bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative analysis of IgE antibodies to food and inhalant allergens in 4‐year‐old children reflects their likelihood of allergic disease
Authors: Wickman M. , Lilja G. , Söderström L. , Hamsten M. v. H. , Ahlstedt S.
Published: April 2005

Background:  It is well established that early diagnosis of allergic disease is warranted.

Methods:  In a prospective birth cohort study (BAMSE) 3743 children at 4 years of age were included. Children were classified as having any allergic disease, e.g. asthma, suspected allergic rhinitis (suspAR), eczema or oro‐gastro‐intestinal symptoms with questionnaire. Blood was obtained from 2612 of these children and analysed for IgE antibodies (ab) towards 14 common food and airborne allergens.

Results:  Positive IgE ab results were found in 38% of the children with any allergic disease, whereas such IgE ab results were found in 17% among those without any allergic disease. Furthermore, among children with any allergic disease the median summated IgE ab levels were 10.7 kUA/l compared with 1.5 kUA/l among those without such symptoms. The highest IgE ab levels were found to birch, peanut, cat and horse. When the sum of the IgE‐ab levels towards the selected allergens was at least 34 kUA/l, or, alternatively, more than four allergen tests were positive, there was a 75% likelihood of identifying the individual with any allergic disease. To identify those with asthma, as well as those with suspAR, a significant interaction was found for the combination of the sum of IgE‐ab levels and number of allergens positive at test. For eczema only, the number of positive allergens at test was associated to the likelihood of such disease.

Conclusions:  In children, 4 years of age, allergic disease was frequently not associated with the presence of single positive IgE antibody results, whereas increased IgE ab levels were significantly more prevalent among those with allergic disease. Thus, testing a certain profile of airborne and food allergens, and utilizing the sum of the IgE‐ab levels in combination with the number of allergens positive at tests, may represent a more efficient diagnostic tool then to use just single positive IgE‐ab results.
Risks of allergic reactions to biotech proteins in foods: perception and reality
Authors: Lehrer S. B. , Bannon G. A.
Published: April 2005

In recent years, significant attention has been paid to the use of biotechnology to improve the quality and quantity of the food supply due in part to the projected growth in the world population, plus limited options available for increasing the amount of land under cultivation. Alterations in the food supply induced by classical breeding and selection methods typically involve the movement of large portions of genomic DNA between different plant varieties to obtain the desired trait. This is in contrast to techniques of genetic engineering which allows the selection and transfers specific genes from one species to another. The primary allergy risk to consumers from genetically modified crops may be placed into one of three categories. The first represents the highest risk to the allergic consumer is the transfer of known allergen or cross‐reacting allergen into a food crop. The second category, representing an intermediate risk to the consumer, is the potential for replacing the endogenous allergenicity of a genetically‐modified crop. The last category involves expression of novel proteins that may become allergens in man and generally represents a relatively low risk to the consumer, although this possibility has received attention of late. In order to mitigate the three categories of potential allergy risk associated with biotech crops, all genes introduced into food crops undergo a series of tests designed to determine if the biotech protein exhibits properties of known food allergens. The result of this risk assessment process to date is that no biotech proteins in foods have been documented to cause allergic reactions. These results indicate that the current assessment process is robust, although as science of allergy and allergens evolves, new information and new technology should help further the assessment process for potential allergenicity.
The inverse association of salmonellosis in infancy with allergic rhinoconjunctivitis and asthma at school‐age: a longitudinal study
Authors: Pelosi U. , Porcedda G. , Tiddia F. , Tripodi S. , Tozzi A. E. , Panetta V. , Pintor C. , Matricardi P. M.
Published: April 2005

Background:  Respiratory allergies are inversely related to early acquisition of food‐borne and fecal‐oral infections, consumption of unpasteurized milk, early exposure to stables and high endotoxin concentrations in a farming environment. We tested therefore if infection by Salmonella in early life can protect from development of respiratory allergies later in life.

Methods:  During 2003, we studied two groups of Sardinian children (age 6–18 years) who had been hospitalized before 4 years of age (during 1989–2001) with non‐typhoid salmonellosis (n = 148) or acute enteritis of nonbacterial etiology (NB‐enteritis) (n = 167). Allergic rhinoconjunctivitis (AR) and asthma were evaluated by telephonic interview with a ISAAC questionnaire; participants reporting AR and/or asthma were further examined through a complete diagnostic work‐up to objectively confirm or exclude current disease. Kaplan–Meier curves and Cox proportional hazard models were used to analyze the role of different types of enteritis on the risk of developing allergic rhinoconjunctivitis or asthma over time.

Results:  Children who had been hospitalized with salmonellosis had a lower prevalence of allergic rhinoconjunctivitis (eight of 148, 5.4%vs 23 of 167, 13.8%; P = 0.019) or asthma (five of 148, 3.4%vs 21 of 167, 12.6%; P = 0.006) than those who had been hospitalized with NB‐enteritis. The proportional hazard of salmonellosis for asthma was 0.23 (95% CI: 0.08–0.67; P < 0.01) and for allergic rhinoconjunctivitis was 0.40 (95% CI: 0.17–0.95; P = 0.04), after adjusting for confounders.

