ALLERGY
Diagnosis,
Diagnostics, Immunodiagnosis & Immunodiagnostics:
ABSTRACTS
3092.
Andre FE. The future of vaccines, immunisation concepts and
practice.Vaccine. 19(17-19):2206-9,
2001 Mar 21.
Abstract
Vaccines have prevented more deaths, disability and suffering than any other medical discovery or intervention. Recent breakthroughs in immunology and genomics offer the prospect of the development of many new prophylactic and therapeutic vaccines not only against infectious diseases but also for use in conditions such as allergy, autoimmunity and carcinogenesis where malfunction of the immune system undoubtedly plays a role. These hopeful perspectives are however dimmed by several counterproductive societal trends that include the spreading-although unjustified-belief that vaccines are not safe and may even be unnecessary, escalating costs of vaccine research, development, production and control that are exacerbated by political pressure on selling prices and expensive lawsuits by 'victims' of vaccination who claim excessive compensation. Negative media coverage of vaccine issues is adversely affecting acceptance of vaccination. In spite of these negative trends, vaccines should have a bright future, because it is increasingly being realised that prevention is not only better than cure but it is often also more cost-effective. A better understanding of the dynamics of microbial transmission in populations is leading to more rational immunisation practices on a global scale that could lead to eradication of several pathogens. Attention is being given to making vaccines more user-friendly through the development of combined vaccines and the introduction of less invasive inoculation techniques.
3093.
Anhoej C. Backer V. Nolte H. Diagnostic evaluation of grass- and
birch-allergic patients with oral allergy syndrome. Allergy. 56(6):548-52, 2001 Jun.
Abstract
BACKGROUND: Patients with birch and grass allergy often suffer from oral allergy symptoms when ingesting cross-reacting fresh fruits and vegetables. However, fruit and vegetable allergen extracts are often readily degradable or contain clinically irrelevant cross-reacting epitopes, resulting in diagnostic discrepancies when fruit and vegetable allergic reactions are evaluated. The risk of using nonstandardized fresh food extracts for skin testing may also be of concern. The objective was to compare and evaluate the clinical utility of selected recombinant grass and birch cross-reacting food allergens with fresh and commercial melon, hazelnut, and apple extracts. METHODS: Thirty-six grass- and or birch-allergic patients and 17 control subjects consented to participate in the study. All subjects were skin prick tested and had basophil histamine-release tests done with fresh fruits and various extracts of hazelnut, apple, and melon. The diagnosis of oral allergy syndrome was confirmed by oral challenges. In addition, histamine release to recombinant Bet v 1 and Bet v 2, and recombinant Phl p 1 and Phl p 2, Phl p 5 was performed. RESULTS: The skin prick test with fresh hazelnut, apple, and melon showed sensitivities of 0.97, 0.92, and 0.89, respectively. The corresponding specificities were 0.78, 0.72, and 0.82, respectively. In contrast, the histamine-release test with hazelnut, apple, and melon gave sensitivities of 0.87, 0.71, and 1.00, respectively. The corresponding specificities were 0.65, 0.93, and 0.43. The skin prick test showed excellent negative predictive value (> 90%). No added value of recombinant allergen testing was noted. Oral challenge did not result in severe systemic reactions, and no systemic reactions were observed with skin prick tests with fresh fruits. CONCLUSION: The skin prick test showed an almost optimal diagnostic value with a satisfactory sensitivity (> 89%) and excellent negative predictive value with fresh fruits. When the skin prick test with fresh nut and apple cannot be performed, histamine release is a diagnostic alternative. Histamine release with melon showed lack of specificity. This was probably due to extensive IgE cross-reactivity with pollen, since these patients also responded to recombinant Phl p 1 and Bet v 1. Skin testing and challenges with fresh fruits were safe.
3094.
Bhave SY. Approach to recurrent respiratory infections. Indian Journal
of Pediatrics. 68 Suppl 2:S26-32, 2001
Apr.
Abstract
Rational approach to diagnosis and management of recurrent
respiratory infections is needed, or else the child is subjected to unnecessary
investigations and multiple drugs. Repeated respiratory symptoms do not mean a
respiratory infection. A diagnosis of viral infection does not justify
prescription of an antibiotic. Recurrent viral infections are part of the
growing up process of any child. Giving antibiotics at every episode to cover
"so-called superadded bacterial infections" will lead to
"recurrent antibiotics" and adverse effects on growth. Systematic
approach should be used to find the underlying cause. An otoscopic examination
of a child should form part of a pediatric examination in all cases of
respiratory infections. Antibiotics should be judiciously chosen depending on
age, socioeconomic status, severity of infection and the type of organism
expected and always given in adequate doses and proper duration. Treatment
should be specific and symptomatic. Adequate drainage of the sinuses is an
important adjuvant therapy. Use of cough syrups with various combinations
should be avoided. Efforts should be made to diagnose and treat manifestations
of hyperactive airway or allergy, role of CEA (cough equivalent asthma) and
WLRI (Wheeze associated lower respiratory infections). Investigations are
needed in recent lower respiratory infections and adverse effect on growth, school
performance, abnormal physical findings. CBC, CRP, ESR, nasal smear,
appropriate cultures, tests for TB, X-Rays, barium studies, milk scan, ultra
sound, CT, MRI, bronchoscopy in selected cases.
3095.
Boccara F. Benhaiem-Sigaux
N. Cohen A. Acute myopericarditis after
diphtheria, tetanus, and polio vaccination. Chest. 120(2):671-2, 2001 Aug.
Abstract
We report the first case of myopericarditis after triple
vaccination against diphtheria, tetanus, and poliovirus in a young adult. He
presented with fever, acute chest pain, and diffuse ST-segment elevation 2 days
after vaccination. Two-dimensional echocardiography findings were normal.
Endomyocardial biopsy showed interstitial edema with diapedesis of
erythrocytes. Laboratory findings showed inflammatory syndrome and elevated
circulating immune complexes. He recovered within a few days with high-dose
aspirin treatment and was without complications at 3-month follow-up. We
discuss the different hypotheses for infective or hypersensitivity myocarditis.
3096.
Broide D. Sriramarao P.
Eosinophil trafficking to sites of allergic inflammation. [Review] [90 refs]
Immunological Reviews. 179:163-72, 2001
Feb.
Abstract
Eosinophils play a prominent pro-inflammatory role in allergic
inflammation. Studies utilizing flow chambers, intravital video-microscopy, and
cytokine and adhesion molecule-deficient mice have provided important insight
into the mechanisms of eosinophil trafficking in inflamed blood vessels and
into tissues in vivo. While the bone marrow generation of eosinophils is finely
regulated by interleukin (IL)-5, the trafficking of eosinophils into tissues is
regulated by several cytokines, chemokines, and adhesion molecules with
overlapping functions. Prospects for therapeutically inhibiting eosinophilic
inflammation by inhibiting eosinophil adhesion to endothelium are dependent on
an improved understanding of the relative importance of individual cytokines
and adhesion molecules in regulating eosinophil adhesion to endothelium.
Alternative strategies to inhibit eosinophilic inflammation include the use of
immunostimulatory DNA sequences containing a CpG motif to act as a Th1 adjuvant
to prevent Th2 responses associated with IL-5 and eosinophilia.
Immunostimulatory DNA sequences do not induce eosinophil apoptosis, but
function at the level of the bone marrow to inhibit the IL-5-induced bone
marrow generation and release of eosinophils. [References: 90]
3097.
Ghaemmaghami AM. Robins A. Gough L.
Sewell HF. Shakib F. Human T
cell subset commitment determined by the intrinsic property of antigen: the
proteolytic activity of the major mite allergen Der p 1 conditions T cells to
produce more IL-4 and less IFN-gamma. European Journal of Immunology. 31(4):1211-6, 2001 Apr.
Abstract
The house dust mite Dermatophagoides pteronyssinus allergen Der p
1 elicits IgE antibody responses in a significant proportion of patients
suffering from dust mite allergy. We have recently shown that Der p 1
proteolytically cleaves a cell surface molecule involved in the homeostatic
control of human IgE synthesis, namely the IL-2 receptor (CD25) on T cells. As
a result, these T cells show markedly diminished proliferation and IFN-gamma
secretion in response to stimulation by anti-CD3 antibody. However, these
observations still leave open the important issue of whether CD25 cleavage, and
the consequent suppression of IFN-gamma secretion, leads to enhanced IL-4
secretion, and whether such cytokine changes would be exhibited by both CD4 and
CD8 T cells. Here we demonstrate for the first time that the proteolytic
activity of Der p 1 biases human CD4 and CD8 T cells towards a type 2 cytokine
profile. Our data provide compelling evidence for the role of the proteolytic
activity of Der p 1 in creating a microenvironment conducive for IgE synthesis.
3098.
Horner AA. Van Uden JH. Zubeldia JM. Broide D. Raz E.
DNA-based immunotherapeutics for the treatment of allergic disease. [Review]
[72 refs] Immunological Reviews.
179:102-18, 2001 Feb.
Abstract
Allergic diseases are a
growing health concern in industrialized countries. Despite a number of
effective therapeutic options for the prevention and treatment of the
pathophysiologic responses which characterize allergic diseases, the induction
of true allergen desensitization remains an elusive therapeutic goal. Only
immunotherapy (IT) has been shown to have any effect on the underlying
hypersensitivities which mediate allergic reactions, and traditional
protein-based allergen IT has a limited scope of efficacy However, a number of
reagents collectively termed DNA-based immunotherapeutics have proven highly
effective in both the prevention and reversal of Th2-mediated hypersensitivity
states in mouse models of allergic disease. Four basic DNA-based
immunotherapeutic modalities have been used for these studies. These include
immunization with gene vaccines, allergen mixed with immunostimulatory
oligodeoxynucleotide (ISS-ODN), and physical allergen-ISS-ODN conjugates (AIC),
as well as immunomodulation with ISS-ODN alone. Results from many laboratories
have generated guarded optimism that DNA-based immunotherapeutics may be
effective for the reversal of allergic hypersensitivity states in humans, and
several clinical trials have already been initiated. This review will focus on
our present understanding of the biological activities of DNA-based
immunotherapeutics and their application to the treatment of allergic diseases.
[References: 72]
3099.
Labidi AH. Estes RC. David HL.
Bollon AP. Mycobacterium recombinant vaccines. [Review] [105 refs]
Tunisie Medicale. 79(2):65-81, 2001
Feb.
Abstract
Intracellular diseases are difficult to treat and constitute a
major problem for modern medicine. In this type of diseases, a TH-1 immune
response favors protection, while a TH-2 response is detrimental to the host.
Current vaccines are using antigens to initiate an immune response regardless
of its nature and its mechanism. New vaccines are designed to combine selected
antigens with potent adjuvants to stimulate the appropriate pathway of the
immune system and deliver a lasting protective immunity. The Mycobacterium
recombinant vaccine system for treatment of intracellular diseases utilizes
antigen delivery systems in the form of non pathogenic Mycobacterium strains,
genetic transfer systems in the form of cloning and expression vectors, and
related technologies to provide products containing non toxic immuno-regulating
Mycobacterium adjuvants, non toxic immuno-stimulating exogenous antigens
specific for a variety of diseases, and non toxic amounts of cytokines that
boost the TH-1 pathway. The cloning and expression Mycobacterium vectors
include both pAL5000-based extra-chromosomal and D29-based integrative vectors.
[References: 105]
3100.
Lebel B. Messaad D. Kvedariene V. Rongier M. Bousquet
J. Demoly P. Cysteinyl-leukotriene
release test (CAST) in the diagnosis of immediate drug reactions. Allergy. 56(7):688-92, 2001 Jul.
Abstract
BACKGROUND: The diagnosis of allergic reactions to drugs is
difficult. Most skin tests are not standardized, and in vitro tests are needed
to avoid provocation tests. Cross-linking of IgE on basophils is known to cause
the release of both cysteinyl leukotriene (Cys-LT) and histamine. We aimed to
evaluate the diagnostic utility (sensitivity, specificity, and efficiency) of
measurement of sulfidoleukotrienes in drug allergy. METHODS: We performed a
prospective study in 55 patients with proven immediate adverse reactions to
drugs (30 to beta-lactams, six to acetaminophen, and 19 to aspirin) and 64
drug-exposed nonallergic controls. Positive diagnosis was established by
history, skin tests, and, if needed, oral provocation tests. Cys-LT release was
determined after drug-allergen stimulation by the cellular antigen stimulation
test (CAST(R)) technique. Histamine release was also assessed on the same
samples by enzyme immunoassay. Spontaneous and anti-FcepsilonRIalpha-induced
mediator release was also studied in all subjects. Sensitivity, specificity,
and efficiency were calculated. RESULTS: Net Cys-LT release was over the
maximal threshold given by the manufacturer in 19/55 patients and in 9/64
controls. Net histamine release was over 5% of total histamine content in 28/55
patients and 34/64 controls. The efficiency of both tests was low. CONCLUSION:
Thus, in most cases, the in vitro Cys-LT test has little or no diagnostic
utility and is not superior to histamine release.
3101.
Luque I. Leyva L. Jose Torres M. Rosal M. Mayorga C. Segura JM.
Blanca M. Juarez C. In vitro
T-cell responses to beta-lactam drugs in immediate and nonimmediate allergic
reactions. Allergy. 56(7):611-8, 2001
Jul.
Abstract
BACKGROUND: beta-Lactam drugs may induce both cellular and
humoral allergic reactions, and there is evidence that T cells play an
important role in the pathogenesis of these reactions. The aim of this work was
to assess the sensitivity and specificity of the lymphocyte transformation test
(LTT) as an in vitro diagnostic tool, in patients with either an immediate or a
nonimmediate reaction to penicillin G and/or amoxicillin. METHODS: Fifty
patients with a well-documented history of allergic reactions to beta-lactams
(31 immediate and 19 nonimmediate) were studied by means of skin tests (prick
and intradermal), radioallergosorbent test (RAST), and, when necessary,
controlled administration of the drug. Twenty-eight healthy subjects with good
tolerance to penicillins served as controls. LTT was performed in all subjects.
RESULTS: Skin tests were positive in 77.4% of the patients with immediate
reactions and in 36.8% of those with nonimmediate reactions. The overall sensitivity
of LTT in the allergic patients was 62%, but, when analyzed separately,
sensitivity was 64.5% for the immediate group and 57.9% for the nonimmediate
group. The LTT specificity was 92.8%. CONCLUSION: The LTT should be considered
a useful in vitro diagnostic tool to identify subjects allergic to penicillins,
especially patients with nonimmediate reactions where the LTT has a better
diagnostic value than skin tests. Interestingly, positive T-cell proliferative
responses can be observed 10 or more years after the occurrence of the reaction
without further exposure to the drug.
3102.
Nguyen MD. Cinman N. Yen J.
Horner AA. DNA-based vaccination for the treatment of food allergy.
[Review] [19 refs] Allergy. 56 Suppl
67:127-30, 2001.
Abstract
At present, avoidance is the only therapeutic option available
for individuals with food allergies. However, studies suggest that DNA-based
vaccination might be an effective therapeutic option for the reversal of
allergic hypersensitivities, including allergies to foods. Because severe
anaphylactic reactions represent a life-threatening risk for individuals with
food allergies, we and others have evaluated the effectiveness of DNA-based
vaccination for the prevention of anaphylactic hypersensitivity in murine
models. Our investigations demonstrated that primary gene and
protein/immunostimulatory sequence oligodeoxynucleotide (ISS-ODN) vaccination
of subsequently Th2-sensitized mice reduced the risk of death after
anaphylactic challenge, significantly. In addition, gene and protein/ISS-ODN
vaccination reduced post challenge plasma histamine levels. Analysis of the
immune profiles of mice receiving DNA-based vaccines showed that both gene and
protein/ISS-ODN vaccination effectively prevented the development of Th2-biased
immune profiles after sensitization. In contrast, vaccination with protein
alone, the experimental equivalent of the traditional protein-based
immunotherapy (IT) reagents used in clinical practice provided no protection
from anaphylaxis, nor did it prevent the development of a Th2-biased immune
profile after allergen sensitization. These studies justify continued optimism
in the potential of DNA-based vaccination for the desensitization of food
allergic individuals. [References: 19]
3103.
Nishiyama K. Yao K. Iguci Y.
Yamamoto K. Suzuki T. Sato K.
Okamoto M. Majima M. Change in
tissue kallikrein level in nasal wash after the administration of oxatomide in
patients with nasal allergy. American Journal of Rhinology. 15(2):105-8, 2001 Mar-Apr.
Abstract
The tissue kallikrein level in the nasal wash was measured before
and after 4-week administration of oxatomide (30 mg per day) in 9 patients with
perennial allergy. It was found that tissue kallikrein level in the nasal wash
obtained following provocation tests significantly decreased from 6.05 +/- 4.43
(10(-10) mol/hour/L) to 1.84 +/- 0.93 (10(-10) mol/hour/L) after the
administration of oxatomide. Improvement in subjective symptoms was also
observed in all patients after the administration. These results would indicate
that kinin in the system is actively involved in the pathogenesis of nasal
allergy.
3104.
Sakaguchi M. Miyazawa H. Inouye S. Specific IgE and IgG to gelatin in
children with systemic cutaneous reactions to Japanese encephalitis vaccines.
Allergy. 56(6):536-9, 2001 Jun.
Abstract
BACKGROUND: Systemic allergic reactions to Japanese encephalitis (JE) vaccine that include urticaria, angioedema, and rash have been reported. In Japan, children who suffered from allergic immediate-type reactions to JE vaccine had antigelatin IgE in their sera. However, the immunologic mechanism of allergic nonimmediate-type reactions that consist of cutaneous signs appearing several hours or more after JE vaccination has not been defined. METHODS: Serum samples were taken from 28 children who showed allergic nonimmediate-type cutaneous reactions to JE vaccine. Furthermore, serum samples were taken from 10 children who showed allergic immediate-type reactions with cutaneous signs and/or respiratory symptoms to JE vaccine. We have defined an immediate-type reaction as one occurring within 1 h after vaccination. RESULTS: Of 10 children who showed immediate-type reactions, all had antigelatin IgE and IgG. Of 28 children who showed systemic nonimmediate-type reactions, one had antigelatin IgE and nine (32%) had antigelatin IgG. The child who had antigelatin IgE showed urticaria 2 h after JE vaccination. CONCLUSION: These results suggest that some children who showed allergic nonimmediate-type reactions to JE vaccine were sensitized to gelatin.
3105.
Weller PF. Plaut M. Taggart V.
Trontell A. The relationship of asthma therapy and Churg-Strauss
syndrome: NIH workshop summary report. Journal of Allergy & Clinical
Immunology. 108(2):175-83, 2001 Aug.
Abstract
The Churg-Strauss syndrome (CSS) is a distinct form of vasculitis
that is notable for its eosinophilia and frequent associations with asthma and
sinusitis. Because there has been an increasing recognition that CSS can
develop in patients with asthma and that CSS might be associated with specific
asthma treatments, the National Heart, Lung, and Blood Institute, the National
Institute of Allergy and Infectious Diseases, the Office of Rare Diseases,
National Institutes of Health, and the US Food and Drug Administration jointly
sponsored a workshop to consider interrelationships among CSS, asthma, and
asthma therapeutics and to assess what is known about underlying mechanisms of
CSS. Issues related to the criteria for defining and diagnosing CSS were
reviewed, including the contemporary understanding that diagnostic biopsies
need only reveal eosinophilic perivascular infiltrates and that asthma need not
be present when CSS develops. From published reports and reports to the US Food
and Drug Administration, treatment of patients with asthma with any of 3
cysteinyl leukotriene receptor antagonists, a 5-lipoxygenase inhibitor, and
inhaled corticosteroids has been associated with CSS development. It is unknown
whether these agents were eliciting CSS. A variety of physiologic and study
design issues might lead to the reported associations of these drugs with CSS.
Because many asthma patients receiving these therapies were able to diminish
their systemic corticosteroid therapy, it is possible that incipient CSS was
unmasked by lessened steroid use. The underlying pathophysiologic mechanisms of
CSS, however, are unknown, and there is no means of identifying which patients
with asthma might be at risk for CSS. Accordingly, investigations with the
goals of defining the underlying pathophysiologic processes of CSS and
establishing the relationships of asthma and its therapies to CSS are needed.
3106.
Werfel T. Skin manifestations in food allergy. [Review] [39 refs]
Allergy. 56 Suppl 67:98-101, 2001.
Abstract
Skin manifestations represent the most often
observed clinical symptoms in food allergy. Immediate symptoms are urticaria,
angioedema and sudden erythema (flush). Delayed symptoms which can be observed
are exanthema and exacerbation or worsening of eczema (most often atopic
dermatitis). Since delayed symptoms are difficult to diagnose, oral provocation
tests are often necessary for patients with a suspected late onset of symptoms
upon food ingestion. There is evidence that besides specific IgE, specific T
cells play a role in the deterioration of eczema in atopic dermatitis. Although
urticarial skin lesions are most often observed upon oral provocation with a
suspected food, the rate of IgE-mediated food allergy in acute or chronic
urticaria is rather low. In some patients suffering from chronic urticaria,
intolerance reactions are also suspected. Since no laboratory or skin tests are
available yet for the identification of clinically relevant food additives
causing urticaria, oral provocation tests are mandatory for these patients.
[References: 39]
3107.
Yman L. Standardization of in vitro methods. [Review] [44 refs]
Allergy. 56 Suppl 67:70-4, 2001.
Abstract
IgE-antibody analysis is a major diagnostic procedure and a
primary tool in allergological research. The determination of sensitization
frequencies and antibody concentrations against allergens of defined sources
provides critical information for the estimation of the relative importance of
food and environment in clinical allergy. True quantitation is essential and
requires assay designs providing allergen excess and mass unit calibration.
Standardized and reproducible methods show geographic and culture dependent
differences between patient populations and contribute to the quality of
diagnosis and treatment of allergic disease. [References: 44]
3108.
Yoshimura C. Miyamasu M. Nagase H.
Iikura M. Yamaguchi M. Kawanami O.
Morita Y. Iwata T. Yamamoto K.
Hirai K. Glucocorticoids induce basophil apoptosis. Journal of Allergy & Clinical
Immunology. 108(2):215-20, 2001 Aug.
Abstract
BACKGROUND: Induction of apoptosis represents an important
mechanism by which glucocorticoids (GCCs) exert their anti-inflammatory
properties. The effects of GCCs on apoptosis have been determined in various
immune cells and found to vary among different cell types. On the other hand,
the effects of GCCs on apoptosis of basophils, active participants in allergic
inflammation, have remained obscure. OBJECTIVE: The objective of this study was
to investigate the effects of GCCs on basophil apoptosis. METHODS: Basophils were
highly purified (purity, >97%) by Percoll density gradient centrifugation
followed by negative selection. Cell status was determined by their ability to
bind annexin V and exclude propidium iodide. DNA fragmentation was determined
by flow cytometry. RESULTS: Dexamethasone (DEX) significantly accelerated the
decrease in live cells and increased the number of apoptotic cells in a
time-dependent fashion. Light microscopy as well as DNA fragmentation assay
confirmed the induction of apoptosis by DEX. A half-maximal effect was observed
in a DEX concentration range from 10(-9) to 10(-8) mol/L. Sex steroids did not
induce basophil apoptosis at all. DEX also induced basophil apoptosis in the
presence of low doses of IL-3. CONCLUSION: GCCs exert potent apoptogenic effects
on basophils. GCC-mediated apoptogenic effects on basophils might have
implications with respect to the mechanism of action of this class of drugs in
allergic disorders.
Arp 02
3763. Aberer W, Woltsche M, Woltsche-Kahr I, Kranke B. IgG antibodies typical for extrinsic allergic alveolitis--an inter-laboratory quality assessment. Eur J Med Res 2001 Nov 20;6(11):498-504
BACKGROUND: Determination of specific IgG antibodies is important for the diagnosis of extrinsic allergic alveolitis (EAA). Various evaluations have however shown, that current methodology lacks sufficient standardization in that the employment of different sources of extracts and techniques makes a comparison of data from one laboratory to another almost impossible. OBJECTIVE: The aim of this study is to establish an external quality control system and to analyse, what the explanations for the different outcomes from various laboratories might be. METHODS: In the past 4 years 5 sera from patients suffering from EAA or healthy controls were sent every 6 months to 11 different allergy laboratories in Austria. The determination of specific IgG antibodies against antigens that are typical for this disease were requested. Results were gained with the method routinely used in the respective laboratory, and then sent back to the reference center for statistical evaluation. Precipitating techniques were used in 8 laboratories during the first mailings, but were gradually exchanged by automated ELISA systems being employed in 8 laboratories in the last mailing. RESULTS: 1127 values were determined in 105 expectedly positive sera and 1003 in 94 negative samples. Of the 562 values obtained with precipitation techniques in positive sera, only 52.0% were reported to be positive, and the results varied considerably among laboratories and antigens. In contrast, 93.3% were positive with commercially available ELISA techniques, with 92.3% for the EnzyDex System and even 95.5% for the UniCAP System. Regarding the specificity however, 93.0% of the expected negative results were correct negative using precipitation methods, whereas merely 75.2% were negative with the EnzyDex System and only 22.5% using the UniCAP System. Moreover 35.8% of the results using this latter method were false-positive. CONCLUSIONS: The traditional precipitation techniques proved not only technically difficult to perform, but also unreliable, difficult to reproduce, insensitive and impractical in daily laboratory work. They suffer from that many draw backs, that their use in daily routine cannot be recommended any more. Automated ELISA systems seem to fulfill the criteria for a routine technique concerning handling, automation, and quality criteria like sensitivity quite well, but not for specificity. Both techniques urgently need external standardization in order to make the results comparable among the different systems and methods; the danger of potentially false-positive results, pretending sensitizations that might be clinically irrelevant in several cases, is high.
3764.
Airaghi L, Lorini M, Tedeschi A. The insulin
analog aspart: a safe alternative in insulin allergy. Diabetes Care 2001 Nov;24(11):2000 No
abstract
3765.
Armstrong JL, Lantz AB, Jerath RS, Meyer CF.
Urticaria, angioedema, and an elevated eosinophil count in an adolescent. Ann
Allergy Asthma Immunol 2001
Dec;87(6):457-60 No abstract
3766.
Axell T. Hypersensitivity of the oral mucosa:
clinics and pathology. Acta Odontol Scand 2001 Oct;59(5):315-9 No abstract
3767.
Bahmer FA. Histamine reactivity of the skin.
Allergy 2001 Dec;56(12):1228 No abstract
3768.
Barbaud A, Trechot P, Reichert-Penetrat S, Commun
N, Schmutz JL. Relevance of skin tests with drugs in investigating cutaneous
adverse drug reactions. Contact Dermatitis
2001 Nov;45(5):265-8
Abstract :Skin
tests with drugs can be of value in investigating patients who have developed
cutaneous adverse drug reactions (CADR), but their specificity and relevance
remain to be determined. A false-positive result on skin testing can happen if
it is not compared to results in control subjects. When performing intradermal
tests (IDT), we have determined the lowest concentrations that induce
false-positive results for many drugs, including betalactam antibiotics,
cephalosporins, other antibiotics or non-steroidal anti-inflammatory drugs.
Some drugs in their commercialized form contain sodium lauryl sulfate and can
induce irritation when patch tested as such. When patch tested with colchicine
at 10% in pet. or with a Cytotec pill (containing misoprostol) at 30% in
pet.,respectively, 80% of the 29 and 9 of the 10 negative controls developed
false-positive results. Lastly, positive results of patch tests with drugs can
be related to contact allergy to one of the components of the commercialized
form of the drug, without any relevance to the investigation of a CADR, as
observed in 2 cases with iodine or avocado oil.
3769.
Barnes PJ. Molecular mechanisms of
corticosteroids in allergic diseases. Allergy 2001 Oct;56(10):928-36 No abstract
3770.
Belhadjali H, Giordano-Labadie F, Bazex J.
Contact dermatitis from vitamin C in a cosmetic anti-aging cream. Contact
Dermatitis 2001 Nov;45(5):317 No abstract
3771.
Berardesca E, Barbareschi M, Veraldi S,
Pimpinelli N. Evaluation of efficacy of a skin lipid mixture in patients with
irritant contact dermatitis, allergic contact dermatitis or atopic dermatitis:
a multicenter study. Contact Dermatitis
2001 Nov;45(5):280-5
Disturbances of skin barrier function occur in several
skin diseases, e.g., atopic dermatitis (AD), irritant/allergic contact
dermatitis (ICD, ACD). Skin barrier damage triggers the production of cytokines
that stimulate lipogenesis which may also cause inflammatory processes. The aim
of this study was to evaluate the efficacy of a topical skin lipid mixture in
the treatment of ICD, ACD and AD. 580 consecutive patients suffering from ICD,
ACD or AD were treated with a skin lipid mixture containing ceramide-3 and
patented nanoparticles. Patients received the lipid mixture alone or in
combination with topical corticosteroids until clearance or for 8 weeks. Both
treatment groups statistically improved all parameters considered at week 4 and
8 as compared to baseline. Between the 2 treatment groups, there was a
statistically significant difference in favour of combined therapy for (ICD,
ACD, AD, respectively): erythema, pruritus and overall disease severity;
erythema and pruritus; erythema, pruritus, fissuring and overall disease
severity. No statistically significant difference was found for (ICD, ACD, AD,
respectively): dryness, scaling and fissuring; scaling, fissuring and overall disease
severity; dryness and scaling. Between the 2 ACD treatment groups, there was a
statistically significant difference in favour of the skin lipid mixture for
dryness. In conclusion, the study shows that balanced lipid mixtures are
effective in improving barrier properties and the clinical condition of the
skin in contact dermatitis.
3772.
Biagini RE, Krieg EF, Pinkerton LE, Hamilton RG.
Administration-cleared serological assays for natural rubber latex-specific
immunoglobulin E antibody. Clin Diagn Lab Immunol 2001 Nov;8(6):1145-9
Receiver operating characteristics (ROC) analyses to
evaluate and compare the diagnostic accuracy of Food and Drug Administration
(510K)-cleared natural rubber latex (NRL)-specific immunoglobulin E (IgE)
antibody immunoassays have not been performed using well-characterized
skin-testing reagents. Sera were collected from 311 subjects (131 latex
puncture skin test [PST] positive and 180 PST negative). All masked, coded sera
were analyzed for latex-specific IgE antibodies in the Diagnostic Products
Corporation microplate AlaSTAT, HYCOR HY-TEC RAST, and Pharmacia-Upjohn CAP
System RAST FEIA (CAP). Diagnostic accuracy was evaluated using GraphRoc for
Windows software to construct and analyze ROC curves in relation to the
subjects' PST status and the results of the immunoassays. The ROC areas under
the curve (AUCs) +/- standard error based on PST for the three diagnostic tests
were 0.858 +/- 0.024, 0.869 +/- 0.024, and 0.924 +/- 0.017, respectively, for
AlaSTAT, CAP, and HY-TEC. The HY-TEC system had a significantly greater AUC
based on PST than those observed for AlaSTAT (P < 0.05) and CAP (P <
0.05) analyses. When the diagnostic tests were probed as to the cutoffs giving
maximal diagnostic efficiency compared to PST, CAP and AlaSTAT yielded values
of <0.35 kU of allergen IgE (kU(A))/liter and <0.35 kU/liter while the
HY-TEC assay yielded 0.11 kU/liter. The diagnostic efficiencies based on PST in
our cohort at these cutoffs were 87.1, 88.1, and 88.7%, respectively. The
HY-TEC assay had a significantly greater AUC than CAP and AlaSTAT using PST as
a diagnostic discriminator in our cohort. When the HY-TEC system was probed at
its maximally efficient cutoff (0.11 kU/liter) versus HYCOR's recommended
cutoff of 0.05 kU/liter, a loss of sensitivity of 8.4% was observed with a gain
in specificity of 19.5%.
3773.
Bielory L, Gewirtz M, Hinrichs C, Lal P. Asthma
and vasculitis: controversial association with leukotriene antagonists. Ann
Allergy Asthma Immunol 2001
Oct;87(4):274-82 No abstract
3774.
Bircher AJ, Stern WB. Allergic contact dermatitis
from "titanium" spectacle frames. Contact Dermatitis 2001 Oct;45(4):244-5 No abstract
3775.
Black AK. Unusual urticarias. J Dermatol 2001 Nov;28(11):632-4 No abstract
3776.
Blease K, Jakubzick C, Schuh JM, Joshi BH, Puri
RK, Hogaboam CM. IL-13 fusion cytotoxin ameliorates chronic fungal-induced
allergic airway disease in mice. J Immunol
2001 Dec 1;167(11):6583-92 No
abstract
3777.
Boguniewicz M, Sampson H, Leung SB, Harbeck R,
Leung DY. Effects of cefuroxime axetil on Staphylococcus aureus colonization
and superantigen production in atopic dermatitis. J Allergy Clin Immunol 2001 Oct;108(4):651-2 No abstract
3778.
Bonamonte D, Mundo L, Daddabbo M, Foti C.
Allergic contact dermatitis from Mentha spicata (spearmint). Contact
Dermatitis 2001 Nov;45(5):298 No
abstract
3779.
Breit S, Rueff F, Przybilla B. 'Deep impact'
contact allergy after subcutaneous injection of local anesthetics. Contact
Dermatitis 2001 Nov;45(5):296-7 No abstract
3780.
Bretsche PA, Ismail N, Menon JN, Power CA, Uzonna
J, Wei G. Vaccination against and treatment of tuberculosis, the leishmaniases
and AIDS: perspectives from basic immunology and immunity to chronic
intracellular infections. Cell Mol Life Sci
2001 Nov;58(12-13):1879-96
Abstract : The occurrence of infectious disease represents
a failure of the immune system, a failure that must be prevented by effective
vaccination or remedied by treatment. Vaccination against acute diseases such
as smallpox and polio are very effective, due to the rapid and increased immune
response of vaccinated individuals upon natural infection. In contrast,
effective vaccination against intracellular pathogens that cause chronic
diseases, such as the leishmaniases, tuberculosis and AIDS, has not been
achieved. Clinical observations suggest cell-mediated, Th1 responses, exclusive
of antibody production and the generation of Th2 cells, are optimally
protective against these intracellular pathogens. Effective vaccination must
ensure the generation of such a protective response. We explore here whether understanding
very broad features of the regulation of the immune response can accommodate
modern findings on the immunological features of these diseases, and provide a
perspective within which strategies for effective vaccination and treatment can
be developed.
3781.
Brown AF, McKinnon D, Chu K. Emergency department
anaphylaxis: A review of 142 patients in a single year. J Allergy Clin Immunol
2001 Nov;108(5):861-6
BACKGROUND: There are few data on the incidence,
clinical features, and management of patients with acute anaphylaxis presenting
to the emergency department. We investigated all presentations to one
department during the course of a year to improve current awareness of this
medical emergency. OBJECTIVE: The purpose of the study was to describe the clinical
features, management, and outcome of anaphylaxis presentations to a single
Australian adult emergency department in a single year, 1998-1999. METHODS:
This was a retrospective, case-based study of adult patients (>or=13 years
of age) attending a single emergency department in Brisbane, Australia, during
the year 1998-1999. The medical records of 304 patients satisfying the relevant
discharge diagnostic codes were studied. We determined incidence, sex ratio,
age, clinical features, management, disposal, asthma prevalence, and causes in
patients presenting with acute allergic reactions and anaphylaxis. RESULTS: In
all, 162 emergency department patients with acute allergic reactions and 142
emergency department patients with anaphylaxis, including 60 whose anaphylaxis
was severe, were seen during the year, for an anaphylaxis presentation
incidence of 1 in 439. One patient died; this gave a case fatality rate of
0.70%. Cutaneous features were present in 94% of the patients with anaphylaxis.
Of those with severe anaphylaxis, 35% had dizziness/syncope before hospital
presentation, 25% laryngeal edema, and 21.7% systolic hypotension on hospital
presentation. A cause was recognized in 73% of the anaphylaxis cases; most
commonly, the causative agent was a drug, insect venom, or food. Adrenaline was
used in 57% of the severe cases before hospital presentation or in the
hospital. The emergency department alone definitively cared for 94% of all
patients, though only 43% severe anaphylaxis cases were referred for follow-up.
CONCLUSION: The emergency department anaphylaxis presentation incidence of 1 in
439 cases is greater than previously recognized, though death remains rare. In
three fourths of cases, a precipitant was identified, a fact that emphasizes
the need for a detailed initial history. Definitive management in the emergency
department alone is possible in most cases, provided that the appropriate use
of adrenaline and the need for allergy clinic follow-up are appreciated.
3782.
Brusasco V, Crimi E. Methacholine provocation
test for diagnosis of allergic respiratory diseases. Allergy 2001 Dec;56(12):1114-20 No
abstract.
3783.
Buckley MG, Variend S, Walls AF. Elevated serum
concentrations of beta-tryptase, but not alpha-tryptase, in Sudden Infant Death
Syndrome (SIDS). An investigation of anaphylactic mechanisms. Clin Exp Allergy
2001 Nov;31(11):1696-704
BACKGROUND: Sudden Infant Death Syndrome, (SIDS) or cot
death, remains the most common category of post-perinatal death in the UK. By
definition, the cause of death is unknown, but a long-standing theory is that
some of these deaths could be the result of anaphylaxis. OBJECTIVE: To
investigate the potential contribution of anaphylactic mechanisms to deaths in
infancy by determining relative levels of alpha- and beta-tryptases and both
total and allergen-specific IgE in sera from groups of infants whose deaths
were attributed to SIDS or to other causes. METHODS: Serum samples were
collected at the time of post-mortem examination from infants whose death was
classed as SIDS (n = 40) and from a comparison group in which cause of death
had been established (n = 32). Serum tryptase concentrations were measured with
a radioimmunoassay with monoclonal antibody G5 which detects primarily
beta-tryptase or an ELISA with antibody AA5 which has equal sensitivity for
alpha- and beta-tryptases. Levels of total IgE and IgE specific for casein,
beta-lactoglobulin, house dust mite and moulds were determined. RESULTS:
Analysis of the results of the two assays for tryptase indicated that levels of
the beta-like tryptase (the form secreted on anaphylactic degranulation) were
significantly higher in serum from infants with SIDS compared with those whose
death was explained. There was no evidence for an increase in serum levels of
alpha-tryptase (the variant secreted constitutively from mast cells). Total
levels of serum IgE did not differ between the two groups and, reflecting the
low circulating IgE concentrations in infancy, an elevation in IgE specific for
the panel of allergens was not detected. CONCLUSIONS: In a proportion of SIDS
victims there may be increased serum levels of beta-like tryptase, a marker for
anaphylaxis. The failure to detect an increase in alpha-tryptase would suggest
that mast cell hyperplasia is not a feature of cot death. The nature of the
inciting agents remains unclear, but anaphylaxis deserves serious consideration
as a possible cause of sudden death in infancy.
3784.
Budinger L, Neuser N, Totzke U, Merk HF, Hertl M.
Preferential usage of TCR-Vbeta17 by peripheral and cutaneous T cells in
nickel-induced contact dermatitis. J Immunol
2001 Nov 15;167(10):6038-44 No
abstract
3785.
Burk K, Melms A, Schulz JB, Dichgans J.
Effectiveness of intravenous immunoglobin therapy in cerebellar ataxia
associated with gluten sensitivity. Ann Neurol
2001 Dec;50(6):827-8 No abstract
3786.
Ciprandi G, Cosentino C, Milanese M, Mondino C,
Canonica GW. Fexofenadine reduces nasal congestion in perennial allergic
rhinitis. Allergy 2001
Nov;56(11):1068-70 No abstract
3787.
Clough GF, Boutsiouki P, Church MK. Comparison of
the effects of levocetirizine and loratadine on histamine-induced wheal, flare,
and itch in human skin. Allergy 2001
Oct;56(10):985-8
BACKGROUND: This randomized, double-blind, crossover
study compared the effects of the R-enantiomer of cetirizine, levocetirizine,
with those of loratadine on the wheal, flare, and itch response to histamine in
human skin. METHODS: Levocetirizine (5 mg), loratadine (10 mg), or placebo was
taken orally 4 h before the intradermal injection of histamine (20 microl, 100
microM) or the control vehicle into the forearm skin of healthy volunteers.
Flare areas were assessed by scanning laser Doppler imaging before and at 30-s
intervals for a period of 9 min. Wheal areas were measured by planimetry at 10
min. Itch was scored every 30 s with a visual analogue scale. RESULTS: After
placebo administration, the mean peak flare area was 23.01+/-1.94 cm(2), the
wheal area 248+/-27 mm(2), and the cumulative itch score 28.8+/-4.6%
(mean+/-SEM). Levocetirizine reduced the flare, wheal, and itch by 60%, 68%,
and 91%, respectively (all P<0.001, Student's t-test for paired data). The
effects of loratadine were variable and not statistically significant.
CONCLUSION: Levocetirizine (5 mg) is a potent inhibitor of the effects of
histamine in human skin with an efficacy that exceeded that of loratadine (10
mg) when single doses of the drugs were administered 4 h before the test.
3788.
