Background: The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. To inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness, and safety of AIT in the management of allergic rhinoconjunctivitis. Methods: We searched nine international biomedical databases for published, in-progress, and unpublished evidence. Studies were independently screened by two reviewers against predefined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication, and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses. Results: We identified 5960 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD −0.53, 95% CI −0.63, −0.42), medication (SMD −0.37, 95% CI −0.49, −0.26), and combined symptom and medication (SMD −0.49, 95% CI −0.69, −0.30) scores while on treatment that were robust to prespecified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, suggesting a benefit in relation to symptom scores. Conclusions: AIT is effective in improving symptom, medication, and combined symptom and medication scores in patients with allergic rhinoconjunctivitis while on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy.

/pdf/allergen-immunotherapy-for-allergic-rhinoconjunctivitis-a-2egr01z8ch.pdf

Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis

OBJECTIVE. Systemic corticosteroids are known to induce osteoporosis and increase the risk for fractures in adults and children. Inhaled corticosteroids have been shown to increase the risk for osteoporosis and fractures in adults at risk; however, long-term prospective studies of children to assess risks of multiple short courses of oral corticosteroids and chronic inhaled corticosteroids have not been performed. Thus, we assessed the effects of multiple short courses of oral corticosteroids and long-term inhaled corticosteroids on bone mineral accretion over a period of years. METHODS. This was a cohort follow-up study for a median of 7 years of children who had mild-to-moderate asthma and initially were randomly assigned into the Childhood Asthma Management Program trial. Serial dual-energy radiograph absorptiometry scans of the lumbar spine for bone mineral density were performed for all patients. Annual bone mineral accretion was calculated for 531 boys and 346 girls who had asthma and were aged 5 to 12 years at baseline (84% of the initial cohort). RESULTS. Oral corticosteroid bursts produced a dosage-dependent reduction in bone mineral accretion (0.052, 0.049, and 0.046 g/cm2 per year) and an increase in risk for osteopenia (10%, 14%, and 21%) for 0, 1 to 4, and ≥5 courses, respectively, in boys but not girls. Cumulative inhaled corticosteroid use was associated with a small decrease in bone mineral accretion in boys but not girls but no increased risk for osteopenia. CONCLUSIONS. Multiple oral corticosteroid bursts over a period of years can produce a dosage-dependent reduction in bone mineral accretion and increased risk for osteopenia in children with asthma. Inhaled corticosteroid use has the potential for reducing bone mineral accretion in male children progressing through puberty, but this risk is likely to be outweighed by the ability to reduce the amount of oral corticosteroids used in these children.

Effect of long-term corticosteroid use on bone mineral density in children: a prospective longitudinal assessment in the childhood Asthma Management Program (CAMP) study.

Addressing Childhood Obesity: Opportunities for Prevention

This European Respiratory Society statement provides a comprehensive overview on protracted bacterial bronchitis (PBB) in children. A task force of experts, consisting of clinicians from Europe and Australia who manage children with PBB determined the overall scope of this statement through consensus. Systematic reviews addressing key questions were undertaken, diagrams in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement constructed and findings of relevant studies summarised. The final content of this statement was agreed upon by all members.The current knowledge regarding PBB is presented, including the definition, microbiology data, known pathobiology, bronchoalveolar lavage findings and treatment strategies to manage these children. Evidence for the definition of PBB was sought specifically and presented. In addition, the task force identified several major clinical areas in PBB requiring further research, including collecting more prospective data to better identify the disease burden within the community, determining its natural history, a better understanding of the underlying disease mechanisms and how to optimise its treatment, with a particular requirement for randomised controlled trials to be conducted in primary care.

https://erj.ersjournals.com/content/erj/50/2/1602139.full.pdf

ERS statement on protracted bacterial bronchitis in children

Pharmacological strategies for improving the efficacy and therapeutic ratio of glucocorticoids in inflammatory lung diseases.

