Recurrent respiratory infections between immunity and atopy

Serum Levels of Selected Cytokines and Chemokines and IgG4 in Children With Recurrent Respiratory Tract Infections

Background: Respiratory tract infections are a common health problem. Cytokines/chemokines play a critical role in the regulation of the immune system. Their defective production may predispose to recurrent respiratory tract infections (RRIs), and an excessive immune response may lead to chronic inflammation and cause damage to the respiratory tract. Another biomarker of respiratory infections may be immunoglobulin-IgG4. Its meaning has still been little explored. We wanted to assess the suitability of the levels of biomarkers tested: interleukin (IL)-17A, IL-18, IL-23, normal T cells expressed and secreted (RANTES), and induced protein (IP)-10, as well as immunoglobilun G4 (IgG4) to predict recurrent infections. Methods: The study group (SG) included a total of 130 children (68 girls, 62 boys) between 3 and 17 years of age with RRI. The control group (CG) included 86 healthy children with no symptoms of inflammatory or allergic diseases (44 girls and 42 boys) of the same age. Blood samples were collected in fasting state and then serum samples were frozen and stored until biomarker assay. Results: Serum RANTES, IL-18, IL-23, and IgG4 concentration were higher in all children with recurrent infections vs. those in the CG (p  < 0001). Serum levels of IL-17A and IP-10 were also significantly higher in the SG than in the CG, but only in the youngest children. Among the six serum markers, RANTES demonstrated the highest area under the receiver operating characteristic curve (area under curve) value (0.998, 95% confidence interval [CI]: 0.98-1.0, p < 0.001) for the diagnosis of RRIs, followed by IL-23 (0.99, 95% CI 0.966-0,999, p < 0.001) and IL-18 (0.957, 95% CI 0.921-0.980, p < 0.001). Conclusions: RANTES, IL-23, and IL-18 could be strong predictors of respiratory infections recurrence in children.

The prevalence and risk factors of hoarseness among pupils in elementary schools in the South of Finland

Purpose: Hoarseness and voice problems are one of the chronic conditions experienced by children. The aim of this study was to investigate the prevalence of hoarseness, possible risk factors and effects of the remediation of school buildings to the prevalence of hoarseness among school children. Methods: The material was gathered from all the schools in a large city in the south of Finland and the collection method used was an e-mail survey sent to the parents of the pupils and a simultaneous survey sent to the personnel in the schools. Results: All 51 schools participated, and 5889 pupils returned the questionnaire (39%). The exposure data was obtained from two building experts who knew the repair history of the schools. A subjective estimation of the quality of the indoor air was obtained from teachers and the parents. The overall prevalence of hoarseness among pupils was 6.3%; prevalence being higher in unrepaired school buildings than in schools in a good condition or buildings with a thorough remediation. Hoarseness was associated with asthma and allergies, several respiratory symptoms, and respiratory infections. Exposure to tobacco smoke increased the risk, and consumption of caffeine containing drinks seemed to reduce the risk. Noise, stuffiness of the indoor air and microbial smells correlated strongly with the occurrence of hoarseness in a logistic regression model when controlled for age, gender, asthma, passive smoking, and caffeine consumption. Conclusions: We recommend renovations in school buildings with the aim of providing better acoustics, sufficient ventilation, and a reduction in exposure to moisture damage microbes.

Streptococcal Serology in Children With Stuttering

Introduction: Stuttering is a pronunciation disorder represented by repetitive perpetuations, duplications, or freezes of spoken words or syllables, as well as nervousness and cognitive shunning. Group A beta-hemolytic Streptococcus (GABHS) can lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS). Many case reports have proposed that stuttering is the result of a PANDAS, and that it can be identified together with Tourette syndrome, which shares many clinical characteristics with stuttering. Aim: The purpose of this study was to examine the association between streptococcal serology and stuttering in children. Method: The participants in this study are 26 children who stutter (CWS; mean age = 8.3 + 3.1 years) and 25 children who do not stutter (CWNS; mean age = 9.2 + 2.9 years). Participants were matched in terms of age (±3 months) and gender. We analyzed serum antistreptococcal antibodies [antistreptolysin O (ASO), anti-deoxyribonuclease B (anti-DNase B), and antistreptokinase] in both groups. Results: In the CWS group, ASO, anti-DNase B, and antistreptokinase were significantly higher than in the CWNS group (P < .0001, P < .0001, P < .0001). Conclusion: The higher serum antistreptococcal antibody amounts in CWS suggest that an increased autoimmune response against GAHBS may be the etiology of childhood stuttering. It has been suggested that CWS should be examined for autoimmune reactions, especially to GAHBS.

