bluuebunny/crossref_metadata_2025 huggingface dataset:
Response to: ‘New Directions in child protection and family support in Western Australia: a policy initiative to re‐focus child welfare practice’
Authors: McCallum Sharon , Eades Di
Published: March 2003

This paper is a response to ‘New Directions in child protection and family support in Western Australia: a policy initiative to re‐focus child welfare practice’, written by Nigel Parton and Richard Mathews and published in Volume 6(2) of Child and Family Social Work. Parton and Mathews’ paper describes the policy and provides an analysis of its impact on child protection practice. They find the policy to have been successful on a number of different dimensions. This paper subjects their findings to a broader lens of analysis and arrives at conclusions somewhat different to those of the authors.
Research with children: sharing the dilemmas
Authors: Cree Viviene E. , Kay Helen , Tisdall Kay
Published: March 2003

This paper identifies a number of significant gaps between the principles of good practice in research with children and the practical realities of conducting a research project with children. The context of the discussion is an ongoing research study of children and young people in Scotland with a parent or carer with HIV. The paper argues that conducting research with what is a hidden (and in many ways secret) population throws into sharp relief some difficulties and contradictions that are at the heart of the research process. The paper does not intend to present easy answers to the complex questions that it raises: the research project it describes is ongoing and not yet at the stage of disseminating findings in any definitive way. Moreover, it seems likely that there are no answers to the questions raised, but that the act of posing the questions may contribute to the development of better, more reflexive research with children.
Parenting distress and parental investment of Hong Kong Chinese parents with a child having an emotional or behavioural problem: a qualitative study
Authors: Ma Joyce L. C. , Lai Kelly , Pun Shuk Han
Published: March 2003

This qualitative study aims to understand the parenting distress and parental investment of Hong Kong Chinese parents with a child having an emotional or behavioural problem. The parents of 24 children and adolescents who sought psychiatric consultation within the study period were interviewed using open‐ended questions. The data revealed a vicious reciprocal interaction in which the symptoms affected the parents’ psychosocial well‐being, which in turn impacted unfavourably on the identified patient. With three exceptions, the parents in this study had engaged in different activities prior to the psychiatric consultation, including information search, changes in the methods of parenting, attempts to reduce family stress, reliance on superstitious beliefs, and reaching out for professional help and social services. The parental investment indicated parents’ resilience in facing the child’s problems. Implications for service development and social work intervention are discussed.
Obstacles to involving children and young people in foster care research
Authors: Gilbertson Robyn , Barber James G.
Published: March 2003

ABSTRACT Despite increasing recognition of the importance of including the perspectives of children and young people in care in alternative care research, in practice this is not always a straightforward matter. This paper describes the recruitment of disruptive young people in care under the jurisdiction of the South Australian statutory authority to three studies on placement instability. Non‐response rates of 72.5% and 82% are reported. A large number of subjects were excluded because agency social workers did not cooperate with the project, and more subjects were excluded for reasons which suggest high levels of distress in this population. The dilemma of providing a voice to distressed subjects when distressed subjects are excluded from research is discussed, and the appointment of an independent representative for children in care to review research proposals and to negotiate research access to children is proposed.
Defining quality care for looked after children: frontline workers’ perspectives on standards and all that?
Authors: Watson David
Published: March 2003

This paper examines residential childcare workers’ perceptions of quality and how they relate to the growing performance measurement culture within social work over the last 10 years. In particular, it is concerned with examining how workers define quality services and what this means for the government's standards approach with its emphasis on tangible activities around process rather than outcomes. In addition this paper considers the prospects for developing quality in residential care and what frontline workers assess as adding to and/or subtracting from that activity. The growing performance measurement and standards culture being propagated by central government is considered in the context of workers’ perceptions and influence, particularly as it relates to the potential to maximize the quality of the service provided. In this context staff perceptions are obtained from nine children's units in two local authorities with the intention of providing research evidence to a debate very often centred on belief rather than fact.
Night waking among 1‐year olds: a study of maternal separation anxiety
Authors: Scher A. , Blumberg O.
Published: March 2003

The relationships between aspects of parenting and infants’ sleep patterns were studied longitudinally with 81 mother‐child pairs. Mothers’ parenting orientation at 6 months was defined using the Facilitator‐Regulator distinction. When the infants were 12 months old, mother and child participated in a laboratory‐based developmental assessment which involved a brief separation episode. Upon reunion, mothers reported on their concerns during separation; they also described their child’s sleep. It was found that high maternal separation anxiety was related to night waking. In addition, night waking was more frequent among first born babies of Facilitators compared with Regulators. How maternal separation anxiety and care‐giving orientation regulate aspects of the child’s sleep awaits further explanation.
Threats to validity in the longitudinal study of psychological effects: the case of short stature
Authors: Stratford R. , Mulligan J. , Downie B. , Voss L.
Published: March 2003

In all studies of health‐related problems and their effects on well‐being, research design issues threaten to compromise the validity of findings. This is particularly so in a longitudinal study, essentially stemming from the tension between maintaining participant compliance and retaining investigator objectivity. Such a tension may be exacerbated where measures of dependent variables such as self‐esteem are used alongside the collection of physical data which is essential to the study, as in research into the psychological effects of short stature on children and young people.

