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Navarrete-Rodríguez EM, Del-Río-Navarro BE, Reyes Noriega N, Berber A, Mérida Palacio V, García-Almaráz R, Ellwood P. Have the prevalence of eczema symptoms increased in the Mexican pediatric population? Prevalence and associated factors according to Global Asthma Network Phase I. World Allergy Organ J 2022; 15:100710. [PMID: 36267354 PMCID: PMC9578987 DOI: 10.1016/j.waojou.2022.100710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 10/31/2022] Open
Abstract
Background In children, atopic dermatitis or eczema is the most common inflammatory disease of the skin. According to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase IIIB in Mexico, 5.8% of children and 4.9% of adolescents had eczema symptoms. In 2012, Global Asthma Network (GAN) was established to update the prevalence of eczema and estimate potential factors contributing to its development. Objective To estimate the prevalence and associated factors for atopic eczema symptoms and diagnosis in children and adolescents according to GAN Phase I and compare the results with ISAAC Phase IIIB in Mexico. Methods A cross-sectional, multicenter survey was conducted in 15 Mexican centers during the period of 2015-2017 using the GAN Phase I questionnaires in children (6-7-year-olds) and adolescents (13-14-year-olds). The prevalences obtained from the GAN Phase I study, were compared with ISAAC Phase IIIB results; a Spearman's correlation analysis was conducted between temperature, relative humidity, and altitude and eczema symptoms, and a logistic regression was performed to predict current eczema symptoms by age group. Results A total of 35 777 children and 41 399 adolescents were included. Since ISAAC Phase IIIB, the prevalence of itchy rash in the past 12 months significantly increased in the children's group [6.6% (95% CI 5.7-7.4) vs 7.8 (95% CI 7.5-8.1), p = 0.000] and adolescents' group [5.8% (95% CI 5.0-6.7) vs 6.7% (95% CI 6.5-7.0), p = 0.000].In the adolescents' group, the prevalence of nocturnal awakenings caused by rash symptoms on more than one night per week had a negative correlation between altitude (Spearman's Rho = -0.558, p value = 0.031), and a positive correlation with the average annual temperature (Spearman's Rho = 0.604, p value = 0.017) and annual relative humidity (Spearman's Rho = 0.742, p value = 0.002). The most significant associations in children were the presence of sneezing or runny or blocked nose in the past 12 months [(OR 3.13, 95% CI 2.60-3.77), p = 0.000], the use of paracetamol in the first year of life ([OR 1.52, 95% CI 1.15-2.01), p = 0.003] and the use of antibiotics in the first year of life [(OR 1.30, 95% CI 1.08-1.55) p = 0.004]. Moreover, altitude at 100-1000 m above sea level was associated with current eczema symptoms in adolescents (p = 0.001). Conclusions There has been a significant increase in eczema symptoms in both age groups since ISAAC Phase IIIB study. Additionally, eczema symptoms were associated with temperature, relative humidity, asthma, hay fever symptoms, the use of paracetamol and antibiotics.
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Affiliation(s)
| | - Blanca Estela Del-Río-Navarro
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico,Corresponding author. Hospital Infantil de México Federico Gómez, Dr. Márquez No. 162, Col. Doctores, Deleg. Cuauhtémoc, 06720, México, D.F., Mexico.
| | - Nayely Reyes Noriega
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Arturo Berber
- Asesor Externo del Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, 1023, New Zealand
| | - GAN Phase I Study groupRamos-GarcíaBeatriz Del CarmenMDfEscalante-DomínguezAlberto JoséMDgLinares-ZapiénFrancisco JavierMDhGardea-MorenoHéctor LeonardoMDiOchoa-LópezGeorginaMDjHernández-MondragónLuis OctavioMDkLozano-SáenzJosé SantosMDlSacre-HazouriJosé AntonioMDmJuan-PinedaMa de los ÁngelesMDnSánchez-CoronelMaría GuadalupeMDoRodríguez-PérezNoelMDpAmbriz-MorenoMaría de JesúsMDpDel-Río-ChivardiJaime MarianoqSaucedo-RamírezOmar JosueMDqInstituto Mexicano del Seguro Social San Luis Potosí, San Luis Potosí, MexicoHospital General Tijuana, Baja California, MexicoCentro de Investigación, Diagnóstico y Tratamiento de Asma y Alergias, Toluca, Estado de México, MexicoHospital Ángeles Chihuahua, Chihuahua, MexicoHospital Ángeles Ciudad Juárez, Chihuahua, MexicoCRIT Michoacán, Morelia, Michoacán, MexicoHospital Ángeles Xalapa, Veracruz, MexicoUniversidad Veracruzana, Córdoba, Veracruz, MexicoPrivate Practice, Puerto Vallarta, Jalisco, MexicoBenemérita Universidad Autónoma de Aguascalientes, Aguascalientes, MexicoHospital General de Matamoros, Tamaulipas, MexicoServicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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Cogo A, Piazza M, Costella S, Appodia M, Aralla R, Zanconato S, Carraro S, Piacentini G. A positive effect of a short period stay in Alpine environment on lung function in asthmatic children. Pediatr Pulmonol 2022; 57:2116-2121. [PMID: 35606932 PMCID: PMC9546332 DOI: 10.1002/ppul.25987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
