The long-term outcomes of persistent childhood allergic asthma: A cross-sectional study from western Anatolia

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"apellidos" => "Plaza" ] 8 => array:1 [ "colaborador" => "Food allergy committee of SEICAP" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054613001407?idApp=UINPBA00004N" "url" => "/03010546/0000004100000005/v1_201310020117/S0301054613001407/v1_201310020117/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S030105461200211X" "issn" => "03010546" "doi" => "10.1016/j.aller.2012.07.002" "estado" => "S300" "fechaPublicacion" => "2013-09-01" "aid" => "415" "copyright" => "SEICAP" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Allergol Immunopathol (Madr). 2013;41:310-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 855 "formatos" => array:3 [ "EPUB" => 5 "HTML" => 544 "PDF" => 306 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Milk-induced wheezing in children with asthma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "310" "paginaFinal" => "314" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.G. Murray, J. Kanuga, E. Yee, S.L. Bahna" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.G." "apellidos" => "Murray" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Kanuga" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Yee" ] 3 => array:2 [ "nombre" => "S.L." "apellidos" => "Bahna" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030105461200211X?idApp=UINPBA00004N" "url" => "/03010546/0000004100000005/v1_201310020117/S030105461200211X/v1_201310020117/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "The long-term outcomes of persistent childhood allergic asthma: A cross-sectional study from western Anatolia" "subtitulo" => "Childhood persistent asthma in western Anatolia" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "315" "paginaFinal" => "319" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ö. Bağ, D. Can, U. Karaarslan, İ. Günay, C.Ş. Turgut, H.T. Nacaroğlu" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Ö." "apellidos" => "Bağ" "email" => array:1 [ 0 => "bagozlem78@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "Can" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "U." "apellidos" => "Karaarslan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "İ." "apellidos" => "Günay" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "C.Ş." "apellidos" => "Turgut" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "H.T." "apellidos" => "Nacaroğlu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Clinics of Pediatrics, Dr. Behçet Uz Children's Teaching and Research Hospital, Izmir, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Clinics of Pediatric Allergy and Immunology, Dr. Behçet Uz Children's Teaching and Research Hospital, Izmir, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "IntroductionAsthma is a chronic airway inflammation characterised by intermittent, recurrent episodes of wheezing, dry coughing and shortness of breath. It is a major health problem for all ages but childhood asthma represents a special aspect in contrast to adulthood asthma because of the age- and growth-dependent changes in anatomy and physiology of the respiratory system. Paediatricians need to know about the natural history of asthma to answer the questions about whether the disease is life-long or the child will grow up with the disease. A large number of population-based studies have been carried out to investigate the long-term outcomes of the disease but the natural history of childhood asthma is still controversial. The aim of this study is to define the long-term outcomes of allergic asthmatic children over 10 years follow-up and to discuss the factors influencing the natural history of childhood asthma in western Anatolia, Turkey.Patients and methodsA total of 176 patients diagnosed with persistent allergic asthma approved by allergen skin testing and followed up for at least 10 years in Allergy-Immunology Clinics of Behçet Uz Children's Hospital, a tertiary care hospital for paediatric age, were evaluated for the study. The patients who were not sensitised in the beginning of the follow-up period and the ones diagnosed with mild intermittent asthma were not included in the study. The patients who refused to answer the questions investigating whether they had an attack in the last year were excluded from the study.Finally, 52 patients participated in the study. All participants agreed to participate according to the principles expressed in the Declaration of Helsinki. The patient's demographics, findings on the time of diagnosis (presence of eosinophilia, increased serum IgE, type of allergen), age at onset of disease, time of diagnosis, history of other allergic conditions, history of parental asthma and allergic disorders, presence of pharmacotherapy (long-term controller medications) and immunotherapy were obtained from patients’ records. Immunotherapy was administered according to WHO and EAACI position papers for allergen immunotherapy.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>The presence of >450eosinophils/μL and serum total IgE >100IU/mL were considered eosinophilia and elevated serum IgE, respectively. At the time of the study, patients with no attack, no use of quick-reliever medications in the previous year and no admission to the emergency department for this reason were accepted on clinical asthma remission.The factors influencing the clinical asthma remission at the end of 10 years follow-up were evaluated. The data were analysed using a statistical software package (SPSS, version 18.0). The Chi-square test or Fisher's exact test, where appropriate, was used to compare proportions in different groups. Factors were considered statistically significant if p values <0.05.ResultsFifty-two persistent allergic asthmatic patients (age range: 11–26 years; mean age: 16.7±3.5; male/female: 27/25) were followed-up for 13±3.2 (min 10–max 22 years). Mean age on diagnosis was 5.6±1.9 (min 2–max 10 years) and the median time of diagnosis after the onset of symptoms was 2 years (min 0–max 6 years) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The frequency of eosinophilia and elevated levels of serum total IgE were 76.9% and 86.5% respectively. The most common aeroallergens in our study group were house-dust mite (61.5%), pollens of grasses-wheat (36.5%), pollens of olive tree (25%), mould (11.5%), animal dander (3.8%) and others (8.5%).