bluuebunny/crossref_metadata_2025 huggingface dataset:
Socio‐economic burden of asthma, allergy, and other atopic illnesses
Authors: Weiss K. B. , Sullivan S. D. , Weiss Kevin B.
Published: June 2007

Asthma and atopic illness account for a substantial burden of social morbidity. The purpose of this brief report will be to provide an overview of the different dimensions to the socio‐economic burden of asthma and other atopic diseases and suggest areas where future research in this area may advance our understanding of the impact of various treatment strategies of these diseases. While there are occasional studies which describe the full dimensions of this social and economic burden, more studies are needed to complete our understanding of this burden especially studies that investigate the relative cost‐effectiveness of medical and non‐medical interventions. These studies will provide the infrastructure to rationally examine the optimal cost‐effective strategies for these illnesses. In particular economic studies are needed to examine how best to balance resource expenditures for preventive versus pharmacologic control. Use of health economic methods will provide insights into the most efficient design and implementation of current disease control, with potentially concomitant reductions in costs and social burden for atopic illnesses, including asthma.
Evaluation of the child with suspected primary immunodeficiency
Authors: Wahn U.
Published: June 2007

Infections are one of the major causes for visits to paediatricians. Most children recover without sequelae, untreated or if treated properly, and develop specific immunity towards the challenging microorganisms (mostly viruses). There is a small proportion of children however, with unusual frequent, severe, chronic, recurrent or opportunistic infections in whom an underlying immunodeficiency must be suspected. Based on current knowledge about the major types of congenital immunodeficiencies this review suggests a diagnostic approach to these children. Early evaluation will allow early identification of affected children and, subsequently, lead to proper treatment before devastating infections cause irreversible organ damage.
Functional assessment of CD2, CD3 and CD28 on the surface of peripheral blood T‐cells from infants at low versus high genetic risk for atopy
Authors: Holt P.G. , Somerville C. , Baron‐Hay M. J. , Holt B. J. , Sly P. D.
Published: June 2007

Recent studies from several laboratories suggest that the rate of postnatal maturation of T‐cell function(s) associated with in vitro activation may be slower in children at high genetic risk for atopy (HR), compared to their normal (low risk; LR) counterparts. The present study compared the in vitro activity of the function‐associated surface molecules CD2, CD3 and CD28 in panels of 27 HR and 13 LR infants, with a reference panel of 10 adults, employing assay systems involving T‐cell stimulation with MoAbs against these molecules. The response maxima induced by saturating levels of the MoAbs were equivalent in all 3 groups, but T‐cells from the HR infants required 10–50 fold higher levels of anti‐CD3 stimulation to attain their maximum response, relative to adults (p = 0.02); T‐cells from LR infants were also less responsive to anti‐CD3 than adults, but these differences were smaller and did not attain statistical significance. It is suggested that these differences are attributable to varying proportions of competent T‐memory cells (which respond to low levels of anti‐CD3) in PBL from these populations, the postnatal accumulation of which proceeds slowest in the HR group.
Elevated levels of serum antibodies to the lectin wheat germ agglutinin in celiac children lend support to the gluten‐lectin theory of celiac disease
Authors: Fälth‐Magnusson K. , Magnusson K.‐E.
Published: June 2007

Lectins recognize carbohydrate moities of glycoproteins and glycolipids, and can elicit several biological effects, including cell agglutination, cell activation and mitogenesis. According to the gluten‐lectin theory, celiac lesions represent a response to a toxic lectin, putatively wheat germ agglutinin (WGA). In this study we compared the serum antibody levels IgA, IgG and IgM to WGA and to gliadin in children under investigation for celiac disease (CD), as compared to reference children. We found that the levels of IgA and IgG to WGA as well as gliadin were significantly higher in celiac children on a gluten‐containing diet, compared to children on gluten‐free diet and reference children. These findings lend support to the concept that WGA is a biologically significant component of gluten. Since WGA can mimic the effects of epidermal growth factor (EGF) at the cellular level, we hypothezise that the crypt hyperplasia seen in celiac children could be due to a mitogenic response induced by WGA.
Individual time‐courses of ECP and EPX during allergen provocation tests in asthmatic children
Authors: Kleinau I. , Niggemann B. , Wahn U.
Published: June 2007

To study the time‐course of eosinophil cationic protein (ECP) and eosinophil protein X (EPX) during bronchial allergen provocation, we investigated 32 asthmatic children sensitive to house‐dust mites as well as 6 non‐atopic young adult controls. In all subjects, allergen challenges were performed with house dust mite extracts of Dermatophagoides pteronys‐sinus or Dermatophagoides farinae. Blood samples were taken at regular intervals during the 24‐h observation period. The individual time‐courses of ECP and EPX revealed different characteristic groups of patterns: (1) an isolated early serum peak of both mediators during or within the first 60 min after provocation (2) an early plus a late peak (3) an isolated late peak 12 h after provocation (4) an isolated late peak 24 h after provocation, and (5) no significant variation during the 24‐h observation period. The early peak could be due to short‐term changes in eosinophil activation, while late peaks may reflect eosinophil proliferation, recruitment, subsequent priming and enhancing of the propensity to release their proteins. ECP and EPX showed a corresponding parallel time‐course in nearly all challenges, with EPX‐concentration exceeding that of ECP. There was no correlation between ECP/EPX serum concentrations and clinical parameters such as lung function data. From our results we conclude that the striking groups of time‐courses of ECP/EPX serum concentration indicate different uniform patterns of eosinophil activation during allergen challenge ‐ but do not predict clinical outcome of provocation. The role of the eosinophil in early asthmatic reactions remains to be established in further studies.
Cockroach sensitivity in asthmatic Egyptian children
Authors: El‐Gamal Y , Awad A. , Hossny E. , El‐Basiony S. , Galal E.
Published: June 2007

