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Zeldovich M, Krol L, Koerte IK, Cunitz K, Kieslich M, Henrich M, Brockmann K, Buchheim A, Lendt M, Auer C, Neu A, Driemeyer J, Wartemann U, Thomé C, Pinggera D, Berweck S, Bonfert MV, Suss J, Muehlan H, von Steinbuechel N. A short scale to measure health-related quality of life after traumatic brain injury in children and adolescents (QOLIBRI-OS-KID/ADO): psychometric properties and German reference values. Qual Life Res 2024:10.1007/s11136-024-03764-3. [PMID: 39215856 DOI: 10.1007/s11136-024-03764-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE The impact of pediatric traumatic brain injury (pTBI) on health-related quality of life (HRQoL) in children and adolescents remains understudied. Short scales have some advantages in terms of economy and administration over longer scales, especially in younger children. The aim of the present study is to psychometrically evaluate the six-item German version of the QOLIBRI-OS-KID/ADO scale for children and adolescents. In addition, reference values from a general German pediatric population are obtained to assist clinicians and researchers in the interpretation of HRQoL after pTBI. METHODS A total of 297 individuals after TBI and 1997 from a general population sample completed the questionnaire. Reliability, validity, and comparability of the assessed construct were examined. RESULTS The questionnaire showed satisfactory reliability (α = 0.75 and ω = 0.81 and α = 0.85 and ω = 0.86 for the TBI and general population samples, respectively). The QOLIBRI-OS-KID/ADO was highly correlated with its long version (R2 = 67%) and showed an overlap with disease-specific HRQoL (R2 = 55%) in the TBI sample. The one-dimensional factorial structure could be replicated and tested for measurement invariance between samples, indicating a comparable HRQoL construct assessment. Therefore, reference values and cut-offs indicating clinically relevant impairment could be provided using percentiles stratified by factors significantly associated with the total score in the regression analyses (i.e., age group and gender). CONCLUSION In combination with the cut-offs, the QOLIBRI-OS-KID/ADO provides a cost-effective screening tool, complemented by interpretation guidelines, which may help to draw clinical conclusions and indications such as further administration of a longer version of the instrument to gain more detailed insight into impaired HRQoL domains or omission of further steps in the absence of an indication.
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Affiliation(s)
- Marina Zeldovich
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria.
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria.
| | - Leonie Krol
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Inga K Koerte
- cBRAIN / Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, LMU University Hospital, Ludwig-Maximilian University, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Boston, USA
| | - Katrin Cunitz
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
| | - Matthias Kieslich
- Department of Paediatric Neurology, Hospital of Goethe University, Frankfurt, Germany
| | - Marlene Henrich
- Department of Paediatric Neurology, Hospital of Goethe University, Frankfurt, Germany
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Goettingen, Germany
| | - Anna Buchheim
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Meerbusch, Germany
| | - Christian Auer
- Department of Neurosurgery, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
- Clinical Research Institute für Neurosciences, Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Axel Neu
- Department of Neurology and Neuropediatry, VAMED Klinik Geesthacht GmbH, Geesthacht, Germany
| | - Joenna Driemeyer
- Department of Pediatrics, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Wartemann
- Department of Neuropediatrics, VAMED Klinik Hohenstücken GmbH, Brandenburg an der Havel, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University lnnsbruck, Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University lnnsbruck, Innsbruck, Austria
| | - Steffen Berweck
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik, Vogtareuth, Germany
| | - Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Development and Children with Medical Complexity, Dr. Von Hauner Children's Hospital, LMU University Hospital, Munich, Germany
| | - Joachim Suss
- Department of Pediatric Surgery, Wilhelmstift Catholic Children's Hospital, Hamburg, Germany
| | - Holger Muehlan
- Department of Health and Prevention, University of Greifswald, Greifswald, Germany
| | - Nicole von Steinbuechel
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria
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Krsmanović L, Arsović N, Bokonjić D, Nešić V, Dudvarski Z, Pavlović D, Dubravac Tanasković M, Ristić S, Elez-Burnjaković N, Balaban R, Ćurčić B, Ivanović R, Vuković N, Vuković M, Milić M, Joksimović B. The Impact of Cytokines on Health-Related Quality of Life in Adolescents with Allergic Rhinitis. Biomedicines 2024; 12:428. [PMID: 38398030 PMCID: PMC10886792 DOI: 10.3390/biomedicines12020428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Frequent episodes of nasal symptoms are the usual clinical manifestations (CM) of allergic rhinitis (AR) and have a significant negative impact on health-related quality of life (HRQoL) in adolescents. The purpose of this cross-sectional study was to test the hypothesis that cytokines in nasal mucus may be associated with HRQoL in adolescents with AR. METHODS European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), "The Adolescent Rhinoconjunctivitis Quality of Life Questionnaire" (AdolRQLQ) and the Total 4 Symptom Score (T4SS) scoring system were administered to 113 adolescents with AR, nonallergic rhinitis (NAR) and to healthy control subjects. Nasal secretions were sampled and tested for 13 cytokines using a multiplex flow cytometric bead assay. RESULTS The AR group had significantly lower EQ-5D-3L (0.661 ± 0.267 vs. 0.943 ± 0.088; p < 0.001) and higher AdolRQLQ total scores (2.76 ± 1.01 vs. 1.02 ± 0.10; p < 0.001) compared to the control group. The AR group had higher concentrations of IL-1β (p = 0.002), IL-6 (p = 0.031), IL-8 (p < 0.001), IL17-A (p = 0.013) and IL-18 (p = 0.014) compared to the control group, and IL-1β, IL-6, IL17-A and IL-18 were significantly (p < 0.050) increased with disease progression. Cytokines IL-1β, IL-6, as well as severe CM, were identified as significant predictors of lower HRQoL in adolescents with AR. CONCLUSIONS This study identified IL-1β, IL-6, as well as severe CM, as predictors of lower HRQoL in adolescents with AR. However, these results should only serve as a starting point for additional confirmation research.
