bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Emergency Department Anaphylaxis: Different Patterns From Adults
Authors: Kelso John M. 
Published: November 2007

Braganza SC, Acworth JP, Mckinnon DR, Peake JE, Brown AF. Arch Dis Child. 2006;91:159–163
PURPOSE OF THE STUDY. Data on acute pediatric anaphylaxis presentations to the emergency department (ED) are limited.
STUDY POPULATION. Patients under 16 years of age who presented to a metropolitan, pediatric teaching hospital ED in Australia over a 3-year period with generalized allergic reactions (skin and/or gastrointestinal symptoms) and anaphylaxis (respiratory, cardiovascular, or hypotensive symptoms) that satisfied relevant International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes.
METHODS. Medical charts were reviewed for incidence, comorbidities, likely etiology, clinical features, management, and disposal.
RESULTS. There were 526 children with generalized allergic reactions (9.3 per 1000 ED presentations) and 57 with anaphylaxis (1 per 1000 ED presentations) included. There were no fatalities. For anaphylaxis cases, a cause was recognized in 68% (food: 56% of total; drug: 5%; sting: 5%; other: 2%), cutaneous features were present in 83%, a past history of asthma was reported in 37%, adrenaline was used in 39%, and follow-up was arranged for 81% (only 28% with an allergy clinic).
CONCLUSIONS. The incidence of generalized allergic reactions of 9.3 in 1000 was greater than in the adults.
REVIEWER COMMENTS. Food, drug, and stinging-insect reactions are the primary causes of anaphylaxis in children (as in adults). Although skin symptoms are present in the majority, the lack of such symptoms should not exclude the diagnosis. All children who suffer an anaphylactic event deserve a consult to an allergist who can confirm the diagnosis, determine or confirm the cause, and instruct the patient on avoidance measures, emergency treatment for subsequent events should they occur, and provide a prognosis regarding possible resolution.
The Influence of Pulmonary Function Testing on the Management of Asthma in Children
Authors: James John M. 
Published: November 2007

Nair SJ, Daigle KL, DeCuir P, Lapin CD, Schramm CM. J Pediatr. 2005;147:797–801
PURPOSE OF THE STUDY. To assess how preevaluation pulmonary-function tests (PFTs) influenced management decisions in children with asthma, beyond what was obtained from history and physical examination alone.
STUDY POPULATION. Children with asthma (N = 367) aged 4 to 18 years.
METHODS. Physicians and nurse practitioners in the outpatient pulmonary office evaluated the children and made initial treatment recommendations before reviewing the specific spirometry results. Any changes based on the test results were documented.
RESULTS. Spirometry results were abnormal in 45% of the visits, related to underlying asthma severity but not to clinical findings. PFT results changed management decisions in 15% of the visits. This frequency was not affected by the patient's age, disease severity, symptom control, or examination findings. When spirometry results did not change treatment decisions, the provider was more likely to maintain therapy (58%) than to increase (17%) or decrease (24%) therapy. In contrast, when spirometry results did change treatment decisions, the provider was more likely to increase therapy (75%) than to maintain (20%) or decrease (5%) therapy.
CONCLUSIONS. Without PFTs, providers often overestimated the degree of asthma control. This incorrect assessment could have resulted in suboptimal therapy.
REVIEWER COMMENTS. This was a very practical clinical study that addressed a common clinical scenario that physicians who treat asthma face daily in clinical practice. Ideally, the patient's presenting clinical history, physical examination, and PFT result should all be factored into the final clinical decision regarding asthma therapy. The data from this investigation demonstrate that spirometry results were abnormal in almost one half of the visits, and this was related to underlying asthma severity and not clinical findings. When the spirometry results did not enter into the management decision, therapy was generally maintained; however, when spirometry results were factored in, the provider was more likely to increase therapy. With this in mind, proper interpretation of PFT data should help prevent overestimation of the degree of asthma control and help prevent suboptimal therapy. An obvious extension of this investigation would be the examination of serial PFTs in patients with asthma to identify clinically relevant trends in these data to assist in the best possible decision-making regarding ongoing asthma therapy and control.
Age Related, Structured Educational Programmes for the Management of Atopic Dermatitis in Children and Adolescents: Multicentre, Randomised Controlled Trial
Authors: Otsu Kanao , Phipatanakul Wanda 
Published: November 2007

