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Notes: Jakobsson T, Croner S, Kjellman N-IM, Pettersson A, Vassella C, Björkstén B. Slight steroid-sparing effect of intravenous immunoglobulin in children and adolescents with moderately severe bronchial asthma.Twenty subjects (aged 6-20 years) with moderately severe bronchial asthma participated in an open controlled trial with intravenous immunoglobulin (IVIG) given as five monthly infusions with a mean dose of 0.8 g/kg body weight. A follow-up was performed 4 and 14 months after the treatment period. Nine of 14 children in the treatment group completed the trial. Two children experienced severe headache after the first infusion, another two patients were taken off the study for reasons unrelated to the IVIG therapy, and one patient dropped out from lack of motivation. In six of the IVIG-treated children, there was a reduction in the daily intake of inhaled steroids at an unchanged or reduced histamine reactivity. Of the remaining three children, two showed a reduction in bronchial hyperreactivity, but their steroid dose was not reduced. Six patients participated in a reference group to determine seasonal variations of symptoms. One of them improved during the study period, and the condition of the other five deteriorated, as indicated by increased medication without reduced histamine reactivity. After 14 months, there were no significant differences in clinical symptoms, nor in sensitivity to histamine between the treated patients and the controls, as the condition had improved also in the latter. We have thus been able to confirm, in a group larger than those in previously published reports, some clinical improvement of asthma by IVIG therapy at a lower dose than previously used and in children with only moderately severe disease. The effect was still present 4 months after the termination of IVIG therapy but not after 14 months. As the effects were small and temporary and the treatment is complicated and expensive, IVIG therapy cannot at present be recommended for general use. A double-blind, placebo-controlled study of the effect of IVIG in asthma is needed.

Notes: Metachromatic cells in the nasal mucosa were studied in relation to symptoms in 16 schoolchildren and 11 adults with hay fever who were challenged with pollen outside the pollen season, using either a gentle scraping-cytocentrifugation method for collection of mucosal specimens or biopsies. There was a temporary redistribution of metachromatic cells towards the mucosal surface appearing 5–24 h after challenge, with a correlation between the quantity of metachromatic cells and symptom scores. Thus, a single exposure to high doses of allergen may contribute to priming in susceptible individuals.

Notes: Polymorphonuclear leucocyte (PMN) function was studied in pregnant women and related to the serum concentration of pregnancy zone protein (PZP) and to mixed lymphocyte culture (MLC) reactivity. Neutrophil chemotaxis was depressed in pregnant women. Pregnancy serum inhibited the MLC-reaction. The serum levels of PZP were inversely related to chemotactic responsiveness (P〈0.05) and depression of MLC reactivity (P〈0.01). The capacity to reduce nitroblue tetrazolium was depressed in PMNs from pregnant women, and pregnancy scrum inhibited phagocytosis of Escherichia colt by control PMNs. Neutrophils from pregnant women showed increased chemiluminescence during phagocytosis of zymosan. The results may be explained by depression of ingestion by pregnancy serum and increased oxidative metabolism in PMNs from pregnant women.

Notes: Cord blood IgE was assayed in 164 newborn babies from the United Arab Emirates. The serum IgE levels ranged between ≤0.1–13.5 kU/1 with a geometric mean of 0.28 kU/1. The cord blood IgE in the 89 babies without immediate family history of allergy was ≤0.1–3.2 kU/1 with a geometric mean of 0.25 kUA and 1.13 kU/1 as the 90th percentile. An influence of prenatal sensitization to helminth antigens on cord blood IgE level was not likely. The data are similar to cord blood IgE values reported in other populations. This indicates that ethnic differences do not influence cord blood IgE levels and that previously published studies on the predictive value of cord blood IgE determination in Caucasians are relevant also for other populations.

Notes: Development of atopic disease was prospectively studied in 148 children from birth to the age of 18 months and related to serum levels of IgG anti-IgE antibody. Children with a dual heredity of allergy, but remaining healthy, had significantly higher IgG anti-IgE levels at birth than children with a similar predisposition to allergy, who became allergic. Children with increased allergy risk, defined by elevated IgE levels at birth (〉= 0.53 kU/l) and with probable allergy symptoms had also significantly higher IgG anti-IgE levels at birth than children of the same risk group, developing definite allergy. Independent of allergy risk, there was a significantly lower prevalence of atopic disease in children with cord serum levels of IgG anti-IgE above 350AU.1 than in children with lower levels. Additionally, we showed that the allergy predictive capacity of IgE levels in cord serum was slightly improved in specificity, sensitivity and efficiency by including not only the family history of allergy, but also cord serum levels of IgG anti-IgE. Our results thus raise the possibility that high levels of IgG anti-IgE protect children of increased allergy risk from early development of atopic disease and reduce the severity of symptoms.

