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"Child`s Health" 6 (66) 2015

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Clinical and Diagnostic Features of Bronchial Asthma in Children on the Background of Latent Food Allergy

Authors: Levytskyi V.M., Yurchyshena E.V., Yurchyshen O.M., Mysko L.V., Mysko Yu.L. - Khmelnytskyi Municipal Children’s Hospital, Khmelnytskyi, Ukraine

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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Summary

На підставі клініко-параклінічного обстеження 112 дітей, хворих на бронхіальну астму, вивчено особливості її перебігу на фоні харчової алергії. Встановлено, що лише сукупність клініко-параклінічних ознак є найбільш значущою для діагностики бронхіальної астми у дітей на фоні замаскованої харчової алергії.

На основании клинико-параклинического обследования 112 детей, больных бронхиальной астмой, изучены особенности ее течения на фоне пищевой аллергии. Установлено, что только совокупность клинико-параклинических признаков является наиболее значимой для диагностики бронхиальной астмы у детей на фоне скрытой пищевой аллергии.

Based on clinical and paraclinical examination of 112 children with bronchial asthma, there were studied the features of its course against the background of food allergy. It was found that only a set of clinical and paraclinical signs is the most important for the diagnosis of bronchial asthma in children on the background of latent food allergy.


Keywords

діти, бронхіальна астма, харчова алергія, інтоксикація, гіпоксія, бронхообструктивний синдром.

дети, бронхиальная астма, пищевая аллергия, интоксикация, гипоксия, бронхообструктивный синдром.

children, bronchial asthma, food allergy, intoxication, hypoxia, broncho-obstructive syndrome.

Introduction

Food allergies (AD) affects morbidity and mortality, speaking home sign "allergic march" [3]. Typical food hypersensitivity reactions are difficult nature of the possible lethal consequences. Clinical manifestations of AD can be isolated and act as part of a generalized anaphylactic reaction [4]. The most common reaction to HA is cutaneous manifestations of acute urticaria or angioedema to koropodibnoho itchy rash. Respiratory manifestations of AD are characterized by rhinorrhea, sneezing, itchy eyes, bronchospasm, laryngeal edema. Violation of bronchial obstruction as a result of chronic persistent allergic inflammation of the bronchial tree [2], which determines the course of asthma is one of the most common clinical signs of AD, when as provoking factors are the components of food [5]. And despite the fact that potential allergens can be many types of foods and their components [6], in fact, food allergies is the result of only a few of them [7]. Diagnosis of asthma in early childhood and most complex should be based on the clinical picture, assessment of symptoms and physical data [8 - 10]. An effective method of confirmation of the diagnosis of asthma in children is a trial therapy bronchodilators and inhaled glucocorticosteroids. The clinical improvement during treatment and after discontinuation of deterioration suggests asthma.

Results

The clinical diagnosis of asthma in children is based on identifying symptoms such as episodic expiratory dyspnea, whistling wheezing, chest compression, cough. Diagnosis of asthma in children, especially at an early age is very difficult, because periodic episodes of bronchial obstruction may be a manifestation of different respiratory pathologies (cystic fibrosis, gastro - oesophageal reflux, foreign body in the trachea and bronchi, malformations, dysfunction tsiliarnoho epithelium compression of mediastinal tumor or enlarged thymus). Based on the identified clinical features of asthma in the background HA, imagined advisable to examine their diagnostic value and epidemiological indicators of risk as a test for the detection of concealed HA on admission to hospital.

Thus, none of the studied severity of clinical signs BOS at admission to hospital of children are not appropriate sufficient sensitivity and / or specificity in the detection of concealed HA. Although probably slightly but raised as attributive risk and proportionality chance to identify HA in the presence of these patients we studied traits, except for impairment of consciousness and combinations of whistling wheeze expiratory dyspnea. The remaining factors are "clinical scoring system airflow obstruction in young children" [1], we also evaluated, but they were even more specific and sensitive in statistically improbable increase the risk of detection in patients disguised HA.

Discussion

Thus, the detection of concealed HA above clinical signs, taken separately, were unsuitable. Therefore, proposed by constellations most important indicators form three main groups syndromolohichni that would vidobrazhuvaly:

(1) "intoxication" - disturbed state of consciousness, decreased muscular tone, hepatosplenomegaly, tachycardia, which does not correspond to the temperature of the body;

(2) hypoxia - cyanosis, respiratory rate above age norms, arrhythmic breathing, chest retraction, inspiratory wheezing;

(3) broncho-obstructive syndrome - cough, value inhale / exhale, percussion box shade sound whistling expiratory wheezing.

Thus, in assessing the severity konstelyatsiynoyu system status of children with asthma found that 1 -, 4 - and and 7 - days of hospitalization of patients and severity group was significantly higher compared with their peers who were second clinical group . The pace of recovery will patients of the main group were faster, and 4 - day stay in hospital the severity of the general condition decreased by an average of 10 points, while the second group of patients - only 3.8 points. However, in the future, reducing the severity of the condition occurred with approximately the same rate, although the seventh day of hospitalization status of the patient and the group was difficult.