In this paper one particular project, the Wessex Growth Study, is used to illustrate the common threats to validity, both internal and external, of such research, and to consider future improvements in design. The Wessex Growth Study, set up in 1986, was designed to overcome some of the methodological problems found in earlier research with short stature children. It is following the growth and psychological development through their school years of a cohort of short children (below third centile for height when first identified) and case‐matched controls (10th−90th centiles) recruited at school entry (ages 5/6). Findings have generally found only small differences between short and average height children.

Though these results so far have mainly been presented cross‐sectionally, the young people involved are followed up at 6‐monthly intervals for height and other data to be collected, and thus to some extent the study also has the advantages and problems of a longitudinal research design.

Using Campbell and Stanley’s criteria this article makes clear the strain on both internal and external validity in the study, but argues that these problems are to some extent inherent in all longitudinal psychological research, and are outweighed in the present research by the collection of data on short stature which would not otherwise be available. Future data collection within the study will introduce further improvements in design.
West African children in private foster care in City and Hackney
Authors: Olusanya B , Hodes D
Published: March 2003

A unique feature of some Africans who come to study and work in Britain is the practice of making private arrangements to send their children to live with foster parents who assume full parental rights. Six hundred randomly selected African families, with a child born between June 1988 and May 1991, resident in one Health Authority, were sent a questionnaire to elicit the proportion of children who had been in private foster care and to gain information on the knowledge and attitudes to fostering and day care provision. Families with children in foster care were asked additional questions about their experiences. Two hundred and six (34%) of the questionnaires were analysed. Seventy‐six per cent of the respondents were from Nigeria, 65% had already heard about private fostering and 29 (14%) had sent one of their children to private foster care. Only one family felt that foster care was a suitable option; the reminder would have preferred alternative facilities such as nursery placement. Of the 29 children in foster care, nine parents said their children were unhappy and five rated the foster parents as bad. Contrary to popular belief, most children were visited fortnightly, some more frequently and only two never visited. Private fostering in this group of children was found to be less common than in earlier studies.
Parent‐reported infant health and illness in a whole year birth cohort
Authors: Spencer N J , Coe C
Published: March 2003

Objective To describe parent‐reported infant health and illness experience at 8 weeks.

Setting Coventry.

Study design Prospective whole year birth cohort.

Outcome measures Period prevalences (birth to 8 weeks) and incidences, unadjusted and adjusted for differential cohort attrition, of parent‐reported infant health outcomes.

Methods Of 3891 live births in 1996, 2572 (66%) were recruited into the study. Data were collected by health visitors as part of routine child health surveillance, at 8 weeks using the Warwick Child Health and Morbidity Profile (WCHMP) incorporated into the Parent Held Record. Period prevalences and incidences of parent‐reported health outcomes in the first 8 weeks of life were calculated with and without adjustment for the effects of different rates of cohort attrition by sociodemographic group.

Results Data were collected on 2572 infants at recruitment. Health outcome data were available on 2072 (53% of all 1996 live births) infants at 8 weeks. There was differential attrition by social group between enrolment and 8 weeks. Nineteen (95% confidence intervals (CIs) 14,24)/1000 infants were reported as not very healthy/unhealthy, 12 (95% CIs 8,16)/1000 as having impaired health‐related quality of life and 11 (95% CIs 7,15)/1000 impaired functional health. Chronic illness had a period prevalence rate of 19 (95% CIs 14,24)/1000. Sixty‐six (95% CIs 55,77)/1000 had acute illnesses requiring medical attention and 43 (95% CIs 34,52)/1000 were admitted to hospital at least once. More minor illness than expected was reported in 87 (95% CIs 75,99)/1000. The incidence rate of accidents requiring medical attention was 16 (95%CIs 9,21)/1000. Behavioural problems had a prevalence rate of 78 (95% Cis 66,90)/1000.

Conclusions Infant health status data have traditionally been based on mortality, hospital admissions and specific diagnoses. This is the first report of health and illness experience during infancy in a whole year birth cohort based on a validated measure of parent‐reported health status incorporated into the Parent Held Record and administered by the family health visitor as part of routine child health surveillance. These data give a more comprehensive picture of infant health and illness experience than traditional measures and provide the basis for infant health needs assessment.
An investigation into aspects of the Mayo early language screening test
Authors: McGinty C
Published: March 2003

The concurrent validity and inter‐tester agreement on the Mayo early language screening test (MELST), and the concurrent validity of parental anxiety about speech and language development as a screening measure were investigated. A sample (aged 18 months to 5 years) comprising 120 children referred to the Mayo speech and language therapy department during 1995 and 80 controls, was assessed on the MELST by their local public health nurse. Within a calendar month each child was reassessed on the MELST by the therapist, who also administered the Reynell developmental language scales (RDLS) and the Edinburgh articulation test (EAT) as criterion measures. Overall, the MELST achieved moderately high sensitivity and specificity measures. Phonological problems were identified with more accuracy than language problems and the test was equally sensitive to impairments in comprehension and expression. The test tended to over‐refer and was least accurate in screening the language skills of children at the highest age level (4–5 years). A significant association was found between parental concern and pass/failure on each of the MELST, RDLS and EAT. As a screening measure, parental anxiety achieved high sensitivity, moderate specificity and a moderate positive predictive value. However, it also tended to over‐refer, and was also least accurate in identifying speech and/or language disorders at the highest age level. Moderately high inter‐tester agreement measures were found, with greater agreement between scoring for controls than referrals. The phonology sections were scored significantly higher by the public health nurses than by the therapist. The results of this study imply that the MELST is sufficiently accurate and reliable to recommend its continued use in child surveillance programmes.
Covert fears and anxiety in asthma and congenital heart disease1
Authors: Gupta S , Mitchell I , Giuffre R Michael , Crawford S
Published: March 2003

