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de Weger WW, Herpertz CEM, van der Meulen GN, Bangma H, Kastelijn W, van Lente L, Koppelman GH, Sprikkelman AB, Kamps AWA. Safe selection of children with a suspected food allergy to introduce peanut or tree nuts at home. Clin Exp Allergy 2024; 54:216-218. [PMID: 38240149 DOI: 10.1111/cea.14451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 03/07/2024]
Affiliation(s)
- W W de Weger
- Department of Paediatrics, Martini Hospital, Groningen, The Netherlands
- Department of Paediatric Pulmonology and Paediatric Allergology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - C E M Herpertz
- Department of Paediatrics, Martini Hospital, Groningen, The Netherlands
- Department of Dietetics, Martini Hospital, Groningen, The Netherlands
| | | | - H Bangma
- Department of Paediatrics, Martini Hospital, Groningen, The Netherlands
| | - W Kastelijn
- Department of Dietetics, Martini Hospital, Groningen, The Netherlands
| | - L van Lente
- Department of Epidemiology, Martini Hospital, Groningen, The Netherlands
| | - G H Koppelman
- Department of Paediatric Pulmonology and Paediatric Allergology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - A B Sprikkelman
- Department of Paediatric Pulmonology and Paediatric Allergology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - A W A Kamps
- Department of Paediatrics, Martini Hospital, Groningen, The Netherlands
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2
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Wijnakker R, van Maaren MS, Bode LGM, Bulatovic M, Hendriks BJC, Loogman MCM, Lutgens SPM, Middel A, Nieuwhof CMG, Roelofsen EE, Schoones JW, Sigaloff KCE, Sprikkelman AB, de Vrankrijker AMM, de Boer MGJ. The Dutch Working Party on Antibiotic Policy (SWAB) guideline for the approach to suspected antibiotic allergy. Clin Microbiol Infect 2023:S1198-743X(23)00178-7. [PMID: 37068548 DOI: 10.1016/j.cmi.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/28/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Prudent handling of reported antibiotic allergy is an important aspect of antibiotic stewardship. The Dutch Working Party on Antibiotic Policy (SWAB) constituted a multidisciplinary expert committee to provide evidence-based recommendations for bedside decision making in antibiotic therapy in patients that report an antibiotic allergy. METHODS The guideline committee generated 12 key questions, most of which were population, intervention, comparison and outcome (PICO) questions relevant for both children and adults with suspected antibiotic allergy. For each question a systematic literature search was performed and reviewed for the best available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Quality of evidence was graded from very low to high and recommendations were formulated in structured discussions as strong or weak. RESULTS Sixty recommendations were provided for suspected allergy to beta-lactam antibiotics (BLA) and non-beta-lactam antibiotics (NBLA). Due to the absence of randomized controlled trials in this field, the underlying evidence was predominantly graded as low or very low. Available data supports that a detailed allergy history should always be performed and critically appraised. When cross-allergy between BLA groups is not to be expected due to absence of molecular similarity of the side chains, the patient can be safely exposed to the alternative BLA. An exception to this rule are severe delayed type reactions, in which reexposure to a BLA should only be considered after consultation of a multidisciplinary team. CONCLUSIONS Accumulated scientific data now supports a more liberal approach that better balances benefits of treatment with first choice and usually smaller spectrum antibiotics with appropriate avoidance of antibiotics in case of a truly high risk of a (severe) allergic reaction. In the Netherlands, a formal guideline was developed that provides recommendations for the approach towards suspected allergy to BLA and frequently used NBLA, thereby strongly supporting antimicrobial stewardship.
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Affiliation(s)
- R Wijnakker
- Department of internal medicine, Tergooi Medical Center, Hilversum & Department of infectious diseases, Leiden University Medical Center, Leiden.
| | - M S van Maaren
- Department of internal medicine, section allergology, Erasmus Medical Center, Rotterdam
| | - L G M Bode
- Department of medical microbiology and infectious diseases, Erasmus Medical Center, Rotterdam
| | - M Bulatovic
- Department of rheumatology and clinical immunology, University Medical Center Utrecht, Utrecht
| | - B J C Hendriks
- Department of clinical pharmacy and toxicology, Leiden University Medical Center, Leiden
| | - M C M Loogman
- General practioner, Dutch college of general practitioners
| | - S P M Lutgens
- Department of medical microbiology, Jeroen Bosch Hospital, 's-Hertogenbosch
| | - A Middel
- Department of internal medicine, University Medical Center Groningen, Groningen
| | - C M G Nieuwhof
- Department of internal medicine and allergology, Maastricht University Medical Center, Maastricht
| | - E E Roelofsen
- Department of clinical pharmacy, Medical Center Haaglanden, The Hague
| | - J W Schoones
- Directorate of Research Policy (formerly: Walaeus Library), Leiden University Medical Center, Leiden
| | - K C E Sigaloff
- Department of infectious diseases, Amsterdam University Medical Center, Amsterdam
| | - A B Sprikkelman
- Department of pediatric pulmonology and allergology, University Medical Center Groningen, Groningen
| | - A M M de Vrankrijker
- Department of pediatric infectious diseases, section infectious diseases, University Medical Center Utrecht, Utrecht
| | - M G J de Boer
- Department of infectious diseases and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden.
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3
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Nitsche C, Westerlaken-van Ginkel CD, Kollen BJ, Sprikkelman AB, Koppelman GH, Dubois AEJ. Eliciting dose is associated with tolerance development in peanut and cow's milk allergic children. Clin Transl Allergy 2019; 9:58. [PMID: 31709035 PMCID: PMC6833210 DOI: 10.1186/s13601-019-0298-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/23/2019] [Indexed: 11/11/2022] Open
Abstract
Background Tolerance development rates differ between food allergies. Almost all previous studies have not used the gold standard method, the double-blind, placebo-controlled food challenge (DBPCFC), which may affect the reported prevalence rates. Little is known about the association of the eliciting dose (ED) obtained during the initial DBPCFC with later tolerance development. Methods This was a retrospective, tertiary care study of children who had a positive DBPCFC to either peanut, milk or egg, and at least one follow-up food challenge (open or DBPCFC) with the same food. The association between ED and negative (tolerant) follow-up food challenge outcome was analyzed by logistic regression, with adjustment for confounders. Suspected confounders were initial DBPCFC test characteristics, atopic comorbidities and serum specific IgE (sIgE) levels. Results In 47 peanut allergic children, tolerance developed in 27.7% (median follow-up duration of 43 months). In 80 milk (follow-up 23 months) and 55 egg (follow-up 37 months) allergic children, tolerance developed in 55.0% and 65.5%. The ED obtained during the initial DBPCFC was significantly associated with tolerance development in peanut and milk allergy, but not in egg allergy. Conclusion Approximately 1 out of 4 children with DBPCFC confirmed peanut allergy developed tolerance, compared to more than half of the children with milk or egg allergy, respectively. Tolerance development in peanut and milk allergy is significantly associated with ED at initial DBPCFC.
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Affiliation(s)
- C Nitsche
- 1University of Oldenburg, Oldenburg, Germany.,Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, CA43, PO BOX 30.001, 9700 RB Groningen, The Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C D Westerlaken-van Ginkel
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, CA43, PO BOX 30.001, 9700 RB Groningen, The Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B J Kollen
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A B Sprikkelman
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, CA43, PO BOX 30.001, 9700 RB Groningen, The Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, CA43, PO BOX 30.001, 9700 RB Groningen, The Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A E J Dubois
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, CA43, PO BOX 30.001, 9700 RB Groningen, The Netherlands.,GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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4
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Hulshof L, Hack DP, Hasnoe QCJ, Dontje B, Jakasa I, Riethmüller C, McLean WHI, van Aalderen WMC, Van't Land B, Kezic S, Sprikkelman AB, Middelkamp-Hup MA. A minimally invasive tool to study immune response and skin barrier in children with atopic dermatitis. Br J Dermatol 2018; 180:621-630. [PMID: 29989151 DOI: 10.1111/bjd.16994] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) affects children of all skin types. Most research has focused on light skin types. Studies investigating biomarkers in people with AD with dark skin types are lacking. OBJECTIVES To explore skin barrier and immune response biomarkers in stratum corneum (SC) tape strips from children with AD with different skin types. METHODS Tape strips were collected from lesional and nonlesional forearm skin of 53 children with AD and 50 controls. We analysed 28 immunomodulatory mediators, and natural moisturizing factors (NMF) and corneocyte morphology. RESULTS Interleukin (IL)-1β, IL-18, C-X-C motif chemokine (CXCL) 8 (CXCL8), C-C motif chemokine ligand (CCL) 22 (CCL22), CCL17, CXCL10 and CCL2 were significantly higher (P < 0·05) in lesional AD skin compared with nonlesional AD skin; the opposite trend was seen for IL-1α. CXCL8, CCL2 and CCL17 showed an association with objective SCORing Atopic Dermatitis score. NMF levels showed a gradual decrease from healthy skin to nonlesional and lesional AD skin. This gradual decreasing pattern was observed in skin type II but not in skin type VI. Skin type VI showed higher NMF levels in both nonlesional and lesional AD skin than skin type II. Corneocyte morphology was significantly different in lesional AD skin compared with nonlesional AD and healthy skin. CONCLUSIONS Minimally invasive tape-stripping is suitable for the determination of many inflammatory mediators and skin barrier biomarkers in children with AD. This study shows differences between children with AD with skin type II and skin type VI in NMF levels, suggesting that some aspects of pathophysiological mechanisms may differ in AD children with light versus dark skin types.
