Clinical Features Cannot Distinguish Allergic from Non-allergic Asthma in Children.

J Asthma. 2011 Dec 2;

Authors: Sinisgalli S, Collins MS, Schramm CM

Abstract
Objective. Environmental allergens are a major trigger of asthma, but not all asthmatics are allergic. This study was designed to review clinical characteristics in children with allergic and non-allergic asthma, based on responsiveness to allergy skin tests, in order to identify a combination of features that could distinguish allergic from non-allergic asthma in children. Methods. Medical records of 321 children who had allergy skin testing were reviewed, and demographic and clinical data were compared between allergic and non-allergic patients. Results. Approximately two-thirds of the asthmatic children had at least one positive skin test. These allergic patients were more likely to have a history of eczema or Medicaid insurance, but these findings had poor predictive value. There was no difference between allergic patients and non-allergic patients in terms of family history of atopy or asthma, home tobacco smoke exposure, age of onset of asthma, gender, rate of obesity, or asthma severity. Among the allergic asthma patients, neither the number of positive skin tests nor specific individual allergic sensitivities correlated with age of onset of asthma or asthma severity. Conclusions. This study failed to identify any combination of features that could reliably distinguish allergic from non-allergic asthma in children. Thus, all children with asthma should undergo allergy testing in order to identify potential allergic triggers in allergic patients and to avoid the institution of unnecessary environmental control measures in non-allergic patients.

PMID: 22136286 [PubMed - as supplied by publisher]

Breastfeeding, asthma, and allergy: a tale of two cities.

Pediatr Allergy Immunol. 2011 Dec 4;

Authors: Brew BK, Kull I, Garden F, Almqvist C, Bergström A, Lind T, Webb K, Wickman M, Marks GB

Abstract
To cite this article: Brew BK, Kull I, Garden F, Almqvist C, Bergström A, Lind T, Webb K, Wickman M, Marks GB. Breastfeeding, asthma, and allergy: a tale of two cities. Pediatr Allergy Immunol 2011: Doi: 10.1111/j.1399-3038.2011.01229.x. ABSTRACT: Background:  The effect of breastfeeding duration on subsequent asthma and allergy remains the subject of much controversy. Objective:  To investigate whether differences in study design or disease-related exposure modification were the cause of the differences in study findings. Method:  The data from two cohorts, the Childhood Asthma Prevention Study (CAPS) from Australia and the Barn Allergi Miljo Stockholm cohort from Sweden, which had reported different findings on the association between breastfeeding and asthma, were combined. For this analysis, the definitions for breastfeeding, asthma, and allergy were harmonized. Subjects were included if they had at least one parent with wheeze or asthma and had a gestational age of more than 36 wks (combined n = 882). The risk of disease-related exposure modification was assessed using survival analysis. Results:  Breastfeeding reduced the risk of asthma at 4/5 and 8 yrs of age in children with a family history of asthma. The effect was stronger in the Swedish cohort. Breastfeeding had no effect on the prevalence of sensitization to inhaled allergens in this cohort with a family history of asthma but was a risk factor for sensitization to cow's milk, peanuts, and eggs in the CAPS cohort at 4/5 yrs and in the combined cohort at 8 yrs. There was no evidence to support the existence of disease-related exposure modification in either cohort. Conclusion:  These findings point to the importance of harmonization of features of study design, including subject selection criteria and variable definitions, in resolving epidemiological controversies such as those surrounding the impact of breastfeeding on asthma and allergic sensitization.

PMID: 22136529 [PubMed - as supplied by publisher]

Measuring Children's Decision-Making Involvement Regarding Chronic Illness Management.

J Pediatr Psychol. 2011 Dec 2;

Authors: Miller VA, Harris D

Abstract
OBJECTIVES: To develop a measure of decision-making involvement in children and adolescents with cystic fibrosis, diabetes, and asthma. METHODS: Parent-child dyads completed the Decision-Making Involvement Scale (DMIS) and measures of locus of control and family communication. DMIS items were subjected to exploratory and confirmatory factor analysis (CFA). Temporal stability and construct validity were assessed. RESULTS: The parent form was reduced to 20 items representing five factors. CFA showed that the five factors were an acceptable fit to the parent- and child-report data. Internal consistency values ranged from 0.71 to 0.91. Temporal stability was supported by moderate-substantial intraclass correlation coefficients. DMIS subscales were associated with child age, child locus of control, and family communication. CONCLUSIONS: The DMIS can be used to inform our understanding of the transition to greater independence for illness management. Additional research is needed to examine outcomes of decision-making involvement, including treatment adherence and responsibility.

PMID: 22138318 [PubMed - as supplied by publisher]

Pediatric Asthma Caregiver's Quality of Life Questionnaire is a useful tool for monitoring asthma in children.

Qual Life Res. 2011 Dec 4;

Authors: Stelmach I, Podlecka D, Smejda K, Majak P, Jerzyńska J, Stelmach R, Janas A, Stelmach W

Abstract
PURPOSE: There is little agreement among researchers whether a caregiver's QOL can be used to detect changes in asthma severity in children. We assessed correlation between QOL in parents and QOL in children with asthma as well as clinical parameters of asthma. We determined whether changes in caregiver's QOL scores reflect changes in child's QOL and their asthma control. METHODS: This was a 9-week period cohort study. One hundred and ten primary caregivers with 110 children were seen in the clinic at enrollment, at week #1, #5 and #9. At each visit, the parents completed the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ). RESULTS: One hundred and one children and 101 caregivers completed the study. We found a significant correlation between asthma diary score in children and QOL in parents (from r = -0.46 to r = -0.53). We also found significant positive correlation between PAQLQ and PACQLQ and significant association between changes in asthma control and PACQLQ score for both domains. We observed significant change in PACQLQ of caregivers whose children obtained asthma control. CONCLUSIONS: PACQLQ is a useful tool for monitoring asthma in children. The implementation of the PACQLQ would be helpful in involving parents in therapy of their children with asthma.

PMID: 22138965 [PubMed - as supplied by publisher]