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Affiliation(s)
- Ljiljana Krsmanović
- University Hospital Foča, 73300 Foča, Bosnia and Herzegovina
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
| | - Nenad Arsović
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine Belgrade, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejan Bokonjić
- University Hospital Foča, 73300 Foča, Bosnia and Herzegovina
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
| | - Vladimir Nešić
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine Belgrade, University of Belgrade, 11000 Belgrade, Serbia
| | - Zoran Dudvarski
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine Belgrade, University of Belgrade, 11000 Belgrade, Serbia
| | - Dragana Pavlović
- University Hospital Foča, 73300 Foča, Bosnia and Herzegovina
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
| | | | - Siniša Ristić
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
| | | | - Radmila Balaban
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
| | - Branislava Ćurčić
- University Hospital Foča, 73300 Foča, Bosnia and Herzegovina
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
| | - Radenko Ivanović
- University Hospital Foča, 73300 Foča, Bosnia and Herzegovina
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
| | | | - Maja Vuković
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
| | - Marija Milić
- Department of Epidemiology, Faculty of Medicine, University of Pristina Temporarily Seated in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
| | - Bojan Joksimović
- Faculty of Medicine Foča, University of East Sarajevo, 73300 Foča, Bosnia and Herzegovina
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Agenäs H, Brorsson AL, Kull I, Lindholm-Olinder A. Treatment with pollen allergen immunotherapy improves health-related quality of life in children and adolescents: a three-year follow-up-study. Allergy Asthma Clin Immunol 2023; 19:4. [PMID: 36650597 PMCID: PMC9843974 DOI: 10.1186/s13223-023-00756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The immunological effect of allergen-specific immunotherapy is well documented, but few studies have examined the long-term effects of pollen subcutaneous immunotherapy (SCIT) on health-related quality of life (HRQoL) in children and adolescents. Therefore, the aims of this study were to evaluate the effect of pollen SCIT on HRQoL and to assess the association between HRQoL and symptoms among children and adolescents with allergic rhinoconjunctivitis in a 3-year follow-up. METHODS A prospective cohort study was conducted at a paediatric clinic in Sweden, including 158 children (5-16 years) on SCIT (birch and/or grass). Health-related quality of life, measured with DISABKIDS, symptom scores and allergen-specific IgE and IgG4 antibodies (blood test), were assessed at start, and after 1, 2 and 3 years of treatment. ANOVA and t-test were used to analyse differences over time, between groups and linear mixed model for the association between HRQoL and influencing factors. RESULTS After 1 year of pollen SCIT, HRQoL improved from 79.5 to 85.1 (p < 0.001), and the improvements were maintained (mean 1 years, 84.8, 3 years 87.2). Symptom scores decreased after 1 year, mean 19.9 to 11.5 (p < 0.001) and were maintained for year two (11.9) and year three (10.3). The proportion of children with severe or very severe symptoms decreased from 35.6% to 4.5% after 1 year of SCIT. Health-related quality of life was associated with symptoms at all measured timepoints (p = 0.001-0.031); higher symptom scores were associated with lower perceived HRQoL. Allergen-specific IgE antibodies decreased, birch from 151.0 to 76.8 kU/L (p < 0.001), and IgG4 antibodies increased, birch from 2.2 to 17.6 g/L (p < 0.001), grass from 0.5 to 14.3 g/L (p < 0.001), during the study period. CONCLUSION After 1 year of pollen SCIT, HRQoL improved, and symptoms decreased; these changes were maintained during the study period. The proportion of severe and very severe symptoms significantly decreased.
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Affiliation(s)
- Helena Agenäs
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden
| | - Anna Lena Brorsson
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Inger Kull
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Anna Lindholm-Olinder
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 118 83 Stockholm, Sweden ,grid.416648.90000 0000 8986 2221Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Zettl I, Ivanova T, Strobl MR, Weichwald C, Goryainova O, Khan E, Rutovskaya MV, Focke‐Tejkl M, Drescher A, Bohle B, Flicker S, Tillib SV. Isolation of nanobodies with potential to reduce patients' IgE binding to Bet v 1. Allergy 2022; 77:1751-1760. [PMID: 34837242 DOI: 10.1111/all.15191] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Recent studies showed that a single injection of human monoclonal allergen-specific IgG antibodies significantly reduced allergic symptoms in birch pollen-allergic patients. Since the production of full monoclonal antibodies in sufficient amounts is laborious and expensive, we sought to investigate if smaller recombinant allergen-specific antibody fragments, that is, nanobodies, have similar protective potential. For this purpose, nanobodies specific for Bet v 1, the major birch pollen allergen, were generated to evaluate their efficacy to inhibit IgE-mediated responses. METHODS A cDNA-VHH library was constructed from a camel immunized with Bet v 1 and screened for Bet v 1 binders encoding sequences by phage display. Selected nanobodies were expressed, purified, and analyzed in regards of epitope-specificity and affinity to Bet v 1. Furthermore, cross-reactivity to Bet v 1-homologues from alder, hazel and apple, and their usefulness to inhibit IgE binding and allergen-induced basophil activation were investigated. RESULTS We isolated three nanobodies that recognize Bet v 1 with high affinity and cross-react with Aln g 1 (alder) and Cor a 1 (hazel). Their epitopes were mapped to the alpha-helix at the C-terminus of Bet v 1. All nanobodies inhibited allergic patients' polyclonal IgE binding to Bet v 1, Aln g 1, and Cor a 1 and partially suppressed Bet v 1-induced basophil activation. CONCLUSION We identified high-affinity Bet v 1-specific nanobodies that recognize an important IgE epitope and reduce allergen-induced basophil activation revealing the first proof that allergen-specific nanobodies are useful tools for future treatment of pollen allergy.
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Affiliation(s)
- Ines Zettl
- Division of Immunopathology Institute of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Tatiana Ivanova
- Institute of Gene Biology Russian Academy of Sciences Moscow Russia
| | - Maria R. Strobl
- Division of Experimental Allergology Institute of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Christina Weichwald
- Division of Immunopathology Institute of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | | | - Evgenia Khan
- Institute of Gene Biology Russian Academy of Sciences Moscow Russia
| | - Marina V. Rutovskaya
- Institute of Gene Biology Russian Academy of Sciences Moscow Russia
- A.N.Severtsov Institute of Ecology and Evolution Russian Academy of Sciences Moscow Russia
| | - Margarete Focke‐Tejkl
- Division of Immunopathology Institute of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | | | - Barbara Bohle
- Division of Experimental Allergology Institute of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Sabine Flicker
- Division of Immunopathology Institute of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - Sergei V. Tillib
- Institute of Gene Biology Russian Academy of Sciences Moscow Russia
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Deutschsprachige Übersetzung und Adaption des Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) für Kinder und Jugendliche zwischen acht und 17 Jahren und Entwicklung einer Proxy-Version für junge Kinder zwischen null und sieben Jahren. ALLERGO JOURNAL 2021. [DOI: 10.1007/s15007-021-4826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Padayachee Y, Flicker S, Linton S, Cafferkey J, Kon OM, Johnston SL, Ellis AK, Desrosiers M, Turner P, Valenta R, Scadding GK. Review: The Nose as a Route for Therapy. Part 2 Immunotherapy. FRONTIERS IN ALLERGY 2021; 2:668781. [PMID: 35387044 PMCID: PMC8974912 DOI: 10.3389/falgy.2021.668781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/28/2021] [Indexed: 12/12/2022] Open
Abstract
The nose provides a route of access to the body for inhalants and fluids. Unsurprisingly it has a strong immune defense system, with involvement of innate (e.g., epithelial barrier, muco- ciliary clearance, nasal secretions with interferons, lysozyme, nitric oxide) and acquired (e.g., secreted immunoglobulins, lymphocytes) arms. The lattice network of dendritic cells surrounding the nostrils allows rapid uptake and sampling of molecules able to negotiate the epithelial barrier. Despite this many respiratory infections, including SARS-CoV2, are initiated through nasal mucosal contact, and the nasal mucosa is a significant "reservoir" for microbes including Streptococcus pneumoniae, Neisseria meningitidis and SARS -CoV-2. This review includes consideration of the augmentation of immune defense by the nasal application of interferons, then the reduction of unnecessary inflammation and infection by alteration of the nasal microbiome. The nasal mucosa and associated lymphoid tissue (nasopharynx-associated lymphoid tissue, NALT) provides an important site for vaccine delivery, with cold-adapted live influenza strains (LAIV), which replicate intranasally, resulting in an immune response without significant clinical symptoms, being the most successful thus far. Finally, the clever intranasal application of antibodies bispecific for allergens and Intercellular Adhesion Molecule 1 (ICAM-1) as a topical treatment for allergic and RV-induced rhinitis is explained.
