bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Can I come home?’ The experiences of young runaways contacting the Message Home helpline
Authors: Mitchell Fiona
Published: March 2003

This paper reports the findings of a 3‐month survey of young people calling the Message Home helpline. Message Home is a national freephone helpline available to people who have run away or left home which allows them to send a message to their family or carer, to seek confidential help and advice and, if necessary, to be helped to a place of safety. The paper explores the characteristics, circumstances and motivations of the young people contacting the helpline. It also considers who the young people contacted through the helpline and the kinds of messages that were relayed to parents, social services and others. This study differs from most preceding studies of runaways in recording the views of young people while they are missing. The immediacy palpable in their accounts highlights the distress and isolation experienced by many of these young people who have run away or been forced to leave home.
More hassle, more alone: adolescents with diabetes and the role of formal and informal support
Authors: Olsen  , Sutton
Published: March 2003

Informal support is a vital part of diabetes care, for adolescents in particular. However, we have a poor appreciation of how adolescents characterize informal support relationships, and how they change over time. This article is based on qualitative, in‐depth interviews and focus groups with 21 adolescents (14–19 years old) in Leicestershire. We studied the content and substance of relationships between adolescents with diabetes and their families and friends, how they change and develop over time, and how they interact with formal support from health professionals. We identify a key problem — progressive independence from family life and progressive withdrawal of formal health service input leaves some older adolescents feeling isolated, with possible implications for likely maintenance of contact with routine services.
Outcome of recommendations for augmentative communication in children
Authors: Ko  , McConachie  , Jolleff
Published: March 2003

Some children with severe motor disorders have unintelligible speech, and may be recommended augmentative communication systems, such as a symbol chart or a voice output aid. The paper reports the outcome after 15–18 months for 35 children of recommendations for augmentative communication. Using structured questionnaires, parents were asked whether equipment was provided as recommended. Their perception of success in children's use of augmentative aids was recorded and related to potentially influential factors. Twenty‐five symbol systems, 10 speech output devices and 11 switches were received; 18 symbol systems were used for communication and 10 were used frequently. Seven speech output devices were used for communication but only two were reported to be used frequently. Factors leading to more successful outcomes include early receipt of the aid, perceived adequate local training in the use of the aid, and children aged 6 years or more at initial assessment. The findings also suggest that referring professionals will need to be better informed about the nature and limitations of augmentative communication aids, and that improved local professional input and careful interagency planning and co‐ordination are required to achieve optimal outcome.
The relationship between the treatment of cough during early infancy and maternal education level, age and number of other children in the household
Authors: Dewey  , Hawkins  ,   the ALSPAC Study Team
Published: March 2003

The main objective of this study was to investigate how the consultation rate and medication use in the treatment of cough symptoms in infants during their first 6 months of life varied by their mothers' education levels, ages and the presence of other children in the household. A prospective cohort of children were studied from birth. Data were collected by means of self‐completion postal questionnaires. All 6682 children born between 1 July 1991 and 30 June 1992, inclusive within the three health districts of former Avon which are within the South‐west Regional Health Authority were included in the study. The proportion of children ever having a cough during their first 6 months of life and of those with cough symptoms, the proportion receiving cough medicine and the proportion consulting a doctor was investigated. Some 61% of children were reported as having had a cough during their first 6 months of life and this proportion did not vary significantly across educational levels. The proportion of children with coughs who were taken to a doctor (60%) and the proportion with coughs who were given cough medicine (20%), however, did vary with education. The association between mother's education level and the treatment of her child's cough was much stronger than with either of the mother's age or number of other children. After controlling for confounding factors, the percentage of mothers who consulted a doctor for their children's coughs decreased progressively with increasing maternal education from 70% (95% confidence interval: 66%, 73%) of those with CSE or less to 50% (95% CI: 45%, 55%) of those with a degree. A similar pattern emerged with the use of cough medicine, 22% (95% CI: 19%, 25%) of children whose mothers were in the lowest education group received cough medicine compared with 12% (95% CI: 9%, 15%) in the highest group. A large proportion, 60%, of children under 6 months with coughs are taken to a doctor. Children of more highly educated mothers are less likely to see a doctor or to receive cough medicine.
The appropriateness of Western models of parent involvement in Calcutta, India. Part 2: implications of family roles and responsibilities
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 study from Guyana was undertaken. The overall aim was to examine the extent to which it is realistic and practicable to apply Western models of parental participation in intervention with families in West Bengal, in terms of the extent to which the project families meet requirements implicit in these Western models. The results are presented in two papers. Part 1 examined parents’ beliefs concerning child development and the effects of teaching on children’s development. This paper explores the division of roles and responsibilities within families in relation to demands on family members and the time available to parents for active participation in a parent involvement project. The results of the study demonstrate that, whilst mothers’ domestic responsibilities are particularly onerous, their roles and those of other family members varied according to the type of family structure. Implications for service delivery and involvement of the wider family are discussed.
Drug information leaflets: adolescent and professional perspectives
Authors: Jones R , Finlay F , Crouch V , Anderson S
Published: March 2003

This study was undertaken to evaluate a range of drug information leaflets from both an adolescent and professional perspective. 72 adolescents were interviewed in focus groups within school settings. Fifteen paediatricians were also interviewed individually. Participants were asked to consider the leaflets under the following categories: initial impact, content and overall suitability for adolescents. Paediatricians were not good judges of which leaflets would appeal to adolescents. They tended to choose the leaflets with comic strip illustrations and those written in a ‘cool’ or witty style. In contrast the adolescents seemed to prefer a more sober approach with high quality factual information combined with clear illustrations.
Coping when a child has a disability: exploring the impact of parent‐to‐parent support
Authors: Kerr S M , McIntosh J B
Published: March 2003

Aim To explore the impact of parent‐to‐parent support when a child is born with a disability.