Cohen D, Hatch KL, Maibach H, Pratt M. Clothes
make the (wo)man: diagnosis and management of clothing dermatitis. Am J Contact
Dermat 2001 Dec;12(4):229-31 No abstract.
3789.
Corazza M, Levratti A, Virgili A. Allergic
contact dermatitis due to methyl glucose dioleate. Contact Dermatitis 2001 Nov;45(5):308 No abstract.
3790.
Decraene T, Goossens A. Contact allergy to
atropine and other mydriatic agents in eye drops. Contact Dermatitis 2001 Nov;45(5):309-10 No abstract.
3791.
Dejobert Y, Delaporte E, Piette F, Thomas P.
Vesicular eczema and systemic contact dermatitis from sorbic acid. Contact
Dermatitis 2001 Nov;45(5):291 No abstract.
3792.
Ezughah FI, Murdoch SR, Finch TM. Occupational
airborne allergic contact dermatitis from medium-density fibreboard containing
phenol-formaldehyde resin-2 (PFR-2). Contact Dermatitis 2001 Oct;45(4):242 No abstract.
3793.
Ezughah FI, Murdoch SR, Finch TM. Occupational
airborne allergic contact dermatitis from medium-density fibreboard containing
phenol-formaldehyde resin-2 (PFR-2). Contact Dermatitis 2001 Oct;45(4):242 No abstract.
3794.
Field SK. Underlying mechanisms of respiratory
symptoms with esophageal acid when there is no evidence of airway response. Am
J Med 2001 Dec 3;111 Suppl
8A:37S-40S
Although a strong association exists between
gastroesophageal reflux (GER) and asthma, results of studies designed to
maximize the likelihood of identifying that GER worsens pulmonary function in
patients with asthma have been negative or inconclusive. Asthma symptoms worsen
during symptomatic reflux episodes, and asthma symptom severity correlates with
the severity of symptomatic reflux. Various reasons have been proposed to
explain these findings. Discomfort associated with GER can cause
reflux-associated respiratory symptoms even when pulmonary function is normal.
New findings suggest that increases in minute ventilation rather than
inhibition of diaphragm activity are responsible for the changes in respiratory
sensation during acid perfusion of the esophagus in nonasthmatic subjects.
These results may also pertain to asthmatic patients, because increasing minute
ventilation can cause dyspnea and bronchospasm in this population. Treating
GER, either medically or surgically, may improve asthma symptoms by preventing
GER-induced changes in minute ventilation.
3795.
Francalanci S, Giorgini S, Ricci L, Sertoli A.
Patch testing by additional series of allergens: results of further experiences.
Am J Contact Dermat 2001
Dec;12(4):203-7
BACKGROUND: Patch testing with additional series (AS) of
allergens may be a useful tool in diagnosing allergic contact dermatitis (ACD).
OBJECTIVE: Aim of the study was to verify the usefulness, to check the
reliability in clinical practice and to evaluate the economic costs of AS
previously built up. METHODS: A total of 281 patients with suspicious ACD
underwent patch test with the standard series (SS) and with one or more AS (51
among 71 built up). RESULTS: A total of 170 patients (60.5%) showed positive
reactions to SS; 116 (41.3%) to AS. Among 582 nonstandard allergens used, 113
(19.4%) elicited 1 or more positive reactions: out of 10,916 patch tests
carried out, 260 (2.4%) positive reactions were observed. The correlation
between SS and AS indicated that 8.2% patients resulted SS-/AS+, 27.7% SS+/AS-,
32.7% SS+/AS+, 31.3% SS-/AS-. The most frequently used AS showed the following
percentages of patients with 1 or more positive reactions: clothes 41.4%, building
industry 51.8%, hairdressers 77.3%, textile industry 42.1%, shoes 36.8%.
Positive reactions to the most frequently used nonstandard allergens resulted:
propylene glycol 0.4%, cobalt chloride 12.6%, phenylmercuric nitrate 2.2%,
p-aminophenol 4.5%. The approximate economic cost of patch testing with AS has
been evaluated in 1.3 euro per single patch test. CONCLUSION: The cost of patch
testing AS is not irrelevant, but it can be compensated by the advantages
deriving from the increase of data concerning ACD etiology. A reduction in the
number of allergens included in single AS should be performed. Cobalt chloride,
taking into account the high percentage of positive reactions observed and its
presence in a large number of AS, could be (re)introduced in the standard
series. Copyright 2001 by W.B. Saunders Company
3796.
Friedman Ross L. Salmeterol and inhaled
corticosteroids in pattients with persistent asthma JAMA 2001 Dec 26;286(24):3076; discussion
3077-8 No abastract
3797.
Ganglberger E, Barbara Sponer, Scholl I, Wiedermann
U, Baumann S, Hafner C, Breiteneder H, Suter M, Boltz-Nitulescu G, Scheiner O,
Jensen-Jarolim E. Monovalent fusion proteins of IgE mimotopes are safe for
therapy of type I allergy. FASEB J 2001
Nov;15(13):2524-6 By screening phage display random peptide libraries with
purified immunoglobulin E (IgE) from birch pollen-allergic patients, we
previously defined peptides mimicking natural IgE epitopes (mimotopes) of the
major birch pollen allergen Bet v 1. The present study aimed to define a monovalent
carrier for the IgE mimotopes to induce protective antibodies directed to the
IgE epitopes, suitable for mimotope-specific therapy. We expressed the selected
mimotopes as fusion proteins together with streptococcal albumin binding
protein (ABP). The fusion proteins were recognized specifically by anti-Bet v 1
human IgE, which demonstrated that the mimotopes fused to ABP resemble the
natural IgE epitope. Bet v 1-specific IgG was induced by immunization of BALB/c
mice with fusion proteins. These IgG antibodies could inhibit IgE binding to
Bet v 1. Skin testing of Bet v 1 allergic mice showed that the ABP mimotope
constructs did not elicit type I skin reactions, although they possess IgE
binding structures. Our data suggest that IgE mimotopes are safe for epitope-specific
immunotherapy of sensitized individuals, when presented in a monovalent form.
Therefore, ABP-fused mimotopes are promising candidates for a new type of
immunotherapy based on the precise induction of blocking antibodies.
3798.
Garvey LH, Roed-Petersen J, Husum B. Anaphylactic
reactions in anaesthetised patients - four cases of chlorhexidine allergy. Acta
Anaesthesiol Scand 2001
Nov;45(10):1290-4
Chlorhexidine is widely used all over the world in many
different preparations. In Denmark chlorhexidine is the standard skin
disinfectant used before surgery or invasive procedures and it is widely used
in the general population in mouthwash or for disinfection of minor scratches
etc. The potential for developing allergy to chlorhexidine is thus great, especially
in surgical patients. We have identified four patients with serious allergic
reactions in connection with surgery and general anaesthesia, who on subsequent
skin testing tested positive for chlorhexidine. Symptoms appeared 20-40 min
into the operation and all four patients required treatment with adrenaline.
All four patients had a history of minor symptoms like rashes or faints in
connection with previous surgery/invasive procedures. Allergy to chlorhexidine
may be more prevalent in surgical patients and cases may have been overlooked
due to the nature of reactions and lack of suspicion towards this substance.
3799.
Gauvreau GM, Parameswaran KN, Watson RM, O'Byrne
PM. Inhaled leukotriene E(4), but not leukotriene D(4), increased airway
inflammatory cells in subjects with atopic asthma. Am J Respir Crit Care Med
2001 Oct 15;164(8 Pt 1):1495-500 No
abstract.
3800.
Gehring U, Bolte G, Borte M, Bischof W, Fahlbusch
B, Wichmann HE, Heinrich J; LISA study group. Lifestyle-Related Factors on the
Immune System and the Development of Allergies in Childhood. Exposure to
endotoxin decreases the risk of atopic eczema in infancy: a cohort study. J
Allergy Clin Immunol 2001 Nov;108(5):847-54 No abstract.
3801.
Gu X, Beardslee T, Zeece M, Sarath G, Markwell J.
Identification of IgE-binding proteins in soy lecithin. Int Arch Allergy
Immunol 2001 Nov;126(3):218-25
BACKGROUND: Soy lecithin is widely used as an emulsifier
in processed foods, pharmaceuticals and cosmetics. Soy lecithin is composed
principally of phospholipids; however, it has also been shown to contain
IgE-binding proteins, albeit at a low level. A few clinical cases involving
allergic reactions to soy lecithin have been reported. The purpose of this
investigation is to better characterize the IgE-binding proteins typically
found in lecithin. METHODS: Soy lecithin proteins were isolated following
solvent extraction of lipid components and then separated on sodium dodecyl
sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The separated lecithin
proteins were immunoblotted with sera from soy-sensitive individuals to
determine the pattern of IgE-binding proteins. The identity of IgE-reactive
bands was determined from their N-terminal sequence. RESULTS: The level of
protein in six lecithin samples obtained from commercial suppliers ranged from
100 to 1,400 ppm. Lecithin samples showed similar protein patterns when
examined by SDS-PAGE. Immunoblotting with sera from soy-sensitive individuals
showed IgE binding to bands corresponding to 7, 12, 20, 39 and 57 kD.
N-terminal analysis of these IgE-binding bands resulted in sequences for 3
components. The 12-kD band was identified as a methionine-rich protein (MRP)
and a member of the 2S albumin class of soy proteins. The 20-kD band was found
to be soybean Kunitz trypsin inhibitor. The 39-kD band was matched to a soy
protein with unknown function. CONCLUSIONS: Soy lecithin contains a number of
IgE-binding proteins; thus, it might represent a source of hidden allergens.
These allergens are a more significant concern for soy-allergic individuals
consuming lecithin products as a health supplement. In addition, the MRP and
the 39-kD protein identified in this study represent newly identified
IgE-binding proteins. Copyright 2001 S. Karger AG, Basel
3802.
Gutgesell C, Fuchs T. Orally elicited allergic
contact dermatitis to tetraethylthiuramdisulfide. Am J Contact Dermat 2001 Dec;12(4):235-6 No
abstract.
3803.
Harding SM. Gastroesophageal reflux, asthma, and mechanisms of
interaction. Am J Med 2001 Dec 3;111
Suppl 8A:8S-12S
Gastroesophageal reflux (GER) is a potential trigger of asthma. The esophagus and lung interact through a variety of mechanisms. Esophageal acid-induced bronchoconstriction can be provoked by a vagally mediated reflex, whereby acid in the distal esophagus produces airway responses; by neural enhancement of bronchial reactivity, whereby esophageal acid augments airway hyperresponsiveness; or by microaspiration, in which small amounts of esophageal acid in the upper airway cause significant airway responses. Interestingly, even in the microaspiration model, the vagus nerve plays a significant role. Neurogenic inflammation in the lung may occur with either vagally mediated mechanisms or with microaspiration. The prevalence of reflux symptoms, esophagitis, and abnormal esophageal acid contact time is higher in patients with asthma than in control populations. Potential mechanisms, whereby asthma may predispose to the development of GER, include autonomic dysregulation, an increased pressure gradient differential between the thorax and the abdomen, a high prevalence of hiatal hernia, alterations in crural diaphragm function, and bronchodilator medication use. Further research will help define how the esophagus and lung interact.
3804.
Holdiness MR. Contact dermatitis to topical drugs
for glaucoma. Am J Contact Dermat 2001
Dec;12(4):217-9
A review of the literature has identified 10 agents causing contact dermatitis among topically administered drugs for glaucoma. These agents include beta-blockers (timolol, befunolol, betaxolol, levobunolol, carteolol, metipranolol), a carbonic anhydrase inhibitor (dorzolamide), a parasympathomimetic (pilocarpine), and sympathomimetics (dipivefrin, apraclonidine). Patch testing has been documented in certain individuals as well as cross sensitization and reactivity. Systemic reactions to these topically applied medications have been briefly noted. Copyright 2001 by W.B. Saunders Company
3805.
Hossny E, Aboul-Magd M, Bakr S. Increased plasma
eotaxin in atopic dermatitis and acute urticaria in infants and children. Allergy 2001 Oct;56(10):996-1002
BACKGROUND: The previously reported eotaxin
overexpression in the lesional skin of atopic dermatitis (AD) led us to the
assumption that circulating levels of eotaxin may be elevated too. We sought to
investigate the plasma expression of eotaxin in children with skin allergy in
relation to clinical activity and type of lesions. METHODS: Plasma eotaxin was
assayed in 78 infants and children, of whom 16 had AD, 19 had acute urticaria
(AU), and 43 were healthy matched subjects. Seven children in the group of AU
were resampled for plasma eotaxin after clinical remission. RESULTS: The plasma
eotaxin levels in AD (median=158 pg/ml, mean [SD]=168 [61] pg/ml) were
significantly higher than the control values (median=60 pg/ml, mean [SD]=59.5
[18.5] pg/ml). Not only did patients with AU demonstrate elevated plasma
eotaxin levels (median=126 pg/ml, mean [SD]=124 [33] pg/ml), but also a
significant decline occurred on follow-up. The coexistence of angioedema with
AU did not cause any further increase in plasma eotaxin expression. Plasma
eotaxin levels were significantly higher in AD than in AU, probably reflecting
the chronic nature of eczematous AD lesions. The plasma eotaxin levels did not
correlate with serum total IgE, peripheral blood absolute eosinophil count, or
age of the patients. However, there was a positive correlation between age and
plasma eotaxin in the control group. CONCLUSION: Our findings imply that
circulating levels of eotaxin increase in AD and during flares of AU, probably
to serve in the recruitment and activation of eosinophils. It may also
represent a biomarker of lesional activity.
3806.
Janefjord CK, Jenmalm MC. PHA-induced IL-12R
beta(2) mRNA expression in atopic and non-atopic children. Clin Exp
Allergy 2001 Oct;31(10):1493-500 No
abstract
3807.
Jeffery PK. Remodeling in asthma and chronic
obstructive lung disease. Am J Respir Crit Care Med 2001 Nov 15;164(10 Pt 2):S28-38
Asthma and chronic obstructive lung disease (COPD) are
both inflammatory conditions of the lung associated with structural
"remodeling" inappropriate to the maintenance of normal lung
function. The clinically observed distinctions between asthma and COPD are
reflected by differences in the remodeling process, the patterns of
inflammatory cells and cytokines, and also the predominant anatomic site at
which these alterations occur. In asthma the epithelium appears to be more
fragile than that of COPD, the epithelial reticular basement membrane (RBM) is
significantly thicker, there is marked enlargement of the mass of bronchial
smooth muscle, and emphysema does not occur in the asthmatic nonsmoker. In
COPD, there is epithelial mucous metaplasia, airway wall fibrosis, and
inflammation associated with loss of surrounding alveolar attachments to the
outer wall of small airways: bronchiolar smooth muscle is increased also.
Emphysema is a feature of severe COPD: in spite of the destructive process,
alveolar wall thickening and focal fibrosis may be detected. The hypertrophy of
submucosal mucus-secreting glands is similar in extent in asthma and COPD. The
number of bronchial vessels and the area of the wall occupied by them increase
in severe corticosteroid-dependent asthma: it is likely that these increases
also occur in severe COPD as they do in bronchiectasis. Pulmonary vasculature
is remodeled in COPD. In asthma several of these structural alterations begin
early in the disease process, even in the child. In COPD the changes begin
later in life and the0 associated inflammatory response differs from that in
asthma. The following synopsis defines and compares the key remodeling
processes and proposes several hypotheses.
3808.
Jeon SH, Park JW, Lee BH. Characterization of
human IgE and mouse IgG1 responses to allergens in three mosquito species by
immunoblotting and ELISA. Int Arch Allergy Immunol 2001 Nov;126(3):206-12
BACKGROUND: IgE-mediated allergic reactions caused by
mosquito bites are a common problem all over the world. This study was
undertaken to determine IgE levels in subjects, to elucidate human IgE and
mouse IgG1 binding patterns and to investigate the cross-reactivity of salivary
gland antigens with three mosquitoes. METHODS: Mosquito larvae of Aedes togoi,
Culex tritaeniorhynchus and Culex pipiens pallens were collected and maintained
in the laboratory. Salivary gland extracts (SGE) and whole-body extracts (WBE)
were prepared from female mosquitoes of each species. Mosquito-specific IgE
levels in 17 subjects were measured by ELISA. Polypeptide patterns were
analyzed by SDS-PAGE. Immunoblotting was performed with sensitized human and
immune mouse sera, and elucidated human IgE and mouse IgG1 binding patterns to
SGE. For the determination of cross-reactivity to the three types of
mosquitoes, ELISA inhibition tests were performed using sera from mice
sensitized by biting of A. togoi. RESULTS: The 9 sera out of 12 with positive
skin reactions to SGE of A. togoi by skin prick test showed significantly
higher anti-mosquito SGE IgE levels than in those without skin reactions.
Protein band patterns of the SGE and WBE of the three species were different
from one another. Specific human IgE reacted to the protein in SGE of 30.5, 33,
37 and 57.5 kD from A. togoi, of 38, 43 an 68 kD from C. tritaeniorhynchus, and
of 23, 33, 34, 43, 44, 60, 74 and 93 kD from C. pipiens pallens. There were
specific mouse IgG1 reactions to the bands of 30.5, 33, 37 and 57.5 kD in the
SGE of A. togoi. The ELISA inhibition studies disclosed almost no
cross-reactivities between A. togoi, C. tritaeniorhynchus and C. pipiens
pallens. CONCLUSIONS: Immunoblot analysis disclosed that allergenic proteins in
the SGE of mosquitoes and their patterns were remarkably similar between human
and mouse sera to the SGE of A. togoi. Species-shared allergens may not exist
among the three mosquito species prevalent in Korea. Copyright 2001 S. Karger
AG, Basel
3809.
Kanerva L, Estlander T, Petman L,
Makinen-Kiljunen S. Occupational allergic contact urticaria to yucca (Yucca
aloifolia), weeping fig (Ficus benjamina), and spathe flower (Spathiphyllum
wallisii). Allergy 2001 Oct;56(10):1008-11
BACKGROUND: Occupational contact urticaria (CU) from
plants is often reported, but it is less often attributed to decorative
houseplants. We present an atopic gardener and caretaker of plants who
developed CU when occupationally exposed to weeping fig, spathe flower, and
yucca. METHODS: Sensitization was evaluated by skin prick tests (SPT) and
analyses for IgE antibodies. RESULTS: SPT were positive to all three plants,
and IgE antibodies were found to weeping fig and spathe flower. SPT were also
performed with several decorative houseplants in more than 600 patients.
Positive SPT was found to weeping fig (12%), African milk tree (8.3%), yucca
(5.8%), Chinese rose (4.7%), massangana (4.6%), bird's nest fern (3.2%), and
spathe flower (3.2%). CONCLUSION: Our study indicates that SPT and tests for
IgE antibody are useful in detecting occupational CU caused by houseplants.
3810.
Kaszuba SM, Baroody FM, deTineo M, Haney L, Blair
C, Naclerio RM. Superiority of an intranasal corticosteroid compared with an
oral antihistamine in the as-needed treatment of seasonal allergic rhinitis.
Arch Intern Med 2001 Nov
26;161(21):2581-7 No abstract.
3811.
Kiehl P, Falkenberg K, Vogelbruch M, Kapp A.
Tissue eosinophilia in acute and chronic atopic dermatitis: a morphometric approach
using quantitative image analysis of immunostaining. Br J Dermatol 2001 Nov;145(5):720-9 No abstract
3812.
Kokkonen J, Haapalahti M, Laurila K, Karttunen
TJ, Maki M. Cow's milk protein-sensitive enteropathy at school age. J
Pediatr 2001 Dec;139(6):797-803 No abstract.
3813.
Kutting B, Weber B, Brehler R. Evaluation of a
dipstick test (Allergodip-Latex) for in vitro diagnosis of natural rubber latex
allergy. Int Arch Allergy Immunol 2001
Nov;126(3):226-30
BACKGROUND: IgE-mediated hypersensitivity to latex has
been recognized as an increasing health problem with far-reaching consequences
for patients, regarding both their occupational situation and safety in medical
care. Therefore, a correct diagnosis of natural rubber latex (NRL) allergy is
essential. The purpose of the study was to evaluate sensitivity and specificity
of several established diagnostic methods for NRL allergy (in vitro assays and
skin prick test) in relation to a new semiquantitative dipstick test
(Allergodip-Latex, Allergopharma) as a screening test for NRL allergy. METHODS:
Data obtained with quantitative assays including Pharmacia CAP System(FEIA),
DPC-AlaSTAT and Magic Lite were compared with the dipstick test results in
latex-sensitized (n = 151) and nonsensitized persons (n = 232). In addition
these in vitro findings were related to clinical symptoms after exposure to
latex and skin prick test results with a panel of different latex allergen
extracts. RESULTS: When comparing sensitivity and specificity of all in vitro
assays relative to skin prick test results the Pharmacia CAP System (FEIA) had
the highest sensitivity in the range of 90%. Sensitivity of the other in vitro
assays was in the range of 73.7-74.9%, specificity varied from 85.3 to 89.8%. A
diagnostic standard was defined in terms of at least three corresponding test
results out of all diagnostic methods (in vitro assays and skin prick test).
The sensitivity and specificity of each diagnostic test were determined
relative to this diagnostic standard. Hereby the Allergodip test results showed
a sensitivity of 91% and a specificity of 93%. CONCLUSION: The dipstick test
results are in line with the data of the other in vitro assays. In contrast to
other in vitro assays the dipstick test requires no further laboratory
equipment and is easy to perform. Copyright 2001 S. Karger AG, Basel
3814.
Kvitko E. Occupational contact dermatitis in the
tanning industry. Contact Dermatitis
2001 Oct;45(4):256 No abstract.
3815.
Lin RY, Trivino MR, Curry A, Pesola GR, Knight
RJ, Lee HS, Bakalchuk L, Tenenbaum C, Westfal RE. Interleukin 6 and C-reactive
protein levels in patients with acute allergic reactions: an emergency
department-based study. Ann Allergy Asthma Immunol 2001 Nov;87(5):412-6
BACKGROUND: Elevations of interleukin 6 (IL-6) have been
described in drug-induced anaphylaxis. Although IL-6 is well known to stimulate
an acute phase response, profiling acute phase protein levels, such as
C-reactive protein (CRP), has, to our knowledge, never been performed in
patients with acute allergic reactions. OBJECTIVE: To examine the pattern of
IL-6 and CRP levels in patients with acute allergic reactions and to relate
these to relevant clinical and laboratory parameters. METHODS: Plasma CRP and
serum IL-6 levels were determined in 85 adult emergency department patients.
These patients had been previously studied with questionnaires, physical
examinations, and histamine/tryptase levels. Clinical and historical features
were related to CRP and IL-6 levels. CRP and IL-6 levels were also examined for
relationships with histamine and tryptase levels. RESULTS: CRP and IL-6 levels
were significantly correlated with one another in the study patients (Spearman
p = 0.36, P =0.0008). Similar to histamine levels, IL-6 levels were
significantly correlated with the extent of erythema manifested by the study
patients. The extent of erythema was independently predicted by both IL-6 and
histamine levels. Histamine levels were negatively correlated with CRP levels
(Spearman p = -0.32, P = 0.003). Unlike histamine levels, IL-6 and CRP did not
show significant relationships with the extent or presence of
urticaria/angioedema or the presence of wheezing. IL-6 levels were correlated
with the duration of symptoms before serologic sampling. An inverse correlation
was observed between IL-6 levels and mean arterial blood pressure. Multivariate
modeling showed significant independent effects from mean arterial pressure,
duration of symptoms, erythema extent, and age in predicting IL-6 levels.
Tryptase levels were higher in patients whose IL-6 levels were >20 pg/mL.
CONCLUSIONS: CRP and IL-6 levels are not simple surrogate markers for histamine
or tryptase release by mast cells or basophils in acute allergic reactions.
Increasing IL-6 levels relate to greater erythema extent, lower mean arterial
blood pressure, and a longer duration of symptoms. It would be interesting to
speculate that CRP and IL-6 increases characterize a late-phase response in
immediate hypersensitivity reactions. In this perspective, the inverse
relationship between CRP and histamine levels could be explained. As histamine
levels are waning, CRP levels are increasing. Timed studies for histamine and
CRP/IL-6 levels in allergic reactions are necessary to confirm this hypothesis.
3816.
Linden A. Role of interleukin-17 and the neutrophil
in asthma. Int Arch Allergy Immunol
2001 Nov;126(3):179-84
Recent clinical evidence shows that acute, severe
exacerbations of asthma are associated with recruitment and activation of
neutrophils in the airways. There is also experimental evidence from rodents
that T-lymphocytes are involved in the recruitment of neutrophils following
allergen challenge in sensitised airways. This review addresses the potential
role of neutrophils and the cytokine interleukin-17 (IL-17) in severe asthma.
IL-17 is produced and released as a free protein from T-lymphocytes of the
memory (CD45RO+) subset. Evidence from rats in vivo suggests that IL-17 can
recruit and activate neutrophils in the airways; the recruitment is mediated by
the rat correlate to the neutrophil chemoattractant interleukin-8 (IL-8)
macrophage inflammatory protein-2 (MIP-2). Endogenous peptidases modulate
neutrophil recruitment by acting on NK-1 receptors in rat airways in vivo.
Human bronchial epithelial cells in vitro respond to stimulation with IL-17 by
increasing the production and release of the human neutrophil chemoattractant
IL-8. This release of IL-8 is functionally significant; it causes neutrophil
chemotaxis in vitro. Furthermore, this IL-8 release is sensitive to a
glucocorticoid and is potentiated by the pro-inflammatory cytokine, tumour
necrosis factor-alpha (TNF-alpha) in vitro. In addition, IL-17 stimulates human
bronchial epithelial cells in vitro to release the neutrophil-activating factor
IL-6. This effect of IL-17 on IL-6, and IL-8 is in part mediated via
mitogen-activated protein kinases. In conclusion, as indicated in rat airways
in vivo and in human bronchial epithelial cells in vitro, IL-17 may constitute
a link between the activation of certain T-lymphocytes and mobilisation of neutrophils
in the airways, via induced release of C-X-C chemokines and tachykinins.
Further studies are required to answer the question whether free, soluble IL-17
protein plays this role in the airways of patients with severe asthma.
Copyright 2001 S. Karger AG, Basel
3817.
Liutu M, Kalimo K, Uksila J, Savolainen J.
Extraction of IgE-binding components of Helicobacter pylori by immunoblotting
analysis in chronic urticaria patients. Int Arch Allergy Immunol 2001 Nov;126(3):213-7
BACKGROUND: An association between Helicobacter pylori
and chronic urticaria has been suspected previously. An IgE-mediated pathway
might be a possible link between H. pylori infection and chronic urticaria, and
therefore we wanted to prepare an optimal H. pylori antigen to detect H. pylori-specific
IgE antibodies in chronic urticaria patients. METHODS: H. pylori antigen
extracts were prepared in different ways to find the optimal antigen extract to
be used in the assays. Immunoblotting was used to detect IgE-binding bands. The
results were applied in an H. pylori RAST assay for specific H. pylori IgE
antibodies in patient sera. RESULTS: In immunoblotting, the largest number of
IgE-stained bands were visualized in the washing fluids and sonicated extracts,
while strong heating and denaturing treatments destroyed the epitopes for IgE
binding, suggesting that they belonged to the flagellar structures of H.
pylori. However, in H. pylori-specific RAST analysis, specific IgE was found
only in 1 of 25 H. pylori-infected patients. CONCLUSIONS: Our findings suggest
that although IgE-binding epitopes were found in H. pylori, H. pylori-specific
IgE antibodies are not common in chronic urticaria, and the clinical
significance of the IgE response is unclear. Copyright 2001 S. Karger AG, Basel
3818.
Lu CY, Sun CC. Localized erythema-multiforme-like
contact dermatitis from rubber gloves. Contact Dermatitis 2001 Nov;45(5):311-2 No
abstract
3819.
MacLean JA, Eidelman FJ. The genetics of atopy
and atopic eczema. Arch Dermatol 2001 Nov;137(11):1474-6 No abstract
3820.
Magnaval JF, Berry A, Fabre R, Morassin B.
Eosinophil cationic protein as a possible marker of active human Toxocara
infection. Allergy 2001
Nov;56(11):1096-9
BACKGROUND: Human toxocariasis is a common, worldwide
helminthozoonosis that may elicit syndromes including various allergy symptoms.
The diagnosis relies upon specific serology. However, this parasitosis is often
self-limiting, and many subjects have residual antibodies, thus making
differential diagnosis quite difficult when blood eosinophilia, a commonly
accepted criterion of active helminthiasis due to tissue-dwelling parasites, is
lacking. METHODS AND RESULTS: We present a patient with chronic irritant cough
displaying negative allergologic screening, normal blood eosinophilia, but
positive toxocariasis immunodiagnosis. Therefore, this case presented the
fortuitous association of an unexplained allergic picture with residual
anti-Toxocara antibodies. In an attempt to distinguish between active and past
toxocaral infection, the subject's level of eosinophil cationic protein (ECP)
was assessed and then compared to those of four control groups, namely, healthy
volunteers, subjects presenting anti-Toxocara residual antibodies, patients
with various helminthiases, and patients with active toxocaral disease. Since
the patient's ECP level was found to be sharply elevated, we hypothesized that
viable Toxocara larvae were still present in the tissues, and the patient was
given anthelmintic therapy. At the control checkup, the cough had waned and the
ECP level had decreased to below the mean value observed in both healthy
subjects and in subjects with past toxocaral infections. CONCLUSIONS: These
data suggest, first, that patients presenting unexplained allergic syndromes
should be checked for helminthiases, even if blood eosinophilia is lacking,
and, second, in such subjects displaying positive toxocariasis immunodiagnosis,
ECP assessment would be a useful marker to distinguish between active and past
toxocaral disease.
3821.
Mallol J, Aguirre V, Rhem R, Rodriguez J, Dolovich
M. Therapeutic equivalence of three metered-dose inhalers containing salbutamol
(Albuterol) in protecting against methacholine-induced bronchoconstriction in
children with asthma. Pediatr Pulmonol
2001 Dec;32(6):447-52
Many pharmaceutical companies sell salbutamol in
metered-dose inhalers (MDI) for the treatment of asthma. However, the
therapeutic equivalence of the more recently released generic products has not
been compared with the original patented product in children. Twenty children
with mild to moderate asthma, presently asymptomatic and with normal lung
function, were randomly allocated to receive 200 microg of inhaled salbutamol
(Albuterol) from three MDIs prepared by different manufacturers: the original
Glaxo product and two generic products. The three drug formulations and placebo
were given 10 min before a methacholine challenge test to determine the degree
of protection provided against methacholine-induced bronchoconstriction (MIB)
by each salbutamol aerosol. Tests were performed on 4 consecutive days.
Doubling concentrations of methacholine were inhaled until the forced expired
volume in 1 sec (FEV(1)) decreased by 20% from its baseline value. Compared to
placebo, all patients increased significantly the provocation concentration that
decreased FEV(1) by 20% (PC(20)) by more than one doubling concentration after
inhaling each of the three salbutamol aerosols. The effectiveness was not
significantly different between medications (P = 0.8). There was a small but
significant difference among MDIs in aerosol particle size and total and
fine-particle dose released per actuation. However, no relation was found
between aerosol particle size or released dose and the protective effect. This
study shows that the three tested brands of salbutamol MDI protected asthmatic
children equally from MIB. When prescribing these salbutamol MDIs to prevent
symptoms triggered by nonspecific stimuli in asthmatic children, the selection
may be based on cost-benefit criteria. Copyright 2001 Wiley-Liss, Inc.
3822.
Mancuso G, Berdondini RM. Allergic contact
blepharoconjunctivitis from dorzolamide. Contact Dermatitis 2001 Oct;45(4):243 No abstract.
3823.
May JR. Allergic rhinitis: nothing to sniffle at.
J Am Pharm Assoc (Wash) 2001
Nov-Dec;41(6):891-2 No abstract.
3824.
Mayo PR. Effect of passive smoking on
theophylline clearance in children. Ther Drug Monit 2001 Oct;23(5):503-5 No
abstract.
The author investigated the effects of passive tobacco
smoking on the metabolism of theophylline in a pediatric population. In a
retrospective analysis of 201 children admitted to a pediatric unit for asthma,
31 were identified with an acute exacerbation of asthma of noninfectious origin
in which environmental exposure to tobacco smoke could be established. The
parents were known smokers with a minimum 1-pack-per-day habit. An age-and
gender-matched control population of children was then identified who had an
acute exacerbation of asthma without any environmental exposure to tobacco
smoke. In addition, the patients in both groups received the same dose of
intravenous aminophylline for a minimum of 48 hours to ensure steady-state
conditions. Total body clearance of theophylline was significantly elevated in
the children exposed to environmental tobacco smoke (1.36 +/- 0.09 vs. 0.90 +/-
0.04 mL/min per kg, p < 0.0001). Steady-state serum levels were
significantly lower in the passive smoking group (55.3 +/- 2.8 vs. 73.2 +/- 3.3
p < 0.00001) for those receiving nearly identical intravenous doses. The
length of hospital stay was longer in the group exposed to passive smoke (4.4
+/- 2.6 vs. 2.9 +/- 1.3 days, p < 0.05). The clearance of theophylline is
greater in asthmatic children exposed to passive tobacco smoke than in
asthmatic children not exposed to passive tobacco smoke. These findings suggest
that passive smoking may increase the clearance of other drugs metabolized in a
manner similar to theophylline.
3825.
McNally NJ, Williams HC, Phillips DR. Atopic
eczema and the home environment. Br J Dermatol
2001 Nov;145(5):730-6
BACKGROUND: There is strong evidence to suggest that the
prevalence of atopic eczema is increasing in developed countries. Environmental
factors have been implicated in the disease. OBJECTIVES: This descriptive
case-control study sheds light on the possible association between atopic eczema
in school children and various home environmental factors, and generates
hypotheses for further studies. METHODS: The study uses data on reported atopic
eczema symptoms collected via a cross-sectional parental postal survey (n =
1350) in Nottingham, U.K. Estimates of the risk of reported eczema associated
with various home environmental factors were calculated by means of odds ratios
(OR), along with population attributable risk percentages. RESULTS: The study
showed statistically significant associations between atopic eczema symptoms
and dampness in the home [OR 1.40; 95% confidence interval (CI) 1.00-1.97], the
use of a radiator to heat the child's bedroom (OR 1.50; 95% CI 1.05-2.16) and
the use of synthetic pillows (OR 1.51; 95% CI 1.01-2.28). Frequent vacuuming in
the home was associated with a decreased prevalence of atopic eczema (OR 0.74;
95% CI 0.58-0.94). The associations with dampness in the home, synthetic
pillows and frequency of vacuuming were not altered significantly after
adjustment for age, sex and socio-economic status. Population attributable risk
percentages for the use of a radiator and synthetic pillows indicate that
although the relative risk estimates for these factors may be small, the
population impact of these factors is considerable (26% and 28%, respectively),
owing to the high prevalence of exposure to these factors among this group of
school children. CONCLUSIONS: Further research is needed to confirm these
associations and additional research is needed to see whether they might be
causative. Practical public health advice about the importance of controlling
the home environment may then be targeted at families with atopic eczema.
3826.
McPherson A, Glazebrook C, Smyth A. Double click
for health: the role of multimedia in asthma education. Arch Dis Child 2001 Dec;85(6):447-9 No
abstract.
3827.
Mehta SS, Reddy BS. Pattern of cosmetic
sensitivity in Indian patients. Contact Dermatitis 2001 Nov;45(5):292-3 No
abstract.
3828.
Menzies-Gow A, Robinson DS. Eosinophil chemokines
and chemokine receptors: their role in eosinophil accumulation and activation
in asthma and potential as therapeutic targets. J Asthma 2001 Dec;38(8):605-13 No abstract.
3829.
Merrill W. Hypersensitivity pneumonitis: just
think of it! Chest 2001
Oct;120(4):1055-7 No abstract.
3830.
Miller FG,
Shorr AF. Salmeterol and inhaled corticosteroids in patients with persistent
asthma. JAMA 2001 Dec
26;286(24):3075-6; discussion 3077-8 No
abstract.
3831.
Miracco C, Lalinga AV, Sbano P, Rubegni P, Romano
C. Delayed skin reaction to Red Sea coral injury showing superficial granulomas
and atypical CD30+ lymphocytes: report of a case. Br J Dermatol 2001 Nov;145(5):849-51 No abstract.
3832.
Mita H, Hasegawa M, Saito H, Akiyama K. Levels of
cysteinyl leukotriene receptor mRNA in human peripheral leucocytes: significantly
higher expression of cysteinyl leukotriene receptor 2 mRNA in eosinophils. Clin
Exp Allergy 2001 Nov;31(11):1714-23
BACKGROUND: Cysteinyl leukotrienes (CysLTs) have been
implicated as important contributors in the pathophysiology of asthma and their
biological effects are mediated by at least two distinct G-protein-coupled
receptors. cDNA sequences of cysteinyl leukotriene receptor 1 (CysLTR1) and
cysteinyl leukotriene receptor 2 (CysLTR2) have recently been
elucidated.OBJECTIVES: Our aim is to explore gene expression and the
comparative expression of CysLTR1 mRNA and CysLTR2 mRNA in human peripheral
blood leucocytes. METHODS: Gene expression of CysLTR1 and CysLTR2 mRNAs in
human peripheral blood eosinophils, neutrophils, monocytes and T lymphocytes
has been measured by competitive reverse transcription-polymerase chain
reactions using RNA or DNA competitors. RESULTS: (a) When cellular levels of
CysLTR1 mRNA were normalized to those of G3PDH mRNA, the relative concentration
of CysLTR1 mRNA in eosinophils (43.8 +/- 37.2, n = 29) was significantly higher
than that in neutrophils (18.7 +/- 23.3, n = 11), monocytes (0.93 +/- 1.1, n =
10) and T lymphocytes (3.4 +/- 2.4, n = 11). (b) When measured using each DNA
competitor, mRNAs for both types of CysLTR coexisted in each type of leucocyte.
The ratio of CysLTR1 mRNA to CysLTR2 mRNA was significantly lower in
eosinophils (0.65 +/- 0.42, n = 12) than in neutrophils (6.9 +/- 4.9, n = 12),
monocytes (1.8 +/- 0.9, n = 10) and T lymphocytes (4.5 +/- 5.7, n = 10). (c)
Human umbilical vein endothelial cells expressed CysLTR2 mRNA, but not CysLTR1
mRNA. CONCLUSION: These studies reveal that CysLTR1 mRNA and, in particular,
CysLTR2 mRNA are abundantly expressed at high levels in eosinophils, raising
the possibility that CysLTR2 may have an important physiological role in
eosinophils and a CysLTR2 antagonist may be a good target for preventing signal
transduction by CysLTs in eosinophils.
3833.
Moneret-Vautrin DA, Kanny G, Morisset M, Flabbee
J, Guenard L, Beaudouin E, Parisot L. Food anaphylaxis in schools: evaluation
of the management plan and the efficiency of the emergency kit. Allergy 2001
Nov;56(11):1071-6
BACKGROUND: Children with severe food allergies can
benefit from a personalized care project (PCP) in schools. The usefulness of
the PCP and the residual risk of allergic emergencies are poorly appreciated.
The objective was to evaluate the efficiency of the management plan and the
training in the use of the emergency kit. METHODS: A telephone survey using a
detailed questionnaire was performed in 45 families whose children had been
previously referred to the department. The distribution of disorders was as
follows: asthma, 37.7%; atopic dermatitis and asthma, 28.8%; atopic dermatitis,
15.5%; angioedema and urticaria, 13.3%; and anaphylactic shock, 4.2%. Food
allergy had been diagnosed in the 45 children by past history, and double-blind
or single-blind, placebo-controlled food challenges (DBPCFCs, or SBPCFCs) with
evidence of specific IgE. Exactly 75.5% of the children had peanut allergy.
Multiple food allergies characterized 46.8% of the subjects. They had benefited
from a strict elimination diet and a protocol for emergency care including a
ready-to-use intramuscular epinephrine injection. A PCP had been requested by
the School Public Health Service. RESULTS: Thirty-nine PCPs were implemented
(86.5% of the requests). They represented 63% of the PCPs for food allergy in
the eastern region of France: one per 5800 school-age children. The
retrospective period of evaluation was 25 months on average. The types of meals
were very diverse, and medically acceptable in 83% of cases. The place where
the emergency kit was stored in the school varied. Forty reactions occurred in
33% of the children (5/6 times in the absence of a PCP), asthma in 28%, shock
in 1%, and immediate skin reactions in 11%. Reactions occurred at home in 78%
of the subjects, and in school in 22% of the subjects. The cause of the
reactions was not specifically known in 63% of cases. Twenty-seven percent of
the reactions were linked to the ingestion of food allergens. In 10% of
subjects, the reaction was due to a modification of ingredients by the food
industry. CONCLUSIONS: The frequency of respiratory symptoms during oral
challenge tests was confirmed by the frequency of asthmatic reactions within
the follow-up period. The role of hidden allergens and of misleading labeling
validates the need for PCPs in the case of peanut and tree nut allergies, past
history of severe reactions, multiple food allergies, reactions to a low dose
in DBPCFCs, and asthmatic reactions to foods. This study provides encouraging
data on the usefulness of PCPs and confirms the need for thorough instruction
and training of the school staff in dealing with allergic emergencies. Addition
of a beta-agonist spray to the emergency kit is suggested.
