Journals Watch - Eczema, migrane and LRTIs

Short of time to catch up on the journals? Dr Suzanne Hunter guides you through the latest research.

Furry pets in eczema
Arch Dermatol 2007; 143: 1,570-77

In line with the confusing advice on prenatal and infantile exposure to peanuts, there is conflicting opinion on the exposure to furry animals in children with eczema.

This systematic review examines the evidence from previous studies. They found there was no clear evidence that early pet exposure was associated with risk of subsequent eczema, and indeed there might even be a protective effect.

Authors felt none of the studies reviewed were of a high enough standard to gain a clear picture, but there is probably enough evidence to endorse the view that parents of children with eczema shouldn't be too hasty about getting rid of Rex.

Migraine prophylaxis
Br J Gen Pract 2008; 58: 98-101

It is recommended that patients who have more than two migraines a month should be offered prophylaxis.

In this Dutch study, researchers examined whether patients wanted this and whether they were on prophylaxis.

The study found that 55 per cent of patients who had more than two attacks a month wanted prophylaxis, but only 8 per cent were on it.

Although most patients felt they could approach their GP about getting prophylaxis, 40 per cent wanted their GP to broach the subject.

This shows a need to raise the topic of prophylaxis at all migraine medication reviews.

Iron in pregnancy
J Epidemiol Community Health 2008; 62: 120-4

Iron is often prescribed to pregnant women for anaemia (even though the anaemia is a dilutional effect).

This study looked at the effect of iron and folic acid on birth weight in the absence of anaemia. It found that folic acid had no effect.

However, iron supplementation of ferrous sulphate 80mg daily nearly halved the risk of having a low birth weight baby.

The duration of cough
Br J Gen Pract 2008; 58: 88-92

It is known that acute lower respiratory tract infections (LTRIs) have a long natural history and antibiotics make little or no difference to the duration of cough.

The 807 patients studied presented with cough as main symptom, and patients with history or findings suggestive of pneumonia were excluded.

This study set out to determine how long a LRTI will last and whether there were any clues to allow you to predict the duration of cough.

The average duration was almost 12 days in adults and 10 days in children.

This was shorter by a day in the presence of a fever, but longer by a day in those who had their activities restricted by the LRTI or a more severe cough on the day they saw the doctor or by a longer duration of symptoms prior to the consultation.

The message from this is to give patients a realistic estimate of duration of symptoms so they don't come back asking for antibiotics after a few days.

Immunomodulation in heart failure
Lancet 2008; 371: 228-36

This is a very interesting idea. Systolic heart failure is known to activate the immune system with higher concentrations of inflammatory cytokines, activation of the complement system and the production of auto-antibodies specific to cardiac antigens.

For this study, patients with grade II-IV chronic heart failure were injected regularly with immunomodulation therapy or a saline placebo as a control group.

The treatment group had a significant reduction in adverse health events, in particular in patients with no previous MI or NYHA class II heart failure, where the reductions were 26 per cent and 39 per cent, respectively. This could point to a new approach to heart failure treatment.

Stopping clopidogrel
JAMA 2008; 299: 532-9

Unlike aspirin, which you can stay on indefinitely after your acute coronary event, clopidogrel is only allowed for a clearly defined period of time.

In my practice our pharmaceutical advisers look at each patient on clopidogrel individually to make sure none breaches the permitted length of treatment.

In this study researchers looked at adverse events on discontinuing clopidogrel after medically-treated and percutaneous coronary intervention-treated patients after an acute coronary syndrome.

In both groups there was a higher rate of death in the first 90 days after stopping clopidogrel than the next 90 days or the 90 days after that.

This raises the possibility of a rebound effect after stopping clopidogrel and the question of why there is such a strict limit on the length of time clopidogrel is allowed.

Is it strictly evidence based, or due to its very high cost?

Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals.

The quick study

  • Eczema does not seem to be affected by prenatal and infantile exposure to furry pets.
  • Migraine patients who experience two or more attacks a month may wish to take prophylaxis but are waiting for their GP to suggest it.
  • Iron supplementation in pregnant women without anaemia almost halved the risk of having a low birth weight baby.
  • LRTI lasts longer in patients whose activities are restricted by their illness.
  • Heart failure patients who received immunomodulation therapy had fewer adverse events than controls.
  • Clopidogrel patients are at increased risk of adverse events in the 90 days after stopping treatment.

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