bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Efficacy and Safety of Heat-Killed Lactobacillus paracasei for Treatment of Perennial Allergic Rhinitis Induced by House-Dust Mite
Authors: Wang Julie 
Published: September 2006

Purpose of the Study.
Live Lactobacillus paracasei 33 (LP33) may effectively improve the quality of life for patients with perennial allergic rhinitis. It has been demonstrated that heat-killed lactic acid bacteria suppress specific immunoglobulin E synthesis and stimulate interleukin-12 production in animals. The aim of this study, therefore, was to evaluate the efficacy of heat-killed LP33 in the treatment of allergic rhinitis induced by house-dust mite in human subjects.

Study Population.
A total of 90 patients older than 5 years with perennial allergic rhinitis characterized by intermittent or continuous nasal symptoms for &gt;1 year were enrolled in a randomized, double-blind, placebo-controlled trial and assigned to 3 treatment groups.

Methods.
Patients in groups A and B received 2 capsules per day of live or heat-killed lactic acid bacteria (5 × 109 colony-forming units per capsule), respectively, over a period of 30 days, whereas those in group C received placebo capsules. A modified questionnaire on pediatric rhinoconjunctivitis-related quality of life was administered to all subjects or their parents during each clinical visit.

Results.
The overall quality-of-life score decreased for groups A and B compared with the placebo group in terms of both frequency (9.47 ± 2.89, 6.30 ± 2.19, and −3.47 ± 1.53, respectively; P &lt; .0001) and level of bother (5.91 ± 3.21, 6.04 ± 2.44, and −2.80 ± 1.64, respectively; P = .004) after the 30-day treatment. The efficacy of the heat-killed LP33 was not inferior to the live variant. No obvious adverse effects were reported for either active-treatment group during the study period.

Conclusions.
The results suggest that heat-killed LP33 can effectively improve the overall quality of life for patients with allergic rhinitis and that it may be efficacious as an alternative treatment.

Reviewer Comments.
The hygiene hypothesis suggests that lack of early exposure to microorganisms is a factor in the recent rise in allergic disorders. Studies have shown the certain gut flora, including Lactobacillus, may have immunomodulatory effects that may be beneficial in regulating allergic responses. Concerns over safety of administering live bacteria as a therapeutic agent led Peng and Hsu to investigate the effectiveness of heat-killed lactobacillus in the treatment of allergic rhinitis. The authors demonstrate that the heat-killed version is effective in improving the quality of life of patients suffering from allergic rhinitis.
Learning Preferences of Caregivers of Asthmatic Children
Authors: Leo Harvey L. 
Published: September 2006

Purpose of the Study.
To determine the learning styles of the caregivers of asthmatic children seen in a pediatric allergy and immunology clinic.

Study Population.
Parents of asthmatic children seen in a tertiary care pediatric allergy and immunology clinic.

Methods.
Caregivers completed the Visual-Aural-Read/Write-Kinesthetic (VARK) questionnaire anonymously, and the responses were evaluated on the basis of previously validated scoring instructions.

Results.
Analysis of 98 respondents showed that 42% had a single learning-modality preference, and the remaining 58% were multimodal learners. Of those who reported a single mode of learning, 61% preferred kinesthetic, 27% preferred reading/writing, and &lt;1% each preferred aural or visual stimuli. Of all 98 caregivers, 82% included kinesthetic as a learning preference, 59% included reading/writing, 50% included aural stimuli, and 41% included visual stimuli.

Conclusions.
The majority of caregivers preferred the kinesthetic learning method, whether as a single learning preference or in combination with other approaches. Incorporating kinesthetic methods of learning, such as role playing and problem-solving case scenarios, into standardized asthma education curricula may be beneficial to patients and families in terms of understanding and using their regimen.

Reviewer Comments.
This is a novel study that attempted to improve asthma care by identifying the learning preferences of the caretakers of asthmatic children. Asthma regimens can be complex, and simplification and understanding of these regimens can improve overall adherence. Individual caretakers demonstrate multiple modes of learning preference, and the current educational modules should focus on role playing and other visual modalities to enhance the understanding of the caretakers’ asthma knowledge. Streamlining and improving these educational methods could result in significant improvement in medication adherence, symptom recognition, and appropriate utilization of medical care.
The Canadian Childhood Asthma Primary Prevention Study: Outcomes at 7 Years of Age
Authors: Arora Rajiv , Mikita Cecilia P. 
Published: September 2006

Purpose of the Study.
To evaluate the effects of a multifaceted intervention program involving high-risk infants on the development of asthma at 7 years of age.

