Pediatrics Subject Collection: Allergy & Dermatology

Practical Management of Asthma [ARTICLES]

Wood, P. R. — 2009-10-01

Objectives Objectives Introduction Initial Assessment Medical Management The Physician-family Partnership... Periodic Monitoring Management of Acute... References Additional Resources After completing this article, readers should be able to: Identify the major environmental factors and comorbid conditions that affect asthma. Describe the role of a written asthma action plan in the management of asthma. Know how to assess asthma control and adjust therapy appropriately. Discuss the evaluation and management of the child who has an acute exacerbation of asthma. ...

Impact of Chlorinated Swimming Pool Attendance on the Respiratory Health of Adolescents [ARTICLES]

Bernard, A. — 2009-10-01

OBJECTIVE: The goal was to estimate the burden of allergic diseases associated with chlorinated pool exposure among adolescents. METHODS: We examined 847 students, 13 to 18 years of age, who had attended outdoor or indoor chlorinated pools at various rates. Of them, 114 had attended mainly a copper-silver pool and served as a reference group. We measured total and aeroallergen-specific immunoglobulin E (IgE) levels in serum and screened for exercise-induced bronchoconstriction. Outcomes were respiratory symptoms, hay fever, allergic rhinitis, and asthma that had been diagnosed at any time (ever asthma) or was being treated with medication and/or was associated with exercise-induced bronchoconstriction (current asthma). RESULTS: Among adolescents with atopy with serum IgE levels of >30 kIU/L or aeroallergen-specific IgE, the odds ratios (ORs) for asthma symptoms and for ever or current asthma increased with the lifetime number of hours spent in chlorinated pools, reaching values of 7.1 to 14.9 when chlorinated pool attendance exceeded 1000 hours. Adolescents with atopy with chlorinated pool attendance of >100 hours had greater risk of hay fever (OR: 3.3-6.6), and those with attendance of >1000 hours had greater risk of allergic rhinitis (OR: 2.2-3.5). Such associations were not found among adolescents without atopy or with copper-silver pool attendance. The population attributable risks for chlorinated pool-related ever-diagnosed asthma, hay fever, and allergic rhinitis were 63.4%, 62.1%, and 35.0%, respectively. CONCLUSION: Chlorinated pool exposure exerts an adjuvant effect on atopy that seems to contribute significantly to the burden of asthma and respiratory allergies among adolescents.

Asthma Epidemiology, Pathophysiology, and Initial Evaluation [ARTICLES]

Hill, V. L. — 2009-09-01

Objectives Objectives Introduction Epidemiology Clinical Aspects References After completing this article, readers should be able to: Describe the underlying pathophysiology of asthma. Discuss the role of atopy in the development of asthma. Identify risk factors for death from asthma. List conditions to be considered in the differential diagnosis of wheezing in children. Introduction Objectives Introduction Epidemiology Clinical Aspects References Asthma is a disease of airway inflammation characterized by hyperresponsiveness and airflow obstruction that lead to symptoms ...

Propranolol for Severe Infantile Hemangiomas: Follow-Up Report [ARTICLES]

Sans, V. — 2009-09-01

OBJECTIVE: Infantile hemangiomas (IHs) are the most-common soft-tissue tumors of infancy. We report the use of propranolol to control the growth phase of IHs. METHODS: Propranolol was given to 32 children (21 girls; mean age at onset of treatment: 4.2 months) after clinical and ultrasound evaluations. After electrocardiographic and echocardiographic evaluations, propranolol was administered with a starting dose of 2 to 3 mg/kg per day, given in 2 or 3 divided doses. Blood pressure and heart rate were monitored during the first 6 hours of treatment. In the absence of side effects, treatment was continued at home and the child was reevaluated after 10 days of treatment and then every month. Ultrasound measurements were performed after 60 days of treatment. RESULTS: Immediate effects on color and growth were noted in all cases and were especially dramatic in cases of dyspnea, hemodynamic compromise, or palpebral occlusion. In ulcerated IHs, complete healing occurred in <2 months. Objective clinical and ultrasound evidence of longer-term regression was seen in 2 months. Systemic corticosteroid treatment could be stopped within a few weeks. Treatment was administered for a mean total duration of 6.1 months. Relapses were mild and responded to retreatment. Side effects were limited and mild. One patient discontinued treatment because of wheezing. CONCLUSION: Propranolol administered orally at 2 to 3 mg/kg per day has a consistent, rapid, therapeutic effect, leading to considerable shortening of the natural course of IHs, with good clinical tolerance.

