the early efficacy of immunotherapy in children with asthma

BACKGROUND Allergen-specific immunotherapy (SIT) is the only available potentially curative approach in the management of allergic diseases. Therapies that boost regulatory T cell induction during SIT might further enhance its effectiveness. OBJECTIVE The purpose of this study was to assess the effect of montelukast treatment on early clinical and immunologic effects of allergen-specific immunotherapy in children with asthma. METHODS It was a randomized, double-blind, placebo-controlled trial conducted in 36 children with asthma and allergy to house dust mites who required from 400 to 800 microg of inhaled budesonide per day during the 7-month run-in period. Patients were randomly allocated to receive 5 mg montelukast daily (n = 18) or placebo (n = 18) as an addition to inhaled corticosteroid (ICS) treatment during the 3-month build-up phase of SIT, when modification of ICS doses was not allowed. During the 7 months of the maintenance phase of SIT, ICS doses were adjusted to control the asthma symptoms. RESULTS After 12 months of SIT, a reduction of the median daily ICS dose, necessary to control asthma symptoms, was 16.7% grater in patients from the placebo group than in patients from the montelukast group. Intervention with montelukast significantly impaired the induction of regulatory T lymphocytes. During the build-up phase of SIT, patients in the placebo group frequently experienced an increase in asthma symptoms leading to exclusions from the per protocol population. CONCLUSION Our study failed to show a beneficial effect of montelukast on SIT. In fact, quite the opposite occurred: compared with placebo, montelukast intervention led to less effectiveness of SIT.

Fractional exhaled nitric oxide (FeNO) may predict exercise-induced bronchoconstriction (EIB) in schoolchildren with atopic asthma.

BACKGROUND There is a need for the performance of exercise-induced bronchoconstriction (EIB) tests in the monitoring of childhood asthma control. We aimed to evaluate whether in children with atopic asthma, EIB can be predicted by one or more of the following parameters or by their combination: fractional exhaled nitric-oxide (FeNO), allergy profile, asthma treatment, total IgE serum concentration and eosinophil blood count (EBC). METHODS It was a retrospective, cross-sectional study. We evaluated data from medical documentation of children with atopic asthma who had performed standardized spirometric exercise challenge test. RESULTS One hundred and twenty six patients with atopic asthma, aged 5-18, were included in the analysis. There were two groups of patients: the EIB group (n=54) and the no-EIB group (n=72). The median FeNO level prior to exercise in the EIB group was 27.6 vs. 16.3 ppb in the no-EIB group (p=0.002). FeNO level higher than 16 ppb had the highest diagnostic value to confirm EIB. When using the FeNO level of >16 ppb, the sensitivity, specificity, negative predictive and positive predictive values for EIB were 83%, 46.9%, 74.2%, and 60%, respectively. In the EIB group, the degree of FeNO elevation did correlate positively with the absolute fall in FEV(1) (p=0.002; r=0.45). The FeNO value of >16 ppb, EBC value of >350 cell/mm(3) and allergy to house dust mites presented the highest odds ratios of EIB. However, the FeNO value of >16 ppb was the only independent odds ratio of EIB. CONCLUSIONS Elevated FeNO level increased the odds of EIB in asthmatic schoolchildren, independently of other asthma severity markers and the intensity of anti-asthma therapy. It seems likely that FeNO measurement may act as a screening tool and help to prevent under-diagnosis and under-treatment of exercise-induced bronchoconstriction in schoolchildren with atopic asthma.