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Podlecka D, Jerzyńska J, Brzozowska A. Don't we overestimate drug allergies in children? Int J Occup Med Environ Health 2023; 36:632-642. [PMID: 37750429 DOI: 10.13075/ijomeh.1896.02227] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES On average about 10% of parents report hypersensitivity to at least 1 drug in their children. After diagnosis process a few of these reactions are being confirmed as drug hypersensitivity reactions. The aim of the study was to assess the real-life prevalence of drug hypersensitivity in children based on drug provocation tests. MATERIAL AND METHODS The authors included 113 children, aged 4-18 years, referred to Pediatrics and Allergy Clinic in Łódź, Poland, due to incidence of adverse reaction during treatment. Medical history regarding allergies to drugs was taken in accordance to the form developed by the United States Food and Drug Administration Adverse Event Reporting System. Skin prick tests, intradermal test and drug provocation test were performed in all patients. RESULTS In all 113 patients suspected of drug allergy, after all diagnostic procedures, the authors proved IgE-mediated allergy to β-lactams, nonsteroid anti-inflammatory drugs, local anesthetics in 19 patients (16.8%). Previous history of allergy was a risk factor for drug allergy in studied patients (p = 0.001). The most frequent symptoms of allergy were urticaria and erythematous papular rash. CONCLUSIONS Drug allergy is a difficult problem in the practice of a doctor and is difficult to diagnose, especially in the pediatric population. It seems that too often isolated symptoms reported during infection or disease are taken as a symptom of drug allergy, and not as a symptom resulting from the course of the disease. Int J Occup Med Environ Health. 2023;36(5):632-42.
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Affiliation(s)
- Daniela Podlecka
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital, Department of Pediatrics and Allergy)
| | - Joanna Jerzyńska
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital, Department of Pediatrics and Allergy)
| | - Agnieszka Brzozowska
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital, Department of Pediatrics and Allergy)
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Jerzyńska A, Polańska A, Trafalska E, Jankowska A, Podlecka D, Brzozowska A. Prenatal polyunsaturated fatty acids and atopic dermatitis and food allergy in children from Polish Mother and Child Cohort study. Int J Occup Med Environ Health 2023; 36:428-436. [PMID: 37681430 PMCID: PMC10663999 DOI: 10.13075/ijomeh.1896.02222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES Polyunsaturated fatty acids (PUFAs) are involved both in immune system regulation and inflammation. The aim of this prospective study was to evaluate the association between maternal dietary intake of PUFAs during pregnancy and atopic dermatitis (AD) and food allergy (FA) in their children up to 7-9 years of age. MATERIAL AND METHODS The study population consists of 557 mother-child pairs from the Polish Mother and Child Cohort (REPRO_PL). Based on the Food Frequency Questionnaire completed between the 20-24th weeks of pregnancy, n-3 and n-6 PUFAs as well as n-6:n-3 fatty acid ratio were estimated using food composition tables. Children's health examinations at the age of 1, 2, and 7-9 years were performed by an allergist. Generalized estimating equations were performed in order to assess the prevalence of AD and FA at 3 time points. Independent variables in the equation were n-3, n-6 PUFAs and n-6:n-3 PUFAs ratio. In addition multivariate models were performed to assess the association of PUFAs with AD and FA. RESULTS The prevalence of AD was 37%, 26% and 21% and FA 26%, 22% and 22% at age of 1, 2 and 7-9 years, respectively. Higher n-6:n-3 fatty acid ratio correlated with higher prevalence of AD at age of 7-9 years (p < 0.07). In multivariate model n-6 PUFAs were significantly associated with increased risk of persistent FA (OR = 1.5, 95% CI: 1.1-2.1). CONCLUSIONS These results may contribute to the existing knowledge on the impact of maternal diet during pregnancy on children's optimal health, however further studies are needed before drawing conclusions and creating clinical practice guidelines. Int J Occup Med Environ Health. 2023;36(3):428-36.
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Affiliation(s)
| | - Alicja Polańska
- Medical University of Lodz, Faculty of Dietetics, Łódź, Poland
| | - Elżbieta Trafalska
- Medical University of Lodz, Department of Nutrition and Epidemiology, Łódź, Poland
| | - Agnieszka Jankowska
- Nofer Institute of Occupational Medicine, Department of Environmental and Occupational Health Hazards, Łódź, Poland
| | - Daniela Podlecka
- Medical University of Lodz, Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Łódź, Poland
| | - Agnieszka Brzozowska
- Medical University of Lodz, Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Łódź, Poland
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Podlecka D, Socha-Banasiak A, Jerzynska J, Nodzykowska J, Brzozowska A. Practical Approach to Hypersensitivity to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Children. Pharmaceuticals (Basel) 2023; 16:1237. [PMID: 37765044 PMCID: PMC10535469 DOI: 10.3390/ph16091237] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND We aimed to assess the real-life prevalence, patient profile, and clinical presentation of drug hypersensitivity to NSAIDs in children after an incidence of an adverse event during treatment, verified by a drug challenge test. METHODS We included 56 children, aged 4-18 years, referred to our allergy clinic due to the incidence of adverse reaction during treatment. Skin prick tests and a drug provocation test were performed in all patients. Diagnostics for persistent urticaria were performed. RESULTS In 56 patients suspected of drug allergy, we proved NSAID hypersensitivity in 17 patients (30.1%). In 84.9% (n = 47) of patients, the clinical manifestations of hypersensitivity revealed angioedema and urticaria. The most common culprit drug among NSAIDs in children was ibuprofen. Thirty-one (55.4%) reactions were immediate, and 25 (44.6%) were delayed or late. Previous history of allergy was a risk factor for NSAID hypersensitivity (p = 0.001). Vitamin D deficiency in the blood serum was a risk factor for NASID hypersensitivity (OR = 5.76 (95% Cl: 1.42-23.41)). CONCLUSIONS Hypersensitivity to NSAIDs is a difficult diagnostic problem in pediatric allergy. The most common manifestation of hypersensitivity to ibuprofen in children is acute urticaria and angioedema. Two important problems in the differential diagnosis are cofactors such as vitamin D levels and viral infections, which require further research.
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Affiliation(s)
- Daniela Podlecka
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland; (D.P.); (J.J.); (J.N.)
| | - Anna Socha-Banasiak
- Department of Gastroenterology, Allergology and Pediatrics, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland;
| | - Joanna Jerzynska
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland; (D.P.); (J.J.); (J.N.)
| | - Joanna Nodzykowska
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland; (D.P.); (J.J.); (J.N.)
- Military Medical Academyy Memorial Teaching Hospital of the Medical, University of Lodz-Central Veteran’s Hospital, 90-549 Lodz, Poland
| | - Agnieszka Brzozowska
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital in Lodz, Medical University of Lodz, 90-419 Lodz, Poland; (D.P.); (J.J.); (J.N.)
