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Cheng DT, Wee LYJ, Teoh OH, Thomas B. Approach to difficult-to-treat asthma in childhood: a narrative review. Singapore Med J 2024:00077293-990000000-00095. [PMID: 38363652 DOI: 10.4103/singaporemedj.smj-2023-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/02/2023] [Indexed: 02/18/2024]
Abstract
ABSTRACT Asthma is a major chronic disease affecting children, and children with difficult-to-treat asthma account for a disproportionate share of resource utilisation and healthcare costs. This review presents a comprehensive and up-to-date overview of the treatment strategies in difficult-to-treat paediatric asthma. Mimickers of asthma must first be ruled out, and the diagnosis confirmed with objective tests whenever possible. The effect of comorbid conditions such as obesity, smoking, other atopic conditions and psychosocial factors on asthma control and severity should be considered. Treatment can then be optimised by implementing personalised strategies, including the use of appropriate drug delivery devices and adherence monitoring. Biologics can be an alternative treatment option for selected patients but should not be a substitute for addressing poor adherence. Many patients with difficult-to-treat asthma may not have severe asthma, and the physician should work with patients and families to achieve good asthma control via an individualised approach.
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Affiliation(s)
- Duo-Tong Cheng
- Department of Paediatrics, Respiratory Medicine Service, KK Women's and Children's Hospital, Singapore
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Powell E, Berk O, Bewick J, Zolkipli ZQ. Fifteen-minute consultation: Child with persistent runny nose. Arch Dis Child Educ Pract Ed 2024; 109:2-7. [PMID: 35728928 DOI: 10.1136/archdischild-2021-323242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 06/07/2022] [Indexed: 11/04/2022]
Abstract
A child with persistent runny nose may cause significant parental anxiety and healthcare utilisation. While the most common diagnoses are recurrent acute viral upper respiratory tract infections and allergic rhinitis, a careful history and examination is necessary to exclude other causes and to identify comorbidities. Treatment can then be tailored to the underlying cause. The aim of this article is to provide a systematic approach to such patients.
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Affiliation(s)
- Elizabeth Powell
- Department of Paediatric Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Omer Berk
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jessica Bewick
- Department of ENT, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zaraquiza Q Zolkipli
- Department of Paediatric Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Park D, Ha EK, Jung H, Kim JH, Shin J, Kim MA, Shin YH, Jee HM, Han MY. Associations of personal urinary volatile organic compounds and lung function in children. J Asthma 2024:1-7. [PMID: 38198535 DOI: 10.1080/02770903.2024.2303770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND We investigated the correlation between urine VOC metabolites and airway function in children exposed to anthropogenic volatile organic compounds (VOCs), notable pollutants impacting respiratory health. METHODS Out of 157 respondents, 141 completed skin prick tests, spirometry, IOS, and provided urine samples following the International Study of Asthma and Allergies in Childhood (ISAAC)-related questions. Allergic sensitization was assessed through skin prick tests, and airway functions were evaluated using spirometry and impulse oscillometry (IOS). Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) was recorded and FEV1/FVC ratio was calculated. Airway mechanics parameters including respiratory resistance at 5 Hz (Rrs5) mean respiratory resistance between 5 Hz and 20 Hz (Rrs5-20), were also recorded. Urine concentrations of metabolites of benzene, ethylbenzene, toluene, xylene, styrene, formaldehyde, carbon-disulfide were analyzed by gas chromatography/tandem mass spectroscopy. RESULTS The median age at study participation was 7.1 (SD 0.3) years. Muconic acid (benzene metabolites) and o-methyl-hippuric acid (xylene metabolites) above medians were associated with a significant increase in Rrs5 (muconic acid: aβ = 0.150, p = .002; o-methyl-hippuric acid: aβ = 0.143, p = .023) and a decrease in FEV1/FVC (o-methyl-hippuric acid: aβ = 0.054, p = .028) compared to those below median. No associations were observed for Rrs5-20 and FEV1 between the groups categorized as above and below the median (all parameter p values > .05). CONCLUSIONS Elevated levels of benzene and xylene metabolites were associated with a significant increase in Rrs5 and a decrease in FEV1/FVC, related to increased resistance and restrictive lung conditions compared to individuals with concentrations below the median.
