August 17, 2014

Food allergy: Diagnosis, management & emerging therapies


Abstract

IgE-mediated food allergy is an important health concern with increasing prevalence worldwide. Manifestations of IgE-mediated food allergy include urticaria, angioedema, pruritus, difficulty in breathing, laryngeal oedema, vomiting, diarrhoea and/or hypotension within minutes to two hours of the offending food's ingestion. Diagnosis requires both a careful history and supportive testing with laboratory studies and possibly oral food challenges. Current treatment of food allergy focuses on avoidance of the allergen and prompt emergency management of reactions. Epinephrine autoinjectors are provided to patients for the treatment of severe reactions. More research is needed to determine the optimal timing with which to introduce common allergens into a child's diet to possibly prevent the development of food allergy. Novel therapies are under investigation given the difficulty of allergen avoidance and the potentially fatal nature of reactions. Both allergen specific therapies such as oral, sublingual and epicutaneous immunotherapy and allergen non-specific therapies such the Chinese herbal formula FAHF-2 and omalizumab show promise though more data on efficacy and long-term safety are needed before these therapies become mainstream.
PMID:
 
25109714
 
[PubMed - in process] 
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Allergy to lidocaine injections: comparison of patient history with skin testing in five patients

abstract:

Original paper

Dorota Jenerowicz, Adriana Polańska, Olga Glińska, Magdalena Czarnecka-Operacz, Robert A. Schwartz

DOI (digital object identifier): 10.5114/pdia.2014.40937
Introduction: True allergy to local anesthetics, especially lidocaine, is uncommon. Most adverse reactions to this group of medications are classified as psychomotor, autonomic or toxic. In the case of suspected hypersensitivity to local anesthetics, skin testing is considered to be a useful tool – patch tests and intradermal tests for delayed hypersensitivity and skin prick tests and intradermal tests for immediate reactions. There is a particular need for such a diagnostic procedure, as patients suspected of hypersensitivity to local anesthetic drugs are frequently admitted.

Aim: To highlight the problem of hypersensitivity to local anesthetics on the basis of authors' own experience and literature data.

Material and methods: We present cases of 5 patients referred to the clinic by their dentists with a suspicion of allergy to local anesthetics, four to lidocaine and 1 to articaine.

Results: Intradermal tests were positive in 1 out of 5 subjects, with a concomitant episode of urticaria. In 1 patient we obtained a doubtful result of intradermal tests. Skin prick tests and patch tests were negative in all cases. In 2 cases we performed an incremental challenge test also with a negative result.

Conclusions: It has to be emphasized that, although rare, consequences of true allergy to local anesthetics can be serious considering a patient’s future management and therapy. That is why this diagnosis may be crucial.
keywords:

lidocaine, skin tests, incremental challenge test


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Cardiovascular safety of antihistamines

Review paper

Anna Olasińska-Wiśniewska, Jerzy Olasiński, Stefan Grajek

DOI (digital object identifier): 10.5114/pdia.2014.43191
Histamine is a mediator, which increases the permeability of capillaries during the early phase of allergic reaction, causes smooth muscle contraction of bronchi and stimulates mucous glands in the nasal cavity. Antihistamines are the basis of symptomatic treatment in the majority of allergic diseases, especially allergic rhinitis, allergic conjunctivitis, urticaria and anaphylaxis. The cardiotoxic effects of the two withdrawn drugs, terfenadine and astemizole, were manifested by prolonged QT intervals and triggering torsades de pointes (TdP) caused by blockade of the ‘rapid’ IKr potassium channels. These phenomena, however, are not a class effect. This review deals with a new generation of antihistamine drugs in the context of QT interval prolongation risk.
keywords:

histamine, H1 receptor, antihistamines, QT interval, torsades de pointes


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Night-time sedating H1-antihistamine increases daytime somnolence but not treatment efficacy in chronic spontaneous urticaria: a randomized controlled trial

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British Journal of Dermatology

Volume 171Issue 1pages 148–154July 2014
M. Staevska, M. Gugutkova, C. Lazarova, T. Kralimarkova, V. Dimitrov, T. Zuberbier, M.K. Church, and T.A. Popov

Summary
Background
Many physicians believe that the most effective way to treat chronic urticaria is to take a nonsedating second-generation H1-antihistamine in the morning and a sedating first-generation H1-antihistamine, usually hydroxyzine, at night to enhance sleep. But is this belief well founded?