Cockroach‐specific IgE antibodies (CR‐IgE) were assayed in the sera of 51 asthmatic and 33 healthy, nonallergic children. Cockroach IgE was detected in 43 asthmatic children (84%), seven of whom showed a high CR‐IgE response (> = 1.5 IU/ml). Only three of the healthy children (9%) had a positive response, and none of them were in the strongly positive category. The difference from the asthmatic group was statistically significant (P < 0.001). Children with clinically mild asthma had a significantly lower CR‐IgE posi‐tivity rate than moderate and severe cases. The presence of other allergic manifestations or family history of atopy had no relationship to CR‐IgE, nor did the residency, age, duration of illness, or total serum IgE levels. However, the CR‐IgE titres were positively correlated with the absolute eosinophil counts. Thus, cockroach antigens are common inhalant allergens in Egyptian asthmatic children.
Infant feeding history shows distinct differences between Swedish celiac and reference children
Authors: Fälth‐Magnusson Karin , Franzen Lennart , Jansson Gunnar , Laurin Pia , Stenhammai Lars
Published: June 2007

Infant feeding history was investigated in 72 celiac and 288 age‐matched reference children in a retrospective questionnaire study. The reply rate was 100% in celiac and 91. 6% in reference children. The celiac children were breast‐fed for a significantly shorter time than reference children, and they were less often breast‐fed at the introduction of gluten. The age of the children at gluten introduction was similar, but the cellac children were significantly more often introduced by a gluten‐containing follow‐up formula, while the reference children more often started on a gluten‐containing porridge. The results can be interpreted in two ways. First, it could be argued that breast milk per se protects against symptoms of celiac disease in childhood. It could, however, also be claimed that breast‐feeding merely modulates the gluten introduction, causing a less abrupt introduction of gluten in the baby diet and thereby fewer overt symptoms of the disease.
Wheezing bronchitis in children. Incidence, viral infections, and other risk factors in a defined population
Authors: Rylander Emma , Eriksson Margareta , Pershagen Göran , Nordvall Lennart , Ehrnsr Anneka , Ziegler Therdi
Published: June 2007

Risk factors for severe wheezing bronchitis were studied in children aged 4 months to 4 years in need of hospitalization. The children included in the study consisted of all cases generated from a geographically defined population, the catchment area of St Göran's hospital in Stockholm, The incidence was 3/1000 children and year, during the two years of observation, with the highest rate in boys under the age of 18 months (4. 7/1000). Symptoms of a preceding upper respiratory tract infection were reported in 90% of the cases, but a viral etiology could only be demonstrated with virus isolation in 26%. Respiratory syncytial virus was the most common finding in younger children. Rhinovirus was primarily seen in older children with a history of previous wheezing. Regardless of whether the cases had a positive or negative virus isolation they showed the same seasonal distribution. Furthermore, there was no difference in risk factors between children with a positive and negative virus isolation. Children older than 18 months with negative virus isolation had higher IgE levels than those with positive isolation, suggesting that atopy is of greater importance in this group.
Mite allergy, clinical atopy, and restriction by HLA class II immune response genes
Authors: Stephan V. , Schmid V. , Frischer T. , SparhoK S. , Forster J. , Wahn V. , Kuehr J.
Published: June 2007

From a community‐based study cohort of 1812 elementary schoolchildren we selected 129 unrelated participants to investigate the relevance of HLA‐class II molecules (DPB, DQB, and DRB) to the regulation of immune response to the mite allergen Der p 1 and to clinical atopic disorders. On the basis of skin prick test results validated by measurement of specific IgE, individuals were selected and divided into three groups: group I (n = 20), controls without detectable specific IgE to common inhalant allergens; group II (n = 22), children sensitized only to non‐mite allergens; group III (n = 85), children sensitized to Der p 1. Clinical history of asthma, eczema, and hay fever was ascertained using standardized questionnaires. In total, 43 different HLA class II alleles (DPB, n = 19; DQB, n = 14; and DRB, n = 10) were determined by sequence‐specific oligonucleotide typing with PCR‐amplified DNA. We were not able to demonstrate significant differences in gene frequencies of any HLA class II allele between the group of mite‐sensitized children and one of the other two groups. However, the presence of certain DRB‐ and DPB‐haplotypes (DRB *0100/*0300/*1100 and DPB *0201/*0401) was significantly associated (p < 0.01) with a history of asthma, hay fever, and atopy (defined as a history of asthma and/or hay fever and/or eczema). Other haplotypes, including DQB *0303/*0503, DRB *0200/*0700, and DPB 0402 were negatively associated with a history of eczema, hay fever, and atopy (p < 0.01). Thus, our findings do not suggest a relevance of HLA‐class II molecules to mite allergy; however, some HLA class n haplotypes appear to be predictive of the incidence of atopic disorders.
Respiratory syncytial virus infection: its role in aeroallergen sensitization during the first two years of life
Authors: Foister J. , Tacke U. , Krebs H. , Streckert H. J. , Werchau H. , Bergmann R. L , Schulz J. , Lau S. , Wahn U.
Published: June 2007

