bluuebunny/crossref_metadata_2025 huggingface dataset:
What do we know about child neglect? A critical review of the literature and its application to social work practice
Authors: Tanner Karen , Turney Danielle
Published: March 2003

Child neglect is a difficult and complex area of practice for social workers and other childcare professionals. To work effectively, practitioners need a good grasp of relevant literature and research – a point underlined by the moves to incorporate ‘research mindedness’ and ‘research literacy’ into social work education, training and practice. This paper aims to contribute to the debate around research literacy by looking in more detail at the research and knowledge base informing work with neglected children and their families, and considering the ways in which this can be applied in practice.

In the first part of the paper, we provide a critical overview of the main aspects of research knowledge, summarizing ‘what we know’ currently about child neglect. Next, we look at some of the difficulties associated with this body of knowledge and at some of its limitations. Having noted these concerns, however, we go on to suggest ways in which the research evidence can be used in mainstream social work. We draw out some of the consequences for work with children and with their parents as well as considering the implications for social workers and their agencies.
Correlates of well‐being in mothers of children and adolescents with cystic fibrosis
Authors: Foster  , Bryon  , Eiser
Published: March 2003

Fifty mothers and 44 well siblings of children and adolescents with cystic fibrosis (CF) participated in this study to identify correlates of maternal well‐being. Participants completed postal questionnaires which assessed maternal well‐being, problems experienced surrounding the illness and treatment and the nature of the sibling relationship. Due to the demanding nature of treatment and the fact that CF is both genetic and incurable at present we anticipate mothers of these children will experience higher levels of stress and consequently poorer well‐being than the normal population. In addition, illness severity, problems with adherence to treatment, child communication, maternal support and the sibling relationship are expected to relate to maternal well‐being. Mothers in this sample did not rate their well‐being as any different to the normal population. Results suggest that mothers are likely to rate their own well‐being as poor when they report more frequent problems surrounding the illness and treatment and well children rate their sibling relationship as having frequent disagreements and aggression. This study highlights factors that are related to maternal well‐being in families where one child has CF. These mothers as a group do not appear to be experiencing more stress in their daily lives than the normal population but certain illness and family variables are related to their well‐being when examining the mothers on certain dimensions.
An activity week for children with cancer: who wants to go and why?
Authors: Balen  , Fielding  , Lewis
Published: March 2003

Many children now live with cancer rather than die from it, and such children need both to continue their social, emotional and cognitive development and to make long‐term psychological adjustments. This paper presents the findings of a research project set up to explore issues pertinent to the current provision of an activity week experience for a group of British paediatric cancer patients. The aims of the study included finding out which factors discriminate between families who apply for a place to attend the week for their child and families who do not, and to develop a knowledge of what factors are considered by parents and children. The findings suggest that the week appeals to children who are confident, active and able to separate from parents and whose parents are keen to encourage independence and new experiences. Children diagnosed and treated at a younger age and further away from treatment were more likely to express concerns about being homesick and safety and to not apply for the week. Issues of protection, independence and disability are discussed with reference to the importance of parental attitude on children's psychological accommodation to disease and treatment and to the experiences of adult survivors of childhood cancer.
The appropriateness of Western models of parent involvement in Calcutta, India. Part 1: parents’ views on teaching and child development
Authors: Goldbart J. , Mukherjee S.
Published: March 2003

As the initial stage of an evaluation of services offered to families at Shishu Sathi, West Bengal, by Spastics Society of Eastern India, a partial replication of a Guyanese study was undertaken. The results are presented in two papers. This paper (part 1) examines parents’ beliefs concerning child development and the effectiveness of teaching. Part 2 explores roles and responsibilities within families in relation to the time available to parents for active participation in a parent involvement project. The aim is to find out in terms of the above issues whether, and to what extent, it is appropriate to apply Western models of intervention with families in West Bengal. The findings suggest that strong similarities exist between parents’ beliefs in this study, the Guyanese sample, and Western expectations, concerning child development and the effects of teaching, though with certain interesting exceptions. Possible reasons for these differences are discussed along with implications for the design and delivery of services.
Emotional reactions in parents and children after diagnosis and treatment of a malignant tumour in the eye
Authors: Ek U
Published: March 2003

Retinoblastoma is a rare malignant tumour in the retina usually presenting before 3 years of age. In Sweden, 6–7 new cases are diagnosed each year. The medical treatment is highly specialized, very effective, with a survival ratio of almost 100%. Very little was known about the emotional and psychosocial effects on the parents and the patients themselves. This study includes all children diagnosed in Sweden between 1992 and 1994. The parents and children were included in our longitudinal support programme immediately after the diagnosis was made. This paper deals with the following topics: how the illness was detected and diagnosed, how the parents were handled by the health professionals, the parents' emotional reactions to the diagnosis and treatment and how the children reacted to the disease and treatment. Children's concepts of illness and acute loss are discussed.
Teamwork in Swedish neuropaediatric habilitation
Authors: Thylefors I , Price E , Persson O , Wendt L von
Published: March 2003

Team collaboration in Swedish paediatric habilitation was analysed by means of a nation‐wide sample of 202 professionals, representing all seven professions normally working in these teams. Provision of paediatric habilitation services as a part of the county secondary level health care is required by law, and has gradually been built up from the 1950s. The study focused on professional co– operation and interaction during different types of formal team meetings. The basic obstacles for the meetings were lack of time, poor meeting technique, and too large a group. The professionals appeared to interact on a fairly equal basis, able to challenge other's views and gaining a hearing for their own views, with the physiotherapists and the paediatricians perceived as being the most dominant team members. The perceived significance of the contribution from the different team members' dominance varied according to the age of the child and to changing needs. The prerequisites for interdisciplinary team working exist as far as meeting structure and a ‘democratic’ pattern of communication during meetings.
Prevalence and morbidity associated with non‐malignant, life‐threatening conditions in childhood
Authors: Lenton S , Stallard P , Lewis M , Mastroyannopoulou K
Published: March 2003

Objective To determine the prevalence of non‐malignant life‐threatening illness in childhood and associated morbidity in the affected child and their family members.