Summary Aim To compare anxiety, fears and behavioural problems in children with asthma and children with congenital heart disease, and with the normative population. To also review the influence of maternal anxiety, time since diagnosis and severity of disease.

Design Children administered Fear Survey Scale (FSSC‐R) and Child Manifest Anxiety Scale (R‐CMAS). Mothers given Child Behaviour Checklist (CBCL) and State Trait Anxiety Scale (STAI‐S and STAI‐T). Normative means and SDs compared with means and SDs for both medical groups. The mother's scores on the STAI‐S and STAI‐T scales were correlated with the child's scores on the FSSC‐R and the R‐CMAS.

Setting Outpatient Asthma and Cardiology multidisciplinary Clinics at a tertiary care paediatric facility, Alberta Children's Hospital.

Subjects: Forty children with asthma (aged 6–17 years) were compared with 39 children with congenital heart disease. Intake questionnaires and interviews determined these children to be without obvious psycho‐social problems.

Results

Children with asthma and children with congenital heart disease had more medical fears, and more physiological anxiety than normative samples. Increased maternal anxiety was correlated in both groups with increased child anxiety, medical fears and behavioural problems in the child. Similarly, increased severity of asthma or cardiac problems was associated with more physiological anxiety and more fears. Less time since diagnosis of the disease adversely affected social interactions in both groups of children.

Conclusion Physiological anxiety, medical fears and maternal anxiety are important issues requiring attention in asthma and cardiac disease, even in the absence of obvious psychosocial problems. There may be specific problems with a recent diagnosis of a chronic illness.
School peer relationships of ‘minority’ children in Scotland
Authors: Closs A , Stead J , Arshad R , Norris C
Published: March 2003

This paper examines selected issues arising from two studies in mainstream education of two minority groupings of children in Scotland–those with serious medical conditions and refugee children–completed in 1997 and 1999, respectively. It draws on first‐person accounts of children, parents and teachers and focuses on school‐based peer relationships, including friendships. Many of the described peer experiences were unhappy or mixed, only a minority were positive. The paper relates the research and its findings to current social and educational policy contexts and to theories on peer relationships, friendship and rejection. It challenges the problematizing of groups or individuals with minority experiences and school staff's acceptance of inevitable difficulty in these children's peer relationships. It hypothesizes that ways of developing all children's peer relationships need to be addressed in schools if the well‐being of children who may be socially vulnerable is to be improved.
Using the Internet to pilot a questionnaire on childhood disability in Rett syndrome
Authors: Fyfe S , Leonard H , Gelmi R , Tassell A , Strack R
Published: March 2003

There is increasing use of the Internet for the transfer and sharing of medical information. Opportunities to pilot surveys online are now also available. An online HTML questionnaire allowed us to pilot a questionnaire about functional ability and the use of health services in Rett syndrome, a rare neurological disorder. Subscribers to a list server completed the online questionnaire and returned data by CGI script‐formatted e‐mail.Text boxes were provided for open‐ended questions. Eighty‐six questionnaires were returned from 224 subscribers with 76% returned within the first week. Almost all respondents were Caucasian, well educated and English speaking. The issue of selection bias and the need for mechanisms to validate the diagnosis are important considerations in any research facilitated through the Internet. However, we were able to contact an otherwise inaccessible group in a fast and cost‐efficient manner and effectively pilot our survey without tapping into our own study population.
Behaviour problems in extremely low birthweight children at 5 and 8 years of age
Authors: Miller M , Bowen J R , Gibson F L , Hand P J , Ungerer J A
Published: March 2003

This study explored the prevalence and stability of behaviour problems and their prediction from neonatal, medical and family context factors in a group of extremely low birthweight (ELBW) infants assessed at 5 and 8 years of age. Behaviour problems were identified on the basis of several measures: the Total Behaviour Problem Scale and the Adaptive Function Scale of the Child Behaviour Checklist, and the Hyperactivity Index and Hyperactivity Scale from the Conners’ Rating Scale. In this group of ELBW infants, the prevalence of behaviour difficulties was somewhat lower than that reported in other studies, and varied according to the measure and informant (parent vs. teacher) used. Also, there was little continuity between those children identified by their parents at 5 years of age as having behaviour problems and those children identified by parent and/or teacher report at 8 years of age. Most of the children identified with behaviour difficulties at 8 years were also reported to have academic difficulties. None of the neonatal or medical factors predicted behaviour difficulties at 8 years of age. In contrast, two family context factors, maternal level of education and family stress, were related to behaviour difficulties at 8 years. These findings indicate that ELBW and the often associated medical complications may not necessarily predispose infants to develop subsequent behaviour difficulties later on in childhood.
Biological vulnerability in infants with failure to thrive: the association with birthweight
Authors: Steward D K
Published: March 2003

