Sublingual immunotherapy in patients with allergic rhinoconjunctivitis

Sublingual immunotherapy (SLIT) is a well-established treatment option for allergic rhinitis in several European countries, but it is considered investigational in the United States. Studies conducted in Europe provided a large body of evidence supporting the safety and efficacy of SLIT, but those studies used allergen products that are different from those that are likely to be approved in the United States, and many of them were not controlled, randomized, double-blinded trials. This review summarize research conducted on the efficacy, safety, and mechanisms of SLIT published during the past year, with a focus on ragweed and grass antigens. Results of recent US studies document the safety and efficacy of SLIT and have started to yield insight into the mechanisms of SLIT.

Preliminary evidence for the feasibility of a stress management intervention for 7- to 12-year-olds with asthma

OBJECTIVE

Evidence supports a bidirectional relationship between stress and asthma exacerbations in children, suggesting that interventions to reduce stress may improve both psychosocial quality of life and disease course. Here, we examine the feasibility of a stress management intervention for 7- to 12-year-olds with asthma.

METHODS

Two trials were conducted. Cohort 1 (n = 11) was recruited from the community and attended intervention sessions at an urban university. Cohort 2 (n = 7) was school based and recruited from an African American charter school. Six individual intervention sessions focused on psychoeducation about asthma, stress, and emotions; problem-solving and coping skills training; and relaxation training paired with physiological feedback. Pre- and post-intervention stress, mood, and lung function data were collected. Satisfaction surveys were administered after intervention completion.

RESULTS

The intervention was rated as highly acceptable by participating families. Feasibility was much stronger for the school-based than the university-based recruitment mechanism. Initial efficacy data suggest that both cohorts showed pre- to post-intervention improvements in lung function, perceived stress, and depressed mood.

CONCLUSION

Findings provide evidence for the feasibility of offering asthma-related stress management training in a school setting. Initial findings offer support for future, large-scale efficacy studies.

[Customer satisfaction in home care: methodological issues based on a survey carried out in Lazio]

Home care customer satisfaction has been, until now, rarely evaluated. After illustrating the main italian regional surveys on this issue, the article presents a customer satisfaction survey carried out in the district of Civitavecchia (Local Health Unit 'Rome F'), Lazio, regarding 30 home care beneficiaries. Methodological aspects emerging from the survey are basically focused on: advantages and disadvantages of quantitative and qualitative approaches (possibly associated each other); main criteria of eligibility of people selected for interviewing, both patients or caregivers; conditions that maximize answers reliability, including training on interviewers. Authors highlight opportunity of using such kind of survey, integrated with other different tools, into a systemic vision, for promoting management changes coming from suggested problems, aimed at total quality management.

Utility of pedometer step recommendations for predicting overweight in children

OBJECTIVE

The purpose of this study was to examine the utility of pedometer-based physical activity recommendations in predicting childhood adiposity.

DESIGN

Subjects (n=608) (9.6 years) were from two Midwestern USA communities. Physical activity was assessed by a pedometer. The percentage of subjects meeting physical activity recommendations was determined using published recommendations. Overweight and obesity were determined based on reference values for the body mass index (BMI) developed by the International Obesity Task Force. An elevated waist circumference (WC) was determined based on age- and sex-specific reference values >75th percentile.

RESULTS

Children who did not meet the pedometer recommendations were about two times more likely to be overweight/obese and have an elevated WC compared with those meeting recommendations. The BMI and WC were significantly different across pedometer step count groups in males and females.

CONCLUSION

Subjects not meeting the recommendations for steps per day were more likely to be classified with the overweight phenotype than those meeting the recommendation. A dose-response relationship between pedometer steps per day and adiposity is also apparent.

Evolving role of leukotrienes in the pathogenesis of viral infections, including otitis media

Otitis media (OM) is one of the most common childhood disorders and has been associated with an alarming rise in prevalence. Because medical therapy with antibiotics, antihistamines, decongestants, and corticosteroids has no demonstrable efficacy in the treatment of OM, the mainstay of treatment is surgical intervention. Although effective, surgical treatment is quite expensive and exposes patients to the risks associated with general anesthesia. Results of recent studies suggest that locally produced leukotrienes may play a role in the pathogenesis of OM. As such, a potential candidate for treatment of OM is the leukotriene receptor antagonist, montelukast, which has been approved by the US Food and Drug Administration for the treatment of asthma and/or allergic rhinitis. If proven effective, this drug's safety/convenience profiles and indication for children as young as 6 months of age would make it suitable for treatment of OM, and perhaps even prophylaxis of OM in at-risk populations.

