bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence into practice: a theory based study of achieving national health targets in primary care
Authors: Michie Susan , Hendy Jane , Smith Jonathan , Adshead MSc FFPH Fiona
Published: August 2004

Rationale, aims and objectives  This study investigates reasons why general practices achieve nationally set milestones to different extents. It compares the beliefs, self‐reported behaviours and organizational context of general practitioners (GPs) who have been successful in achieving milestones set out in the UK's National Service Framework (NSF) for Coronary Heart Disease (CHD) with those who have been less successful.

Methods  Sixteen London GPs were interviewed, eight ‘high implementers’ (having met five or more of six CHD NSF milestones) and eight ‘low implementers’ (having met one or two milestones). Practices were matched for practice size across the groups as far as possible. The interview consisted of open‐ended questions, based on theoretical constructs identified as key to implementation research in a previous project. Interviews were transcribed and analysed with Interpretative Phenomenological Analysis (IPA).

Results  There were three main areas that differentiated high and low implementers: beliefs about evidence‐based practice, control over professional practice and consequences of achieving the milestones.

Low implementers: (i) expressed less belief in evidence‐based guidelines as the basis of their practice; (ii) were more concerned about their lack of control over the development and implementation of the guidelines (lack of ownership), and over their own practice (lack of autonomy); and (iii) perceived more negative consequences and fewer positive consequences, both for themselves and for patient care.

Conclusions  This study demonstrates the application of psychological theory in trying to understand and improve professional practice. The results suggest areas that could be targeted in developing interventions to increase guideline implementation in primary care.
Using iron deficiency tests for colorectal cancer screening: a feasibility study in one UK general practice
Authors: Edwards Adrian , Penney Michael , Allison Miles
Published: August 2004

Iron deficiency is common at presentation in colorectal cancer. Testing for it may complement other screening tests such as faecal occult blood testing and sigmoidoscopy. We therefore examined the feasibility of offering iron deficiency testing to patients in a primary care setting in the UK, offering testing to all 1240 patients aged 55–74 years in one general practice in South Wales, UK. Patients with abnormal results were assessed and offered further investigations. Five hundred and fifty‐one people (44.4%) attended for iron deficiency blood tests, of whom 26 patients (4.7%) were iron deficient and offered endoscopic assessment. This identified two cases of benign neoplasia amenable to treatment and no cases of cancer. Iron deficiency testing in a screening context appeared feasible although uptake may be low.
Modes of transmission of Glugea plecoglossi (Microspora) via the skin and digestive tract in an experimental infection model using rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Lee S‐J , Yokoyama H , Ogawa K
Published: August 2004

Glugea plecoglossi (Microspora) is a significant cause of economic loss in cultured ayu, Plecoglossus altivelis, in Japan, due to the unsightly appearance of infected fish harbouring xenomas in the body cavity. Modes of transmission of G. plecoglossi via the skin and digestive tract were studied in an experimental infection model using rainbow trout, Oncorhynchus mykiss. Combined with Uvitex 2B and in situ hybridization (ISH) assays, the early development of G. plecoglossi was successfully traced. Following a bath exposure of fish Uvitex 2B‐labelled G. plecoglossi spores were observed to attach to microscopic injuries (trypan blue‐positive sites) of fish skin, after which ISH‐positive sporoplasms were found to invade the epidermis as early as 5 min post‐infection (PI), migrating rapidly to the subdermis. It was also shown that G. plecoglossi entering via the skin does not spread into the internal organs but develops into subdermal xenomas. After rainbow trout were exposed to G. plecoglossi spores by oral intubation, spores germinated in the intestinal lumen, followed by penetration of sporoplasms into the gut mucosal epithelium 5 min PI. In vitro trials determining stimulation factors (fish mucus, changes in pH, digestive enzymes) for the extrusion of the polar tube were inconclusive. The present study indicates that skin wounds and the gut epithelium can be portals of entry of G. plecoglossi and that natural infection in fish seems to occur perorally rather than via the skin.
The induction of laboratory‐based amoebic gill disease revisited
Authors: Morrison R N , Crosbie P B B , Nowak B F
Published: August 2004

Previous work in our laboratory defined a method of inducing laboratory‐based amoebic gill disease (AGD) in Atlantic salmon, Salmo salar L. Gills of AGD‐affected fish were scraped and the debris placed into fish‐holding systems, eliciting AGD in naïve Atlantic salmon. While this method is consistently successful in inducing AGD, variability in the kinetics and severity of infections has been observed. It is believed that the infections are influenced by inherently variable viability of post‐harvest amoeba trophozoites. Here, a new method of experimental induction of AGD is presented that redefines the infection model including the minimum infective dose. Amoebae were partially purified from the gills of AGD‐affected Atlantic salmon. Trophozoites were characterized by light microscopy and immunocytochemistry and designated Neoparamoeba sp., possibly Neoparamoeba pemaquidensis. Cells were placed into experimental infection systems ranging in concentration from 0 to 500 cells L−1. AGD was detected by gross and histological examination in fish held in all systems inoculated with amoebae. The number of gross and histological AGD lesions per gill was proportional to the inoculating concentration of amoebae indicating that the severity of disease is a function of amoeba density in the water column. The implications of these observations are discussed in the context of the existing AGD literature base as well as Atlantic salmon farming in south‐eastern Tasmania.
Successful treatment of eosinophilic pustular folliculitis with topical tacrolimus
Authors: Kawaguchi Masakazu , Mitsuhashi Yoshihiko , Kondo Shigeo
Published: August 2004

