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  • Munksgaard International Publishers  (2,579)
  • 2005-2009  (2,259)
  • 1990-1994  (320)
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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A rising prevalence of food hypersensitivity (FHS) and severe allergic reactions to food has been reported the last decade. To estimate the prevalence of FHS to the most common allergenic foods in an unselected population of children and adults. We investigated a cohort of 111 children 〈3 yr of age, 486 children 3 yr of age, 301 children older than 3 yr of age and 936 adults by questionnaire, skin prick test, histamine release test and specific immunoglobulin E followed by oral challenge to the most common allergenic foods. In total, 698 cases of possible FHS were recorded in 304 (16.6%) participants. The prevalence of FHS confirmed by oral challenge was 2.3% in the children 3 yr of age, 1% in children older than 3 yr of age and 3.2% in adults. The most common allergenic foods were hen's egg affecting 1.6% of the children 3 yr of age and peanut in 0.4% of the adults. Of the adults, 0.2% was allergic to codfish and 0.3% to shrimp, whereas no challenges with codfish and shrimp were positive in the children. The prevalence of clinical reactions to pollen-related foods in pollen-sensitized adults was estimated to 32%. This study demonstrates the prevalence of FHS confirmed by oral challenge to the most common allergenic foods in an unselected population of children and adults.
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  • 3
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Cysteinyl leukotrienes (CysLTs) contribute to the development of airway obstruction and inflammation in asthma; however little information is available on the role of these molecules in the pathophysiology of respiratory syncytial virus (RSV) bronchiolitis. This study was designed to evaluate the effects of RSV infection on CysLTs production in a well-established mouse infection model. Furthermore, we assessed the effect of anti-inflammatory agents (a leukotriene receptor antagonist, MK-571, and dexamethasone) on the functional and immune changes induced by RSV infection. Six to 8-wk-old BALB/c mice were infected with human RSV (strain A2). Measurements of airway function were performed using whole body plethysmography. Lung inflammation was assessed by cell counts, measurement of cytokines and CysLTs in bronchoalveolar lavage fluid (BALF) in the absence and presence of treatment with MK-571 or dexamethasone. RSV infection produced a marked increase in CysLTs in the BALF and lung tissue, recruitment of neutrophils and lymphocytes into the airways, increased IFN-γ levels and airway hyperresponsiveness (AHR). Treatment with MK-571 decreased RSV-induced AHR without affecting the cellular and inflammatory responses to RSV. Dexamethasone decreased AHR and markedly reduced the recruitment of inflammatory cells and production of IFN-γ. Our findings suggest CysLTs play an important role in the pathogenesis of RSV-induced airway dysfunction. Treatment with MK-571 decreases RSV-induced AHR but does not appear to alter the lung inflammatory responses to RSV. In contrast, dexamethasone decreases RSV-induced AHR but interferes with recruitment of inflammatory cells, resulting in decreased Th1 cytokines (a potentially Th2-prone environment) in this model. These studies support recent reports on the beneficial effects of CysLT receptor antagonist in human trials and provide a model for investigating the role of CysLTs in RSV bronchiolitis.
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  • 4
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study aims to assess the relationship among incidence of tuberculosis and measles, in the general population, within the year of birth and the prevalence of asthma, rhinoconjunctivitis and atopic eczema in teenagers from different Brazilian cities enrolled in the International Study of Asthma and Allergies in Childhood (ISAAC) phases I and III. Positive answers to the questions: ‘Have you had wheezing or whistling in the chest in the past 12 months?’, ‘In the past 12 months, has this nose problem been accompanied by itchy-watery eyes?’ and ‘Has this itchy rash at any time affected any of the following places: the folds of the elbows, behind the knees, in front of the ankles, under the buttocks, or around the neck, ears or eyes?’ identified the teenagers with asthma, rhinoconjunctivitis, and atopic eczema, respectively. The incidence of tuberculosis and measles, in the general population, observed in the year of birth of the enrolled teenagers (1981/82 and 1988/89) were obtained from governmental agencies: National Foundation of Health (FUNASA) and Brazilian Institute of Geography and Statistics (IBGE). They were compared with the prevalence of asthma, rhinoconjunctivitis and atopic eczema reported in both ISAAC phases I and III. Although we observed reduction of the incidence of tuberculosis and measles in the general population in all cities, the prevalence of asthma, rhinoconjunctivitis and atopic eczema remained stable in most of the centers. In Pernambuco and Paraná, there has been a significant increase in the prevalence of rhinoconjunctivitis. These data do not corroborate the findings of an inverse relationship between the prevalence of atopic diseases and the decreasing incidence of tuberculosis and measles.
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  • 5
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Allergen-specific immunotherapy (IT) has been effectively used for the treatment of asthma. Allergen specific IT induced immune tolerance with induction of TH2 cells anergy remain to be clarified. The aim of this study was to evaluate whether the mite allergen Dermatophagoides pteronyssinus (Dpt) specific IT serially decreased IL-4+/CD4+ (TH2) lymphocytes and induced apoptosis of TH2 lymphocytes in asthmatic children. Sixty Dpt-sensitive asthmatic children were randomly assigned to a received IT and an untreated group. Dermatophagoides pteronyssinus specific IT treated patients were examined at three time points: before IT, after 6 months of an increased dose phase and with maximum tolerated doses after 1 yr. Peripheral blood mononuclear cells (PBMC) were isolated and cultured for 48 h for cellular staining with CD4+, CD45RO cell phenotypes and interleukin (IL)-4 and interferon-γ expression by fluorescence monoclonal antibodies. Apoptosis was measured using the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling (TUNEL) method. A simultaneous flow cytometric study using the same permeabilized cell was examined to determine whether apoptosis occurred preferentially in TH2 lymphocytes. The data demonstrated that Dpt specific IT decreased Dpt-specific IgE levels (p 〈 0.01) after 1 yr of treatment. In addition, decreased CD4+IL-4+ TH2 cells with increased CD4+IFN-γ+ TH1 cells were observed at 6 months and 1 yr after IT treatment (p 〈 0.05). At the same time, apoptosis of CD4+IL-4+ TH2 lymphocytes in the IT group had increased after 1 yr of treatment when compared with the results before treatment (p 〈 0.001) and after 6 months of treatment (p = 0.046). In addition, CD45RO cells apoptosis mainly occurred after 6 months of IT treatment and after 1-year period of IT treatment (p 〈 0.05). All of the data suggested that Dpt specific IT decreased Dpt specific IgE and CD4+IL-4+ TH2 lymphocytes with induction apoptosis of CD4+IL-4+ TH2 lymphocytes subsets serially.
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  • 6
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The etiology of allergy is multifactorial, with many variables contributing to the final expression of atopic disease. Three breeding grounds are needed to develop allergic disease: the appropriate genetic background, contact with the allergen(s) and environmental factors. Timing and dosing of allergen(s) are of major importance. Contact with (dietary) allergens and various agents such as tobacco smoke and infections occur not only during post-natal life, but also perinatally and even pre-natally. A critical review of published evidence regarding the impact of maternal exposure to antigens during pregnancy on later development of allergy in the offspring can only conclude that more research is urgently needed. Contact with multiple dietary allergens should be in general of benefit to the fetus to develop tolerance. Current knowledge suggests that pregnant women should have a normal diversified diet, avoiding toxic agents such as tobacco and alcohol. The role of maternal intake of poly-unsaturated fatty acids on the development of atopy in the infants needs to be further evaluated. If parental history would be insufficient to determine the fetal risk, preventive measurements would be advisable for all fetuses.
