Teija Dunder

Diet, serum fatty acids, and atopic diseases in childhood

Background:u2002The reasons behind the reported increase in the occurrence of childhood atopic sensitization rates are unclear. We wanted to evaluate the association between dietary fats, serum fatty acids, and the occurrence and development of atopic diseases.

Association of an early respiratory syncytial virus infection and atopic allergy

Background: Respiratory syncytial virus (RSV) causes postbronchiolitic wheezing but its role in allergic sensitization is controversial. The purpose of the study was to examine the effect of an early RSV infection on allergic sensitization.

Cytokine responses in cord blood predict the severity of later respiratory syncytial virus infection.

BACKGROUNDnIt has been claimed that an early respiratory syncytial virus (RSV) infection can induce asthma and recurrent wheezing.nnnOBJECTIVEnWe addressed the question of whether infants contracting an early RSV infection differ from healthy children in their cytokine production at birth.nnnMETHODSnIn a prospective cohort study cord blood samples were collected from 1084 newborns during autumn 2001. Of 47 of these newborns with subsequent virologically confirmed RSV infection before 6 months of age, 24 had enough cells for stimulation in cord blood samples (14 of those were hospitalized). Twenty-eight children had other respiratory virus infections (16 with enough cells), and samples from 48 healthy children of the 1084 total served as control specimens. Stimulated cytokine production of mononuclear cells was measured. The responses in the groups were evaluated by means of factor analysis.nnnRESULTSnThe infants hospitalized for RSV infection had higher LPS-stimulated combined IL-6 and IL-8 responses than the infants treated as outpatients (P = .005) or the healthy control subjects (P = .02). The hospitalized patients with RSV showed lower IL-1beta, IL-2, IL-4, IL-5, and IL-10 responses than those treated as outpatients (P = .02). High IL-6 and IL-8 responsiveness predicted a severe RSV infection (odds ratio, 2.20; 95% CI, 1.17-4.14; P = .01). The unstimulated cytokine responses at birth did not differ between the patients and healthy control subjects.nnnCONCLUSIONnThe results suggest that natural differences in innate immunity predispose children to severe RSV infection rather than the infection modifying immune responses in childhood.

Infants under 6 months with bronchiolitis are most likely to need major medical interventions in the 5 days after onset

This study examined the need for, and timing of, major medical interventions (MMIs) in infants under 6 months of age with bronchiolitis.

Risk factors for croup in children with recurrent respiratory infections: a case-control study.

Croup accounts for approximately 15% of all lower respiratory disease in children, but little is known about risk factors or its recurrence rate. The aim of this study was to determine the risk factors for croup and recurrent croup and to find out whether it is possible to predict the course of the disease. We considered croup patients who visited the Paediatric Department of Oulu University Hospital as primary health care patients at night during 1996-2000. For most analyses we used sex- and age-matched control patients who had had other respiratory infection but for environmental factors we used population controls. We performed conditional logistic regression analysis on data applying to 182 pairs of patients and controls. The recurrence rate was high, as 61% of the croup patients had had at least three episodes. Family history of croup was the most significant risk factor for both croup itself and recurrent croup. In multivariable analysis the odds ratio (OR) for the parents having a history of croup was 3.2 (95% CI 1.5, 7.1, P < 0.01) and 4.1 (95% CI 1.4, 11.7, P < 0.01) for recurrent croup. Parental smoking appeared to be a risk factor for respiratory infections but not for croup. Patients with croup had a cat as a pet less often than the controls, with OR 0.5 (95% CI 0.2, 1.0, P = 0.04). Family history appeared to be an exceptionally strong predictive factor for croup and its recurrence. In this patient series prone to respiratory infections recurrence of croup was common.

Consumption of asthma medication after RS‐virus epidemic – A population based survey

It has been suggested that a respiratory syncytial virus (RSV) infection in infancy increases the likelihood of development of asthma in childhood. The RSV epidemics have a special 2‐yr pattern in Finland and this allows the evaluation of the association of RSV and asthma by epidemiological means. We evaluated whether being 0–6u2003months of age during an RSV epidemic has an impact on the use of asthma medication later in the childhood. The consumption of asthma medication at the age of 3–16u2003yr and the number of those entitled to special reimbursement for asthma medication were identified for a total of 637,922 children. These subjects were grouped in cohorts according to whether they had been aged 0–6u2003months (exposed) or not (unexposed) during an RSV epidemic. The means of the proportions taking asthma medication and of those receiving reimbursement were calculated for each cohort. The means of the proportions in the unexposed vs. exposed cohorts were 20.5% vs. 20.3% for consumption and 4.8% vs. 4.9% for reimbursement. These differences were insignificant. In conclusion exposure to a RSV epidemic in infancy does not increase the consumption of asthma medicines at the population level.

Intravenous magnesium sulfate for acute wheezing in young children: a randomised double-blind trial

Magnesium sulfate has been shown to be an effective treatment in older children with asthma exacerbations, but it has not been investigated in acute severe virus-induced wheezing in young children. The study enrolled 61 children aged 6u2005months to 4u2005years. Inclusion criteria were severe wheezing, classified as a score of ≥6 points as assessed by the Respiratory Distress Assessment Instrument (RDAI) after initial treatment with salbutamol, and the symptoms of acute viral infection. The children were randomly allocated to receive either an infusion of magnesium sulfate (40u2005mg·kg−1) or 0.9% sodium chloride as a placebo infusion for 20u2005min. Primary outcome measure was mean change in RDAI scores from baseline to 6u2005h after the treatment. Change in the severity of wheezing from baseline to 6u2005h after the treatment, as measured by mean±sd RDAI scores, was 4.7±2.6 in the magnesium sulfate group and 4.2±4.2 in the placebo group (difference 0.5, 95% CI −1.3 to 2.3, p=0.594). Intravenous magnesium sulfate was ineffective in treating acute severe virus-induced wheezing in young children, in contrast to the previous efficacy demonstrated in older children. Intravenous magnesium sulfate was ineffective in treating acute severe virus-induced wheezing in young children http://ow.ly/sfcF30hHc0e

The Comparison of Inhaled Bronchodilators by Lung Sound Analysis in Children with Acute Bronchiolitis

The Comparison of Inhaled Bronchodilators by Lung Sound Analysis in Children with Acute Bronchiolitis

Diet, Serum Fatty Acids and Atopic Diseases in Childhood

BACKGROUNDnThe reasons behind the reported increase in the occurrence of childhood atopic sensitization rates are unclear. We wanted to evaluate the association between dietary fats, serum fatty acids, and the occurrence and development of atopic diseases.nnnMETHODSnFrom a longitudinal database of a population-based sample, 231 sex- and age-matched pairs in 1980 and 154 pairs in 1986 were chosen, between whom we compared the dietary data, serum fatty acid composition, and occurrence of atopic diseases. The same variables were also compared between those who developed atopic disease later and those who did not during the 9-year follow-up.nnnRESULTSnExamination of the dietary data in 1980 for those who had developed atopic disease compared with those who had remained healthy showed that the atopic children had used less butter before the expression of atopy. According to the cross-sectional data, the children with atopic disease consumed more margarine (mean 8.6 vs 7.3 [P = 0.04]), and less butter (mean 9.4 vs 11.6 g/1000 kcal [P = 0.002]), than the nonatopic children in 1980. Differences supporting these dietary findings were similarly found in the serum fatty acid data.nnnCONCLUSIONnThe diet of the atopic children differed from that of the nonatopic children in the consumption of polyunsaturated fat.