RESUMEN
In recent years, to the list of classic pet animals (dogs and cats) as allergens we must now add the "new pet animals" (NPAs). This group of animals, referred to by the Anglo-Saxons as "pets", includes both those previously recognized (rabbit, guinea pig, hamster, birds) and the "truly new NPAs"; by general agreement "NPA" will include all animals other than cats and dogs. Some rather rare animals are regularly added to this list. The emergence of "NPAs" can be related to a social phenomenon, in particular, to the fashion and need for the exotic (http://www.aquadesign.be). They are a very diverse group: warm-blooded animals, spiders, batrachia (frogs, toads, salamanders, etc.) and reptiles. Besides the physical risks from their natural aggressive behaviour, the "NPAs" can be an allergic risk factor and this risk has a tendency to increase. Allergists and paediatricians have a role to play in the diagnosis and prevention of these allergies by giving advice on the choice of pet animals. This review concerns allergies to rodents, reptiles, batrachians, spiders, etc.
Asunto(s)
Hipersensibilidad/etiología , Animales , Humanos , Reptiles , Roedores , ArañasAsunto(s)
Publicidad/historia , Asma/historia , Francia , Historia del Siglo XIX , Historia del Siglo XX , HumanosRESUMEN
The history of tuberculosis has given rise to a great number of publications. The aim of this review is to describe the main steps of this history from Antiquity to our time. The permanent fight against tuberculosis has eventually been won, even though the disease remains worrying in many countries of the world affected by serious economical difficulties. This fight has served as a model for the present management of chronic diseases like diabetes mellitus, asthma or allergies.
Asunto(s)
Tuberculosis/historia , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia Antigua , Historia Medieval , Humanos , Salud Pública/historiaRESUMEN
Inhaled steroids are recommended for long-term control of asthma, but their use may be limited in young children because of difficulties in using the associated inhaler device. The use of nebulizers may help to overcome this issue, without compromising therapeutic efficacy or safety. This 14-week, multicentre, randomized, controlled, open-label, parallel-group study compared the efficacy and safety of nebulized corticosteroids in paediatric patients (aged 6 months to 6 years) with severe persistent asthma. Beclometasone dipropionate (BDP) 800 microgday(-1) suspension for nebulization and budesonide (BUD) 750 microg day(-1) given by nebulization in a twice-daily regimen, and when used in addition to the usual maintenance therapy, resulted in comparable clinical efficacy across all parameters. The primary efficacy endpoint was the number of patients who did not experience any major exacerbation, this being 40.4% and 51.7% in the BDP and BUD groups respectively in the ITT population (P = 0.28), and the mean number of global exacerbations (major plus minor) decreased respectively by -37.5% in the BDP group and -23.3% in the BUD group. Both treatments were also associated with marked reductions in the number of nights with wheezing and the number of days of oral steroid use. Moreover, the two treatment groups had a similar adverse-event incidence and profile. Only 11 adverse events were reported, and no serious adverse events were related to treatment. Urinary cortisol and the time course of height and weight were unaffected by both treatments, and BDP was confirmed to have a neutral effect on bone metabolism. In conclusion, this study demonstrates that both BDP 800 microg day(-1) suspension for nebulization and BUD 750 microgday(-1) administered by nebulization are effective, with an acceptable safety profile, for treatment of severe persistent asthma in infants and young children.
Asunto(s)
Antiasmáticos/administración & dosificación , Asma/tratamiento farmacológico , Beclometasona/administración & dosificación , Broncodilatadores/administración & dosificación , Budesonida/administración & dosificación , Administración por Inhalación , Antiasmáticos/efectos adversos , Beclometasona/efectos adversos , Broncodilatadores/efectos adversos , Budesonida/efectos adversos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Nebulizadores y Vaporizadores , Resultado del TratamientoRESUMEN
Asthma of infants and young children (under school age) is a syndrome and not a disease. While the definitions given in 1981 by Tabachnik an Levision and by Geubelle still hold good, recent epidemiological findings show that several situations exist. Less than 20% of asthmatic infants in fact have allergic asthma that will persist after the age of 10. Bronchiolitis due to respiratory syncytial virus leads to a common variety of asthma. But pre-existing abnormalities of the small airways which create favorable conditions for bronchiolitis may also lead us to overestimate the sequelae. Prospective follow-up of cohorts of newborns is thus very important, and all wheezy children should undergo careful examination to exclude "false asthma" and identify "true asthma".