Design The research approach was qualitative. Data were collected retrospectively and were derived from in‐depth interviews with parents. The audio‐taped interviews were transcribed and then analysed using constant comparative procedures.

Setting Scotland.

Participants The parents of 63 children born with a congenital upper limb deficiency.

Findings The early weeks and months following the birth of their baby was a difficult and emotional time for most parents. Feelings of isolation were common and there was a lot of concern about what the future would hold. Although a certain amount of support was derived from contact with family, friends and health professionals, parents did not generally obtain the level of support that was required from these sources. Contact with other parents of limb‐deficient children, however, clearly exerted a powerful stress‐buffering influence, providing much needed emotional, social and practical support.

Conclusions This study suggests that parents of children with special needs are uniquely qualified to help each other. The challenge is to ensure that health professionals are aware of the potential benefits of parent‐to‐parent support and provide parents with information about appropriate local organizations/ contacts.
Assessing children's and teenagers' bereavement when a sibling dies from cancer: a secondary analysis
Authors: Birenbaum L K
Published: March 2003

The purposes of this paper are to: (1) provide conceptual and empirical descriptions of the most frequently reported children's and teenagers' responses in anticipation of and after the death of a sibling from cancer; (2) describe these behaviours by age groups (3–5, 6–11 and 12–19 years); and (3) discuss the clinical utility of two new scales measuring children's bereavement. The literature review and an exploratory secondary analysis from a prospective longitudinal design were used to develop the empirical criteria for behavioural items indicative of bereavement. Data from four points in time: (1) 2 months before a child's death; (2) 2 weeks after death; (3) 4 months after death; and (4) 12 months after death were treated as a cross‐sectional design, because of sample size, to describe bereavement behaviours and to discuss the beginning development of a screening tool for childhood bereavement services
‘If I had a friend in a wheelchair’: children's thoughts on disabilities
Authors: Tamm M , Prellwitz M
Published: March 2003

The purpose of the present study was to examine what notions there are among ordinary preschool children and schoolchildren about physically handicapped children using wheelchairs. Forty‐eight children–16 children of preschool age (half boys, half girls, aged around 6), 16 children in primary school class 2 (half boys, half girls, aged around 8) and 16 children in class 4 (half boys, half girls, aged around 8)–constituted the investigated group. The method used was a combination of drawings produced by the children themselves serving as a projective image, interview questions in connection with the drawings and a self‐assessment scale, based on Osgood's semantic differential technique. The results showed that most children had favourable attitudes towards a child in a wheelchair. They were willing to include the disabled child in their games and recreational activities, and they considered that the disabled child would have many friends and a high self‐esteem. However, they saw real obstacles for the disabled child both in play situations and in other environmental settings. No tangible differences between the sexes could be found; however, differences by age were present. The results were discussed with regard to earlier research and topics for further research are suggested.
Difficulties for mothers in using an early intervention service for children with cerebral palsy in Bangladesh
Authors: McConachie H , Huq S , Munir S , Kamrunnahar  , Akhter N , Ferdous S , Khan N Z
Published: March 2003

Given the numbers of disabled children in Bangladesh and the lack of trained professionals, innovative forms of service delivery are required. The Bangladesh Protibondhi Foundation has developed an outreach parent training service based at two centres, one urban and one rural. Mothers are shown how to use pictorially based Distance Training Packages (DTP), which they take home. This paper presents findings concerning factors which seem to affect mothers’ attendance with their children at DTP advisory sessions. The study followed 47 children with cerebral palsy, aged between 2 and 5.5 years, over a period of around 18 months. The main factors predicting higher attendance were the child’s sex (i.e. boys were brought back more often), particularly in the rural area, and lower adaptation to the child reported by the mother. The problems described by mothers in using the DTP advisory service were economic (such as transport costs), cultural (such as mothers not being permitted out alone), and medical (such as the child having repeated fits). The implications for future service development are discussed.
Children’s understanding of the physical, cognitive and social consequences of impairments
Authors: Smith L A , Williams J M
Published: March 2003