Study Population.
Of the original 545 high-risk infants in the Canadian Childhood Asthma Primary Prevention Study, 380 were evaluated at 7 years of age. Infants at high risk for asthma development were defined as those with at least 1 first-degree relative with asthma or 2 first-degree relatives with other immunoglobulin E–mediated allergic diseases.

Methods.
The initial 545 high-risk infants were randomly assigned before birth to a multifaceted intervention group (n = 279) or the control group (n = 266). The multifaceted intervention program, which was implemented before birth and during the first year of life, included house dust mite–control measures, pet-avoidance measures, avoidance of environmental tobacco smoke, breastfeeding, and/or using partially hydrolyzed whey formula. This study describes the follow-up assessment of 380 subjects at 7 years of age who completed a questionnaire and were evaluated by a pediatric allergist for asthma. Allergy skin testing and methacholine challenge were also performed.

Results.
A significantly lower number of subjects had pediatric allergist–diagnosed asthma in the intervention group (14.9%) than in the control group (23.0%; adjusted relative risk [RR]: 0.44). The prevalence of asthma, defined as wheeze plus bronchial hyperreactivity (methacholine challenge), was also significantly lower in the intervention group when compared with the control group (12.9% vs 25%, respectively; adjusted RR: 0.39). There was no significant difference in the diagnosis of allergic rhinitis or atopic dermatitis, allergen skin-test reactivity, or bronchial hyperreactivity alone between the 2 groups. Symptoms of wheeze and wheeze apart from colds in the last 12 months were significantly lower in the intervention group compared with the control group. There were no significant differences in nocturnal symptoms, exercise-related symptoms, medication use, emergency visits for wheeze, nasal symptoms, or skin rash.

Reviewer Comments.
Asthma and allergic diseases likely result from a combination of environmental and genetic factors. This study showed that the prevalence of asthma was decreased after an intervention program implemented early in life. Thus, recommending environmental controls as a safe method to decrease the risk of developing asthma in high-risk patients is reasonable. It is unclear from this study whether a specific environmental control or a combination of interventions is more effective. It is interesting that no difference was noted in the prevalence of allergic rhinitis or atopic dermatitis between the groups, which, theoretically, could also be affected by environmental controls.
The PREVASC Study: The Clinical Effect of a Multifaceted Educational Intervention to Prevent Childhood Asthma
Authors: Phipatanakul Wanda 
Published: September 2006

Purpose of the Study.
To evaluate the clinical effectiveness of a multifaceted education intervention to prevent childhood asthma.

Study Population.
General practitioners recruited 476 high-risk children during the prenatal period.

Methods.
These high-risk children were randomly assigned to either a control group, receiving usual care, or an intervention group, in which families received instruction from nurses on how to reduce exposure of newborns to dust mite, pet, and food allergens and passive smoking.

Results.
A total of 443 infants were followed up for 2 years. At 2 years of age, those in the intervention group (n = 222) had less asthma-like symptoms, including wheezing, shortness of breath, and nighttime cough, compared with those in the control group (n = 221). No significant differences in total and specific immunoglobulin E were found between the groups. During the first 2 years of life, the incidence of asthma-like symptoms was similar in both groups; however, subanalysis revealed a significant reduction in the females but not in the males in the intervention group.

Conclusions.
The intervention used in this study was not effective in reducing asthma-like symptoms in high-risk children during the first 2 years of life, although it was modestly effective at 2 years. Follow-up is necessary to confirm whether the intervention can actually prevent the development of asthma.

Reviewer Comments.
This is a well-designed study in a primary care environment to investigate the clinical effectiveness of a multifaceted approach to prevent the development of asthma in high-risk children. It seemed that the intervention was moderately able to reduce exposure to dust mite, pet, and food allergens, but no significant effect was observed on parentally observed symptoms or allergen-specific immunoglobulin E in the first 2 years of life. Perhaps a more focused intervention or longer follow-up period would have proven more useful. The effectiveness of a variety of multifaceted randomized intervention trials on asthma prevention has yet to be determined. Although a host of epidemiologic studies have helped identify risk factors, we will all be interested in determining whether any practical interventions may be promising in preventing asthma development.
IL-19 Induced Th2 Cytokines and Was Up-regulated in Asthma Patients
Authors: Sharma Hemant , Matsui Elizabeth 
Published: September 2006

Purpose of the Study.
Interleukin-10 (IL-10) has been shown to inhibit allergen-induced airway hyperresponsiveness and inflammation. This study evaluates whether IL-19, a member of the IL-10 family, is associated with asthma.

Study Population.
The authors investigated IL-19 levels in 100 asthmatic patients, aged 3 to 12 years, as well as 50 healthy adults and 50 age-matched children. A dust mite–induced mouse model of asthma was also used to study the association of IL-19 with asthma.

