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1.  Advances in Pediatric Asthma in 2010: Addressing the Major Issues 
Last year’s Advances in Pediatric Asthma concluded with the following statement “If we can close these [remaining] gaps through better communication, improvements in the health care system and new insights into treatment, we will move closer to better methods to intervene early in the course of the disease and induce clinical remission as quickly as possible in most children”. This year’s summary will focus on recent advances in pediatric asthma that take steps moving forward as reported in Journal of Allergy and Clinical Immunology publications in 2010.
Some of those recent reports show us how to improve asthma management through steps to better understand the natural history of asthma, individualize asthma care, reduce asthma exacerbations, manage inner city asthma, and some potential new ways to use available medications to improve asthma control. It is clear that we have made many significant gains in managing asthma in children but we have a ways to go to prevent asthma exacerbations, alter the natural history of the disease, and to reduce health disparities in asthma care.
Perhaps new directions in personalized medicine and improved health care access and communication will help maintain steady progress in alleviating the burden of this disease in children, especially young children.
doi:10.1016/j.jaci.2010.11.018
PMCID: PMC3032272  PMID: 21211645
asthma; asthma control; asthma impairment; asthma risk; asthma severity; early intervention in asthma; biomarkers; genetics; inhaled corticosteroids; leukotriene receptor antagonists; long-acting β-adrenergic agonists; omalizumab; personalized medicine; therapeutics
2.  328 Epidemiology of Asthma Cases in the Allergy Service of a Third Level Medical Center. Six Year Expirience 
The World Allergy Organization Journal  2012;5(Suppl 2):S122-S123.
Background
The creation of an Allergy service was required because of the high frequency of allergic diseases among paediatric population in the general consultation of a third level medical centre.
Objective
The purpose of this study is to report the cases of asthma diagnosed in the Allergy service from a Third level medical centre since its creation in July 2005.
Methods
This is a descriptive, retrospective, transversal study from July 2005 to February 2011. Selected medical records of patients apply for diagnostic criteria for an allergy disease. GINA guide 2009 was used to make diagnosis of asthma. Patients were classified by age and sex and find out how many of them skin prick test were made and also how many patients began treatment with immunotherapy.
Results
Thirteen thousand seven hundred thirty seven consultations were attended in the Allergy service between the time period mentioned above. Two thousand three hundred thirty seven medical records of patients were selected, 1608 patients applied for a specific diagnosis for an allergy disease as follows: Asthma 411, Atopic Conjunctivitis 58, Atopic Dermatitis 180, Allergic Rhinitis 869, Urticaria 90. Four hundred eleven patients completed criteria for Asthma. Two hundred thirteen (51.8%) patients were female, 198 (48.2%) patients were male. Two hundred twenty seven (55.2%) patients were found to be in the range of 0 to 9 years, 141 (62.1%) of them were between 5 to 9 years. The majority of asthma patients were males in the range of 5 to 9 years. Some increase in asthma cases were found in females between 30 and 40 years of age, 75 (35.2%) of total female cases, about 18% of total cases of asthma. Skin prick test were made in 164 (40%) asthma patients. In 134 were positive to a specific allergen and began immunotherapy.
Conclusions
Asthma represents the second highest incidence in allergy diseases among children. However, it is the main cause of hospitalization among allergy diseases because of the presence of crises that increases the cost of medical attention. It is very important therefore to make a good diagnosis of asthma early on in order to bring adequate treatment, including immunotherapy. Education to these patients is also an important task, mainly in children.
doi:10.1097/01.WOX.0000412091.26343.dd
PMCID: PMC3512707
3.  Prevalence of Childhood Asthma in Korea: International Study of Asthma and Allergies in Childhood 
Childhood asthma is a major concern because it leads to more hospital visits and a heavy economic burden. Proper management and prevention strategies for childhood asthma must be based on correct evaluation of prevalence and risk factors for its development. In Korea, nationwide studies were conducted in 1995 and 2000 on students from 68 elementary schools (age, 6-12 years) and junior high schools (age, 12-15 years) by the Korean Academy of Pediatric Allergy and Respiratory Diseases. We used the Korean version of the International Study of Asthma and Allergies in Childhood (ISAAC) written and video questionnaires at the same schools during the same period (October-November). The prevalence of asthma in junior high school children seemed to increase over 5 years. However, in elementary school children, the prevalence of asthma symptoms decreased, although the prevalence of 'diagnosis of asthma, ever' and 'treatment of asthma, last 12 months' increased. In addition, it was found that various factors, such as obesity, passive smoking, dietary habits, raising pets at home, and fever/antibiotic use during infancy were associated with childhood asthma. When prevalence of asthma in Korea was compared with that in different regions, the prevalence changes in the 6-7 years age group did not seem to be consistent between regions, whereas similar trends were observed among children aged 13-14 years. To conduct another epidemiological study to evaluate the time trend over time, a third nationwide survey is planned in 2010, and we anticipate ISAAC Phase 3 will explore recent changes in the prevalence of childhood asthma and assess its risk factors in Korean children. On the basis of accurate data on the current status of childhood asthma in 2010, we will be able to establish proper management strategies.
doi:10.4168/aair.2010.2.2.61
PMCID: PMC2846742  PMID: 20358019
Asthma; child; Korea
4.  Monitoring and Management of Childhood Asthma in Asian Countries A Questionnaire Study 
Background
A recent study by the International Study of Asthma and Allergies in Childhood has shown that asthma symptom prevalence is still increasing in parts of Asia. As such, it is important to know how well asthma is being managed. Practices of physicians in India, China, Sri Lanka, Australia, Singapore, Indonesia, Philippines, and Taiwan in monitoring and treating childhood asthma were examined.
