bluuebunny/crossref_metadata_2025 huggingface dataset:
Medigap Premiums and Medicare HMO Enrollment
Authors: McLaughlin Catherine G , Chernew Michael , Taylor Erin Fries
Published: March 2003

Objective. Markets for Medicare HMOs (health maintenance organizations) and supplemental Medicare coverage are often treated separately in existing literature. Yet because managed care plans and Medigap plans both cover services not covered by basic Medicare, these markets are clearly interrelated. We examine the extent to which Medigap premiums affect the likelihood of the elderly joining managed care plans.

Data Sources. The analysis is based on a sample of Medicare beneficiaries drawn from the 1996–1997 Community Tracking Study (CTS) Household Survey by the Center for Studying Health System Change. Respondents span 56 different CTS sites from 30 different states. Measures of premiums for privately‐purchased Medigap policies were collected from a survey of large insurers serving this market. Data for individual, market, and HMO characteristics were collected from the CTS, InterStudy, and HCFA (Health Care Financing Administration).

Study Design. Our analysis uses a reduced‐form logit model to estimate the probability of Medicare HMO participation as a function of Medigap premiums controlling for other market‐ and individual‐level characteristics. The logit coefficients were then used to simulate changes in Medicare participation in response to changes in Medigap premiums.

Principal Findings. We found that Medigap premiums vary considerably among the geographic markets included in our sample. Measures of premiums from different insurers and for different types of Medigap policies were generally highly correlated across markets. Our models consistently indicate a strong positive relationship between Medigap premiums and HMO participation. This result is robust across several specifications. Simulations suggest that a one standard deviation increase in Medigap premiums would increase HMO participation by more than 8 percentage points.

Conclusions. This research provides strong evidence that Medigap premiums have a significant effect on seniors’ participation in Medicare HMOs. Policy initiatives aimed at lowering Medigap premiums will likely discourage enrollment in Medicare HMOs, holding other factors constant. Although the Medigap premiums are just one factor affecting the future penetration rate of Medicare HMOs, they are an important driver of HMO enrollment and should be considered carefully when creating policy related to seniors’ supplemental coverage. Similarly, our results imply that reforms to the Medicare HMO market would influence the demand for Medigap policies.
Social Classes in Classical and Marxist Political Economy
Authors: Milios John
Published: March 2003

The notion social class attains a well‐defined theoretical content in the works of the classical political economists, who defined classes on the basis of the specific income form that each category of people (class) obtains. This approach to class constitutes a first form of a ‘friendly merger’ between political economy and sociology. When combined with the classical labor value theory, it has led to a theory of class exploitation of the laboring class by the capitalist class. As economic theory became increasingly apologetic after the ‘Marginalist Revolution’ (setting itself the aim of justifying capitalism), the theory of class has been totally banished from the corpus of ‘modern (neoclassical) economic science.’ This paper claims that the scientific elements inherent in classical political economy's class theory were preserved by the Marxist class theory, which further revolutionized the classical approach, creating a new, purely non‐economistic and non‐mechanistic ‘relationist’ class theory, and forming thus a vivid economic‐sociological approach to social classes. On the basis of the Marxist approach, complex problems concerning the class structure of contemporary societies can be tackled.
An Empirical Test of the Institutionalist View on Income Inequality
Authors: Rodriguez Carolyn B.
Published: March 2003

This paper analyzes the relationship between income inequality and economic growth within the United States using state level data. It describes income inequality in the U.S. since 1960, then employs a two‐step causal model to test the institutionalist contention that income inequality leads to socio‐political instability, which has a negative impact on economic progress. The empirical results offer support for the institutionalist view.
Anti‐Abortion Activities and the Market for Abortion Services: Protest as a Disincentive
Authors: Caudill Steven B. , Mixon Franklin G.
Published: March 2003

Cross‐section data for the US are used to estimate the effects of anti‐abortion activity on the demand and supply of abortion services in 1992. Empirical results show that anti‐abortion activity had a signi~cant negative impact on both the demand and supply of abortion services. Using estimates from a two‐stage least‐squares estimation of demand and supply, anti‐abortion activities (measured as picketing with physical contact or blocking of patients) have decreased the market equilibrium abortion rate by an estimated 19 percent and raised the price of an abortion by approximately 4.3 percent. Taken together, the empirical results show that anti‐abortion activities have been successful in making abortion services scarcer.
An Empirical Approach
Authors: Lambsdorff Johann Graf
Published: March 2003

There is empirical evidence that investors’ confidence is not only adversely affected by corruption but also by the lack of predictability and confidence that accompanies corrupt deals. However, the positive aspect of this lack of confidence is that it acts as a deterrent to corruption. Empirical data provided here on a cross–section of countries proves that confidence in corrupt deals enhances the further spread of corruption. This suggests that the adverse effects of corruption cannot be avoided by divesting it of its unpredictability.
Stereotype Threat and Race of Interviewer Effects in a Survey on Political Knowledge
Authors: Davis Darren W. , Silver Brian D.
Published: March 2003