Our aim was to study the influence of infection with the respiratory syncytial virus (RSV) in non‐hospitalized infants on sensitization to aeroallergens and the early manifestation of atopy. Six hundert and nine infants from the prospective German Multicenter Cohort Study on Atopy were included, 38% of whom had an elevated atopic risk. RSV IgG and IgM antibodies were tested by ELISA with gradient purified RSV antigen. Specific IgE against mites, cat dandruff, birch and grass pollens and relevant nutritional antigens were tested with CAP‐RAST‐FEIA (Pharmacia, Sweden). Of the cord sera 99% were positive for RSV‐IgG, 44. 7% at one year and 64. 2% (n=265) at two years of age. The positivity rate after 12 months varied with the season of birth, the number of siblings and the degree of exposure to tobacco smoke; and correlated closely with attacks of wheezing during infancy. Twenty (2. 8%) children were found to be sensitized against at least one aeroallergen at one year, and 28 (10. 5%) at two years. By the first birthday, mite sensitization (n=3) could only be seen in the RSV‐infected children; grass pollen sensitization (n=9) was associated with RSV seropositivity (logistic regression model including the confounders mentioned above: with RSV IgG p=0.04 > and IgM p=0.0006), as was birch sensitization (n=5) with RSV IgM (p=0.009). No such differences could be detected at two years. No correlation of RSV seropositivity to any allergic manifestation could be found. We conclude, that it is only in the first year of life, that RSV infection plays a significant role in promoting sensitization against aeroallergens, which do not at this time produce allergic symptoms.
Serum levels of the soluble low affinity receptor for IgE and soluble interleukin‐2 receptor in childhood, and their relation to age, gender, atopy and allergic disease
Authors: Miller A. L , Stern D. A. , Martinez F. D. , Wright A. L , Taussig L M. , Halonen M.
Published: June 2007

Identifying immune factors associated with the development of atopy can enhance our understanding of the in vivo mechanisms involved and may have utility in paradigms designed to prevent disease. Two candidates sug‐gested for such roles are the soluble low affinity receptor for IgE (sCD23) and the soluble interleukin‐2 receptor (sCD25). To assess serum levels of these factors blood samples were collected at birth and at age 6 in a large nonselected population from Tucson, AZ. Log mean sCD23 and sCD25 lev‐els decreased from birth to age 6, (for sCD23 0. 60 ffi 0. 26pg/l, n=340 and 0. 53 + 0. 28pg/l, n=333 and for sCD25 1. 95 i 0. 14pM. n=304 and 1. 86 ffi 0. 20pM, n=327. for the two ages respectively. Anglo children had lower sCD23 levels at birth compared to Hispanic children (p < 0.01); no effect of gender was observed. Skin test reactivity at age 6 was directly related to sCD25 levels at age 6 (p=0.007) and even levels at birth showed a similar trend (p=0.06). These relations were distinct from any relation to total se‐rum IgE. No relation was observed with sCD23 levels for either skin test re‐activity or serum IgE. The prevalences of asthma, rhinitis and eczema by age 6 were unrelated to sCD25 or sCD23 levels. The results indicate that soluble CD23 and CD25 have higher levels at birth than later in childhood and that the development of skin test reactivity may be associated with reg‐ulatory mechanisms involving sCD25, whereas sCD23 was not similarly implicated.
Hypoalbuminemia, oliguria and peripheral cyanosis in an infant with severe atopic dermatitis
Authors: Capulong M.C.T. , Kimura K. , Sakaguchj N. , Kawahara H. , Matsubara K. , Likura Y.
Published: June 2007

A six‐month old male infant with severe atopic dermatitis was admitted with hypoalbuminemia, oliguria and cyanosis of the extremitie. s. There was marked edema and generalized eczema with foul, yellowish exudates. The patient's major clinical manifestations were attributed to the loss of albumin through the skin. Although atopic dermatitis is a common disease in children, here we want to show that systemic disturbances may arise from such condition, describe the total care given the patient, and emphasize the wholistic approach in managing cases of severe atopic dermatitis, intensive treatment was instituted and the patient was discharged after three weeks and remained in a stable condition.
In vitro cytokine production and phenotype expression by blood mononuclear cellsfrom umbilical cords, children and adults
Authors: Müller K. , Zak M. , Nielsen S. , Pedersen F. K. , de Nully P. , Bendtzen K.
Published: June 2007

Age related differences in immunological reactions include variations in the in vitro functions of blood mononuclear cells (MNC). In an attempt to understand the mechanism behind these differences we examined age related differences in the phenotype profiles of MNC in parallel with the in vitro production of interleukin IL‐6, tumour necrosis factor alpha (TNFα) and in‐terferon gamma (IFNg) in neonates, children and adults. In cultures without added polyclonal activators IL‐6 and TNFα levels in children were 3–6 times higher than those of umbilical cords and adults. However, using optimal in vitro stimulation (E. coli lipopolysaccharide (LPS), phytohaemmag‐glutinin or pokeweed mitogen (PWM)) no significant differences in the levels of these cytokines were observed. The levels of IFNg in PWM driven cultures followed a different pattern with comparable levels in children and adults, and unmeasurable levels in cord blood MNC. Flow cytometry analysis of the phenotypic distribution of MNC revealed age related differences in the expression of CD3, CD4, CD8, CD14, CD19, CD45RA, CD45RO, CD2, LFA‐1, ICAM‐1 and LFA‐3. Correlation studies did not indicate that the observed differences in cytokine production could be ascribed to differences in the frequency of monocytes, T cells or B cells. The TNFα levels in suboptimally stimulated cultures correlated negatively with the expression of LFA‐3 and positively with CD45RA. while IFNg correlated positively with CD2, LFA‐1, CD45R0 and CD8.