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>A total of 20 patients (38.5%) were on clinical asthma remission at the end of 10 years. The remission rate in the house-dust mite subgroup was 46.9% and was higher than other allergen's subgroup but the difference was not statistically significant (OR=2.64; 95% CI=0.77–9.0)The frequency of multi-allergen sensitivity (at least two positive aeroallergen sensitivity on skin-prick test response in a panel of 12 common aeroallergens) was 51.9%. Multi-allergen sensitivity did not affect the remission rate either (OR=0.88; 95% CI=0.28–2.69). Neither eosinophilia and high levels of total Ig E nor the type of aeroallergen was effective on clinical asthma remission.The frequencies of allergic rhinitis, atopic dermatitis and food allergy were 57.7%, 5.8% and 3.8%, respectively. The remission rate in patients having only asthma was higher (52.6%) than in patients with accompanying allergic disorders (30.3%). However, the difference was not statistically significant (OR=2.55; 95% CI=0.79–8.21).The frequency of tobacco smoke exposure was 38.5%, in the study group. The remission rate in the smoke-exposure group was 35.5%, while it was 40.6% in the smoke non-exposure group and tobacco smoke exposure seems to be ineffective on the clinical asthma remission.In our study group, 21.2% of the patients were mild persistent, 76.9% were moderate persistent and 1.9% were severe persistent on follow-up. At the end of 10 years, the rate of remission was 45.5% in the mild persistent asthmatic group, while being 36.6% in the moderate and severe group. The difference was not statistically significant (OR=1.44; 95% CI=0.37–5.55). The remission at the end of 10 years in immunotherapy-administered group and non-administered group was 40.7% and 36.6%, respectively. The effect of immunotherapy on remission could not be documented (OR=1.22; 95% CI=0.39–3.74) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>In our study group, all patients were treated with long-term controller medications including ICS (inhaled corticosteroids) (44%), ICS combined with leukotriene modifiers (23%), LABAs (long acting inhale β-agonist) (11.5%), leukotriene modifiers (6%), antihistaminics (7%) and others (9%). Because of the retrospective design of our study, there was not a homogenous treatment regimen on persistent childhood asthma.DiscussionWe characterised 52 children with persistent allergic asthma over a follow-up period of 10 years. A total of 20 patients (38.5%) were on clinical asthma remission at the end of 10 years. Eosinophilia, high levels of serum IgE, type of allergen, the severity of the disease, immunotherapy or any long-term controller medications seems to be ineffective on clinical remission.The natural history of asthma can be learned by following cohort studies from birth to adulthood.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Some cohorts are based on asthma outpatients<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> while some are based on general population.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> Most of the studies are conducted in western countries. However, the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> Variable remission rates of 14–75% have been reported in unselected population-based or pre-selected cohorts.<a class="elsevierStyleCrossRefs" href="#bib0020">4–7</a> This variability could be largely due to a lack of a standard definition for asthma remission and the heterogeneity of the populations from which the estimates were derived. In this current study, we aimed to evaluate the factors influencing clinical remission rates in childhood asthma because it is reported that bronchial hyperreactivity continues also in long-lasting clinical remission in adolescence.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> Clinical asthma remission has been defined as the absence of need for pulmonary medication and does not require any tests (e.g. lung function tests) while the definition of complete asthma remission also includes the absence of bronchial hyperreactivity and normal lung function (FEV1>90% predicted).<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a> This evaluation may have resulted in relatively higher remission rates than in some other reports.De Marco et al. point out that subjects living in the Mediterranean region have higher incidences and lower remission rates than persons living in the subcontinental region.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> For this reason, many studies must be conducted to evaluate incidence and remission rates in each region. The International Study of Asthma and Allergies in Childhood (ISAAC) reported the asthma prevalence in Turkey as being between 2.8% and 14.5%<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a> and there are only a few reports documenting the factors predicting asthma persistence in childhood from Turkey. Sekerel et al.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> reported diminished airflow, female gender and eosinophilia to predict the disease persistence in early adulthood, from the Middle-Eastern Region of Turkey while Bahçeciler et al.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> reported that respiratory symptoms were significantly predicted by initial FEF 25–75% and sensitivity to allergens and from the Marmara Region, an industrial zone of Turkey. But there is still a lack of data on long-term outcomes and risk factors affecting the persistence of childhood asthma in Turkey and the Aegean Region. This study is conducted in a single-centre clinic, but a reference clinic in a tertiary care hospital for paediatric age, so it serves large number of patients from western Anatolia. Thus, we believe this study respects the outcomes of the entire Aegean Region.In studies of the natural history of asthma, female gender has been cited as a risk factor for the persistence of symptoms from childhood to adulthood.<a class="elsevierStyleCrossRefs" href="#bib0015">3,7,15,17,18</a> Although there are factors associated with airway responsiveness in both males and females, sex-specific factors are reported to contribute to new insights into asthma pathogenesis.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> In this current study, females have a lower remission rate than males but our study is relatively small to document a sex- specific association.Although allergy and atopy are reported to be risk factors for persistent asthma in childhood,<a class="elsevierStyleCrossRef" href="#bib0095">19</a> this issue is still controversial. Roorda et al.,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> and then Van Beer et al.,<a class="elsevierStyleCrossRef" href="#bib0105">21</a> showed that allergy and atopy do not contribute to the persistence of asthma. In our study, the frequency of eosinophilia and high levels of serum total IgE were 76.9% and 86.5%, respectively. They were not effective on both the severity of the disease and the remission at the end of 10 years. In addition, the remission rate in patients having only asthma was slightly higher (52.6%) than in patients with accompanying allergic disorders (30.3%), but the difference was not statistically significant; so our study could not document an association between atopy, allergy and clinical remission of childhood asthma.In recent studies, the association of sensitisation to indoor allergens with the development<a class="elsevierStyleCrossRef" href="#bib0110">22</a> and severity<a class="elsevierStyleCrossRef" href="#bib0115">23</a> of asthma in childhood has been recognised. The CAMP study,<a class="elsevierStyleCrossRef" href="#bib0120">24</a> reported that avoiding or limiting exposure to relevant indoor allergens in children who are allergic may alter the course of asthma in childhood. In our study, the most common aeroallergen was house-dust mite allergy (61.5%) and the remission rate in house-dust mite subgroup was 46.9%; higher than other allergen's subgroup in contrast with other reports. This may be associated with the properties of other aeroallergens existing in our region.Some authors have reported that recent asthma exacerbations contribute strongly and independently to the prediction of a future exacerbation.