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Affiliation(s)
- Dawon Park
- Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Eun Kyo Ha
- Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Haeri Jung
- Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Ju Hee Kim
- Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeewon Shin
- Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Mi Ae Kim
- Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Youn Ho Shin
- Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hye Mi Jee
- Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Man Yong Han
- Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
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Trybus E, Trybus W, Król T. Cytological Study of Topical Effect of Azelastine Hydrochloride on the Nasal Mucous Membrane Cells in Various Nasal Rhinitis Types. Cells 2023; 12:2697. [PMID: 38067125 PMCID: PMC10706206 DOI: 10.3390/cells12232697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
Previous reports on the benefits of using local therapy with azelastine in rhinitis focus on the assessment of clinical symptoms and the analysis of nasal lavage for the presence of inflammatory cells and the expression of adhesion molecules. Little attention has been paid to studies assessing the effect of azelastine on individual cytotypes of the nasal mucosa, especially epithelial cells, also in the context of inducing morphological changes. The aim of this study was the cytological analysis of swabs taken from the surface of the nasal mucosa of patients with allergic rhinitis (AR) and nonallergic/vasomotor rhinitis (NAR/VMR) who were subjected to 4 weeks of therapy with azelastine and then comparing the obtained results with the pre-treatment condition. The technique of obtaining materials for cytoanalysis included sampling, staining of smears, microscopic analysis, and preparation of cytograms. Our studies confirmed the therapeutic benefits of azelastine in both study groups. Significant changes were demonstrated, confirming the regeneration of ciliated cells and the induction of autophagy and apoptosis in epithelial cells. Such changes indicate new mechanisms of action of azelastine, which play a significant role in restoring homeostasis in the nasal mucosa. The presented research also results in a detailed description of cytological changes in both studied rhinitis types, which complements the knowledge regarding prognostic indicators.
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Affiliation(s)
- Ewa Trybus
- Department of Medical Biology, Jan Kochanowski University of Kielce, Uniwersytecka 7, 25-406 Kielce, Poland;
| | - Wojciech Trybus
- Department of Medical Biology, Jan Kochanowski University of Kielce, Uniwersytecka 7, 25-406 Kielce, Poland;
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Carvalho T, Mello Jr JFD, Caldini ETEG, Salgado DC, Carvalho NMGD, Damaceno-Rodrigues NR, Voegels RL. Perivascular Innervation in the Nasal Mucosa and Clinical Findings in Patients with Allergic Rhinitis and Idiopathic Rhinitis. Int Arch Otorhinolaryngol 2023; 27:e723-e732. [PMID: 37876708 PMCID: PMC10593529 DOI: 10.1055/s-0043-1775581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/26/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction The nonspecific hyperreactivity of rhinitis has been attributed to neurotrophins activating sensory nerves and inflammatory cells. The relationship between these markers and the intensity of the symptoms is not well established and few studies have evaluated individuals with idiopathic rhinitis. Objective The present study aims to evaluate whether perivascular innervation and nerve growth factor (NGF) are related to the intensity of the clinical conditions in allergic rhinitis (AR) and idiopathic rhinitis (IR). Methods A total of 15 patients with AR and 15 patients with IR with the indication for inferior turbinectomy (associated or not with septoplasty) were selected. The patients received a score according to their signs and symptoms. After the surgery, we quantified eosinophils, mast cells, NGF, and nerve fibers in the nasal turbinate. Results The score of the signs and symptoms was higher in the AR group. Nerve growth factor was found in the cytoplasm of inflammatory cells in the submucosa in greater quantity in the AR group. The nerve fibers were distributed throughout the tissue, mainly in the subepithelial, glandular, and vascular regions, and there was no difference between the groups. Greater perivascular innervation was associated with a higher signs and symptoms score. Conclusions We concluded that these findings suggest that the NGF produced by submucosal inflammatory cells stimulates increased perivascular innervation in rhinitis, thus directly reflecting in more intense clinical conditions, especially in AR.