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Affiliation(s)
- L Hulshof
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Paediatric Respiratory Medicine and Allergy, Amsterdam, the Netherlands
| | - D P Hack
- Department of Dermatology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Q C J Hasnoe
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - B Dontje
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Paediatric Respiratory Medicine and Allergy, Amsterdam, the Netherlands
| | - I Jakasa
- Department of Chemistry and Biochemistry, Laboratory for Analytical Chemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia
| | | | - W H I McLean
- Centre for Dermatology and Genetic Medicine, Division of Molecular Medicine, Colleges of Life Sciences and Medicine, Dentistry & Nursing, University of Dundee, Dundee, U.K
| | - W M C van Aalderen
- Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Department of Paediatric Respiratory Medicine and Allergy, Amsterdam, the Netherlands
| | - B Van't Land
- University Medical Centre Utrecht, Wilhelmina Children's Hospital, Department of Paediatric Immunology, Utrecht, the Netherlands.,Nutricia Research, Department of Immunology, Utrecht, the Netherlands
| | - S Kezic
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - A B Sprikkelman
- University of Groningen, University Medical Centre Groningen, Beatrix Children's Hospital, Department of Paediatric Pulmonology and Paediatric Allergology, Groningen, the Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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5
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Grabenhenrich LB, Reich A, Bellach J, Trendelenburg V, Sprikkelman AB, Roberts G, Grimshaw KEC, Sigurdardottir S, Kowalski ML, Papadopoulos NG, Quirce S, Dubakiene R, Niggemann B, Fernández-Rivas M, Ballmer-Weber B, van Ree R, Schnadt S, Mills ENC, Keil T, Beyer K. A new framework for the documentation and interpretation of oral food challenges in population-based and clinical research. Allergy 2017; 72:453-461. [PMID: 27670637 PMCID: PMC5324701 DOI: 10.1111/all.13049] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND The conduct of oral food challenges as the preferred diagnostic standard for food allergy (FA) was harmonized over the last years. However, documentation and interpretation of challenge results, particularly in research settings, are not sufficiently standardized to allow valid comparisons between studies. Our aim was to develop a diagnostic toolbox to capture and report clinical observations in double-blind placebo-controlled food challenges (DBPCFC). METHODS A group of experienced allergists, paediatricians, dieticians, epidemiologists and data managers developed generic case report forms and standard operating procedures for DBPCFCs and piloted them in three clinical centres. The follow-up of the EuroPrevall/iFAAM birth cohort and other iFAAM work packages applied these methods. RECOMMENDATIONS A set of newly developed questionnaire or interview items capture the history of FA. Together with sensitization status, this forms the basis for the decision to perform a DBPCFC, following a standardized decision algorithm. A generic form including details about severity and timing captures signs and symptoms observed during or after the procedures. In contrast to the commonly used dichotomous outcome FA vs no FA, the allergy status is interpreted in multiple categories to reflect the complexity of clinical decision-making. CONCLUSION The proposed toolbox sets a standard for improved documentation and harmonized interpretation of DBPCFCs. By a detailed documentation and common terminology for communicating outcomes, these tools hope to reduce the influence of subjective judgment of supervising physicians. All forms are publicly available for further evolution and free use in clinical and research settings.
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Affiliation(s)
- L. B. Grabenhenrich
- Institute for Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Reich
- Institute for Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - J. Bellach
- Department of Paediatric Pneumology and Immunology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - V. Trendelenburg
- Department of Paediatric Pneumology and Immunology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. B. Sprikkelman
- Department of Pediatric Pulmonology & Pediatric Allergology; University Medical Center Groningen; Groningen The Netherlands
| | - G. Roberts
- Clinical and Experimental Sciences Academic Units; Faculty of Medicine; University of Southampton; Southampton UK
| | - K. E. C. Grimshaw
- Clinical and Experimental Sciences Academic Units; Faculty of Medicine; University of Southampton; Southampton UK
- Department of Nutrition and Dietetics; Southampton Children's Hospital; Southampton UK
| | - S. Sigurdardottir
- Department of Immunology; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - M. L. Kowalski
- Department of Clinical Immunology and Allergy; University of Łódź; Łódź Poland
| | - N. G. Papadopoulos
- Institute of Human Development; University of Manchester; Manchester UK
- Allergy Department; 2nd Paediatric Clinic; University of Athens; Athens Greece
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research; Madrid Spain
| | - R. Dubakiene
- Faculty of Medicine; Vilnius University; Vilnius Lithuania
| | - B. Niggemann
- Department of Paediatric Pneumology and Immunology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | - B. Ballmer-Weber
- Allergy Unit; Department of Dermatology; University Hospital; Zürich Switzerland
| | - R. van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
| | - S. Schnadt
- German Allergy and Asthma Association; Mönchengladbach Germany
| | - E. N. C. Mills
- Institute of Inflammation and Repair; University of Manchester; Manchester UK
| | - T. Keil
- Institute for Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. Beyer
- Department of Paediatric Pneumology and Immunology; Charité - Universitätsmedizin Berlin; Berlin Germany
- Icahn School of Medicine at Mount Sinai; New York NY USA
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6
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Xepapadaki P, Fiocchi A, Grabenhenrich L, Roberts G, Grimshaw KEC, Fiandor A, Larco JI, Sigurdardottir S, Clausen M, Papadopoulos NG, Dahdah L, Mackie A, Sprikkelman AB, Schoemaker AA, Dubakiene R, Butiene I, Kowalski ML, Zeman K, Gavrili S, Keil T, Beyer K. Incidence and natural history of hen's egg allergy in the first 2 years of life-the EuroPrevall birth cohort study. Allergy 2016; 71:350-7. [PMID: 26514330 DOI: 10.1111/all.12801] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Parents and health staff perceive hen's egg allergy (HEA) as a common food allergy in early childhood, but the true incidence is unclear because population-based studies with gold-standard diagnostic criteria are lacking. OBJECTIVE To establish the incidence and course of challenge-confirmed HEA in children, from birth until the age of 24 months, in different European regions. METHODS In the EuroPrevall birth cohort study, children with a suspected HEA and their age-matched controls were evaluated in 9 countries, using a standardized protocol including measurement of HE-specific immunoglobulin E-antibodies in serum, skin prick tests, and double-blind, placebo-controlled food challenges (DBPCFC). RESULTS Across Europe, 12 049 newborns were enrolled, and 9336 (77.5%) were followed up to 2 years of age. In 298 children, HEA was suspected and DBPCFC was offered. HEA by age two was confirmed in 86 of 172 challenged children (mean raw incidence 0.84%, 95% confidence interval (95% CI) 0.67-1.03). Adjusted mean incidence of HEA was 1.23% (95% CI 0.98-1.51) considering possible cases among eligible children who were not challenged. Centre-specific incidence ranged from United Kingdom (2.18%, 95% CI 1.27-3.47) to Greece (0.07%). Half of the HE-allergic children became tolerant to HE within 1 year after the initial diagnosis. CONCLUSIONS The largest multinational European birth cohort study on food allergy with gold-standard diagnostic methods showed that the mean adjusted incidence of HEA was considerably lower than previously documented, although differences in incidence rates among countries were noted. Half of the children with documented HEA gained tolerance within 1 year postdiagnosis.
