bluuebunny/crossref_metadata_2025 huggingface dataset:
Service evaluation and development: experience of a paediatric disability team
Authors: Cass H. , Kugler B.
Published: March 2003

Classical audit frameworks encourage the use of audit cycles, with performance being evaluated against predefined quality targets and modified accordingly. This approach has obvious validity in clinical settings where treatments have very clear endpoints and outcome measures can be prioritized with ease. The situation becomes more complex in disability service settings, where the impact of clinical intervention is often qualitative rather than quantitative, and where management strategies are dependent on working in partnership with families, purchasers and other professional colleagues. There is thus a danger of neglecting aspects of service delivery which are of major importance to one sector of this extensive network.

To ensure that service goals and standards comprehensively reflect the specific concerns of all parties, it is proposed that measures of service quality should be defined within the context of a dynamic multi‐user framework. Development of such a framework is dependent on collating information on specific needs from parents, referrers, purchasers and other involved professionals, and determining areas of overlap, as well as areas of potential conflict. Audit techniques for key Issues can then be devised, alongside a timetable to revisit these issues at appropriate intervals.

Application of this approach is illustrated by reference to our own paediatric disability service.
Clumsiness, Dyspraxia and Developmental Co‐ordination Disorder: how do health and educational professionals in the UK define the terms?
Authors: Peters JM , Barnett AL , Henderson SE
Published: March 2003

At the turn of the century, the idea that there might be a discrete childhood syndrome, which had ‘clumsiness’ of movement as its defining symptom, began to emerge. Since then numerous labels have been applied to the syndrome. In spite of recent attempts to standardise the terminology used, variation continues to compromise inter‐professional communication and interpretation of research. The aim of this study was to determine how the three terms ‘Clumsy’, ‘Dyspraxia’ and ‘Developmental Co‐ordination Disorder (DCD)’ are viewed by health and educational professionals in the UK. Two hundred and thirty‐four adults (57% from the health professions and 43% from education) provided a written definition of each term. Content analysis of the 702 definitions was used to determine: (1) the extent to which the terms were familiar/acceptable to the respondents; and (2) to capture differences in the meaning of the term being defined. The results indicated that the terms ‘DCD’ and ‘Dyspraxia’ were less familiar than the term ‘clumsy’ which was, however, least acceptable. Amongst those professionals who were familiar with all three terms, there was general agreement that all were used to describe some sort of overall movement difficulty. Beyond that point, divergence of understanding and inter‐professional differences in emphasis emerged. The implications of these differences for clinical and educational practice, research and policy making are discussed.
Children with sialorrhoea in the absence of neurological abnormalities
Authors: Johnson Hilary , King Jane , Reddihough Dinah S.
Published: March 2003

Objective To study the outcome of 21 typically developing children who had been referred to the Saliva Control Clinic at the Royal Children’s Hospital, Melbourne.

Method Information was collected on various aspects of the child’s health, oromotor function and severity of drooling. A follow‐up telephone survey was completed by the parents of these children after a mean period of 3.4 years. Information was gathered regarding their child’s drooling, current health, oromotor status and the usefulness of the clinic.

Results There was a statistically significant improvement (P< 0.01) in the saliva control measures analysed on follow‐up. Thirteen children ceased to drool, three still drooled occasionally, and five continued to drool. The recommendations, mainly advice and referrals to other health professionals, were generally reported to be helpful by the parents.

Conclusions This cohort of children was established retrospectively, and the study is therefore limited in both numbers and design. The results indicate that some typically developing children may be delayed in the development of saliva control. Parents and professionals can be reassured that this problem is likely to resolve.
Early rehabilitation service utilization patterns in young children with developmental delays
Authors: Majnemer A. , Shevell M.I. , Rosenbaum P. , Abrahamowicz M.
Published: March 2003

Objective
There is a growing demand for interdisciplinary rehabilitation services for children with developmental disabilities, however, information is lacking on service utilization patterns. This study describes the type, frequency and location of initial rehabilitation services provided to young children recently diagnosed with a developmental delay.

Methods
A telephone survey was conducted on a consecutive cohort of children referred to subspecialists for the first investigation of their delay.

Results
Out of 129 respondents, only 30 (23%) did not receive any rehabilitation services within the first 6 months following medical evaluation, and 61 (47%) received two or more services. Services were provided most frequently in the hospital setting, especially for occupational or physical therapy (73–80%). Services were less often rendered in a rehabilitation centre (5–13%) or in the community (< 10%). Services were provided privately for a subset, particularly for speech language pathology and psychology (34% and 30% respectively). Interventions were typically given weekly or bi‐weekly. Children receiving physical therapy were significantly younger whereas children referred to speech language pathology were older than the age of our cohort at intake. Overall, parents’ educational level did not influence services received with the exception of private services, which were more likely to occur in children of fathers with university education.