Asunto(s)
Asma/fisiopatología , Hiperreactividad Bronquial/fisiopatología , Asma/epidemiología , Asma/etiología , Bronquiolitis/complicaciones , Preescolar , Humanos , Incidencia , Lactante , Recién Nacido , Pronóstico , Factores de Riesgo , Síndrome , Terminología como AsuntoRESUMEN
The prevalence of food as a cause for asthma is not well known. The aim of this study was to define with standardized tests the incidence of food-induced asthma, the distribution of foods allergens in asthmatic children with food allergy. The study was carried on 163 asthmatic children with food allergy followed during average of 5.5 years. Asthma has been identified with pulmonary function tests (reversibility of FEV1 to bronchodilators) and food allergy has been documented by double-blind placebo-controlled food challenge (DBPCFC). Familial atopic disease was found in 148 children (90.7%). Inhalant sensitization was documented in 132 children (81%). Positive DBPCFC were observed in 250 of 385 challenges (65%) carried on these 163 children. The most frequent offending foods were, sometimes in association, peanut (30.6%), egg (23.1%), cow's milk (9.3%), mustard (6.9%), codfish (6%), shrimp (4.5%), kiwi fruit (3.6%), hazelnut (2.7%), cashew nut (2.1%), almond (1.5%), garlic (1.2%). Symptoms occurring during DBPCFC were cutaneous (143 cases, 59%), respiratory symptoms (58 cases, 23.9%), gastrointestinal symptoms (28 cases, 11.5%) and 15 anaphylactic shock (6.1%). Respiratory symptoms were oral allergy syndrome in 13 cases (5.3%), rhinoconjunctivitis in 15 cases (6.1%), asthma in 23 cases (9.5%). Only seven of these children had asthma only (2.8% of cases). The prevalence of asthma induced by food allergy is low. In our study, asthma induced by food allergy concerned 9.5% of cases and asthma alone was identified in only 2.8% of cases. We observed new food allergens associated with respiratory symptoms such as kiwi fruit, tree-nuts (hazelnut, cashew) and spices. Diagnosis relied upon data obtained from history, skin prick-tests and specific IgE. Oral food challenge is the corner stone of the diagnosis. Asthma induced by food allergens is potentially severe leading to prescribe to these patients a first aid kit with bronchodilators and epinephrine auto-injectors.
Asunto(s)
Asma/etiología , Asma/inmunología , Hipersensibilidad a los Alimentos/complicaciones , Niño , Preescolar , Ingestión de Alimentos , Femenino , Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/epidemiología , Humanos , Inmunoglobulina G/análisis , Lactante , Masculino , Anamnesis , Prevalencia , Valores de Referencia , Pruebas de Función Respiratoria , Pruebas CutáneasRESUMEN
UNLABELLED: Pulmonary abscess is an uncommon complication of pneumonia in children. Pyogenes, in particular Staphylococcus aureus or Streptococcus pneumoniae are the principal responsible bacteria. Mycoplasma pneumoniae is rarely the cause. CASE REPORT: A 14-year-old child was hospitalized with right thoracic pain. The patient was non-febrile and had a recent history of moderate infection. He was receiving antibiotic (macrolide) and non-steroidal anti-inflammatory therapy. CT scan confirmed a mid-lobe abscess in the right lung. Interruption of therapy resulted in fever and increase in C-reactive level with hyperleucocytosis, suggesting that the abscess was caused by a bacterial infection. The child's general condition and the radiographic picture improved with combined antibiotic therapy with amoxycillin and clavulanic acid, aminoglycosides and macrolides. The suspected diagnostic of M. pneumoniae was confirmed by increased IgM antibodies for M. pneumoniae. Recovery was complete two months later without sequelae. COMMENT: Pulmonary abscess is a rare complication of M. pneumoniae infection in children. This complication should be considered when the general condition does not improve despite appropriate early treatment of a pneumonia, as in the case of our patient.