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  • 8
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study aimed to compare the efficacy of nebulized therapy with salbutamol alone or in combination with fluticasone. In a randomized, double-blind clinical trial, 150 children with moderate acute asthma were randomly assigned to receive by nebulizations either (i) three doses of salbutamol 30 μl/kg per dose, each dose administered every 15 min, (ii) three doses of salbutamol plus two doses of fluticasone 500 μg/dose at 15 and 30 min after first dose of salbutamol, or (iii) three doses of salbutamol/fluticasone 500 μg/dose, each combined dose administered every 15 min. Pulse oxymetry (SaO2), peak expiratory flow (PEF) and Wood et al. (Am J Dis Child, 123, 1972, 123) clinical scale were evaluated at baseline, 15, 30, 45, 60, 90 and 120 min after the first nebulization. Patients in the three groups significantly improved since 15 min after the first nebulization. We did not observe differences in the recovery of SaO2 and PEF among the three groups of treatment (p 〉 0.10). In group 3, children showed better clinical response at 120 min than the other two groups (p 〈 0.05). No significant adverse effects were observed with any treatment. To summarize, in children with acute moderate asthma, nebulized salbutamol at an accumulated dose of 90 μl/kg plus fluticasone at an accumulated dose of 1500 μg produced better clinical relief after 2 h. However, similar PEF and SaO2 responses were observed with salbutamol alone or in combination with different doses of fluticasone.
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  • 9
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Ataxia telangiectasia (AT) is an infrequent condition, which is difficult to diagnose in children. The objective was to describe the evolution of all affected patients controlled in our hospital and to highlight the keys for an early diagnosis considering the variability of immunological disorders. The present study is a retrospective review of all patients diagnosed and controlled of AT in our hospital. Twelve patients were found, including two couples of siblings. The most frequent reason for consultation was unstable gait. Seven patients suffered repeated infections, being pneumonia the most frequent cause of infection, followed by sinusitis. One of the patients developed Burkitt's lymphoma, and another patient, Hodgkin's lymphoma, which caused the death of the patient at the age of 11. A couple of siblings aged 17 and 22 years developed insulin-resistant diabetes mellitus. The most frequent immunity disorders were the IgG deficiency and the decrease of T lymphocytes. Seven patients were treated with non-specific gamma-globulin. By the end of the follow-up, 8 patients (ages ranged 7 to 12 years) lost gait. Molecular genetic testing was conducted in patients who are still cared for in our hospital. Clinical suspicion of this entity will lead to an early diagnosis, the treatment of complications, and to provide genetic counselling for the families.
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  • 10
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Good household hygiene practices may improve indoor air quality in the domestic environment. Conversely, a ‘hygiene hypothesis’ is challenging the importance of hygiene and sanitation at home. This study aims to investigate the relationship between household hygiene practices and dampness at home and current wheezing, asthma and other allergic conditions among Australian children. Nine hundred and ninety-six children from four primary schools in Perth, Western Australia, were recruited for a domestic environmental and health survey during March and April of 2002. The results showed that high cleanliness scores were negatively associated with moulds at home before and after adjustment for age of dwelling (p 〈 0.001). High ventilation scores were inversely related with damp patches, condensation and moulds at home (p 〈 0.05). However, households with high cleanliness scores appeared to have significantly higher prevalence of current wheezing (p 〈 0.05) and current rhino-conjunctivitis (p 〈 0.05) in children. The association remained even after controlling for confounders such as age and gender of children, asthma history of parents, passive smoking and dampness at home.
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  • 11
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Peanut allergy has been associated with the intake of soy milk or a soy formula. We studied the development of immunoglobulin E antibodies specific to soy and peanuts and of allergic reactions caused by peanuts, in children with confirmed cow's milk (CM) allergy fed either a soy formula or an extensively hydrolyzed formula (EHF). One hundred and seventy infants with documented CM allergy (CMA) were randomly assigned to receive either a soy formula or an EHF. The children were followed to the age of 4 yr. Peanut-specific immunoglobulin E was measured at the age of 4. A detailed history of the occurrence of allergic reactions caused by peanuts was recorded by the parents. Soy-specific immunoglobulin E antibodies were measured at the time of diagnosis and at the ages of 1, 2 and 4 yr. Immunoglobulin E antibodies to soy (≥0.35 kU/l) were found in 22 of 70 children fed the soy formula, and in 14 of 70 of the children fed the EHF (p = 0.082). In an open challenge with soy at the age of 4, no immediate reactions were observed. One of 72 children from the soy group had a delayed reaction. immunoglobulin E antibodies to peanuts (≥0.35 kU/l) were found in 21 of 70 children fed the soy formula and 17 of 69 infants fed the EHF (p = 0.717). The incidence of reported peanut allergy in the soy group was two of 72 (3%) and four of 76 (5%) in the EHF group (p = 0.68). Development of immunoglobulin E-associated allergy to soy and peanuts was rare in our study group of milk allergic children. The use of a soy formula during the first 2 yr of life did not increase the risk of development of peanut-specific immunoglobulin E antibodies or of clinical peanut allergy.
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  • 12
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Non-specific bronchial hyper-responsiveness has been reported in most of the eczematous children even in the absence of asthmatic symptoms. We therefore investigated the occurrence of exercise-induced bronchoconstriction (EIB) in children with atopic eczema (AE) and the predictors of EIB. Fifty-five children referred to the paediatric clinic for AE and a control group of 17 healthy children were recruited. They all carried out a physical examination and skin prick test (SPT) both to inhalant and food allergens, prior to the exercise challenge test. Their parents filled a questionnaire on atopic diseases. They underwent exercise challenge test that consisted in free running for 6 min. Spirometric measurements were carried out before running and till 11 min after. Exercise challenge test was positive in 13 (23%) children with AE. None of the children in the control group had a positive exercise challenge test [OR (95% CI) = 1.31 (1.13–1.51); p = 0.030]. Sixteen (29%) eczematous children had a history of EIB. Such history was not reliable for identifying children who had a positive exercise test. Twenty-nine (52%) children with AE had asthma. Allergic rhinitis affected 33 (60%) of eczematous children and allergic conjunctivitis 28 (50%). EIB was not related to any history of asthma, allergic rhinitis, allergic conjunctivitis, severity of eczema or SPT results. Our study shows that EIB is common in children with AE. Our data also indicate that screening by medical history and physical examination is not a sensitive marker of EIB. This may explain why EIB is often ignored in eczematous children.
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  • 13
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Occupational asthma (OA) is one of the leading causes of pulmonary diseases and has been extensively studied in adults. Childhood employment, a significant problem in many developing countries, should be studied to determine and evaluate its effects on psychosocial and lung health. In order to investigate the presence of work-related asthma-like symptoms and OA in apprentice adolescent car painters, 72 adolescents between the ages of 15–20 yr studying in Vocational Training Centres of Ankara were investigated using questionnaire, pulmonary function test (PFT), serial peak expiratory flow (PEF) measurements and methacholine inhalation tests. As a control group, 72 adolescents studying in Industrial and Commercial Training Centres located in the same environment were investigated with questionnaire and PFT. Almost 50% of the study group had work-related asthma-like symptoms for which occupational dermatitis history was predictive [odds ratio: 2.9 (1.026–8.13) (95% confidence interval)]. Seventeen of 22 with serial PEF measurements showed a variability of ≥20% and three (4.2%) of 12 tested with methacholine inhalation test had a PC20≤8 mg/ml, which led to the diagnosis of OA. There was no statistically significant difference between study and control groups in terms of PFT. In conclusion, the high prevalence of work-related asthma-like symptoms among adolescent car painters clearly indicates the need for routine follow-up of adolescent workers for lung health.
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  • 14
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The neonatal immune system is immature and may be affected by Bacillus Calmette-Guèrin (BCG) vaccine. We investigated the influence of BCG given at two different ages on the peripheral blood (PB) T-cell subpopulations. Forty full term healthy newborns were randomly chosen. Twenty of them were vaccinated with BCG at birth (group I) and the remaining at the age of 2 months (group II). The cell analysis were carried out before (pre-BCGI and pre-BCGII), and 2 months after (post-BCGI and post-BCGII) the vaccination. The analysis of the gamma/delta and alpha/beta T-cell receptor (TCR) antigens was done by two-colour flowcytometer. The purified protein derivative (PPD) response was investigated 2 months after vaccination. The results showed that although T-cell (TCR+ cell) counts showed no difference in PB before and after vaccination in both study groups, the total lymphocyte and non-T cell (TCR− cell) populations increased significantly whereas αβT-cell population significantly decreased after vaccination. On the contrary, γδT-cell counts in PB increased significantly 2 months after vaccination in group I but not in group II. Total lymphocyte and non-T cell counts in vaccinated infants at 2 months of age (post-BCGI) were significantly higher than in unvaccinated infants of the same age whereas αβT-cell count in vaccinated infants was significantly low. However, total T-cell and γδT-cell counts showed no difference. PPD positivity was similar in both study groups (61% in group I, 66% in group II). Neither αβT- nor γδT-cell counts were different in PPD positive and PPD negative infants. Our study shows that BCG causes marked quantitative changes in the PB T-cell subpopulations in young infants.
