Asthma, Allergies, Paediatrics: Links and Stories

Use children as medicine guinea pigs No, this is not yet another bizarre version of recent MMR-vaccine-autism reporting but a rather sensationalist take on a perfectly sensible call by Prof. John Warner for the inclusion of children in medical trials. Children are not small adults. This is one of the reasons that Clark Bartram initiated Paediatric Grand Rounds. This stark fact is a headache for pharmaceutical companies who are frequently criticised for their lack of drugs that are specifically formulated for children and tested on them. Understandably, however, it is difficult to obtain ethical approval for drug trials (or any therapeutic trials) that involve children. There has been a lot of adverse publicity about the effect of anti-depressants on children. There is increasing controversy about the effectiveness of current asthma treatments for children.

Professor Warner, who is Chair in Paediatrics and Head of the Department of Paediatrics at Imperial College and consultant paediatrician at St Mary's Hospital, explained that researchers need to design therapies specifically for children and their problems, rather than the present situation that relies upon scaling-down treatments as if children are small adults. In some significant ways, children differs from adults: they have different metabolisms; their organs are not as mature as adults'; and both diseases and drugs can behave differently in children's bodies. Warner said:

To create the best therapies for children we need to include them in our research. A lot of paediatricians' work doesn't have much of a scientific evidence base and we prescribe drugs by extrapolating from what we know about adult bodies. We have a desperate need to understand precisely how children's bodies work so that we can custom-design therapies for them and their problems.

A Review of Psychogenic Cough and Its Diagnosis and Misdiagnosis in AsthmaAsthma takes so many forms that some researchers have said that it is long past time to abandon the idea of asthma as a single disease concept. Until such time as that happens, we will all continue to refer to cough-variant asthma in which chronic cough is the sole presenting manifestation of bronchial asthma in all age groups. The review authors report that recent findings indicate that most children with persistent cough but without other respiratory symptoms do not have asthma. They argue that cough should not be used as a single or major determinant to diagnose and treat asthma; it should be taken as a major clue if trials with medication fail to alleviate symptoms. The reviewers argue that when medical staff consider the range of illnesses that might cause cough, no single management guideline can be universally effective.

Briffa discusses food allergies and intolerance in children with allergic rhinitis or asthma Briffa comments on a recent paper where the authors indicated that:

rhinitis is generally not due to food allergy, and that treatment for rhinitis due to food allergy is therefore rarely indicated.

Briffa disagrees and argues that his clinical experience indicates otherwise. All of which is fair enough but Briffa indulges in truthiness and referenciness to such an extent that this story deserves its own post. I'm waiting to hear back from the authors of a paper that he discussed. In case I don't get round to doing this, note that the elimination studies to which Briffa refers are in infants rather than children and he omits some significant findings from those papers such as the incidence of asthma in those children at follow-up.

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