We present two cases of Eosinophilic pustular folliclulitis (EPF) who were successfully treated with topical tacrolimus. Indomethacin is the most frequently used agent for the treatment of EPF, however, tacrolimus ointment may become the treatment of choice for patients with EPF.
A case of human insulin allergy induced by short‐acting and intermediate‐acting insulin but not by long‐acting insulin
Authors: Adachi Atsuko , Fukunaga Atsushi , Horikawa Tatsuya
Published: August 2004

A 66‐year‐old woman suffering from pollinosis developed generalized urticaria after injection of intermediate‐acting insulin for diabetes mellitus. She had human insulin‐specific IgE, and in skin tests was positive for human recombinant insulin and negative for additives. Uniquely, she reacted to fast‐acting and slow‐acting insulin but not to long‐acting insulin. We further confirmed that human insulin preparations could stimulate her peripheral basophils to release a significant amount of histamine. Genetically generated human insulin analogs, aspart and lispro, induced positive skin tests and histamine release from basophils. She was recommended to use a long‐acting insulin preparation and was free from symptoms thereafter.
Tinea capitis in a dermatology center in the city of Fortaleza, Brazil: the role of Trichophyton tonsurans
Authors: Brilhante Raimunda S. N. , Cordeiro Rossana A. , Rocha Marcos F. G. , Monteiro Andre J. , Meireles Tereza E. F. , Sidrim Jose J. C.
Published: August 2004

Background  Over a 3‐year period (March 1999 to March 2002), 944 patients with scalp lesions attended a dermatology reference center in the city of Fortaleza, Ceará, Brazil. Clinical specimens were examined at the Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza‐CE, Brazil, to detect patients with tinea capitis.

Methods  Specimens were obtained from pus, scales, and hairs from suspected lesions of tinea capitis. Mycologic analyses were conducted by direct microscopy and by fungal culture on Sabouraud dextrose agar, with or without chloramphenicol and Mycosel agar. The culture tubes were incubated at 28 °C and examined daily for 1 month.

Results  Fungi were seen in 438 (46.4%) of the 944 clinical specimens. The percentage of positive direct microscopic examinations of the clinical specimens was 83.7%. Of those patients with tinea capitis, 157 (35.8%) were males and 281 (64.2%; P < 0.001) were females. The distribution of dermatophyte species in males, from 136 positive cultures, was Trichophyton tonsurans (54.41%), Microsporum canis (38.97%), T. rubrum (4.41%), T. mentagrophytes var. mentagrophytes (1.47%), and M. gypseum (0.74%). On the other hand, only three species, from 251 positive cultures, were present in females: T. tonsurans (80.08%), M. canis (17.53%), and T. rubrum (2.39%). There was a high proportion of positive results in children under 10 years of age (n = 309). No significant difference was detected in the seasonal distribution of tinea capitis.

Conclusions  Our data show that T. tonsurans is the main etiologic agent of tinea capitis, and is more likely to be found in females and in the prepubertal population.
Additional conjunctival and penile pigmentation in Laugier–Hunziker syndrome: a report of two cases
Authors: Ayoub Nakhlé , Barete Stéphane , Bouaziz Jean‐David , Pelletier François Le , Frances Camille
Published: August 2004

Background Laugier–Hunziker syndrome is a rare acquired hyperpigmentation of the oral mucosa and lips which is often associated with longitudinal melanonychia. We report two patients exhibiting the classical features of Laugier–Hunziker syndrome with additional and previously unreported conjunctival and penile pigmentation.

Patients and methods Two patients presented with a history of progressive acquired macular pigmentation of the oral mucosa, the lips, the ocular conjunctiva and the penis. Longitudinal melanonychia was found in one patient. Microscopic features (basal epithelial melanosis, moderate acanthosis and superficial pigmentary incontinence) and ultrastructural details (increased number of normal‐appearing melanosomes inside basal keratinocytes and dermal melanophages) were characteristic of Laugier–Hunziker syndrome.

Conclusions These two observations illustrate the topographical variations of Laugier–Hunziker syndrome and highlight the need to expand the originally described features to include more widespread areas of hyperpigmentation.
Use of Ber‐EP4 protein in recurrent metastatic basal cell carcinoma: a case report and review of the literature
Authors: Saladi Rao N. , Singh Fiza , Wei Huachen , Lebwohl Mark G. , Phelps Robert G.
Published: August 2004

The occurrence of metastatic basal cell carcinoma (MBCC) is extremely low, ranging from 0.0028 to 0.5%. We present a rare case report of MBCC in a 57‐year‐old Caucasian male with a known history of numerous nonmelanoma cutaneous neoplasms. The patient presented with a large ulcerated right axillary mass that recurred 2 months after an initial BCC was resected from the same site. An excisional biopsy of the recurrent mass and regional lymph nodes showed atypical basaloid cells with hyperchromatic nuclei, stromal retraction and rare squamous features in the soft tissue and lymph node. The tumor cells were bcl‐2 negative and positive for Ber‐EP4. The negative expression of bcl‐2 correlates with the aggressive nature of this tumor and Ber‐EP4 confirmed the diagnosis of BCC.
Bee moth (Galleria mellonella) allergic reactions are caused by several thermolabile antigens
Authors: Villalta D. , Martelli P. , Mistrello G. , Roncarolo D. , Zanoni D.
Published: August 2004

Background:  Exposure and contact with bee moth (Galleria mellonella) larvae (Gm) can cause an allergic reaction both in anglers and breeders. We described the case of an amateur fisherman who experienced an allergic reaction using Gm but not using heat‐treated Gm (h‐Gm) (mummies). The aim of this study was to demonstrate by immunoblotting and radioallergosorbent test (RAST)‐inhibition experiments the loss of allergenic epitopes in h‐Gm extracts.