Social desirability is generally thought to underlie the propensity for survey respondents to tailor their answers to what they think would satisfy or please the interviewer. While this may in fact be the underlying motivation, especially on attitudinal and opinion questions, social desirability does not seem to be an adequate explanation for interviewer effects on factual questions. Borrowing from the social psychology literature on stereotype threat, we test an alternative account of the race‐of‐interviewer effects. Stereotype threat maintains that the pressure to disconfirm and to avoid being judged by negative and potentially degrading stereotypes interferes with the processing of information. We argue that the survey context contains many parallels to a testing environment in which stereotype threat might alter responses to factual questions. Through a series of framing experiments in a public opinion survey and the reliance on the sensitivity to the race of the interviewer, our results are consistent with expectations based on a theory of “stereotype threat.” African American respondents to a battery of questions about political knowledge get fewer answers right when interviewed by a white interviewer than when interviewed by an African American interviewer. The observed differences in performance on the political knowledge questions cannot be accounted for by differences in the educational background or gender of the respondents.
Voting's Rewards: Voter Turnout, Attentive Publics, and Congressional Allocation of Federal Money
Authors: Martin Paul S.
Published: March 2003

Scholars have had limited success empirically demonstrating the importance of political participation. This study shows that political participation matters because it influences political rewards. Political participation, specifically voting, acts as a political resource for geographic groups. Voting is a resource because members of Congress seek to maximize the benefits of Federal budget allocations going to their districts. Members of Congress not only try to direct resources into their districts, but they also attempt to allocate strategically those resources to the areas that provide the best return in terms of votes. Hence, areas within congressional districts that vote at higher rates will be privileged over areas that vote at lower rates.
Cost and Profit Efficiency of the Turkish Banking Industry: An Empirical Investigation
Authors: Isik Ihsan , Hassan M. Kabir
Published: March 2003

By employing a stochastic frontier approach, we examine the effect of bank size, corporate control, and governance, as well as ownership, on the cost (input) and alternative profit (input‐output) efficiencies of Turkish banks. We find that the average profit efficiency is 84% for Turkish banks. The oligopolistic nature of the Turkish banking industry has contributed to less than optimal competition in the loan market and deposit markets. Our results indicate that the degree of linkage between cost and profit efficiency is significantly low. This suggests that high profit efficiency does not require greater cost efficiency in Turkey, and that cost inefficient banks can continue to survive in this imperfect market, where profit opportunities are abundant for all types and sizes of banks. Accordingly, our results indicate that the different sizes of banks have capitalized these opportunities equivalently.
Is Off–Board Trading Detrimental to Market Liquidity?
Authors: Hamet Joanne
Published: March 2003

Dual trading can have opposite effects: although competition between markets should induce dealers to offer cheaper transactions, market fragmentation could reduce market activity, liquidity, and exchange efficiency. This paper shows that for French stocks traded on the London Stock Exchange’s SEAQ International (SEAQ–I), market activity decreases significantly in the Paris Bourse during UK bank holidays. Thus, SEAQ–I market makers seem to divert a new clientele to the Paris Bourse, increasing both market activity and the breadth of the Bourse’s order book. Also, contrary to the fragmentation hypothesis, dual trading does not seem to increase information asymmetry.
Spiritual Practices: The True Test of Spirituality
Authors: Spohn William C.
Published: March 2003

“Spirituality” may be the most loaded word in conversations on religion today. In this article I want to examine the current tensions between spirituality and religion and also suggest that “spiritual practices” are the key to authentic spirituality.
Discipleship Training Of Children and Youth
Authors: Hunneshagen Dean M.
Published: March 2003

Today, we all face an infinite number of faith choices, especially youth. This makes confirmation ministry as discipleship training most important in our churches. This article explores the confirmation ministry of Lord of Life Lutheran Church in Depew, NY, and critically analyzes the methodology—4 turnings, 6 disciplines, and 19 assets—behind the ministry. This methodology has been developed from researchers such as Jean Piaget, James Fowler, Duffy Robins, and researchers at the Search Institute.
Confirmation Ministry in the Batak Church
Authors: Nainggolan Binsar
Published: March 2003

Historically, confirmation ministry among Batak’s took the form of missionaries presenting the Christian religion in an apologetic and persuasive tone, in an effort to ready Batak converts for Baptism. Today, confirmation ministry among Batak Christians is understood as a fleshing out of what it means to be baptized into the church community. This article explores the method and aims of the confirmation rite and ministry among Batak Christians.
Internalization of the thrombopoietin receptor is regulated by 2 cytoplasmic motifs
Authors: Dahlen Debra D. , Broudy Virginia C. , Drachman Jonathan G.
Published: March 2003

Receptor-mediated internalization appears to be the primary mean of regulating the plasma level of thrombopoietin (TPO). However, the processes that regulate Mpl internalization have not previously been described. Using the cytokine-dependent cell line BaF3, we have identified 2 distinct motifs within the cytoplasmic domain of Mpl that underlie ligand-dependent internalization. Removal of the fourth cytoplasmic tyrosine residue by deletion or truncation results in a significant decrease in maximal internalization. The remaining receptor internalization is abrogated by deletion of cytoplasmic residues 54-69, which include the core box2 region (L54L55E56I57L58) and the only dileucine motifs (L54L55 and I57L58) within the cytoplasmic domain of Mpl. Receptor internalization mediated by this latter subdomain does not require Jak2 activation. Furthermore, TPO-stimulated cellular proliferation appears to be directly correlated with receptor internalization, indicating that internalization of the TPO/Mpl complex may be essential for normal signal transduction. Finally, we have demonstrated that upon removal of TPO from the supernatant, Mpl promptly reappears on the cell surface, suggesting that a pool of intracellular Mpl can be rapidly recycled to the cell surface. These data help identify the receptor motifs involved in TPO-induced internalization of Mpl and suggest that Mpl translocation may be necessary for normal cellular proliferation. (Blood. 2003;102:102-108)
Analysis of Microsatellite Instability in Sporadic Parathyroid Adenomas
Authors: Mallya Sanjay M. , Gallagher James J. , Arnold Andrew
Published: March 2003