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Affiliation(s)
- Yorissa Padayachee
- Department of Respiratory Medicine, Faculty of Medicine, Imperial College Healthcare NHS Trust, Imperial College London, London, United Kingdom
| | - Sabine Flicker
- Center for Pathophysiology, Infectiology and Immunology, Institute of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Sophia Linton
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
- Allergy Research Unit, Kingston Health Sciences Centre (KHSC), Kingston, ON, Canada
| | - John Cafferkey
- Department of Respiratory Medicine, Faculty of Medicine, Imperial College Healthcare NHS Trust, Imperial College London, London, United Kingdom
| | - Onn Min Kon
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sebastian L. Johnston
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Anne K. Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Martin Desrosiers
- Department of Otorhinolaryngologie, The University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Paul Turner
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Rudolf Valenta
- Division of Immunopathology, Medical University of Vienna, Vienna, Austria
| | - Glenis Kathleen Scadding
- Royal National Ear Nose and Throat Hospital, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
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7
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Papapostolou G, Kiotseridis H, Romberg K, Dahl Å, Bjermer L, Lindgren M, Aronsson D, Tunsäter A, Tufvesson E. Cognitive dysfunction and quality of life during pollen season in children with seasonal allergic rhinitis. Pediatr Allergy Immunol 2021; 32:67-76. [PMID: 32767782 PMCID: PMC7818136 DOI: 10.1111/pai.13328] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Allergic rhinitis often gives rise to impaired quality of life and is believed to also affect cognitive function. We aimed to examine whether cognitive functions were impaired during grass pollen season in symptomatic allergic children and to relate the degree of impairment to quality of life and biomarkers related to stress and inflammation. METHODS Forty-three grass pollen-allergic children (age 8-17 years) with non-satisfactory effect of medication (antihistamines and nasal steroids daily) during previous seasons were included. In addition, 26 matched non-allergic children were included as controls. Both groups performed cognitive tests (CANTAB) and completed Quality of Life questionnaires outside and during the pollen season. Blood samples were collected and analyzed for stress and inflammatory biomarkers. Pollen level was measured daily. RESULTS Impaired cognitive function was found in spatial working memory, where the allergic group made more errors compared to the non-allergic group during pollen season, but not off-season. No significant differences could be seen between the allergic group and the controls in the other tests investigating visual memory or attention. Quality of health questionnaires revealed more symptoms and impaired quality of life in allergic compared to non-allergic children, and increased symptoms in allergic children were associated with longer reaction time for simple movement during pollen season. No differences in stress or inflammatory biomarkers could be found between the groups. CONCLUSION Cognitive function was affected during pollen season in pollen-allergic children, and the more symptoms the allergic children had, the longer the reaction time in the cognitive tests.
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Affiliation(s)
- Georgia Papapostolou
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Hampus Kiotseridis
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Kerstin Romberg
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Health Care Center, Näsets Läkargrupp, Höllviken, Sweden
| | - Åslög Dahl
- Department of Plant and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - David Aronsson
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alf Tunsäter
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ellen Tufvesson
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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8
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Flicker S, Zettl I, Tillib SV. Nanobodies-Useful Tools for Allergy Treatment? Front Immunol 2020; 11:576255. [PMID: 33117377 PMCID: PMC7561424 DOI: 10.3389/fimmu.2020.576255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/15/2020] [Indexed: 11/13/2022] Open
Abstract
In the last decade single domain antibodies (nanobodies, VHH) qualified through their unique characteristics have emerged as accepted and even advantageous alternative to conventional antibodies and have shown great potential as diagnostic and therapeutic tools. Currently nanobodies find their main medical application area in the fields of oncology and neurodegenerative diseases. According to late-breaking information, nanobodies specific for coronavirus spikes have been generated these days to test their suitability as useful therapeutics for future outbreaks. Their superior properties such as chemical stability, high affinity to a broad spectrum of epitopes, low immunogenicity, ease of their generation, selection and production proved nanobodies also to be remarkable to investigate their efficacy for passive treatment of type I allergy, an exaggerated immune reaction to foreign antigens with increasing global prevalence.
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Affiliation(s)
- Sabine Flicker
- Division of Immunopathology, Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Ines Zettl
- Division of Immunopathology, Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Sergei V. Tillib
- Institute of Gene Biology, Russian Academy of Sciences, Moscow, Russia
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9
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Kansen HM, Le TM, Meijer Y, Uiterwaal CSPM, Knulst AC, van der Ent CK, van Erp FC. Perceived triggers of asthma impair quality of life in children with asthma. Clin Exp Allergy 2019; 49:980-989. [PMID: 31038823 PMCID: PMC6851977 DOI: 10.1111/cea.13407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/15/2019] [Accepted: 04/20/2019] [Indexed: 12/29/2022]
Abstract
Background Data on the impact of the number and nature of perceived asthma triggers on health‐related quality of life (HRQL) in children are scarce. Objective To investigate the impact of perceived asthma triggers on both asthma‐specific and generic HRQL in children. Methods A cross‐sectional study was conducted among children (7‐18 years) with asthma in secondary and tertiary care. Children were screened with electronic questionnaires regarding respiratory and allergic symptoms. Asthma‐specific HRQL was assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) (score range 1‐7) and generic HRQL using the RAND questionnaire (score range 7‐32). The Kruskal‐Wallis test and one‐way ANOVA were used to test the difference of, respectively, the PAQLQ and RAND scores across the number of perceived asthma triggers (0, 1‐2, 3‐4, or ≥ 5). Univariable and multivariable linear regression analyses were performed to evaluate the association between individual triggers and HRQL. Results A total of 527 children with a mean (SD) age of 12.1 (2.9) years were included. Children with a higher number of perceived triggers had significantly lower PAQLQ and RAND scores (ie poorer HRQL). The difference in PAQLQ scores was clinically relevant between children with 0 versus 3‐4 or ≥ 5 triggers and 1‐2 versus ≥ 5 triggers (mean difference 0.66, 1.02 and 0.63, respectively). Especially, non‐allergic triggers (physical exercise, the weather, (cigarette) smoke and emotions) were significantly associated with reduced PAQLQ scores. Emotions and food/drinks were associated with reduced RAND scores. Conclusion and Clinical Relevance A higher number of perceived triggers of asthma were associated with reduced HRQL in children with asthma. Especially, non‐allergic triggers were associated with reduced HRQL.