The present study explored typically developing children’s (n= 77) understanding of physical, cognitive and social competencies of children with impairments. Children in each of four age groups (4–5 years, 6–7 years, 9–10 years and 11–12 years) were interviewed to explore their ideas about the abilities of children with physical impairments (minor: missing thumb; major: wheel‐chair bound), sensory impairments (vision and hearing), learning disabilities (non‐specific and Down’s syndrome) and emotional/behavioural difficulties (attention deficit hyperactivity disorder and lack of social skills). Significant age differences were found in children’s judgements of the capabilities of children with impairments. Furthermore, children’s understanding of the consequences of impairments varied as a function of disability type. Findings are discussed in relation to previous research on children’s disability concepts and implications for inclusive education practices.
Hair‐element analysis — still on the fringe
Authors: Morley N. , Ford R. P. K.
Published: March 2003

Increasing biological interest in minerals has led to the search for reliable methods to quantify body levels of trace elements and toxic metals. Hair has been a prime candidate because of its ease of collection and the possibility that this body tissue might accurately reflect body loads of these substances. A vast amount of research effort has been expended to explore the value of hair‐element analysis. Unfortunately, there are so many confounding factors that influence these measurements that isolated individual results cannot be relied upon. Their current value is in epidemiological studies.
Central and peripheral temperature change in normal infants
Authors: Tappin D. M. , Ford R. P. K. , Price B. , Macey P. M. , Larkin J.
Published: March 2003

The purpose was to explore the relationship between the fall in rectal temperature seen in normal infants after being put down to sleep and the concomitant rise in peripheral shin temperature. In this observational study 21 normal infants had continuous overnight peripheral shin and central rectal temperature recorded, for three nights at 2 weeks, 6 weeks, 3 months and 5 months of age. Parents documented the start and end of feed/nappy changing episodes during the night. All recordings were made in the infants’ own home. A strong inverse linear correlation (median r2 = 0.95, lower quartile 0.92, upper quartile 0.97) was seen between rectal temperature and shin temperature on falling to sleep when put down on 106 (65%) of 161 nights. On many other nights a significant non‐linear association was present. It was not possible to exclude the process of being put down to sleep as a confounding variable in this strong association. However, a similar inverse relationship between shin and rectal temperature was seen overnight during 111 of 121 (92%) feed/nappy changing episodes. If causal, the development in early infancy of an inverse relationship between shin and rectal temperature may be important for cardiovascular homeostasis. Further sleep laboratory work including video recording is required to separate the peripheral and central temperature changes that take place on falling to sleep from those associated with removal of clothing during a nappy change.
A dose–response relationship between short sleeping hours and childhood obesity: results of the Toyama Birth Cohort Study
Authors: Sekine Michikazu , Yamagami Takashi , Handa Kyoko , Saito Tomohiro , Nanri Seiichiro , Kawaminami Katsuhiko , Tokui Noritaka , Yoshida Katsumi , Kagamimori Sadanobu
Published: March 2003

Background Short sleeping hours could cause obesity through increased sympathetic activity, elevated cortisol secretion and decreased glucose tolerance. The aim of this study was to clarify parental and lifestyle factors, particularly sleeping habits, associated with obesity in Japanese children.

Methods Between June and July 1996, 8274 children (4194 males and 4080 females) aged 6–7 years living in Toyama prefecture, Japan, were investigated by questionnaire survey and the collection of anthropometric data. Subjects with a body mass index (BMI; weight in kg divided by square of height in m) greater than the age‐ and sex‐specific cut‐off points linked to adulthood overweight (BMI of 25 kg/m2 or more) were defined as obese subjects. Parental obesity was defined as a BMI of 25 kg/m2 or more. Logistic regression analysis was performed to evaluate the strength of the relationships between parental obesity or lifestyle factors and childhood obesity, adjusted for possible confounding factors.

Results Parental obesity, long hours of TV watching and physical inactivity were significantly associated with childhood obesity. Although wake‐up time was not related to obesity, there was a significant dose–response relationship between late bedtime or short sleeping hours and childhood obesity. Compared with children with 10 or more hours of sleep, the adjusted odds ratio was 1.49 (95% confidence interval 1.08–2.14) for those with 9–10 h sleep, 1.89 (1.34–2.73) for those with 8–9 h sleep and 2.87 (1.61–5.05) for those with <8 h sleep, after adjustment for age, sex, parental obesity and other lifestyle factors.

Conclusion A strong inverse association was observed in the relationship between sleeping hours and childhood obesity. Longitudinal research will be required to confirm this causality.
Psychological adjustment in children with end stage renal disease: the impact of maternal stress and coping
Authors: Madden S. J. , Hastings R. P. , Hoff W. V’ant
Published: March 2003

Objective To explore maternal and child perspectives on children’s adjustment in the context of paediatric renal disease, and maternal psychological variables that may account for variance in child and maternal ratings.

Methods Forty‐three children with end stage renal disease and their maternal caregivers completed the Strengths and Difficulties Questionnaire (SDQ). Mothers also reported on their own mental health, and the strategies they used to cope with their child’s illness. The severity of the child’s condition was rated independently by a renal clinician.

Results Compared with normative data for the SDQ, mothers reported their children to be at increased risk of psychological problems. However, the children themselves reported no more problems than a normative sample. Mothers’ coping and mental health explained some of the variance in their ratings of the child’s adjustment but were not predictive of the children’s self‐ratings.