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Malewska-Kaczmarek K, Podlecka D, Mańkowski T, Jerzyńska J, Stelmach I. Exercise-Induced Bronchoconstriction in Children: A Comparison between Athletes and Non-Athletes. Healthcare (Basel) 2023; 11:healthcare11091349. [PMID: 37174890 PMCID: PMC10177973 DOI: 10.3390/healthcare11091349] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/17/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is a dysfunction of the respiratory tract consisting of transient airflow obstruction. This study is a retrospective analysis of two prospective studies concerning EIB symptoms in two adolescent populations. Our study group included 400 non-athletes and 101 athletes. Due to the similarity of indoor exercise conditions, an analysis was performed on the basis of where training took place. The study aims to assess the EIB prevalence in the following groups of adolescent children: non-athletes and athletes. In "indoor" athletes, the EIB prevalence was 22.4%. Among non-athletes, EIB was diagnosed in 10.2% (p = 0.007). A history of asthma was found in 6.5% of non-athletes and 29.3% of indoor athletes (p < 0.001). The incidence of EIB without asthma was higher in indoor athletes (14.6%) than in non-athletes (9.9%). Athletes achieved higher mean values in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and maximum expiratory flow rate at 25% (MEF25) parameters. In the group of non-athletes, higher results were observed in forced expiratory volume in one second % of vital capacity (FEV1%VC), MEF50, and MEF75. The findings of the study present the complexity of the EIB diagnosis among children training in an indoor environment.
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Affiliation(s)
- Kamila Malewska-Kaczmarek
- Korczak Pediatric Center, Department of Pediatrics and Allergology, Medical University of Lodz, al. Pilsudskiego 71, 92-328 Lodz, Poland
| | - Daniela Podlecka
- Korczak Pediatric Center, Department of Pediatrics and Allergology, Medical University of Lodz, al. Pilsudskiego 71, 92-328 Lodz, Poland
| | - Tymoteusz Mańkowski
- Department of Radiology, Nicolaus Copernicus Regional Multi-Specialty, Oncology and Trauma Centre in Lodz, 93-513 Lodz, Poland
| | - Joanna Jerzyńska
- Korczak Pediatric Center, Department of Pediatrics and Allergology, Medical University of Lodz, al. Pilsudskiego 71, 92-328 Lodz, Poland
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Podlecka D, Jerzyńska J, Sanad K, Polańska K, Bobrowska-Korzeniowska M, Stelmach I, Brzozowska A. Micronutrients and the Risk of Allergic Diseases in School Children. Int J Environ Res Public Health 2022; 19:12187. [PMID: 36231487 PMCID: PMC9566642 DOI: 10.3390/ijerph191912187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Microelements and vitamins are believed to have immunomodulatory effects. The aim of the study was to establish the role of antioxidants (vitamins A, E, D) and microelements such as copper (Cu), selenium (Se), and zinc (Zn) levels in allergic diseases in schoolchildren. The study uses a cohort of 80 children (40 with and 40 without allergy/asthma diagnosis) aged 9 to 12 years recruited for the Polish Mother and Child Cohort Study. At nine to twelve years old, the children were tested for microelement and vitamin content and health status (including skin-prick test and spirometry, urine cotinine level). Demographic data were collected from mothers by an allergist. The risk of asthma occurrence was found to be significantly related to the levels of Cu and Zn. The level of Cu was also particularly closely associated with allergic rhinitis and was indicated as a significant predictor of food allergy. The levels of Cu and Zn, and poor nutritional status in general, can influence the immune system and may be considered risk factors for developing asthma, allergic rhinitis and food allergy.
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Affiliation(s)
- Daniela Podlecka
- Department of Pediatrics and Allergy, Medical University of Lodz, 90-328 Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, Medical University of Lodz, 90-328 Lodz, Poland
| | | | - Kinga Polańska
- Department of Pediatrics and Allergy, Medical University of Lodz, 90-328 Lodz, Poland
- Department of Environmental and Occupational Health Hazards, Nofer Institute of Occupational Medicine, 91-324 Lodz, Poland
| | | | | | - Agnieszka Brzozowska
- Department of Pediatrics and Allergy, Medical University of Lodz, 90-328 Lodz, Poland
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Kapszewicz K, Podlecka D, Polańska K, Stelmach I, Majak P, Majkowska-Wojciechowska B, Tymoniuk B, Jerzyńska J, Brzozowska A. Home Environment in Early-Life and Lifestyle Factors Associated with Asthma and Allergic Diseases among Inner-City Children from the REPRO_PL Birth Cohort. Int J Environ Res Public Health 2022; 19:11884. [PMID: 36231188 PMCID: PMC9564989 DOI: 10.3390/ijerph191911884] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We hypothesized that, in our REPRO_PL cohort, exposure to indoor allergens and lifestyle factors in early life are associated with risk of asthma, atopic dermatitis, and allergic rhinitis at ten years of age. METHODS We only examined children who had lived in the same house from birth. Children's exposure to tobacco smoke was assessed based on cotinine levels in urine. House dust samples were collected. RESULTS Higher Fel d1 concentration in house dust was associated with significantly higher risk of developing asthma at age 10 years (95% CI,10.87 to 20.93; p < 0.001). Frequent house cleaning was associated with development of atopic dermatitis (odds ratio 0.61; 95% CI 0.37 to 0.99; p = 0.045). Clustering of exposure to HDM revealed two types of environment. Cluster 1, defined as lower HDM (dust), in contrast to Cluster 2, defined as higher HDM, was characterized by old-type windows, lower fungus and dampness levels, as well as more frequent house cleaning. CONCLUSION Exposure to cat allergens and new-type buildings that limit air flow while increasing the condensation of steam on the windows and thereby stimulating the growth of fungi are risk factors for the development of asthma.