Methods:  Galleria mellonella larvae and h‐Gm were homogenized and extracted at 10% (w/v) in 0.5 M phosphate‐buffered saline, pH 7.4 containing 0.5% NaN3 for 16 h at 4°C. Gm and h‐Gm extracts were electrophoresed in a 10% polyacrylamide precast Nupage Bis–Tris gel at 180 mA for 1 h and the resolved proteins stained with 0.1% Coomassie brilliant blue and the molecular weight calculated. For the immunoblotting detection of allergenic components the resolved extracts were transferred onto a nitrocellulose membrane and incubated with the patient's serum. Bound specific‐IgE was detected by peroxidase‐conjugated anti‐human IgE. RAST inhibition experiments were performed according to the Ceska method.

Results:  The protein profile of Gm and h‐Gm extracts resulted markedly different in number, intensity and the position of bands, indicating that heat‐treatment modifies the chemical–physical characteristics of the protein contents. The Gm extract showed a strong‐coloured band at 73 kDa and more than 20 components ranging from 12 to 133 kDa; h‐Gm showed two main band at 77 and 38 kDa and about 15 faint bands between 20 and 133 kDa apparently without any correspondence to the bands present in the Gm extract. Immunoblotting with the patient's serum demonstrated several bands of reactivity with the Gm extract ranging from 20 to 100 kDa and no recognizable bands, but only a diffuse smear with h‐Gm. When used in a RAST inhibition experiment the h‐Gm extract demonstrated an inability to compete with the Gm one for the binding to patient's IgE serum.

Conclusions:  The h‐Gm seems to lose the allergenic epitopes and has two advantages for anglers: to avoid new possible sensitizations as well as allergic symptoms in sensitized people, without interfering with their skills and satisfaction in their fishing performance.
Sensitization to petrolatum: an unusual cause of false‐positive drug patch‐tests
Authors: Ulrich G. , Schmutz J. L. , Trechot Ph. , Commun N. , Barbaud A.
Published: August 2004

We report on an unexpected sensitization to petrolatum diagnosed with the occurrence of multiple nonrelevant and false‐positive drug patch‐tests performed while investigating a patient suffering from many cutaneous adverse drug reactions. All the positive drug patch‐tests were prepared with GILBERT® vaseline. This petrolatum reaction is positive as it was tested with five other brands of petrolatums a few months later. As the same petrolatums, but from different batches were tested, patch‐tests with GILBERT® petrolatum were doubtful, while other petrolatums were positive. White petrolatum is a mixture of semisolid hydrocarbons of the methane series. The sensitizing impurities of petrolatum are polycyclic aromatic hydrocarbons, e.g. phenanthrene derivatives. The purity of petrolatum depends on both the petroleum stock and on the production and packaging methods. Even if rare, contact sensitization to petrolatum can disturb the interpretation of drug patch‐tests. It is necessary in the interpretation of drug patch‐tests to test both in petrolatum and other vehicles and with all the different petrolatums used in preparing the material for drug patch‐tests. So, it is essential to advise the patients sensitized to petrolatum to remove all the topical drugs, such as all the cosmetics, which contain petrolatum in their formulation.
Monoclonal antibody‐based ELISA to quantify the major allergen of Artemisia vulgaris pollen, Art v 1
Authors: Jimeno L. , Duffort O. , Serrano C. , Barber D. , Polo F.
Published: August 2004

Background:  Pollen of Artemisia vulgaris (mugwort) is a relevant cause of pollinosis in temperate and humid regions. Recently, the major allergen of this pollen, Art v 1, has been characterized.

Objective:  To develop a monoclonal antibody (mAb)‐based enzyme‐linked immunosorbent assay (ELISA) to quantify Art v 1, and to assess the correlation of Art v 1 content with the biological activity of mugwort pollen extracts.

Methods:  Art v 1‐specific mAbs were obtained from a BALB/c mouse immunized with high‐performance liquid chromatography (HPLC)‐purified Art v 1. One of these antibodies (Av 3.7), which recognizes the N‐terminal defensin‐like domain of Art v 1, was used as the capture antibody in an ELISA method for allergen quantitation. An anti‐A. vulgaris rabbit serum was used as the second antibody. Art v 1 was purified by immunoaffinity chromatography and used as the standard in the assay.

Results:  The purity and identity of the affinity‐purified Art v 1 was confirmed by sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS–PAGE), mass spectrometry, amino acid composition, and N‐terminal amino acid sequencing. The prevalence of specific IgE against Art v 1, determined by radioallergosorbent test (RAST) in a population of 44 mugwort‐allergic patients, was 79%. The Art v 1‐ELISA developed displays a detection limit of 0.1 ng/ml, and a practical working range of 0.2–10 ng/ml. The concentration of Art v 1 was measured in 10 A. vulgaris pollen extracts, and a good correlation was observed between the Art v 1 content and the allergenic activity of the extracts.