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> Furthermore, remission is reported to occur mainly in patients with less severe asthma.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> But severity is not a fixed feature of asthma, and may change over months or years, whereas the classification by severity suggests a static feature. Moreover, using severity as an outcome measure has limited value in predicting what treatment will be required and what the response to that treatment might be.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> Indeed, in our study group, the rate of remission was 45.5% in mild persistent asthmatic group, yet was 36.6% in the moderate and severe group. The difference was not statistically significant.There is convincing evidence that allergen specific immunotherapy induces clinical and immunological tolerance and has long-term efficacy. Subcutaneous immunotherapy has been widely used and has been shown to be effective in reducing symptoms.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> It represents the only treatment modality that might alter the natural course of the disease.<a class="elsevierStyleCrossRefs" href="#bib0145">29–31</a> However, it has been reported that immunotherapy for asthma does not provide benefits beyond those achievable with alternative modalities.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> Furthermore, uncommon but severe and nearly fatal systemic reactions and repeated injections leading to serious complaints among patients have restricted the administration.<a class="elsevierStyleCrossRefs" href="#bib0165">33–36</a> In our study group, subcutaneous immunotherapy was administered in 51.9% of the patients according to WHO and EAACI position papers for allergen immunotherapy.<a class="elsevierStyleCrossRefs" href="#bib0005">1,13</a> The remission at the end of 10 years in immunotherapy-administered group and the non-administered group was 40.7% and 36.6%, respectively. The difference was not statistically significant so our results could not document the efficacy of immunotherapy in childhood asthma. In recent reports, specific immunotherapy is reported to improve asthma related quality of life in childhood.<a class="elsevierStyleCrossRef" href="#bib0185">37</a> In our study, asthma related quality of life or the decrease in the need of quick-reliever medications were not evaluated.Another argumentative issue on asthma is whether the use of long term controller medications influences the natural history of asthma by reducing inflammation, subsequent remodelling and thus preventing the decline in lung function. Agertoft and Pedersen<a class="elsevierStyleCrossRef" href="#bib0190">38</a> reported the first study to suggest that inhaled corticosteroids influence lung function and they postulated that early intervention may prevent the development of irreversible airway obstruction. START study was a randomised double-blind trial documenting the lesser decline of FEV1 in inhaled budesonide group than placebo while IMPACT study reported no significant difference in post-bronchodilator FEV1 in budesonide, zafirlukast and placebo.<a class="elsevierStyleCrossRefs" href="#bib0195">39,40</a> There is not a consistent protocol in our treatment strategies, so we cannot comment on long-term controller medications.The limitation of our study is its retrospective design. There is insufficient information on patients’ records including data about exclusive breastfeeding rate, number of children and living conditions of the family, socioeconomic status and pet ownership rates that may alter the course of the disease. Moreover, although the lung function tests were not required for the definition of clinical remission, spirometry was performed on patients during clinical follow up. However, the data about lung function tests were not evaluated because of lack of standardisation due to the retrospective design.ConclusionIn conclusion, this is the first study to report long term outcomes of childhood asthma from western Turkey. As the course of the disease may differ due to environmental factors, the findings may be enlightening for especially Mediterranean physicians documenting high remission rates with no predictor. The limitation of this cross-sectional study is its retrospective design. Prospective studies performed in larger asthmatic populations may obtain further data about the natural course of the disease.Ethical disclosuresPatients’ data protectionConfidentiality of data. The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.Right to privacy and informed consentRight to privacy and informed consent. The authors have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence is in possession of this document.Protection of human subjects and animals in researchProtection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this investigation.Conflict of interestThe authors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres278113" "titulo" => array:6 [ 0 => "Abstract" 1 => "Background" 2 => "Objective" 3 => "Methods" 4 => "Results" 5 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec259961" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 7 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Patients’ data protection" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Protection of human subjects and animals in research" ] ] ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack64113" "titulo" => "Acknowledgements" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-02-08" "fechaAceptado" => "2012-05-24" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec259961" "palabras" => array:5 [ 0 => "Long-term outcomes" 1 => "Asthma" 2 => "Childhood" 3 => "Natural history" 4 => "Immunotherapy" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "BackgroundProspective cohort studies have provided useful knowledge about the natural history of asthma. However, most of the studies are conducted in western countries but the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors. ObjectiveThe aim of this study is to describe the long-term outcomes of childhood asthma, with data from a follow-up study of at least 10 years, in western Anatolia, Turkey. MethodsFifty-two patients diagnosed with persistent allergic asthma