Selected abstracts:

1.             Allen CW, Campbell DE, Kemp AS. Egg allergy: are all childhood food allergies the same? J Paediatr Child Health. 2007 Apr;43(4):214-8.

Department of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Westmead, and Discipline of Paediatrics and Child Health, Clinical School, University of Sydney, Sydney, New South Wales, Australia.

Egg allergy is one of the most common food allergies in childhood affecting about 1-2% of preschool children and differs in a number of ways from other common childhood food allergies such as cows milk and peanut. Common egg allergens are altered both by heat and gastric enzymes. Compared with peanuts/tree nuts and milk, egg allergy appears less likely to cause severe life-threatening reactions or fatal anaphylaxis. Children are much more likely to outgrow egg allergy by school age as compared with peanut allergy. While the MMR vaccine is no longer contraindicated in egg allergy, influenza vaccine is contraindicated in children with anaphylaxis to egg. An understanding of the similarities and differences in these common food allergies of childhood is helpful in the management of these common and increasing problems.

2.            Caudri D, Wijga A, Gehring U, Smit HA, Brunekreef B, Kerkhof M, Hoekstra M, Gerritsen J, de Jongste JC. Respiratory symptoms in the first 7 years of life and birth weight at term: the PIAMA Birth Cohort. Am J Respir Crit Care Med. 2007 May 15;175(10):1078-85.

Department of Pediatrics/Respiratory Medicine, Erasmus University, 3000 CB Rotterdam, The Netherlands.

RATIONALE: The relation between birth weight and respiratory symptoms and asthma in children remains unclear. Previous studies focused on a relation at separate ages. A longitudinal analysis may lead to a better understanding. OBJECTIVES: To estimate the effect of birth weight on the development and course of respiratory symptoms and asthma in the first 7 years of life. METHODS: In a prospective birth cohort study, 3,628 children with a gestational age 37 weeks or more were monitored for 7 years. Parental questionnaires were used to assess respiratory health yearly. Associations of birth weight with respiratory symptoms (wheezing, coughing, respiratory infections) and doctor's diagnosis of asthma were assessed in a repeated-event analysis. MEASUREMENTS AND MAIN RESULTS: Lower birth weight was associated with more respiratory symptoms (odds ratio [OR] per kg decrease in birth weight, 1.21; 95% confidence interval [CI], 1.09-1.34). The effect of birth weight increased from age 1 to 5, but decreased thereafter and was no longer significant at the age of 7. The effect of birth weight on respiratory symptoms was significantly greater among children exposed to tobacco smoke in their home than among nonexposed children (OR at 5 yr: 1.21 [95% CI, 1.02-1.44] and 1.52 [95% CI, 1.23-1.87], respectively). Birth weight and a doctor's diagnosis of asthma were not related (OR, 1.06; 95% CI, 0.82-1.37). CONCLUSIONS: A lower birth weight in children born at term is associated with a transiently increased risk of respiratory symptoms. This effect is enhanced by environmental tobacco smoke exposure.

3.             Duckworth L, Hsu L, Feng H, Wang J, Sylvester JE, Kissoon N, Sandler E, Lima JJ. Physician-diagnosed asthma and acute chest syndrome: associations with NOS polymorphisms. Pediatr Pulmonol. 2007 Apr;42(4):332-8.

Pharmacogenetics Center, Nemours Children's Clinic, Jacksonville, Florida 32207, USA.

The main objectives of this paper were to test the hypothesis that polymorphisms in NOS1 and NOS3 genes associate with ACS in SCD patients and to characterize the association between physician-diagnosed asthma and acute chest syndrome (ACS). Case-control study of sickle cell disease patients >or=5 years old with ACS (cases; n=86) and those without ACS (controls; n=48) was carried out. Associations between ACS and the AAT repeat in intron 13 (formerly intron 20) of the NOS1, and with NOS3 T-786C polymorphism were explored. Physician-diagnosed asthma was determined by chart review, patient- or parent (guardian)-reported asthma, and drug use. Eighty five percent of participants with asthma had at least one episode of ACS compared to 14.6% of controls: adjusted odds ratio (OR) (95%CI) 5.46 (2.20,13.5), P= or<0.0001. Asthma correlated with the number of episodes of ACS (P<0.001). NOS1 AAT repeat polymorphism associated with the risk of ACS (P=0.001) in patients without physician-diagnosed asthma. No associations were found between the genotype of the NOS3 T-786C SNP and ACS. Physician-diagnosed asthma is a major risk factor for ACS. NOS1 AAT repeat polymorphism may contribute to physician-diagnosed asthma. (c) 2007 Wiley-Liss, Inc.

4.            Eigenmann PA. The spectrum of cow's milk allergy. Pediatr Allergy Immunol. 2007 May;18(3):265-71.

Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland. philippe.eigenmann@hcuge.ch

Childhood cow's milk allergy is a diagnosis encompassing various syndromes. Antigen-immunoglobulin E (IgE) antibody interaction is classically involved in mast cell degranulation in IgE-mediated food allergy, while non-IgE mediated cow's milk allergy is mostly mediated by cellular mechanisms. The diagnosis of cow's milk allergy largely relies on a good knowledge of the clinical expression of the disease. In this educational review series, we describe three cases of cow's milk allergy, first a 7-yr-old girl with persisting IgE-mediated cow's milk allergy, second a 8-month-old boy with cow's milk induced flares of atopic dermatitis, and third a 6-yr-old boy with sheep and goat milk allergy, in the absence of cow's milk allergy. The cases are discussed and summarized with more general recommendations for the clinical management of cow's milk allergy.