Conclusions
The findings would suggest that long waiting times and lack of resources may limit access to comprehensive services, particularly in community settings. Service utilization patterns were not consistent within types of developmental disability, suggesting that formal and co‐ordinated interdisciplinary programmes are not in place for this population of interest.
Disability in children from different ethnic populations
Authors: Morton R. , Sharma V. , Nicholson J. , Broderick M. , Poyser J.
Published: March 2003

We report on the prevalence of severe neurodisability in children in the Southern Derbyshire Health Authority from different ethnic groups. Information was obtained from the health records of children at the Child Development Centre (CDC), and analysed according to ethnic group. There were 53 in the Pakistani group, 20 in the Indian group and 764 in a mixed group, of which 95% were of European origin. It was estimated that all children with severe disability in the area of the Health Authority had notes at the CDC, except for 10% of the mixed group living on the periphery. The numbers of children with different disabling conditions were recorded, together with a measure of the level of individual disability; the ‘Disability Scores’. We also noted if the condition was genetic or chromosomal in origin. Pakistani children showed a higher prevalence than the other groups of severe learning disorder, severe and profound hearing loss and severe visual problems. They also had a slightly increased prevalence of autism and cerebral palsy. Conversely, they showed a lower prevalence of language disorder. Disability scores for Pakistani children attending the CDC were higher than for other groups. Genetic disease causing disability was 10 times more common in the Pakistani children than other ethnic groups. Disability is more common in Pakistani children probably as a result of the cultural practice of consanguineous marriages. This community needs special help for disabled children, and their families, for general support and appropriate genetic counselling.
The recruitment and training crisis in community paediatrics: what do registrars think?
Authors: Reading R. , Surridge H. , Steel S. , Sansome A.
Published: March 2003

Objective There is currently a crisis in the recruitment of trainees into community paediatrics. Focus groups were conducted to explore the views of paediatric specialist registrars about this crisis.

Design A total of 18 registrars participated in two focus groups. Data were analysed qualitatively by content analysis.

Results The overriding theme was the poor status and image of community compared with acute paediatrics. This existed at five levels, which could be arranged from a ‘macro’ structural level down to a ‘micro’ individual level. These were: the hospital/community divide, issues related to training, practical experience, the influence of role models, and personal factors.

Conclusions We identified several specific implications for community paediatric training. However, the deep divide between acute and community paediatrics, as perceived by registrars, is unlikely to change unless training programmes are designed to produce paediatricians suited to the needs of future child health services rather than existing models of acute and community paediatricians.
Dissimilarity in adolescent and maternal representations of Type 1 diabetes: exploration of relations to adolescent well‐being
Authors: Law G. Urquhart
Published: March 2003

Purpose

To compare the illness representations of adolescents with Type 1 diabetes and their mothers, and to explore how congruence and incongruence influences adolescent psychological adjustment.

Methods

A total of 30 adolescents (13–19 years) with Type 1 diabetes completed self‐report questionnaires of illness representations and psychological well‐being; 26 mothers completed the illness representation questionnaire.

Results

t‐Test and correlation analyses showed convergence on the majority of the illness representation dimensions with maternal representations differing significantly on only two dimensions: perceiving their adolescent's diabetes to have more serious consequences and to have a greater emotional impact. Computation of dissimilarity scores between mothers and adolescents, showed mothers to maximize the seriousness of diabetes across several dimensions, but no significant associations were found with adolescent psychological well‐being.

Conclusions

Chronic illness in children and young people exists in a social context and the management of diabetes requires an ongoing supportive relationship between parent and child. The results show a high degree of consistency in the beliefs adolescents and their mothers hold, and such congruence is presumed to benefit psychological well‐being. However, the mediators and moderators for family belief processes are unclear and several possibilities are discussed.
Immune‐reactivity of recombinant isoforms of the major house dust mite allergen Der p 2
Authors: Hakkaart G. A. J. , Chapman M. D. , Aalberse R. C. , Van Ree R.
Published: March 2003

Background

Recombinant Der p 2, expressed in yeast, lacked reactivity with 5 monoclonal antibodies against natural Der p 2.

Objective

The aim of this study was to investigate whether the lack of reactivity with recombinant Der p 2 can be explained by the existence of isoforms.

Methods

By site‐directed mutagenesis three recombinant isoforms of Der p 2 were produced. Reactivity with monoclonal antibodies and human IgE was analysed by means of RAST and RAST‐inhibition.

Results

All five monoclonals that lacked reactivity with the originally selected isoform, showed reactivity upon replacement of aspartic acid by asparagine at position 114. The other two substitutions (at position 26 and 47) had no effect. Binding of human IgE (n = 10) was not significantly influenced by the isogenetic variation at position 114.

Conclusions

Monoclonal antibodies raised against natural Der p 2 can sometimes discriminate between different isoforms, allowing the study of the natural occurrence of isoforms. For application in allergen‐measurement assays, non‐discriminating monoclonal antibodies should be selected.
Changes in CD23 expression of blood and skin in atopic eczema after Chinese herbal therapy
Authors: Banerjee  , XU X.‐J. , Poulter  , Rustin
Published: March 2003

Background

Aberrant expression of CD23 (low affinity IgE receptor) on cells of the monocyte/macrophage series in peripheral blood and lesional skin of patients with atopic eczema has been demonstrated. It is not known whether this abnormality results from a fundamental systemic problem of the monocytes of these patients or reflects local changes to cell populations within the skin tissues.