Conclusions:  The results prove the usefulness of the Art v 1‐ELISA for the standardization of A. vulgaris pollen extracts intended for clinical use.
IgE level and Phadiatop® in an elderly population from the PAQUID cohort: relationship to respiratory symptoms and smoking
Authors: Raherison C. , Nejjari C. , Marty M. L. , Filleul L. , Barberger‐Gateau P. , Dartigues J. F. , Tessier J. F.
Published: August 2004

Background:  In the last decades in industrialized countries, the increase of life expectancy has resulted in an increase in the population of the elderly. However, little is known about the prevalence of allergies in the elderly population. The aim of the study was to investigate the specific relationship of serum IgE and Phadiatop, with asthma, rhinitis, and smoking in a sample of an elderly population.

Methods:  Subjects from the Paquid cohort living in Gironde Department (age 65 years and over) in France were followed up since 1988 (PAQUID cohort).

Results:  Among the randomized sample of 352 subjects, there were 158 men (45%) and 194 women (55%). The lowest levels of IgE were in subjects with chronic sputum; and in normal subjects (47.1 ± 56.4 vs 56.2 ± 73.9, NS). Multiple linear regression was performed with log10 IgE values as a dependent variable and age, Phadiatop test, smoking, and respiratory symptoms independently in men and in women. In men, a significant relationship was observed between IgE values and Phadiatop test (P < 0.001), asthma history (P = 0.002), and smoking (P = 0.019).

Conclusions:  Respiratory allergy is present in persons >65 years of age. There is an association between smoking and IgE level independent of allergic reactivity to common allergens in the elderly.
Birch pollen‐related food as a provocation factor of allergic symptoms in children with atopic eczema/dermatitis syndrome
Authors: Breuer K. , Wulf A. , Constien A. , Tetau D. , Kapp A. , Werfel T.
Published: August 2004

Background:  Food allergy to cow's milk or hen's egg is a common problem in children with atopic eczema/dermatitis syndrome (AEDS) but the role of birch pollen‐related food for the induction of allergic symptoms is still not clear.

Patients/methods:  Twelve children (median age 5 years) with AEDS underwent an oral challenge with those birch pollen‐related foods which were reported to induce no immediate symptoms, but were consumed on a regular basis. Total IgE and specific IgE to birch pollen, Bet v 1/2 and various birch pollen‐related foods were determined.

Results:  Seven of 12 children showed immediate and/or late eczematous reactions upon ingestion of birch pollen‐related foodstuff. Four children showed a worsening of eczema 24 h upon oral challenge with a significant difference in SCORAD before and after challenge. There were no differences in terms of total IgE or birch pollen‐specific IgE between children with a late eczematous response and non‐reacting children.

Conclusions:  Birch pollen‐related food may induce allergic symptoms in children with AEDS who exhibit a sensitization to birch pollen. Oral challenge tests should be performed in those children who suffer from severe AEDS and who are highly sensitized to birch pollen allergens even in the absence of a history suggestive of food allergy.
Efficacy in allergen control and air permeability of different materials used for bed encasement
Authors: Peroni D. G. , Ress M. , Pigozzi R. , Del Giudice M. Miraglia , Bodini A. , Piacentini G. L.
Published: August 2004

Background:  Different types of textile are used for the preparation of covers for bed encasement. The aim of the present study was to evaluate different fabrics employed for mattress covers regarding their efficacy in blocking Der p 1 and Fel d 1 as well as their air permeability.

Methods:  Eleven different commercially available fabrics manufactured for allergen avoidance have been tested and compared with regular cotton. Dust samples titered for Der p 1 and Fel d 1 were pulled through the different fabrics using a modified Fussnecker dust trap and collected by a filter located downstream. Airflow through the dust trap was controlled by a vacuum pump operating for 5 min and measured at the beginning (T0) and at the end (T1) of the test.

Results:  All the tightly woven and laminated materials were able to control mite allergen permeability allowing air passage but they significantly differed in Fel d 1 permeability. Laminated tissues and laminated tissue not tissued were effective in controlling both the allergens but they did not allow air permeability.

Conclusions:  Detailed knowledge about the actual properties of the products for bed encasement needs to be considered in order to optimize allergen avoidance, disease control and sleep comfort.
Control and exacerbation of asthma: a survey of more than 3000 French physicians
Authors: Demoly P. , Crestani B. , Leroyer C. , Magnan A. , Mounedji N. , Humbert M.
Published: August 2004

Background:  Asthma control and prevention of exacerbations are primary objectives for asthma care. However there is a lack of universal definition of these notions which may therefore have a different meaning according to the physician's practice.

Methods:  In the present survey, 1805 general practitioners, 551 pulmonologists, 176 allergologists and 470 resuscitation/emergency care physicians were randomly selected in fall 2001 and asked to answer one question on asthma control and three questions on asthma exacerbation.

Results:  Regarding asthma control, the presence of minimum symptoms was the primary criterion for asthma specialists (pulmonologists and allergologists), while a normal respiratory function was first considered by nonspecialist physicians (general practitioners and emergency care physicians). The first criterion of mild exacerbation for asthma specialists was the occurrence during at least 2 days of an increase in the frequency of dyspnoea and/or the use of short‐acting bronchodilators. For nonspecialist physicians, dyspnoea affecting daily activities and/or sleeping was the preferred notion. Hospitalization was unanimously recognized as the first criterion for severe exacerbations. A decrease in peak expiratory flow of more than 30% below the baseline value on two consecutive days and an episode requiring systemic corticosteroids were the next criteria.