3834.
Morali T, Yilmaz A, Erkan F, Akkaya E, Ece F,
Baran R. Efficacy of inhaled budesonide and oral theophylline in asthmatic
subjects. J Asthma 2001
Dec;38(8):673-9
The aim of present study was to evaluate clinical,
functional, and anti-inflammatory effects of inhaled budesonide and oral
theophylline treatments in patients with mild to moderate asthma. The study
included 38 patients. After a 10-day run-in period, the patients were randomly
assigned into two groups. Group 1 received inhaled budesonide (Pulmicort
Turbuhaler) 800 microg/day for 4 weeks. Group 2 received oral theophylline
(Talotren tablets, 200 mg twice daily) for 4 weeks. Inhaled budesonide therapy
was accompanied by a significant decrease in serum interleukin (IL)-5 levels (p
< 0.0005) and blood, sputum, and nasal eosinophil counts (p < 0.005). It
produced a significant reduction in daytime (p < 0.01) and nighttime (p <
0.005) symptom scores and an increase in morning (p < 0.005) and evening (p
< 0.05) peak expiratory flow (PEF) and forced expiratory volume in I sec
(FEV1) values (p < 0.01). Theophylline therapy was associated with a
significant decrease in blood (p < 0.02) and nasal (p < 0.01) eosinophil
counts and serum IL-5 levels (p < 0.01). It resulted in significant
improvements in daytime and nighttime symptom scores (p < 0.05), and morning
PEF and FEV1 values (p < 0.05). These changes were more significant in group
I than in group 2. There was no statistically significant difference between
the two groups with respect to post-treatment values. Our results confirm the
role of inhaled corticosteroids in the treatment of asthma and are consistent
with the recommendation that theophylline exerts an anti-inflammatory effect.
Further studies should be conducted to determine long-term benefits of
theophylline.
3835.
Mowad CM. Cocamidopropyl betaine allergy. Am J
Contact Dermat 2001
Dec;12(4):223-4
Cocamidopropyl betaine (CAPB) is a surfactant, and
reports of allergic contact dermatitis to this chemical have been reported in
the literature. Although most commonly found in rinse-off products, the
chemical nonetheless has been shown to induce allergy. The actual component
responsible for allergic reaction may be the final compound itself, CAPB, or
one of the substances used in its synthesis that may be present as an impurity.
Allergy to CAPB is most commonly seen in a head and neck distribution, although
other patterns have been identified. Copyright 2001 by W.B. Saunders Company
3836.
Nayak AS, Schenkel E. Desloratadine reduces nasal
congestion in patients with intermittent allergic rhinitis. Allergy 2001 Nov;56(11):1077-80 No
abstract.
3837.
Nentwich I, Michkova E, Nevoral J, Urbanek R,
Szepfalusi Z. Cow's milk-specific cellular and humoral immune responses and
atopy skin symptoms in infants from atopic families fed a partially (pHF) or
extensively (eHF) hydrolyzed infant formula. Allergy 2001 Dec;56(12):1144-56
BACKGROUND: Hydrolyzed milk formulas are recommended to
feed infants at high risk of atopy if breast-feeding is not possible. We
studied the specific cellular and humoral immune response to cow's milk
proteins and occurrence of atopic dermatitis under different feeding regimens:
two hydrolyzed infant milk formulas (partially [pHF] and extensively hydrolyzed
[eHF]) and under exclusive breast-feeding (BF). METHODS: Seventy-two infants
from families with atopic symptoms were randomized in the pHF and eHF groups,
respectively. At 6 and 12 months of age, peripheral blood mononuclear cell
proliferation along with specific IgG and IgE to cow's milk proteins was
determined in infants fed pHF or eHF, respectively, and those who had not yet
received any formula at 6 months of age (BF). Cases of atopic dermatitis were
recorded throughout the first 12 months of life, and their severity was
evaluated with SCORAD points. RESULTS: A significantly decreased proliferation
to cow's milk caseins was found in the pHF group compared to the exclusively
breast-fed group. Medians of stimulation indexes for CAS at 6 months were as
follows: pHF 1.18; n=24; BF 1.70; n=24 (P=0.033, Mann-Whitney U-test). Higher
levels of plasma IgG antibodies to BCAS were found in infants fed pHF than in
those fed eHF at 12 months. Optical density (OD): (25th percentile; median;
75th percentile): pHF: 0.00; 0.14; 0.38; n=30; eHF: 0.00; 0.03; 0.14; n=28;
P=0,089, Mann-Whitney U-test. Cow's milk-specific IgE was detected at 6 months
as follows: BF: 3 of 24; eHF: 2 of 21; pHF: 0 of 23. The number of cases of
atopic dermatitis and their severity did not differ among the groups during the
first 12 months. CONCLUSIONS: Feeding pHF appears to suppress cow's
milk-specific cellular responses and stimulate specific IgG production.
Specific IgE sensitization can occur also with breast-feeding.
3838.
Neva FA, Gam AA, Maxwell C, Pelletier LL. Skin
test antigens for immediate hypersensitivity prepared from infective larvae of
Strongyloides stercoralis. Am J Trop Med Hyg
2001 Nov;65(5):567-72
More rapid and simplified diagnostic procedures are
needed for the diagnosis of strongyloidiasis. One approach is the use of an
immediate hypersensitivity skin test that would reliably identify infected
people. Accordingly, somatic and excretion/secretion (E/S) antigens were
prepared from filariform larvae of Strongyloides stercoralis and were treated
to remove possible adventitious agents. By use of a quantitative method for
measurement of skin reactions, several preparations of the 2 antigens were
tested in uninfected controls and in various groups of patients. Doses of 0.35
microg of E/S and 4 microg of somatic antigens elicited positive skin tests in
82-100% of infected people, depending on clinical status. A lower frequency of
positive skin tests was found in strongyloidiasis patients also infected with
human T-cell lymphotropic virus type 1. Cross-reactions, especially to somatic
antigens, were frequently found in patients with filarial infections. Despite
these limitations and the need for further study of specificity, these results
provide a basis for future development of a diagnostic skin test antigen for
strongyloidiasis.
3839.
Nilsson S, Bergstrand L, Erikson U, Johansson J,
Smedby O, Walldius G. Allergic reactions at repeat femoral angiography with
ioxaglate. Acta Radiol 2001
Nov;42(6):608-11
PURPOSE: To study the occurrence of allergy-like
reactions at angiography, repeated several times, and, secondly, to evaluate
the effect of prophylactic treatment in individuals who had earlier experienced
such reactions. MATERIAL AND METHODS: One hundred and fifty-seven patients with
hypercholesterolaemia, participating in the Probucol Quantitative Regression
Swedish Trial (PQRST), underwent aortofemoral angiography with ioxaglate
(Hexabrix) repeated annually for 3 years. Allergic reactions to the contrast
medium were recorded. At the following angiographies, all patients who had
earlier experienced such reactions were treated prophylactically with steroids
and antihistamine. RESULTS: Allergic reactions were observed in 35 patients.
Twelve reacted only year 0, 3 only year 1, 5 only year 2 and 6 only year 3.
Eight patients had at least one reaction also when treated prophylactically. It
was significantly (p<0.05) more common to react at year 0 but not at year 1
than to react at year 1 but not at year 0. At years 1, 2 and 3 the frequency of
reactions was significantly greater in the group given prophylactic treatment
than in the group without any earlier reaction at all: 8/20 versus 3/137, 4/23
versus 6/134, and 6/29 versus 6/128, respectively. CONCLUSION: Some individuals
had an increased risk of an allergy-like reaction to the contrast agent.
Prophylactic treatment reduced the risk of renewed reactions, but not to the
same level as for those without earlier reaction. Nevertheless, individuals who
have had earlier reactions can be investigated in the future, with prophylactic
treatment.
3840.
Noell CA, Roland PS, Mabry RL, Shoup AG. Inhalant
allergy and Meniere's disease: Use of electrocochleography and intranasal
allergen challenge as investigational tools. Otolaryngol Head Neck Surg 2001 Oct;125(4):346-50
INTRODUCTION: In an earlier study, we demonstrated the
feasibility of using electrocochleography (ECoG) to document changes in inner
ear function objectively after intranasal challenge of patients with inhalant
allergy (with no prior immunotherapy) and Meniere's disease, using the antigen
to which they were most sensitive. OBJECTIVE: We expand on this earlier study
and continue to investigate the feasibility of this model in a subset of
patients with inhalant allergy and Meniere's disease after immunotherapy. STUDY
DESIGN: Prospective study of 11 patients identified with both Meniere's disease
and inhalant allergy in the practices of 2 neurotologists at our institution.
Patients underwent a baseline ECoG, followed by intranasal challenge with the allergen
to which they were most sensitive. This was followed by a second ECoG. RESULTS:
Six of 11 patients had at least 1 year of immunotherapy (group 1), and 5 of 11
had had 0 to 6 months of immunotherapy (group 2). Four of 6 group 1 patients
had a >15% increase in SP/AP ratio after immunotherapy. In group 2, 2
patients increased the SP/AP in at least 1 ear. No patient with a normal ECoG
experienced vestibular symptoms after allergen challenge, whereas 2 of group 1
and 2 of group 2 had vestibular symptoms with abnormal ECoGs. CONCLUSION: This
protocol is a useful tool for investigating the relationship of inhalant
allergy and Meniere's disease, but needs a larger group of patients and further
study to draw valid statistical conclusions.
3841.
Nolles G, Hoekstra MO, Schouten JP, Gerritsen J,
Kauffman HF.Prevalence of immunoglobulin E for fungi in atopic children. Clin
Exp Allergy 2001
Oct;31(10):1564-70
BACKGROUND: The prevalence of sensitization to fungi in
young atopic patients in relation to age and clinical importance is largely
unknown. OBJECTIVE: The aim of this study was to investigate the prevalence of
sensitization to different fungi in atopic children in relation to age and
other aeroallergens. METHODS: A total of 137 atopic children (male 62%, female 38%;
mean age 5 years and 9 months, range 5 months-14 years) were studied. Sera of
all patients were routinely tested for total IgE and specific IgE against
aeroallergens and milk. Positive sera were also tested for IgE against
Alternaria alternata, Aspergillus fumigatus, Cladosporium herbarum and
Penicillium chrysogenum, using the Pharmacia Enzyme CAP procedure. RESULTS: In
this study in atopic children total IgE showed a significant linear relation
with age, whereas specific IgE against outdoor fungi, indoor fungi and house
dust mite showed significant non-linearity with age. Prevalence of specific IgE
for Cladosporium ranked first, followed closely by Aspergillus and Alternaria.
Calculation of the sensitization of indoor and outdoor fungi showed maximum prevalence
at 7.8 years, followed by lower values at higher ages. A similar significant
relation was also found for Alternaria, while this relation was not significant
for the other individual fungi. Specific IgE for indoor and outdoor fungi was
associated with the presence of specific IgE for aeroallergen and milk. We
found that all children aged 4 years and older showed IgE for house dust mite
that did not decline with increasing age. CONCLUSIONS: Sensitization to fungi
is prevalent in childhood, with an age-dependent distribution reaching maximum
values at 7.7-7.8 years, followed by a decline for all fungal sensitization
with increasing age. The importance and relative contribution of fungal
sensitization to airway disease, compared with the other allergens, remains to
be established.
3842.
Nolte H, Backer V, Porsbjerg C. Environmental
factors as a cause for the increase in allergic disease. Ann Allergy Asthma
Immunol 2001 Dec;87(6 Suppl
3):7-11
LEARNING OBJECTIVES: To be able to understand the
interaction among genetic factors, environmental exposure to allergens, and
nonspecific adjuvant factors contributing to the increase in atopic diseases in
developed countries. DATA SOURCES: Peer-reviewed literature identified by
searching medical databases. STUDY SELECTION: Careful review of epidemiologic
cross-sectional, sequential, and longitudinal population studies and, when
appropriate, intervention studies. The criteria used to accept a study
reporting environmental factors influencing the prevalence of allergic diseases
were adopted from the report published by the US Department of Health and
Education in 1964 (Hill AB, Principles of Medical Statistics, 9th Ed. New York:
Oxford University Press, 1971, p. 323) RESULTS: There is ample evidence that
specific environmental factors may cause sensitization and development of
allergic symptoms and disease in susceptible individuals. It is unclear when
and how long a sufficient exposure will result in clinical symptoms related to
the immunoglobulin E-sensitizing agents. CONCLUSIONS: Environmental factors
play an important role for the development and manifestation of allergic
conditions in genetically predisposed subjects. It is well documented that
increased exposure to indoor allergens and selected outdoor allergens (eg, grass
pollen and molds) and smoking are important risk factors for development of
asthma and allergic sensitization. The importance of other environmental
factors is less clear and which environmental factors that cause the increase
in prevalence of allergic disease is still unknown.
3843.
Nyan OA, Walraven GE, Banya WA, Milligan P, Van
Der Sande M, Ceesay SM, Del Prete G, McAdam KP. Atopy, intestinal helminth
infection and total serum IgE in rural and urban adult Gambian communities.
Clin Exp Allergy 2001 Nov;31(11):1672-8
BACKGROUND: The rarity of atopy in traditional societies
has been attributed to high parasite-driven blocking IgE concentrations.
Information is lacking on the relationship between atopy, IgE and intestinal
helminth infection in African populations. OBJECTIVE: To determine the
prevalence of atopy and intestinal helminth infection and to relate these to
wheeze history and serum total IgE in a community sample of adults from an
urban (Banjul) and a rural (Farafenni) area of the Gambia. METHODS: Six hundred
and ninety-three adults were interviewed about respiratory symptoms using a
modified version of the IUTLD questionnaire, and had skin prick testing using
four allergens. Stools were examined after formol-ether concentration. Total
serum IgE concentration was measured in a subset of participants. RESULTS: The
prevalence of atopy (mean weal diameter > or = 3 mm) in the urban and rural
area was 35.3% and 22.5% (P = 0.05); D. pteronyssinus and Mold mix being the
common sensitizing allergens. Prevalence of wheeze in the previous 12 months
was 4.4% and 3.5% for the urban and rural areas, respectively. Wheezing was not
significantly associated with atopy. Seventeen per cent of urban and 8.2% of
rural subjects had helminths detected in stools. There was an inverse
association between atopy and intestinal helminth infection; 7% of atopic
subjects had helminths, compared to 13% of non-atopic subjects (unadjusted odds
ratio 0.51, 95%CI 0.24-1.1, P = 0.09; adjusted odds ratio 0.37, 95%CI
0.15-0.92, P = 0.03). Non-atopics had total serum IgE concentrations about 2.5
times the upper limit of the reference range in non-atopic Western populations.
Geometric mean total serum IgE concentration was significantly higher among
atopic subjects (570 IU/mL, IQR 91-833) than non-atopic subjects (259 IU/mL,
IQR 274-1303) (P < 0.001). IgE concentration was not associated with the
presence of helminth infection. CONCLUSION: Further studies are needed to
clarify why asthma is still relatively uncommon in spite of the prevalence of
atopy in Gambian adults. Our data are also compatible with the idea that atopy
might protect against helminth infection.
3844.
Oehlschlager S, Reece P, Brown A, Hughson E, Hird
H, Chisholm J, Atkinson H, Meredith C, Pumphrey R, Wilson P, Sunderland J. Food
allergy--towards predictive testing for novel foods. Food Addit Contam 2001 Dec;18(12):1099-107
The risks associated with IgE-mediated food allergy
highlight the need for methods to screen for potential food allergens. Clinical
and immunological tests are available for the diagnosis of food allergy to
known food allergens, but this does not extend to the evaluation, or prediction
of allergenicity in novel foods. This category, includes foods produced using
novel processes genetically modified (GM) foods, and foods that might be used
as alternatives to traditional foods. Through the collation and analysis of the
protein sequences of known allergens and their epitopes, it is possible to
identify related groups which correlate with observed clinical cross-reactivities.
3-D modelling extends the use of sequence data and can be used to display
eptiopes on the surface of a molecule. Experimental models support sequence
analysis and 3-D modelling. Observed cross-reactivities can be examined by
Western blots prepared from native 2-D gels of a whole food preparation (e.g.
hazelnut, peanut), and common proteins identified. IgEs to novel proteins can
be raised in Brown Norway rat (a high IgE responder strain) and the proteins
tested in simulated digest to determine epitope stability. Using the CSL serum
bank, epitope binding can be examined through the ability of an allergen to
cross-link the high affinity IgE receptor and thereby release mediators using
in vitro cell-based models. This range of methods, in combination with data
mining, provides a variety of screening options for testing the potential of a
novel food to be allergenic, which does not involve prior exposure to the
consumer.
3845.
Ou LS, Kuo ML, Huang JL. Anaphylaxis to
riboflavin (vitamin B2). Ann Allergy Asthma Immunol 2001 Nov;87(5):430-3
BACKGROUND: Vitamin supplements are used more commonly
in normal healthy subjects than in patients with vitamin deficiency. Thiamine
(vitamin B,) is the vitamin that most frequently induces allergic reactions. To
the best of our knowledge, no case of anaphylaxis to riboflavin (vitamin B2)
has thus far been reported in the literature. OBJECTIVE: We describe a
previously healthy 15-year-old boy in whom anaphylaxis developed several times
after he drank one soft drink or took a single multivitamin tablet. This study
was done to determine which of the many components found in the soft drink and
vitamin tablet caused the anaphylactic reaction. METHODS: In an outpatient
clinic with the availability of complete resuscitative procedures, we performed
single-blind prick skin tests and intradermal skin tests on the patient with
various pure vitamin components of the soft drink and the multivitamin tablet.
Physiologic saline and histamine were used for negative and positive controls, respectively.
RESULTS: Riboflavin, a component of both the soft drink and the vitamin tablet,
produced positive reactions on intradermal skin tests in the patient. Positive
reactions were not present in the normal control subjects. CONCLUSIONS:
Riboflavin is a previously unreported cause of anaphylaxis. Free-form
riboflavin may potentially be associated with an anaphylactic reaction. It is a
vitamin widely used in many patients with chronic disease and in healthy
subjects. Vitamin B2 must be considered as a cause of anaphylaxis.
3846.
Pacor ML, Di Lorenzo G, Corrocher R. Efficacy of
leukotriene receptor antagonist in chronic urticaria. A double-blind,
placebo-controlled comparison of treatment with montelukast and cetirizine in
patients with chronic urticaria with intolerance to food additive and/or
acetylsalicylic acid. Clin Exp Allergy
2001 Oct;31(10):1607-14
BACKGROUND: The cause and pathogenesis of chronic
urticaria are still poorly understood. IgE-independent reactions, are common in
adult patients with chronic urticaria, who have daily spontaneous occurrence of
weals. H(1)-receptor antagonists (antihistamines) are the major class of
therapeutic agents used in the management of urticaria and angioedema.
Nevertheless, chronic urticaria is often difficult to treat and may not be
controlled by antihistamines alone. It has been postulated that mediators other
than histamine, such as kinins, prostaglandin and leukotrienes, may be
responsible for some of the symptoms in urticaria which are not controlled by
antihistamines. In this study, which was randomized double-blind,
placebo-controlled, we compare the clinical efficacy and safety of montelukast
(MT) 10 mg given once a day and cetirizine (CET) 10 mg given once a day with
placebo (PLA), in the treatment of patients with chronic urticaria who have
positive challenge to acetylsalicylic acid (ASA) and/or food additives.
PATIENTS AND METHODS: A group of 51 patients, ranging in age from 15 to 71
years, with chronic urticaria and positive challenge to food additives and/or
ASA, participated in this study for a period of 4 weeks, starting from a 3-day
run-in. The assessment of the efficacy was based on scores of daily urticaria
symptoms. RESULTS: MT significantly increased the percentage of symptom-free
days for hive and itch. Analysis of frequency distribution of urticaria scores
for each symptom gave similar results (MT vs. CET and MT vs. PLA, P <
0.001). The interference with sleep due to their skin condition was also lower
in the group treated with MT (P < 0.001). In addition, the median number of
days without the rescue medication was significantly higher in the MT group (24
days) than both the CET and the PLA groups (18 days, P < 0.001, and 20 days,
P < 0.001, respectively). Finally, a low incidence of adverse events was
observed in this study. CONCLUSION: The results of this comparative study
demonstrate that montelukast orally administered once a day is very effective
for the treatment of cutaneous symptoms in patients with chronic urticaria due
to food additives and/or ASA.
3847.
Palczynski C, Walusiak J, Ruta U, Gorski P.
Occupational asthma and rhinitis due to glutaraldehyde: changes in nasal lavage
fluid after specific inhalatory challenge test. Allergy 2001 Dec;56(12):1186-91
BACKGROUNDd: Glutaraldehyde (GA) is a known respiratory
sensitizers, and some studies have reported occupational asthma in exposed
workers. Specific changes in nasal lavage fluid (NLF) induced by
high-molecular-weight allergen provocation in sensitized subjects were
described previously. The purpose of this study was to evaluate the changes in
cytogram, protein content, eosinophil cationic protein (ECP), and mast-cell
tryptase concentrations in NLF after GA inhalation challenge in patients with a
positive history of GA-induced asthma and late or dual asthmatic response due
to exposure to low-level GA. METHODS: A single-blind, placebo-controlled study
was performed on 11 health workers with occupational asthma and rhinitis due to
GA. The control groups comprised 10 atopic subjects with perennial asthma and
rhinitis and 10 healthy ones. A "nasal pool" technique was used to
evaluate the examined parameters in nasal washings before and 30 min, 4 h, and
24 h after the inhalatory provocation with GA and placebo. RESULTS: There was a
significant increase in eosinophil number and percentage, and albumin, ECP, and
tryptase concentrations in NLF from patients with occupational asthma and
rhinitis when compared to controls. CONCLUSIONS: The results indicate the
immunologic mechanism of GA-induced asthma and the applicability of the
"nasal pool" technique as the diagnostic procedure in GA-induced
airway allergy.
3848.
Palma-Carlos AG, Spinola-Santos A, Ferreira MB,
Santos MC, Palma-Carlos ML. Immunotherapy in allergic rhinitis. Allerg Immunol
(Paris) 2001 Oct;33(8):323-6
Allergen specific immunotherapy (IT) represents a
cornerstone of allergic rhinitis treatment and his efficacy has been confirmed,
through open and double blind trials and meta-analysis. In the last few years
non invasive routs for IT (oromucosal, nasal) were developed gained general
acceptation mainly in children and were validated by WHO. The efficacy of IT
could be markers, the pattern of specific antibody response or by the effect on
sequential nasal challenges. We have evaluated the effect of IT in allergic
rhinitis by different methods. Nasal IT decreased mean symptoms and
pharmacological scores as well as in seasonal as in perennial rhinitis. The
same decrease has been observed after oromucosal IT. The effect of IT in
allergic inflammation has been confirmed by a decrease in the level of soluble
adhesion molecule sVCAM-1 which is related to eosinophilic inflammation but not
statistically for sICAM-1. We have also evaluated the immunoblotting pattern or
specific IgE after oromucosal IT for house dust mites. For D. pteronyssinus in
4 patients the bands intensity decreased and in 3 patients the bands decreased
and in 10 disappeared. IT decreases tryptase and ECP in nasal lavage after
sequential nasal challenges. Therefore IT decreases clinical scores, inflammation
markers, specific IgE immunoblotting bands and response to allergen challenge.
These different results confirm his efficacy and usefulness in allergic
rhinitis.
3849.
Parnia S, Frew AJ. Is diesel the cause for the
increase in allergic disease? Ann Allergy Asthma Immunol 2001 Dec;87(6 Suppl 3):18-23
LEARNING OBJECTIVES: The purpose of this review is to
objectively critique available data regarding the role of diesel exhaust
particles (DEPs) in allergic disease. Readers of this review should understand
the ways in which diesel particulates can affect human airways and the extent
of the scientific data which are currently available. DATA SOURCES: Data were
obtained from published studies and reviews. STUDY SELECTION: The specific
reviewed studies selected for this review met the following criteria: human and
animal in vivo, in vitro, and pulmonary dosimetry studies, as well as
epidemiologic studies to examine the role of DEPs and particulates on the
airways. RESULTS: The results of the published studies show that although DEPs
may play a role in the increased levels of allergic disorders through a number
of immunologic mechanisms, it remains to be proven whether it is responsible
for the recent rise in the prevalence of asthma and other allergic disorders.
CONCLUSIONS: Further studies in humans are needed to elucidate the mechanisms
by which DEPs may be responsible for the increased prevalence of allergic
disorders.
3850.
Patel L, Wales JK, Kibirige MS, Massarano AA,
Couriel JM, Clayton PE. Symptomatic adrenal insufficiency during inhaled
corticosteroid treatment. Arch Dis Child
2001 Oct;85(4):330-4
Symptomatic adrenal insufficiency, presenting as
hypoglycaemia or poor weight gain, may occur on withdrawal of corticosteroid
treatment but has not previously been reported during inhaled corticosteroid
treatment. This case series illustrates the occurrence of clinically
significant adrenal insufficiency in asthmatic children while patients were on
inhaled corticosteroid treatment and the unexpected modes of presentation.
General practitioners and paediatricians need to be aware that this unusual but
acute serious complication may occur in patients treated with inhaled
corticosteroids.
3851.
Raj Kumar:: Allergic bronchopulmonary
aspergillosis with aspergilloma mimicking pulmonary tuberculosis. Indian J
Tuberc 2000, 47(2), 103-5. (013253). July 1,
2001. No abstract.
3852.
Rak S, Heinrich C, Jacobsen L, Scheynius A, Venge
P. A double-blinded, comparative study
of the effects of short preseason specific immunotherapy and topical steroids
in patients with allergic rhinoconjunctivitis and asthma. J Allergy Clin
Immunol 2001 Dec;108(6):921-8
BACKGROUND: Both specific immunotherapy (SIT) and nasal
steroid (NS) have been shown to effectively reduce symptoms of allergic
rhinitis. Although a number of investigators have convincingly shown
anti-inflammatory effects of both treatments in separate studies, few
comparative studies have been performed. OBJECTIVE: The purpose of this study
was to compare the effects of preseason SIT with a standardized allergen
extract and NS in seasonal allergic disease (rhinoconjunctivitis and asthma).
METHODS: We examined 41 patients allergic to birch pollen, 21 with
rhinoconjunctivitis and 20 with both rhinoconjunctivitis and asthma; they were
treated in a randomized, double-blinded comparative study with birch SIT and NS
(budesonide 400 microg daily). Bronchial hyperresponsiveness was measured
before and during the season. Changes in eosinophil number, eosinophil cationic
protein, and eosinophil chemotactic activity (ECA) in peripheral blood were
investigated. RESULTS: Symptoms of rhinoconjunctivitis increased significantly
less in the NS-treated patients than in the SIT-treated patients during the
final 2 weeks of the season (P = .03 and P = .04, respectively). Seasonal peak
expiratory flow values decreased significantly only in the NS-treated patients
(P = .01). In the NS-treated patients, bronchial hyperresponsiveness increased
significantly during the season (P = .0001); however, SIT treatment prevented seasonal
PC(20) increase in the asthmatic patients. Measurement of blood eosinophils,
eosinophil cationic protein, and eosinophil chemotactic activity demonstrated
significant seasonal increase only in the NS-treated asthmatic patients.
CONCLUSION: Treatment with NS was more effective than short-course preseason
SIT in reducing symptoms of rhinoconjunctivitis; however, the 2 therapies were
equivalent in terms of the need for rescue medication. SIT prevented seasonal
increase in bronchial hyperresponsiveness, eosinophil number, eosinophil
cationic protein, and eosinophil chemotactic activity only in asthmatic
patients. The mechanisms underlying bronchial hyperresponsiveness developing
during allergen exposure in rhinitis might be different from those operating in
asthma.
3853.
Ravenscroft J, Goulden V, Wilkinson M. Systemic
allergic contact dermatitis to 8-methoxypsoralen (8-MOP). J Am Acad
Dermatol 2001 Dec;45(6 Suppl):S218-9
Photochemotherapy with psoralens and UVA (PUVA) is
widely used in the treatment of psoriasis and many other skin conditions.
Cutaneous adverse reactions to 8-methoxypsoralen (8-MOP) appear to be rare and
may be difficult to distinguish from phototoxicity or UV-induced polymorphic
light eruption. We describe a patient who had a systemic allergic contact
dermatitis to 8-MOP develop during her second course of PUVA treatment for
psoriasis.
3854.
Rebollo S, Sanchez P, Vega JM, Sedano E, Sanchis
ME, Asensio T, Callejo A. Hypersensitivity syndrome from isoniazid with
positive patch test. Contact Dermatitis
2001 Nov;45(5):306 No abstract.
3855.
Reche M, Pascual CY, Vicente J, Caballero T,
Martin-Munoz F, Sanchez S, Martin-Esteban M. Tomato allergy in children and
young adults: cross-reactivity with latex and potato. Allergy 2001 Dec;56(12):1197-201
BACKGROUND: Several studies have shown that allergy to
natural rubber latex is associated with cross-reactivity to certain foods such
as tomato and potato. The objective was to investigate the clinical and
immunologic differences between a group of patients with clinical allergy to
tomato and latex and another which had only clinical allergy to tomato. We also
aimed to assess, in vitro, the relationship of tomato and latex allergens,
which could explain the cross-reactivity. METHODS: Forty patients with
histories of adverse reactions to tomato and IgE-mediated hypersensitivity were
enrolled in the study. Tomato, latex, and potato components were analyzed by
SDS-PAGE immunoblotting. CAP and immunoblot inhibition were used to study
allergen cross-reactivity. RESULTS: Patients from group A had a mean age of
13.2 years, and in group B the mean age was 21.7 years. In group B, 9/10
patients belonged to the latex-fruits syndrome. All patients of both groups
tolerated potato. Immunoblotting patterns obtained with patients' sera from
pool A showed IgE-binding bands to tomato ranging from 44 to 46 kDa and a
triple band at 67 kDa. For latex, there was a strong binding at 44 kDa, and
potato showed a strong band of 44 kDa and a 67-kDa triple band. In pool B, the
binding to the band of 44 kDa in latex and tomato was more intense than in pool
A. In pool A, immunoblot inhibition with potato allergen showed an intense
inhibition of the three allergens (potato, latex, and tomato); with latex,
inhibition was partial and with tomato, a complete inhibition of tomato and
latex was observed, and a partial inhibition of potato. In pool B, the
inhibition pattern followed a similar tendency to pool A. The CAP inhibition
confirmed the high rate of cross-reactivity between tomato, potato, and latex.
CONCLUSIONS: In our study, tomato, potato, and latex showed a common band of
44-46 kDa probably corresponding to patatin. This protein could be implicated
in the high cross-reactivity between tomato, latex, and potato observed in the
immunoblot and CAP inhibition.
3856.
Renstrom A, Karlsson AS, Malmberg P, Larsson PH,
van Hage-Hamsten M. Working with male rodents may increase risk of allergy to
laboratory animals. Allergy 2001
Oct;56(10):964-70
BACKGROUND: Our aim was to study the risk of laboratory
animal allergy (LAA) among research staff working in laboratories separate from
the animal confinement area. The roles of atopy and exposure intensity in LAA
were studied with special regard to exposure to male rodents, who excrete
higher levels of urinary allergens than female rodents. METHODS: Eighty
rodent-exposed subjects gave blood samples for the analysis of total IgE,
Phadiatop, and specific IgE against rat (RUA) and mouse urinary allergens
(MUA), and answered questionnaires. Air samples were collected for RUA and MUA
aeroallergen measurement in both laboratories and animal confinement
facilities. RESULTS: Twenty percent of the subjects had IgE >0.35 kU/l to
RUA and/or MUA, and 32% had experienced animal work-related symptoms, although
90% of aeroallergen samples from the research department laboratories were
below the detection limit (<0.26 ng RUA per m(3) and <0.8 ng MUA per
m(3)). Atopy (positive Phadiatop), total IgE >100 kU/l, other allergies
(especially to other animals), or more than 4 years of exposure significantly
increased laboratory animal sensitization and symptoms. Working with mainly
male rodents gave odds ratios (95% CI) of 3.8 (0.97-15) for sensitization and
4.4 (1.4-14) for symptoms. Subjects with both exposure to mainly male rodents
and atopy or elevated total IgE had a 10-fold higher frequency of sensitization
than exposed subjects with neither risk factor. CONCLUSION: A majority of
subjects with a combination of exposure to mainly male rodents and atopy or
elevated total IgE developed sensitization to and symptoms from laboratory
animals. Current low exposure seems to maintain the presence of specific IgE.
Further measures must be undertaken to provide a safe workplace for laboratory
animal workers.
3857.
Rhodes HL, Sporik R, Thomas P, Holgate ST, Cogswell
JJ. Early life risk factors for adult asthma: a birth cohort study of subjects
at risk. J Allergy Clin Immunol 2001 Nov;108(5):720-5
BACKGROUND: Prediction of adult asthma is important, and
early prevention strategies should be targeted at those most at risk.
Identifying high-risk children at an early age, however, is currently
difficult. OBJECTIVE: We sought to determine those factors present in early
life that predict an increased risk of adult asthma. METHODS: A prospective
cohort study of subjects at risk of asthma and atopy was undertaken in Poole,
England. One hundred babies of atopic parents were recruited at birth. During
the first 5 years of life, subjects were recalled annually, all respiratory
events were reported, and skin prick tests and total serum IgE measurements
were performed. At 11 and 22 years, bronchial hyperresponsiveness was also
measured. Seventy-three subjects were followed up at 5 years, 67 at 11 years,
and 63 at 22 years. RESULTS: Twenty-three (37%) adult subjects reported
wheezing within the previous 12 months. Fifteen (25%) of these subjects showed
signs of bronchial hyperresponsiveness and were regarded as asthmatic. Wheezing
before the age of 2 years occurred in 28% and was not significantly related to
adult asthma (odds ratio, 0.3; 95% CI, 0.03-1.7; P =.19). A positive skin prick
test response to hen's egg, cow's milk, or both in the first year was
independently predictive of adult asthma (odds ratio, 10.7; 95% CI, 2.1-55.1; P
= .001; sensitivity, 57%; specificity, 89%). CONCLUSION: Prediction of adult
asthma remains difficult. In this study of subjects at risk of atopy, skin
sensitivity to hen's egg or cow's milk in the first year was predictive of
adult asthma.
3858.
Riediker M, Monn C, Koller T, Stahel WA, Wuthrich
B. Air pollutants enhance rhinoconjunctivitis symptoms in pollen-allergic
individuals. Ann Allergy Asthma Immunol
2001 Oct;87(4):311-8
BACKGROUND: Little is know about the relation of
airborne pollen allergens to nasal and ocular symptoms in combination with air
pollutants. OBJECTIVE: The hypothesis was that air pollutants exacerbate
allergic symptoms of the nose and eyes during the pollen season. In addition,
the use of allergen measurements instead of pollen counts should be tested.
METHODS: Fifteen pollen-allergic, nonsmoking subjects with weak reactivity of
the airways recorded rhinoconjunctival symptoms and medication every morning
and evening throughout the pollen season. Symptoms were compared with air
pollutants (nitrogen oxide [NOx], particulate matter smaller than 10 microm,
and ozone) and birch and grass pollen counts or, alternatively, to airborne
birch and grass allergens determined using ELISA-techniques. A multiple linear
regression model was used which controlled for autocorrelation of the residuals
of the time series (Cochrane-Orcutt approach). This model was applied to each
subject individually, followed by calculations of summary scores for the group.
RESULTS: Air pollution levels were moderate, often meeting air quality
standards. Effect estimates (increase of score with 10-fold increase of
concentration) were NOx = 1.06, P < 0.01; ozone = 1.59, P < 0.01; and
pollen = 0.48, P < 0.001. Using allergen concentrations instead of pollen
counts resulted in similar effect estimates. Using particulate matter smaller
than 10 microm instead of NOx gave comparable but less consistent results.
CONCLUSIONS: Symptoms were related to moderate levels of pollutants, suggesting
that rhinoconjunctival tissue is very sensitive to irritant stimuli during an
ongoing allergic inflammation, and that susceptibility toward allergens might
be increased in areas with increased levels of air pollutants. Allergen
measurements seem equally usable as pollen counts to investigate
rhinoconjunctivitis.
3859.
Ring J, Eberlein-Koenig B, Behrendt H.
Environmental pollution and allergy. Ann Allergy Asthma Immunol 2001 Dec;87(6 Suppl 3):2-6
OBJECTIVES: Among the theories supporting the increase
of allergic diseases in modern western countries during the last several
decades is the concept that environmental pollutants may play a vital role.
Reading this article will enable the reader to recognize the effect of
different types of environmental pollution on the development, modulation, and
persistence of allergic reactions. DATA SOURCES: Data sources include
references to relevant articles and texts. To characterize the influence of
environmental pollutants on allergic reactions (allergotoxicology),
epidemiologic, clinical, and experimental data are considered. RESULTS: The
investigations show that air pollution patterns differ with respect to their
effect upon allergies. Classical air pollution (type I) with high sulfur
dioxide and dust particles seems not to be associated with allergic disease in
humans. However, type II pollution characterized by elevation of oxides of
nitrogen (NOx), ozone (O3), tobacco smoke, fine and ultrafine particulate
matter, and diesel exhaust particles seems to enhance allergic disease.
CONCLUSIONS: The data suggest that environmental pollution can act at different
levels and by complex interactions both outside and inside the individual and
influence allergic diseases.
3860.
Ring J, Kramer U, Schafer T, Behrendt H. Why are
allergies increasing? Curr Opin Immunol
2001 Dec;13(6):701-8
The incidence of atopic allergy is increasing in certain
'Western' countries but this remains unexplained. Various hypotheses with
differing amounts of evidence and/or relevance have been assessed, including
increased awareness of the diseases, improved diagnostics, genetic
susceptibility, psycho-socialinfluences, allergen exposure, decreased
immune-system stimulation, underlying disease, anti-allergic therapy and
pollution.
3861.
Rose EA, Schwartz K. Is a 2-day course of oral
dexamethasone more effective than 5 days of oral prednisone in improving symptoms
and preventing relapse in children with acute asthma? J Fam Pract 2001 Nov;50(11):993 No abstract.
3862.
Rosenberg HF, Domachowske JB. Eosinophils,
eosinophil ribonucleases, and their role in host defense against respiratory
virus pathogens. J Leukoc Biol 2001
Nov;70(5):691-8
Eosinophils remain among the most enigmatic of cells, as
our appreciation of their detrimental activities--e.g., asthma and allergic
disease—far outweighs our understanding of their beneficial effects. Among the
major secretory effector proteins of eosinophils are the ribonucleases
eosinophil-derived neurotoxin (EDN) and eosinophil cationic protein (ECP) in
primates and their orthologs, the eosinophil-associated ribonucleases (EARs) in
rodents. The rapid diversification observed among these ribonucleases suggested
that the ultimate target(s) might be similarly efficient at generating sequence
diversity while maintaining an unalterable susceptibility to ribonucleolytic
cleavage. This has prompted us to consider a role for these proteins and by
extension, for eosinophils, in host defense against single-stranded RNA virus
pathogens. We detail our studies of the antiviral activity of eosinophils and
eosinophil ribonucleases against respiratory syncytial virus (RSV) in vitro and
the related, natural rodent pathogen, pneumonia virus of mice (PVM), in vivo,
and consider the possibility that antiviral host defense and the dysregulated
responses leading to asthma represent opposing sides of an eosinophil-mediated
double-edged sword.
3863.
Rudin A, Macaubas C, Wee C, Holt BJ, Slya PD,
Holt PG. "Bystander" amplification of PBMC cytokine responses to
seasonal allergen in polysensitized atopic children. Allergy 2001
Nov;56(11):1042-8
BACKGROUND: Atopic children show increased expression
and production of the Th2-associated cytokines IL-4, IL-5, IL-13, and IL-9 from
PBMCs after stimulation with allergen, but it has previously not been clearly
determined whether the Th2-cytokine production is restricted to the inhalant
allergen the child is sensitized to, and whether perennial or seasonal
allergens induce different cytokine responses. Our purpose was to determine
whether in vitro Th2 cytokine production is specific to the sensitizing
allergen, and to compare the cytokine responses to a perennial and a seasonal
allergen in monosensitized and polysensitized children. METHODS: Using
semiquantitative RT-PCR, we analyzed the expression of the cytokines IL-4,
IL-5, IL-13, IL-9, IL-10, and IFN-gamma after stimulation of PBMCs with
house-dust-mite (HDM) or ryegrass allergen. The cells were sampled from groups
of 6-year-old children sensitized to either HDM (n=20) or ryegrass (n=24), or
to both allergens (n=20), as well as from a nonatopic group (n=20). RESULTS:
After stimulation with HDM allergen, PBMCs from children sensitized only to HDM
expressed increased mRNA levels of the Th2 cytokines, but not of IL-10 and
IFN-gamma, whereas ryegrass stimulation did not result in increased cytokine
expression. PBMCs from children sensitized to HDM and ryegrass expressed increased
Th2 cytokines after stimulation with either of the two allergens. In contrast,
PBMCs from children sensitized only to ryegrass did not express increased
levels after stimulation with either of the allergens. CONCLUSIONS: The
expression of Th2 cytokines after in vitro stimulation of PBMCs from atopic
children is specific to the sensitizing allergen, indicating that atopic status
per se does not affect the type of T-cell response. In addition, T cells
specific to seasonal allergens circulate in the blood out of season only if the
child is concomitantly sensitized to a perennial allergen.
