Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

Building Bridges for Innovation in Ageing: Synergies between Action Groups of the EIP on AHA

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

Allergy immunotherapy across the life cycle to promote active and healthy ageing: from research to policies: An AIRWAYS Integrated Care Pathways (ICPs) programme item (Action Plan B3 of the European Innovation Partnership on active and healthy ageing) and the Global Alliance against Chronic Respiratory Diseases (GARD), a World Health Organization GARD research demonstration project

Allergic diseases often occur early in life and persist throughout life. This life-course perspective should be considered in allergen immunotherapy. In particular it is essential to understand whether this al treatment may be used in old age adults. The current paper was developed by a working group of AIRWAYS integrated care pathways for airways diseases, the model of chronic respiratory diseases of the European Innovation Partnership on active and healthy ageing (DG CONNECT and DG Santé). It considered (1) the political background, (2) the rationale for allergen immunotherapy across the life cycle, (3) the unmet needs for the treatment, in particular in preschool children and old age adults, (4) the strategic framework and the practical approach to synergize current initiatives in allergen immunotherapy, its mechanisms and the concept of active and healthy ageing.

Pathophysiological mechanisms of exercise-induced anaphylaxis: an EAACI position statement

This document is the result of a consensus on the mechanisms of exercise-induced anaphylaxis (EIAn), an unpredictable and potentially fatal syndrome. A multidisciplinary panel of experts including exercise physiologists, allergists, lung physicians, paediatricians and a biostatistician reached the given consensus. Exercise-induced anaphylaxis (EIAn) describes a rare and potentially fatal syndrome in which anaphylaxis occurs in conjunction with exercise. The pathophysiological mechanisms underlying EIAn have not yet been elucidated although a number of hypotheses have been proposed. This review evaluates the validity of each of the popular theories in relation to exercise physiology and immunology. On the basis of this evidence, it is concluded that proposed mechanisms lack validity, and it is recommended that a global research network is developed with a common approach to the diagnosis and treatment of EIAn in order to gain sufficient power for scientific evaluation.

EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy

Food allergy can have significant effects on morbidity and quality of life and can be costly in terms of medical visits and treatments. There is therefore considerable interest in generating efficient approaches that may reduce the risk of developing food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Prevention and is part of the EAACI Guidelines for Food Allergy and Anaphylaxis. It aims to provide evidence-based recommendations for primary prevention of food allergy. A wide range of antenatal, perinatal, neonatal, and childhood strategies were identified and their effectiveness assessed and synthesized in a systematic review. Based on this evidence, families can be provided with evidence-based advice about preventing food allergy, particularly for infants at high risk for development of allergic disease. The advice for all mothers includes a normal diet without restrictions during pregnancy and lactation. For all infants, exclusive breastfeeding is recommended for at least first 4-6 months of life. If breastfeeding is insufficient or not possible, infants at high-risk can be recommended a hypoallergenic formula with a documented preventive effect for the first 4 months. There is no need to avoid introducing complementary foods beyond 4 months, and currently, the evidence does not justify recommendations about either withholding or encouraging exposure to potentially allergenic foods after 4 months once weaning has commenced, irrespective of atopic heredity. There is no evidence to support the use of prebiotics or probiotics for food allergy prevention.

Paediatric oral peanut challenges: a comparison of practice in London and western Switzerland

BACKGROUND

There are guidelines on how to develop a food challenge protocol, but at present there is no gold standard guidance on method, and separate units produce differing protocols.

METHODS

We performed a retrospective analysis of 200 patients' data from the paediatric allergy units in Lausanne and Geneva, Western Switzerland, and St Thomas' Hospital (STH), UK.

RESULTS

St Thomas' Hospital has a younger cohort with a lower overall mean spIgE (2.36 kU/l vs. 8.00 kU/l, P = 0.004). The target peanut protein volumes differed: Switzerland 4.4 g vs. STH 8.4 g. Despite this, the dose actually achieved in positive challenges was not significantly different (2.33 g vs. 1.49 g, P = 0.16). 26% of challenges reacted at 4 g or more of peanut protein.

CONCLUSIONS

The differences in results highlight how the variation in reasoning behind food challenge alters the outcome. Standardization of food challenges would allow easy comparison between hospitals and geographical areas for research purposes.

The use of adrenaline autoinjectors by children and teenagers

BACKGROUND

Although adrenaline is recommended as first line treatment for anaphylaxis, it is often not utilized. There has been a debate about when adrenaline autoinjectors should be prescribed and how many should be dispensed.

OBJECTIVES

To see how many adrenaline autoinjectors were used during anaphylactic reactions and to determine why they were not used in situations where they were clinically indicated.

METHODS

Patients were recruited prospectively at 14 paediatric allergy clinics throughout UK. Participants completed a questionnaire covering demographic data, atopic status and details of allergic reactions in the previous year and reasons for using more than one device.

RESULTS

A total of 969 patients were recruited of whom 466 (48.1%, 95% CI: 37.9-58.2) had had at least one reaction in the previous year; 245 (25.3%, 95% CI: 16.2-34.4) of these reactions were anaphylaxis. An adrenaline autoinjector was used by 41 (16.7%, 95% CI: 11.7-21.3) participants experiencing anaphylaxis. Thirteen participants received more than one dose of adrenaline, for nine of these a health professional gave at least one. The commonest reasons for using more than one were severe breathing difficulties (40%), lack of improvement with first dose (20%) and miss-firing (13.3%). The commonest reasons for not using adrenaline in anaphylaxis were 'thought adrenaline unnecessary' (54.4%) and 'unsure adrenaline necessary' (19.1%). Many with wheeze did not use their autoinjector.

