Paul L P Brand

..In the future, oral immunotherapy may be a promising new treatment for cow's milk allergy...

..Because of their superior efficacy and excellent long-term efficacy and safety profile, inhaled corticosteroids are the treatment of first choice for the maintenance therapy of childhood asthma, irrespective of age or clinical phenotype...

..If such views, convictions, and choices are stated explicitly (as is recommended in the GRADE methodology for developing guidelines), physicians are more likely to really follow the guidelines...

..A stepwise and pragmatic approach to evaluating children with recurrent lower respiratory tract infections is recommended...

..Based on the CanMEDS framework and the European Training Charter for Clinical Radiology a new radiology curriculum was designed in the Netherlands. Both the development process and the resulting new curriculum are presented in this paper...

..This illustrates that many recommendations in evidence-based guidelines are not firmly based on high-quality evidence, but on expert opinion alone. This calls for caution in using such guidelines as standards of care...

..Clinical supervisors find the STAMPPOT method easy to learn; it is also highly appreciated by registrars and house officers as it helps them to better understand and improve their clinical diagnostic skills...

..Oral food challenges are the gold standard of food allergy diagnosis; they should preferably be performed in a double-blind fashion...

..It is probable that only the mild forms of eczema are to a certain extent delayed. For the time being, therefore, the prevention of allergy is an illusion...

..5% of children but are more often regarded incorrectly as the cause of symptoms in young children. Therefore, a critical attitude is warranted when parents suspect that their child is allergic to one or more types of food...

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..When prescribing an epinephrine autoinjector, the patient and all caregivers should be instructed carefully in its correct use; referral to an allergist is recommended...

..When growth is reduced by > 0.25 standard deviation score within 1 year, the use of ICS needs to be reconsidered. This decision can best be made by a paediatrician or after consulting one...

..A cautious approach in advising interventions with hypoallergenic formulae to prevent allergy in high-risk infants is warranted...

..There is an even greater lack of studies on the impact of chronic disorders in childhood on quality of life and social and emotional well-being in later life...

..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...

..Whether or not day care is a risk factor for SIDS can only be evaluated by further and better designed studies. At present, there is no scientific basis to discourage day care for young children...

..In addition, no measures were taken to implement the guideline when it was published. This means that the usefulness of the finding that the guideline is poorly adhered to is limited...

..Until results of well-designed studies become available, sublingual immunotherapy in children should not be used...

..The Novolizer device, a new multidose dry powder inhaler (DPI), shows many of these characteristics making it potentially very suitable for children with asthma...

..In view of the availability of effective treatment options, it is important to recognise this condition in children who present with cough and malaise...

..Because a reliable inhalation technique is the key to successful inhalation therapy, inhalation technique should be instructed carefully and checked repeatedly in every asthmatic child using an inhaler device...

..Therefore, when confronted with a young child with signs and symptoms that could be caused by food intolerance, other causes should be considered prior to focusing on the food intolerance...

..These differences were statistically significant for all features, except for acceptability by the child. Conclusion: Two-thirds of parents prefer NebuChamber over Babyhaler for the treatment of their young asthmatic children...

..We propose to reconfirm aspiration of a radiopaque foreign body by fluoroscopy shortly before commencing bronchoscopy...

..Lumbar puncture should be performed when meningeal irritation is suspected. In children this can be identified using the Vincent test as well as the Kernig and Brudzinski tests...

..Mumps was diagnosed in an 11-year-old girl with bilaterally swollen cheeks. She had received mumps-measles-rubella vaccine as an infant...

..Monitoring of hyperresponsiveness and nitric oxide cannot be recommended for routine use at present. Clinical judgement and expiratory flow-volume loops remain the cornerstone of monitoring asthma in secondary care...

..Few large-scale studies have examined inhaled corticosteroid treatment in preschool children with recurrent wheeze. We assessed the effects of ciclesonide in preschool children with recurrent wheeze...

..Such associations should be examined in case-control studies before preventive advice can be given. The Dutch SIDS risk-factor studies are an example of how epidemiologic studies can have a great impact on public health...

..To establish the effects of manual therapy, chiropractic, or osteopathic treatment of the KISS-syndrome (kinetic imbalance due to suboccipital strain) in infants with positional preference, plagiocephaly, and colic...

..To evaluate the effects of transient hypoglycaemia on the first day of life in 75 healthy term large for gestational age (LGA) infants, born to non-diabetic mothers, on their neurodevelopmental outcome at the age of 4 years...

..To assess prevalence of behavioural problems in preschool children with asthma with electronically verified exposure to inhaled corticosteroids (ICS)...

..The variation of PIF through the Accuhaler and Turbohaler adapter was significantly greater for children < or =7 years of age and for patients experiencing moderate or severe symptoms of asthma...

..Conclusion. Severe EVW at preschool age has a high risk of asthma at age 5-10 years, and this is reinforced by a positive family history of asthma and to elevated FeNO levels...