Microsatellite instability (MSI) is the form of genomic instability associated with defective DNA mismatch repair (MMR) in human tumorigenesis. Recent reports have suggested a role for MSI in the pathogenesis of sporadic parathyroid adenomas. However, because of their small sample sizes and/or lack of systematic analysis of genome-wide MSI, these studies have not provided conclusive evidence that MMR defects are a common occurrence in parathyroid neoplasia. To further investigate whether MSI plays an important role in parathyroid tumorigenesis, we analyzed 49 sporadic parathyroid adenomas for MSI using a panel of 5 microsatellite DNA markers that has been recommended for sensitive detection of MSI by the NCI Workshop and validated in other tumor types. These microsatellite loci were amplified by PCR using fluorescent-labeled primers from the 49 samples of template tumor DNA and matching normal DNA isolated from the same patients’ peripheral blood leukocytes. None of the 49 tumors showed evidence of MSI at any of the analyzed loci of the NCI marker panel. These observations strongly suggest that defective DNA MMR plays a minor role, if any, in the pathogenesis of sporadic parathyroid adenomas.
Sensitization to airborne and food allergens in Reykjavík (Iceland) and Uppsala (Sweden) – a comparative study
Authors: Gislason D. , Björnsson E. , Gislason T. , Janson C. , Boman G. , Sjöberg O. , Elfman L.
Published: March 2003

Background: The aim of this study was to compare the prevalence of atopic sensitization and possible risk factors for allergies in two ethnically similar but geographically widely separated urban populations.

Methods: Data from two centers of the European Community Respiratory Health Survey, Reykjavík, Iceland, and Uppsala, Sweden, were utilized. This included a structured interview, skin prick tests, and blood samples for total and specific IgE for common aeroallergens. Additional measurements of specific IgE antibodies to common food antigens were performed. Furthermore, data on social environment, lifestyle, air pollution, and meteorologic variables were compared.

Results: Skin prick tests were done on 540 individuals in Reykjavík and 527 in Uppsala. The overall prevalence of at least one positive prick test was 20.5% in Reykjavík and 34.2% in Uppsala (P<0.001). Total and specific IgE were measured in serum from 521 subjects in Reykjavík and 472 in Uppsala. The geometric mean value for total IgE was significantly lower in Reykjavík (13.4 kU/l) than in Uppsala (24.7 kU/l) (P<0.001). Similarly, the overall prevalence of at least one specific IgE to airborne allergens was 23.6% in Reykjavík and 32.3% in Uppsala (P<0.01). Specific IgE to a food panel (fx5) was measured in 502 subjects in Reykjavík, and 434 in Uppsala. In Reykjavík, 20 individuals (4.0%) were positive to one or more of the allergens in the food panel compared to 27 (6.0%) in Uppsala. When the single allergens present in the food panel were measured, altogether 16 positive reactions were found in Reykjavík compared to 47 in Uppsala (P<0.05).

Conclusions: The prevalence of sensitization to both airborne and food allergens was lower in Reykjavík than in Uppsala. The difference may be due to environmental and/or dietary differences or to some yet undefined factor.
Major basic protein, but not eosinophil cationic protein or eosinophil protein X, is related to atopy in cystic fibrosis
Authors: Koller D.Y. , Halmerbauer G. , Müller J. , Frischer T. , Schierl M.
Published: March 2003

Increased eosinophil granule proteins have been described in serum and sputum samples of patients with cystic fibrosis (CF). It has been assumed that eosinophil degranulation is enhanced in atopic subjects – as in asthmatics. Since in CF no differences in eosinophil cationic protein (ECP), eosinophil protein X (EPX), and eosinophil peroxidase between atopic and nonatopic subjects have been detected, we investigated whether major basic protein (MBP) is increased in serum and sputum samples derived from atopic (n=14) compared with nonatopic CF subjects (n=26). In CF patients, high mean serum (sputum) levels of ECP 29.7 μg/l (2.7 mg/l), EPX 53.7 μg/l (7.9 mg/l), and MBP 984.6 μg/l but low sputum MBP levels (57.4 μg/l) were measured. In addition, in serum and in sputum samples, a significant correlation between MBP and ECP (P<0.03 and P<0.0001, respectively) or EPX (P<0.05 and P<0.0004, respectively) was detected. By subdivision of the patients into allergic and nonallergic subjects, significant differences were found for serum MBP values only (mean 1382.2 μg/l vs 770.5 μg/l; P<0.0001), but not for ECP or EPX serum levels or for eosinophil proteins in sputum. Although no differences between atopic and nonatopic CF patients in ECP and EPX were found, serum MBP levels were higher in patients sensitized to inhalant allergens than in nonsensitized subjects. These results indicate differential release of eosinophil granule proteins in peripheral blood from eosinophils, and they also indicate that MBP in serum likely is to be a better discriminator of atopy in CF.
Airway mast‐cell activation in asthmatics is associated with selective sputum eosinophilia
Authors: Bettiol J. , Radermecker M. , Sele J. , Henquet M. , Cataldo D. , Louis R.
Published: March 2003

Background: Tryptase is a serine endoprotease selectively released from mast cells. Although mast cells are known to be activated after experimental allergic provocation, their role in naturally occurring asthma is still debated.

