bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast-feeding Duration and Infant Atopic Manifestations, by Maternal Allergic Status, in the First 2 Years of Life (KOALA Study)
Authors: James John M. 
Published: October 2008

Snijders BEP, Thijs C, Dagnelie PC, et al. J Pediatr. 2007;151(4):347–351
PURPOSE OF THE STUDY. To investigate the potential effect of modification by maternal allergic status on the relationship between breastfeeding duration and infant atopic manifestations in the first 2 years of life.
STUDY POPULATION. Data from 2705 infants of the KOALA Birth Cohort Study (Netherlands) were analyzed.
METHODS. The data were collected by repeated questionnaires at 34 weeks’ gestation and 3, 7, 12, and 24 months postpartum. Total and specific immunoglobulin E measurements were taken on venous blood samples collected during home visits when the infants were 2 years of age. Relationships were analyzed by using logistic regression analysis.
RESULTS. Longer duration of breastfeeding was associated with a lower risk for eczema in infants of mothers without allergy or asthma (Ptrend = .01) and slightly lower risk in those of mothers with allergy but no asthma (Ptrend = .14). There was no such association for asthmatic mothers (Ptrend = .87). Longer breastfeeding duration decreased the risk of recurrent wheeze independent of maternal allergy (Ptrend = .02) or asthma (Ptrend = .06) status.
CONCLUSIONS. The findings show that the relationship between breastfeeding and infant eczema in the first 2 years of life is modified by maternal allergic status. The protective effect of breastfeeding on recurrent wheeze may be associated with protection against respiratory infections.
REVIEWER COMMENTS. The role of diet in preventing and treating atopic disease has been and continues to be an active area of clinical research. Snijders et al found that a longer duration of breastfeeding was associated with a lower risk of eczema in infants of mothers without allergy or asthma. There was a slight effect in mothers with allergy but no asthma, yet no such relationship was observed for asthmatic mothers. It is interesting to note that no effect modification of maternal allergy/asthma on infant IgE or allergen sensitization was observed. Finally, longer breastfeeding reduced the risk of recurrent wheezing independent of maternal allergic or asthma status, which the authors speculated may be the effect of reduced numbers of respiratory infections. Overall, these findings do support the role of breastfeeding in prevention of atopy, and additional studies are needed to better define the influence of maternal and infant diets during this time frame.
Relationship of Body Mass Index With Asthma Indicators in Head Start Children
Authors: Goldsobel Alan B. 
Published: October 2008

Vargas P, Perry T, Robles E, et al. Ann Allergy Asthma Immunol. 2007;99(1):22–28
PURPOSE OF THE STUDY. To examine the relationship of BMI and asthma in children in the Head Start program in Arkansas.
STUDY POPULATION. A group of 213 children aged 3 to 5 years with physician-diagnosed asthma were compared with 816 age-matched peer control subjects from the sample of the National Health and Nutrition Examination Survey (NHANES) and with 1024 children in prekindergarten in Arkansas public schools.
METHODS. Caregivers of the children with asthma from the Head Start program were interviewed with a structured questionnaire including the Juniper Asthma Quality of Life Survey, and the children's medical charts were reviewed. One hundred forty-one of the 213 children underwent skin-prick testing. One hundred forty-five of the children had urine cotinine levels measured to determine exposure to environmental tobacco smoke. These data were compared with the 2 reference groups in a cross-sectional analysis.
RESULTS. The prevalence of obesity (BMI &gt; 95th percentile) was significantly higher in the Head Start children with asthma compared with the NHANES children (P &lt; .001) and the prekindergarten children (P &lt; .05). Compared with Head Start children with a BMI at &lt;85th percentile, Head Start asthmatic patients with a BMI at &gt;85th percentile reported significantly more school days missed, lifetime hospitalizations, emergency department visits, activity limitations, and oral corticosteroid bursts. No significant differences were observed in rescue and controller medications, environmental tobacco smoke exposure, prick-puncture allergy testing, quality of life, or nighttime symptoms.
CONCLUSIONS. Obesity (BMI &gt; 95th percentile) was associated with increased asthma prevalence and morbidity. There was no association with the number or type of asthma medications or atopic status.
REVIEWER COMMENTS. This is another study showing the association of obesity and asthma. In this study, 18.8% of the Head Start children with asthma had a BMI at &gt;95th percentile, compared with 10.8% of the NHANES and 14.4% of the prekindergarten general-population children. The mechanisms of association have not been clearly established. Both conditions are characterized by chronic inflammation.
Safety of Open Food Challenges in the Office Setting
Authors: Järvinen Kirsi M. 
Published: October 2008