Conclusions The results suggest that maternal factors may not explain the variability in children’s adjustment to chronic illness, perhaps especially within the age range studied here. Practical implications of the data are also discussed. In particular, a systemic approach to paediatric liaison by psychologists is emphasized.
Waiting time for rehabilitation services for children with physical disabilities
Authors: Feldman D. Ehrmann , Champagne F. , Korner‐Bitensky N. , Meshefedjian G.
Published: March 2003

Background

Early rehabilitation may minimize disability and complications. However, children often wait a long time to gain admission to rehabilitation centres.

Objectives

To describe waiting times for paediatric physical and occupational therapy and to determine factors associated with these waiting times.

Research Design

The study was a prospective cohort design. Patients were followed from 1 January 1999 to 1 March 2000.

Subjects

All children with physical disabilities, aged 0–18 years, referred in 1999 from the Montreal Children's Hospital to paediatric rehabilitation centres.

Measures

Data on date of referral, date of first appointment at the rehabilitation centre, age, gender, diagnosis, region and language were obtained from the rehabilitation transfer database. Primary family caregivers of children who were transferred to a rehabilitation facility participated in a telephone interview regarding their perceptions of the transfer process.

Results

There were 172 children referred to rehabilitation facilities. The mean age of the children was 2.5 years. Average waiting time was 157.4 days (SD 57.1) for occupational therapy and 129.4 days (SD 51.6) for physical therapy. Decreased waiting time was associated with living in the city as opposed to the suburbs (hazard ratio = 1.77; 95% confidence interval = 0.92–3.41) and inversely associated with age (hazard ratio = 0.46; 95% confidence interval = 0.34–0.62). Among the 41 primary family caregivers who participated in the survey, higher empowerment scores were associated with shorter waits for rehabilitation.

Conclusion

Waiting time for rehabilitation services needs to be reduced. Empowered parents appear to manoeuvre within the system to reduce waiting times for their children.
A multimethod approach to the evaluation of community preschool speech and language therapy provision
Authors: Glogowska Margaret , Campbell Rona , Peters Tim J , Roulstone Sue , Enderby Pam
Published: March 2003

Objectives The paper presents a research study investigating the effectiveness and acceptability of community speech and language therapy provision for preschool children with early speech/language delays. As a ‘worked example’, it demonstrates the value of a multimethod approach to evaluation.

Methods The paper examines how the research findings of a pragmatic randomized controlled trial (RCT), a survey questionnaire and qualitative in‐depth interviews, which were the methods used in the evaluation, overlap and complement each other.

Results  There was little evidence to establish the effectiveness of the speech and language therapy provided in the trial. This lack of difference was reflected in responses of parents to items on the questionnaire. The findings of the RCT, questionnaire and interviews all cast considerable doubt on the prospect of spontaneous resolution of the children's difficulties. Although the RCT showed few differences between the children allocated to immediate therapy or ‘watchful waiting’, the questionnaire and interviews revealed the circumstances in which the parents felt that these intervention strategies had been acceptable and unacceptable.

Conclusions  Although the trial provided information about the progress of the children, the questionnaire and interview components highlighted the advantages and limitations of the intervention from the viewpoint of parents, thereby helping to explain the RCT findings. Thus, the study demonstrates how a multimethod approach to evaluation can yield useful information to explain the findings of RCTs.
IgG subclass responses to pigeon intestinal mucin are related to development of pigeon fanciers' lung
Authors: Baldwin  , Todd  , Bourke  , Allen  , Calvert
Published: March 2003

Background

Pigeon fanciers' lung (PFL) is a form of extrinsic allergic alveolitis. Affected individuals produce antibodies to various pigeon antigens, and the resulting immune complexes are thought to initiate the disease. However, high antibody titres also occur in some asymptomatic individuals. Previously attention has focused on protein antigens, but we have recently identified pigeon intestinal mucin as a novel antigen in PFL.

Objective

To determine the relationship between IgG subclass antibodies to pigeon intestinal mucin and the development of pigeon fanciers' lung.

Methods

Sera were collected from 250 pigeon fanciers, who also completed a clinical questionnaire. Sera were screened for precipitating antibodies to pigeon serum and droppings. Individuals with symptoms and precipitating antibodies were considered to have classical PFL. Serum IgG and IgG subclass antibodies to pigeon intestinal mucin and pigeon serum proteins were investigated by quantitative enzyme‐linked immunosorbent assay (ELISA).

Results

Very high titres of IgG antibodies against pigeon mucin were found in all precipitin‐positive individuals. A strong positive correlation was seen between titres of antibodies to mucin and to serum proteins, but this was not due to crossreactivity. No significant differences in IgG titres to either mucin or pigeon serum proteins were found between individuals with PFL and asymptomatic precipitin positive fanciers. IgG1 and IgG2 were the major subclasses of anti‐mucin, with lower titres of IgG3. Patients with PFL had significantly higher titres of IgG1 to mucin than asymptomatic, precipitin‐positive individuals. In contrast, no significant differences were seen between PFL and asymptomatic precipitin‐positive sera with respect to the subclass titres against pigeon serum proteins.