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Affiliation(s)
- Hannah M Kansen
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thuy-My Le
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yolanda Meijer
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cuno S P M Uiterwaal
- Julius Center for Health Science and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - André C Knulst
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Francine C van Erp
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
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10
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Hon KL, Bao YM, Chan KC, Chau KW, Chen RS, Cheok KTG, Chiu WK, Deng L, He CH, Ieong KM, Kung JSC, Lam P, Lam SYD, Lee QU, Lee SL, Leung TF, Leung TNH, Shi L, Siu KK, Tan WP, Wang MH, Wong TW, Wu BJ, Yip AYF, Zheng YJ, Ng DK. Determinants for asthma control, quality of life and use of complementary and alternative medicine in asthmatic pediatric patients in four cities. World J Pediatr 2018; 14:482-491. [PMID: 30047047 DOI: 10.1007/s12519-018-0167-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 05/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Asthma is a significant chronic health problem worldwide. Management aims at disease control by reducing functional impairment and exacerbations and improving quality of life (QoL). We report a multi-center study to survey asthma control and QoL in four cities in the Pearl River Delta. METHODS The conjoint survey involved ten Hong Kong pediatric hospitals/units, two Shenzhen hospitals, two Macau hospitals, and two Guangzhou hospitals on asthma control (using Asthma Control Test) and QoL (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ). Acceptability of a treatment is graded as very good/good/fair/poor. RESULTS Good asthma control was only reported in 80% subjects in Hong Kong, but higher in sister cities (85-94%, P < 0.001). Allergic rhinitis, "incense burning", and "smoker in family" were prevalent among the four cities. Logistic regression showed better control of asthma was associated with better PADQLQ (B = - 0.029, P < 0.001), better acceptability of bronchodilator (B = - 1.488, P = 0.025), negatively with "smoker in family" (B = - 0.83, P = 0.015) and various PADQLQ domains. Conversely, worse PADQLQ was associated with allergic rhinitis severity (B = 4.77, P < 0.001), poor control of asthma (B = 7.56, P < 0.001), increased frequency of traditional Chinese medicine use (B = 1.7, P < 0.05), increased frequency of bronchodilator usage (B = 1.05, P < 0.05), "smoker in family" (B = 4.05, P < 0.05), and incense burning at home (B = 3.9, P < 0.05). CONCLUSIONS There are some clinical and cultural differences among the four southern Chinese cities within the Guangdong province. This study identifies potentially modifiable environmental and treatment factors associated with poor asthma control and QoL for health-care interventions. Having a smoker in the family is independently associated with poor asthma control and QoL.
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Affiliation(s)
- Kam Lun Hon
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China.
| | - Yan Min Bao
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen, 518026, China
| | - Kate C Chan
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Kin Wai Chau
- Hong Kong Society of Pediatric Respirology and Allergy, Hong Kong SAR, China.,Pediatric Respiratory and Sleep Disorders Center, Room 1315D, Argyle Centre Phase 1, 688 Nathan Road, Mongkok, Kowloon, Hong Kong SAR, China
| | - Rong-Shan Chen
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | | | - Wa Keung Chiu
- Department of Pediatrics and Adolescent Medicine, United Christian Hospital, 130, Hip Wo Street, Kwun Tong, Hong Kong SAR, China
| | - Li Deng
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Chun-Hui He
- Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Kin Mui Ieong
- Department of Pediatrics, Central Hospital Conde S. Januario, Macau, China
| | - Jeng Sum C Kung
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Ping Lam
- Department of Pediatrics and Adolescent Medicine, Caritas Medical Center, 111, Wing Hong Street, Sham Shui Po, Hong Kong SAR, China
| | - Shu Yan David Lam
- Department of Pediatrics and Adolescent Medicine, Tuen Mun Hospital, 23 Tsing Chung Koon Road,Tuen Mun, New Territories, Hong Kong SAR, China
| | - Qun Ui Lee
- Department of Pediatrics and Adolescent Medicine, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Lai Chi Kok, Kowloon, Hong Kong SAR, China
| | - So Lun Lee
- Department of Pediatrics and Adolescent Medicine, Queen Mary Hospital, 102, Pokfulam Road, Hong Kong SAR, China.,Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ting Fan Leung
- Department of Pediatrics, The Chinese University of Hong Kong 6/F Prince of Wales Hospital, Room 84042, Shatin, N.T, Hong Kong SAR, China
| | - Theresa N H Leung
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chaiwan, Hong Kong SAR, China.,Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian, Shenzhen, China
| | - Lei Shi
- Department of Pediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chaiwan, Hong Kong SAR, China
| | - Ka Ka Siu
- Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, 1, Haiyuan 1st Road, Futian, Shenzhen, China
| | - Wei-Ping Tan
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
| | - Maggie Haitian Wang
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.,JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tak Wai Wong
- Department of Pediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, 11, Chuen On Road, Tai Po, Hong Kong SAR, China
| | - Bao-Jing Wu
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Ada Y F Yip
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
| | - Yue-Jie Zheng
- Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen, 518026, China
| | - Daniel K Ng
- Department of Pediatrics and Adolescent Medicine, Kwong Wah Hospital, 25 Waterloo Road, KLN Hong Kong SAR, China
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11
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Sterner T, Uldahl A, Svensson Å, Björk J, Svedman C, Nielsen C, Tunsäter A, Bruze M, Kiotseridis H. The Southern Sweden Adolescent Allergy-Cohort: Prevalence of allergic diseases and cross-sectional associations with individual and social factors. J Asthma 2018; 56:227-235. [PMID: 29621411 DOI: 10.1080/02770903.2018.1452033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Asthma and allergic diseases are the most frequent chronic diseases in childhood worldwide, and considered a burden for the affected children and their families. The diseases impose an economic burden on society if not diagnosed and treated properly and management of and these diseases are challenging for healthcare professionals. The aim of the present investigation was to assess the prevalence of allergic diseases in an unselected cohort of adolescents in southern Sweden. Additionally, associations with sociodemographic factors were investigated, as well as impact on daily life. METHODS This cross-sectional study was based on a cohort of n = 1 530 school children, aged 13 to 14, from 13 municipalities in southern Sweden. Data were collected through web-based questionnaires. RESULTS Of all children 32% reported at least one allergic disease. 67% reported one allergic disease and 33% reported more than one. No allergy-related disease were reported by 68%. Current asthma was reported by 9.8% and current rhino-conjunctivitis was reported by 13%. The prevalence of food hypersensitivity was 12% and the prevalence of eczema was 11%. One to three wheezing attacks were reported from 55% and 40% reported more than four attacks of wheezing in the preceding year. The self-reported allergic diseases were diagnosed by a doctor in; 36% (food hypersensitivity) to 69% (rhinoconjunctivitis) of the cases. CONCLUSIONS A high number of affected children were identified. Some children being undiagnosed and some not receiving satisfactory treatment. These results suggest that additional studies to evaluate treatment procedures in order to improve healthcare for allergic children are warranted.