Asunto(s)
Absceso Pulmonar/microbiología , Mycoplasma pneumoniae/patogenicidad , Neumonía por Mycoplasma/complicaciones , Adolescente , Antibacterianos/uso terapéutico , Humanos , Inmunoglobulina M/análisis , Absceso Pulmonar/tratamiento farmacológico , Absceso Pulmonar/etiología , Masculino , Mycoplasma pneumoniae/aislamiento & purificación , Neumonía por Mycoplasma/diagnóstico , Neumonía por Mycoplasma/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Recurrent or chronic cough can be the symptom of a worrying condition which must be diagnosed without delay (cystic fibrosis, asthma, bronchial foreign body, bronchiectasis). Investigation of recurrent or chronic cough is based on simple principles: careful history-taking concerning the characteristics of the cough, full clinical examination to look for any associated symptoms, and auxological assessment to detect any interruption in weight increase. Only when this initial evaluation has been carried out can complementary investigations be sought. Ordinary respiratory infections that are part of the building up of immunity are predominant in coughs of children aged under 6 years and are aggravated by deleterious factors such as passive exposure to tobacco, early introduction to communal life, and urban pollution. We describe the most frequent causes of cough and their frequency according to the age of the child.
Asunto(s)
Tos/etiología , Infecciones del Sistema Respiratorio/complicaciones , Factores de Edad , Asma/complicaciones , Asma/diagnóstico , Bronquiectasia/complicaciones , Niño , Preescolar , Enfermedad Crónica , Tos/fisiopatología , Tos/terapia , Fibrosis Quística/complicaciones , Fibrosis Quística/diagnóstico , Árboles de Decisión , Diagnóstico Diferencial , Reacción a Cuerpo Extraño , Humanos , Lactante , Recién Nacido , Anamnesis , Planificación de Atención al PacienteRESUMEN
Gastroesophageal reflux (GER) is one of the three most common causes of chronic cough in children, along with postnasal drip syndrome and asthma. There may be no gastrointestinal symptoms up to 50-75% of the time. GER plays a causative role in chronic cough, asthma without allergy and posterior laryngitis. GER most commonly provokes coughing by stimulating an esophageal-bronchial reflex and by irritating the lower respiratory tract by microaspiration. Twenty-four-hour pH monitoring of the distal esophagus is the most accurate diagnostic method for children with suspected GER and it helps to establish a temporal correlation between cough and GER. The first step of the treatment is the association of postural and dietetic measures and medications (prokinetics and antacids). The length of the treatment is a minimum of 3 months up to the age of walking. Surgical treatment must be reserved for the failure of medical treatment. The benefits of minimally invasive surgery are evident in children with chronic cough, who have a faster recovery with fewer complication than after open surgery.
Asunto(s)
Tos/etiología , Reflujo Gastroesofágico/complicaciones , Adolescente , Factores de Edad , Antiácidos/uso terapéutico , Asma/fisiopatología , Niño , Preescolar , Enfermedad Crónica , Tos/fisiopatología , Diagnóstico Diferencial , Determinación de la Acidez Gástrica , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/terapia , Humanos , Lactante , Recién Nacido , Procedimientos Quirúrgicos Mínimamente InvasivosRESUMEN
UNLABELLED: Spacers with face masks are widely used for the treatment of asthma in young children. A poor inhalation technique may compromise the treatments efficiency. METHODS: The inhalation technique of spacers with face masks was evaluated in a prospective study of 60 children below four years of age. A checklist of 12 items was used, each one being coded by zero or one, and a total score < or = 12 points was calculated. RESULTS: Mean total score was 8.93 +/- 1.84 (extremes: 6-12). The canister was shaken before use in 48.3% of cases, one puff delivered when the child was breathing in 71.7% and the valve's mobility checked in 85%. The canister was shaken before the second puff in 13.3% of cases and two consecutive puffs individualized in 28%. DISCUSSION: The usual mistakes are lacking to shake the canister and consecutive puffs' individualization. Medical partners and families education should be reinforced.
Asunto(s)
Asma/tratamiento farmacológico , Máscaras , Administración por Inhalación , Aerosoles , Preescolar , Diseño de Equipo , Humanos , Lactante , Nebulizadores y Vaporizadores , Cooperación del Paciente , Educación del Paciente como AsuntoRESUMEN
Prenatal and childhood passive tobacco smoke exposure resulting from parental smoking may have severe side effects, such as low birth weight, prematurity, sudden infant death syndrome, upper and lower respiratory tract infections and asthma. By giving information to parents, and particularly by emphasizing the dangers of passive smoke exposure for their children, pediatricians have a critical role to play in their prevention. This may also be helpful for adolescents who are starting to smoke actively by trying to understand the needs that they express by this behavior, and encouraging them to go to a stop smoking counseling center.