5.            Fleming L, Wilson N, Bush A. Difficult to control asthma in children. Curr Opin Allergy Clin Immunol. 2007 Apr;7(2):190-5. Review.

Department of Paediatric Respiratory Medicine, Imperial College of Science, Technology and Medicine at the National Heart and Lung Institute, London, UK.

PURPOSE OF REVIEW: The management of children with difficult asthma requires a systematic approach. These children are prescribed high doses of inhaled or oral corticosteroids and a balance must be struck between therapeutic efficacy and side effects. It is important to ensure the diagnosis is correct and that the reasons for poor control in a given child are characterized so that treatment can be targeted for maximal effect. RECENT FINDINGS: Recent data have demonstrated the correlation between invasive and noninvasive measurement of airway eosinophils. Noninvasive markers of inflammation can be used to determine phenotype and there is increasing evidence on the utility of repeated measures to monitor control and treatment effects. Side effects of high-dose corticosteroids remain a concern. The emergence of new therapies may be of benefit. These are often expensive, however, and have the potential for major side effects. Adherence remains a significant obstacle to the effective management of difficult asthma. SUMMARY: Children with difficult asthma are a heterogeneous group. Characterization and monitoring of these children can be enhanced by measurements of noninvasive markers of inflammation. Further evaluation of new and phenotype-specific treatments for children with difficult asthma need to be evaluated in prospective randomized controlled trials.

6.             Jantchou P, Schirrer J, Bocquet A. Appropriateness of upper gastrointestinal endoscopy in children: a retrospective study. J Pediatr Gastroenterol Nutr. 2007 Apr;44(4):440-5.

Pediatrics Department, Besançon Teaching Hospital, Besançon, France.

BACKGROUND: Upper gastrointestinal endoscopy (UGIE) is appropriate in many situations in adults and children. Recommendations for UGIE use in children were published recently by the French-language Paediatric Hepatology, Gastroenterology, and Nutrition Group (GFHGNP). PATIENTS AND METHODS: We retrospectively reviewed the 293 UGIE procedures undertaken in 251 children between January 1, 2024 and June 30, 2023 by 2 senior endoscopists. The UGIE procedures were categorized as appropriate or inappropriate based on GFHGNP recommendations, and diagnostic efficiency was compared in the 2 groups with the chi2 test followed by multivariate logistic regression analysis. RESULTS: Of the 293 UGIE procedures, 52 (17.7%) were considered inappropriate. Diagnostic efficiency was 51% in the appropriate group versus 17.3% in the inappropriate group (odds ratio, 4.2; 95% CI, 2-8.7; P < 10(-3)). The proportion of appropriate UGIE procedures was higher among inpatients than outpatients (odds ratio, 2.51; 95% CI, 1.24-5.08; P = 0.01). Inappropriate reasons for performing UGIE included isolated failure to thrive and follow-up after neonatal esophagogastroduodenitis. Nine inappropriate UGIE procedures contributed useful information: ulcerative esophagitis in 1 patient, hemorrhagic esophagitis in 4 patients, duodenitis in 1 patient, and malabsorption in 3 patients caused in 1 case by cow's milk allergy and in 2 cases to fully documented celiac disease. CONCLUSIONS: UGIE was usually performed appropriately in our pediatric hospital. Inappropriate UGIE procedures were more common in outpatients than in admitted patients. Awareness of the recommendations for appropriate UGIE use needs to be improved among office-based and hospital-based physicians.

7.            Liem JJ, Kozyrskyj AL, Huq SI, Becker AB. The risk of developing food allergy in premature or low-birth-weight children. J Allergy Clin Immunol. 2007 May;119(5):1203-9.

Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.

BACKGROUND: Premature or low-birth-weight children have increased gut permeability compared with term or normal-birth-weight children. OBJECTIVE: To determine whether premature or low-birth-weight children have an increased risk of developing food allergy compared with term or normal-birth-weight children. METHODS: The 1995 Manitoba Birth Cohort was studied using the Manitoba Health Services Insurance Plan (MHSIP) database. This database is a population-based, health care administrative and prescription database. It has records of every child born and subsequent utilization of the provincial health care system. The diagnosis of food allergy (ICD-9-CM code of 693 in hospital/medical claims or a prescription of injectable epinephrine excluding a sole diagnosis of venom allergy) was obtained up until the year 2002. The relative risks of food allergy in premature or low-birth-weight children compared with term or normal-birth-weight children were determined. RESULTS: A total of 13,980 children were born in 1995 and continue to live in the province of Manitoba. Of these, 592 children (4.23%) were found to have food allergy and epinephrine was prescribed in 316 (2.26%) children. No gestational age or birth weight group had a statistically significant increased risk for food allergy. CONCLUSION: Prematurity and low birth weight are not associated with a change in risk for development of food allergy in childhood. CLINICAL IMPLICATIONS: Immaturity of the gastrointestinal tract or immune response does not seem to change the risk for development of food allergies. We ask whether early exposure to food antigens may protect premature children by increasing immune tolerance to those antigens.