Conclusions:  This survey emphasizes the complexity of the notions of asthma control and exacerbation and provides novel informations to orient continuing education programmes.
Determinants of neonatal IgE level: parity, maternal age, birth season and perinatal essential fatty acid status in infants of atopic mothers
Authors: van Gool C. J. A. W. , Thijs C. , Dagnelie P. C. , Henquet C. J. M. , Van Houwelingen A. C. , Schrander J. , Menheere P. P. C. A. , van, den Brandt P. A.
Published: August 2004

Objective:  The hygiene hypothesis suggests that the protective ‘siblings effect’ against atopic diseases such as atopic dermatitis, allergic asthma and hay fever is a result of recurrent infections during early childhood. A recent study and review have indicated that this protective effect may already arise in utero. Lower n‐3 essential fatty acid (EFA) status is associated with increased parity, and EFA status has also been related to atopy. The present study confirms the negative association between parity and neonatal immunoglobulin E (IgE) levels and further unravel the role of perinatal EFA status.

Methodology:  In a prospective cohort study in 184 atopic mothers and their neonates, we simultaneously measured serum total IgE and EFA levels in plasma phospholipids, both in the mother at 34–36 weeks of gestation and in the neonate at the age of 1 week. Linear regression analysis was used to estimate the effect of parity on maternal and neonatal IgE and EFA status, and the independent effects of parity and EFA status on IgE, controlling for confounding factors such as maternal age and birth season.

Results:  Parity was associated with lower neonatal IgE level (P < 0.01), as well as with lower docosahexanoic acid (DHA, 22:6n‐3) status of the mother (P = 0.01) but not of the neonate (P > 0.69). In the multivariate analysis, higher parity, higher maternal IgE, lower maternal age and birth in the first 3 months of the year were independently associated with neonatal IgE level. No association was detected between maternal or neonatal EFA status and neonatal IgE.

Conclusions:  As neonatal total serum IgE is predictive of later atopy, our results support the hypothesis that the sibling effect in atopy is already being programmed in utero. Our data also confirm earlier findings that DHA status is lower in multiparous women, but this did not confound the relation between parity and neonatal IgE.
Acupuncture and Chinese herbal medicine in the treatment of patients with seasonal allergic rhinitis: a randomized‐controlled clinical trial
Authors: Brinkhaus B. , Hummelsberger J. , Kohnen R. , Seufert J. , Hempen C.‐H. , Leonhardy H. , Nögel R. , Joos S. , Hahn E. , Schuppan D.
Published: August 2004

Background:  Patients with allergic rhinitis (AR) increasingly use complementary medicine. The aim of this study was to determine whether traditional Chinese therapy is efficacious in patients suffering from seasonal AR.

Methods:  Fifty‐two patients between the ages of 20 and 58 who had typical symptoms of seasonal AR were assigned randomly and in a blinded fashion to (i) an active treatment group which received a semi‐standardized treatment of acupuncture and Chinese herbal medicine, and (ii) a control group which received acupuncture applied to non‐acupuncture points in addition to a non‐specific Chinese herbal formula. All patients received acupuncture treatment once per week and the respective Chinese herbal formula as a decoction three times daily for a total of 6 weeks. Assessments were performed before, during, and 1 week after treatment. The change in severity of hay fever symptoms was the primary outcome measured on a visual analogue scale (VAS).

Results:  Compared with patients in the control group, patients in the active treatment group showed a significant after‐treatment improvement on the VAS (P = 0.006) and Rhinitis Quality of Life Questionnaire (P = 0.015). Improvement on the Global Assessment of Change Scale was noted in 85% of active treatment group participants vs 40% in the control group (P = 0.048). No differences between the two groups could be detected with the Allergic Rhinitis Symptom Questionnaire. Both treatments were well‐tolerated.

Conclusions:  The results of this study suggest that traditional Chinese therapy may be an efficacious and safe treatment option for patients with seasonal AR.
Comparative immunophenotyping of monocytes from symptomatic and asymptomatic atopic individuals
Authors: Von Bubnoff D. , Scheler M. , Hinz T. , Matz H. , Koch S. , Bieber T.
Published: August 2004

Background:  Allergy has at least two components – a genetic predisposition referred to as atopy and the progress from an atopic state to clinically apparent disease. Peripheral blood monocytes are circulating myeloid precursors of antigen‐presenting cells. The expression of cell surface proteins on monocytes may therefore witness the disease status and affect the development of allergic disease.

Methods:  Monocytes were isolated from atopic individuals with seasonal allergic rhinitis (n = 10), from atopic individuals sensitized to aeroallergens but without any signs of acute disease (n = 11), and from healthy nonatopic donors (n = 21). Detailed comparative phenotypic analysis of CD14+ and FcɛRI+CD14+ monocytes was performed by flow cytometry.

Results:  CD14+ monocytes from symptomatic atopic donors showed a significant increase in the cell surface intensity of the integrin adhesion molecule CD11c over monocytes from asymptomatic atopic and nonatopic donors. Asymptomatic atopic individuals showed significantly enhanced expression of FcɛRI on the CD14highCD16dim monocyte subset compared with this subset from symptomatic atopic and nonatopic donors.

Conclusion:  The increase in monocyte surface intensity of the adhesion molecule CD11c may be involved in the manifestation of allergic disease. FcɛRI on CD14highCD16dim monocytes of asymptomatic atopic donors may be of functional importance for the maintenance of clinical unresponsiveness toward allergens.
Exposure to house dust endotoxin and allergic sensitization in adults
Authors: Gehring U. , Bischof W. , Schlenvoigt G. , Richter K. , Fahlbusch B. , Wichmann H.‐E. , Heinrich J. ,   for the INGA study group
Published: August 2004

Background:  It has been suggested that exposure to elevated levels of endotoxin decreases the risk of allergic sensitization.

