Genoa, Italy; 2UO Pediatria ad Indirizzo Penumologico ed Allergologico,. Istituto Giannina .... Herberto Jose Chong Neto, MD, PhD, Nelson Rosario, MD, PhD,.
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decreased. Skin dryness and itch scores were reduced in most volunteers. After washed with soap and rinsed in UPSW for 2 weeks, severe dermatitis of NC/Tnd mice were reduced as well as TEWL. On the other hand, dermatitis in NC/Tnd mice rinsed in tap water became worse. Plasma total IgE was increased in mice that were immunized with metallic soap. Conclusions: UPSW protected skins from residue of metallic soap. Metallic soap has antigenic activity and increased plasma IgE levels. Clinical symptoms and the skin barrier function were improved by the use of soap with UPSW. UPSW is beneficial for the skin of patients with atopic dermatitis.
CHILDHOOD ASTHMA AND ALLERGIES 50 The Allergic March Resolved at Allergen Component Level Giovanni Melioli, MD,1 Laura Marcomini, BS,1 Alessia Agazzi, BS,1 Gyada Bazurro, BS,1 Lucilla Rossi,1 Mariangela Tosca, MD,2 Paola Minale,3 Renato Rossi,4 Giovanni Passalacqua, MD,5 and Giorgio Walter Canonica, PhD5. 1Laborario Centrale di Analisi, Istituto Giannina Gaslini, Genoa, Italy; 2UO Pediatria ad Indirizzo Penumologico ed Allergologico, Istituto Giannina Gaslini, Genoa, Italy; 3Allergologia, AOU San Martino, Genoa, Italy; 4Rete di Allergologia Regione Piemonte, Azienda Sanitaria Cuneo 1, Cuneo, Italy; 5Allergy & Respiratory Diseases, Universita Degli Studi Di Genova, Genoa, Italy. Background: The allergic march is well known at the level of pattern of sensitisation, but there is no information of its evolution in term of sensitzation to single allergenic molecules. We investigated the evolution of the IgE repertoire by means of a microarray allergen assay. Methods: Serum samples from allergic patients of a wide age range were analyzed by a micorarray chip, which allow to identify in a single assay the presence of specific IgE towards 103 allergenic molecules. Total IgE were also evaluated as an internal control. Patients were stratified in 6 groups according to their age (0–2; 3–5; 6–9; 10–13; 14–17 and .17 years). Results: Samples from 609 patients were analysed. The behaviour of total IgE according to age strictly paralleled that of the sum of specific IgE. Foodrelated components were the more frequently recognized in the first ages, whereas specific IgE to plant allergens appeared later. Nonetheless, mitespecific IgE were the most represented in all age classes. Specific IgE against cross-reacting allergens were virtually absent in the first years and tended to appear after the age of 6. Conclusions: The molecular pattern of allergen recognition according to age well reflects the clinical characteristics of the allergic march.