In conclusion, the study provides evidence of age related differences in the production of TNFα, IL‐6 and IFNg among neonates, children and adults. These differences may to some extent be caused by differences in the expression of cell surface molecules involved in cellular interactions and signalling.
Comparison of three immunoassays for diagnosing sensitization to latex in children with spina bifida
Authors: Niggemann B. , Michael T. , von Moers A. , Seidel U. , Wahl R. , Jacobsen L , Scheffer D. , Wahn U.
Published: June 2007

As natural rubber latex (latex) has become more widespread in our environment, physicians have become increasingly aware of the problem of possible allergic reactions. Many fatal and near‐fatal incidents have been reported (mainly during surgery) (1—3) and data has been published on groups frequently exposed to latex, such as patients with spina bifida (4—9), healthcare professionals (10—12) and occupationally exposed persons (13). The incidence of latex allergy in children seems to be increasing (14). Tests are therefore needed which can reliably detect sensitization to latex. Our aim was to compare the diagnostic accuracy of three commercial immunoassays for measuring specific IgE in serum to latex.
Short stature in children with respiratory allergy
Authors: Sant'Anna Celso Avelar , Solé Dirceu , Naspitz Charles Kirov
Published: June 2007

We evaluated the prevalence of short stature (SS) among children with respiratory allergic disease followed up in a specialised centre. These patients (N = 617; 8 months to 16 years) with respiratory allergy (asthma and/or rhinitis) were evaluated for SS (stature shorter than the 3rd percentile, NCHS pattern). The possilble links between SS and gender; current age; type, severity, and duration of the allergic disease, treatment with cortico‐steroid and birth weight were also studied. To assess the influence of the socioeconomic level on SS frequency among atopies, 120 of these patients were compared to their non‐atopies siblings. The overall prevalence of SS was 7. 9%. Relationship between SS and gender type and severity of the allergic disease and treatment with corticosteroids were not observed. A significant higher frequency of SS occurred among patients with longer period of disease and birth weight less than 2, 500 gr. Analysis of the pairs of brothers showed significant higher frequency of SS between allergies (12. 5% x 4. 2%) showing influence of allergic disease per se. Longitudinal studies for long periods of time are required to properly establish the relation between atopic disease and SS.
Isolation of type 1 and type 2 cloned mite allergen‐specific T cells from an asthmatic child
Authors: Chiang Bor‐Luen , Ding Han‐Jen , Chou Chen‐Cheng , Hsieh Kue‐Hsiung
Published: June 2007

Allergen‐specific T cells have been thought to play a central role in the pathogenesis of asthma. It has been well documented that allergen‐specific T cells derived from atopic patients are predominantly of type 2 T helper cell pattern. However, allergen‐specific T cells derived in nonatopic normals are of type 1 in contrast to alopic patients. The purpose of the study was to develop and characterize both mite allergen‐specific TH1 and TH2 clones from the same asthmatic child. With exogenous supplemental cytokine, both TH1 and TH2 clones from the same patient have been developed and maintained in this laboratory for more than one year. All these T cell clones showed dose dependent allergen‐specific proliferative response and expressed with CD4+, CD45RA− markers. Elucidation of the origin and interaction between these two different types of T helper cells might shed light on understanding the pathogenesis of atopic diseases and the mechanisms of hyposensitization in atopic patients.
Early intervention for the prevention of atopic dermatitis
Authors: Hide D. W.
Published: June 2007

Based on a lecture given to the European Society for Pediatric Allergy and Clinical Immunology.

Diseases associated with atopy are increasing throughout the world. Individuals appear to have a genetic predisposition to atopy which is then provoked by environmental influences. Ingested or inhaled allergens provoke an antibody response and a state of sensitization. In many but not all sensitized individuals subsequent exposure to allergen will provoke a release of histamine and other mediators from sensitized mast cells and produce clinical signs of an allergic reaction in the target organ or throughout the body. At the present time one approach to the prevention or reduction of such reactions appears to be the identification of the high‐risk infant and then preventing or limiting exposure to the potentially allergenic protein materials in the child's diet or immediate environment.

This paper outlines the problems of identifying high‐risk infants and comments on the success claimed in the intervention studies that have been undertaken. The possible hazards to mothers and infants of dietary exclusion are emphasized and the provision of appropriate medical and dietetic support are regarded as of paramount importance. Although more studies are needed, the Isle of Wight intervention programme offers hope to families at high‐risk of atopy that the problem can be reduced for the next generation.
Measles vaccine in egg allergic children: poor immunogenicity of the Edmoston‐Zagreb strain
Authors: Bruno Giovanna , Grandolfo Michele , Lucenti Patrizia , Novello Francesco , Ridolfi Barbara , Businco Luisa
Published: June 2007

Despite the fact that a number of recent studies have shown that measles/ mumps/rubella vaccine is safe for egg allergic children, many pediatricians are still concerned about immunization in egg allergic children. In Europe, a measles vaccine with the Edmoston‐Zagreb strain (EZMV) grown in human fibroblast culture has been developed and recommended for children with egg allergy. However, some doubt arises on the efficacy of this strain due to its weak immunogenicity. The aim of this study was to investigate the immunogenicity of the EZMV in comparison to the measles vaccine with the Schwarz strain (SWMV) grown in a chick embryo fibroblast culture.