Objectives
To test this belief by comparing the effectiveness and prevalence of unwanted sedative effects when treating patients with chronic spontaneous urticaria (CSU) with levocetirizine 15 mg daily plus hydroxyzine 50 mg at night (levocetirizine plus hydroxyzine) vs. levocetirizine 20 mg daily (levocetirizine monotherapy).

Methods
In this randomized, double-blind, cross-over study, 24 patients with difficult-to-treat CSU took levocetirizine plus hydroxyzine or levocetirizine monotherapy for periods of 5 days each. At the end of each treatment period, assessments were made of quality of life (Chronic Urticaria Quality of Life Questionnaire, CU-Q2oL), severity of urticaria symptoms (Urticaria Activity Score, UAS), sleep disturbance during the night and daytime somnolence.

Results
Both treatments significantly decreased UAS, night-time sleep disturbances and CU-Q2oL scores (P < 0·001) without significant differences between the two. Compared with baseline, daytime somnolence was significantly reduced by levocetirizine monotherapy (P = 0·006) but not by levocetirizine plus hydroxyzine (P = 0·218). Direct comparison of the two treatment modalities in terms of daytime somnolence favoured levocetirizine monotherapy (P = 0·026).

Conclusions
The widespread belief that sleep is aided by the addition of a sedating first-generation H1-antihistamine, usually hydroxyzine, at night is not supported. These results are in line with the urticaria guidelines, which state that first-line treatment for urticaria should be new-generation, nonsedating H1-antihistamines only.


Dietary pattern and asthma: a systematic review and meta-analysis

Authors Lv N, Xiao L, Ma J
Published Date August 2014 Volume 2014:7 Pages 105—121
Received 4 April 2014Accepted 26 May 2014, Published 12 August 2014

Nan Lv,1 Lan Xiao,1 Jun Ma1,2
1Palo Alto Medical Foundation Research Institute,2Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

Background: The literature on the relationship between diet and asthma has largely focused on individual nutrients, with conflicting results. People consume a combination of foods from various groups that form a dietary pattern. Studying the role of dietary patterns in asthma is an emerging area of research. The purpose of this study was to systematically review dietary patterns and asthma outcomes in adults and children, to review maternal diet and child asthma, and to conduct a meta-analysis on the association between asthma prevalence and dietary patterns in adults.
Methods: We searched Medline, Scopus, and ISI Web of Knowledge up to January 2014. Two researchers independently reviewed studies meeting the inclusion criteria using the American Dietetic Association quality criteria. A linear mixed model was used to derive the pooled effect size (95% confidence interval) for each of three dietary pattern categories (healthy, unhealthy, and neutral).
Results: Thirty-one studies were identified (16 cross-sectional, one case-control, 13 cohort, and one randomized controlled trial), including 12 in adults, 13 in children, five in pregnant woman–child pairs, and one in both children and pregnant woman–child pairs. Six of the 12 adult studies reported significant associations between dietary patterns and asthma outcomes (eg, ever asthma and forced expiratory volume in one second). Seven of ten studies examining the Mediterranean diet showed protective effects on child asthma and/or wheeze. Four of the six studies in mother-child pairs showed that maternal dietary patterns during pregnancy were not associated with child asthma or wheeze. The meta-analysis including six adult studies, the primary outcome of which was the prevalence of current or ever asthma, showed no association with healthy, unhealthy, or neutral dietary patterns.
Conclusion: The evidence suggests no association of dietary patterns with asthma prevalence in adults or of maternal diet with child asthma or wheeze. The Mediterranean diet in children may prevent asthma or wheeze, but randomized controlled trials are lacking.

Keywords: dietary pattern, asthma, systematic review, meta-analysis, adults, children
Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at:http://www.dovepress.com/permissions.php

August 13, 2014

Birth after preeclamptic pregnancies: association with allergic sensitization and allergic rhinoconjunctivitis in late childhood; a historically matched cohort study.



Byberg KK1, Ogland B, Eide GE, Oymar K.