The development of failure to thrive (FTT) is hypothesized to be caused by the interaction between biological and environmental factors. Birthweight is one biological variable thought to play a role in the infant’s growth failure. In studies that enrolled infants with FTT who were full‐term at birth, the reported birthweights of these infants were significantly less than healthy control infants (M=2959 g vs.M=3364 g), t(14)= −4.597,P<0.000. There is growing evidence that there is a subgroup of full‐term newborn infants who actually may have experienced some degree of intrauterine growth retardation but their birthweights remain above the traditional cut‐off of 2500 g so that they go unrecognized. The question to consider is whether these infants are as behaviourally vulnerable as full‐term infants with classic intrauterine growth retardation. It may be that this unrecognized group is at a higher risk of developing FTT. The purpose of this manuscript is to discuss birthweight as a possible precursor to the development of FTT.
Parental participation in the habilitation process — evaluation from a user perspective
Authors: Granat T. , Lagander B. , Börjesson M.‐C.
Published: March 2003

Aim  To develop a national instrument for evaluation of parental participation: (1) to obtain a functional measure of quality from a user perspective; (2) as part of quality development in child habilitation services departments; (3) to create common grounds for the evaluation of important aspects of the habilitation process based on the opinions of users and care professionals; (4) to enable evaluation of individual service departments from a more general viewpoint and to highlight areas for improvement; and (5) to enable comparisons of individual service departments in the future against those of others via benchmarking.

Method The Measurement of Processes of Care (MPOC) was deemed to be the method that corresponded most closely with these formulated aims. A shortened version, MPOC 20, had already been produced and was awaiting publication. This shortened version measures the same important aspects of habilitation as the original MPOC. It also has a new scale, with verbal clarification for each step. This makes it more user friendly, as the results are easier to interpret. MPOC 20 was modified to become MPOC 28. This questionnaire was sent out in 11 of 26 counties in Sweden. The target group for the questionnaires was families with children up to 18 years of age who had been in contact with a habilitation services department for at least 1 year. The sample group comprised 4013 randomly selected families. A total of 3391 (84.5%) returned the questionnaire, and 2458 (61%) had responded to the questions.

Results Twelve particular questions that can be regarded as fundamental to the habilitation processes emerged from the questionnaire in the regression analysis. These are measures of good quality in the habilitation process as perceived by the parents and are important in their overall satisfaction with habilitation services. Apart from the specific information category, these questions represented all the factors, i.e. enabling/partnership, general information, co‐ordinated/comprehensive care and respectful/supportive care.

Conclusion MPOC 28 can be useful as an analytical tool for comparisons over time and for measuring changes in the way in which parents rank the various question areas linked to their overall level of satisfaction with the habilitation services in general.
Validation of the measure of processes of care for use when there is no Child Development Centre
Authors: McConachie H. , Logan S.
Published: March 2003

Introduction   Clinical governance requires measurement of the outcomes of health care. The Measure of Processes of Care (MPOCKing, Rosenbaum & King 1995) is a postal questionnaire developed in Canada to reflect parents’ perceptions of the quality of services received.

Aim   To examine the usefulness of the MPOC for the evaluation of services for children with disabilities and their families.

Methods

  The MPOC was revised minimally for British idiom, taking out explicit references to a ‘Centre’. Surveys of parents using child disability services were carried out in three rural and two urban communities, where there are no Child Development Centres, with a total of 495 analysable questionnaires returned. In addition, 32 parents using a home nursing service for children with multiple disabilities completed questionnaires.

Results   The rate of return ranged from 49% to 67%. Factor analysis confirmed a five‐factor solution but only one factor mapped clearly onto the Canadian structure. Using the revised structure, the surveys provide evidence of the discriminating potential of the MPOC, comparing the perceptions of parents who do or do not have a care coordinator, and comparing recipients of a home nursing service with matched users of general services.

Conclusions   The MPOC can be used as a measure of outcome for child disability services of differing organizational structures.
Cetirizine and hydrocortisone differentially regulate ICAM‐1 expression and chemokine release in cultured human keratinocytes
Authors: Albanesi  , Pastore  , Fanales‐Belasio  , Girolomoni
Published: March 2003

Background

Cetirizine is a H1 histamine antagonist which possesses anti‐inflammatory properties through inhibition of leucocyte recruitment and activation, and reduction of ICAM‐1 expression on mucosal epithelial cells. No studies have addressed the potential anti‐inflammatory activities of cetirizine on skin keratinocytes.

Objectives

Cetirizine and hydrocortisone were compared in their capacity to counteract human keratinocytes activation by IFNγ. In particular, expression of immuno‐modulatory membrane molecules and chemokine release have been examined.

Methods

Keratinocyte cultures established from normal skin of healthy donors were activated by IFNγ (100–500 U/mL) in the absence or presence of cetirizine (10−3–103 μM) or hydrocortisone (10−3–102 μM), and tested for expression of ICAM‐1, HLA‐DR, MHC class I and CD40 as well as for release of RANTES, IL‐8, macrophage chemotactic protein‐1 (MCP‐1) and granulocyte macrophage‐colony stimulating factor (GM‐CSF).

