bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventive effect of feeding high‐risk infants a casein hydrolysate formula or an ultrafiltrated whey hydrolysate formula. A prospective, randomized, comparative clinical study
Authors: Halken S. , Høst A. , Hansen L G. , Østerballe O.
Published: June 2007

In a prospective study of a 1‐year birth cohort of 158 high‐risk infants the effect of feeding breastmilk, a casein hydrolysate (Nutramigen®) or a new ultrafiltrated whey hydrolysate (Profylac®) on the development of cow milk protein allergy/intolerance (CMPA/CMPI) was assessed and compared. All the infants had biparental or severe single atopic predisposition, the latter combined with cord blood IgE ≥ 0. 5 kU/L. At birth all infants were randomized to Nutramigen or Profylac, which was used when breastfeeding was insufficient or not possible during the first 6 months of life. During the same period this regimen was combined with avoidance of solid foods and cow milk protein. All mothers had unrestricted diets and were encouraged to do breastfeeding only. Moreover, avoidance of daily exposure to tobacco smoking, furred pets and dust‐collecting materials in the the bedroom was advised. The infants were followed prospectively from birth to 18 months of age. All possible atopic symptoms were registered and controlled elimination/challenge studies were performed when symptoms suggested CMPA/CMPI. A total of 154 (97%) were followed up and 141 followed the diet strictly. Eighty‐eight (62%) of the infants were breastfed for at least 6 months, 20 (14%) were breastfed exclusively, 59 and 62 had varying amounts of Nutramigen or Profylac respectively. CMPA/CMPI was diagnosed in 1/20, 1/59 and 3/62 in the breastfed, the Nutramigen and Profylac groups respectively, but 1 of the latter also had Nutramigen. None of the infants showed reactions against Nutramigen or Profylac. In 4 infants symptoms were provoked by breastmilk when the mother ingested cow milk and in 1 only by cow milk. The incidence of CMPA/CMPI among the infants who followed the dietary prevention programme was 3. 6% (5/141) which was a significant reduction compared to 20% (15/75) in an identically defined high‐risk group without dietary preventive measures. None of the infants in the prevention group developed CMPA/CMPI after the age of 6 months. We conclude that feeding breastmilk, an extensively hydrolysed casein formula (Nutramigen) or an ultrafiltrated whey hydrolysate (Profylac) combined with avoidance of solid foods during the first 6 months of life in high‐risk infants significantly reduced the cumulative incidence of CMPA/CMPI during the first 18 months of life. No difference was noted whether the infants were fed breastmilk, Nutramigen or Profylac and a diet period of 6 months seems sufficient. Both formulae were well tolerated and accepted by the infants.
Lymphocyte subsets, sIL2‐R and sICAM‐1 in blood during allergen challenge tests in asthmatic children
Authors: Schmitt M. , Niggemann B. , Kleinau I. , Nasert S. , Kapp A. , Wahn U.
Published: June 2007

In order to study cell activation in peripheral blood on bronchial allergen provocation up to 24 h, we investigated 32 asthmatic children, sensitive to house‐dust mites. Six healthy young adult volunteers served as controls. Lymphocyte subsets (CD3, CD19, CD4, CDS) and activation markers (CD25‐T, HLADR‐T, CD23) in peripheral blood as well as soluble IL2‐R and soluble ICAM‐1 in scrum were evaluated. In terms of clinical reaction, 23 children exhibited a DAR, 6 an EAR, 6 a LAR and 3 children did not show a bronchoconstrictor response to allergen challenge with house‐dust mite extract (NAR). In comparison to controls, asthmatic children showed a significantly higher expression of CD23 on B‐lymphocytcs (p < 0.05). Other subsets were in the same range in both groups. After provocation there was a significant increase of CD4/CD8‐ratio only in asthmatic children. Serum levels of sIL2‐R were significantly higher in asthmatic children compared to controls at baseline as well as at 12 and 24 h after provocation, without variation during observation period, No differences were noted for SICAM‐1. Our results confirm the hypothesis that lymphocytes, as important cells in regulation of allergic immune response, are recruited into peripheral blood under allergen challenge conditions in sensitized asthmatic children.
Cord blood IgE levels are influenced by gestational age but do not predict allergic manifestations in infants
Authors: Eiríksson T. H. , Sigurgeirsson B. , Árdal B. , Sigfússon Á. , Valdimarsson H.
Published: June 2007

The predictive value of cord blood IgE (clgE) for atopy and related disorders was investigated. Samples were collected from 792 infants delivered consecutively at the National University Hospital in Reykjavik in 1987. The concentration of IgE, but not that of IgA, was found to increase with increasing gestational age at birth. There was no correlation between IgE and IgA levels in individual samples. At the age of 18–23 months 180 of these children were studied for manifestations of allergy and related disorders. Included were all available infants with detectable (≥ 23 kU/L) clgE. However, infants born by Cesarean section or with IgA exceeding 10 mg/L were excluded because of potential contamination with maternal blood. The clinical evaluation was made without knowledge of the IgE levels. Sixty‐six of the 180 participants (36.6%) were judged to have had definite allergic manifestations. However, no striking correlation was found between allergic symptoms and cIgE levels in this study, nor did high levels of IgE add significantly to the predictive value of family history. Children with atopic features had more frequently been affected by otitis media. Unexpectedly, infants with intermediate cIgE levels (0.2–0.6 kU/L) were significantly less affected by otitis media than children with unmeasurable (< 0.2 kU/L) or high (≥ 0.7 kU/L) cIgE levels. It is concluded that cord blood IgE can not be used to predict allergic manifestations in children under the age of 2 years.
Evaluation of the immunogenicity of protein hydrolysate formulas using laboratory animal hyperimmunization
Authors: Cordle C. T. , Duska‐McEwen G. , Janas L. M. , Malone W. T. , Hirsch M. A.
Published: June 2007