Methods
A 6-page standardized questionnaire was sent to physicians via post. The questionnaire is made up of 3 parts, including (1) methods of monitoring of childhood asthma, (2) practices in managing acute asthma exacerbations, and (3) choice of therapy in maintenance treatment.
Results
Our study reflects mostly the practices of physicians who practice in urban regions. Of respondents, 41.4% were general pediatricians, whereas 26.3% were general practitioners. A small fraction of physicians used score cards or diaries to monitor asthma, ranging from 0% (Philippines and Australia) to 15.9% (India). Only 8.1% (Sri Lanka) to 52.0% (Australia) use either a peak flow meter and/or spirometry to monitor asthma. However, for frequency of use, 35% (China) to 94% (Indonesia) never or seldom make use of a peak flow meter, and 33% (China) to 97.6% (Indonesia) never or seldom use spirometry for monitoring. Most physicians treat acute asthma appropriately with short-acting bronchodilators. For maintenance treatment, an inhaled corticosteroid was the most frequently chosen first-choice therapy. However, a significant fraction of physicians chose a long-acting β-agonist monotherapy as a first-choice treatment for asthma maintenance. For infants, the percentage ranged from 1.4% (Australia) to 76.3% (Indonesia); in preschoolers, 1.8% (Australia) to 43.3% (Indonesia); and in older children, 0% (Philippines) to 28.8% (Indonesia). These results may be related to the overall affluence of each nation.
Conclusions
There is much room for improvement in increasing physicians' awareness to guidelines for more effective management of pediatric asthma in Southeast Asia, especially regarding the high use of long-acting β-agonist monotherapy, even in young children.
doi:10.1097/WOX.0b013e318194c0f6
PMCID: PMC3651034  PMID: 23282887
childhood asthma; physicians; questionnaire; Southeast Asia
5.  231 Pattern of Positive Sensitization in Patient with Asthma and Rhinitis to 3600 MSNM (La Paz, Bolivia) 
Background
In the high altitude exists very few studies about allergies, we seek to give to know our sensitization in population with breathing problems (asthma and Allergic Rhinitis).
Methods
They were carried out allergy tests to 94 patients between 6 and 13 years with breathing symptoms predominantly allergic rhinitis and asthma. They were carried out allergy tests to foods like peanut, wheat, almond, tomato, milk, fish, soya, nuts, corn egg, chocolate, dog epithelia, cat, rabbit, feathers, horse, dermatophagoides spp, blatella, periplaneta pollens: lolium, poa, cynodon, festuca, ambrosia, artemisa, plantago, chenopodium, rumex, zea mays, populus, cupressus, platanus, fraxinus, schinus, dactylis, and mushrooms like it would alternate, aspergillus and cladosporium. They took positive all hives bigger than 3 mm of diameter.
Results
Of the 94 patients 9 gave negative to the tests, 88 positive%. In the foods, milk prevails (lactoglobuline 39%; casein 21%), tomato 33%, fish, almond and wheat; 23% peanut and nuts less than 10%. In the epithelia: cat 20%. Dermatophagoides 46%, pollens grasses lolium 13% and poa 14%, other pollens important festuca, chenopodium and dactylis with 21 to 23%, trees less than 15% and mushrooms with less than 15%. You begin handling predominantly according to these tests to dematophagoides, poa, lolium, festuca, dactylis, mushrooms and cat epithelium since their reactions were similar to the positive challenge of histamine. It is necessary to mention that the diagnoses were alone allergic Rinitis on the whole in 60%, asthma allergic single 10% and asthma and rinitis 30%.
Conclusions
Although this is a closed population, it guides us that to 3600 m.s.n.m. the allergen more frequent is dermatophagoides, and many articles refers that to high altitude we are liberated of the mites but it is not this way. Another important discovery is the positive to milk, tomato and very little to other foods that it is part of our population's diet. They are data that deserve the attention and we will continue advancing in finding other factors of risk, clinic and prevalence.
doi:10.1097/01.WOX.0000411988.03051.09
PMCID: PMC3512971
6.  On-campus physicians witnessing changes in medical problems faced by university students. 
Most Canadian universities offer on-campus health services for their students. Ten years ago minor health problems such as infections, cuts and bruises were the common causes of visits to student health centres, but today medical staff report that students are seeking help for more serious problems such as sexually transmitted diseases, stress, sports injuries, eating disorders and asthma and allergies. Many are also seeking psychiatric counselling.
PMCID: PMC1488113  PMID: 8542567
7.  Cockroach allergy and asthma in a 30-year-old man. 
Environmental Health Perspectives  1999;107(3):243-247.