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Affiliation(s)
- Thiago Carvalho
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - João Ferreira de Mello Jr
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Grupo de Alergia em Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Elia Tamaso Espin Garcia Caldini
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Pathology Department, Cellular Biology Laboratory, Faculty of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Nilsa Regina Damaceno-Rodrigues
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Laboratórios de Investigação Médica (LIM 59), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Richard Louis Voegels
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Departamento de Otorrinolaringologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Kim JH, Cha HR, Ha EK, Kwak JH, Kim H, Shin J, Jee HM, Han MY. Association between First-Generation Antihistamine Use in Children and Cardiac Arrhythmia and Ischemic Heart Disease: A Case-Crossover Study. Pharmaceuticals (Basel) 2023; 16:1073. [PMID: 37630987 PMCID: PMC10457948 DOI: 10.3390/ph16081073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiotoxicity from first-generation H1-antihistamines has been debated since the 1990s. However, large-scale studies on this topic in a general pediatric population are lacking. This study aimed to assess the association between first-generation H1-antihistamine use and cardiovascular events in a nationwide pediatric population. In this case-crossover study, the main cohort included children with cardiovascular events from the National Health Insurance Service database (2008-2012 births in Korea) until 2018. The second cohort excluded children with specific birth histories or underlying cardiovascular diseases from the main cohort. Cardiovascular events of interest included cardiac arrhythmia and ischemic heart disease. Odds ratios (ORs) of cardiovascular events were estimated using conditional logistic regression models, comparing first-generation H1-antihistamine use during 0-15 days before cardiovascular events (hazard period) with use during 45-60 and 75-90 days before events (control periods). Among the participants, 1194 (59.9%) were aged 24 months to 6 years, and 1010 (50.7%) were male. Cardiovascular event risk was increased among users of first-generation H1-antihistamines (adjusted OR [aOR], 1.201; 95% confidence interval, 1.13-1.27). Significant odds of cardiovascular events persisted within 10 and 5 days (aOR, 1.25 and 1.25). In the second cohort, the association was comparable with that in the main cohort. Our findings indicate that cardiovascular event risk is increased in children who are administered first-generation H1-antihistamines.
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Affiliation(s)
- Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea;
| | - Hye Ryeong Cha
- Department of Computer Science and Engineering, Sungkyunkwan University, Suwon 16419, Republic of Korea;
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea;
| | - Ji Hee Kwak
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
| | - Hakjun Kim
- Department of Obstetrics and Gynecology, Hwacheon County Health and Medical Center, Hwacheon 24119, Republic of Korea;
| | - Jeewon Shin
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea;
| | - Hye Mi Jee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea;
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea;
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Nasal eosinophilia as a preliminary discriminative biomarker of non-allergic rhinitis in every day clinical pediatric practice. Eur Arch Otorhinolaryngol 2023; 280:1775-1784. [PMID: 36271956 DOI: 10.1007/s00405-022-07704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 10/12/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Non-allergic rhinitis (NAR) in children, named local allergic rhinitis (LAR) and non-allergic rhinitis with eosinophilia syndrome (NARES), are recently termed entities in childhood characterized by symptoms suggestive of allergic rhinitis in the absence of systemic atopy. Nasal eosinophils (nEo) are the principal cells involved in the allergy inflammation and nasal allergen provocation test is the gold standard method for the diagnosis, albeit with several limitations. The aim of this study was to validate the presence of nEo in combination with the therapeutic response to nasal steroids, as a preliminary discriminator of NAR in real life data. METHODS In a prospective cohort study, 128 children (63.3% male, aged 72 ± 42 m) with history of NAR were enrolled and followed up for 52 ± 32 m. Nasal cytology was performed and nasal steroids trial was recommended initially in all and repeatedly in relapsing cases. Response to therapy was clinically evaluated using 10-VAS. RESULTS Significant nEo was found in 59.3% of the cases and was related to reported dyspnea episodes. 23.4% had no response to therapy, whereas 51.5% were constantly good responders. Response to therapy was related to nEo and a cutoff point of 20% was defined as the most reliable biological marker with 94% sensitivity and 77% specificity. CONCLUSIONS In children with symptoms of NAR, the presence of nEo > 20% constantly responding to nasal steroid therapy, is a clear indicator of atopy. In an everyday clinical setting, it emerged as an easy, preliminary, cell biomarker suggestive of further investigation such as NAPT, to discriminate LAR from NARES.