We investigated differences in the distribution of the incidence of severe state of patients comparing groups 1, 4 and 7 days relative to the average for their ballroom indicator of severity. Thus, 1 - day average severity of the general condition of patients and the group was 18,3 ± 1,9 points. The number of patients whose condition was estimated at 18 or more points in Group amounted to 53,6 ± 4,7%, while in the second group - 42,2 ± 3,7% of observations (P <0.05). Indicators of clinical risk -epidemiolohichnoho presence of HA disguised in children whose condition for 1 day at 18 points and above were as follows: AR = 12%, RR - 1,27 (95% CI: 1,0 - 1,6) i OR - 1.58 (95% CI: 0,9 - 2,7), χ2 = 3,1 P <0.05. On the fourth day of treatment was considered more serious condition of children and groups with an average of 10,1 ± 1,5 points. The number of patients of group, the severity of the general condition in which the fourth day was estimated at 10 points and above, was 53,6 ± 4,7%, while in the second group of children was 27,5 ± 4,3% (P <0 , 05). Indicators of clinical - epidemiological risk detection masked food allergy in these patients were more significant and equal to: AR - 27%, RR - 1,68 (95% CI: 1,2 - 2,4), OR - 3,04 (95 % CI: 1,8 -5,3), χ2 = 17,0, P <0,001. 7 night stay in hospital the average severity of the general condition of the patient and the group was 5,1 ± 0,6 points, so we evaluated differences in the distributions of gravity equal to 6 points. Thus, the seventh day of treatment in the evaluation of patients with 6 points or higher and clinical group was 58,9 ± 4,6%, and in the second - 42,2 ± 4,7% of cases (P <0.05) . Indicators epidemiological risk detection masked food allergy in children with asthma, severity of the general condition of which was assessed on day 7 and 6 points above, the following: AR - 17%, RR - 1,4 (95% CI: 1,1 - 1,8), OR - 1,97 (95% CI: 1,1 - 3,4), χ2 = 7,5, P <0,01.

Thus, it should be noted that children with AD, BA course is also characterized by greater severity and longer overall condition at a rapid pace dezobstruktsiyi, characterized by a predominance of patients with indicators scoring above serednohrupovu 4 - and 7 - days of hospitalization. This may reflect the relative resistance of these patients to conventional treatment without the need for elimination activities.

We also studied the diagnostic value relative to detect HA components conventionally selected our clinical syndrome. Thus, the greatest risk of having concealed HA Signs of hypoxia on admission to the hospital accompanied by signs of inspiratory dyspnea. In particular, AR was 28%, RR - 0,5 (95% CI: 0,3-0,9), OR- 0,3 (95% CI: 0,2-0,6), χ2 = 3,6 , P <0.05. Signs conventionally called "intoxication syndrome" - tachycardia had the following risk indicators epidemiolihichnoho presence of HA: AR = 24%, RR = 1,5 (95% CI: 1,0-2,3), OR = 2,74 (95% CI: 1,5-4,9), χ2 = 6,9, P <0.01. Indicators of bronchial obstruction greatest diagnostic value in detecting the presence of HA had expiratory wheezes: AR = 40%, RR = 2,1 (95% CI: 1,4-3,3), OR = 5,6 (95% CI: 3,0-10,5), χ2 = 32,7, p <0.001.

Thus, in the presence of hypoxia treatment in a test vyvlenni HA decreased the sensitivity, while growing and acquiring the probability of such qualities as specificity, predictive value and clinical indicators - epidemiological significance. This suggests that the presence of 7 days, the treatment of the signs of hypoxemia in patients with asthma patients with sufficient specificity testifies to the presence of a cause - significant allergen that supports conservation severity of general condition, one of which should be considered as food allergens requiring correction traditional treatment of asthma napadnoho period.

So that when evaluating hipoksemichnyh and signs, the presence of biofeedback in the treatment of a test in the detection of AD gradually lose sensitivity and specificity and gained credibility, although epidemiological indicators of risk decreased. In our opinion, it is connected with positive shifts in clinical asthma attack perebizi influenced by traditional dezobstruktyvnoyi therapy reduced the diagnostic significance of BOS in detecting AD, and a large proportion of both false positive and false negative results of this test for 4 and 7- day hospitalization vykorysovuvaty allows it to identify HA.

However, the likely clinical - epidemiological significance in detecting signs of AD conventionally called "intoxication syndrome" (impaired consciousness, m`yazeva hypotension, tachycardia, hepatosplenomegaly) had only a 4 night stay in hospital. Thus, as a test for the detection of HA, the syndrome on the 4th day of treatment had the following risk indicators: Se -63,4%, Sp - 48,6%, PV (+) - 55,9%, PV (-) - 56,1%, Acc - 56,1%, Prev - 50,7%, AR = 12%, RR = 1,27 (95% CI: 1,0-1,6), OR = 1,6 (95 % CI: 1,0-2,7), χ2 = 4,3, P <0.05. But, as in the previous cases, the 7th day of treatment specificity of this test in detecting HA increased to 83.5% and the sensitivity decreased to 21.4%, the positive predictive value was 57.1% and the negative - 50 8%, the accuracy of the method - 52.0%, and the prevalence - 50.7%.

That is typical for both groups was faster dezobstruktsiya combined with preservation syndromes "intoxication" bronchial obstruction and hypoxia, which may have explained at admission trofalerheniv undiagnosed AD children who did not receive elimination diet. In our opinion, this might be explained by high specificity in detecting the presence of HA masked clinical symptom during treatment in the hospital.

Thus, the signs of "intoxication" syndrome and / or hypoxemia stored in the treatment of patients with asthma may with sufficient specificity and accuracy mediocre used as a test to detect them masked food allergy. This, in our opinion, requires staged (at 4 and 7 days) the severity of the general condition of patients by konstelyatsiynoyu point system to address the possibility of a causal role in the development of BOS food allergies and appropriate correction treatment strategy.

Conclusions

1. In a food allergy detection of concealed some clinical signs were useless.

2. Children with food allergies course of asthma is characterized by greater severity and longer overall condition at a rapid pace dezobstruktsiyi,

3. Symptoms "intoxication" syndrome and / or hypoxemia stored in the treatment of patients with asthma may with sufficient specificity and accuracy mediocre used as a test for the detection of concealed them in a food allergy.


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