A growing body of evidence has implicated allergens derived from cockroaches as an important environmental factor that may aggravate asthma in sensitized persons. We present the case of a 30-year-old man with asthma and a cockroach allergy. Allergy skin testing confirmed hypersensitivity to cockroach extract, and a home visit revealed visual evidence of infestation and the presence of Bla g 1 German cockroach allergen in vacuumed dust. As is typical of patients with a cockroach allergy and asthma, multiple factors in addition to cockroach allergen appeared to aggravate the patient's asthma. A multimodality therapeutic regimen, which included medications as well as cleaning of the home, integrated pest management, and professional application of chemical controls, resulted in substantial clinical improvement. The pathophysiology, epidemiology, and clinical features of cockroach-allergic asthma are reviewed, and an approach to diagnosis and management is suggested.
Images
PMCID: PMC1566372  PMID: 10064555
8.  Assessing the clinical ethical competence of undergraduate medical students. 
Journal of Medical Ethics  1993;19(4):230-236.
At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context.
PMCID: PMC1376346  PMID: 8308879
9.  Predictive value of specific IgE for clinical peanut allergy in children: relationship with eczema, asthma, and setting (primary or secondary care) 
The usefulness of peanut specific IgE levels for diagnosing peanut allergy has not been studied in primary and secondary care where most cases of suspected peanut allergy are being evaluated. We aimed to determine the relationship between peanut-specific IgE levels and clinical peanut allergy in peanut-sensitized children and how this was influenced by eczema, asthma and clinical setting (primary or secondary care). We enrolled 280 children (0–18 years) who tested positive for peanut-specific IgE (> 0.35 kU/L) requested by primary and secondary physicians. We used predefined criteria to classify participants into three groups: peanut allergy, no peanut allergy, or possible peanut allergy, based on responses to a validated questionnaire, a detailed food history, and results of oral food challenges.
Fifty-two participants (18.6%) were classified as peanut allergy, 190 (67.9%) as no peanut allergy, and 38 (13.6%) as possible peanut allergy. The association between peanut-specific IgE levels and peanut allergy was significant but weak (OR 1.46 for a 10.0 kU/L increase in peanut-specific IgE, 95% CI 1.28-1.67). Eczema was the strongest risk factor for peanut allergy (aOR 3.33, 95% CI 1.07-10.35), adjusted for demographic and clinical characteristics. Asthma was not significantly related to peanut allergy (aOR 1.93, 95% CI 0.90-4.13). Peanut allergy was less likely in primary than in secondary care participants (OR 0.46, 95% CI 0.25-0.86), at all levels of peanut-specific IgE.
The relationship between peanut-specific IgE and peanut allergy in children is weak, is strongly dependent on eczema, and is weaker in primary compared to secondary care. This limits the usefulness of peanut-specific IgE levels in the diagnosis of peanut allergy in children.
doi:10.1186/2045-7022-3-34
PMCID: PMC3852137  PMID: 24112405
Peanut allergy; Peanut-specific IgE; Peanut sensitization; Eczema; Asthma; Children; Teenagers
10.  445 Inability of Medical Students to Use of Three Types of Inhaler 
Background
Several studies have demonstrated that a significant percentage of health care professionals are deficient in both knowledge and skill regarding the inhalers. But no data is available about the assessment of inhaler technique and knowledge among medical students in Korea. The aim of this study was to evaluate the proficiency and knowledge of medical students in proper use of 3 kinds of inhalers (metered dose inhaler, turbuhaler, and diskus).
Methods
We enrolled 40 third-year medical students who are on hospital training course. The participants received 25 to 35 minutes of instruction from a trained nurse educator for asthma. Three month later, we assessed their knowledge and skill regarding inhaler use. They were asked to discriminate each type of 3 devices and to demonstrate the use of each device using placebo inhalers. Also, they were asked about the prevention and management for local adverse reaction induced by inhaled corticosteroids (ICS). Participants's inhaler skill was assessed into 3 levels as good, inadequate, and poor for each device type.
Results
Only 12.5% (5/40) of medical students could explain the merits of inhalation therapy compared to oral route. 67.5% (27/40) of participants could not discriminate all types of inhaler devices. With regards to prevention and treatment option for ICS-related local side effects, only 22.5% (9/40) answered correctly. Subjects with good performance grade were found in 12.5% for metered dose inhaler, 40.0% for turbuhaler, and 57.5% for diskus.
Conclusions
We conclude that large percent of medical students were deficient in knowledge and proficiency regarding the inhalers. A brief educational session with demonstration by trained asthma nurse was not effective in enhancing inhaler technique or increasing knowledge on inhaler treatment.
doi:10.1097/01.WOX.0000412208.83691.0b
PMCID: PMC3513172
11.  232 Epidemiology of Allergic Rhinitis Cases in the Allergy Service of a Third Level Medical Center. Six Year Experience 
Background
The purpose of this study is to report the cases of Allergic Rhinitis (AR) in the Allergy service from a Third level medical centre since its creation in July 2005.
Methods
This is a descriptive, retrospective, transversal study from July 2005 to February 2011. Selected medical records of patients apply for diagnostic criteria for an allergy disease were made. ARIA guide 2009 was used to make diagnosis of allergic rhinitis. Patients were classified by age and sex and find out how many skin prick test were made in such patients, and how many patients began immunotherapy.