Thirty‐nine children affected by severe immediate manifestations due to IgE mediated egg allergy were enrolled. The children received at random the SWMV (Morupar, Sclavo) or the EZMV (Triviraten, Berna) in one 0. 5 ml subcutaneous injection, and were checked for any immediate allergic reactions in the following 4 hours. Blood samples were taken for the detection of specific antibody response 5 months after the immunization. In SWMV seroconverted children (18/19) the geometric mean antibody liter was 3 times higher than that observed in EZMV seroconverted children (17/20) (p < 0.01). No allergic reactions occurred following the immunization with the two different vaccines. This data confirms the safety of SWMV in egg allergic children. In addition, the present study provides further data on the lower immunogenicity of the EZMV in comparison to the SWMV.
Double‐blind placebo‐controlled study of sublingual immunotherapy with house dust mite extract (D. pt.) in children
Authors: Hirsch Th. , Sähn M. , Leupold W.
Published: June 2007

Safety and efficacy of sublingual (sublingual‐swallow) immunotherapy (IT) with house dust mite extract were evaluated in 30 children (6 ‐ 152/3 years of age) over the first 12 months of an ongoing study. The cumulative dose was 570 μg Der p I (five times that administered with subcutaneous therapy). Safety: One patient on active treatment dropped out after 8 weeks because of a subjective feeling of severe weakness, questionably induced by the therapy. Five patients on active therapy and one patient on placebo reported minor local side effects. Efficacy: Pulmonary symptoms were reduced after 12 months in actively treated asthmatics, but this was not consistent with the lack of improvement in bronchial reactivity, skin sensitivity and specific IgG and IgG4 against D. pt. in this group. In patients with rhinitis nasal sensitivity was reduced in the placebo group without concomitant improvement in the nasal symptom score. Specific IgE (D. pt. and D. f.) in creased significantly more in the active treatment group after 3 and 12 months. We conclude that sublingual IT over 12 months with the fivefold Der p 1 dose of subcutaneous IT was well tolerated, but there was no consistent clinical or immunological benefit compared to placebo.
Labial food challenge in children with food allergy
Authors: Ranee F. , Dutau G.
Published: June 2007

The current increase in the prevalence of food allergies appears to have several causes including better screening, improved diagnosis and changes in both the techniques used by food manufacturers and eating habits. Labial food challenge (LFC)is simple, rapid to perform and is associated with only low risks of systemic reaction. It is thus an appealing alternative to the oral food challenge (OFC) for pediatric use.

We report a series of 202 LFC performed over two years in 142 children with food allergy suspected from the case history, positive skin prick tests and specific serum IgE assays: 156 LFC were positive; and 46 negative, followed by positive single‐blind, placebo‐controlled food challenges (SB‐PCFC). The foods provoking reactions were egg white (75 cases), peanut (60 cases), mustard (23 cases), cow's milk (13 cases), cod (8 cases), kiwi fruit, shrimp (4 cases each), chicken, peanut oil (3 cases each), hazel nuts (2 cases), and snails, apple, fennel, garlic, chilli peppers, pepper, and duck (1 case each). LFC positivity was mostly (89. 7% of cases) manifested as a labial edema with contiguous urticaria. There were systemic reactions in 4. 5% of cases: generalized urticaria, hoarseness and rapid‐onset and generalized eczema. The 46 infants with negative LFC results had positive SBPCFC. The reactions were in 34 cases generalized urticaria, 10 cases asthma attacks, 2 cases early and generalized eczema, and in one case general anaphylactic shock. The sensitivity of the LFC was 77%. The LFC was easy to perform with children. Positive results indicate the presence of food allergy, but negative results require further investigations preferably double‐blind, placebo‐controlled food challenge (DBPCFC)
Peripheral blood T and B lymphocyte subpopulations in infants with acute respiratory syncytial virus brochiolitis
Authors: Raes Marc , Peeters Veerle , Alliet Philippe , Gillis Philippe , Kortleven Jan , Magerman Koen , Rummens Jean Luc
Published: June 2007

Most data concerning immunopathogenetic mechanisms involved in respiratory syncytial virus (RSV) infection are derived from animal studies. In infants with RSV bronchiolitis the target organ i. e. the airway is hard to explore. We looked for specific alterations in peripheral blood lymphocyte subpopulations in infants hospitalized for RSV bronchiolitis. Flow cytometric analysis with a large panel of monoclonals was performed on peripheral blood lymphocytes in thirty‐two infants (mean age: 4. 9 months) admitted for RSV bronchiolitis. Data collected on admission were compared with age‐matched control values and also with results obtained at the end of the first week of hospitalization. Differences between age‐groups (older or younger than 4 months) and between clinical subgroups (clinical severity score more or less than 6) were looked for. In the group of infants as a whole, regardless of age and clinical score the number of CD4+ cells on admission was significantly elevated compared to normal values for age (p < 0.001) including a high fraction of the naive suppressor‐inducer subpopulation (CD4+/CD45RA+) and a low fraction of the reciprocal memory helper‐inducer subpopulation (CD4+/CD29+). Within the CD8+ cell population the number of T cells with cytotoxic activity (CD8+/S6F1+) was significantly elevated (p < 0.001) as were other types of cytotoxic cells. A significant decrease (p < 0.0001) in the proportion of the precursor/suppressor‐effector subpopulation (CD8+/S6F1‐) was seen. Absolute numbers and percentages of CD 19+ B cells were significantly elevated (p < 0.001) with a significant increase in the CD5+ subfraction (p < 0.001) as well as in the CD 10+ subfraction (p < 0.001). In the older age group immunophenotypic cytotoxicity was more pronounced with increased clinical score. During recovery the CD45RA+: CD29+ ratio tended to normalize within the CD4+ T cells. Within the B lymphocyte subsets significant increase in the CD19+/ CD5+ fraction (p < 0.5) was seen. We conclude that there are significant changes in the number of peripheral blood lymphocyte subsets in infants with RSV bronchiolitis as compared to age‐related controls. We hope that present data could be useful in further exploration of RSV immunology in humans. A possible link between RSV bronchiolitis and the subsequent development of atopy is mentioned.
Soy allergy is not common in atopic children: a multicenter study
Authors: Bruno G. , Giampietro P. G. , Guercio M. J/Del , Gallia P. , Giovannini L , Lovati C. , Paolucci P. , Quaglio L , Zoratto E. , Businco L
Published: June 2007