Mankad VS, Williams LW, Lee LA, LaBelle GS, Anstrom KJ, Burks AW. Ann Allergy Asthma Immunol. 2008;100(5):469–474
PURPOSE OF THE STUDY. To examine the safety of open food challenges (OFCs) administered in an office setting.
STUDY POPULATION. A total of 109 patients aged ≤18 years who underwent OFCs at the Duke University pediatric allergy-immunology clinic, excluding patients with a history of severe symptoms with previous reactions, were studied. Patient-selection criteria were based on the clinical history, results of skin-prick tests, and food-specific immunoglobulin E (IgE) levels that were much lower than those previously published levels predictive of a high likelihood of a clinical reaction.
METHODS. The authors performed a retrospective medical chart review of OFCs.
RESULTS. Among a total of 150 OFCs, most of which were to milk (n = 39), peanut (n = 37), and egg (n = 29), there were 40 positive test results (27% of all challenges) in 33 patients. Reactions were mild-to-moderate in 92% of the positive challenges. Cutaneous reactions occurred in 68% of the positive challenges, followed by gastrointestinal tract reactions (45%) and upper respiratory tract reactions (38%), excluding laryngeal symptoms. No patient had cardiovascular involvement, received epinephrine, or required hospitalization. Interventions included observation or antihistamine only for 92% of the positive challenges. Food-specific IgE values did not correlate with reaction severity. Of the 23 OFCs to milk, egg, and peanut without a history of clinical reactions, 8 were positive. For negative challenges, median prechallenge food-specific IgE levels approached previously published negative predictive values for these foods (1.22 kUA/L for milk, 0.96 kUA/L for peanut, and 0.65 kUA/L for egg). Negative challenge results for patients allowed the introduction of 19 different foods into the diets of 88 patients.
CONCLUSIONS. The authors concluded that OFCs are a safe procedure in the office setting for patients selected on the basis of food-specific IgE levels that approach negative predictive values and a lack of adverse reactions within the previous year.
REVIEWER COMMENTS. This nice report suggests that open OFCs performed by experienced practitioners in a clinic setting on carefully selected patients can be of significant benefit for patients who are tolerant to a food to avoid unnecessarily restrictive diets. Keeping in mind that the authors detected positive challenges in 4 patients with an undetectable food-specific IgE level and that there was a lack of association between the food-specific IgE level and severity of a reaction, prechallenge skin-prick tests and careful review of the clinical history should be used. Every challenge should be approached with appropriate precautions (emergency medications and equipment readily available) to treat potentially severe reactions.
Recognition, Clinical Diagnosis and Management of Patients With Primary Antibody Deficiencies: A Systematic Review
Authors: Bonilla Francisco A. 
Published: October 2008

Wood P, Stanworth S, Burton J, et al. Clin Exp Immunol. 2007;149(3):410–423
PURPOSE OF THE STUDY. To create an evidence-based literature review of clinical diagnosis and management of primary antibody deficiency.
METHODS. Computer literature searches were conducted for randomized clinical trials in medical literature databases including the US National Library of Medicine (Medline), the Excerpta Medica database (EMBASE), the Cochrane Library, the Database of Abstracts of Reviews of Effects (DARE) of the Centre for Reviews and Dissemination (University of York), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) up to June 2006. Reports were rated on the basis of relevance and quality or type of evidence. Disease entities included were X-linked agammaglobulinemia, common variable immunodeficiency, hyper–immunoglobulin M (IgM) syndromes, IgG subclass deficiency with and without IgA deficiency, and specific antibody deficiency. Reports that involved only a limited number of patients were not included.
RESULTS. Individuals who present with recurrent respiratory infections of all types, especially with excessive frequency and severity, should be screened for antibody deficiency. In children, common associations included growth delay and failure to thrive, recurrent fevers without a source, and poor school attendance or performance. Chronic diarrhea was found in 40% to 60% of the patients at all ages. The median delay in diagnosis was 1 year but ranged to &gt;10 years. Delayed diagnosis led to increased risk of bronchiectasis, pulmonary hypertension, and cor pulmonale. Randomized trials of the efficacy of γ-globulin replacement versus placebo do not currently exist. Many observational studies have confirmed the benefit of IgG therapy for reducing infectious morbidity. Higher IgG doses are associated with reduced incidence and severity of infections.
CONCLUSIONS. Delayed diagnosis was common as a result of lack of recognition of presenting symptoms and signs. Delay was less frequent when patients were referred to specialists. Delayed diagnosis led to delayed therapy (IgG) and a higher rate of infections and morbidity. Several areas for additional research were identified, including studies of efficacy and dose of IgG and adjunct therapies (antibiotics), microbiologic study of pathogens, identification of prognostic markers, and effective monitoring of disease (eg, lung function, other organs, cancer). Collaboration and pooling of data among centers nationally and internationally would likely lead to better data.
REVIEWER COMMENTS. This study again points out the human cost of delayed or undiagnosed immunodeficiency and the difficulties in accumulating high-quality data on therapy and outcomes. Several initiatives are taking shape in the United States and abroad to collaborate to answer many of the remaining questions pointed out in this study.
Glutamine-Enriched Enteral Nutrition in Very Low-Birth-Weight Infants: Effect on the Incidence of Allergic and Infectious Diseases in the First Year of Life
Authors: Kim Jennifer S. 
Published: October 2008

