Allergic rhinitis is one of the most prevalent chronic diseases in
Europe. Besides nose symptoms such as sneezing and a blocked nose,
patients also suffer from general complaints like fatigue, sleeping
problems and difficulty concentrating. Allergic rhinitis can have a
serious impact on the daily life of children, because it interferes with
their social activities, hobbies and schoolwork.
Allergen avoidance and symptomatic treatment will only result in
short-term relief. Allergen-specific immunotherapy on the other hand,
targets the cause of the disease and can induce long-term remission of
the allergic symptoms.
This thesis presents an overview of the evidence for the efficacy of
immunotherapy in children with allergic rhinitis and the results of the
STARDROP-study. In this study the clinical efficacy, immunological
effects and adherence to sublingual immunotherapy (SLIT) with a grass
pollen extract in children with hay fever were investigated.http://repub.eur.nl/res/pub/31635/120229_R%C3%B6der%2C%20Esther.pdf
Preterm birth occurs before 37 weeks of gestation and includes late preterm birth
(gestational age: 32-37 weeks), very preterm birth (gestational age < 32 weeks), and
extremely preterm birth (gestational age < 27 weeks) according to the World Health
Organization (2010). Risk factors associated with preterm birth include ethnicity, multiple
pregnancies, pregnancy after in vitro fertilization, maternal or infant infections,
and unfavorable social environmental circumstances. The obstetric precursors leading
to preterm birth are delivery for maternal or fetal indications, in which labor is either
induced or the infant is delivered by caesarean section, spontaneous preterm labor with
intact membranes, and, preterm premature rupture of the membranes, irrespective
of whether delivery is vaginal or by caesarean section. In the Netherlands, 7.7% of
all births are preterm and 1.5% are very preterm.3 Because of technological advances
and collaboration between obstetricians and neonatologists, survival rates for (very)
preterm infants have dramatically increased. A 1-kg infant who was born in 1960 had a
mortality risk of 95% but had a 95% probability of survival by 2000.
Despite the improved perinatal care, developmental outcomes of these infants remain of
concern since immature organs, such as brains and lungs, are extremely vulnerable for
adverse consequences of very preterm birth. Adverse developmental outcomes include
respiratory illnesses and abnormal growth patterns, but also severe neurosensory
disabilities, such as cerebral palsy, mental retardation, and deafness or blindness.
These problems are generally detected and treated early in infancy and the incidence
is fortunately relatively low. There is growing awareness, however, that the majority
of very preterm children that survive without such overt neurosensory disabilities and
with normal intelligence suffers from long-term problems. These long-term problems
become apparent at school age and comprise fine and gross motor dysfunction, neurocognitive
dysfunction such as impaired visuo-spatial, or language skills, poor academic
achievement, and behavior problems. In the Netherlands, 38% of these children have
special assistance at school10 and about 20% attend special education compared to
4.8% of the normal population.