The aim of the present study was to evaluate the prevalence of soy allergy (positive skin test and positive challenge test) in a large cohort of atopic children, many of them soy fed early in life for several months. In order to investigate the prevalence of soy allergy, two groups of children were enrolled into the study. The first group comprised a cohort of 505 children with personal history suggestive of food allergy. The second group included 243 children born of atopic parents, who had been soy protein formula fed for the first six months of life for the prevention of cow's milk allergy and who had been prospectively followed up, from birth to 5 years.

As regards the prevalence of soy allergy in the cohort of children suffering from allergic disease: 31/505 children (6%) had positive skin prick test to soy, however only six of the 31 children with positive skin prick test to soy had positive challenge test to soy.

With regard to the prevalence of soy allergy in the children who had been soy protein formula fed in the first six months of life (second group): 14/ 243 children (6%) had positive skin prick test to soy, but the double blind placebo control oral food challenge to soy was positive in only one of these 14 children. In conclusion documented soy allergy is not common in atopic children.
Inflammation markers and symptom activity in children with bronchial asthma. Influence of atopy and eczema
Authors: Carlsen Kai‐Håkon , Halvorsen Raghnild , Penersen Morten , Lødrup Carlsen Karin Cecilie
Published: June 2007

Background. Eosinophil cationic protein (ECP) has been reported to reflect the eosinophil inflammatory activity in asthma. However, the relative impact of asthma symptoms and atopic eczema upon serum (s)‐ECP in asthmatic children has not been established.

Objectives. To examine s‐ECP levels and s‐myeloperoxidase (MPO) in relation to asthma symptoms and atopic eczema in asthmatic children.

Methods. S‐ECP and s‐MPO were assessed in relation to symptom activity, lung function, exercise induced bronchoconstriction and bronchial responsiveness in 101 children; median age 9 years, range 1‐16 years; with moderate to severe asthma, admitted to Voksentoppen Center.

Result. S‐ECP was significantly higher in children with persistent compared to episodic or no asthma symptoms in the past four weeks, S‐ECP was also higher in children with atopic compared to non‐atopic asthma, as well as in those with active compared to past history of no history of atopic eczema. SMPO was higher in children with persistent asthma symptoms, but did not differ in relation to atopy of eczema state. Persistent asthma symptoms had the greatest impact upon s‐ECP levels, followed by atopy and active eczema.

Conclusion. S‐ECP may be used in assessing symptom activity in asthmatic children, but with the realisation that active eczema and the presence of atopy may also influence levels.
Endotoxin exposure and symptoms in asthmatic children
Authors: Cândida Rizzo M. , Naspitz Charles K. , Fernández‐Caldas Enrique , Lockey Richard F. , Mimiça Igor , Solé Dirceu
Published: June 2007

Endotoxins (ET) are pro‐innammatory substances present in hou.sc dust which may increase non‐specific bronchial reactivity in asthmatic patients. Endotoxins (EU/g) and Der p I levels were compared in the homes often asthmatic and ten control children, aged 6‐16 years, living in Sao Paulo, Brazil. The houses were visited once a month from February 1993 lo February 1994 and dust samples were collected from the bedding and floor of each subject's house. No significant differences were observed in ET and Derp 1 levels in the homes of asthmatics and controls. The highest ET levels were detected in January and November, whereas the lowest levels were detected in April and August (p < 0.05). demonstrating a distinct seasonal distribution. The highest Der p I levels in bedding were observed in July and the lowest in February (p < 0.05). while Derp I levels in floor did not show significant differences throughout the year. Symptom and medication scores were evaluated monthly in the group of asthmatic children. There was a significant correlation (p < 0.05. r = 0.63) between clinical symptom scores and ET exposure, however no significant correlation was found for mite exposure (p > 0.05. r = 0.19). The results suggest that ET exposure exacerbates asthmatic symptoms in mite allergic, asthmatic children.
Variable increases of IgG and IgM antibodies in milk of IgA deficient women
Authors: Hahn‐Zoric Mirjana , Carlsson Barbro , Björkander Janne , Mellander Lotta , Friman Vanda , Padyukov Leonid , Hanson Lars Å.
Published: June 2007

Serum, milk and saliva from seven IgA deficient mothers were studied for the presence of IgA, IgG and IgM antibodies to Escherichia coli and polio virus antigens. Different variable patterns were obtained. One mother had very much increased IgM and IgG antibodies in milk and saliva against both antigens; the milk IgG antibodies were 11–14 times higher than the reference milk pool. Another mother showed also striking increases of both IgM and IgG antibodies in milk, as well as in saliva where the increases were much higher for the poliovirus than the E. coli antibodies. Yet another mother showed a certain increase of IgM but not of IgG antibodies in the milk. The uneven appearance of IgG and IgM antibodies in serum and secretions suggests local production. So do the differences ot antibody avidities, the variations in IgG subclass distribution of antibodies and different patterns after isoelectric focusing (IEF) /immunoblotting analysis of antibody spec‐trotypes in secretions and serum.