Association of Maternal Body Mass Index During Early Pregnancy With Offspring Lower Respiratory Infections: A Nationwide Cohort Study

OBJECTIVE

To assess whether or to what extent maternal obesity during early pregnancy could increase the risk of offspring lower respiratory infections (LRI).

STUDY DESIGN

This population-based cohort included 688,457 live singleton births born in Denmark between 2004 and 2016. The exposure was maternal body mass index (BMI) during early pregnancy, and the outcome was LRI in offspring. Cox regression models were used to estimate hazard ratios with their 95% confidence intervals (CI) for the association. We also performed subanalysis stratified by the LRI onset age, number of infection episodes before the age of 3, infection pathogens, infection sites, duration of hospital stay due to LRI and allergic constitution of children.

RESULTS

A total of 64,725 LRIs in offspring were identified during follow-up. Maternal overweight (BMI 25.0-29.9 kg/m 2 ), moderate or severe obesity (BMI 30.0-39.9 kg/m 2 ) and very severe obesity (BMI ≥40 kg/m 2 ) were associated with a 7% (95% CI: 5%-9%), 16% (95% CI: 14%-19%) and 21% (95% CI: 13%-28%) increased risk of LRI in offspring, respectively. Higher maternal BMI was positively associated with earlier onset age, more episodes before the age of 3, and longer hospital stay of LRI in offspring. In addition, allergic constitution of offspring significantly enhanced the effect of maternal BMI on offspring LRI (44% increased risk, 95% CI: 5%-97% for very severe obesity).

CONCLUSIONS

Maternal BMI during early pregnancy might be a risk factor for offspring LRI, especially in children with allergic constitution.

Turbinate Hypertrophy, Allergic Rhinitis, and Otitis Media

PURPOSE OF REVIEW

Otitis media (OM) is a disease with high prevalence in infancy; it has a substantial burden on healthcare resources, and a relevant impact on the quality of life of families. The link between OM and allergic rhinitis (AR) is still debated. However, there is agreement about the relevance of type 2 inflammation on turbinate hypertrophy (TH) generation. There is also evidence that TH is associated with middle ear dysventilation: a pathogenic factor promoting OM. Therefore, a vicious circle among AR, TH, and OM may occur.

RECENT FINDINGS

There are some recent studies exploring this issue through different approaches, such as epidemiological, mechanistic, and therapeutic. Identifying allergy as a pathogenic factor for OM could improve the management of OM patients. Vice versa, suspecting AR in OM patients, could be reasonable in selected patients. The current narrative review provides an overview of the evidence concerning the potential role of AR, and associated TH, in OM patients.

Turbinate Hypertrophy, Allergic Rhinitis, and Otitis Media

PURPOSE OF REVIEW

Otitis media (OM) is a disease with high prevalence in infancy; it has a substantial burden on healthcare resources and a relevant impact on the quality of life of families. The link between OM and allergic rhinitis (AR) is still debated. However, there is agreement about the relevance of type 2 inflammation on turbinate hypertrophy (TH) generation. There is also evidence that TH is associated with middle ear dysventilation: a pathogenic factor promoting OM. Therefore, a vicious circle among AR, TH, and OM may occur.

RECENT FINDINGS

There are some recent studies exploring this issue through different approaches, such as epidemiological, mechanistic, and therapeutic. Identifying allergy as a pathogenic factor for OM could improve the management of OM patients. Vice versa, suspecting AR in OM patients could be reasonable in selected patients. The current narrative review provides an overview of the evidence concerning the potential role of AR, and associated TH, in OM patients.