Airway disease and environmental aeroallergens in eczematics approaching adulthood

Atopic Dermatitis: Conventional and Integrative Medicine

Although Western medicine and ideas about atopic dermatitis (AD) have become popular in many Asian countries, local beliefs about the disease and its treatment often prevail. The multi- racial background of these countries as well as the influence of the diverse religions (such as Taoism and Ramadan) in these regions often lead to diverse belief systems about the causes of AD (such as the Chi concept, also known as the balance of yin and yang) and the types of treatment (e.g. herbal remedies, topical versus concoctions, and decoctions). In addition, many of the cultural practices are preserved among the Southeast Asian minorities residing in the United Kingdom and North America. Eastern treatments typically take a holistic approach to AD and emphasize the psychosomatic component of the disorder. This overview provides a summary of the difference between conventional, complementary, alternative, and integrative medicine in terms of epidemiology, aetiology, therapy, and prognosis in children with AD. There are a number of similarities in genetic and environmental factors in epidemiology and aetiology; however, differences exist in terms of the concept of management. Complementary and alternative medicine, traditional Chinese medicine, and integrative medicine usage are not only prevalent among the Asian population but are also becoming more popular and accepted in Western societies.

Quality of Life for Children with Allergic Skin Diseases

Allergic skin diseases are highly prevalent among children. Patients with allergic skin diseases experience sociopsychological and quality-of-life (QoL) burdens in excess of those in the general population. Children and their caregivers are especially vulnerable to the burden of many of the common allergic skin diseases. In the past few decades, researchers have developed a number of disease-specific scores and indices for the measurement of QoL for childhood skin diseases. Most of the research in this area has focused on atopic eczema and urticaria and less so on allergic contact dermatitis. We provide an overview of QoL and its assessment for these dermatologic conditions.

Outcome of status asthmaticus at a pediatric intensive care unit in Hong Kong

OBJECTIVES

To characterize the clinical course and outcome of children with status asthmaticus (SA) admitted to a pediatric intensive care unit (PICU) METHODS: All patients with SA who were admitted to a PICU from January 2003 to December 2018 were reviewed. Polymerase chain reaction (PCR) studies on nasopharyngeal aspirate for respiratory pathogens were performed from 2014 to 2018.

RESULTS

Sixty-seven SA admissions constituted 2.4% of total PICU admissions (n = 2788). Fifteen (22.4%) children required noninvasive ventilation (NIV), while 7 children (10%) required invasive mechanical ventilation. Nonadherence to prior asthma therapy was common. PCR was positive for enterorvirus/rhinovirus in 84% (16 out of 19) and for any virus in 95% of nasopharyngeal aspirate (NPA) samples of patients between 2014 and 2018. Over the 16-year period, increased utilization of ipratropium bromide, magnesium sulfate and NIV was noted (P < .05). Patients who required invasive mechanical ventilation had significantly higher heart rate, lower pH and longer PICU length of stay (LOS) when compared to nonintubated children (P < .05). There was no mortality, gender difference, or seasonal characteristics in these SA admissions. Median LOS in PICU was 2 days (interquartile range 1-3 days).

CONCLUSIONS

SA accounts for a small proportion of PICU admissions. LOS was short and prognosis generally good. Nonadherence to prior asthma therapy was common. The most common trigger is enterovirus/rhinovirus for children with severe asthma requiring PICU admission. A trend of increase in usage of ipratropium, magnesium sulfate and NIV was observed. Primary prevention and early treatment of exacerbation are the most important step in managing children with asthma. Regular follow-up to ensure compliance together with annual vaccination could possibly avoid PICU admissions.