Recent advances on diagnosis and management of childhood asthma and food allergies

Traditional Chinese Medicine Based Acupoint Application for Asthma Treatment in Children: A Meta-Analysis and Systematic Review

Objective

By conducting a systematic review of the efficacy of acupoint application on children with asthma.

Methods

We searched Chinese databases (CNKI, VIP, and Wanfang) and English databases (PubMed, Embase, and Cochrane Library) for studies from the establishment of the database to October 2021. The included literature studies were randomized control studies investigating the treatment of asthma in children by acupoint application. The primary outcomes included the cure rate, the resolution time of cough, and the resolution time of wheezing. The secondary outcomes included pulmonary function and interleukins. Stata 15 and RevMan 5.4 were used to analyze the extracted data.

Results

A total of 24 related studies were included containing 2716 cases. The meta-analysis showed that TCM group was superior to control group in terms of cure rate, pulmonary function (FEV1), and resolution time of wheezing in children with asthma [RR = 1.26,95% (1.21,1.31), P < 0.05; SMD = 0.81, 95%CI (0.05,1.56), P < 0.05; WMD = -1.40, 95%CI (-1.75, -1.05), P < 0.05].

Conclusions

The present study shows that acupoint application is an effective treatment for children with asthma in China, especially in alleviating wheezing and improving quality of life.

Retrospective definition of reaction risk in Italian children with peanut, hazelnut and walnut allergy through component-resolved diagnosis

BACKGROUND

Serum IgE evaluation of peanut, hazelnut and walnut allergens through the use of component-resolved diagnosis (CRD) can be more accurate than IgE against whole food to associate with severe or mild reactions.

OBJECTIVES

The aim of the study was to retrospectively define the level of reaction risk in children with peanut, hazelnut and walnut sensitization through the use of CRD.

METHODS

34 patients [n=22 males, 65%; median age eight years, interquartile range (IQR) 5.0-11.0 years] with a reported history of reactions to peanut and/or hazelnut and/or walnut had their serum analyzed for specific IgE (s-IgE) by ImmunoCAP^® and ISAC^® microarray technique.

RESULTS

In children with previous reactions to peanut, the positivity of Arah1 and Arah2 s-IgE was associated with a history of anaphylaxis to such food, while the positivity of Arah8 s-IgE were associated with mild reactions. Regarding hazelnut, the presence of positive Cora9 and, particularly, Cora14 s-IgE was associated with a history of anaphylaxis, while positive Cora1.0401 s-IgE were associated with mild reactions. Concerning walnut, the presence of positive Jug r 1, Jug r 2, Jug r 3 s-IgE was associated with a history of anaphylaxis to such food. ImmmunoCAP^® proved to be more useful in retrospectively defining the risk of hazelnut anaphylaxis, because of the possibility of measuring Cor a14 s-IgE.

CONCLUSIONS

Our data show that the use of CRD in patients with allergy to peanut, hazelnut and walnut could allow for greater accuracy in retrospectively defining the risk of anaphylactic reaction to such foods.

Evaluation of the improvement effect of laser acupuncture biostimulation in asthmatic children by exhaled inflammatory biomarker level of nitric oxide

Variable therapy of asthma is not sufficient yet to achieve good asthma control. Therapy decision requires serial investigations. Low-level laser acupuncture is a suitable non-invasive modality of complementary medicine. The exhaled breath condensate (EBC) is easy and useful to evaluate the efficacy of drugs or novel therapy. This study aimed to evaluate the effectiveness of low-level laser biostimulation of acupuncture points on asthma improvement in children. Forty-eight asthmatic children were subdivided into case (laser) group, which received 12 direct contact low-power laser acupuncture sessions (three sessions/week) on specific traditional Chinese acupuncture points for bronchial asthma, and control asthmatic group, which received sham laser acupuncture on the same acupoints and number of sessions of the case (laser) group. Low-power Multichannel Aculas-AM laser (grade II) of wave length 780 nm, output power 800 mw, and beam spot size 0.1 cm² with continuous mode was used. Eighteen acupoints were stimulated for 2 min, giving energy of 9.6 J/cm²/acupoint. The total session time was 3 min. Both groups were evaluated pre- and post-laser acupuncture intervention by recording levels of asthma control, pulmonary function, and EBC nitric oxide. In the case (laser) group, 91.7 % of patients experienced an improvement in the level of asthma control versus 25 % in the control group (p < 0.001). This was associated with a significant decrease of the breath condensate FENO concentration (p < 0.001) and significant increase of spirometry parameters (p < 0.001) in the case (laser) group. Application of laser acupuncture treatment given with conventional therapy can effectively improve bronchial asthma more than prescription of medications alone could.