1Paediatric Department, Stavanger University Hospital, Post box 8100, N-4068 Stavanger, Norway. kristine.kjer.byberg@sus.no.

Abstract

BACKGROUND:
The development of allergic sensitization and allergic disease may be related to factors during intrauterine life, but the role of maternal preeclampsia is not known.We studied if maternal preeclampsia is associated with long-term allergic sensitization, allergic rhinoconjunctivitis, atopic dermatitis, asthma and with altered lung function in late childhood.
METHODS:
617 children participated in a 1:2 matched and controlled historical cohort study; 230 born after preeclamptic pregnancies and 387 born after normotensive pregnancies. Specific IgE in serum and lung function were measured at the age of 12.8 years and questionnaires on maternal and adolescent data were completed at the ages of 10.8 years (girls) and 11.8 years (boys), and at 12.8 years (both genders). The association between birth after preeclampsia and the main outcome measures allergic sensitization, allergic rhinoconjunctivitis, atopic dermatitis, asthma and lung function in late childhood were analysed with multiple regression analyses, including possible confounders.
RESULTS:
Severe maternal preeclampsia was associated with high level allergic sensitization (sum of specific IgE in serum ≥ 3.9 kU/l; the 25 percentile for all children being sensitized); odds ratio (OR): 3.79; 95% confidence interval (CI): (1.54, 9.32); p = 0.015 and with allergic rhinoconjunctivitis in offspring; OR: 2.22, 95% CI: (1.19, 4.14), p = 0.047. Preeclampsia was not associated with atopic dermatitis, asthma or altered lung function in late childhood.
CONCLUSION:
Maternal preeclampsia was associated with allergic sensitization and allergic rhinoconjunctivitis in offspring in late childhood, but not with other atopic diseases.

PMID: 24725676 [PubMed - indexed for MEDLINE] PMCID: PMC3995723



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Increased risk of primary Sjögren's syndrome in female patients with thyroid disorders: a longitudinal population-based study in Taiwan



Lu MC1, Yin WY, Tsai TY, Koo M, Lai NS.

Abstract
BACKGROUND:
A number of reports have indicated an association between thyroid diseases and primary Sjögren's syndrome (pSS). However, fewer studies have investigated whether the presence of thyroid diseases is associated with increased risk of developing pSS. Thus, the aim of our study was to use a nationwide health claims database to explore the prevalence and risk of pSS in female patients with thyroid diseases.
METHODS:
From the Registry of Catastrophic Illness database in the National Health Insurance Research Database in Taiwan, we identified 389 female patients with a diagnosis of pSS from 2005 to 2010. We also obtained 1945 control subjects frequency-matched on sex, 10-year age interval, and year of index date from the Longitudinal Health Insurance Database (LHID2000). Both groups were retrospectively traced back to a period of eight years to obtain diagnosis of thyroid diseases prior to index date.
RESULTS:
A significantly higher risk of pSS was associated with the presence of thyroid diseases (adjusted odds ratio (AOR) = 2.1, 95% confidence interval (CI) = 1.6-2.9). Among the sub-categories of thyroid diseases, patients with thyroiditis (AOR = 3.6, 95% CI = 1.7-7.5), thyrotoxicosis (AOR = 2.5, 95% CI = 1.6-3.8), and unspecified hypothyroidism (AOR = 2.4, 95% CI = 1.2-4.6), and simple and unspecified goiter (AOR = 2.0, 95% CI = 1.3-3.3) were significantly associated with increased risk of pSS. The associations were generally stronger in the mid-forties to mid-sixties age group, except in patients with unspecified hypothyroidism.
CONCLUSIONS:
The risk of pSS was significantly increased in female patients with thyroid diseases, particularly those in their mid-forties to mid-sixties. An increased awareness of the possibility of pSS in perimenopausal females with thyroid diseases is important to preserve their quality of life and to avoid comorbidity.


