Relationships between lung function, allergy, and wheezing in urban children

BACKGROUND

Allergic sensitization and low lung function in early childhood are risk factors for subsequent wheezing and asthma. However, it is unclear how allergic sensitization affects lung function over time.

OBJECTIVE

We sought to test whether allergy influences lung function and whether these factors synergistically increase the risk of continued wheezing in childhood.

METHODS

We analyzed longitudinal measurements of lung function (spirometry and impulse oscillometry) and allergic sensitization (aeroallergen skin tests and serum allergen-specific IgE) throughout early childhood in the Urban Environmental and Childhood Asthma study, which included high-risk urban children living in disadvantaged neighborhoods. Intraclass correlation coefficients were calculated to assess lung function stability. Cluster analysis identified low, medium, and high allergy trajectories, which were compared with lung function and wheezing episodes in linear regression models. A variable selection model assessed predictors at age 5 years for continued wheezing through age 12 years.

RESULTS

Lung function adjusted for growth was stable (intraclass correlation coefficient, 0.5-0.7) from age 5 to 12 years and unrelated to allergy trajectory. Lung function and allergic sensitization were associated with wheezing episodes in an additive fashion. In children with asthma, measuring lung function at age 5 years added little to the medical history for predicting future wheezing episodes through age 12 years.

CONCLUSIONS

In high-risk urban children, age-related trajectories of allergic sensitization were not associated with lung function development; however, both indicators were related to continued wheezing. These results underscore the importance of understanding early-life factors that negatively affect lung development and suggest that treating allergic sensitization may not alter lung function development in early to mid-childhood.

Omalizumab for Treatment of Idiopathic Angioedema

BACKGROUND

Omalizumab has been shown to improve outcomes in patients with chronic spontaneous urticaria (CSU). Idiopathic angioedema (IAE) is increasingly being recognized as a condition with similar underlying mechanisms as CSU and a form of CSU. We hypothesized that add-on therapy with omalizumab would benefit patients with uncontrolled IAE.

OBJECTIVE

To study the safety and efficacy of omalizumab for the treatment of IAE in adults.

METHODS

We conducted a randomized, placebo-controlled trial to study the efficacy of omalizumab in adults with two or more episodes of angioedema (AE) in the past 6 months for which no clinical or laboratory cause of AE could be found. Ten patients were randomized on a 1:1 basis to receive omalizumab 300 mg SQ or placebo every 4 weeks for 24 weeks with a 12 week follow up period. The primary endpoint was the change in the Angioedema Activity Score (AAS). Secondary endpoints included the Angioedema Quality of Life Questionnaire (AE-QoL), the Visual Analog Scale (VAS) and the number of angioedema episodes per month.

RESULTS

We observed improvement in the AAS score (-2.93 ln odds; 95% confidence interval (CI) -4.84, -1.02; p = 0.003), VAS (-3.49 ln odds; 95% CI -6.58, -0.40; p = 0.03), AE-QoL (-9.43 score; 95% CI -17.63, -1.24; p = 0.028) and number of angioedema episodes per month (-1.93 ln count; 95% CI -3.23, -0.63; p = 0.005) in patients that received omalizumab vs placebo.

CONCLUSION

This study provides preliminary prospective evidence that omalizumab improves outcomes in patients with IAE.

Meta-Analysis of Trials on Prophylactic Use of Levosimendan in Patients Undergoing Cardiac Surgery

BACKGROUND

The role of prophylactic levosimendan in patients undergoing cardiac surgery is controversial.

METHODS

We performed a computerized search of Medline, Embase, and Cochrane databases through September 2017 for randomized trials evaluating the prophylactic use of levosimendan in patients undergoing cardiac surgery (ie, patients without low cardiac output syndrome). The main study outcome was mortality at 30 days.

RESULTS

The final analysis included 16 randomized trials with total of 2,273 patients. There was no statistically significant difference in mortality at 30 days between levosimendan and control groups (relative risk 0.68, 95% confidence interval [CI]: 0.45 to 1.03). Subgroup analysis showed no statistically significant difference in mortality at 30 days for patients with reduced left ventricular ejection fraction compared with patients having preserved left ventricular ejection fraction (p for interaction = 0.12). Further analysis suggested that levosimendan might be associated with improved mortality at 30 days when compared with active-control but not when compared with placebo (p for interaction = 0.01). The levosimendan group had a significant reduction in acute kidney injury (relative risk 0.59, 95% CI: 0.38 to 0.92), intensive care unit stay (standardized mean difference = -0.21, 95% CI: -0.29 to -0.13), and ventilation time (standardized mean difference = -0.43, 95% CI: -0.61 to -0.25), whereas it had higher rates of atrial fibrillation (relative risk 1.11, 95% CI: 1.00 to 1.24). No statistically significant differences were observed between groups in mortality beyond 30 days, postoperative dialysis, or myocardial infarction.

CONCLUSIONS

Prophylactic use of levosimendan does not appear to reduce the mortality at 30 days or beyond 30 days in patients undergoing cardiac surgery. This lack of benefit was noted irrespective of the LVEF.

Mast cells and pterygium

A total of thirty pterygia were studied for mast cells using metachromatic dye (toluidine blue) together with routine histological stains. On microscopic examination, the lesion was differentiated and classified into angiomatous, fibrous and mixed varieties based on the vascular and collagenous components. The mast cell counts were undertaken in all types and were found to have significant correlation with the morphological types when compared to normal conjunctiva. 15.1 +/- 3.1, 22.7 +/- 3.8, 9.5 +/- 3.2 mast cell per mm2 were found in the angiomatous, mixed and fibrous types respectively. In the control material, the mast cell count was 12.4 +/- 2.3 per mm2. The results are discussed. It is believed that mast cells are actively involved in the genesis and progress of pterygium.