51 Prevalence of Wheezing and Risk Factors Associated to Wheezing in Infants in the First Year of Life, Cuibá, MT, Brazil Lillian Sanchez Lacerda Moraes, MD,1 Olga Akiko Takano, PhD,2 and Dirceu Solé, PhD1. 1Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil; 2Department of Pediatrics, Federal University of Mato Grosso, Cuiabá, Brazil. Background: The purpose of this study was to evaluate the prevalence of wheezing and risk factors related to wheezing in infants (12–15 month-old) in the city of Cuiabá, Mato Grosso State, Brazil. Methods: Cross-sectional study by applying a standardized written questionnaire from “Estudio Internacional de sibilancia en lactentes” (EISL) phase III. Parents and/or guardians of infants were interviewed at a primary health care clinic or at home from August 2009 to November 2010. Signed written informe consent was obtained from parents and/or guardians of all
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subjects. Factors associated to wheezing were studied using bivariate and multivariate analysis (SPSS v.18.0) and expressed as odds ratio (OR) and confidence interval 95% (95% CI). Results: One thousand sixty parents were interviewed (N ¼ 1060), 27.7% (N ¼ 294) infants had at least one wheezing episode in their first year of life, with onset at 5.8 6 3.0 months (mean 6 standard deviation), and 45.9% (N ¼ 135) had had 3 or more episodes (recurrent wheezing). The use of inhaled b2-agonists, oral corticosteroids or leukotriene receptor antagonist, nocturnal symptoms, respiratory distress, hospitalization and medical diagnose of asthma were significantly more frequent in the group with recurrent wheezing (P , 0.05). Independent risk factors associated with wheezing in the first year of life were: history of previous pneumonia (OR ¼ 10.80; 95% CI, 4.52-25.77); to have more than 6 upper respiratory infections (URI) (OR ¼ 2.95; 95% CI, 2.11-4.14); asthma in sibling (OR ¼ 2.13; 95% CI, 1.18-3.87); asthma in father (OR ¼ 1.98; 95% CI, 1.223.23); asthma in mother (OR ¼ 1.62; 95% CI, 1.07-2.43); exposure to paracetamol in the first year of life for URI (OR ¼ 2.13; 95% CI, 1.54-2.95); exposure to moderate air pollution from traffic (OR ¼ 1.59; 95% CI, 1.08-2.33); and a first URI before of third month of age (OR ¼ 1.50; 95% CI, 1.04-2.17). Conclusions: The prevalence of wheezing episodes among one year-old infants living in Cuiabá was high and early in life. Risk factors for wheezing are similar to risk factors for asthma. Exposure to paracetamol was associated with wheezing but more researches are required to clarify this potential association.
52 Risk Factors Associated to Wheezing in Mexican Children. A Multicentric Isaac-based Survey Study Armando Partida-Gaytan, MD,1 Blanca del Rio, MD,1 Dino PietropaoloCienfuegos, MD,1 Jaime Mariano del Río-Chivardí, MD,1 Lourdes Avila, MD,1 Juan Valente Merida Palacios, MD,2 Sergio de Jesus Romero Tapia, MD,3 Francisco Javier Linares Zapien, MD,4 Alberto Escalante Dominguez, MD,5 Sandra González-Díaz, MD, PhD,6 Roberto GarcíaAlmaraz, MD,7 and Sergio Carvajal Abdala, MD8. 1Pediatric Allergy and Clinical Immunology, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico; 2Mexicali Health Care, Mexicali, Mexico; 3Hospital Angeles Villahermosa, Villahermosa, Mexico; 4COMPEDIA, Toluca, Mexico; 5Hospital General de Rosarito, Tijuana, Mexico; 6Hospital Universitario, Medical School, Universidad Autónoma de Nuevo León, Monterrey, Mexico; 7COMPEDIA, Tamaulipas, Mexico; 8COMPEDIA, Veracruz, Mexico. Background: Asthma affects around 300 million people around the world, and is expected to increase 100 million more in the next 15 years. Multiple risk factors had been associated with its prevalence, though little is known about the regional variations of these risk factors. Objective: Identify the main risk factors associated to the presence of wheezing in the last 12 months in Mexican children aged 6 to 7 years old. Methods: Multicentric, cross-sectional survey. The standardized Spanishversion ISAAC questionnaire was applied to tutors of children aged 6 to 7 years old in 8 cities of the Mexican Republic. Sample was randomly selected through public and private schools of each city, and a sample of 3000 children per center was advisable. Risk analysis was made through multivariate logistical regression, central tendency and dispersion measures were obtained with respective 95% confidence intervals. Results: Nine centers of 8 cities participated, data of 24,504 questionnaires were analyzed with an answer rate of 90.7%. Grouping the 9 participating centers, a prevalence of 8.4% (95% CI, 8.1-8.8%) for wheezing in the last 12 months was found, with the next distribution: Monterrey 8.6% (95% CI, 7.6-9.6%), Mexicali 9.6% (95% CI, 8.410.7%), Ciudad Victoria 8.6% (95% CI, 7.5-9.7%), Villahermosa 10.2% (95% CI, 9.1-11.4%), Northern Distrito Federal 7.3% (95% CI, 6.5-8.2%),