Results

Cetirizine at high concentrations (102–103 μM) markedly inhibited IFNγ‐induced expression of membrane ICAM‐1, HLA‐DR and up‐regulation of MHC class I, but had no effect on CD40 expression. In contrast, hydrocortisone (102 μM) enhanced IFNγ‐induced membrane ICAM‐1, reduced expression of HLA‐DR and did not alter expression of MHC class I and CD40. Consistently, high doses of cetirizine decreased, whereas hydrocortisone increased, soluble ICAM‐1 levels in the supernatants of IFNγ‐treated keratinocytes. The inhibiting and stimulating effects of cetirizine and hydrocortisone, respectively, on ICAM‐1 expression were confirmed at the mRNA level by Northern blot analysis. Finally, cetirizine, but not hydrocortisone, inhibited the release of MCP‐1 and RANTES from IFNγ‐stimulated keratinocytes. In contrast, hydrocortisone, but not cetirizine, reduced GM‐CSF and IL‐8 release.

Conclusions

The results indicate that cetirizine has the capacity to block the IFNγ‐induced activation of keratinocytes, and thus can exert important regulatory effects on TH1 cell‐mediated immune responses in the skin. The high doses required for evidencing these activities suggest the potential benefits of a topical use of cetirizine.
Changes in sputum composition during sputum induction in healthy and asthmatic subjects
Authors: Holz  , JÖrres  , Koschyk  , Speckin  , Welker  , Magnussen
Published: March 2003

Background

Induced sputum is increasingly used to characterize the cellular and biochemical composition of the airways.

Objective

We studied whether the composition of induced sputum is different between samples obtained sequentially during one sputum induction.

Methods

Subjects with mild asthma (n = 7) or healthy subjects (n = 6) produced sputum during and after three consecutive 10 min periods of hypertonic saline inhalation. Samples were analysed separately for the three periods. To determine the reproducibility of the cellular composition, sputum induction was repeated on another two days.

Results

The mean percentage of neutrophils decreased significantly (P < 0.01) during sputum induction in asthmatic (36.9, 29.8, 16.3%) and healthy subjects (43.6, 17.2, 18.0%). Correspondingly, percentages of macrophages increased and percentages of eosinophils were 4.9, 3.5, and 3.7% in the asthmatic and 0.6, 0.7, and 0.5% in the healthy subjects, without significant change over the three periods; mean eosinophil numbers were significantly higher in the subjects with asthma (P < 0.05). Reproducibility of percentage cell counts did not markedly depend on sampling periods in terms of coefficients of variation. The concentration of eosinophil cationic protein decreased in both groups during sputum induction (P < 0.01), geometric mean values being 579, 143, 57.4 μg L–1 in the asthmatic and 130, 47.3, 28.4 μg L–1 in the healthy subjects. Similar changes were seen for lactate dehydrogenase.

Conclusion

The separate analysis of induced sputum from three consecutive sampling periods of a single induction procedure demonstrated significant changes in their cellular and biochemical composition, both in healthy and mild asthmatic subjects.
Preserved epitope‐specific T cell activation by recombinant Bet v 1‐MBP fusion proteins
Authors: Van Neerven  , Sparholt  , Schou  , Larsen
Published: March 2003

Background

Allergen‐specific T cells play an important role in the allergic immune response, and are thought to be the principal target in specific immunotherapy.

Objective

The aim of the present study was to evaluate if fusion proteins of allergens with bacterial proteins can be used to activate and bias allergen‐specific T cells, and to characterize T cell epitopes.

Methods

The complete gene of Bet v 1, the major birch pollen allergen, was amplified by PCR from birch pollen mRNA, and cloned in pKK223–3. The complete gene or truncated sequences were transferred to pMAL‐c and expressed in E. coli as fusion proteins with maltose binding protein (MBP). The complete fusion protein, and the truncated fusion proteins were used for studies with Bet v 1‐specific T cells.

Results

Bet v 1‐specific T cells reacted similarly with purified and crude Bet v 1‐MBP proteins. Therefore, crude preparations were used to study the epitope‐specificity of 11 Bet v 1‐specific T cell clones. Six distinct T cell epitopes were determined in this way. Interestingly, the T cell epitope of three T cell clones, that did not react with synthetic peptides in a previous study, was identified. In addition, the presence of MBP as a fusion partner to Bet v 1 was shown to influence TH2/TH1 cytokine production in T cell lines, but not in established T cell clones.

Conclusion

Using crude preparations of recombinant fusion proteins of Bet v 1 with MBP, multiple T cell epitopes were identified in Bet v 1. As T cell activation is preserved in this system, the generation of recombinant allergens with TH1‐inducing proteins as fusion partners might be considered as a T‐cell targeted approach for specific immunotherapy.
Decrease of allergen‐specific T‐cell response induced by local nasal immunotherapy
Authors: Giannarini  , Maggi
Published: March 2003

Background

The clinical efficacy and safety of local nasal immunotherapy (LNIT) with lyophilized ‘macronized’ powder has been demonstrated. However, the immunological changes possibly induced by LNIT which may account for the clinical improvement are still unclear.