Methods: We have investigated the levels of tryptase in the whole induced sputum collected from 51 asthmatics (31 atopic and 20 intrinsic) seen in our outpatient clinic and 22 normal nonatopic healthy volunteers. Tryptase was measured by a new immunoassay based on B12 monoclonal antibody recognition of total tryptase (UniCAP System, Pharmacia) with a sensitivity of 1 ng/ml.

Results: While being below the threshold of detection in all normal volunteers, tryptase was detectable in the sputum from 9/51 asthmatics (18%) including five atopic and four intrinsic asthma cases. In these patients, among whom three were asymptomatic asthmatics, the values ranged between 1 and 6.1 ng/ml. The asthmatics with detectable sputum tryptase had greater sputum eosinophil counts (P<0.05) but lower neutrophil counts (P<0.05) than those in whom tryptase was undetectable. When compared to control subjects, asthmatics without tryptase had still greater eosinophil counts (P<0.0001) but also raised neutrophil counts (P<0.05). No significant difference could be found between asthmatics with tryptase and those without tryptase with respect to the age, the baseline lung function, the methacholine bronchial responsiveness, and the frequency of treatment with inhaled steroids.

Conclusions: With the UniCAP System, tryptase was detectable in the sputum from 18% of asthmatics irrespective of atopy and current symptoms. Asthmatics with tryptase appeared to have a selective increase in sputum eosinophil counts while those without tryptase displayed a mixed sputum granulocyte infiltration with raised eosinophil and neutrophil counts.
Latex allergy in Saudi children with spina bifida
Authors: Kattan H , Harfi Ha , Tipirneni P
Published: March 2003

Background: Children with spina bifida (SB) are exposed to latex soon after birth during bladder catheterization, rectal disimpaction, and multiple surgical procedures. IgE‐mediated latex‐allergic reactions have been reported recently in these children. Our study was designed to assess the prevalence of allergic reactions to latex products in a group of Saudi Arabian children with SB in a tertiary care hospital.

Methods: Fifty‐nine patients, aged 1–20 years, with SB were evaluated by a questionnaire on type of latex reactions; family and personal history of other allergic disorders, such as asthma, rhinitis, and urticaria; type and number of surgical procedures; and frequency of bladder catheterization and manipulation with latex materials. Confirmation of latex sensitivity was measured by skin prick test (SPT), CAP test, and latex skin challenge.

Results: Allergy to latex was detected in 25% of the study group. There was a significant variation in allergic reaction by sex (males 42%, females 12%) (P<0.01), use of catheters (yes 38%, no 13%) (P<0.05), and urologic surgery (yes 60%, no 18%) (P<0.01). The number of surgical procedures, age of patient, and V–P shunt were not significantly related to allergic reactions.

Conclusions: Our findings support previous studies indicating a high prevalence of latex allergy among SB patients. The CAP test was a more sensitive measure of latex allergy in SB patients than SPT or latex challenge. There was significant correlation with urologic procedures and the use of urethral catheters.
A 17‐kDa allergen detected in pine nuts
Authors: García‐Menaya J. M. , Gonzalo‐Garijo M. A. , Moneo I. , Fernández B. , García‐González F. , Moreno F.
Published: March 2003

Background: Few cases of allergy to pine nuts have been described. We report a case of anaphylactic reaction to pine nuts. The patient needed to be treated in the emergency room due to a systemic reaction immediately after eating pine nuts.

Methods: The patient was studied by prick tests and prick by prick tests. Specific IgE was measured by CAP and by SDS–PAGE/immunoblotting by a diffusion method.

Results: The patient showed positive prick by prick tests to pine nuts (12 mm of maximum wheal diameter). Specific IgE was positive (0.79 kU/l). The patient's serum recognized several proteins by immunoblot. However, a 17‐kDa allergen band was detected with high intensity. This protein was found to be sensitive to reducing agents, losing its IgE‐binding properties after reduction.

Conclusions: The patient presented an IgE‐mediated reaction and detected a 17‐kDa protein from pine nuts not previously described.
Allergen‐specific immunotherapy in birch‐ and grass‐pollen‐allergic rhinitis. I. Efficacy estimated by a model reducing the biasof annual differences in pollen counts
Authors: Winther L. , Malling H‐J. , Moseholm L. , Mosbech H.
Published: March 2003

Background: Evaluation of the efficacy of allergen‐specific immunotherapy (IT) with pollen extracts is complicated by annual variation in pollen intensity. Our study aimed to evaluate the efficacy of birch and grass IT, taking into consideration these variations.

Methods: After 1 year of observation, 52 patients with rhinoconjunctivitis and allergy to birch as well as grass pollen were allocated to double‐blinded clustered IT with aluminum‐adsorbed extract produced from either birch (Betula verrucosa) pollen or grass (Phleum pratense) pollen. After 1 year of treatment, the patients continued IT with their original extract and also received the other extract. During the three consecutive pollen seasons, the rhinoconjunctivitis symptom score and the use of antihistamines, eye‐drops, and oral prednisolone were recorded. Longitudinal data analysis was used to investigate the relation between different pollen counts and the magnitude of clinical efficacy.

Results: An effect of IT was found on symptom score, antihistamine intake, and eye‐drop use for both birch and grass (P values <0.05). The mean reduction in symptom score/medication by IT ranged from 24% to 95%, depending on mean seasonal pollen counts. A minimum mean seasonal grass‐pollen count of 20–30 pollen grains m3 was required for the efficacy of grass IT to emerge.