Profiling Families Enrolled in Food Allergy Immunotherapy Studies [ARTICLES]

DunnGalvin, A. — 2009-09-01

BACKGROUND: Little is known about specific psychological factors that affect parents' decisions to take part in clinical studies. We examined factors, related to health-related quality of life (HRQoL), that may influence parents' decision to allow their children to participate in research on clinical food allergy. METHODS: Parents of children with food allergies were offered investigational oral immunotherapy (OIT) in a regular outpatient clinic. Forty parents (group A) declined, and 25 parents (group B) agreed to take part. Both groups agreed to complete the Food Allergy Quality of Life-Parent Form and the Food Allergy Independent Measure. RESULTS: Children were aged between 1 and 12 years (mean: 6.5 years). Groups A and B displayed a similar and typical distribution for gender, age, number of foods, severity and number of symptoms, and socioeconomic variables. Parents who chose to enroll their children in the OIT trial reported a similar impact of food allergy on the HRQoL of their children as parents of children who did not volunteer for the study. Participating parents perceived a significantly higher likelihood (odds ratio: 6.753) of their child having a severe reaction and dying if food is ingested. By using this model, the likelihood of taking part in immunotherapy could be predicted accurately in 90% of cases. CONCLUSIONS: Parents who had higher anxiety about negative outcomes from accidental ingestion were more likely to consent to experimental therapy for their child. This finding has ethical implications for investigators and supports the need to create mechanisms to avoid unintended coercion in vulnerable groups.

Visual Diagnosis: Two Infants Who Have Skin Lesions That React to Minor Trauma [ARTICLES]

Gori, A. — 2009-07-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Diagnoses: Cutaneous... Conclusion Summary Suggested Reading A 2-year-old girl presents to the outpatient clinic for a routine health supervision visit. She was born at term with congenital hydronephrosis requiring antibiotic prophylaxis. Except for one episode of pyelonephritis during infancy, her past medical history has been uneventful. Growth and development are normal for age. Family history is unremarkable. Routine physical examination reveals a happy, playful, well-developed toddler who has nine skin lesions located on the abdominal wall and back. The lesions range from red to tan to brown and appear as macules, papules, or plaques (Fig. 1). Stroking one of t ...

Periodic Fever Syndromes [INTERNET-ONLY ARTICLE]

Goldsmith, D. P. — 2009-05-01

Objectives Objectives Introduction Familial Mediterranean Fever... Tumor Necrosis Factor Receptor... Hyper-IgD Syndrome (HIDS) Cryopyrin-associated Periodic... Periodic Fever, Aphthous... Practical Clinical Advice References After completing this article, readers should be able to: Describe the differences between the periodic fever (or autoinflammatory syndromes) and autoimmune disorders. Summarize the ethnic predilection and genetic basis for the most common periodic fever syndromes. Recognize the salient clinical features of the most common periodic fever syndromes List the current therapeutic choices for the management of the ...

Visual Diagnosis: A Child Who Has Hyperpigmented Spots and a Forearm Deformity [ARTICLES]

Al-Owain, M. — 2009-05-01

Presentation Presentation Diagnosis: Neurofibromatosis... Summary Suggested Reading A 10-year-old boy who has multiple hyperpigmented spots on his skin and a deformed left forearm since birth presents to a tertiary care center for additional evaluation. He was born at term via vaginal delivery. He has been healthy except for functional and cosmetic problems related to his deformed left forearm. The family resides in a locale that lacks advanced health-care services. In the past, a local health practitioner informed the family that their child's skin lesions and limb deformity were congenital and no treatment was available. No surgical correction has been attempted. However, recent evaluation by a pediatrician prompted referral to the tertiary care center. The child h ...

Herpes Simplex [ARTICLES]

Chayavichitsilp, P. — 2009-04-01

Objectives Objectives Introduction Epidemiology Etiology Transmission Diagnosis Clinical Manifestations Principles of Management References After completing this article, readers should be able to: Characterize the epidemiology of herpes simplex virus (HSV) infection, including mode of transmission, incubation period, and period of communicability. Recognize the difference in clinical manifestations of HSV1 and HSV2 infection. Diagnose various manifestations of HSV infection. Describe the difference in the clinical manifestations and outcome of HSV infection in newborns and older infants and children. Disc ...

Intestinal Microbiota: Does It Play a Role in Diseases of the Neonate? [ARTICLES]

Sharma, R. — 2009-04-01

Humans maintain a diverse, dynamic, and complex intestinal microbiota that performs a multitude of vital functions, such as growth and development of the epithelial barrier, stimulation of intestinal angiogenesis, regulation of nutrition, metabolic functions, and education of naive neonatal innate immunity. After birth, host environment and attributes lend and opt for a stable intestinal microbiota for long-term symbiosis. Dysregulation (dysbiosis) of this process during the early postnatal period can form the basis for later inflammatory, immune, and allergic disorders. The initial immunologic exposure of neonates has long-term consequences. Because of this remarkable influence of microbiota on health and disease, learning about characteristics of microbiota and the factors that modulate it has become the focus of ongoing research. Further knowledge in this field should assist in developing strategies to promote health and prevent diseases. This article reviews recent advances in the understanding of microbiota.