participated in the study. The patient's demographics, findings on admission, age at onset of disease, time of diagnosis, history of other allergic conditions, history of parental asthma and allergic disorders, presence of pharmacotherapy and immunotherapy were obtained from patients’ records. The factors influencing remission at the end of 10 years follow-up were evaluated. ResultsA total of 20 patients (38.5%) were on remission at the end of 10 years. The type of allergen, multi-allergen sensitivity, eosinophilia and elevated serum immunoglobulin E on admission, accompanying allergic disorders and atopy in parents, and allergen immunotherapy did not affect the remission rate (p>0.05). ConclusionChildhood persistent asthma is not a homogeneous clinical entity but high clinical remission rates are obtained in western Anatolia. There is no significant predictor of clinical remission in long term follow-up. Prospective studies should be performed in larger asthmatic populations to obtain further data about the natural course of childhood asthma." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25/52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.7±3.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Follow-up period<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13±3.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age on asthma onset<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.7±1.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age on diagnosis<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.6±1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Delay for diagnosis<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27/52 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab400653.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "years, mean±SD." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "years, median." ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of subjects and follow-up period." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9/25 (36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.26–2.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11/27 (40.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.39–3.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.72 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Accompanying allergic disorder \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/33 (30.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.12–1.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/19 (52.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.79–8.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Atopic disease in parents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7/24 (29.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15–1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13/28 (46.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.66–6.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eosinophilia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15/40 (37.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.22–3.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5/12 (41.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.32–4.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elevated serum Ig E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16/43 (37.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.17–3.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4/9 (44.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.31–5.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.68 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">House-dust allergy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15/32 (46.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.77–9.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5/20 (25.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.11–1.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multi-allergen sensitivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/27 (37.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.28–2.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/25 (40%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.37–3.46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5/11 (45.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.37–5.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15/41 (36.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18–2.226 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11/27 (40.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.39–3.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9/25 (36.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.26–2.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.72 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab400652.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Remission rates of subjects according to risk factors, severity of the disease and immunotherapy." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allergen immunotherapy: therapeutic vaccines for allergic diseases. 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We are grateful to the staff of Pediatric Allergy Clinics and the children and their parents participating in this study." ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000004100000005/v1_201310020117/S0301054612002091/v1_201310020117/en/main.assets" "Apartado" => array:4 [ "identificador" => "5554" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004100000005/v1_201310020117/S0301054612002091/v1_201310020117/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054612002091?idApp=UINPBA00004N"]

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Ö. Bağa,

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bagozlem78@yahoo.com

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, D. Canb, U. Karaarslana, İ. Günaya, C.Ş. Turgutb, H.T. Nacaroğlub

a Clinics of Pediatrics, Dr. Behçet Uz Children's Teaching and Research Hospital, Izmir, Turkey

b Clinics of Pediatric Allergy and Immunology, Dr. Behçet Uz Children's Teaching and Research Hospital, Izmir, Turkey