Notes: Allergic sensitization and symptoms from the airways in relation to air pollution were compared in 10–12-year-old school children (n= 1113) from urban Konin in central Poland and both urban and rural parts of Sundsvall in northern Sweden. The measurements included parental questionnaires, skin-prick tests and serial peak flow measurements during 2 weeks with simultaneous monitoring of outdoor air pollutants. The skin-prick test technique was validated by IgE antibody determinations. The levels of common industrial pollutants, SO2 and smoke particles were much higher in Konin than in urban Sundsvall and the levels of NO2 were similar. Various respiratory symptoms were more often reported among school children in Konin (except for wheezing and diagnosed asthma). Multiple logistic regression analyses yielded the following increased odds ratios for children in Konin as compared with the reference group (rural Sundsvall): chest tightness and breathlessness 348 (95% confidence interval 2.08–5.82), exercise-induced coughing attacks 3.69 (95% confidence interval 1.68–8.10), recurrent episodes of common cold 2.79 (95% confidence interval 1.53–5.09) and prolonged cough 4–89 (95% confidence interval 2.59–9.23). In contrast, as compared with rural Sundsvall, the adjusted odds ratio for a positive skin-prick test was decreased in Konin, but increased in urban Sundsvall, 0.58 (95% confidence interval 0.37–0.91) and 1.67 (95% confidence interval 1.15–2.42) respectively. The study confirms that living in urban, as compared with rural areas, is associated with an increased prevalence of respiratory symptoms and sensitization to allergens. These differences could be explained by air pollution. Respiratory symptoms were more common in a similar urban group of Polish children who were exposed to even higher levels of air pollution. These children, however, had a much lower prevalence of sensitization to allergens, as compared with the Swedish children. This indicates that differences in lifestyle and standard of living between western Europe and a former socialist country influences the prevalence of atopy.

Notes: The role of aluminium for IgG and IgE responses to pertussis toxin (PT), as well as for side effects, was investigated in 49 children with known atopy status. Primary immunization had been given with an adsorbed monocomponent or an adsorbed two-component acellular pertussis vaccine. The children were then randomized to receive a booster immunization with either aluminiumadsorbed or non-adsorbed, whole cell, pertussis vaccine. Both vaccines induced good IgG responses with the adsorbed vaccine giving higher post-booster levels (p 〈 0.05). The adsorbed vaccine was, however, associated with more local side effects (p 〈 0.05) and tended to induce higher PT-IgE responses than the non-adsorbed vaccine. Furthermore, individuals who had received the two-component vaccine as primary immunization had higher PT-IgE responses after the booster, compared with individuals initially receiving the monocomponent vaccine (p = 0.041). No correlation between PT-IgE and PT-IgG levels was seen in any of the groups. Total serum IgE levels correlated to PT IgE levels, particularly in children with atopy (r = 0.950, p 〈 0.001). The addition of aluminium to the pertussis vaccine, was, thus, associated with a stronger IgG antibody response, but tended also to induce a stronger IgE antibody response. The correlation between total IgE and PT-IgE, which was most prominent in children with atopy, indicates that the role of immunization for the development of allergy merits further studies.

Notes: Allergenicity and antigenicity of various commercially available cow milk hydrolysates intended for infant feeding were analysed in 45 children with cow milk allergy. The hydrolysates included the whey hydrolysates Beba HA® (Good Start HA®) and Profylac®, and the casein hydrolysates Alimentum® and Nutramigen®. Positive skin prick tests were recorded against Beba HA in 10 of 41 tested children (24%), against Profylac® in 5/34 (15%) and in one each (2.5%) against Alimentum and Nutramigen. Double-blind placebo-controlled oral challenge tests were performed in 11 children with cow milk allergy using Alimentum, cow milk (positive control) and their regular well-tolerated formula (Nutramigen or soy) used as negative control. One child reacted to Alimentum. This patient was the only one with circulating antibodies against the product, as indicated by a positive RAST. High density SDS-PAGE electrophoresis showed that Beba HA contained a number of unresolved proteins, and non-degraded or partially degraded whey proteins in the range of 5–20 kD. Profylac contained strongly stained protein material in the low molecular weight region 1–10 kD. No protein bands could be identified in the casein-based hydrolysates. Residual antigenicity was tested by measuring the content of betalactoglobulin in the hydrolysates. Three of the hydrolysates contained 〈 0.06 μg/g dry weight, while the concentration in Beba HA was 200 μg/g dry weight. Positive RAST against Beba HA was detected in 11/45 sera (24%) compared to 7–13% against the other hydrolysates. RAST inhibition with the hydrolysates using cow milk discs was very low for all of them. Using dot immuno-binding assay a weak IgE binding with Alimentum was detected in 4 sera, Beba HA and Profylac in each 2 sera and with Nutramigen in one. The data taken together show that all 4 tested hydrolysates retain some allergenicity. There were differences between the products, one of the whey hydrolysates being substantially more allergenic and antigenic than the other tested formulas. The casein hydrolysate Alimentum showed few reactions in vivo and in vitro in this selected group of children but one child reacted when challenged with Alimentum, indicating that there is a risk for general reactions when using any hydrolysed product in subjects allergic to cow milk.

Notes: The appearance of metachromatic cells in nasal scrapings was studied prospectively in 67 children from birth to 18 months of age. The findings were related to family history of atopy and development of allergic disease in the infants. Allergic disease was diagnosed during the 18-month follow-up period in 54% of the infants with heredity for atopic disease. The corresponding figure for children with no heredity was 11%. Using a gentle scraping-cytocentrifugation method for collection of mucosal specimens, metachromatic cells were identified in the nasal scrapings in 20 of 30 children who developed definite allergic disease (67%) and in 6 of 9 with probable allergy. The cells appeared before or at the time of diagnosis in 19 of the infants with definite allergic disease. Metachromatic cells were also found in 7 of 25 healthy children who did not develop allergic disease during the follow-up period. Six of them had definite and one possible heredity for allergic disease. No metachromatic cells were found in any of the 8 infants who lacked heredity for atopy and did not develop atopic disease. In conclusion, the appearance of metachromatic cells in the nasal mucosa during the first 18 months of life of infants was associated with atopic propensity, as defined by development of atopic disease and/or a strong family history of allergy.