8.            Linehan MF, Frank TL, Hazell ML, Francis HC, Morris JA, Baxter DN, Niven RM. Is the prevalence of wheeze in children altered by neonatal BCG vaccination? J Allergy Clin Immunol. 2007 May;119(5):1079-85. 

General Practice Research Unit, North West Lung Research Centre, Wythenshawe Hospital, Manchester. linehanmary@yahoo.co.uk

BACKGROUND: The prevalence of asthma and atopic disease has increased in recent decades, but precise reasons for this increase are unknown. BCG vaccination is thought to be among a group of vaccines capable of manipulating the immune system toward T(H)1 dominance and therefore reducing the likelihood of atopic disease. OBJECTIVE: The aim of this study was to determine the influence of neonatal BCG vaccination on the prevalence of wheeze in a large community population of children. METHOD: In a historical cohort study, a parent-completed questionnaire was used to identify the prevalence of wheeze in BCG-vaccinated and nonvaccinated children in Manchester, England. RESULTS: There were 2414 participants aged between 6 and 11 years. In a univariate analysis neonatal BCG vaccination was associated with a significantly lower prevalence of wheeze (odds ratio, 0.69; 95% CI, 0.55-0.86), and statistical significance was retained when the analysis was adjusted for potential confounders (odds ratio, 0.68; 95% CI, 0.53-0.87). CONCLUSION: These results demonstrate an association between asthma symptom prevalence and neonatal BCG vaccination, relating to a possible 27% reduction in prevalence, and are therefore of considerable public health importance. CLINICAL IMPLICATIONS: The capacity of neonatal BCG vaccination to reduce the prevalence of respiratory symptoms in children warrants further investigation.

9.            Sawni A, Thomas R. Pediatricians' attitudes, experience and referral patterns regarding Complementary/Alternative Medicine: a national survey. BMC Complement Altern Med. 2007 Jun 4;7:18. 

Department of Adolescent Medicine, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201-2119, USA. asawni@med.wayne.edu

BACKGROUND: To assess pediatricians' attitudes toward & practice of Complementary/Alternative Medicine (CAM) including their knowledge, experience, & referral patterns for CAM therapies. METHODS: An anonymous, self-report, 27-item questionnaire was mailed nationally to fellows of the American Academy of Pediatrics in July 2004.648 of 3500 pediatricians' surveyed responded (18%). RESULTS: The median age ranged from 46-59 yrs; 52% female, 81% Caucasian, 71% generalists, & 85% trained in the US. Over 96% of pediatricians' responding believed their patients were using CAM. Discussions of CAM use were initiated by the family (70%) & only 37% of pediatricians asked about CAM use as part of routine medical history. Majority (84%) said more CME courses should be offered on CAM and 71% said they would consider referring patients to CAM practitioners. Medical conditions referred for CAM included; chronic problems (headaches, pain management, asthma, backaches) (86%), diseases with no known cure (55.5%) or failure of conventional therapies (56%), behavioral problems (49%), & psychiatric disorders (47%). American born, US medical school graduates, general pediatricians, & pediatricians who ask/talk about CAM were most likely to believe their patients used CAM (P < 0.01). CONCLUSION: Pediatricians' have a positive attitude towards CAM. Majority believe that their patients are using CAM, that asking about CAM should be part of routine medical history, would consider referring to a CAM practitioner and want more education on CAM.

10.          Turck D. Soy protein for infant feeding: what do we know? Curr Opin Clin Nutr Metab Care. 2007 May;10(3):360-5. Review.

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Children's Hospital and Faculty of Medicine, Hôpital Jeanne de Flandre, 2 avenue Oscar Lambret, 59037 Lille cedex, France. dturck@chru-lille.fr

PURPOSE OF REVIEW: This review discusses the safety, nutritional adequacy and recommendations for use of soy protein formulae, based mainly on the most relevant reports published during 2005 and 2006. RECENT FINDINGS: Concerns have recently been raised regarding potential risks with soy protein formulae, in particular regarding their high phytoestrogenic isoflavone content. Recent data are insufficient to draw definitive conclusions on safety, but authorities and paediatric societies from several countries recently advised health professionals to use soy protein formulae only in certain cases. Indications for use of soy protein formulae, mainly for prevention and management of food allergy, have also been better defined. SUMMARY: Soy protein formulae ensure normal growth and development in healthy term infants but they have no nutritional advantages over cow's milk protein formulae. Main indications include severe lactose intolerance, galactosaemia and need to avoid foods of animal origin. Soy protein formulae have no role in preventing allergy or in management of nonspecific gastrointestinal symptoms (e.g. infantile colic and regurgitation). They should not be used in preterm infants or infants with food allergy before age 6 months. After 6 months, soy protein formulae may be considered if tolerance to soy protein is established.