Results
13737 consultations were attended in the Allergy service between the period mentioned above. 2337 medical records of patients were selected, 1608 patients applied for a specific diagnosis for an allergy diseases as follows: Asthma 411, Atopic conjuctivitis 58, Atopic Dermatitis 180, Allergic Rhinitis 869, Urticaria 90. 869 patients completed criteria for Allergic Rhinitis. 433 (49.9%) patients were female, 436 (50.1%) patients were male. 490 (56.3%) patients were found to be in the range of 0 to 14 years. The mayority of allergic rhinitis patients were males in the range of 5 to 14 years, with 270 (42.5%) patients. There were an increase of AR cases in females in the range of 20 to 40 years, with 171 (39.4%) of total female cases. In 408 (47%) patients skin prick test were made, in 305 (35%) patients were positive and began treatment with immunotherapy.
Conclusions
In this study, AR represents the most frequent allergy disease among children, a good diagnosis of AR is mandatory because of the confusion of symptoms mainly related with upper respiratory tract infections, that implies a different management, increasing the risk of complications, such as asthma and therefore the cost of treatment, including immunotherapy. The results of this study are helpful to improve specialized medical attention not only in paediatric patients but also in adults.
doi:10.1097/01.WOX.0000411989.03051.40
PMCID: PMC3512972
12.  Work-related allergy in medical doctors: atopy, exposure to domestic animals, eczema induced by common chemicals and membership of the surgical profession as potential risk factors 
Purpose
To investigate the risk factors associated with work-related allergy-like symptoms in medical doctors.
Methods
Self-administered questionnaire survey and CAP test were conducted among medical school students in the 4th grade of their 6-year medical course in 1993–1996 and 1999–2001. Follow-up questionnaires were sent in 2004 to the graduates. These questionnaires enquired into personal and family history of allergic diseases, lifestyle, history of allergy-like symptoms including work-relatedness and occupational history as medical doctors. Relationships between allergy-like symptoms and relevant factors were evaluated by multivariate logistic regression analysis.
Results
Of 261 respondents at the follow-up survey, 139 (53.3%) and 54 (20.7%) had a history of any allergy-like symptoms and any work-related allergy-like symptoms, respectively. Female gender and family history of allergic diseases were significantly associated with any allergy-like symptoms. Personal history of allergic disease, exposure to domestic animals, eczema caused by rubber gloves, metallic accessories, or cosmetics during schooling days, and membership of the surgical profession were significant risk factors for work-related allergy-like symptoms. On the contrary, to work-related allergy-like symptoms, gender, age, and smoking status were not significantly related, and consumption of prepared foods was inversely related.
Conclusions
Personal history of atopy and eczema induced by common goods and the history of keeping domestic animals may be predictors of work-related allergy-like symptoms in doctors. After graduation from medical school, physicians start with exposure to various allergens and irritants at work, which relate to work-related allergy-like symptoms, especially for surgeons.
Electronic supplementary material
The online version of this article (doi:10.1007/s00420-011-0682-z) contains supplementary material, which is available to authorized users.
doi:10.1007/s00420-011-0682-z
PMCID: PMC3334482  PMID: 21853315
Occupational allergy; Doctor; Dermatitis; Rhinitis; Asthma; Environment; Occupational Medicine/Industrial Medicine; Environmental Health; Rehabilitation
13.  444 Associations between Self-reported Adherence to Asthma Anti-inflammatory Therapy and Risk Factors for Non-adherence (NA) in Pediatric Patients 
The World Allergy Organization Journal  2012;5(Suppl 2):S158-S159.
Background
Identifying patient adherence status and reasons for non-adherence are important components of asthma management. GINA 2008 Guidelines have identified risk-factors associated with poor adherence
Methods
Three hundred sixty one parents of children with intermittent and persistent asthma (59.6% male; 64.1% Caucasian; mean age 8.07 years) completed the AsthmaPACT, a 96-item asthma survey hosted by the Asthma and Allergy Foundation of America website. The AsthmaPACT identifies risk-factors for not following treatment recommendations as well as medication use. Asthma surveys were completed from August 2009 thru June 2011.
Results
Descriptive statistics indicated that 259 of the sample reported giving their child one or more of the anti-inflammatory medication prescribed. Of these, 69 (27%) were diagnosed as NA, operationalized as whether a parent reported giving the child anti-inflammatory medication "less than prescribed by their physician." During the 4 weeks prior to completing the survey, 43.0% were having symptoms daily and 39.4% were using albuterol MDI daily. In this cross-sectional data set, items intended to relate risk factors to NA were examined using chi square (χ2). Parents who claimed that their child receive less anti-inflammatory medication than prescribed, were more likely to report: 1) symptoms from emotional states: crying χ2(df = 2) = 8.643 P = 0.013; frustration χ2(df = 2) 6.202 P = 0.045; anger χ2(df = 2) = 11.029 P = 0.0042); Parent more likely to see child as anxious or a worrier χ2(df = 2) = 6.527 P = 0.038; 2) Child's Quality of Life (QoL): is more likely to be effected at school χ2(df = 2) = 12.963 P = 0.002; and interfere with family activities χ2 (df = 2) = 8.856 P = 0.012; 3) Parent's QoL is more likely to interfere with work χ2 (df = 2) = 16.517 P < 0.001; recreational activities χ2 (df = 2) 17.759 P < 0.001 and family activities χ2 (df = 2) = 16.517 P < 0.001; 4) Parents are more likely not to agree regarding asthma management χ2 (df = 2) = 7.677 P = 0.022; not to agree with relatives/caregivers on how to manage asthma χ2 (df = 2) = 9.853 P = 0.007; lack confidence in teachers/school personnel to manage asthma at school χ2(df = 2) = 20.216 P < 0.001.