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  • 15
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Actinidia chinensis (gold kiwi) is a newly available fruit which has been shown to have in vitro immunoglobulin E (IgE) cross-reactivity with green kiwi. This is the first study to investigate clinical reactivity of gold kiwi. Five patients clinically allergic to green kiwi were investigated by skin test and double-blind placebo controlled food challenge (DBPCFC) with gold kiwi fruit. IgE-binding patterns of individual sera from the five challenged patients and a pool of sera from a further nine patients with kiwi allergy were compared in the two fruits by Western blotting. Cross reactivity of proteins in the two fruits was assessed by inhibition of immunoblots and by IgE enzyme-linked immunosorbent assay (ELISA) inhibition. Four of the five patients had a positive DBPCFC to gold kiwi. Western blotting showed marked differences in the allergen patterns of green and gold kiwi. However, inhibition of the immunoblots and ELISA assay reveals extensive inhibition of IgE binding to proteins in each fruit by the alternative species. Gold kiwi fruit is allergenic and patients allergic to green kiwi are at risk of reacting to the gold kiwi fruit. Despite having different protein profiles and IgE-binding patterns, the two species have proteins that extensively cross-inhibit the binding to IgE.
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  • 16
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Suboptimal immune responses to vaccination have been suggested among atopic infants. The aim of this study was to assess the influence of atopy and atopic asthma on the humoral response to Bordetella pertussis vaccination. Immunoglobulin (Ig)G and IgA specific antibodies were measured by enzyme linked-immunosorbent assay in 102, 10-yr-old atopic children (66 of them also being asthmatics) and compared with 76 non-atopic and 53 non-atopic non-asthmatic controls of similar age. The levels of antibodies and the percentage of positives to B. pertussis were comparable in all groups. Children with a very high total serum immunoglobulin (Ig)E (Percentile (Pct) 〉 90th) showed higher (p = 0.01) IgG pertussis antibodies than children with very low serum IgE (Pct 〈 10th). In conclusion, we found normal pertussis antibody levels in atopic and in atopic asthmatic children in late childhood, thus overriding any possible suboptimal response during infancy.
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  • 17
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 18
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 19
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 20
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The aim of the KOALA Birth Cohort Study in the Netherlands is to identify factors that influence the clinical expression of atopic disease with a main focus on lifestyle (e.g., anthroposophy, vaccinations, antibiotics, dietary habits, breastfeeding and breast milk composition, intestinal microflora composition, infections during the first year of life, and gene–environment interaction). The recruitment of pregnant women started in October 2000. First, participants with ‘conventional lifestyles’ (n = 2343) were retrieved from an ongoing prospective cohort study (n = 7020) on pregnancy-related pelvic girdle pain. In addition, pregnant women (n = 491) with ‘alternative lifestyles’ with regard to child rearing practices, dietary habits (organic, vegetarian), vaccination schemes and/or use of antibiotics, were recruited through organic food shops, anthroposophic doctors and midwives, Steiner schools, and dedicated magazines. All participants were enrolled between 14 and 18 wk of gestation and completed an intake questionnaire on family history of atopy and infant care intentions. Documentation of other relevant variables started in the pregnant mother and covered the first and third trimester as well as early childhood by repeated questionnaires at 14–18, 30, and 34 wk of gestation and 3, 7, 12, and 24 months post-partum. A subgroup of participants, including both conventional and alternative lifestyles, was asked to consent to maternal blood sampling, breast milk and a faecal sample of the infant at 1 month post-partum, capillary blood at age 1 yr, venous blood and observation of manifestation of atopic dermatitis during home visits at the age of 2 yr (using the UK working party criteria and the severity scoring of atopic dermatitis index), and buccal swabs for DNA isolation from child–parent trios. From the start, ethical approval and informed consent procedures included gene–environment interaction studies. Follow-up at 3 and 7 months post-partum was completed with high response rates (respectively 90% and 88% in the conventional group, and 97% and 97% in the alternative group). The home visits at 2 yr of age will be completed in 2005. Preliminary results show that we have succeeded in recruiting a large population with various lifestyle choices with a fairly large contrast with regard to dietary habits (including organic foods, vegetarian diet), vaccination schemes and/or use of antibiotics. We have also been able to collect a large number of faecal samples (n = 1176) and capillary blood samples at age 1 yr (n = 956). Furthermore, a large proportion of the participants have consented with genetic studies. Mid 2006 we expect to report our first results on the relationship between the various exposures in early life and childhood atopy. An outline of the focus and design of the KOALA Birth Cohort Study is presented.
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  • 21
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The aims of this study were to define the development of sensitization and clinical allergy to multiple nut types by age, and to identify associations. This observational cross- sectional study was carried out in a tertiary level allergy clinic. Seven hundred and eighty four nut-allergic children, prospectively enrolled on first attendance with history of a type-1 allergic reaction shortly after definite nut ingestion with evidence of sensitization (presence of nut-specific IgE) by skin prick test (SPT) to peanut, Brazil, almond, hazel and walnut (positive ≥ 3 mm). Details of exposure (tolerance or allergy) to each nut were obtained. The main outcome measures were mono or multisensitization (specific IgE to one or more than one nut type, demonstrated by SPT); mono or multiallergy (clinical allergy to one or more than one nut type). By 2 yr of age at least 19% were multisensitized, and 2% multiallergic. Increasing proportions were exposed to multiple nut types with increasing age (23% at 2 yr to 73% by 10 yr) and greater proportions were multisensitized (19% at 2 yr to 86% at 5–14 yr) and multiallergic (2% at 2 yr to 47% at 14 yr). This study is the first to define the natural history of multiple nut allergies in childhood. New findings are that a large proportion of those aged 0–1 yr with nut allergy are already sensitized (have specific IgE) to multiple nut types, implying in utero or early life sensitization; those who present later in childhood are increasingly likely to be sensitized and clinically allergic to multiple nuts. This is related to increased duration of allergy and exposure to multiple nut types with age. Children with nut allergy should avoid all nut types from the onset.
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  • 22
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Asthma-like symptoms and airway hyper-responsiveness (AHR) are frequently reported in children subsequent to premature birth and bronchopulmonary dysplasia (BPD). There is limited knowledge on the mechanisms underlying these respiratory manifestations. Generally, childhood asthma and AHR is described within a context of inheritance, allergy and eosinophilic airway inflammation, and often in relation to cigarette exposures. We investigated these factors in relation to current asthma and AHR in a population-based cohort of 81 young people, born with gestational age ≤28 wk or birth weight ≤1000 g, and in a matched term-born control population. In the pre-term population, asthma and AHR were additionally studied in relation to neonatal respiratory morbidity. At follow up, more pre-term than control subjects had asthma. Forced expiratory volume in first second (FEV1) was reduced, AHR was substantially increased, and the level of the urinary leukotriene metabolite E4 (U-LTE4) was increased in the pre-term population compared to the term-born. In control subjects, asthma and AHR was associated with a pattern consistent with inheritance, allergy, airway inflammation, and cigarette exposures. In the pre-terms, asthma and AHR was either unrelated or less related to these factors. Instead, AHR was strongly related to a neonatal history of BPD and prolonged requirement for oxygen treatment. In conclusion, asthma and AHR subsequent to extremely premature birth differed from typical childhood asthma with respect to important features, and AHR was best explained by neonatal variables. These respiratory manifestations thus seem to represent a separate clinical entity.
