Asthma risk is lower after wheezing associated with respiratory syncytial virus (RSV) than with non-RSV infection in infancy. RSV is the main wheezing-associated virus in infants aged ,6 months. We evaluated the outcome of children hospitalised for bronchiolitis at ,6 months of age, with special focus on viral aetiology and early risk factors.Out of 205 infants hospitalised for bronchiolitis at ,6 months of age, 127 (62%) attended a control visit at a mean age of 6.5 yrs and the parents of an additional 39 children were interviewed by telephone. Thus, follow-up data collected by identical structured questionnaires were available from 166 (81%) children. Viral aetiology of bronchiolitis, studied on admission by antigen detection or PCR, was demonstrable in 97% of cases.Current asthma was present in 21 (12.7%) children: 8.2% in the 110 former RSV patients versus 24% in non-RSV patients (p50.01). 45 (27%) children had ever had asthma. In adjusted analyses, atopic dermatitis, non-RSV bronchiolitis and maternal asthma were independently significant early-life risk factors for asthma.The risk of asthma was lower after RSV bronchiolitis than after bronchiolitis caused by other viruses in children hospitalised at ,6 months of age.
This placebo-controlled, double-blind study confirmed that OIT was effective in desensitizing schoolchildren with CMA. With occasional exceptions, the reached desensitization sustained for more than 3 years.
Though reduced lung function and increased airway reactivity were rather common, evidence for persistent lung function reduction was rare, less than 1%, at preschool age in children hospitalized for bronchiolitis caused mainly by respiratory syncytial virus at age less than 6 months.
Background
The safety and efficacy of long‐term milk oral immunotherapy (OIT) in Finnish children with persistent cow's milk allergy (CMA) were evaluated in an open‐label, non‐randomized study.
Methods
During the 11‐year study, 296 children aged 5 years or older with immunoglobulin E (IgE)‐mediated CMA started milk OIT. Follow‐up data were collected at three time points: the post‐buildup phase, 1 year thereafter, and at the cross‐sectional long‐term follow‐up between January 2016 and December 2017. Patients were divided according to baseline milk‐specific IgE (sIgE) level and by the amount of milk consumption at the long‐term follow‐up. The high‐dose group consumed ≥2 dL of milk daily, while the failure group consumed <2 dL of milk or were on a milk‐avoidance diet.
Results
Out of the initial study group, 244/296 (83%) patients participated in the long‐term follow‐up. Among these patients, 136/244 (56%) consumed ≥2 dL of milk daily. The median follow‐up time was 6.5 years. Of the recorded markers and clinical factors, the baseline milk sIgE level was most associated with maintaining milk OIT (P < 0.001). Respiratory symptoms in the post‐buildup phase increased the risk of treatment failure (OR 3.5, 95% CI: 1.5‐8.1, P = 0.003) and anaphylaxis (OR 14.3, 95% CI: 1.8‐114, P = 0.01).
Conclusion
More than half of the patients were able to maintain the targeted milk dose in their daily diet. Baseline milk sIgE level and reactivity during the early treatment stage strongly predicted the long‐term outcome and safety of milk OIT.
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