Effect of tetanus immunization on t-helper cytokine production in adults with and without allergic rhinitis

Epidemiological evidence links T-helper type 2 (Th2) cytokine responses to the pathogenesis of atopy/asthma. It is hypothesized that certain immunizations may induce/amplify Th2 cytokine responses. The objective of this study was to determine whether Th cytokine responses to immunization with tetanus toxoid differ in adults with and without allergic rhinitis (AR). Thirty subjects were enrolled (15 AR and 15 non-AR subjects as confirmed by history and allergy skin testing). Blood was collected before (day 0) and on days 3, 7, 14, and 28 after immunization with tetanus toxoid. Peripheral blood mononuclear cells (PMNCs) were purified and cultured with either PHA or tetanus toxoid for 2 or 6 days, respectively. Supernatants were harvested and assayed for IFN-gamma and IL-13 levels (pg/mL) by EIA. Results were normalized by log transformation and analyzed by stepwise regression. Baseline (day 0) cytokine values were similar in both groups. PHA and tetanus-induced IFN-gamma were increased (p < 0.05) in non-AR (3.2 +/- 0.3 and 1.4 +/- 0.3 on day 7, and 3.5 +/- 0.2 and 1.9 +/- 0.2 on day 14, respectively) compared with AR subjects (2.3 +/- 0.3 and 0.9 +/- 0.3 on day 7, and 2.7 +/- 0.3 and 1.2 +/- 0.3 on day 14, respectively). PHA-induced, but not tetanus-induced, IL-13 production was increased (p < 0.05) in non-AR compared with AR subjects on day 7 (p < 0.05). PHA-induced IL-13 production was 3.1 +/- 0.2 in non-AR and 2.6 +/- 0.3 in AR subjects on day 7. These results indicate differential Th cytokine responses in AR and non-AR subjects after immunization with tetanus toxoid. Future studies are warranted and may result in the identification of potential prevention/treatment strategies for atopy/asthma.

Nickel ions release in patients with fixed orthodontic appliances

AIM

The extent to which orthodontic appliances can cause contact allergies due to nickel release is a controversial matter. Since the data provided by literature are contrasting, the Authors think that it is important to analyse nickel ions released in organic tissues by means of a plasma spectrometer.

METHODS

About 100 intact hairs were taken from 15 patients wearing fixed orthodontic appliances. The hairs had been washed 12 to 24 h before, in order to limit environmental contamination. The same procedure was carried out on a control group corresponding in sex, age and abode. The samples of hair were taken from at least 3 different scalp sites: frontal, vertex and occipital areas.

RESULTS

According to the spectrophotometric analysis of the hair, there were no differences in nickel concentrations between the test group (0.50 mg/g on average) and control group (0.64 mg/g) (*P<0.005). The mean value was reduced even further if minimum and maximum values were excluded (test group 0.46 mg/g, control group 0.52 mg/g). Even though there was a slight difference (0.14 mg/g), it showed that more nickel concentration was found in the control sample (without orthodontic appliances) to a maximum of 2.20 mg/g. This suggests that environmental contamination, in particular diet, has an influence on ion concentration. Other studies also confirm that gut absorption of nickel released in the mouth by orthodontic appliances is much lower than the absorption of nickel release through diet.

CONCLUSIONS

It can be assumed that orthodontic appliances do not release significant values of nickel to be a risk factor to the patient's health.

Nasal cytokines as mediators of illness during the common cold

Identification of a pharmacologically targeted mediator of the common cold is a desirable, but, to date, elusive goal of current research. The roles of various mediators, such as histamine, leukotrienes, bradykinin, and, more recently, chemokines and cytokines, in the pathophysiology and development of complications of the common cold are the subject of previous and current investigations. Establishing causality of a mediator in the common cold has been difficult for a number of reasons, including the limitations of our research tools and protocols and the complexity of the inflammatory and immune pathways that participate during the common cold. The available evidence for mediation of the common cold is the subject of this manuscript.

Comparison of objective and subjective measurements of cough frequency in patients with seasonal allergic rhinitis

BACKGROUND

Cough is a frequent complaint of patients with a variety of respiratory disorders, including seasonal allergic rhinitis (SAR), and it is often evaluated subjectively to determine disease status and response to treatment. However, it is not known whether subjective reports of cough from patients with SAR are accurate.

OBJECTIVE

To compare a novel objective measurement with subjective reports of cough frequency in a subset of 28 patients (aged > or = 12 years) with active SAR who were enrolled in a large, multicenter trial examining the efficacy of an active treatment for SAR.

METHODS

In this supplemental pilot study, subjective data were collected on a diary card and objective data were collected using home-based telemetry. Three 24-hour recording sessions were conducted with each patient: 2 consecutive baseline sessions (day 1 and day 2) and 1 session after randomization to placebo or active cough treatment (day 3).

RESULTS

Strong correlations existed between cough frequency data for days 1 and 2 (Spearman correlation coefficient = 0.91; P < .001) and between subjective and objective data for days 1, 2, and 3 (daytime greater than nighttime) (Spearman correlation coefficient = 0.51; P < .001).

CONCLUSION

These results have implications for the design and interpretation of results from clinical trials that evaluate cough frequency as a treatment outcome.

Association between environmental tobacco smoke and diminished dendritic cell interleukin 10 production during infancy

BACKGROUND

Diminished interleukin 10 (IL-10) production has been documented in children and adults with asthma and atopy. Environmental tobacco smoke (ETS) is recognized as a risk factor for the development of childhood asthma.