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  • 23
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 24
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 25
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Secretory IgA in mucosal secretions has a broad protective function. The insufficient protection provided by the respiratory mucosa in children with selective IgA deficiency (sIgAD) might facilitate the development of bronchial hyper-responsiveness (BHR) and consequently asthma symptoms. This study was conducted to clarify the prevalence of BHR in sIgAD children and the relationship with atopic status. A cohort of 20 children (group A) aged 6.4–20.1 yr (median: 12.6) with sIgAD (serum IgA 〈6 mg/dl) were evaluated for BHR using inhaled hypertonic saline test as well as for atopy by skin prick testing (SPT) to eight common aero-allergens. Seventy other children with normal levels of serum IgA, but sensitized to aero-allergens (group B) and 102 with normal IgA and negative SPTs (group C) were also evaluated. Baseline spirometry demonstrated that forced vital capacity (FVC) values in group A were significantly lower than in C. Forced expiratory volume in 1 s values were similar in all groups, but impairment of the forced expiratory flow over the middle half of the FVC was detected in group B. The prevalence of BHR was similar among group A (30.0%) and group B (35.7%) (p = 0.79) but they differed from group C (5.9%) (p = 0.005). An association between BHR and reported current (p = 0.001) but not lifetime asthma symptoms among group A was also observed. There was no association between atopy and BHR in group A but only to mites’ sensitization (p = 0.03). In conclusion, these results indicate that sIgAD constitutes a risk factor for development of BHR but it appears to be related to sensitization to mites.
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  • 26
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Few epidemiological studies have compared the risk factors of asthma or wheezing between atopic and non-atopic children. The objective of this study was to determine if there are specific risk factors for current wheezing related to atopic status in schoolchildren. Schoolchildren 9–12 yr of age from three Spanish cities (n = 2720) were subject to a cross-sectional study of asthma risk factors (by questionnaire) and atopy (by skin prick test) according to the ISAAC phase-II protocol. Risk factors for current wheezing (in the last 12 months) as reported by parents were investigated among the atopic (positive prick test to at least one allergen) and the non-atopic (negative prick test) children. The prevalence of current wheezing was 13.1% in the whole group, 22.1% in the atopic group and 7.8% in the non-atopic group. However, only 62.4% of children with current wheezing were atopic. Male gender and asthma in the mother and/or the father were both significant and independent risk factors for current atopic wheezing, whereas maternal smoking in the first year of the child's life and mould stains on the household walls were for current non-atopic wheezing. In summary, this study shows that atopic and current non-atopic wheezing children in Spain do not share identical environmental and family risk factors.
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  • 27
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 28
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We present three infants who showed hypertransaminasemia without extrahepatic symptoms, which improved by eliminating cows’ milk formulas. The levels of milk protein-specific lymphocyte proliferation were elevated in all three patients. These cases indicate the importance of food allergy in the diagnosis of infantile hepatic dysfunction.
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  • 29
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Investigations of parental smoking during childhood and allergic sensitization have produced contradictory results, but this may be because of variations in the definition of allergy and other influences. We investigated associations of parental smoking with an objective measure of allergy, skin prick testing (SPT), and considered associations with maternal and paternal smoking, independently of each other. A stratified random sample, aged 22–74 yr, of 720 Swedish FinEsS-study members were skin prick tested for 15 allergens. Subjects with at least one positive SPT were defined as atopic. Data on childhood exposures, including parental smoking, were collected by structured interview. Logistic regression used atopy as the dependent variable. After adjustment, paternal smoking was statistically significantly associated with an increased risk and maternal smoking a non-statistically significant decreased risk in offspring, with odds ratios (and 95% confidence intervals) of 1.48 (1.04–2.10) and 0.73 (0.48–1.12), respectively. Analysis of families with a non-smoking mother produced an odds ratio for paternal smoking of 1.61 (1.09–2.37). The negative association between maternal smoking and atopy may not operate through passive smoke exposure and could conceal a significant increased risk associated with passive exposure to tobacco smoke in childhood.
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  • 30
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The prevalence of asthma is increasing in Taiwan but data remain limited. The aim of this study was to determine the prevalence, severity, demographic and seasonal variations of asthma, rhinitis, and eczema in Taiwan. Using a one-stage stratified cluster random sampling, first grade (aged 6–8) and eighth grade (aged 13–15) students from Taoyuan, northern Taiwan, were invited to participate in this survey. The results showed a total of 6190 students, 3079 aged 6–8 and 3111 aged 13–15, completed this survey. In general, children aged 6–8 had significantly higher prevalence rates of diagnosed asthma, rhinitis, and eczema than children aged 13–15 (12.2%, 29.8%, and 10.2% vs. 9.6%, 18.3%, and 4.7%, respectively). Similarly, children aged 6–8 had significantly higher proportions of allergic symptoms, except for exercise-induced wheezing (5.8% vs. 17.8%, p 〈 0.0001). Among those with allergic disorders, children aged 6–8 presented a greater severity of wheezing attacks in the last 12 months. As regards gender, boys aged 6–8 had a significantly higher proportion of asthma or rhinitis symptoms than girls aged 6–8 but not in children aged 13–15. In children aged 6–8, asthma and rhinitis peaked in winter, especially in December. However, children aged 13–15 had two peaks (winter and summer) for asthma or rhinitis.
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  • 31
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4; CD152) is a surface molecule of activated T cells with sequence homologous to CD28, and may act as a negative regulator of T-cell activation. In murine animal models, cross-linkage of CTLA-4 molecules on the cell surface results in decreased T-cell proliferation, accompanied by increased interleukin (IL)-2 production and apotosis. To clarify the activation of peripheral blood T cells, we studied the CTLA-4 expression in 32 patients with atopic dermatitis who visited our institution, and 19 normal children who visited for pre-operative laboratory examination were used as normal controls. Whole blood was obtained from all subjects and stained with anti-CD3, anti-CD4, anti-CD8 monoclonal antibodies (mAb). After erythrocyte lysis with lysing solution, the cells were stained with anti-CTLA-4 mAb, and stained cells were analysed by fluorescence-activated cell sorter (FACScan) flow cytometer. Intracellular expression of CTLA-4 was significantly upregulated in peripheral blood CD3+ T cells (36.8%), CD4+ T cells (21.7%) and CD8+ T cells (18.7%) of patients with atopic dermatitis, compared with normal control (18.3%, 9.7%, 9.8%; respectively). Furthermore, CTLA-4-positive CD3+ T cells in patients with severe atopic dermatitis were significantly higher compared with milder group (42.8% vs. 32.2%). However, no significant difference was obtained in CD4+ and CD8+ T cells. Mean percentage of T cells expressing CTLA-4 in patients with atopic dermatitis was higher than the control group. These observations suggest the possibility that the disease activity can be correlated with the CTLA-4 level.
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  • 32
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 33
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We report the first case presenting with successive anaphylactic reaction and extra-pyramidal syndrome after treatment with thiethylperazine maleate (thiethylperazine). Both reactions were caused due to this anti-emetic drug, but an additive effect of clemastine fumarate, prescribed to treat the anaphylactic reaction, is suggested by the sequence of events. We discuss the importance of knowing the pharmacological similitudes of common prescribed drugs in order to avoid the occurrence of side effects.
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  • 34
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Live Lactobacillus paracasi 33 (LP33) may effectively improve the quality of life for patients with perennial allergic rhinitis. It has been demonstrated that heat-killed lactic acid bacteria (LAB) suppress specific immunoglobulin E synthesis and stimulate interleukin-12 production in animals. The aim of this study was, therefore, to evaluate the efficacy of heat-killed LP33 in the treatment of allergic rhinitis induced by house-dust-mite in human subjects. A total of 90 patients were enrolled in a randomized, double blind, placebo-controlled trial and assigned to three treatment groups. Patients in groups A and B received two capsules per day of live or heat-killed LAB (5 × 109 colony-forming units/capsule), respectively, over a period of 30 days while those in Group C received placebo capsules. A modified questionnaire on pediatric rhinoconjunctivitis-related quality of life was administered to all subjects or their parents during each clinical visit. The overall quality of life score decreased for groups A and B, as compared with the placebo group, in terms of both frequency (9.47 ± 2.89, 6.30 ± 2.19, vs. −3.47 ± 1.53, respectively; p 〈 0.0001) and level of bother (5.91 ± 3.21, 6.04 ± 2.44, vs. −2.80 ± 1.64, respectively; p = 0.004) after the 30-day treatment. The efficacy of the heat-killed LP33 was not inferior to the live variant. No obvious side effects were reported for either active treatment group during the study period. Our results suggest that heat-killed LP33 can effectively improve the overall quality of life for patients with allergic rhinitis, and that it may be efficacious as an alternative treatment.