The study illustrates the variable patterns of compensatory increases of IgG and IgM antibodies which may occur in IgA deficiency. It also shows that the milk from IgA deficient mothers can still be rich in antibodies, in spite of the lack of secretory IgA.
Parity among atopic and non‐atopic mothers
Authors: Nilsson Lennart , Max Kjellman N‐L , Löfman Owe , Björkstén Bengt
Published: June 2007

A temporary Th2 skewed immunity is essential for a successful outcome of pregnancy. It is also a hallmark of atopic disease. We recorded the number of siblings to 3667 children in relation to maternal atopy. In all, 65% of the allergic and 56% of the non‐allergic mothers had more than one child (p < 0.001). These data support a hypothesis that the atopic genotype may be associated with an increased likelihood for a successful outcome of pregnancy and thus from an evolutionary point of view compensate for the less efficient host defence against microbial infections associated with this type of immunity.
Hypersensitivity to the diphtheria component in the Di‐Te‐Pol vaccinene. A type I allergic reaction demonstrated by basophil histamine release
Authors: Skov Per Stahl , Pelck Inger , Ebbesen Finn , Poulsen Lars Kærgaard
Published: June 2007

We describe a two year‐old multiallergic boy who developed generalized urticaria after the third Di‐Te‐Pol vaccination. A Type I reaction to the vaccine was demonstrated by performing basophil histamine release to the complete vaccine. Further, we found that the reaction could be exclusively ascribed to Diphtheria Toxoid whereas no release was observed by the Polio and Tetanus component. The latter result was confirmed since no specific IgE to Tetanus Toxoid could be demonstrated.
Concentrations of cat (Fel d 1), dog (Can f 1) and mite (Der f 1 and Der p 1) allergens in the clothing and school environment of Swedish schoolchildren with and without pets at home
Authors: Berge Marsa , Munir A. K. , Dreborg Sten
Published: June 2007

To investigate whether our hypothesis that cat and dog owners bring allergens to public areas in their clothes was true or not, we studied the levels of Fel d 1, Can f 1, Der p 1 and Der f 1 in dust from the clothes and classrooms of children in a Swedish school. We also investigated the levels of allergen in different areas in the four classrooms used by the children. Thirty‐one children were selected in four classes, forming three groups: cat owners, dog owners and children without a cat or dog at home. Furthermore, a group of children with asthma was included. Cat and dog allergens were detected in all 57 samples from clothes and classrooms. Mite allergen Der f 1 was detected in low concentrations in 6 out of 48 and Der p 1 in 5 out of 46 samples investigated. The concentrations of Can f 1 were higher than those of Fel d 1 in samples from clothes (geometric mean: 2676 ng/g fine dust and 444 ng/g) and classrooms (Can f 1: 1092 ng/g, Fel d 1: 240 ng/g). The dog owners had significantly higher concentrations of Can f 1 (8434 ng/g fine dust) in their clothes than cat owners (1629 ng/g, p <0.01), children without cat or dog (2742 ng/g, p < 0.05) and children with asthma (1518 ng/g, p < 0.001). The cat owners did not have significantly higher levels of Fel d 1 (1105 ng/g) in their clothes compared to the other three groups (D: 247 ng/g, nCnD: 418 ng/g, A: 386 ng/g) but the levels were significantly higher than for all children without a cat at home (345 ng/g, p < 0.05). No concentrations of mite allergen and low concentrations of Fel d 1 and Can f 1 were found in the children's hair. There were significantly higher concentrations of Fel d 1 and Can f 1 in dust from curtains than in samples from floors and bookshelves (p < 0.05). There was no significant difference between the allergen concentrations in samples from curtains and from desks and chairs, including the teachers' chairs, the only upholstered furniture in the rooms. Our results support the hypothesis that cat and dog owners bring allergens to public areas in their clothes and support other studies showing that textiles and upholstered furniture function as reservoirs of cat and dog allergens. Thus, children with asthma and other allergic diseases will be exposed to cat and dog allergens at school and by contact with pet owners, even if they avoid animal allergens at home.
Development of latex allergy in children up to 5 years of age ‐ a retrospective analysis of risk factors
Authors: Niggemann Bodo , Kulig Michael , Bergmann Renate , Wahn Ulrich
Published: June 2007