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Mometasone Furoate in Non-Allergic Rhinitis: A Real-Life Italian Study. J Pers Med 2022; 12:jpm12071179. [PMID: 35887676 PMCID: PMC9322075 DOI: 10.3390/jpm12071179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background: In order to evaluate the efficacy of intranasal mometasone furoate in patients with non-allergic rhinitis (NAR), a real-life, observational, prospective study is performed. Methods: Thirty-one patients (age 18–64 years) receive intranasal (mometasone furoate, 200 µg b.i.d. for 15 consecutive days per month for 6 consecutive months), plus isotonic nasal saline. The cytologic pattern of local inflammation, nasal airflow, through peak nasal inspiratory flow (PNIF), quality of life (QoL), through the rhinitis quality of life questionnaire (RQLQ), the sinonasal outcome test (SNOT-22), the short-form 36-item health survey (SF-36v2), and the combined symptom medication score (CSMS), and, finally, olfactory function, through Sniffin’ sticks-16 identification test (SSIT-16), are evaluated at baseline and after treatment. Results: NARNE is the most frequent cytological pattern (48% of the total sample). The therapeutic response shows improvement in olfactory function and QoL. Conclusions: The results of this study confirm that intranasal mometasone furoate is an effective treatment for patients with NAR.
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Clinical Evidence of Type 2 Inflammation in Non-allergic Rhinitis with Eosinophilia Syndrome: a Systematic Review. Curr Allergy Asthma Rep 2022; 22:29-42. [PMID: 35141844 DOI: 10.1007/s11882-022-01027-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Non-allergic rhinitis (NAR) includes different subtypes, among which NAR with eosinophilia syndrome (NARES) is the most important because of severity of symptoms and the high risk of comorbidities. Its pathophysiology is still object of debate, but a crucial role of chronic eosinophilic inflammation has been recognized. The aim of this review is to critically analyze the current evidence regarding the hypothesis that NARES may be considered a type 2 inflammatory disorder. RECENT FINDINGS The definition and diagnostic criteria for NARES are not universally shared and adopted, thus generating difficulties in reproducing the results. At present, there is extreme heterogeneity in sampling methods and disagreement in the cut-off of local eosinophilic count to determine a diagnosis of NARES. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standard was applied to identify English-language experimental and clinical articles regarding NARES. The search was performed in April 2021. Twenty-six articles were included. Our data suggest a particular heterogeneity regarding sampling and specific cut-offs adopted for diagnosis of NARES and consensus should be reached. We suggest that eosinophil count should be reported as an absolute value for at least 10 observed rich fields in order to increase the level of standardization. Consensus among authors on this topic should be reached with particular attention to the cut-off for diagnosis. In the future, this limitation may be overcome by the identification of repeatable biomarkers to refine diagnosis and prognosis of NARES. Furthermore, our data strongly suggest that NARES have numerous similarities with clinical features of the most common type 2 diseases such as eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP): late onset, association with type 2 comorbidities, selective eosinophilic tissue infiltration, remarkable response to oral and intranasal corticosteroids, and progression in a type 2 CRSwNP.