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  • 35
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Early catch-up growth and subsequent overweight are suggested to be associated with later cardiovascular diseases and later type II diabetes. However, the impact of early catch-up growth and childhood overweight on the development of asthma has been less studied, particularly in children born with very low birth weight (VLBW). A birth cohort of 74 VLBW children (birth weight ≤ 1500 g) was followed from birth and investigated on asthma at 12 yr of age. Early rapid weight gain was in one way defined as an increase of weight ≥1 standard deviation score (SDS) at 6 months of corrected postnatal age. Current overweight was defined by body mass index (BMI) exceeding 21.2 and 21.7 kg/m2, respectively, for boys and girls at 12 yr of age. Current asthma was diagnosed by a pediatrician, according to asthma ever in combination with a positive response to hypertonic saline bronchial provocation test and/or wheeze at physical examination at 12 yr old. Being overweight at 12 yr of age was associated with an increased risk for current asthma in the VLBW children [crude odds ratio (OR): 5.5, 95% confidence interval (CI): 1.3–22.2]. After adjustment for early weight gain and neonatal risk, the OR of overweight increased nearly three times (adjusted OR: 15.3, 95% CI: 2.5–90.6). Early rapid weight gain seemed to be inversely associated with current asthma (adjusted OR: 0.49 for an increase of weight equal to 1 SDS, 95% CI: 0.23–1.02, p = 0.06). In addition, early rapid weight gain was inversely associated with the magnitude of bronchial responsiveness at 12 yr (coefficient −1.15, p 〈 0.01). There was a strong and positive association between overweight and asthma at 12 yr of age in the VLBW children. This strong association had been reduced by early rapid weight gain, possibly via the reduction of bronchial responsiveness.
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  • 36
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Respiratory syncytial virus (RSV) infection is a risk factor for the development of asthma. It is very hard to distinguish bronchiolitis with respiratory virus infection from allergic asthma at first wheezing attack in early childhood. To distinguish wheezing children with RSV bronchiolitis from asthmatic children, we measured leukotriene E4(LTE4) in urine and ECP in nasopharyngeal aspiration (NPA) at first day of admission with wheezing attack. Thirty-two non-atopic children younger than the age of 3 yr with RSV induced bronchiolitis, 35 atopic asthmatic children with/without respiratory viral infection, and 23 children who exhibited no evidence of atopy, asthma, or virus infections as controls were selected in this study. We measured urinary LTE4 and ECP level in NPA from subjects. Urinary LTE4 concentrations in children with asthma were significantly higher than urinary LTE4 in bronchiolitis and in controls (240.8 ± 129.8 vs. 162.8 ± 73.9 vs. 85.1 ± 31.6 pg/ml). Children with RSV infection demonstrated higher urinary LTE4 levels compared to children without RSV infection among asthmatic children. ECP in NPA was significantly correlated with urinary LTE4 (r = 0.57, p 〈 0.01) in children entered this study who had detectable levels for both LTE4 and ECP. In summary, Urinary LTE4 concentrations may be suggested to useful mediators for differential diagnosis of wheezy diseases in early childhood. RSV infection also is associated with synergizing LT biosynthesis and this study demonstrated ECP in NPA was significantly correlated with urinary LTE4 and may suggest that cysteinyl leukotriene initiate the production of ECP in early childhood, which could contribute to the development of wheeze.
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  • 37
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study aimed at identifying in a daily-life setting the influence of facemask design on drug delivery via a spacer to young children. In a 4-week randomized crossover study, 24 children (7–23-months old) with recurrent wheeze tested the AstraZeneca®, Galemed®, and Hans Rudolph® facemask combined with the NebuChamber® at home. Each mask was tested twice daily for seven consecutive days. Filters positioned between the NebuChamber and facemask trapped the budesonide aerosol (200 μg, Pulmicort®). Parents were asked to score the child's degree of cooperation during administration on diary cards. The administration procedure was evaluated through video recordings. Mean filter dose (standard deviation (s.d.)), expressed as % of nominal dose, was 39% (14), 47% (12), and 42% (11) for the AstraZeneca, the Galemed and the Hans Rudolph mask, respectively. Irrespective of the degree of cooperation, the Galemed mask gave significantly higher mean filter doses than the other masks (level of significance) (p 〈 0.045). Median (range) within-subject dose variability, expressed, as coefficient of variation (CV), was 37% (19–255), 32% (9–114), and 30% (9–115) for the AstraZeneca mask, the Galemed mask and the Hans Rudolph mask, respectively, not significant. Dose variability increased with decreasing cooperation for all three masks (p = 0.007). Drug delivery to young children with recurrent wheeze by means of the NebuChamber can be enhanced using the Galemed facemask. Dose variability seems to be independent of facemask design but mainly depends on cooperation.
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  • 38
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: There are only a few studies which have assessed the impact of asthma on the quality of life (QoL) compared to healthy children. In this study we wanted to compare QoL between asthmatic and healthy children in a population based setting. We surveyed 2159 children aged 11–15 yr with a Child Health Questionnaire; a generic QoL measure for children. This method gives a profile of the QoL consisting of 11 scales giving a range from 0 to 100. Asthma was defined based on the ISAAC questionnaire on asthma and asthma symptoms. In all, 192 children (8.9%) reported to have asthma diagnosed by a doctor and 61 of them (2.8% of all children) had been symptomatic during the previous month. Among these symptomatic children significantly impaired QoL was observed in 8 of the11 scales compared to non-asthmatics. The most affected scales were those defining the physical part of child's QoL: Mean General Health scores were 60 for asthmatic and 74 for non-asthmatic children and mean Bodily Pain scores 71 and 86, respectively. Symptoms during longer periods were associated with an overall decreased QoL. In conclusion, a child's asthma impairs the QoL and especially the physical dimensions.
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  • 39
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 40
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 41
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 42
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The chromosomal region 19q13 has been found in linkage to allergic diseases in several genome-wide linkage screens. One candidate gene within this region is the gene coding for TGF-β1. Transforming growth factor (TGF)-β acts as an anti-inflammatory cytokine suppressing allergic inflammation and hyper-reactivity. However, in ongoing inflammation of the lungs it can induce fibrosis and airway remodelling as seen in chronic asthma. Several polymorphisms within TGF-β1 have been identified and one, −C509T, has been shown to be in association with elevated immunoglobulin E levels and severe bronchial asthma in different populations. However, other studies failed to confirm the association. The present study investigated two polymorphisms within the gene coding for TGF-β1, −C509T and G915C, and for their potential association with bronchial asthma in Caucasian children. Genotyping of these polymorphisms was performed by means of restriction fragment length polymorphisms in a population of 231 asthmatic children and a control population of 269 individuals. Statistical analyses made use of the Armitage's trend test. In addition haplotypes were calculated by arlequin. None of the two polymorphisms showed association with bronchial asthma. They were found to be in linkage disequilibrium. We conclude from our data that TGF-β1 is unlikely to represent a major gene in the development of bronchial asthma in the Caucasian population.
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  • 43
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 44
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Measurement of exhaled nitric oxide (eNO) offers a non-invasive means for assessment of airway inflammation. The currently available methods are difficult to apply in preschool children. We evaluated four methods potentially applicable for eNO measurement during tidal breathing in young children. eNO was assessed during tidal breathing in 24 children, 2–7 yr old, using a facemask which separated nasal and oral airflow. Facemasks with and without a one-way valve allowing exhalation through the nose were used. Expiratory flow control was not attempted. Measurements of eNO were performed both on-line and off-line. In 11 children, 8–12 yr old, measurements were compared with the standard single breath on-line method. eNO was significantly lower applying the one-way valve in on-line and off-line measurements in comparison with measurements without the valve [4.6 and 3.9 parts per billion (ppb) vs. 6.9 ppb and 6.5 ppb]. The mean within subject coefficient of variation (CV) was significantly lower in on-line measurements with the one-way valve (9.6%) compared with the other three methods (18.8, 27.7 and 29.3% respectively). Measurements with a facemask fitted with a one-way valve yielded similar eNO levels as the standard single breath method (7.0 ppb vs. 6.9 ppb) and reproducibility (9.8% vs. 7.1%). In conclusion, reproducible measurements of eNO can be obtained without control of expiration flow using a facemask fitted with a one-way valve on the nasal compartment. The likely explanation to this is that the one-way valve reduces the admixture of nasal NO, thereby improving the reliability of eNO measurements.