Conclusion

The high titres of anti‐mucin IgG in sera of all individuals with PFL, together with the finding that high IgG1 titres to mucin are associated with the development of disease confirm pigeon intestinal mucin as an important antigen in PFL.
Association of asthma and the interleukin‐4 promoter gene in Japanese
Authors: Noguchi  , Shibasaki  , Arinami  , Takeda  , Yokouchi  , Kawashima  , Yanagi  , Matsui  , Hamaguchi
Published: March 2003

Background

Susceptibility to the development of asthma and other atopic diseases is known to be associated with genetic components. Several investigator have linked the interleukin‐4 (IL‐4) gene and nearby markers located on chromosome 5 to atopy and asthma. Recent study has demonstrated that the T allele of a polymorphism in the IL‐4 gene promoter region (C‐590T) is associated with elevated levels of total serum IgE.

Objective

The objective of this study was to evaluate the possible role of this IL‐4 polymorphism (C‐590T) in modulating the allergic response and asthma in Japanese children.

Method and Results

The study was conducted in two different populations: families ascertained through asthmatic children (asthmatic group, 306 members) in whom linkage of asthma and atopy to chromosome 5q31–33 is suggested and a random general population (control group, 215 members). The IL‐4 C‐590T polymorphism was genotyped by PCR‐restriction fragment length polymorphism analysis. Frequency of the T allele was 0.73 in the asthmatic group and 0.70 in the control group. No significant difference in the levels of total serum IgE and specific IgE to house dust mite was observed between subjects with homozygote for the C allele, a heterozygote and a homozygote for the T allele by intrafamilial and interfamilial comparisons. Using the transmission disequilibrium test, however, we found a significantly frequent transmission of the T allele to asthmatic children (χ2 = 5.72, P = 0.023).

Conclusion

Our data suggest that the IL‐4 promoter C‐590T polymorphism may be associated with the development of asthma in Japanese children, but not through modulating total serum IgE levels.
Various immunological phenotypes are associated with increased airway responsiveness
Authors: Herz  , Braun  , RÜckert  , Renz
Published: March 2003

Background

Bronchial asthma is characterized by a TH2 type immune response, chronic inflammation of the airways and increased airway responsiveness. The relationship between IgE‐ and inflammatory‐dependent mechanisms that contribute to bronchial asthma are not well defined.

Objective

The purpose of this study was to compare and analyse the immune pathways that resulted in development of allergen‐induced and/or inflammatory dependent increased airways responsiveness.

Results

BALB/c and C57BL/6 mice responded to OVA‐sensitization with elevated allergen‐specific IgE/IgG1 serum antibody‐titres and the development of cutaneous immediate‐type hypersensitivity reactions. Increased airway responsiveness was observed following airway allergen challenges. However, the inflammatory component of the lung differed between the strains. In OVA‐sensitized BALB/c mice a marked increase in lymphocytes, eosinophils and neutrophils in BAL fluids was parallelled with elevated production of IL‐4, IL‐5 and TNFα in the lung. In contrast in OVA‐sensitized C57BL/6 mice, the inflammatory immune response in the lung was much weaker. We postulate that two pathways can regulate the induction of increased airway responsiveness. One depends on the presence of allergen‐specific IgE/IgG1 and allergen, and a second is mediated by allergen‐independent inflammation of the lung. To test this hypothesis, BALB/c mice were treated nasally with low doses of bacterial superantigen (SEB) as a prototypical inducer of airway inflammation, following which influx of lymphocytes, eosinophils and neutrophils into the airways was parallelled by development of increased airway‐responsiveness in the absence of allergen‐specific IgE/IgG1 antibodies and allergen.

Conclusions

These results indicate that increased airway responsiveness is associated with different immunological phenotypes in BALB/c and C57BL/6 mice.
GM‐CSF, IL‐5 and RANTES immunoreactivity and mRNA expression in chronic hyperplastic sinusitis with nasal polyposis (NP)
Authors: Hamilos  , Leung  , Huston  , Kamil  , Wood  , Hamid
Published: March 2003

Background

Eosinophils are a prominent feature of chronic hyperplastic sinusitis with nasal polyposis (CHS/NP). Our previous studies showed that their presence was associated with the expression of GM‐CSF and RANTES mRNA. In allergic NP, increased expression of IL‐5 was also found.

Objective

We wished to examine cytokine immunoreactivity for IL‐5, GM‐CSF and RANTES mRNA in allergic and non‐allergic NP and compare immunoreactivity with expression of cytokine mRNA by in situ hybridization.

Methods

NP were obtained from five allergic and eight non‐allergic subjects with CHS/NP. Middle turbinate tissue from eight normal subjects were used as controls. Cell‐associated cytokine mRNA was detected by in situ hybridization (ISH). Cytokine immunoreactive cells were enumerated by immunostaining. Colocalization immunostaining was also performed to identify specific cell types producing IL‐5.

