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Prevention and Treatment of Allergic Asthma in Pregnancy: From Conventional Drugs to New Therapeutical Approaches.

Different conventional anti-asthmatic and anti-allergic drugs are commonly used in pregnancy, including inhaled corticosteroids, long- and short-acting β-agonists, leukotriene modifiers, cromolyn, and theophylline. Alternatively, immunotherapy with allergens before and during pregnancy is accepted as a causal treatment of allergies, but the allergy specifity and severity in combination with a variety of application protocols and procedures cause wide heterogenity of this treatment principle.

Furthermore, the pharmacokinetic characteristics and the US Food and Drug Administration (FDA) classification of conventional anti-allergic drugs and immunological implications of immunotherapy are summarized in this review, and insights on fetal programming of allergies are introduced. We propose a potential perspective of treatment with anti-inflammatory and pro-resolving mediators, such as lipoxins, resolvins and protectins; these are lipid mediators physiologically generated during the immune response from arachidonic acid, eicosapentaenoic acid and docosahexaenoic acid.

This proposal fits with the recently appreciated approaches to allergy prevention for the newborn child by a balanced maternal nutrition and omega-3 long-chain polyunsaturated fatty acid consumption.

No effect of fluticasone propionate on linear growth in preschool children with asthma.

Eighty percent asthmatic children develop asthma symptoms by the age of five years. Inhaled corticosteroids (ICS), depending on dosage, may cause linear growth reduction and adrenal gland suppression. There are few studies about linear growth of preschool children with asthma. Aim of this investigation was to evaluate if there is any effect of fluticasone propionate (FP) on linear growth and adrenal gland function.

METHODS: Twenty eight children aged 18 to 52 months with persistent asthma receiving ICS fluticasone propionate 100-200 mcg daily were studied over a year. By clinical parameters patients were divided into group of well (group 1) and poorly controlled (group 2). Height was measured every 3 months and expressed as height standard deviation score (SDS). Cumulative dose of FP expressed in mg was calculated for every patient. Early morning levels of serum ACTH and cortisol were assessed at the beginning and at the end of the study.

RESULTS: Patients were taking FP for average of 11 months in group 1 and 16 months in group 2, which was not statistically significant difference. At the end of the study height SDS difference was - 0.0143 in group 1 and - 0.2000 in group 2 which was not statistically significant difference ( t = 0.6072, p = 0.5489). There was also no statistically significant difference for average cortisol (p = 0.4381) and ACTH (p = 0.5845) concentration at the end of the study.

CONCLUSION: FP 100 - 200 mcg daily had no effect on linear growth and hypothalamic- pituitary-adrenal gland axis but further follow up is necessary.

Comparison in asthma and allergy prevalence in the two major cities in Greece: the ISAAC phase II survey.

Variability in the prevalence of allergic diseases has been detected not only between different countries, but also between cities with similar national and different socio-economic or climatic characteristics.

The aim of this study was to determine the prevalence of childhood asthma and allergies and which factors are associated with them, in the two largest Greek cities, Athens and Thessaloniki.

METHODS: Two thousand and twenty-three Greek 9-10-year-old schoolchildren from Athens (Central Greece) and Thessaloniki (North Greece, more humid), were included in ISAAC-II study. All participants followed the ISAAC-II protocol by questionnaire, skin prick testing and flexural dermatitis examination.

RESULTS: Compared with Athens, the prevalence of current wheezing (8.4% vs. 5.7%, p=0.002), lifetime asthma (11.5% vs. 7.7%, p=0.004), atopic current asthma (3.2% vs. 1.6%, p=0.02), allergic rhinitis (8.2% vs. 5.2%, p=0.007), and hay fever (21.7% vs. 12.5%, p<0.001) were higher in Thessaloniki. The overall sensitisation rate was also higher in Thessaloniki than in Athens (25.2% vs. 16%, p<0.001) with more prevalent sensitising due to the perennial allergens (D. pteronyssinus, D. farinae, Alternaria tenuis) and cat dander. Perennial allergens sensitisation was a risk factor for current asthma in both cities.

CONCLUSION: A higher prevalence of asthma symptoms, allergic rhinitis, and sensitisation rate was detected in Greek schoolchildren living in Thessaloniki compared to those in Athens. Allergy to mites and mould was more prevalent in Thessaloniki. The more humid weather of Thessaloniki may be implicated.

Prevalence of Possible Occupational Asthma in Hairdressers Working in Hair Salons for Women.

The aim of this study was to determine the prevalence of possible occupational asthma (OA) in hairdressers.

Methods: A telephone questionnaire (Q1) was administered to 1,334 individuals from a total of 1,875 hairdressers working in hair salons for women in Barcelona (response rate 71%) to identify those with respiratory symptoms. Multiple correspondence analysis showed 5 specific questions for assessing symptoms of asthma. Individuals who gave a positive response to 1 of these questions (n = 251) were given a second validated questionnaire (Q2) to identify those with suspected OA. OA was defined according to a classification tree based on the response to queries on nasal itching, daily symptoms throughout the week at work, nasal secretions, voice loss, wheezing, and sputum production as reported previously. Moreover, we calculated the prevalence of OA according to the conventional criteria of improvement and/or worsening of symptoms in relation to exposure at work and during off-work time on weekends and during vacations.

Results: Asthma was present in 9.5% of hairdressers. From Q2 data, 72 were classified as having possible OA, yielding a prevalence of OA from 5.4 (72/1,334) to 7.8% according to the classification tree previously described. A prevalence from 4.6 (62/1,334) to 6.7% was obtained using conventional criteria. Rhinitis or dermatitis (OR 7.80), as well as exacerbation of symptoms at work and persistence of symptoms on weekends (OR 2.99) were associated with the development of OA.

Conclusions: Hairdressing employment can induce asthma. Episodes of rhinitis or dermatitis seem to be risk factors for the development of OA in this population.

Food allergy: Riding the second wave of the allergy epidemic

Food allergy is a substantial and evolving public health issue, recently emerging over the last 10–15 yr as a ‘second wave’ of the allergy epidemic. It remains unclear why this new phenomenon has lagged decades behind the ‘first wave’ of asthma, allergic rhinitis and inhalant sensitization. In regions like Australia, which lead the respiratory epidemic, challenge‐proven IgE‐mediated food allergy now affects up to 10% of infants.

Although their parents were among the first generation to experience the large‐scale rise in allergic diseases, disorders of oral tolerance were previously uncommon. Of further concern, this ...

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