Allergologia et immunopathologia
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Allergic diseases, particularly asthma and asthma equivalents, are among the most frequent disorders seen in the pediatric clinic. Approximately 25% of children from developed countries have presented wheezing in recent years, and half of these children later experience major asthma attacks. Likewise, 25% of children between 8 and 11 years have at some time used beta agonists and at least 10% of them use preventive asthma medication. ⋯ The environmental factors most closely involved in the occurrence of asthma are: diet (early exposure to sensitizing foods); domestic, outside, and occupational seroallergens; pollution (particularly smoking and urban and industrial pollution); and infections, particularly viral infections. In the present study, the methods used for the early identification of children at risk are evaluated, as well as the role of the primary care pediatrician in the early detection of allergic children and the interventions that they carry out. Finally, an analysis is made of the preventive measures that should be taken in children at risk of allergic disease, particularly: 1) increasing awareness of health, 2) reduction of exposure to smoking. 3) reduction of urban and industrial pollution, 4) delayed introduction of certain foods, reduction in the level of domestic allergens, 6) control of infections, and 7) pharmacological measures designed to prevent the occurrence of asthma in children.
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Allergol Immunopathol (Madr) · May 1998
Review[Epidemiology and chronology of allergic diseases and their risk factors].
An increase in allergic diseases in Western societies has been observed in all epidemiological studies. Various risk factors have been invoked to explain this increase, but the results are still inconclusive. We examined the type of patients who visited a hospital pediatric allergology unit in terms of the type of pathology presented, environmental factors, and time from the onset of symptoms until referral for allergy study. ⋯ Therefore, we think that it would be advisable if epidemiological studies would attempt to follow a model, which would facilitate the comparison of studies. Our aim was to evaluate the type of patients who required allergy studies in relation to the pathologies that they present and the different diagnostic methods to determine the presence of false allergies or non-allergies, the delay until study, most frequent pathologies, and environment. We report the data obtained from a sample of 200 children who visited our department for the first time in the period of a natural year.
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The occurrence of allergic diseases depends on genetic and environmental factors. Genetic factors determine individual risk and these persons should undergo early detection. However, the methods currently available (mainly clinical history and IgE in umbilical cord blood) have poor predictive value so their use in the general population is not practical. ⋯ Therefore, several modes of action have been proposed, based mainly on prolonging breast-feeding (with the mother avoiding allergenic foods) and delaying the introduction of complementary foods considered to be a risk. Use of cow milk protein hydrolysates may have a preventive effect similar to that of breast-feeding, but their administration is not problem-free. The preventive effect of partial hydrolysates or soybean formulas is even more questionable.
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The prevalence of atopic dermatitis and other allergic diseases is increasing in industrialized countries. Today we know that atopy is conditioned genetically, but the development of the atopic phenotype requires environmental factors. It is believed that the genetic factors have not changed and that the increased prevalence is due to the increase in exposure to allergenic and non-specific environmental factors. ⋯ At present, pharmacological prevention is being studied, without overlooking environmental prevention, in children at high risk of atopic disease for the purpose of preventing chronic inflammations that will condition their future as adults. In our daily clinical experience, atopic dermatitis is responsible for 8% of visits to a pediatric allergology unit. We emphasize that 62.5% of our patients with dermatitis are referred when they already have bronchial asthma, which represents an important delay in diagnosis with respect to the onset of symptoms.