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Oral immunotherapy for egg allergy
Many children with egg allergy will ‘grow out’ of their allergy by5 years of age, but for those in whom allergy persists, dietaryavoidance is the only recommended therapy. In a small ran-domised controlled trial, 40 children aged 5–11 years with per-sistent egg allergy were randomised to desensitisation withincreasing doses of powdered egg white and 15 to placebo.1
After 10 months, they were challenged with egg (see Fig. 1),and 22 of 40 (55%) in the oral immunotherapy tolerated egg,but none of 15 in the placebo group. Immunotherapy wascontinued until 22 months, and although the authors describe75% of children as being desensitised at that point, only 11 of 40
(28%) passed an oral egg challenge at 24 months. However,these 11 continued to tolerate egg in their diet over the nextyear. Egg allergy is troublesome and oral immunotherapy offersa cure (or ‘sustained unresponsiveness’ as the authors call it) toa proportion of children over 5 years of age.
Reference
1 Burks AW et al. N. Engl. J. Med. 2012; 367: 233–43.
Reviewer: David Isaacs, [email protected]
Mobile phone data on human movementand malaria transmission
Mobile phones can be used as tracking devices. Researchershave found that using mobile phones to track human move-ments is a rich source of data on transmission of infection. Theauthors of a study in Kenya used data for 1 year from almost 15million mobile phones to analyse the regional travel patterns ofindividuals.1 The mobile phone data were entered together withmalaria prevalence data into a mathematical model of malariatransmission to map routes of parasite dispersal. There are twomain sources of importation of parasites: individuals visitingendemic areas may become infected during their stay and carryparasites back to their primary settlement or (infected individu-als can carry parasites when they visit other settlements. Theauthors ranked settlements as net emitters (sources) or netreceivers (sinks) of people and parasites (see Fig. 1). Theyshowed that Nairobi imports a lot of malaria via visitors to the
Fig. 1 Big chook by Jeremy Parnell.
Fig. 1 (a) Travel sources and sinks. (b) Parasite sources and sinks.
doi:10.1111/jpc.12136
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Journal of Paediatrics and Child Health 49 (2013) 339–340© 2013 The AuthorsJournal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
339
coast, Lake Victoria and central Kenya. The ability to detectlikely importation hot spots could allow them to reduce malariatransmission by targeting hot spots for spraying, mosquitohabitat removal, insecticides, antimalarials and bed net use.
Reference
1 Wesolowski AW et al. Science 2012; 338: 267–70.
Reviewer: David Isaacs, [email protected]
Smacking children: Spare the rod
We have previously published on the evidence suggesting thatsmacking children is harmful, while acknowledging that studiesmay possibly be confounded by factors such as socio-economicstatus and parental stress.1,2 A review article summarises 20years of research on physical punishment of children.3 Theauthors point out that 75% of substantiated physical abuse ofchildren in Canada occurred during episodes of physical pun-ishment. They provide evidence that suggests that the associa-tion between smacking children and child aggression is causal.They review the evidence, including randomised controlled trialevidence, that parental support and education programmes to
help parents reduce their physical punishment of children areassociated with improvements in the children’s behaviour. Theauthors are long-term advocates for the use of positive parent-ing programmes and for legal change to outlaw the use ofphysical punishment of children. As such, their non-systematicreview is not necessarily totally free of bias, but the largeamount of evidence they have accumulated and their passion-ate advocacy is certainly persuasive.
References
1 Oates RK. J. Paed. Child Health 2011; 47: 507–11.2 Isaacs D. J. Paed. Child Health 2011; 47: 491–2.3 Durrant J, Ensom R. Can. Med. J. 2012; 184: 1373–7.
Reviewer: David Isaacs, [email protected]
Weaning preterm babies from CPAP
Term babies are often taken straight off continuous positiveairways pressure (CPAP) without weaning, but it is unknownwhether or not weaning from CPAP is helpful for pretermbabies. In a controlled trial, 177 Australian babies <30 weeksgestation who were clinically stable on CPAP were randomisedto (i) being taken straight off CPAP; (ii) being cycled on and offCPAP with increasing time off; or (iii) as for the previous pointbut with low-flow ventilatory support by nasal cannula duringthe off periods.1 Method 1 significantly reduced the time onCPAP (11.3 vs. 16.8 vs. 19.4 days, respectively). Time on oxygenand duration of admission were also significantly shorter andbronchopulmonary dysplasia was less common with method 1.This study gives strong support to removing preterm babies whoare clinically stable, as defined by the authors, from CPAPwithout weaning.
Reference
1 Todd DA et al. Arch. Dis. Child Fetal Neonatal Ed. 2012; 97: F236–40.
Reviewer: David Isaacs, [email protected]
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Journal of Paediatrics and Child Health 49 (2013) 339–340© 2013 The Authors
Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
340