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Affiliation(s)
- P. Xepapadaki
- Allergy Unit; 2nd Pediatric Clinic; University of Athens; Athens Greece
| | - A. Fiocchi
- Division of Allergy; Pediatric Hospital Bambino Gesù; Rome Italy
| | - L. Grabenhenrich
- Institute of Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - G. Roberts
- Clinical and Experimental Sciences Academic Units; Faculty of Medicine; University of Southampton; Southampton UK
| | - K. E. C. Grimshaw
- Clinical and Experimental Sciences Academic Units; Faculty of Medicine; University of Southampton; Southampton UK
| | - A. Fiandor
- Department of Allergy; Hospital La Paz Institute for Health Research; Madrid Spain
| | - J. I. Larco
- Department of Allergy; Hospital La Paz Institute for Health Research; Madrid Spain
| | - S. Sigurdardottir
- Department of Immunology; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - M. Clausen
- Children's Hospital; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - N. G. Papadopoulos
- Allergy Unit; 2nd Pediatric Clinic; University of Athens; Athens Greece
- Centre for Paediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
| | - L. Dahdah
- Division of Allergy; Pediatric Hospital Bambino Gesù; Rome Italy
| | - A. Mackie
- Institute of Food Research; Norwich Research Park; Colney Norwich UK
| | - A. B. Sprikkelman
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; Amsterdam The Netherlands
| | - A. A. Schoemaker
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; Amsterdam The Netherlands
| | - R. Dubakiene
- Vilnius University Faculty of Medicine; Vilnius Lithuania
| | - I. Butiene
- Faculty of Health Sciences; Klaipeda University; Klaipeda Lithuania
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
| | - K. Zeman
- Department of Pediatrics, Immunology and Nephrology; Polish Mother's Health Centre Research Institute Łódź; Lodz Poland
| | - S. Gavrili
- Neonatal Intensive Care Unit; Alexandra University Hospital; Athens Greece
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
- Institute for Clinical Epidemiology and Biometry; University of Würzburg; Würzburg Germany
| | - K. Beyer
- Department of Paediatric Pneumonology and Immunology; Charité - Universitätsmedizin Berlin; Berlin Germany
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7
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Grimshaw KE, Beyer K, Grabenhenrich L, Keil T, Sprikkelman AB, Roberts G. Reply. Allergy 2015; 70:1680. [PMID: 27163118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- K E Grimshaw
- Clinical Experimental Science Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - K Beyer
- Department of Paediatric Pneumology and Immunology, Charité University Medical Centre, Berlin, Germany
| | - L Grabenhenrich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre, Berlin, Germany
| | - A B Sprikkelman
- Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - G Roberts
- Clinical Experimental Science Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
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8
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Koletzko S, Heine RG, Grimshaw KE, Beyer K, Grabenhenrich L, Keil T, Sprikkelman AB, Roberts G. Non-IgE mediated cow's milk allergy in EuroPrevall. Allergy 2015; 70:1679-80. [PMID: 26769086 DOI: 10.1111/all.12681] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- S. Koletzko
- Division of Gastroenterology and Hepatology; Dr. von Hauner Children's Hospital; Ludwig Maximilians University Munich; Munich Germany
| | - R. G. Heine
- Department of Gastroenterology & Clinical Nutrition; Royal Children's Hospital; Murdoch Childrens Research Institute; University of Melbourne; Melbourne Australia
| | - K. E. Grimshaw
- Clinical Experimental Science Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
| | - K. Beyer
- Department of Paediatric Pneumology and Immunology; Charité University Medical Centre; Berlin Germany
| | - L. Grabenhenrich
- Institute of Social Medicine, Epidemiology and Health Economics; Charité University Medical Centre; Berlin Germany
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics; Charité University Medical Centre; Berlin Germany
| | - A. B. Sprikkelman
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Centre; Amsterdam The Netherlands
| | - G. Roberts
- Clinical Experimental Science Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
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9
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Katz Y, Nowak-Wegrzyn A, Grimshaw KE, Beyer K, Grabenhenrich L, Keil T, Sprikkelman AB, Roberts G. Is it the true incidence of IgE-cow's milk allergy (CMA) or CMA or IgE-CMA in some countries and CMA in others. Allergy 2015; 70:11. [DOI: 10.1111/all.12669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y. Katz
- Allergy and Immunology Institute; Assaf Harofeh Medical Center; Zerifin Israel
| | | | - K. E. Grimshaw
- Clinical Experimental Science Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
| | - K. Beyer
- Department of Paediatric Pneumology and Immunology; Charité University Medical Centre; Berlin Germany
| | - L. Grabenhenrich
- Charité University Medical Centre; Epidemiology and Health Economics, Charité University Medical Centre; Berlin Germany
| | - T. Keil
- Charité University Medical Centre; Epidemiology and Health Economics, Charité University Medical Centre; Berlin Germany
| | - A. B. Sprikkelman
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Centre; Amsterdam The Netherlands
| | - G. Roberts
- Clinical Experimental Science Academic Unit; University of Southampton Faculty of Medicine; Southampton UK
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10
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Oliver EM, Grimshaw KEC, Schoemaker AA, Keil T, McBride D, Sprikkelman AB, Ragnarsdottir HS, Trendelenburg V, Emmanouil E, Reche M, Fiocchi A, Fiandor A, Stanczyk-Przyluska A, Wilczynski J, Busacca M, Sigurdardottir ST, Dubakiene R, Rudzeviciene O, Vlaxos GD, Beyer K, Roberts G. Dietary habits and supplement use in relation to national pregnancy recommendations: data from the EuroPrevall birth cohort. Matern Child Health J 2015; 18:2408-25. [PMID: 24752313 DOI: 10.1007/s10995-014-1480-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Assessing maternal dietary habits across Europe during pregnancy in relation to their national pregnancy recommendations. A collaborative, multi-centre, birth cohort study in nine European countries was conducted as part of European Union funded EuroPrevall project. Standardised baseline questionnaire data included details of food intake, nutritional supplement use, exposure to cigarette smoke during pregnancy and socio-demographic data. Pregnancy recommendations were collected from all nine countries from the appropriate national organisations. The most commonly taken supplement in pregnancy was folic acid (55.6 % Lithuania-97.8 % Spain) and was favoured by older, well-educated mothers. Vitamin D supplementation across the cohort was very poor (0.3 % Spain-5.1 % Lithuania). There were significant differences in foods consumed in different countries during pregnancy e.g. only 2.7 % Dutch mothers avoided eating peanut, while 44.4 % of British mothers avoided it. Some countries have minimal pregnancy recommendations i.e. Lithuania, Poland and Spain while others have similar, very specific recommendations i.e. UK, the Netherlands, Iceland, Greece. Allergy specific recommendations were associated with food avoidance during pregnancy [relative rate (RR) 1.18 95 % CI 0.02-1.37]. Nutritional supplement recommendations were also associated with avoidance (RR 1.08, 1.00-1.16). Maternal dietary habits and the use of dietary supplements during pregnancy vary significantly across Europe and in some instances may be influenced by national recommendations.
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Affiliation(s)
- E M Oliver
- Clinical and Experimental Sciences Academic Unit, Level F, South Academic Block, Faculty of Medicine, Southampton General Hospital, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK,
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Schoemaker AA, Sprikkelman AB, Grimshaw KE, Roberts G, Grabenhenrich L, Rosenfeld L, Siegert S, Dubakiene R, Rudzeviciene O, Reche M, Fiandor A, Papadopoulos NG, Malamitsi-Puchner A, Fiocchi A, Dahdah L, Sigurdardottir ST, Clausen M, Stańczyk-Przyłuska A, Zeman K, Mills ENC, McBride D, Keil T, Beyer K. Incidence and natural history of challenge-proven cow's milk allergy in European children--EuroPrevall birth cohort. Allergy 2015; 70:963-72. [PMID: 25864712 DOI: 10.1111/all.12630] [Citation(s) in RCA: 276] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cow's milk allergy (CMA) is one of the most commonly reported childhood food problems. Community-based incidence and prevalence estimates vary widely, due to possible misinterpretations of presumed reactions to milk and differences in study design, particularly diagnostic criteria. METHODS Children from the EuroPrevall birth cohort in 9 European countries with symptoms possibly related to CMA were invited for clinical evaluation including cows' milk-specific IgE antibodies (IgE), skin prick test (SPT) reactivity and double-blind, placebo-controlled food challenge. RESULTS Across Europe, 12 049 children were enrolled, and 9336 (77.5%) were followed up to 2 years of age. CMA was suspected in 358 children and confirmed in 55 resulting in an overall incidence of challenge-proven CMA of 0.54% (95% CI 0.41-0.70). National incidences ranged from 1% (in the Netherlands and UK) to <0.3% (in Lithuania, Germany and Greece). Of all children with CMA, 23.6% had no cow's milk-specific IgE in serum, especially those from UK, the Netherlands, Poland and Italy. Of children with CMA who were re-evaluated one year after diagnosis, 69% (22/32) tolerated cow's milk, including all children with non-IgE-associated CMA and 57% of those children with IgE-associated CMA. CONCLUSIONS This unique pan-European birth cohort study using the gold standard diagnostic procedure for food allergies confirmed challenge-proven CMA in <1% of children up to age 2. Affected infants without detectable specific antibodies to cow's milk were very likely to tolerate cow's milk one year after diagnosis, whereas only half of those with specific antibodies in serum 'outgrew' their disease so soon.