Conclusions
The AsthmaPACT provides an assessment of 1) risk-factors for non-adherence and 2) patient self-report of adherence, and is readily available as a tool to individuals with asthma who have access to the Internet. Findings in this study are consistent with GINA 2008 Guidelines regarding common risk-factors for non-adherence and specifically to the child's emotional state and QoL for both the child and parent. The AsthmaPACT might be considered for symptomatic patients to identify barriers to treatment and diagnose adherence status.
doi:10.1097/01.WOX.0000412207.83691.ef
PMCID: PMC3512985
14.  299 Association of Asthma and IGE Levels 
Background
Asthma is a multifactorial chronic inflammatory disease that presents with varying degrees of bronchospasm which can be triggered by multiple causes. One of the best known triggers is allergies, or contact with allergens that have different immunological mechanisms leading to activation of the inflammatory process characteristic of asthma. Immunoglobulin E is a protein that normally rises in the allergic process and used as a marker.
Objectives
To assess the prevalence of IgE as a key factor in asthma and to estimate the incidence of non IgE-mediated asthma.
Methods
50 Patients (72% female and 28% male) aged 12 and 50 years old, diagnosed with asthma who met the inclusion and exclusion criteria, were taken from the Allergy and Immunology department. A complete medical history was performed, and the diagnosis was confirmed through a clinical history and spirometric criteria, according to GINA 2007. Subsequently, total IgE in serum were measured by electrochemiluminescence using the Cobascore equipment.
Results
72% of the patients in the study, had an elevated total IgE which suggests that this group has an allergic cause as a trigger for their disease, meanwhile the cause for the remaining patients were due to other causes.
Conclusions
Evaluation of serum IgE levels should be considered in asthmatic patients in order to determine the specific etiologic treatment. Additionally, these results enhance the importance of a multidisciplinary working diagnosis, and management of this condition, considering that up to a quarter of asthma patients may have Non-IgE mediated etiology
doi:10.1097/01.WOX.0000412056.12941.dc
PMCID: PMC3512693
15.  Perception of asthma as a factor in career choice among young adults with asthma 
BACKGROUND/AIM:
Asthma is a common chronic condition that can be aggravated by workplace exposures. Young adults with asthma should know how their future occupation might affect their asthma, and potentially, their quality of life. The aim of the present study was to assess the awareness of young adults to occupational risks for asthma and high-risk occupations, as well as their perception of the role of asthma in career choice.
METHODS:
Young adults 16 to 22 years of age with reported physician-diagnosed asthma were recruited to complete a questionnaire eliciting information regarding asthma control, career choice and awareness of occupational exposure risks.
RESULTS:
A small majority of the study cohort (56.4%) could identify occupations that cause or exacerbate asthma, and 34.7% indicated that asthma was an important factor in their career plans. Family physicians were most responsible for asthma management (80.2%), but young adults were more likely to discuss asthma and career plans with their parents (43.6%) or friends (29.7%) than with their family physician (13.9%; P<0.001).
CONCLUSION:
Young adults with asthma have suboptimal awareness of potential work-related asthma risks. Family physicians most commonly provide asthma care to these young adults. However, few young adults are talking to their family physicians about career choices and asthma. This observation represents an area of asthma care that needs to be explored in young adults with asthma.
PMCID: PMC2807797  PMID: 20011720
Asthma; Career choice; Occupational asthma; Risk perception; Socioeconomic factors survey; Work-exacerbated asthma; Work-related asthma; Young adults
16.  Asthma prevalence among 16- to 18-year-old adolescents in Saudi Arabia using the ISAAC questionnaire 
BMC Public Health  2012;12:239.
Background
Most of the studies investigating the prevalence of asthma in various countries have focused on children below the age of 15 years or adults above the age of 18 years. There is limited knowledge concerning the prevalence of asthma in 16- to 18-year-old adolescents. Our objective was to study the prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia.
Methods
A cross-sectional study was conducted in secondary (high) schools in the city of Riyadh utilizing the International Study of Asthma and Allergies in Children (ISAAC) questionnaire tool.
Results
Out of 3073 students (1504 boys and 1569 girls), the prevalence of lifetime wheeze, wheeze during the past 12 months and physician-diagnosed asthma was 25.3%, 18.5% and 19.6%, respectively. The prevalence of exercise-induced wheezing and night coughing in the past 12 months was 20.2% and 25.7%, respectively. The prevalence of rhinitis symptoms in students with lifetime wheeze, physician-diagnosed asthma and exercise-induced wheeze was 61.1%, 59.9% and 57.4%, respectively. Rhinitis symptoms were significantly associated with lifetime wheeze (OR = 2.5, p value < 0.001), physician-diagnosed asthma (OR = 2.2, p < 0.001), and exercise-induced wheeze (OR = 1.9, p value < 0.001).
Conclusions
The prevalence of asthma and associated symptoms in 16- to 18-year-old adolescents in Saudi Arabia is high, although it is within range of reported prevalence rates from various parts of the world.
doi:10.1186/1471-2458-12-239
PMCID: PMC3384472  PMID: 22443305
17.  533 Viral Respiratory Infections and the Development of Atopy and Asthma 
Background
There is an association between severe RSV bronchiolitis in early childhood, recurrent wheezing, asthma, and allergy in later childhood. And also becomes increasingly evident that other viruses such as RV, also showed association with the development of asthma. The objective of this study is to know the relationship between viral respiratory infections in the first 5 years of age and the development of atopy and asthma.
