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The BAMSE study: Symptoms of asthma in children at four years of age
J ALLERGY CLIN IMMUNOL VOLUME 109, NUMBER 1
81A
Asthma Deaths During Sports: Report of a Seven Year Experi"T
ence
Jack Michael Becker*, James Rogers§, Gregory Rossini§, Haresh Mirchandani*, Gilbert E D'alonzo§ *MCP/Hahnemann University, Philadelphia, PA §Temple University School of Medicine, Philadelphia, PA BACKGROUND: A variety of studies have investigated asthma mortality and the mortality of athletes during sports, but there are no data describing asthma as the cause of death in competitive athletes. METHODS: The Temple Sports Asthma Research Center identified athletes from July 1993 until December 2000 who died during or following sporting activity using the nationwide Burrell's information service. Once a death was identified, a request for a copy of the autopsy was made to the local coroner or medical examiner and an attempt was made to contact the family. The contact with the family was limited to information about the death, past medical history, sports involvement and any medication usage by the person who had died. Also, all verifiable information that was published in news reports were used to determine if the subject died of asthma during or immediately following a sporting activity. RESULTS: Two hundred and sixty-three cases were identified. Sixtyone deaths met criteria for study occlusion. Nearly a two to one ratio of Caucasian to African American, and males to females, were found. The majority of the subjects were under the age of twenty years, with the most prevalent age group being between 10 to 14 years of age. Approximately half (32) Of the subjects were between 13 and 17 years old. Fifty-one percent (18/35) of the athletes had their fatal event while participating in their organized sport with four deaths occurring during a competitive event. Basketball was followed by track/running as the two most frequent activities that were being performed at the time of the fatal event. CONCLUSION: Sudden fatal asthma occurs in both competitive and recreational athletes during or immediately following a sporting activity. These subjects are usually Caucasian males between the ages of ten and twenty years. Females are also reported to be affected, but at a slightly lower number. Mild intermittent or persistent asthma by history was commonly identified.
1 ~ T h e BAMSE Study: Symptoms of Asthma in Children at Four | ~| Years of Age Erik Meldn*, lnger Kull*, Lennart Nordvall§, Grran Pershagen~,, Lena Tollin*, Magnus Wickman* *Department of Environmental Health, Stockholm, Sweden §Institute of Woman and Child Health, Uppsala, Sweden ¥Karolinska Institute, Stockholm, Sweden PURPOSE: To study the prevalence and progress of allergic diseases in a large prospective birth cohort. METHODS: The study is based on 4089 children born in Stockholm, Sweden between 1994-96. The parents have answered questionnaires at the children's birth and at one, two and four years of age. A clinical investigation was performed at four years of age, and blood samples were drawn for immunologic and genetic analyses. Asthma at four years of age was defined as any episode of wheezing after two years of age (at least one of which during the past 12 months) combined either with reported signs of bronchial hyperreactivity or prescription of inhaled steroids. Asthma up to two years of age was defined as at least three episodes of wheezing after three months of age combined either with signs of hyperreactivity without an ongoing cold or prescription of inhaled steroids. RESULTS: The response rate (questionnaire data) at four years of age was 92% (3742 children). The criteria for asthma were fulfilled by 7.9% of the children (60% boys), compared to 5.8 and 3.7% at the age of two and one years, respectively. Of those who fulfilled our criteria for asthma during their first two years, 19% were free both of symptoms and medication at the age of four and 58% did not fulfil the criteria any longer. Heredity for allergic diseases was found in 48% of children with asthma at the age of four
Abstracts
$267
compared to 28% in non-asthmatic children. Any episode of wheezing after two years of age was reported in 17% of the children, 12% reported wheezing triggered by colds (69% of those with asthma) and 6.3% (40% of those with asthma) wheezing triggered by allergen exposure (cat, dog, birch or grass). Treatment in the emergency room for breathing problems after the age of two was reported by 9.5% (52% of those with asthma), 9.3% had received prescription of inhaled [32-agonist and 7.7% of inhaled steroids. CONCLUSIONS: The prevalence of asthma in children at four years of age is in the BAMSE study estimated to 7.9%, of which 45% fulfilled the criteria for asthma up to two years of age. The study will allow further analyses, e.g. of gene-environment interactions, and of risk factors associated with disease development in young children.