Staab D, Diepgen TL, Fartasch M, et al. BMJ. 2006;332:933–938
PURPOSE OF THE STUDY. To determine the effects of age-related, structured educational programs on the management of moderate-to-severe atopic dermatitis in childhood and adolescence.
STUDY POPULATION. A total of 992 of 1010 patients who were eligible for the study were given random group assignment. Children aged 3 months to 18 years were enrolled in group sessions of standardized intervention programs for atopic dermatitis once weekly for 6 weeks in a multicenter trial in Germany.
METHODS. The study was a randomized, controlled intervention trial. The 3 participating groups were parents of children with atopic dermatitis who were 3 to 7, 8 to 12, or 13 to 18 years old. Participants were recruited from 7 hospitals in Germany. The inclusion criteria were (1) diagnosis of atopic dermatitis according to predefined criteria, (2) eczema duration of at least 3 months, and (3) severity of eczema of at least 20 points on the scoring-of-atopic-dermatitis scale. Each treatment group received a tailored (age-specific) educational program once weekly for 2 hours over the course of 6 weeks. The control groups did not receive any education. Participants in the intervention and control groups were followed up at 6 and 12 months. Primary outcome measures were the differences in severity of eczema based on the scoring-of-atopic-dermatitis scale as well as parents’ quality of life over 12 months.
RESULTS. Significant improvements in severity of eczema were seen in all intervention groups compared with control groups after 12 months on the basis of the severity score. Moreover, improvement in quality of life for mothers of children aged 3 months to 7 years was significantly greater in the intervention group for all 5 subscales of the quality-of-life questionnaire and for mothers of children aged 8 to 12 years for 3 of the subscales.
CONCLUSIONS. Age-related educational programs for the control of atopic dermatitis in children and adolescents are effective in the long-term management of the disease.
REVIEWER COMMENTS. This study showed that educational interventions that use a multidisciplined approach that addresses psychosocial, pharmacologic, and nutritional factors served to decrease the severity of atopic dermatitis in the intervention groups. However, severity of disease was seen to decrease as well in the control groups that did not participate in the interventional programs despite having similar pharmacologic interventions in both groups. The authors attributed this finding to the assumption that the control groups were also highly motivated and tried to optimize therapies. Nonetheless, such standardized educational/support groups seem to have beneficial consequences in children as well as parents dealing with this chronic illness.
Effect of Probiotic Supplementation for the First 6 Months of Life on Allergen- and Vaccine-Specific Immune Responses
Authors: Oh Miae , Sicherer Scott H. 
Published: November 2007

Taylor AL, Hale J, Wiltschut J, Lehmann H, Dunstan JA, Prescott SL. Clin Exp Allergy. 2006;36:1227–1235
PURPOSE OF THE STUDY. To determine if probiotic dietary supplementation in the first 6 months of life could modify allergen- and vaccine-specific immune responses.
STUDY POPULATION. One hundred seventy-eight term infants born to women with a history of allergic disease and a positive prick-skin test result were enrolled in Australia between July 2002 and March 2005.
METHODS. In a randomized double-blind, placebo-controlled design, 3 × 109 colony-forming units of Lactobacillus acidophilus (LARVI-A1; Probiomics, Eveleigh, New South Wales, Australia) was administered daily to term infants for the first 6 months of life. Peripheral blood mononuclear cell cytokine responses to tetanus toxoid (TT), house dust mite (HDM), ovalbumin, β-lactoglobulin, Staphylococcus enterotoxin B, and phytohemagglutinin were measured at 6 months of age.
RESULTS. Of the 178 infants who completed the study, blood samples were available from 118 children (60 placebo treated, 58 probiotic treated). Infants treated with probiotics had significantly lower interleukin 10 (IL-10) production to TT vaccine antigen than those in the placebo group (P = .03). Infants treated with probiotics had no significant differences in the levels of T-helper 1 and T-helper 2 cell responses to foods (ovalbumin or β-lactoglobulin) or inhalant allergens (HDM). However, the number of infants who had detectable tumor necrosis factor α and IL-10 responses to HDM were less than those who had received probiotics (P = .046 and 0.014, respectively). In addition, children who received probiotics had decreased productions of IL-5 and transforming growth factor β in response to Staphylococcus enterotoxin B (P = .044 and 0.015, respectively).
CONCLUSIONS. Although there were no consistent effects on allergen-specific responses, children treated with probiotics may have immunomodulatory effects on TT responses. The clinical ramifications of this have yet to be determined.
REVIEWER COMMENTS. It is interesting to note that the TT vaccine-specific responses in IL-10 were significant, whereas the allergen-specific responses were not. However, the clinical implication of this is not known. The authors pointed out that the types of probiotics selected and dosing regimen may be important in regard to immunologic outcomes. Some studies have shown a protective effect of probiotic supplementation on outcomes of atopic dermatitis (some have not), and the effect on allergen-specific responses, if any, remains unclear. This study began to tease out the allergen-specific outcomes. Although clinical atopic dermatitis evaluations were not made during this study, the immunologic effects of probiotics in infants with a maternal history of atopy are seemingly not allergen specific.
The Role of Immune Response to Staphylococcus aureus Superantigens and Disease Severity in Relation to the Sensitivity to Tacrolimus in Atopic Dermatitis
Authors: Maloney Jennifer M. 
Published: November 2007