3864.
Sakaguchi M, Inouye S. Anaphylaxis to
gelatin-containing rectal suppositories. J Allergy Clin Immunol 2001 Dec;108(6):1033-4
BACKGROUND: Some children--though the number is few-have
been sensitized with gelatin. OBJECTIVE: To investigate the relationship
between the presence of antigelatin IgE and anaphylaxis to gelatin-containing
rectal suppository, we measured antigelatin IgE in the sera of the children
with anaphylaxis. METHODS: Ten children showed systemic allergic reactions,
including anaphylaxis, to a chloral hydrate rectal suppository containing
gelatin (231 mg/dose) that had been used as a sedative. These children's
clinical histories and serum samples were submitted from physicians to the
National Institute of Infectious Diseases during a 2-year period from 1996 to
1997. RESULTS: Of the 10 children, 5 showed apparent anaphylaxis, including
hypotension and/or cyanosis, along with urticaria or wheezing; 2 showed both urticaria
and wheezing without hypotension or cyanosis; the other 3 showed only
urticaria. All of the children had antigelatin IgE (mean value +/- SD, 7.9 +/-
8.4 Ua/mL). As a control, samples from 250 randomly selected children had no
antigelatin IgE. These findings suggest that the 10 children's systemic
allergic reactions to this suppository were caused by the gelatin component.
CONCLUSION: Gelatin-containing suppositories must be used with the same caution
as gelatin-containing vaccines and other medications.
3865.
Sampson HA. Use of food-challenge tests in
children. Lancet 2001 Dec
1;358(9296):1832-3 No abstract.
3866.
Sasseville D. Exacerbation of allergic contact
dermatitis from amcinonide triggered by patch testing. Contact Dermatitis 2001 Oct;45(4):232-3 No abstract.
3867.
Schappi GF, Konrad V, Imhof D, Etter R, Wuthrich
B. Hidden peanut allergens detected in various foods: findings and legal
measures. Allergy 2001
Dec;56(12):1216-20
BACKGROUND: Undeclared allergens in foodstuffs represent
a major health problem for sensitized persons. Until recently, most food
control authorities were not in the position to monitor hidden allergens and to
take legal measures against their presence in foodstuffs. METHODS: In this
study, we employed human sera-based immunoassay techniques, enabling
semiquantitative detection and identification of peanut allergens in a variety
of foodstuffs. RESULTS: This study showed the presence of undeclared allergens
in products belonging to various food categories, such as cereals, cookies, cakes,
and snacks. The detection limit for peanut contamination was in most instances
less than 50 mg peanut material per kg, i.e., less than about 5 mg peanut
allergens per kg. We legally objected to products with more than one part per
thousand or 1000 mg/kg of peanut contamination. CONCLUSIONS: In most cases,
food producers, confronted with our results, were able to detect and eliminate
the sources of the contamination. They implemented measures to prevent the
presence of hidden peanut allergens in their products, increasing food safety
for sensitized persons and overall food quality.
3868.
Schellenberg RR, Isserow SH. Anaphylactoid
reaction to a cyclooxygenase-2 inhibitor in a patient who had a reaction to a
cyclooxygenase-1 inhibitor. N Engl J Med
2001 Dec 20;345(25):1856 No
abstract.
3869.
Schlievert PM. Use of intravenous immunoglobulin
in the treatment of staphylococcal and streptococcal toxic shock syndromes and
related illnesses. J Allergy Clin Immunol
2001 Oct;108(4 Suppl):S107-10
Pyrogenic toxin superantigens comprise a large family of
exotoxins made by Staphylococcus aureus and group A streptococci. These toxins
include toxic shock syndrome toxin-1, the staphylococcal enterotoxins, and the
streptococcal pyrogenic exotoxins (synonyms: scarlet fever toxins and
erythrogenic toxins), all of which have the ability to cause toxic shock
syndromes and related illnesses. These toxins have a similar three-dimensional
structure that allows them to interact with relatively invariant regions of
major histocompatibility complex class II molecules on the surface of
antigen-presenting cells and with certain variable regions of the T-cell
receptor-beta chain. The consequence of these interactions (and other
immunobiological properties of the toxins) is the exaggerated release of
bioactive cytokines. The latter molecules are responsible for the clinical
signs of illness associated with these toxins.
3870.
Schulman ES. Development of a monoclonal
anti-immunoglobulin E antibody (omalizumab) for the treatment of allergic
respiratory disorders. Am J Respir Crit Care Med 2001 Oct 15;164(8 Pt 2):S6-11
Immunoglobulin E (IgE) mediates many of the inflammatory
processes that underlie the symptoms of asthma and other allergic respiratory
disorders. Recently, a recombinant, humanized, monoclonal antibody (mAb) that
binds to and neutralizes IgE has been developed for the treatment of these
disorders. Preclinical and clinical studies have shown that this mAb, directed
against IgE and known as omalizumab, inhibits the binding of IgE to its receptors
on effector cells, reduces IgE synthesis by B cells in response to allergen
exposure, decreases the expression of IgE receptors, and attenuates both
immediate and delayed inflammatory airway responses following exposure to
inhaled allergen. Omalizumab is nonanaphylactogenic, and clinical experience to
date suggests that omalizumab is safe and well tolerated by patients. These
results suggest that specific inhibition of IgE may be an important new
therapeutic option for the treatment of asthma and related disorders.
3871.
Scott MB, Ellis MH, Cruz-Rivera M, Fitzpatrick S,
Smith JA. Once-daily budesonide inhalation suspension in infants and children
< 4 and > or = 4 years of age with persistent asthma. Ann Allergy Asthma
Immunol 2001 Dec;87(6):488-95
BACKGROUND: Budesonide inhalation suspension (Pulmicort
Respules; AstraZeneca LP, Wilmington, DE), a nebulized corticosteroid, was
developed for use in infants and young children with persistent asthma.
OBJECTIVE: To compare the efficacy and safety of once-daily budesonide
inhalation suspension in children < 4 years of age and in those > or = 4
years of age with persistent asthma. METHODS: A retrospective analysis
stratified by age group was performed on data from two randomized,
double-blind, placebo-controlled, parallel-group studies that evaluated the
efficacy and safety of budesonide inhalation suspension 0.25 mg, 0.5 mg, or 1.0
mg once daily for 12 weeks in children 6 months to 8 years of age with
persistent asthma. Clinical assessments included nighttime and daytime asthma
symptoms, breakthrough medication use, adverse events, and
hypothalamic-pituitary-adrenal-axis function. RESULTS: In both randomized
studies, budesonide inhalation suspension demonstrated statistically
significant improvement in nighttime and daytime asthma symptom scores compared
with placebo. In the retrospective analysis of pooled data from these studies,
the efficacy of budesonide was maintained when children were stratified by age
group. Clinical improvements from baseline in nighttime and daytime asthma
symptom scores were observed in both age groups at all budesonide inhalation
suspension dose levels. No significant differences were observed between age
groups in breakthrough medication use in any of the treatment groups. No
differences were observed in the incidence of adverse events between the two
age groups, and significant (P < 0.01) effect on
hypothalamic-pituitary-adrenal-axis function was apparent only in children <
4 years of age at the 0.25-mg dose level. CONCLUSIONS: Once-daily budesonide
inhalation suspension is effective in the treatment of persistent asthma in
children aged < 4 and > or = 4 years of age.
3872.
Sharland CE. Suspected latex allergies. SADJ 2001 Oct;56(10):452-3 No abstract.
3873.
Shida K, Koizumi H, Shiratori I, Matsumoto M,
Kikkawa S, Tsuji S, Begum NA, Fukumori Y, Toyoshima K, Seya T. High serum
levels of additional IL-18 forms may be reciprocally correlated with IgE levels
in patients with atopic dermatitis. Immunol Lett 2001 Dec 3;79(3):169-75
We established an ELISA system for determination of as
yet unidentified species of interleukin 18 (IL-18), named IL-18 type 2, in
human serum. Serum IL-18 levels and their effect on IgE levels were examined in
18 patients with atopic dermatitis (AD) with no other allergic symptoms. Three
of these patients showed high IL-18 type 2 concentrations (25-100 ng/ml) in
their blood serum, and this IL-18 type 2 was detectable only with our
established ELISA system. In contrast, the level of the conventional form of
IL-18 (type 1) was found to be 50-400 pg/ml in all patients by the commercially
available ELISA. The levels of type 1 IL-18 showed no correlation with those of
type 2 and approximately 2-fold higher in AD patients than in normal subjects.
IL-12 p40 and IgE levels were correlated in the patients with no IL-18 type 2,
and interestingly, relatively low IgE concentrations were detected in the three
IL-18 type 2-positive patients. They showed considerable levels of IL-12 p40
unlike normal subjects. The IFNgamma-inducing activity of IL-18 type 2 was
>100-fold less potent by weight ratio than that of a recombinant 'active'
IL-18 preparation, even after the treatment with Caspase 1. Although the
relationship between AD and serum IgE levels is not clear cut, IL-18 type 2
appears to play some roles in the Th2-polarization involving IgE production in
association with immune responses occurring in local inflammatory milieu such
as atopic lesions.
3874.
Silvestre JF, Carnero L, Ramon R, Albares MP,
Botella R. Allergic contact dermatitis from apraclonidine in eyedrops. Contact
Dermatitis 2001 Oct;45(4):251 No
abstract.
3875.
Smith KJ, Rosario-Collazo J, Skelton H. Delayed
cutaneous hypersensitivity reactions to hirudin. Arch Pathol Lab Med 2001 Dec;125(12):1585-7
Hirudin is one of the new synthetic antithrombin agents,
which is most commonly used in patients with type II heparin-induced
thrombocytopenia and in patients with hypersensitivity reactions to
unfractionated heparin as well as low-molecular-weight heparins. Hirudin is
comparable to heparin as an antithrombotic agent and also has been studied as a
primary treatment in patients who experienced acute myocardial infarctions. We
describe a patient with a history of type II heparin-induced thrombocytopenia
who was placed on intravenous hirudin therapy. After extravasation of the
intravenous hirudin site, the patient developed a delayed hypersensitivity
reaction that histologically showed an epithelioid granulomatous infiltrate.
Although rare reports of hypersensitivity reactions to hirudin have been published,
these reactions have not been well characterized and the histopathologic
changes have not been described.
3876.
Smurthwaite L, Walker SN, Wilson DR, Birch DS,
Merrett TG, Durham SR, Gould HJ. Persistent IgE synthesis in the nasal mucosa
of hay fever patients. Eur J Immunol
2001 Dec;31(12):3422-31
The location of IgE synthesis has been a longstanding
controversy, with previous evidence favoring either the mucosa or lymphoid
tissue in the region of allergen entry. The evidence for IgE synthesis in
mucosal tissues has always been circumstantial. We have developed a novel
explant culture system, using ELISA and radioactive amino acid incorporation,
to measure de novo IgE protein synthesis in the nasal mucosa of hay fever
patients. Surprisingly, IgE synthesis continues between seasons in the explants
from grass pollen-sensitive patients and a higher proportion of this IgE
compared to serum IgE is allergen specific. Persistent IgE synthesis may ensure
the expression of immediate hypersensitivity in the mucosa and promote rapid
amplification of the allergic response in the local lymphoid tissue on allergen
provocation. Our work demonstrates definitively for the first time that the
local mucosa is a site of ongoing IgE synthesis.
3877.
Strachan DP, Wong HJ, Spector TD. Concordance and
interrelationship of atopic diseases and markers of allergic sensitization
among adult female twins. J Allergy Clin Immunol 2001 Dec;108(6):901-7
BACKGROUND: Previous twin studies of asthma and allergy
implicate both genetic and environmental factors in disease risk, but few have
related the occurrence of clinical disease to objective markers of allergic
sensitization in twins. OBJECTIVE: We sought to investigate the concordance and
interrelationships of self-reported allergic disease and total and
aeroallergen-specific IgE levels within pairs of British adult female twins.
METHODS: Three hundred forty monozygotic and 533 dizygotic pairs, aged 18 to 72
years, completed questionnaires about allergic disease. Of these, 282
monozygotic and 270 dizygotic pairs were tested for total IgE and specific IgE
to Der p 1, mixed grass pollen, and cat dander by means of fluoroimmunoassay.
RESULTS: Concordance rates for all variables were higher for monozygotic than
for dizygotic twins, significantly (P < .05) so for hay fever, eczema, and
specific IgE positivity but not (P > .05) for self-reported asthma or
allergies. Within-pair correlations of log-transformed IgE were 0.59 for
monozygotic twins and 0.29 for dizygotic twins, implying heritability of 60%.
Within both monozygotic and dizygotic pairs discordant for hay fever or
reported allergies, the affected twin had significantly higher total and
specific IgE levels. Within pairs who were doubly discordant for 3 allergic
diseases, associations between diseases were of similar strength for
monozygotic and dizygotic pairs. CONCLUSIONS: These results confirm that
genetic factors influence susceptibility to aeroallergen sensitization and
clinical allergic disease. However, genetically identical twins are often
discordant in their expression of atopy, suggesting a substantial modifying
role for environmental factors.
3878.
Streit M, Braathen LR. Contact dermatitis:
clinics and pathology. Acta Odontol Scand
2001 Oct;59(5):309-14
Contact dermatitis or eczema is a polymorphic inflammation of the skin. It occurs at the site of contact with irritating or antigenic substances. In the acute phase there is occurrence of itching erythema, papules, and vesicles, whereas in the chronic phase there is dryness, hyperkeratosis, and sometimes fissures. Contact dermatitis can be divided into irritant and allergic types. Allergic contact dermatitis is a type-IV T-cell-mediated reaction occurring in a sensitized individual after contact with the antigen/allergen. Such antigens are usually low molecular weight substances (MW approximately 500), called haptens; 3000 contact allergens are known. The diagnosis of contact allergy is made on the basis of the history, clinical findings, and a positive epicutancous test result. Allergic, but not irritative, contact dermatitis can spread beyond the area of contact to other body parts. Eczematous lesions are characterized by a mononuclear infiltrate consisting mainly of T cells in the dermis and epidermis, together with an intercellular epidermal edema that is. spongiosis. In allergic contact dermatitis, skin-applied antigen is taken up by epidermal Langerhans cells and transported with the afferent lymph to the regional lymph nodes. Here, naive T lymphocytes are sensitized to become antigen-specific effector T cells, which then leave the lymph node, enter the circulation, and are recruited to the skin by means of specific cell surface molecules, to form the infiltrates. Cytokines released by infiltrating T cells eventually cause keratinocyte apoptosis.
3879.
Tai YS, Liu BY, Wang JT, Sun A, Kwan HW, Chiang
CP. Oral administration of milk from cows immunized with human intestinal
bacteria leads to significant improvements of symptoms and signs in patients
with oral submucous fibrosis. J Oral Pathol Med 2001 Nov;30(10):618-25
BACKGROUND: Previous studies have shown that the local and systemic upregulation of fibrogenic cytokines and downregulation of antifibrotic cytokine are central to the pathogenesis of oral submucous fibrosis (OSF). The milk from cows immunized with human intestinal bacteria (immune milk) contains an anti-inflammatory component that may suppress the inflammatory reaction and modulate cytokine production. Therefore, it was decided to test whether immune milk may have some beneficial effects on controlling the symptoms and signs in OSF patients. METHODS: In this preliminary study, 26 OSF patients who received immune milk treatment (45 g of immune milk powder twice a day) for 3 months and oral habit intervention were included in the experimental group. Another 20 OSF patients who received only oral habit intervention served as the control group. RESULTS: We found that the interincisor distance was significantly improved (> or =3 mm of the baseline measurement) in 18 of the 26 (69.2%) OSF patients in the experimental group at exit. However, in the control group none of the OSF patients had an increase in interincisor distance greater than 2 mm. In addition, disappearance or significant improvement of symptoms at exit was observed in 80% (16/20) of the patients with intolerance to spicy foods (P < 0.001) and 72.2% (13/18) of the patients with xerostomia (P < 0.005) in the experimental group, compared with 17.6% (3/17) of the patients with improvement of intolerance to spicy foods and 15.4% (2/13) of the patients with improvement of xerostomia in the control group. Partial regression of concomitant oral leukoplakia or erythroplakia (judged from the size reduction of the lesions) at exit was noted in 71.4% (5/7) of the patients in the experimental group (P < 0.05), compared with none (0/5) of the patients with improvement in the control group. CONCLUSION: We conclude that oral administration of immune milk leads to significant improvements of symptoms and signs in OSF patients.
3880.
Thami GP, Kaur S, Kanwar AJ. Allergic contact
dermatitis to henna. Allergy 2001
Oct;56(10):1013-4 No abstract.
3881.
Thawani V R, Gharpure K J, Balani N D, Paranjpe B
D: Penicillin allergic deaths: the phobia leading to disuse. Indian J clin
Pract 2001, 11(9), 52-4. (017451) Sept 1, 2023 No abstract.
3882.
Trautmann A, Akdis M, Brocker EB, Blaser K, Akdis
CA. New insights into the role of T cells in atopic dermatitis and allergic
contact dermatitis. Trends Immunol 2001 Oct;22(10):530-2 No abstract.
3883.
Trautmann A, Akdis M, Schmid-Grendelmeier P,
Disch R, Brocker EB, Blaser K, Akdis CA. Targeting keratinocyte apoptosis in
the treatment of atopic dermatitis and allergic contact dermatitis. J Allergy
Clin Immunol 2001 Nov;108(5):839-46
BACKGROUND: Activation and
skin-selective homing of T cells and effector functions in the skin represent
sequential events in the pathogenesis of atopic dermatitis and allergic contact
dermatitis. OBJECTIVE: T cell-mediated keratinocyte apoptosis plays a key
pathogenetic role in the formation of eczematous dermatitis. IFN-gamma released
from activated T cells upregulates Fas on ke-ratinocytes, which renders them
susceptible to apoptosis. The lethal hit is given to keratinocytes by means of
Fas ligand expressed on the T-cell surface or released to the inflammatory
microenvironment. We sought to investigate whether drugs used for the treatment
of eczematous disorders interfere with this pathogenic pathway. METHODS: T
cell-mediated, Fas-induced keratinocyte apoptosis in a keratinocyte-T cell
coculture system serves as an in vitro model of eczematous dermatitis. We
tested, in this model, whether immunomodulatory agents (dexamethasone,
cyclosporine A, rapamycine, tacrolimus/FK506, intravenous immunoglobulin
[IVIG], and theophylline) are able to inhibit apoptosis of keratinocytes.
Additionally, skin biopsy specimens from patients with untreated and
successfully treated eczematous dermatitis were evaluated for keratinocyte
apoptosis. RESULTS: Dexamethasone, cyclosporine A, FK506, rapamycine, and IVIG
are inhibitors of keratinocyte apoptosis induced by activated T cells. This
effect is mediated by 2 major mechanisms directed on T cells or keratinocytes.
T-cell activation was mainly inhibited by dexamethasone, FK506, cyclosporine A,
and rapamycine. Interestingly, high-dose dexamethasone and IVIG directly
inhibited Fas-mediated keratinocyte apoptosis. In vivo keratinocyte apoptosis
was significantly reduced after successful topical treatment of eczematous
lesions. CONCLUSION: These results demonstrate mechanisms of action of current
treatment approaches and provide a future for more focused therapeutic
applications.
3884.
Turjanmaa K. Community management of severe
allergies must be integrated and comprehensive, and must consist of more than
just epinephrine. Allergy 2001
Nov;56(11):1023-5 No abstract.
3885.
Tzaneva S, Seeber A, Schwaiger M, Honigsmann H,
Tanew A. High-dose versus medium-dose UVA1 phototherapy for patients with
severe generalized atopic dermatitis. J Am Acad Dermatol 2001 Oct;45(4):503-7 No abstract.
3886.
van der Meer JB, Schuttelaar ML, Toth GG, Kardaun
SH, Beerthuizen G, de Jong MC, Jonkman MF, Nieuwenhuis P. Successful
dexamethasone pulse therapy in a toxic epidermal necrolysis (TEN) patient
featuring recurrent TEN to oxazepam. Clin Exp Dermatol 2001 Nov;26(8):654-6
A 62-year-old female patient is described who developed toxic epidermal necrolysis (TEN) after medication with phenytoin and oxazepam. Initially phenytoin was discontinued and dexamethasone pulse therapy (1.5 mg/kg on 3 consecutive days) was initiated on the tenth day of skin disease. This resulted in clinical improvement. Histologically re-epithelialization could be demonstrated below the necrotic epidermis. However, on the eighteenth day of skin disease (10 days after discontinuation of phenytoin and 8 days after the start of dexamethasone pulse therapy), a histologically verified rebound-TEN developed with a detachment of 95%. Oxazepam was stopped and a second series of dexamethasone pulse therapy was given. Re-epithelialization began within 24 h of the start of the second series of dexamethasone pulse therapy, and continued to almost complete recovery within 1 week.
3887.
Vila L, Beyer K, Jarvinen KM, Chatchatee P,
Bardina L, Sampson HA. Role of conformational and linear epitopes in the
achievement of tolerance in cow's milk allergy. Clin Exp Allergy 2001 Oct;31(10):1599-606
BACKGROUND: Cow's milk (CM) is one of the leading causes of food allergy in children. However, approximately 85% of milk-allergic children become clinically tolerant to CM within the first 3 years of life. The mechanisms involved in the achievement of tolerance remain unknown. OBJECTIVE: To study whether IgE antibodies from children with persistent cow's milk allergy (CMA) differ from children who become clinically tolerant in their ability to recognize linear and conformational epitopes of alpha(s1)- and beta-casein. METHODS: Thirty-six milk-allergic children were included in the study: 11 of the children became clinically tolerant, and 25 had persistent CMA. Blood was obtained from all patients during the time they showed clinical reactions to milk challenge. Six non-milk-allergic children served as controls. Specific IgE antibodies against linear (denatured) as well as conformational (native) milk proteins were determined by probing dot-blots with patients' sera. In addition, selected decapeptides from alpha(s1)- and beta-casein, previously found to be suggestive of persistent CMA, were synthesized on a cellulose-derivatized membrane and probed with individual sera from 10 patients who outgrew CMA and from 10 patients with persistent CMA. RESULTS: Analysis of immunodot-blots showed that, in comparison to tolerant patients, milk-allergic children with persistent symptoms had a significantly higher ratio of specific IgE antibodies to linearized than to native alpha- and beta-casein (P < 0.005 and P < 0.02, respectively). Comparing the selected decapeptides, six of the 10 patients with persistent allergy recognized the peptide corresponding to amino acids 69-78 from alpha(s1)-casein while none of the patients who outgrew CMA had IgE binding to this epitope. CONCLUSION: Patients with persistent milk allergy possess higher detectable levels of IgE antibodies to linear epitopes from alpha(s1)- and beta-casein than children who have achieved tolerance. Specific IgE binding to particular linear epitopes in alpha(s1)-casein may be a predictive factor for persistence of CMA.
3888.
Vissers M, Doekes G, Heederik D. Exposure to
wheat allergen and fungal alpha amylase in the homes of bakers. Clin Exp
Allergy 2001 Oct;31(10):1577-82
BACKGROUND: Few data are available on exposure to occupational allergens in dwellings occupied by inhabitants with occupational exposure to allergens. In small bakeries working and living often takes place in the same building. It is possible that allergens from the bakery can be transported into the homes of the bakers, via the clothes or shoes of the baker. OBJECTIVE: The aims of this study were to investigate exposure to occupational allergens, wheat and fungal alpha-amylase in the homes of bakers, and evaluate potential determinants of exposure. Sensitization in family members to occupational allergens was investigated in a small preliminary survey. METHODS: Floor dust samples were collected in the homes of 34 bakers. Levels of wheat and fungal alpha-amylase allergens were determined in an extract of the dust samples. Blood samples were collected from bakers and their family members to determine the prevalence of sensitization to occupational allergens. RESULTS: The concentration of wheat and alpha-amylase allergens ranged from 38.9 to 172.4 microgeq/m(2) (GM), to 10.5-76.7 ngeq/m(2) (GM). Higher levels of dust and allergens were measured when the house could be reached directly through the bakery, and in houses with textile floor covers. Higher concentrations were also measured when bakers brought their work clothes and shoes into the house and when textiles from the bakery were laundered at home. Some family members appeared to be sensitized to wheat flour and alpha-amylase, but it cannot be excluded that they became sensitized because of their incidental presence in the bakery. CONCLUSIONS: Occupational allergens can be found in house dust from the homes of bakers and levels are associated with hygienic behaviour and distance to the bakery.
3889.
von Mutius E. Pro: the increase in asthma can be
ascribed to cleanliness. Am J Respir Crit Care Med 2001 Oct 1;164(7):1106-7; discussion 1108-9 No abstract.
3890.
Walker WA. Cow's milk protein-sensitive
enteropathy at school age: a new entity or a spectrum of mucosal immune
responses with age. J Pediatr 2001
Dec;139(6):765-6 No abstract.
3891.
Weiss KS. Anaphylactic reaction to ondansetron.
Arch Intern Med 2001 Oct
8;161(18):2263 No abstract.
3892.
Wictorin A, Hansson C. Allergic contact
dermatitis from a bismuth compound in an eye ointment. Contact Dermatitis 2001 Nov;45(5):318 No abstract.
3893.
Wong CS, Beck MH. Allergic contact dermatitis
from triclosan in antibacterial handwashes. Contact Dermatitis 2001 Nov;45(5):307 No abstract.
3894.
Yadav S P S, Chandra R: Fluticasone propionate –
a new steriod nasal spray for management of allergic rhinits. Indian J clin
Pract 2001, 11(12), 23-4. (016545) Aug 16, 2001.
Corticosteroids are the most effective medication available for the treatment of allergic rhinitis. They are frequently used intranasally, because intranasal corticosteroids have their action on both early as well as late phase of allergic reaction. On the other hand, oral steroids have an unacceptable risk of slide effects and have no effect on the early phase reaction.
3895.
Yesudian PD, King CM. Allergic contact dermatitis
from stearyl alcohol in Efudix cream. Contact Dermatitis 2001 Nov;45(5):313-4 No abstract.
3896.
Zollner TM, Spengler K, Podda M, Ergezinger K,
Kaufmann R, Boehncke WH. The Western blot is a highly sensitive and efficient
technique in diagnosing allergy to wasp venom. Clin Exp Allergy 2001 Nov;31(11):1754-61
BACKGROUND: Diagnosis of allergy to wasp venom and decision to perform immunotherapy are based on the patient's history, along with skin and in vitro tests. OBJECTIVE: Given the high prevalence of specific IgE also in non-allergic individuals, we evaluated the sensitivity and specificity of Western blots as a possible alternative to serum analyses of venom-specific IgE. METHODS: Skin prick and/or intracutaneous tests were performed in 30 patients with allergy to wasp venom (generalized reaction following sting) along with serum analysis of venom-specific IgE (AlaSTAT microplate) and Western blots. Western blots were subsequently scanned and evaluated qualitatively and semiquantitatively by means of densitometry. Bands were scored 'positive' in cases of signal intensities beyond the mean plus 3 standard deviations of control sera. Twenty newborns (age 2-7 days) and 30 adults without systemic or increased local reactions to hymenoptera stings served as controls. RESULTS: Western blot sensitivity reached 100% in the samples studied and was thus superior to the sensitivities of serum analysis of venom-specific IgE using AlaSTAT microplate assay (90%) and skin tests (87%). The sensitivity of detection of a phospholipase A1 and antigen 5-specific band was higher compared with a hyaluronidase-specific band (97%, 97% and 86%, respectively). Twenty-four out of twenty-nine (83%) patients exhibited specific IgE antibodies against at least three distinct allergens. With regard to the specificities, skin tests as well as AlaSTAT microplate assays were comparable (90% and 93%, respectively), whereas the specificity of the Western blots was 70% if the appearance of any single band was regarded as a positive result. However, when analysing the appearance of a specific band for antigen 5 or hyaluronidase the specificity and overall diagnostic value increased markedly, making it the most efficient test (specificity 97% and 100%, efficiency 96.8% and 93.2%, respectively). CONCLUSION: As allergy to wasp venom is a severe and potentially life threatening disease, false-negative test results need to be minimized. Therefore, the superiority of the Western blot with regard to sensitivity, specificity and overall efficiency makes this technique a valuable tool for its diagnosis.
July
2002
4421. Aalberse RC, Schuurman J. IgG4 breaking the rules. Immunology.
2002 Jan;105(1):9-19. Review.
Immunoglobulin G4 (IgG4) antibodies have been known for some time to be functionally monovalent. Recently, the structural basis for this monovalency has been elucidated: the in vivo exchange of IgG half-molecules (one H-plus one L-chain) among IgG4. This process results in bispecific antibodies that in most situations will behave as functionally monovalent antibodies. The structural basis for the abnormal behaviour of IgG4 seems to be largely the result of a single amino acid change relative to human IgG1: the change of a proline in core hinge of IgG1 to serine. This results in a marked shift in the equilibrium between interchain disulphide bridges and intrachain disulphide ridges, which for IgG4 results in 25-75% absence of a covalent interaction between the H-chains. Because of strong non-covalent interactions between the CH3 domains (and possibly also between the CH1 domain and the trans-CH2 domain) IgG4 is a stable four-chain molecule and does not easily exchange half-molecules under standard physiological conditions in vitro. We postulate that the exchange is catalysed in vivo by protein disulphide isomerase (PDI) and/or FcRn (the major histocompatibility complex (MHC)-related Fc receptor) during transit of IgG4 in the endosomal pathway in endothelial cells. Because IgG4 is predominantly expressed under conditions of chronic antigen exposure, the biological relevance of this exchange of half-molecules is that it generates antibodies that are unable to form large immune complexes and therefore have a low potential for inducing immune inflammation. In contrast to monovalent immunoglobulin fragments, these scrambled immunoglobulins have a normal half-life. The significance of the ensuing bispecificity needs further evaluation, because this will be relevant only in situations where high IgG4 responses are found to two unrelated antigens that happen to be present in the body at the same time and place. In this context the significance of IgG4 autoreactivity might have to be re-evaluated. The main function of IgG4, however, is presumably to interfere with immune inflammation induced by complement-fixing antibodies, or, in the case of helminth infection or allergy, by IgE antibodies.
4422. Abraham
WM. Tryptase: potential role in airway inflammation and remodeling. Am J
Physiol Lung Cell Mol Physiol. 2002 Feb;282(2):L193-6. Review. No abstract.
4423. Aldrich
TK. Pink puffers vs blue bloaters in asthma too? Chest. 2002
Feb;121(2):313-5. No abstract.
4424. Baki A,
Orhan F. The effect of loratadine in exercise-induced asthma. Arch Dis Child.
2002 Jan;86(1):38-9.
AIMS: To assess the effect of loratadine in exercise induced asthma. METHODS: Randomised, double blind, placebo controlled study of 10 mg oral loratadine, once daily for three days in 11 children. At the end of the treatment period FEV(1) was measured, and patients were exercised on a treadmill. FEV(1) measurements were repeated at intervals after exercise. RESULTS: Loratadine significantly reduced the decrease in FEV(1) after exercise at two, five, 10, 15, and 30 minutes, compared with placebo (p < 0.05). However, the mean decrease in FEV(1) at five minutes was more than 15% of baseline in the loratadine group. CONCLUSIONS: Loratadine reduces, but does not prevent, exercise induced asthma in children.
4425. Barnes
PJ. Cytokine modulators as novel therapies for asthma. Annu Rev Pharmacol
Toxicol. 2002;42:81-98. Review.
Cytokines play a critical role in orchestrating and perpetuating inflammation in asthmatic airways and several specific cytokine and chemokine inhibitors are now in development for the treatment of asthma. Inhibition of IL-4 with soluble IL-4 receptors has shown promising early results in asthma. Anti-IL-5 antibody is very effective at inhibiting peripheral blood and airway eosinophils but does not appear to be effective in symptomatic asthma. Inhibitory cytokines, such as IL-10, interferons, and IL-12 are less promising because systemic delivery produces intolerable side effects. Inhibition of TNF-alpha may be useful in severe asthma. Many chemokines are involved in the inflammatory response of asthma, and small-molecule inhibitors of chemokine receptors are in development. CCR3 antagonists are now in clinical development for the treatment of asthma. Because so many cytokines are involved in asthma, drugs that inhibit the synthesis of multiple cytokines may prove to be more useful. Several such classes of drug are now in clinical development, and the risk of side effects with these nonspecific inhibitors may be reduced by the inhaled route of delivery.
4426. Bartunkova
J, Kolarova I, Sediva A, Holzelova E.
Antineutrophil cytoplasmic antibodies, anti-Saccharomyces cerevisiae
antibodies, and specific IgE to food allergens in children with inflammatory
bowel diseases. Clin Immunol. 2002 Feb;102(2):162-8.
Differential diagnosis between ulcerative colitis (UC) and Crohn's disease (CD) is difficult in the initial phases in pediatric patients with inflammatory bowel diseases (IBD). This study was performed to determine the significance of anti-neutrophil cytoplasmic antibodies (ANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) in IBD. ANCA were specified with regard to their antigenic specifity, significance to the diagnosis, and correlation of titer with the disease activity. The occurrence of food allergy was questioned, too. Serum samples from 44 children with UC (n = 23) or CD (n = 21) and from disease-control children (coeliac disease, n = 21) were analyzed for IgG ANCA, ANCA target antigens, IgA and IgG ASCA, and IgE to food allergens. Results show that ANCA occur more frequently in UC than in CD and disease-control (74, 24, and 10%, respectively). The presence of ANCA does not reflect disease activity. Antigenic specificity does not differ in any group. IgA-ASCA are found more often in patients with CD (76% versus 17% in UC). The testing for both ANCA and ASCA enabled clear-cut differential diagnosis between UC and CD based on the high specificity (ANCA+ ASCA- 92.5% for UC, ANCA- ASCA+ 93.2% for CD). Specific IgE to food allergens were found in 8.7, 14.3, and 23.8% of patients with UC, CD, and coeliac disease, respectively. We conclude that combined testing of ANCA and ASCA represents a valuable tool in the differential diagnosis between UC and CD in pediatric patients, minimizing invasive diagnostic procedures. Monitoring of ANCA, its specificity, and titer determination does not bring more information. Testing for specific IgE to food allergens may be considered in individual patients. Copyright 2001 Elsevier Science (USA).
4427. Becker
AB, Chan-Yeung M. Primary prevention of asthma. Curr Opin Pulm Med. 2002
Jan;8(1):16-24. Review.
There has been a dramatic increase in the prevalence of asthma over the last quarter century, particularly in the industrialized world. Although our understanding of asthma continues to improve, there is no cure for the disease. Primary prevention of asthma is the focus of this review. Asthma is a disease with multiple gene-environment interactions. Candidate genes for asthma are considered, and potential interaction between one of those genes, CD14, and an environmental factor, endotoxin, is reviewed as it relates to the hygiene hypothesis. Environmental risk factors for asthma including allergens, pollutants, infectious factors, and dietary modifications are considered, particularly their potential for primary prevention of asthma. Ongoing cohort studies including the Canadian Allergy and Asthma Prevention Study, the Manchester Allergy and Asthma Study, the Children's Asthma Prevention Study from Australia, and the Prevention and Incidence of Asthma and Mite Allergy Study from the Netherlands are briefly reviewed. A more definitive understanding of genetic background and environmental triggers and their interactions is required before any specific approach to the primary prevention of asthma can be championed aggressively.
4428. Bhullar
N, Folzenlogen DD. Henoch-Schonlein
purpura: upper respiratory tract infection or drug induced? Arch Intern Med.
2002 Jan 28;162(2):222-3. No abstract.
4429. Browne
GJ, Trieu L, Van Asperen P. Randomized, double-blind, placebo-controlled trial
of intravenous salbutamol and nebulized ipratropium bromide in early management
of severe acute asthma inchildren presenting to an emergency department.Crit
Care Med. 2002 Feb;30(2):448-53.
BACKGROUND: In acute severe asthma, treatment must be initiated early to reverse the pathophysiology that may render airways less responsive to bronchodilation. The addition of nebulized ipratropium bromide to initial emergency department therapy improves pulmonary function, but it is unclear whether this approach results in earlier hospital discharge. The early use of bolus intravenous salbutamol has also been shown to improve outcome, including earlier discharge. We therefore assessed the relative benefits of intravenous salbutamol and nebulized ipratropium bromide in the early management of acute severe asthma in children by a double-blind, randomized, controlled trial. METHODS: This study was undertaken at a tertiary children's hospital, The Children's Hospital at Westmead, The Royal Alexandra Hospital for Children, Westmead, Sydney, Australia. Only children with severe acute asthma as determined by the National Asthma Campaign guidelines criteria and pulmonary index were included. All children received initial nebulized salbutamol therapy (2.5-5 mg salbutamol in 4 mL of normal saline depending on age) at initial emergency department presentation. If asthma remained severe 20 mins later, an intravenous cannula was inserted and intravenous methylprednisolone (1 mg/kg) was administered to all children receiving nebulized salbutamol every 20 mins. Children were then randomized to one of three groups: intravenous salbutamol (15 microg/kg as a single bolus over 10 mins), ipratropium bromide (250 microg), or intravenous salbutamol plus ipratropium bromide. All observers were blinded to treatment groups. Children were randomly assigned to receive a single-dose intravenous bolus of either saline or salbutamol and either nebulized saline or ipratropium bromide determined by a number generated randomly in the hospital pharmacy. The primary outcomes were recovery time and discharge time of each group. Respiratory and hemodynamic monitoring were continuous during the first 2 hrs of the study and then children were monitored clinically for 24 hrs. RESULTS: A total of 55 children with acute severe asthma were entered into the study over an 18-month period. The three groups were similar demographically, with a mean age of 5.9 yrs, and mean duration of attack of 19.6 hrs. No side effects or treatment intolerance were reported. Children in the groups that received intravenous salbutamol had a significant reduction in recovery time to achieving second hourly inhaled salbutamol (p =.008) compared with those administered inhaled bronchodilator alone. The addition of ipratropium bromide to intravenous salbutamol provided no significant further benefit in terms of nebulizer therapy (intravenous salbutamol compared with intravenous salbutamol plus ipratropium bromide). Children administered intravenous salbutamol ceased supplemental oxygen therapy earlier than those administered ipratropium alone at 12 hrs post-randomization (p =.0003). Children administered intravenous salbutamol could be discharged from the hospital 28 hrs earlier than those administered ipratropium bromide (p =.013). CONCLUSION: Children administered intravenous salbutamol for severe acute asthma showed a more rapid recovery time, which resulted in earlier discharge from the hospital than those administered inhaled ipratropium bromide. There was no additional benefit obtained by combining ipratropium bromide and intravenous salbutamol administration.
4430. Cameron
I. "Help me breathe." Finding the right way to respond. Can Fam
Physician. 2002 Feb;48:263-4. No abstract.
4431. Colice
GL. Categorizing asthma severity and monitoring control of chronic asthma. Curr
Opin Pulm Med. 2002 Jan;8(1):4-8. Review.
Asthma is a distressing disease, affecting up to 8% of the US population and causing considerable morbidity. Effective management of asthma requires accurate categorization of asthma severity and effective methods for monitoring the activity of the disease with treatment. Currently, symptoms, lung function, and requirements for corticosteroid treatment are the most accepted factors used for asthma severity categorization. Measures of airway hyperresponsiveness, particularly the use of methacholine, may provide additional information regarding the duration of asthma. Assessing airway inflammation using either sputum eosinophilia or exhaled nitric oxide levels has added little to clinical methods for determining asthma severity, but may be useful in monitoring the activity of the disease.
4432. Davenport
PW. What caused the screech, whamity, bang, and thump? Am J Respir Crit Care
Med. 2002 Jan 1;165(1):2-3. No abstract.
4433. Dixon
JK. Kids need clean air: air pollution and children's health. Fam Community
Health. 2002 Jan;24(4):9-26. Review.
Air pollution affects
children's health in many ways, including reduced lung function, increased
morbidity, increased use of health care services, and infant mortality.
Information on the relationship of air pollution and children's health is
discussed, with a focus on the diversity of research methods used to understand
this relationship. Decisions affecting air quality ultimately are made through
political and social processes. Health care and health promotion practitioners
who are concerned about the health of children should provide leadership for
advocacy to promote environmental health in our communities.
4434. Donnelly
LE, Barnes PJ. Expression and regulation of inducible nitric oxide synthase
from human primary airway epithelial cells. Am J Respir Cell Mol Biol. 2002
Jan;26(1):144-51.