The aim of the study was to investigate possible associations between the time course of early sensitization to latex and various life style factors. Of the 398 children from a prospective birth cohort study, 20 (5%) showed specific serum IgE to latex at the age of 5 years. Sensitization started beyond the first year of life and 19 out of 20 sensitized children showed increasing specific IgE‐values over time. All 20 sensitized children were atopic (p < 0.00000). Total IgE was significantly higher in the sensitized group (median 394.5 kU/I) than in the non‐sensitized group (median 39.2 kU/1) (p < 0.00001). Comparing the latex‐sensitized group with the non‐sensitized children, there were significantly more operations in the latex group (p < 0.05) during the first 5 years of life. Medical history, certain foods, the use of pacifiers, mattress composition and socio‐economic data proved not to be significant risk factors. From our study we conclude that ‐besides the number of operations and an atopic predisposition ‐ no other definite risk factor for developing sensitization or allergy to latex (such as everyday household objects) can be identified in children up to 5 years of age.
Longitudinal study on latex sensitization in children with spina bifida
Authors: Cremer Reinhold , Hoppe Ania , Kleine‐Diepenbruck Ursula , Bläker Felix
Published: June 2007

The course of latex sensitization is rarely documented, and only a few reports about the influence of prophylaxis in the occupational environment have been published concerning health care workers. Therefore we did a follow‐up study in the high risk group of patients with spina bifida and evaluated the efficacy of latex prophylaxis. For this purpose we measured IgE antibodies (FEIA) against latex and inhalative allergens in the sera of 67 patients with spina bifida and reevaluated them 0.6 to 4.1 years later, having instructed the patients about prophylactic measures and established a latex‐free environment for surgery of all spina bifida patients in our hospital. 37% of the patients did not develop latex antibodies during the follow‐up period, 27% showed decreasing levels of antibodies (12% to non‐detectable levels), 19% had an increase in latex sensitization (6% newly sensitized), and 9% showed no change in levels of latex antibodies. From our data it may be concluded that surgery without strict latex prophylaxis is the main cause of new sensitization and worsening of preexisting latex antibody levels. Mild sensitization can be reduced by prophylactic measurements to non‐detectable antibody levels. With consistent prophylaxis, even symptomatic patients can be operated without risk of allergic complications or increasing antibodies.
Vocal cord dysfunction in three children ‐ misdiagnosis of bronchial asthma?
Authors: Niggemann Bodo , Paul Karl , Keitzer Rolf , Wahn Ulrich
Published: June 2007

Vocal cord dysfunction (VCD) is a paradoxical function of the vocal cords, leading to intermittent predominantly inspiratory dyspnea, but with no response to bronchodilator and anti‐inflammatory drug therapy. We report on three children with VCD: 1) A 12‐year old boy, who was treated for many years for bronchial asthma and who presented with inspiratory dyspnea and a functional reduction of the inspiratory and expiratory flow‐volume curve, 2) a 13‐year old girl who was also treated for bronchial asthma on a long‐term basis and in whom the paradoxical vocal cord movement could be demonstrated by laryngoscopy, and 3) a 17‐year old girl who, besides clinical symptoms of bronchial asthma in her anamnesis, suffered from an intermittent severe inspiratory dyspnea, refractory to bronchodilator treatment. Laryngoscopy proved the diagnosis of VCD. No patient showed a deterioration on discontinuation of their antiasthmatic therapy. VCD is best diagnosed by assessment of the vocal cords during laryngoscopy. The following therapeutic measures are helpful: 1) Demonstration of diagnosis (e.g. videodocumentation of laryngoscopy) and reassurance of patients and parents, 2) speech therapy, and 3) psychological intervention and/or psychotherapy. Our three cases point to a differential diagnosis of recurrent dyspnea in children and adolescents which may be overlooked. It is important to question earlier diagnoses, and to objectively evaluate the type of dyspnea.
Latex hypersensitivity in only one uniovular twin: a case report
Authors: Resano Alfredo , Esteve Cristina , Benitez Margarita Fernández
Published: June 2007

We present the clinical case of uniovular twins with cerebral palsy, confirming the development of sensitisation to latex in one of the twins, due to the fact that he underwent surgery more times (nine) than his brother (four) as well as to his different clinical evolution.
Eosinophil and mast cell parameters in children with stable moderate asthma
Authors: Hoekstra Maarten Otto , Grol Marjon H. , Hovenga Hessel , Bouman Katelijne , Stijnen Theo , Koëter Gerard H. , Gerritsen Jorrit , Kauffman Henk F.
Published: June 2007

Mast cells and eosinophils are important cells that contribute to the process of inflammation in asthma either by activating other cells or by secreting products which are potentially toxic to the respiratory epithelium. The influx of these cells in the airways and the secretion of toxic products by these cells is abrogated by inhaled corticosteroids.

Methods ‐ In a double blind randomised, placebo controlled, study in children with stable moderate asthma (N = 34,15 children received fluticasone propionate (FP), an inhaled corticosteroid, and 19 children used a placebo), we investigated the influence of treatment with FP 100 μg bd on various parameters of inflammation: number of eosinophils, secretory products of eosinophils i.e. ECP and EDN (in serum and urine) and a secretory product of mast cells, histamine, which is determined as the compound to which histamine is converted and excreted by the human body: NT‐methyl‐hista‐mine.

Results ‐ Previously we reported that lung function increased and bronchial hyperresponsiveness decreased in the 30 children that completed the study during treatment with FP. In these children we found that none of the laboratory parameters of inflammation changed significantly during treatment with either FP or placebo. However, the decrease in urinary EDN almost reached significance (P = 0.07).

Conclusions ‐ Our results indicate that the number of eosinophils, serum ECP and EDN and urinary EDN as well as urinary NT‐methyl‐histamine do not reflect asthma disease activity in children with stable moderate asthma. Our data on urinary EDN warrant further study of the use of this parameter to monitor asthma in children.