Results

Immunostaining for GM‐CSF, IL‐5 and RANTES protein was increased in both allergic and non‐allergic NP compared with control middle turbinates. Allergic polyps contained greater numbers of IL‐5 immunoreactive cells (P = 0.01), whereas non‐allergic polyps contained greater numbers of GM‐CSF immunoreactive cells (P = 0.04). Immunostaining was primarily associated with inflammatory cells, but immunostaining for RANTES and, to a lesser extent GM‐CSF, was also seen in the epithelium. The density of immunoreactive cells was variably correlated with cytokine mRNA+ cells (GM‐CSF: R = 0.56, P = 0.05; IL‐5: R = 0.76, P = 0.003; and RANTES: R = 0.89, P = 0.0005). Colocalization immunostaining revealed that the majority of IL‐5 immunoreactive cells in both allergic and non‐allergic NP were T lymphocytes. However, allergic NP contained greater numbers of IL‐5+/CD3+ T lymphocytes and IL‐5+ mast cells, whereas non‐allergic NP contained greater numbers of IL‐5+ eosinophils.

Conclusion

We conclude that GM‐CSF, IL‐5 and RANTES are produced in increased amounts in both allergic and non‐allergic NP. Distinguishing features of non‐allergic NP include fewer numbers of CD3 T lymphocytes, fewer IL‐5+/CD3+ T lymphocytes and greater numbers of IL‐5+ eosinophils. These differences may suggest different mechanisms of eosinophil accumulation and activation in allergic vs non‐allergic NP.
Expression of B7 co‐stimulatory molecules and CD1a antigen by alveolar macrophages in allergic bronchial asthma
Authors: Agea  , Forenza  , Piattoni  , Russano  , Monaco  , Flenghi  , Bistoni  , Gillies  , Azuma  , Bertotto  , Spinozzi
Published: March 2003

Background

Lung allergen recognition that takes place in the airways of asthmatic subjects is still a controversial matter.

Objective

We hypothesized that a rapid allergen recognition process requires the presence, at the mucosal surface, of professional APC, such as B7+ alveolar macrophages (AM) and/or CD1+ dendritic cells, which usually have a lower expression in the normal human lung.

Methods

Studies were performed on bronchoalveolar lavage (BAL) fluid collected from 10 untreated allergic subjects and 10 adult normal volunteers. Further controls consisted of five untreated pulmonary sarcoidosis (PS) and four extrinsic allergic alveolitis (EAA) individuals. To ascertain whether T helper 2‐type cytokines or allergen influence B7 and CD1 antigen expression, in vitro studies were carried out using unprimed (naive) cord blood plastic‐adherent monocytes.

Results

Cytofluorymetric analysis revealed that AM from asthmatics, unlike those from normal subjects or patients with PS or EAA, overexpressed B7‐2, CD1a and, to a lesser extent, B7‐1 surface molecules. Immunohistochemical studies confirmed the presence of CD1+ dendritic cells in the BAL fluid from asthmatic subjects. On in vitro cultured naive cord blood monocytes both purified Dermatophagoides pteronyssinus allergen and T‐cell cytokines, i.e. IL‐4 and granulocyte macrophage colony‐stimulating factor, induced surface expression of B7‐2 and CD1a receptors, whereas they had no appreciable effect on that of B7‐1 membrane molecule.

Conclusions

Taken together, these findings support the proposal that airways of atopic individuals are equipped with professional APC that synergize with allergen‐specific T cells for the recognition of intact allergens. When the recognition process takes place, asthmatic symptoms could develop in genetically susceptible individuals.
Why is allergy increasing? – environmental factors
Authors: Davies  , Rusznak  , Devalia
Published: March 2003

Data from epidemiological studies have shown that allergic conditions have increased over the last 30–40 years, particularly in developed countries, despite a decrease in the severity of grass pollen seasons. Other epidemiological studies suggest an interaction between allergic diseases and traffic pollution, and laboratory findings indicate that diesel exhaust particles enhance sensitivity to allergens. In an in vitro study, we found evidence to suggest that cigarette smoke may render the airway epithelium more susceptible to adverse effects of allergens. Evidence from other studies indicates that O3 and NO2, with or without SO2, can enhance the airway allergic response in susceptible individuals such as those with asthma and rhinitis. Studies investigating cellular and subcellular mechanisms suggest that pollutants are likely to influence the actions and interactions of a variety of cells, and lead to the synthesis of proinflammatory mediators that modulate the activity and functions of inflammatory cells.
Optimizing treatment options
Authors: Naclerio
Published: March 2003

Full and accurate diagnosis of allergic rhinitis is important as a basis for treatment decisions, as many nasal disorders have similar signs and symptoms. Optimal allergen avoidance is the starting point of treatment, so causative allergens need to be identified. Oral antihistamines are effective in relieving the majority of symptoms of allergic rhinitis and allergic conjunctivitis, but provide only partial relief from nasal congestion. Topical α‐adrenergic decongestants help to relieve congestion, but prolonged use leads to rhinitis medicamentosa. Systemic decongestants are less effective than topical agents and their use is limited by systemic and central side‐effects. The value of leukotriene antagonists has yet to be fully evaluated. Intranasal ipratropium bromide helps to control watery secretions, and an aerosol may be more effective than an aqueous solution. Topical glucocorticosteroids, such as triamcinolone, are the most potent and effective agents available for treating allergic rhinitis. The available evidence indicates that there is very little systemic absorption. Sodium cromoglycate is effective in allergic rhinitis, though less so than topical steroids, and has the least adverse effects among the antiallergic agents. Immunotherapy can be effective and may be indicated in individuals who cannot avoid the causative allergen. Special considerations apply to the treatment of allergic rhinitis in elderly or pregnant patients. Finally, patients with long‐standing allergic conditions should be re‐assessed regularly.
Gene by environment interactions in the development of asthma
Authors: Martinez
Published: March 2003