Objective

To investigate the effects of a successful LNIT‐treatment on the allergen‐driven T cell response, cytokine secretion and IgE and IgG antibody production.

Methods

Three groups (untreated, subcutaneous immunotherapy‐ SIT‐ and LNIT‐treated) of grass‐sensitive patients suffering from seasonal rhinitic symptoms were ramdomized for the 2‐year study. The proliferative response of PBMC to purified Rye‐1 allergen and serum levels of grass‐specific IgE and IgG were evaluated before treatment and during the 2‐year subsequent pollination periods. The proliferative response of allergen‐specific short‐term T‐cell lines, as well as production of allergen‐driven cytokine by PBMC, were also assessed.

Results

Both SIT and LNIT induced a significant reduction of symptom scores during the pollination season. SIT, but not LNIT, induced a significant change in serum levels of allergen‐specific IgE and IgG antibody. By contrast, both SIT and LNIT reduced the increase of the proliferative response of allergen‐specific T cells driven by natural allergen exposure and significantly decreased T cell proliferation to low doses of allergen, as shown also by the mitogenic index of allergen‐specific T‐cell lines. A reduced IL‐4 and IFNγ production by PBMC of LNIT‐ and SIT‐treated patients was also observed in the absence of a clearcut TH2‐TH1 switch.

Conclusions

These data suggest that a common mechanism of both LNIT and SIT is the induction of T‐cell tolerance, thus providing a rational basis to explain why LNIT may be clinically successful in allergic patients with rhinits.
Detection and quantification of group 4 allergens in grass pollen extracts using monoclonal antibodies
Authors: Fahlbusch  , MÜller  , Rudeschko  , JÄger  , Cromwell  , Fiebig
Published: March 2003

Background

Grass pollen extracts are complex mixtures consisting of different major allergenic and non‐allergenic components. Phl p 4 is an important allergen, because more than 75% of grass pollen allergic patients produce specific IgE antibodies against group 4 allergens.

Objective

This study was designed to investigate the specificity of monoclonal antibodies (MoAbs) produced against Phl p 4 and to verify the presence of group 4‐like proteins in different grass pollen. Furthermore the usefulness of MoAbs for quantification of group 4 allergens was studied.

Methods

Group 4 analogues were investigated by immunoblotting and ELISA inhibition using three MoAbs. The specificity of antibodies was studied using isolated group 1 and group 5 allergens. Quantification of group 4 allergen was achieved by a two‐site solid‐phase ELISA. Phl p 4 was purified from whole pollen extract by chromatographic or electrophoretic techniques and used as standard.

Results

The MoAbs studied bound strongly to proteins from timothy grass pollen extract at a mw of 55 kDa and a pI of 9.0–9.3. Phl p 4 homologes with similar mw were detected in Dactylis glomerata, Festuca pratensis, Holcus lanatus, Poa pratensis, Lolium perenne. Epitope mapping showed that all three MoAb recognized unrelated regions on Phl p 4. A two‐site binding ELISA using MoAbs was developed for determination of Phl p 4 in Phleum pratense extracts. The method was able to evaluate group 4 in mass units with a working range between 150 and 2000 ng/mL. The absolute amounts of group 4 in extracts of several grasses varied considerably but was always less than 1% of the total protein.

Conclusion

Group 4 homologes are present in the various grass extracts but to different extents. The group 4 ELISA could be very useful as a additional tool for providing information concerning the composition of grass pollen extracts.
Induced sputum eosinophil cationic protein (ECP) measurement in asthma and chronic obstructive airway disease (COAD)
Authors: Gibson  , Woolley  , Carty  , Murree‐Allen  , Saltos
Published: March 2003

Background

Induced sputum is a useful way to monitor airway inflammation in asthma, but cell counts are time‐consuming and labour intensive.

Objective

The aim of this study was to evaluate a novel processing method using eosinophil cationic protein (ECP) as a biochemical marker of sputum eosinophil number and activation in subjects with asthma and other airway diseases. Methods Sputum was dispersed with dithiothreitol and centrifuged to yield cell free supernatant and a cell pellet. The pellet was treated with a cellular lysis buffer to release cell‐associated ECP. ECP was measured in sputum supernatant and in the lysed cell pellet and was compared with sputum eosinophil counts in 31 adults with asthma, chronic obstructive airway disease (COAD), bronchiectasis and healthy controls. The ratio of supernatant to pellet ECP was evaluated as an index of eosinophil degranulation. The effect of sputum processing reagents and storage time on ECP measurement was also evaluated.

Results

ECP measured in the cell pellet lysate correlated closely with sputum absolute eosinophil counts across a range of subject groups (r = 0.72, P = 0.004). Sputum eosinophil counts were less well correlated with supernatant ECP levels (r = 0.54, P < 0.05). Incubation with dithiothreitol or lysis buffer did not influence ECP measurement and sputum ECP levels were stable over a 6–9 month period. Sputum supernatant and pellet lysate ECP concentrations were increased in stable asthma, asthma exacerbations and COAD/bronchiectasis (P < 0.05). The ratio of supernatant to pellet ECP was used as an index of eosinophil degranulation and found to be elevated in asthma exacerbations, COAD and bronchiectasis, but not in stable asthma.