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Asthma is a chronic airway inflammation characterised by intermittent&#44; recurrent episodes of wheezing&#44; dry coughing and shortness of breath&#46; It is a major health problem for all ages but childhood asthma represents a special aspect in contrast to adulthood asthma because of the age- and growth-dependent changes in anatomy and physiology of the respiratory system&#46; Paediatricians need to know about the natural history of asthma to answer the questions about whether the disease is life-long or the child will grow up with the disease&#46; A large number of population-based studies have been carried out to investigate the long-term outcomes of the disease but the natural history of childhood asthma is still controversial&#46; The aim of this study is to define the long-term outcomes of allergic asthmatic children over 10 years follow-up and to discuss the factors influencing the natural history of childhood asthma in western Anatolia&#44; Turkey&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">A total of 176 patients diagnosed with persistent allergic asthma approved by allergen skin testing and followed up for at least 10 years in Allergy-Immunology Clinics of Beh&#231;et Uz Children&#39;s Hospital&#44; a tertiary care hospital for paediatric age&#44; were evaluated for the study&#46; The patients who were not sensitised in the beginning of the follow-up period and the ones diagnosed with mild intermittent asthma were not included in the study&#46; The patients who refused to answer the questions investigating whether they had an attack in the last year were excluded from the study&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Finally&#44; 52 patients participated in the study&#46; All participants agreed to participate according to the principles expressed in the Declaration of Helsinki&#46; The patient&#39;s demographics&#44; findings on the time of diagnosis &#40;presence of eosinophilia&#44; increased serum IgE&#44; type of allergen&#41;&#44; age at onset of disease&#44; time of diagnosis&#44; history of other allergic conditions&#44; history of parental asthma and allergic disorders&#44; presence of pharmacotherapy &#40;long-term controller medications&#41; and immunotherapy were obtained from patients&#8217; records&#46; Immunotherapy was administered according to WHO and EAACI position papers for allergen immunotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The presence of &#62;450<span class="elsevierStyleHsp" style=""></span>eosinophils&#47;&#956;L and serum total IgE &#62;100<span class="elsevierStyleHsp" style=""></span>IU&#47;mL were considered eosinophilia and elevated serum IgE&#44; respectively&#46; At the time of the study&#44; patients with no attack&#44; no use of quick-reliever medications in the previous year and no admission to the emergency department for this reason were accepted on clinical asthma remission&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The factors influencing the clinical asthma remission at the end of 10 years follow-up were evaluated&#46; The data were analysed using a statistical software package &#40;SPSS&#44; version 18&#46;0&#41;&#46; The Chi-square test or Fisher&#39;s exact test&#44; where appropriate&#44; was used to compare proportions in different groups&#46; Factors were considered statistically significant if <span class="elsevierStyleItalic">p</span> values &#60;0&#46;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">Fifty-two persistent allergic asthmatic patients &#40;age range&#58; 11&#8211;26 years&#59; mean age&#58; 16&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&#59; male&#47;female&#58; 27&#47;25&#41; were followed-up for 13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2 &#40;min 10&#8211;max 22 years&#41;&#46; Mean age on diagnosis was 5&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9 &#40;min 2&#8211;max 10 years&#41; and the median time of diagnosis after the onset of symptoms was 2 years &#40;min 0&#8211;max 6 years&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The frequency of eosinophilia and elevated levels of serum total IgE were 76&#46;9&#37; and 86&#46;5&#37; respectively&#46; The most common aeroallergens in our study group were house-dust mite &#40;61&#46;5&#37;&#41;&#44; pollens of grasses-wheat &#40;36&#46;5&#37;&#41;&#44; pollens of olive tree &#40;25&#37;&#41;&#44; mould &#40;11&#46;5&#37;&#41;&#44; animal dander &#40;3&#46;8&#37;&#41; and others &#40;8&#46;5&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 20 patients &#40;38&#46;5&#37;&#41; were on clinical asthma remission at the end of 10 years&#46; The remission rate in the house-dust mite subgroup was 46&#46;9&#37; and was higher than other allergen&#39;s subgroup but the difference was not statistically significant &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;64&#59; 95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;77&#8211;9&#46;0&#41;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The frequency of multi-allergen sensitivity &#40;at least two positive aeroallergen sensitivity on skin-prick test response in a panel of 12 common aeroallergens&#41; was 51&#46;9&#37;&#46; Multi-allergen sensitivity did not affect the remission rate either &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;88&#59; 95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;28&#8211;2&#46;69&#41;&#46; Neither eosinophilia and high levels of total Ig E nor the type of aeroallergen was effective on clinical asthma remission&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The frequencies of allergic rhinitis&#44; atopic dermatitis and food allergy were 57&#46;7&#37;&#44; 5&#46;8&#37; and 3&#46;8&#37;&#44; respectively&#46; The remission rate in patients having only asthma was higher &#40;52&#46;6&#37;&#41; than in patients with accompanying allergic disorders &#40;30&#46;3&#37;&#41;&#46; However&#44; the difference was not statistically significant &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;55&#59; 95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;79&#8211;8&#46;21&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The frequency of tobacco smoke exposure was 38&#46;5&#37;&#44; in the study group&#46; The remission rate in the smoke-exposure group was 35&#46;5&#37;&#44; while it was 40&#46;6&#37; in the smoke non-exposure group and tobacco smoke exposure seems to be ineffective on the clinical asthma remission&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In our study group&#44; 21&#46;2&#37; of the patients were mild persistent&#44; 76&#46;9&#37; were moderate persistent and 1&#46;9&#37; were severe persistent on follow-up&#46; At the end of 10 years&#44; the rate of remission was 45&#46;5&#37; in the mild persistent asthmatic group&#44; while being 36&#46;6&#37; in the moderate and severe group&#46; The difference was not statistically significant &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;44&#59; 95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;37&#8211;5&#46;55&#41;&#46; The remission at the end of 10 years in immunotherapy-administered group and non-administered group was 40&#46;7&#37; and 36&#46;6&#37;&#44; respectively&#46; The effect of immunotherapy on remission could not be documented &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;22&#59; 95&#37; CI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;39&#8211;3&#46;74&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In our study group&#44; all patients were treated with long-term controller medications including ICS &#40;inhaled corticosteroids&#41; &#40;44&#37;&#41;&#44; ICS combined with leukotriene modifiers &#40;23&#37;&#41;&#44; LABAs &#40;long acting inhale &#946;-agonist&#41; &#40;11&#46;5&#37;&#41;&#44; leukotriene modifiers &#40;6&#37;&#41;&#44; antihistaminics &#40;7&#37;&#41; and others &#40;9&#37;&#41;&#46; Because of the retrospective design of our study&#44; there was not a homogenous treatment regimen on persistent childhood asthma&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">We characterised 52 children with persistent allergic asthma over a follow-up period of 10 years&#46; A total of 20 patients &#40;38&#46;5&#37;&#41; were on clinical asthma remission at the end of 10 years&#46; Eosinophilia&#44; high levels of serum IgE&#44; type of allergen&#44; the severity of the disease&#44; immunotherapy or any long-term controller medications seems to be ineffective on clinical remission&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The natural history of asthma can be learned by following cohort studies from birth to adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Some cohorts are based on asthma outpatients<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> while some are based on general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Most of the studies are conducted in western countries&#46; However&#44; the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Variable remission rates of 14&#8211;75&#37; have been reported in unselected population-based or pre-selected cohorts&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> This variability could be largely due to a lack of a standard definition for asthma remission and the heterogeneity of the populations from which the estimates were derived&#46; In this current study&#44; we aimed to evaluate the factors influencing clinical remission rates in childhood asthma because it is reported that bronchial hyperreactivity continues also in long-lasting clinical remission in adolescence&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Clinical asthma remission has been defined as the absence of need for pulmonary medication and does not require any tests &#40;e&#46;g&#46; lung function tests&#41; while the definition of complete asthma remission also includes the absence of bronchial hyperreactivity and normal lung function &#40;FEV1<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>90&#37; predicted&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> This evaluation may have resulted in relatively higher remission rates than in some other reports&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">De Marco et al&#46; point out that subjects living in the Mediterranean region have higher incidences and lower remission rates than persons living in the subcontinental region&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> For this reason&#44; many studies must be conducted to evaluate incidence and remission rates in each region&#46; The International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41; reported the asthma prevalence in Turkey as being between 2&#46;8&#37; and 14&#46;5&#37;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> and there are only a few reports documenting the factors predicting asthma persistence in childhood from Turkey&#46; Sekerel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> reported diminished airflow&#44; female gender and eosinophilia to predict the disease persistence in early adulthood&#44; from the Middle-Eastern Region of Turkey while Bah&#231;eciler et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> reported that respiratory symptoms were significantly predicted by initial FEF 25&#8211;75&#37; and sensitivity to allergens and from the Marmara Region&#44; an industrial zone of Turkey&#46; But there is still a lack of data on long-term outcomes and risk factors affecting the persistence of childhood asthma in Turkey and the Aegean Region&#46; This study is conducted in a single-centre clinic&#44; but a reference clinic in a tertiary care hospital for paediatric age&#44; so it serves large number of patients from western Anatolia&#46; Thus&#44; we believe this study respects the outcomes of the entire Aegean Region&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In studies of the natural history of asthma&#44; female gender has been cited as a risk factor for the persistence of symptoms from childhood to adulthood&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;7&#44;15&#44;17&#44;18</span></a> Although there are factors associated with airway responsiveness in both males and females&#44; sex-specific factors are reported to contribute to new insights into asthma pathogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> In this current study&#44; females have a lower remission rate than males but our study is relatively small to document a sex- specific association&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Although allergy and atopy are reported to be risk factors for persistent asthma in childhood&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> this issue is still controversial&#46; Roorda et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and then Van Beer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> showed that allergy and atopy do not contribute to the persistence of asthma&#46; In our study&#44; the frequency of eosinophilia and high levels of serum total IgE were 76&#46;9&#37; and 86&#46;5&#37;&#44; respectively&#46; They were not effective on both the severity of the disease and the remission at the end of 10 years&#46; In addition&#44; the remission rate in patients having only asthma was slightly higher &#40;52&#46;6&#37;&#41; than in patients with accompanying allergic disorders &#40;30&#46;3&#37;&#41;&#44; but the difference was not statistically significant&#59; so our study could not document an association between atopy&#44; allergy and clinical remission of childhood asthma&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In recent studies&#44; the association of sensitisation to indoor allergens with the development<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> and severity<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> of asthma in childhood has been recognised&#46; The CAMP study&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> reported that avoiding or limiting exposure to relevant indoor allergens in children who are allergic may alter the course of asthma in childhood&#46; In our study&#44; the most common aeroallergen was house-dust mite allergy &#40;61&#46;5&#37;&#41; and the remission rate in house-dust mite subgroup was 46&#46;9&#37;&#59; higher than other allergen&#39;s subgroup in contrast with other reports&#46; This may be associated with the properties of other aeroallergens existing in our region&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Some authors have reported that recent asthma exacerbations contribute strongly and independently to the prediction of a future exacerbation&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Furthermore&#44; remission is reported to occur mainly in patients with less severe asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> But severity is not a fixed feature of asthma&#44; and