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Affiliation(s)
- Therese Sterner
- a Department of Clinical Sciences , Lunds Universitet , Malmö , Lund , Sweden.,b Department of Dermatology , Skåne University Hospital , Malmö , Sweden.,c Skåne Regional Council , Competence Center of Allergy, Asthma and COPD , Lund , Sweden
| | - Ada Uldahl
- a Department of Clinical Sciences , Lunds Universitet , Malmö , Lund , Sweden.,b Department of Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Åke Svensson
- b Department of Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Jonas Björk
- d Department of Occupational and Environmental Medicine , Lunds Universitet , Lund , Sweden
| | - Cecilia Svedman
- e Department of Occupational and Environmental Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Christel Nielsen
- d Department of Occupational and Environmental Medicine , Lunds Universitet , Lund , Sweden
| | - Alf Tunsäter
- f Respiratory Medicine and Allergology , Medical Sciences, Lunds university , Sweden
| | - Magnus Bruze
- e Department of Occupational and Environmental Dermatology , Skåne University Hospital , Malmö , Sweden
| | - Hampus Kiotseridis
- c Skåne Regional Council , Competence Center of Allergy, Asthma and COPD , Lund , Sweden
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12
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Abstract
BACKGROUND Asthma exacerbations in school-aged children peak in autumn, shortly after children return to school following the summer holiday. This might reflect a combination of risk factors, including poor treatment adherence, increased allergen and viral exposure, and altered immune tolerance. Since this peak is predictable, interventions targeting modifiable risk factors might reduce exacerbation-associated morbidity and strain upon health resources. The peak occurs in September in the Northern Hemisphere and in February in the Southern Hemisphere. OBJECTIVES To assess the effects of pharmacotherapy and behavioural interventions enacted in anticipation of school return during autumn that are designed to reduce asthma exacerbations in children during this period. SEARCH METHODS We searched the Cochrane Airways Group Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, reference lists of primary studies and existing reviews, and manufacturers' trial registries (Merck, Novartis and Ono Parmaceuticals). We searched databases from their inception to 1 December 2017, and imposed no restriction on language of publication. SELECTION CRITERIA We included all randomised controlled trials comparing interventions aimed specifically at reducing autumn exacerbations with usual care, (no systematic change in management in preparation for school return). We included studies providing data on children aged 18 years or younger. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened records identified by the search and then extracted data and assessed bias for trials meeting the inclusion criteria. A third review author checked for accuracy and mediated consensus on disagreements. The primary outcome was proportion of children experiencing one or more asthma exacerbations requiring hospitalisation or oral corticosteroids during the autumn period. MAIN RESULTS Our searches returned 546 trials, of which five met our inclusion criteria. These studies randomised 14,252 children to receive either an intervention or usual care. All studies were conducted in the Northern Hemisphere. Three interventions used a leukotriene receptor antagonist, one used omalizumab or a boost of inhaled corticosteroids, and the largest study, (12,179 children), used a medication reminder letter. Whilst the risk of bias within individual studies was generally low, we downgraded the evidence quality due to imprecision associated with low participant numbers, poor consistency between studies, and indirect outcome ascertainment.A US study of 513 children with mild/severe asthma and allergic sensitisation was the only study to provide data for our primary outcome. In this study, the proportion of participants experiencing an exacerbation requiring oral corticosteroids or hospital admission in the 90 days after school return was significantly reduced to 11.3% in those receiving omalizumab compared to 21.0% in those receiving placebo (odds ratio 0.48, 95% confidence interval 0.25 to 0.92, moderate-quality evidence). The remaining studies used alternative exacerbation definitions. When data from two leukotriene receptor antagonist studies with comparable outcomes were combined in a random-effects model, there was no evidence of an effect upon exacerbations. There was no evidence that a seasonal medication reminder letter decreased unscheduled contacts for a respiratory diagnosis between September and December.Four studies recorded adverse events. There was no evidence that the proportion of participants experiencing at least one adverse event differed between intervention and usual care groups. Lack of data prevented planned subgroup and sensitivity analyses. AUTHORS' CONCLUSIONS Seasonal omalizumab treatment from four to six weeks before school return might reduce autumn asthma exacerbations. We found no evidence that this strategy is associated with increased adverse effects other than injection site pain, but it is costly. There were no data upon which to judge the effect of this or other seasonal interventions on asthma control, quality of life, or asthma-related death. In future studies definitions of exacerbations should be provided, and standardised where possible. To investigate possible differential effects according to subgroup, participants in future trials should be well characterised with respect to baseline asthma severity and exacerbation history in addition to age and gender.
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Affiliation(s)
- Katharine C Pike
- UCL Great Ormond Street Institute of Child HealthRespiratory, Critical Care & AnaesthesiaLondonUK
| | - Melika Akhbari
- King's College LondonGKT School of Medical EducationLondonUK
| | - Dylan Kneale
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
| | - Katherine M Harris
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
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13
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Kiotseridis H, Arvidsson P, Backer V, Braendholt V, Tunsäter A. Adherence and quality of life in adults and children during 3-years of SLIT treatment with Grazax-a real life study. NPJ Prim Care Respir Med 2018; 28:4. [PMID: 29434271 PMCID: PMC5809499 DOI: 10.1038/s41533-018-0072-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/06/2017] [Accepted: 01/02/2018] [Indexed: 12/28/2022] Open
Abstract
Respiratory allergic disease represents a global health problem, 30% of the population suffers from allergic rhinoconjunctivitis and 20% suffer from asthma. Allergy immunotherapy induce immunological tolerance and thereby modify the response to allergens and sublingual immunotherapy (SLIT) offers the possibility of home administration of allergen therapy, but adherence is more uncertain. The aim of the study was to investigate the adherence with GRAZAX in adults and children ≥ 5 years during three consecutive years of treatment. This was a non-interventional, prospective, observational, multi-center, open-label study to investigate adherence, quality of life, safety and tolerability of GRAZAX in adult and pediatric patients in a real-life setting. During the 3-years study period estimation of adherence was done regularly. Quality of life as well as symptom score was also assessed. In total, 399 patients (236 adults and 163 children) were included in the study. At baseline, 100% suffered from moderate-severe eyes and nose symptoms, and 31% had asthma in the grass pollen season. Overall, 55% completed a 3-years treatment period, whereas 37% stopped before end of study and 8% were lost to follow up. After 3 years, the adherence rate decreased from 98.2% (first month), 93.7% (first year), 93.2% (second year) and 88.9% (third year) and adverse events were the main reason for pre-term termination. The study suggests a good adherence to treatment in a real life setting among the patients finalizing 3-years SLIT therapy. The treatment was effective both on symptoms and HRQL. A three-year trial of the allergy immunotherapy GRAZAX shows good adherence and tolerance among adults and children. Respiratory allergic disease is a significant global health burden, with 30 per cent of Europe’s population suffering from hayfever and 20 per cent from allergic asthma. While antihistamines and steroids can treat symptoms successfully, they do not tackle the underlying allergy. Recent progress in immunotherapies such as GRAZAX—a therapy specifically targeting grass pollen allergy—have shown promise. Hampus Kiotseridis at Lund University, Sweden, and co-workers tracked patient adherence and health in 399 adults and children taking GRAZAX over three years. 55 per cent of patients completed the study treatment, with 85 per cent taking GRAZAX six to seven times a week. GRAZAX proved to be well-tolerated overall, effectively tackling symptoms and improving patients’ quality of life.
