Development and validation of the parent-reported Drug Hypersensitivity Quality of Life Questionnaire

Summary

Background. Drug hypersensitivity in children impacts the quality of life of the patients and their caregivers. Measurements of the quality of life in children are different from adults, because children cannot answer the questions. This research aimed to develop and validate the Parent-reported Drug Hypersensitivity Quality of Life Questionnaire (P-DrHy-Q). Methods. The 21-item scale was initially generated by researchers. Then, 3 experts were asked for their opinion about the scale. After adjusting the contents and language, the scale was answered by 97 caregivers. A factor analysis was carried out to select the items for the final scale, and Cronbach's alpha assessed the internal consistency. Finally, we examined the test-retest reliability in another group of 10 caregivers. Results. The 21-item scale was grouped into 6 factors. However, some factors were inappropriate. Therefore, the number of factors was reduced using a statistical analysis. The final 12-item scale included two factors: mental health and social activity. The scale had good internal consistency (Cronbach's á = 0.897) and the test-retest associations were good (R = 0.9439; p minor 0.001). Conclusions. The P-DrHy-Q is the first scale for assessment to consider the interaction of biopsychosocial factors on drug allergy that includes the carer-child dyad. It shows good internal consistency and reliability. Its application might be relevant for future research, and provide clinicians and researchers with a solid tool to define which type of psychosocial support is required to provide more comprehensive care in drug hypersensitivity.

Adiposity rebound from three to six years of age was associated with a higher insulin resistance risk at eight-and-a-half years in a birth cohort study

AIM

The association between adiposity rebound and insulin resistance in middle childhood has seldom been studied. We examined the effect of body mass index (BMI) velocity and early adiposity rebound on the insulin resistance of prepubertal children.

METHODS

BMI data from a longitudinal follow-up of a birth cohort in Thailand were used. The homoeostatic model assessment of insulin resistance (HOMA-IR) was calculated from 12-hour fasting plasma glucose and serum insulin at eight-and-a-half years of age. BMI velocity was calculated from four periods: zero to one, one to three, three to six and six to eight-and-a-half years of age. A multiple linear regression model was used to assess the association of BMI velocity during these four periods and insulin resistance at the age of eight-and-a-half years.

RESULTS

In 814 children - 76.7% of the initial cohort - BMI velocities between years one to three, three to six and six to eight-and-a-half years were positively associated with HOMA-IR levels after adjusting for demographic, behavioural and socio-economic factors. Children who had BMI gains between three and six years had mean HOMA-IR values that were 43% higher than those who did not.

CONCLUSION

BMI velocity during early and middle childhood, and early adiposity rebound between three and six years, was associated with a higher insulin resistance risk at eight-and-a-half years.

Prospective cohort study on change in weight status and occurrence of habitual snoring in children

OBJECTIVE

To determine the association between the change in weight status and newly developed snoring in children.

DESIGN

This was a prospective cohort study.

SETTING

Structured interviews were conducted at participants' homes, and physical examinations were performed at The-pa Community Hospital in Southern Thailand.

PARTICIPANTS

Cohort subjects (n = 1076) were recruited from children born over a 1-year period between November 2000 and October 2001 in The-pa District of Songkhla Province, Southern Thailand. Data collection was performed when the child was 5 and 8.5 years old.

MAIN OUTCOME MEASURES

The child's snoring, weight, height and tonsillar size were examined. The change in weight status was categorised into four groups: not obese, became not obese, became obese and persistently obese.

RESULTS

Of 1076, 983 subjects (91.4%) completed both surveys. The overall prevalence of habitual snoring decreased from 13% at age 5 to 10.9% at age 8.5 years. Of the 855 children who reported not snoring in the first survey, 61 (7.1%) had become habitual snorers. After adjusting for tonsillar size, children who had become obese or were persistently obese had a significant association with becoming a new snorer with an odds ratio of 5.8 (Confidence interval, CI, 1.3-25.8) and 11.7 (CI, 2.5-54.9), respectively.

CONCLUSIONS

Children with newly developed obesity at 8.5 years old were strongly associated with new snoring occurrence, which is similar to the findings of long-term follow-up studies in adults. Our findings support the idea that the patterns of changes in weight status and snoring development in adults begin as early as the primary school years.

A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup

BACKGROUND

Although previous studies have shown that dexamethasone is useful in croup, the optimal dosage has not been clarified yet. The aim of this study was to investigate the effectiveness of dexamethasone 0.15 mg/kg single dose compared with the recommended dose of 0.6 mg/kg for treatment of hospitalized children with moderate to severe croup.

METHOD

Forty-one children aged 6 months to 5 years admitted from March 2001 to October 2003 at the pediatric ward of Hatyai Hospital with moderate to severe croup were recruited for the study. After random allocation, each child received a single intravenous injection of either dexamethasone 0.6 mg/kg (maximum dose 12 mg) or 0.15 mg/kg (maximum dose 3 mg). All children were given a single dose of epinephrine nebulization at the beginning of the study. The croup scores were measured at 0, 1, 2, 3, 4, 6, 8, 10 and 12 h after the dexamethasone injection.

RESULTS

One hour following the injection, the mean croup scores were significantly reduced from baseline values in both groups (p<0.01). There was no difference in the mean croup scores between the two groups at any time. Median times to croup scores equal or less than two in both high- and low-dose groups were 8 and 7.9 h, respectively. No patient required intubation or was removed from the study because of a rising croup score after enrollment. There was no significant adverse reaction from dexamethasone treatment in either group.

CONCLUSION

Dexamethasone 0.15 and 0.6 mg/kg are equally effective in the treatment of moderate to severe croup.

