bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Corticosteroid on Henoch-Schönlein Purpura: A Systematic Review
Authors: Weiss Pamela F. , Feinstein James A. , Luan Xianqun , Burnham Jon M. , Feudtner Chris 
Published: November 2007

OBJECTIVE. No consensus exists among general pediatricians or pediatric rheumatologists regarding whether corticosteroid therapy ameliorates the acute manifestations of Henoch-Schönlein purpura or mitigates renal injury. Therefore, we sought to synthesize the reported experimental and observational data regarding corticosteroid use.
METHODS. We performed a meta-analysis based on a comprehensive review of the literature in the Medline database (1956 to January 2007) and the Cochrane Controlled Trials Register. On the basis of reported outcomes among patients with Henoch-Schönlein purpura who were treated at diagnosis with corticosteroids compared with patients treated with supportive care only, we calculated odds ratios for the resolution of abdominal pain, the need for surgical intervention secondary to severe pain or intussusception, the likelihood of Henoch-Schönlein purpura recurrence, and the development of transient or persistent renal disease.
RESULTS. Of 201 articles retrieved from the initial literature search, 15 were eligible for inclusion. Corticosteroid treatment did not reduce the median time to resolution of abdominal pain but did significantly reduce the mean resolution time and increased the odds of resolution within 24 hours. Early corticosteroid treatment significantly reduced the odds of developing persistent renal disease. In addition, although the results were not statistically significant, the prospective data suggest reduced odds of both surgical intervention and recurrence.
CONCLUSIONS. Corticosteroids, given early in the course of illness, seem to produce consistent benefits for several major clinically relevant Henoch-Schönlein purpura outcomes.
Infant-Feeding Methods and Childhood Sleep-Disordered Breathing
Authors: Montgomery-Downs Hawley Evelyn , Crabtree Valerie McLaughlin , Capdevila Oscar Sans , Gozal David 
Published: November 2007

OBJECTIVE. Childhood sleep-disordered breathing has an adverse impact on cognitive development, behavior, quality of life, and use of health care resources. Early viral infections and other immune-mediated responses may contribute to development of the chronic inflammation of the upper airway and hypertrophic upper airway lymphadenoid tissues underlying childhood sleep-disordered breathing. Breastfeeding provides immunologic protection against such early exposures. Therefore, we sought to explore whether sleep-disordered breathing severity would differ for children who were breastfed as infants.
METHODS. The parents or guardians of 196 habitually snoring children (mean ± SD: 6.7 ± 2.9 years old) who were undergoing overnight polysomnography at Kosair Children's Hospital Sleep Medicine and Apnea Center completed a retrospective survey on the method(s) used to feed the child as an infant.
RESULTS. Among habitually snoring children, those who were fed breast milk for at least 2 months had significantly reduced sleep-disordered breathing severity on every measure assessed, including apnea-hypopnea index, oxyhemoglobin desaturation nadir, and respiratory arousal index. Breastfeeding for longer than 5 months did not contribute additional benefits.
CONCLUSIONS. Our findings support the notion that breastfeeding may provide long-term protection against the severity of childhood sleep-disordered breathing. Future research should explore mechanism(s) whereby infant-feeding methods may affect the pathophysiology of development of childhood sleep-disordered breathing.
Pediatricians’ Perspectives Regarding Community Child Health: Training, Involvement, and Expectations According to Age
Authors: Minkovitz Cynthia S. , O'Connor Karen G. , Grason Holly , Palfrey Judith S. , Chandra Anita , Tonniges Thomas F. 
Published: November 2007