Design Cross‐sectional survey.

Setting Bath Clinical Area (total population 411 800).

Subjects Children aged 0–19 years.

Results One hundred and twenty‐three children were identified, giving a prevalence of 1.2/1000 children. Morbidity assessed in 93 children showed 60% in pain or discomfort, 35% unable to walk and 25% with severe cognitive impairment. Mental health problems were found in 54% of mothers and 30% of fathers, and significant emotional and behavioural problems in 24% of healthy siblings.

Conclusions Non‐malignant life‐threatening illness is more prevalent than reported in previous studies. Considerable morbidity is experienced by the child and their family. An individual and family approach is required.

Key messages (1) The prevalence of non‐malignant life‐threatening illness is four times greater than previous estimates. (2) This group of conditions have significant implications for all family members. (3) Early comprehensive assessment and access to effective interventions may pre‐empt later problems.
Why is smoking a risk factor for Sudden Infant Death Syndrome?
Authors: Gordon A. E. , Ahmer O. R. El , Chan R. , Madani O. M. Al , Braun J. M. , Weir D. M. , Busuttil A. , Blackwell C. C.
Published: March 2003

Smoking is a major risk factor for both Sudden Infant Death Syndrome (SIDS) and respiratory tract infections. Such infections, both viral and bacterial, also increase the SIDS risk. This study investigated the effect of cigarette smoke at two stages of infection: 1) mucosal surface colonization; 2) induction and control of inflammatory responses. For colonization, RSV or influenza A infected cells bound several bacterial species in significantly higher numbers due to increased expression of host cell antigens. Buccal epithelial cells from smokers bound significantly more bacteria. For Staphylococcus aureus, this was associated with increased tar levels. Some SIDS deaths have been proposed to result from high levels of pro‐inflammatory mediators elicited by infection and/or cigarette smoke during a developmental period when infants are less able to control inflammatory responses. Inflammatory reponses were compared between blood samples from smokers (n = 42) and non‐smokers (n = 60) stimulated with TSST‐1 or LPS. Non‐smokers had significantly higher IL‐6 (P = 0.011), IFN (P = 0.003) and IL‐10 (P = 0.000) baseline levels. Non‐smokers had higher IFN (P = 0.008) and IL‐1 (P = 0.001, 0.007) responses to LPS and higher IL‐10 responses to TSST‐1 (P < 0.05) and LPS (P < 0.000). This study highlights that smoking increases the SIDS risk by greater susceptibility to viral and bacterial infections and enhanced bacterial binding after passive coating of mucosal surfaces with smoke components. In animal models, IL‐10 reduced the lethal effect of staphylococcal toxins. In this study, smokers had lower IL‐10 responses to TSST‐1 and LPS. Dose response effects of cigarette smoke exposure needs to be established in relation to inflammatory response control and infantile infections.
Evidence for a genetic component in Sudden Infant Death Syndrome
Authors: Gordon A. E. , MacKenzie D. A. C. , Ahmer O. R. El , Madani O. M. Al , Braun J. M. , Weir D. M. , Busuttil A. , Blackwell C. C.
Published: March 2003

There is increasing evidence that inflammatory responses have been elicited in some Sudden Infant Death Syndrome (SIDS) infants and that these responses are under genetic control. The objective of this study was to investigate the hypothesis that the cytokine responses of SIDS parents (n = 41) differed significantly from control donors (n = 61). Blood samples were stimulated with the staphylococcal toxin TSST‐1 and LPS from Eschericia coli and assessed for production of TNF, IL‐1, IL‐6, IFN and IL‐10. In response to TSST‐1 (P < 0.02) and LPS (P < 0.002), SIDS parents produced higher levels of IL‐1 than the controls. SIDS parents produced higher levels of IFN in response to TSST‐1 compared to LPS (P < 0.001) although in response to LPS, the IFN (P = 0.0008) and IL‐6 (P < 0.0002) responses of the SIDS parents were lower than those of the controls. For TNF and IL‐10, there was little difference between the two groups unless the effect of smoking was considered. As part of this work, a small pilot genotyping study was carried out using DNA from SIDS parents (n = 10), control donors (n = 10) and Bangladeshi subjects (n = 10). An IFN polymorphism (3/3) was found in 40%, 15.4% and 0% of donors respectively. Staphylococcal toxins have been identified in SIDS infants therefore this study highlights the importance of assessing IL‐1 levels. Determination of cytokine polymorphisms and consideration of interactions between these and environmental factors such as smoking in high, average and low risk ethnic groups will assist in establishing the contribution of these factors to an infant's susceptibility to SIDS.
Child sexual abuse treatment: misinterpretation and mismanagement of child sexual behaviour
Authors: Kools S. , Kennedy C.
Published: March 2003

Objective The purpose of the study was to examine caregiver understanding of the impact of child sexual abuse and the management of abused children in residential treatment.

