All posts by petergreally

In this months Clinical Microbiology Reviews 2012, 25;(1):164-92, Dogget and co-workers review the unexplained worldwide resurgence in Cimex lecticularis (Bed bugs) blood sucking insects. Unless the bug burden is very high they may not always be visible. They can cause skin lesions which may mimic urticaria and other forms of dermatitis. Proteins from their gut wall are allergenic in humans and may cause asthma symptoms akin to more common dust mite. Skin test reactivity to their allergens has been described. Sounds disgusting ! but  the author has seen at least one case last year where asthma was triggered by these insects.

These new guidelines were released this month  (Dec 2011) by the UK’s National Institute for Clinical Excellence. Their expert panel reviewed all the available evidence on anaphylaxis for adults and children. The main recommendations regarding children are summarised as follows :

1) Children younger than 16 years who have had emergency treatment for suspected anaphylaxis should be admitted to hospital under the care of a paediatric medical team.

 2) After emergency treatment for suspected anaphylaxis, parents of children should be offered a referral to a specialist allergy service consisting of healthcare professionals with the skills and competencies necessary to accurately investigate, diagnose, monitor and provide ongoing management of, and patient education about, suspected anaphylaxis.

3) After emergency treatment for suspected anaphylaxis, individuals should be offered (or, as appropriate, their parent and/or carer) an appropriate adrenaline injector as an interim measure before the specialist allergy service appointment. Guidelines are available at http://guidance.nice.org.uk/CG134/Guidance/pdf/English

This book covers all aspects of asthma in an accesible Q&A style. Do you know someone who has a child with asthma ? or does your child have asthma. ? Consider buying this book. Published by Liberties Press, it is available in all good bookstores now and on-line RRP Euro 12.99. All royalties will go to the Asthma Society of Ireland.

Obese Children Have More Asthma Attacks !
Reuters recently reported a study published online in the Journal of Allergy and Clinical Immunology showing that heavier children with asthma tended to need more prescriptions for rescue inhalers as well as daily inhalers compared to non-obese children. The researchers speculated that obese children may feel more heaviness in their lungs, leading to the need for more reliever medication. or perhaps they do not respond as well to inhaled steroids as wells as others. It can be embarassing for a parent to be told that their child is overweight/obese. However, weight management must be a key component of a holistic asthma management plan in this situation.

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An interesting study published recently in the American Journal of Respiratory & Critical Care Medicine evaluated vitamin D status and its effect on asthma in children with severe treatment-resistant asthma.  Relationships between serum vitamin D, lung function,and pathology were investigated. Vitamin D levels were significantly lower in the treatment-resistant group compared to controls. There was a positive correlation between Vitamin D levels and  lung function and the asthma control test in all subjects. Vitamin D levels were inversely associated with asthma attacks and  dose of inhaled steroid . The link between Vitamin D and airway function suggests that Vitamin D supplementation may be useful in paediatric asthma where levels are deficient or insufficient.  Another study published earlier this year on asthmatic children from Poland demonstrated some interesting trends. Those children who received Vitamin D supplement at a dose 500iu daily as well an inhaled steroid appeared to have better outcomes in terms of asthma control compared to children who received the inhaled steroid alone. However this study size was small and the dose of Vitamin D quite low. Further large scale studies are underway and at the time of writing, routine supplementation with Vitamin D cannot be routinely recommended for improving asthma control