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Affiliation(s)
- A. A. Schoemaker
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Centre; Amsterdam The Netherlands
| | - A. B. Sprikkelman
- Department of Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Centre; Amsterdam The Netherlands
| | - K. E. Grimshaw
- Clinical and Experimental Sciences Academic Unit; Faculty of Medicine; University of Southampton; Southampton UK
| | - G. Roberts
- Clinical and Experimental Sciences Academic Unit; Faculty of Medicine; University of Southampton; Southampton UK
- NIHR Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - L. Grabenhenrich
- Institute of Social Medicine; Epidemiology and Health Economics; Charité University Medical Centre; Berlin Germany
| | - L. Rosenfeld
- Department of Paediatric Pneumology and Immunology; Charité University Medical Centre; Berlin Germany
| | - S. Siegert
- Department of Paediatric Pneumology and Immunology; Charité University Medical Centre; Berlin Germany
- German Agency for Quality in Medicine; Berlin Germany
| | - R. Dubakiene
- Faculty of Medicine; Vilnius University; Vilnius Lithuania
| | | | - M. Reche
- Sofia Children's University Hospital; Madrid Spain
| | - A. Fiandor
- University Hospital La Paz; Madrid Spain
| | - N. G. Papadopoulos
- Department of Allergy; Second Paediatric Clinic; University of Athens; Athens Greece
| | - A. Malamitsi-Puchner
- Neonatal Division; Second Department of Obstetrics and Gynaecology; University of Athens; Athens Greece
| | - A. Fiocchi
- Division of Allergy; Department of Pediatrics; Pediatric Hospital Bambino Gesù; Rome Italy
| | - L. Dahdah
- Division of Allergy; Department of Pediatrics; Pediatric Hospital Bambino Gesù; Rome Italy
| | - S. Th. Sigurdardottir
- Department of Immunology; Landspitali-The National University Hospital of Iceland; Reykjavik Iceland
| | - M. Clausen
- Children's Hospital; Landspitali-The National University Hospital of Iceland; Reykjavik Iceland
| | - A. Stańczyk-Przyłuska
- Department of Pediatrics, Preventive Cardiology and Immunology; Medical University of Łódź; Łódź Poland
| | - K. Zeman
- Department of Pediatrics, Preventive Cardiology and Immunology; Medical University of Łódź; Łódź Poland
- Department of Pediatrics, Immunology and Nephrology; Department of Pediatrics, Clinical Immunology and Cardiology; Polish Mother's Health Centre Research Institute Łódź; Medical University of Łódź; Łódź Poland
| | - E. N. C. Mills
- Institute of Inflammation and Repair; Manchester Academic Health Science Centre; Manchester Institute of Biotechnology; University of Manchester; Manchester UK
| | - D. McBride
- Institute of Social Medicine; Epidemiology and Health Economics; Charité University Medical Centre; Berlin Germany
| | - T. Keil
- Institute of Social Medicine; Epidemiology and Health Economics; Charité University Medical Centre; Berlin Germany
- Institute of Clinical Epidemiology and Biometry; University of Würzburg; Würzburg Germany
| | - K. Beyer
- Department of Paediatric Pneumology and Immunology; Charité University Medical Centre; Berlin Germany
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Petrus NCM, Thomasse YEM, Sprikkelman AB, van Aalderen WMC, ten Tusscher GW. Comment on: Prenatal exposure to acid-suppressive drugs and the risk of allergic disease in the offspring: a cohort study. Clin Exp Allergy 2014; 44:1003-4. [DOI: 10.1111/cea.12336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N. C. M. Petrus
- Department of Paediatrics and Neonatology; Westfriesgasthuis; Hoorn the Netherlands
- Department of Paediatric Respiratory Medicine and Allergy; Emma Children's Hospital AMC; Amsterdam the Netherlands
| | - Y. E. M. Thomasse
- Department of Paediatrics and Neonatology; Westfriesgasthuis; Hoorn the Netherlands
| | - A. B. Sprikkelman
- Department of Paediatric Respiratory Medicine and Allergy; Emma Children's Hospital AMC; Amsterdam the Netherlands
| | - W. M. C. van Aalderen
- Department of Paediatric Respiratory Medicine and Allergy; Emma Children's Hospital AMC; Amsterdam the Netherlands
| | - G. W. ten Tusscher
- Department of Paediatrics and Neonatology; Westfriesgasthuis; Hoorn the Netherlands
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Petrus NCM, Kole EA, Schoemaker AA, van Aalderen WMC, Sprikkelman AB. Exclusively breastfed infants at risk for false negative double blind placebo controlled milk challenge. Eur Ann Allergy Clin Immunol 2014; 46:43-45. [PMID: 24702875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The double blind placebo controlled food challenge (DBPCFC) is the gold standard for diagnosing cow's milk allergy (CMA). However, false-negative DBPCFC have been reported. We present 2 cases with a false negative DBPCFC in exclusively breastfed infants suspected of CMA. These cases highlight the occurrence of severe allergic reactions of infants who were exclusively breastfed. Several reported causes of a false negative DBPCFC will be discussed. However, there is currently no clear understanding of the cause of a false negative DBPCFC. This paper highlights that a negative outcome of a DBFCFC must be interpreted with caution, because a severe allergic reaction might occur upon re-introduction of cow's milk. Therefore, an additional open food challenge under medical supervision is recommended in exclusively breastfed infants with a negative DBPCFC.
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Affiliation(s)
- N C M Petrus
- Department of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
| | - E A Kole
- Nutricia Advanced Medical Nutrition Division, Schiphol, The Netherlands
| | - A A Schoemaker
- Department of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, The Netherlands
| | - W M C van Aalderen
- Department of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, The Netherlands
| | - A B Sprikkelman
- Department of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital AMC, Amsterdam, The Netherlands
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van Rhijn BD, van Ree R, Versteeg SA, Vlieg-Boerstra BJ, Sprikkelman AB, Terreehorst I, Smout AJPM, Bredenoord AJ. Birch pollen sensitization with cross-reactivity to food allergens predominates in adults with eosinophilic esophagitis. Allergy 2013; 68:1475-81. [PMID: 24351068 DOI: 10.1111/all.12257] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2013] [Indexed: 01/07/2023]
Abstract
EoE patients show variable sensitization patterns to food and aeroallergens. The value of allergy testing in adult EoE patients is unclear. Component-resolved diagnosis (CRD) may offer additional insights into sensitization patterns. The aim of this study was to characterize sensitization patterns in adult EoE patients using CRD. Serum from 76 patients (17 female), age 38.6 ± 1.5 years, was analyzed for reactivity to 112 different allergen components using an immuno-solid-phase allergen chip (ISAC). We observed any sensitization in 59 patients (78%), of which 54 patients were polysensitized. Aeroallergen sensitization, mostly against components of grass or tree pollen, or house dust mite, was observed in 74% of the patients. Birch pollen (rBet v 1) sensitization with cross-reactivity to food allergen components was observed in 30 patients (39%). In conclusion, food sensitizations in EoE patients are mainly caused by cross-reactivity to food allergens after primary birch pollen sensitization. Pollen and food sensitizations may cause or maintain esophageal inflammation in EoE patients. CRD provides more insight into sensitization patterns, identifies additional food allergen sensitizations and might be useful to direct dietary therapy in EoE.