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Affiliation(s)
- Katarzyna Kapszewicz
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Pabianicka Street 62, 93-513 Lodz, Poland
| | - Daniela Podlecka
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Pabianicka Street 62, 93-513 Lodz, Poland
| | - Kinga Polańska
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Pabianicka Street 62, 93-513 Lodz, Poland
- Department of Environmental and Occupational Health Hazards, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland
| | | | - Pawel Majak
- Department of Pediatric Pulmonology, Copernicus Memorial Hospital, Medical University of Lodz, 93-513 Lodz, Poland
| | | | - Bogusław Tymoniuk
- Department of Immunology and Allergy, Medical University of Lodz, 93-513 Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Pabianicka Street 62, 93-513 Lodz, Poland
| | - Agnieszka Brzozowska
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Pabianicka Street 62, 93-513 Lodz, Poland
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Brzozowska A, Podlecka D, Jankowska A, Król A, Kaleta D, Trafalska E, Nowakowska-Świrta E, Kałużny P, Hanke W, Bal-Gierańczyk K, Kowalska M, Polańska K, Jerzyńska J. Maternal diet during pregnancy and risk of allergic diseases in children up to 7-9 years old from Polish Mother and Child Cohort study. Environ Res 2022; 208:112682. [PMID: 34999032 DOI: 10.1016/j.envres.2022.112682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/16/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The impact of maternal diet during pregnancy on the risk of allergic diseases in childhood is an increasing scientific and public health concern. We evaluated the associations of maternal type of diet and essential elements and vitamins intake during pregnancy with offspring allergic and respiratory outcomes. METHODS The study population included 557 mother-child pairs from Polish Mother and Child Cohort (REPRO_PL). Based on the Food Frequency Questionnaire filled in between the 20th-24th week of pregnancy, overall maternal diet was evaluated as the difference between the Prudent Dietary Pattern (PDP) score and Western Dietary Pattern (WDP) score ((PDP-WDP) score) and maternal achievement of dietary recommendations (estimated average requirement, EAR) for essential elements and vitamins was assessed. Children's health examination at age of 1, 2, and 7-9 years covered the following symptoms: infections, wheezing/asthma, food allergy, allergic rhinitis, and atopic dermatitis. At age of 7-9 years, children underwent spirometry and skin-prick tests. RESULTS Children of the mothers who were not achieving adequate intake of vitamin C during pregnancy had a higher risk of wheezing and having more than two infections within the first two years of life comparing to those who met EAR (OR = 2.6, p = 0.05, and OR = 2.3, p = 0.04, respectively). Inadequate intake of vitamin E during pregnancy was related to a higher risk of atopic dermatitis (OR = 2.7, p = 0.04), whereas inadequate intake of magnesium during pregnancy was associated with the risk of wheezing in the offspring at age of two years (OR = 3.7, p = 0.03). A lower (PDP-WDP) score during pregnancy (indicating unhealthier diet) was associated with a higher risk of infections (OR = 1.5, p = 0.007) but a lower risk of atopic dermatitis (OR = 0.7, p = 0.02) at age of 7-9 years. CONCLUSIONS These results may contribute to the body of evidence for the impact of maternal diet during pregnancy for children's optimal health, however further studies are needed before drawing conclusions and recommendations for clinical practice.
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Affiliation(s)
- Agnieszka Brzozowska
- Department of Paediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, 90-329, Lodz, Poland.
| | - Daniela Podlecka
- Department of Paediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, 90-329, Lodz, Poland.
| | - Agnieszka Jankowska
- Department of Environmental and Occupational Health Hazards, Nofer Institute of Occupational Medicine, 91-348, Lodz, Poland.
| | - Anna Król
- Department of Environmental and Occupational Health Hazards, Nofer Institute of Occupational Medicine, 91-348, Lodz, Poland.
| | - Dorota Kaleta
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-752, Lodz, Poland.
| | - Elżbieta Trafalska
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-752, Lodz, Poland.
| | - Ewa Nowakowska-Świrta
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348, Lodz, Poland.
| | - Paweł Kałużny
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, 91-348, Lodz, Poland.
| | - Wojciech Hanke
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, 91-348, Lodz, Poland.
| | - Katarzyna Bal-Gierańczyk
- Department of Paediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, 90-329, Lodz, Poland.
| | - Małgorzata Kowalska
- Department of Epidemiology, Medical University of Silesia, 40-752, Katowice, Poland.
| | - Kinga Polańska
- Department of Environmental and Occupational Health Hazards, Nofer Institute of Occupational Medicine, 91-348, Lodz, Poland; Department of Hygiene and Epidemiology, Medical University of Lodz, 90-752, Lodz, Poland.
| | - Joanna Jerzyńska
- Department of Paediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, 90-329, Lodz, Poland.
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Rahimo M, Jerzyńska J, Brzozowska A, Podlecka D. When toothache results in asthma diagnosis. Int J Occup Med Environ Health 2022; 35:107-110. [PMID: 34346923 PMCID: PMC10464722 DOI: 10.13075/ijomeh.1896.01810] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/26/2021] [Indexed: 10/20/2022] Open
Abstract
Local anesthetics (LA) have been used for a wide variety of procedures over the years due to their analgesic effect. These drugs have been seen to cause adverse events in the pediatric population, but an actual allergy must be in question. A case of an apparent hypersensitivity reaction to LA used in the setting of dental procedures in a 14.5-year-old girl with a forgotten history of asthma was reported and medical documentation review was performed. After treatment with LA during several dental procedures, the patient presented the shortness of breath, malaise and fainting, which then resolved spontaneously. After proper history taking, and skin and provocation tests, the patient was diagnosed with bronchial asthma and emotional sensitivity. The patient's recommendation included using an antihistamine and controlling her asthma before the use of LA, and administering the drug in a supine position. It is essential to consider all possible etiologies of an adverse event after using drugs in the pediatric population and to perform proper testing before making the diagnosis of a drug allergy.
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Affiliation(s)
- Maryam Rahimo
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital, Korczak Paediatric Center, Department of Pediatrics and Allergy)
| | - Joanna Jerzyńska
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital, Korczak Paediatric Center, Department of Pediatrics and Allergy)
| | - Agnieszka Brzozowska
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital, Korczak Paediatric Center, Department of Pediatrics and Allergy)
| | - Daniela Podlecka
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital, Korczak Paediatric Center, Department of Pediatrics and Allergy)
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Smejda K, Jerzynska J, Podlecka D, Brzozowska A. Sensitization to cat and dog components and prediction of symptoms in cat-sensitized children. Asian Pac J Allergy Immunol 2021. [PMID: 33865296 DOI: 10.12932/ap-070920-0953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sensitization to cat and/or dog allergens during childhood represents a risk factor for the development of allergic diseases later in life. OBJECTIVE The study investigated the association of patterns of sensitization to cat and dog allergen components with clinical symptoms of allergy to these furry animals among cat-sensitized children. METHODS The children were evaluated for the presence of bronchial asthma, atopic dermatitis and allergic rhinitis. Their mothers completed a questionnaire on pet exposure at home. Levels of serum IgE cat epitopes Fel d (1, 2, 4), as well as dog components Can f (1, 2, 3, 5) were measured in all the studied children. RESULTS Respiratory symptoms following exposure to the cat allergen were most common in children with Fel d 2 epitope (p = 0.041). After contact with a dog, respiratory symptoms were most common in children with Can f 1 epitope (p = 0.042), atopic dermatitis in children with sensitization to both Can f 1 (p = 0.009) and Can f 2 (p = 0.002), whereas eye symptoms occurred mostly in children with Can f 3 (p = 0.039). CONCLUSIONS Molecular diagnosis in patients with pet allergy may help clinicians to predict clinical symptoms and their severity.