Methods A purposive sample of 20 registered nurses and child care workers were interviewed about their experiences working in residential treatment and their knowledge about child development and child sexual abuse and its application to practice. Data from interviews and field notes were analysed using dimensional analysis.

Findings Caregivers had limited knowledge of the sequelae of child sexual abuse. Developmentally appropriate behaviour of sexually abused children, as well as behavioural manifestations of child sexual abuse, were often misinterpreted and mismanaged.

Conclusion Residential care of sexually abused children should be based on sound developmental principles and caregiver sensitivity.
Nightmares and anxiety in elementary‐aged children: is there a relationship?
Authors: Mindell J. A. , Barrett K. M.
Published: March 2003

Objective To determine whether a relationship exists between children’s anxiety level and nightmare occurrence.

Method A total of 60 kindergarten, second and fourth grade school children and their parents completed questionnaires assessing nightmare occurrence and anxiety.

Results According to parental report, children who experience nightmares have significantly higher levels of anxiety than children who do not experience nightmares. The results also indicate a relationship between nightmare distress and trait anxiety.

Conclusion These findings suggest that anxiety issues should be considered in children who are experiencing nightmares.
Perceptions of the quality of life for the adolescent with a chronic illness by teachers, parents and health professionals: a Delphi study
Authors: Meuleners L. B. , Binns C. W. , Lee A. H. , Lower A.
Published: March 2003

Aims

The perceptions that teachers, parents and health professionals have on the relative importance of different aspects of quality of life (QOL) for the adolescent with a chronic illness were explored using a three‐round Delphi study.

Methods

The first round questionnaire identified the level of importance each panel attached to 16 aspects relating to QOL. Panellists were also encouraged to provide additional comments on why they felt a particular item was important. In round two, panellists were asked to prioritize the items in order of importance, whereas round three attempted to achieve consensus among each of the three panels.

Results

Differences between and within panels in the prioritization of items in round one and round two were evident. However, consensus was achieved in round three, except for the prioritization of very important items by the panel of teachers. Items identified by all three panels as extremely important included the adolescent's attitude, family relationships and friendships with the same age group. Themes to emerge from the qualitative responses to the open‐ended questions included the perception of the chronically ill adolescent ‘not wanting to be different’ and the importance of a ‘positive attitude’. The majority of participants also perceived adolescents with a chronic illness as having worse QOL than their healthy counterparts.

Conclusions

By increasing the awareness among the different groups of the impact of chronic illness on various aspects of adolescent QOL, the overall care and support of those adolescents could be improved. Further studies should also be undertaken to explore the views of the chronically ill adolescents themselves.
GC/MS analysis of urinary excretion of 9α,11β‐PGF2 in acute and exercise‐induced asthma in children
Authors: Nagakura T. , Obata T. , Shichijo K. , Matsuda S. , Sigimoto H. , Yamashita K. , Masaki T. , Maekawa K.
Published: March 2003

Background

9α,11β‐Prostaglandin (PG) F2 is an initial metabolite of PGD2 which has a potent bronchoconstrictive activity.

Objectives

We measured the urinary levels of 9α,11β‐PGF2 in asthmatic children to investigate its role in not only acute asthmatic attack in a time course study but also in exercise‐induced asthma (EIA).

Methods

In the acute asthma study, 30 asthmatic children were examined. Urine samples were collected on the first, third, and sixth days. Urinary levels of 9α,11β‐PGF2 were measured with gas chromatography mass spectrometry using the electron impact method. In the exercise challenge study, 14 children with EIA and 14 children without EIA were studied. Urine samples were collected before exercise challenge, and at 1 h, and 5 h after exercise challenge. Urinary levels of 9α,11β‐PGF2 were measured.

Results

Elevated urinary levels of 9α,11β‐PGF2, which were observed on the first day when treatment was started in the hospital, were gradually decreased on the third day (P < 0.05), and on the sixth day (P < 0.01). A significant correlation between urinary levels of 9α,11β‐PGF2 and symptom scores (P < 0.005) was observed on the first day. In EIA, there was a significant increase in urinary levels of 9α,11β‐PGF2 at 1 h (P < 0.01) and at 5 h (P < 0.01) after exercise challenge, but not in the children without EIA.

Conclusion

9α,11β‐PGF2 may be involved in the pathogenesis of acute and exercise‐induced asthma in children.
Prospective, double‐blind, placebo‐controlled, multicentre study on the effect of high‐dose, intravenous immunoglobulin in children and adolescents with severe bronchial asthma
Authors: Niggemann B. , Leupold W. , Schuster A. , Schuster R. , Berg A. v. , Grübl A. , Hardt H. v. d. , Eibl M. M. , Wahn U.
Published: March 2003

Objective

In order to study the effect of high‐dose, intravenous immunoglobulin (IVIG) in severe childhood asthma, we investigated 31 children and adolescents (15 girls, 16 boys) aged 9–22 years (median age of 14 years) suffering from severe bronchial asthma.

Methods

In a prospective, double‐blind fashion, patients received either four doses of IVIG (1 g/kg body weight) or identical doses of intravenous human serum albumin. The first two doses were given on two consecutive days, followed by two further doses at 4 week intervals.