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Affiliation(s)
- B. D. van Rhijn
- Department of Gastroenterology & Hepatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - R. van Ree
- Department of Experimental Immunology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
- Department of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - S. A. Versteeg
- Department of Experimental Immunology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - B. J. Vlieg-Boerstra
- Department of Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - A. B. Sprikkelman
- Department of Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - I. Terreehorst
- Department of Otorhinolaryngology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - A. J. P. M. Smout
- Department of Gastroenterology & Hepatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - A. J. Bredenoord
- Department of Gastroenterology & Hepatology; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
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Petrus NCM, Hulshof L, Rutjes NWP, de Vreede I, van Aalderen WMC, Sprikkelman AB. Response to: Cost-effectiveness of using an extensively hydrolysed formula compared to an amino acid formula as first-line treatment for cow milk allergy in the UK. Pediatr Allergy Immunol 2012; 23:686; author reply 687. [PMID: 22985421 DOI: 10.1111/j.1399-3038.2012.01311.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hulshof L, Schoemaker AA, Petrus NCM, van Aalderen WMC, Sprikkelman AB. Re: Oral desensitization as a useful treatment in 2-year-old children with cow's milk allergy. Clin Exp Allergy 2012; 41:1815-6; author reply 1817-8. [PMID: 22107143 DOI: 10.1111/j.1365-2222.2011.03871.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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McBride D, Keil T, Grabenhenrich L, Dubakiene R, Drasutiene G, Fiocchi A, Dahdah L, Sprikkelman AB, Schoemaker AA, Roberts G, Grimshaw K, Kowalski ML, Stanczyk-Przyluska A, Sigurdardottir S, Clausen M, Papadopoulos NG, Mitsias D, Rosenfeld L, Reche M, Pascual C, Reich A, Hourihane J, Wahn U, Mills ENC, Mackie A, Beyer K. The EuroPrevall birth cohort study on food allergy: baseline characteristics of 12,000 newborns and their families from nine European countries. Pediatr Allergy Immunol 2012; 23:230-9. [PMID: 22192443 DOI: 10.1111/j.1399-3038.2011.01254.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It is unclear why some children develop food allergy. The EuroPrevall birth cohort was established to examine regional differences in the prevalence and risk factors of food allergy in European children using gold-standard diagnostic criteria. The aim of this report was to describe pre-, post-natal and environmental characteristics among the participating countries. In nine countries across four major European climatic regions, mothers and their newborns were enrolled from October 2005 through February 2010. Using standardized questionnaires, we assessed allergic diseases and self-reported food hypersensitivity of parents and siblings, nutrition during pregnancy, nutritional supplements, medications, mode of delivery, socio-demographic data and home environmental exposures. A total of 12,049 babies and their families were recruited. Self-reported adverse reactions to food ever were considerably more common in mothers from Germany (30%), Iceland, United Kingdom, and the Netherlands (all 20-22%) compared with those from Italy (11%), Lithuania, Greece, Poland, and Spain (all 5-8%). Prevalence estimates of parental asthma, allergic rhinitis and eczema were highest in north-west (Iceland, UK), followed by west (Germany, the Netherlands), south (Greece, Italy, Spain) and lowest in central and east Europe (Poland, Lithuania). Over 17% of Spanish and Greek children were exposed to tobacco smoke in utero compared with only 8-11% in other countries. Caesarean section rate was highest in Greece (44%) and lowest in Spain (<3%). We found country-specific differences in antibiotic use, pet ownership, type of flooring and baby's mattress. In the EuroPrevall birth cohort study, the largest study using gold-standard diagnostic criteria for food allergy in children worldwide, we found considerable country-specific baseline differences regarding a wide range of factors that are hypothesized to play a role in the development of food allergy including allergic family history, obstetrical practices, pre- and post-natal environmental exposures.
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Affiliation(s)
- D McBride
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
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Kivit S, Saeland E, Kraneveld AD, Kant HJG, Schouten B, Esch BCAM, Knol J, Sprikkelman AB, Aa LB, Knippels LMJ, Garssen J, Kooyk Y, Willemsen LEM. Galectin-9 induced by dietary synbiotics is involved in suppression of allergic symptoms in mice and humans. Allergy 2012; 67:343-52. [PMID: 22229637 DOI: 10.1111/j.1398-9995.2011.02771.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Prebiotic galacto- and fructo-oligosaccharides (scGOS/lcFOS) resembling non-digestible oligosaccharides in human milk reduce the development of atopic disorders. However, the underlying mechanisms are still unclear. Galectins are soluble-type lectins recognizing β-galactoside containing glycans. Galectin-9 has been shown to regulate mast cell degranulation and T-cell differentiation. In this study, the involvement of galectin-9 as a mechanism by which scGOS/lcFOS in combination with Bifidobacterium breve M-16V protects against acute allergic symptoms was investigated. METHODS Mice were sensitized orally to whey, while being fed with a diet containing scGOS/lcFOS and Bifidobacterium breve M-16V (GF/Bb) or a control diet. Galectin-9 expression was determined by immunohistochemistry in the intestine and measured in the serum by ELISA. T-cell differentiation was investigated in the mesenteric lymph nodes (MLN) as well as in galectin-9-exposed peripheral blood mononuclear cells (PBMC) cultures. Sera of the mice were evaluated for the capacity to suppress mast cell degranulation using a RBL-2H3 degranulation assay. In addition, in a double-blind, placebo-controlled multicenter trial, galectin-9 levels were measured in the sera of 90 infants with atopic dermatitis who received hydrolyzed formulae with or without GF/Bb. RESULTS Galectin-9 expression by intestinal epithelial cells and serum galectin-9 levels were increased in mice and humans following dietary intervention with GF/Bb and correlated with reduced acute allergic skin reaction and mast cell degranulation. In addition, GF/Bb enhanced T(h)1- and T(reg)-cell differentiation in MLN and in PBMC cultures exposed to galectin-9. CONCLUSIONS Dietary supplementation with GF/Bb enhances serum galectin-9 levels, which associates with the prevention of allergic symptoms.
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Affiliation(s)
- S. Kivit
- Division of Pharmacology; Utrecht Institute Pharmaceutical Sciences; Faculty of Science; Utrecht University; The Netherlands
| | - E. Saeland
- Molecular Cell Biology and Immunology; VU University Medical Center; Amsterdam; The Netherlands
| | - A. D. Kraneveld
- Division of Pharmacology; Utrecht Institute Pharmaceutical Sciences; Faculty of Science; Utrecht University; The Netherlands
| | - H. J. G. Kant
- Division of Pharmacology; Utrecht Institute Pharmaceutical Sciences; Faculty of Science; Utrecht University; The Netherlands
| | - B. Schouten
- Danone Research - Centre for Specialised Nutrition; Wageningen; The Netherlands
| | | | - J. Knol
- Danone Research - Centre for Specialised Nutrition; Wageningen; The Netherlands
| | - A. B. Sprikkelman
- Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Amsterdam; the Netherlands
| | - L. B. Aa
- Pediatric Respiratory Medicine and Allergy; Emma Children's Hospital; Amsterdam; the Netherlands
| | | | | | - Y. Kooyk
- Molecular Cell Biology and Immunology; VU University Medical Center; Amsterdam; The Netherlands
| | - L. E. M. Willemsen
- Division of Pharmacology; Utrecht Institute Pharmaceutical Sciences; Faculty of Science; Utrecht University; The Netherlands
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Lenoir-Wijnkoop I, van Aalderen WMC, Boehm G, Klaassen D, Sprikkelman AB, Nuijten MJC. Cost-effectiveness model for a specific mixture of prebiotics in The Netherlands. Eur J Health Econ 2012; 13:101-110. [PMID: 21165666 DOI: 10.1007/s10198-010-0289-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 11/22/2010] [Indexed: 05/30/2023]
Abstract
UNLABELLED The objective of this study was to assess the cost-effectiveness of the use of prebiotics for the primary prevention of atopic dermatitis in The Netherlands. A model was constructed using decision analytical techniques. The model was developed to estimate the health economic impact of prebiotic preventive disease management of atopic dermatitis. Data sources used include published literature, clinical trials and official price/tariff lists and national population statistics. The comparator was no supplementation with prebiotics. The primary perspective for conducting the economic evaluation was based on the situation in The Netherlands in 2009. The results show that the use of prebiotics infant formula (IMMUNOFORTIS(®)) leads to an additional cost of € 51 and an increase in Quality Adjusted Life Years (QALY) of 0.108, when compared with no prebiotics. Consequently, the use of infant formula with a specific mixture of prebiotics results in an incremental cost-effectiveness ratio (ICER) of € 472. The sensitivity analyses show that the ICER remains in all analyses far below the threshold of € 20,000/QALY. CONCLUSION This study shows that the favourable health benefit of the use of a specific mixture of prebiotics results in positive short- and long-term health economic benefits. In addition, this study demonstrates that the use of infant formula with a specific mixture of prebiotics is a highly cost-effective way of preventing atopic dermatitis in The Netherlands.