Asunto(s)
Protección a la Infancia , Pediatría , Rol del Médico , Contaminación por Humo de Tabaco/efectos adversos , Adolescente , Conducta del Adolescente , Adulto , Asma/etiología , Asma/prevención & control , Niño , Preescolar , Consejo , Femenino , Humanos , Lactante , Recién Nacido de Bajo Peso , Recién Nacido , Masculino , Trabajo de Parto Prematuro/etiología , Trabajo de Parto Prematuro/prevención & control , Relaciones Padres-Hijo , Educación del Paciente como Asunto , Embarazo , Infecciones del Sistema Respiratorio/etiología , Infecciones del Sistema Respiratorio/prevención & control , Muerte Súbita del Lactante/etiología , Muerte Súbita del Lactante/prevención & control , Contaminación por Humo de Tabaco/prevención & controlAsunto(s)
Bronquiolitis/complicaciones , Asma/etiología , Infecciones Bacterianas/etiología , Bronquiolitis/inmunología , Humanos , Hipersensibilidad Inmediata/etiología , Inmunoglobulina E/inmunología , Lactante , Recién Nacido , Mediadores de Inflamación/inmunología , Factores de Riesgo , Factores Socioeconómicos , Sobreinfección/etiología , Contaminación por Humo de Tabaco/efectos adversosAsunto(s)
Hipersensibilidad a los Alimentos/diagnóstico , Hipersensibilidad a los Alimentos/fisiopatología , Planta de la Mostaza/efectos adversos , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Hipersensibilidad a los Alimentos/sangre , Humanos , Inmunoglobulina E/sangre , Lactante , Masculino , Pruebas CutáneasRESUMEN
We retrospectively analyzed the long-term outcome of idiopathic pulmonary hemosiderosis (IPH) in 15 children. IPH started at a mean age of 5 years, and the mean duration of follow-up was 17.2 years (range, 10-36 yr). Four patients developed immune disorders, 3 cases of rheumatoid polyarthritis or rheumatoid polyarthritis-like diseases and 1 case of celiac disease. Respiratory outcome showed that 3 patients had severe symptoms: 2 patients developed severe pulmonary fibrosis resulting in major chronic respiratory insufficiency, and 1 patient had severe asthma. Twelve patients (80%) had mild or no respiratory problems and were able to lead a normal life. According to chest X-ray and pulmonary function test data, 4 patients had normal chest X-ray and no evidence of restrictive syndrome, 6 patients had an interstitial pattern on chest X-ray and evidence of restrictive pattern, 1 patient had an interstitial pattern but normal lung function, and 1 patient had a normal chest X-ray but evidence of mixed obstructive and restrictive pattern. Our results show that long-term survival is possible in patients with IPH. Factors of poor prognosis seem to be the presence of antineutrophil cytoplasm antibodies (ANCA) or other autoantibodies. No other clinical or biological predictive factors for prolonged survival were found.