Conclusion

The measurement of ECP in the sputum cell pellet provides a reliable and efficient estimate of sputum eosinophil counts which can potentially be used in clinical trials and epidemiological surveys. The ECP ratio may be a useful marker of eosinophil activation, and was increased in asthma exacerbation and COAD. The increased ECP in COAD reflects a non‐selective accumulation of eosinophils in this condition.
Persistent cow's milk protein intolerance in infants: the changing faces of the same disease
Authors: Iacono  , Cavataio  , Montalto  , Soresi  , Notarbartolo  , Carroccio
Published: March 2003

Background

Recent research has shown that cow's milk protein intolerance (CMPI) often persists beyond 4 years of age.

Aims

To evaluate the clinical and immunological characteristics of a group of infants with persistent CMPI.

Patients and methods

Twelve infants (6 m, 6f) with persistent CMPI were followed up from birth until a median age of 5 years. The patients underwent CMP challenge each year to evaluate CMP‐tolerance. As controls we followed 26 infants (12 m, 14 f) with CMPI that resolved within 1–2 years.

Results

A family history of atopic disease was found in 10/12 patients with persistent CMPI and in 10/26 controls (P < 0.01). Clinical presentation changed over time: at onset symptoms were prevalently gastrointestinal, while at the end of the study there was an increased frequency of wheezing and constipation and a higher frequency of delayed reactions to CMP‐challenge than at study commencement (9/12 vs 2/12;P < 0.007). 11/12 infants with persistent CMPI and 3/26 controls (P < 0.0001) presented multiple food intolerance. During the observation period 9/12 infants with persistent CMPI and 2/26 controls showed atopic disease: asthma, rhinitis, eczema (P < 0.0001).

Conclusions

Persistent CMPI forms are characterized by: (a) considerable importance of familial atopic disease; (b) change in CMPI manifestations over time and more prolonged delay between CMP consumption and manifestation of symptoms; (c) very high frequency of multiple food intolerance and allergic diseases.
Alimentary allergy to pork. Crossreactivity among pork kidney and pork and lamb gut
Authors: LLÁtser  , Polo  , DE LA Hoz  , Guillaumet
Published: March 2003

Background

A patient suffered from anaphylaxis after the ingestion of pork gut and kidney, but she tolerated pork meat. Clinical symptoms were also triggered upon intake of lamb gut.

Objective

To demonstrate an IgE‐mediated hypersensitivity and identify the pork proteins involved. And also, to study the possible cross‐allergenicity among proteins from lamb gut and pork.

Methods and results

The patient had strong positive skin‐prick test responses to pork kidney, gut and liver, and lamb gut and kidney. RAST technique showed specific IgE to pork kidney, gut and meat. Immunoblotting after SDS‐PAGE disclosed the presence of four prominent IgE‐binding polypeptides in pork kidney (200, 90, 57, and 47 kDa), two in gut (57 and 27 kDa), and three in meat (51, 40, and 28–30 kDa), apart from other weaker radiostained bands in each extract. The binding of IgE to 200 and 90 kDa allergens from pork kidney was inhibited by gut from pork and lamb in immunoblotting inhibition assays. No inhibition was produced by pork meat.

Conclusions

A mechanism of IgE‐mediated hypersensitivity has been demonstrated in this case of anaphylaxis provoked by pork products. Four main allergens were detected in pork kidney, two of which (200 and 90 kDa) share allergenic epitopes with proteins from pork and lamb gut. On the other hand, pork meat does not seem to have allergenic epitopes in common with pork kidney.
Cereal α‐amylase inhibitors cause occupational sensitization in the wood industry
Authors: LÓpez‐Rico  , Moneo  , Rico  , Curiel  , SÁnchez‐Monge  , Salcedo
Published: March 2003

Background

Cereal flours are used in the wood industry to improve the quality of the glues necessary to produce veneer panels. However, up to now, no cases of sensitization to cereal flour in this kind of industry have been reported. Cereal α‐amylase inhibitors have been previously described as important occupational allergens responsible for baker's asthma.

Objective

To determine whether cereal allergens were responsible for occupational sensitization in three wood industry workers.

Methods

The diagnosis was made by clinical questionnaire, physical examination, skin‐prick tests to cereals, CAP and immunoblotting.

Results

The three patients had positive skin prick tests and CAP to cereal flours. An IgE‐immunoblotting revealed that only low molecular weight proteins (under 20 kDa) were detected by the three sera. These main IgE‐binding proteins were members of the α‐amylase inhibitor family which have been described as one of the group of main allergenic proteins in rye, barley and wheat. The three patients changed their workplace and remain asymptomatic in spite of the fact that they are still in contact with different woods and exposed to high concentrations of wood dust and other chemicals such as formaldehyde.

Conclusion

Proteins from cereal flours are important occupational allergens in some wood industries.
House dust mite allergen (Der p 1) accumulation on new synthetic and feather pillows
Authors: Rains  , Siebers  , Crane  , Fitzharris
Published: March 2003

Background

We have previously demonstrated that synthetic pillows contain significantly more Der p 1 than feather pillows. The aim of this study was to compare the accumulation of Der p 1 allergen on new synthetic and new feather pillows.