Methods
This study is a prospective follow-up study in 2 communities, 9 years after a respiratory infection study was performed. Assessment included questionnaires, physical examination, skin prick tests (SPT), pulmonary function test (PFT), and reversibility testing.
Results
Three hundred thirty-two children, age 7 to 14 years, including 182 (54.8%) boys, were enrolled in the study. In 86 children, histories of viral respiratory infections (RSV, RV, and hMPV) were detected. The rate of positive SPT was high (81.6%), and 15 (4.5%) children showed dermatographism. The percentage of positive SPT among children with and without viral respiratory infections was almost similar (83.4% vs 85.4%). The positive SPT > 1 in children with history of viral respiratory infections was 65.9%; 5.9% with 1 positive, 27.1% with 2 to 3 positive, 20% with 4 to 5 positive and 18.8% with > 5 positive; while the positive SPT > 1 in the non viral respiratory infections was 75,3%; 9.3%, 23.9%, 30.4%, and 21.1%, respectively. The difference between those 2 groups of children was not significant (P = 0.076). History of asthma in the children with history of respiratory infections was higher compared with the non infections group (19.7% vs 8.1%). However, the spirometry results show no difference (P > 0.05) of FEV1 < 80%, FVC < 80%, FEV1/FVC < 80% and bronchodilator response > 12%, between those 2 groups.
Conclusions
The positive rate of SPT in the children is high, but no difference is found between history of viral respiratory infections in early life in relation to the later development of atopy and asthma. The spirometry test results show no difference between the 2 groups.
doi:10.1097/01.WOX.0000411648.79818.dc
PMCID: PMC3512968
18.  Proposed Model for Iranian National System of Registration of Allergy and Asthma 
Acta Informatica Medica  2013;21(3):196-199.
Introduction:
Asthma and allergies in addition to demanding social costs–the economic community, one of the major causes of morbidity and mortality in the world is considered. In the last decade in Iran despite the positive developments in many areas of health records into categories based asthma and allergy international standards, less attention has been paid. Improving the quality of care system, identifying groups at risk of asthma and allergies, control plan, prevention and assessment of asthma and allergies due to possible that when allergy and asthma information registration system and create the complete and timely data to be collected. Considering now an efficient national system of registration allergy and asthma that can meet the health needs can no need for this study was felt.
Materials and Methods:
This study, study–the comparison was done in the years 2010-2011. In this research, using library resources, information networks and consultations with experts inside the country gathered on the main axis and branches of national registration system, asthma and allergies in American countries–Australia and England were examined and given economic conditions, cultural and geographical themes for our records system, the axes were proposed objectives, structure, data elements, standard registration process? Data and classification systems are given.
Results:
The proposed model for national registration system, asthma and allergies in the country is shown in a table. In this table the proposed system based on six main “targets”, “structure”, “data elements”, “data collection process,” “registration criteria” and “classification system” is designed.
Conclusion:
The results and recommendations to the International Institute for asthma and allergies, reduction in low registers, and can increase the quality of the proposed model, including advantages in comparison with the existing system of the country noted.
doi:10.5455/aim.2013.21.196-199
PMCID: PMC3804503  PMID: 24167391
Asthma; National Information System; Iran.
19.  Neighborhood differences in exposure and sensitization to cockroach, mouse, dust mite, cat and dog allergens in New York City 
Background
Asthma prevalence varies widely among neighborhoods within New York City. Exposure to mouse and cockroach allergens has been suggested as a cause.
Objective
To test the hypotheses that children living in high asthma prevalence neighborhoods (HAPN) would have higher concentrations of cockroach and mouse allergens in their homes than children in low asthma prevalence neighborhoods (LAPN), and that these exposures would be related to sensitization and asthma.
Methods
In the NYC Neighborhood Asthma and Allergy Study, a case-control study of asthma, 7–8 year old children from HAPN (n=120) and LAPN (n=119) were recruited through the same middle-income health insurance plan. Children were classified as asthma cases (n=128) or non-asthma controls (n=111) based on reported symptoms or medication use. Allergens were measured in bed dust.
Results
HAPN homes had higher Bla g 2 (P=0.001), Mus m 1 (P=0.003) and Fel d 1 (P=0.003) and lower Der f 1 (P=0.001) than LAPN homes. Sensitization to indoor allergens was associated with asthma, but relevant allergens differed between LAPN and HAPN. Sensitization to cockroach was more common among HAPN than LAPN children (23.7% vs. 10.8%, P=0.011). Increasing allergen exposure was associated with increased probability of sensitization (IgE) to cockroach (P<0.001), dust mite (P=0.009) and cat (P=0.001), but not mouse (P=0.58) or dog (P=0.85).
Conclusions
These findings further demonstrate the relevance of exposure and sensitization to cockroach and mouse in an urban community and suggest that cockroach allergen exposure could contribute to the higher asthma prevalence observed in some compared with other NYC neighborhoods.
doi:10.1016/j.jaci.2011.02.044
PMCID: PMC3271316  PMID: 21536321
Asthma; Urban; Cockroach; Mouse; Dust mite; Allergy
20.  Frequently asked questions in allergy practice 
Asia Pacific Allergy  2014;4(1):48-53.
