G Stores, A Ellis, L Wiggs, C Crawford, and A Thomson

University of Oxford Section of Child and Adolescent Psychiatry, Park Hospital for Children, Headington, UK.

This article has been cited by other articles in PMC.

Abstract

Subjective and objective sleep disturbance was studied in children with nocturnal asthma. Relations between such disturbance and daytime psychological function were also explored, including possible changes in learning and behaviour associated with improvements in nocturnal asthma and sleep. Assessments included home polysomnography, parental questionnaires concerning sleep disturbance, behaviour, and mood and cognitive testing. Compared with matched controls, children with asthma had significantly more disturbed sleep, tended to have more psychological problems, and they performed less well on some tests of memory and concentration. In general, improvement of nocturnal asthma symptoms by changes in treatment was followed by improvement in sleep and psychological function in subsequent weeks. The effects of asthma on sleep and the possible psychological consequences are important aspects of overall care.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

Strachan DP, Anderson HR, Limb ES, O’Neill A, Wells N. A national survey of asthma prevalence, severity, and treatment in Great Britain. Arch Dis Child. 1994 Mar;70(3):174–178.

Janson C, De Backer W, Gislason T, Plaschke P, Björnsson E, Hetta J, Kristbjarnarson H, Vermeire P, Boman G. Increased prevalence of sleep disturbances and daytime sleepiness in subjects with bronchial asthma: a population study of young adults in three European countries. Eur Respir J. 1996 Oct;9(10):2132–2138.

Kales A, Beall GN, Bajor GF, Jacobson A, Kales JD. Sleep studies in asthmatic adults: relationship of attacks to sleep stage and time of night. J Allergy. 1968 Mar;41(3):164–173.

Montplaisir J, Walsh J, Malo JL. Nocturnal asthma: features of attacks, sleep and breathing patterns. Am Rev Respir Dis. 1982 Jan;125(1):18–22.

Fitzpatrick MF, Engleman H, Whyte KF, Deary IJ, Shapiro CM, Douglas NJ. Morbidity in nocturnal asthma: sleep quality and daytime cognitive performance. Thorax. 1991 Aug;46(8):569–573.

Kales A, Kales JD, Sly RM, Scharf MB, Tan TL, Preston TA. Sleep patterns of asthmaticchildren: all-night electroencephalographic studies. J Allergy. 1970 Nov;46(5):300–308.

Avital A, Steljes DG, Pasterkamp H, Kryger M, Sanchez I, Chernick V. Sleep quality in children with asthma treated with theophylline or cromolyn sodium. J Pediatr. 1991 Dec;119(6):979–984.

Dunleavy RA, Baade LE. Neuropsychological correlates of severe asthma in children 9-14 years old. J Consult Clin Psychol. 1980 Apr;48(2):214–219.

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Signs and symptoms

Symptoms

Kawasaki disease often begins with a high and persistent fever that is not very responsive to normal doses of paracetamol (acetaminophen) or ibuprofen. The fever may persist steadily for up to two weeks and is normally accompanied by irritability. Affected children develop red eyes, red mucous membranes in the mouth, red cracked lips, a “strawberry tongue“, iritis, keratic precipitates (detectable by an ophthalmologist but usually too small to be seen by the unaided eye), and swollen lymph nodes. Skin rashes occur early in the disease, and peeling of the skin in the genital area, hands, and feet (especially around the nails and on the palms and soles) may occur in later phases. Some of these symptoms may come and go during the course of the illness. If left untreated, the symptoms will eventually relent, but coronary artery aneurysms will not improve, resulting in a significant risk of death or disability due to myocardial infarction (heart attack). If treated in a timely fashion, this risk can be mostly avoided and the course of illness cut short.^{[citation needed]}

Pediatrics, Kawasaki disease. Note the appearance of the hand and lips. Photo courtesy of Sam Richardson, MD.

BAYI DENGAN KAWAZAKI

DermNet.com is developed & maintained by Alan N. Binnick & Thomas P. Habif, Dartmouth Medical School, New Hampshire.          DermNet.com is developed & maintained by Alan N. Binnick & Thomas P. Habif, Dartmouth Medical School, New Hampshire.