The rabbit hyperimmunization model has previously been used to evaluate candidate hypoallergenic protein ingredients. Use of the model has been expanded to include the evaluation of protein hydrolysate formulas. Each formula's immunological reactivity was determined by ELISA measurement of formula‐specific rabbit antibody. Animals hyper‐immunized with formulas containing extensively hydrolyzed proteins (Alimentum, Nutramigen, and Pregestimil) generated very weak immune responses (<100 fold antibody increase). Products containing intact or partially hydrolyzed proteins (Similac, Enfamil, Good Start, Beba HA, and Nidina HA) elicited high level (>10,000 fold increase) immune responses. Immunogenicity results were then compared to measurements of residual antigen content (by inhibition ELISA) and clinical performance. Correlation of formula immunogenicity, antigenicity and clinical performance indicates that the rabbit model is useful for screening “hypoallergenic” formulas to predict allergenic reactivity.
Lymphocyte response to cow's milk proteins in patients with cow's milk allergy: relationship to antigen exposure
Authors: Suomalainen H. , Soppi E. , Isolauri E.
Published: June 2007

The cellular immune response to cow's milk was measured in patients with challenge‐proven cow's milk allergy (CMA), manifested with either gastrointestinal or skin symptoms. After 2–4 weeks on milk elimination, 44 children, mean (SD) age 15.7 (9.4) months, were challenged, and cow's milk‐induced lymphocyte transformation was measured before the clinical challenge (Day 1) and / or one week later (Day 8). During the clinical challenge period, 17 (39%) patients showed gastrointestinal reactions, 9 (20%) had urticarial or eczematous skin eruptions, and 18 (41%) were negative to challenge. On Day 1, the mean [95% confidence interval] stimulation index for lymphocytes in patients manifesting CMA with gastrointestinal symptoms, 2.60 [1.60, 4.10], was significantly higher than that in patients with skin symptoms, 1.15 [0.60, 2.30], or patients with negative clinical challenge, 0.83 [0.64, 1.08], F = 9.0, p = 0.001. After the clinical challenge (Day 8), this cow's milk‐induced lymphocyte proliferation response was abrogated. At the same time, CMA patients evidenced a significantly higher spontaneous lymphocyte proliferation response in RPMI medium‐containing control cultures than those with negative clinical challenge. We conclude that in patients with CMA, the number of circulating cow's milk‐sensitized lymphocytes is depleted or their function is impaired after clinical exposure to cow's milk antigens.
Salivary anti‐RSV IgA antibodies and respiratory infections during the first year of life in atopic and non‐atopic infants
Authors: Banzhoff A. , Dulleck A. , Petzoldt S. , Rieger C. H. L.
Published: June 2007

Salivary SIgA antibodies against RS virus were studied in 105 children during the first year of life. The infants were divided into groups according to their risk of atopy. At birth 13 neonates showed measurable amounts of SIgA to RS virus. In another 26 children specific antibodies were detected but in concentrations too low for quantitative analysis. During the first year of life this increased to 29 antibody‐positive samples with measurable amounts of antibody and 39 with concentrations too low for quantitative determination. At this time 8 children of the high risk group had developed symptoms of allergy. None of these children had measurable amounts of SIgA anti‐RSV in their saliva. In comparison, 10 of the remaining 26 high risk infants without symptoms of allergy did have such antibodies. Atopic infants had significantly more respiratory infections during the first year of life than nonatopic infants. The avidity of SIgA anti‐RSV in neonatal samples was significantly higher than avidity determined in breast milk SIgA but comparable to the avidity of serum IgG. During the first year of life a continuing decrease of salivary SIgA avidity was observed.
Cord blood IgE levels in the United Arab Emirates
Authors: Alawar B. , Kalla S. El , Björkstén B.
Published: June 2007

Cord blood IgE was assayed in 164 newborn babies from the United Arab Emirates. The serum IgE levels ranged between ≤0.1–13.5 kU/1 with a geometric mean of 0.28 kU/1. The cord blood IgE in the 89 babies without immediate family history of allergy was ≤0.1–3.2 kU/1 with a geometric mean of 0.25 kUA and 1.13 kU/1 as the 90th percentile. An influence of prenatal sensitization to helminth antigens on cord blood IgE level was not likely. The data are similar to cord blood IgE values reported in other populations. This indicates that ethnic differences do not influence cord blood IgE levels and that previously published studies on the predictive value of cord blood IgE determination in Caucasians are relevant also for other populations.
Leukotriene B4 and C4 generation by blood leukocytes after ex vivo stimulation by Ca‐ionophore and opsonized zymosan in children with atopic dermatitis
Authors: Shimizu T. , Kristjansson S. , Wennergren G. , Strannegård I.‐L. , Strandvik B. , Shimizu Toshiaki
Published: June 2007