Relationship between atopic dermatitis and wheeze in the first year of life: analysis of a prospective cohort of Thai children

BACKGROUND

Patients with atopic dermatitis show increased risk of concomitant respiratory symptoms such as wheeze and cough. However, limited data is available on respiratory symptoms in atopic dermatitis patients when the disease is in remission.

OBJECTIVE

The aim of this study was to investigate the relationship between atopic dermatitis and wheeze during periods of active disease and remission of atopic dermatitis.

METHODS

The study formed part of the Prospective Cohort Study of Thai Children (PCTC) involving children born during the period October 2000 to September 2002. The principal caregiver in each family was identified and interviewed about socioeconomic factors, paternal health, and exposure to tobacco smoke. Data on wheeze and atopic dermatitis were collected from questionnaires administered at 6 and 12 months after birth.

RESULTS

Of the 4245 live births included in the PCTC cohort, 4021 (94.7%) participated in the follow-up survey at age 6 months and 12 months. The prevalence of wheeze and eczema were 13.8% and 7.4%, respectively. There was also a significant association between current atopic dermatitis and wheeze in the same period (P < .01). However, no significant association was observed between previous atopic dermatitis and wheeze when atopic dermatitis was in remission.

CONCLUSION

There is a significant increase in the risk of wheeze in infants with current atopic dermatitis but not in those in whom the disease is in remission.

Endotoxin Levels in Rural Thai and Urban Singaporean Homes

BACKGROUND

Exposure to dust endotoxin and allergens in early childhood may influence the development of allergic diseases.

AIMS

This study aimed to evaluate dust endotoxin and dust mite allergens in urban Singapore and rural Thai homes of young children and study potential environmental influences.

METHODS

Mattress dust endotoxin and Der p 1, Der f 1, group 2 (Der f 2 and Der p 2) and Blo t 5 allergen levels were quantified in 101 infant mattress dust samples, 51 from urban Singapore and 50 from rural Thailand. Comprehensive questionnaires on the home environment and cleaning practices were completed.

RESULTS

Endotoxin levels in rural Thailand were significantly higher than in urban Singapore (geometric mean 26,334.12 +/- 4.60 and 18,377.85 +/- 2.52 endotoxin units/g, respectively; p = 0.032). In contrast, higher levels of Der f 1 (p = 0.02), group 2 (p < 0.01) and Blo t 5 (p < 0.01) allergens were found in Singapore homes compared with rural Thai homes. Multiple logistic regression analysis showed that the use of detergents (p = 0.001) and disinfectants (p = 0.024) to clean floors and mattress protectors (p = 0.021) were independently associated with lower endotoxin levels.

CONCLUSION

Endotoxin levels are higher in rural compared with urban homes in South East Asia. The reverse was true for dust mite allergen levels. Certain identifiable home environmental conditions and practices accounted for the differences in endotoxin levels.

Evaluation of three methods for using the Duotip-Test device for skin testing

The sensitivity and precision of rotation, prick and puncture methods of using the Duotip-Test for epicutaneous allergy skin testing were evaluated. Forty-one volunteers who had not taken any antihistamines within the previous two weeks were recruited. The mean age was 21.6 years (range 18 to 25 years). Histamine hydrochloride 1 mg/ml and 50% glycerol saline were used as positive and negative controls, respectively. Each method of testing was performed in triplicate on the volar surface of both forearms. Wheal and flare were measured 15 minutes later. Rotation, prick and puncture methods produced histamine mean wheal diameter +/- standard deviation of 6.61 +/- 0.87 mm, 3.86 +/- 1.03 mm, and 3.00 +/- 0.65 mm, respectively (p < 0.01). The coefficient of variation of rotation method was 13.13%. It was the only method that gave coefficient of variation lower than 20%. False negative and false positive proportions of rotation method using a 4 mm criterion for positive reaction were 1.5% and 0.75%, respectively. Rotation method was well accepted by the volunteers although it was ranked highest in pain. We concluded that the rotation method of using Duotip-Test is a highly reliable technique for skin testing.

Partial mattress encasing significantly reduces house dust mite antigen on bed sheet surface: a controlled trial

BACKGROUND

The most effective measure in house dust mite antigen reduction is mattress encasing with an impermeable membrane. A reduction in encasing costs will help increase patients' compliance in mite antigen avoidance.

OBJECTIVE

To investigate the effectiveness of partial mattress encasing with a nylon sheet produced in Thailand on the reduction of group I mite antigens from beddings.

METHODS

Sixty regularly-used beds from the house officers' dormitory of the Siriraj Hospital Mahidol University, Thailand, were randomly matched into two groups according to mite antigen levels. The control group (CG) used only regular cotton bed sheets whereas the partial encasing group (PG) used mattresses partially covered with a locally produced nylon sheet underneath the regular cotton bed sheets. Dust collection from the beddings was performed at baseline, 2, 4 and 6 months after application of the nylon sheet. Mite antigen levels were detected by a two step monoclonal antibody ELISA.

RESULTS

Mite antigen levels in both groups were not different at the beginning of the study. The PG had significantly lower group I antigen levels on regular bed sheet surfaces than the CG (P < .004) at the 2, 4 and 6 month timepoints. However, antigen levels on the mattress surface of the PG was significantly higher than the CG at the end of the study (P < .004). The barrier efficacy of the nylon sheet in preventing migration of group I mite antigens from the mattress to the surface of the regular cotton bed sheet was 94% whereas that of the regular cotton bed sheet was 66% (P = .007).

CONCLUSION

Partial mattress encasing with a locally made nylon sheet can reduce mite antigens on the regular cotton bed sheet surfaces for up to 6 months.