Fukushima H, Hirano T, Shibayama N, et al. Int Arch Allergy Immunol. 2006;141:281–289
PURPOSE OF THE STUDY. To examine the prevalence and role of Staphylococcus aureus superantigens on the pathophysiology and immunosuppressive drug sensitivity in patients with atopic dermatitis (AD).
STUDY POPULATION. Twenty-nine patients with AD and 13 healthy control patients were included in the study.
METHODS. Twenty-nine patients with AD were classified into 2 groups on the basis of their clinical AD scores: a low-score group (n = 14), corresponding to patients with mild-to-moderate AD, and a high-score group (n = 15), corresponding to patients with severe AD. Plasma antistaphylococcal enterotoxin B or toxic-shock syndrome toxin-1 (TSST-1) immunoglobulin E (IgE) levels were measured for the patients and healthy subjects by enzyme-linked immunosorbent assay. Also, individual drug sensitivity was estimated by determining the drug concentrations that would provide 50% inhibition (IC50) of peripheral blood mononuclear cell (PBMC) proliferation in vitro.
RESULTS. The levels of plasma anti-staphylococcal enterotoxin B or TSST-1 IgE in the patients with severe AD were significantly higher than those in the patients with mild-to-moderate AD (P &lt; .05 and P &lt; .01, respectively). When stimulated with concanavalin A in vitro, PBMCs in the patients with severe AD exhibited low sensitivity to the suppressive efficacy of tacrolimus (FK506) as compared with the patients with mild-to-moderate AD (P &lt; .01). Furthermore, there was a significant correlation between the IC50 values of FK506 and plasma anti–TSST-1 IgE levels (P &lt; .01).
CONCLUSIONS. PBMCs in patients with severe AD exhibited lower sensitivity to FK506 and had higher plasma levels of anti–TSST-1 IgE as compared with the patients with mild AD. S aureus superantigens seem to be one of the causes of decreased PBMC sensitivity to FK506; therefore, an alternative treatment would be useful on the basis of individual drug-sensitivity data and anti–TSST-1 IgE levels.
REVIEWER COMMENTS. Patients with AD commonly develop superinfections that require antimicrobial treatment. This study suggests that untreated superinfection may contribute to the ineffectiveness of topical medications that are commonly used as routine skin care for patients with AD. Attentiveness to the presence of concomitant skin infection is necessary for comprehensive skin care for patients with AD.
Improved Preventive Care for Asthma: A Randomized Trial of Clinician Prompting in Pediatric Offices
Authors: Bailey Sally Joo 
Published: November 2007