Q 1 ~ Negative Patch Tests and Skin Tests in Patients With Delayed U | V Cutaneous Manifestation to Penicillins Marie-Noel Prirneau*, Robert G Hamilton§, Elizabeth Whitmore~, A RomanoV, N Franklin Adkinson Jr§ *Johns Hopkins University School of Medicine, Baltimore, MO §Johns Hopkins University School of Medicine, Balitmore, MD ¥Johns Hopkins University School of Medicine, Baltimrore, MD ~Catholic University, Rome, Italy BACKGROUND: Delayed-type hypersensitivity reactions in the skin to penicillin and aminopenicillins are common. Patch tests and delayed reading of intradermal skin tests have been reported as effective diagnostic tools for delayed cutaneous immunologic drug reactions. Most of these studies have been conducted in Europe. OBJECTIVE: To determine the incidence of positive patch tests and delayed intradermal skin test responses in American patients with delayed cutaneous immunologic reactions to penicillins. METHOD: Fifteen patients with a history of delayed cutaneous reaction to penicillins within the past 5 years provided consent and underwent intradermal skin tests in duplicate with penicilloyl-polylysine (Pre-Pen®), benzylpenicillin (10 000IU/nfl), ampicillin (3 mg/ml), amoxicillin (3 mg/ml), saline-diluent and histamine. Skin tests were read at 15 minutes, 48 hrs and 72 hrs. Patch tests were performed in duplicate with benzylpenicillin (10 000, 50 000 and 200 000 IU/g in petroleum jelly [PJ]), ampicillin (5% and 50%w/w in PJ) and amoxicillin (5% and 50%w/w in PJ). Patch tests were removed after 48 hrs and read 30 minutes and 24 hours later. Cutaneous reaction characteristics: Amoxicillin was involved in the reported reactions in 9 cases (60%), amoxicillin/clavulanic acid in 3 cases (20%), and non-identified penicillins in 3 cases (20%). The mean time interval between the cutaneous reaction and testing was 34.5 +/- 23.2 months. The mean time interval between the start of treatment and the onset of the cutaneous reaction was 5.0 +/- 3.0 days. The mean duration of the cutaneous reaction was 5.0 +/- 4.1 days. The reaction consisted of a maculopapular rash in 7 (50%) subjects, urticaria in 2 (13%), a mixture of urticaria and maculopapular eruptions in 3 (20%), and generalized erythema in 3 (20%). Four patients were treated with systemic steroids, 3 with topical steroids, 4 with anti-histamines, and 4 received no treatment. RESULTS: One subject had equivocal puncture skin tests to all the reagents including the saline control and intradermal skin tests were not performed. Patch tests and delayed reading of intradermal skin tests were negative in all patients. Five subjects were re-tested within a 6 months period with a European source of amoxicillin (Velamox, SmithKline Beecham) both by intradermal skin tests (3 mg/ml and 20 mg/ml amoxicillin) and patch tests (5% and 50%w/w amoxicillin in PJ). The results remained negative. CONCLUSION: Our results differ from European studies where 50% of patients with penicillin-induced delayed maculopapular rash had positive patch tests and/or delayed skin test responses. More studies are needed to determine the clinical utility of delayed-reading penicillin skin tests and patch tests in the diagnosis of delayed cutaneous reactions to ~-lactam antibiotics.
81A
Asthma Deaths During Sports: Report of a Seven Year Experi"T
ence
Jack Michael Becker*, James Rogers§, Gregory Rossini§, Haresh Mirchandani*, Gilbert E D'alonzo§ *MCP/Hahnemann University, Philadelphia, PA §Temple University School of Medicine, Philadelphia, PA BACKGROUND: A variety of studies have investigated asthma mortality and the mortality of athletes during sports, but there are no data describing asthma as the cause of death in competitive athletes. METHODS: The Temple Sports Asthma Research Center identified athletes from July 1993 until December 2000 who died during or following sporting activity using the nationwide Burrell's information service. Once a death was identified, a request for a copy of the autopsy was made to the local coroner or medical examiner and an attempt was made to contact the family. The contact with the family was limited to information about the death, past medical history, sports involvement and any medication usage by the person who had died. Also, all verifiable information that was published in news reports were used to determine if the subject died of asthma during or immediately following a sporting activity. RESULTS: Two hundred and sixty-three cases were identified. Sixtyone deaths met criteria for study occlusion. Nearly a two to one ratio of Caucasian to African American, and males to females, were found. The majority of the subjects were under the age of twenty years, with the most prevalent age group being between 10 to 14 years of age. Approximately half (32) Of the subjects were between 13 and 17 years old. Fifty-one percent (18/35) of the athletes had their fatal event while participating in their organized sport with four deaths occurring during a competitive event. Basketball was followed by track/running as the two most frequent activities that were being performed at the time of the fatal event. CONCLUSION: Sudden fatal asthma occurs in both competitive and recreational athletes during or immediately following a sporting activity. These subjects are usually Caucasian males between the ages of ten and twenty years. Females are also reported to be affected, but at a slightly lower number. Mild intermittent or persistent asthma by history was commonly identified.