Complications

The cardiac complications are the most important aspect of the disease. Kawasaki disease can cause vasculitic changes (inflammation of blood vessels) in the coronary arteries and subsequent coronary artery aneurysms. These aneurysms can lead to myocardial infarction (heart attack) even in young children. Overall, about 10–18% of children with Kawasaki disease develop coronary artery aneurysms with much higher prevalence among patients who are not treated early in the course of illness. Kawasaki disease and rheumatic fever are most common causes of acquired heart disease among children in the United States.

Causes

Like all autoimmune diseases, the cause of Kawasaki disease is presumably the interaction of genetic and environmental factors, possibly including an infection. The specific cause is unknown,^[6][7][8] but current theories center primarily on immunological causes for the disease. Evidence increasingly points to an infectious etiology,^[9] but debate continues on whether the cause is a conventional antigenic substance or a superantigen.^[10] Children’s Hospital Boston reports that “[s]ome studies have found associations between the occurrence of Kawasaki disease and recent exposure to carpet cleaning or residence near a body of stagnant water; however, cause and effect have not been established.”

An association has been identified with a SNP in the ITPKC gene, which codes an enzyme that negatively regulates T-cell activation.An additional factor that suggests genetic susceptibility is the fact that regardless of where they are living, Japanese children are more likely than other children to contract the disease.The HLA-B51 serotype has been found to be associated with endemic instances of the disease.

Diagnosis

Kawasaki disease can only be diagnosed clinically (ie. by medical signs and symptoms). There exists no specific laboratory test that for this condition. It is normally difficult to establish the diagnosis, especially early in the course of illness, and frequently children are not diagnosed until they have seen several health care providers, or visited a number of different health care providers. Many other serious illnesses can cause similar symptoms, and must be considered in the differential diagnosis, including scarlet fever, toxic shock syndrome, juvenile idiopathic arthritis, and childhood mercury poisoning (acrodynia).

Classically, five days of fever^[plus four of five diagnostic criteria must be met in order to establish the diagnosis. The criteria are: (1) erythema of the lips or oral cavity or cracking of the lips; (2) rash on the trunk; (3) swelling or erythema of the hands or feet; (4) red eyes (conjunctival injection) (5) swollen lymph node in the neck of at least 15 millimeters.

Many children, especially infants, eventually diagnosed with Kawasaki disease do not exhibit all of the above criteria. In fact, many experts now recommend treating for Kawasaki disease even if only three days of fever have passed and at least three diagnostic criteria are present, especially if other tests reveal abnormalities consistent with Kawasaki disease. In addition, the diagnosis can be made purely by the detection of coronary artery aneurysms in the proper clinical setting.

Investigations

A physical examination will demonstrate many of the features listed above.

Blood tests

• Complete blood count (CBC) may reveal normocytic anemia and eventually thrombocytosis
• Erythrocyte sedimentation rate (ESR) will be elevated
• C-reactive protein (CRP) will be elevated
• Liver function tests may show evidence of hepatic inflammation and low serum albumin

Other tests (may or may not be performed)

• Electrocardiogram may show evidence of ventricular dysfunction or, occasionally, arrhythmia due to myocarditis
• Echocardiogram may show subtle coronary artery changes or, later, true aneurysms.
• Ultrasound or computerized tomography may show hydrops (enlargement) of the gallbladder
• Urinalysis may show white blood cells and protein in the urine (pyuria and proteinuria) without evidence of bacterial growth
• Lumbar puncture may show evidence of aseptic meningitis
• Angiography was historically used to detect coronary artery aneurysms and remains the gold standard for their detection, but is rarely used today unless coronary artery aneurysms have already been detected by echocardiography.

Treatment

Children with Kawasaki disease should be hospitalized and cared for by a physician who has experience with this disease. When in an academic medical center, care is often shared between pediatric cardiology and pediatric infectious disease specialists (although no specific infectious agent has been identified yet^[5]). It is imperative that treatment be started as soon as the diagnosis is made to prevent damage to the coronary arteries.