may change over months or years&#44; whereas the classification by severity suggests a static feature&#46; Moreover&#44; using severity as an outcome measure has limited value in predicting what treatment will be required and what the response to that treatment might be&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Indeed&#44; in our study group&#44; the rate of remission was 45&#46;5&#37; in mild persistent asthmatic group&#44; yet was 36&#46;6&#37; in the moderate and severe group&#46; The difference was not statistically significant&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">There is convincing evidence that allergen specific immunotherapy induces clinical and immunological tolerance and has long-term efficacy&#46; Subcutaneous immunotherapy has been widely used and has been shown to be effective in reducing symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> It represents the only treatment modality that might alter the natural course of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#8211;31</span></a> However&#44; it has been reported that immunotherapy for asthma does not provide benefits beyond those achievable with alternative modalities&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> Furthermore&#44; uncommon but severe and nearly fatal systemic reactions and repeated injections leading to serious complaints among patients have restricted the administration&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#8211;36</span></a> In our study group&#44; subcutaneous immunotherapy was administered in 51&#46;9&#37; of the patients according to WHO and EAACI position papers for allergen immunotherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;13</span></a> The remission at the end of 10 years in immunotherapy-administered group and the non-administered group was 40&#46;7&#37; and 36&#46;6&#37;&#44; respectively&#46; The difference was not statistically significant so our results could not document the efficacy of immunotherapy in childhood asthma&#46; In recent reports&#44; specific immunotherapy is reported to improve asthma related quality of life in childhood&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> In our study&#44; asthma related quality of life or the decrease in the need of quick-reliever medications were not evaluated&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Another argumentative issue on asthma is whether the use of long term controller medications influences the natural history of asthma by reducing inflammation&#44; subsequent remodelling and thus preventing the decline in lung function&#46; Agertoft and Pedersen<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> reported the first study to suggest that inhaled corticosteroids influence lung function and they postulated that early intervention may prevent the development of irreversible airway obstruction&#46; START study was a randomised double-blind trial documenting the lesser decline of FEV1 in inhaled budesonide group than placebo while IMPACT study reported no significant difference in post-bronchodilator FEV1 in budesonide&#44; zafirlukast and placebo&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39&#44;40</span></a> There is not a consistent protocol in our treatment strategies&#44; so we cannot comment on long-term controller medications&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The limitation of our study is its retrospective design&#46; There is insufficient information on patients&#8217; records including data about exclusive breastfeeding rate&#44; number of children and living conditions of the family&#44; socioeconomic status and pet ownership rates that may alter the course of the disease&#46; Moreover&#44; although the lung function tests were not required for the definition of clinical remission&#44; spirometry was performed on patients during clinical follow up&#46; However&#44; the data about lung function tests were not evaluated because of lack of standardisation due to the retrospective design&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">In conclusion&#44; this is the first study to report long term outcomes of childhood asthma from western Turkey&#46; As the course of the disease may differ due to environmental factors&#44; the findings may be enlightening for especially Mediterranean physicians documenting high remission rates with no predictor&#46; The limitation of this cross-sectional study is its retrospective design&#46; Prospective studies performed in larger asthmatic populations may obtain further data about the natural course of the disease&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patients&#8217; data protection</span><p id="par0120" class="elsevierStylePara elsevierViewall">Confidentiality of data&#46; The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">Right to privacy and informed consent&#46; The authors have obtained the informed consent of the patients and&#47;or subjects mentioned in the article&#46; The author for correspondence is in possession of this document&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human subjects and animals in research</span><p id="par0130" class="elsevierStylePara elsevierViewall">Protection of human and animal subjects&#46; The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
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              "identificador" => "sec0035"
              "titulo" => "Patients&#8217; data protection"
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              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
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              "titulo" => "Protection of human subjects and animals in research"
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          "titulo" => "Conflict of interest"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2012-02-08"
    "fechaAceptado" => "2012-05-24"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Long-term outcomes"
            1 => "Asthma"
            2 => "Childhood"
            3 => "Natural history"
            4 => "Immunotherapy"
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    "resumen" => array:1 [