The ex vivo release of leukotrienes B4 (LTB4) and C4 (LTC4) from the leukocytes of children with atopic dermatitis (AD) was evaluated after stimulation with Ca‐ionophore and opsonized zymosan and compared with that of control children of similar ages. The blood eosinophil counts and total serum IgE levels in AD children were significantly higher than those in control children. The production of LTC4, but not LTB4, was significantly higher in AD children than in control children. There was a significant correlation between the relative blood eosinophil count and LTC4 generation after stimulation with both Ca‐ionophore and opsonized zymosan in all subjects. Calculations of the amount of LTC4 produced per eosinophilic cell showed that there was no significant difference between cells from AD children and control children in terms of their ability to produce LTC4. These findings suggest that the enhanced LTC4 generation is due to increased numbers of eosinophils rather than to enhanced releasability of these cells.
Eosinophil cationic protein in nasopharyngeal secretions and serum of infants infected with respiratory syncytial virus
Authors: Zelaya E. A. Colocho , Örvell C. , Strannegård Ö.
Published: June 2007

Eosinophil cationic protein (ECP) was assayed in nasopharyngeal secretion (NPS) and serum from 42 infants, hospitalized with acute lower respiratory infection, in El Salvador and the results analyzed in relation to etiology of the infection. ECP concentrations were high in NPS, at an average 50 times higher than those found in serum. Exceedingly high levels of ECP (> 1000 μg/L) were found more frequently in wheezing than in non‐wheezing children (30% vs 7%) and, accordingly, were more commonly found in children hospitalized with bronchiolitis than in those with pneumonia. Excessive levels were significantly more common in girls than in boys. Of the 42 cases, 28 were found to be caused by respiratory syncytial virus (RSV) subgroup A, and 3 by RSV‐B, by means of detection of RSV antigen in nasopharyngeal cells. ECP serum levels were moderately elevated during the acute phase of the respiratory infection and increased slightly but significantly, in cases with RSV antigen‐positive bronchiolitis, but not in those with pneumonia. The ECP levels in NPS from patients in Sweden who, by antigen detection in NPS cells, were diagnosed as either RSV or para‐influenza 3 infection or none of these, were similar. These results indicate that elevation of ECP in NPS is associated with acute lower respiratory infection in general, but particularly pronounced in cases of bronchiolitis. Elevation of ECP is not an exclusive consequence of RSV infection, but may occur to an equal extent in infections caused by other agents. Girls generally seem to be less prone than boys to developing airway obstruction and may, therefore, acquire severe bronchiolitis only when large amounts of inflammatory mediators, such as ECP, accumulate in the airways.
Acquired IgA deficiency
Authors: Gleeson M. , Clancy R. L. , Cripps A. W. , Henry R. L. , Hensley M. J. , Wlodarczyk J. H.
Published: June 2007

During a prospective study of the ontogeny of the mucosal immune system using saliva, one subject acquired a selective IgA deficiency at 3 years 6 months of age. Prior to this time the infant had normal ontogeny patterns for salivary immunoglobulins and the salivary IgA was confirmed to be dimeric IgA containing secretory component. Two respiratory tract infections at 3 years 4 months and 3 years 5 months were reported prior to the collection of a saliva sample which was deficient in IgA. All subsequent saliva collections remained IgA deficient. Serum and saliva collected at 11 years of age confirmed persistent IgA deficiency. There was a family history of organ‐specific autoimmune disease. The prospectively collected data indicate in this subject that the IgA deficiency was not congenital, but was acquired closely associated with two episodes of respiratory tract infections, against a genetic background of disturbed immune regulation.
Role of atopy in the natural history of wheeze and bronchial hyper‐responsiveness in childhood
Authors: Asperen P. P. Van , Mukhi A.
Published: June 2007

The role of atopy in the development of asthma has become increasingly recognised. We have been prospectively following a birth cohort of children of atopic parents to document the development of atopic disease. Our aim in this study was to document the natural history of BHR and wheeze at 10 years of age and to relate this to atopy. We reviewed 47 of our original cohort of 79 infants at 10 years of age and documented their clinical history of atopic disease and performed allergen skin prick tests and BHR to histamine. Thirty‐three (70%) children wheezed at some time during their 10 years of life, with 13 commencing in infancy. Twenty‐two children (47%) had current wheeze at 10 years of age. Wheeze in infancy was a poor predictor (RR 1.23, Cl95 0.66–2.23) of current wheeze while wheeze commencing after infancy was a good predictor (RR 2.89, Cl95 1.45–5.2). In contrast both atopy in infancy (RR 2.94, Cl95 1.92–4.53) and current atopy (RR 3.58, Cl95 1.43–9.03) were strong predictors of current wheeze. Analysis of BHR confirmed the importance of atopy in predicting its occurrence and severity. Sensitisation to D. pteronyssinus appeared to be the strongest predictor of both current wheeze and BHR. These observations confirm the importance of atopy in predicting outcome in children with asthma and suggest that wheezing in infancy and wheezing in later childhood may have different pathogenetic mechanisms.
Variations in serum soluble IL‐2 receptor concentration
Authors: Jones A. C. , Besley C. R. , Warner J. A. , Warner J.O.
Published: June 2007

Soluble interleukin‐2 receptor (sIL‐2R) concentrations were measured in the sera of 18 healthy adult volunteers, 40 healthy children aged 5 months ‐ 16 years 8 months and cord blood from 10 babies, using two commercially available ELISA kits (T‐cell Sciences and Serotec). In the presence of normal C‐reactive protein (CRP) children (aged 0‐16 years 8 months) had significantly higher sIL‐2R concentrations than adults aged (18‐37 years). In children up to the age of 16 years there was a significant negative correlation between age and sIL‐2R (r = ‐0.725 p < 0.0001 T‐Cell Sciences, r = ‐0.646 p < 0.0001 Serotec). A comparison was also made between the two kits, which indicated that both kits yielded reproducible results but the T‐Cell Sciences kit had a larger working concentration range than the Serotec kit. Following 12‐h sampling in adult volunteers, a lower concentration of sIL‐2R was observed at 4 am compared with 10 am (p = 0.0052) which indicates diurnal variation. These observations emphasize the importance of the study of normals as part of any research, and raises further questions regarding the many factors which influence immune function.
Glucocorticoids and growth in asthmatic children
Authors: Kamada A. K. , Szefler S.J.
Published: June 2007