PMID: 24204772 [PubMed - indexed for MEDLINE] PMCID: PMC3799635 

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Toll-Like Agonists in the Treatment of Allergic Rhinitis and Asthma


Vol. 164, No. 1, 2014
Issue release date: June 2014
Editor's Choice -- Free Access

A New Era of Targeting the Ancient Gatekeepers of the Immune System: Toll-Like Agonists in the Treatment of Allergic Rhinitis and Asthma

Aryan Z.a · Holgate S.T.c · Radzioch D.e · Rezaei N.a,b,d 
aMolecular Immunology Research Center and Department of Immunology, School of Medicine and bResearch Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; cFaculty of Medicine, Clinical and Experimental Sciences, Southampton General Hospital, Southampton, anddDepartment of Infection and Immunity, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK; eDepartment of Medicine and Department of Human Genetics, McGill University, Montreal, Que., Canada
email Corresponding Author


 goto top of outline Abstract
Toll-like receptors (TLR) belong to a large family of pattern recognition receptors known as the ancient ‘gatekeepers' of the immune system. TLRs are located at the first line of defense against invading pathogens as well as aeroallergens, making them interesting targets to modulate the natural history of respiratory allergy. Agonists of TLRs have been widely employed in therapeutic or prophylactic preparations useful for asthma/allergic rhinitis (AR) patients. MPL® (a TLR4 agonist) and the CpG oligodeoxynucleotide of 1018 ISS, a TLR9 agonist, show strong immunogenicity effects that make them appropriate adjuvants for allergy vaccines. Targeting the TLRs can enhance the efficacy of specific allergen immunotherapy, currently the only available ‘curative' treatment for respiratory allergies. In addition, intranasal administration of AZD8848 (a TLR7 agonist) and VTX-1463 (a TLR8 agonist) as stand-alone therapeutics have revealed efficacy in the relief of the symptoms of AR patients. No anaphylaxis has been so far reported with such compounds targeting TLRs, with the most common adverse effects being transient and local irritation (e.g. redness, swelling and pruritus). Many other compounds that target TLRs have been found to suppress airway inflammation, eosinophilia and airway hyper-responsiveness in various animal models of allergic inflammation. Indeed, in the future a wide variability of TLR agonists and even antagonists that exhibit anti-asthma/AR effects are likely to emerge.
© 2014 S. Karger AG, Basel

August 12, 2014

The presence of H.pylori in cases of chronic idiopathic urticaria

Rashad Feddah
Ibraheem Banihameem
Anwar Farhan
Saeed Al-Ahmari
Fayeh Asiri
Hamad AL Fahaad
Wadha Alfarwan


Correspondence:
Dr. Anwar Farhan, MD 
Consultant dermatologist
King Khalid Hospital, Najran, Saudi Arabia
Tel: (Cell phone) +966 553044333
Email: anwarfarhan@yahoo.com
Abstract
Introduction: Urticaria (or hives) are a kind of skin rash notable for dark red, raised, itchy bumps.Chronic urticaria, defined as urticaria that persists for longer than 6 weeks, it is not a single disease but a reaction pattern that represents cutaneous mast cell degranulation, resulting in extravasation of plasma into the dermis and the patients may not improve or may depend on medication for years to relieve symptoms. chronic urticaria is one of the most common problems facing dermatologists and other specialities. It is the problem which bothers both the patient and the dermatologist. Traditionally, the approach in patients with chronic urticaria (when physical etiology has been excluded) has been to order a panel of laboratory tests to discover an occult medical condition responsible for the skin findings. In many patients, an extensive workup does not discover an etiology. Patients in whom no explanation for his urticaria are said to have chronic idiopathic urticaria. Various infectious agents have been reported as causes of urticaria, including Helicobacter pylori (H. pylori), which is a common worldwide bacterial infection. Its role in inducing allergic conditions, such as chronic urticaria, has been suggested in some reports and ignored in others.

Aim : In our research, we want to look for the prevalence of Helicobacter pylori in the serum of patient who presented with chronic urticaria .The patient has endure treatment and is not cured besides partial treatment causes temporary relive of symptoms. So, it is important to make the right decisions regarding the treatment of chronic urticaria by adding triple therapy for those who are H.pylori positive.

Subjects and Methods: This study is a non controlled , consecutive interventional study involving 60 patients during the period from November 2012 to April 2013 with history of urticarial lesions of > 6 weeks, to search for the possible cause of their chronic urticaria.