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Malliori S, Ntzounas A, Lampropoulos P, Koliofoti E, Priftis KN, Fouzas S, Anthracopoulos MB. Diverging trends of respiratory allergies and eczema in Greek schoolchildren: Six surveys during 1991-2018. Allergy Asthma Proc 2022; 43:e17-e24. [PMID: 34983719 DOI: 10.2500/aap.2022.43.210110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: The prevalence of childhood asthma, rhinoconjunctivitis, and eczema in the city of Patras, Greece, has been followed in four consecutive surveys since 1991. After a continuous rise in the prevalence of all three of these disorders, a plateau was reached for asthma between 2003 and 2008, whereas the prevalence of rhinoconjunctivitis and eczema continued to increase. Objective: To investigate these trends in the same population into the following decade. Methods: We repeated two methodologically identical cross-sectional parental questionnaire surveys in 2013 and 2018 among 8-9-year-old schoolchildren (N = 2554 and N = 2648, respectively). In 2018, spirometry and fractional exhaled nitric oxide (FeNO) measurements were also performed. Results: Current asthma (i.e., wheeze/asthma in the past 2 years) decreased from 6.9% in 2008 to 5.2% in 2013 and 4.3% in 2018 (p for trend < 0.001). The prevalence of lifetime ("ever had") rhinoconjunctivitis also declined (5.1% in 2008, 4.4% in 2013, 3.0% in 2018; p for trend < 0.001), whereas that of lifetime eczema increased (10.8%, 13.6%, and 16.1%, respectively; p for trend < 0.001). The relative risk of current asthma in children with ever-had rhinoconjundtivitis was 7.73 in 2008, 6.00 in 2013, and 6.69 in 2018, whereas the relative risk in those with ever-had eczema was 5.15, 2.80, and 2.22, respectively. Among children with asthma, those with rhinoconjunctivitis had lower forced expiratory volume in the first second of expiration and higher FeNO values than those with eczema. Conclusion: The prevalence of asthma and rhinoconjunctivitis declined during the past decade in Greek schoolchildren, whereas the prevalence of eczema continued to rise. Nevertheless, the relationship between rhinoconjunctivitis and asthma remained strong, whereas the association between eczema and asthma appears to have weakened.
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Affiliation(s)
- Styliani Malliori
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Alexandros Ntzounas
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Panagiotis Lampropoulos
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Eleana Koliofoti
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Kostas N. Priftis
- Third Department of Paediatrics, “Attikon” Hospital, University of Athens Medical School, Athens, Greece
| | - Sotirios Fouzas
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Michael B. Anthracopoulos
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
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Ha EK, Lee SW, Kim JH, Lee JE, Jee HM, Chae KY, Han MY, Rhie S. Changes in childhood growth after adenotonsillectomy: a population-based cohort study. Sleep Med 2021; 89:114-121. [PMID: 34971927 DOI: 10.1016/j.sleep.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/18/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study aimed to investigate the association between adenotonsillectomy (T&A) and serial changes in growth in children through a population-based nationwide study as well as the national health insurance service (NHIS) database. METHODS Propensity score (PS) matched children with and without T&A were selected in NHIS database, which includes all individuals born in Korea in 2008-2009. Serial changes of BMI and height were compared in children with and without T&A, and growth changes depending on the time of operation were also considered. The outcomes were differences in age-/sex-standardized BMI (BMI-z) and height (height-z) between the groups. Changes in BMI-z and height-z were further analyzed according to the timing of operation. RESULTS Of 919,707 individuals born in Korea in 2008-2009, 3172 children were included in the operation group and 31,663 PS-matched children were included in the control group. T&A was related to increased weight and height in the operation group than in the control group. At 66-71 months of age, BMI-z and height-z were 0.41 (0.02) and 0.42 (0.02), respectively, in the operation group and 0.18 (0.01) and 0.35 (0.01), respectively, in the control group. On adjustment with preoperative BMI-z, more weight gain was noted in the operation group (p < 0.001). Shortly after T&A, BMI-z increased significantly in the operation group; a significant increase in height-z was observed more than 1 year after T&A. CONCLUSIONS Children who underwent T&A tended to experience a growth spurt; when surgical intervention such as T&A is required, care should be taken to minimize or reverse the anticipated weight gain.
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Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea; Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
| | - Ju Hee Kim
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Jung Eun Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
| | - Hye Mi Jee
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Kyu Young Chae
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Man Yong Han
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
| | - Seonkyeong Rhie
- Departments of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
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