Objectives

This study was designed to determine whether this aberrant expression was caused by local cutaneous influences on mature cells or fundamental changes in monocyte differentiation. The possible relationship between these aberrations and clinical severity was also investigated by repeating these immunopathological studies after a course of efficacious treatment with Chinese herbal therapy (CHT).

Methods

Peripheral blood mononuclear cells were obtained from patients with atopic eczema before, and after 8 weeks of treatment. Efficacy of CHT was quantified on clinical grounds. Monocytes were isolated by adherence to plastic and cultured for up to 7 days. Samples were harvested at 2, 5 and 7 days of culture and cytospins prepared. Immunocytochemical staining to identify phenotypic subsets was performed on the monocytes at time 0 and on maturing cells from culture. This immunocytology was quantified using computerized image analysis equipment to determine the emergence of macrophage subsets and their level of CD23 expression. Biopsies were taken from lesional skin before and after treatment and immunohistology was performed on cryostat sections to determine the number of antigen presenting cells expressing CD23 as well as the level of expression of these molecules.

Results

The results showed that increased numbers of monocytes from patients with atopic eczema express CD23 at day 0 and that cultured monocytes from these patients differentiate faster during the 7 day culture period as compared to normal controls. Efficacious treatment did not affect the number of peripheral blood monocytes expressing CD23. However, treatment did lead to a significant decrease in the number of CD23+ mature macrophages in the skin as well as a reduction in the level of expression of this moiety. These results demonstrate that changes in clinical severity are more closely related to the expression of CD23 on mature antigen presenting cells in lesional skin rather than to differentiating peripheral blood monocyte CD23 expression.

Conclusions

These results suggests that local factors within lesional skin govern the accumulation and the expression of CD23 on mature macrophages and that these factors may be more relevant to the pathogenesis of the disease than aberrations in CD23 expression that may occur systemically.
Exposure–response relationships of occupational inhalative allergens
Authors: Baur  , Chen  , Liebers
Published: March 2003

Only a few threshold limit values exist at present for allergens in the workplace known to cause bronchial asthma. This contrasts with the great number of occupational asthma cases observed in industrialized countries. Recently published studies provide clear evidence for exposure intensity response relationships of occupational allergens of plant, microbiological, animal or man‐made origin. If allergen exposure levels fall short of determined limit values, they are not associated with an increased risk of occupational asthma. Corresponding data are available for wheat flour (1–2.4 mg/m3), fungal α‐amylase (0.25 ng/m3), natural rubber latex (0.6 ng/m3), western red cedar (0.4 mg/m3) and rat allergens (0.7 μg/m3). It is suggested to stipulate legally binding threshold limit values (TLV/TWA) on this basis in order to induce more effective primary preventive measures. If no reliable data on the health risk of an occupational airborne noxa exist, the lowest reasonably practicable exposure level has to be achieved. Appropriate secondary preventive measures have to be initiated in all workplaces contaminated with airborne allergens. Verified exposure–response relationships provide the basis for risk assessment and for targeted interventions to reduce the incidence of occupational asthma also in consideration of cost benefit aspects. ‘Occupational asthma is a disease characterized by variable airflow limitation and/or airway hyperresponsiveness due to causes in a working environment. These causes can give rise to asthma through immunological or non‐immunological mechanisms [
1]. Up to 15% of all asthma cases are of occupational origin or have at least a significant causal occupational factor [
1–10]. According to the New Zealand part of the European Respiratory Health Survey, an increased risk of asthma prevalence was found for several occupations such as laboratory technicians, food producers, chemical workers, plastic and rubber workers [
11]. The Spain part of this study comprising 2646 Spanish subjects showed an asthma risk to be attributed to occupational exposures between 5 and 6.7% [
12]. Main asthma‐inducing agents in the workplace are flour, grain and feed dust, animal dander/urinary proteins and isocyanates. Further, several inhalative irritants such as chlorine, acid or alkaline aerosols play a pivotal role. Many low molecular weight chemicals have irritative as well as allergenic effects on the airways, e. g. isocyanates and acid anhydrides. In addition to chronic or repetitive exposures, also singular accidental exposure to high concentrations of irritative or toxic airborne substances can cause occupational asthma. This condition is frequently called reactive airways dysfunction [
13].
Neutrophil infiltration and release of IL‐8 in airway mucosa from subjects with grain dust‐induced occupational asthma
Authors: Park  , Jung  , Hwang  , Nahm  , Yim
Published: March 2003

Background

The immuno‐pathological mechanism for occupational asthma induced by grain dust (GD) remains to be clarified. There have been few reports suggesting the involvement of neutrophils inducing bronchoconstriction after inhalation of GD.

Objective

To further understand the role of neutrophil in the pathogenesis of GD‐induced asthma.

Materials and methods

We studied the phenotype of leucocytes of the bronchial mucosa in patients with GD‐induced asthma. Bronchial biopsy specimens were obtained by fibreoptic bronchoscopy from six subjects with GD‐induced asthma. Six allergic asthma patients sensitive to house dust mite were enrolled as controls. Bronchial biopsy specimens were examined by immunohistochemistry with a panel of monoclonal antibodies to tryptase‐containing mast cell (AA1), activated eosinophil (EG2), pan T‐lymphocyte (CD3) and neutrophil elastase (NE). Induced sputum was collected before and after the GD‐bronchoprovocation test. The IL‐8 level in the sputum was measured using ELISA.