Background
Over the last 10-20 years, international guidelines and consensus statements for the management of common allergic diseases (e.g. allergic rhinitis and asthma) have been developed and disseminated worldwide. However, their impact on knowledge and standard of clinical practice among primary care physicians and specialists is unknown.
Objective
To investigate need for an improvement in the dissemination of international guidelines for the diagnosis and management of allergic rhinitis.
Methods
Seven medical students who attended 3-day 1st International Basic Allergy Course (2010) took down all questions raised during the entire course. A systemic analysis of these questions was performed to identify areas for improvement in diagnosis and management of allergic diseases mainly in the Association of Southeast Asian Nations (ASEAN) region.
Results
268 participants, 143 males and 125 females, comprising Ear, Nose and Throat (ENT) specialists (n = 106) and trainees (n = 34), general practitioners (n = 87), and other healthcare professionals (n = 41) attended the course. Of the 103 questions recorded, 59 were regarding treatment modalities in allergy practice such as immunotherapy (n = 38), pharmacologics (n = 15), nasal surgery (n = 2), and others (n = 4). 41 questions (39.8%) have answers based in the Allergic Rhinitis and its Impact on Asthma guidelines (2001 and 2008). Certain questions were selected for further analysis because they appeared to be (a) more commonly asked (e.g. immunotherapy) or (b) were deemed to be challenging or, even controversial (e.g. food allergy and differential diagnosis between vasovagal and anaphylaxis reaction), as the recommendations in current international guidelines were less well-defined.
Conclusion
Our study identified several problems that, if tackled, could help minimize confusion and provide better care for patients suffering from allergic diseases especially in the ASEAN region.
doi:10.5415/apallergy.2014.4.1.48
PMCID: PMC3921870  PMID: 24527411
Allergic diseases; International guidelines; Management; Immunotherapy; Vasovagal and anaphylaxis reaction; Food allergy
21.  Dunno if you've any plans for the future: medical student indirect questioning in simulated oncology interviews 
Background
This exploratory study investigated the motives of medical students (N = 63) for using indirect questions of the type I don't know if [you have already heard about chemotherapies], I don't know how [you are], or I don't know what [you do for a living] in simulated patient interviews during a communication skills course.
Methods
I don't know questions (IDK-Qs) were observed during the initial evaluation of students' communication skills; they were systematically identified through video screening and subjected to a qualitative content and discourse analysis considering their context, their content, their intent and their effect on the simulated patients. To evaluate the specificity of medical students' IDK-Qs, the data were compared with a data set of oncologists (N = 31) conducting simulated patient interviews in the context of a Communication Skills Training (CST).
Results
During the interviews, 41.3% of the students asked 1-6 IDK-Qs. The IDK-Qs were attributed to three content categories: medical/treatment questions (N = 24); lifestyle/psychosocial questions (N = 18); and "inviting questions" questions (N = 11). Most of the IDK-Qs had an exploratory function (46/53), with simulated patients providing detailed responses or asking for more information (36/53). IDK-Qs were rare in the oncologist sample compared to the student sample (5 vs. 53 occurrences).
Conclusions
IDK-Qs showed a question design difference between medical students and oncologists in simulated patient interviews. Among other reasons for this difference, the possible function of IDK-Qs as a protective linguistic strategy and marker for psychological discomfort is discussed.
doi:10.1186/1472-6920-12-8
PMCID: PMC3310746  PMID: 22385555
22.  342 Epidemiology of Atopic Dermatitis in the Allergy Service of a Third Level Medical Center 
Background
The creation of an Allergy service was required because of the high frequency of allergic diseases among paediatric population in the general consultation of a third level medical centre.
Objective
The purpose of this study is to report the cases of Atopic Dermatitis (AD) in the Allergy service from a Third level medical centre since its creation in July 2005.
Methods
This is a descriptive, retrospective, transversal study from July 2005 to February 2011. Selected medical records of patients, some records supplied by the Dermatology service, applied for diagnostic criteria for an allergy disease. The EAACI/AAAI/PRACTALL/ 2006 guide was used to make diagnosis of AD. Patients were classified by age and sex and find out how many skin prick test were made in such patients, and how many patients began immunotherapy.
Results
Thirteen thousand seven hundred thirty seven consultations were attended in the Allergy service between the time period mentioned above. Two thousand three hundred thirty seven medical records of patients were selected, 1608 patients applied for a specific diagnosis for an allergy diseases as follows:
Asthma 411; atopic conjuctivitis 58; atopic dermatitis 180; allergic rhinitis 869; and urticaria 90.869 patients completed criteria for allergic rhinitis.
From 180 patients with diagnosis of AD, 111 (61.6%) patients were female, 69 (38.4%) patients were male. Ninety six (53.3%) patients were found to be in the range of 0 to 9 years. The mayority of atopic dermatitis patients were females in the range of 0 to 14 years, with 82 (45.5%) patients.
There was an increase of atopic dermatitis cases in females in the range of 30 years compared with males (F 10/ M 3). In 111 patients with DA skin prick test were made, only in 76 (42%) patients were positive and began treatment with immunotherapy.