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Affiliation(s)
- Hampus Kiotseridis
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden.
| | | | - Vibeke Backer
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vagn Braendholt
- Vagn Braendholt, Department of medicine, Holbæk Sygehus, Holbæk, Denmark
| | - Alf Tunsäter
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
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14
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Perikleous E, Steiropoulos P, Nena E, Iordanidou M, Tzouvelekis A, Chatzimichael A, Paraskakis E. Association of Asthma and Allergic Rhinitis With Sleep-Disordered Breathing in Childhood. Front Pediatr 2018; 6:250. [PMID: 30255006 PMCID: PMC6141753 DOI: 10.3389/fped.2018.00250] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/24/2018] [Indexed: 11/20/2022] Open
Abstract
Objective: Asthma and allergic rhinitis (AR) are the most common chronic conditions in childhood and have previously been linked to sleep-related breathing disorder (SRBD). Aim of the study was to examine the association between SRBD risk and asthma control in children with asthma and with or without AR. Methods: The assessment of FeNO and pulmonary function tests were performed in 140 children (65 with asthma, 57 with both asthma, and AR, 18 with only AR). Children with asthma completed the childhood Asthma Control Test (c-ACT), and the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (PSQ). C-ACT scores ≤ 19 are indicative of poor asthma control whereas SRBD from PSQ scores ≥ 0.33 are suggestive of high risk for SRBD. Results: Mean age ± SD was 7.8 ± 3.1 years. Mean PSQ ± SD and c-ACT ± SD scores were 0.17 ± 0.14 and 24.9 ± 3.2, respectively. High risk for SRBD was identified in 26 children. Children at high risk for SRBD had significantly decreased c-ACT score (P = 0.048), verified by a negative association between c-ACT and PSQ-SRBD scores (r = -0.356, P < 0.001). Additionally a difference in diagnosis distribution between children at high or low risk for SRBD was observed. More specifically, among children at high risk, 88.5% were diagnosed with both atopic conditions, while this percentage among children at low risk was 29.8%. Asthma was mainly diagnosed in the latter group (P < 0.001). Conclusions: Poor asthma control is associated with SRBD. The presence of AR in children with asthma seems to increase the prevalence of SRBD in that particular population, requiring further investigation toward this direction.
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Affiliation(s)
- Evanthia Perikleous
- Master Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paschalis Steiropoulos
- Master Program in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Iordanidou
- Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Argyrios Tzouvelekis
- Division of Immunology, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Athanasios Chatzimichael
- Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Emmanouil Paraskakis
- Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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15
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Smith H, Horney D, Jones C, Goubet S, Mukhopadhyay S, Frew A. Pragmatic randomized controlled trial of an allergy intervention for children aged 6-16 with asthma and rhinitis in general practice. Clin Exp Allergy 2017; 46:1227-35. [PMID: 27438431 DOI: 10.1111/cea.12781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is widely believed that for allergic rhinitis and asthma, avoidance of specific triggers can improve symptom control. Whilst many children with asthma or rhinitis are sensitized to airborne allergens, primary care diagnostic and management decisions are often made without a detailed history of the allergic triggers or allergy testing. Thus, treatment decisions are empirical and allergen avoidance advice is either not given or, if given, not tailored to the child's sensitivities. OBJECTIVE To ascertain whether allergy assessment and tailored advice in general practice enhances outcomes of children with asthma and rhinitis. METHOD Pragmatic RCT of allergy intervention (structured allergy history, skin prick testing and appropriate allergy avoidance advice) vs. usual care in children with asthma and/or rhinoconjunctivitis. A blinded observer assessed outcomes at 12 months. Main outcome measures were symptom scores and disease-specific health-related QoL. Secondary outcomes were healthcare utilization, days unable to pursue usual activities and self-rated improvement. RESULTS A total of 335 participants were randomized to formal allergy assessment or normal care. There were no differences in participants' demographic or clinical characteristics at baseline (all P > 0.05). At 12 months, participants receiving the allergy intervention had fewer rhinitis symptoms (MD - 3.14, 95% CI - 6.01, - 0.81) and an improvement in QoL (MD - 0.50, 95% CI 0.32, 0.68). There were no significant changes in asthma symptoms, healthcare utilization or number of days unable to pursue usual activities. CONCLUSION Amongst children with known asthma and/or rhinitis in primary care, taking a structured allergy history with skin prick testing and tailored advice on allergy avoidance resulted in reduced symptoms of rhinitis and improved QoL.
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Affiliation(s)
- H Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - D Horney
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - C Jones
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - S Goubet
- Clinical Investigation Research Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - S Mukhopadhyay
- Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
| | - A Frew
- Department of Allergy & Respiratory Medicine, Royal Sussex County Hospital, Brighton, UK
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16
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Abstract
BACKGROUND Asthma is a common chronic disease in both adults and children. Inhaled corticosteroids (ICS) and β2-agonists are the major medications treating asthma with many side effects. Acupuncture has been used in many diseases including asthma. We aim to assess the efficacy and safety of acupuncture for asthma. METHODS The following electronical databases will be searched from inception to January 1, 2017: Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), SinoMed, the China National Knowledge Infrastructure Database (CNKI), the Chinese Scientific Journal Database (VIP database), and the Wanfang database. We will also search reference lists of identified studies, potential gray literatures, relevant conference abstracts, and registers of clinical trials. Two reviewers will independently undertake study selection, data extraction, and quality assessment. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. Changes in lung function will be assessed as the primary outcome. The level of control, medication usage, quality of life, exacerbations, symptoms, adverse events will be evaluated as the secondary outcomes. The RevMan V.5.3.5 will be employed for meta-analysis. Continuous outcomes will be presented as mean difference or standard mean difference, while dichotomous data will be expressed as relative risk. RESULTS This study will provide a high-quality synthesis of current evidence of acupuncture for asthma from several aspects including lung function, the level of control, medication usage, quality of life, exacerbations, symptoms and adverse events. CONCLUSION The conclusion of our study will provide updated evidence to judge whether acupuncture is an effective intervention for children with asthma. ETHICS AND DISSEMINATION It is not necessary for ethical approval because individuals cannot be identified. The protocol will be disseminated in a peer-reviewed journal or presented at a relevant conference. PROSPERO REGISTRATION NUMBER PROSPERO CRD42017054562.