van den Berg A, van Zwol A, Moll HA, Fetter WP, van Elburg RM. Arch Pediatr Adolesc Med. 2007;161(11):1095–1101
PURPOSE OF THE STUDY. To determine the effect of glutamine-enriched enteral nutrition in very low birth weight infants on the incidence of allergic and infectious diseases during the first year of life. The authors hypothesized that glutamine may enhance maturation of the immune response by shifting the fetal T-helper 2 (Th2) response toward Th1 cytokine responses in early infancy, leading to decreased allergic disease later in life.
STUDY POPULATION. Infants with a gestational age of &lt;32 weeks and/or birth weight of &lt;1500 g who were admitted to a level III NICU were randomly assigned to receive enteral glutamine or control (l-alanine) supplementation.
METHODS. Enteral glutamine supplementation (l-glutamine, 0.3 g/kg per day) was administered to the intervention group from 3 through 30 days of life. Validated questionnaires were later sent to the parents of all eligible children, when they were a corrected age of 1 year, to assess the incidence of allergic and infectious diseases during the child's first year of life. Bronchial hyperreactivity was defined by report of at least 3 of the following physician-diagnosed symptoms: dyspnea, wheezing, humming/sawing breath sounds, or nightly dry cough without rhinitis.
RESULTS. Of 90 eligible infants, 77 participated (response rate: 86%). The risk for atopic dermatitis (AD) was lower in the glutamine-supplemented group (odds ratio: 0.13 [95% confidence interval: 0.02–0.97]). However, other outcomes did not differ between the intervention and control groups, such as incidence of bronchial hyperreactivity, upper respiratory tract infections, lower respiratory tract infections, and gastrointestinal infections.
CONCLUSIONS. Glutamine-enriched enteral nutrition in very low birth weight infants decreased the incidence of AD during the first year of life but had no effect on the incidence of bronchial hyperreactivity and infectious diseases during the first year of life.
REVIEWER COMMENTS. The sample size was relatively small and was not powered sufficiently, specifically to assess the incidence of bronchial hyperreactivity. Moreover, the corrected age of 1 year is too early for assessing the incidence of development of atopy and infections. Therefore, it is unclear as to whether AD was prevented or simply delayed in onset among this cohort.
Platelet-Activating Factor, PAF Acetylhydrolase, and Severe Anaphylaxis
Authors: Smart Brian A. 
Published: October 2008

Vadas P, Gold M, Perelman B, et al. N Engl J Med. 2008;358(1):28–35
PURPOSE OF THE STUDY. To characterize the roles of platelet-activating factor (PAF) and PAF acetylhydrolase, the enzyme that inactivates PAF, in humans.
STUDY POPULATION. The population was a variety of pediatric and adult patients with different levels of allergic disease along with nonallergic controls.
METHODS. Serum PAF levels and activity of PAF acetylhydrolase were measured in 41 patients with anaphylaxis and in 23 control patients. Serum PAF acetylhydrolase activity was also measured in 9 patients with peanut allergy who had fatal anaphylaxis and compared with that in 26 nonallergic pediatric control patients, 49 nonallergic adult control patients, 63 children with mild peanut allergy, 24 patients with nonfatal anaphylaxis, 10 children who died of nonanaphylactic causes, 15 children with life-threatening asthma, and 19 children with non–life-threatening asthma.
RESULTS. Mean serum PAF levels were significantly higher in patients with anaphylaxis than in patients in the control groups and were correlated with the severity of anaphylaxis. The proportion of subjects with elevated PAF levels increased from 4% in the control groups to 20% in the group with grade 1 anaphylaxis, 71% in the group with grade 2 anaphylaxis, and 100% in the group with grade 3 anaphylaxis. There was an inverse correlation between PAF levels and serum PAF acetylhydrolase activity. The proportion of patients with low PAF acetylhydrolase activity increased with the severity of anaphylaxis. Serum PAF acetylhydrolase activity was significantly lower in patients with fatal peanut anaphylaxis than in control patients.
CONCLUSIONS. Serum PAF levels were directly correlated and serum PAF acetylhydrolase activity was inversely correlated with the severity of anaphylaxis. PAF acetylhydrolase activity was significantly lower in patients with fatal anaphylactic reactions to peanuts than in patients in any of the control groups. Failure of PAF acetylhydrolase to inactivate PAF may contribute to the severity of anaphylaxis.
REVIEWER COMMENTS. PAF is 1 of the proinflammatory mediators that are released systemically by the degranulation of mast cells and basophils. Although PAF is not the only mediator that plays a role in anaphylaxis, these results suggest that PAF is very important. Therefore, it may be useful to develop new pharmaceutical agents that block its actions. Additional research is also needed to determine if PAF and PAF acetylhydrolase measurements may be used as a screening tool to select patients at highest risk for fatal anaphylaxis.
Health Plan Notification and Feedback to Providers Is Associated With Increased Filling of Preventer Medications for Children With Asthma Enrolled in Medicaid
Authors: Duplantier John E. 
Published: October 2008