Objective:  To examine the associations between current exposure to bacterial endotoxin in house dust and allergic sensitization in adults.

Methods:  In 1995–1996, we conducted a nested case–control study following a cross‐sectional study performed within the European Community Respiratory Health Survey (ECRHS). Data of 350 adults aged 25–50 years was analysed. Allergic sensitization was assessed by measurement of specific immunoglobulin E (IgE) against several inhalant allergens. Living room floor dust samples were taken. The endotoxin content was quantified using a chromogenic kinetic Limulus amoebocyte lysate test.

Results:  Multiple logistic regression analysis showed a negative association between exposure to house dust endotoxin and severe allergic sensitization. Odds ratios (95% CI) adjusted for place of residence, gender, age, and ‘caseness’ were 0.80 (0.64–1.00) for sensitization to ≥1 allergen and 0.72 (0.56, 0.92) for sensitization to ≥2 allergens using 3.5 kU/l as a cut‐off value for sensitization. With regard to single allergens, the protective effect of endotoxin was strongest for pollen sensitization [aOR (95% CI) = 0.74 (0.58, 0.93)].

Conclusion:  Our results indicate that current exposure to higher levels of house dust endotoxin might be associated with a decreased odds of allergic sensitization in adults.
The co‐seasonal application of anti‐IgE after preseasonal specific immunotherapy decreases ocular and nasal symptom scores and rescue medication use in grass pollen allergic children
Authors: Rolinck‐Werninghaus C. , Hamelmann E. , Keil T. , Kulig M. , Koetz K. , Gerstner B. , Kuehr J. , Zielen S. , Schauer U. , Kamin W. , Von Berg A. , Hammermann J. , Weinkauf B. , Weidinger G. , Stenglein S. , Wahn U. ,   The Omalizumab Rhinitis Study Group
Published: August 2004

Background: Specific immunotherapy (SIT) and treatment with anti‐immunoglobulin (Ig)E antibody are complementary approaches to treat allergic rhinoconjunctivitis, which may be used for single or combined treatment.

Objective:  A randomized, double‐blind, placebo‐controlled trial was conducted to compare the efficacy of single and combined treatment with SIT and anti‐IgE (Omalizumab) in reducing symptom severity and rescue medication use.

Methods:  A total of 221 subjects with birch and grass pollen allergic rhinoconjunctivitis aged 6–17 years were analysed during the grass pollen season. Group A (SITbirch + placebo) served as a reference group obtaining no effective treatment for grass pollen allergy. Group B received anti‐IgE monotherapy during grass pollen season, group C SIT grass pollen monotherapy, and group D the combined treatment of SIT and Omalizumab.

Results:  Preseasonal treatment with grass pollen SIT alone compared with SIT with the nonrelated allergen did not reduce symptoms or rescue medication use. Anti‐IgE monotherapy significantly diminished rescue medication use and number of symptomatic days. The combined treatment with SIT and anti‐IgE showed superior efficacy on symptom severity compared with anti‐IgE alone.

Conclusions:  Co‐seasonal Omalizumab therapy showed considerable effects in children with seasonal allergic rhinitis. The combination of SIT plus Omalizumab was clinically superior to each treatment alone during the first year of observation.
Genes of tolerance
Authors: Akdis C. A. , Blaser K. , Akdis M.
Published: August 2004

Activation‐induced cell death, anergy and/or immune response modulation by T‐regulatory cells (TReg) are essential mechanisms of peripheral T‐cell tolerance. There is growing evidence that anergy, tolerance and active suppression are not entirely distinct, but rather, represent linked mechanisms possibly involving the same cells and multiple suppressor mechanisms. Skewing of allergen‐specific effector T cells to TReg cells appears as a crucial event in the control of healthy immune response to allergens and successful allergen‐specific immunotherapy. The TReg cell response is characterized by abolished allergen‐induced specific T‐cell proliferation and suppressed T helper 1 (Th1)‐ and Th2‐type cytokine secretion. In addition, mediators of allergic inflammation that trigger cAMP‐associated G‐protein coupled receptors, such as histamine receptor 2 may contribute to peripheral tolerance mechanisms. The increased levels of interleukin‐10 (IL‐10) and transforming growth factor‐β (TGF‐β) that are produced by TReg cells potently suppress immunoglobulin E (IgE) production, while simultaneously increasing production of noninflammatory isotypes IgG4 and IgA, respectively. In addition, TReg cells directly or indirectly suppress effector cells of allergic inflammation such as mast cells, basophils and eosinophils. In conclusion, peripheral tolerance to allergens is controlled by multiple active suppression mechanisms. It is associated with regulation of antibody isotypes and effector cells to the direction of a healthy immune response and opens a window for novel therapies of allergic diseases.
Dietary prevention of allergic diseases in infants and small children
Authors: Muraro Antonella , Dreborg Sten , Halken Susanne , Høst Arne , Niggemann Bodo , Aalberse Rob , Arshad Syed H. , Berg Andrea von , Carlsen Kai‐Håkon , Duschén Karel , Eigenmann Philippe , Hill David , Jones Catherine , Mellon Michael , Oldeus Göran , Oranje Arnold , Pascual Cristina , Prescott Susan , Sampson Hugh , Svartengren Magnus , Vandenplas Yvan , Wahn Ulrich , Warner Jill A. , Warner John O. , Wickman Magnus , Zeiger Robert S.
Published: August 2004