Methods

Der p 1 was measured in dust samples from pairs of synthetic and feather pillows placed together on 12 beds over a 12‐month period.

Results

After 12 months synthetic pillows contained higher concentrations of Der p 1 (19.28 μg/g; 95% confidence interval: 9.76–38.07) than feather pillows (6.45 μg/g; 2.96–14.05). There was a significant correlation between Der p 1 concentrations of pillows at 12 months and Der p 1 concentrations of the mattresses at the beginning of the study (r = 0.72; P = 0.008 for both types of pillows).

Conclusions

Synthetic pillows accumulate Der p 1 more rapidly than feather pillows and the accumulation rate of Der p 1 on pillows is governed by the Der p 1 concentration in the immediate environment they are placed in.
Prevalence of rhinitis, pillow type and past and present ownership of furred pets
Authors: FROSH  , SANDHU  , JOYCE  , STRACHAN
Published: March 2003

Background

There has been no previous work investigating the effects of furred pet ownership and pillow type on the risk of developing rhinitis. Recently, unexpected and unexplained associations of asthma with nonfeather pillows have been reported.

Objective

We developed a questionnaire‐based cross‐sectional survey to determine whether the past or present ownership of cats or dogs, or the use of nonfeather pillows contributes to the development of seasonal or perennial rhinitis.

Methods

We surveyed 2555 accompanying friends and relatives of patients attending the outpatients departments at one London hospital in 1996. Individuals with rhinitis were defined as those suffering with three or more symptoms of rhinitis either throughout the year (perennial) or for part of the year (seasonal). Present or childhood ownership of cats or dogs was recorded.

Results

A strong association was seen with nonfeather pillow use and both seasonal [odds ratio (OR) 1.85; 95% confidence interval (CI) 1.43–2.5] and perennial (OR 2.63; CI 1.67–5.0) rhinitis. However, more than one‐third of rhinitics had changed their pillow type. After restricting the data to exclude subjects who changed their pillow to avoid allergies, the strong association of nonfeather pillow use with perennial rhinitis remained (OR 2.44; CI 1.25–5.0). Adjusting the data to the extreme situation where all former pillow type was feather changes the apparent risk to 0.99 (CI 0.67–1.43). No associations for either seasonal or perennial rhinitis were seen for feather pillows. A weak association of current dog ownership is demonstrated for seasonal rhinitis (OR 1.47; CI 1.01–2.14). No associations were seen for childhood dog ownership or cat ownership at any time with either type of rhinitis.

Conclusions

Feather pillow use and the ownership of furred pets appears unlikely to increase the risk of developing perennial or seasonal rhinitis. In fact, in contrast with currently held views, there is evidence that the use of nonfeather pillows may increase the risk.
Attenuation of house dust mite Dermatophagoides farinae‐induced airway allergic responses in mice by dehydroepiandrosterone is correlated with down‐regulation of TH2 response
Authors: Yu  , Yang  , Lei  , Chen  , Liu  , Chen  , Liu
Published: March 2003

Background

Dehydroepiandrosterone (DHEA), an abundant androgen in circulation, has important immunomodulating effects on T‐cell differentiation; however, it is not known whether this hormone influences allergic responses.

Objective

We have established a murine model of airway inflammation induced by house dust mite Dermatophagoides farinae (Der f). Der f challenge of sensitized mice would elicit a pulmonary eosinophilic inflammation. In the present study, we employed this model system to explore the effect of DHEA on allergic responses.

Methods

Female BALB/c mice were fed with a standard diet incorporated with 1.5% (w/w) of DHEA for 1 week before sensitization and every other day for an additional 2 weeks after sensitization. After intratracheal inoculation of allergen, the Der f‐induced airway inflammation, immunoglobulin (Ig)E antibody production, and cytokine expression were compared between control and DHEA‐fed mice.

Results

In control mice the Der f‐induced eosinophilia in bronchoalveolar lavage (BAL) fluids was accompanied by an increase in production of interleukin (IL)‐4, IL‐5, and interferon IFN‐γ systemically and locally. DHEA supplementation did not affect the body weight of mice. However, in mice that were receiving DHEA, the numbers of eosinophils and lymphocytes in BAL fluids significantly decreased at days 2 and 6 after challenge as compared with control mice. Concomitantly, total IgE antibody concentrations as well as IL‐4, IL‐5, and IFN‐γ levels in BAL fluids or serum also significantly reduced. Immunocytochemical staining of BAL cells revealed that there were fewer IL‐4‐, IL‐5‐, IL‐10‐, but not IFN‐γ‐positive stained cells in DHEA‐fed mice than in mice who consumed unsupplemented diet. Reverse transcription‐polymerase chain reaction analysis demonstrated DHEA decreased the expression of IL‐5 and IL‐10 transcripts in BAL cells.

Conclusions

Our results showed that administration of DHEA during allergic sensitization could attenuate the subsequent allergic responses elicited by challenge, and that the suppressive effect of DHEA was associated with a down‐regulation of TH2 response.