Results

There was a significant increase in the number of AA1+ and NE+ cells in bronchial mucosa of GD‐induced asthma, compared with those of allergic asthma (P = 0.01, P = 0.01, respectively). No significant differences were observed in the number of EG2+ and CD3+ cells (P = 0.13, P = 0.15, respectively). IL‐8 was abundant in the sputum of all GD‐induced asthma patients and significantly increased after the bronchial challenges compared with the baseline value (P = 0.03).

Conclusion

These findings support the view that neutrophil recruitment together with mast cells may contribute to the bronchoconstriction induced by GD. A possible involvement of IL‐8 was suggested.
Determinants of dust mite allergen concentrations in infant bedrooms in Tasmania
Authors: Couper  , Ponsonby  , Dwyer
Published: March 2003

Background

High exposure to house dust mite allergen during the first year of life has been found to increase the risk of subsequent asthma and mite sensitization. Environmental factors, home construction and cleaning methods used are associated with levels of dust mites in the home.

Objective

To investigate determinants of levels of Der p 1 and Der f 1 mite allergens in homes of infants in southern Tasmania.

Methods

Dust samples were collected from 72 homes of infants participating in the Tasmanian Infant Health Survey (TIHS). The Der p 1 and Der f 1 allergen concentrations in these samples were measured. The TIHS interviewers obtained information from the mothers of the infants via a questionnaire, observed specified aspects of the home environment, and took readings of bedroom temperature and humidity. The effect of each item on allergen concentration in dust from bedroom floors was examined in a variety of ways. Those items which in this study appeared to be significantly related to allergen concentrations plus items which in other studies have been found to be related to allergen concentrations were then investigated further in multivariate models.

Results

Der p 1 allergen concentration (μg/g) and density (μg/m2) in dust from bedroom floors were found to be related to several home environment factors. In the univariate analyses, indoor humidity, 24 h maximum temperature, number of residents and a combination of floor covering and cleaning methods appeared to have a significant effect on allergen levels. These factors remained important in the multivariate model except that indicators for mould in the bathroom and drying washing on an outside line replaced indoor humidity.

Conclusion

Features related to home dampness, the number of residents and floor covering and cleaning were major determinants of Der p 1 levels in the bedrooms studied.
A new collection method for the evaluation of nasal mucus proteins
Authors: Ruocco  , Fattori  , Romanelli  , Martelloni  , Casani  , Samolewska  , Rezzonico
Published: March 2003

Background

Different sampling techniques for collecting nasal mucus have been used. The eosinophil and its granule toxin proteins, especially the eosinophil cationic protein (ECP), is an important inflammatory cell.

Objective

In the healthy subjects (with no acute or chronic disease of the respiratory tract), no detailed quantitative data on mucus nasal proteins have been reported, so the aim of the study is to demonstrate a simple and reliable method for the collection of nasal mucus and for measuring nasal ECP.

Methods

Our method consists in collecting two specimens of mucus from each nasal fossa, using a square of sterile pre‐humidified gauze, centrifuged at 2000 
g for 20 min and stored at −20°C until tested. To evaluate the reproducibility of the technique, 30 healthy subjects were retested after 24 h.

Results

The amounts of secretion gathered in the 89 collections did not show any statistical difference between the sexes. In the pooled subjects (n = 59), the mean levels of ECP were 108 ng/mL and 325 ng/g and total protein (TP) levels were 701 mg/dL and 2.5 mg/g (expressed in absolute concentration and concentration related to the weight in grams). In the classes, according to age, no statistical differences were found on analysis of the groups by: sex, recovery rate, and ECP and TP concentrations. The Reproducibility Index was very good for the recovery rate (0.78), ECP (ng/mL = 0.95, ng/g = 0.83) and TP (mg/dL = 0.89, mg/g = 0.76).

Conclusion

With our method, the sample collections were taken with minimal stimulation of the mucosa and it was well tolerated by the subjects; the low known dilution factor is also adequate for analysing small quantities of mucus recovered, and the protein concentration can be measured as an absolute value.
Anaphylactic reaction to ingestion of Quercus ilex acorn nut
Authors: Vega  , DomÍnguez  , Cosmes  , MartÍnez  , BartolomÉ  , MartÍnez  , Palacios
Published: March 2003

Background

A patient experienced an anaphylactic reaction after eating acorn nuts, fruit of the holm oak (Quercus ilex), one of the most abundant trees in Spain. Several urticaria episodes upon ingestion of peanuts were also referred.

Objective

To assess the hypersensitivity reaction to acorn and to characterize the allergenic proteins involved.

Methods

Cutaneous tests were performed using the skin‐prick technique, using a large variety of grass, tree and weed pollens as well as fresh nuts and nut extracts. Specific IgE determination was assessed by RAST. IgE binding bands were determined by SDS‐PAGE immunoblotting.