Halterman JS, Fisher S, Conn KM, et al. Arch Pediatr Adolesc Med. 2006;160:1018–1025
PURPOSE OF THE STUDY. To determine if clinician prompting regarding asthma severity and guideline recommendations at the time of an office visit improves the delivery of preventive asthma care.
STUDY POPULATION. Children aged 2 to 12 years (N = 226) with persistent asthma from 2 inner-city pediatric practices in Rochester, New York. Children were at the clinic for a well-child check, asthma care, or non–asthma-related illness care and were randomly assigned to 1 of 2 groups: clinician-prompting group (CPG) or standard-care group (SCG).
METHODS. A baseline survey was conducted to obtain information regarding household demographics, medication use, and environmental tobacco-smoke exposure. Parents of the children who were randomly assigned to the CPG were instructed to give a prompt sheet to their clinician along with a blank asthma action plan form. Parents of the children who were assigned to the SCG also completed baseline assessment interviews but were not given a prompt sheet, and no information regarding the interview was shared with the clinician. Follow-up information was collected within 60 days through telephone interviews.
RESULTS. The children in the CPG were more likely to have any preventive action related to asthma taken at the visit compared with children in the SCG (86.6% vs 69.3%). Children in the CPG were also more likely to have received an asthma action plan (50.0% vs 23.7%), recommendation for a specific asthma follow-up visit (53.6% vs 36.8%), discussion regarding asthma (75.0% vs 63.2%), and smoke-reduction counseling (57.5% vs 35.4%) compared with those in the SCG. There were no statistical differences in referrals for specialty care, treatment of comorbid conditions, or changes in preventive medications between the 2 groups.
CONCLUSIONS. Clinician prompting regarding asthma severity and care guidelines at the time of an office visit increased the likelihood of delivering preventive asthma care.
REVIEWER COMMENTS. Several studies have demonstrated that health care providers often underestimate asthma severity and have demonstrated poor adherence to National Asthma Education and Prevention Program guidelines. Successful management of asthma requires both accurate determination of asthma severity and proper treatment. This study demonstrates a method that may increase the likelihood of delivering preventive asthma care at non–asthma-related office visits by prompting clinicians. However, as the authors pointed out, although prompting improved the delivery of preventive asthma care, a large percentage of patients in the CPG did not have follow-up–visit recommendations (46.4%), received no asthma action plan (50%), and received no discussion related to asthma (25%). This study demonstrates that a better system needs to be implemented to increase the rate of delivering appropriate preventive care for patients with asthma.
Neonatal-Onset Multisystem Inflammatory Disease Responsive to Interleukin-1β Inhibition
Authors: Yu Joyce E. , Sicherer Scott H. 
Published: November 2007

Goldbach-Mansky R, Dailey NJ, Canna SW, et al. N Engl J Med. 2006;355:581–592
PURPOSE OF THE STUDY. Neonatal-onset multisystem inflammatory disease (NOMID) is a chronic inflammatory disease that develops in infancy and is characterized by an urticarial rash, arthropathy, and central nervous system disease, including aseptic meningitis, cerebral atrophy, mental retardation, seizures, and vision and hearing loss. Approximately 60% of patients have a mutation in the cold-induced autoinflammatory syndrome 1 (CIAS1) gene, which is involved in the interleukin 1β (IL-1β) pathway. This study evaluated the effect of anakinra (Kineret, Amgen), an IL-1 receptor antagonist, on the various clinical and laboratory aspects of NOMID.
STUDY POPULATION. A cohort of 18 patients aged 4 to 32 years with clinical NOMID (67% with mutations in CIAS1) who had active disease despite treatment with other antiinflammatory agents.
METHODS. Patients were given a daily subcutaneous dose of anakinra. The drug was withdrawn from 11 patients at 3 months with the development of a clinical flare. Thereafter, all patients were continued on daily treatments up to 24 months. Clinical and laboratory assessments were made at 1, 3, and 6 months during therapy with anakinra. Primary end points included changes in a disease-specific daily diary score and changes in the serum levels of acute-phase reactants.
RESULTS. All patients had an immediate response to anakinra with resolution of rash and conjunctivitis. There was an improvement in diary scores at 3 months that was maintained at 6 months. Serum amyloid A, C-reactive protein, and the erythrocyte sedimentation rate significantly declined with treatment. All the patients had headache at baseline, which resolved or improved with therapy, and cochlear and leptomeningeal lesions were improved on MRI. Serum levels of IL-1β, which were initially higher than those in healthy controls, decreased over the first 6 months of therapy. All the patients who underwent a treatment withdrawal experienced rapid improvement of their symptoms after resuming anakinra. Other than injection-site reactions, which resolved with continued treatment, there were no serious adverse events.
CONCLUSIONS. Anakinra may be a safe and effective treatment for patients with NOMID.
REVIEWER COMMENTS. This study suggests that anakinra may have a role in the treatment of other diseases in which IL-1β mediates inflammation (eg, systemic juvenile rheumatoid arthritis). Additional studies are needed to determine its long-term effects and clinical application. This study is an example of how specific immunomodulatory therapy may be useful in treating those diseases that have a defined molecular pathophysiologic profile.
Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy
Authors: Randolph Christopher 
Published: November 2007

