Notes: A pilot study was performed to investigate a clinical algorithm using serum-eosinophil cationic protein level (S-ECP) as an objective parameter for tapering the anti-inflammatory treatment in chronic childhood asthma. We studied 21 outpatient asthmatic children (6 girls and 15 boys, mean age 9 yr, range 3–12 yr, all with initial S-ECP ≥ 15 µg/l) over a period of 12 months at monthly intervals. At each visit a short history, clinical examination, blood sample for S-ECP and eosinophil count, lung function tests and drug compliance were assessed. According to the initial S-ECP, patients were allocated to two anti-inflammatory treatment groups: patients with S-ECP between 15 µg/l and 30 µg/l were treated with Budesonide 200 µg twice daily, while patients with S-ECP of 30 µg/l and above received Budesonide 400 µg twice daily. After this induction treatment the anti-inflammatory medication was tapered at monthly intervals according to actually measured S-ECP: patients with S-ECP 〈 15 µg/l received sodium cromoglycate (SCG) 10 mg twice daily per inhalation via spacer, patients with S-ECP ≥ 15 µg/l and 〈 30 µg/l received Budesonide 200 µg twice daily via spacer, and patients with S-ECP ≥ 30 µg/l received Budesonide 400 µg twice daily. Prior to inhalation of topical steroids or SCG all patients had to inhale 500 µg Terbutaline twice daily for optimal bronchodilatation. The use of medication was assessed by weighing the metered dose inhaler containers each month. Our results showed a decrease in symptoms (p = 0.0001) and in S-ECP (p = 0.02) and MEF50% predicted (p = 0.02) after the initial month of Budesonide treatment. During a total of 246 months of investigation there was no need for emergency room treatment or hospital admission, and no need for oral steroids. During the whole study period there was a tendency for inhaled steroids to be more effective than SCG in reduction of markers of airway inflammation, improvement of symptoms and lung function. Inadequate use of medication was related to an increase in S-ECP in all treatment groups. From this open pilot study it is concluded that a clinical algorithm including S-ECP for tapering the anti-inflammatory treatment may be helpful in childhood asthma. These first observations should be confirmed by a controlled long-term study.

Notes: The primary aim of the study was to assess the validity of the ISAAC core questions on rhinitis in a population of Swiss school children by comparing them to skin prick test results. Second, the positive predictive value in detecting atopy among children with rhinitis symptoms was determined. Third, agreement between parental reports of hay fever and rhinitis symptoms was evaluated, since earlier Swiss prevalence surveys had exclusively relied on reported hay fever.Material and methods: Two thousand nine hundred and fifty-four (81. 2%) parents of 7, 10 and 14-year old children filled in an exhaustive questionnaire which included the ISAAC core questions on rhinitis. Two thousand one hundred and twenty children also underwent skin prick testing against six common aeroallergens (grass mixture, birch, mugwort, D. pteronyssinus, cat and dog dander). The analysis is restricted to children with both questionnaire data and skin prick test results.Results: Sensitization to any allergen was most strongly associated with reported hay fever (OR = 5. 7, 95% CI 4. 4—7. 4), nose problems accompanied by itchy-watery eyes (OR = 4. 4, 95% CI: 3. 3—5. 7), symptoms occurring only during pollen season (March through September) (OR = 4. 9, 95% CI: 3. 6–6. 5) and a combination of these latter two symptoms (OR = 5. 8, 95% CI: 4. 1—8. 1). The association was stronger for a sensitization to outdoor allergens than for indoor allergens. The specificity of the various questions was high, ranging from 77. 5% to 97. 6%, but the sensitivity was low (2. 6% to 42. 7%). The positive predictive value for atopy among children with symptoms was 63% for sneezing accompanied by itchy-watery eyes, 67% for symptoms occurring only during the pollen season and 70% for reported hay fever. However, agreement between reptirted rhinitis symptoms and hay fever was only moderate. About one third of the children with symptoms indicative of seasonal rhinitis did not report the label “hay fever”. Conclusions: We conclude from our analyses that the ISAAC core questions on rhinitis are highly specific and therefore useful in excluding atopy. In addition they have a high positive predictive value in detecting atopy among children with symptoms, but they are not helpful for detecting atopy in a general population of children (low sensitivity). To monitor time trends in the prevalence of allergic rhinitis in Switzerland, questions on rhinitis symptoms as well as on the diagnostic label “hay fever” have to be included in a questionnaire because they contain complementary information since under-diagnosis of allergic rhinitis is common.

Notes: We aimed to evaluate the value of exhaled breath condensates in monitoring airway inflammation in childhood asthma before and after high altitude climate therapy.Forty-eight asthmatic children on regular anti-asthma treatment with a normal FEV1 and positive skin prick test for house dust mites were recruited. All children had been referred to an alpine clinic for high altitude climate therapy, because of persistent asthmatic symptoms despite use of daily anti-inflammatory treatment. Subjects were assessed on their arrival and before departure from the alpine clinic. Spirometry, bronchial provocation tests and measurements of nitrites in breath condensates were performed.Median levels of nitrites were significantly higher before than after high altitude climate therapy (1.27 vs. 0.93 μm; p = 0.008). In addition, MEF50 improved significantly (p 〈 0.0005). There was a significant correlation between nitrites in breath condensates and MEF50 (r = −0.63, p 〈 0.0001), symptoms (r = 0.47, p = 0.0007) and airway hyper-reactivity (AHR) (r = −0.41, p = 0.004).In summary, we found a reduction in nitrites in breath condensates after a high altitude climate therapy. Significant correlations were found between nitrites and MEF50, AHR and symptoms. We conclude that the measurement of nitrites may be feasible to objectively assess airway inflammation in asthmatic children in order to detect ongoing inflammation in children with normal FEV1 but persistent symptoms.

Notes: Background: Previous studies consistently found remarkable prevalence rates of posttraumatic stress symptoms (PTSS) and posttraumatic stress disorders (PTSD) in pediatric patients and their parents. Findings suggest a significant association between child and parent PTSS. The present study examined, in a sample of pediatric patients with different conditions, incidence rates and determinants of PTSS and PTSD in the patients, and their mothers and fathers. Also, associations of maternal, paternal and child PTSS and PTSD were analyzed.Method: Two hundred and nine children (aged 6.5–14.5 years) were interviewed 5–6 weeks after an accident or a new diagnosis of cancer or diabetes mellitus type 1 by means of the Child PTSD Reaction Index. Their mothers (n = 180) and fathers (n = 175) were assessed with the Posttraumatic Diagnostic Scale.Results: Children reported PTSS levels in the mild range. Sixteen percent of the fathers and 23.9% of the mothers met full DSM-IV diagnostic criteria for current PTSD. Type of trauma impacted differently on parents and children. In children, accident-related injury was associated with higher PTSS scores. Conversely, in parents, diagnosis of cancer in their child was associated with more symptoms. Functional status of the child was also found to be an important predictor of PTSS in children and parents. PTSS scores of mothers and fathers were significantly correlated with each other. However, child PTSS were not significantly related to PTSS of mothers and fathers. This was true for total scores as well as for DSM-IV symptom clusters.Conclusions: There is a need for careful evaluation of PTSS and PTSD in pediatric patients with accidental injuries or sudden onset of severe chronic diseases and in their respective parents. Importantly, children, their mothers, and their fathers should be assessed separately, because a significant association between child and parental PTSS may not exist.