Conclusions
In this study, AD represents the third cause of allergy disease in frequency among children. AD requires interdisciplinary management because of dermatological and allergological aspects for treatment, including immunotherapy. Education of parents and patients is also an important task in the treatment of AD. The results of this study are helpful to improve specialized medical attention in paediatric patients and adults with AD.
doi:10.1097/01.WOX.0000412105.65354.ab
PMCID: PMC3513176
23.  Early detection of allergic diseases in otorhinolaryngology 
Asthmatic diseases have been reported since the ancient world. Hay fever for instance, was described for the first time in the late 18th century, and the term “allergy” was introduced about 100 years ago. Today the incidence of allergies is rising; almost one third of the Western population suffers from its side effects. Allergies are some of the most chronic medical complaints, which results in high health expenditures. Therefore, they have a large health and political relevance.
Caused by genetic and environmental factors, the group of IgE mediated allergies is large. It consists of e.g. atopic dermatitis, allergic asthma or allergic rhinitis. This paper aims to emphasize the ways of early diagnosis of allergic rhinitis (AR) as AR represents the most important representative of allergic diseases in ENT.
doi:10.3205/cto000049
PMCID: PMC3199832  PMID: 22073091
allergic rhinitis; atopic/allergic diseases; in vitro-diagnosis; specific immunotherapy
24.  The Study of Egg Allergy in Children With Atopic Dermatitis 
Context
Food allergy plays a significant pathogenic role among children with atopic dermatitis (AD).
Objective
The aims of this study were to evaluate allergy to egg in these children and determine the egg specific immunoglobulin E (IgE) cutoff point.
Design and Setting
It was a cross-sectional study that took place at Immunology, Asthma and Allergy Research Institute from 2005 to 2007.
Methods
Children younger than 14 years old with AD entered the study. Careful medical histories were taken and skin prick and Immuno-CAP tests with the most commonly offending foods (cow's milk, egg, wheat, peanut, and soy) were performed. Children with a clear, positive history of food allergy and a positive IgE-mediated test or those with positive responses to both IgE-mediated tests were determined to have food allergies. The egg-specific IgE level cutoff point was determined.
Results
A hundred patients entered the study (from 2 months to 12 years old). They were divided into 3 age groups: first <2 years, second from 2 to <6 years, and third from 6 to 14 years. The most common food allergens were egg (39.22%) in the first, cow's milk (35.13%) and egg (32.43%) in the second, and peanut (25%) and egg (16.67%) in the third group. The egg-specific IgE cutoff point value was 0.62 kUA/L (kilounits of allergen-specific IgE per liter). The positive predictive value was 95%.
Conclusion
Prevalence of egg allergy is highly significant in patients with AD.To use egg-specific IgE level cutoff point, the patient population under study must be considered.
doi:10.1097/WOX.0b013e3181abe7cb
PMCID: PMC3650957  PMID: 23283060
egg allergy; atopic dermatitis; food allergy; specific IgE cutoff point
25.  Comparison of prevalence and severity of asthma among adolescents in the Caribbean islands of Trinidad and Tobago: results of a nationwide cross-sectional survey 
BMC Public Health  2005;5:96.
Background
Asthma is a growing problem in the Caribbean but the prevalence in most islands is unknown and possible inter-island variation in prevalence has not been determined. A nationwide cross-sectional survey was conducted to compare the prevalence of asthma symptoms among high school students in the two islands of the Republic of Trinidad and Tobago.
Methods
Questionnaire and video instruments based on those developed by the International Study of Asthma & Allergy in Childhood (ISAAC) were used to assess asthma prevalence among 6394 children (age range, 11–19 years; mean age, 14.08 yrs) in the second and third years of 35 randomly selected high schools in Trinidad and Tobago. This cross sectional survey was conducted between September and December 2002.
Results
A total of 4988 questionnaires were available for analysis (3519 in Trinidad and 1469 in Tobago). Among respondents from the two islands, there were no significant differences in the prevalence of ever wheezing (24.1% and 24.3% for Trinidad and Tobago, respectively, RR 0.99, 95% CI, 0.90–1.08); wheezing in the previous 12 months (13.1% & 13.4%, RR 0.98, 95% CI 0.84–1.15); a previous or current diagnosis of asthma (12.8% & 13.5%, RR 0.95, 95% CI 0.82–1.12) and night cough in the past 12 months (35.4% & 38.3%, RR0.93, 95% CI 0.86–1.00). However, symptoms of severe asthma were significantly more common among students from Tobago and included having had more than one acute attack in the past year (13.4% & 15.8%, RR 0.85, 95% CI 0.73–1.00, p = 0.0004), night waking as a result of wheeze (7.4% & 10.9%, RR 0.68, 95% CI 0.56–0.83, p < 0.0001) and speech limitation in the past year (5.2% & 8.7%, RR 0.59, 95% CI 0.47–0.74, p < 0.001) Exercise-associated wheezing was also more frequent among Tobagonian adolescents (17.5% & 20.2%, RR 0.87, 95% CI 0.76 – 0.98, p = 0.04).
Conclusion
Self-reported wheeze is common among adolescents in Trinidad and Tobago. Variation in symptoms was found between the two territories; high school students from Tobago, the less industrialized of the two islands, reported more symptoms of severe asthma and exercise-induced wheeze. Difference in the ethnic composition rather than socio-economic factors may be contributing to the observed differences in symptom prevalence.
doi:10.1186/1471-2458-5-96
PMCID: PMC1249582  PMID: 16162294

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