Present knowledge suggests that asthma is a heterogeneous condition. Different genetic backgrounds may or may not express themselves as asthma‐like symptoms, depending on both the nature and the timing of exposures in the individual. Although particular attention has been paid to environmental factors that may increase the risk of asthma, it is equally important to understand ‘protective’ exposures that may have decreased during the last decades and may thus explain the reported increases in asthma prevalence. Among these ‘protective’ factors are certain infections and the role they may have in the inception of allergics and asthma, particularly when they occur at critical times in the development of the immune system.
Evolution of asthma through childhood
Authors: Sears
Published: March 2003

The greatest incidence of childhood asthma is among males under 5 years, with decreasing numbers of new cases with age. Many young children wheeze, but remission is common especially in non‐atopic children without a family history of allergy or asthma, whose wheezing relates more to infections and environmental tobacco smoke exposure. The prognosis of childhood asthma is best established from population studies, in which some two‐thirds of wheezy children become symptom‐free as adults, whereas follow‐up studies of wheezing children seen in office or specialty clinic practice, who generally have more severe asthma, show a much greater likelihood (60–80%) of persistence of asthma into adulthood. Factors predisposing to persistence of childhood asthma include a positive family history, development of atopy, environmental exposures to allergens and cigarette smoke, markers of severity of childhood asthma, and female gender.
Isolation and characterization of major banana allergens: identification as fruit class I chitinases
Authors: SANCHEZ‐MONGE  , BLANCO  , DÍAZ‐PERALES  , COLLADA  , CARRILLO  , ARAGONCILLO  , SALCEDO
Published: March 2003

Background

Banana allergy has been associated with the latex–fruit syndrome. Several IgE‐binding components, the relevant ones being proteins of 30–37‐kDa, have been detected in banana fruit, but none of them have been isolated and characterized yet. Objective To purify and characterize the 30–37  kDa banana allergens.

Methods

Fifteen patients allergic to banana were selected on the grounds of a latex‐allergic population. Prick by prick tests to this fruit were performed. Total and specific IgE to banana were determined. Banana allergens were isolated by affinity chromatography, followed by cation‐exchange chromatography. Their characterization includes N‐terminal sequencing, enzymatic activity assays, immunodetection with sera from allergic patients and with antichitinase antibodies, and CAP and immunoblot inhibition tests. Skin prick tests with banana extracts and with the purified allergens were also carried out.

Results

Two major IgE‐binding proteins of 34 and 32 kDa, also recognized by polyclonal antibodies against chestnut chitinases, were immunodetected in crude banana extracts. Purification and characterization of both proteins have allowed their identification as class I chitinases with an hevein‐like domain. Each isolated allergen reached inhibition values higher than 90% in CAP inhibition assays, and fully inhibited the IgE‐binding by the crude banana extract when tested by an immunoblot inhibition method. The two purified allergens provoked positive skin prick test responses in more than 50% of the banana‐allergic patients.

Conclusions

Class I chitinases with an hevein‐like domain are major allergens in banana fruit. Their presence in other fruits and nuts, such as avocado and chestnut, could explain the cross‐sensitization among these foods.
Ribonuclease‐gold ultrastructural localization of heparin in isolated human lung mast cells stimulated to undergo anaphylactic degranulation and recovery in vitro
Authors: Dvorak  , Morgan
Published: March 2003

Background

Human mast cells are a rich and unique source of heparin, which is stored in cytoplasmic secretory granules and accounts for metachromasia, a staining property used to identify mast cells by light microscopy.

Objective

The sub‐cellular locations of heparin in secretory human mast cells and human mast cells recovering from secretion are not known. Acquisition of this knowledge requires ultrastructural imaging of well‐preserved cells with a visible probe which binds to heparin. We sought to develop this knowledge regarding human mast cell secretion by using a labelling method for heparin that depends on the well‐known property of ribonuclease inhibition by heparin.

Methods

Human lung mast cells were isolated, partially purified, either stimulated or not stimulated to secrete with anti‐IgE, and recovered 20 min or 6 h later for routine electron microscopy. Histamine secretion was also determined. A previously developed post‐embedding, enzyme‐affinity‐gold electron microscopic technique to image ribonucleic acid (RNA) with ribonuclease‐gold (R‐G), which also binds to the enzyme inhibitor, heparin, was employed to determine the sub‐cellular locations of heparin in non‐secretory and secretory mast cells as well as in mast cells recovered from short‐term cultures after secretion. Specificity controls for the novel use of this method and quantification of granule labelling in these controls were performed.