The effects of asthma and oral and inhaled glucocorticoid therapy on growth in children are reviewed. Previous reports have shown that asthma itself may delay the onset of puberty, an effect which may masquerade as growth suppression. Oral glucocorticoids appear to impair growth; however, lower doses and alternate‐day therapy may have less risk of this effect. While a controversial topic, inhaled glucocorticoids in lower doses appear to be associated with a small risk of adverse effects on growth. Minimal data are available for higher doses. Knemometry, a relatively new technique used for measuring small changes in growth, has detected short‐term effects with both oral and inhaled glucocorticoids therapy. However, a number of limitations are associated with short‐term growth studies. Clinicians should be aware of the potential for growth impairment with glucocorticoid therapy so adequate monitoring can be undertaken and appropriate intervention introduced when deemed necessary.
Comparison of cytokine production in blood cell cultures of healthy children and adults
Authors: Elsässer‐Beile U. , Dursunoglu B. , Gallati H. , Mbnting J. Schulte , von Kleist S.
Published: June 2007

The production of the cytokines IL‐l‐α, IL‐l‐β, IL‐2, TNF‐α, and IFN‐γ was measured by a sensitive immunological assay in stimulated whole blood cell cultures from 52 healthy children (33 aged from 1 to 9 years and 19 aged between 10 and 17 years) and 67 healthy adults. When the higher absolute mononuclear cell counts in the peripheral blood samples of the children were taken into account, the relative production of all measured cytokines was lower in the cell cultures of the children than of the adults. In the group of the younger children (< 10 years) the differences were significant for all measured cytokines. In the group of older children (> = 10 years) the values were higher than in the younger children but lower than in adults. The findings indicate that the cellular immunological competence is or can be reduced in children and adolescents, particularly young children below 10 years of age. There seems to be a gradual development of cytokine production during childhood.
Cryptococcal meningitis in a child with hyperimmunoglobulin E syndrome
Authors: Garty B.‐Z. , Wolacfr B. , Ashkenazi S. , Weisman Y. , Rachmel A. , Nitzan M.
Published: June 2007

A 13‐year‐old boy with hyperimmunoglobulin E (hyper‐IgE) syndrome presented with headache, blurred vision, photophtobia and bilateral papilledema due to cryptococcal meningitis. Treatment with amphotericin B, and S‐fluorocytosine for several weeks and repeated lumbar punctures did not reduce the intracranial pressure, and a myeloperitoneal shunt was performed. The child was maintained on fluconazole for an additional six months. Patients with hyper‐IgE syndrome are at increased risk of opportunistic fungal infections such as cryptococcal meningitis.
Nonspecific bronchial hyperresponsiveness and development of asthma in children with hay fever
Authors: Añibarro B. , García‐Ara M. C. , Martín F. , Díaz J. M. , Boyano T. , Ojeda J. A.
Published: June 2007

It has been suggested that patients with allergic rhinitis who present nonspecific bronchial hyperresponsiveness (BHR) are those most likely to develop asthma. Therefore, a study was conducted in children with rhinoconjunctivitis to ascertain whether BHR to methacholine might predict the development of asthma in these patients. Fifteen patients with hay fever and no previous symptoms of asthma were selected. All underwent clinical symptom tests and methacholine tests, during the pollen season in the 4 consecutive years following the start of the study. At the end of this period, 5 patients had developed asthma. It may thus be affirmed that, in this group, neither the presence nor the degree of previous BHR was useful for predicting which patients would later develop asthma.
Eosinophils and basophilic cells in sputum and nasal smears taken from infants and young children during acute asthma
Authors: Nagayama Y. , Odazima Y. , Nakayama S. , Toba T. , Funabashi S.
Published: June 2007

To examine the increase in eosinophils and basophilic cells in the respiratory areas of infants and young children with asthma (n= 111), we analyzed the numbers of eosinophils and basophilic cells in sputum and nasal smears. The number of children with eosinophilia grades of 2+ or greater (> = 11 cells/five fields in x 1000 magnification) in sputum and nasal smears, respectively, in each age group was as follows: 33% and 21% under 1 year, 59% and 64% at 1 year, and 79–80% and 75–78% at 2–3 years. An increased infiltration of basophilic cells according to age was also observed. Infiltration of these cells began earlier than the appearance of IgE antibodies to mite in blood.
Adverse central nervous system effects of older antihistamines in children
Authors: Simons F. Estelle R. , Fraser Terry G. , Reggin James D. , Roberts Janet R. , Simons Keith J.
Published: June 2007