Results

There was no statistical difference in the actively treated group when compared with the placebo group in symptom‐score, bronchial hyperreactivity or peak‐flow‐variability. There was a trend for fewer total days of upper respiratory tract infections and also symptom‐scores in the IVIG group but these did not reach statistical significance.

Conclusion

Our data indicate that treatment with IVIG in asthmatic children did not show a significant reduction in the incidence of upper respiratory tract infections, but the patients who did have upper respiratory infections in the IVIG‐group appear to have less protracted infections. Severity and bronchial hyperreactivity do not seem to be affected by the treatment as performed in our study.
Post‐translational modifications influence IgE reactivity to the major allergen Phl p 1 of timothy grass pollen
Authors: Petersen  , Schramm  , Schlaak  , Becker
Published: March 2003

Background

Grass group I consists of very potent allergenic components which are found in the pollen of all temperate grasses. Several post‐translational modifications are predicted from the cDNA data.

Objective

The aim of this study was to identify sequential IgE‐binding sites on the allergen Phl p 1 and to determine their influence on IgE reactivity.

Methods

Based on cDNA data and microsequencing results we synthesized overlapping decapeptides covering the complete Phl p 1 molecule and tested them for immunological reactivity by means of the PEPSCAN technique. In a dot test we determined the frequency of IgE reactivities to post‐translationally modified structures (hydroxylated proline residues, carbohydrate structure, and disulphide formations).

Results

Screening by overlapping peptides demonstrated an IgE binding site on the 10 N‐terminal amino acids. Comprehensive studies showed that the two hydroxyproline residues of the native Phl p 1 allergen (at positions 5 and 8) and the N‐glycan (at position 9) can result in an increased IgE reactivity; 3.3% of the sera exclusively bound to the hydroxyproline bearing peptide, while only 0.4% bound to the proline containing peptide. With regard to glycosylation, we estimated that 20% of sera recognized protein and carbohydrate epitopes, while one serum exclusively bound to the glycan. The formation of disulphide bonds has no detectable effect on the IgE reactivity to Phl p 1.

Conclusion

Our results indicate that the post‐translational modifications, the carbohydrate structure and the hydroxylation of proline residues, can enhance the IgE reactivity of Phl p 1.
HLA class II DRB1, DQB1 and DPB1 genotypic associations with peanut allergy: evidence from a family‐based and case‐control study
Authors: Howell W. M. , Turner S. J. , O'B Hourihane J. , Dean T. P. , Warner J. O.
Published: March 2003

Background

Peanut is one of the most common foods provoking allergic reactions and is the most frequent cause of fatal and near‐fatal food‐induced anaphylaxis. However, as yet, little is known of the genetic and immunological mechanisms which underly peanut allergy.

Objective

Based on findings in other allergic diseases, we have investigated whether particular human leucocyte antigen (HLA) class II genetic polymorphisms contribute to the development of peanut allergy.

Methods

All individuals from 37 families each containing one or more peanut allergic individuals, plus nine unrelated patients (161 individuals in total, defined as the study group) were typed for the HLA class II DRB1, DQB1 and DPB1 loci, by PCR‐based techniques. Genotype frequencies were compared with those found in 293 unrelated controls.

Results

Four class II genotypes (DRB1*08 (13.7% vs 4.8%; Pc = 0.026), DRB1*08/12 tyr 16 (22.4% vs 8.2%; Pc = 0.021), DQB1*04 (12.2% vs 2.7%; Pc = 0.0026) and DPB1*0301 (49.1 vs 22.5%; Pc = 0.00062)) were present at a significantly higher frequency in the study group compared with controls. Three of these genotypes (DRB1*08 (18.0%; Pc = 0.027), DRB1*08/12 tyr16 (24.0%; Pc = 0.029) and DQB1*04 (16.7%; Pc = 0.0029)) were also significantly increased in peanut allergic individuals compared with controls. In addition, two genotypes (DPB1*0101 and 0201) were significantly decreased in frequency in the overall study group, but not specifically in peanut allergic individuals.

Conclusion

While other genetic factors may be important, results from this study indicate that HLA class II genetic polymorphism may play a role in determining susceptibility to peanut allergy.
Histamine release from bronchoalveolar lavage cells from asthmatic subjects after allergen challenge and relationship to the late asthmatic response
Authors: Heaney L. G. , Cross L. J. M. , Ennis M.
Published: March 2003

Background

Metachromatic cells obtained from asthmatic subjects demonstrate increased spontaneous and stimulated histamine release in vitro. Their ability to synthesize and store proinflammatory cytokines has focused renewed interest on their role in asthma.

Objective

The late asthmatic response provides a useful model of clinical asthma. The aim of the study was to examine metachromatic cell derived mediators and histamine releasability in vitro after in vivo allergen exposure in atopic subjects with and without asthma and relate them to the type of physiological response observed.

Methods

Bronchoalveolar lavage (BAL) cells were obtained 4 h after challenge from asthmatics exhibiting a single early response (EAR, n = 5), a dual response (LAR, n = 7), unchallenged (basal, n = 5), atopic non‐asthmatic (ANA, n = 6) and non‐atopic non‐asthmatics (normal, n = 5). BAL histamine and tryptase concentrations and in vitro histamine release (HR) after stimulation with anti‐IgE, allergen, A23187, conconavalin A and substance P were compared.