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Affiliation(s)
- Katarzyna Smejda
- Siriraj Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland
| | - Joanna Jerzynska
- Siriraj Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland
| | - Daniela Podlecka
- Siriraj Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland
| | - Agnieszka Brzozowska
- Siriraj Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland
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Bobrowska-Korzeniowska M, Jerzyńska J, Mitał M, Podlecka D, Brzozowska A, Stelmach I, Stelmach W. Effectiveness of ongoing face-to-face anti-tobacco intervention in children with asthma. Allergy Asthma Proc 2020; 41:198-203. [PMID: 32375964 DOI: 10.2500/aap.2020.41.200010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Interventions to help parents quit smoking may yield important benefits for children with asthma. Children's exposure to environmental tobacco smoke can be measured by reporting of an adult in the household and testing the child's biomarker, e.g., cotinine. Objective: The aim of the study was to assess the effectiveness of "face-to-face" intervention carried out since 2016 in families with children diagnosed with asthma 3 years after beginning the anti-tobacco intervention. Methods: This study was a follow-up to an interventional study that assessed the effectiveness of direct patient education versus educational leaflets alone about parental tobacco smoking. The patients with asthma (ages 4-17 years) enrolled in our original intervention study conducted in 2016 were under the care of the allergy outpatient clinic. The active group was individually educated about the harmful effects of environmental tobacco smoke on their children. The control group included patients and parents, among whom only leaflets were distributed. After 3 years of ongoing intervention, in patients from both groups, exposure to tobacco smoking was evaluated with a questionnaire addressed to parents and/or caregivers and measurement of cotinine in children's urine. The forced expiratory volume in the first second of expiration and fractional exhaled nitric oxide levels were measured. Results: Seventy participants completed the study: 37 in the active group and 33 in the control group. In the active group, 27% of the parents quit smoking entirely compared with 9.4% of parents in the control group. In the group of active intervention, a significant decrease in the cotinine level (p < 0 .001) and the number of cigarettes smoked daily were observed (p < 0.001) 3 years after the active intervention compared with values right after the intervention. In the control group, there were no significant changes in the above-mentioned parameters. Conclusion: "Face-to-face" intervention among families with smokers were effective and lowered cotinine levels in children with asthma and the number of cigarettes smoked assessed 3 years after the intervention.
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Affiliation(s)
- M. Bobrowska-Korzeniowska
- From the Department of Paediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland, and
| | - J. Jerzyńska
- From the Department of Paediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland, and
| | - M. Mitał
- Social Medicine Institute, Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - D. Podlecka
- From the Department of Paediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland, and
| | - A. Brzozowska
- From the Department of Paediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland, and
| | - I. Stelmach
- From the Department of Paediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland, and
| | - W. Stelmach
- Social Medicine Institute, Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
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Podlecka D, Gromadzińska J, Mikołajewska K, Fijałkowska B, Stelmach I, Jerzynska J. Longitudinal effect of phthalates exposure on allergic diseases in children. Ann Allergy Asthma Immunol 2020; 125:84-89. [PMID: 32244034 DOI: 10.1016/j.anai.2020.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/11/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Environmental chemicals, such as phthalates, phenols, and parabens, may affect children's immune development and contribute to the risk of atopic diseases and asthma. OBJECTIVE To evaluate the associations between prenatal and childhood phthalate exposure and atopic diseases in children at the age of 9 years. METHODS This analysis is restricted to 145 mother-child pairs from the prospective Polish Mother and Child Cohort Study. Phthalate metabolite levels were assessed in the urine samples collected from mothers during the third trimester of pregnancy and from children at age of 2 and 9 years. For the appropriate recognition of children's health status, a questionnaire was administered to the mothers and completed with information from the medical record of each child. The clinical examination was performed by a pediatrician/allergist in the presence of the mother or a relative. RESULTS A higher urine concentration of mono-2-ethyl-5-oxohexyl phthalate increased the risk of food allergy in children at the age of 9 years (odds ratio [OR], 1.75; 95% CI, 1.19-2.57; P = .004) and decreased the risk of atopic dermatitis (OR, 0.49; 95% CI, 0.27-0.87; P = .02). For mono-2-ethyl-5-hydroxyhexyl phthalate, an increased risk of atopic dermatitis was observed (OR, 1.90; 95% CI, 1.18-3.05; P = .008). A higher urine concentration of mono-benzyl phthalate increased the risk of asthma in children (OR, 1.67; 95% CI, 1.08-2.58; P = .02), but the risk of asthma decreased when the concentration of mono-2-ethylhexyl phthalate was higher (OR, 0.64; 95% CI, 10.43-0.97; P = .04). CONCLUSION Our study has not provided clear evidence of the negative effect of phthalate exposure during pregnancy and within the 9 years after birth on allergic diseases in children.
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Affiliation(s)
- Daniela Podlecka
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Jolanta Gromadzińska
- Department of Biological and Environmental Monitoring, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Karolina Mikołajewska
- Department of Biological and Environmental Monitoring, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Beata Fijałkowska
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Joanna Jerzynska
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland.
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Malewska-Kaczmarek K, Jerzyńska J, Podlecka D, Mospinek E, Górska K, Stelmach I. Effect of regular training on lung function in adolescents. Pediatr Med Rodz 2019. [DOI: 10.15557/pimr.2019.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Koniarek-Maniecka A, Olszowiec-Chlebna M, Podlecka D, Jerzyńska J, Stelmach I. The effect of treatment with calcitriol and cholecalciferol on calcium and phosphate metabolism in patients with cystic fibrosis. PEDIATR MED RODZ 2019. [DOI: 10.15557/pimr.2019.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Podlecka D, Jerzynska J, Malewska-Kaczmarek K, Stelmach I. A Case of a Child With Several Anaphylactic Reactions to Drugs. Glob Pediatr Health 2019; 6:2333794X19855287. [PMID: 31259207 PMCID: PMC6587380 DOI: 10.1177/2333794x19855287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/16/2018] [Revised: 04/30/2019] [Accepted: 05/10/2019] [Indexed: 11/23/2022] Open
Abstract
Adverse drug reaction is defined as any harmful, unintended, and undesired effect of a drug that occurs at doses used for treatment, prevention, or diagnoses. Most of these reactions are classified as type A reactions, which by definition are predictable, common, dose-dependent, and caused by known pharmacological actions of the drug, drug toxicity, and side effects. Allergic reactions are qualified as type B reactions independent of dose, affecting a small population, suggesting that individual patient host factors are important. In pediatric population, β-lactam antibiotics are the most common reason for adverse drug reactions, followed by nonsteroidal anti-inflammatory drugs. In this article, we report the case of a child with several anaphylactic reactions to several drugs, including cefuroxime, amoxicillin/clavulanate, clarithromycin, ibuprofen, and budesonide, in a context of suspected Helicobacter pylori infection.
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Affiliation(s)
- Daniela Podlecka
- N. Copernicus Memorial Hospital, Lodz, Poland, Medical University of Lodz, Poland
| | - Joanna Jerzynska
- N. Copernicus Memorial Hospital, Lodz, Poland, Medical University of Lodz, Poland
| | | | - Iwona Stelmach
- N. Copernicus Memorial Hospital, Lodz, Poland, Medical University of Lodz, Poland
- Iwona Stelmach, Pilsudskiego 71 Street, Łodz 90-328, Poland.