Although older, potentially sedating, “first‐generation” antihistamines (H1‐receptor antagonists) are commonly used in childhood, their central nervous system (CNS) effects have not been well‐documented in young subjects. We hypothesized that diphenhydramine and hydroxyzine would affect CNS function adversely in this population. Our objective was to evaluate the effects of these medications on central and peripheral histamine H1‐receptors in children. Fifteen subjects with allergic rhinitis were tested before and 2‐2. 5 h after administration of diphenhydramine, hydroxyzine, or placebo in a double‐blind, single‐dose, three‐way crossover study. Impairment of cognitive processing was assessed objectively by the latency of the P300 event‐related potential (P300). Somnolence was assessed subjectively by a visual analog scale. Peripheral H1‐blockade was assessed by suppression of the histamine‐induced wheals and flares. At the central (Cz) and frontal (Fz) electrodes, diphenhydramine and hydroxyzine increased the P300 latency significantly (P < 0.05) compared to baseline. Hydroxyzine increased somnolence, as recorded on the visual analog scale, significantly compared to baseline (P < 0.05), with a similar trend for diphenhydramine (P= 0.07). Both antihistamines reduced histamine‐induced wheals and flares significantly compared to baseline and compared to placebo. In children, diphenhydramine and hydroxyzine are effective H1‐receptor antagonists, but both these medications cause CNS dysfunction, as evidenced by increased P300 latency, a measure of cognitive function, and by increased subjective somnolence.
Prevalence of bronchial hyperreactivity asd etermined by several methods among Estonian schoolchildren
Authors: Vasar M. , Braåbaäck L , Julge K. , Knutsson A. , Riikjaärv M. A. , Bjoõrksteén B.
Published: June 2007

There is a lack of established criteria to identify asthma and bronchial hyerreactivity (BHR) in epidemiological studies, although both conditions appear to bear some relationship to atopy, at least in children. Recent studies indicate a low prevalence of atopy in former Socialist countries in Europe, yet the prevalence of BHR has been reported to be high. We have analysed the relationship between the outcome of various lung function tests, atopy and clinical symptoms of bronchial asthma in an epidemiological survey of Estonian 10‐12 year old schoolchildren. Metacholine provocation test (four steps with the cumulative doses 100, 300, 700 and 1100uμg), exercise challenge test and PEF‐variability over two weeks were done in 806 children in Tallinn (coastal, industrialised city) and 774 children in Tartu (inland, uniersity town). A positive response to the metacholine challenge test was recorded in 19% in Tallinn and in 32% in Tartu (p < 0.001). A similar tendency was observed for a more than 15% decrease of FEV1 in the exercise challenge test, i. e. 6% in Tallinn and 18% in Tartu. There was only a weak relationship between BHR, as defined by either a positive metacholine challenge and/or exercise test, diagnosed asthma and reported wheezing. Thus, 47% of the wheezing children and 30% of the children with asthma had negative test results. Only 17% of the children with a positive metacholine challenge were atopic, as defined by at least one positive skin prick test. In conclusion, none of the methods employed to assess bronchial hyperre‐sponsiveness were very useful for the identification of wheezing and asthmatic children in this epidemiological study. In contrast to the results of studies in Western Europe, most children with bronchial hyperreactivity in Estonia are not atopic.
Eosinophil cationic protein in induced sputum as a marker of inflammation in asthmatic children
Authors: Sorva Ritva , Metso Tuula , Turpeinen Markku , Juntunen‐Backman Kaisu , Björksten Fred , Haahtela Tari
Published: June 2007

We evaluated the usefulness of eosinophil cationic protein (ECP) in induced sputum and in serum as markers of asthmatic inflammation in children. We measured ECP in serum and in total indticed sputum samples from 14 children (7‐11 years) with newly detected asthma before and after treatment, and from ten healthy non atopic controls of the same age. The patients inhaled budesonide, 800 μg/m2/day for the first month and 400 μg/m2/day for the next 5 months, both divided into two doses, and nedocromil, 4 mg three times daily for the following 6 months. In both sputum and serum, ECP levels were higher in the patients than in the controls, but the difference was more distinct in sputum. Significant clinical improvement during the treatment was accompanied by a decrease in sputum ECP. whereas serum ECP did not change. The results suggest that induced sputum is useful as a non invasive source material for evaluating asthmatic inflammation in children, total sputum ECP being more sensitive than serum ECP for diagnosing and monitoring asthma.
Natural history of soy allergy and/or intolerance in children, and clinical use of soy‐protein formulas
Authors: Cantani Arnaldo , Lucenti Patrizia
Published: June 2007

Atopic diseases of infants and children are common, debilitating, chronic and sometimes even life‐threatening. Several well‐conducted studies in high risk babies have demonstrated a significant reduction in the prevalence and severity of atopic diseases with dietary and environmental manipulations. The currently available cow's milk (CM) substitutes for infants are soy protein (SP) formulas (SPFs), hydrolyzed formulas (HF), and home‐made meat‐based formulas. Soybeans have been cultivated in Eastern countries for many centuries and were first used to feed US babies with CM allergy (CMA) in 1929. Since then, SPFs containing purified SP, a mixture of vegetable oils, and purified carbohydrate have been developed. From a nutritional point of view, SPFs are adequate, support normal growth, protein status, bone mineralization, are well accepted, and economical.