Results

Metachromatic cell numbers were lower in normal controls compared with all asthmatic groups and in LAR compared with EAR. Metachromatic cell derived mediators were higher in asthmatic compared with normal subjects. Spontaneous HR in LAR (20.5 ± 5.0%) was lower than EAR (29.5 ± 3.9%) and ANA (30.2 ± 1.4%) (P < 0.05). No differences were seen in stimulated HR between EAR and LAR. HR in ANA stimulated with anti‐IgE was greater than LAR (P < 0.05). HR in ANA stimulated with anti‐IgE was greater than LAR (P < 0.05). After stimulation with ionophore A23187 (1 μM), release was greater in LAR compared with basal (P < 0.05) and no different at 5 μM. All subject groups responded to substance P (SP) but was significantly more in the asthmatic subjects compared to normal controls (P < 0.05). Allergen challenge did not modify the response of asthmatic subjects to SP.

Conclusion

Functional differences in metachromatic cell reactivity are present in atopic subjects 4 h after in vivo allergen exposure which relate to the physiological response observed after this time and suggest that there is ongoing metachromatic cell degranulation subjects who subsequently develop LAR.
Inflammatory mediators in naturally occurring rhinitis
Authors: Wilson S. J. , Lau L. , Howarth P. H.
Published: March 2003

Background

The mediators released during the allergic inflammatory reaction induce the clinical symptoms of the allergic disease and although there have been numerous studies investigating mediator release in allergen challenge models of allergic rhinitis very few have extended this approach to the study of natural disease.

Objective

The aim of this investigation was therefore to measure mast cell and eosinophil mediator levels and indices of vascular permeability in naturally occurring rhinitis.

Methods

Three groups of subjects were studied, normal non‐rhinitics, seasonal allergic rhinitics in and out of the grass pollen season and perennial allergic rhinitics. Mediators were recovered using the technique of nasal lavage and the levels of tryptase, histamine, eosinophil cationic protein and albumin were determined. In addition, eosinophils were enumerated in nasal smears as an indices of underlying inflammation.

Results

The levels of tryptase, eosinophil cationic protein and albumin were significantly higher in the lavage recovered from the symptomatic seasonal allergic rhinitics than when asymptomatic (P = 0.05,P = 0.003,P = 0.009, respectively). These levels of eosinophil cationic protein and albumin were also significantly higher than those of the normal non‐rhinitics (P = 0.0008,P = 0.0.003, respectively). In the perennial allergic rhinitics the levels of tryptase, eosinophil cationic protein and albumin were higher than the normal non‐rhinitics (P  < 0.0001,P = 0.0003,P = 0.0001, respectively). The levels of tryptase and histamine were higher in the perennial allergic rhinitics than the seasonal allergic rhinitics (P = 0.0003,P = 0.006, respectively). These changes in mediator levels were accompanied by a significant influx of eosinophils into the nasal mucosa of both the symptomatic seasonal rhinitics, compared with asymptomatic (P = 0.04) and normal controls (P = 0.0006) and the perennial rhinitics compared to normal controls (P = 0.03).

Conclusion

These results indicate that in both naturally occurring seasonal allergic rhinitis and perennial allergic rhinitis mast cell and eosinophil activation occurs and this is accompanied by an increase in vascular permeability. These measurements in lavage fluid provide a method of monitoring the mucosal cellular events in response to therapy.
Determinants of eosinophil cationic protein in nasal lavages in children
Authors: Wojnarowski  , Studnicka  , KÜhr  , Koller  , Haschke  , Gartner  , Renz  , Frischer
Published: March 2003

Background

Nasal lavages are increasingly used to assess airways inflammation in children. However, there are no studies assessing how measurement error as well as biological influences contribute to the concentration of nasal inflammatory parameters in a population based survey.

Objective

To investigate determinants of concentration of eosinophil cationic protein (ECP) in nasal lavages we studied 147 schoolchildren (mean age 8.1 years, sd 0.6 years) by repeated nasal lavages/year over a 2 year period.

Methods

Standardized questionnaires were completed by the parents each year. A skin‐prick test with seven aeroallergens (birch, cat, dog, hazel, weeds, Dermatophagoides pteronyssinus and D. farinae) was performed. One hundred and one children could perform valid lavages at least five times a year. As a measure of reproducibility the intraclass coefficient of reliability was calculated.

Results

The intraclass coefficient of reliability was 0.27 over all observations suggesting that about a quarter of total variance is due to between‐subject variance. Taking means over each year increased reliability to 0.60. Linear regression analyses with ECP being the dependent variable demonstrated significant higher values for boys (β = 12.26; P < 0.01), children sensitized to seasonal (β = 34.27; P = 0.02) but not to perennial allergens (β = – 4.44; P = 0.57), and for children with a serous (β = 10.01; P = 0.01) or purulent rhinitis (β = 22.45; P < 0.001).

Conclusion

Assessment of inflammatory mediators in nasal lavages is a useful tool for epidemiological paediatric studies. However, due to the relatively high intraindividual variability of ECP concentrations multiple lavages are necessary to characterize the individual.
Cord blood‐IgE as risk factor and predictor for atopic diseases
Authors: Edenharter  , Bergmann  , Bergmann  , Wahn  , Forster  , Zepp  , Wahn
Published: March 2003

Background

Cord blood‐IgE as risk factor or predictor for atopic diseases in infants has been discussed in a large number of papers with contradictory results. Our aim was to evaluate cord blood‐IgE as risk factor and predictor for atopic dermatitis, recurrent wheezing and sensitization with emphasis on a clear‐cut distinction between risk factor and predictor.