Results

Skin‐prick tests were strongly positive with acorn and peanut. Olea europaea, Quercus alba, Quercus ilex and grass pollens also elicited a weal higher than negative control. Patient serum had measurable levels of IgE antibodies especially to acorn, peanut and grass pollens. Only one protein band, of 17.9 kDa molecular mass, showed IgE‐binding properties in the acorn extract. The possible homology of this strong allergenic protein with the group 1 tree pollen allergens was evidenced by the partial inhibition of the western blot with Bet v 1.

Conclusions

We present a case of anaphylaxis to acorn ingestion as demonstrated by in vivo and in vitro results. A 17.9 kDa IgE‐binding band, showing some homology to group 1 pollen tree allergens, was recognized by patient serum.
Circulating cat allergen and immune complexes in cat‐ allergic children
Authors: Casas  , Djerf  , HÄggstrÖM  , FerrÁndiz  , BJÖrkstÉN
Published: March 2003

Background

The first encounters with allergens seem to influence the development of allergy. Food antigens have been detected in sera as free antigens and in complexes with IgG but less is known about the presence of inhalant allergens.

Objective

To investigate the presence of the major cat allergen Fel d 1, either as free allergen and/or in complexes with IgG and IgE antibodies in sera from atopic children.

Methods

Serum samples from 33 cat allergic asthmatic children, 7–17 years old, and 15 non‐allergic controls were investigated for the presence of Fel d 1 by ELISA (detection limit 0.13 μg/L). To detect immune complexes (IC), the IgG fraction from Fel d 1 positive sera was purified by affinity chromatography. Purified and non‐absorbed material was then analysed for allergen content and specific IgG antibody levels. Immune complexes with Fel d 1 IgE were detected by coupling anti‐Fel d 1 MoAb to paramagnetic particles.

Results

Fel d 1 was detected (0.15–1.8 μg/L) in 23 of the 33 patients (70%) but not from any of the controls. Eighteen samples contained IgE‐Fel d 1 IC and two of four tested samples contained Fel d 1 in the IgG fraction. Electrophoresis and Western blotting of IgG purified material using anti‐Fel d 1 MoAb corroborated the presence of IgG‐Fel d 1 IC.

Conclusion

Free‐circulating inhalant allergen and IC with allergens may contribute to maintaining immune responsiveness and sensitivity.
Serological characteristics of peanut allergy
Authors: Clarke  , Kilburn  , O'B. Hourihane  , Dean  , Warner  , Dean
Published: March 2003

Background

Peanut is the most common cause of severe or fatal food‐associated anaphylaxis. Studies indicate that peanut extracts contain many allergenic proteins. The identification of major and minor allergenic components is necessary for standardization of experimental and diagnostic extracts.

Objective

To identify further major and minor allergenic components of peanut extract using a large population of peanut allergics, and to relate serological findings to clinical parameters.

Methods

The crude peanut extract was fractionated by fast protein liquid chromatography and the IgE binding proteins identified by sodium dodecyl sulphate polyacrylamide gel electrophoresis followed by western blotting. Serum from 89 peanut allergics with a positive history of peanut allergy and elevated specific IgE and control serum from four atopic and four non‐atopic, non‐peanut allergics were used.

Results

Nineteen peanut proteins were found to bind IgE from peanut allergic sera. Over 70% of subjects reacted to protein bands of 63 and 17 kDa (consistent with Ara h 1 and Ara h 2, respectively), confirming the importance of these two proteins as major allergens. A high proportion of patient sera also bound proteins at 15, 10, 30, 18 and 51 kDa in decreasing order. The percentage of cases with sensitivity to a 15 kDa protein was found to be higher in patient groups with severe reactions to peanut.

Conclusion

This study highlights the diversity of peanut allergens. Diagnostic extracts containing a high proportion of the 15 kDa component may aid in diagnosis.
Genetics of complex human diseases: genome screening, association studies and fine mapping
Authors: Xu  , Wiesch  , Meyers
Published: March 2003

Positional cloning has been applied successfully to many Mendelian disorders. Because of the public health significance, there is strong interest in mapping susceptibility genes for common disorders, such as asthma and allergy, that have a genetic component. Genome‐wide screening has been very useful in detecting regions of the genome likely to contain susceptibility genes. There are multiple chromosomal regions implicated in asthma and now the difficult process of finding the genes and relevant mutations is underway. Two approaches that are being utilized are those of association studies in candidate genes, and haplotype sharing or identical by descent (IBD) mapping. Although these are useful approaches, it is important to realize the strengths and limitations of each. The level of significance needed for an initial study or a replication study should be considered in light of the prior evidence for studying a specific gene polymorphism. Haplotype‐sharing approaches, although difficult to use in outbred heterogeneous populations, may provide important insight into fine mapping and gene localization.
Are chronic obstructive pulmonary disease (COPD) and asthma different diseases?
Authors: Magnussen  , Richter  , Taube
Published: March 2003