Elevated levels of exhaled nitric oxide are seen in inflammatory airway diseases such as asthma, but the cellular source remains unknown. This study investigated whether human airway epithelial cells express inducible nitric oxide synthase (iNOS). Human bronchial epithelial cells stimulated with 50 ng/ml interleukin-1beta, tumor necrosis factor-alpha, and interferon-gamma express iNOS mRNA, protein and increased nitrite in the cell culture media, which was inhibited by the selective iNOS inhibitor 1400W. Cells derived from subjects with asthma produced less nitrite than cells from normal subjects (6.59 +/- 0.99 microM nitrite, n = 15 versus 3.89 +/- 0.42 microM nitrite, n = 20; P < 0.05). This was not attributed to steroid treatment of subjects with asthma because there was no difference in the amount of nitrite released from steroid-naive and steroid-treated cells (3.51 +/- 0.46 versus 4.27 +/- 0.7 microM nitrite, n = 10). Neither dexamethasone nor budesonide inhibited iNOS mRNA induction, protein expression, or nitrite accumulation. The cells were not steroid insensitive because steroids inhibited GM-CSF release. Therefore, although these cells express iNOS under inflammatory conditions, they do not appear to be regulated directly by glucocorticosteroids.
4435. Dorhofer
DM, Sigmon ST. Physiological and psychological reactivity in women with asthma:
the effects of anxiety and menstrual cycle phase. Behav Res Ther. 2002
Jan;40(1):3-17.
The relation between menstrual cycle timing, panic attacks, and diagnosis of asthma was explored in this study. Women with or without asthma and with or without a history of panic attacks engaged in a psychophysiological task during either the intermenstrual or premenstrual cycle phase and completed self-report measures of menstrual symptoms and attitudes, general psychological symptoms, and attitudes toward illness. No significant differences were identified for psychological or psychophysiological measures with menstrual cycle phase as a factor. However, women with both asthma and a history of panic attacks reported more general psychological distress than women in the other groups, and more state anxiety than controls. Women in the asthma, asthma and panic, and panic groups reported higher anxiety sensitivity than the control group. After listening to asthma-related scenes, women with asthma exhibited a decrease in peak expiratory air flow, and women with asthma and panic exhibited increased skin conductance response magnitude. Implications for the role of anxiety in
lung function are discussed, as well as directions for future research with asthma and anxiety populations.
4436. Douma
WR, Kerstjens HA, de Gooijer A, Overbeek SE, Koeter GH, Postma DS. Initial
improvements in lung function and bronchial hyperresponsiveness are maintained
during 5 years of treatment with inhaled beclomethasone dipropionate and
terbutaline. Chest. 2002 Jan;121(1):151-7.
OBJECTIVES: Treatment with inhaled corticosteroids reduces bronchial hyperresponsiveness and relieves airways obstruction in patients with asthma. Up to now, it is unknown whether initial improvements are maintained over a long period of time. Therefore, we assessed whether initial improvements in FEV(1), provocative concentration of histamine causing a 20% fall in FEV(1) (PC(20)), and peak expiratory flow (PEF) persist with a constant dose of inhaled corticosteroids. Furthermore, we investigated whether FEV(1), PC(20), PEF indexes, and symptom scores improve after increasing the dose of inhaled corticosteroids in patients who did not respond sufficiently to treatment with beclomethasone dipropionate (BDP), 800 microg/d. METHODS: Sixty-eight patients with bronchial hyperresponsiveness and airways obstruction completed a previous study on 3 years of treatment with terbutaline, 500 microg qid, and BDP, 200 microg qid. Fifty-eight of these patients participated in the current extension of another 2.5 years of follow-up. Every 6 months, FEV(1) and PC(20) were measured. Five patients dropped out of the study, one for pulmonary reasons. Forty-four patients continued treatment with BDP, 800 microg/d (BDP-800 group), and 9 patients received a higher dose of BDP (500 microg tid; BDP-1,500 group) after the first 3 years because of a rapid decline in FEV(1) (> 50 mL/yr) despite BDP treatment during the previous study period. RESULTS: After the initial improvement, the mean slope of individual regression lines for FEV(1), PC(20), and morning PEF were - 28 mL/yr, - 0.01 doubling concentrations per year, and 0.6 L/min/yr, respectively, in the BDP-800 group. In the BDP-1,500 group, there were no statistically significant improvements in FEV(1), PC(20), PEF indexes, and symptom scores after increasing the dose of BDP. CONCLUSIONS: We conclude that initial improvements in FEV(1), PC(20), and PEF are well preserved over 5 years in patients with obstructive airways diseases who are treated with terbutaline and BDP. In the patients who responded sufficiently to 800 microg/d of BDP, there was no accelerated decline in FEV(1) compared with the general population. Increasing the dose of BDP in a small group of patients with an accelerated fall in FEV(1) (initially treated with a moderate dose of BDP) resulted in no significant improvement in FEV(1), PC(20), PEF indexes, and symptom scores.
4437. Douwes
J, Pearce N, Heederik D. Does environmental endotoxin exposure prevent asthma?
Thorax. 2002 Jan;57(1):86-90. Review.
The evidence as to whether exposure to environmental airborne endotoxin plays a protective or an inducing role in the development of asthma is reviewed. Studies of endotoxin and atopy, endotoxin and asthma, and farming and asthma are considered and, in each instance, a distinction is made between evidence of primary causation and evidence of secondary causation. It is concluded that, although it is plausible that bacterial endotoxin may protect against the development of asthma, there is considerable reason for caution regarding this hypothesis.
4438. Ernst
P. Pesticide exposure and asthma. Am J Respir Crit Care Med. 2002 Mar
1;165(5):563-4. No abstract.
4439. Frenkel
M, Hermoni D. Effects of homeopathic intervention on medication consumption in
atopic and allergic disorders. Altern Ther Health Med. 202 Jan-Feb;8(1):76-9.
CONTEXT: Allergies are the most common immunologic diseases among the general population. Increasing evidence suggests that the incidence of allergic disorders is rising dramatically. Conventional medicine provides only limited relief and does not offer a complete cure to this health problem. Consequently, patients seek additional approaches and therapies to integrate into their healthcare. Homeopathy is one of the leading complementary modalities used to treat this health problem. OBJECTIVE: This preliminary study assessed the effect of integrating homeopathic treatment in allergic diseases on conventional medication consumption in a health maintenance organization. DESIGN: Retrospective outcome study designed as a before-after trial. SETTING: Patients were studied in a complementary medicine clinic affiliated with an Israeli health maintenance organization. PARTICIPANTS: Forty-eight patients were treated for allergic diseases with homeopathic remedies and conventional medications. MAIN OUTCOME MEASURES: A computerized medication chart for each patient was evaluated for conventional medication consumption 3 months before and 3 months after the homeopathic intervention. Each patient served as his or her own control. RESULTS: Fifty-six percent of patients in this study reduced their use of conventional medication following the homeopathic intervention. Patients who used conventional medications for their allergic disorders reduced their medication expense by an average of 60%, with an average savings of $24 per patient in the 3-month period following the homeopathic intervention. CONCLUSIONS: This retrospective outcome study demonstrates cost savings for an Israeli health maintenance organization. The homeopathic intervention led to a modest but significant reduction in the use of medications commonly used to treat allergic conditions and their complications. Larger controlled studies are needed to verify these findings.
4440. Frew
AJ. Asthma biomarkers and drug trials.
J Allergy Clin Immunol. 2002 Feb;109(2):210-3.
No abstract.
4441. Fritz
SB, Singer AM, Revan VB, Baker JR Jr.
Bioterrorism: relevance to allergy and immunology in clinical practice.
J Allergy Clin Immunol. 2002 Feb;109(2):214-28. Review.
It has become clear in recent months that the threat of bioterrorism is very real. All physicians need to be aware of the presenting signs and symptoms of the most likely agents. Allergists and immunologists care for a unique population of patients with several alterations of their immune system that might change the expected course of illnesses from biologic terror agents. In this review, we discuss specific bioterrorism agents, focusing on their presentation, pathogenesis, and immunology. In addition, we describe how these illnesses might differ in the population of patients followed by allergists and immunologists.
4442. Fuji Y,
Shima M, Ando M, Adachi M, Tsunetoshi Y. Effect of air pollution and
environmental tobacco smoke on serum hyaluronate concentrations in school
children. Occup Environ Med. 2002 Feb;59(2):124-8.
OBJECTIVES: To evaluate serum hyaluronate concentrations relative to air pollution, environmental tobacco smoke (ETS), and respiratory health in Japanese school children. METHODS: Respiratory symptoms and serum IgE concentrations were examined in 1037 school children living in four communities in Japan with differing levels of air pollution. Serum hyaluronate concentrations were assayed in 230 children, consisting of all the children who had symptoms of either asthma or wheeze (65 and 50 subjects, respectively) and normal controls adjusted for sex, school grade, and school without these symptoms (115 subjects). RESULTS: Although serum hyaluronate concentrations did not differ for either asthma or wheeze, the concentrations were significantly higher in children living in communities with higher levels of air pollution. Children with asthma or wheeze and those with serum IgE concentrations of 250 IU/ml or above showed differences in hyaluronate concentrations that related to the degree of air pollution in the communities. In children with higher serum IgE concentrations, the hyaluronate concentrations among subjects exposed to ETS were significantly higher than among those without exposure to ETS. CONCLUSIONS: The present results suggest that serum hyaluronate concentration is related to the degree of air pollution and exposure to ETS. Children with asthma or wheeze and children with higher IgE concentrations are considered to be more susceptible to environmental factors.
4443. Griffith
OW. Glutaminase and the control of airway pH: yet another problem for the asthmatic
lung? Am J Respir Crit Care Med. 2002 Jan 1;165(1):1-2. Review. No abstract.
4444. Hadjikoumi
I, Loader P, Bracken M, Milner AD. Bronchodilator therapy and hyperactivity in
preschool children. Arch Dis Child. 2002 Mar;86(3):202-3.
The common report of parents of asthmatic children that inhaled/nebulised salbutamol causes overactive behaviour was investigated. Nineteen children were assessed in a standardised setting before and after the administration of nebulised salbutamol and placebo. Neither parental report nor observer ratings suggested any significant increase in the child's level of activity.
4445. Hastie
AT, Kraft WK, Nyce KB, Zangrilli JG, Musani AI, Fish JE, Peters SP.Asthmatic
epithelial cell proliferation and stimulation of collagen production: human
asthmatic epithelial cells stimulate collagen type III production by human lung
myofibroblasts after segmental allergen challenge. Am J Respir Crit Care Med.
2002 Jan 15;165(2):266-72.
Epithelial injury and subepithelial collagen deposition are characteristic of asthma. We hypothesized that epithelial cell proliferation increases after airway injury in asthmatics, that epithelial cells stimulate lung myofibroblast collagen production, and that both processes are modulated by allergen-recruited inflammatory cells. Epithelial cells obtained at baseline, 1 d, and 1 and 2 wk after endobronchial allergen challenge from asthmatics and nonasthmatics were placed in culture, with and without bronchoalveolar lavage cells obtained from the same segment. Epithelial cell proliferation and collagen synthesis by human lung myofibroblasts stimulated with culture medium from these epithelial cells were determined. Epithelial proliferation increased (108 +/- 50% above baseline, p = 0.01 for d, and p = 0.004 for group x day interaction) 1 wk postchallenge in cells from asthmatics, but not from nonasthmatics, and required bronchoalveolar lavage cell coculture. Culture medium from epithelium harvested from asthmatics, but not from nonasthmatics, at 1 to 2 wk postchallenge stimulated collagen type III production 50% to 70% (p = 0.043 for clinical group, p = 0.012 for day, and p = 0.022 for group x day interaction), but not collagen type I. This effect was independent of an acute eosinophilic response. We conclude that epithelial cells from asthmatics, but not from nonasthmatics, are stimulated to proliferate after allergen challenge, and over 1 to 2 wk postchallenge, stimulate collagen type III synthesis by lung myofibroblasts. Epithelial cell proliferation appears dependent upon infiltrating inflammatory cells, but stimulation of collagen type III does not.
4446. Hawrylowicz
C, Richards D, Loke TK, Corrigan C, Lee T. A defect in corticosteroid-induced
IL-10 production in T lymphocytes from corticosteroid-resistant asthmatic
patients. J Allergy Clin Immunol. 2002 Feb;109(2):369-70. No abstract.
4447. Hogman
M, Holmkvist T, Wegener T, Emtner M, Andersson M, Hedenstrom H, Merilainen P.
Extended NO analysis applied to patients with COPD, allergic asthma and
allergic rhinitis. Respir Med. 2002 Jan;96(1):24-30.
The recommended method to measure exhaled nitric oxide (NO) cannot reveal the source of NO production. We applied a model based on the classical Fick's first law of diffusion to partition NO in the lungs. The aim was to develop a simple and robust solution algorithm with a data quality control feature, and apply it to patients with known alterations in exhaled NO. Subjects with allergic rhinitis, allergic asthma, chronic obstructive pulmonary disease (COPD) smokers and controls were investigated. NO was measured at three expiratory flow rates. An iteration method was developed to partition NO. The airway tissue content of NO was increased in asthma, 144 +/- 80 ppb (P = 0.04) and decreased in smokers, 56 +/- 36 ppb (P = 0.02). There was no difference between subjects with rhinitis, 98 +/- 40 ppb and controls, 98 +/- 44 ppb. The airway transfer rate was increased in allergic asthma and allergic rhinitis, 12 +/- 4 vs. 12 +/- 5 ml sec(-1), compared to controls, 8 +/- 2 ml sec(-1) (P < 0.001). The alveolar levels were no different from controls, 2 +/- 1 ppb. In COPD the alveolar levels were increased, 4 +/- 2 ppb (P < 0.001). Extended NO analysis reveals from where in the respiratory system NO is generated. Hence, this new test can be added to the tools the physician has for the diagnosis and treatment of patients with respiratory disorders.
4448. Jacoby
DB. Virus-induced asthma attacks. JAMA. 2002 Feb 13;287(6):755-61.
Viral respiratory tract infections are a common cause of asthma attacks. Study of this phenomenon has revealed multiple mechanisms and contributed to understanding of the increase in airway inflammation and bronchoconstriction observed in this context. Changes in the neural control of the airways contribute to bronchoconstriction, which is reflected in an increased efficacy of anticholinergic medications during acute asthma attacks. The ability to prevent or treat viral respiratory tract infections is currently limited. However, as more effective antiviral treatments and vaccines become available, such therapies are likely to be effective in patients with asthma. Clinical management of this problem is illustrated in this article by the case of a 40-year-old woman with history of mild asthma who was admitted to an intensive care unit with severe bronchospasm and an upper respiratory tract infection.
4449. Kelly
HW, Bisgaard H. Leukotriene modifiers.Pediatrics. 2002 Jan;109(1):170-1. No abstract.
4450. Kilpi
T, Kero J, Jokinen J, Syrjanen R, Takala AK, Hovi T, Isolauri E. Common
respiratory infections early in life may reduce the risk of atopic dermatitis.
Clin Infect Dis. 2002 Mar 1;34(5):620-6. No
abstract.
4451. Klemola
T, Vanto T, Juntunen-Backman K, Kalimo K, Korpela R, Varjonen E. Allergy to soy
formula and to extensively hydrolyzed whey formula in infants with cow's milk
allergy: a prospective, randomized study with a follow-up to the age of 2
years. J Pediatr. 2002 Feb;140(2):219-24.
OBJECTIVES: We conducted a prospective, randomized study to evaluate the cumulative incidence of allergy or other adverse reactions to soy formula and to extensively hydrolyzed formula up to the age of 2 years in infants with confirmed cow's milk allergy. STUDY DESIGN: Infants (n = 170) with documented cow's milk allergy were randomly assigned to receive either a soy formula or an extensively hydrolyzed formula. If it was suspected that the formula caused symptoms, a double-blind, placebo-controlled challenge (DBPCFC) with the formula was performed. The children were followed to the age of 2 years, and soy-specific immunoglobulin E antibodies were measured at the time of diagnosis and at the ages of 1 and 2 years. RESULTS: An adverse reaction to the formula was confirmed by challenge in 8 patients (10%; 95% confidence interval, 4.4%-18.8%) randomly assigned to soy formula and in 2 patients (2.2%; 95% confidence interval, 0.3% to 7.8%) randomly assigned to extensively hydrolyzed formula. Adverse reactions to soy were similar in IgE-associated and non-IgE-associated cow's milk allergy (11% and 9%, respectively). IgE to soy was detected in only 2 infants with an adverse reaction to soy. Adverse reactions to soy formula were more common in younger (<6 months) than in older (6 to 12 months) infants (5 of 20 vs 3 of 60, respectively, P =.01). CONCLUSIONS: Soy formula was well tolerated by most infants with IgE-associated and non-IgE-associated cow's milk allergy. Development of IgE-associated allergy to soy was rare. Soy formula can be recommended as a first-choice alternative for infants >or=6 months of age with cow's milk allergy.
4452. Krishna
MT, Salvi SS. BCG vaccination and prevention of allergic disease. Pediatrics.
2002 Feb;109(2):346-7. No abstract.
4453. Lilly
CM, Churg A, Lazarovich M, Pauwels R, Hendeles L, Rosenwasser LJ, Ledford D,
Wechsler ME. Asthma therapies and
Churg-Strauss syndrome. J Allergy Clin Immunol. 2002 Jan;109(1):S1-19.
The pulmonary vasculitides are a group of rare but serious disorders that require early recognition, accurate diagnosis, and effective therapy. Churg-Strauss syndrome (CSS) is classified as small vessel vasculitis. Four different definitions for the diagnosis of CSS have been developed: (1) the pathologic criteria put forth by Churg and Strauss, (2) the criteria based on clinical grounds from Lanham and colleagues, (3) the criteria based on clinical grounds from the American College of Rheumatology, and (4) the criteria from the Chapel Hill Consensus Conference, which closely concur with the Churg and Strauss definition. It is apparent that cessation, diminution, or even a switch from low-dose systemic to inhaled corticosteroid therapy can precipitate the appearance of CSS. The term forme fruste has been used to indicate that the signs and symptoms of CSS were (inadvertently) suppressed by cortico-steroids. The clinical risk factors for CSS are moderately severe or severe asthma, chronic sinusitis, or reductions in systemic corticosteroid therapy. Differential diagnosis, treatment, and ongoing monitoring of CSS therapeutic responses are reviewed. The introduction of leukotriene modifiers and high-potency inhaled corticosteroids have allowed control of asthma symptoms, which results in avoidance or reduction in oral corticosteroid use. The advent of these agents has been associated with reports of CSS appearing in patients with asthma. The available data regarding the association of CSS and antiasthma agents are most consistent with the unmasking of a previously contained pathologic condition (forme-fruste CSS) or disease that progresses because systemic corticosteroids were avoided. Early recognition and immunosuppressive therapy are the keystones of successful treatment of this rare disorder.
4454. Lin YC,
Su HJ, Hsiue TR, Lee CH, Chen CW, Guo YL. Levels of house dust mite-specific
IgE and cockroach-specific IgE and their association with lower pulmonary
function in Taiwanese children. Chest. 2002 Feb;121(2):347-53.
OBJECTIVE: Sensitization to an aeroallergen is known to diminish pulmonary function in young children and adults; however, it remains unclear whether it produces similar effects in adolescents. This study, therefore, examined the relationship between serum allergen-specific IgE levels and pulmonary function in adolescents. DESIGN: Middle-school children were invited for a physician's evaluation and pulmonary function test when not experiencing an asthma attack and for the determination of serum levels of specific IgE to common allergens. SETTING: National Cheng Kung University Hospital, Taiwan. SUBJECTS: Middle-school children in southern Taiwan, who had completed both a nationally administered Chinese version of the International Study of Asthma and Allergies in Childhood questionnaire and a pulmonary function test in October 1996. RESULTS: Forty-two then currently asthmatic children, 38 children with asthma in remission (no reported attack for > 12 months), and 69 children without asthma completed the study. Children with asthma had a significantly lower adjusted forced expiratory flow between 25% and 75% of FVC (FEF(25-75%)) and FEV(1)/FVC than children without asthma. A greater percentage of children with asthma were more sensitized to Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), and German cockroach but not cat dander or dog dander. Children with asthma with Der f-specific IgE > 100 IU/mL, or cockroach-specific IgE > 0.7 IU/mL showed lower pulmonary function. No such association was found in children without asthma. CONCLUSION: Our findings suggest that sensitization to Der f and German cockroach was a critical factor for the lower pulmonary function observed in middle-school children with asthma.
4455. Loukides
S, Bouros D, Papatheodorou G, Panagou P, Siafakas NM. The relationships among hydrogen peroxide in expired breath
condensate, airway inflammation, and asthma severity. Chest. 2002
Feb;121(2):338-46.
STUDY OBJECTIVE: To investigate which cells are the main source of hydrogen peroxide (H(2)O(2)) production in stable patients with asthma and the associations among H(2)O(2) levels, airway inflammation, and disease severity. SETTING: Inpatient respiratory unit and outpatient clinic in tertiary-care hospital. PATIENTS: Fifty stable asthmatic patients with disease severity ranging from mild to moderate. METHODS: H(2)O(2) was measured in expired breath condensate and was correlated with variables expressing both asthma severity (ie, FEV(1) percent predicted, peak expiratory flow rate [PEFR] variability, symptom score, and histamine airways responsiveness) and airway inflammation (ie, differential cell counts from induced sputum and levels of eosinophil cationic protein [ECP]). RESULTS: The mean (95% confidence interval [CI]) concentration of H(2)O(2) was significantly elevated in patients with asthma compared to that in control subjects (mean, 0.67 microM [95% CI, 0.56 to 0.77 microM] vs 0.2 microM [95% CI, 0.16 to 0.24 microM]; p < 0.0001). The difference was primarily due to the elevation of H(2)O(2) in patients with moderate asthma whose expired breath H(2)O(2) level of 0.95 microM (95% CI, 0.76 to 1.12 microM) was significantly higher from that of patients with mild-persistent and mild-intermittent asthma (mean, 0.59 microM [95% CI, 0.47 to 0.7 microM] and 0.27 [95% CI, 0.23 to 0.32 microM], respectively; p < 0.0001). H(2)O(2) concentration was positively related to sputum eosinophilia as well as to ECP concentration. A similar correlation was found between H(2)O(2) and neutrophils in patients with moderate asthma. A positive correlation was observed between H(2)O(2) level, symptom score, and PEFR variability. H(2)O(2) level was negatively related to FEV(1) percent predicted. Further analysis showed that only patients with moderate asthma who were not receiving inhaled steroids were found to have a strong relationship with the variables tested. CONCLUSIONS: Eosinophils are the predominate cells that generate H(2)O(2) in all forms of the disease, while neutrophils might be responsible for the highest levels that are observed in the more severe forms of the disease. The role of H(2)O(2) concentration in predicting the severity of the disease as well as in the inflammatory process is limited and depends on the use of inhaled steroid therapy and the classification of the severity of the disease.
4456. Loza
MJ, Peters SP, Zangrilli JG, Perussia B. Distinction between IL-13+ and
IFN-gamma+ natural killer cells and regulation of their pool size by IL-4. Eur
J Immunol. 2002 Feb;32(2):413-23.
The hypothesis that distinct subsets of NK cells produce type 2 and type 1 cytokines in resting naive lymphocytes was tested analyzing cytokine production at the single-cell level. Two non-overlapping IL-13+ and IFN-gamma+ subsets were identified in adult and neonatal NK cells. IL-2 maintained their relative proportion. Accumulation of the former was induced by IL-4, but not IL-13, and inhibited by IL-12; that of the latter was induced by IL-12 and inhibited by IL-4 and IL-13. IL-4 induced preferential proliferation of the pre-existing peripheral IL-13+ cells, whereas IL-12 had minimal effect on proliferation of the IFN-gamma+ NK cells. The IL-13+ cells (CD161+ only) are phenotypically distinct from the IFN-gamma+ ones (CD56+) before and after culture under any condition analyzed, and produce IL-13 in response to NK-sensitive target cells and PMA+Ca(2+) ionophore, whereas also FcgammaRIIIA and IL-2+IL-12 stimulate IFN-gamma production. These data define the existence and regulation of two distinct resting peripheral NK cell subsets producing type 1 and type 2 cytokines, and suggest possible roles for IL-13+ NK cells in allergy.
4457. Martinez
FD. Development of wheezing disorders and asthma in preschool children. Pediatrics.
2002 Feb;109(2 Suppl):362-7. Review.
Recent longitudinal studies have shed light on the pathogenesis and progression of asthma. The patterns of expression of childhood asthma that persist into adult life have been explored. Distinct asthma phenotypes (transient wheezing, nonatopic wheezing, and atopy-associated asthma) have been identified. Defining which children are at risk for persistent asthma could allow for better management and, potentially, for reduced morbidity and mortality.
4458. McConnell
R, Berhane K, Gilliland F, London SJ, Islam T, Gauderman WJ, Avol E, Margolis
HG, Peters JM. Asthma in exercising children exposed to ozone: a cohort study.
Lancet. 2002 Feb 2;359(9304):386-91.
BACKGROUND: Little is known
about the effect of exposure to air pollution during exercise or time spent
outdoors on the development of asthma. We investigated the relation between
newly-diagnosed asthma and team sports in a cohort of children exposed to
different concentrations and mixtures of air pollutants. METHODS: 3535 children
with no history of asthma were recruited from schools in 12 communities in
southern California and were followed up for up to 5 years. 265 children
reported a new diagnosis of asthma during follow-up. We assessed risk of asthma
in children playing team sports at study entry in six communities with high
daytime ozone concentrations, six with lower concentrations, and in communities
with high or low concentrations of nitrogen dioxide, particulate matter, and
inorganic-acid vapour. FINDINGS: In communities with high ozone concentrations,
the relative risk of developing asthma in children playing three or more sports
was 3.3 (95% CI 1.9-5.8), compared with children playing no sports. Sports had
no effect in areas of low ozone concentration (0.8, 0.4-1.6). Time spent
outside was associated with a higher incidence of asthma in areas of high ozone
(1.4, 1.0-2.1), but not in areas of low ozone. Exposure to pollutants other
than ozone did not alter the effect of team sports. INTERPRETATION: Incidence
of new diagnoses of asthma is associated with heavy exercise in communities
with high concentrations of ozone, thus, air pollution and outdoor exercise
could contribute to the development of asthma in children.
4459. McKeever
TM, Lewis SA, Smith C, Collins J, Heatlie H, Frischer M, Hubbard R. Early
exposure to infections and antibiotics and the incidence of allergic disease: a
birth cohort study with the West Midlands General Practice Research Database. J
Allergy Clin Immunol. 2002 Jan;109(1):43-50.
BACKGROUND: It has been suggested that the rise in prevalence of allergic disease in westernized countries is due in part to a decrease in exposure to infections and an increase in the use of antibiotics early in life. OBJECTIVE: The purpose of this investigation was to quantify the relationships between (1) exposure to personal infections, infections in siblings, and use of antibiotics in early life and (2) the incidence of allergic disease. METHODS: Using the West Midlands section of the UK General Practice Research Database, we established a historical birth cohort of children (N = 29,238). For each child, we identified all personal infections and infections in siblings and determined the use of antibiotics in early life; we also noted incident diagnoses of asthma, eczema, and hay fever. The data were analyzed through use of Cox regression. RESULTS: There was no clear protective effect of exposure to either personal infections or infections in siblings with respect to the incidence of allergic disease. Antibiotic exposure was associated with an increased risk of developing allergic disease in a dose-related manner: having 4 or more courses of antibiotics in the first year of life was associated with an increased incidence of asthma (hazard ratio [HR], 3.13; 95% CI, 2.75-3.57), eczema (HR, 1.48; 95% CI, 1.31-1.68), and hay fever (HR, 2.12; 95% CI, 1.68-2.66). However, adjusting for consulting behavior reduced these effects (adjusted HR [95% CI]: asthma, 1.99 [1.72-2.31]; eczema, 1.01 [0.88-1.17]; hay fever, 1.14 [0.88-1.47]). CONCLUSIONS: We found no evidence that exposure to infections reduced the incidence of allergic disease, and infections did not explain the previous findings of a strong birth order effect in this cohort. The use of antibiotics might be associated with early diagnoses of allergic disease.
4460. Moira
CY, Ferguson A, Dimich-Ward H, Watson W, Manfreda J, Becker A. Effectiveness of
and compliance to intervention measures in reducing house dust and cat allergen
levels. Ann Allergy Asthma Immunol. 2002 Jan;88(1):52-8.
BACKGROUND: Allergic sensitization is a major risk factor in asthma. OBJECTIVE: To evaluate the effectiveness of and compliance to intervention measures in reducing levels of house-dust mite and cat allergen in the context of a randomized, controlled study in the primary prevention of asthma. METHODS: A total of 545 high-risk families were recruited prenatally and randomly assigned into the intervention group (n = 278) and the control group (n = 267). Intervention measures were instituted before birth of the infants and maintained for 12 months afterward in the intervention group and the control group received the usual care from their family physician. Dust samples were collected at six sites in the homes before birth and at specific intervals up to 24 months after birth for analysis of allergens. At 24 months, there were 244 families in the intervention group and 228 in the control group available for followup examination. RESULTS: House-dust mite avoidance measures, consisting of encasement of mattresses, pillows, and duvets, and hot-water washing of bedding were effective in reducing mite allergen in parents' mattresses to one-third from baseline, significantly lower than the control group, even at 24 months. The use of an acaricide did not reduce mite allergen levels in carpets and upholstered furniture. Seventeen intervention families gave up their cats but six families acquired a new one over a period of 24 months, similar to control families. Cat allergen levels decreased in all sites in the homes of those who removed the cat, similar in both groups. CONCLUSIONS: House-dust mite avoidance measures were effective in reducing house-dust mite allergen in mattresses, but not on floors. Reduction in cat allergen levels were evident for those families who got rid of their cats, but the advice to remove pets was not adhered to by most families.
4461. Moller
C, Dreborg S, Ferdousi HA, Halken S, Host A, Jacobsen L, Koivikko A, Koller DY,
Niggemann B, Norberg LA, Urbanek R, Valovirta E, Wahn U. Pollen immunotherapy reduces the development
of asthma in children with seasonal rhinoconjunctivitis (the PAT-study). J
Allergy Clin Immunol. 2002 Feb;109(2):251-6.
BACKGROUND: Children with allergic rhinitis are likely to develop asthma. OBJECTIVE: The purpose of this investigation was to determine whether specific immunotherapy can prevent the development of asthma and reduce bronchial hyperresponsiveness in children with seasonal allergic rhinoconjunctivitis. METHODS: From 6 pediatric allergy centers, 205 children aged 6 to 14 years (mean age, 10.7 years) with grass and/or birch pollen allergy but without any other clinically important allergy were randomized either to receive specific immunotherapy for 3 years or to an open control group. All subjects had moderate to severe hay fever symptoms, but at inclusion none reported asthma with need of daily treatment. Symptomatic treatment was limited to loratadine, levocabastine, sodium cromoglycate, and nasal budesonide. Asthma was evaluated clinically and by peak flow. Methacholine bronchial provocation tests were carried out during the season(s) and during the winter. RESULTS: Before the start of immunotherapy, 20% of the children had mild asthma symptoms during the pollen season(s). Among those without asthma, the actively treated children had significantly fewer asthma symptoms after 3 years as evaluated by clinical diagnosis (odds ratio, 2.52; P <.05). Methacholine bronchial provocation test results improved significant in the active group (P <.05). CONCLUSION: Immunotherapy can reduce the development of asthma in children with seasonal rhinoconjunctivitis.
4462. Orr WC.
Sleep-related breathing disorders: is it all about apnea? Chest. 2002
Jan;121(1):8-11. No abstract.
4463. Paredi
P, Kharitonov SA, Barnes PJ. Faster rise of exhaled breath temperature in
asthma: a novel marker of airway inflammation? Am J Respir Crit Care Med. 2002
Jan 15;165(2):181-4.
In asthma there is increased vascularity of the airway mucosa, altering heat loss in the airways. We hypothesized that as a result of these inflammatory changes, asthmatic patients would have elevated rates of the exhaled air temperature increase (Deltae degrees T). We measured Deltae degrees T in 18 asthmatic subjects (mean age +/- SEM, 38 +/- 8 yr; 9 male, FEV(1) 74 +/- 10%) and 16 normal volunteers (mean age +/- SEM, 33 +/- 3 yr) and compared it with exhaled nitric oxide (NO) as a marker of inflammation. Deltae degrees T was measured during a flow- and pressure-controlled single exhalation with a fast response (1 ms) thermometer. The end-expiratory plateau temperature was similar in asthmatic compared with normal subjects (35.75 +/- 0.6 degrees C and 34.45 +/- 0.8 degrees C, p > 0.05). However, Deltae degrees T was greater in asthmatic subjects (8.17 +/- 0.83 degrees C/s and 4.12 +/- 0.41 degrees C/s, p < 0.01) and correlated with NO (r = 0.65, p = 0.034). Deltae degrees T was increased in normal subjects (from 4.28 +/- 0.8 degrees C/s to 7.60 +/- 0.5 degrees C/s, p < 0.01) but not in asthmatic patients (from 8.28 +/- 0.41 degrees C/s to 8.80 +/- 0.41 degrees C/s, p > 0.05) after the inhalation of albuterol, indicating that Deltae degrees T may reflect bronchial blood flow. Asthmatic subjects have elevated Deltae degrees T. This may represent a novel, noninvasive means of measuring airway blood flow and inflammation in asthma.
4464. Pelaia
G, Gallelli L, Vatrella A, Grembiale RD, Maselli R, De Sarro GB, Marsico SA.
Potential role of potassium channel openers in the treatment of asthma and
chronic obstructive pulmonary disease. Life Sci. 2002 Jan 18;70(9):977-90.
Review.
Airway smooth muscle (ASM) cells express various types of potassium (K+) channels which play a key role in determining the resting membrane potential, a relative electrical stability and the responsiveness to both contractile and relaxant agents. In addition, K+ channels are also involved in modulation of neurotransmitter release from airway nerves. The most important K+ channels identified in airways include large and small Ca2+-activated, delayed-rectifier, and ATP-sensitive channels. These K+ channels are structurally and functionally different, thus playing distinct roles in airway electrophysiology and pharmacology. Many in vitro and in vivo studies, performed in both animals and humans, have shown that K+ channel openers are able to induce hyperpolarization of ASM cells, bronchodilation, suppression of airway hyperresponsiveness (AHR), and inhibition of neural reflexes. Therefore, airway K+ channels represent a suitable pharmacological target for the development of new effective therapeutic options in the treatment of asthma and chronic obstructive pulmonary disease (COPD).
4465. Rhodes
HL, Thomas P, Sporik R, Holgate ST, Cogswell JJ. A birth cohort study of
subjects at risk of atopy: twenty-two-year follow-up of wheeze and atopic
status. Am J Respir Crit Care Med. 2002 Jan 15;165(2):176-80.
This study describes the natural history of atopic and wheezy disorders from birth to adult life in a cohort at risk of atopy. One hundred subjects born in Poole, England, were selected at birth in 1976 on the basis that at least one parent was atopic. Subjects were examined annually in the preschool years, and at the ages of 11 and 22 yr. Skin prick tests and total serum immunoglobulin E (IgE) were performed at each visit, and at 11 and 22 yr, bronchial hyperresponsiveness (BHR) to inhaled histamine was measured. Sixty-three subjects remained on follow-up at 22 yr. The annual prevalence of both wheeze and atopy increased with age. Twenty-five percent of adults showed both wheeze and BHR (asthma). Remission of wheeze was common in subjects younger than 5 yr of age and likely if wheezing occurred on less than two occasions, but wheeze at 11 yr was likely to persist. Sixty percent of the adult subjects with asthma developed sensitivity to common allergens by the age of 2 yr and were showing BHR by mid-childhood. Sensitization to dietary allergens occurred in infancy and waned after early childhood but predicted the early sensitization to inhalant allergens. In conclusion, adults with asthma can begin wheezing at any age but tend to sensitize early and have abnormal airway characteristics by the age of 11 yr.
4466. Schapowal
A. Randomised controlled trial of butterbur and cetirizine for treating
seasonal allergic rhinitis. BMJ. 2002 Jan 19;324(7330):144-6.
OBJECTIVES: To compare the efficacy and tolerability of butterbur (Petasites hybridus) with cetirizine in patients with seasonal allergic rhinitis (hay fever). DESIGN: Randomised, double blind, parallel group comparison. SETTING: Four outpatient general medicine and allergy clinics in Switzerland and Germany. PARTICIPANTS: 131 patients were screened for seasonal allergic rhinitis and 125 patients were randomised (butterbur 61; cetirizine 64). INTERVENTIONS: Butterbur (carbon dioxide extract tablets, ZE 339) one tablet, four times daily, or cetirizine, one tablet in the evening, both given for two consecutive weeks. MAIN OUTCOME MEASURES: Scores on SF-36 questionnaire and clinical global impression scale. RESULTS: Improvement in SF-36 score was similar in the two treatment groups for all items tested hierarchically. Butterbur and cetirizine were also similarly effective with regard to global improvement scores on the clinical global impression scale (median score 3 in both groups). Both treatments were well tolerated. In the cetirizine group, two thirds (8/12) of reported adverse events were associated with sedative effects (drowsiness and fatigue) despite the drug being considered a non-sedating antihistamine. CONCLUSIONS: The effects of butterbur are similar to those of cetirizine in patients with seasonal allergic rhinitis when evaluated blindly by patients and doctors. Butterbur should be considered for treating seasonal allergic rhinitis when the sedative effects of antihistamines need to be avoided.
4467. Singh
D, Arora V, Sobti PC. Chronic/recurrent cough in rural children in Ludhiana,
Punjab. Indian Pediatr. 2002 Jan;39(1):23-9.
OBJECTIVE: To determine the prevalence, age distribution and common causes of chronic/recurrent cough in rural children. DESIGN: Prospective study. SETTING: Pediatric population in five villages of Dehlon Block of Ludhiana, Punjab. METHODS: 2275 children in the age group of 1 to 15 years were screened by house to house survey for chronic/recurrent cough using defined criteria. A detailed work up of selected cases was carried out. Underlying etiology was determined using clinical and laboratory parameters. Five hundred children in the study population formed the control group. Variables associated with chronic/recurrent cough were analyzed in cases and controls. RESULTS: Twenty four children were diagnosed with chronic/recurrent cough showing a prevalence rate of 1.06 percent. The most common cause was bronchial asthma (66.7 percent) followed by postnasal drip syndrome (25 percent). Family history of allergy/asthma was noted in 11 (45.8 percent) children as compared to 52 (10.4 percent) in the control group (p < 0.01). Family history of smoking was recorded in 16.7 percent of cases in contrast to 6.4 percent in controls (p = 0.05). There was no significant association with overcrowding, pets and kind of cooking fuel used. CONCLUSIONS: The most common cause of chronic/recurrent cough was bronchial asthma. There was a significant association with family history of allergy/asthma and smoking.
4468. Stelmach
I, Jerzynska J, Kuna P. A randomized, double-blind trial of the effect of
treatment with montelukast on bronchial hyperresponsiveness and serum
eosinophilic cationic protein (ECP), soluble interleukin 2 receptor (sIL-2R),
IL-4, and soluble intercellular adhesion molecule 1 (sICAM-1) in children with
asthma. J Allergy Clin Immunol. 2002 Feb;109(2):257-63.
BACKGROUND: Anti-inflammatory properties of leukotriene modifiers and their effect on bronchial hyperresponsiveness have not been studied in children with asthma. OBJECTIVE: The primary objective of this study was to determine the changes in serum levels of inflammatory mediators, clinical efficacy, and bronchial hyperresponsiveness after treatment with montelukast. METHODS: In this double-blind, randomized, placebo-controlled trial, 39 children with mild-to-moderate atopic asthma were randomly allocated to receive montelukast or placebo for 6 weeks. Main outcome measures were changes in serum concentrations of soluble interleukin 2 receptor (sIL-2R), IL-4, and soluble intercellular adhesion molecule 1 (sICAM-1); peripheral blood eosinophil count; and eosinophilic cationic protein (ECP). Asthma severity score, FEV(1), and bronchial hyperreactivity (BHR) for histamine were secondary end points. RESULTS: Compared to placebo, serum concentrations of IL-4, sICAM-1, and ECP and eosinophil blood counts significantly decreased after 6 weeks of treatment with montelukast. Montelukast significantly improved asthma control and FEV(1). Montelukast resulted in within-group significant decrease in levels of serum sIL-2R (611 vs. 483 pg/mL), IL-4 (0.123 vs 0.102 pg/mL), sICAM-1 (280 vs. 244 ng/mL), and ECP (74 vs. 59 microg/mL) and in eosinophil blood counts (349 vs. 310 cells/mm(3)). Mean FEV(1) value changed from 85% of predicted to 95% (P <.001) and for histamine (PC(20)H) from 2.8 mg/mL to 3.8 mg/mL (P <.001) after treatment with montelukast. There was no significant difference between montelukast and placebo recipients in the serum concentrations of sIL-2R and PC(20)H after treatment. CONCLUSION: Montelukast provides clinical benefit to patients with chronic asthma and decreases bronchial hyperresponsiveness. Montelukast caused a statistically significant decrease of serum concentrations in cytokine, ICAM-1, and ECP and peripheral blood eosinophil counts over the 6-week treatment period. This observation raises the possibility that leukotriene receptor antagonists, such as montelukast, may have effects on parameters of asthmatic inflammation.