SPFs are used for different conditions including CMA, lactose and galactose intolerance and in the management of severe gastroenteritis, and some studies show that feeding SPFs for the first six months of life significantly reduces the prevalence of atopic diseases in high risk babies. Although gastrointestinal symptoms and atopic dermatitis (AD) may occur in some SPF‐fed children, anaphylaxis following the ingestion of soybean is extremely rare in children. However, in the past few years the antigenicity/allergenicity of SPFs has been over‐emphasized in the medical literature. In this paper on the natural history of soy antigenicity/allergenicity we discuss all the pros and cons of SPFs, their composition and nutritional value, the basic immune definitions, chemistry and characterization of SPs. We then discuss the antigenicity and allergenicity of SPFs in animals, recent data on the use of SPFs and the incidence of soy allergy in children, clinical reactions to SPFs, and the clinical relevance of skin testing and IgE antibodies to soy, challenge test procedure, clinical indication of SPFs, and their relevance in the prevention of atopy. We have meta‐analyzed 17 different studies and conclude that history‐based SPF allergy incidence totals 27%, in skin prick tests (SPT) RAST‐oral food challenge (OFC)/double‐blind food challenge (DBFC)‐based epidemiological studies attains 3%, and in challenge test studies 4%. We suggest that double‐blind placebocontrolled food challenge (DBPCFC) studies in larger cohorts of babies may establish a more reliable prevalence of SPF allergy in different disorders associated with CMA.
A reason why measures to avoid mite‐induced asthma are more effective in children than in adults
Authors: Murray Andrew B , Morrison Brenda J
Published: June 2007

Mite‐sensitive asthmatics seem to respond more markedly to a reduction in mite allergen in the bedding if they are children than if they are adults. In order to investigate this difference, 882 children who attended our allergy clinic were studied. The accompanying parents were asked standardized questions, and skin prick tests to Dermatophagoides pteronyssinus and D. farinae were performed on the children. The number of hours that the children spent in bed lessened progressively with increasing age, from a mean of 13. 6 hrs. for 1 year olds to 9. 5 hrs for 17 yr olds: the mean for the total population was 12. 0 hrs. This was significantly longer than the mean for the parents, 8. 4 hrs (p=. 000). It is likely that a longer period of exposure to mite allergen in bed is an important reason why children respond more markedly to avoidance measures in the bedroom than adults do.
Life‐threatening fish allergy successfully treated with immunotherapy
Authors: Casimir G , Cuvelier Ph. , AIIard S. , Duchateau J.
Published: June 2007

Manifestations of fish allergy can include near‐fatal anaphylactic reaction. In very sensitive patients, fish odors and cooking vapors may have some al‐lergenic activity. We reported a case of life‐threatening fish allergy in a girl of 39 months referred for three episodes of Quincke edema with wheezing, cyanosis and severe urticaria after fish consumption or inhalation. Reagins were found against codfish and direct skin prick test with fresh food (cod fish) showed important local reaction. Strict avoidance of fish in the diet is usually the only recommended procedure. However, in this particular case, the life‐threatening nature of the allergic reaction was the major considera tion to perform a desensitization. The child was treated by RUSH immuno therapy using codfish extracts from BENCARD company, following the schedule for insect venom allergy described by Pharmacia. Immunotherapy was performed immediately after determination of the threshold of sensi tivity by specific skin prick tests and intra‐dermal injections. Desensitiza tion was initiated with a 1/10 dilution of the cut‐off solution and 5 subcuta neous injections were administered daily. When important local reactions were observed, additional doses were necessary to obtain tolerance. After the RUSH therapy, the child was submitted to uncooked codfish odors without any reaction. No reaction has been observed even when the child has accidentally eaten a little piece of codfish.
Determinants of total and specific IgE in infants with atopic dermatitis
Authors: Warner J. O.
Published: June 2007

ETAC (Early Treatment of the Atopic Child), a multi‐centre predominantly European study to investigate the potential for cetirizine to prevent the development of asthma in infants with atopic dermatitis has completed enrolment: 817 children have been randomised to 18 months' treatment with either active or placebo and a subsequent 18 months of post‐treatment follow‐up. Results of the therapeutic effects will not be available for some time, but the study has provided an opportunity to investigate influences on sensitization to allergens in a large cohort of 1‐2 years olds with already established atopic dermatitis, resident in different countries and in different environments.

The study shows that in infants with atopic dermatitis, raised serum total IgE has significantly different determinants from that a specific allergen sensitization. In infancy, increased total IgE is more affected by factors increasing risk of intercurrent infection and non‐specific airway inflammation, such as environmental tobacco smoke exposure (p < 0.001) and the use of gas cookers (p=0.02). Specific allergen sensitization as represented by detectable IgE antibodies is influenced primarily by allergen exposure. In Sweden, low level exposure to allergens is associated with reduced specific allergen sensitization rates even though the infants already have atopic dermatitis.
Is asthma an endocrine disease?
Authors: Wjst Matthias , Dold Sigrid
Published: June 2007

The prevalence of pediatric asthma has increased in many parts of the world. This increase started more than 30 years ago and is particularly ob‐vious in Studies which document the onset of asthma in native populations when they change to a “Western” lifestyle. Besides a genetic influence, nu‐merous environmental factors have been described for the development of asthma. Genetic factors are unlikely to explain the sharp increase within the short time period and also allergen and pollution exposure or any spe‐cific infection does not actually seem to be the main cause for this phe‐nomenon. Another factor, however, that fits well into the geographical and temporal background of the asthma epidemic is the mother's oral contra‐ceptive use. We therefore review the epidemiological association with later asthma in the children, give a summary of estrogen effects on immune function and develop a preliminary theory how oral contraception could influence later pregnancy.
A case of cow's milk allergy in the neonatal period‐evidence for intrauterine sensitization?
Authors: Feiterna‐Sperling Cornelia , Rammes Stefanie , Kewitz Gabriele , Versmold Hans , Niggemann Bodo
Published: June 2007