In the past it has been hypothesized that asthma and chronic obstructive pulmonary disease (COPD) are related diseases. As both show high prevalences and as smoking may occur in both groups of patients the simultaneous presence of both diseases in the same subject may well occur. The most characteristic features of asthma are short‐term changes in airway caliber, reversible airflow limitation, bronchial hyperresponsiveness as well as eosinophilic and lymphocytic airway inflammation. The common definition of COPD implies long‐term changes in airway calibre, less or irreversible airflow obstruction, no or less common bronchial hyperresponsiveness and neutrophilic airway inflammation. By analysing the results of epidemiology, risk factors, airway morphology, lung function and markers of airway inflammation in both diseases, it becomes clear that asthma and COPD share some similarities. However, their pathological presentations differ considerably and this provides evidence that the two syndromes are, in fact, different diseases. Furthermore, the analysis of data on lung volumes, diffusion capacity and aerosol‐derived airway morphology shows important differences between asthma and COPD. It is suggested that the specific type of airway inflammation in both diseases is responsible for the peculiar pattern of lung function abnormalities.
What can we learn from murine models of asthma?
Authors: VARGAFTIG B.B.
Published: March 2003

Even though a complex disease such as asthma does not have a comprehensive animal model, some characteristics can be duplicated in mice and guinea‐pigs. The murine model offers advantages with respect to strain control and availability of molecular biology tools. We introduced the use of the BP2 ‘Biozzi’ mice, which have high IgE titres and expresses bronchopulmonary hyperresponsiveness (BHR) after a single antigenic provocation. BHR is accompanied by airway sequestration of lymphocytes and eosinophils, and by a newly described IgE‐bearing granulocyte, identified to basophils. The murine model permits studies for cellular and molecular biology and to investigate the mode of action of drugs.
Interaction of viral infections with muscarinic receptors
Authors: Jacoby D. B. , Fryer A. D.
Published: March 2003

Both in humans and in experimental animals, much of the airway hyperresponsiveness that accompanies viral infections is the result of increased reflex bronchoconstriction. The M3 muscarinic receptors on the airway smooth muscle function normally during viral infections so that the direct effects of acetylcholine on the smooth muscle are not altered. In contrast, the M2 muscarinic receptors on the vagal nerve endings, which normally inhibit acetycholine release, are markedly dysfunctional during viral infections. This leads to substantial increases in acetylcholine release and potentiated reflex bronchoconstriction. Multiple mechanisms account for virus‐induced M2 receptor dysfunction. Viral neuraminidase may deglycosylate the M2 receptor, decreasing acetylcholine affinity. Furthermore, both viruses and interferon‐γ decrease M2 receptor gene expression. Finally, in atopic hosts, viral infection causes M2 receptor dysfunction by activating eosinophils, causing them to release major basic protein which binds to the M2 receptor, functioning as an endogenous antagonist.
The role of interleukin‐5, interleukin‐8 and RANTES in the chemotactic attraction of eosinophils to the allergic lung
Authors: Lampinen  , Rak  , Venge
Published: March 2003

Background

Bronchoalveolar lavage (BAL) fluid from patients with birch‐pollen allergy lavaged during the season showed an elevated chemotactic activity for eosinophils compared with BAL fluid from the same patients before the start of the season.

Aim

The aim of this study was to identify the eosinophil chemotactic agents in the BAL fluid, to compare these findings with in vitro studies on selected cytokines, and to investigate the interactions between these cytokines.

Methods

Neutralizing antibodies for interleukins (IL) ‐2, ‐5 and ‐8, RANTES and leukaemia inhibitory factor (LIF) were added to the BAL fluid, and the chemotactic activity was tested with eosinophils from allergic donors. Eosinophils from healthy donors were preincubated with IL‐5 in order to mimic the primed state of eosinophils from allergics, and the migration towards recombinant IL‐5, IL‐8, and RANTES in different combinations was measured. Eosinophils from allergic donors were also used.

Results

Anti‐IL‐5, anti‐IL‐8 and anti‐RANTES inhibited the chemotactic activity in the BAL fluid. Recombinant RANTES induced migration, which was enhanced by preincubation of the cells with IL‐5. Only eosinophils from symptomatic allergics responded to IL‐8, and IL‐5 was not sufficient to prime normal eosinophils in vitro to an IL‐8 response. A negative correlation was found between the level of in vivo activation of the cells and their response to IL‐5, and a positive correlation with the response to RANTES.

Conclusion

IL‐8 and RANTES are important for eosinophil accumulation to the lung of pollen‐allergic asthmatics. IL‐5 alone may not be responsible for the priming of eosinophils in vivo, but is an essential cofactor for the other chemoattractants.
Bronchial eosinophilic infiltration in Crohn's disease in the absence of pulmonary disease
Authors: LOUIS  , LOUIS  , SHUTE  , LAU  , FRANCHIMONT  , LAMPROYE  , RADERMECKER  , DJUKANOVIC  , BELAICHE
Published: March 2003

Background

Immunological and functional bronchopulmonary abnormalities may be present in up to two‐thirds of patients with Crohn's disease. Having recently described a mild increase in methacholine airways responsiveness in these patients, we investigated whether this physiological abnormality is associated with bronchial inflammation since it has previously been described in asthma.