Efficacy of acupuncture in children with asthma: a systematic review

Background

We performed a systematic review of the efficacy of various types of acupuncture in the treatment of asthma in children.

Methods

We searched the MEDLINE, Embase, and Cochrane Library databases up to October 20, 2014. Randomized controlled trials (RCTs) of children and adolescents (<18 years of age) with asthma were included. Data extraction was applied, and methodologic quality was assessed.

Results

A total of 32 articles were assessed for eligibility, and seven studies comprising 410 patients were included in the systematic review. Two RCTs showed significant improvement in peak expiratory flow (PEF) variability for acupuncture (traditional and laser) vs. control, with one showing significant improvement in asthma-specific anxiety level, but no significant differences in other lung function parameters or quality of life. Another RCT reported significant benefits of laser acupuncture on lung function parameters but did not describe or report statistical analyses. One crossover RCT showed significant improvements in response to both acupuncture and placebo acupuncture, with better improvements with acupuncture compared to placebo acupuncture (forced exhaled volume in 1 s [FEV₁], PEF). Two additional crossover RCTs showed no significant differences between single sessions of laser acupuncture and placebo acupuncture on baseline, postacupuncture, and postinduced bronchoconstriction values (% predicted FEV₁, maximum expiratory flow). A recent study showed a significant effect of acupuncture paired with acupressure on medication use and symptoms in preschool-age children. Methodologic and reporting variability remains an issue. However, the results suggest that acupuncture may have a beneficial effect on PEF or PEF variability in children with asthma.

Conclusions

The efficacy of acupuncture on other outcome measures is unclear. Large-scale RCTs are needed to further assess the efficacy of acupuncture in the treatment of asthma in children.

Mast cells' integrated actions with eosinophils and fibroblasts in allergic inflammation: implications for therapy

Mast cells (MCs) and eosinophils (Eos) are the key players in the development of allergic inflammation (AI). Their cross-talk, named the Allergic Effector Unit (AEU), takes place through an array of soluble mediators and ligands/receptors interactions that enhance the functions of both the cells. One of the salient features of the AEU is the CD48/2B4 receptor/ligand binding complex. Furthermore, MCs and Eos have been demonstrated to play a role not only in AI but also in the modulation of its consequence, i.e., fibrosis/tissue remodeling, by directly influencing fibroblasts (FBs), the main target cells of these processes. In turn, FBs can regulate the survival, activity, and phenotype of both MCs and Eos. Therefore, a complex three players, MCs/Eos/FBs interaction, can take place in various stages of AI. The characterization of the soluble and physical mediated cross talk among these three cells might lead to the identification of both better and novel targets for the treatment of allergy and its tissue remodeling consequences.

Food allergies in school: design and evaluation of a teacher-oriented training action

Background

Food allergies are perceived as a significant problem in school environments; as a result, a teacher’s ability to recognise and deal with allergic reactions is of fundamental importance to protect children’s health. This paper includes the results of a study conducted for the purposes of designing, implementing and monitoring a specific set of teacher-oriented communication actions.

Methods

The study involved designing, implementing and assessing five workshops. These workshops were designed on the basis of the analysis of perceptions and information needs investigated by three focus groups (25 teachers). The level of the teachers’ knowledge and appreciation of the workshops was evaluated by using two structured questionnaires (n = 158).

Results

The teachers feel that they are insufficiently informed about food allergies; this knowledge gap is confirmed by an analysis of their knowledge before participating in the workshops. According to the teachers, the information which would be most useful to them has to do with the practical management of allergies in school. They feel that there is a lack of a professional contact person for precise and reliable information on health issues. The workshops seem to be appreciated as an information method. In addition, there appears to be a need to involve all children in awareness raising activities and education projects on this subject.

Conclusions

There is an urgent need for training actions on food allergies in Italian schools, in particular the communication of practical information regarding the management of allergies and emergencies. More communication between the medical and school staff is, in particular, advisable.