The role of primary prevention of allergic diseases has been a matter of debate for the last 40 years. In order to shed some light on this issue, a group of experts of the Section of Pediatrics EAACI reviewed critically the existing literature on the subject. An analysis of published peer‐reviewed observational and interventional studies was performed following the statements of evidence as defined by WHO. The results of the analysis indicate that breastfeeding is highly recommended for all infants irrespective of atopic heredity. A dietary regimen is unequivocally effective in the prevention of allergic diseases in high‐risk children. In these patients breastfeeding combined with avoidance of solid food and cow's milk for at least 4–6 months is the most effective preventive regimen. In the absence of breast milk, formulas with documented reduced allergenicity for at least 4–6 months should be used.
Is bronchodilator response in 2‐yr‐old children associated with asthma risk factors?
Authors: Lødrup Carlsen Karin C. , Pettersen Morten , Carlsen Kai‐Håkon
Published: August 2004

Factors that might influence lung function bronchodilator response by 2 yr of age is largely unknown, thus we aimed to assess this in the ‘Environment and Childhood asthma’ (ECA) study in Oslo. A clinical investigation at mean age 26 months was attended by 516 (84%) children included in a nested case–control study [children with recurrent bronchial obstruction (rBO)] (n = 265) and controls without a history of lower respiratory disease (n = 251). Tidal lung function measures before and after inhaled nebulized salbutamol (bronchodilator response) (when clinically without BO) were obtained in 46%. Clinical characteristics and personal and family history of allergic/respiratory diseases (asthma risk factors) were ascertained by structured interview and clinical examination. Allergic sensitization was assessed by skin prick test/specific IgE antibody analyses to common allergens. Mean (95% CI) per cent change in time to reach peak flow/total expiratory time (tPTEF/tE) from before to after salbutamol was significantly larger in children with rBO [17.3 (9.4–25.3) than controls (−2.2 (−7.7 to 3.0)]. The bronchodilator response increased significantly (p = 0.001) with increasing number of asthma risk factors, but was not significantly associated with allergic sensitization, parental ‘atopy’, or maternal smoking alone. Children treated with inhaled corticosteroids had greater bronchodilator response than those treated with bronchodilators alone. Bronchodilator response in asymptomatic 2‐yr‐old children was most closely associated with the presence of rBO, but increasing number of asthma risk factors and treatment with inhaled corticosteroids were associated with increased bronchodilator response.
Comparative effect of triamcinolone, nedocromil and montelukast on asthma control in children: A randomized pragmatic study
Authors: Stelmach Iwona , Majak Pawel , Jerzynska Joanna , Stelmach Wlodzimierz , Kuna Piotr
Published: August 2004

Asthma severity can be judged by measurements of symptoms, lung function, and medication requirements. The objective was to compare the effect of a 4‐wk monotherapy with low‐dose triamcinolone, montelukast and nedocromil on asthma control, lung function, eosinophil blood count, and bronchial hyper‐reactivity in children with mild to moderate asthma allergic to dust mite. Two hundred fifty‐six children, aged 6–18 yr, with mild to moderate asthma, participated in an 8‐wk study. This was a three‐arm, randomized no blinding or placebo pragmatic trial comparing the effect of triamcinolone acetonide (400 μg/day), inhaled nedocromil and montelukast sodium on clinical parameters of asthma [score, forced expiratory volume in 1 s (FEV1)], PC20H, and eosinophil blood count. Two hundred forty‐six children completed the study. After 4 wk of treatment with triamcinolone and montelukast, FEV1 and PC20H significantly increased, and mean total symptoms score and mean number of eosinophil count in serum significantly decreased. Triamcinolone had a stronger effect on PC20H than montelukast. Nedocromil improved total asthma symptoms score and lung function. There was a reduction in the daytime and night‐time symptom scores after treatment with all three drugs. Triamcinolone and montelukast had a stronger effect on asthma symptoms than nedocromil. There were statistically significant differences in reduction of nocturnal asthma symptoms between the triamcinolone and nedocromil groups (p < 0.001) and between montelukast and nedocromil (p = 0.001) groups, but not between the triamcinolone and montelukast groups. There was a reduction in beta‐agonists use after treatment with all three drugs, with the strongest effect of triamcinolone. The study showed the strongest effect of low‐dose inhaled steroids on clinical symptoms, lung function, bronchial hyper‐reactivity and eosinophil blood count when compared to other asthma medications.
The use of spirometers and peak flow meters in the diagnosis and management of asthma among Spanish pediatricians. Results from the TRAP study
Authors: García‐Marcos Luis , Castro‐Rodríguez José A. , Montaner Amparo Escribano , Garde Jesús Garde , Bernabé Juan José Morell , Belinchón Javier Pellegrini ,   the Spanish Pediatric Asthma Study Group
Published: August 2004