Methods

Eighteen patients with Crohn's disease and 15 healthy controls matched for age, atopy and smoking habit, were studied. All the subjects underwent a bronchial methacholine challenge (1, 4 and 16 mg/mL) and a sputum induction by inhalation of hypertonic saline (NaCl 4.5%). The sputum samples were analysed for their cellular composition as well as for the levels of several mediators and proteins in the fluid phase, including eosinophil cationic protein (ECP), myeloperoxydase, albumin, α2‐macroglobulin, interleukin‐8 (IL‐8), IgA and IL‐8/immunoglobulin A complexes.

Results

When compared to control subjects, patients with Crohn's disease had significantly higher sputum eosinophil counts (14.5% [0–79.9%] vs 0.2% [0–2.3%]; P < 0.001) and ECP levels (26.2 μg/L [4–124.2 μg/L] vs 9.8 μg/L [0–94.2 μg/L]; P < 0.05). However, patients with Crohn's disease had no sign of increased plasma exudation as reflected by sputum levels of albumin and α2‐macroglobulin similar to those seen in control subjects. Furthermore the sputum levels of IL‐8, IgA and IL‐8/IgA complexes were not significantly different between the two groups. The magnitude of the fall in forced expiratory volume in 1 s after methacholine inhalation was significantly increased in Crohn's disease patients although it did not correlate with the extent of sputum eosinophilia or with the sputum ECP levels.

Conclusions

Crohn's disease patients without any clinical respiratory involvement have airway eosinophilia without local increased plasma exudation. However, bronchial eosinophilia in Crohn's disease per se is not sufficient to induce clinically significant airway hyperresponsiveness, suggesting that other factors than bronchial eosinophilic infiltration are required for the clinical expression of an airway instability.
Allergy to complex salts of platinum in refinery workers: prospective evaluations of IgE and Phadiatop® status
Authors: CALVERLEY  , REES  , DOWDESWELL
Published: March 2003

Background    Experience has shown some variation in the associations between IgE, atopy, and sensitization to platinum salts. Clarification of these associations, and the value of the parameters in predicting and diagnosing sensitization of workers at risk, required prospective investigation. Objectives    Evaluation of total IgE and Phadiatop® status to establish baseline values, and changes during employment, predictive or associated with subsequent platinum salt sensitization. Methods    A 24‐month prospective study, in a South African primary platinum refinery, of a cohort of 78 healthy recruits without evidence of atopy (tested negative to skin prick test with common allergens). Subsequently they were categorized as 22 sensitized (positive skin prick test to platinum salts), 46 not sensitized (negative skin prick test and symptom free), and 10 symptomatic subjects not included in either category. Results    (1) Pre‐employment: four (18%) of the subsequently sensitized subjects and eight (17%) not sensitized were Phadiatop® positive. Levels of total IgE > 100 kU/L, present in 16 subjects were associated with positive Phadiatop® status and race. (2) During employment: Phadiatop® status converted from negative to positive in more sensitized (12/18) than unsensitized (6/38) subjects (P ≤ 0.0001). Total IgE levels at outcome had increased in more sensitized subjects, and median levels were higher than in unsensitized subjects (17 (77%) vs six (13%), and 92 vs 26 kU/L, P = 0.0015). Multivariate analysis showed the likelihood of an increase in total IgE was nine times greater in subjects sensitized to platinum salts, and five times greater with higher platinum salt exposure. Specific IgE was demonstrated, generally in only one sample of the series, in two sensitized and three unsensitized subjects. Positive responses to skin prick tests with common allergens occurred in five (23%) sensitized and 11 (24%) unsensitized subjects. Conclusion    Platinum salt sensitivity was not predicted by pre‐employment Phadiatop® or IgE status, but was subsequently associated with conversion to positive Phadiatop® status, and an increase in total IgE (independent of Phadiatop® status).
Specific immunoglobulin E to peanut, hazelnut and brazil nut in 731 patients: similar patterns found at all ages
Authors: Pumphrey  , Wilson  , Faragher  , Edwards
Published: March 2003

Background

Previous studies have reported reactions to an increasing range of nuts as patients with nut allergy grow older. Most patients with symptoms suggesting nut allergy have specific IgE to more than one nut. Furthermore, fatal reactions have followed eating nuts different from any causing the deceased's previous reactions.

Objective

To explore the pattern of specific IgE to three distantly related nuts in patients of all ages with nut allergy.

Methods

This study includes all patients referred to our laboratory for nut allergy testing from January 1994 to August 1998 who were tested for peanut, hazelnut and brazil nut, and had specific IgE to at least one of these nuts. All tests were performed using the Pharmacia Unicap system.

Results

Seven hundred and thirty‐one patients (age 7 months to 65 years, median 6.6 years) had specific IgE > 0.35 kUA/L to at least one of these three nuts: 282 had IgE to one nut, 130 to two nuts, and 319 to all three nuts. When analysed by gender and age quartile, very similar patterns were found in all subgroups though significant age trends and age interactions were found for IgE to individual nuts and combinations of nuts.