Conclusions: A model was developed for evaluation of efficacy in longitudinal IT studies, taking the differences in annual pollen counts into consideration. The model showed a significant beneficial role of pollen IT in rhinoconjunctivitis patients allergic to birch and grass pollen.
Comparison of antibody responses to hen's egg and cow's milk proteins in orally sensitized rats and food‐allergic patients
Authors: Knippels L.M.J. , Van Der Kleij H.P.M. , Koppelman S. J. , Houben G. F. , Penninks A. H. , Knippels L.M.J. , Penninks A. H. , Felius A.A.
Published: March 2003

Background: No adequate enteral sensitization models are available to study food allergy and the allergenicity of food proteins. To further validate a enteral brown Norway (BN) rat sensitization model under development, we studied specific protein recognition to determine whether a comparable pattern of proteins is recognized by the rat immune system and the human immune system.

Methods: The animals were exposed to either ovalbumin as a positive reference control, hen's egg‐white‐protein extract, or a cow's milk preparation by daily gavage dosing (0.5, 1, 2.5, 5, 10, or 15 mg protein per rat/day) for 9 weeks. No adjuvants were used during the sensitization studies. The specificities of antibodies against hen's egg‐white proteins or cow's‐milk proteins in sera from orally sensitized rats and food‐allergic patients were studied and compared by immunoblotting.

Results: The IgG and IgE antibodies to hen's egg‐white proteins and cow's‐milk proteins present in sera from orally sensitized rats and food‐allergic patients showed a comparable pattern of protein recognition.

Conclusions: Upon daily intragastric exposure to food allergens, the specificities of the induced antibody responses in the BN rat resemble those found in food‐allergic patients. These studies add further support to the hypothesis that the BN rat may provide a suitable animal model for food allergy research and research on the allergenicity of food proteins.
Expression of the American cockroach Per a 1 allergen in mammalian cells
Authors: Wu C.H. , Lee M.F. , Wang N.M.
Published: March 2003

Background: Cockroach allergens are one of the major etiologic risk factors for developing IgE‐mediated allergic respiratory illness throughout the world. Per a 1 is a cross‐reactive allergen of American and German cockroaches. This study aimed to investigate the expression of a recombinant American cockroach (Periplaneta americana) Per a 1, C42, allergen in mammalian COS‐1 cells.

Methods: The COS‐1 cells and Escherichia coli were used to express the P. americana C42 allergen. Recombinant proteins were purified with hydroxylapatite and DE52 chromatography. Biologic reactivities of recombinant proteins were examined by direct IgE binding and IgE inhibition studies with the enzyme‐linked immunosorbent assay (ELISA).

Results: C42 was successfully expressed in the mammalian COS‐1 cell as a 50‐kDa secreted protein, and purified from the culture medium. The specific human IgE antibodies against recombinant C42 from either E. coli (C42‐E. coli) or COS‐1 (C42‐COS‐1) were compared by ELISA with 12 sera from Per a 1 and C42 skin‐test‐positive patients. All atopic sera contained specific IgE antibodies to C42 from either E. coli or COS‐1. Moreover, recombinant C42‐COS‐1 bound higher levels of serum IgE than recombinant C42‐E. coli among C42‐sensitive atopic patients, and a statistically significant difference (P<0.01) was found between them. In addition, recombinant C42‐COS‐1 as an inhibitor revealed higher inhibition of IgE binding to natural Per a 1 than recombinant C42‐E. coli.

Conclusions: The biologically highly reactive recombinant C42 produced in the COS‐1 cell provides an alternative expression system and will facilitate studies on the immune response of asthma patients to cockroach allergens.
Loratadine in the treatment of mosquito‐bite‐sensitive children
Authors: Karppinen A. , Kautiainen H. , Reunala T. , Petman L. , Reunala T. , Brummer‐Korvenkontio H.
Published: March 2003

Background: Children frequently experience harmful whealing and delayed papules from mosquito bites. Whealing is mediated by antisaliva IgE antibodies and histamine, but the effect of antihistamines on mosquito‐bite symptoms has not been evaluated in children.

Methods: The effect of loratadine (0.3 mg/kg) was examined in 28 mosquito‐bite‐sensitive children (aged 2–11 years). The double‐blind, placebo‐controlled, crossover study was performed with exposure to Aedes aegypti laboratorymosquitoes. The size of the bite lesion and the intensity of pruritus (visual analog scale) were measured at 15 min and at 2, 6, and 24 h.

Results: Loratadine decreased the size of the wheals by 45% (P<0.001, 25 children) and accompanying pruritus by 78% (P=0.011, 12 children) at 15 min compared to placebo. The size of the 24‐h delayed bite lesion also decreased significantly (P=0.004), but there was no change at 2 or 6 h. Loratadine was well tolerated and no marked side‐effects were recorded.