Discussion:  The strength of the observed associations suggests that Salmonella may contribute to shape the natural history of respiratory allergies. However, further studies are needed to test in other settings the association observed in Sardinian children. We speculate that clinical or subclinical infection by Salmonella may contribute to the atopy protective influence of a traditional farming environment or of areas endemic for food‐borne and fecal‐oral infections. Food hygiene and prevention of salmonellosis must remain however a public health priority.
Nonimmediate reactions to systemic corticosteroids suggest an immunological mechanism
Authors: Padial A. , Posadas S. , Alvarez J. , Torres M.‐J. , Alvarez J. A. , Mayorga C. , Blanca M.
Published: April 2005

Background:  Administration of corticosteroids (CS) by different routes may cause varying types of allergic reactions, thereby hampering their further use in affected patients. In order to verify an immunological involvement we evaluated a group of patients with symptoms compatible with nonimmediate allergic reactions to CS.

Methods:  Studies included patch and intradermal tests, immunohistochemical studies and controlled administration to reproduce the response. The cytokines interleukin (IL)‐4, interferon (IFN)‐γ and tumor necrosis factor (TNF)‐α were quantified in peripheral blood during the response.

Results:  Of 32 subjects evaluated presenting nonimmediate urticaria or exanthema, 21 were finally considered positive after re‐exposure. The drugs most frequently involved were betamethasone and dexamethasone. Fewer than half the patients responded to prednisolone whilst some responded to three or more CS. Hydrocortisone and deflazacort were well tolerated by all the patients. Subjects with a positive intradermal or patch test had a perivascular mononuclear cell infiltrate with the presence of CD4 and CD8 lymphocytes positive for CD45RO+ (memory) and CD69 (activation marker) cells. Monitoring peripheral blood during the acute response showed expression of IFN‐γ and TNF‐α, with downregulation of IL‐4.

Conclusion:  Adverse systemic responses to different CS are suggestive of a nonimmediate reaction. The symptoms elicited together with the immunlogical studies suggest a T‐cell mediated response. The response to closely related CS was especially marked between betamethasone and dexamethasone, whereas hydrocortisone and deflazacort were well tolerated.
A differing pattern of association between dietary fish and allergen‐specific subgroups of atopy
Authors: Andreasyan K. , Ponsonby A.‐L. , Dwyer T. , Kemp A. , Dear K. , Cochrane J. , Carmichael A.
Published: April 2005

Background:  We examined the role of fish intake in the development of atopic disease with particular reference to the possibility of differential effects on allergen‐specific subgroups of sensitization.

Methods:  The exposure of interest was parental report of fish intake by children aged 8 years at the 1997 Childhood Allergy and Respiratory Health Study (n = 499). The outcomes of interest were subgroups of atopy: house dust mite (HDM)‐pure sensitization [a positive skin‐prick test (SPT) ≥2 mm to Der p or Der f only], ryegrass‐pure sensitization (a positive SPT ≥2 mm to ryegrass only); asthma and hay fever by allergen‐specific sensitization.

Results:  A significant association between fish intake and ryegrass‐pure [adjusted odds ratio (AOR) 0.37 (0.15–0.90)] but not HDM‐pure sensitization [AOR 0.87 (0.36–2.13)] was found. Fish consumption significantly decreased the risk for ryegrass‐pure sensitization in comparison with HDM‐pure sensitization [AOR 0.20 (0.05–0.79)].

Conclusions:  We have demonstrated a differential effect of fish intake for sensitization to different aeroallergens. This may be due to the different timing of allergen exposure during early life. Further investigation of the causes of atopic disease should take into account allergen‐specific subgroups.
Monophosphoryl lipid A (MPL®)* promotes allergen‐induced immune deviation in favour of Th1 responses
Authors: Puggioni F. , Durham S. R. , Francis J. N.
Published: April 2005

Background:  Monophosphoryl lipid A (MPL®) is a nontoxic derivative of the lipopolysaccharide (LPS) of Salmonella minnesota R595. MPL has been used as an adjuvant in grass and tree pollen vaccines for the treatment of seasonal allergic rhinitis. Little is known about the influence of MPL on cellular responses to allergens in man. We therefore studied the effects of MPL in vitro on peripheral blood mononuclear cells (PBMC) obtained from patients with grass pollen hay fever.

Methods:  The PBMCs from 13 subjects were cultured with grass pollen Phleum pratense extract (0, 2 and 20 μg/ml) and MPL (0 and 10 μg/ml; defined as an optimal concentration in preliminary studies) and after 6 days proliferative responses were measured by thymidine incorporation and cytokine production by enzyme‐linked immunosorbent assay (ELISA).

Results:  Proliferative responses were unaffected by the presence of MPL whereas MPL induced a significant increase in allergen‐induced interferon (IFN)‐γ production [allergen alone, 645 ± 466 pg/ml (mean ± SE) vs allergen + MPL, 3232 ± 818 pg/ml; P < 0.001]. In addition, there was a significant decrease in interleukin (IL)‐5 production (4307 ± 1030 pg/ml vs 2997 ± 826 pg/ml; P < 0.01). Although MPL alone could induce modest increases in IL‐10 production, MPL did not influence the production of this cytokine in allergen‐stimulated cultures. Addition of neutralizing antibody against IL‐12 resulted in 95% inhibition of MPL‐induced IFN‐γ production. Depletion of monocytes from the culture system abrogated the effects of MPL on elevated cytokine production.