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Southeast Distrito Federal 9.9% (95% CI, 8.5-11.3%), Toluca 5.9% (95% CI, 5.1-6.7%), Tijuana 8.2% (95% CI, 7.2-9.2%), Veracruz 9.7% (95% CI, 8.4-10.9%).Identified risk factors for the presence of wheezing in the last 12 months were: nasal symptoms accompanied with ocular symptoms (itching and tearing) in the last 12 months, OR 2.31 (95% CI, 2.01-2.66; P # 0.0001). Nasal symptoms (blocked nose, runny nose, and/or itching) in the last 12 months, OR 2.2 (95% CI, 1.66-2.92; P # 0.0001). Hay fever diagnosis by medical staff OR 2.02 (95% CI, 1.72-2.37; P # 0.0001). Atopic dermatitis symptoms (classic morphology and distribution) in the last 12 months, OR 1.65 (95% CI, 1.39-1.96; P # 0.0001). Use of antibiotics in the first 12 months of life, OR 1.68 (95% CI, 1.48-1.90; P # 0.0001). Use of acetaminophen in the last 12 months, OR 1.49 (95% CI, 1.35-1.65; P # 0.0001). Conclusions: The presence of allergic rhinoconjuntivitis symptoms in the last 12 months doubles the risk for the presence of wheezing in Mexican children.
53 Association Between Eosinophil Apoptosis in Induced Sputum and Asthma Severity in Children Alla Nakonechna, MD, PhD,1 Yuriy Antipkin,2 Tatiana Umanets, MD, PhD,2 Vladimir Lapshyn,2 and Tamara Zadorozhnaja, MD2. 1Allergy, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Neston, United Kingdom; 2Institute of Paediatrics, Obstetrics and Gynaecology, Kiev, Ukraine. Background: There is increasing evidence that the disorder of eosinophil apoptosis contributes to the mechanism of prominent airway inflammation in asthma. However the relationship between dysregulation of eosinophil apoptosis and severity of childhood asthma is still unclear. Objective: Investigate the relationship between eosinophil apoptosis in induced sputum and severity of asthma in children. Methods: Eighty-six children aged 6 to 12 years with asthma and 32 agematched healthy controls were observed. Diagnosis of asthma was made using a clinical questionnaire, physical examination and skin prick tests (SPTs). Lung function, and induced sputum analysis were measured in all patients. Total and antigen specific IgE levels were assessesed by ELISA. Eosonophils apoptosis was determined by staining nuclei with propidium iodide, and analyzed with a FACScan. Expression Apo-1/Fas antigen (CD95) in sputum eosinophils was assessed by immunohistochemical staining techniques. Results: Diagnosis of asthma was confirmed by positive SPT and increased total and specific IgE levels. Asthma severity (assessed by FEV1, peak expiratory flow (PEF) variability and daily symptom scores) complied with mild and moderate asthma. The percentage sputum eosinophils was expressively increased (threshold of ,3%) in all asthmatic children (compared to control group) and directly correlated with peripheral blood eosinophilia, skin sensitization, increased level of total and specific IgE and clinical symptoms of asthma and all of these markers were more significant in children with moderate asthma (P , 0.05). Asthma children showed decreased eosinophils apoptosis (“apoptotic ratio”-AR) in induced sputum as compared to controls (P , 0.001), which directly correlated with predicted value of FEV1, PEF variability and inversely with symptoms score (P ¼ 0.005), and was significantly lower in patients with moderate asthma than those in patients with mild (P ¼ 0.001). More of that, these parameters also correlated with decreased expression of Apo-1/Fas antigen (CD95), especially in moderate asthmatic children (P , 0.05). Conclusions: Our investigation: 1. Confirms that reduced eosinophil apoptosis in induced sputum associated with increased clinical severity of asthma in children. 2. Provides additional evidence that eosinophil apoptosis may be important in the resolution of eosinophilic airway inflammation in asthma, because of their prolonged survival that maintains inflammation.