Conclusions: This study in children shows that prophylactically given loratadine decreases significantly the whealing and pruritus caused by mosquito bites and also reduces the size of the 24‐h bite lesions. Therefore, the therapeutic profile of loratadine extends from immediate to delayed allergic symptoms in mosquito‐bite‐sensitive children.
Laboratory diagnosis of hypersensitivity to Anisakis simplex: a review
Authors: Moneo I. , Curiel G. , Fernández de Corres L. , García M. , Del Pozo M. D.
Published: March 2003

Patients suffering anaphylactic reactions after parasitized fish consumption have been reported in Spain in recent years. This reaction is different from the well‐known acute or chronic anisakiasis and causes intolerance to parasitized fish ingestion, even after appropriate cooking. High specific IgE values are usually found in these subjects. IgE immunoblotting is now needed to confirm the presence of specific IgE directed to several parasite antigens in order to exclude cross‐reactions. Positive specific IgG4 by immunoblotting was found in 60% of the patients, as well as in patients with anisakiasis, and probably reflected recent contact with the parasite proteins. The most specific response of IgE antibodies was directed to low‐molecular‐mass antigens of the parasite. Therefore, recombinant or purified antigens for in vivo and in vitro use will in future overcome some of the problems found in the diagnosis of sensitized patients.
The pharmacologic profile of desloratadine: a review
Authors: Henz B. M.
Published: March 2003

Desloratadine is a new agent for the treatment of diseases such as seasonal allergic rhinitis and chronic urticaria. The pharmacologic profile of desloratadine offers particular benefits in terms of histamine H1‐receptor binding potency and H1 selectivity. Desloratadine has a half‐life of 21–24 h, permitting once‐daily dosing. No specific cautions are required with respect to administration in renal or hepatic failure, and food or grapefruit juice have no effect on the pharmacologic parameters. No clinically relevant racial or sex variations in the disposition of desloratadine have been noted. In combination with the cytochrome P450 inhibitors, ketoconazole and erythromycin, the AUC and Cmax of desloratadine were increased to a small extent, but no clinically relevant drug accumulation occurred. With high‐dose treatment (45 mg/day for 10 days), no significant adverse events were observed, despite the sustained elevation of plasma desloratadine levels. Specifically, desloratadine had no effects on the corrected QT interval (QTc) when administered alone, at high dose, or in combination with ketoconazole or erythromycin. Preclinical studies also show that desloratadine does not interfere with HERG channels or cardiac conduction parameters even at high dose. Desloratadine is nonsedating and free of antimuscarinic/anticholinergic effects in preclinical and clinical studies. Novel antiallergic and anti‐inflammatory effects have also been noted with desloratadine, a fact which may be relevant to its clinical efficacy.
Comparison of the effects of levocetirizine and loratadine on histamine‐induced wheal, flare, and itch in human skin
Authors: Clough G. F. , Boutsiouki P. , Church M. K.
Published: March 2003

Background: This randomized, double‐blind, crossover study compared the effects of the R‐enantiomer of cetirizine, levocetirizine, with those of loratadine on the wheal, flare, and itch response to histamine in human skin.

Methods: Levocetirizine (5 mg), loratadine (10 mg), or placebo was taken orall_y 4 h before the intradermal injection of histamine (20 µl, 100 µM) or the control vehicle into the forearm skin of healthy volunteers. Flare areas were assessed by scanning laser Doppler imaging before and at 30‐s intervals for a period of 9 min. Wheal areas were measured by planimetry at 10 min. Itch was scored every 30 s with a visual analogue scale.

Results: After placebo administration, the mean peak flare area was 23.01±1.94 cm2, the wheal area 248±27 mm2, and the cumulative itch score 28.8±4.6% (mean±SEM). Levocetirizine reduced the flare, wheal, and itch by 60%, 68%, and 91%, respectively (all_ P<0.001, Student's t‐test for paired data). The effects of loratadine were variable and not statisticall_y significant.

Conclusions: Levocetirizine (5 mg) is a potent inhibitor of the effects of histamine in human skin with an efficacy that exceeded that of loratadine (10 mg) when single doses of the drugs were administered 4 h before the test.
Measurement of IgE antibodies against purified grass‐pollen allergens (Phl p 1, 2, 3, 4, 5, 6, 7, 11, and 12) in sera of patients allergic to grass pollen
Authors: Rossi R. E. , Monasterolo G. , Monasterolo S.
Published: March 2003

Background: Current allergy diagnosis is performed with allergen extracts which contain a variety of allergenic and nonallergenic components. The availability of highly purified and well‐characterized allergen molecules seems to be an advantage of component‐based diagnosis.

Methods: With the immunoenzymatic CAP FEIA System, we measured specific IgE levels to the recombinant allergens rPhl p 1, rPhl p 2, rPhl p 5, rPhl p 6, rPhl p 7, rPhl p 11, rPhl p 12, and native Phl p 4 in 77 sera of patients allergic to grass pollen, in order to evaluate the IgE‐binding frequency to these purified grass‐pollen allergens and their relationship to rBet v 4, rBet v 2, and other allergens.

Results: The frequency of sensitization was as follows: rPhl p 1=93.5%; rPhl p 2=67.5%; rPhl p 5=72.7%; rPhl p 6=68.8%; rPhl p 7=7.8%; rPhl p 11=53.2%; rPhl p 12=35.1%; and native Phl p 4=88.3%. As expected, rPhl p 7 and rPhl p 12 had a very good correlation (Spearman's r) with Bet v 4 (r=0.95%, P<0.05) and rBet v 2 (r=0.99, P<0.05), respectively. Good correlations of rPhl p 12 with papain (r=0.93, P<0.05), latex (r=0.92, P<0.05), and bromelain (r=0.86, P<0.05) were found. Highly variable individual sensitization patterns were observed.