OBJECTIVE

To determine whether there is an association between ETS and dendric cell (DC) IL-10 production during infancy.

METHODS

ETS was evaluated by questionnaire, and blood samples were obtained at 2 weeks, 3 months, and 5 months of age in 37 healthy infants. DCs were cultured and stimulated, and supernatants were assayed for IL-10 by enzyme immunoassay.

RESULTS

Sixteen infants had no history of exposure to ETS, and 21 infants had a history of ETS exposure. The frequency of subjects with detectable IL-10 levels was similar in both groups at 2 weeks and 3 months but significantly different at 5 months (P < .001). In those without ETS exposure, the frequency with detectable IL-10 levels increased during the observation period (25% at 2 weeks, 20% at 3 months, and 36% at 5 months; P = .03 vs 2 weeks). In contrast, in those with ETS exposure, the frequency with detectable IL-10 levels decreased during the observation period (33% at 2 weeks, 19% at 3 months; P = .02 vs 2 weeks; and 7% at 5 months; P < .001 vs 2 weeks).

CONCLUSIONS

Our study results demonstrate an association between ETS and diminished DC IL-10 production during infancy. Future studies need to expand on these sample sizes and explore whether diminished DC IL-10 production is the mechanism by which ETS predisposes patients to the development of asthma and/or atopy.

[The quality of medical records: a retrospective study in Lazio Region, Italy]

INTRODUCTION

Medical records have an important role in the communication among different care providers and in forensic medicine. In Italy, information on completeness and correctness of medical records is scanty, whereas future hospital accreditation could take into account their quality as a proxy of good medical practice.

PURPOSE

We performed a retrospective study in order to assess the quality of medical records in the Lazio region.

METHODS

From all 37009 hospital discharges for five different diseases in 123 hospitals (acute myocardial infarction (AMI), coronary artery bypass surgery, pneumonia, cerebrovascular disorders, breast surgery), registered in the Regional Hospital Information System, we selected a random sample of 2022 (5.5% of the total). Ten physicians, previously trained, reviewed the relative medical charts and filled in "ad hoc" questionnaires.

RESULTS

A total of 1960 (97% of the target) charts were reviewed. Organization and structure of data recording strongly varied. Important differences were found across the diseases for various items: presence of anamnesis 98.1% (range: from 95.6% for breast surgery to 100% for AMI); presence of physical examination 92.7% (range: from 88.1% for breast surgery to 98.5% for AMI), completeness of the daily medical records was good in 70.8% (range: from 34.2% for pneumonia to 93.9% for cerebrovascular disorders). Variability among different type of hospitals was also observed, being teaching hospitals and some private hospitals more accurate.

CONCLUSIONS

Quality of medical records tended to vary across different type of hospitals and different diseases. Actions for improving the quality should be undertaken as a priority. Efforts have to be done in restructuring charts, creating guidelines and training caregivers. The development and application of computer based health information systems should help solving these problems.

The effects of intranasal triamcinolone acetonide and intranasal fluticasone propionate on short-term bone growth and HPA axis in children with allergic rhinitis

OBJECTIVE

The purpose of this study was to evaluate the effects of triamcinolone acetonide (TAA) and fluticasone propionate (FP) aqueous nasal sprays on short-term lower-leg growth velocity and hypothalamic-pituitary-adrenal (HPA-axis function in pediatric subjects.

METHODS

In this controlled, double-blinded (TAA) or single-blinded (FP), four-way crossover trial, 59 subjects (mean age: 7.2 years) were randomized to receive each of four 2-week treatments in random order: TAA nasal spray 110 microg, TAA nasal spray 220 microg, FP nasal spray 200 microg, and placebo, administered by a third party once daily with a 2-week washout period between treatments. Lower-leg growth velocity was measured by knemometry, and HPA-axis function was measured using 12-hour overnight urinary cortisol levels.

RESULTS

Forty-nine subjects completed all four treatments and were included in the analyses. Mean growth velocity (+/- standard error) was 0.46 (+/- 0.06) mm/week for placebo, 0.37 (+/- 0.06) and 0.31 (+/- 0.06) mm/week for TAA nasal spray 110 and 220 microg, respectively, and 0.37 (+/- 0.06) mm/week for FP nasal spray. The treatment effect on mean growth velocity compared with placebo was -19.6% with TAA 110 microg, -32.6% with TAA 220 microg, and -21.7% with FP; none of these effects was considered statistically or clinically significant according to predefined criteria. No significant differences in changes in urine cortisol/creatinine ratios were observed between TAA 110 microg or 220 microg and placebo (4.38, 3.60, and -0.67, respectively, P > or = 0.157). In contrast, the change in mean urine cortisol/creatinine ratio values for FP (-3.59) were significantly lower compared with TAA 220 microg (P = 0.033) and placebo (P = 0.003). Knemometry exhibited less time-dependent variability than overnight urinary cortisol measurements.

CONCLUSIONS

Neither TAA nor FP had a clinically significant effect on lower-leg growth velocity. In contrast to FP, TAA nasal spray did not significantly affect HPA-axis function when used over a 2-week interval.