Conclusions:  In summary, use of MPL with grass pollen extract results in immune deviation of allergen‐induced peripheral Th2‐cell responses in favour of ‘protective’ Th1 responses in an IL‐12 and monocyte‐dependent fashion.
Peanut‐ and cow's milk‐specific IgE, Th2 cells and local anaphylactic reaction are induced in Balb/c mice orally sensitized with cholera toxin
Authors: Adel‐Patient K. , Bernard H. , Ah‐Leung S. , Créminon C. , Wal J.‐M.
Published: April 2005

Background:  The development of animal models developing specific immunoglobulin (Ig)E presenting the same specificity as human IgE and similar clinical symptoms as those observed in allergic patients are of great interest for the understanding of mechanisms involved in the induction and regulation of food allergy.

Methods:  Balb/c female mice were sensitized with whole peanut protein extract (WPPE) by means of intraperitoneal (i.p.) injections with alum or gavages with cholera toxin (CT). The WPPE specific IgE, IgG1 and IgG2a were monitored. Th2 cells activation was analysed assaying interleukin (IL)‐4 and IL‐5 vs IFNγ on reactivated splenocytes. Local anaphylactic reaction was evaluated by assaying histamine in faecal samples. The oral sensitization protocol was further extended to cow's milk proteins (CMP).

Results:  Balb/c mice developed high peanut‐specific IgE and IgG1 responses either after i.p. or oral sensitizations. In both cases, antibodies were specific to polymer of glycinin fragments, containing polypeptides from Ara h3/4, and to a lesser extent to Ara h1 and Ara h2. Interleukin‐4 and IL‐5 production were evidenced. Balb/c mice could also be sensitized to CMP, as demonstrated by CMP‐specific IL‐4 and IL‐5 secretions and induction of IgE specific for whole caseins, β‐lactoglobulin, serum bovine albumin and lactoferrin. Of interest was the occurrence of a local anaphylactic reaction in the peanut and CM models.

Conclusions:  In contrast with previous authors, Balb/c mice were sensitized and evidenced an allergic reaction after oral administrations of peanut or CMP plus CT, providing an interesting model for further studies on immunopathogenic mechanisms.
Possible circadian variation of serum mast cell tryptase concentration
Authors: Dugas‐Breit S. , Przybilla B. , Schöpf P. , Ruëff F.
Published: April 2005

Background:  A temporarily elevated level of serum mast cell tryptase (ST) indicates mast cell activation and occurs in systemic anaphylactic reactions (SAR). We measured ST following a sting challenge in vespid venom‐allergic patients treated with venom immunotherapy (VIT) and in healthy controls, respectively.

Aim of the study:  To assess changes of ST over time in vespid venom‐allergic patients at the occasion of a re‐sting and in healthy controls.

Methods:  A sting challenge was performed in 20 patients on vespid VIT to monitor efficacy of VIT. ST was measured between 9.00 and 10.00 a.m. (baseline). Sting challenge was performed at 2.00 p.m., and ST was determined again 20 min, 90 min and 18 h later. Measurements at corresponding times of the day were done in nine healthy controls.

Results:  One patient developed a mild SAR to the sting challenge which was associated with a temporary increase of ST. In the other 19 patients who tolerated the sting challenge without SAR ST decreased significantly by 18.0% (median, range 8.3–36.7%). Twenty minutes after the sting when compared with baseline levels (P < 0.001), a significant decrease of ST was still present after 90 min (median 13.7%) (P < 0.001), but not after 18 h (P = 0.57). A comparably significant temporary decline was found in controls.

Conclusions:  The temporary decline of ST in patients and in controls suggests a circadian variation of ST concentration. A normal diurnal pattern of ST concentration after sting challenge is associated with successful treatment.
Early effects of Asthma Prevention Program on asthma diagnosis and hospitalization in urban population of Poland
Authors: Stelmach W. , Majak P. , Jerzynska J. , Stelmach I.
Published: April 2005

Background:  Asthma is one of the commonest public health problems in Poland and the commonest chronic disorder in children. Lodz Regional Health Insurance Fund was a sponsor of the Prevention Asthma Program in 2000–03, directed at increasing early detection and providing optimal treatment of allergies by specialists in children.

Methods:  All funds were divided between 127 primary and 12 specialized care centres participated in the programme. Primary care centre goals were: anamnestic information, mapping of allergy‐causing factors, repeated auscultation of the lungs, bronchial dilation test, peak expiratory flow (PEF) measurement at the clinic and at home for 2 weeks. After preliminary diagnosis patients have been send to specialized centres. Specialized care centre goals were as follows: skin testing, spirometry, repeated bronchial dilation test, determination of eosinophilic white blood cells and eosinophil cationic protein (ECP) in blood.

Results:  Increasing trend of new asthma diagnosis, expressed per 1000 inhabitants, was observed from 0.99 in 2000 to 2.19 in 2003. In the first year of Asthma Prevention Program, we observed more hospital episodes because of asthma exacerbation in comparison with year 1999 but from the second year of programme we showed systematically decreasing number of hospital episodes as a result of asthma exacerbation from 1.48 in 2000 to 0.84 in 2003. We found significantly decreasing trend in duration of hospitalization due to asthma exacerbation (P = 0.001).