Cooper WO, Ray WA, Arbogast PG, Garrison M, Dudley JA, Christakis DA. J Pediatr. 2008;152(4):481–488
PURPOSE OF THE STUDY. To determine if children enrolled in Medicaid managed care that provides asthma-specific communication to providers would be more likely to have adequate asthma-medication filling.
STUDY POPULATION. The study included 4498 children between the ages of 2 and 17 years with moderate-to-severe asthma enrolled in Medicaid in Tennessee and Washington State from 2000 and 2002.
METHODS. Study subjects had (1) an asthma hospitalization or asthma emergency department (ED) visit, (2) high use of asthma medications in the 6 months before their hospitalization or ED visit, and (3) stayed in the same Medicaid health plan from study entry through follow-up. Interviews were conducted with health plans to identify communication strategies used to improve asthma care by providers in the plan. The main outcome measure was guideline-recommended filling of asthma-preventer medications.
RESULTS. In the 365-day follow-up period, children in plans that provided specific feedback to providers about asthma quality and notified providers when children had an asthma-related event had higher rates of filling prescriptions than children in plans with neither (164.6 ± 13 vs 135.3 ± 10.8 days; P &lt; .05). For children with the greatest asthma severity, enrollment in a plan with both features was associated with 27.1 additional days of filling (95% confidence interval: 0.7–53.4 days) during the follow-up period.
CONCLUSIONS. Health plan communication to providers was associated with increased preventer filling in children with moderate-to-severe asthma in 2 state Medicaid programs.
REVIEWER COMMENTS. The children with the higher preventer fill rates only used their medications for less than half of the year. Identification of patients at high risk and frequent follow-up are needed to ensure more regular use of preventer medications. Health plans could assist providers by providing quarterly updates of fill rates for these patients at high risk so that intervention could occur before the patient ends up in the hospital or ED.
Decreased Markers of Atopy in Children With Presumed Early Exposure to Allergens, Unhygienic Conditions, and Infections
Authors: Järvinen Kirsi M. 
Published: October 2008

Stelmach I, Smejda K, Jerzynska J, et al. Ann Allergy Asthma Immunol. 2007;99(2):170–177
PURPOSE OF THE STUDY. To compare 2 populations of children with different risk and protective factors for the development of atopy.
STUDY POPULATION. The study group consisted of 415 children living in community foster homes in Lodz, a large industrial city in Poland. The reference group consisted of 500 children who were living with their parents at home and recruited from primary care centers.
METHODS. Questionnaires were completed by parents or guardians. The primary outcome measures were skin-prick test results to 14 environmental and 4 food allergens and specific immunoglobulin E (IgE) in serum. Secondary outcomes included symptoms of asthma and allergic diseases, lung function, parental allergy, and family history, including life conditions in early childhood, and markers of allergy, such as total IgE serum concentration and eosinophil blood cell count. Stool samples were analyzed for parasites.
RESULTS. The analysis included 408 study children and 402 reference children. Atopy was significantly more prevalent in the reference group (25.9%) than in the foster home children (11.3%). More positive skin-prick test results were observed in children from the reference group than in study children. Specific IgE was significantly higher to dust mites, timothy, and mugworth, as were asthma, rhinitis, and atopic dermatitis, in the reference group. To explain this phenomenon, the investigators selected 16 variables that differed in both groups in the first year of life and related them to atopy. They found that the more cumulative features characteristic of the foster home population (poor living conditions), the lower the risk of atopy.
CONCLUSIONS. Extremely unfavorable environmental circumstances, which are characteristic of the foster home population during early childhood, might prevent atopy.
REVIEWER COMMENTS. These data may suggest that many of our recommendations to parents (cleaning, reducing mold, prevention of infections) are not protective against development of atopy. The limitation of the study was lack of a search for the mechanism that is protective of atopy for those living in poor conditions. One factor could be endotoxin exposure in old homes, which was the case for 90% of those in foster homes. Furthermore, parasitic infections, prevalent in poor socioeconomic and poor hygienic conditions and further suggested by high eosinophil blood counts and serum total IgE concentrations in the nonatopic foster home children, were not fully evaluated.