Methods

A cohort of 1314 newborns was recruited in six German obstetric departments and followed‐up for 5 years. Four hundred and ninty‐nine infants (38%) were considered to be at high risk with at least two atopic family members and/or a cord blood‐IgE value above the threshold of 0.9 kU/L. At follow‐up visits, parents filled in a questionnaire, the infants were clinically examined, and blood samples were taken.

Results

With regard to early onset atopic dermatitis up to 12 months we found that the odds ratios at the cord blood‐IgE cut‐off points of 0.70 kU/L and 1.25 kU/L with values of 0.53 and 0.32, respectively, were smaller than one (i.e. protective factors) and highly statistically significant. No significant association was found between elevated cord blood‐IgE and recurrent wheezing. There was a strong positive association between elevated cord blood‐IgE levels and sensitization at 12 months, but even in this case the predictive performance was rather poor: a maximum positive predictive value of 42% was attained with a cut‐off point of 3.0 kU/L, but the sensitivity was only 10%.

Conclusion

We conclude that even when elevated cord blood‐IgE levels are identified as a strong risk factor for sensitization, their poor predictive performance may make them useless as a basis for preventive measures.
Role of tachykinins in distilled water‐induced bronchoconstriction in guinea‐pigs
Authors: Fujimura  , Amemiya  , Myou  , Mizuguchi  , Ishiura  , Sasaki  , Matsuda
Published: March 2003

Background

An inhalation of ultrasonically nebulized distilled water (UNDW) induces bronchoconstriction only in asthmatics, but the mechanism underlying the response is not fully understood. We recently showed that bronchoconstriction occurs immediately after UNDW is inhaled 20 min after an aerosolized antigen challenge in passively sensitized guinea‐pigs.

Objective

This study was conducted to examine the role of tachykinins in this response.

Methods

Passively sensitized animals were anaesthetized and artificially ventilated, and changes in pressure at the airway opening (Pao) were measured as an overall index of airway narrowing. A tachykinin NK1 and NK2 dual receptor antagonist, FK224, and a tachykinin NK1 selective antagonist, FK888, were intravenously administered 15 min after the antigen challenge. The effects of capsaicin desensitization and a neutral endopeptidase inhibitor, phosphoramidon, were also examined.

Results

FK224 and FK888 significantly (P < 0.05 and P < 0.05, respectively) reduced the time course curve of the increase in Pao caused by UNDW inhalation in a dose‐dependent manner. The percentage increase in Pao from the preantigen challenge value at 1 min after the UNDW inhalation was 267.4 ± 17.1, 358.0 ± 33.7 and 412.4 ± 27.6% with 10 mg/kg of FK224, 1.0 mg/kg of FK224 and vehicle, respectively, (P < 0.01 between 10 mg/kg of FK224 and vehicle) and the value was 254.4 ± 48.5% with 10 mg/kg of FK888, 327.1 ± 57.6% with 1.0 mg/kg of FK888 and 418.5 ± 39.0% with vehicle, respectively (P < 0.05 between 10 mg/kg of FK888 and vehicle). The capsaicin desensitization, but not phosphoramidon, significantly reduced the UNDW‐induced increase in Pao.

Conclusion

These results suggest that tachykinins, at least substance P, are involved in a part of the UNDW‐induced bronchoconstriction in our guinea‐pig model.
Comparison of skin‐prick test and specific serum IgE determination for the diagnosis of latex allergy
Authors: Blanco  , Carrillo  , Ortega  , Alvarez  , Dominguez  , Castillo
Published: March 2003

Background

Latex IgE‐mediated hypersensitivity has been recognized as an international health problem. However, there is poor information on the efficiency of the diagnostic methods available.

Objective

The purpose of this study was to specify the efficiency of several diagnostic methods for latex allergy.

Methods

We designed a prospective study involving 50 adult patients with latex allergy, as diagnosed by a suggestive clinical history and a positive skin‐prick test (SPT) to a latex extract. One control group of 50 subjects paired for age, sex, total IgE levels and latex exposure, and another control group of 30 subjects with pollen allergy were used. A low‐ammoniated natural‐latex and several glove‐latex extracts were elaborated. SPTs with these extracts, as well as with four different commercial‐latex extracts were performed. Latex‐specific serum IgE was determined by the CAP and the AlaSTAT methods.

Results

Diagnostic sensitivity was 98% for the natural‐latex extract SPT, from 90% to 98% for the commercial‐latex extract SPT, and from 64% to 96% for the glove‐latex extract SPT. Diagnostic specificity of SPT was 100%, and no severe adverse reactions were observed during skin testing. With respect to the latex‐specific serum IgE determinations, sensitivity was 86% for the CAP system and 84% for the AlaSTAT assay, and specificity was dependent on the population considered.

Conclusion

SPT with natural latex extracts has shown a diagnostic efficiency close to 100%, significantly higher than that of latex‐specific serum IgE determination.
Prevalence and determinants of house dust mite allergen in East German homes
Authors: Hirsch  , Range  , Walther  , Hederer  , LÄssig  , Frey  , Leupold
Published: March 2003

Background

In 1990/91, allergic sensitization to house dust mites (HDM) and other allergens was more prevalent in children from West Germany than from East Germany.