Abstract
Lung function is a central issue in diagnosis and determination of asthma severity and asthma control has been previously reported to improve after a stay in mountain environment for at least 2 weeks. No data are available for shorter periods of stay, in particular for small airways during a stay at altitude. The aim of this study is to focus on changes in respiratory function, regarding both the central airways and the peripheral airways in the first 2 weeks of stay in a mountain environment in asthmatic children. In this study, 66 asthmatic children (age: 14 ± 2.8 years) were evaluated through spirometric and oscillometric tests at the time of arrival at the Istituto Pio XII, Misurina (BL), Italy, 1756 m above sea level (T0), after 24 h (T1), and 168 h (T2) of stay. FEV1%, FEF25%-75%, and FEV1/FVC increased significantly from T0 value both at T1 and T2 (respectively, p = 0.0002, p < 0.0001, p = 0.0002). Oscillometry showed a significant improvement in R5, R20, and R5-20 at both T1 and T2 as compared to T0 (respectively, p = 0.0001, p = 0.0002, and p = 0.049). Reactance at 5 Hz (X5) improved significantly at T2 versus T0, p = 0.0022. The area under reactance curve between Fres and 5 Hz (AX) was significantly reduced (p = 0.0001) both at T1 and T2 as compared to T0. This study shows an improvement in respiratory indices as soon as after 24 h of stay at altitude, persisting in the following week.
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Affiliation(s)
- Annalisa Cogo
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Silvia Costella
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | | | - Raffaele Aralla
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | - Stefania Zanconato
- Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - Silvia Carraro
- Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
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Fieten KB, Drijver‐Messelink MT, Cogo A, Charpin D, Sokolowska M, Agache I, Taborda‐Barata LM, Eguiluz‐Gracia I, Braunstahl GJ, Seys SF, den Berge M, Bloch KE, Ulrich S, Cardoso‐Vigueros C, Kappen JH, Brinke AT, Koch M, Traidl‐Hoffmann C, da Mata P, Prins DJ, Pasmans SGMA, Bendien S, Rukhadze M, Shamji MH, Couto M, Oude Elberink H, Peroni DG, Piacentini G, Weersink EJM, Bonini M, Rijssenbeek‐Nouwens LHM, Akdis CA. Alpine altitude climate treatment for severe and uncontrolled asthma: An EAACI position paper. Allergy 2022; 77:1991-2024. [PMID: 35113452 PMCID: PMC9305916 DOI: 10.1111/all.15242] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/14/2022] [Accepted: 01/30/2022] [Indexed: 12/30/2022]
Abstract
Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro‐immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways.
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Fieten KB, Weststrate ACG, van Zuuren EJ, Bruijnzeel-Koomen CA, Pasmans SGMA. Alpine climate treatment of atopic dermatitis: a systematic review. Allergy 2015; 70:12-25. [PMID: 25130620 DOI: 10.1111/all.12514] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
Abstract
Climate therapy has been used for decades in the treatment of atopic dermatitis (AD), but evidence of its effectiveness has not yet been assessed systematically. A systematic literature search in Medline, Embase, and the Cochrane library was performed to identify all original studies concerning alpine climate treatment. The risk of bias of individual studies was assessed following the Cochrane Handbook, and level of evidence was rated using GRADE guidelines. Fifteen observational studies were included concerning 40 148 patients. Four studies concerning 2670 patients presented follow-up data over a period of 1 year. Disease activity decreased in the majority of patients during treatment (96% of n = 39 006) and 12-month follow-up (64% of n = 2670). Topical corticosteroid use could often be reduced or stopped during treatment (82% of n = 1178) and during 12-month follow-up (72% of n = 3008). Quality assessment showed serious study limitations, therefore resulting in a very low level of evidence for the described outcomes. Randomized controlled trials designed with a follow-up period including well-defined patient populations, detailed description and measurement of applied interventions during climate therapy and using validated outcomes including cost-effectiveness parameters, are required to improve the evidence for alpine climate therapy as an effective treatment for patients with AD.