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van der Aa LB, Lutter R, Heymans HSA, Smids BS, Dekker T, van Aalderen WMC, Sillevis Smitt JH, Knippels LMJ, Garssen J, Nauta AJ, Sprikkelman AB. No detectable beneficial systemic immunomodulatory effects of a specific synbiotic mixture in infants with atopic dermatitis. Clin Exp Allergy 2011; 42:531-9. [PMID: 22092915 DOI: 10.1111/j.1365-2222.2011.03890.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 08/05/2011] [Accepted: 09/02/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND In a murine model of allergic inflammation, Bifidobacterium breve M-16V has been shown to reduce IL-4 and IgE by inducing IL-10 and IFN-γ. However, it remains unknown whether this strain has the same effect in humans with allergic disease. OBJECTIVE To determine the effects of Bifidobacterium breve M-16V combined with a prebiotic oligosaccharide mixture (synbiotic) on atopic markers, ex vivo cytokine production by peripheral blood mononuclear cells (PBMCs) and circulating regulatory T cell percentage in infants with atopic dermatitis. METHODS In a double-blind, placebo-controlled multi-centre trial, 90 infants with atopic dermatitis, age <7 months, were randomized to receive an infant formula with Bifidobacterium breve M-16V and a mixture of short chain galactooligosaccharides and long chain fructooligosaccharides (Immunofortis(®) ), or the same formula without synbiotics during 12 weeks. At week 0 and 12, plasma levels of IL-5, IgG1, IgG4, CTACK and TARC, ex vivo cytokine responses by PBMCs and percentage of regulatory T cells, were determined. RESULTS There were no significant differences between the synbiotic and the placebo group in IL-5, IgG1, IgG4, CTACK and TARC levels and ex vivo cytokine production by anti-CD3/anti-CD28-stimulated PBMCs. With allergen-specific stimuli, we found a decreased IL-12p40/70 and IL-12p70 production in response to egg allergen (P = 0.04 and P = 0.01, respectively) and decreased IL-12p70 production in response to peanut allergen (P = 0.003) in the synbiotic compared with the placebo group. Circulating regulatory T cell percentage did not significantly differ between the groups. CONCLUSIONS AND CLINICAL RELEVANCE This synbiotic mixture has no detectable effect on plasma levels of the analysed atopic disease markers, ex vivo cytokine production and circulating regulatory T cell percentage in infants with atopic dermatitis, besides down-regulation of IL-12 production in egg- and peanut-stimulated PBMCs. These results do not support the use of this synbiotic in clinical practice.
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Affiliation(s)
- L B van der Aa
- Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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van der Aa LB, van Aalderen WMC, Heymans HSA, Henk Sillevis Smitt J, Nauta AJ, Knippels LMJ, Ben Amor K, Sprikkelman AB. Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis. Allergy 2011; 66:170-7. [PMID: 20560907 DOI: 10.1111/j.1398-9995.2010.02416.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Infants with atopic dermatitis (AD) have a high risk of developing asthma. We investigated the effect of early intervention with synbiotics, a combination of probiotics and prebiotics, on the prevalence of asthma-like symptoms in infants with AD. METHODS In a double-blind, placebo-controlled multicentre trial, ninety infants with AD, age <7\ months, were randomized to receive an extensively hydrolyzed formula with Bifidobacterium breve M-16V and a galacto/fructooligosaccharide mixture (Immunofortis(®) ), or the same formula without synbiotics during 12 weeks. After 1 year, the prevalence of respiratory symptoms and asthma medication use was evaluated, using a validated questionnaire. Also, total serum IgE and specific IgE against aeroallergens were determined. FINDINGS Seventy-five children (70.7% male, mean age 17.3 months) completed the 1-year follow-up evaluation. The prevalence of 'frequent wheezing' and 'wheezing and/or noisy breathing apart from colds' was significantly lower in the synbiotic than in the placebo group (13.9%vs 34.2%, absolute risk reduction (ARR) -20.3%, 95% CI -39.2% to -1.5%, and 2.8%vs 30.8%, ARR -28.0%, 95% CI -43.3% to -12.5%, respectively). Significantly less children in the synbiotic than in the placebo group had started to use asthma medication after baseline (5.6%vs 25.6%, ARR -20.1%, 95% CI -35.7% to -4.5%). Total IgE levels did not differ between the two groups. No children in the synbiotic and five children (15.2%) in the placebo group developed elevated IgE levels against cat (ARR -15.2%, 95% CI -27.4% to -2.9%). CONCLUSION These results suggest that this synbiotic mixture prevents asthma-like symptoms in infants with AD.
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Affiliation(s)
- L B van der Aa
- Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, Amsterdam, the Netherlands.
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Keil T, McBride D, Grimshaw K, Niggemann B, Xepapadaki P, Zannikos K, Sigurdardottir ST, Clausen M, Reche M, Pascual C, Stanczyk AP, Kowalski ML, Dubakiene R, Drasutiene G, Roberts G, Schoemaker AFA, Sprikkelman AB, Fiocchi A, Martelli A, Dufour S, Hourihane J, Kulig M, Wjst M, Yazdanbakhsh M, Szépfalusi Z, van Ree R, Willich SN, Wahn U, Mills ENC, Beyer K. The multinational birth cohort of EuroPrevall: background, aims and methods. Allergy 2010; 65:482-90. [PMID: 19793062 DOI: 10.1111/j.1398-9995.2009.02171.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM The true prevalence and risk factors of food allergies in children are not known because estimates were based predominantly on subjective assessments and skin or serum tests of allergic sensitization to food. The diagnostic gold standard, a double-blind placebo-controlled food provocation test, was not performed consistently to confirm suspected allergic reactions in previous population studies in children. This protocol describes the specific aims and diagnostic protocol of a birth cohort study examining prevalence patterns and influential factors of confirmed food allergies in European children from different regions. METHODS Within the collaborative translational research project EuroPrevall, we started a multi-center birth cohort study, recruiting a total of over 12 000 newborns in nine countries across Europe in 2005-2009. In addition to three telephone interviews during the first 30 months, parents were asked to immediately inform the centers about possible allergic reactions to food at any time during the follow-up period. RESULTS All children with suspected food allergy symptoms were clinically evaluated including double-blind placebo-controlled food challenge tests. We assessed sensitization to different food allergens by measurements of specific serum immunoglobulin E and skin prick tests, collect blood, saliva or buccal swabs for genetic tests, breast milk for measurement of food proteins/cytokines, and evaluate quality-of-life and economic burden of families with food allergic children. CONCLUSIONS This birth cohort provides unique data on prevalence, risk factors, quality-of-life, and costs of food allergies in Europe, leading to the development of more informed and integrated preventative and treatment strategies for children with food allergies.
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Affiliation(s)
- T Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany
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van der Aa LB, Heymans HS, van Aalderen WM, Sillevis Smitt JH, Knol J, Ben Amor K, Goossens DA, Sprikkelman AB. Effect of a new synbiotic mixture on atopic dermatitis in infants: a randomized-controlled trial. Clin Exp Allergy 2010; 40:795-804. [PMID: 20184604 DOI: 10.1111/j.1365-2222.2010.03465.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical trials investigating the therapeutic effect of probiotics on atopic dermatitis (AD) show inconsistent results. Better results can possibly be achieved by combining probiotics with prebiotics, i.e. synbiotics. OBJECTIVE To investigate the therapeutic effect of a synbiotic mixture on the severity of AD in infants. METHODS In a double-blind, placebo-controlled multi-centre trial, 90 infants with AD [SCORing Atopic Dermatitis (SCORAD) score > or =15], aged < 7 months and exclusively formula fed, were randomly assigned to receive either an extensively hydrolysed formula with Bifidobacterium breve M-16V and a galacto-/fructooligosaccharide mixture (Immunofortis), or the same formula without synbiotics for 12 weeks. The primary outcome was severity of AD, assessed using the SCORAD index. A secondary outcome measure was intestinal microbiota composition. RESULTS There was no difference in SCORAD score improvement between the synbiotic and the placebo group. The synbiotic group did have a significantly higher percentage of bifidobacteria (54.7% vs. 30.1%, P<0.001) and significantly lower percentages of Clostridium lituseburense/Clostridium histolyticum (0.5 vs. 1.8, P=0.02) and Eubacterium rectale/Clostridium coccoides (7.5 vs. 38.1, P<0.001) after intervention than the placebo group. In the subgroup of infants with IgE-associated AD (n=48), SCORAD score improvement was significantly greater in the synbiotic than in the placebo group at week 12 (-18.1 vs. -13.5 points, P=0.04). CONCLUSIONS This synbiotic mixture does not have a beneficial effect on AD severity in infants, although it does successfully modulate their intestinal microbiota. Further randomized-controlled trials should explore a possible beneficial effect in IgE-associated AD.