4469. Stevens
CA, Wesseldine LJ, Couriel JM, Dyer AJ, Osman LM, Silverman M. Parental education and guided
self-management of asthma and wheezing in the pre-school child: a randomised
controlled trial. Thorax. 2002 Jan;57(1):39-44.
BACKGROUND: The effects on morbidity were examined of providing an educational intervention and a written guided self-management plan to the parents of pre-school children following a recent attendance at hospital for asthma or wheeze. METHODS: A prospective, randomised, partially blinded, controlled trial was designed at two secondary care centres. Over a 13 month period 200 children aged 18 months to 5 years at the time of admission to a children's ward or attendance at an accident and emergency department or children's (emergency) assessment unit (A&E/CAU) with a primary diagnosis of acute severe asthma or wheezing were recruited. 101 children were randomised into the control group and received usual care and 99 were assigned to the intervention group and received: (1) a pre-school asthma booklet; (2) a written guided self-management plan; and (3) two 20 minute structured educational sessions between a specialist respiratory nurse and the parent(s) and child. Subjects were assessed at 3, 6, and 12 months. The main outcomes were GP consultation rates, hospital re-admissions, and attendances at A&E/CAU. Secondary outcomes included disability score, caregivers' quality of life, and parental knowledge of asthma. RESULTS: There were no statistically significant differences between the two groups during the 12 month follow up period for any of the main or secondary outcome measures. CONCLUSIONS: These results do not support the hypothesis that the introduction of an educational package and a written guided self-management plan to the parents of pre-school children with asthma who had recently attended hospital for troublesome asthma or wheeze reduces morbidity over the subsequent 12 months.
4470. Suri
JC, Sen MK, Chakrabarti S, Mehta C. Vocal cord dysfunction presenting as
refractory asthma. Indian J Chest Dis Allied Sci. 2002 Jan-Mar;44(1):49-52.
Vocal cord dysfunction is a rare variety of upper airway obstruction characterized by typical laryngoscopic features and may mimic an acute asthma attack. The case presented in this report pertains to a 15-year-old girl who had repeated acute episodes of dyspnoea and wheezing and remained non-responsive to corticosteroids and inhaled bronchodilators requiring endotracheal intubations for adequate control. Laryngoscopic findings were consistent with vocal cord dysfunction. She was treated with a tracheostomy and psychological support.
4471. Timonen
KL, Pekkanen J, Tiittanen P, Salonen RO. Effects of air pollution on changes in
lung function induced by exercise in children with chronic respiratory
symptoms. Occup Environ Med. 2002 Feb;59(2):129-34.
OBJECTIVE: To investigate how daily variations in ambient air pollution, especially in particles, during the cold of winter affect repeated measurements of baseline lung function and exercise induced bronchial responsiveness among primary school children with chronic respiratory symptoms. METHODS: During alternate school weeks (maximum five) from February to April 1994, 33 children took part in exercise challenge tests (n=141 tests). The exercise challenges were conducted outdoors in a school yard in the centre of Kuopio, Finland. Spirometric lung functions were measured indoors before the exercise, and 3 and 10 minutes after. Daily mean concentrations of PM(10), black smoke (BS), NO(2), CO, SO(2), and particle size and numbers were monitored at a nearby fixed monitoring site. RESULTS: Daily variations in ambient air pollution were not associated with enhanced bronchial responsiveness. However, increased concentrations of BS, PM(10), particle numbers, NO(2), and CO were consistently associated with an impairment of baseline lung functions. The reductions in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV(1)) were 0.5% and 0.6%, respectively, for each 10 microg/m(3) increase in BS (lag 2). CONCLUSION: Particles derived from combustion affect baseline lung function rather than bronchial responsiveness among children with chronic respiratory symptoms.
4472. Tinghino
R, Twardosz A, Barletta B, Puggioni EM, Iacovacci P, Butteroni C, Afferni C,
Mari A, Hayek B, Di Felice G, Focke M, Westritschnig K, Valenta R, Pini C. Molecular, structural, and immunologic
relationships between different families of recombinant calcium-binding pollen
allergens. J Allergy Clin Immunol. 2002 Feb;109(2):314-20.
BACKGROUND: Calcium-binding plant allergens can be grouped in different families according to the number of calcium-binding domains (EF hands). OBJECTIVE: We sought to identify pollens containing crossreactive calcium-binding allergens and to investigate structural and immunologic similarities of members belonging to different families of calcium-binding allergens. METHODS: By means of multiple sequence alignment and molecular modeling, we searched for structural similarities among pollen allergens with 2 (Phl p 7, timothy grass; Aln g 4, alder), 3 (Bet v 3, birch) and 4 EF hands (Jun o 4, prickly juniper). Purified recombinant Aln g 4 and Jun o 4 were used to determine the prevalence of IgE recognition in 210 patients sensitized to different pollens and to search, by means of ELISA competition, for the presence of cross-reactive epitopes in pollens from 16 unrelated plant species. IgE cross-reactivity among the allergen families was studied with purified rPhl p 7, rAln g 4, rBet v 3, and rJun o 4 and 2 synthetic peptides comprising the N-terminal and C-terminal EF hands of Phl p 7 by means of ELISA competition. RESULTS: Structural similarities were found by using molecular modeling among the allergens with 2, 3, and 4 EF hands. Pollens from 16 unrelated plants contained Aln g 4- and Jun o 4-related epitopes. Twenty-two percent of the patients with multiple pollen sensitization reacted to at least one of the calcium-binding allergens. A hierarchy of IgE cross-reactivity (rPhl p7 > rAln g 4 > rJun o 4 > rBet v 3) could be established that identified rPhl p 7 as the EF-hand allergen containing most IgE epitopes in the population studied. CONCLUSION: The demonstration that members of different families of calcium-binding plant allergens share similarities suggests that it may be possible to use representative molecules for the diagnosis and therapy of allergies to EF-hand allergens.
4473. Toda M,
Tulic MK, Levitt RC, Hamid Q. A
calcium-activated chloride channel (HCLCA1) is strongly related to IL-9
expression and mucus production in bronchial epithelium of patients with
asthma. J Allergy Clin Immunol. 2002 Feb;109(2):246-50.
BACKGROUND: One of the cardinal features of airway remodeling in asthma is mucus gland hyperplasia and mucus overproduction and hypersecretion. Recently, a calcium-activated chloride channel, HCLCA1, was described that is upregulated by IL-9 and thought to regulate the expression of soluble gel-forming mucins, such as MUC5A/C, a critical component of mucus in the airways. OBJECTIVE: We sought to examine the expression of HCLCA1 in bronchial biopsy specimens of asthmatic subjects compared with those of control subjects and to demonstrate its relationship with IL-9, IL-9 receptor (IL-9R), and markers of mucus production. METHODS: Bronchial biopsy specimens from asthmatic (n = 9) and control (n = 10) subjects were stained with periodic acid-Schiff to identify mucus glycoconjugates. IL-9- and IL-9R-positive cells were identified with immunocytochemistry, and HCLCA1 expression was detected by means of in situ hybridization with cRNA probes. RESULTS: We demonstrate significant increases in IL-9 (P <.001) and IL-9R (P <.05) immunoreactivity, as well as increased expression of HCLCA1 mRNA (P <.001), in the epithelium of asthmatic patients compared with that found in control subjects. There was also an increase in the number of mucusproducing cells in biopsy specimens from asthmatic subjects (P <.001). HCLCA1 mRNA was strongly and selectively colocalized with periodic acid-Schiff and IL-9R-positive epithelial cells. In particular, a strong positive correlation was observed between HCLCA1 mRNA expression and IL-9-positive (r = 0.69, P < 0.01) or IL9R-positive (r = 0.79, P <.01) cells. CONCLUSION: An upregulation of HCLCA1 in the IL-9- responsive mucus-producing epithelium of asthmatic subjects compared with that seen in control subjects supports the hypothesis that this channel may be responsible, in part, for the overproduction of mucus in asthmatic subjects. These preliminary findings suggest the inhibition of HCLCA1 may be an important new therapeutic approach to control mucus overproduction in chronic airway disorders.
4474. Van der
Wouden JC, Bueving HJ, Bernsen RM. Influenza vaccine and asthma. J Pediatr. 2002 Feb;140(2):278-9. No
abstract.
4475. Venis
S. Transcription factor shown to have a role in triggering asthma. Lancet. 2002
Jan 12;359(9301):138. No abstract.
4476. Vercelli
D. The functional genomics of CD14 and its role in IgE responses: an integrated
view. J Allergy Clin Immunol. 2002 Jan;109(1):14-21. No abstract.
4477. Wachholz
PA, Nouri-Aria KT, Wilson DR, Walker SM, Verhoef A, Till SJ, Durham SR. Grass
pollen immunotherapy for hayfever is associated with increases in local nasal
but not peripheral Th1:Th2 cytokine ratios. Immunology. 2002 Jan;105(1):56-62.
Grass pollen immunotherapy is the only treatment for hayfever that is both effective and confers long-term benefit. Immunotherapy may act by altering the local nasal mucosal T helper type 2 (Th2) to type 1 (Th1) cytokine balance either by down-regulation and/or immune deviation of T-lymphocyte responses. There is controversy as to whether these changes are detectable in peripheral blood. We therefore examined both local nasal and peripheral T-cell responses to allergen exposure in the same subjects before and after immunotherapy. In a double-blind trial of grass pollen immunotherapy, nasal biopsies were obtained at baseline and during the peak pollen season following 2 years of immunotherapy. Placebo-treated patients showed a seasonal increase in CD3(+) T cells (P = 0.02) and in interleukin-5 (IL-5) mRNA(+) cells (P = 0.03) and no change in interferon-gamma (IFN-gamma ) mRNA(+) cells (P = 0.2) in the nasal mucosa. In contrast, in the immunotherapy-treated group, there were no changes in the number of CD3(+) T cells (P = 0.3) and IL-5 mRNA+ cells (P = 0.2) but a significant increase in the number of IFN-gamma mRNA(+) cells (P = 0.03). Furthermore, clinical improvement in the immunotherapy-treated group was accompanied by a seasonal increase in the ratio of IFN-gamma to IL-5 mRNA(+) cells in the nasal mucosa (P = 0.03). In contrast, there were no significant changes in peripheral T-cell proliferative responses or cytokine production for IFN-gamma or IL-5 in response to grass pollen either within or between the two treatment groups. We conclude that successful grass pollen immunotherapy was associated with an increase in the ratio of IFN-gamma to IL-5 mRNA(+) cells in the nasal mucosa, whereas these changes were not reflected by alterations in peripheral blood T-cell proliferative responses or cytokine production before/after treatment.
4478. Weber
RW. Atopic persons sensitive to cat dander. Ann Allergy Asthma Immunol. 2002
Jan;88(1):A4. No abstract.
4479. Woods
RK, Thien F. Polyunsaturated fats and asthma. Thorax. 2002 Jan;57(1):94. No abstract.
4480. Zanen
P. PC(20) adenosine 5'-monophosphate is more closely associated with airway
inflammation in asthma than PC(20) methacholine. Am J Respir Crit Care Med.
2002 Mar 1;165(5):730. No abstract.
Oct
2002
5045.
Adams RJ,
Fuhlbrigge AL, Finkelstein JA, Weiss ST. Intranasal steroids and the risk of emergency department visits for asthma. J
Allergy Clin Immunol. 2002 Apr;109(4):636-42.
BACKGROUND: In patients with asthma, treatment for associated conditions, such
as rhinitis, is recommended. It is unknown whether this treatment can reduce
the risk for emergency department (ED) visits for asthma. OBJECTIVES: We sought
to determine whether treatment with intranasal steroids or prescription
antihistamines in persons with asthma is associated with a reduced risk for ED
visits caused by asthma. METHODS: We performed a retrospective cohort study of
members of a managed care organization aged greater than 5 years who were
identified during the period of October 1991 to September 1994 as having a
diagnosis of asthma by using a computerized medical record system. The main
outcome measure was an ED visit for asthma. RESULTS: Of the 13,844 eligible
persons, 1031 (7.4%) had an ED visit for asthma. The overall relative risk (RR)
for an ED visit among those who received intranasal corticosteroids, adjusted
for age, sex, frequency of orally inhaled corticosteroid and beta-agonist
dispensing, amount and type of ambulatory care for asthma, and diagnosis of an
upper airways condition (rhinitis, sinusitis, or otitis media), was 0.7 (95%
confidence interval [CI], 0.59-0.94). For those receiving prescription
antihistamines, the risk was indeterminate (RR, 0.9; 95% CI, 0.78-1.11). When
different rates of dispensing for intranasal steroids were examined, a reduced
risk was seen in ED visits in those with greater than 0 to 1 (RR, 0.7; 95% CI,
0.57-0.99) and greater than 3 (RR, 0.5; 95% CI, 0.23-1.05) dispensed
prescriptions per year. CONCLUSIONS: Treatment of nasal conditions,
particularly with intranasal steroids, confers significant protection against
exacerbations of asthma leading to ED visits for asthma. These results support
the use of intranasal steroids by individuals with asthma and upper airways
conditions.
5046.
Agarwal S,
Gawkrodger DJ. Occupational allergic contact dermatitis to silver and
colophonium in a jeweler. Am J Contact Dermat. 2002 Jun;13(2):74.
The aim of this study was to determine any occupationally
relevant allergic contact sensitizations in hand dermatitis in a jeweler. Patch
test with European Standard, vehicle, medicaments, and metal series (Finn
chambers on Scanpor) was performed. Readings were taken on day 2 and day 4.
Allergic positive reaction to colophonium 20% pet and silver nitrate 0.5% aq
was detected. The contact sensitivities to silver and colophonium seem to be
occupationally relevant in this case. Copyright 2002, Elsevier Science (USA).
All rights reserved.
5047.
Al-Mobeireek
A, Alamoudi O. Allergic bronchopulmonary aspergillosis mimicking pulmonary
tuberculosis. Saudi Med J. 2002 Apr;23(4):476; discussion 476. No
abstract.
5048.
Amirav I,
Newhouse MT. Treatment failures in children with asthma due to inappropriate
use of Turbuhaler. J Pediatr. 2002 Apr;140(4):483. No abstract.
5049.
Baima B,
Sticherling M. How specific is the TUNEL reaction? An account of a
histochemical study on human skin. Am J Dermatopathol. 2002 Apr;24(2):130-4.
The TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP
nick-end labeling) technique has been described as sensitive method of labeling
apoptotic nuclei in tissues, which preferentially stains apoptotic strand
breaks. In the current study, three commercially available TUNEL kits for
paraffin-embedded and cryostat tissues were tested to optimize this method for
the studies on human skin. The investigation included normal skin (n = 10),
atopic eczema (n = 4), basal cell carcinoma (n = 5), and lupus erythematosus
(LE) (n = 31) sections. Additionally, the expression of certain apoptotic
markers (Fas antigen and Bcl-2 protein) was studied immunohistologically on
normal and LE skin. During TUNEL labeling according to the manufacturers' protocols,
abnormally high background and nonspecific staining were found in all skin
sections. The manipulation with the pretreatment time and, in particular, the
introduction of an additional step (terminating the labeling reaction by
inhibiting the terminal deoxynucleotidyl transferase activity) in two kits led
to a remarkable improvement in their performance. The conclusions are that it
is generally difficult to establish a functionally specific TUNEL technique for
skin sections and that the choice of a kit is absolutely crucial for obtaining
reliable results. Considering the extent to which the apoptosis research has
been carried out recently, it is advisable to remain critical in evaluating the
results. Further, it is necessary to combine the TUNEL technique with the
investigation of other apoptotic markers.
5050.
Bassiri S,
Cohen DE. Bilateral palmar dermatitis. Am J Contact Dermat. 2002
Jun;13(2):75-6. No abstract.
5051.
Beigelman-Aubry
C, Capderou A, Grenier PA, Straus C, Becquemin MH, Similowski T, Zelter M. Mild intermittent asthma: CT assessment of
bronchial cross-sectional area and lung attenuation at controlled lung volume.
Radiology. 2002 Apr;223(1):181-7.
PURPOSE: To evaluate, with thin-section computed tomography
(CT), changes in bronchial cross-sectional area and lung attenuation induced by
bronchial stimulation in patients with mild intermittent asthma, at a given
lung volume monitored with pneumotachography. MATERIALS AND METHODS: Twelve
patients with mild intermittent asthma who were nonsmokers (National Institutes
of Health staging) and six nonsmoking healthy volunteers, age and sex
ratio-matched, were examined by using helical thin-collimation CT at the level
of basal bronchi at 65% of total lung capacity. Three sets of acquisitions were
obtained: at baseline and after inhalation of methacholine and then salbutamol.
Cross-sectional areas of bronchi greater than 4 mm(2) were segmented and
calculated from CT images. Lung attenuation was measured in the anterior,
lateral, and posterior areas of the right lung parenchyma. Gas trapping was
evaluated by using thin-section CT at residual volume in six of the patients
with asthma. Statistical analysis included two factors repeated-measurement
analysis of variance and Mann-Whitney and Kruskal-Wallis nonparametric tests.
RESULTS: Bronchial cross-sectional areas and lung attenuation did not vary
significantly compared with baseline values following bronchial challenge in
healthy volunteers or patients with asthma. However, in patients with asthma,
bronchial cross-sectional areas were significantly smaller than in healthy
volunteers, except after inhalation of salbutamol. Lung attenuation and
anteroposterior attenuation gradient were significantly higher in patients with
asthma than in healthy patients (P <.001). Air-trapping scores were
significantly higher after methacholine challenge. CONCLUSION: Helical
thin-collimation CT at controlled lung volume and at full expiration associated
with bronchial challenge may help evaluate bronchoreactivity and inflammation
in mild intermittent asthma.
5052.
Bensch GW,
Nelson HS, Borish LC. Evaluation of cytokines in nasal secretions after nasal
antigen challenge: lack of influence of antihistamines. Ann Allergy Asthma
Immunol. 2002 May;88(5):457-62.
BACKGROUND: Previous studies of inflammation in allergic
rhinitis using nasal irrication have been unsatisfactory because of 1) poor
reproducibility; 2) the tendency of irrigation to overdilute mediators; and 3)
the failure of this technique to evaluate interstitial concentrations of relevant
mediators. For this study we used filter paper as a matrix to collect nasal
secretions in patients undergoing nasal antigen challenge. OBJECTIVE: To
evaluate inflammatory mediators of allergen-induced rhinitis during a clinical
trial of fexofenadine. METHODS: Subjects evaluated at a referral medical center
were placed on traditional dosing of fexofenadine at 60 mg, twice daily, or
placebo in a double-blind, crossover fashion for 1 week before the nasal
challenge. Nasal challenge was performed with nasal insufflation of either
1,000 AU timothy or 0.1 mL ragweed (1:100 wt/vol) extract outside the pollen
season. Nasal secretions were collected at baseline and then at 2, 4, and 6
hours after nasal challenge. Secretions were evaluated for expression of the cellular
adhesion molecule-1, tumor necrosis factor (TNF)-alpha, interleukin (IL)-4,
IL-10, macrophage inflammatory protein (MIP)-1alpha, and granulocyte-macrophage
colony-stimulating factor (GM-CSF) using commercially available enzyme-linked
immunoadsorbent assay kits. Patients' symptom scores were evaluated during the
nasal challenge. RESULTS: Significantly (P < 0.05) increased peak levels of
TNF-alpha, IL-4, IL-10, and MIP-1alpha were detected after antigen challenge as
compared with baseline levels. There was a nonsignificant trend toward an
increase in GM-CSF after antigen challenge (P = 0.07). There was no difference
in the peak levels of TNF-alpha, IL-4, IL-10, MIP-1alpha, or GM-CSF measured
when patients were on fexofenadine versus placebo. Finally, there were no
significant differences in patients' symptom scores during antigen challenge
when subjects were on fexofenadine versus placebo. CONCLUSIONS: Collection of
nasal secretions using a filter paper matrix provides a reproducible model for
accurately detecting and evaluating changes in cytokine levels after nasal
challenge. Cytokine levels tend to peak 3 to 4 hours after antigen challenge.
Standard doses of fexofenadine do not seem to have a mitigating effect on the
production of these cytokines. Symptoms of allergic rhinitis using this type of
antigen challenge did not differ from treatment with fexofenadine versus
placebo.
5053.
Bonnans C,
Vachier I, Chavis C, Godard P, Bousquet J, Chanez P. Lipoxins are potential
endogenous antiinflammatory mediators in asthma. Am J Respir Crit Care Med.
2002 Jun 1;165(11):1531-5.
Lipoxins, endogenous eicosanoids biosynthetized in vivo at
inflammation sites, are potential antiinflammatory mediators. Subjects with
severe asthma present chronic inflammation of the airways despite long-term
treatment with oral glucocorticoids. Therefore it is of interest to investigate
the potential antiinflammatory effects of lipoxin A4 (LXA4) and lipoxin B4
(LXB4) that could attenuate chronic inflammation. In a first time, we detected
interleukin (IL)-8 and LXA4 in supernatants of induced sputum. IL-8 was
heightened in severe asthma (p = 0.001), whereas high concentrations of lipoxin
A4 were present in mild asthma (p = 0.001). We then studied the effects of LXA4
on IL-8 released in vitro. Nanomolar concentrations of LXA4 and LXB4 inhibited
the IL-8 released by peripheral blood mononuclear cells from the two groups of
patients with asthma: a maximal inhibition of 29.4% (p < 0.01) was observed
for patients with mild asthma, and 41.5% inhibition (p < 0.001) for patients
with severe asthma at 1 nM and 100 nM LXA4 concentrations, respectively.
Polymerase chain reaction analysis indicated that peripheral blood mononuclear
cells from patients with asthma expressed the LXA4 receptor mRNA. Moreover, pertussis
toxin reversed LXA4- and LXB4-inhibited IL-8 release. These findings suggest
that lipoxins have potential antiinflammatory action in asthma.
5054.
Borish
L. Endothelin-1: a useful marker for
asthmatic inflammation? Ann Allergy Asthma Immunol. 2002 Apr;88(4):345-6. No abstract.
5055.
Borrish L.
Sinusitis and asthma: entering the realm of evidence-based medicine. J Allergy
Clin Immunol. 2002 Apr;109(4):606-8. No
abstract.
5056.
Burford
JC. Sensitivity to UV-cured inks used
in bank notes. Australas J Dermatol. 2002 May;43(2):153-4. No abstract.
5057.
Buzzetti R,
D'Amico R, Addis A. New drug treatment for asthma: clinical versus statistical
significance. J Pediatr. 2002 Apr;140(4):484; discussion 484-5. No
abstract.
5058.
Cainelli F,
Vento S. BCG efficacy and tuberculin
skin testing. Lancet. 2002 Apr 27;359(9316):1521-2. No abstract.
5059.
Caress AL,
Luker K, Beaver K, Woodcock A. Adherence to peak flow monitoring. Information
provided by meters should be part of self management plan. BMJ. 2002 May
11;324(7346):1157; discussion 1157. No
abstract.
5060.
Chan E, Zhan
C, Homer CJ. Health care use and costs for children with
attention-deficit/hyperactivity disorder: national estimates from the medical
expenditure panel survey. Arch Pediatr Adolesc Med. 2002 May;156(5):504-11.
CONTEXT: Although attention-deficit/hyperactivity disorder
(ADHD) is a highly prevalent chronic condition of childhood, little is known
about patterns of health care use and associated expenditures. OBJECTIVE: To
compare health care use and costs among children with ADHD, children with
asthma, and the general pediatric population. DESIGN AND SETTING: The 1996
Medical Expenditure Panel Survey, a nationally representative household survey.
PARTICIPANTS: All 5439 children aged 5 to 20 years from the 1996 Medical
Expenditure Panel Survey were included in this analysis. Children who had ADHD,
asthma, or neither (general population) were identified from International
Classification of Diseases, Ninth Revision, Clinical Modification codes and
prescription records. MAIN OUTCOME MEASURES: Mean health care use (outpatient
visits, emergency department visits, hospital stays, home health visit days,
and prescriptions) and associated expenditures. RESULTS: We identified 165
children with ADHD, 322 with asthma, and 4952 with neither diagnosis. Children
with ADHD had significantly higher mean total health care costs ($1151)
compared with children with asthma ($1091; P<.05) and the general population
($712; P<.001). After adjusting for age, sex, race, household income, access
to care, parent education, and marital status, excess total costs were $479 for
children with ADHD (P<.001) and $437 for children with asthma (P<.01).
CONCLUSIONS: Overall costs of care for children with ADHD are comparable to
costs for children with asthma and significantly greater than for the general
pediatric population. Specific types of health care use and the sources of
expenditures differ between children with ADHD and children with asthma.
Because much ADHD-related care occurs within school and mental health settings,
these figures likely underestimate the true costs of caring for children with
this condition.
5061.
Chhabra SK,
Bhatnagar S. Comparison of bronchodilator responsiveness in asthma and chronic
obstructive pulmonary disease. Indian J Chest Dis Allied Sci. 2002 Apr-Jun;44(2):91-7.
While asthmatics are known to have a greater response to
bronchodilators than patients of chronic obstructive pulmonary disease (COPD),
whether the pattern of response also differs has not been explored. Forced
vital capacity (FVC) and forced expiratory volume in 1st second (FEV1) were
measured before and 20 minutes after inhalation of 200 microg salbutamol in
patients of bronchial asthma (n=133) and (COPD) (n=116). Three types of
responses (defined as > or = 12% and 200 ml increase in FEV1 or FVC) were
identified: increase in (i) only FVC (FVC response), (ii) only FEV1 (FEV1
response), and, (iii) both FVC and FEV1 (double response). The mean +/- SEM
absolute increase in FEV1 was significantly greater in asthmatics (307+/-17ml)
as compared to 120+/-12 ml in COPD patients (p<0.0001). On the other hand,
the increase in FVC was not different in the two groups (296+/-22 ml and
230+/-24 ml, respectively, p>0.05). The proportion of subjects showing a
> or = 200 ml increase in FEV1 was greater among asthmatics as compared to
COPD (p<0.0001) but the proportions showing a > or = 200 ml in FVC were
similar (p>0.05). All the three types of responses were observed in
asthmatics with a double response being the commonest. In COPD, an FVC response
was the predominant response while the FEV1 response was rare. Multinomial
logistic regression revealed that younger subjects (below 45 years) were more
likely to have a double or exclusive FEV1 response. Greater severity of
obstruction was associated with higher odds for each of the three responses,
the odds being especially very high for an exclusive FEV1 response. The odds
for a double response and an exclusive FEV1 response were significantly
increased in asthmatics as compared to COPD. For FVC response, age category and
disease were not significant determinants. It was concluded that bronchodilator
responsiveness in asthma and COPD differs not only quantitatively but also in
the pattern.
5062.
Creticos P,
Knobil K, Edwards LD, Rickard KA, Dorinsky P.
Loss of response to treatment with leukotriene receptor antagonists but
not inhaled corticosteroids in patients over 50 years of age. Ann Allergy
Asthma Immunol. 2002 Apr;88(4):401-9.
BACKGROUND: There are limited published data describing the
relative efficacy of available treatment options in younger versus older
patients with persistent asthma. OBJECTIVE: To compare the efficacy of
fluticasone propionate (FP) and zafirlukast (Z) in younger (12 to 49 years of
age) versus older (50 years and older) patients with asthma. METHODS: A
retrospective analysis of five randomized, double-blind, double-dummy studies 4
to 12 weeks in duration of 1,742 patients <50 years of age and 243 patients
aged 50 years or older. Interventions were inhaled fluticasone propionate (FP)
88 microg, oral Z 20 mg, or placebo twice daily. RESULTS: Treatment with FP
resulted in significantly greater improvements than Z in all efficacy
measurements (except for nighttime awakenings) regardless of age. In older
patients, treatment with FP significantly increased pulmonary function compared
with Z: FEV (FP= +0.19 L; placebo = -0.34 L; Z = -0.06 L); AM peak expiratory
flow rate [PEFR] (FP = +25 L/minute; placebo = -18 L/minute; Z = +4 L/minute);
PM PEFR (FP = +24 L/minute; placebo = -24 L/minute; Z = +5 L/minute; P < or
= 0.023; for all comparisons). Compared with Z, treatment with FP in older
patients also resulted in significantly greater increases in the percentage of
symptom-free days (25% vs 13%) and rescue-free days (35% vs 17%); and
significantly greater reductions in albuterol use (-1.6 vs -0.3 puffs/day) and
the percentage of patients with exacerbations (2.7% vs 14.3%; P < or =
0.031). CONCLUSIONS: Regardless of age, treatment with FP in patients with
asthma significantly improved pulmonary function and overall asthma control. In
contrast, treatment with Z in older patients with asthma resulted in small
improvements in asthma symptoms, whereas lung function improved minimally or
not at all, and exacerbations increased. These data suggest that FP effectively
controls inflammation in older patients, whereas Z may mask inflammation and
may not provide the level of bronchodilatory or anti-inflammatory activity
needed for effective asthma control in older patients.
5063.
Criado RF,
Criado PR, Malaman F, Ensina LF, Vasconcellos C, Aun WT, Mello JF, Pires
MC. Nonoccupational allergic contact
dermatitis to cashew nut simulating photosensitivity eczema. Am J Contact
Dermat. 2002 Jun;13(2):85-6. No abstract.
5064.
Davies P.
Industry funding in medical education. Lancet. 2002 Jun 1;359(9321):1949-50. No abstract.
5065.
de la Sierra
A, Giner V, Bragulat E, Coca A. Lack of correlation between two methods for the
assessment of salt sensitivity in essential hypertension. J Hum Hypertens. 2002
Apr;16(4):255-60.
The existence
of a heterogeneous blood pressure (BP) response to salt
intake, a phenomenon known as salt sensitivity, has increasingly
become a subject of clinical hypertension research, and has important clinical
and prognostic implications. However, two different methodologies are currently
used to diagnose salt sensitivity. The aim of the present study was to compare
the BP response to intravenous sodium load and depletion on the one hand, and
to changes in dietary salt intake on the other, in order to assess salt
sensitivity in a group of essential hypertensive patients. Twenty-nine
essential hypertensives underwent two different procedures separated by 1
month: a dietary test consisting of a 2-week period of low (20 mmol/day) and
high (260 mmol/day) salt intakes, and an intravenous test consisting of a 2
litre saline load over a 4-h period, followed by 1 day of low (20 mmol) salt
intake and furosemide (40 mg/8 h orally) administration. BP was registered at
the end of every period using 24-h ambulatory BP monitoring. In the whole group
of hypertensive patients studied, both low salt intake and furosemide
administration significantly (P < 0.01) decreased mean BP. Correlation
coefficients of BP changes obtained using the two methodologies were between
0.3 and 0.4. Moreover, coefficients of agreement between the oral and the
intravenous tests, using several cut points for BP changes, were systematically
below 0.5, thus indicating a misclassification of salt sensitivity greater than
50%, depending on the method used. None of the cut points for BP changes during
furosemide administration showed a good combination of sensitivity and
specificity compared with changes in response to low dietary salt. The present
results indicate that the diagnosis of salt-sensitive hypertension should be
based on the BP response to changes in dietary salt intake, while BP response
to saline and furosemide administration leads to a systematic misclassification
of more than 50% of patients, even using different cutpoints for changes in BP.
5066.
DiMango EA,
Lubetsky H, Austin JH. Assessment of bronchial wall thickening on
posteroanterior chest radiographs in acute asthma. J Asthma. 2002
May;39(3):255-61.
A central bronchus that is readily visible end-on in
approximately 50% of normal frontal chest radiographs is the bronchus to the
anterior segment of either upper lobe. Bronchial wall thickening, or
"cuffing," is considered to be a radiographic sign of an asthmatic
exacerbation and is cited as a useful sign in a number of leading textbooks;
however, to the authors' knowledge, no prior chest radiographic study has
quantitatively assessed this specific sign in a population of asthmatics
suffering an acute exacerbation. Posterior chest radiographs were reviewed
retrospectively for 51 nonasthmatic, nonsmoking control subjects and for 45
adult asthmatic subjects during an acute exacerbation of moderate to severe
asthma. Readers were blinded as to whether the radiograph was from an asthmatic
or control subject. If visible end-on, the bronchus to the anterior segment of either
upper lobe was assessed by measuring the diameter of the lumen and the
thickness of the bronchial wall. At least one clearly defined bronchus to the
anterior segment of an upper lobe was visible end-on in 22 patients (43%) in
the control group and in 21 patients (47%) in the asthma group (p = NS). Mean
wall thickness was 0.7 +/- 0.1 mm in the control group and 0.8 +/- 0.1 mm in
the asthma group (p = 0.04). Lumen/wall thickness was 3.1 +/- 0.2 (SEM) in the
control group and 2.5 +/- 0.2 in the asthma group (p = 0.055). The presence of
bronchial wall thickness does not reliably distinguish radiographs of acutely
asthmatic from normal individuals.
5067.
Duarte I,
Lazzarini R, Bedrikow R. Excited skin syndrome: study of 39 patients. Am J
Contact Dermat. 2002 Jun;13(2):59-65.
BACKGROUND: Excited skin syndrome (ESS) is an adverse reaction
obtained when carrying out epicutaneous patch tests, characterized by multiple
positive test results, associated with one or more strongly positive tests,
which are not all reproduced when the patient is tested afterward. OBJECTIVE:
The aim of this study was (1) to determine the frequency of ESS in patients
submitted to patch testing, (2) to confirm the influence of the evolution time
of the primary dermatosis with ESS induction, (3) to determine differences
among patients according the rate of positive test loss, and (4) to compare the
number of positive tests for each substance between the first test, when all
allergens in the test battery were applied, and the second test, when only the
allergens with positive tests on the first occasion were applied at a greater
distance from one another. METHODS: Epicutaneous tests were carried out in 630
patients with a suspected diagnosis of allergic contact dermatitis. Patients
presenting 2 or more positive test results were considered to have ESS and were
submitted to a second patch test. RESULTS AND CONCLUSIONS: ESS developed in 39
of the 630 patients tested, corresponding to a frequency of 6.2%. Analysis of
data found a longer duration of the primary dermatitis in patients who in whom
ESS developed compared with those who did not. Parabens, fragrance mix, and
thimerosal had more positive patch test reactions using standard application
techniques relative to the retest procedure, which placed the substances at a
greater distance from one another, suggesting that, in addition to the factors
previously reported to influence the reduction of ESS, the position of the
allergens in the testing procedure also should be considered. Copyright 2002, Elsevier
Science (USA). All rights reserved.
5068.
Ekici A,
Ekici M, Erdemoglu AK. Effect of azithromycin on the severity of bronchial
hyperresponsiveness in patients with mild asthma. J Asthma. 2002
Apr;39(2):181-5.
The effect of azithromycin on bronchial hyperresponsiveness was
measured in a group of 11 patients with mild asthma. Azithromycin 250 mg orally
was administered intermittently to all the patients twice a week for eight
weeks. The only other treatment was inhaled beta2 agonist, when required. A
histamine inhalation test was performed at the beginning and at the fourth and
the eighth week of the study. The mean PC20 values increased significantly over
the initial value at the eighth week after the administration of azithromycin
(p < 0.05) but mean values for FEV1 and FEV1 percent predicted did not
differ significantly. These results suggested that eight weeks of intermittent,
low-dose administration of azithromycin in patients with mild asthma might
reduce the severity of bronchial hyperresponsiveness.
5069.
El-Gamal Y,
Hossny E, Awwad K, Mabrouk R, Boseila N. Plasma endothelin-1 immunoreactivity
in asthmatic children. Ann Allergy Asthma Immunol. 2002 Apr;88(4):370-3.
BACKGROUND: Endothelin-1 (ET-1) has been formerly demonstrated
to have potent vasocontractile as well as bronchoconstrictor effects in vitro.
This followup study was aimed to evaluate the possible changes in ET-1 levels
in the plasma of asthmatic children, according to disease activity and
severity. METHODS: Plasma ET-1 was estimated by enzyme-linked immunoadsorbent
assay in 30 asthmatic patients (6 to 12 years old) during and after remission
of an acute attack. Thirty age- and sex-matched healthy children were included
as a control group. RESULTS: Plasma ET-1 immunoreactivity was significantly increased
in the asthmatic children during the attacks (17.2+/-6.9 pg/mL) in comparison
to the levels during quiescence of symptoms (0.9+/-1.13 pg/mL). Further, both
values were significantly higher than the control value (0.22+/-0.29 pg/mL).
The severity of attacks as judged clinically and by peak expiratory flow rate
measurement did not influence the plasma endothelin status; neither did the
family history of atopy nor the absolute eosinophil count. However, serum total
IgE levels could be positively correlated to the plasma endothelin
concentrations measured after remission of the asthmatic attacks (P < 0.05).
CONCLUSIONS: Our findings reinforce the concept that ET-1 may be implicated in
the pathogenesis of bronchoconstriction. This may encourage further studies on
the value of ET-1 antagonism among alternative therapeutic modalities of
childhood asthma.
5070.
Faul JL,
Demers EA, Burke CM, Poulter LW. Alterations in airway inflammation and lung
function during corticosteroid therapy for atopic asthma. Chest. 2002 May;121(5):1414-20.
INTRODUCTION: Although corticosteroid therapy for asthma
improves lung function and reduces airway inflammation, the relation between
these two events is unclear. This article investigates associations between
changes in bronchial inflammation and lung function during high-dose inhaled
corticosteroid therapy for asthma. METHODS: Nine subjects with atopic asthma
received high-dose inhaled fluticasone propionate (FP), 2,000 microg/d for 8
weeks. Fiberoptic bronchoscopy with endobronchial biopsies, spirometry, and
histamine provocation challenge were performed on each subject at baseline,
after 2 weeks, and again after 8 weeks of therapy. Spearman rank correlation
coefficients between changes in parameters of bronchial inflammation and lung
function were computed. RESULTS: As expected, significant down-regulation of
airway inflammation and improvements in lung function were observed after both
short-term and long-term therapy with high-dose inhaled FP. During
corticosteroid therapy, changes in lymphocyte and macrophage numbers in
bronchial biopsy specimens were closely correlated. Changes in EG1+ eosinophils
were associated with changes in EG2+ eosinophils after 8 weeks of therapy.
Although changes in airway inflammation and changes in lung function were not
closely associated after 2 weeks of therapy, changes in eosinophils (EG1) in
bronchial biopsy specimens correlated with changes in bronchodilator response
(r = 0.77, p = 0.016) after 8 weeks of therapy. CONCLUSION: In patients with
atopic asthma, changes in bronchial eosinophils and lung function during
steroid therapy are closely related but do not occur simultaneously.
5071.
Field SK.
Asthma and gastroesophageal reflux: another piece in the puzzle? Chest. 2002
Apr;121(4):1024-7. No abstract.
5072.
Freishtat RJ,
Goepp JG. Episodic stridor with latex nipple use in a 2-month-old infant. Ann
Emerg Med. 2002 Apr;39(4):441-3.
Latex allergy in the pediatric population is most commonly
identified in patients who have undergone multiple operations for neural tube
defects or exstrophic genitourinary anomalies. However, there are a significant
number of children who, without the usual risk factors, clinically and/or
serologically appear to be latex allergic. There is sporadic information in the
medical literature regarding reactions to latex allergens in household items,
especially in patients younger than 1 year old. Several recent reports even
support the existence of reactions to latex pacifiers. We report a case of an
atopic 2-month-old infant who experienced the previously unreported reaction of
repeated stridor on exposure to a latex nipple while feeding. It is important
that clinicians recognize stridor as a potential reaction to latex in infants.
5073.
Gendel
SM. Where do we go from here? A
discussion summary. Ann N Y Acad Sci. 2002 May;964:197-200. No
abstract.
5074.
Govindarao D.
Studies on immuno modulation by honey on induction of allergen-specific immune
response in murine system. Department of Biochemistry, Andhra University;
Waltair, 2001. No abstract.
5075.
Greaves MW,
Hussein SH. Drug-induced urticaria and angioedema: pathomechanisms and
frequencies in a developing country and in developed countries. Int Arch
Allergy Immunol. 2002 May;128(1):1-7. Review.
A careful drug history should be obtained from all patients with
acute or chronic urticaria/angioedema, especially in the elderly. Although
strictly comparable data are lacking, drug-induced urticaria appears to be more
common in developed countries than in Malaysia, at least in a Hospital setting.
Culprit drugs include antibiotics, analgesics and contrast media.
Pseudoallergic drug-induced urticaria mimicks true allergic urticaria, but
without an evident immunological basis, and is at least as common as the
allergic type. In Malaysia, and in many other countries compulsory, ingredient
labelling of 'traditional' medicines would do much to reduce the frequency of
drug-induced urticaria. Copyright 2002 S. Karger AG, Basel
5076.