Objective

To test the hypothesis that low indoor exposure to HDM allergen in East Germany has contributed to this difference.

Methods

HDM allergen concentrations were determined in 634 East German dwellings shortly after the German reunification.

Results

HDM group I allergen (Der p 1 + Der f 1) levels in mattresses (median 2.16, geometric mean 2.07, maximum 278.9 μg/g dust) and carpets (median 0.41, geometric mean 0.48, maximum 96.3 μg/g dust) were within the range of levels determined in West Germany in other studies. One particular East German type of dwelling (light concrete buildings) was associated with lower mite allergen exposure, but only a minority of the population lived there. Coal heating, installed in the majority of dwellings before 1989, was associated with higher allergen exposure. Higher relative humidity (RH) was a main risk factor for higher Der p 1 exposure (odds ratio [OR] for exposure to > 0.05 μg/g dust on carpets: 1.4 [95% confidence intervall (CI) 1.2–1.8] for + 10% RH) but not for higher Der f 1 exposure. Higher temperature was associated with a lower risk for elevated Der p 1 levels (> 0.05 μg/g dust on carpets): OR 0.6 (95% CI 0.5–0.8) for + 2 °C.

Conclusion

Mite allergen exposure is not lower in East Germany than in West Germany. The data does not support the hypothesis, that low HDM allergen exposure in East Germany is a cause for the lower prevalence of HDM sensitization in East German children.
Dermatophagoides sp. and IgE anti‐D. pteronyssinus and D. farinae detection in a Venezuelan community at more than 2000 m above the sea level
Authors: Rangel  , Salmen  , MUÑoz  , GarcÍA  , HernÁndez
Published: March 2003

Background

It has been reported that the concentration of Dermatophagoides sp. population, the main trigger of asthma in sensitized atopic subjects, is inversely related with altitude and probably directly with humidity and that this population are scarcely found over 1750 m above sea level.

Objective

We studied the presence of Dermatophagoides sp. in a Venezuelan community between 2040 and 2600 m above sea level, and also the IgE response to D. pteronnyssinus and D. farinae in atopic subjects living on that region.

Methods

The presence of Dermatophagoides sp. was determined by microscopic identification of mites in dust, obtained by brushing the mattresses surface in 93 randomly selected houses between 2040 and 2600 m above sea level. The indoor relative humidity was also measured. The specific IgE serum levels were studied in 65 subjects classified as asthmatics, allergic non‐asthmatics and non‐allergic.

Results

A mean concentration of 188 mites/g of room dust was determined in 82.4% of houses with an indoor relative humidity ranging from 89% and 92% independently of altitude. The density of Dermatophagoides sp. was sufficiently high to sensitize the atopic subjects, IgE levels were 6.8 PRU mean value for asthmatic, against 0.38 PRU in non‐atopic.

Conclusions

We conclude that: (a) Dermatophagoides sp. can be found up to 2600 m above sea level in a Venezuelan neotropical region where a high indoor relative humidity is characteristic of most dwellings; (b) sensitization by D. pteronyssinus and D. farinae were demonstrated in atopic subjects resident at that region.
Allergen challenge‐induced extravasation of plasma in mouse airways
Authors: ErjefÄlt  , Andersson  , Gustafsson  , Korsgren  , Sonmark  , Persson
Published: March 2003

Background

Mouse models are extensively used to study genetic and immunological mechanisms of potential importance to inflammatory airway diseases, e.g. asthma. However, the airway pathophysiology in allergic mice has received less attention. For example, plasma extravasation and the ensuing tissue‐deposition of plasma proteins, which is a hallmark of inflammation, has not been examined in allergic mice.

Objective

This study aims to examine the vascular permeability and the distribution of plasma proteins in mouse airways following exposure to allergen and serotonin. Methods Extravasated plasma was quantified by a dual isotop technique using intravascular (131I‐albumin) and extrasvascular (125I‐albumin) plasma tracers. Histological visualization of fibrinogen and colloidal gold revealed the tissue distribution of extravasated plasma.

Results

Allergen aerosol exposure (3% OVA, 15min) of sensitized animals resulted in a marked plasma extravasation response in the trachea (P < 0.01) and the bronchi but not in the lung parenchyma. A similar extravasation response was induced by serotonin (P < 0.001). Extravasating vessels (assessed by Monastral blue dye) were identified as intercartilaginous venules. Extravasated plasma abounded in the subepithelial tissue but was absent in the epithelium and airway lumen. The allergen‐induced response was dose‐dependently inhibited by iv administration of formoterol (P < 0.001), a vascular antipermeability agent.

Conclusion

The present study demonstrates that serotonin and allergen challenge of sensitized mice increase airway venular permeability to cause transient extravasation and lamina propria distribution of plasma in the large airways. We suggest that the extravasation response is a useful measure of the intensity and the distribution of active inflammation
Occupational respiratory hypersensitivity caused by preparations containing acrylates in dental personnel
Authors: PiirilÄ  , Kanerva  , Keskinen  , Estlander  , HytÖnen  , Tuppurainen  , Nordman
Published: March 2003

Background

Allergic contact dermatitis caused by acrylate compounds is common in dental personnel; they also often complain of work‐related respiratory or conjunctival symptoms.

Objective

The aim of the present study was to report the cases of acrylates induced respiratory hypersensitivity in dental personnel diagnosed in Finland during the last 6 years.