Conclusions:  Effects of this programmes are: early identification of allergic diseases, mainly asthma, reduced number and shorter duration of hospitalization because of asthma exacerbation and establishing new Asthma Schools Education.
Anti‐IL‐5 recombinant humanized monoclonal antibody (Mepolizumab) for the treatment of atopic dermatitis
Authors: Oldhoff J. M. , Darsow U. , Werfel T. , Katzer K. , Wulf A. , Laifaoui J. , Hijnen D. J. , Plötz S. , Knol E. F. , Kapp A. , Bruijnzeel‐Koomen C. A. F. M. , Ring J. , de Bruin‐Weller M. S.
Published: April 2005

Background:  Eosinophils may play an important role in the pathogenesis of atopic dermatitis (AD). Interleukin‐5 is essential for eosinophil growth, differentiation and migration. A monoclonal antibody to human interleukin‐5 (mepolizumab) was developed for atopic diseases. This study was designed to study the effect of mepolizumab in AD.

Methods:  Two single doses of 750 mg mepolizumab, given 1 week apart, were studied in patients with moderate to severe AD using a randomized, placebo‐controlled parallel group design. The primary endpoint of ‘success’ to treatment was defined as the percentage of patients with at least ‘marked improvement’ after 2 weeks as assessed by the Physician's Global Assessment of Improvement (PGA). Furthermore, SCORing AD (SCORAD), pruritus scoring, number of blood eosinophils and serum thymus and activation‐regulated chemokine (TARC) values served as secondary endpoints. Fluticason propionate cream 0.05%, once daily could be used as rescue medication from day 16 if no improvement was recorded.

Results:  Eighteen patients received mepolizumab and 22 placebo treatment. Peripheral blood eosinophil numbers were significantly reduced in the treatment group compared with placebo (P < 0.05). No clinical success was reached by PGA assessment (P = 0.115), SCORAD (P = 0.293), pruritus scoring and TARC values in the mepolizumab‐treated group compared with placebo. However, modest improvement (<50% improvement) assessed by PGA was scored significantly more in the mepolizumab‐treated group compared with placebo (P < 0.05).

Conclusion:  Two single doses of 750 mg mepolizumab did not result in clinical success in patients with AD, despite a significant decrease in peripheral blood eosinophils.
Predictors of indoor exposure to mouse allergen in urban and suburban homes in Boston
Authors: Phipatanakul W. , Gold D. R. , Muilenberg M. , Sredl D. L. , Weiss S. T. , Celedón J. C.
Published: April 2005

Background:  Mouse allergen exposure is prevalent among urban children with asthma. Little is known about mouse allergen exposure in children at risk for the development of allergic diseases.

Aims of the study:  To assess indoor mouse allergen exposure in early life among children with parental history of asthma or allergies.

Methods:  Prospective birth cohort study of 498 children with a history of allergy or asthma in at least one parent living in metropolitan Boston.

Results:  Of the 498 participating children, 357 (71.7%) resided outside the city of Boston and 439 (90.7%) lived in households with incomes >$30 000. Mouse allergen was detected in 42% of the homes of study participants. In a multivariate analysis adjusting for sex, income, and endotoxin, black race [odds ratio (OR) = 3.0; 95% confidence interval (CI) = 1.3–6.6, P = 0.009], signs of mice in the home at age 2–3 months (OR = 3.0; 95% CI = 1.6–5.6, P = 0.0006), and kitchen cockroach allergen levels ≥0.05 to <2 U/g (OR = 1.8; 95% CI = 1.1–3.2, P = 0.02) were associated with detectable mouse allergen in the kitchen. In this model, living in a single detached house was inversely associated with detectable kitchen mouse allergen levels (OR = 0.4; 95% CI = 0.2–0.6, P = 0.0001).

Conclusion:  Infants with a parental history of asthma or allergies are commonly exposed to mouse allergen in their homes. Among infants at high risk for atopy, predictors of increased mouse allergen levels included black race, reported mice exposure, and moderate levels of cockroach allergen.
Antenatal steroids may reduce adverse neurological outcome following chorioamnionitis: Neurodevelopmental outcome and chorioamnionitis in premature infants
Authors: Kent Alison , Lomas Fred , Hurrion Elizabeth , Dahlstrom Jane E
Published: April 2005

Objective:  To examine the effect of antenatal steroid exposure and in utero inflammation on the development of severe intraventricular haemorrhage, periventricular leukomalacia and long‐term neurological outcome in infants less than 30 completed weeks gestation.

Method:  Infants less than 30 completed weeks gestation from January 1996 to July 2001 were identified from a prospectively managed database. Placental pathology was reviewed for the presence or absence of chorioamnionitis and funisitis. Infants were divided into three groups depending on the degree of exposure to fetal inflammation (no inflammation, chorioamnionitis only and chorioamnionitis and funisitis). Data relating to gestational age, birthweight, sex, antenatal steroid exposure, surfactant treatment, days of positive pressure ventilation and days of oxygen requirement were collected. Cerebral ultrasound studies were examined for evidence of intraventricular or intraparenchymal echodensity and periventricular leukomalacia. Long‐term neurological outcome was assessed by neurological examination for cerebral palsy and by Griffiths Mental Developmental Assessment for general developmental quotient.