Intravenous immunoglobulin (IVIG) is the standard treatment for Kawasaki disease and is administered in high doses with marked improvement usually noted within 24 hours. If the fever does not respond, an additional dose may have to be considered. IVIG by itself is most useful within the first 7 days of onset of fever, in terms of preventing coronary artery aneurysm.

Salicylate therapy, particularly aspirin, remains an important part of the treatment (though questioned by some)^[15] but salicylates alone are not as effective as Intravenous immunoglobulin. Aspirin therapy is started at high doses until the fever subsides, and then is continued at a low dose when the patient returns home, usually for 2 months to prevent blood clots from forming. Except for Kawasaki disease and a few other indications, aspirin is otherwise normally not recommended for children due to its association with Reye’s syndrome.

Corticosteroids have also been used, especially when other treatments fail or symptoms recur, but in a randomized controlled trial, the addition of corticosteroid to immune globulin and aspirin did not improve outcome.

There are also treatments for iritis and other eye symptoms.

Epidemiology

By far the highest incidence of Kawasaki disease occurs in Japan (175 per 100,000), though its incidence in the United States is increasing. Kawasaki disease is predominantly a disease of young children, with 80% of patients younger than 5 years of age. The disease affects boys more than girls. Kawasaki was extremely uncommon in caucasians until the last few decades. Approximately 2000-4000 cases are identified in the United States each year.

Prognosis

With early treatment, rapid recovery from the acute symptoms can be expected and the risk of coronary artery aneurysms greatly reduced. Untreated, the acute symptoms of Kawasaki disease are self-limited (i.e. the patient will recover eventually), but the risk of coronary artery involvement is much greater. Overall, about 2% of patients die from complications of coronary vasculitis. Patients who have had Kawasaki disease should have an echocardiogram initially every few weeks, and then every 1–2 years to screen for progression of cardiac involvement.

It is also not uncommon that a relapse of symptoms may occur soon after initial treatment with IVIG. This usually requires re-hospitalization and retreatment. Treatment with IVIG can cause allergic and non-allergic acute reactions, aseptic meningitis, fluid overload and, rarely, other serious reactions. Aspirin may increase the risk of bleeding from other causes and may be associated with Reye’s syndrome. Overall, life-threatening complications resulting from therapy for Kawasaki disease are exceedingly rare, especially compared with the risk of non-treatment.

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Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider. 

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It is essential to monitor the growth and development of a child with Cow Milk Allergy, especially during weaning, to ensure that proper dietary advice is adhered to.

• Growth in Infants with Cow Milk Allergy Given Hypoallergenic Infant Milk Formulas
• New foods for milk allergic babies: handy hints
• Avoid potential food allergenic exposure: handy hints
• Introducing solid foods in the child diet
• Cow Milk Allergy Symptoms Regression in Children
• Weaning a child with Cow Milk Allergy or other Food Allergies

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htpp://www.childrenallergyclinic.wordpress.com/

Clinical and Editor in Chief :

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email : judarwanto@gmail.com,

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

Copyright © 2009, Children Allergy Clinic Information Education Network. All rights reserved.

• The Link between Children Food Allergy and Asthma
• Skin Rash and Food Allergies in Children
• Normal Acid Reflux in babies or a more serious disease?
• Diarrhea and Cow Milk Allergy
• Short Bowel Syndrome and Food Allergy
• Dietary Protein-Induced Proctisis and Proctolisis
• Dietary Protein Induced Enteropathy / Enterocolitis
• Baby, Infant Colic and Persistent Crying
• Atopic Dermatitis (Atopic Eczema)
• Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD)
• Eosinophilic Esophagitis and Gastroenteropathies

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htpp://www.childrenallergyclinic.wordpress.com/ 

Clinical and Editor in Chief :

DR WIDODO JUDARWANTO 

email : judarwanto@gmail.com,

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

Copyright © 2009, Children Allergy Clinic Information Education Network. All rights reserved.

