Pneumonia is a type of acute lower respiratory infection that is common and severe. The outcome of lower respiratory infection is determined by the degrees to which immunity is protective and infla...

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Integrative Physiology of Pneumonia.

Background The relationships between cockroach and mouse allergen exposure, anti-cockroach and anti-mouse IgE, and wheeze, rhinitis, and atopic dermatitis in children as young as age 3 years are of public health importance but have not been thoroughly evaluated. Objective We hypothesized that inner-city children might have anti-cockroach and anti-mouse IgE by age 3 years, and their presence would be associated with respiratory and atopic symptoms. Methods Children were followed prospectively from birth through age 3 years (n = 404). Residential levels of cockroach and mouse allergens, sera levels of anti-cockroach and anti-mouse IgE, and parental report of wheeze, rhinitis, and atopic dermatitis were measured. Results The odds of early wheeze were significantly higher among children who had IgE to cockroach (odds ratio [OR], 3.3; 95% CI, 1.8-6.2), mouse (OR, 4.6; 95% CI, 2.3-9.0), or both (OR, 9.7; 95% CI, 3.4-27.3). The odds of rhinitis or atopic dermatitis were also higher among children with IgE to cockroach, mouse, or both. Higher IgE class to cockroach and mouse was associated with wheeze and atopic dermatitis (tests for trend, P Conclusions Children age 2 to 3 years who have anti-cockroach and anti-mouse IgE are at increased risk of wheeze and atopy. Moreover, a dose-response relationship was found between higher IgE class and increased prevalence of wheeze, rhinitis, or atopic dermatitis. These findings indicate the importance of reducing exposure to cockroach and mouse allergens for susceptible children.

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Anti-cockroach and anti-mouse IgE are associated with early wheeze and atopy in an inner-city birth cohort.

Assessment of allergen sensitization in a general population-based survey (European Community Respiratory Health Survey I).

This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Environmental assessment and remediation: a practice parameter." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single person, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

Environmental assessment and exposure reduction of cockroaches: A practice parameter

An accurate diagnosis of aeroallergen sensitization is pivotal to clinical practice and research. Given the recent technological advances in analyzing serum allergen-specific IgE, the question of which testing method, skin or serum testing, is superior in diagnosing allergic sensitization must be readdressed, as well as their value in predicting clinical disease. This review article provides a detailed summary of recent studies addressing these questions. Conclusively, most studies show substantial discordance between serum-specific IgE and skin testing results, suggesting that the two testing methods compliment each other and cannot be used interchangeably. On average, using only one testing method may misdiagnose every fourth allergically sensitized patient as non-sensitized. In addition, depending on the allergen tested, skin prick testing and serum-specific IgE testing appear to be the methods of choice in predicting outcomes of experimental allergen challenge, while intradermal testing is less contributory.

Skin testing versus serum-specific IgE testing: which is better for diagnosing aeroallergen sensitization and predicting clinical allergy?

Pneumonia plays an important role in children’s morbidity and mortality. In Brazil, epidemiological and social changes occurred concomitantly with the universal introduction of the 10-valent pneumococcal conjugate vaccine. This study identified risk factors for pneumonia following the implementation of a pneumococcal vaccination program. A hospital-based, case-control study involving incident cases of pneumonia in children aged 1–59 months was conducted between October 2010 and September 2013 at a tertiary hospital in northeastern Brazil. The diagnosis of pneumonia was based on the World Health Organization (WHO) criteria. The control group consisted of children admitted to the day-hospital ward for elective surgery. Children with comorbidities were excluded. The risk factors for pneumonia that were investigated were among those classified by the WHO as definite, likely and possible. A multivariate analysis was performed including variables that were significant at p ≤ 0.25 in the bivariate analysis. The study evaluated 407 children in the case group and 407 children in the control group. Household crowding (OR = 2.15; 95 % CI, 1,46–3,18) and not having been vaccinated against the influenza virus (OR = 3.59; 95 % CI, 2,62–4.91) were the only factors found to increase the likelihood of pneumonia. Male gender constituted a protective factor (OR = 0.53; 95 % CI, 0,39–0,72). Changes on risk factors for pneumonia were most likely associated with the expansion of the vaccination program and social improvements; however, these improvements were insufficient to overcome inequalities, given that household crowding remained a significant risk factor. The protection provided by the influenza vaccine must be evaluated new etiological studies. Furthermore, additional risk factors should be investigated.

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Risk factors for community-acquired pneumonia in children under five years of age in the post-pneumococcal conjugate vaccine era in Brazil: a case control study

OBJETIVOS: Comparar a prevalencia da sensibilizacao a baratas (Blattella germanica e Periplaneta americana) em criancas com e sem asma, verificando a concordância entre testes cutâneos e IgE especifica bem como determinar a relacao entre a sensibilizacao a baratas e niveis sericos de IgE total. METODOS: Foi realizado um estudo caso-controle, envolvendo 76 criancas asmaticas e 42 nao asmaticas, entre 6 e 14 anos de idade, em Recife, Brasil. Todas as criancas submeteram-se ao teste cutâneo e dosagem serica de IgE especifica para B. germanica e P. americana e determinacao serica da IgE total. RESULTADOS: As criancas asmaticas apresentaram maior positividade aos testes cutâneos para B. germanica (27,6 versus 4,8%) e P. americana (27,6 versus 2,4%) que aquelas do grupo controle. A concordância entre o teste cutâneo e a IgE especifica foi razoavel para B. germanica (Kappa = 0,25) e fraca para P. americana (Kappa = 0,17). A media geometrica da IgE total foi 591,70 kU/L entre pacientes asmaticos e 345,85 kU/L entre os controles, nao havendo diferenca estatisticamente significante. Em pacientes com testes positivos para baratas, a media geometrica da IgE total foi significativamente maior em comparacao aos pacientes cujos exames foram negativos. CONCLUSAO: A sensibilizacao a baratas foi associada a asma. O teste cutâneo pode refletir mais apropriadamente uma sensibilizacao a baratas clinicamente relevante que a IgE especifica.

https://www.scielo.br/pdf/jped/v82n3/en_v82n3a09.pdf

Maria Isabella Londres Lopes

Papers

Risk factors for community-acquired pneumonia in children under five years of age in the post-pneumococcal conjugate vaccine era in Brazil: a case control study

Use of the skin prick test and specific immunoglobulin E for the diagnosis of cockroach allergy.