OBJECTIVE. There are increasing opportunities for pediatricians to promote children's health through community involvement during and after residency training. Little is known about whether younger relative to established pediatricians have different experiences regarding community activities. In this study we examined whether pediatricians’ training, perspectives, and involvement in community activities vary by age.
METHODS. Eight hundred seventy-six pediatricians participated in a national, random-sample, mailed periodic survey of US members of the American Academy of Pediatrics in 2004 (response rate: 58%). χ2 statistics and median tests were used to measure associations of age (≤34, 35–39, 40–50, and ≥51 years) with training, perspectives, and involvement.
RESULTS. Younger pediatricians reported more training in community child health during and before residency but were less likely to be involved currently (37.9% for ≤34 years, 44.4% for 35–39 years, 46.2% for 40–50 years, 48.3% for ≥51 years). They were more likely to report that their current involvement was too little versus just right or too much (81.3%, 73.5%, 60.7%, and 47.1%, respectively). Younger pediatricians were more willing to spend ≥1 hour/month on community child health activities (95.0%, 91.2%, 89.7%, and 85.4%, respectively). Younger versus older pediatricians were more likely to sense moderate or greater responsibility for improving children's health in their community (83.6%, 77.2%, 76.7%, and 70.2%, respectively) and expected their community work to increase during the next 5 years (80.0%, 67.5%, 59.7%, and 40.1%, respectively). Age findings persisted when adjusted for gender.
CONCLUSIONS. Although practice constraints may limit community involvement, younger pediatricians anticipated growing participation in community activities. Longitudinal studies are needed to determine whether such expectations are realized.
Racial Disparities in Childhood Asthma in the United States: Evidence From the National Health Interview Survey, 1997 to 2003
Authors: Virnig Christine , Gern James E. 
Published: November 2007

McDaniel M, Paxson C, Waldfogel J. Pediatrics. 2006;117(5). Available at: www.pediatrics.org/cgi/content/full/117/5/e868
PURPOSE OF THE STUDY. To evaluate the differences in asthma prevalence and emergency department (ED) visits between non-Hispanic black and white children, as well as the factors that might explain those differences.
STUDY POPULATION. Cross-sectional study of 14 487 non-Hispanic black children and 49 042 non-Hispanic white children interviewed from 1997 to 2003 as part of a large, nationally representative sample.
METHODS. Information was collected as part of the National Health Interview Survey, a cross-sectional, in-person, household interview administered annually by the Centers for Disease Control and Prevention. Data were obtained on lifetime asthma, current asthma, ED visits in the previous year, age, gender, birth weight, family income, rural versus urban environment, type of health insurance, accessibility of routine medical care, and maternal history of asthma, smoking, depression, and BMI.
RESULTS. Being black was associated with a 20% greater likelihood of having current asthma as well as a greater likelihood of having gone to the ED for asthma treatment in the past year. Furthermore, this increased asthma risk was greatest in younger children and remained even after child and family characteristics were controlled for.
CONCLUSIONS. Black children were more likely to have asthma and to have experienced ED visits in the past year than were otherwise comparable white children; these racial disparities could not be completely explained by differences in child or family characteristics.
REVIEWER COMMENTS. It has long been recognized that asthma, while affecting individuals of all ages, races, ethnicities, and incomes, disproportionately afflicts black and poor children. Past studies have identified multiple contributors to asthma prevalence and severity, including environmental factors, birth weight, socioeconomic and demographic differences, access to medical care and health insurance, and parental history. Because many of these factors are closely associated with race, especially in inner-city environments, it has been difficult to determine if race is independently associated with asthma. This study used a nationally representative sample of children to determine which, if any, of these social and environmental influences could explain the discrepancy in asthma prevalence between black and white children. The results indicate that the difference in asthma prevalence between black and white children remains significant, even when possible confounding variables are taken into account. This study will provide a baseline for tracking asthma trends in the future and should stimulate research aimed at determining the reasons for this increased asthma susceptibility.
Allergy Immunotherapy as an Early Intervention in Patients With Child-Onset Atopic Asthma
Authors: Wang Julie 
Published: November 2007