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Stelmach I, Kwarta P, Jerzyńska J, Stelmach W, Krakowiak J, Karbownik M, Podlecka D, Hanke W, Polańska K. Duration of breastfeeding and psychomotor development in 1-year-old children - Polish Mother and Child Cohort Study. Int J Occup Med Environ Health 2019; 32:175-184. [PMID: 30829342 DOI: 10.13075/ijomeh.1896.01328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the association between breastfeeding duration and child neurodevelopment based on the Polish Mother and Child Cohort Study. MATERIAL AND METHODS The current analysis included 501 mother-child pairs. The analysis evaluating the association between the length of breastfeeding and child neurodevelopment considered the following variables: maternal age and body mass index, weight gain during pregnancy, parental level of education, marital status, socioeconomic status, child gender, birthweight, type of delivery, preterm delivery, pre- and postnatal exposure to tobacco constituents and child day care attendance. Psychomotor development was assessed in 1-year-olds on the <i>Bayley Scales of Infant and Toddler Development</i>. RESULTS The length of breastfeeding correlated positively with maternal age at delivery (ρ = 0.13), maternal and paternal level of education (ρ = 0.2 and ρ = 0.14 respectively), birthweight (ρ = 0.1) and marital status (ρ = 0.16) (p < 0.05). A negative correlation between the length of breastfeeding and maternal smoking status during the first year after delivery (ρ = -0.19) and weight gain during pregnancy (r = -0.1) was observed (p < 0.05). The association between the duration of breastfeeding and child development was not statistically significant in the model with the inclusion of confounding variables. A significant association between language development and maternal level of education (p = 0.004), gender of the child (p = 0.0007) and maternal weight gain during pregnancy (p = 0.01) was found. A negative association between cognitive development and maternal salivary cotinine during pregnancy (p = 0.03) and a negative association between motor development and maternal smoking status during the first year after delivery (p = 0.007) were also found. CONCLUSIONS This study found no significant association between the duration of breastfeeding and child development after adjustment for confounders. Int J Occup Med Environ Health. 2019;32(2):175-84.
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Affiliation(s)
- Iwona Stelmach
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital in Łódź, Department of Pediatrics and Allergy).
| | - Paulina Kwarta
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital in Łódź, Department of Pediatrics and Allergy).
| | - Joanna Jerzyńska
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital in Łódź, Department of Pediatrics and Allergy)
| | - Włodzimierz Stelmach
- Medical University of Lodz, Łódź, Poland (Department of Social and Preventive Medicine)
| | - Jan Krakowiak
- Medical University of Lodz, Łódź, Poland (Department of Social and Preventive Medicine)
| | - Michał Karbownik
- Medical University of Lodz, Łódź, Poland (Department of Pharmacology and Toxicology)
| | - Daniela Podlecka
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital in Łódź, Department of Pediatrics and Allergy)
| | - Wojciech Hanke
- Nofer Institute of Occupational Medicine, Łódź, Poland (Department of Environmental Epidemiology)
| | - Kinga Polańska
- Nofer Institute of Occupational Medicine, Łódź, Poland (Department of Environmental Epidemiology)
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Fuss P, Bal K, Jerzyńska J, Podlecka D, Stelmach W, Stelmach I. Association between environmental exposure and CD4+CD25+ regulatory T cells. Allergol Immunopathol (Madr) 2019; 47:43-46. [PMID: 29980400 DOI: 10.1016/j.aller.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND It is considered that farm areas protect young patients from allergy and asthma due to high exposure to endotoxins. AIM To compare CD4+/CD25+ T-regulatory cells and forkhead transcription factor Foxp3 expression in asthmatic children allergic to house dust mites (HDM) living in rural and farm areas. MATERIALS AND METHODS This was a prospective analysis of 35 children living in farm areas (n=19) and rural areas (n=16), aged 8-16, with allergic rhinitis (allergic to dust mites) and newly diagnosed asthma. Surface molecule CD4+CD25+Foxp3+ expression on cultured PBMCs was estimated by flow cytometry using fluorophore-conjugated monoclonal antibodies in each patient. RESULTS Thirty-five children were included into the analysis: 19 children living in farm areas and 16 in rural areas. Within and between-groups (farm area vs. rural area) differences in CD4+/CD25+ and CD4+/CD25+Foxp3+ cell expression did not reach the level of significance. CONCLUSION The current analysis showed that CD4+/CD25+ and CD4+/CD25+Foxp3+ cell expression was not associated with place of living in asthmatic children sensitive to HDM.
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Podlecka D, Malewska-Kaczmarek K, Jerzyńska J, Stelmach W, Stelmach I. Secondhand smoke exposure increased the need for inhaled corticosteroids in children with asthma. Ann Allergy Asthma Immunol 2018; 121:119-121. [PMID: 29709642 DOI: 10.1016/j.anai.2018.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/15/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Daniela Podlecka
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Kamila Malewska-Kaczmarek
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Wlodzimierz Stelmach
- Social Medicine Institute Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - Iwona Stelmach
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland.
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Jerzyńska J, Stelmach W, Rychlik B, Majak P, Podlecka D, Woicka-Kolejwa K, Stelmach I. Clinical and immunological effects of vitamin D supplementation during the pollen season in children with allergic rhinitis. Arch Med Sci 2018; 14:122-131. [PMID: 29379542 PMCID: PMC5778420 DOI: 10.5114/aoms.2016.61978] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/29/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Vitamin D deficiency has been proposed as a potential contributing factor in patients with allergic diseases. We compared the clinical and immunological effects of vitamin D supplementation to placebo during the pollen season in children with allergic rhinitis. MATERIAL AND METHODS Thirty-eight children aged 5-12, sensitive to grass pollen, participated in a prospective, randomized, double-blind, placebo-controlled trial. Children received either vitamin D 1000 IU daily supplementation or placebo. We studied symptoms/medication score, lung function, exhaled nitric oxide concentration (FENO), methacholine bronchial provocation test and serum level of 25(OH)D, as well as; CD4+CD25+Foxp3+ cells, TLR4, IL-1, IL-6, TNF and the IL-10 and transforming growth factor β1 (TGF-β1) levels in cell culture supernatants. RESULTS Vitamin D therapy was effective in reduction of the symptoms/medication score (p = 0.0371). In vitamin D group an increase in the CD4+CD25+Foxp3+ cells (7.06 vs. 10.5%; p = 0.0013) and serum 25(OH)D concentration (49.6 vs. 96.6 ng/ml; p = 0.0001) and in control group an increase in FENO (15.6 vs. 21 ppb; p = 0.0331) and serum 25(OH)D level were observed (82.9 vs. 100.3 ng/ml; p = 0.0003).We revealed a higher increase from baseline in the percentage of CD4+CD25+Foxp3+ cells in the vitamin D group compared to the control group (p = 0.0058). A significant correlation between CD4+CD25+Foxp3+ cell induction and FENO reduction in the vitamin D group was observed (p = 0.0217). CONCLUSIONS Vitamin D 1000 IU as a supplementary treatment of grass pollen allergy in children with allergic rhinitis during the pollen season significantly reduced the symptoms/medication score. The study revealed an immunological effect of vitamin D.