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Prospective cohort studies have provided useful knowledge about the natural history of asthma&#46; However&#44; most of the studies are conducted in western countries but the course of the disease and long-term outcomes may differ between countries due to environmental and cultural factors&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study is to describe the long-term outcomes of childhood asthma&#44; with data from a follow-up study of at least 10 years&#44; in western Anatolia&#44; Turkey&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Fifty-two patients diagnosed with persistent allergic asthma participated in the study&#46; The patient&#39;s demographics&#44; findings on admission&#44; age at onset of disease&#44; time of diagnosis&#44; history of other allergic conditions&#44; history of parental asthma and allergic disorders&#44; presence of pharmacotherapy and immunotherapy were obtained from patients&#8217; records&#46; The factors influencing remission at the end of 10 years follow-up were evaluated&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 20 patients &#40;38&#46;5&#37;&#41; were on remission at the end of 10 years&#46; The type of allergen&#44; multi-allergen sensitivity&#44; eosinophilia and elevated serum immunoglobulin E on admission&#44; accompanying allergic disorders and atopy in parents&#44; and allergen immunotherapy did not affect the remission rate &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Childhood persistent asthma is not a homogeneous clinical entity but high clinical remission rates are obtained in western Anatolia&#46; There is no significant predictor of clinical remission in long term follow-up&#46; Prospective studies should be performed in larger asthmatic populations to obtain further data about the natural course of childhood asthma&#46;</p>"
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                  \t\t\t\t">Female gender&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25&#47;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Follow-up period<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Age on diagnosis<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Immunotherapy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27&#47;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">9&#47;25 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;26&#8211;2&#46;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#47;27 &#40;40&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;39&#8211;3&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Accompanying allergic disorder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;33 &#40;30&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&#8211;1&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;19 &#40;52&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;79&#8211;8&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atopic disease in parents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#47;24 &#40;29&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15&#8211;1&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;28 &#40;46&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;66&#8211;6&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eosinophilia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;40 &#40;37&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;22&#8211;3&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;12 &#40;41&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;32&#8211;4&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elevated serum Ig E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#47;43 &#40;37&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&#8211;3&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;9 &#40;44&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;31&#8211;5&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">House-dust allergy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;32 &#40;46&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;77&#8211;9&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;20 &#40;25&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&#8211;1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multi-allergen sensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;27 &#40;37&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;28&#8211;2&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;25 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;37&#8211;3&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#47;11 &#40;45&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;37&#8211;5&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;41 &#40;36&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;18&#8211;2&#46;226&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Immunotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;27 &#40;40&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;39&#8211;3&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#47;25 &#40;36&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;26&#8211;2&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab400652.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Remission rates of subjects according to risk factors&#44; severity of the disease and immunotherapy&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Allergen immunotherapy&#58; therapeutic vaccines for allergic diseases&#46; A WHO position paper"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Bousquet"
                            1 => "R&#46; Lockey"
                            2 => "H&#46;J&#46; Malling"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2012.05.008

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	5	2	7
2024 September	13	4	17
2024 August	12	2	14
2024 July	10	4	14
2024 June	22	1	23
2024 May	7	3	10
2024 April	11	12	23
2024 March	13	6	19
2024 February	9	7	16
2024 January	13	0	13
2023 December	11	13	24
2023 November	17	6	23
2023 October	26	3	29
2023 September	21	5	26
2023 August	6	4	10
2023 July	16	3	19
2023 June	9	2	11
2023 May	6	2	8
2023 April	10	2	12
2023 March	10	5	15
2023 February	3	6	9
2023 January	9	7	16
2022 December	8	3	11
2022 November	13	9	22
2022 October	12	52	64
2022 September	12	23	35
2022 August	13	6	19
2022 July	13	7	20
2022 June	10	8	18
2022 May	9	18	27
2022 April	14	12	26
2022 March	17	5	22
2022 February	4	9	13
2022 January	13	8	21
2021 December	10	12	22
2021 November	6	9	15
2021 October	13	10	23
2021 September	9	11	20
2021 August	7	3	10
2021 July	9	8	17
2021 June	14	11	25
2021 May	11	9	20
2021 April	10	11	21
2021 March	23	10	33
2021 February	13	11	24
2021 January	5	7	12
2020 December	3	1	4
2020 July	0	1	1
2018 February	2	1	3
2018 January	0	1	1
2017 November	1	2	3
2017 October	8	3	11
2017 September	6	5	11
2017 August	7	4	11
2017 July	7	5	12
2017 June	8	15	23
2017 May	11	4	15
2017 April	8	5	13
2017 March	12	16	28
2017 February	16	1	17
2017 January	13	0	13
2016 December	11	3	14
2016 November	15	3	18
2016 October	26	4	30
2016 September	9	1	10
2016 August	14	4	18
2016 July	2	4	6
2016 June	11	4	15
2016 May	4	1	5
2016 April	11	12	23
2016 March	11	7	18
2016 February	9	12	21
2016 January	6	7	13
2015 December	5	6	11
2015 November	9	2	11
2015 October	11	3	14
2015 September	6	3	9
2015 August	7	5	12
2015 July	8	1	9
2015 June	1	2	3
2015 May	5	2	7
2015 April	5	13	18
2015 March	2	3	5
2015 February	8	1	9
2015 January	18	3	21
2014 December	19	6	25
2014 November	17	4	21
2014 October	11	9	20
2014 September	28	5	33
2014 August	2	1	3
2014 July	0	1	1
2014 June	0	1	1
2014 May	0	2	2
2014 March	22	10	32
2014 February	17	4	21
2014 January	15	5	20
2013 December	14	8	22
2013 November	19	8	27
2013 October	12	8	20

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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