Nagaya H, Maren S, Nagaya N. Int Arch Allergy Immunol. 2006;139:9–15
PURPOSE OF THE STUDY. In patients with bronchial asthma, an effective treatment is required at early stages of the disease to prevent irreversible structural changes of the airways. The objective of this study was to evaluate the beneficial effects of routine immunotherapy as an early intervention on forced expiratory volume in 1 second (FEV1) in patients with childhood-onset atopic asthma.
STUDY POPULATION. Forty-three patients with child-onset atopic asthma who had received regular immunotherapy injections and periodic FEV1 measurements.
METHODS. Beneficial effects of successful immunotherapy on FEV1 were analyzed retrospectively in 43 unselected patients who received standard subcutaneous immunotherapy with periodic FEV1 measurements and became asymptomatic.
RESULTS. Although there was no significant correlation between the duration of asthma symptoms before immunotherapy and the changes in FEV1 before and after immunotherapy in the 43 unselected patients, there was a significant inverse correlation between these 2 parameters in 23 patients whose asthma duration was &lt;20 years. Because the FEV1 increased after immunotherapy in all 14 patients whose asthma duration was &lt;5 years, the 43 patients were divided into group, 1 including these 14 patients, and group 2, including 29 patients whose asthma duration was &gt;5 years. The FEV1 decreased in 7 of the 29 asymptomatic patients in group 2. There was no difference in the initial FEV1 between the 2 groups, but the final FEV1 and the mean of the average increase in FEV1 per year during immunotherapy were significantly higher in group 1 than in group 2.
CONCLUSIONS. Immunotherapy should be started as early as possible at the youngest age to increase a beneficial effect of successful immunotherapy on FEV1.
REVIEWER COMMENTS. Specific immunotherapy has demonstrated clinical benefits for allergic asthma in double-blind, placebo-controlled trials. The results from this study indicate that immunotherapy can modify the natural progression of asthma by improving lung function. Furthermore, early intervention leads to a greater improvement in FEV1, which suggests that early use of immunotherapy should be considered in allergic asthmatic patients. Additional studies will be needed to assess whether this improvement in lung function persists after the discontinuation of immunotherapy.
Accidental Ingestions in Children With Peanut Allergy
Authors: Davis Karla L. , Mikita Cecilia P. 
Published: November 2007

Yu JA, Kagan R, Verreault N, et al. J Allergy Clin Immunol. 2006;118:466–472
PURPOSE OF THE STUDY. To determine the current frequency of accidental exposures occurring in peanut-allergic children and identify factors associated with exposure.
STUDY POPULATION. Children 4 years of age and older, who were diagnosed with peanut allergy at the Montreal Children's Hospital Allergy Clinic (Quebec, Canada) between January 2000 and February 2005.
METHODS. Parents of children with peanut allergy completed questionnaires about accidental exposure to peanut occurring over the preceding year. Details of the accidental exposure requested included age of the child, quantity and type of food ingested, location of ingestion, allergic symptoms, onset and duration of reaction, and treatment administered. Medical charts were reviewed to confirm eligibility criteria, demographic information, atopic history, family history, details of the initial and most severe accidental reaction, number of previous accidental reactions, and previous use of epinephrine.
RESULTS. A total of 252 (57.7%) of 437 parents of children with peanut allergy completed a questionnaire. Chart review allowed comparison between participants and nonparticipants. Of participants, 62% were boys and the mean age was 8.1 years. The mean age at diagnosis was 2 years. There were 35 accidental exposures among 29 children over a period of 244 patient-years (annual incidence rate: 14.3%). Reactions were mild (15), moderate (16), and severe (4). Of the 20 children with reactions that were moderate to severe, only 4 received epinephrine. Eighty percent of children attended schools that prohibit peanut; only 1 accidental exposure occurred at school. Neither univariate nor multivariate logistic regression analyses identified any clinically important associations with inadvertent exposure to peanut.
CONCLUSIONS. Children with peanut allergy residing in Quebec had an annual incidence rate of accidental exposure to peanut of 14.3%. This finding is substantially lower than previously reported incidence rates. Predictors of accidental exposure could not be identified.
REVIEWER COMMENTS. In this study, only 1 of 35 accidental exposures occurred in school. Coupled with the lower incidence of accidental exposures reported in this study, these data may suggest that enhanced education about and awareness of peanut allergy in the public sector have been effective. The majority of accidental exposures occurred at the patient's home (14) or the home of a friend or relative (12), which underscores the critical importance of education of the family, friends, and caregivers of children with peanut allergy.
Grass Pollen Immunotherapy as an Effective Therapy for Childhood Seasonal Allergic Asthma
Authors: Andrews Timothy , Banks James R. 
Published: November 2007

