Zave Chad

Canadian Pediatric Asthma Consensus Guidelines, 2003 (updated to December 2004): Introduction

Background: Although guidelines for the diagnosis and management of asthma have been published over the last 15 years, there has been little focus on issues relating to asthma in childhood. Since the last revision of the 1999 Canadian asthma consensus report, important new studies, particularly in children, have highlighted the need to incorporate this new information into asthma guidelines. Objectives: To review the literature on asthma published between January 2000 and June 2003 and to evaluate the influence of new evidence on the recommendations made in the Canadian Asthma Consensus Report, 1999 and its 2001 update with a major focus on pediatric issues. Methods: Diagnosis of asthma in young children, prevention strategies, pharmacotherapy, inhalation devices, immunotherapy and asthma education were selected for review by small expert resource groups. In June 2003, the reviews were discussed at a meeting under the auspices of the Canadian Network For Asthma Care and the Canadian Thoracic Society. Data published up to December 2004 were subsequently reviewed by the individual expert resource groups. Results: This report evaluates early life prevention strategies and focuses on treatment of asthma in children. Emphasis is placed on the importance of an early diagnosis and prevention therapy, the benefits of additional therapy and the essential role of asthma education. Conclusion: We generally support previous recommendations and focus on new issues, particularly those relevant to children and their families. This guide for asthma management is based on the best available published data and the opinion of health care professionals including asthma experts and educators.

Management of anaphylaxis in primary care: Canadian expert consensus recommendations

To cite this article: Waserman S, Chad Z, Francoeur MJ, Small P, Stark D, Vander Leek TK, Kaplan A, Kastner M. Management of anaphylaxis in primary care: Canadian expert consensus recommendations. Allergy 2010; 65: 1082–1092.

Dietary exposures and allergy prevention in high-risk infants: a joint position statement of the Canadian Society of Allergy and Clinical Immunology and the Canadian Paediatric Society

Allergic conditions in children are a prevalent health concern in Canada. The burden of disease and the societal costs of proper diagnosis and management are considerable, making the primary prevention of allergic conditions a desirable health care objective. This position statement reviews current evidence on dietary exposures and allergy prevention in infants at high risk of developing allergic conditions. It revisits previous dietary recommendations for pregnancy, breastfeeding and formula-feeding, and provides an approach for introducing solid foods to high-risk infants. While there is no evidence that delaying the introduction of any specific food beyond six months of age helps to prevent allergy, the protective effect of early introduction of potentially allergenic foods (at four to six months) remains under investigation. Recent research appears to suggest that regularly ingesting a new, potentially allergenic food may be as important as when that food is first introduced. This article has already been published (Paediatr Child Health. 2013 Dec;18(10):545–54), and is being re-published with permission from the original publisher, the Canadian Paediatric Society.

Omalizumab treatment of moderate to severe asthma in the adolescent and pediatric population

Background In Canada and the US, omalizumab is indicated for adults and adolescents (>12 years of age) with moderate to severe persistent allergic asthma. In the EU, omalizumab has been approved for children (age 6 – 11 years) since 2009. The pediatric population within Canada and the United States has very few treatment options available for severe asthma. Current treatments options can lead to other health concerns such as adrenal insufficiency and osteoporosis. These cases demonstrate that early treatment of moderate to severe asthma with omalizumab is an effective treatment and can help to prevent or reverse damage done by long-term use of other treatment options.

Indoor airborne fungi as risk factors in IgE-mediated respiratory allergy

The purpose of this epidemiological study was to assess respiratory allergy in relation to the presence of indoor airborne fungi. The relationship between IgE-mediated respiratory allergy (skin test positivity) and the presence of fungi (CFU/m3) in the indoor environments of 104 subjects was assessed in a cross-sectional study by controlling for extraneous variables (age, gender, predisposition, asthma, rhinitis, skin positivity to ragweed and mite, and smoking). The qualitative and quantitative measurements of airborne seasonal fungi (Alternaria spp. andCladosporium spp.) and non-seasonal airborne fungi (Penicillium spp. andAspergillus spp.) were taken in the subjects’ indoor environments twice in a 2-year period by volumetric methods (Burkard Personal Sampler). There was a significant association between skin test positivity to seasonal fungi and to ragweed (Adj. OR=3.42, CI=1.76–6.66). There was no association between skin test positivity to seasonal fungi and asthma (Adj. OR=0.52, CI=0.28–0.98), but a significant association was found between skin test positivity to seasonal fungi and rhinitis (Adj. OR=5, CI=2.03–12.32). In a logistic regression analysis (maximum likelihood estimates—model A), no statistical association was found indoors between skin prick test positivity to seasonal fungi (Alternaria and/orCladosporium) and airborneAlternaria and/orCladosporium concentrations (Adj. OR=1.18, CI=0.66–2.07). There was a significant association between skin prick test positivity to seasonal fungi and to non-seasonal fungi (Adj. OR=12.81, CI=1.67–98.34). There was no association between asthma and airbornePenicillium concentrations (Adj. OR=1.86, CI=0.47–7.33) nor between rhinitis and airbornePenicillium concentrations (Adj. OR=0.18, CI=0.03–1.19). In another logistic regression analysis (maximum likelihood estimates — model B) using non-seasonal fungi (Aspergillus andPenicillium), no statistical association was found indoors between skin prick test positivity to non-seasonal fungi and airbornePenicillium concentrations (Adj. OR=0.33, CI=0.07–1.69). These findings suggest an association between rhinitis and seasonal fungi. In the rhinitis stratum, subjects who had skin test positivity to ragweed had a higher risk of being sensitive to seasonal airborne fungal allergens. Subjects with non-seasonal fungal allergy had a high relative risk if they were also allergic to seasonal fungi. There was no association between asthma and airborne fungi, as the epidemiological study (cross-sectional design), by definition, does not allow an etiological evaluation of chronic disease. This would require a longitudinal study, i.e. the measurement of repeated exposure as an independent variable (allergen) and repeated measurement as a function of the disease as outcome in humans as a dependent variable.