Results:  Two hundred and twenty infants were identified. The mean gestational age was 27.7 weeks and the mean birthweight 1092 g. Seventy‐two per cent of mothers had received a complete course of antenatal steroids. The risk of Grade III intraventricular haemorrhage or intraparenchymal echodensity was associated with exposure to in utero inflammation if a complete course of antenatal steroids had not been received (P = 0.002). This association did not exist if a complete course of antenatal steroids was given (P = 0.62). Fourteen infants had cerebral palsy (7%). The presence of cerebral palsy was also associated with in utero inflammation in the absence of complete antenatal steroid cover (P = 0.03) and not in the presence of complete cover (P = 0.59). The mean general developmental quotient on Griffiths Mental Developmental Assessment at 12 months or 3 years was not affected by exposure to in utero inflammation regardless of antenatal steroid exposure.

Conclusion:  Risk of intraventricular haemorrhage or intraparenchymal echodensity and cerebral palsy was associated with in utero inflammation in the absence of a complete course of antenatal steroids. A complete course of antenatal steroids appeared to extinguish any association between in utero inflammation and adverse neurological outcome.
Parents' evaluation of developmental status in children born with a birthweight of 1250 g or less
Authors: Pritchard Margo A , Colditz Paul B , Beller Elaine M ,   Queensland Optimising Preterm Infant Outcomes Group
Published: April 2005

Objective:  To evaluate the agreement between parental reporting of development of children born very preterm using the Parents' Evaluation of Developmental Status (PEDS) questionnaire and professional assessment by a paediatric developmental team in the detection of sensorineural disability.

Methods:  A cross‐sectional cohort study of 362 children born in Queensland with a birthweight ≤1250 g, who were surviving at 2 and 4 years of age corrected for prematurity, was conducted. Parents completed the PEDS questionnaire prior to their child receiving a neurodevelopmental assessment. The level of agreement for sensorineural disability between the neurodevelopmental assessment and the parents' score on the PEDS questionnaire was measured using the kappa statistic, and screening test characteristics were calculated. Logistic regression was used to investigate factors that might affect agreement.

Results:  Two hundred and eighty‐three (78%) of the eligible children were located and contacted. Of these, 216 (76%) agreed to participate in the study (110, 2‐year‐olds; 106, 4‐year‐olds). Agreement between the two forms of rating sensorineural disability (developmental quotient > −2SD (standard deviation), cerebral palsy, bilateral blindness and deafness requiring aids) for the 4‐year age group children was fair (κ= 0.27, P= 0.001). PEDS accurately identified 69% (11 of 16) of disabled children and 72% (65 of 90) non‐disabled children. The test characteristics for these children were similar to Glascoe's norming sample with a PPV 31% (95% CI: 14–48%), specificity 72% (95% CI: 62–81%), but lower sensitivity 69% (95% CI: 62–81%) and higher false‐negative rate 31% (95% CI: 11, 59). Agreement for the 2‐year age group was fair with poor test characteristics. Other comparisons for both age groups (PEDS A and B compared using a disability status with DQ > −1SD) showed poor agreement and test characteristics. Gestation age <27 weeks and maternal education at or below grade 10 in the 2‐year age group were the only factors independently affecting agreement.

Conclusions:  The agreement between parental evaluation of sensorineural disability status using PEDS and paediatrics developmental assessment in children born very preterm at 4‐years corrected age for prematurity compares favourably with Glascoe's norming sample. The lower agreement seen in the 2‐year age group limits the utility of PEDS to be used as a screen for disability at an age when early intervention may be useful. The PEDS questionnaire is designed and normed for the general paediatric population, and it is not clear if parents of children born very preterm may have interpreted the PEDS questionnaire in relation to their satisfaction with their child's developmental progress rather than their child's functional ability.
Cardiac pacing in the management of severe pallid breath‐holding attacks
Authors: Wilson Dyanne , Moore Philip , Finucane A Kirsten , Skinner Jonathan R
Published: April 2005

Abstract:  Reflex anoxic seizures (pallid breath‐holding attacks) can be managed with reassurance in the majority of individuals. In a minority of cases where frequent syncopal and seizure activity occurs, intervention needs to be considered. We report a case of a 19‐month infant with a history of severe reflex anoxic seizures who underwent pacemaker insertion with a spectacular result, with complete termination of syncope and seizures, and improvement in quality of life for the patient and family. A literature review of the safety and effectiveness of pacemaker insertion is also presented to support its use as a treatment option for this condition.
Aspirin‐sensitive asthma
Authors: Morwood K. , Gillis D. , Smith W. , Kette F.
Published: April 2005

Abstract

Aspirin‐sensitive asthma is a common and often underdiagnosed disease affecting up to 20% of the adult asthmatic population. It is associated with more severe asthma, requires increased use of inhaled and oral corticosteroids, more presentations to hospital and a risk of life‐threatening reactions with aspirin/non‐steroid anti‐inflammatory drug (NSAID) ingestion. Aspirin‐sensitive asthma is often accompanied by severe rhinosinusitis and recurrent nasal polyposis, causing significant impairment of patients’ quality of life. The pathogenesis of aspirin‐sensitive asthma is complex and involves chronic eosinophilic inflammatory changes, with evidence of increased mast cell activation. The cyclo‐oxygenase pathways play a major role in the respiratory reactions that develop after aspirin ingestion. The cysteinyl‐leukotrienes have also been shown to play a role in the pathogenesis of aspirin‐sensitive asthma. The clinical management of aspirin‐sensitive asthma is complicated by the lack of diagnostic testing, other than challenge procedures. Other aspects of management include management of the underlying asthma and avoidance of NSAID in the majority of patients. Other considerations in the management of patients with aspirin‐sensitive asthma include the role of leukotriene modifying agents, aspirin desensitization, and the use of other agents, such as roxithromycin. The management of nasal polyposis in patients with aspirin‐sensitive asthma often needs to be considered as a separate issue, and requires a team approach. (Intern Med J 2005; 35: 240–246)
Systemic scleroderma: a spatiotemporal clustering
Authors: Englert H. , Joyner J. , Bade R. , Thompson M. , Morris D. , Chambers P. , Carroll G. , Manolios N.
Published: April 2005

