Skin‐prick testing as a diagnostic aid for childhood asthma

Chan, E. Y.; Dundas, Isobel; Bridge, Pete; Healy, M. J. R.; McKenzie, S A

doi:10.1002/ppul.20227

Cited by 37 publications

(28 citation statements)

References 34 publications

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“…Limited evidence is available regarding the prevalence of sensitisation in preschool children presenting to healthcare workers with wheeze. One study comparing children aged 2-5 yrs with doctor-confirmed wheeze who were responding favourably to a bronchodilator to healthy non-wheezing children found that 32% of wheezy children gave positive skin-prick test results to one or more aeroallergens, compared to 11% of healthy children (likelihood ratio 2.9) [53].…”

Section: Tests Of Sensitisation To Allergensmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

Eur Respir J

750

759

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There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis.Based on the limited evidence available, inhaled short-acting b 2 -agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop.Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit.Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

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Section: Tests Of Sensitisation To Allergensmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

Eur Respir J

750

759

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“…Investigations are also performed to obtain information that may support a diagnosis of asthma. These include tests to confirm atopy [9], such as serum immunoglobulin (Ig)E and the radioallergosorbent test (RAST), assessment of the extent of eosinophilic airway inflammation in bronchoalveolar lavage (BAL) and endobronchial biopsy, and measurement of reticular basement membrane (RBM) thickness in biopsies. This approach is intended to allow subsequent management to be rationalised, with treatment targeted at specific conditions.…”

mentioning

confidence: 99%

Investigation of young children with severe recurrent wheeze: any clinical benefit?

Saglani

Nicholson²,

Scallan³

et al. 2006

Eur Respir J

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The management of young children with severe recurrent wheeze is difficult because symptoms are often refractory to conventional asthma therapy and other diagnoses must be excluded. The present authors aimed to evaluate the outcome of detailed, invasive investigations in such patients.Children aged between 3 months and 5 yrs with severe recurrent wheezing, who had been referred to a tertiary centre, underwent a protocol of investigations including a chest computed tomography scan, blood tests, nasal ciliary brushings, fibreoptic bronchoscopy, bronchoalveolar lavage (BAL), endobronchial biopsy and passage of an oesophageal pH probe.A total of 47 children (25 males) with a median age of 26 (range 5-58) months underwent investigation. Of these, 39% were atopic, two-thirds had evidence of gastro-oesophageal reflux and 37 out of 47 had an abnormal bronchoscopy. Findings included structural abnormalities (13 out of 37), excessive mucus (20 out of 37) and macroscopic inflammation (10 out of 37). BAL revealed bacterial growth in 12 out of 44 (27%) patients. Good quality endobronchial biopsies were obtained from 36 out of 46 (78%) patients; of these, 44% had tissue eosinophila and 28% had a thickened reticular basement membrane.Additional investigations (including bronchoscopy) in young children with severe wheeze may help to identify positive diagnoses and provide information to support a clinical diagnosis of asthma. This hypothesis-generating work should form the basis of future interventional studies.

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“…Kožni testovi izvode se standardnim setom aeroalergena koji su u dobi iznad 5. godina života imaju osetljivost 82% i specifičnost 85% [8].…”

Section: Uvodunclassified

Significance of prick test in asthma diagnosis

Čukalović¹,

Dragica²,

Milovanović³

et al. 2014

Praxis Med

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Astma predstavlja veliki zdravstveni problem širom sveta. Poslednjih decenija je uočen porast u prevalenciji i incidenciji astme u pedijatrijskom uzrastu. To je hronična inflamatorna bolest koja se klinički karakteriše rekurentnim respiratornim simptomima, dispnejom, stezanjem u grudima i kašljem.Simptomi su često praćeni reverzibilnim ograničenjem protoka vazduha kroz disanje puteve. U rutinskoj kliničkoj praksi dijagnostika astme u dečjem uzrastu postavlja se na osnovu anamneze, fizikalnog pregleda, odgovora na bronhodilatatore, alergološkog testiranja i ispitivanja plućnih funkcija. Alergološki testovi su primarna dijagnostička metoda u alergologiji. U kliničkoj dijagnostici se najčešće izvodi prick test (PT), zbog svoje osetljivosti, specifičnosti, reproducibilnosti i dobre korelacije sa nivoom serumskog IgE i bronhijalnom reagibilnošću. Istraživanje je preduzeto s ciljem da se utvrdi učestalost pozitivnog nalaza alergijskih kožnih testova na alergene u dece obolele od astme, obzirom da je alergološko ispitivanje jedan od kriterijuma za postavljanje dijagnoze. Ispitivano je 25-oro dece iz kontrolne grupe i 75-oro dece sa astmom. Podelu na grupe vršili smo prema težini astme i tako oformili tri grupe: deca sa lakom, srednje teškom i teškom astmom. Pozitivne kožne probe uočene su u 44,0% dece u kontrolnoj grupi, 84,0% dece sa lakom astmom, 88,0% dece sa sredenje teškom astmom i kod sve dece sa teškom astmom. Najčešće pozitivne probe su na Dermatophagoides: u grupi dece sa teškom astmom 92,0%, sa srednje teškom astmom 75,0% i sa lakom astmom 63,3%, dok su pozitivni testovi na druge alergene bili zastupljeni u manjem procentu.Ključne reči: astma, prick test, deca UVODAstma je kompleksna i multifaktorijalna bolest u kojoj intereakcijom genetskih faktora i faktora okoline dolazi do složenih patofizioloških zbivanja u organizmkoje podrazumeva složeno delovanje inflamatornih ćelija i medijatora inflamacije na ćelije i tkiva disajnih puteva što dovodi do njihovog suženja i promenljivog ograničenja protoka vazduha. Ona je posebno česta u dece sa porodičnom anamnezom o atopiji. Svako sedmo dete u našoj sredini ima astmu, a svako treće neki oblik alergijske bolesti. Važan faktor u patofiziologiji astme su alergeni unutrašnje i spoljašne sredine, a da bi se razvila alergijska senzibilizacija bitan je kontakt senzibilisane osobe sa alergenom.Od alergena unutrašnje sredine najvažnije su grinje iz porodice Dermatophagoides (koje čine 90% grinja iz kućne prašine), gljivice, buđi, životinjski alergeni. Nova istraživanja ukazuju na mogući protektivni učinak ranog izlaganja životinjskim alergenima [1,2]. Alergija na hranu u odojčeta je češća nego na aeroalergene i manifestuje se na koži i gastrointestinalnom traktu [3]. Pojava alergije na hranu kao riziko faktor za razvoj simptoma astme javlja se tek nakon 4 godine života [4,5]. U kasnijem uzrastu simptomi astme su udruženi sa aeroalergenima.Od alergena spoljašnje sredine u patofiziologiji astme bitni su polen trave, drveća i ambrozije i za njih je karakteristično da se kliničk...

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Skin‐prick testing as a diagnostic aid for childhood asthma

Cited by 37 publications

References 34 publications

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Investigation of young children with severe recurrent wheeze: any clinical benefit?

Significance of prick test in asthma diagnosis

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