• Treating the Anaphylactic Shock
• Treatment of Cow Milk Allergy
• Dairy Allergy and Dairy Products
• Feeding Tips to reduce Colic in your Baby
• What to do to Reduce Hives Skin Rash
• How to Help your Baby with Acid Reflux
• Symtoms, Diagnosis and Treatment of Cow Milk Allergy related Diarrhea
• Managing Cow Milk Allergy and other Food Allergies
• How to discover the allergenic foods for the child
• Infant Diet for Cow Milk Allergy: the Soy Protein based Formula
• Infant Diet for Cow Milk Allergy: the Protein Hydrolysed Formulas (pHF, eHF)
• Treating Cow Milk Allergy with Amino Acid-based Hypoallergenic Formula

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Clinical and Editor in Chief :

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email : judarwanto@gmail.com,

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

Copyright © 2009, Children Allergy Clinic Information Education Network. All rights reserved.

Atopic Dermatitis (or Atopic Eczema) is a chronic relapsing inflammatory skin disorder in infancy and childhood associated with increased serum IgE levels, allergen sensitisation and a family history of allergic diseases.

Symptoms for severe cases of atopic dermatitis are:

• persistent skin lesions;
• regular use of topical steroids;
• co-existent allergic morbidities (diarrhea, vomiting, rhinitis, wheeze);
• faltering growth.

Originally controversial, the association of food allergy with atopic dermatitis has now been clearly demonstrated, especially in severe disease of infancy.

The association between food allergy and atopic dermatitis has been demonstrated through various studies and clinical observations: 37% of children with atopic eczema have food allergy.

There is an increasing prevalence with increasing severity. Many children out-grow their allergies. Transient allergies include those to milk, eggs, soy and wheat, whereas allergies to peanut, tree nuts, fish and shellfish appear to be more persistent.

The management of infantile atopic dermatitis should therefore incorporate appropriate strategies to diagnose and manage underlying food allergies. Food elimination has been shown to resolve symptoms of atopic dermatitis.
In cases where appropriate dietary elimination must accompany measures taken to reduce inflammation in the skin, treatment goals are twofold the control of cutaneous symptoms and the promotion of optimal growth.

source : act against allergy

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email : judarwanto@gmail.com,

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

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Skin rashes in children may result from various conditions, resulting in different types of rashes. Usually, skin rash due to allergic or non allergic reaction to foods, chemicals, plants, animals, insects or other environmental factors appears as red, itchy bumps or patches.

Alternatively, scaly patches of skin may be caused by a fungous or a bacterial infection.

Skin rashes in children can be localized, appearing in a certain part of the body, or systemic, coming out all over the body .

Localized skin rash is typical because of a skin contact with an allergen, that triggers the rash in the area that has being exposed to the allergenic substance.

A systemic skin rash often is due to a more generic allergic reaction to an ingested or inhaled allergen, as in food allergy or in allergic rhinitis, and may be coupled by other symptoms, including sneezing , nausea and swelling.

So, skin rash is a general name that includes several forms on allergic rashes. Main rash manifestations due to food allergies are:

• Atopic dermatitis (eczema)
  The word dermatitis identifies an inflammation of the skin caused by allergies, and the term “atopy” indicates that the reaction is associated with allergies that usually are inherited by the family. So, atopic dermatitis is often a chronic condition that triggers a rash generally red, itchy, and scaly, usually located on the scalp, arms, legs, and torso.
• Hives (or urticaria)
  Urticaria is characterized by elevated patches of often discolored and itchy skin. Urticaria as a skin rash manifestation of a food allergy is very common in children.
• Angioedema
  Angoioedema indicates a condition when swelling occurs deep in the skin, especially around the face, lips and eyes. If irritated, swollen areas can be red, itchy and painful.

Beyond allergic reactions, other skin rash manifestations include:

• Psoriasis, that tends to occur as red, scaly, itchy patches over joints and along the scalp. Fingernails may be affected.
• Impetigo, an infection that is common in children and that is from bacteria that live in the top layers of the skin. Appears as red sores that turn into blisters, ooze, then crust over.
• Shingles, a painful blistered skin condition caused by the same virus as chickenpox. The virus can lie dormant in your body for many years and re-emerge as shingles.
• Childhood illnesses such as chicken pox, measles, roseola, rubella, hand-foot-mouth disease, fifth disease, and scarlet fever.
• Medications and insect bites or stings.

Source: Medline Plus – US National Library of Medicine and National Institute of Health

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Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

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