Methods

Occupational asthma, rhinitis, laryngitis and pharyngitis cases were diagnosed according to patient history, PEF monitoring, and a work‐simulating provocation test.

Results

Twelve cases of respiratory hypersensitivity caused by acrylates diagnosed in dental personnel (six dentists and six dental nurses) in 1992–97 are reported. During this period one case of conjunctivitis and one of laryngitis have been published separately. Nine cases of occupational asthma, two rhinitis cases, and one laryngitis case were verified according to the challenge tests with dental acrylate compounds (acrylates, methacrylates and epoxy acrylates). Only three patients had positive skin‐prick test reactions to common environmental allergens, and none reacted to acrylates in the skin‐prick tests. Five patients had an elevated total IgE (>110 kU/L). PEF follow‐up showed an occupational effect in all examined eight patients with diagnosed asthma. The mean duration of exposure to acrylates was 22 years, and the duration of respiratory symptoms 8 years.

Conclusions

The results indicate that acrylates constitute an important hazard for dental workers. The mechanism of respiratory hypersensitivity is still unknown, and it is probably not IgE‐mediated.
Responses of human birch pollen allergen‐reactive T cells to chemically modified allergens (allergoids)
Authors: Dormann  , Ebner  , Jarman  , Montermann  , Kraft  , Reske‐Kunz
Published: March 2003

Background

Allergoids are widely used in specific immunotherapy for the treatment of IgE‐mediated allergic diseases.

Objective

The aim of this study was to analyse whether a modification of birch pollen allergens with formaldehyde affects the availability of T‐cell epitopes.

Methods

Efficient modification of the allergens was verified by determining IgE and IgG binding activity using ELISA inhibition tests. T‐cell responses to birch pollen allergoids were analysed in polyclonal systems, using peripheral blood mononuclear cells (PBMC) of five birch pollen‐allergic individuals, as well as birch pollen extract‐reactive T‐cell lines (TCL), established from the peripheral blood of 14 birch pollen‐allergic donors. To determine whether the modification of natural (n)Bet v 1 with formaldehyde or maleic anhydride results in epitope‐specific changes in T‐cell reactivities, 22 Bet v 1‐specific T‐cell clones (TCC), established from nine additional birch pollen‐allergic individuals, were tested for their reactivity with these products.

Results

The majority of PBMC and TCL showed a reduced response to the birch pollen extract allergoid. Bet v 1‐specific TCC could be divided into allergoid‐reactive and ‐non‐reactive TCC. No simple correlation between possible modification sites of formaldehyde in the respective T‐cell epitopes and the stimulatory potential of the allergoid was observed. Mechanisms of suppression or of anergy induction were excluded as an explanation for the non‐reactivity of representative TCC. All TCC could be stimulated by maleylated and unmodified nBet v 1 to a similar extent.

Conclusion

These results demonstrate differences in the availability of T‐cell epitopes between allergoids and unmodified allergens, which are most likely due to structural changes within the allergen molecule.
Altered antigenicity of M‐177, a 177‐kDa allergen from the house dust mite Dermatophagoides farinae, in stored extract
Authors: Fujikawa  , Uchida  , Yanagidani  , Kawamoto  , Aki  , Shigeta  , Wada  , Suzuki  , Jyo  , Ono
Published: March 2003

Background

A high molecular weight allergen, M‐177 (177 kDa) was isolated from Dermatophagoides farinae using a specific antibody raised to an allergenic clone Mag 3, which was obtained by immunoscreening a mite cDNA library. The potent IgE reactivity of M‐177 is comparable with that of Der f 2.

Objective

The aim of this study was to analyse the molecular characteristics and the allergenic activity of M‐177 in stored mite extracts.

Methods

Antigens were analysed by immunoblotting and enzyme‐linked immunosorbent assay (ELISA; inhibition). Allergenic activity was estimated from IgE reactivity and the results of a histamine release assay.

Results

The intact M‐177 molecule was present in high concentrations in fresh extract obtained from purified mite bodies, but was only detected in small amounts in stored extracts. Instead of the intact molecule, anti‐Mag 3 antibody detected various cross‐reactive antigens in the stored preparations. Studies of a stored liquid extract showed that these cross‐reactive antigens were produced by the degradation of M‐177, and that this change was suppressed by the addition of protease inhibitors. Interestingly, the allergenic activity of the fragmented M‐177 (sM‐177) isolated from the stored extracts was greater than that of the intact antigen. Specific IgE reacted with sM‐177 in 84.2% of 38 sera samples from patients allergic to mites, while 65.8% were positive for M‐177‐specific IgE. Similarly, the histamine release test showed that sM‐177 had greater allergenic activity in vitro. ELISA inhibition indicated that the increased allergenic activity resulted from alteration of the antigenicity with the degradation of M‐177.

Conclusions

M‐177 is a protease‐sensitive allergen. The breakdown products of M‐177 provoked higher allergenic activity than the intact allergen.
Early life markers of atopy and asthma
Authors: Wahn  , Bergmann  , Nickel
Published: March 2003

Since early intervention could modulate the natural course of atopic disease, the availability of predictive markers is of considerable interest. As long as specific genetic markers are not available, early IgE‐responses (hen's egg) together with a positive family history of atopy can be proposed as highly specific and predictive markers, which could define subgroups as potential candidates for secondary prevention.