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  • 45
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The incidence of alloimmune neonatal neutropenia combined with neonatal alloimmune thrombocytopenia is very low. We report a case of a neonate who suffered severe neutropenia and thombocytopenia with widespread petechial spots. The presence of alloantibodies in mother's and patient's sera was analyzed by lymphocytotoxicity test, agglutination test, granulocyte indirect immunofluorescence test, platelet immunofluorescence test (PIFT) and solid phase enzyme-linked immunosorbent assay. Human neutrophil antigens (HNA) and human platelet antigen (HPA) genotypes were tested by polymerase chain reaction analyses. The mother's and patient's sera reacted with neutrophils and lymphocytes of the father. PIFT revealed the presence of IgG anti-platelet antibodies in the patient's serum but the test was negative in the maternal serum. Analyses of HNA-1 and HPA genotypes of the family revealed maternal-neonatal HNA-1a and HPA-3b mismatch. The study of the mother's and patient's sera showed the presence of anti HNA1a, HPA-3b and HLA antibodies specific for HLA-A3 and HLA-B38 antigens. These results suggest that the transplacental passage of maternal HNA-1a, HPA-3b and HLA alloantibodies caused neutropenia and thrombocytopenia in this patient.
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  • 46
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 47
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A delayed and local gastrointestinal hypersensitivity to cow's milk (CM) protein is difficult to diagnose and there are limited data on this disorder. The aim of this study was to investigate local intestinal cytokine secretion in the upper small intestine in children with delayed-type cow's milk allergy (CMA). Duodenal biopsy samples from 31 children with delayed CMA, 14 with celiac disease (CD), and 14 healthy controls were studied for the spontaneous release of IFN-γ, TNF-α, IL-2, IL-4, IL-5, and IL-10, measured by cytometric bead array, and of TGF-β and IL-6 measured by ELISA. The children with delayed CMA secreted more IFN-γ than the controls (p = 0.006) and the children with CD (p = 0.006). The children with CD secreted more IL-6 compared to the controls (p = 0.008) and the children with delayed CMA (p = 0.002). The children with delayed CMA who had continuously been exposed to CM secreted less TGF-β than the children with delayed CMA who avoided CM (p = 0.050), and showed a tendency towards lower secretion compared to the controls (p = 0.078). Secretions of TNF-α, IL-2, IL-4, IL-5, and IL-10 were low in general; however, the children with delayed CMA who did not avoid CM secreted more IL-4 and IL-10 than the controls (p = 0.016, 0.059). In conclusion, the children with delayed CMA showed up-regulation of IFN-γ. Interestingly, TGF-β secretion was up-regulated in those children with delayed CMA who avoided CM suggesting recovery of regulation mechanisms.
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  • 48
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    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Bronchus-associated lymphoid tissue consists of lymphoid follicles with or without a germinal center within the bronchial wall. Bronchus-associated lymphoid tissue is part of the integrated mucosal immune system and present in about 50% of healthy infants. We examined a series of 141 fetal and neonatal lungs and detected bronchus-associated lymphoid tissue in 100% of cases with amniotic infection while postpartum perinatal pneumonia did not elicit bronchus-associated lymphoid tissue formation. Only rarely and in low density, bronchus-associated lymphoid tissue was present in non-infected fetuses. The in utero formation of bronchus-associated lymphoid tissue seems to be a reactive phenomenon and – as has been shown in another study – does not portend an adverse prognosis.
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  • 49
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Povidone is an allergic agent present in numerous substances, food and medicines. The authors present the clinical case of a 9-yr-old male child admitted in the emergency room with anaphylaxis, in two occasions separated by a 6-month period. The first episode occurred 5 min after the first oral administration of Fluvermal® (flubendazole) and the second occurred 10 min after cutaneous application of Bétadine® (povidone iodine solution). Previous cutaneous application of this solution and ingestion of mebendazole occurred without apparent adverse reactions. The allergy study revealed eosinophilia, an elevated total IgE level and positive prick-by-prick test for both drugs. A cutaneous prick-by-prick test with povidone (the sole common constituent) was also positive. This is probably the first case described in the literature of anaphylaxis induced by povidone in a child.
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  • 50
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    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Mannose-binding lectin (mbl), one of the important components of innate immunity, can activate the lectin pathway of the complement system. After binding mannose containing carbohydrate structures of foreign antigen, mbl initiates and regulates the inflammatory responses. Asthma is a complex inflammatory disease of the lung involving many components of the immune system. Our objective was to investigate the serum mbl levels of asthmatic children in comparison with healthy controls. Serum mbl levels were determined by nephelometric assay in 72 asthmatic children (5–15 yr old) and 30 healthy age-matched controls. Mbl levels of asthmatic children were measured both during acute attack and after complete remission. There was no significant difference between the mbl levels during acute attack (median 4.1 mg/l) or quiescence of symptoms (median 3.6 mg/l). Serum mbl levels both during acute attack or quiescence of symptoms was significantly higher in asthmatic children than in the healthy controls (median 2.8 mg/l, p 〈 0.0001 for each). Furthermore, mbl levels of asthmatic children positively correlated with peripheral blood eosinophils (r = 0.377, p 〈 0.001), which is a systemic component of airway inflammation in asthma. Our findings indicate that mbl may be implicated in the pathogenesis of asthma by contributing to airway inflammation or by increasing the risk of developing asthma.
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  • 51
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Earlier studies on breastfeeding and atopy in infants have yielded contradictory results. We examined the relationship between exclusive breastfeeding and atopic dermatitis (AD) in a cohort of infants born between 1 October 1997 and 1 October 1999 in south-east Sweden. We evaluated the risk of AD ‘at least once’ or ‘at least three times’ during the first year of life in relation to duration of exclusive breastfeeding: 〈4 months (short exclusive breastfeeding; SEBF) vs. ≥4 months. All data were obtained through questionnaires. Of 8346 infants with breastfeeding data, 1943 (23.3%) had suffered from AD during the first year of life. Duration of exclusive breastfeeding was not associated with lower risk of AD (p = 0.868). SEBF did not influence the risk of any AD (OR = 1.03; 95% CI OR = 0.91–1.17; p = 0.614) or AD at least three times (OR = 0.97; 95% CI OR = 0.81–1.16; p = 0.755) during the first year of life. Adjustment for confounders did not change these point estimates. Neither was there any link between SEBF and risk of AD among infants with a family history of atopy [adjusted odds ratio (AOR) = 1.16; 95% CI AOR = 0.90–1.48; p = 0.254]. Furred pets at home were linked to a lower risk of AD both among infants with a family history of atopy (AOR = 0.76; 95% CI AOR = 0.60–0.96; p = 0.021) and among infants with no such history (AOR = 0.79; 95% CI AOR = 0.69–0.90; p 〈 0.001). Infants with no family history of atopy were less prone to develop AD if parents smoked (AOR = 0.76; 95% CI AOR = 0.61–0.95; p = 0.016). This study indicates that exclusive breastfeeding does not influence the risk of AD during the first year of life, while presence of furred pets at home seems to be negatively associated with AD.