Conclusions

The probability of a patient with nut allergy having specific IgE to a particular combination of peanut, hazelnut and brazil nut is similar, whatever their age or sex. The apparent increase in multiple nut reactivity with increasing age may therefore be due to exposure of previously unchallenged sensitivity. The frequency of multiple‐nut specificity is sufficiently high that patients should always be tested for allergy to a range on nuts if they have a history of reacting to any nut.
Possible influences of Staphylococcus aureus on atopic dermatitis — the colonizing features and the effects of staphylococcal enterotoxins
Authors: Morishita  , Tada  , Sato  , Toi  , Kanzaki  , Akiyama  , Arata
Published: March 2003

Background

Heavy colonization of atopic dermatitis (AD) with Staphylococcus aureus is well documented. This phenomenon suggests that S. aureus in AD lesions influences the disease processes of AD.

Objective

We describe the importance of the presence of S. aureus and staphylococcal enterotoxins A and B (SEA, SEB) in AD lesions.

Methods

We investigated the colonizing features of S. aureus in AD lesions using electron microscopy, the distribution of SEB in the eczematous skin of AD using immunofluorescence, the effects of SEA and SEB on normal human epidermal keratinocytes in organ culture, and the presence of specific IgE antibodies to SEA and/or SEB in serum of AD patients by enzyme immunoassay.

Results

S. aureus in AD lesions colonized on and in the horny layers of the eczematous skin. SEB produced by S. aureus was distributed mainly on the dermal‐infiltrated cells, especially on eosinophils. SEA and SEB stimulated expression of ICAM‐1 and HLA‐DR in normal human keratinocytes. More than half of the AD patients in the present study had specific IgE antibodies to SEA and/or SEB in their serum.

Conclusion

S. aureus and SEs have important roles in the exacerbation and prolongation of AD.
Sensitization to cat without direct exposure to cats
Authors: CHAN‐YEUNG  , MCCLEAN  , SANDELL  , SLUTSKY  , ZAMEL
Published: March 2003

Background

Allergy to pets, particularly cats, is one of the most important determinants of asthma and asthma‐like symptoms in many parts of the world. Cat allergen is found in homes and public places without cats.

Objective

The purpose of the study is to investigate the prevalence of sensitization to cat on the island of Tristan da Cunha where cats have been eliminated since 1974.

Methods

A cross‐sectional survey was conducted in 1993 on all residents on the island including allergy skin testing. Dust samples were collected from 20 homes on the island for measurement of house dust mite and cat allergens.

Results

Positive skin test reaction to cat was present in 57 (20.1%) of all islanders and in six (12.8%) of those born in or after 1975, 1 year after cats had been exterminated. Five of these six residents were born within 5 years of extermination of cats; two of these had attended school outside the island. A low level of cat allergen (Fel d 1) was found in only one out of 20 homes even though house dust mite allergens (Der p 1 or Der f 1) were found in all homes.

Conclusion

Sensitization to cat allergen occurs on the island of Tristan da Cunha where there is no direct exposure to cats. This is due either to the persistence of the allergen after the removal of the animal or to the allergen being brought in on visitors' clothing.
Pollinosis to Ricinus communis (castor bean): an aerobiological, clinical and immunochemical study
Authors: García‐González  , Bartolomé‐Zavala  , Del Mar Trigo‐Pérez  , Barceló‐Muñoz  , Fernández‐Meléndez  , Negro‐Carrasco  , Carmona‐Bueno  , Vega‐Chicote  , Muñoz‐Román  , Palacios‐Peláez  , Cabezudo‐Artero  , Martínez‐Quesada
Published: March 2003

Background

Ricinus communis (castor bean) is a species included into the Euphorbiaceae family, common to all the warm regions of the world. Although the allergenicity of its seed is well known, references are scarce regarding the role played by its pollen as a pneumo‐allergen.

Objectives

To carry out an aerobiological study of this pollen in the Málaga area (southern Spain); describe the physicochemical characteristics of its most relevant allergens; and to demonstrate the existence of patients with respiratory allergy due to this pollen.

Methods

A Burkard spore trap was used for the aerobiological study from 1992 to 1996. Skin prick tests with castor bean pollen extract were performed to 1946 patients with rhinitis and/or asthma. Specific IgE levels were measured in castor bean‐positive SPT patient sera. Immunochemical characterization of the most relevant allergens was performed using electrophoretic techniques. In vitro cross‐reactivity studies using positive patient sera were carried out. Nasal challenge tests were done in 32 subjects randomly selected from the sensitized patient group.

Results

Castor bean is a perennial pollen with total annual pollen levels never exceeding 1%. One hundred and eighteen (7.7%) patients showed positive prick test (74 rhinitis, 36 rhinitis and asthma, eight asthma). Nine were monosensitized. Specific IgE levels were ≥ 0.35 PRU/mL in 39 (33%) of patient sera. Nasal challenge test: 10 subjects presented non‐specific nasal hyperactivity, 15 were positive and seven negative. The molecular masses and isoelectric points of the main IgE‐binding proteins, ranged from ≈ 67–15.5/14.5 kDa and ≈ 4.5–5.5, respectively. Profilin of the extract was purified by poli‐ L‐proline‐Sepharose chromatography and it appeared as one of the most frequent allergens.

Conclusion

Castor bean pollen is an allergen which causes respiratory (mainly nasal) symptoms.