Background and aims: The aetiology of systemic scleroderma remains poorly understood. Twin studies suggest a low genetic input. Of the incriminated environmental agents, silica and vinyl chloride monomer exposure appear the most convincing. Spatiotemporal clustering has been demonstrated only three times previously. We now report a fourth cluster around Edenhope, western Victoria in terms of numerator and denominator estimates, cumulative incidence, distribution in time and space, and possible aetiological factors.

Methods: Prevalence/cumulative incidence numerator and denominator values were obtained and validated. Each case was age‐and gender‐matched with two controls. A standardized postal questionnaire was used to obtain data on current, past history, family history, and occupational and non‐occupational environmental exposure.

Results: Six systemic scleroderma cases and one mixed connective tissue disease patient with a predominance of scleroderma features were identified. The 5‐year cumulative incidence was 6.1/10 000, tenfold higher than the Sydney estimates for a similar, though non‐identical time period. The gender ratio was 1:1. No cases were genetically related. A family history of scleroderma was validated in one instance and a family history of Raynaud's was noted in first degree relatives of two cases and one control. In all instances, Edenhope residence preceded disease onset. No one environmental agent was implicated in all cases.

Conclusion: A spatiotemporal cluster of systemic scleroderma was confirmed and validated. It occurred with a tenfold increased cumulative incidence to that expected and also extended beyond the initially defined 50 km radius of Edenhope. The cases identified were not related. Although no one specific environmental agent was identified, the spatiotemporal clustering would be compatible with an agent occurring at relatively high frequency, but with low disease conversion rates, such as silica inhalation (assuming sufficiently small particle size) or reaction to an infective agent. (Intern Med J 2005; 35: 228–233)
Clinical recognition of neurally mediated syncope
Authors: Hamer A. W. F. , Bray J. E.
Published: April 2005

Abstract

Background:  Most cases of syncope are due to hypotension, with a vasovagal response the commonest single mechanism. Neurally mediated syncope (NMS) is a vasovagal response evoked by common physical or psychological stress factors in susceptible individuals. Although upright tilt table testing (TTT) has been developed to diagnose this condition, the clinical recognition of this common syndrome in the general community remains poor.

Aims:  To evaluate the clinical presentation of patients with NMS and pre‐syncope, proven by TTT, and compare them to patients with syncope that have a low probability of having NMS (e.g. older patients with cardiac disease and negative TTT).

Methods:  Prospective evaluation by questionnaire at the time of TTT, including documentation of presenting symptoms and signs, and provoking factors in consecutive patients. Comparisons between patient groups analyzed using chi‐squared tests and logistic regression.

Results:  Neurally mediated syncope patients were more likely to present with both syncope and pre‐syncope, often with prolonged histories of pre‐syncope. Certain provoking stress factors were more common in NMS, with multiple factors often present. Most NMS patients had a hypotensive prodrome before syncope, whereas control patients had a higher incidence of syncope without warning.

Conclusion:  Neurally mediated syncope patients present with situational syncope that is not only stereotypical for the individual, but shares common features with other similar patients. While none of the clinical observations is unique to NMS, a carefully detailed history can elicit a convincing diagnostic pattern that can often obviate the need for extensive and expensive investigation, and in younger patients a TTT may not be required to make the diagnosis. (Intern Med J 2005; 35: 216−221)
Implementation of a split‐night protocol to improve efficiency in assessment and treatment of obstructive sleep apnoea
Authors: Elshaug A. G. , Moss J. R. , Southcott A. M.
Published: April 2005

Abstract

In Australia, unmet demand for sleep study services is resulting in protracted waiting lists and treatment delays for those in need. This present study gauged efficiency gains that could be achieved by implementing a split‐night protocol within the laboratory. Results demonstrate improved technical efficiency by at least 15%, reducing time to treatment for the most severe cases and increasing patient throughput within the clinic. With over 56 000 sleep studies carried out annually, this technique has significant utility in evidence‐based practice. (Intern Med J 2005; 35: 251–254)
Nickel mine spoils revegetation attempts: effect of pioneer plants on two functional bacterial communities involved in the N‐cycle
Authors: Héry Marina , Philippot Laurent , Mériaux Eve , Poly Franck , Le Roux Xavier , Navarro Elisabeth
Published: April 2005