Groneberg DA,
Eynott PR, Lim S, Oates T, Wu R, Carlstedt I, Roberts P, McCann B, Nicholson
AG, Harrison BD, Chung KF. Expression of respiratory mucins in fatal status
asthmaticus and mild asthma. Histopathology. 2002 Apr;40(4):367-73.
AIMS: The airways of patients with asthma are characterized by
chronic inflammatory changes comprising mainly T-cells and eosinophils, and
airway remodelling with goblet cell metaplasia and submucosal gland
hyperplasia. Mucus hypersecretion is often a marked feature, particularly in
status asthmaticus. The matrix of airway sputum consists of high molecular
glycoproteins and mucins. In this study, the expression and distribution of the
major gel-forming mucins MUC5AC and MUC5B were studied in fatal status
asthmaticus tissues and bronchial biopsies of mild asthmatic patients. The
effect of inhaled corticosteroids on the expression of these mucins was also
investigated. METHODS AND RESULTS: Polyclonal antibodies specific for MUC5AC
and MUC5B, and a monoclonal antibody for MUC5B were used to stain lung tissues
and airway mucosal biopsies obtained from patients who died of status
asthmaticus (n=5) and from mild asthmatics (n=4), respectively.
Immunohistochemistry for MUC5AC revealed abundant staining of goblet cells
situated in the epithelial surface lining and glandular ducts of tissues from
patients with fatal asthma. MUC5B immunoreactivity was restricted to mucous
cells of submucosal glands and to epithelial cells. In mild asthmatics, large
amounts of MUC5B, but not MUC5AC, positive extracellular mucus was found in the
airway lumen as plugs, adjacent to the epithelial lining and in the necks of
glandular secretory ducts of mild asthmatics. The distribution of MUC5AC and
MUC5B in bronchial biopsies of mild asthmatics was similar before and after
inhaled steroid treatment. CONCLUSIONS: The expression of MUC5AC and MUC5B
shares a similar distribution to normal airways in different states of asthma.
The distribution is not affected by topical corticosteroid therapy.
5077.
Hammerman SI,
Becker JM, Rogers J, Quedenfeld TC, D'Alonzo GE Jr. Asthma screening of high
school athletes: identifying the undiagnosed and poorly controlled. Ann Allergy
Asthma Immunol. 2002 Apr;88(4):380-4.
BACKGROUND: It is believed that there are many high school-age
athletes who have undiagnosed asthma or exercise-induced asthma (EIA). The
screening of these athletes for EIA will allow them to be identified and
treated. OBJECTIVES: 1) To obtain reliable peak expiratory flow rate (PEFR)
measurements and administer questionnaires to high school-age athletes to
evaluate their asthma risk. 2) To identify high-risk athletes for having EIA or
asthma by a free run challenge test. 3) To evaluate whether an athlete's
present asthma control is adequate. 4) To evaluate these tools for their value
as screening tools for asthma or EIA. METHODS: Eight hundred one student athletes
from 10 suburban Pittsburgh schools were screened for more than 18 months for
asthma as part of their preparticipation sports physicals. The screening
included all athletes from all high school sports. The athletes were given a
brief questionnaire, had PEFR measured, and then participated in a free running
exercise challenge. RESULTS: Forty-six of 801 athletes had asthma or EIA, Of
the remaining 755 athletes, 49 athletes were identified as having undiagnosed
asthma. In the previously unrecognized athletes with EIA, the positive and
negative predictive value of the questionnaire was 42% and 97%, respectively.
Eighty-five percent (39 of 46) of the known asthmatic athletes, using their
recommended medication, failed their free running test by a >15% drop of their
PEFR. CONCLUSIONS: The free running test is a good test for identifying and
assessing the athlete with EIA. The PEFR meter is not a good screening tool for
EIA in the high school athlete. A questionnaire may be a good negative
screening tool, but further development is needed before it can be used for
widespread screening.
5078.
Hunter CJ,
Brightling CE, Woltmann G, Wardlaw AJ, Pavord ID. A comparison of the validity
of different diagnostic tests in adults with asthma. Chest. 2002
Apr;121(4):1051-7.
STUDY OBJECTIVES: Diagnosing asthma is not always easy, and
there are times when objective tests can be helpful. The extent to which these
tests alter the probability of asthma depends on how much more commonly the
test result is positive in subjects with asthma compared to healthy subjects
and particularly subjects with conditions that are commonly confused with
asthma. We set out to compare the sensitivity and specificity of different
tests in this setting. DESIGN: Single-center, cross-sectional, observational study.
SETTING: Teaching hospital. PATIENTS: Twenty-one healthy control subjects, 69
patients with asthma, and 20 subjects referred to the hospital with a diagnosis
of asthma who were found to have alternative explanations for their symptoms
(i.e., pseudoasthma). INTERVENTIONS: We measured methacholine airway
responsiveness, the maximum within-day peak expiratory flow amplitude mean
percentage (derived from twice-daily readings for > 2 weeks), the FEV(1)/FVC
ratio, the percentage change in FEV(1) 10 min after the administration of 200
microg inhaled albuterol, and the differential eosinophil count in blood and
induced sputum. We derived normal ranges (from the 95% upper or lower limit for
healthy subjects), sensitivity, and specificity (ie, the percentage of subjects
with pseudoasthma who had negative test results). RESULTS: Most tests were less
specific when the reference population was composed of subjects with conditions
that can be confused with asthma. Methacholine airway responsiveness and the
sputum differential eosinophil count were the most sensitive (91% and 72%,
respectively) and specific (90% and 80%, respectively) tests. CONCLUSION: We
conclude that methacholine airway responsiveness and the sputum differential
eosinophil count are the most useful objective tests in patients with mild
asthma.
5079.
Incorvaia C,
Asero R, Bertelli G, Pilone R, Nitti F.
Efficacy of a questionnaire for allergy. Allergy. 2002
Apr;57(4):367-8. No abstract.
5080.
Keeler GJ,
Dvonch T, Yip FY, Parker EA, Isreal BA, Marsik FJ, Morishita M, Barres JA,
Robins TG, Brakefield-Caldwell W, Sam M. Assessment of personal and
community-level exposures to particulate matter among children with asthma in
Detroit, Michigan, as part of Community Action Against Asthma (CAAA). Environ
Health Perspect. 2002 Apr;110 Suppl 2:173-81.
We report on the research conducted by the Community Action
Against Asthma (CAAA) in Detroit, Michigan, to evaluate personal and
community-level exposures to particulate matter (PM) among children with asthma
living in an urban environment. CAAA is a community-based participatory
research collaboration among academia, health agencies, and community-based
organizations. CAAA investigates the effects of environmental exposures on the
residents of Detroit through a participatory process that engages participants
from the affected communities in all aspects of the design and conduct of the
research; disseminates the results to all parties involved; and uses the
research results to design, in collaboration with all partners, interventions
to reduce the identified environmental exposures. The CAAA PM exposure
assessment includes four seasonal measurement campaigns each year that are
conducted for a 2-week duration each season. In each seasonal measurement
period, daily ambient measurements of PM2.5 and PM10 (particulate matter with a
mass median aerodynamic diameter less than 2.5 microm and 10 microm,
respectively) are collected at two elementary schools in the eastside and
southwest communities of Detroit. Concurrently, indoor measurements of PM2.5
and PM10 are made at the schools as well as inside the homes of a subset of 20
children with asthma. Daily personal exposure measurements of PM10 are also
collected for these 20 children with asthma. Results from the first five
seasonal assessment periods reveal that mean personal PM10 (68.4 39.2
microg/m(3)) and indoor home PM10 (52.2 30.6 microg/m(3)) exposures are
significantly greater (p < 0.05) than the outdoor PM10 concentrations (25.8
11.8 microg/m(3)). The same was also found for PM2.5 (indoor PM2.5 = 34.4 21.7
microg/m(3); outdoor PM2.5 = 15.6 8.2 microg/m(3)). In addition, significant
differences (p < 0.05) in community-level exposure to both PM10 and PM2.5
are observed between the two Detroit communities (southwest PM10 = 28.9 14.4
microg/m(3)), PM2.5 = 17.0 9.3 microg/m(3); eastside PM10 = 23.8 12.1
microg/m(3), PM2.5 = 15.5 9.0 microg/m(3). The increased levels in the
southwest Detroit community are likely due to the proximity to heavy industrial
pollutant point sources and interstate motorways. Trace element
characterization of filter samples collected over the 2-year period will allow
a more complete assessment of the PM components. When combined with other
project measures, including concurrent seasonal twice-daily peak expiratory
flow and forced expiratory volume at 1 sec and daily asthma symptom and
medication dairies for 300 children with asthma living in the two Detroit
communities, these data will allow not only investigations into the sources of
PM in the Detroit airshed with regard to PM exposure assessment but also the
role of air pollutants in exacerbation of childhood asthma.
5081.
Konig P.
Irreversible airway obstruction in childhood asthma? A clinician's viewpoint.
Pediatr Pulmonol. 2002 Apr;33(4):307-10.
Even though childhood asthma is assumed to comprise reversible
airway obstruction, some children develop irreversible airway obstruction (not
reversed by a bronchodilator or corticosteroids); this may be due to
inflammation that has caused remodeling. Lately, it has been claimed that in
the absence of treatment with inhaled corticosteroids, most patients will
develop progressive irreversible obstruction. Several studies culminating with
the Childhood Asthma Management Program (CAMP) study, which was the first
randomized placebo-controlled prospective long-term study designed to test for
irreversible obstruction, did not show the development of such progressive
irreversible obstruction. Nevertheless, deterioration in pulmonary function
does occur in some patients, probably due to inadequate anti-inflammatory
treatment, and possibly also due to maintenance adrenergic treatment. Most
previous studies concentrated on forced expiratory volume in 1 sec (FEV(1)), a
test assessing mostly large airway obstruction. More studies are needed to
investigate the presence of small airway obstruction. Copyright 2002
Wiley-Liss, Inc.
5082.
Kress JP,
Noth I, Gehlbach BK, Barman N, Pohlman AS, Miller A, Morgan S, Hall JB. The utility of albuterol nebulized with
heliox during acute asthma exacerbations. Am J Respir Crit Care Med. 2002 May
1;165(9):1317-21.
Heliox improves lung deposition of inhaled particles when
compared with air or oxygen inhalation. We studied the spirometric effects of
albuterol nebulized with heliox during emergency room visits for asthma
exacerbations. Forty-five patients were randomized to receive albuterol
nebulized with oxygen (control) versus heliox (n = 22 control and 23 heliox
subjects). At baseline, demographics, outpatient asthma medications, vital
signs, oxygen saturation, and forced expiratory volume in one second were not
different between the two groups. Three consecutive albuterol treatments were
given to each group. The heliox group had a significantly higher heart rate
after albuterol nebulization compared with the control group. Following
albuterol Treatment 1, the median change in forced expiratory volume in one
second was 14.6% in the control group and 32.4% in the heliox group (p =
0.007). After Treatment 2, the results were 22.7% versus 51.5%, respectively (p
= 0.007). After Treatment 3, the results were 26.6% versus 65.1%, respectively
(p = 0.016). We conclude that during acute asthma exacerbations, albuterol
nebulized with heliox leads to a more significant improvement in spirometry
when compared with albuterol nebulized with oxygen. This is likely due to the
low-density gas improving albuterol deposition in the distal airways.
5083.
Kumar N,
Singh N, Locham KK, Garg R, Sarwal D. Clinical evaluation of acute respiratory
distress and chest wheezing in infants. Indian Pediatr. 2002 May;39(5):478-83. No abstract.
5084.
Lieu TA,
Lozano P, Finkelstein JA, Chi FW, Jensvold NG, Capra AM, Quesenberry CP, Selby
JV, Farber HJ. Racial/ethnic variation
in asthma status and management practices among children in managed medicaid.
Pediatrics. 2002 May;109(5):857-65.
OBJECTIVE: Racial/ethnic disparities in hospitalization rates
among children with asthma have been documented but are not well-understood.
Medicaid programs, which serve many minority children, have markedly increased
their use of managed care in recent years. It is unknown whether racial/ethnic
disparities in health care use or other processes of care exist in managed
Medicaid populations. This study of Medicaid-insured children with asthma in 5
managed care organizations aimed to 1) compare parent-reported health status
and asthma care processes among black, Latino, and white children and 2) test
the hypothesis that racial/ethnic variations in processes of asthma care exist
after adjusting for socioeconomic status and asthma status. METHODS: This
cross-sectional study collected data via telephone interviews with parents and
computerized records for Medicaid-insured children with asthma in 5 managed
care organizations in California, Washington, and Massachusetts. The American Academy
of Pediatrics (AAP) Children's Health Survey for Asthma was used to measure
parent-reported asthma status. We used multivariate models to evaluate
associations between race/ethnicity and asthma status while controlling for
other sociodemographic variables. We evaluated racial/ethnic variations in
selected processes of asthma care while controlling for other demographic
variables and asthma status. RESULTS: The response rate was 63%. Of the 1658
children in the respondent group, 38% were black, 19% were Latino, and 31% were
white. Black children had worse asthma status than white children on the basis
of the AAP asthma physical and emotional health scores, symptom-days, and
school days missed in the past 2 weeks. Latino children had equivalent AAP scores
but missed more school days than white children. On the basis of the AAP asthma
physical health score, the black-white disparity persisted after adjusting for
other sociodemographic variables. After adjusting for sociodemographic
variables and asthma status, black and Latino children were less likely to be
using inhaled antiinflammatory medication than white children (relative risk
for blacks: 0.69; relative risk for Latinos: 0.58). They were more likely to
have home nebulizers. Other processes of asthma care, including ratings of
providers and asthma care, use of written management plans, use of preventive
visits and specialists, and having no pets or smokers at home, were equal or
better for minority children compared with white children. CONCLUSIONS: Black
and Latino children had worse asthma status and less use of preventive asthma
medications than white children within the same managed Medicaid populations.
Most other processes of asthma care seemed to be equal or better for minorities
in the populations that we studied. Increasing the use of preventive
medications is a natural focus for reducing racial disparities in asthma.
5085.
Little SA,
MacLeod KJ, Chalmers GW, Love JG, McSharry C, Thomson NC. Association of forced expiratory volume with
disease duration and sputum neutrophils in chronic asthma. Am J Med. 2002 Apr
15;112(6):446-52.
Some patients with chronic asthma develop irreversible airflow
obstruction. Our aim was to assess whether reported duration of asthma and
induced sputum cell counts were associated with pulmonary function in patients
with asthma who did not smoke.Maximal forced expiratory volume in the first
second (FEV(1)) was determined following a steroid trial (oral prednisolone, 30
mg/d [n = 92 patients]; or inhaled fluticasone, 2000 microg/d [n = 5]; for 2
weeks) and 2.5 mg of nebulized albuterol. Asthma history was recorded with
duration from first diagnosis. All subjects were nonsmokers, or were to have
stopped smoking > or =5 years previously and smoked < or =5 pack-years (n
= 12). Induced sputum was obtained from 59 subjects for analysis of airway cell
counts.Maximal FEV(1) was inversely associated with asthma duration (r = -0.47,
P <0.0001), age (r =-0.40, P <0.0001), and the proportion of sputum
neutrophils (r(s) = -0.50, P =0.00004). After adjusting for age, both duration
of disease and sputum neutrophils were independently associated with maximal
FEV(1). Neutrophil activation, as measured by sputum myeloperoxidase levels,
was positively associated with the proportion of sputum neutrophils (r(s) =
0.45, P = 0.0004) and inversely associated with maximal FEV(1) (r(s) = -0.59, P
<0.0001). Long disease duration may be a predisposing factor for the
development of irreversible airflow obstruction in patients with chronic
asthma. The negative associations of sputum neutrophil count and activation
with maximal FEV(1) suggest that neutrophils may be involved in the
pathophysiology of irreversible airflow obstruction in asthma.
5086.
Malmstrom K,
Peszek I, Al Botto, Lu S, Enright PL, Reiss TF. Quality assurance of asthma clinical trials. Control Clin Trials.
2002 Apr;23(2):143-56.
Accuracy and repeatability of spirometry measurements are
essential to obtain reliable efficacy data in randomized asthma clinical
trials. We report our experience with a centralized spirometry quality
assurance program that we implemented in our phase III asthma trials. Six
asthma trials of 4 to 21 weeks in duration were conducted at 232 clinical
centers in 31 countries. Approximately 23,100 prebronchodilator and 13,700
postbronchodilator spirometry tests were collected from 2523 adult and 336
pediatric asthmatic patients. The program used a standard spirometer (the
Renaissance spirometry system) with maneuver quality messages and automated
quality grading of the spirometry tests. Each clinical center transmitted
spirometry data weekly to a central database, where uniform monitoring of data
quality was performed and feedback was provided in weekly quality reports.
Seventy-nine percent of all patients performed spirometry sessions with quality
that either met or exceeded American Thoracic Society standards and improved
over time. Good-quality spirometry was associated with (1) less severe asthma;
(2) active treatment; (3) infrequent nocturnal awakenings; (4) age above 15 years;
and (5) low body weight. Maneuver-induced bronchospasm was rare. Good-quality
spirometry was observed in multicenter asthma clinical trials that employed a
standard spirometer and continuous monitoring. Both within- and between-patient
variability decreased. Spirometry quality improved with time as study
participants and technicians gained experience.
5087.
Marinkovich
VA. Mild asthma. N Engl J Med. 2002 Apr 25;346(17):1335-6; discussion 1335-6. No abstract.
5088.
McConnell R,
Berhane K, Gilliland F, Islam T, Gauderman WJ, London SJ, Avol E, Rappaport EB,
Margolis HG, Peters JM. Indoor risk
factors for asthma in a prospective study of adolescents. Epidemiology. 2002
May;13(3):288-95.
BACKGROUND: The risk of asthma associated with pets and other
indoor exposures has been examined in both cross-sectional and prospective
studies of younger children. However, there has been little investigation of
the effect of the indoor environment on incident asthma in adolescents.
METHODS: Risk factors for the development of asthma were examined in a cohort
of 3535 Southern California school children with no history of asthma at 1993
entry into the study, who were followed for up to 5 years. Newly diagnosed
cases of asthma were identified by yearly interview report. A total of 265
children reported a new diagnosis of asthma during the follow-up period; 163 of
these had reported no history of wheeze at baseline. The risk associated with
indoor exposures assessed by questionnaire at entry into the study was examined
using Cox proportional hazards models. RESULTS: In children with no history of
wheezing, an increased risk of developing asthma was associated with a
humidifier (relative risk [RR] 1.7; 95%
confidence interval [CI] = 1.2-2.4), any pet (RR = 1.6; 95% CI = 1.0-2.5), or
specifically a dog (RR = 1.4; 95% CI = 1.0-2.0) in the home. An estimated 32%
of new asthma cases could be attributed to pets. CONCLUSIONS: We conclude that
furry pets are a common and potentially remediable risk factor for new onset
asthma in adolescents. Our results suggest that a humidifier in the home may
contribute to the onset of asthma in this age group.
5089.
Meltzer EO,
Lockey RF, Friedman BF, Kalberg C, Goode-Sellers S, Srebro, Edwards L, Rickard
K. Efficacy and safety of low-dose fluticasone propionate compared with
montelukast for maintenance treatment of persistent asthma. Mayo Clin Proc.
2002 May;77(5):437-45.
OBJECTIVE: To compare the long-term effects of an inhaled
corticosteroid with those of a leukotriene modifier on measures of clinical
efficacy, subject preference, and safety in patients with persistent asthma.
PATIENTS AND METHODS: Between November 17, 1998, and May 26, 2000, we conducted
a multicenter, randomized, double-blind, double-dummy, parallel-group study of
patients aged 15 years or older with persistent asthma. The patients were
symptomatic while taking short-acting beta2-agonists alone and were treated
with fluticasone propionate (88 microg [2 puffs of 44 microg] twice daily) or
montelukast (10 mg/d) for 24 weeks. Measures of pulmonary function, asthma
symptoms, albuterol use, nighttime awakenings, physician assessments of
efficacy, patient satisfaction, asthma-related quality of life, and safety were
evaluated. RESULTS: A total of 522 patients were randomized to receive
fluticasone or montelukast, and 395 patients completed the study. At end point,
treatment with fluticasone significantly improved pulmonary function, asthma
symptom scores, the percentage of symptom-free days, rescue albuterol use, and
the number of nighttime awakenings due to asthma when compared with montelukast
(P< or = .002, each comparison). Significantly more patients were satisfied
with fluticasone therapy (83%) compared with montelukast therapy (66%)
(P<.001), and fluticasone therapy was rated as effective by a significantly
greater portion of physicians (67%) than was montelukast therapy (54%)
(P<.001). Treatment with fluticasone significantly improved asthma-related
quality-of-life measures compared with montelukast (P< or =.01). The
incidence of asthma exacerbations was similar in the fluticasone (19 patients,
7%) and montelukast (21 patients, 8%) treatment groups, although slightly more
patients in the montelukast group were withdrawn from the study because of
asthma exacerbations (6% vs 4%, respectively). CONCLUSION: Long-term treatment
with a low dose of inhaled fluticasone is more effective than oral montelukast
as first-line maintenance therapy for the treatment of persistent asthma.
5090.
Miller FG,
Shorr AF. Ethical assessment of industry-sponsored clinical trials: a case
analysis. Chest. 2002 Apr;121(4):1337-42.
The rapid growth of clinical trials sponsored by the
pharmaceutical industry and conducted by community physicians raises concerns
about the scientific quality of this research and the adequacy of protections
for research participants. In this article, we present an in-depth ethical
analysis of a recent industry-sponsored placebo-controlled study for treatment
of asthma. The ethical analysis uses a proposed ethical framework for
evaluating clinical research focusing on seven ethical requirements: (1)
scientific value, (2) scientific validity, (3) fair subject selection, (4)
favorable risk/benefit ratio, (5) independent review, (6) informed consent, and
(7) respect for enrolled subjects.
5091.
Nahm DH, Lee
YE, Yim EJ, Park HS, Yim H, Kang Y, Kim JK. Identification of cytokeratin 18 as
a bronchial epithelial autoantigen associated with nonallergic asthma. Am J
Respir Crit Care Med. 2002 Jun 1;165(11):1536-9.
The allergic response to common environmental agents (allergens)
has been regarded as an important mechanism in the development of airway
inflammation of patients with asthma. However, allergic sensitization cannot be
detected in a significant number of adult patients with asthma. The etiologic
mechanism responsible for nonallergic asthma has not yet been identified. The
idea of a possible involvement of autoimmunity in the pathogenesis of
nonallergic asthma has been proposed by earlier studies. To test for the
possible presence of an autoimmune response to bronchial epithelial cell
antigens in nonallergic asthma, we examined circulating autoantibodies to
cultured human bronchial epithelial cells (BEAS-2B) in sera from patients with
nonallergic asthma by immunoblot analysis. IgG autoantibodies to the 49-kD
bronchial epithelial cell antigen were detected in 10 of 23 patients with
nonallergic asthma (43%), 3 of 27 patients with allergic asthma (11%), 2 of 20
patients with systemic lupus erythematosus (10%), and 3 of 34 healthy
volunteers (9%) (p < 0.005). The 49-kD auto-antigen was purified and
identified as cytokeratin 18 by amino acid sequencing. In this study, we
identified cytokeratin 18 as a bronchial epithelial autoantigen associated with
nonallergic asthma. Further studies are needed to determine the significance of
autoimmunity in nonallergic asthma.
5092.
Ortega AN,
Huertas SE, Canino G, Ramirez R, Rubio-Stipec M. Childhood asthma, chronic
illness, and psychiatric disorders. J Nerv Ment Dis. 2002 May;190(5):275-81.
Asthma is a serious and vexing problem for many children and
their families. Asthma, like most syndromes, has many symptoms and potential
causes and effects. Studies have shown that pediatric asthma is associated with
psychiatric disorders, but the specificity and temporality of these relations
is not well known. This study examined the associations between any and
specific psychiatric disorders and both childhood asthma and other childhood
chronic illnesses. The study used the Methods for the Epidemiology of Child and
Adolescent Mental Disorders data, a four-site, community-based study of 1,285
pairs of youths and caretakers. Psychiatric disorders were assessed using the
Diagnostic Interview Schedule for Children (DISC 2.3). Methods for the
Epidemiology of Child and Adolescent Mental Disorders was also used to assess
individual characteristics, parental reports of asthma, and other chronic
illnesses. Asthma and 'other' chronic illnesses were associated with different
psychiatric disorders. In particular, having a history of asthma was associated
with having an anxiety disorder, after adjustment for potential confounding,
but was not associated with having an affective disorder. Having a chronic
illness other than asthma or cancer was associated with having any affective
disorder and dysthymia but not anxiety disorder. These results call for more
mechanistic research that explores the specific relations between childhood
anxiety disorder and asthma and between affective disorder and other pediatric
chronic illnesses.
5093.
Ortega HG,
Weissman DN, Carter DL, Banks D. Use of specific inhalation challenge in the
evaluation of workers at risk for occupational asthma: a survey of pulmonary,
allergy, and occupational medicine residency training programs in the United
States and Canada. Chest. 2002 Apr;121(4):1323-8.
STUDY OBJECTIVES: To document the current practice of
occupational asthma (OA) diagnosis and use of specific inhalation challenge
(SIC). DESIGN, SETTING, AND PARTICIPANTS: A survey evaluating the current
practice of SIC was mailed to 259 residency training programs in adult
pulmonary diseases, allergy and immunology, and occupational medicine
accredited in the United States and Canada during the year 2000. RESULTS:
Forty-six percent (123 of 259 programs) participated. Ninety-two programs
reported that patients with OA were seen during the previous year, 15 programs
reported that SIC had been performed, and 10 programs reported that patients
had been referred to other sites for SIC. A total of 259 patients underwent
SIC. No unexpected adverse reactions were reported. Forty-one programs reported
that they had been willing to undertake SIC but were unable to do so. The most
common barriers cited were lack of availability of SIC within the evaluating
institution, inability to locate a site for referral, concerns about
reimbursement, and lack of an appropriate diagnostic reagent for use in SIC.
Seventy-four programs indicated that SIC was useful, and 34 programs included
training in the use of SIC was part of the residency curriculum. CONCLUSION:
Although SIC is considered the "gold standard" for objective
documentation of OA, the test is performed in only a few institutions in the
United States and Canada. Many institutions indicate that SIC is not available,
even when desired for patient management. Only a minority of participating
residency training programs include SIC as a formal part of the training
curriculum.
5094.
Ortona E,
Vaccari S, Margutti P, Delunardo F, Rigano R, Profumo E, Buttari B, Rasool O,
Teggi A, Siracusano A. Immunological characterization of Echinococcus
granulosus cyclophilin, an allergen reactive with IgE and IgG4 from patients
with cystic echinococcosis. Clin Exp Immunol. 2002 Apr;128(1):124-30.
By immunological screening of a cDNA library derived from
protoscoleces of Echinococcus granulosus with IgE from patients with cystic
echinococcosis (CE) and allergic manifestations, we isolated a protein
identical to E. granulosus cyclophilin. The protein, named EA21, has close
homology with Malassezia furfur cyclophilin allergen (Mal f 6) and with human
cyclophilin. Using immunoblotting (IB) with a polyclonal antibody specific to
EA21, we identified E. granulosus cyclophilin both in protoscoleces and in
sheep hydatid fluid. Of the 58 sera from patients with CE, 29 (50%) were IgE
positive to EA21, whereas, despite the high sequence homology, none were IgE
positive to Mal f 6 or human cyclophilin. Only 26 of the 58 patients (45%) had
IgG specific to EA21, whereas all patients (100%) had IgG specific to Mal f 6
and human cyclophilin. IB analysis showed that serum IgE-binding reactivity to
EA21 differed significantly in patients with and without allergic reactions (20
of 25, 80% versus nine of 33, 27%; P < 10(-4)). Conversely, five of the 25
patients who had CE-related allergic manifestations (20%) and 21 of the 33 who
did not (63%) had specific IgG4 (P = 10(-3)) and total IgG to EA21. EA21
induced a proliferative response in 15 of 19 (79%) patients' PBMC regardless of
the allergic manifestations, but it induced no IL-4 production. Overall, these
findings suggest that E. granulosus cyclophilin is a conserved, constitutive,
parasite protein that does not cross-react with cyclophilins from other
organisms and is involved in the allergic symptoms related to CE.
5095.
Packham S.
Outcomes of adults with respiratory disease treated by specialists and
generalists. Arch Intern Med. 2002 Jun 10;162(11):1313; discussion 1313-4. No abstract.
5096.
Sampson HA.
Clinical practice. Peanut allergy. N Engl J Med. 2002 Apr 25;346(17):1294-9. No abstract.
5097.
Shahid SK,
Kharitonov SA, Wilson NM, Bush A, Barnes PJ. Increased interleukin-4 and
decreased interferon-gamma in exhaled breath condensate of children with
asthma. Am J Respir Crit Care Med. 2002 May 1;165(9):1290-3.
Exhaled breath condensate analysis for noninvasive
quantification of airway inflammation in asthma is a potentially useful
research tool in children. There is an imbalance between T-helper (Th)-2 cells,
which secrete interleukin (IL)-4, and Th1 cells, which secrete interferon
(IFN)-gamma, in asthma. We measured concentrations of IL-4 and IFN-gamma in
breath condensates of 37 children (11 normal, 12 steroid-naive, and 14
steroid-treated children with asthma). Exhaled IFN-gamma was significantly
lower in steroid-naive and steroid-treated children with asthma compared with
normal control subjects (3.7 +/- 0.2 versus 5.1 +/- 0.4 pg/ml, p < 0.01 and
4.1 versus 5.1 pg/ml, p < 0.05). By contrast, mean exhaled IL-4 was elevated
in asthma (53.7 +/- 4.2 pg/ml) compared with normal children (35.7 +/- 6.2
pg/ml, p < 0.05) and concentrations were lower with steroid treatment (37.5
+/- 5.6 pg/ml, p < 0.05). Exhaled IL-4 was significantly lower in children
with asthma on more than 600 microg inhaled steroid/day. The IL-4/IFN-gamma
ratio was significantly greater in children with asthma compared with control
children and the children with asthma on inhaled steroid therapy. We have shown
for the first time that IFN-gamma and IL-4 can be assayed in exhaled breath
condensate and shows an increased ratio of IL-4/IFN-gamma, consistent with
predominance of Th2 cells in airways of children with asthma. Exhaled breath
condensate analysis may have a useful role in studying allergic inflammation in
childhood asthma.
5098.
Shapira MY,
Berkman N, Ben-David G, Avital A, Bardach E, Breuer R. Short-term acupuncture
therapy is of no benefit in patients with moderate persistent asthma. Chest.
2002 May;121(5):1396-400.
STUDY OBJECTIVES: Acupuncture traditionally has been used to
treat asthma. Nevertheless, only a few controlled studies have been performed
to determine the efficacy of this treatment. Our study aimed to determine the
efficacy of acupuncture in patients with moderate persistent asthma. METHODS:
Twenty-three patients with moderate persistent asthma who had been treated only
with inhaled beta(2)-agonists were randomly assigned to receive four sessions
of real acupuncture (RA) or sham acupuncture (SA) in a blinded manner. After a
washout period of 3 weeks, the patients were crossed over. Monitoring included
FEV(1), methacholine challenge, daily peak flow (PF) variability, and the
keeping of an asthma diary. RESULTS: Twenty of 23 patients completed the study.
There was no significant change in FEV(1) following treatment. The mean (+/-
SE) FEV(1) values before and after the RA were 73 +/- 4% and 73 +/- 3%,
respectively (not significant [NS]). FEV(1) values before and after SA were 70
+/- 3% and 70 +/- 3%, respectively (NS). There was also no change in
provocative methacholine concentration causing a 20% fall in FEV(1) (PC(20))
before and after treatment. The mean PC(20) values before and after RA were
0.92 +/- 0.42 mg/mL and 1.16 +/- 0.51 mg/mL, respectively (p = 0.71), while the
PC(20) values before and after SA were 1.47 +/- 0.83 mg/mL and 1.11 +/- 0.79
mg/mL, respectively (p = 0.59). There was no change in the mean PF variability
before and after the RA (1.6 +/- 3.1% and 1.8 +/- 2.3%, respectively [NS]). The
PF variability before and after SA were 3.6 +/- 2.8% and 2.8 +/- 3.4%,
respectively (NS). No significant difference was demonstrated for symptom
scores or for the use of beta(2)-agonist inhalers (RA, 6.7 +/- 3.4; SA, 8.1 +/-
3.6; p = 0.58). CONCLUSION: In patients with moderate persistent asthma, a
short course of acupuncture treatment resulted in no change in lung functions,
bronchial hyperreactivity, or patient symptoms.
5099.
Sicherer SH.
Clinical update on peanut allergy. Ann Allergy Asthma Immunol. 2002
Apr;88(4):350-61; quiz 361-2, 394. Review.
BACKGROUND: Peanut allergy is common, potentially severe, and
there has been a recent surge in clinical investigation of this important food
allergen. OBJECTIVE: To provide the reader with a clinically oriented update on
peanut allergy. DATA SOURCES: English language articles were selected from
PubMed searches (search terms: peanut allergy, food allergy, anaphylaxis) and
selected abstracts with a bias toward recent (3 years) studies judged to have
immediate, practical clinical implications. RESULTS: Peanut allergy is an
increasing problem in western diets that include this food. Both genetic and
environmental factors influences the expression of this allergy. The at-risk
subject is an atopic individual, with heightened risk for those with atopic
dermatitis and/or other food allergies. The allergy is long-lived for most, may
increase slightly in severity over time, but approximately 20% of young
children will develop tolerance. Parameters that may identify the subset likely
to achieve tolerance have been identified. Several large studies have
determined laboratory parameters (skin tests, peanut-specific serum
immunoglobulin E concentrations) with excellent predictive value (>95%) to
diagnose current clinical reactivity or tolerance, although oral food
challenges are necessary for a definitive diagnosis. Numerous practical lessons
concerning management (avoidance, treatment, and prevention) have been
identified. CONCLUSIONS: Recent studies provide the clinician with an armament
of improved diagnostic and treatment modalities for peanut allergy. Studies are
underway that are likely to provide more definitive therapies in the near future.
5100.
Singh B.
Acropalynological studies at Jabalpur with special emphasis on allergenic
pollens. Department of Botany, Rani Durgawati Vishwavidyalaya, Jabalpur ; 2001.
No Abstract.
5101.
Steven K,
Morrison J, Drummond N. Lay versus professional motivation for asthma
treatment: a cross-sectional, qualitative study in a single Glasgow general
practice. Fam Pract. 2002 Apr;19(2):172-7.
OBJECTIVE: Our aim was to identify the factors which motivate
patient self-management in asthma and to compare the results with the factors
which appear to have motivated the content of the British Thoracic Society
(BTS) clinical guidelines for chronic asthma in adults. METHOD: We conducted a
cross-sectional, qualitative survey of asthma patients from a single general
practice list in Glasgow, Scotland. Twenty-three adult asthma patients on at
least step 2 of the BTS guidelines were selected from the practice asthma
register. RESULTS: Only seven of the 23 subjects had asthma treatment goals.
People with asthma are motivated by the effect of the illness on self-image,
the experience of symptoms, the value of life experiences affected, the
perceived consequences of asthma, their acceptance of the diagnosis and their
attitude towards medication. Asthma is largely viewed as unproblematic. CONCLUSIONS:
The BTS guidelines appear to be motivated by a desire to heighten professional
awareness about the disease. Patient goals and preferences for asthma treatment
are largely unrecognized by the guidelines. A concordant model of disease
management, involving the explicit acknowledgement of patient goals by
professionals, alongside their own goals for treatment, may improve adherence
to treatment perceived by patients as relevant and achievable.
5102.
Szczeklik A,
Nizankowska E, Mastalerz L, Szabo Z. Analgesics and asthma. Am J Ther. 2002
May-Jun;9(3):233-43. Review.
The incidence of asthma is increasing throughout the world,
which presents both public health and economic concerns. It is widely
recognized that in some adult patients with asthma, aspirin and other
nonsteroidal anti-inflammatory drugs (NSAIDs) that inhibit cyclooxygenase
(COX)-1 exacerbate the condition. This is a distinct clinical syndrome called
aspirin-induced asthma (AIA). The disease develops according to a
characteristic pattern of symptoms. Persistent eosinophilic rhinosinusitis
precedes development of nasal polyposis, aspirin hypersensitivity, and asthma.
There is no in vitro test, and diagnosis can only be established by provocation
tests with aspirin. At the biochemical level, AIA is characterized by a chronic
overproduction of cysteinyl leukotrienes. The key enzyme, leukotriene C4
synthase, is overexpressed in bronchi, and its messenger RNA is upregulated in
peripheral blood eosinophils. This can be partly related to the genetic polymorphism
of the enzyme. The disease runs a protracted course, even if COX-1 inhibitors
are avoided. The course of AIA is often severe, and at least half of the
patients need systemic corticosteroids to control their asthma. To prevent
life-threatening reactions, patients with AIA should avoid aspirin and other
analgesics that inhibit COX-1. The incidence of cross-sensitivity to
paracetamol in AIA patients is low and, when a reaction does occur, the
symptoms experienced are shorter and milder than if the reactions were evoked
by an NSAID. Rapidly growing evidence indicates that highly specific COX-2
inhibitors, known as coxibs, are well tolerated and can be safely used by AIA
patients.
5103.
Talini D,
Benvenuti A, Carrara M, Vaghetti E, Martin LB, Paggiaro PL. Diagnosis of
flour-induced occupational asthma in a cross-sectional study. Respir Med. 2002
Apr;96(4):236-43.
The diagnosis of occupational asthma is usually performed in
epidemiology using a combination of symptoms and bronchial hyperresponsiveness,
while in a clinical setting the 'gold standard' for the diagnosis of
occupational asthma is the specific bronchial challenge test in the laboratory
The aim of this study was to detect new cases of flour-induced occupational
asthma (OA) in a group of workers exposed to grain and/or flour dust, by means
of a step-by-step approach, as used in a clinical setting. In an
epidemiological study, III millers and 186 bakers were examined by means of
questionnaire, pulmonary function tests and skin-prick tests (SPT) to common allergens
and to wheat flour dust extracts. From the whole sample, 82 subjects who showed
asthma-like symptoms in the questionnaire and/or low forced expiratory volume
in 1 sec (FEV1) were selected. Selected subjects underwent methacholine
challenge test, and hyperreactive subjects underwent specific bronchial
challenge with flour dust in the laboratory. Sixty-two of the selected subjects
performed the methacholine challenge test, and 22 (33 8%) were hyperreactive
(PD20 FEV1 <1 mg of methacholine). Fifteen of 22 hyperreactive subjects
underwent specific bronchial challenge test (s BCT) with flour dust; a positive
response was elicited in six subjects. These subjects can be diagnosed as
having flour-induced occupational asthma. Atopy and skin sensitivity to flour
was partially related to the response to flour bronchial challenge. Bronchial
hyperreactivity can be observed in a small percentage of subjects with
asthma-like symptoms and/or low FEV1, and a positive response to s BCTwas
observed in a subgroup of hyperreactive subjects.Therefore, using these
selection criteria, a diagnosis of flour-induced OA, as commonly performed in a
clinical setting, can be performed in few previously undiagnosed subjects.This
approach could be relevant for an early diagnosis ofoccupational asthma.
5104.
van
Steekelenburg J, Clement PA, Beel MH. Comparison of five new antihistamines
(H1-receptor antagonists) in patients with allergic rhinitis using nasal
provocation studies and skin tests. Allergy. 2002 Apr;57(4):346-50.
BACKGROUND: It was the aim of the authors to compare all of the
latest second-generation antihistamines and to see if there were significant
differences in their efficacy. It is important for ENT specialists to know if
these differences exist, as it is for general practitioners trying to choose
between these drugs. METHODS: In 12 confirmed grass pollen allergic patients
the authors performed nasal smears to asses eosinophilia, histamine/grass
pollen skin tests, and grass pollen nasal provocation tests. All tests were performed
before and after administration of one of five different antihistamines
(cetirizine, loratadine, ebastine, fexofenadine, mizolastine) or placebo. The
order of administration of antihistamines and placebo was randomised, and
patients were not aware of which drug they were given. A decrease in nasal
eosinophilia (nasal smear), or nasal or skin reactivity (provocation tests) was
looked for. RESULTS: A significant decrease in nasal eosinophilia was observed
for all antihistamines but not for placebo. For the grass pollen nasal
provocation tests, the decrease was significant for nasal blockage and
sneezing; for rhinorrhea there was an insignificant decrease that was true for
all antihistamines. A significant reduction in histamine/grass pollen skin test
reactivity was also observed for all antihistamines, during an 8 h observation
period. A significant difference in efficacy between the different
antihistamines could not be found with any of the tests performed. CONCLUSIONS:
For the newer nonsedating H1-antagonists there appears to be no clinically
relevant differences in activities--at least not in our study. Preference of
the patient may be the most important factor in making a choice between these
drugs.