Results: Among 60 patients suffering from chronic Urticaria only 40 (66.7%) patients were enrolled in the study with chronic idiopathic urticaria.

25 patients (62.5%) of chronic idiopathic urticaria were infected with H.pylori and 15 patients (37.5%) had negative serology for H.pylori. 80% of patients with positive H.pylori had G.I.T symptoms ,18 patients (72%) were achieved eradication with the first line therapy while 5 patients (20%) required the second line therapy for eradication. In 2 patients (8%) H.pyloripersisted despite two courses of eradication therapy. Response to eradication therapy was evident in 19 patients (76%) in whom H.pylori was eradicated while 4 patients (16%) showed no response despite eradication of H.pylori. Two patients (8%) with persistent H.pylori infection showed no improvement in the urticarial symptoms at the end of study period.

Conclusion: The results of our study strongly suggest that H.pylori should be specifically tested in all patients of CIU, to identify subset of patients who are infected and who could benefit from eradication therapy. H.pylori should be included in the diagnostic work up of all patients with CIU.

Key words : H.pylori, chronic idiopathic urticaria , chronic urticaria




Non-tumor necrosis factor-based biologic therapies for rheumatoid arthritis: present, future, and insights into pathogenesis


Published Date December 2013 Volume 2014:8 Pages 1—12

DOI http://dx.doi.org/10.2147/BTT.S35475

Received 16 September 2013, Accepted 11 October 2013, Published 9 December 2013

Filipe Seguro Paula,1 José Delgado Alves1,2

1Immunomediated Systemic Diseases Unit, Department of Medicine 4, Fernando Fonseca Hospital, Amadora, 2Center for the Study of Chronic Diseases, Department of Pharmacology, Faculty of Medical Sciences, Lisbon, Portugal

Abstract: The way rheumatoid arthritis is treated has changed dramatically with the introduction of anti-tumor necrosis factor (anti-TNF) biologics. Nevertheless, many patients still have less than adequate control of their disease activity even with these therapeutic regimens, and current knowledge fails to explain all the data already gathered. There is now a wide range of drugs from different classes of biologic disease-modifying anti-rheumatic drugs available (and soon this number will increase significantly), that provides the opportunity to address each patient as a particular case and thereby optimize medical intervention. Currently available biologics for the treatment of rheumatoid arthritis apart from anti-TNF-based therapies are reviewed, along with an analysis of the new insights they provide into the pathogenesis of the disease and a discussion of future prospects in the area.

Keywords: rheumatoid arthritis, non-anti-tumor necrosis factor, treatment, pathogenesis

Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at:http://www.dovepress.com/permissions.php


August 11, 2014

Capsaicin-sensitive cough receptors in lower airway are responsible for cough hypersensitivity in patients with upper airway cough syndrome


Yu L1, Xu X, Wang L, Yang Z, Lü H, Qiu Z.

Abstract
BACKGROUND:
Cough hypersensitivity may be related to the pathogenesis of upper airway cough syndrome (UACS). The purpose of the study was to investigate the role of capsaicin-sensitive cough receptors on the laryngopharynx and lower airway in the cough hypersensitivity of patients with UACS.
MATERIAL AND METHODS:
59 patients with UACS, 33 patients with rhinitis/sinusitis without cough, and 39 healthy volunteers were recruited for the study. Cough threshold C5, defined as the lowest concentration of capsaicin required for the induction of ≥ 5 coughs upon exposure to capsaicin, were determined at baseline and after laryngopharngeal anesthesia with lidocaine in all the subjects. After induced sputum cytology, the concentrations of histamine, prostaglandin E2 (PGE2), and calcitonin-gene-related peptide (CGPR) in the induced sputum were measured by ELISA. In 15 patients with UACS, sputum cytology and measurement of the above mediators were repeated after successful therapy.
RESULTS:
C5 response to capsaicin was significantly lower in the UACS group than in the rhinitis/sinusitis group and healthy control groups [3.9 (0.98, 7.8) µmol/L vs. 7.8 (3.9, 93.75) µmol/L vs. 31.2 (15.6, 62.5) µmol/L, H=40.12, P=0.000]. Laryngopharngeal anesthesia with lidocaine dramatically increased C5 to capsaicin in the subjects of all 3 groups by a similar degree, but the increase in the UACS group was still the lowest, with an increased level of histamine, PGE2, and CGRP in the induced sputum. When cough resolved with the treatment of cetirizine alone or in combination with erythromycin, the levels of CGRP and histamine in the induced sputum decreased significantly in 15 patients with UACS, with no obvious change in cell differential or concentration of PGE2 in the induced sputum.
CONCLUSIONS:
Laryngeal TRPV1 plays an important role in cough sensitivity, but sensitization of capsaicin-sensitive cough receptors in the lower airway may be more responsible for the cough hypersensitivity in patients with UACS.