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Affiliation(s)
- K. B. Fieten
- Department of (Pediatric) Dermatology and Allergology; University Medical Center Utrecht; Utrecht the Netherlands
- High Altitude Clinic Merem Dutch Asthma Center Davos; Davos Switzerland
| | - A. C. G. Weststrate
- Department of (Pediatric) Dermatology and Allergology; University Medical Center Utrecht; Utrecht the Netherlands
| | - E. J. van Zuuren
- Department of Dermatology; Leiden University Medical Center; Leiden The Netherlands
| | - C. A. Bruijnzeel-Koomen
- Department of (Pediatric) Dermatology and Allergology; University Medical Center Utrecht; Utrecht the Netherlands
| | - S. G. M. A. Pasmans
- Department of (Pediatric) Dermatology and Allergology; University Medical Center Utrecht; Utrecht the Netherlands
- Department of Pediatric Dermatology; Sophia Children's Hospital; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
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Fieten KB, Zijlstra WT, van Os-Medendorp H, Meijer Y, Venema MU, Rijssenbeek-Nouwens L, l'Hoir MP, Bruijnzeel-Koomen CA, Pasmans SGMA. Comparing high altitude treatment with current best care in Dutch children with moderate to severe atopic dermatitis (and asthma): study protocol for a pragmatic randomized controlled trial (DAVOS trial). Trials 2014; 15:94. [PMID: 24670079 PMCID: PMC3975250 DOI: 10.1186/1745-6215-15-94] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/13/2014] [Indexed: 01/07/2023] Open
Abstract
Background About 10 to 20% of children in West European countries have atopic dermatitis (AD), often as part of the atopic syndrome. The full atopic syndrome also consists of allergic asthma, allergic rhinitis and food allergy. Treatment approaches for atopic dermatitis and asthma include intermittent anti-inflammatory therapy with corticosteroids, health education and self-management training. However, symptoms persist in a subgroup of patients. Several observational studies have shown significant improvement in clinical symptoms in children and adults with atopic dermatitis or asthma after treatment at high altitude, but evidence on the efficacy when compared to treatment at sea level is still lacking. Methods/Design This study is a pragmatic randomized controlled trial for children with moderate to severe AD within the atopic syndrome. Patients are eligible for enrolment in the study if they are: diagnosed with moderate to severe AD within the atopic syndrome, aged between 8 and 18 years, fluent in the Dutch language, have internet access at home, able to use the digital patient system Digital Eczema Center Utrecht (DECU), willing and able to stay in Davos for a six week treatment period. All data are collected at the Wilhelmina Children’s Hospital and DECU. Patients are randomized over two groups. The first group receives multidisciplinary inpatient treatment during six weeks at the Dutch Asthma Center in Davos, Switzerland. The second group receives multidisciplinary treatment during six weeks at the outpatient clinic of the Wilhelmina Children’s Hospital, Utrecht, the Netherlands. The trial is not conducted as a blind trial. The trial is designed with three components: psychosocial, clinical and translational. Primary outcomes are coping with itch, quality of life and disease activity. Secondary outcomes include asthma control, medication use, parental quality of life, social and emotional wellbeing of the child and translational parameters. Discussion The results of this trial will provide evidence for the efficacy of high altitude treatment compared to treatment at sea level for children with moderate to severe AD. Trial Registration Current Controlled Trials ISRCTN88136485.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Suzanne G M A Pasmans
- Department of (Pediatric) Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Jung A, Heinrichs I, Geidel C, Lauener R. Inpatient paediatric rehabilitation in chronic respiratory disorders. Paediatr Respir Rev 2012; 13:123-9. [PMID: 22475259 DOI: 10.1016/j.prrv.2011.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 06/28/2011] [Accepted: 08/13/2011] [Indexed: 11/29/2022]
Abstract
Inpatient pulmonary rehabilitation programs have evolved from tuberculosis sanatoriums to modern medical centres providing standardized comprehensive care in a multidiciplinatory environment. Goals of rehabilitation programs for children and adolescents include restoration of professional activity, improvement of health condition, compliance and disease management as well as restoration of quality of life. Eligibility for an intervention is assessed by defined social and medical criteria. Comprehensive pulmonary rehabilitation programs provide a wide range of health care recourses, including diagnostic procedures, specific medical care, educational interventions and a multiprofessional team. Paediatric rehabilitation programs for chronic respiratory diseases, such as asthma or cystic fibrosis, have been shown to reduce symptoms, increase aerobic fitness and physical strength, improve pulmonary function and inflammation and enhance compliance, self-management, quality of life and psychological symptoms. Regional climatic effects have demonstrated an additional positive effect on the rehabilitation outcome. In addition, first evidence suggests an overall reduction of health care costs.
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Huss-Marp J, Krämer U, Eberlein B, Pfab F, Ring J, Behrendt H, Gulyas AF. Reduced exhaled nitric oxide values in children with asthma after inpatient rehabilitation at high altitude. J Allergy Clin Immunol 2007; 120:471-2. [PMID: 17498787 DOI: 10.1016/j.jaci.2007.03.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 03/14/2007] [Accepted: 03/27/2007] [Indexed: 11/22/2022]
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