Asunto(s)
Hemosiderosis/diagnóstico , Enfermedades Pulmonares/diagnóstico , Adolescente , Niño , Preescolar , Femenino , Estudios de Seguimiento , Hemosiderosis/terapia , Humanos , Lactante , Enfermedades Pulmonares/terapia , Masculino , Pronóstico , Estudios RetrospectivosRESUMEN
UNLABELLED: Inhaled albuterol is the most frequently used bronchodilator for acute wheezing, and nebulization is the standard mode of delivery in hospital setting. However, recent guidelines consider spacer devices as an easier to use, and cost-saving alternative and recommend the high-dose metered-dose inhaler bronchodilator. OBJECTIVE: To demonstrate clinical equivalence between a spacer device and a nebulizer for albuterol administration. DESIGN: Randomized, double-blind, parallel group equivalence trial. SETTING: Pediatric emergency wards at 2 tertiary teaching hospitals. PATIENTS: Sixty-four 12- to 60-month-old children with acute recurrent wheezing (32 per group). INTERVENTIONS: Albuterol was administered through the spacer device (50 microg/kg) or through the nebulizer (150 microg/kg) and repeated 3 times at 20-minute intervals. Parents completed a questionnaire. OUTCOME MEASURES: Pulmonary index, hospitalization, ease of use, acceptability, and pulse oximetry saturation. RESULTS: The 90% confidence interval of the difference between treatment groups for the median absolute changes in pulmonary index values between T0 and T60 was [-1; +1] and was included in the equivalence interval [-1.5; +1.5]. Clinical improvement increased with time. Less than 10% of the children (3 in each group) required hospitalization (2 in each group attributable to treatment failure). Parents considered administration of albuterol using the spacer device easier (94%) and better accepted by their children (62%). CONCLUSIONS: The efficacy of albuterol administered using the spacer device was equivalent to that of the nebulizer. Given its high tolerance, repeated 50-microg/kg doses of albuterol administered through the spacer device should be considered in hospital emergency departments as first-line therapy for wheezing.
Asunto(s)
Albuterol/administración & dosificación , Broncodilatadores/administración & dosificación , Nebulizadores y Vaporizadores , Ruidos Respiratorios/efectos de los fármacos , Enfermedad Aguda , Albuterol/efectos adversos , Broncodilatadores/efectos adversos , Preescolar , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Diseño de Equipo , Femenino , Humanos , Lactante , Masculino , Recurrencia , Equivalencia TerapéuticaRESUMEN
Data of the literature over the last 20 years indicate that infantile asthma, although heterogeneous, often appears following RSV bronchiotitis, especially when sufficiently severe to justify hospitalisation. The risk of developing episodes of wheezing (bronchial obstruction syndrome) over the following 2 to 3 years is higher than 50%, but estimations vary according to the authors. Functional disturbances (pulmonary distension, nonspecific bronchial hypperreactivity, hypoxia), with or without associated clinical symptoms, may be observed several months to several years after hospitalisation for bronchiolitis. On the other hand, mild bronchiolitis, and most of the recurrent expiratory obstructive syndromes with asymptomatic free intervals between episodes do not appear to carry a risk of functional sequelae. Children suffering from severe bronchiolitis usually develop a severe bronchial obstruction syndrome. In asthma, the percentage of IgE-dependent sensitization is less than 20% before the age of 4 years. The presence of positive skin tests and/or specific serum IgE directed against the usual allergens are associated with the persistence of asthma during the childhood. Similarly, the appearance of wheezing after the age of 3 years (or recurrence after this age) is associated with the persistence of asthma. Prospective studies of cohorts followed since birth show that pre-existing functional abnormalities can promote the appearance of bronchiolitis and bronchial obstruction syndrome. Asthma in infants comprises several phenotypes with very different prognoses.
Asunto(s)
Asma/etiología , Bronquiolitis/complicaciones , Infecciones por Virus Sincitial Respiratorio/complicaciones , Asma/virología , Bronquiolitis/virología , Niño , Preescolar , Femenino , Humanos , Inmunoglobulina E/inmunología , Lactante , Recién Nacido , Masculino , Ruidos Respiratorios/etiología , Infecciones por Virus Sincitial Respiratorio/virología , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
There are two phases in allergologic diagnosis of respiratory diseases related to immediate hypersensitivity reactions: establishment of the allergic origin of the symptoms and identification of the causal allergen or allergens. In addition to the basic information obtained from history taking and physical examination, prick tests provide an easy, rapid, and low cost means of correctly identifying specific allergens. Laboratory tests such as serum assay of specific IgE can be useful when history and prick tests provide conflicting information, in exceptional cases when prick tests cannot be performed, or when specific desensitization is indicated. IgE assay is however of little use if prick tests are negative or clinical history poorly suggestive. The role of screening for atopy using multiple-allergen prick tests which give a global positive or negative result is poorly defined. Screening tests would be interesting if symptoms suggest, among other hypotheses, an allergic disease, especially if prick tests cannot be performed rapidly. Other atopy tests, such as total serum IgE, have little use. Finally, specific provocation tests are rarely needed for routine allergologic diagnosis. They may be useful in complex clinical situations or in particular conditions such as occupational allergy.