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Affiliation(s)
- L B van der Aa
- Department of Pediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam, The Netherlands
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24
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van der Aa LB, Sprikkelman AB, van Aalderen WMC. Impact of maternal atopy and probiotic supplementation during pregnancy on infant sensitization. Clin Exp Allergy 2008; 38:1698; author reply 1698-9. [PMID: 18721254 DOI: 10.1111/j.1365-2222.2008.03089.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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van der Aa LB, van der Heide M, Sprikkelman AB, Brinkhorst G, Tytgat GAM, van den Berg JM. [Wegener's granulomatosis in 2 adolescents]. Ned Tijdschr Geneeskd 2007; 151:1522-6. [PMID: 17763812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Wegener's granulomatosis was diagnosed in 2 boys, aged 17 and 16 years. The first presented with pain in the right flank, without coughing or dyspnoea. He did have peaks of fever, night sweats, weight loss, headache, and epistaxis. The second presented with progressive dyspnoea, haemoptysis, malaise, and headache. Because an infection was suspected, both were given antibiotics, but without effect. Chest X-rays revealed infiltrative abnormalities. A lung biopsy in the first patient and a nasal biopsy in the second revealed a granulomatous inflammation, and both patients had an elevated titre of antineutrophilic cytoplasmic antibodies (ANCA), with a cytoplasmic pattern, and an elevated result of the ELISA test for antiproteinase-3 (PR3). Both patients recovered after aggressive immunosuppressive treatment. Wegener's granulomatosis is a systemic necrotising vasculitis, mostly localised in airways and kidneys. The disease is very rare in children, but may be life-threatening. Therefore, in children with pulmonary problems resistant to antibiotics, it is important to consider a diagnosis of Wegener's granulomatosis and test for ANCA and PR3.
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Affiliation(s)
- L B van der Aa
- Afd. Kindergeneeskunde, Emma Kinderziekenhuis AMC, Amsterdam.
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26
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Kiezebrink-Lindenhovius HH, van den Berg YL, Sprikkelman AB, Weel JF, Veenhoven RH. [Cytomegalovirus infection: congenital or postnatally acquired? Importance of the Guthrie card]. Ned Tijdschr Geneeskd 2001; 145:1259-61. [PMID: 11455694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A girl aged 4 weeks had persistent pulmonary hypertension of the newborn, haematological abnormalities and hepatosplenomegalia due to a cytomegalovirus (CMV) infection; thereafter she had a psychomotoric retardation. A girl aged 6 months had psychomotoric retardation and microcephaly due to a CMV infection, with epilepsy and perception deafness. A polymerase chain reaction (PCR) for CMV-DNA in the blood on the Guthrie card demonstrated retrospectively in both cases that the infection was congenital. A 4-month-old boy had parents who had both experienced a CMV infection around the birth of the child. The child was infected with CMV but the absence of CMV-DNA in the blood on the Guthrie card revealed that the infection was not congenital. Only 10% of infants with congenital CMV infection are symptomatic at birth; the prognosis is then poor. Up to 10-15% of the asymptomatic patients will develop neurological manifestations. For the diagnosis of congenital CMV infection virus isolation is required within 3 weeks after birth. However, when CMV infection is not considered during this period it is later still possible to diagnose congenital CMV infection with a PCR for CMV-DNA in blood spots of Guthrie cards taken during the first week of life.
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Sprikkelman AB, Heymans HS, Van Aalderen WM. Development of allergic disorders in children with cow's milk protein allergy or intolerance in infancy. Clin Exp Allergy 2000; 30:1358-63. [PMID: 10998010 DOI: 10.1046/j.1365-2222.2000.00846.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A B Sprikkelman
- Emma Children's Hospital, Academic Medical Center/University of Amsterdam, The Netherlands
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Abstract
Follow-up studies have demonstrated that bronchiolitis caused by respiratory syncytial virus (RSV) is strongly associated with wheezing in the ensuing years. During the acute infection the immune response may induce long-lasting detrimental effects, thereby contributing to post-bronchiolitis wheezing (PBW). Therefore, immune-modulating drugs like corticosteroids, administered in the acute phase of RSV bronchiolitis, may prevent PBW and asthma. To evaluate this, we performed a controlled prospective follow-up study after a randomized double-blind placebo-controlled intervention in the acute phase with oral prednisolone. Fifty-four patients under 2 years of age and hospitalized for RSV bronchiolitis between 1992 and 1995 were randomly assigned to prednisolone 1 mg/kg/day for 7 days or placebo. At the mean age of 5 years, 47 patients had completed their follow-up. Patients were divided into four groups: no wheezing, transient wheezing (wheezing during the first year of life); persistent wheezing (wheezing during the first year of life and asthma at the age of 5); and late-onset wheezing (no wheezing during the first year of life but asthma at the age of 5). Prevalence of wheezing and asthma were investigated through an interview by telephone, using a standardized questionnaire. We found no significant differences between the prednisolone- and the placebo-treated group in the number of patients with transient wheezing (8% vs. 17%), persistent wheezing (42% vs. 31%), or late-onset wheezing (17% vs. 13%). We conclude that oral prednisolone during the acute phase of RSV bronchiolitis is not effective in preventing PBW or asthma at the mean age of 5 years. Pediatr Pulmonol. 2000; 30: 92-96.
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Affiliation(s)
- J B van Woensel
- Emma Children's Hospital AMC, University of Amsterdam, Amsterdam, The Netherlands.
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Maarsingh EJ, van Eykern LA, Sprikkelman AB, Hoekstra MO, van Aalderen WM. Respiratory muscle activity measured with a noninvasive EMG technique: technical aspects and reproducibility. J Appl Physiol (1985) 2000; 88:1955-61. [PMID: 10846005 DOI: 10.1152/jappl.2000.88.6.1955] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A new method is being developed to investigate airway obstruction in young children by means of noninvasive electromyography (EMG) of diaphragmatic and intercostal muscles. The purpose of this study was to evaluate the reproducibility of the EMG measurements. Eleven adults, 39 school children (20 healthy, 19 asthmatic), and 16 preschool children were studied during tidal breathing on separate occasions: two for adults with a time interval of 3 wk and three for children with time intervals of 1 and 24 h. Single electrodes were placed on the second intercostal space left and right of the sternum and at the height of the frontal and the dorsal diaphragm. Bipolar electrode pairs were placed on the rectus abdominis muscle. A newly designed digital physiological amplifier without any analog filtering was used to measure the EMG signals. Except for the average dorsal diaphragm EMG derivation in healthy school children on the second occasion, a significant correlation between the mean peak-to-peak inspiratory activity of average diaphragmatic and intercostal EMG was found in the different age groups on the different measurement occasions (P < 0.05). To assess the repeatability, we described the agreement between the repeated measurements within the same subjects. No significant differences were found between the measurements on the separate occasions. Our observations indicate that the EMG signals derived from the diaphragm and intercostal muscles are, in different age groups with and without asthma, reproducible during tidal breathing.
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Affiliation(s)
- E J Maarsingh
- Beatrix Children's Hospital, University Hospital Groningen, Amsterdam, The Netherlands
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Abstract
There is now extensive evidence that asthma results from inflammation in large and small airways, and that the degree of inflammation reflects the clinical severity of the disease. Most of this evidence, however, has come from studies in adult patients. Evidence in children comes largely from indirect studies such as measurements of peripheral blood cells and inflammatory markers, rather than from direct bronchoscopic examination. Studies in adults show that inflammation in asthma is characterized by eosinophilia, epithelial damage, and bronchial hyperresponsiveness, and that activation of allergen-specific T cells plays an important role in orchestrating the inflammatory process. In children, indirect evidence of inflammation comes from the observation that anti-inflammatory agents such as inhaled corticosteroids improve symptoms and bronchial hyperresponsiveness, reduce the number of asthma exacerbations, and limit the progressive decline in lung function. Further evidence comes from measurements of nitric oxide and hydrogen peroxide (potential inflammatory markers) in exhaled air, and of inflammatory mediators in plasma and urine. As in adults, there is evidence that lymphocytes play an important role in orchestrating the inflammatory process. The immunologic profile appears to shift from a Th1-type cytokine profile to an allergen-related Th2-type profile prior to birth. Such a Th2 predominance constitutes a risk factor for the subsequent development of bronchial hyperresponsiveness and asthma in response to allergen.