Roberts G, Hurley C, Turcanu V, Lack G. J Allergy Clin Immunol. 2006;117:263–268
PURPOSE OF THE STUDY. There is abundant evidence to support the use of specific immunotherapy (SIT) in the treatment of allergic rhinoconjunctivitis. Studies that have looked at the role of SIT for the treatment of seasonal allergic asthma are lacking. This study evaluated the safety and effectiveness of SIT for the treatment of seasonal allergic asthma in children.
STUDY POPULATION. A total of 39 of 161 screened subjects 3 to 16 years old were enrolled onto the study from the allergy clinic at St Mary's Hospital (London, United Kingdom). All of them had history of grass-pollen–induced asthma that required 200 μg of inhaled beclomethasone (or equivalent) daily. All subjects had a positive skin-prick–test response: a positive specific immunoglobulin E level (Pharmacia CAP) to a relevant grass pollen (Phleum pratense). Subjects also had a positive conjunctival provocation test. Subjects were excluded if they previously had been treated with grass-pollen immunotherapy or had a history of perennial asthma requiring inhaled corticosteroids, significant perennial allergic rhinitis, or sensitization to a pet present in the household.
METHODS. The study was a single-center, randomized, double-blind, placebo-controlled study over 2 successive pollen seasons. Subjects were randomly assigned to receive SIT or placebo. The primary outcome was the asthma-symptom–medication score during the second pollen season. Secondary outcome measures included lung function, cutaneous, conjunctival, and bronchial allergen reactivity, and both exhaled nitric oxide and sputum eosinophil levels.
RESULTS. The use of SIT was associated with a substantial reduction in asthma-symptom–medication score as compared with placebo (P = .04). There was significant reduction in cutaneous (P = .002), conjunctival (P = .02), and bronchial (P = .01) reactivity to allergen after SIT compared with placebo. Children in the 2 groups had similar levels of airway inflammation, although less inhaled steroids were required for those in the active group. No serious adverse events were reported, and no subjects withdrew because of adverse events.
CONCLUSIONS. SIT is effective and well tolerated in children with seasonal allergic asthma to grass pollen.
REVIEWER COMMENTS. There are limited studies that have demonstrated the efficacy of immunotherapy for treatment of asthma. On the basis of the complex nature of asthma and realizing that multiple phenotypes exist, it is understandable that there is difficulty in evaluating SIT for asthma. This study provided encouraging evidence for the role of SIT in the treatment of seasonal allergic asthma. Unfortunately, the majority of allergic patients are sensitized to multiple allergens, and symptoms are typically triggered by several different allergens.
Peanut Allergen Exposure Through Saliva: Assessment and Interventions to Reduce Exposure
Authors: Nowak-Wegrzyn Anna 
Published: November 2007