Clinical manifestations of cow's milk allergy rarely occur in the first days after birth. We report on a newborn presenting with hemorrhagic mecon‐ium in the first hour of life followed by bloody diarrhea in the next few days. At day 14, an elevaled total IgE, specific IgE to cow's milk and an eosinophilia in peripheral blood were found. Symptoms disappeared when the milk feed was changed to an extensively hydrolyzed casein formula. Two challenges with cow's milk formula (on day 30 and at 7 months of age) were followed by recurrence of vomiting, watery diarrhea and failure to thrive. At the age of 17 months cow's milk was tolerated well. Although other pathogenetic mechanisms cannot completely be ruled out, there is strong evidence that cow's milk allergy— induced by intrauterine sensiti‐zation—explains the symptoms in our patient. In conclusion, cow's milk allergy can occur even in the first days of life, and our clinical observation supports the concept of intra‐uterine sensitization to allergens.
Enhanced IL‐4 but normal interferon‐gamma production in children with isolated IgE mediated food hypersensitivity
Authors: Campbell Dianne E. , Hill David J. , Kemp Andrew S.
Published: June 2007

Atopic disorders such as atopic dermatitis and asthma have been characterised by an imbalance in interferon‐gamma (INF‐γ) and IL‐4. Whether similar imbalances are found in atopic disorders with different clinical manifestations, such as IgE mediated immediate food hypersensitivity, is not clear. We have examined the in vitro production of INF‐γ and IL‐4 in peripheral blood mononuclear cells (PBMC) following phytohaemagglutinin stimulation from children with isolated immediate IgE mediated food hypersensitivity (egg, milk, “nut”), children with moderate and severe atopic dermatitis, and normal children. Children with immediate food reactions were excluded if they had a history or evidence of atopic dermatitis or asthma. PBMC from children with IgE mediated food hypersensitivity produced significantly more IL‐4 (p = 0.013) but equivalent INF‐γ (p=0.26) compared to PBMC from control children. In contrast, PBMC from children with atopic dermatitis produced significantly less INF‐γ (p < 0.001) and more IL‐4 (p < 0.008) than PBMC from normal children. In addition, there was no difference in IL‐4 (p = 0.74) but significantly less INF‐γ (p < 0.001) produced by PBMC from the children with atopic dermatitis than food hypersensitivity. We demonstrate that children with IgE mediated food hypersensitivity and no other manifestation of atopic disease have enhanced IL‐4 production without the defect in INF‐γ production observed in childhood AD and asthma. We postulate that isolated IL‐4 enhancement promotes the development of IgE mediated hypersensitivity disorders such as food allergy, whilst the combination of defective INF‐γ and enhanced IL‐4 production promotes inflammatory atopic disorders such as AD and asthma.
Differential patterns of circulating adhesion molecules in children with bronchial asthma and acute bronchiolitis
Authors: Øymar Knut , Bjerknes Robert
Published: June 2007

The object of the study was to assess the levels of circulating forms of the cellular adhesion molecules ICAM‐I, VCAM‐1, E‐selectin, L‐selectin and P‐selectin in young children with asthma and acute bronchiolitis. Thirty‐nine children aged 12 to 84 months with mild or moderate asthma were studied at admission for acute asthma (n = 15) or in a stable phase (n = 24). Ten of the children with acute asthma were seen again after one month. Twenty‐two children aged 1 to 17 months with acute bronchiolitis and nine non‐atopic controls were also included in the study. In children with acute asthma, the mean concentration of circulating soluble ICAM‐1 (SICAM‐I) was increased compared to children with stable asthma (mean 442 μg/l versus 363 μg/l; p < 0.001) and to controls (363 μg/l; p < 0.05). The levels of SICAM‐1 remained high at follow up. In children with stable asthma, the mean serum concentration of soluble L‐selectin (sL‐selectin) (2080 μg/l) was significantly higher than in the controls (1664 μg/l; p < 0.05). The levels of circulating cellular adhesion molecules were similar in atopic and non‐atopic asthmatics. Children with acute bronchiolitis had increased serum levels of soluble VCAM‐1 (sVCAM‐I) (1637 μg/l versus 1019 μg/l in the controls; p < 0.01) and sL‐selectin (2041 μg/l versus 1664 μg/l in the controls; p < 0.05). There was no difference between the levels of circulating cellular adhesion molecules in children with respiratory syncytial virus (RSV) positive and RSV negative bronchiolitis. Soluble E‐selectin (sE‐se‐lectin) and soluble P‐selectin (sP‐selectin) in serum were not significantly increased in any of the groups studied. In conclusion, our data suggest differential patterns of circulating cellular adhesion molecules in young children with acute asthma, stable asthma, and acute bronchiolitis, which may reflect differences in the underlying inflammatory processes in these obstructive pulmonary diseases.
Differential effects of inhaled budesonide on serum osteocalcin in children and adolescents with asthma
Authors: Wolthers Ole D. , Heuck Carsten
Published: June 2007