Conclusions: A new clinical approach has allowed the determination of specific allergograms for the different patients and may therefore be of great importance for more specific diagnosis. The use of component‐resolved diagnostics may be useful to evaluate the allergen content of an extract for immunotherapy by monitoring patient's IgE and IgG directed to relevant allergens.
Tomato allergy in children and young adults: cross‐reactivity with latex and potato
Authors: Reche M. , Pascual C. Y. , Vicente J. , Caballero T. , Muñoz F. M. , Sanchez S. , Esteban M. M.
Published: March 2003

Background: Several studies have shown that allergy to natural rubber latex is associated with cross‐reactivity to certain foods such as tomato and potato. The objective was to investigate the clinical and immunologic differences between a group of patients with clinical allergy to tomato and latex and another which had only clinical allergy to tomato. We also aimed to assess, in vitro, the relationship of tomato and latex allergens, which could explain the cross‐reactivity.

Methods: Forty patients with histories of adverse reactions to tomato and IgE‐mediated hypersensitivity were enrolled in the study. Tomato, latex, and potato components were analyzed by SDS–PAGE immunoblotting. CAP and immunoblot inhibition were used to study allergen cross‐reactivity.

Results: Patients from group A had a mean age of 13.2 years, and in group B the mean age was 21.7 years. In group B, 9/10 patients belonged to the latex‐fruits syndrome. All patients of both groups tolerated potato. Immunoblotting patterns obtained with patients' sera from pool A showed IgE‐binding bands to tomato ranging from 44 to 46 kDa and a triple band at 67 kDa. For latex, there was a strong binding at 44 kDa, and potato showed a strong band of 44 kDa and a 67‐kDa triple band. In pool B, the binding to the band of 44 kDa in latex and tomato was more intense than in pool A. In pool A, immunoblot inhibition with potato allergen showed an intense inhibition of the three allergens (potato, latex, and tomato); with latex, inhibition was partial and with tomato, a complete inhibition of tomato and latex was observed, and a partial inhibition of potato. In pool B, the inhibition pattern followed a similar tendency to pool A. The CAP inhibition confirmed the high rate of cross‐reactivity between tomato, potato, and latex.

Conclusions: In our study, tomato, potato, and latex showed a common band of 44–46 kDa probably corresponding to patatin. This protein could be implicated in the high cross‐reactivity between tomato, latex, and potato observed in the immunoblot and CAP inhibition.
Dietary micronutrients/antioxidants and their relationship with bronchial asthma severity
Authors: Picado C. , Deulofeu R. , Lleonart R. , Agustí M. , Mullol J. , Torra M. , Quintó L.
Published: March 2003

Background: Because little is known about micronutrient/antioxidant intake and asthma severity, we investigated dietary intake and plasma/serum levels of micronutrients/antioxidants in a group of asthma patients with various degrees of severity, and compared the results with healthy subjects.

Methods: A case control study was carried out on 118 asthma patients and 121 healthy subjects. The severity of the disease was classified by division of patients into four groups. Normal dietary micronutrient/antioxidant intake was estimated from a food frequency questionnaire. Plasma/serum levels of vitamins C, E, and A, selenium, magnesium, zinc, and platelet glutathione peroxidase (GSH‐Px) activity were also determined.

Results: No differences in daily micronutrient/antioxidant intake were seen between patients and healthy subjects. The severity of the disease showed no significant relationship with micronutrient/antioxidant intake. There were no differences in plasma/serum levels in any of the micronutrients/antioxidants between healthy subjects and asthmatics. Nor were any differences found between asthma groups in severity in the biochemical measures, except in platelet GSH‐Px activity, which was significantly lower in the most severe groups.

Conclusions: In this study, we found no evidence of any association between micronutrient/antioxidant intake or plasma/serum levels of micronutrients/antioxidants and asthma. Reduction of platelet GSH‐Px activity in the most severe patients suggests that these patients have a diminished capacity to restore part of the antioxidant defences.
Effectiveness of occlusive bedding in the treatment of atopic dermatitis – a placebo‐controlled trial of 12 months' duration
Authors: Holm L. , Öhman S. , Bengtsson Å. , Van Hage‐Hamsten M. , Scheynius A.
Published: March 2003

Background: Several studies on avoidance of house‐dust‐mite (HDM) and cat allergens have been carried out, most of them in asthmatic patients and only a few in patients with atopic dermatitis (AD). No study so far has focused on which subgroup of AD patients benefits from avoidance measures.

Methods: Forty adult patients with AD completed the 12‐month avoidance study. They were divided into an active treatment (n=22) and a placebo (n=18) group. Active treatment comprised use of polyurethane‐coated cotton encasings for bedding, and placebo use of cotton covers. Patients came for regular checkups during the 12‐month period, when eczema severity was assessed and blood samples were analyzed for total IgE, HDM‐ and cat‐specific IgE and soluble CD30 (sCD30) in serum. Dust samples were collected from mattresses before treatment and after 3, 6, and 12 months, and analyzed for content of HDM and cat allergen.

Results: Eczema severity decreased significantly in both groups (P<0.001), with a more pronounced decrease in patients with active covers. The HDM exposure decreased significantly in the active treatment group (P<0.001), and the levels of HDM‐specific IgE were reduced (P<0.05). Exposure to cat allergens was unchanged in the active treatment group but decreased, albeit not significantly (P=0.19), in the placebo group. sCD30 levels were significantly reduced in both groups (P<0.001). Patients not sensitized to HDM allergens benefited from the bedcovers as much as sensitized patients.