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Affiliation(s)
- Joanna Jerzyńska
- Departament of Pediatrics and Allergy, Medical University of Lodz, N. Copernicus Hospital, Lodz, Poland
| | - Włodzimierz Stelmach
- Departament of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - Błażej Rychlik
- Departament of Molecular Biophysics, University of Lodz, Lodz, Poland
| | - Paweł Majak
- Departament of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Daniela Podlecka
- Departament of Pediatrics and Allergy, Medical University of Lodz, N. Copernicus Hospital, Lodz, Poland
| | - Katarzyna Woicka-Kolejwa
- Departament of Pediatrics and Allergy, Medical University of Lodz, N. Copernicus Hospital, Lodz, Poland
| | - Iwona Stelmach
- Departament of Pediatrics and Allergy, Medical University of Lodz, N. Copernicus Hospital, Lodz, Poland
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Podlecka D, Jach B, Podsiadłowicz-Borzęcka M, Stelmach I. Lung abscess in an immunocompetent 4-year-old girl – a case report. PEDIATR MED RODZ 2017. [DOI: 10.15557/pimr.2017.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Jerzynska J, Podlecka D, Polanska K, Hanke W, Stelmach I, Stelmach W. Prenatal and postnatal exposure to polycyclic aromatic hydrocarbons and allergy symptoms in city children. Allergol Immunopathol (Madr) 2017; 45:18-24. [PMID: 27789067 DOI: 10.1016/j.aller.2016.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Studies indicate that exposure to polycyclic aromatic hydrocarbons (PAH) is associated with adverse respiratory and allergy outcomes. Exposure to PAH may impair the immune function of the foetus and, subsequently, be responsible for an increased susceptibility of children to allergic diseases. OBJECTIVES The aim of the present study was to assess the association between mother's exposure to PAH during pregnancy and allergy diseases in their infants. We also assessed the above associations using measured PAH exposure in children's urine during the first two years of life. METHODS The current analysis was restricted to 455 mothers and their children from Lodz district. The women were interviewed three times during the pregnancy in order to collect demographic, socio-economic and medical history data. Children's health status was assessed at the age of 10-18 months and repeated at two years of age. The associations between dependent dichotomous variables and urine concentrations of 1-hydroxypyrene (1-HP) were analysed using logistic regression. RESULTS We showed that higher urine concentrations of 1-HP in mothers at 20-24 weeks of pregnancy increased the risk of more frequent respiratory infections (p=0.02) in children during their first year of life. Higher 1-HP concentrations in children's urine increased the risk of food allergy (p=0.002) in children during their first two years of life. CONCLUSIONS This study suggests awareness of environmental factors, which may affect children's health since PAH showed to be a risk factor for airway infections and food allergy in children after adjustment for other risk factors.
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Hanke W, Jerzynska J, Podlecka D, Polanska K, Majak P, Stelmach I, Stelmach W. Prenatal and postnatal exposure to polycyclic aromatic hydrocarbons and allergy symptoms in children. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Stelmach I, Sztafińska A, Jerzyńska J, Podlecka D, Majak P, Stelmach W. New insights into treatment of children with exercise-induced asthma symptoms. Allergy Asthma Proc 2016; 37:466-474. [PMID: 27931302 DOI: 10.2500/aap.2016.37.3993] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Exercise is one of the most common triggers of bronchoconstriction and affects up to 80% of children with asthma. OBJECTIVE The purpose of this randomized, double-blind, placebo-controlled study was to assess the effectiveness of treatment with ciclesonide 160 microgram, either alone, with a higher dose, with a leukotriene receptor antagonist (LTRA), or with a long-acting beta-agonist (LABA) in children with asthma with postexercise-induced symptoms. METHODS Eighty adolescents, ages 1218 years, with asthma and postexercise symptoms were enrolled. Children were treated in one of four treatment groups: ciclesonide 160 microgram daily dose (cic 160), ciclesonide 320 microgram daily dose (cic 320), ciclesonide 160 microgram daily dose combined with montelukast (cic + LTRA), or ciclesonide 160 microgram daily combined with formoterol (cic + LABA). The impact of treatment on clinical symptoms, maximum percentage decrease in forced expiratory volume in 1 second after intense exercise effort, fractional exhaled nitric oxide in exhaled breath, and the contribution of inflammatory mediators in exhaled breath condensate were assessed. RESULTS In children with asthma and with postexercise symptoms, 8-week daily administration of ciclesonide 320 microgram, ciclesonide 160 microgram plus LABA, and ciclesonide 160 microgram alone decreased daytime symptoms; decrease in maximal fall in forced expiratory volume in 1 second reached the level of significance in the cic 320, cic + LABA, and cic + LTRA groups. A higher prevalence of positive responses to treatment after addition of an LTRA or LABA to ciclesonide 160 microgram for patients with exercise treadmill challengeinduced clinical symptoms only was revealed. CONCLUSION Monotherapy with ciclesonide 320 microgram can be as effective as combined therapy in reducing exercise-induced bronchoconstriction. We revealed a higher prevalence of positive responses to treatment after the addition of LTRA or LABA to ciclesonide 160 microgram for patients with exercise treadmill challengeinduced clinical symptoms only. ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov"www.ClinicalTrials.gov/ext-link NCT01798823.
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Affiliation(s)
- Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Poland
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Jerzynska J, Stelmach W, Rychlik B, Lechańska J, Podlecka D, Stelmach I. The clinical effect of vitamin D supplementation combined with grass-specific sublingual immunotherapy in children with allergic rhinitis. Allergy Asthma Proc 2016; 37:105-14. [PMID: 26932169 DOI: 10.2500/aap.2016.37.3921] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND An important issue in sublingual immunotherapy (SLIT) is how to improve efficacy. OBJECTIVE To compare the clinical efficacy of SLIT with vitamin D supplementation with placebo in children with allergic rhinitis. Secondary end points included lung function, exhaled nitric oxide concentration, methacholine bronchial provocation test, and serum level of calcifediol (25[OH]D). METHODS Fifty children, ages 5-12 years, sensitive to grass pollen, with allergic rhinitis (eight patients had concomitant asthma) participated in a 5-month prospective, randomized, double-blind, placebo-controlled trial. Children received a 5-grass pollen sublingual 300 IR tablet with either vitamin D 1000 IU daily supplementation or placebo. RESULTS When compared with the placebo group, SLIT plus vitamin D group therapy was more effective in the reduction of nasal symptoms (p = 0.04), asthma symptoms (p = 0.001), and the combined symptom-medication score (p = 0.001); there was no significant difference between the groups in medication and ocular scores. We observed a significant improvement of forced expiratory volume in 1 second (vitamin D group, p = 0.014; placebo group, p = 0.015) and the proportion of a person's vital capacity expired in the first second of forced expiration levels (vitamin D group, p = 0.004; placebo group, p < 0.001), within both groups, between visits. Fractional exhaled nitric oxide and provocative dose producing a 20% fall in forced expiratory volume in 1 second results did not statistically significantly differentiate the study participants in terms of receiving SLIT along with vitamin D or placebo. We showed a significant increase in calcifediol in the SLIT plus vitamin D group as well as in SLIT plus placebo group. CONCLUSIONS Vitamin D supplementation combined with grass-specific SLIT was more effective in the reduction of nasal and asthma symptoms. Vitamin D supplementation combined with SLIT provides an effective and well-tolerated new immunotherapy modality for treating children with allergic rhinitis. A 5-grass pollen sublingual 300 IR tablet was effective in both studied groups and also in children with comorbid mild asthma.