Methods.
Cytokine levels were quantified by enzyme-linked immunosorbent assay. IL-19 levels were measured in all study subjects, but among asthmatic patients, the levels of IL-4 and IL-13 were analyzed in the 27 patients with the highest and 25 patients with the lowest IL-19 levels. By using a dust mite–sensitized murine asthma model, IL-19 levels were measured in asthmatic and control mice. To test whether IL-19 upregulates T-helper 2 (Th2) cytokines, IL-19 complementary DNA was injected into healthy mice using intramuscular electroporation, and serum levels of IL-4, IL-5, IL-10, and IL-13 were later monitored. After injection of IL-19 into asthmatic mice, IL-13 and immunoglobulin E (IgE) levels were measured. To determine if IL-19 could induce Th2 cytokine production in vitro, IL-19 was incubated with CD4+ T cells and IL-4, IL-5, IL-10, and IL-13 levels were quantified in the cell-culture supernatant.

Results.
Among asthmatic patients, the serum level of IL-19 was twice that of healthy controls, and those with a high level of IL-19 also had high levels of IL-4 and IL-13. In the murine asthma model, asthmatic mice also had IL-19 levels twice that of healthy control mice. Injection of the IL-19 gene into healthy mice induced production of IL-4, IL-5, and IL-10 but not IL-13. IL-19 upregulated IL-13 in asthmatic mice and also upregulated IgE production. In vitro, IL-19 was associated with increased IL-4, IL-5, IL-10, and IL-13 production by activated cells.

Conclusions.
IL-19 upregulates production of Th2 cytokines in activated T cells and may be an important molecule in the pathogenesis of asthma.

Reviewer Comments.
The Th2 cytokines upregulated by IL-19 play crucial roles in the pathogenesis of asthma. IL-13 regulates airway hypersensitivity and mucus hypersecretion; IL-4 is critical for IgE antibody switching; and IL-5 plays a key role in eosinophil maturation. The findings from this study suggest that IL-19 is another potentially important molecule in asthma pathogenesis and may be responsible, at least in part, for upregulation of Th2 cytokines that are critical to the development of allergic disease.
Asthma in Remission: Can Relapse in Early Adulthood Be Predicted at 18 Years of Age?
Authors: Bollinger Mary Beth 
Published: September 2006

Purpose of the Study.
To determine the frequency of asthma relapse in young adults in remission at 18 years over an 8-year follow-up period and to determine possible prognostic indicators of relapse.

Study Population.
A subset of 68 subjects in asthma remission at 18 years of age from of a cohort of 1037 subjects born in New Zealand from 1972 to 1973 followed from birth through the Dunedin Multidisciplinary Health and Development Study.

Methods.
The cohort was enrolled at 3 years old and followed every 2 years until age 15 and again at ages 18, 21, and 26. Subjects were given respiratory questionnaires and lung-function assessment by spirometry. Methacholine testing for bronchial hyperreactivity was performed at 9, 11, 13, 15, and 21 years of age in some. Atopy was assessed by skin tests at ages 13 and 21 years. Remission of asthma at 18 years was defined as no current symptoms with previous reported symptoms at ≥2 previous assessments.

Results.
At 18 years of age, there were 108 subjects with current asthma and 68 subjects with previous asthma in remission. Those in remission at age 18 had a later age of onset of asthma (6.4 ± 4.5 vs 4.7 ± 4 years for current asthma) and had better lung function. Those with current asthma at age 18 were more atopic at age 18, with higher skin-test reactivity for house dust mite and cat. They had higher bronchial hyperreactivity by methacholine at all age points between 9 and 18 than their counterparts in remission. Of the 68 subjects in remission at age 18, 44 remained in remission and 24 relapsed by age 26. Multiple logistic-regression analysis identified dust mite sensitization at age 13 (odds ratio [OR]: 2.63; 95% confidence interval [CI]: 1.23–5.61) and decreased forced expiratory volume in 1 second/forced vital capacity ratio at age 18 (OR: 0.9 per 1% higher ratio; 95% CI: 0.81–0.99). Those with better lung function had lower likelihood of asthma relapse by 16 years of age. Variables such as methacholine reactivity and tobacco smoking were not significant predictors.

Conclusions.
Approximately one third of young adults with a history of asthma in childhood in remission at 18 years of age will relapse by 26 years of age. Most will have mild disease at relapse. There were weak associations with atopy and lower lung function at a young age as predictors of asthma relapse.

Reviewer Comments.
Families often ask if their child will “outgrow” asthma. This study was consistent with other studies in finding that approximately one third of those in remission may have relapse, but the factors found by other groups as potential predictors such as atopy, lower lung function, and tobacco smoking were not as strong.
Safety of Budesonide Inhalation Suspension in Infants Aged Six to Twelve Months With Mild to Moderate Persistent Asthma or Recurrent Wheeze
Authors: James John 
Published: September 2006

Purpose of the Study.
To compare the safety of budesonide inhalation suspension (BIS) with placebo.

