Current opinion in pediatrics
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This review discusses recent literature that has focused on the epidemiology, clinical and laboratory evaluation and treatment of episodes of acute illnesses associated with fever and also of prolonged episodes of fever in children. ⋯ In the review period, there was a particular emphasis on invasive disease caused by S. pneumoniae and the impact of vaccination with conjugated pneumococcal vaccine, on the occurrence of serious bacterial infection in febrile infants with RSV infections, and on the broad spectrum of diagnoses in children with prolonged fever in varying geographic locales.
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Bronchiolitis is a very common and potentially serious respiratory disease of young children. To date, there is not a single, widely practiced, evidence-driven treatment approach. This review summarizes important recently published studies on the treatment of acute bronchiolitis for both outpatients and hospitalized children. ⋯ The routine and repetitive use of bronchodilators, epinephrine, or corticosteroids to treat bronchiolitis in the absence of demonstrated clinical benefits for individual patients is not justified.
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Curr. Opin. Pediatr. · Dec 2004
ReviewUnderstanding asthma pathogenesis: linking innate and adaptive immunity.
Treatment and even prevention of allergic asthma will require a detailed understanding of disease pathogenesis and in particular identification of factors that govern T-helper type 2 (Th2) immunity. This review defines the priming and differentiation steps necessary to develop antiallergen Th2 immunity and highlights recently identified stimuli that satisfy these requirements. ⋯ The adaptive immune system cannot initiate a response without the "permission" of the innate immune system, and this holds true for Th2 responses to aeroallergens, although induction of Th2 immunity in response to TLR signaling varies with the type and dose of TLR ligand. However, under conditions of ongoing Th2 inflammation, the adaptive immune system can act as its own adjuvant and provide the necessary activating signals to initiate an immune response to foreign protein antigens. This may be the mechanism underlying the clinically observed phenomenon of polysensitization in atopic patients and provides another therapeutic target in asthma.