Nickel mine spoils in New Caledonia represent an extreme environment, rich in nickel and strongly deficient in elementary elements such as carbon and nitrogen. To rehabilitate these sites, revegetation attempts are performed with endemic plant species establishing dinitrogen‐fixation symbiosis (Gymnostoma webbianum and Serianthes calycina). As this biological fixation process provides the major source of available nitrogen in this extreme environment, it could be expected that nitrogen cycling would be stimulated. To study the revegetation effect on mine spoils, the effect of the two pioneer plants on the structure and activity of two functional bacterial communities involved in the N‐cycle was investigated. nifH and narG genes were used as molecular markers for dinitrogen‐fixers and dissimilatory nitrate reducers respectively. In order to assess the influence of the plants on both communities, nine clone libraries were constructed for each targeted gene. Libraries containing 602 and 513 nifH and narG clones, respectively, were screened by restriction fragment length polymorphism (RFLP) analysis. One hundred and forty‐one and 78 representative clones from at least all RFLP families containing more than one clone were sequenced from nifH and narG clone libraries respectively. Both pioneer plants modified the diversity and activity of the two functional communities. However, distinct effects were observed depending on the plant species and the community considered. Serianthes calycina strongly selected a diazotroph phylotype and restored the potential activity of both communities. In contrast, G. webbianum selected no particular phylotype and only restored a fixing activity.
Genetic diversity of marine Synechococcus and co‐occurring cyanophage communities: evidence for viral control of phytoplankton
Authors: Mühling Martin , Fuller Nicholas J. , Millard Andrew , Somerfield Paul J. , Marie Dominique , Wilson William H. , Scanlan David J. , Post Anton F. , Joint Ian , Mann Nicholas H.
Published: April 2005

Unicellular cyanobacteria of the genus Synechococcus are a major component of the picophytoplankton and make a substantial contribution to primary productivity in the oceans. Here we provide evidence that supports the hypothesis that virus infection can play an important role in determining the success of different Synechococcus genotypes and hence of seasonal succession. In a study of the oligotrophic Gulf of Aqaba, Red Sea, we show a succession of Synechococcus genotypes over an annual cycle. There were large changes in the genetic diversity of Synechococcus, as determined by restriction fragment length polymorphism analysis of a 403‐ bp rpoC1 gene fragment, which was reduced to one dominant genotype in July. The abundance of co‐occurring cyanophage capable of infecting marine Synechococcus was determined by plaque assays and their genetic diversity was determined by denaturing gradient gel electrophoresis analysis of a 118‐bp g20 gene fragment. The results indicate that both abundance and genetic diversity of cyanophage covaried with that of Synechococcus. Multivariate statistical analyses show a significant relationship between cyanophage assemblage structure and that of Synechococcus. These observations are consistent with cyanophage infection being a major controlling factor in picophytoplankton succession.
Marine actinomycetes related to the ‘Salinospora’ group from the Great Barrier Reef sponge Pseudoceratina clavata
Authors: Kim Tae Kyung , Garson Mary J. , Fuerst John A.
Published: April 2005

Ten strains identified as marine actinomycetes related to the ‘Salinospora ’ group previously reported only from marine sediments were isolated from the Great Barrier Reef marine sponge Pseudoceratina clavata. The relationship of the isolates to ‘Salinospora’ was confirmed by phylogenetic analysis of 16S rRNA gene sequences. Colony morphology and pigmentation, occurrence and position of spores, and salinity requirements for growth were all consistent with this relationship. Genes homologous to β‐ketosynthase, an enzyme forming part of a polyketide synthesis complex, were retrieved from these isolates; these genes shared homology with other Type I ketosynthase genes, and phylogenetic comparison with amino  acid  sequences  derived  from  database β‐ketosynthase genes was consistent with the close relationship of these isolates to the actinomycetes. Primers based on 16S rRNA gene sequences and designed for targeting amplification of members of the ‘Salinospora’ group via polymerase chain reaction have been used to demonstrate occurrence of these actinomycetes within the sponge tissue. In vitro bioassays of extracts from the isolates for antibiotic activity demonstrated that these actinomycetes have the potential to inhibit other sponge symbionts in vivo, including both Gram‐negative and Gram‐positive bacteria.
Microbial diversity of benthic mats along a tidal desiccation gradient
Authors: Rothrock Michael J. , Garcia‐Pichel Ferran
Published: April 2005

We investigated the influence of desiccation frequency, indicated by tidal position, on microbial community structure, diversity and richness of microbial mats. We independently characterized cyanobacterial, bacterial and archaeal communities, and their spatial variability for two distinct microbial mat systems: subtidal hypersaline mats and intertidal sand flat mats. Community fingerprints based on 16S rDNA were obtained via denaturing gradient gel electrophoresis using polymerase chain reaction primers specific for each group. Fingerprints for all three groups were consistently similar [≥85% according to Weighted Pair Group with Arithmetic Mean (WPGMA) analysis] along a 1‐km‐long transect in subtidal mats. Here, pair‐wise comparison analysis yielded minimal variation in diversity and richness for all groups. Fingerprints of three sites along an intertidal transect were heterogenous (≥32% similarity according to WPGMA analysis) with clear shifts in community structure in all three microbial groups. Here, all groups exhibited statistically significant decreases in richness and diversity with tidal height (as desiccation frequency increases). Regression analysis yielded a strong correlation between diversity or richness estimates and position along the tidal gradient, for both Archaea and Bacteria, with Cyanobacteria exhibiting a weaker correlation. These results suggest that desiccation frequency can shape the structure of microbial mat communities, with Archea being least tolerant and Cyanobacteria most tolerant.
Quorum sensing: the power of cooperation in the world of Pseudomonas
Authors: Juhas Mario , Eberl Leo , Tümmler Burkhard
Published: April 2005