In recent years, measurement of serum osteocalcin has been introduced for assessment of bone turnover in patients treated with exogeneous glucocorticoids. Studies in children with asthma on inhaled glucocorticoids, however, have shown inconsistent results. The aim of the present study is to assess bone turnover in prepubertal children and in adolescents with asthma treated with inhaled budesonide using three different osteocalcin assays: the Pharmacia Osteocalcin CAP FEIA, the CIS OSTK‐PR and CIS IRMA ELSA‐OSTEO assays. Two studies were conducted: 1) a randomised double blind two‐period crossover study of 22 prepubertal children aged 5‐12 years. In one period 800 μg budesonide was given once in the morning, in the other 400 μg was given twice daily; 2) a randomised double blind placebo controlled two period crossover study of inhaled budesonide 400 μg twice daily in fourteen 13‐16 year old adolescents with pubertal stages II‐V. In both studies, treatment periods were of four weeks duration, and blood samples were collected at the last day of each period. In the prepubertal children none of the osteocalcin assays detected any statistically significant differences between any of the periods. In the adolescent group reduced levels of osteocalcin were seen during budesonide treatment. The suppression reached statistical significance with the CAP FEIA (P = 0.03) and the OSTK‐PR (P =0.01) assays, but not with the ELSA‐OSTEO assay (P = 0.06). Correlation analyses showed statistically significant correlation coefficients varying between 0.58 and 0.91 (P=0.03 and P < 0.0001, respectively). The effect of inhaled glucocorticoids on serum osteocalcin may depend on the assay applied, and inhaled glucocorticoids have differential effects in children and adolescents.
Handling hot spots
Authors: Gratton Lynda
Published: June 2007

Organizational “hot spots”, centres of high performance and breakthrough innovation, need a special touch when it comes to management. Lynda Gratton has discovered how executives manage hot spots without getting burned.
Pyramid Vision
Authors: Crainer Stuart
Published: June 2007

Increasingly, business leaders influence and set the political and economic agendas. They want to change the world. Inspirationally, Fadi Ghandour is already doing so. Stuart Crainer reports.
CUSUM: Computer Simulation for Statistics Teaching
Authors: THOMAS F. H. , MOORE J. L.
Published: June 2007

The use of computers for simulation can be used not only to introduce CUSUM (cumulative sum) techniques but also to improve students' understanding of statistical inference and decision making.
Minimise Your Losses
Authors: FALK RUMA
Published: June 2007

Teaching Elementary Statistics Through the Concept of “Loss‐Function”
Analogies and Parables in the Teaching of Statistics
Authors: Brewer James K.
Published: June 2007

In this article James Brewer offers some useful aids to getting across fundamental statistical concepts.
What do we mean by the Mean?
Authors: Cassell David
Published: June 2007

This article explores what school‐pupils understand by the term “mean” and suggests apparatus to help with teaching the concept.
Training Teachers to Teach Statistics
Authors: Hawkins Anne
Published: June 2007

This is a report on the International Statistical Institute's Round Table Conference, 23rd‐27th July, 1988, held in Hungary, and convened by Anne Hawkins.
Probabilistic Combinatorics
Authors: Goodall G. W.
Published: June 2007

In a recent article in Teaching Statistics, Marcuson (1989) has presented an interesting alternative approach to establishing some combinatorial identities, quite different from the usual induction proofs. The purpose of this short note is to suggest yet another way in whcih combinatorics can sometimes be approached.
Modelling of Statistical Investigation
Authors: Tamura Hirokuni
Published: June 2007

The conventional approach for introducing statistics to beginning students is to start with descriptive measures such as histograms, means and standard deviations, followed by other technical notions. The problem of such an approach is lack of motivation. It is useful to introduce students, at an early stage, to an overview of the statistical approach used to obtain the desired information. Accordingly, schematic models for the purpose of introducing two fundamental designs for statistical investigation are presented in this article.
Statistics at German Universities before 1810
Authors: Stamhuis Ida H.
Published: June 2007

This article discusses one of the predecessors of modern statistics: the German university teaching tradition called Staotenkunde or Statistik, the reaction of this tradition to people who started at the end of the eighteenth century to order available (mostly numerical) information in tables, and the probable source for the word “statistics”.
Graphwork‐Developing a Progression Part 1 ‐ The early stages
Authors: Rangecroft Margaret
Published: June 2007

This article indicates how a sound basis for graphwork can be covered in the early years of schooling.
Using World Statistics in the Classroom
Authors: Lachenbruch Peter A.
Published: June 2007

This article describes the use of a data set on 128 countries in the classroom. We can perform various statistical analyses on these data, but the most important message lies in questioning the validity of the data collection.
Book Reviews
Authors: GRIFFIN JOE , SHAYLOR JAN , GREEN DAVID
Published: June 2007

Books Reviewed in this Article:

Go for IT.

A First Course in Information Tech nology.

Archimedes' Revenge.
Teaching Statistics to Medical Undergraduates
Authors: Day Simon
Published: June 2007

This article summarises the proceedings of a conference entitled ‘Teaching Statistics to Medical Undergraduates’. Eight invited speakers and discussants presented their views to an audience representing teachers of medical statistics from Universities throughout the United Kingdom and Irish Republic.
All Fall Down!
Authors: Garbutt Jim
Published: June 2007

This article reports on a practical activity which provides a realistic context for collecting and analysing data.
The Game of Luk KOW
Authors: Wang Ann‐Lee
Published: June 2007

Luk Kow is a Chinese game played with three dice. Students may find it interesting to simulate the game and to study its properties.
An Easy Ridiculous Unbiased Estimator
Authors: MacEachern Steven , Stasny Elizabeth A.
Published: June 2007

The principle of unbiased estimation is very attractive to students of introductory statistics courses. Unfortunately, there exist problems in which all unbiased estimators will sometimes provide ridiculous estimates of the parameter of interest. In this paper we present an excellent example of this shortcoming.
Assumptions are Important
Authors: Rayner J.C.W.
Published: June 2007

The relationship between the test statistics for the paired and pooled t tests, when applied to the same data set, is obtained. This assists us to understand why each is preferred over the other in appropriate circumstances.