Results

Heparin was labelled by R‐G in electron‐dense granules within non‐secretory human lung mast cells (HLMCs), in electron‐dense granules that persisted in secretory HLMCs at the maximum histamine secretion time (20 min), and in electron‐dense granules within recovering HLMCs. Specificity controls showed that gold alone did not label HLMCs and that absorption with heparin significantly reduced or abrogated HLMC granule staining with R‐G, but that RNA absorption did not. Heparin stores were absent in newly formed, electron‐lucent intracytoplasmic degranulation channels in secretory HLMCs. Electron‐dense granule matrices in the process of extrusion to the cell exterior still retained heparin at the instant of cellular secretion. Non‐granule heparin stores bound R‐G in recovering HLMCs. These locations included resolving degranulation channels, as newly emergent granules partitioned and condensed within them, and electron‐dense content‐containing vesicles and progranules within synthetic mast cells. Ultimately, all known ultrastructural patterns of HLMC granules developed in recovering cells, and each of them contained heparin.

Conclusion

Heparin was secreted from HLMCs which were stimulated by anti‐IgE, and heparin was recovered by a combination of conservative and synthetic mechanisms in HLMCs after a secretory event.
Anti‐inflammatory effect of roxithromycin in patients with aspirin‐intolerant asthma
Authors: SHOJI  , YOSHIDA  , SAKAMOTO  , HASEGAWA  , NAKAGAWA  , AMAYASU
Published: March 2003

Background

Fourteen‐membered macrolides, such as roxithromycin, have been reported to exhibit other pharmacological activity including anti‐asthmatic effects, besides antibiotic activity.

Objective

This study was designed to investigate the protective effect of roxithromycin on airway responsiveness to the sulpyrine provocation test and to investigate whether this protective activity is associated with a reduction in aspirin‐induced excretion of urinary leucotriene E4 (u‐LTE4), a marker of cysteinyl leucotriene overproduction that participates in the pathogenesis of aspirin‐intolerant asthma. Also, the present study was designed to examine whether or not its anti‐asthmatic activity was associated with a reduction in eosinophilic inflammation.

Methods

For 8 weeks before analysis, subjects received 150 mg of roxithromycin or matching placebo twice daily. We assessed the effects of pretreatment with roxithromycin on bronchoconstriction precipitated by inhalation of sulpyrine in 14 adult patients with mild or moderate aspirin‐intolerant asthma; those who were in stable clinical condition and were hyperresponsive to sulpyrine provocation test were allocated to this study. A double‐blind, randomized, crossover design was used. Urinary LTE4 was measured by a combined reverse‐phase high‐performance liquid chromatography (rp‐HPLC) enzyme immunoassay on sulpyrine provocation testing day. Blood and sputum samples were taken in the morning on the sulpyrine provocation testing day. Eosinophil counting and measurement of eosinophilic cationic protein (ECP) were performed.

Results

After the 8 weeks of treatment with roxithromycin, patients' symptoms, blood eosinophils, serum ECP, sputum eosinophils, and sputum ECP were significantly decreased. On the other hand, values of PC20‐sulpyrine did not improve after roxithromycin at all. Furthermore, although challenge with sulpyrine caused a significant increase in u‐LTE4, pretreatment with roxithromycin or placebo did not affect excretion of u‐LTE4.

Conclusion

Although roxithromycin does not have antileucotriene effects, it has an antibronchial inflammatory effect associated with eosinophilic infiltration. This study raises further interesting therapeutic possibilities and warrants further trials of new approaches to the treatment of aspirin‐intolerant asthma.
Cross‐reactivity between milk proteins from different animal species
Authors: RESTANI  , GAIASCHI  , PLEBANI  , BERETTA  , CAVAGNI  , FIOCCHI  , POIESI  , VELONÀ  , UGAZIO  , GALLI
Published: March 2003

Background

Cow's milk allergy is quite frequent in the first years of human life. When breast‐feeding is not possible, a cow's milk substitute must be provided for allergic subjects. Different alternatives to cow's milk have been suggested as protein sources (soy, hydrolysed proteins, goat's milk, etc.), but all these dietetic solutions are not without risks for polyallergic or more sensitive subjects.

Objective

To obtain new information on the suitability of other mammalian milks for allergic children, we evaluated the cross‐reactivity between milk proteins from different animal species.

Methods

Milk samples were analysed by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS‐PAGE). To detect antibody–antigen complexes, immunoblotting was performed by using sera from children allergic to cow's and ewe's milk (RAST class ≥ 4) and monoclonal antibodies (MoAb) specific for bovine proteins (caseins and β‐lactoglobulin).

Results

IgEs from children allergic to cow's milk are capable of recognizing most part of milk proteins from mammals bred in European countries (ewe, goat, buffalo), while no serum used in this study contains IgEs reacting with camel's milk proteins. Camel's milk was also not recognized from circulating IgEs from a child specifically allergic to ewe's milk. Specific antibovine monoclonal antibodies cross‐reacted with proteins from other mammalian species, apart from those of camel.

Conclusions

Homologies in amino acidic composition could justify the cross‐reactivity observed between proteins from different animal species. On the other hand, the phylogenetic difference could be responsible for the failed recognition of camel's proteins by circulating IgEs and monoclonal antibodies.