..Asthma and allergic rhinitis are the two most common chronic disorders in childhood and adolescence. To date, no study has examined the impact of comorbid allergic rhinitis on asthma control in children...

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..Variation of lung function is considered to be a hallmark of asthma. Although guidelines recommend measuring it as a diagnostic tool for asthma, the usefulness of this approach has not been studied in children...

..To describe the results of double-blind placebo-controlled food challenges (DBPCFC) with cow's milk, hen's eggs, soy, peanuts and hazelnuts in a general hospital...

..The aim of this study was to investigate whether treatment of allergic rhinitis with an intranasal corticosteroid protects against EIB in asthmatic children...

..Sensitization to aeroallergens is common in preschool children with symptoms of allergic disease, and more common in boys than in girls. Screening tests for allergy in infants and toddlers should include inhalant allergens...

..Therefore, a BDR, measured immediately after completing a methacholine challenge, cannot be used as a substitute for a separate bronchodilator test...

..The strongest modifiable risk factor for wheeze in the first year of life is home dampness. Interventions to reduce home dampness to reduce wheeze in infancy should be examined...

..To compare the prevalence of current wheeze in children with Down syndrome (DS), their siblings, and nonrelated population controls...

..We assessed the agreement in vivo between measurements of lung function on an electronic spirometer (Koko Peak Pro) and those obtained by the gold standard, a hospital lung function laboratory pneumotachograph...

..We evaluated the effect of early discharge with tube feeding of preterm infants under close supervision by paediatric nurse specialists on the duration of breast feeding...

..Using home spirometry, we studied prospectively whether mild respiratory symptoms, prompting reliever therapy are accompanied by a clinically relevant drop in lung function in children with asthma...

..Further studies are urgently needed to identify the prevalence, and, more importantly, the effects of these comorbidities and their treatment on the degree of asthma control in children...

..This limits the usefulness of home spirometry in childhood asthma...

..To describe the results of allergic sensitization tests to food and inhalant allergens in children younger than 4 years of age and in older children...

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..To describe clinical characteristics of infants with colic admitted to hospital because of ongoing excessive crying (colic)...

..This belief is mainly based on cross-sectional population studies. Recent evidence suggests a more complex relationship between early eczema and asthma...

..Being the 95th percentiles of the distributions in healthy children, a peak flow variation of 12.3% and an forced expiratory volume in one second variation of 11.8% are suggested as cut-off values for disease when using home spirometry...

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..Until now, care provided by asthma nurses has been additional to care provided by paediatricians. A study was undertaken to compare nurse led outpatient management of childhood asthma with follow up by a paediatrician...

..The association between dysfunctional breathing and asthma control suggests that this may be a clinically relevant comorbidity in paediatric asthma...

..Therefore, further exploration of the patient's needs should be worthwhile...

..e. shared decision-making about therapy by doctors and patients. Appropriately targeted interventions, such as motivational interviewing, may influence patient beliefs and improve adherence...

..This study was designed to assess the reliability of test weighing in clinical practice, expressed as precision (scatter of measurements around the real value) and accuracy (the ability of a method to measure the real value)...

..In isolated cases however, such as patients who poorly perceive a deterioration of their asthma, or when it is unclear what triggers asthmatic symptoms, the peak flow meter can be useful...

..1% lower for nurse-led outpatient management compared to traditional medical care. Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians...

..Only infants with acute allergic symptoms directly related to ingestion, i.e. urticaria and gastrointestinal symptoms, should be evaluated for food allergies by a double-blind, placebo-controlled food challenge...

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..We investigated whether there is evidence of the beneficial effect of the addition of metformin to insulin therapy in adolescents with DM1...

..In conclusion, the allergy preventive effect of dietary interventions in infancy is limited. Counselling of future parents on allergy prevention should pay attention to these limitations...

..4% to 97.9% after three comprehensive instruction sessions. CONCLUSION: Inhalation instruction should be given repeatedly to achieve and maintain correct inhalation technique in asthmatic children...

..For children with symptomatic asthma despite low to moderate doses of inhaled corticosteroids, evidence is still lacking whether to add a long-acting bronchodilator or to increase the dose of inhaled corticosteroids...

..This is probably because infant weighing scales are not sensitive enough to pick up small changes in an infant's weight after feeding. Because of its unreliability, test weighing should not be used in clinical practice...

..Two-thirds of cases of cow's milk allergy diagnosed before referral were rejected based on the food challenge results. Many reactions attributed to cow's milk allergy did not appear to be caused by cow's milk allergy...

..Scarlet fever was diagnosed in a girl with high fever, a sore throat and exanthema marginatum...

..There is no indication for immediate diagnostic or therapeutic interventions. It is important, however, to counsel parents about their own anxiety and distress and the influence these may have on the infant's crying behaviour...

..Our goal was to evaluate clinical, methodologic, and reporting aspects of systematic reviews on the management of acute asthma in children...

..Therefore, the role of ICS in the management of preschool children with recurrent respiratory symptoms is unclear. We assessed the effectiveness of ICS in preschool children with recurrent respiratory symptoms in general practice...

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