Work over the past few years has provided evidence that quorum sensing is a generic regulatory mechanism that allows bacteria to launch a unified, coordinated response in a population density‐dependent manner to accomplish tasks which would be difficult, if not impossible, to achieve for a single bacterial cell. Quorum sensing systems are widespread among pseudomonads and the one of the human opportunistic pathogen Pseudomonas aeruginosa belongs to the most extensively studied cell‐to‐cell communication systems. In this organism, quorum sensing is highly complex and is made up of two interlinked N‐acyl homoserine lactone (AHL)‐dependent regulatory circuits, which are further modulated by a non‐AHL‐related signal molecule and numerous regulators acting both at the transcriptional and post‐transcriptional level. This genetic complexity may be one of the key elements responsible for the tremendous environmental versatility of P. aeruginosa. Work of the past few years showed that quorum sensing is essential for the expression of a battery of virulence factors as well as for biofilm formation in P. aeruginosa and thus represents an attractive target for the design of novel drugs for the treatment of P. aeruginosa infections. Furthermore, the cell‐to‐cell communication ability was also demonstrated in a number of additional pseudomonads.
Ultrastructural Study of Encystation and Excystation in Acanthamoeba castellanii
Authors: CHÁVEZ‐MUNGUÍA BIBIANA , OMAÑA‐MOLINA MARITZA , GONZÁLEZ‐LÁZARO MÓNICA , GONZÁLEZ‐ROBLES ARTURO , BONILLA PATRICIA , MARTÍNEZ‐PALOMO ADOLFO
Published: April 2005

Abstract. Encystation and excystation of Acanthamoeba castellanii were studied by transmission electron microscopy. The differentiation process was induced in asynchronous cultures grown axenically. Cytoplasmic vesicles containing a dense fibrous material very similar in appearance to the cyst wall were observed in trophozoites induced to encyst. When these trophozoites were incubated with calcofluor white m2r, fluorescence was observed in cytoplasmic vesicles, suggesting that the material contained in these vesicles corresponded to cyst wall precursors. Semithin cryosections of mature cysts with the same treatment showed fluorescence in the ectocyst and a less intense fluorescence in the endocyst, suggesting the presence of cellulose in both structures of the cyst wall. In mature cysts induced to excystation, small structures very similar to electron‐dense granules (EDG) previously described in other amoebae were frequently observed. The EDGs were either sparsely distributed in the cytoplasm or associated with the cytoplasmic face of the plasma membrane. Many of them were located near the ostiole. In advanced phases of excystation, endocytic activity was suggested by the formation of endocytic structures and the presence of vacuoles with fibrous content similar to that of the cyst wall. Electron‐dense granules in the process of dissolution were also observed in these vacuoles. Furthermore, the formation of a pseudopod suggests a displacement of the amoeba toward the ostiole.
Electron Tomographic and Ultrastructural Analysis of the Cryptosporidium parvum Relict Mitochondrion, its Associated Membranes, and Organelles
Authors: KEITHLY JANET S. , LANGRETH SUSAN G. , BUTTLE KAROLYN F. , MANNELLA CARMEN A.
Published: April 2005

Abstract. Sporozoites of the apicomplexan Cryptosporidium parvum possess a small, membranous organelle sandwiched between the nucleus and crystalloid body. Based upon immunolabelling data, this organelle was identified as a relict mitochondrion. Transmission electron microscopy and tomographic reconstruction reveal the complex arrangement of membranes in the vicinity of this organelle, as well as its internal organization. The mitochondrion is enveloped by multiple segments of rough endoplasmic reticulum that extend from the outer nuclear envelope. In tomographic reconstructions of the mitochondrion, there is either a single, highly‐folded inner membrane or multiple internal subcompartments (which might merge outside the reconstructed volume). The infoldings of the inner membrane lack the tubular “crista junctions” found in typical metazoan, fungal, and protist mitochondria. The absence of this highly conserved structural feature is congruent with the loss, through reductive evolution, of the normal oxidative phosphorylation machinery in C. parvum. It is proposed that the retention of a relict mitochondrion in C. parvum is a strategy for compartmentalizing away from the cytosol toxic ferrous iron and sulfide, which are needed for iron sulfur cluster biosynthesis, an essential function of mitochondria in all eukaryotes.
Taxonomic Characterization of Two Marine Peritrichous Ciliates, Pseudovorticella clampi n. sp. and Zoothamnium pararbuscula n. sp. (Ciliophora: Peritrichia), from North China
Authors: JI DAODE , SONG WEIBO , AL‐RASHEID KHALED A. S. , LI LIFANG
Published: April 2005

Abstract. The morphology, infraciliature, and silverline system of two new peritrichous ciliates, Pseudovorticella clampi n. sp. and Zoothamnium pararbuscula n. sp., have been investigated based on both living and silver‐impregnated specimens. Partial sequence of 18S‐ITS1‐5.8S rDNA of Z. pararbuscula is also determined in order to compare it with the closely related congener, Zoothamnium arbuscula. Zoothamnium pararbuscula can be distinguished from its close form Z. arbuscula by the different habitats, the appearance of the main stalk, the position of the contractile vacuole, and the information derived from 18S‐ITS1‐5.8S rDNA sequence analysis. Pseudovorticella clampi n. sp. is distinguished from its congeners by its body shape and size, pellicle granules, habitat, and number of transverse silverlines.