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Affiliation(s)
- Joanna Jerzynska
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland
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Stelmach I, Cichalewski Ł, Majak P, Smejda K, Podlecka D, Jerzyńska J, Stelmach W. School environmental factors are predictive for exercise-induced symptoms in children. Respir Med 2016; 112:25-30. [PMID: 26847408 DOI: 10.1016/j.rmed.2016.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/23/2015] [Accepted: 01/18/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Environmental factors in schools have a significant effect on the exercise-induced bronchoconstriction and symptoms in a general paediatric population. OBJECTIVES To determine the environmental factors such as atmospheric conditions and the presence of allergens in gymnasiums, that could be predictive of the presence of exercise-induced symptoms/bronchospasm in children during physical education (PE). METHODS 1370 schoolchildren were enrolled. Children attended 45 min PE lesson with similar exercise intensity. Pulmonary function tests were performed before and after PE lesson. Air temperature, humidity and pressure, samples of dust for allergen exposure in the gymnasiums were taken. Children who reported symptoms induced during PE lesson were invited to the clinic for ETC (exercise treadmill challenge) and atopy measurement. RESULTS 1033 participants were included into the analysis. Sixty seven(6.5%) children reported dyspnea/cough, and in 94(9.4%) children bronchoconstriction induced during PE lesson was documented. There is a correlation between the results of the ETC and bronchoconstriction after PE (OR: 2.55; 95%CI: 1.07-6.05; p = 0.034). Exposure to higher air pressure and higher humidity independently increase the risk of clinical symptoms reported during or after PE lesson. Exposure to cat's allergens increase the risk of bronchoconstriction (independently from atopy status). We showed significant interaction between presence of asthma and current ICS therapy as a risk of physical inactivity at school (OR: 4; 95%CI: 1.3-12; p < 0.001). CONCLUSION This study showed an effect of cat allergen and environmental factors (humidity, air pressure) on the appearance of exercise related cough/bronchoconstriction during activity class in a natural environment at school in a large urban population of schoolchildren.
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Affiliation(s)
- Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland.
| | - Łukasz Cichalewski
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Paweł Majak
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Katarzyna Smejda
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Daniela Podlecka
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital, Lodz, Poland
| | - Włodzimierz Stelmach
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
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Zaczeniuk M, Woicka-Kolejwa K, Stelmach W, Podlecka D, Jerzyńska J, Stelmach I. Methacholine challenge testing is superior to the exercise challenge for detecting asthma in children. Ann Allergy Asthma Immunol 2015; 115:481-4. [PMID: 26602490 DOI: 10.1016/j.anai.2015.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/17/2015] [Accepted: 09/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise-induced bronchoconstriction occurs in a large proportion of children with asthma. OBJECTIVE To compare the predictive value of methacholine challenge testing (MCCT) and the exercise treadmill challenge (ETC) for detecting asthma in children with postexercise symptoms. METHODS This was a prospective study of children 10 to 18 years old with postexercise symptoms. During asthma diagnosis, they underwent MCCT and ETC. There were 2 study visits. All subjects underwent ECT at visit 1 and MCCT 1 week later at visit 2. RESULTS One hundred one children were included; 62.9% had a history of atopy, and asthma was confirmed in 43.6%. MCCT showed 90.9% sensitivity, 82.5% specificity, 80.0% positive predictive value, and 92.2% negative predictive value; the respective values for ECT were 77.3%, 68.4%, 65.4%, and 79.6%. Positive MCCT results showed significantly higher sensitivity and higher positive predicative value in the diagnosis of asthma in children with postexercise symptoms compared with a 10% decrease in forced expiratory volume in 1 second for ECT (P = 0.034). Conducting MCCT during asthma diagnosis confirmed asthma in an additional 24.3% of children with exercise-induced symptoms. With a cutoff level at 17% of forced expiratory volume in 1 second for ECT, the discrepancy was decreased and reasonable values for sensitivity, specificity, positive predictive value, and negative predictive value were attained (61.0%, 77.1%, 69.4%, and 69.8%, respectively). CONCLUSION A large number of school children with asthma and postexercise symptoms could have positive MCCT and negative ECT findings. Untreated asthma in children with exercise-induced bronchoconstriction could cause them to be discharged from physical education classes. TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NCT01798823.
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Affiliation(s)
- Magdalena Zaczeniuk
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland
| | | | - Wlodzimierz Stelmach
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - Daniela Podlecka
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland
| | - Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland.
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Stelmach I, Majak P, Jerzynska J, Podlecka D, Stelmach W, Polańska K, Ligocka D, Hanke W. The effect of prenatal exposure to phthalates on food allergy and early eczema in inner-city children. Allergy Asthma Proc 2015; 36:72-8. [PMID: 26108074 DOI: 10.2500/aap.2015.36.3867] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE We hypothesized that maternal prenatal and children urine metabolite concentration of phthalates would be associated with food allergy and early eczema among inner-city children. The study was based on data from the Polish Mother and Child Cohort. METHODS Prenatal and postnatal exposure to the following phthalates: diethyl phthalate, diisobutyl phthalate, di-n-butyl phthalate, butyl-benzyl phthalate, di(2-ethylhexyl) phthalate, diisononyl phthalate, and di-n-octyl phthalate were determined by measuring phthalate metabolites in the urine collected from the mothers during the third trimester of pregnancy and from their children at age 2 years. Pre- and postnatal observations limited the response rate and final sample size; data from 147 participants were included in the analysis. Children's health status was assessed at 24 months of age by using a questionnaire administered to the mothers. We studied associations between the urine level of phthalates and the presence of food allergy and atopic dermatitis in logistic regression analysis. All associations were adjusted for independent risk factors of dependent variables. Associations with atopic dermatitis were adjusted for the effect of atopy in the family, the father's education, frequency of house cleaning, and breastfeeding; associations with food allergy were adjusted for the presence of pets at home during pregnancy and breastfeeding. RESULTS The prevalence of the outcomes were as follows: atopic dermatitis, 12.2%, and food allergy, 48.9%. We showed that higher urine concentrations of monobenzyl phthalate in mothers during pregnancy increased the risk of food allergy in children during the first 2 years of life (odds ratio 4.17 [95% confidence interval, 1.17-17.89]). There were no associations with children's urine and allergic symptoms. CONCLUSIONS Results of our study indicated awareness of environmental factors that may affect children's health because the phthalates were shown to be risk factors for food allergy in children.