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  • 52
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The argument of whether early immunization against infections promotes allergy or protects from it is presently under debate. The relationship between childhood immunization and the development of atopic diseases (asthma, allergic rhinitis and eczema) was examined in a population-based sample of 718 adolescents by taking individual data drawn from personal paediatric records on the schedule and the type of vaccination into account. Atopic diseases were determined using a standardized questionnaire. After adjustment for sex, age, father's socioeconomic status and active smoking, adolescents having been vaccinated (n = 694) had a significant lower risk to suffer from asthma or atopic diseases than non-vaccinated adolescents did (n = 24) [odds ratio (OR) = 0.30; 95% CI: 0.10, 0.92]. The relationship did not depend on the disease against which the vaccine was used as prophylaxis, the observance of the vaccination schedule or the number of inoculations. A higher protection was observed in the case of live attenuated vaccines (oral poliomyelitis and bacilli Camille-Guerin; OR = 0.26; 95% CI: 0.08, 0.83). These results, in agreement with previous ecological data, support the hypothesis that early vaccines could promote Th1 proliferation in response to the infectious agent contained in it, which inhibits the enhancement of atopic manifestations. Further studies are needed to confirm the phenomenon.
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  • 53
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: American Thoracic Society (ATS) guidelines recommend to refrain from spirometry or exercise before measuring fractional exhaled nitric oxide (FENO) because forced breathing maneuvers might influence FENO values. However the few studies already reported in children have given conflicting results. The aim of the study was to observe to what extent spirometry or exercise could affect FENO in asthmatic children. Twenty-four asthmatic children (mean age 12.8 yr) were enrolled. Measurements of FENO were performed before and 5, 15, 30, 45 and 60 min after spirometry or a 6-min walk test, on two separate days in random order. Geometric mean FENO at baseline was 25.6 parts per billion (ppb) before spirometry and 23.5 ppb before exercise. A small drop of FENO to 24.2 and 23.7 ppb was found 5 and 15 min after spirometry (both p = 0.04). After exercise, FENO values showed a larger drop to 18.5 ppb after 5 min and 20.7 ppb after 15 min (p 〈 0.001; p = 0.004 respectively). Changes in FENO occurred after exercise irrespective of baseline FENO and values returned to baseline within 30 min. We conclude that both spirometry and exercise affect FENO in asthmatic children. As the changes after exercise may lead to erroneous interpretations, children should refrain from physical exercise during at least 30 min before FENO measurements.
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  • 54
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 55
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Exhaled nitric oxide (eNO) levels are correlated with several markers of atopy and inflammatory activity in the airways, but the relationship between eNO and total serum IgE has not been fully elucidated in the context of allergic sensitization. The aim of this study was to investigate the relationship between eNO, total serum IgE and allergic sensitization in childhood asthma and allergic rhinitis. eNO levels, lung function, skin prick tests and total serum IgE were determined in 109 children (mean age, 10.4 yr) with mild intermittent asthma and in 41 children (mean age, 10.1 yr) with allergic rhinitis; 25 healthy non-atopic children were recruited as controls. eNO levels (median) were significantly higher in patients with asthma (22.7 p.p.b.) and in those with allergic rhinitis (15.3 p.p.b.) than in healthy controls (5.9 p.p.b.). Children with allergic asthma had higher eNO levels than children with allergic rhinitis. A significant positive correlation was found between eNO and total serum IgE (asthma, r = 0.42, p 〈 0.0001; allergic rhinitis, r = 0.31, p 〈 0.01), and between eNO and the number of positive skin prick tests (asthma, r = 0.31, p 〈 0.0001; allergic rhinitis, r = 0.39, p 〈 0.01). eNO levels were better correlated with total IgE than with the number of positive skin prick tests. This correlation was independent of allergic sensitization. High total serum IgE represents a specific and predictive marker of eNO increase in children with asthma or allergic rhinitis. This finding adds further support to the hypothesis that increased serum IgE could be a marker itself of airway inflammation in patients with allergic disease.
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  • 56
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Allergen-specific immunoglobulins of the Immunoglobulin A (IgA) type have been found in the nasal fluid of patients with allergic rhinitis. IgA may play a protective role, but there are also data which show that allergen-specific IgA can induce eosinophil degranulation. The aim of this study was to quantitate Bet v 1-specific IgA in relation to total IgA in the nasal fluid of children with birch pollen-induced intermittent allergic rhinitis and healthy controls, after allergen challenge and during the natural pollen season. Eosinophil cationic protein (ECP), Bet v 1-specific IgA and total IgA were analyzed in nasal fluids from 30 children with birch pollen-induced intermittent allergic rhinitis and 30 healthy controls. Samples were taken before the pollen season, after challenge with birch pollen and during the pollen season, before and after treatment with nasal steroids. During the pollen season, but not after nasal allergen challenge, Bet v 1-specific IgA increased in relation to total IgA in children with allergic rhinitis. No change was found in the healthy controls. The ratio of Bet v 1-specific IgA to total IgA increased from 0.1 × 10−3 (median) to 0.5 × 10−3 in the allergic children, p 〈 0.001. No change was seen after treatment with nasal steroids, although symptoms, ECP and eosinophils were reduced. In conclusion, allergen-specific IgA in relation to total IgA increases in nasal fluids during the pollen season in allergic children but not in healthy controls. These findings are compatible with the hypothesis that allergen-specific IgA plays a role in the allergic inflammation and further studies are needed to clarify the functional role of these allergen-specific antibodies.
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  • 57
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 58
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 59
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The aim of this study was to investigate the mite fauna in mattresses dust samples from cribs or beds in the south Brazilian city of Londrina, State of Paraná. A total of 133 dust samples from upper and lower mattress surfaces, and bed frames were aspirated once from 38 dwellings (18 cribs and 21 beds), and one day nursery (six cribs). A total of 758 mite bodies were counted in slides: 233 (30.7%) from cribs and 525 (69.3%) from beds (p 〈 0.001). House dust mites – mainly Dermatophagoides pteronyssinus, represented 72% and 84% of total mite count in crib and bed dust samples, respectively. The mean HDM body concentration in crib or bed slides were, respectively, 289.9 ± 136.7 and 875.0 ± 183.6 mites/g. Statistical analysis showed a significantly higher mite bodies count on lower mattress surface compared with upper surface in bed samples only (p = 0.025). Data herein show that cribs like mattress have sufficient mite bodies to cause sensitization to humans. The use of mattress covers for cribs and beds should be encouraged in order to avoid allergens exposure.
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  • 60
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study compared the prevalence of asthma among Taiwanese adolescents with individual-level risk factors and municipal-level air pollution and meteorology data to determine whether changes in these factors could explain the observed change in prevalence. We conducted two national surveys of respiratory illness and symptoms in Taiwanese middle-school students in 1995–96 and 2001. The effects of personal and environmental factors were assessed and temporal changes of outdoor monitoring data were also compared with asthma prevalence difference. A total of 44,104 children from the 1995–96 survey and 11,048 children from the 2001 survey attended schools located within 1 km of 22 monitoring stations. Lifetime prevalences of physician-diagnosed and questionnaire-determined asthma increased during this period. After adjustment for potential risk factors, the prevalence differences were statistically unchanged. Although parental education level contributed most, changes in investigated personal and environmental factors might not explain the observed changes in asthma prevalence. Municipalities with higher temperature increase were significantly associated with prevalence difference in questionnaire-determined asthma. We concluded that correlates of the investigated individual-level factors, which have changed over time, still underlie changes in asthma prevalence. Increasing temperature might be the main reason for the rising trends of asthma in Taiwanese adolescents.
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  • 61
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Spina bifida children have a high prevalence of latex allergy in studies reported from Europe and the USA. This study investigated the prevalence of latex allergy in a cohort of 24 spina bifida children at the Red Cross Children's Hospital from Cape Town, South Africa. The children were investigated using a detailed questionnaire, skin prick tests (ALK-Abello), ImmunoCap RASTs, Western blotting and ELISA, using the purified latex proteins Hev b1 and Hev b3 and whole latex preparation. A low overall prevalence of latex sensitization of 16.7% was found in the children. Children who were sensitive reacted to water insoluble to Hev b1 and Hev b3 proteins. The low prevalence of latex sensitization in the South African children may not be entirely explained by stringent latex avoidance. The children were from a low socioeconomic social status and ‘hygiene’ and other factors should be considered.