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Affiliation(s)
- Meng Li
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Xing Zhang
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Haipeng Bao
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Chunlei Li
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Peitong Zhang
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
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17
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Borres N, Nilsson N, Drake I, Sjölander S, Nilsson C, Hedlin G, Nordlund B. Parents' perceptions are that their child's health-related quality of life is more impaired when they have a wheat rather than a grass allergy. Acta Paediatr 2017; 106:478-484. [PMID: 27925295 DOI: 10.1111/apa.13688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 11/01/2016] [Accepted: 11/28/2016] [Indexed: 11/29/2022]
Abstract
AIM It is unknown whether food allergies have greater impact on quality of life than respiratory allergies. This study compared health-related quality of life (HRQoL) in children allergic to wheat or grass. METHODS We surveyed 63 children with wheat allergies (median age of five) and 72 with grass allergies (median age 12), with their parents. The Child Health Questionnaires for parents (CHQ-PF28) and children (CHQ-CF87) were applied. RESULTS The parents of children in the wheat group recorded significantly lower CHQ-PF28 scores for the impact of their child's allergy on general behaviour, general health perceptions, parental impact of emotions and time and family activities, than the parents of children with grass allergies (p values ≤0.001). However, parents in the grass group recorded lower scores for the change in health item than the parents of children with wheat allergies (p = 0.020). In the grass group, children and parents reported similar scores for the different questions, but there was poorer correlation between parents and children in the wheat allergy group. CONCLUSION HRQoL was lower in children with wheat than grass allergies according to parental reports, with more consistent perceptions of HRQoL among parents and children in the grass allergy than wheat allergy group.
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Affiliation(s)
- Nora Borres
- Department of Clinical Science; Medical Faculty; University of Lund; Malmö Sweden
| | - Nora Nilsson
- Department of Women's and Children's Health; Division for Lung Allergology; Karolinska Institutet; Stockholm Sweden
- Astrid Lindgren Children's Hospital; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - Isabel Drake
- Department of Clinical Science; Medical Faculty; University of Lund; Malmö Sweden
| | | | - Caroline Nilsson
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet and Sacchska Children's Hospital; Stockholm Sweden
| | - Gunilla Hedlin
- Department of Women's and Children's Health; Division for Lung Allergology; Karolinska Institutet; Stockholm Sweden
- Astrid Lindgren Children's Hospital; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - Björn Nordlund
- Department of Women's and Children's Health; Division for Lung Allergology; Karolinska Institutet; Stockholm Sweden
- Astrid Lindgren Children's Hospital; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
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18
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Interventions for autumn exacerbations of asthma in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Petersson C, Huus K, Åkesson K, Enskär K. Children's experiences about a structured assessment of health-related quality of life during a patient encounter. Child Care Health Dev 2016; 42:424-32. [PMID: 26888733 DOI: 10.1111/cch.12324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/04/2015] [Accepted: 01/02/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has been stated that care for children with chronic health conditions tends to focus on condition-specific issues rather than how these children experience their health and everyday life functioning. AIM The aim of this study was to explore children's experiences about a structured assessment of health-related quality of life applied during a patient encounter. METHODS Prior to the start of the study, a clinical intervention based on the questionnaire DISABKIDS Chronic Generic Measure (DCGM-37) was performed. A qualitative explorative design was chosen, and 25 children between 10-17 years of age were interviewed after the consultation at four different paediatric outpatient clinics. Data were analysed according to qualitative content analysis. RESULTS The results were twofold: children experienced that the assessment was providing them with insights about their health, which motivated them to make lifestyle changes. When outcomes were discussed and requested, the children felt encouraged. CONCLUSIONS The use of an assessment of health-related quality of life may promote insights about health and encourage children with chronic health conditions to discuss their outcomes with healthcare professionals.
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Affiliation(s)
- C Petersson
- School of Health and Welfare, Research School of Health and Welfare, Jönköping University and The Jönköping Academy for Improvement of Health and welfare, CHILD Research Group, Jönköping, Sweden
| | - K Huus
- School of Health and Welfare, Research School of Health and Welfare, Jönköping University and The Jönköping Academy for Improvement of Health and welfare, CHILD Research Group, Jönköping, Sweden.,Department of Nursing, School of Health and Welfare, Jönköping University, Sweden
| | - K Åkesson
- School of Health and Welfare, Research School of Health and Welfare, Jönköping University and The Jönköping Academy for Improvement of Health and welfare, CHILD Research Group, Jönköping, Sweden.,The Jönköping Academy for Improvement of Health and welfare, Jönköping University and Futurum, Academy for Health and Care, Jönköping County, Sweden
| | - K Enskär
- Department of Nursing, School of Health and Welfare, Jönköping University, Sweden
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Abstract
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. However, to date there is limited evidence on how to monitor patients with asthma. Childhood asthma introduces specific challenges in terms of deciding what, when, how often, by whom and in whom different assessments of asthma should be performed. The age of the child, the fluctuating course of asthma severity, variability in clinical presentation, exacerbations, comorbidities, socioeconomic and psychosocial factors, and environmental exposures may all influence disease activity and, hence, monitoring strategies. These factors will be addressed in herein. We identified large knowledge gaps in the effects of different monitoring strategies in children with asthma. Studies into monitoring strategies are urgently needed, preferably in collaborative paediatric studies across countries and healthcare systems. Monitoring asthma in children is essential for disease control and should reflect age, triggers and disease activityhttp://ow.ly/J0k7f
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Affiliation(s)
- Karin C Lødrup Carlsen
- Dept of Paediatrics, Oslo University Hospital, Oslo, Norway Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mariëlle W Pijnenburg
- Dept of Paediatric/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
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21
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Rottier BL, Eber E, Hedlin G, Turner S, Wooler E, Mantzourani E, Kulkarni N. Monitoring asthma in childhood: management-related issues. Eur Respir Rev 2016; 24:194-203. [PMID: 26028632 PMCID: PMC9487817 DOI: 10.1183/16000617.00003814] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Management-related issues are an important aspect of monitoring asthma in children in clinical practice. This review summarises the literature on practical aspects of monitoring including adherence to treatment, inhalation technique, ongoing exposure to allergens and irritants, comorbid conditions and side-effects of treatment, as agreed by the European Respiratory Society Task Force on Monitoring Asthma in Childhood. The evidence indicates that it is important to discuss adherence to treatment in a non-confrontational way at every clinic visit, and take into account a patient's illness and medication beliefs. All task force members teach inhalation techniques at least twice when introducing a new inhalation device and then at least annually. Exposure to second-hand tobacco smoke, combustion-derived air pollutants, house dust mites, fungal spores, pollens and pet dander deserve regular attention during follow-up according to most task force members. In addition, allergic rhinitis should be considered as a cause for poor asthma control. Task force members do not screen for gastro-oesophageal reflux and food allergy. Height and weight are generally measured at least annually to identify individuals who are susceptible to adrenal suppression and to calculate body mass index, even though causality between obesity and asthma has not been established. In cases of poor asthma control, before stepping up treatment the above aspects of monitoring deserve closer attention. ERS review summarising and discussing the management-related issues regarding the monitoring of asthma in childhoodhttp://ow.ly/JfjGs
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Affiliation(s)
- Bart L Rottier
- Dept of Pediatric Pulmonology and Allergology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Gunilla Hedlin
- Dept of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Steve Turner
- Dept of Paediatrics, University of Aberdeen, Aberdeen, UK
| | | | - Eva Mantzourani
- Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Neeta Kulkarni
- Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
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22
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Pijnenburg MW, Baraldi E, Brand PLP, Carlsen KH, Eber E, Frischer T, Hedlin G, Kulkarni N, Lex C, Mäkelä MJ, Mantzouranis E, Moeller A, Pavord I, Piacentini G, Price D, Rottier BL, Saglani S, Sly PD, Szefler SJ, Tonia T, Turner S, Wooler E, Lødrup Carlsen KC. Monitoring asthma in children. Eur Respir J 2015; 45:906-25. [PMID: 25745042 DOI: 10.1183/09031936.00088814] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma. 22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus. This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised. Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence.