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Affiliation(s)
- W M van Aalderen
- Department of Paediatric Pulmonology, Emma's Children's Hospital AMC, Amsterdam, The Netherlands
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Sprikkelman AB, Schouten JP, Lourens MS, Heymans HS, van Aalderen WM. Agreement between spirometry and tracheal auscultation in assessing bronchial responsiveness in asthmatic children. Respir Med 1999; 93:102-7. [PMID: 10464860 DOI: 10.1016/s0954-6111(99)90298-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We have recently found that changes in lung sounds correspond well with a 20% fall in the forced expiratory volume in 1 s (FEV1) after methacholine challenge in asthmatic children. Up to now, little was known about the agreement between a 20% fall in FEV1 and a change in lung sounds after repeated bronchial challenge. In this study we investigated the agreement between the total cumulative histamine dose causing a fall in FEV1 of 20% or more (PD20) and the detection of a change in lung sounds (PDlung sounds) after two bronchial challenges on different occasions in asthmatic children. Fifteen asthmatic children (nine boys), mean age 10.8 years (range 9-15), were studied. All performed two histamine challenge tests on 2 days, with a 24 h to 1 week interval. Lung sounds were recorded over the trachea for 1 min and stored on tape. Lung sounds were analysed directly and also scored from the tape-recording by a blinded second investigator. Wheeze, cough, and an increase in respiratory rate were assessed. The relationship between PD20 and PDlung sounds was calculated by Bland and Altman's measurement of agreement. Eleven children had a positive challenge test (PD20 < or = 16.0 mg ml-1) on both test days; four had a positive challenge on one test day. In 24 out of 26 positive challenges, wheeze, cough, prolonged expiration and/or increased respiratory rate were detected one dose-step before, or at the dose-step of histamine that induced a fall in FEV1 of 20% or more. In two challenges, PD20 was not detected by a change in lung sounds. In four out of four negative challenges (PD20 > 16.0 mg ml-1) no change in lung sounds could be detected. Good agreement between the logarithm of PD20 and the logarithm of PDlung sounds was found on both test days. The mean difference was 0.04 and the limits of agreement (d +/- 2 SD of the differences) were 0.04 +/- 0.41. A good agreement was found between the total cumulative histamine dose causing a fall in FEV1 of 20% or more and the detection of a change in lung sounds after two bronchial challenges on different occasions in asthmatic children.
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Affiliation(s)
- A B Sprikkelman
- Beatrix Children's Hospital, University Hospital Groningen, The Netherlands
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Sprikkelman AB, Van Eykern LA, Lourens MS, Heymans HS, Van Aalderen WM. Respiratory muscle activity in the assessment of bronchial responsiveness in asthmatic children. J Appl Physiol (1985) 1998; 84:897-901. [PMID: 9480949 DOI: 10.1152/jappl.1998.84.3.897] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We investigated whether an increase in transcutaneous electromyographic (EMG) activity of the diaphragm and intercostal muscles corresponds with the concentration of histamine that induces a 20% fall in the forced expiratory volume in one second (FEV1; PC20). Eleven asthmatic children (mean age 11.9 yr) were studied after they were given histamine challenge. EMG activity at PC20 or at the highest histamine concentration was compared with activity at baseline by calculating the ratio of the mean peak-to-peak excursion at the highest histamine dose to that at baseline [EMG activity ratio (EMGAR)]. In all children reaching PC20, an increase in diaphragmatic and intercostal EMGAR was observed. No increase was found at the dose step before PC20 was reached. In six challenges, no fall in FEV1 was induced, and no increase in EMGAR was seen. In two challenges, no fall in FEV1 was induced, but increase in diaphragmatic or intercostal EMGAR was observed. Increase in the electrical activity of the diaphragm and intercostal muscles in asthmatic children corresponds closely to a 20% fall in FEV1 induced by histamine challenge.
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Affiliation(s)
- A B Sprikkelman
- Beatrix Children's Hospital, University Hospital Groningen, 9700 RB Groningen, The Netherlands
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Sprikkelman AB, Tupker RA, Burgerhof H, Schouten JP, Brand PL, Heymans HS, van Aalderen WM. Severity scoring of atopic dermatitis: a comparison of three scoring systems. Allergy 1997; 52:944-9. [PMID: 9298180 DOI: 10.1111/j.1398-9995.1997.tb01255.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In studies on atopic dermatitis (AD), different scoring systems are used to evaluate the severity of the disease. The objective of this study was to investigate agreement between observers in the assessment of the overall severity of AD, and interobserver variation in the assessment of severity of AD for each scoring item separately, using the Simple Scoring System (SSS), the Scoring Atopic Dermatitis (SCORAD) index, and the Basic Clinical Scoring System (BCSS), and, furthermore, to investigate agreement between these three scoring systems in the assessment of the overall severity of AD. Eighty-two patients (42 male) with AD, mean age 13.4 years (range 0.2-67.0), were included. Agreement between observers in assessing the overall AD severity scores, and interobserver variation in assessing AD severity of each scoring item separately were determined in 34 of these 82 patients by two physicians scoring the severity of AD by the three scoring systems. To determine agreement between the scoring systems, one physician scored the severity of AD in all patients with the three scoring systems. Agreement between observers and agreement between the three scoring systems was calculated by Cohen's kappa (kappa) and by the measure of agreement according to Bland & Altman. kappa > 0.4 represents fair agreement; kappa > 0.75 excellent agreement. In addition, interobserver variation for each scoring item separately was calculated by the Wilcoxon signed rank test. The mean differences (d) and the limits of agreement (d +/- 2 SD of the differences) between observers by the SSS and the SCORAD were -0.82 +/- 5.58 and -0.28 +/- 7.49, respectively, kappa between observers for the BCSS was 0.90 (95% CI 0.79-1.03). By the SSS, significant interobserver variation was found in assessing the severity of excoriations (P = 0.02) and scales (P = 0.02). By the SCORAD, significant interobserver variation was found in assessing the severity of edema/population (P = 0.04), erythema (P = 0.04), and excoriations (P = 0.01). No significant interobserver variation was found in assessing the extent of AD. The mean difference and the limits of agreement between the SSS and the SCORAD were -4.17 +/- 9.52. kappa between the SSS and the BCSS was 0.21 (95% CI 0.09-0.33), and kappa between the SCORAD and the BCSS was 0.38 (95% CI 0.26-0.51). We found good agreement between observers assessing the overall severity of AD in the lower and higher scoring rates by the SSS and the SCORAD, and excellent agreement by the BCSS. Significant interobserver variation was found on the isolated intensity items scales, excoriations, edema/population, and erythema. We found poor agreement between the three scoring systems in assessing the overall severity of AD, indicating that the SSS, the SCORAD, and the BCSS cannot be used interchangeably to assess the overall severity of AD.
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Affiliation(s)
- A B Sprikkelman
- Department of Pediatric Pulmonology, Beatrix Children's Hospital, University Hospital Graningen, The Netherlands
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Sprikkelman AB, Grol MH, Lourens MS, Gerritsen J, Heymans HS, van Aalderen WM. Use of tracheal auscultation for the assessment of bronchial responsiveness in asthmatic children. Thorax 1996; 51:317-9. [PMID: 8779140 PMCID: PMC1090648 DOI: 10.1136/thx.51.3.317] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND It can be difficult to assess bronchial responsiveness in children because of their inability to perform spirometric tests reliably. In bronchial challenges lung sounds could be used to detect the required 20% fall in the forced expiratory volume in one second (FEV1). A study was undertaken to determine whether a change in lung sounds corresponded with a 20% fall in FEV1 after methacholine challenge, and whether the occurrence of wheeze was the most important change. METHODS Fifteen children with asthma (eight boys) of mean age 10.8 years (range 8-15) were studied. All had normal chest auscultation before the methacholine challenge test. Lung sounds were recorded over the trachea for one minute and stored on tape. They were analysed directly and also scored blindly from the tape recording by a second investigator. Wheeze, cough, increase in respiratory rate, and prolonged expiration were assessed. RESULTS The total cumulative methacholine dose causing a fall in FEV1 of 20% or more (PD20) was detected in 12 children by a change in lung sounds - in four by wheeze and in eight by cough, increased respiratory rate, and/or prolonged expiration. In two subjects altered lung sounds were detectable one dose step before PD20 was reached. In three cases in whom no fall in FEV1 occurred, no change in lung sounds could be detected at the highest methacholine dose. CONCLUSION Changes in lung sounds correspond well with a 20% fall in FEV1 after methacholine challenge. Wheeze is an insensitive indicator for assessing bronchial responsiveness. Cough, increase in respiratory rate, and prolonged expiration occurs more frequently.
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Affiliation(s)
- A B Sprikkelman
- Beatrix Children's Hospital, University Hospital Groningen, Netherlands
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