CONCLUSIONS AND CLINICAL RELEVANCE

Adrenaline is used by only a minority of patients experiencing anaphylaxis in the community. Thirteen of the 41 patients with anaphylaxis who used their autoinjector needed another dose of adrenaline. Further research is needed to consider how to best encourage the usage of adrenaline when clinically indicated in anaphylaxis.

The diagnosis of IgE-mediated food allergy in childhood

IgE-mediated food allergy is a common condition in childhood and a recognized public health concern. An accurate diagnosis of food allergy facilitates the avoidance of the allergen - and cross-reactive allergens - and allows for safe dietary expansion. The diagnosis of food allergy relies on a combination of rigorous history, physical examination, allergy tests [skin prick tests (SPT) and/or serum-specific IgE] and oral food challenges. Diagnostic cut-off values for SPT and specific IgE results have improved the diagnosis of food allergy and thereby reduced the need to perform oral food challenges. This clinical case series seeks to highlight a contemporary approach to the diagnosis of food allergy in children strategies.

The difficulties of diagnosing food-dependent exercise-induced anaphylaxis in childhood -- a case study and review

We describe a case report of peanut and hens egg-dependent exercise-induced anaphylaxis in a 13-yr-old child, and assess the fundamental importance of careful investigations to differentiate food-dependent exercise-induced anaphylaxis from other forms of allergic reactions.

Imaging findings in a patient with eosinophilic pneumonia (Loffler's syndrome)

Löffler’s syndrome was initiallydescribed as a disorder characterisedby transient pulmonary infiltratesaccompanied by peripheral bloodeosinophilia in asymptomatic ormildly ill patients. Abnormal chestradiographic findings are said tooccur in 95% of patients but there areno descriptions of CT findings. Thereare many causes of this syndrome, butin developing countries the mostcommon presentation remains secondaryto the migratory larvae ofcommon intestinal helminths. Wepresent the clinical and radiologicalfeatures of a boy with clearly definedLöffler's syndrome due to larvalmigration.

Food allergy as a risk factor for nutritional rickets

The case of a 14-month-old boy with vitamin D deficiency rickets as a result of unsupervised dietary manipulation in the context of cow's milk allergy is presented. Adequate supervision by a qualified dietician, coupled with appropriate supplementation, is essential if nutritional compromise is to be avoided in children with food allergy.

Observer variation in detecting lymphadenopathy on chest radiography

OBJECTIVE

To assess inter- and intra-observer agreement in the detection of lymphadenopathy on chest radiography in children at risk for tuberculosis.

PATIENTS AND METHODS

Retrospective examination of the antero-posterior and lateral chest radiographs of children aged 1 month to 11 years discharged from the short-stay ward of the Red Cross Children's Hospital, Cape Town, with a diagnosis of tuberculosis or pneumonia. Four paediatric pulmonologists viewed the radiographs independently. The main outcome measures were inter- and intra-observer agreement on the presence or absence of lymphadenopathy, reported as present, absent or equivocal, and expressed as weighted kappa statistics.

RESULTS

Weighted kappa for the six pairs of observers ranged from 0.14 (95%CI 0.02-0.30) to 0.52 (95%CI 0.35-0.69). After a 3-month interval, intra-observer agreement ranged from 0.44 (95%CI 0.25-0.62) to 0.71 (95%CI 0.56-0.87). The average weighted kappa for inter-observer agreement was 0.33, and the average intra-observer kappa was 0.55.

CONCLUSIONS

There was 'fair' inter- and 'moderate' intra-observer agreement among paediatric pulmonologists in detecting lymphadenopathy on chest radiography in children. Caution is necessary when basing clinical decisions on the presence of lymphadenopathy on chest radiography.

Congenital upper limb anomalies and scoliosis

In 104 children with various forms of congenital upper limb anomalies the incidence of idiopathic scoliosis was 6,7%. This is significantly higher than the 2,5% incidence in the general population. Patients with more severe anomalies such as amelia, phocomelia, hemimelia and thumb anomalies had a 40% incidence of scoliosis. With the current emphasis on early detection of scoliosis by the screening of schoolchildren, the obvious clue offered by a congenital abnormality of an arm or a hand should not be ignored.

Congenital calcifying hamartoma. A resolving lesion producing gastrocnemius contracture--report of a case

An 18-month-boy developed a calcifying mass in the gastrocnemius muscle. The lesion presented on the day of birth and resolved completely within 5 months leaving only a fibrous cord replacing the medial head of the gastrocnemius. There were no facts in the history to suggest the etiology of this lesion. Calcification of a vascular hamartoma with subsequent fibrosis is proposed as a possible explanation. The benign course of this lesion is evidence of the value of conservative treatment.

Acute haemodilutional autotransfusion in the surgical management of scoliosis

Homologous blood transfusions are not without risks, especially in young women and girls. In patients undergoing certain elective surgical procedures autologous blood transfusion is a good alternative. Normovolaemic haemodilution in association with autotransfusion offers the additional advantages of reduced loss of red cell mass during the operation and an increase in tissue blood flow. In this study twenty-seven adolescent patients undergoing Harrington instrumentation for idiopathic scoliosis had haemodilutional autotransfusions during their operations, none requiring homologous blood. Eighteen were given an average of 750 millilitres of homologous blood in the postoperative period which compared favourably with controls who required 1280 millilitres.