Maloney JM, Chapman MD, Sicherer SH. J Allergy Clin Immunol. 2006;118:719–724
PURPOSE OF THE STUDY. To determine the time course of major peanut allergen (Arah1) persistence in saliva after ingestion of peanut butter and to evaluate mouth-cleansing interventions to reduce salivary peanut allergen.
STUDY POPULATION. A convenient sample of adults without peanut allergy.
METHODS. Thirty-eight individuals ingested 2 tablespoons of peanut butter, and saliva was collected at various time points. At another time, samples were collected after 5 interventions (brushing teeth, brushing and rinsing, rinsing, waiting then brushing, waiting then chewing gum). Detection of Arah1 was performed by a monoclonal-based enzyme-linked immunosorbent assay (detection limit: 15–20 ng/mL).
RESULTS. Salivary peanut allergen Arah1 varied considerably immediately after ingestion but included levels expected to invoke reactions (as much as 40 μg/mL). Most (87%) subjects with detectable peanut after a meal had undetectable levels by 1 hour with no interventions. None had detectable levels several hours later after a peanut-free lunch. This result indicates (with 95% confidence) that 90% would have undetectable Arah1 in saliva under these circumstances. All of the immediate interventions reduced salivary Arah1, in some cases by &gt;95%, but Arah1 remained detectable in ∼40% of the samples (although typically below thresholds reported to induce reactions).
CONCLUSIONS. Patients with peanut allergy require counseling regarding the risks of kissing or sharing utensils, even if their partners have brushed their teeth or chewed gum. Advice to reduce risks, although not as ideal as total avoidance, includes waiting a few hours plus eating a peanut-free meal.
REVIEWER COMMENTS. Passionate kissing was reported to cause allergic reactions to foods, including anaphylaxis. Waiting several hours and ingesting a peanut-free meal were more effective at reducing salivary peanut protein concentration than simple, immediate interventions. Teenagers with peanut and other food allergies need to be reminded that to stay safe, restraint and patience are necessary even in the most intimate situations.
Long-term Follow-up of Atopic Dermatitis: Retrospective Analysis of Related Risk Factors and Association With Concomitant Allergic Diseases
Authors: Spergel Jonathan M. 
Published: November 2007

Ricci G, Patrizi A, Baldi E, Menna G, Tabanelli M, Masi M. J Am Acad Dermatol. 2006;55:765–771
PURPOSE OF THE STUDY. To examine the natural course of atopic dermatitis (AD), the factors influencing its persistence, and the appearance of other allergic diseases with particular focus on asthma and the presence of specific immunoglobulin E (IgE) at first observation.
STUDY POPULATION. The prospective study included 252 children between 6 and 36 months of age with AD noted on first clinical visit to a pediatric or dermatology department in Bologna, Italy.
METHODS. Patients were followed for 13 to 22 years. AD diagnosis was based on the criteria of Hanifin and Rajka. Allergic rhinitis and asthma were determined by physician diagnosis. AD severity was based on validated clinical score. Total IgE and specific IgE to various allergens (cow's milk, egg white, soybean, wheat, peanut, nut, codfish, tomato, grass pollens, house dust mites, cat dander, horse dander, dog dander, and Alternaria) were determined at baseline. For radioallergosorbent test (RAST) testing, ≥1 was considered positive for inhalant allergen and ≥2 was considered positive for food allergies.
RESULTS. AD had completely resolved in 124 cases (60.5%). Other allergic manifestations that appeared included asthma in 70 cases (34.1%) and rhinoconjunctivitis in 118 cases (57.6%). Generally, the average age of patients who recovered from AD was higher in severe AD (6.0 ± 3.5 years) than in its moderate or mild forms (5.8 ± 4.5 and 5.5 ± 3.9 years, respectively). This phenomenon was particularly evident in children with egg sensitization, who showed a longer persistence of the condition (P &lt; .02). The initial severity score of AD (P &lt; .001) or egg sensitization (P &lt; .007) was significantly related to the later development of asthma. Egg sensitization also predicted rhinitis (P &lt; .05). A retrospective analysis of related risks factors and their association with concomitant allergic diseases showed that the egg sensitization, severity of AD, and onset of allergic rhinitis were positively related to the occurrence of asthma.
CONCLUSIONS. AD severity and the course of AD are significantly related to egg sensitivity. AD severity and egg allergy are risk factors for asthma.
REVIEWER COMMENTS. This article provides further evidence of the “atopic march” of AD to asthma. However, it is important to realize that a positive IgE test is simply evidence for sensitization, not confirmed clinical allergy. Also, the diagnosis of asthma and allergic rhinitis was not clearly defined. Nevertheless, patients with severe AD, egg sensitization, and allergic rhinitis are at higher risk for progressing in the atopic march to asthma and allergic rhinitis.