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Affiliation(s)
- Mariëlle W Pijnenburg
- Dept of Paediatrics/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Eugenio Baraldi
- Women's and Children's Health Dept, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy
| | - Paul L P Brand
- Dept of Paediatrics/Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Kai-Håkon Carlsen
- Dept of Paediatrics, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Frischer
- Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria
| | - Gunilla Hedlin
- Depart of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Neeta Kulkarni
- Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Pediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Eva Mantzouranis
- Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ian Pavord
- Dept of Respiratory Medicine, University of Oxford, Oxford, UK
| | - Giorgio Piacentini
- Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - David Price
- Dept of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Bart L Rottier
- Dept of Pediatric Pulmonology and Allergology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sejal Saglani
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Denver, USA
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Steve Turner
- Dept of Paediatrics, University of Aberdeen, Aberdeen, UK
| | | | - Karin C Lødrup Carlsen
- Dept of Paediatrics, Women and Children's Division, Oslo University Hospital, Oslo, Norway Dept of Paediatrics, Faculty of Medicine, University of Oslo, Oslo, Norway
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Efficacy and safety of beclomethasone dipropionate nasal aerosol in pediatric patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2013; 111:408-414.e1. [PMID: 24125150 DOI: 10.1016/j.anai.2013.07.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 06/04/2013] [Accepted: 07/26/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aerosolized intranasal corticosteroid formulations are desirable for many patients with allergic rhinitis (AR), especially children, who wish to avoid the "wet feeling" and "drip down the throat" associated with aqueous formulations. Beclomethasone dipropionate (BDP) hydrofluoroalkane nasal aerosol has been shown to be safe and effective in adolescents and adults with AR. OBJECTIVE To evaluate the efficacy and safety of BDP nasal aerosol in pediatric patients with moderate to severe seasonal AR. METHODS In this double-blinded, placebo-controlled study, children (6-11 years of age) with seasonal AR were randomized to once-daily treatment with BDP nasal aerosol 80 μg (n = 239) or 160 μg (n = 242) or placebo (n = 234). The primary end point was change from baseline in average morning and evening reflective total nasal symptom score over the 2-week treatment period. RESULTS Treatment with BDP nasal aerosol showed significantly greater improvements in average morning and evening reflective total nasal symptom score vs placebo (80 μg, -0.71; 160 μg, -0.76; P < .001 for the 2 comparisons). Similarly, significantly greater improvements in average morning and evening instantaneous total nasal symptom score were seen with BDP nasal aerosol vs placebo (80 μg, -0.63; 160 μg, -0.73; P < .001 for the 2 comparisons). The incidence of adverse events from BDP nasal aerosol was comparable to that from placebo. CONCLUSION BDP nasal aerosol (80 or 160 μg/d) provided significant and clinically meaningful nasal symptom relief and an established overall safety profile similar to that of placebo, suggesting that it is an effective and well-tolerated treatment option for pediatric patients with moderate to severe seasonal AR. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT012073190.
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Kiotseridis H, Cilio CM, Bjermer L, Tunsäter A, Jacobsson H, Dahl A. Grass pollen allergy in children and adolescents-symptoms, health related quality of life and the value of pollen prognosis. Clin Transl Allergy 2013; 3:19. [PMID: 23799882 PMCID: PMC3699361 DOI: 10.1186/2045-7022-3-19] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/03/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION An association between pollen count (Poaceae) and symptoms is well known, but to a lesser degree the importance of priming and lag effects. Also, threshold levels for changes in symptom severity need to be validated. The present study aims to investigate the relationship between pollen counts, symptoms and health related quality of life (HRQL), and to validate thresholds levels, useful in public pollen warnings. MATERIAL AND METHODS Children aged 7-18 with grass pollen allergy filled out a symptom diary during the pollen season for nose, eyes and lung symptoms, as well as a HRQL questionnaire every week. Pollen counts were monitored using a volumetric spore trap. RESULTS 89 (91%) of the included 98 children completed the study. There was a clear association between pollen count, symptom severity and HRQL during the whole pollen season, but no difference in this respect between early and late pollen season. There was a lag effect of 1-3 days after pollen exposure except for lung symptoms. We found only two threshold levels, at 30 and 80 pollen grains/m(3) for the total symptom score, not three as is used today. The nose and eyes reacted to low doses, but for the lung symptoms, symptom strength did hardly change until 50 pollen grains/m(3). CONCLUSION Grass pollen has an effect on symptoms and HRQL, lasting up to 5 days after exposure. Symptoms from the lungs appear to have higher threshold levels than the eyes and the nose. Overall symptom severity does not appear to change during the course of season. Threshold levels need to be revised. We suggest a traffic light model for public pollen warnings directed to children, where green signifies "no problem", yellow signifies "can be problems, especially if you are highly sensitive" and red signifies "alert - take action".
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Affiliation(s)
- Hampus Kiotseridis
- Pediatric Clinic, Malmö, Skåne University Hospital, Lund University, Lund, Sweden ; Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Corrado M Cilio
- Pediatric Clinic, Malmö, Skåne University Hospital, Lund University, Lund, Sweden
| | - Leif Bjermer
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Alf Tunsäter
- Departments of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Helene Jacobsson
- Competence Centre for Clinical Research, Skåne University Hospital, Lund, Sweden
| | - Aslög Dahl
- Departments of Biological and Environmental Sciences, Gothenburg University, Gothenburg, Sweden
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