5105.
Wood RA. Skin
testing: making the most of every prick. Ann Allergy Asthma Immunol. 2002
Apr;88(4):347-9. No abstract.
5106.
Woodruff PG,
Fahy JV. A role for neutrophils in asthma? Am J Med. 2002 Apr
15;112(6):498-500. No abstract.
5107.
Yawn BP,
Wollan P, Kurland M, Scanlon P. A longitudinal study of the prevalence of
asthma in a community population of school-age children. J Pediatr. 2002
May;140(5):576-81.
OBJECTIVE: Using a unique county-wide resource that links all
health care providers' medical records to assess current and "ever"
prevalence of physician-diagnosed asthma. To describe the age and sex rates and
temporal trends in new asthma diagnoses and associations with race and
socio-economic status. STUDY DESIGN: A longitudinal retrospective evaluation of
a population-based cohort of school children using linked medical and school
records. RESULTS: Overall, 17.6% of children in grades kindergarten through 12
had a physician diagnosis of asthma and 12.9% had an asthma-related visit
within the past 2 years. An additional 19.7% had visits for reactive airway disease
or recurrent wheezing or bronchospasm with no diagnosis of asthma. Children
provided with free and reduced-cost lunches had lower cumulative and incident
asthma rates from birth through their current school age. Race was not related
to rates of physician-diagnosed asthma. There was a significant temporal
increase in rates of new asthma diagnoses. CONCLUSIONS: In this community, 1 in
3 children have had a physician-documented recurrent wheezing-type illness, and
1 in 6 were diagnosed with asthma. Diagnoses rates were directly related to
socioeconomic status.
5108.
Zaas D, Brock
M, Yang S, Sylvester JT. An uncommon
mimic of an acute asthma exacerbation. Chest. 2002 May;121(5):1707-9.
Foreign body aspiration in adults has a variety of clinical
presentations and often goes unrecognized. We describe the case of a patient
who experienced crack cocaine aspiration and presented with symptoms of an
acute asthma exacerbation requiring mechanical ventilation until the eventual
diagnosis and bronchoscopic removal of the foreign body.
Pathogenesis:
5109.
Akpinarli A,
Guc D, Kalayci O, Yigitbas E, Ozon A. Increased interleukin-4 and decreased
interferon gamma production in children with asthma: function of atopy or
asthma? J Asthma. 2002 Apr;39(2):159-65.
Both atopy and asthma are claimed to be associated with a Th-2
cytokine pattern. We sought to determine the contribution of atopy and asthma
to the observed Th-2/Th-1 imbalance in these conditions. Of 60 children aged
6-16 years that were included in the study, 13 were nonatopic nonasthmatic, 15
atopic nonasthmatic, 14 nonatopic asthmatic, and 18 atopic asthmatic. Atopic
children had positive skin prick tests to grass pollens only. All children were
studied after an asymptomatic and drug-free period of at least three months. Total
IgE was measured in serum. Peripheral blood mononuclear cells were cultured and
stimulated in vitro with phytohemagglutinin and interferongamma (IFN-gamma) and
interleukin-4 (IL-4) measured in the supernatants. Total IgE was significantly
higher in atopic asthmatics compared to nonatopic asthmatics (p = 0.004), and
nonatopic nonasthmatics (p = 0.001), but was not different from atopic
nonasthmatics (p >0.05). On the other hand, IL-4 was significantly elevated
in atopic asthmatics and in nonatopic asthmatics compared to nonatopic
nonasthmatics (p = 0.037 and p = 0.009, respectively). Although atopic
asthmatics had lower IFN-gamma values than nonatopic asthmatics, the difference
did not reach statistical significance. No correlation was detected between any
two parameters. Our results suggest that both atopy and asthma contribute to
the increased levels of IL-4 and that, whereas nonatopic asthma is associated
with increases in both IL-4 and IFN-gamma release by mononuclear cells, only
atopic asthma is characterized by a Th-2 type cytokine dominance.
5110.
Arvidsson MB,
Lowhagen O, Rak S. Effect of 2-year placebo-controlled immunotherapy on airway
symptoms and medication in patients with birch pollen allergy. J Allergy Clin
Immunol. 2002 May;109(5):777-83.
BACKGROUND: Birch pollen is a common allergen in northern,
central, and eastern Europe. Earlier studies of specific immunotherapy using
birch pollen extract were not placebo-controlled or were only preseasonal.
Long-term, placebo-controlled studies with subcutaneously administered
standardized birch pollen extract are lacking. OBJECTIVE: The aim of this study
was to evaluate the effect of immunotherapy with birch pollen extract on airway
symptoms and use of medication in adult birch pollen-allergic patients in a double-blind,
placebo-controlled trial. METHODS: Forty-nine patients with histories of birch
pollen allergy from the upper and lower airways, positive skin prick test and
conjunctival provocation test results, and in vitro specific IgE to birch
pollen (Betula verrucosa ) extract were included. Immunotherapy with birch
pollen extract was given during 2 consecutive years in a double-blind,
randomized, placebo-controlled study. Clinical symptom scores from the upper
and lower airways and use of rescue medication were registered throughout the
pollen season. RESULTS: Forty-six patients reached the maintenance dose and
were maintained on that dose during the 2-year study. The median symptom scores
during the 1997 and 1998 seasons were 1.3 and 2.6, respectively, in the
specific immunotherapy group and 2.1 and 4.3, respectively, in the placebo
group. The differences between the groups were significant (P =.05 in 1997 and
P =.005 in 1998). The placebo group used significantly more rescue medication
during both seasons than the specific immunotherapy group (P =.004 for 1997 and
P =.004 for 1998). CONCLUSION: Specific immunotherapy with birch pollen extract
is an effective and safe treatment for reducing clinical allergy symptoms and
medication use in birch pollen-allergic patients during the pollen season.
5111.
Babu KS,
Holgate ST. Newer therapies for asthma: a focus on anti-IgE. Indian J Chest Dis
Allied Sci. 2002 Apr-Jun;44(2):107-15. Review.
The prevalence of asthma and other allergic disorders has been
on the increase not only in the western world but also in the developing
countries. This increasing prevalence has lead research into the discovery and
development of various new therapeutic strategies. The improved understanding
about the pathophysiology of asthma has prompted the developments of novel
molecules to tackle this problem. These include newer phosphodiesterase
inhibitors, cytokine modulation strategies, allergen immunotherapy, and
anti-IgE. Immunoglobulin E plays a major role in airway inflammation in asthma.
Omalizumab, a novel humanised monoclonal antibody directed against the high
affinity FcepsilonRI portion of the IgE has shown a lot of promise in the
control of asthma symptoms and as a steroid sparing agent in the management of
allergic asthma. This new molecule has an excellent safety profile and could
play an important role in the management of patients with severe asthma. This
review gives a brief overview of the newer therapies under investigation with
special reference to omalizumab in the treatment of allergic asthma.
5112.
Barnetson RS,
Rogers M. Childhood atopic eczema. BMJ. 2002 Jun 8;324(7350):1376-9.
Review. No abstract.
5113.
Beasley R.
The burden of asthma with specific reference to the United States. J Allergy
Clin Immunol. 2002 May;109(5 Suppl):S482-9. Review.
During the second half of the 20th century, the increasing
prevalence, morbidity, economic burden, and, in some countries, mortality from
asthma have generated worldwide concern. The prevalence in the United States
and other English-speaking countries is higher than that in most other
countries, but worldwide variations cannot be explained by current knowledge of
recognized risk or protective factors. According to hospital admission rates,
asthma morbidity rates have also risen throughout the world during the past 40
years. These trends are likely due to many different factors, including an
increase in the prevalence of severe asthma. Asthma mortality rates gradually
declined in the United States during the 1960s and 1970s but have exhibited a substantial,
progressive increase during the past 20 years. This trend stands in contrast to
those in most other western countries, where asthma mortality rates have
generally been decreasing during the 1990s. In both western and developing
countries, the considerable economic burden of asthma disproportionately
affects individuals with severe disease. This observation illustrates the
potential for reducing the costs associated with asthma through management
approaches that have been proven to reduce morbidity and mortality.
5114.
Black J. The
role of mast cells in the pathophysiology of asthma. N Engl J Med. 2002 May
30;346(22):1742-3. No abstract.
5115.
Bohadana AB,
Hannhart B, Teculescu DB. Nocturnal worsening of asthma and sleep-disordered
breathing. J Asthma. 2002 Apr;39(2):85-100. Review.
Asthma has a tendency, to destabilize and get worse at night,
probably due to a nocturnal increase in airiway inflammation and bronchial
responsiveness. Nocturnal airway narrowing in asthma is often associated with
sleep disorders, such as episodes of nocturnal and early morning awakening,
difficulty in maintaining sleep, and day time sleepiness. On the other hand, an
association has been documented between nocturnal sleep-disordered breathing
and asthma. This review highlights the causes of nocturnal worsening of asthma
and examines the evidence pointing toward a causal relationship between
nocturnal asthma and sleep-disordered breathing.
5116.
Bonnin
AJ. Mild asthma. N Engl J Med. 2002 Apr
25;346(17):1335-6; discussion 1335-6. No abstract.
5117.
Burks W.
Current understanding of food allergy. Ann N Y Acad Sci. 2002 May;964:1-12.
Review.
IgE-mediated hypersensitivity reactions account for the majority
of well-documented food allergy reactions, but non-IgE-mediated immune
mechanisms do cause some hypersensitivity disorders. A variety of
gastrointestinal, cutaneous, respiratory, and generalized symptoms and
syndromes have been associated with IgE-mediated food allergy. The diagnostic
approach to adverse food reactions begins with a careful medical history and
physical examination. Laboratory studies may then be used appropriately in the
evaluation. Once the diagnosis of food allergy is established, the only proven
therapy is the strict elimination of the food from the patient's diet. Studies in
both children and adults indicate that symptomatic reactivity to food allergens
is often lost over time, except possibly reactions to peanuts, tree nuts, and
seafood.
5118.
Chen JT,
Krieger N, Van Den Eeden SK, Quesenberry CP. Different slopes for different folks:
socioeconomic and racial/ethnic disparities in asthma and hay fever among
173,859 U.S. men and women. Environ Health Perspect. 2002 Apr;110 Suppl
2:211-6.
Although allergic diseases such as asthma and hay fever are a
major cause of morbidity in industrialized countries, most studies have focused
on patterns of prevalence among children and adolescents, with relatively few
studies on variations in prevalence by race/ethnicity and socioeconomic
position among adults. Our study examined racial/ethnic and socioeconomic
patterns in the prevalence of asthma overall, asthma with hay fever, asthma
without hay fever, and hay fever overall, in a population of 173,859 women and
men in a large prepaid health plan in northern California. Using education as a
measure of socioeconomic position, we found evidence of a positive gradient for
asthma with hay fever with increasing level of education but an inverse
gradient for asthma without hay fever. Hay fever was also strongly associated
with education. Compared with their White counterparts, Black women and men
were more likely to report asthma without hay fever, and Black women were less
likely to have asthma with hay fever. Asian men were also more likely to report
asthma with hay fever, and Asian women and men were much more likely to have
hay fever. Racial/ethnic disparities in prevalence of allergic diseases were
largely independent of education. We discuss implications for understanding
these social inequalities in allergic disease risk in relation to possible differences
in exposure to allergens and determinants of immunologic susceptibility and
suggest directions for future research.
5119.
Chiaverini L.
Asthma, particulates, and diesel exhaust. Med Health R I. 2002
Apr;85(4):140-2. No abstract.
5120.
Cinquetti M,
Micelli S, Voltolina C, Zoppi G. The pattern of gastroesophageal reflux in
asthmatic children. J Asthma. 2002 Apr;39(2):135-42.
The association between gastroesophageal reflux (GER) and asthma
is not fortuitous. The objective of our study was to test a group of children
with asthma by, 24 hr gastroesophageal pH monitoring and to relate the results
to the patients medical history and clinical data. We studied 77 children aged
from 39 to 170 months suffering from particularly recurrent and/or therapy
resistant asthma. Medical history data were collected for each patient and
included: severity and characteristics of respiratory symptoms, presence, if
any of allergy; presence, if any, of GER-related symptoms; and presence, if
any, of esophagitis-related symptoms. Esophageal pH was measured by 24 hr
computerized monitoring of the main measures in all patients. Forty-seven
children were also examined by gastroesophageal endoscopy. The prevalence of
GER was 61% on the basis of the reflux index (cutoff: 4.2%). Gastroesophageal reflux
in these asthmatic children was characterized mainly by short-lasting daytime
episodes. The patients tended to present GER mainly associated with vomiting
but not with signs and symptoms of esophagitis. The short-lasting nature of the
reflux episodes demonstrates good esophageal clearance. The time of onset of
respiratory symptoms (day/night) was not associated with any particular type of
GER, the severity of which tends to be proportional to the seriousness of the
asthma. No correlation was found between GER and allergy. No statistically
significant differences were found in clinical or medical history findings
between patients with pathologic and nonpathologic GER.
5121.
Cook N,
Freeman S. Photosensitive dermatitis due to sunscreen allergy in a child. Australas
J Dermatol. 2002 May;43(2):133-5. No
abstract.
5122.
Drake AJ,
Howells RJ, Shield JP, Prendiville A, Ward PS, Crowne EC. Symptomatic adrenal
insufficiency presenting with hypoglycaemia in children with asthma receiving
high dose inhaled fluticasone propionate. BMJ. 2002 May
4;324(7345):1081-2. No abstract.
5123.
Eng PA,
Reinhold M, Gnehm HP. Long-term efficacy of preseasonal grass pollen
immunotherapy in children. Allergy. 2002 Apr;57(4):306-12.
BACKGROUND: In a previous controlled study we demonstrated that preseasonal
grass pollen immunotherapy for three years was effective in children. In the
current study we examined the same group of patients to see if there is still a
benefit six years after discontinuation of treatment. METHODS: Thirteen of 14
patients with previous specific immunotherapy (SIT) and 10 out of 14 patients
of the control group were prospectively followed during the grass pollen
season. Outcome measures were seasonal symptom scores for eyes, nose and chest,
the use of symptomatic medication and visual analog scale. Objective measures
included skin prick test reactivity to seasonal and perennial allergens and
conjunctival provocation testing. RESULTS: During the 13 week observation time
scores for overall hayfever symptoms (P < 0.004) and individual symptoms for
eyes (P <0.02), nose (P < 0.04) and chest (P < 0.01) as well as
combined symptom and medication scores (P < 0.002) remained lower in the
group with previous SIT. Only 23% of patients with previous pollen-asthma who
had received SIT experienced pollen-associated lower respiratory tract symptoms
compared to 70% in the control group (P < 0.05). There was no significant
difference in the use of pharmacological treatment during the pollen season
except for asthma medication. The average visual analog scale was lower in the
post-SIT group (P <0.05). Six years after cessation of SIT the immediate
skin response to grass pollen remained decreased compared to the reaction of
the controls (P < 0.01). There was also a tendency for higher allergen concentration
to provoke a conjunctival response in the post-SIT group but without reaching
statistical significance. Eight years after commencement of SIT, 61% of the
initially pollen-monosensitized children had developed new sensitization to
perennial allergens compared to 100% in the control group (P < 0.05).
CONCLUSIONS: There is still a significant clinical benefit six years after
discontinuation of preseasonal grass pollen immunotherapy in childhood. SIT in
children with pollen-allergy reduces onset of new sensitization and therefore
has the potential to modify the natural course of allergic disease.
5124.
Faul JL,
Demers EA, Burke CM, Poulter LW. Alterations in airway inflammation and lung
function during corticosteroid therapy for atopic asthma. Chest. 2002 May;121(5):1414-20.
INTRODUCTION: Although corticosteroid therapy for asthma
improves lung function and reduces airway inflammation, the relation between
these two events is unclear. This article investigates associations between
changes in bronchial inflammation and lung function during high-dose inhaled
corticosteroid therapy for asthma. METHODS: Nine subjects with atopic asthma
received high-dose inhaled fluticasone propionate (FP), 2,000 microg/d for 8
weeks. Fiberoptic bronchoscopy with endobronchial biopsies, spirometry, and
histamine provocation challenge were performed on each subject at baseline,
after 2 weeks, and again after 8 weeks of therapy. Spearman rank correlation
coefficients between changes in parameters of bronchial inflammation and lung
function were computed. RESULTS: As expected, significant down-regulation of
airway inflammation and improvements in lung function were observed after both
short-term and long-term therapy with high-dose inhaled FP. During
corticosteroid therapy, changes in lymphocyte and macrophage numbers in
bronchial biopsy specimens were closely correlated. Changes in EG1+ eosinophils
were associated with changes in EG2+ eosinophils after 8 weeks of therapy.
Although changes in airway inflammation and changes in lung function were not
closely associated after 2 weeks of therapy, changes in eosinophils (EG1) in
bronchial biopsy specimens correlated with changes in bronchodilator response
(r = 0.77, p = 0.016) after 8 weeks of therapy. CONCLUSION: In patients with
atopic asthma, changes in bronchial eosinophils and lung function during
steroid therapy are closely related but do not occur simultaneously.
5125.
Field SK.
Asthma and gastroesophageal reflux: another piece in the puzzle? Chest. 2002
Apr;121(4):1024-7. No abstract.
5126.
Gerlini G,
Prignano F, Pimpinelli N. Acute leucocytoclastic vasculitis and aquagenic
pruritus long preceding polycythemia rubra vera. Eur J Dermatol. 2002
May-Jun;12(3):270-1. No abstract.
5127.
Gern JE.
Rhinovirus respiratory infections and asthma. Am J Med. 2002 Apr 22;112 Suppl
6A:19S-27S. Review.
Viral infections, particularly respiratory illnesses caused by
rhinovirus, are the most common cause of asthma exacerbations in children and
contribute in large part to asthma morbidity in adults. Epidemiologic studies
and increasingly sophisticated viral detection methodologies have helped to
define the role of rhinovirus as a potential causative agent in asthma
exacerbations. Rhinovirus-induced lung disease is multifaceted and can be
characterized in terms of a variety of physiologic, immunologic, and viral
processes. The precise direct and indirect mechanisms of viral contribution to
exacerbations must still be elucidated. Understanding them will have an impact
on the design of future treatment modalities.
5128.
Goodman B. Immunology. Drink your shots. Sci Am. 2002
Apr;286(4):26. No abstract.
5129.
Grammer LC,
Harris KE, Yarnold PR. Effect of
respiratory protective devices on development of antibody and occupational
asthma to an acid anhydride. Chest. 2002 Apr;121(4):1317-22.
STUDY OBJECTIVES: To determine whether the use of respiratory
protective equipment would reduce the incidence of occupational asthma due to
exposure to hexahydrophthalic anhydride (HHPA). DESIGN: Prospective cohort
study. SETTING: A facility that makes an epoxy resin product requiring HHPA for
its manufacture. PARTICIPANTS: Sixty-six individuals newly hired at a facility
that makes an epoxy resin product requiring HHPA for its manufacture.
INTERVENTION: Employees who wished to use respiratory protective equipment
could choose from three types of masks: dust mask, half-face organic vapor
respirator, or full-face organic vapor respirator. MEASUREMENTS: Workers were
evaluated annually for development of positive antibody to HHPA and
occupational, immunologic respiratory disease, including occupational asthma.
RESULTS: With use of respiratory protective equipment, the rate of developing
an occupational immunologic respiratory disease was reduced from approximately
10 to 2% per year. Occupational asthma developed in only three individuals, and
they were all in the higher exposure category. Statistically, one respirator
was not superior to the others. CONCLUSION: Respiratory protective equipment
can reduce the incidence of occupational immunologic respiratory disease,
including occupational asthma, in employees exposed to HHPA.
5130.
Hallett R,
Haapanen LA, Teuber SS. Food allergies and kissing. N Engl J Med. 2002 Jun
6;346(23):1833-4. No abstract.
5131.
Huynh NT,
Commens CA. Scrubbing for cutaneous procedures can be hazardous. Australas J
Dermatol. 2002 May;43(2):102-4.
Office-based minor cutaneous surgery is a service provided by
many medical practitioners. In New South Wales, Australia, it is a legal
requirement for practitioners to surgically scrub before donning sterile gloves
for all forms of invasive surgery, including minor cutaneous procedures.
Frequent scrubbing causes altered skin barrier function, irritant dermatitis
and a potential risk of latex sensitization. These adverse effects are
associated with significant morbidity and cost. Better tolerated alternatives,
including alcohol-based hand rubs, should be considered in preference to
traditional surgical scrubs in order to reduce these occupational risks for
minor proceduralists. Well-controlled, prospective studies should explore what
extent of hand washing is necessary for donning sterile gloves for minor
cutaneous surgery.
5132.
Jensen CS,
Lisby S, Baadsgaard O, Volund A, Menne T. Decrease in nickel sensitization in a
Danish schoolgirl population with ears pierced after implementation of a
nickel-exposure regulation. Br J Dermatol. 2002 Apr;146(4):636-42.
BACKGROUND: To reduce the skin nickel exposure of the
population, the Danish Ministry of Environment issued a regulation that was
implemented in 1992, and the European Union countries have recently adopted an
expanded regulation. OBJECTIVES: The aim of our combined patch testing and
questionnaire investigation of girls in public schools and high
schools/production schools was to evaluate whether the regulation has had an
impact on the prevalence of nickel sensitization. METHODS: To find a group of
girls with ears pierced mainly after implementation of the nickel-exposure
regulation in Denmark, girls were recruited from the fifth and sixth grade in
12 public schools (the public school group). After the public school level
almost all girls from a public school population continue their education in
high schools or other schools such as production schools or technical schools.
Therefore, to find girls demographically similar to the public school girls but
older, and with ears pierced before implementation of the regulation, girls
from seven high schools and two production schools were recruited (the high
school group). Four hundred and twenty-seven girls in the public school group
(mean age 12.4 years, range 10-14) and 534 in the high school group (mean age
18.8 years, range 17-22) participated. All participants filled out a
questionnaire concerning ear piercing, use of oral braces and former patch
testing for nickel sensitivity. Three hundred and five girls (71.4%) in the
public school group and 275 (51.5%) in the high school group were patch tested
or had been tested previously and the results of these tests were included in
the study. The relation between the frequency of nickel sensitization and the
various factors that might influence the prevalence of nickel sensitization was
evaluated by multivariate logistic regression analysis. The investigation was
conducted from March 1999 to March 2000. RESULTS: The study showed that both
increasing age and having ears pierced before 1992 enhanced the prevalence of
nickel sensitization. We found that 17.1% of the girls in the high school group
demonstrated a positive patch test reaction to nickel. In contrast, the
prevalence of nickel sensitization in the public school group was only 3.9%.
Comparing girls with and without pierced ears, the prevalence of nickel
sensitization was significantly higher in girls with ears pierced before, but
not after, 1992 (odds ratio 3.34 and 1.20, respectively). Only in the high
school group was there a tendency that wearing oral braces before ear piercing
had a protective effect on nickel sensitization, but this did not reach
statistical significance. CONCLUSIONS: As we found an effect of ear piercing
before but not after 1992, this study strongly suggests that implementation of
the nickel-exposure regulation in 1992 in Denmark has had the intended effect
of protecting the female population from becoming allergic to nickel.
5133.
Jones CA,
Holloway JA, Popplewell EJ, Diaper ND, Holloway JW, Vance GH, Warner JA, Warner
JO. Reduced soluble CD14 levels in
amniotic fluid and breast milk are associated with the subsequent development
of atopy, eczema, or both. J Allergy Clin Immunol. 2002 May;109(5):858-66.
BACKGROUND: Exposure to various microbial products in early life
reduces the risk of atopy. Such exposure induces downregulation of T(H)2
allergy-biased responses by means of pattern recognition molecules, such as
CD14, an LPS receptor. OBJECTIVE: We sought to determine whether infant and
maternal levels of soluble CD14 (sCD14) are associated with the atopic outcomes
of infants. METHODS: Levels of sCD14 in plasma, amniotic fluid, and breast milk
were measured with a specific ELISA in different cohorts. Expression of
toll-like receptors in the fetal gut was examined by using RT-PCR. RESULTS:
Soluble CD14 levels increased during fetal development and postnatally,
attaining adult levels by around 4 months of age, with an overshoot of adult
levels from 6 months of age. There was no difference in plasma sCD14 levels at
birth of children with a high compared with those with a low risk of
development of atopy. Amniotic fluid sCD14 levels at midgestation (16-17 weeks)
were significantly lower when the child was subsequently atopic (P <.05).
Soluble CD14 levels in breast milk collected 3 months postpartum were
significantly lower in children with eczema at 6 months of age, irrespective of
whether they were atopic (P =.003). Transcripts for toll-like receptor 4, which
would enable transmembrane signaling for LPS/sCD14 complexes, were expressed
within fetal gut and skin. CONCLUSION: Exposure to reduced levels of sCD14 in
the fetal and neonatal gastrointestinal tract is associated with the
development of atopy, eczema, or both. Thus the exogenous supply of sCD14 might
influence immunologic reactivity both locally and systemically in early life
and thereby influence disease outcome.
5134.
Kolbe J,
Fergusson W, Vamos M, Garrett J. Case-control study of severe life threatening
asthma (SLTA) in adults: psychological factors. Thorax. 2002 Apr;57(4):317-22.
BACKGROUND: Severe life threatening asthma (SLTA) is important
in its own right and as a proxy for asthma death. In order to target hospital
based intervention strategies to those most likely to benefit, risk factors for
SLTA among those admitted to hospital need to be identified. Adverse
psychological factors are purported risk factors for asthma death and SLTA
/near fatal asthma. A study was undertaken to determine whether, in comparison
with patients admitted to hospital with acute asthma, those with SLTA have
specific adverse psychological factors. METHODS: A case-control study was
undertaken. Cases (n=77) were admitted to the intensive care unit with SLTA
(mean (SD) pH 7.17 (0.15), PaCO(2) 10.7 (5.0) kPa). Controls (n=239) were
admitted to general wards with acute asthma and were matched only by date of
index attack. An interviewer administered questionnaire was undertaken 24-48
hours after admission. A random sample of community based asthmatics was
recruited to provide normative data on asthmatics for comparison with cases and
hospital controls. RESULTS: The risk of SLTA increased with age (OR 1.04/year,
95% CI 1.01 to 1.07) and was less for women (OR 0.36, 95% CI 0.20 to 0.68). These
variables were controlled for in all further analyses. There was a high
prevalence of psychological disorder in both cases and matched controls, but
there was no difference in prevalence of caseness for anxiety or depression,
total (or individual) life events in last 12 months, availability of general or
disease specific social support, nor in any of the domains of the Attitudes and
Beliefs about Asthma Questionnaire (emotional (mal) adjustment, doctor-patient
relationship, stigma, self-efficacy). Cases (SLTA) were less likely to have had
previous emotional counselling (25% v. 35%, p<0.05). However, when
comparison was made with a community based group of asthmatic patients, those
admitted to hospital with acute asthma (SLTA and hospital controls) had a higher
prevalence of anxiety and depression, higher total life events, and higher
prevalence of certain specific life events. CONCLUSIONS: There was considerable
psychological morbidity generally (and anxiety specifically) in those admitted
with acute asthma. Specific adverse psychological factors were not risk factors
for SLTA, when comparison was made with those admitted to hospital with acute
asthma, but adverse psychological factors were a risk factor for
hospitalisation for acute asthma (including SLTA). Psychological risk factors
for adverse events in asthma are dependent both on the type of event under
study and the comparison group used.
5135.
Konig P.
Irreversible airway obstruction in childhood asthma? A clinician's viewpoint.
Pediatr Pulmonol. 2002 Apr;33(4):307-10.
Even though childhood asthma is assumed to comprise reversible
airway obstruction, some children develop irreversible airway obstruction (not
reversed by a bronchodilator or corticosteroids); this may be due to
inflammation that has caused remodeling. Lately, it has been claimed that in
the absence of treatment with inhaled corticosteroids, most patients will
develop progressive irreversible obstruction. Several studies culminating with
the Childhood Asthma Management Program (CAMP) study, which was the first
randomized placebo-controlled prospective long-term study designed to test for
irreversible obstruction, did not show the development of such progressive
irreversible obstruction. Nevertheless, deterioration in pulmonary function
does occur in some patients, probably due to inadequate anti-inflammatory
treatment, and possibly also due to maintenance adrenergic treatment. Most
previous studies concentrated on forced expiratory volume in 1 sec (FEV(1)), a
test assessing mostly large airway obstruction. More studies are needed to
investigate the presence of small airway obstruction. Copyright 2002
Wiley-Liss, Inc.
5136.
Lawrence DA.
Psychologic stress and asthma: neuropeptide involvement. Environ Health
Perspect. 2002 May;110(5):A230-1; discussion A231. No abstract.
5137.
Macdougall
CF, Cant AJ, Colver AF. How dangerous is food allergy in childhood? The
incidence of severe and fatal allergic reactions across the UK and Ireland.
Arch Dis Child. 2002 Apr;86(4):236-9.
AIMS: To discover the incidence of fatal and severe allergic
reactions to food in a large population of children. METHODS: A retrospective
search for fatalities in children 0-15 years from 1990 to February 1998,
primarily of death certification at offices of national statistics. A
prospective survey of fatal and severe reactions from March 1998 to February
2000, primarily through the British Paediatric Surveillance Unit. MAIN OUTCOME
MEASURES: were deaths and severe reactions. A case was deemed severe if one or
more of the following criteria was met: cardiorespiratory arrest; need for
inotropic support; fluid bolus >20 ml/kg; more than one dose of epinephrine;
more than one dose of nebulised bronchodilator. A case was deemed near fatal if
intubation was necessary. RESULTS: The UK under 16 population is 13 million.
Over the past 10 years, eight children died (incidence of 0.006 deaths per 100
000 children 0-15 years per year). Milk caused four of the deaths. No child
under 13 died from peanut allergy. Two children died despite receiving early
epinephrine before admission to hospital; one child with a mild food allergic
reaction died from epinephrine overdose. Over the past two years, there were
six near fatal reactions (none caused by peanut) and 49 severe ones (10 caused
by peanut), yielding incidences of 0.02 and 0.19 per 100 000 children 0-15
years per year respectively. Coexisting asthma is more strongly associated with
a severe reaction than the severity of previous reactions. CONCLUSIONS: If 5%
of the child population have food allergy, the risk that a food allergic child
will die from a food allergic reaction is about 1 in 800 000 per year. The food
allergic child with asthma may be at higher risk. Prescribing an epinephrine
autoinjector requires a careful balance of advantages and disadvantages.
5138.
Mendell MJ,
Fisk WJ, Petersen MR, Hines CJ, Dong M, Faulkner D, Deddens JA, Ruder AM,
Sullivan D, Boeniger MF. Indoor
particles and symptoms among office workers: results from a double-blind
cross-over study. Epidemiology. 2002 May;13(3):296-304.
BACKGROUND: We studied the effects of removing small airborne
particles in an office building without unusual contaminant sources or occupant
complaints. METHODS: We conducted a double-blind crossover study of enhanced
particle filtration in an office building in the Midwest United States in 1993.
We replaced standard particle filters, in separate ventilation systems on two
floors, with highly efficient filters on alternate floors weekly over 4 weeks.
Repeated-measures models were used to analyze data from weekly worker
questionnaires and multiple environmental measurements. RESULTS: Bioaerosol
concentrations were low. Enhanced filtration reduced concentrations of the
smallest airborne particles by 94%. This reduction was not associated with
reduced symptoms among the 396 respondents, but three performance-related
mental states improved; for example, the confusion scale decreased (-3.7%; 95%
confidence limits (CL) = -6.5, -0.9). Most environmental dissatisfaction
variables also improved; eg, "stuffy" air, -5.3% (95% CL = -10.3,
-0.4). Cooler temperatures within the recommended comfort range were associated
with remarkably large improvement in most outcomes; for example, chest
tightness decreased -23.4% (95% CL = -38.1, -8.7) for every 1 degrees C
decrease. CONCLUSIONS: Benefits of enhanced filtration require assessment in
buildings with higher particulate contaminant levels in studies controlling for
temperature effects. Benefits from lower indoor temperatures need confirmation.
5139.
Park HS, Frew
AJ. Genetic markers for occupational asthma. J Allergy Clin Immunol. 2002
May;109(5):774-6. Review. No abstract.
5140.
Plaud B,
Donati F, Debaene B. Anaphylaxis during anaesthesia. Br J Anaesth. 2002
Apr;88(4):604-5; discussion 605-6. No
abstract.
5141.
Rauh VA, Chew
GR, Garfinkel RS. Deteriorated housing contributes to high cockroach allergen
levels in inner-city households. Environ Health Perspect. 2002 Apr;110 Suppl
2:323-7.
The high prevalence of childhood asthma in low-income,
inner-city populations is not fully understood but has been at least partly
attributed to the disproportionate exposures associated with socioeconomic
disadvantage. The contribution of indoor allergens to asthma is well
documented, but links between socioeconomic disadvantage and indoor allergen
levels are not clear. We investigated levels of cockroach allergens (Bla g 2)
in a sample of 132 Dominican or African American low-income households with
young children in northern Manhattan in New York City (40% were receiving
public assistance) to determine whether the distribution of allergens is a
function of housing deterioration. Deterioration was measured by the presence
and number of physical housing problems (holes in the ceilings and walls, water
damage, etc.). More than 50% of the sample had two or more types of housing
dilapidation, and 67% of the sample reported cockroach sightings in their
homes. Samples of dust were collected from kitchen and bedroom surfaces. We
hypothesized that the greater the dilapidation, the higher the allergen levels,
independent of income, sociocultural factors, and pest-control methods. In
addition, we hypothesized that the homes of families characterized by frequent
moves (23.5%) would have higher allergen levels than more stable families.
Results showed significant positive associations between housing deterioration
and allergen levels in kitchens, after adjusting for income and ethnicity, with
independent effects of residential stability (p< 0.05). Bedroom allergen
levels were associated with housing instability (p < 0.01) and ethnicity
(p< 0.01). Findings demonstrated that indoor household allergen levels are
related to degree of household disrepair, after adjusting for individual family
attributes, suggesting that social-structural aspects of housing may be
appropriate targets for public health interventions designed to reduce allergen
exposure.
5142.
Ravenna F,
Caramori G, Panella GL, Papi A, Benea G, Adcock IM, Barnes PJ, Ciaccia A. An
unusual case of congenital short trachea with very long bronchi mimicking
bronchial asthma. Thorax. 2002 Apr;57(4):372-3.
Case reports of a short trachea with early branching of the main
bronchi are uncommon. The case is presented of a 64 year old woman with upper
airway obstruction due to this anatomical abnormality which caused
breathlessness and wheezing that was misdiagnosed (and treated) as bronchial
asthma for many years.
5143.
Sicherer SH.
Clinical update on peanut allergy. Ann Allergy Asthma Immunol. 2002
Apr;88(4):350-61; quiz 361-2, 394. Review.
BACKGROUND: Peanut allergy is common, potentially severe, and
there has been a recent surge in clinical investigation of this important food
allergen. OBJECTIVE: To provide the reader with a clinically oriented update on
peanut allergy. DATA SOURCES: English language articles were selected from
PubMed searches (search terms: peanut allergy, food allergy, anaphylaxis) and
selected abstracts with a bias toward recent (3 years) studies judged to have
immediate, practical clinical implications. RESULTS: Peanut allergy is an
increasing problem in western diets that include this food. Both genetic and
environmental factors influences the expression of this allergy. The at-risk
subject is an atopic individual, with heightened risk for those with atopic
dermatitis and/or other food allergies. The allergy is long-lived for most, may
increase slightly in severity over time, but approximately 20% of young
children will develop tolerance. Parameters that may identify the subset likely
to achieve tolerance have been identified. Several large studies have
determined laboratory parameters (skin tests, peanut-specific serum
immunoglobulin E concentrations) with excellent predictive value (>95%) to
diagnose current clinical reactivity or tolerance, although oral food
challenges are necessary for a definitive diagnosis. Numerous practical lessons
concerning management (avoidance, treatment, and prevention) have been
identified. CONCLUSIONS: Recent studies provide the clinician with an armament
of improved diagnostic and treatment modalities for peanut allergy. Studies are
underway that are likely to provide more definitive therapies in the near
future.
5144.
Stephenson
J. Scientists find some genes a bad
omen for anti-HIV drug. JAMA. 2002 Apr 3;287(13):1637. No
abstract.
5145.
Uehara M,
Sugiura H, Tanaka K. Rarity of hypertension in adult patients with atopic
dermatitis. Br J Dermatol. 2002 Apr;146(4):631-5.
BACKGROUND: Patients with atopic dermatitis show a tendency for
vasoconstriction of the small vessels in the skin. As peripheral
vasoconstriction contributes to the cause of hypertension, it is natural to
suppose that blood pressures might be on the high side in adult patients with
atopic dermatitis. In the literature, however, there was little information on
the subject. OBJECTIVES: To study the incidence of hypertension in adult patients
with atopic dermatitis. PATIENTS/METHODS: Blood pressure was measured in 521
adult patients with active atopic dermatitis (235 males; 286 females) aged
30-59 years, and 87 adults with "healed" atopic dermatitis (26 males;
61 females) aged 34-52 years. The blood pressures were classified as definite
hypertension, borderline hypertension or normal blood pressure. RESULTS: In
those patients aged 30-39 years with active atopic dermatitis, the incidence of
definite hypertension in the male patients and the female patients was 1.1% and
1.6%, respectively. The incidence remained almost at a plateau for the
30-39-year-old age group through to the 50-59-year-old age group, in both the
male and female patients. There was no difference in the incidence of definite hypertension
between patients with severe dermatitis and patients with mild dermatitis.
Adult patients with "healed" atopic dermatitis also showed a low
incidence of definite hypertension. CONCLUSIONS: These findings indicate that
hypertension is rare in adult patients with atopic dermatitis. It is most
probable that the rarity of hypertension is a primary feature of the disease.
5146.
Varner AE.
The increase in allergic respiratory diseases: survival of the fittest? Chest.
2002 Apr;121(4):1308-16. Review.
The prevalence of allergic respiratory diseases, asthma and
allergic rhinoconjunctivitis, has increased since the advent of
industrialization. The inverse relationship between the number of infections
early in life and atopy has been interpreted as the "hygiene hypothesis."
That is, many infections early in life promote the development of T helper type
1 cytokines, while fewer infections early in life favor the development of T
helper type 2 (Th2) cytokines and atopy. An alternate interpretation of the
same data, that atopy is protective against infections early in life, is rarely
considered. With epidemiologic, historical, and immunologic data, I suggest
that human evolution has favored individuals with an atopic predisposition. Th2
immune responses promote parity, and ensure successful pregnancy and term
birth; provide the infant protection against infections and the inflammation
induced by common pathogens in the
first years of life until the immune system matures; and protect young adults
exposed to viral respiratory pathogens. These traits are of particular value
with the advent of industrialization, especially so in the era prior to the
development of antibiotics. This theory contradicts the assumption that there
is no biological or evolutionary advantage for allergic disease to exist in
humans and has significant implications for our current and future treatments
of allergic diseases.
5147.
Woodruff PG,
Fahy JV. A role for neutrophils in asthma? Am J Med. 2002 Apr
15;112(6):498-500. No abstract.
Vaccines :
5148.
Smits AJ, Hak
E, Stalman WA, van Essen GA, Hoes AW, Verheij TJ. Clinical effectiveness of
conventional influenza vaccination in asthmatic children. Epidemiol Infect.
2002 Apr;128(2):205-11.
Influenza immunization rates among young asthmatics remain
unsatisfactory due to persistent concern about the impact of influenza and the
benefits of the vaccine. We assessed the effectiveness of the conventional
inactivated trivalent sub-unit influenza vaccine in reducing acute respiratory
disease in asthmatic children. We conducted a two-season retrospective cohort
study covering the 1995-6 and 1996-7 influenza outbreaks in 22 computerized
primary care practices in The Netherlands. In total, 349 patients aged between
0 and 12 years meeting clinical asthma-criteria were included; 14 children were
lost to follow-up in the second season. The occurrence of physician-diagnosed
acute respiratory disease episodes including influenza-like illness, pneumonia.
bronchitis, bronchiolitis, asthma exacerbation and acute otitis media in vaccinated
and unvaccinated children were compared after adjustments for age, prior health
care and medication use. The occurrence of acute respiratory disease in
unvaccinated children was 28% and 24% in the 1995-6 and 1996-7 season,
respectively, and was highest in children under 6 years of age (43%). The
overall pooled clinical vaccine effectiveness was 27% (95% confidence interval
-7 to 51%, P = 0.11) after adjustments. A statistically higher vaccine
protectiveness of 55% (95% CI 20-75%, P = 0.01) was observed among asthmatics
under 6 years of age compared with -5% in older children (95% CI -81 to 39%).
The occurrence of acute respiratory disease among asthmatic children during
influenza epidemics is very high, notably in the youngest. Influenza vaccination
may reduce morbidity in asthmatic infants and pre-school children. However,
larger, preferably experimental, studies are needed to establish the benefits
of vaccination, notably in older asthmatic children.