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54 Antibiotics but not Paracetamol Reduce the Risk for Recurrent Wheezing in Infants Herberto Jose Chong Neto, MD, PhD, Nelson Rosario, MD, PhD, Flávia Carnieli Silva, Lylia Fátima Melniski Bojarski, Emanuel Antonio Grasselli, Cristine Secco Rosario, Bernardo Augusto Rosario, and Fernando Henrique Chong. Allergy and Immunology, Federal University of Paraná, Curitiba, Brazil. Background: Paracetamol (PCM) and antibiotic (ATB) use have been associated with risk for wheezing and asthma in children. The aim of this study was to verify the association of recurrent wheezing ($3 episodes) in infancy and use of ATB or PCM in the first year of life. Methods: Cross-sectional study using a standardized and validated questionnaire (EISL: Estudio Internacional sobre Sibilancias en Lactantes) with questions: Has your baby had wheezing or whistling in the chest area or bronchitis in the first 12 months of life? Has your baby had 3 or more wheezing episodes in the first year of life? How often has your baby used antibiotics in the first year of life? How often has your baby used paracetamol in the first year of life? Parents of infants, ages 12 to 15 months that attended to Health Centers for routine immunization were interviewed between September 2009 to September 2010 (EISL Phase III). Risk was demonstrated using Odds ratio and 95% CI. Results: One thousand and 3 parents participated in the survey and 19.8% of infants had recurrent wheezing starting at 6.1 6 3 months. The use of PCM was not related to the presence of recurrent wheezing [No PCM (OR ¼ 0.91; 95% CI, 0.38-2.19; P ¼ 0.83), PCM 1–3 times (OR ¼ 1.21; 95% CI, 0.77-1.91; P ¼ 0.4), PCM 4–6 times (OR ¼ 1.21; 95% CI, 0.77-1.9; P ¼ 0.41) and PCM $7 times (OR ¼ 0.76; 95% CI, 0.51-1.13; P ¼ 0.17)], while more frequent use of ATB reduced the risk of recurrent wheezing in the first year of life [No ATB (OR ¼ 2.18; 95% CI, 1.35-3.51; P ¼ 0.001), ATB 1–3 times (OR ¼ 1.39; 95% CI, 0.93-2.07; P ¼ 0.1), ATB 4–6 times (OR ¼ 0.37; 95% CI, 0.22-0.62; P ¼ 0.001) and PCM$7 times (OR ¼ 0.22; 95% CI, 0.07-0.66; P ¼ 0.001)]. Conclusions: The frequent use of ATB reduced the risk of recurrent wheezing in the first year of life unlike PCM that was not associated with recurrent wheezing in this study population.
CONJUNCTIVITIS 55 Ocular Signs and Symptoms Elicited by a Naturalistic Allergen Challenge in an Environmental Exposure Chamber Model Versus a Direct Allergen Instillation Model Michael S. Blaiss, MD,1 Maria J. Tort, 2 Richard Ornberg,2 Bruno Lay,3 Fiona Soong,4 and Anne Marie Salapatek 4. 1Allergy and Asthma Care, Germantown, TN; 2Alcon Research Ltd, Fort Worth, TX; 3ADCIS, Hérouville Saint-Clair, France; 4Cetero Research, Mississauga, ON, Canada. Background: Direct-instillation ocular models are well established for eliciting allergic responses in research and clinical testing. This study compared direct ocular instillation of allergen to a more naturalistic airborne allergen exposure. Methods: Thirteen subjects with histories of ragweed allergy and positive skin prick responses attended screening, dose-finding, dose‑confirmation, and analysis study visits. For conjunctival allergen provocation testing (CAPT), 1 drop of ragweed allergen was administered to each eye, at the lowest possible subject-specific concentration between 1.6 and 100 protein nitrogen units per 25 ml drop. For environmental exposure chamber (EEC) testing, subjects were exposed to continual airborne ragweed pollen at 3500 6 500 particles/m3. Symptoms of itching and tearing were self-assessed on diary cards by subjects. Signs of hyperemia, swelling, and mucous discharge were assessed by clinicians. Assessment time points started at 30 minutes before exposure and continued through 180 minutes after exposure.
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