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Affiliation(s)
- Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland
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Stelmach I, Podlecka D, Eusebio MO, Grzelewski T, Pietruczuk M. The patents on glucocorticosteroids and selected new therapies for the management of asthma in children: update. ACTA ACUST UNITED AC 2014; 8:41-7. [PMID: 24475945 DOI: 10.2174/1872213x08666140128143020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/08/2014] [Accepted: 01/24/2014] [Indexed: 11/22/2022]
Abstract
Despite the continuous increase in the prevalence of asthma in many developing countries, there have been major advances in understanding and managing this disease. The remarkable role of inflammation in asthma is well known. Current asthma guidelines recommend the use of anti-inflammatory drugs and immunotherapy for long-term management of asthma. The management of asthma in children is a challenge because of their inability to express warning signs and seek medical attention in a timely manner. Unlike adults, asthmatic children must rely on their parents or caregivers for the administration of asthma medications. The inability to carry and self-administer asthma drugs may increase the risk of non-compliance. Glucocorticosteroids, the most important drugs for patients with asthma, are associated with an increased level of side effects and compliance issues mostly in children. In an attempt to solve that dilemma, emphasis is being placed on the modification of current management tactics and the introduction of other drugs. This review presents more recent patents for childhood asthma therapies for the management of asthma in children.
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Affiliation(s)
| | | | | | | | - Miroslawa Pietruczuk
- Department of Pediatrics and Allergy, N Copernicus Hospital, 62 Pabianicka Street, 93-513, Lodz, Poland.
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Stelmach I, Majak P, Jerzynska J, Podlecka D, Stelmach W, Polańska K, Gromadzińska J, Wąsowicz W, Hanke W. Cord serum 25-hydroxyvitamin D correlates with early childhood viral-induced wheezing. Respir Med 2014; 109:38-43. [PMID: 25468413 DOI: 10.1016/j.rmed.2014.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 10/02/2014] [Accepted: 10/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are investigations concluding that reduced vitamin D status in pregnancy, may be a risk factor for the development of allergic outcomes in offspring. However, studies on the relationship between cord levels of 25-hydroxyvitamin D (25[OH]D) and risk of early childhood wheezing and early-onset atopic dermatitis/food allergy are very limited. OBJECTIVE To assess the associations between cord blood concentration of 25[OH]D and occurrence of the incidence of wheezing, atopic dermatitis, food allergy, during the first two years of life. METHODS We evaluated 240 children by the age of 2 years from the Polish Mother and Child Cohort Study. Women were interviewed during pregnancy to collect demographic and socioeconomic data, the medical and reproductive history. At delivery, umbilical cord blood plasma was sampled. The child's health status were examined at approximately 2 years. In the analyses multivariable model was used. RESULTS Data from 190 participants were included into the analysis. The median value and quartile range of 25[OH]D in cord blood [ng/ml] were as follows: 6.33, 4.16-8.53. 25[OH]D in cord blood below lower quartile increases the risk of multi-triggered wheezing (MTW) in children during first 2 years of life (OR: 2.81; 95% CI: 1.13-7.00). Higher cord serum level of 25[OH]D reduces the risk of viral induced wheezing (VIW). The cord serum level of 25[OH]D below median value (OR: 6.06; 95% CI: 1.3-28.3) or below lower quartile (OR: 5.43; 95% CI: 1.66-17.7) increases the risk of VIW. All above effects of vitamin D level in cord blood were corrected for the effects other independent risk factors of wheezing and VIW in this cohort. CONCLUSIONS Cord serum 25[OH]D levels were inversely associated with the risk of multi-triggered wheezing, and especially viral-induced wheezing by the age of 2 years, but no association was found with food allergy, atopic dermatitis and frequencies of infections.
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Affiliation(s)
- I Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland.
| | - P Majak
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland
| | - J Jerzynska
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland
| | - D Podlecka
- Department of Pediatrics and Allergy, Medical University of Lodz, Copernicus Memorial Hospital in Lodz, Poland
| | - W Stelmach
- Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - K Polańska
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - J Gromadzińska
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - W Wąsowicz
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - W Hanke
- Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
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Stelmach I, Podlecka D, Smejda K, Majak P, Jerzyńska J, Stelmach R, Janas A, Stelmach W. Pediatric asthma caregiver's quality of life questionnaire is a useful tool for monitoring asthma in children. Qual Life Res 2011; 21:1639-42. [PMID: 22138965 PMCID: PMC3472050 DOI: 10.1007/s11136-011-0070-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2011] [Indexed: 11/30/2022]
Abstract
Purpose There is little agreement among researchers whether a caregiver’s QOL can be used to detect changes in asthma severity in children. We assessed correlation between QOL in parents and QOL in children with asthma as well as clinical parameters of asthma. We determined whether changes in caregiver’s QOL scores reflect changes in child’s QOL and their asthma control. Methods This was a 9-week period cohort study. One hundred and ten primary caregivers with 110 children were seen in the clinic at enrollment, at week #1, #5 and #9. At each visit, the parents completed the Pediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ). Results One hundred and one children and 101 caregivers completed the study. We found a significant correlation between asthma diary score in children and QOL in parents (from r = −0.46 to r = −0.53). We also found significant positive correlation between PAQLQ and PACQLQ and significant association between changes in asthma control and PACQLQ score for both domains. We observed significant change in PACQLQ of caregivers whose children obtained asthma control. Conclusions PACQLQ is a useful tool for monitoring asthma in children. The implementation of the PACQLQ would be helpful in involving parents in therapy of their children with asthma.
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Affiliation(s)
- Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, N. Copernicus Hospital, 62 Pabianicka Str., 93-513, Lodz, Poland.
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Stelmach I, Podlecka D, Majak P, Jerzyńska J, Stelmach R, Janas A, Krakowiak J, Stelmach W. Validity of the Pediatric Asthma Quality of Life Questionnaire in Polish children. Pediatr Allergy Immunol 2011; 22:660-6. [PMID: 21950677 DOI: 10.1111/j.1399-3038.2011.01162.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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
BACKGROUND Although the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was translated for use in Polish asthmatic children, it is necessary to confirm that its validity, reliability, and the accuracy of the responses are not influenced by culture difference. Therefore, the objective of this study was to validate the Polish version of the Pediatric Asthma Quality of Life Questionnaire. METHODS This was a 9-week period cohort study. The patients were interviewed using the PAQLQ on four occasions: at baseline, 1 wk after inclusion, and after 5 and 9 wk. At each clinic visit, lung functions test and NO measurements were performed. Asthma control (according to GINA) was assessed throughout the study. RESULTS One hundred and one patients completed the study. At all visits, moderate correlations (from r = -0.51 to -0.68) between all PAQLQ domains and the asthma diary were observed. We noticed a significant improvement in the understanding of the questions during the last visit compared to baseline. The gradient of correlation coefficients between the symptoms domain of PAQLQ and asthma diary was observed across study visits. The standards of reliability defined by Cronbach's α-coefficient (from 0.75 to 0.91) were fulfilled in all domains of the questionnaire, at all visits. We found a higher increase in PAQLQ score in patients who obtained asthma control compared to those who lost control during the study. There was no relation between PAQLQ and FeNO. At all visits, moderate correlations (from r = -0.51 to -0.68) were shown between all PAQLQ domains and the asthma diary. CONCLUSIONS We showed that Polish version of PAQLQ is valid and reliable among our study group. Moreover, as far as clinical practice is concerned, PAQLQ seems to be a useful tool for monitoring asthma in children especially based on the physician's grading of asthma severity according to GINA guidelines.
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Affiliation(s)
- Iwona Stelmach
- Department of Pediatrics and Allergy, Medical University of Lodz, Lodz, Poland.
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