Background. The two most frequent types of microcytic anemia are beta thalassemia trait (β-TT) and iron deficiency anemia (IDA). We retrospectively evaluated the reliability of various indices for differential diagnosis of microcytosis and β-TT in the same patient groups. Methods. A total of 290 carefully selected children aged 1.1–16 years were evaluated. We calculated 12 discrimination indices in all patients with hemoglobin (Hb) values of 8.7–11.4 g/dL. None of the subjects had a combined case of IDA and β-TT. All children with IDA received oral iron for 16 weeks, and HbA2 screening was performed after iron therapy. The patient groups were evaluated according to red blood cell (RBC) count; red blood distribution width index; the Mentzer, Shine and Lal, England and Fraser, Srivastava and Bevington, Green and King, Ricerca, Sirdah, and Ehsani indices; mean density of hemoglobin/liter of blood; and mean cell density of hemoglobin. Results. The Mentzer index was the most reliable index, as it had the highest sensitivity (98.7%), specificity (82.3%), and Youden’s index (81%) for detecting β-TT; this was followed by the Ehsani index (94.8%, 73.5%, and 68.3%, resp.) and RBC count (94.8%, 70.5%, and 65.3%). Conclusion. The Mentzer index provided the highest reliabilities for differentiating β-TT from IDA.

https://downloads.hindawi.com/journals/anemia/2014/576738.pdf

Hematological indices for differential diagnosis of Beta thalassemia trait and iron deficiency anemia.

http://spiral.imperial.ac.uk/bitstream/10044/1/31282/7/1-s2.0-S0954611113002333-main.pdf

Sublingual immunotherapy in children with allergic rhinoconjunctivitis mono-sensitized to house-dust-mites: A double-blind-placebo-controlled randomised trial

This study aims to evaluate the children with chronic cough and to analyze their etiological factors according to the age groups. Five hundred sixty-three children with chronic cough were included. The last diagnosis were established and were also emphasized according to the age groups. The mean age was 5.4 ± 3.8 years (2-months–17-years) and 52 % of them were male. The most common final diagnosis from all the participants were: asthma (24.9 %), asthma-like symptoms (19 %), protracted bacterial bronchitis (PBB) (11.9 %), and upper airway cough syndrome (9.1 %). However, psychogenic cough was the second most common diagnosis in the subjects over 6 years of age. Asthma and asthma-like symptoms were the most common diagnosis in children. Different age groups in children may have a different order of frequencies. Psychogenic cough should be thought of in the common causes especially in older children.

/pdf/evaluation-of-563-children-with-chronic-cough-accompanied-by-2c1jegurs2.pdf

Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm

Background.Although treatment with oral corticosteroids can cause reactivation of latentMycobacterium tuberculosis(TB) infection in purified protein derivative (PPD)-positive individuals with no evidence of clinical disease, little is known about the effects of inhaled corticosteroids in thi

Inhaled corticosteroid therapy is safe in tuberculin-positive asthmatic children.

In this cross-sectional study, we aimed to compare anteroposterior (AP) spine and total body bone mineral density (BMD) measurements of children with asthma treated with long-term inhaled budesonide (n = 52, mean age 6.4+/-2.2yr, M/F = 22/30) (Group I) with those of asthmatic children who had never received treatment with inhaled corticosteroids (Group II) (n = 22, mean age 6.8+/-2.2, M/F = 10/12). Boys and girls were comparable for age, weight, height, cumulative corticosteroid (CS) dosage, duration of disease and inhaled corticosteroid (ICS) treatment within each group. The mean total accumulated dosage of budesonide for children in Group I was 154.0+/-135.3mg (mean daily dosage = 419+/-154 microg) and the mean treatment duration was 13.0+/-9.8 months. The two groups were comparable with respect to age, gender, weight, height, Tanner's stage and duration of disease. There was no significant difference between subjects in the two groups for total (p = 0.214) and (AP) spine BMD results (p = 0.661), respectively. Our results provide additional support for the safety of ICS therapy on bone density of asthmatic children.

Mustafa Atilla Nursoy

Papers

Hematological indices for differential diagnosis of Beta thalassemia trait and iron deficiency anemia.

Sublingual immunotherapy in children with allergic rhinoconjunctivitis mono-sensitized to house-dust-mites: A double-blind-placebo-controlled randomised trial

Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm

Inhaled corticosteroid therapy is safe in tuberculin-positive asthmatic children.

Inhaled corticosteroids and bone density of children with asthma.