1 ~ T h e BAMSE Study: Symptoms of Asthma in Children at Four | ~| Years of Age Erik Meldn*, lnger Kull*, Lennart Nordvall§, Grran Pershagen~,, Lena Tollin*, Magnus Wickman* *Department of Environmental Health, Stockholm, Sweden §Institute of Woman and Child Health, Uppsala, Sweden ¥Karolinska Institute, Stockholm, Sweden PURPOSE: To study the prevalence and progress of allergic diseases in a large prospective birth cohort. METHODS: The study is based on 4089 children born in Stockholm, Sweden between 1994-96. The parents have answered questionnaires at the children's birth and at one, two and four years of age. A clinical investigation was performed at four years of age, and blood samples were drawn for immunologic and genetic analyses. Asthma at four years of age was defined as any episode of wheezing after two years of age (at least one of which during the past 12 months) combined either with reported signs of bronchial hyperreactivity or prescription of inhaled steroids. Asthma up to two years of age was defined as at least three episodes of wheezing after three months of age combined either with signs of hyperreactivity without an ongoing cold or prescription of inhaled steroids. RESULTS: The response rate (questionnaire data) at four years of age was 92% (3742 children). The criteria for asthma were fulfilled by 7.9% of the children (60% boys), compared to 5.8 and 3.7% at the age of two and one years, respectively. Of those who fulfilled our criteria for asthma during their first two years, 19% were free both of symptoms and medication at the age of four and 58% did not fulfil the criteria any longer. Heredity for allergic diseases was found in 48% of children with asthma at the age of four
Abstracts
$267
compared to 28% in non-asthmatic children. Any episode of wheezing after two years of age was reported in 17% of the children, 12% reported wheezing triggered by colds (69% of those with asthma) and 6.3% (40% of those with asthma) wheezing triggered by allergen exposure (cat, dog, birch or grass). Treatment in the emergency room for breathing problems after the age of two was reported by 9.5% (52% of those with asthma), 9.3% had received prescription of inhaled [32-agonist and 7.7% of inhaled steroids. CONCLUSIONS: The prevalence of asthma in children at four years of age is in the BAMSE study estimated to 7.9%, of which 45% fulfilled the criteria for asthma up to two years of age. The study will allow further analyses, e.g. of gene-environment interactions, and of risk factors associated with disease development in young children.
Q 1 ~ Negative Patch Tests and Skin Tests in Patients With Delayed U | V Cutaneous Manifestation to Penicillins Marie-Noel Prirneau*, Robert G Hamilton§, Elizabeth Whitmore~, A RomanoV, N Franklin Adkinson Jr§ *Johns Hopkins University School of Medicine, Baltimore, MO §Johns Hopkins University School of Medicine, Balitmore, MD ¥Johns Hopkins University School of Medicine, Baltimrore, MD ~Catholic University, Rome, Italy BACKGROUND: Delayed-type hypersensitivity reactions in the skin to penicillin and aminopenicillins are common. Patch tests and delayed reading of intradermal skin tests have been reported as effective diagnostic tools for delayed cutaneous immunologic drug reactions. Most of these studies have been conducted in Europe. OBJECTIVE: To determine the incidence of positive patch tests and delayed intradermal skin test responses in American patients with delayed cutaneous immunologic reactions to penicillins. METHOD: Fifteen patients with a history of delayed cutaneous reaction to penicillins within the past 5 years provided consent and underwent intradermal skin tests in duplicate with penicilloyl-polylysine (Pre-Pen®), benzylpenicillin (10 000IU/nfl), ampicillin (3 mg/ml), amoxicillin (3 mg/ml), saline-diluent and histamine. Skin tests were read at 15 minutes, 48 hrs and 72 hrs. Patch tests were performed in duplicate with benzylpenicillin (10 000, 50 000 and 200 000 IU/g in petroleum jelly [PJ]), ampicillin (5% and 50%w/w in PJ) and amoxicillin (5% and 50%w/w in PJ). Patch tests were removed after 48 hrs and read 30 minutes and 24 hours later. Cutaneous reaction characteristics: Amoxicillin was involved in the reported reactions in 9 cases (60%), amoxicillin/clavulanic acid in 3 cases (20%), and non-identified penicillins in 3 cases (20%). The mean time interval between the cutaneous reaction and testing was 34.5 +/- 23.2 months. The mean time interval between the start of treatment and the onset of the cutaneous reaction was 5.0 +/- 3.0 days. The mean duration of the cutaneous reaction was 5.0 +/- 4.1 days. The reaction consisted of a maculopapular rash in 7 (50%) subjects, urticaria in 2 (13%), a mixture of urticaria and maculopapular eruptions in 3 (20%), and generalized erythema in 3 (20%). Four patients were treated with systemic steroids, 3 with topical steroids, 4 with anti-histamines, and 4 received no treatment. RESULTS: One subject had equivocal puncture skin tests to all the reagents including the saline control and intradermal skin tests were not performed. Patch tests and delayed reading of intradermal skin tests were negative in all patients. Five subjects were re-tested within a 6 months period with a European source of amoxicillin (Velamox, SmithKline Beecham) both by intradermal skin tests (3 mg/ml and 20 mg/ml amoxicillin) and patch tests (5% and 50%w/w amoxicillin in PJ). The results remained negative. CONCLUSION: Our results differ from European studies where 50% of patients with penicillin-induced delayed maculopapular rash had positive patch tests and/or delayed skin test responses. More studies are needed to determine the clinical utility of delayed-reading penicillin skin tests and patch tests in the diagnosis of delayed cutaneous reactions to ~-lactam antibiotics.