Poole JA, Barriga K, Leung DYM, et al. Pediatrics. 2006;117:2175–2182
PURPOSE OF THE STUDY. To ascertain the relationship between cereal-grain exposure, wheat, barley, rye, and oats in the infant diet and the subsequent development of wheat allergy.
STUDY POPULATION. A birth cohort of 1612 children followed to a mean age of 4.7 years.
METHODS. A total of 1612 children were enrolled in a birth cohort with questionnaire data, and dietary exposures were determined at 3, 6, 9, 15, and 24 months and annually thereafter. The primary outcome measure was apparent report of wheat allergy. Wheat-specific immunoglobulin E (IgE) levels in children reported to have wheat allergy were obtained. Children with celiac disease with autoimmunity were excluded.
RESULTS. Sixteen children (1%) noted wheat allergy. Children who were first exposed to cereal after 6 months of age had a &gt;4 times prevalence of wheat allergy when compared with children who were first exposed to cereals before 6 months of age, after controlling for family history and allergic disorder and history of food allergy before 6 months of age. All 4 children with detectable wheat-specific IgE were initially given cereal grains after 6 months. Having a first-degree relative with a history of atopy (ie, asthma, eczema, or hives) was also independently associated with an enhanced risk of subsequent development of wheat allergy.
CONCLUSIONS. Delaying first exposure to cereal grains until after 6 months enhanced the risk of subsequent development of wheat allergy. These results do not support delaying introduction of cereal grains for protection against food allergy.
REVIEWER COMMENTS. This study was limited by its dependence of parental report of wheat allergy, although IgE was obtained as well. No formal diagnostic oral food challenges were performed. The possibility of reverse causality was addressed by eliminating confounding factors related to history of food allergy but could still be a potential explanation. The birth cohort also was selected on the basis of HLA-genotype screening and family history of diabetes, which may limit its generalizability. However, the results, that delaying exposure to cereal grains until after 6 months is associated with increased risk of wheat allergy, not a protective outcome, are still provocative. Additional large prospective studies using double-blind, placebo-controlled food challenge to confirm these findings are needed.
Loss-of-Function Variations Within the Filaggrin Gene Predispose for Atopic Dermatitis With Allergic Sensitizations
Authors: Haymore Bret R. , Mikita Cecilia P. 
Published: November 2007

Weidinger S, Illig T, Baurecht H, et al. J Allergy Clin Immunol. 2006;118:214–219
PURPOSE OF THE STUDY. Evaluation for genetic basis for impaired epidermal skin barrier in atopic dermatitis (AD).
STUDY POPULATION. White German families with AD (N = 476).
METHODS. Evaluation of the association of the loss-of-function mutations Arg501Xaa and 2282del4 within the filaggrin (FLG) gene by using the transmission-disequilibrium test.
RESULTS. This study revealed prominent associations between the 2 loss-of-function FLG mutations and AD, as previously observed in a traditional Mendelian linkage analysis and case-control cohort analysis approach. In addition, an association of the FLG mutations was made in particular with the extrinsic subtype of AD, which is characterized by high total serum immunoglobulin E levels and concomitant allergic sensitization. Furthermore, FLG mutations were significantly associated with palmar hyperlinearity in patients with AD, which represents a shared feature of AD and ichthyosis vulgaris.
CONCLUSIONS. These data implicate FLG as the first strong genetic factor identified in a common complex disease.
REVIEWER COMMENTS. These findings confirm the importance of FLG as a genetic factor in AD as found by other investigators. This is the strongest genetic evidence to date to identify a cause of the breakdown of the epidermal barrier in AD. Filaggrin may be the “mortar” that is essential within the “bricks” of keratinocytes to maintain the integrity of the epithelial barrier. These findings further support the crucial role of the skin barrier in preventing allergic sensitization.