Study Population.
Infants (aged 6–12 months) with mild-to-moderate persistent asthma or recurrent wheeze.

Methods.
A multicenter, randomized, double-blinded, parallel-group, placebo-controlled study, in which 141 infants received 0.5 mg of BIS (n = 48), 1.0 mg of BIS (n = 44), or placebo (n = 49) once daily for 12 weeks. The primary variable was adrenal function, which was based on cosyntropin-stimulated plasma cortisol levels. Spontaneous adverse events and clinical laboratory findings were monitored.

Results.
Overall, the types and frequencies of adverse events reported during the study were comparable across treatment groups. The response to cosyntropin stimulation was similar across treatment groups, with no significant difference between BIS treatment and placebo.

Conclusions.
The safety profile of BIS was similar to that of placebo, with no suppressive effect on adrenal function in patients 6 to 12 months of age with mild-to-moderate persistent asthma or recurrent wheeze.

Reviewer Comments.
Inhaled corticosteroids remain the preferred choice for the long-term management of persistent asthma in pediatric patients. In addition, because BIS has become available for clinical use, more and more infants and young children with persistent asthma and/or recurrent episodes of wheezing have been managed with this inhaled antiinflammatory medication. In turn, appropriate questions have arisen from caregivers and providers about the overall safety of this therapy in these very young patients. Although the safety and efficacy of nebulized BIS have been confirmed in well-designed investigations in patients 6 months to 8 years of age, controlled clinical studies addressing the safety and efficacy of inhaled corticosteroids exclusively in the infant age range have been lacking. This current investigation provides very useful safety data for BIS in this understudied infant population. The data demonstrate that once-daily administration of BIS, 0.5 or 1.0 mg, was not associated with a decrease in adrenal function, which was based on cosyntropin-stimulated plasma cortisol levels. This information should be very useful to health care providers who prescribe this medication for young infants with mild-to-moderate persistent asthma or recurrent wheeze.
Adult Asthma Severity in Individuals With a History of Childhood Asthma
Authors: Andrews Timothy , Banks James R. 
Published: September 2006

Purpose of the Study.
Childhood asthma has a range of outcomes in adulthood. This study sought to identify clinical features and exposures associated with persistence and severity of childhood asthma in adulthood.

Study Population.
Subjects had been previously enrolled in the Childhood Asthma Study, a double-blind, randomized, placebo-controlled trial designed to study the role of immunotherapy as an adjunct treatment. The 121 original study members, aged 5 to 12 years at the time of randomization, had moderate-to-severe asthma and had been followed for at least 1 year before enrollment. Evaluations performed during the original study included daily medication-symptom diaries, home allergen analysis, allergy skin testing, and methacholine challenges. The cohort had varied socioeconomic status, genders, and ethnicities. For this study an attempt was made to enroll all original participants.

Methods.
Eighty-five of the original subjects participated in the adult evaluation, underwent spirometry and inhalant allergy skin testing, and completed questionnaires regarding their interim medical history, asthma symptoms, and medications. Asthma severity was classified by using a modified version of the 1997 National Asthma Education and Prevention Program algorithm. Postbronchodilator spirometry was used for severity categorization. Subjects were categorized in the most severe category for which they qualified.

Results.
Thirteen (15.3%) of these young adults, aged 17 to 30 years, were in remission. Another 19 (22%) had only mild intermittent asthma. There were 12 (14%) with mild persistent asthma, 25 (29%) with moderate persistent asthma, and 16 (19%) with severe persistent disease. Subjects in remission, compared with subjects with mild intermittent or persistent asthma, had lower serum immunoglobulin E in childhood (412 vs 1136 vs 968 ng/mL, respectively) and fewer positive allergy skin tests (7 vs 9 vs 10, respectively, from a panel of 18 allergens). Subjects in remission also had milder childhood asthma, indicated by lower average daily medication usage scores and lower percentage of days on inhaled corticosteroids (13.7% vs 24.7% vs 40.9%). There was no association found between current asthma severity and childhood immunotherapy.

Conclusions.
The prognosis of childhood allergic asthma in adulthood is largely determined early in life. The degree of atopy seems to be a critical determinant of asthma persistence.

Reviewer Comments.
The authors point out that numerous studies of the natural history of asthma have suggested associations between childhood atopy and disease severity with risk of asthma persistence and severity in later childhood and adulthood. It remains to be seen whether there is any sort of intervention at a very early phase in the disease that will more favorably alter the course of asthma. Thus far, there are no compelling candidates.