Conclusions: Occlusive bedding significantly reduced HDM exposure in bed (P<0.001) and eczema severity, and sCD30 levels decreased significantly (P<0.001). Patients not sensitized to HDM and not exposed to HDM allergens benefited equally from use of the bedcovers, a result which could be due to a reduction of other important allergens, superantigens, or irritants in bed. We therefore recommend the use of bedcovers as part of treatment for AD.
Increase of asthma in adults in northern Finland?– a report from the FinEsS study
Authors: Kotaniemi J‐T. , Lundbäck B. , Nieminen M. M. , Sovijärvi A. R. A. , Laitinen L. A.
Published: March 2003

Background: According to previous studies, the prevalence of asthma has been lower in Finland than in other Nordic countries. In the present study, we assessed the prevalence of asthma and respiratory symptoms in northern Finland and calculated risk factors for these conditions.

Methods: In November 1995, 7937 randomly selected subjects, 20‐69 years of age, in northern Finland were invited to participate in a postal questionnaire survey. Complete answers were received from 6633 subjects (83.6%).

Results: Asthma diagnosed by a physician was reported by 6.0%, while 6.3% were using asthma medicines. Asthma was most common in young adults and the elderly. The prevalence of wheezing during the previous 12 months was reported by 19.7%, while wheezing with shortness of breath apart form colds during the previous 12 months was reported by 7.1%. Only small differences between the sexes were found in prevalence of asthma and respiratory symptoms. All symptoms were strongly smoking‐dependent. Sixty‐three percent of men and 42% of women were current or ex‐smokers. Family history of obstructive airway disease was the strongest risk factor for asthma (OR 2.9), while increasing age, smoking, and family history of obstructive airway disease were the most important risk factors for frequent wheeze.

Conclusions: The results indicate that the prevalence of asthma and symptoms associated with asthma in adults in northern Finland is now similar to that observed in Sweden and the other Nordic countries.
Determination of Blomia tropicalis‐specific IgE and IgG subclasses in atopic dermatitis patients
Authors: Mori J. C. , Pires M. C. , Galvão C. E. S. , Ferreira de Mello J. , Golcher F. M. , Montealegre F.
Published: March 2003

Background: To verify the importance of Blomia tropicalis in atopic dermatitis (AD), we determined the cutaneous reactivity and the serum level of B. tropicalis‐specific IgE and IgG subclasses in AD patients.

Methods: B. tropicalis‐specific IgE and IgG subclasses were determined in AD patients and compared with bronchial asthma (BA) patients and a control group (CG) of nonatopic subjects. Specific IgE was obtained by skin prick test and RAST. B. tropicalis‐specific IgG subclasses were determined by ELISA. The data were statistically analyzed by chi‐square test (Mantel‐Haenszel) and odds ratio (OR).

Results: We detected positive skin prick tests in 61.76% of AD and 83.33% of BA patients, and in 12.5% of the CG. RAST was positive in 44.12% of AD and in 61.90% of BA patients, but not in the CG. B. tropicalis‐specific IgG1 and IgG2 subclasses showed no significant differences between the three groups. IgG3 subclass positivity was statistically significant in AD patients (41.17%) when compared to BA patients (14.29%) and the CG (16.67%). The determination of B. tropicalis‐specific IgG4 was positive in 32.35% of AD patients, 21.43% of BA patients, and 8.33% of the CG.

Conclusions: These results confirm that the storage mite B. tropicalis is an important allergen in AD. It is possible that IgG3 activates the complement in AD patients, releasing vasoactive amines that further amplify the allergic reaction. The positive results of the B. tropicalis‐specific IgG4 found in AD and BA were probably due to chronic exposure to this storage mite in the home environment.
Eosinophil cationic protein and specific IgE in serum and nasal mucosa of patients with grass‐pollen‐allergic rhinitis and asthma
Authors: Sensi L. G. , Marcucci F. , Migali E. , Coniglio G.
Published: March 2003

Background: After allergen exposure, IgE‐bearing mast cells surface in respiratory mucosa. Eosinophils are also recruited locally by chemotactic mediators; they are the main cell directly involved in the late phase of allergic inflammation. IgE antibody and eosinophil cationic protein (ECP) are routinely determined mainly in serum although they exert their pathogenetic role more directly on mucosal surfaces.

Methods: We performed a comparative study of IgE antibody to grass and ECP on nasal mucosa and blood samples in order to evaluate the relevance of monitoring allergic inflammation in the target organ. Thirty‐one patients and 10 nonatopic controls were enrolled in the protocol. Twenty‐six subjects allergic to grass, 11 with rhinitis (group 1) and 15 with asthma and rhinitis (group 2), completed the study. Five patients dropped out. Specific IgE to grass and ECP was determined in nasal mucosa by our method based on in situ incubation.

Results: Serum IgE to grass did not increase during the pollen peak, as did nasal IgE, in group 1 from before the pollen peak, from 2.3 to 3.2 kU/l (P=0.02), and in group 2 at the pollen peak, from 4.8 to 12.2 kU/l (P=0.01). Serum ECP did not show any significant variation in group 1, but it increased at pollen peak from 6 to 11.2 µg/l (P=0.01) in group 2. Nasal ECP increased significantly in both groups even before the pollen peak. In group 1, ECP values rose from 15 to 39.9 µg/l (P=0.01). In group 2, ECP increase was much higher than in group 1, from 9 to 213 µg/l (P=0.001). Serum eosinophils, like nasal ECP, showed a significant increase of values from before the pollen peak in both groups, without correlation with serum ECP in rhinitic patients.

Conclusions: Both specific IgE and ECP in the nasal mucosa showed a better correlation with allergen exposure than serum evaluations. With an appropriate method, allergic inflammation may be best monitored in the nasal mucosa.