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Natural killer cells from patients with chronic rhinosinusitis have impaired effector functions




Kim JH1, Kim GE, Cho GS, Kwon HJ, Joo CH, Kim HS, Jang YJ.

Abstract

Natural killer (NK) cells are multicompetent lymphocytes of the innate immune system that play a central role in host defense and immune regulation. Although increasing evidence suggests that innate immunity plays a key role in the pathogenesis of chronic rhinosinusitis (CRS), the role of NK cells in CRS has been poorly studied. This study aimed to characterize the peripheral blood NK cells from patients with CRS, and to compare the functions of these cells with those from non-CRS controls. The correlation between NK cell functional activity and prognosis was also assessed. Eighteen CRS patients and 19 healthy non-CRS controls were included. The patients with CRS were classified into two subgroups, namely a treatment-responsive group and recalcitrant group. NK cell degranulation was determined by measuring the cell surface expression of CD107a against 721.221 and K562 cells. Intracytoplasmic cytokine production was determined by flow cytometry. Compared to the controls, the NK cells of CRS group had an impaired ability to degranulate and to produce cytokines such as IFN-γ and TNF-α. The recalcitrant subgroup showed the most severe defects in NK cell effector functions. Moreover, the decreased NK cell functions in patients with CRS were associated with poor prognostic factors such as concomitant asthma and peripheral blood eosinophilia. NK cells, which were originally named for their ability to mediate spontaneous cytotoxicity towards diseased cells including infected cells, may play an important role in regulating the inflammatory process in CRS pathogenesis.


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Vitamin A supplementation and risk of atopy: long-term follow-up of a randomized trial of vitamin A supplementation at six and nine months of age

Research article
Nicholas Kiraly12*Aliu Balde1Ida Marie Lisse1Helle Brander Eriksen13Peter Aaby13and Christine Stabell Benn13
1Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau
2Gastro and Food Allergy, Murdoch Childrens Research Institute, Royal Children’s Hospital, Flemington Rd, Parkville VIC 3052, Australia
3Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, 5 Artillerivej, Copenhagen S DK-2300, Denmark
For all author emails, please log on.
BMC Pediatrics 2013, 13:190  doi:10.1186/1471-2431-13-190

The electronic version of this article is the complete one and can be found online at:http://www.biomedcentral.com/1471-2431/13/190

Received:21 July 2013
Accepted:15 November 2013
Published:19 November 2013
© 2013 Kiraly et al.; licensee BioMed Central Ltd. 
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The World Health Organization recommends high-dose vitamin A supplementation (VAS) for children above six months of age in low-income countries. VAS has been associated with up-regulation of the Th2 response. We aimed to determine if VAS is associated with atopy in childhood.

Methods

Infants in Guinea-Bissau were randomly allocated VAS or placebo, either at six and nine months of age, or only at nine months of age. At six months of age, children were furthermore randomized to measles vaccine or inactivated polio vaccine. At nine months of age all children received measles vaccine. Children were revisited seven years later and skin prick testing was performed. Atopy was defined as a skin prick reaction ≥3 mm.

Results

40 of 263 children (15%) were atopic. Overall VAS had no significant effect on the risk of atopy (Prevalence Ratio 1.23; 95% CI 0.69-2.18). The Prevalence Ratio was 1.60 (0.66-3.90) for males and 1.00 (0.46-2.15) for females.

Conclusions

There was no significant effect of VAS in infancy on atopy later in childhood. The role of infant VAS in the development of atopy is still unclear.
Keywords: 
Atopy; Immunization; Measles vaccine; Vitamin A supplementation

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