The objective of this study was to determine the level of adherence of pediatricians in Spain to the Spanish National Guidelines for Asthma Treatment with regard to the use of a peak flow meter (PEFR) or a spirometer in the diagnosis and management of asthma in childhood and to analyze sources of variations in these practices. A prospective survey (consisting of demographic and asthma knowledge sections) was conducted over a 2‐wk time interval of 3000 pediatricians throughout the country. At least one part of the questionnaire was completed and returned by 2773 individuals (92.4%), with 2347 (78.2%) answering both sections; results are for this population. Around 62% of the pediatricians reported having a peak flow meter or a spirometer in their office; however, only 33% and 48% of them used the devices for the diagnosis and treatment of asthma, respectively. There was a significant association between being older (36–55 yr old) and using PEFR or spirometry for the diagnosis (OR: 1.35, 95% CI 1.11–1.66) and the management (OR 1.47, 95% CI 1.22–1.77) of asthma. Males used a peak flow meter or a spirometer more often than females for the diagnosis (37.8% vs. 30.9%, p = 0.001) and management of asthma (52.0% vs. 45.6%, p = 0.008). Pediatricians with formal pediatric residence training used these devices more for the diagnosis (OR: 1.39, 95% CI 1.09–1.75) and management (OR: 1.58, 95% CI 1.27–1.96) than those without. Working in a hospital was also related with more peak flow meter or spirometer use than working in health centers (OR: 2.08, 95% CI 1.71–2.54 for diagnosis; OR: 1.83, 95% CI 1.50–2.22 for management). About one‐third of the Spanish pediatricians surveyed use spirometers and/or peak flow meters for diagnosing asthma and about half use one of these devices occasionally for managing the disease. Independent factors favoring their use are: age 36–55 yr, male gender, working in a hospital setting, and having been trained in a formal pediatric residence program.
Self‐reported traffic density and atopic disease in children. Results of the ISAAC Phase III survey in Muenster, Germany
Authors: Behrens Thomas , Taeger Dirk , Maziak Wasim , Duhme Heinrich , Rzehak Peter , Weiland Stephan K. , Keil Ulrich
Published: August 2004

Positive associations between traffic exposure and atopic respiratory disorders in children have been described in several studies. We analyzed data related to self‐reported truck traffic density and several symptoms and diagnoses of asthma and hay fever (12‐month wheezing and rhinitis symptoms, diagnoses of asthma and hay fever) from the ISAAC Phase III survey in Muenster, Germany, using core written and video questionnaires. Data were collected from representative school‐based samples (n = 7345) of 6–7‐ and 13–14‐yr‐olds. In 13–14‐yr‐olds, according to exposure levels categorized into rare, frequent, and constant, with the ‘never’‐category used as reference, the sex‐adjusted prevalence ratios were 1.29 (95% CI = 1.08–1.53), 1.58 (1.29–1.94), and 1.57 (1.18–2.10) for wheeze in the past 12 months, and 1.20 (1.06–1.34), 1.35 (1.17–1.55), and 1.69 (1.42–2.0) for rhinitis symptoms in the past 12 months. Prevalence ratios in 6–7‐yr‐olds and results for a diagnosis of asthma were less consistent while no positive association was detected between hay fever and truck traffic in both age groups. When analyses were based on a more general traffic indicator (self‐reported traffic noise), no consistent associations were observed. Our data provide support for the hypothesis that residential exposure to truck traffic may adversely affect the health of children.
Hypersensitivity to non‐steroidal anti‐inflammatory drugs in childhood
Authors: Sánchez‐Borges Mario , Capriles‐Behrens Eric , Caballero‐Fonseca Fernan
Published: August 2004

Although largely investigated in adults, the issue of hypersensitivity to non‐steroidal anti‐inflammatory drugs (NSAIDs) in childhood is unsettled due to lack of sufficient data. The purpose of this study is to examine the clinical syndromes of hypersensitivity to NSAIDs in children and adolescents. We performed a review of relevant papers on cutaneous and respiratory adverse reactions triggered by NSAIDs in pediatric patients, and a recount of our own experience in 43 well‐characterized NSAID‐sensitive children with cutaneous reactions who were submitted to controlled oral challenges with NSAIDs and the new inhibitors of the enzyme isoform cyclooxygenase‐2 (COX‐2). Although it has been suggested that allergic and pseudoallergic reactions to NSAIDs in children occur rarely, their prevalence remains largely unknown due to the scarcity of studies. About 23% of NSAID‐sensitive patients seen in our institutions are young patients aged 8–18 yr who more frequently develop facial angioedema as their main clinical manifestation. Most patients are atopic and show reactions to more than one drug (cross‐reactors). Drugs that inhibit COX‐2 with higher specificity than classic NSAIDs are better tolerated in young NSAID‐hypersensitive patients.
Exhaled NO and eosinophil markers in blood, nasal lavage and sputum in children with asthma after withdrawal of budesonide
Authors: Lönnkvist Karin , Anderson Martin , Hedlin Gunilla , Svartengren Magnus
Published: August 2004

Background: There is a need for controlled trials among children with asthma to evaluate and compare different markers of inflammation.

Objective: Our goal was to investigate the effect of withdrawal of inhaled budesonide on repeated measurements of exhaled NO (ENO), peripheral blood eosinophils (PBE), sputum/NAL/serum‐eosinophil cationic protein (ECP), bronchial hyperresponsiveness (BHR) and forced expiratory volume in 1 s (FEV1) in children with allergic asthma.

Methods: Eighteen asthmatic children were randomly allocated to continue or discontinue use of inhaled budesonide. They were followed up, at six visits for 4 months with regular blood, serum, sputum, and NAL samples. Sixteen age‐matched healthy children served as controls.

Results: ENO, PBE, and S‐ECP increased significantly in the withdrawal group (p < 0.05) but not in the continuous treatment group. No trend could be observed during the study for markers in sputum or in NAL in either group.

Conclusion: The present data provide evidence for the clinical usefulness of measuring ENO, PBE, and S‐ECP and when combined they could help to avoid over‐ and undertreatment with corticosteroids in the growing child.