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  • 62
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Damp dwellings increase the risk for house dust mite (HDM) infestation in temperate climate zones and may be associated with an increased risk for allergic disease. The aim of the study was to assess possible relationships between allergen levels in house dust, characteristics of residence buildings and allergic diseases in children. A subsample of 12-yr-old children, having the same address in 1991 and 1996, was selected from a population-based sample of children from the Göteborg area. Health inspectors examined the residences of all the 109 children and several different building characteristics including humidity and indoor temperature were collected. Dust samples for analysis of HDM allergens were collected from the children's beds, and for analysis of cat and dog allergens from the living room. Current health status was assessed by questionnaires, interviews and skin prick tests (SPT). Dog or cat allergens were found in all houses, even in houses without such animals. HDM allergens were found in 60% of the houses, but only six of them had levels exceeding 2 μg/g dust. There was a strong association between HDM-infestation and wheeze, but not with specific sensitization to HDM. The type of building (houses when compared with flats), the ventilation system and the presence of a basement had all major implications on respiratory symptoms, atopy and HDM infestation. We can conclude that dog or cat allergens were found in all houses, and a strong association between HDM infestation and indoor environment. Building construction affected both respiratory morbidity and sensitisation independently, suggesting not only worsening of symptoms but also a causative relationship with disease development.
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  • 63
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The physiopathology of atopic dermatitis (AD) has still to be elucidated. T effector cells with cutaneous homing receptors or T-cell derived cytokines have been assumed to be implicated in the pathogenetic mechanisms in AD and to be responsible for the different immunologic responses of patients. In fact, the large majority of AD patients display high IgE levels while others do not develop an abnormal IgE response. Although, there are not significant clinical features characterizing the two different groups, patients with normal IgE belong to a younger age range, raising the possibility that the hypothesized dichotomy of AD might be due to age. In the present study we included 172 outpatient children attending the Pediatric Department of our institution. Serum IgE levels and percentages of peripheral T lymphocytes expressing the cutaneous homing antigen (CLA) were evaluated and results were analyzed in relation to the activity of the disease (SCORAD index) or age. In the overall patients, the IgE levels increased significantly with age (0–1 yr: 19.50 IU/ml; 1–3 yr: 62.0 IU/ml; 3–8 yr: 96.0 IU/ml; 〉8 yr: 148.5 IU/ml; p 〈 0.001) and with the severity of the disease (SCORAD low: 46.80 IU/ml; medium: 42.90 IU/ml; high: 148.5 IU/ml; p = 0.01). Percentages of CLA+ peripheral T lymphocytes also increased with age (0–1 yr: 3.3; 1–3 yr: 4.85; 3–8 yr: 10.6; 〉8 yr: 12.5; p 〈 0.001), although they were not significantly different in patients with different SCORAD (p = 0.89). We further investigated the cellular immune response to a specific antigen in 25 subjects, matched for age, SCORAD, and CLA+ T-cell percentages. Among them, 13 patients had casein serum specific IgE and 12 had no evidence of casein sensitization. Peripheral blood mononuclear cells were kept in short-term culture with endotoxin-free casein fractions and IFN-γ, TNF-α, IL-5, IL-10 cytokine-producing cells were detected by ELISpot. Statistical analysis showed significant higher numbers of TNF-α- or IL-10-producing cultures (stimulation index 〉3) in the ‘allergic’ patients than in the milk tolerant subjects (p = 0.01 and 0.05). The analysis of individual responses confirmed this finding but also provide evidence of a significant increase in IFN-γ-producing cells (p = 0.05) induced by casein stimulation in the group of ‘non-allergic’ children. Our data showed that immunologic parameters as IgE levels or CLA+ T cells in AD pediatric patients are influenced by the age, confirming that age could represent a bias in the analysis of immune response in those patients. Although, we demonstrated in children with AD the existence of different cytokine patterns of the lymphocyte response that could account for the different immunologic features between the two hypothesized forms of AD, which are not dependent on age.
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  • 64
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The objective of this study was to evaluate the role of rhinitis (R) and atopic eczema (E) on asthma severity among asthmatic (A) schoolchildren identified by the International Study of Asthma and Allergies in Childhood written questionnaire (WQ). WQ was applied to parents of 6–7-yr-old schoolchildren (SC, n = 3033), and to adolescents (AD, 13–14 yr old, n = 3487), living in São Paulo, Brazil. An affirmative response to ‘has your child/have you had wheezing/whistling in the last year’ identified those with A, and an affirmative response to ‘the last 12 months has your child/have you had sneezing/runny/blocked nose when he/she you did not have a cold/flu?’ identified those with R. Subjects with an affirmative response to ‘has your child/have you had this itchy rash at any time in the past 12 months?’ were identified as having E. Subjects who had R associated with A were identified as AR and those with A associated with R and E as ARE. A who had at least two affirmative responses to questions for asthma severity: speech disturbance, more than four acute attacks, sleep disturbance, and wheezing with exercise were defined as having severe asthma. 22.1% AD and 24.3% SC were identified as A; 47.1% of those AD and 42.0% SC had AR and 10.0% of those AD and 12.8% of SC had ARE. Considering ARE, AR and A groups, speech disturbance during an acute episode of asthma was significantly higher among ARE AD (20.0% vs. 11.5% vs. 8.7%, p 〈 0.05), and ARE SC (22.1% vs. 13.9% vs. 10.5%, p 〈 0.05) in comparison with A. Likewise, more than four acute attacks in the last year was significantly higher among ARE AD (24.0% vs. 14.0% vs. 10.5%, p 〈 0.05) and ARE SC (32.6% vs. 19.4% vs. 12.8%, p 〈 0.05) as the frequency of sleep disturbance due to wheezing, for AD (61.3% vs. 42.0% vs. 38.4%, p 〈 0.05) and SC (77.9% vs. 67.3% vs. 58.4%, p 〈 0.001) and for ‘wheezing associated with exercise’ for AD (72.0% vs. 47.5% vs. 39.9%, p 〈 0.001) and SC (36.8% vs. 31.4% vs. 14.1%, p 〈 0.001). Prevalence of severe asthma was higher among ARE AD (57.3% vs. 31.9% vs. 27.0%, p 〈 0.05) and ARE SC (52.6% vs. 36.9% vs. 22.5%). In patients with A, the presence of R or E are risk factors for severe asthma, and both together (R and E) are a higher risk.
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  • 65
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To evaluate the role of Chlamydia pneumoniae respiratory tract infection on pediatric asthma, allergic rhinitis or atopic eczema initiation, children of three age groups (n = 1211) were prospectively studied for a C. pneumoniae infection using throat swabs and polymerase chain reaction (PCR) with enzyme immunoassay (EIA) detection. Infected children (study group, SG) were examined monthly until the agent could not be detected, quantifying persistent infection. They were compared with randomly selected, non-infected children without asthma matched for age, gender and origin (control group, CG) regarding lung function and inflammatory parameters as well as initiation of allergic diseases judged by family doctor diagnosis after, in median, 22 months. At the first follow-up examination, SG children revealed a higher leukotriene B4 (median 36 pg/ml vs. 19, p = 0.04) and 8-isoprostane (median 15 pg/ml vs. 12, p = 0.04) in breath condensate characterizing neutrophil, agent-related inflammation and oxidative stress in the lower airways. Cysteinyl leukotrienes, important in acute allergic inflammation, were without difference. Local, anti C. pneumoniae secretory immunoglobulin A antibodies were higher in children after C. pneumoniae infection (optical density median 0.7 vs. 0.4, p = 0.001) confirming PCR–EIA results. At the final examination, there was no difference in pathological lung function tests, parameters of exhaled breath condensate or eosinophilia of the nasal mucosa. Incidence of asthma (0/55 vs. 5/54, p = 0.03) and allergic rhinitis [3/53 vs. 10/52, p = 0.04, odds ratio and 95% confidence interval-OR 0.25 (0.06;0.98)] as well as prevalence of asthma [1/56 vs. 9/58, p = 0.02, OR 0.1 (0.01;0.81)] and allergic rhinitis [6/56 vs. 16/58, p = 0.03, OR 0.32 (0.11;0.88)] were lower in the SG children. There was no association in atopic eczema. Three children with persistent infection revealed a slightly higher incidence in allergic rhinitis without significance than those with single C. pneumoniae detection (1/3 vs. 2/50), however, not to the CG. In conclusion a C. pneumoniae upper respiratory tract infection may be regarded as a protective factor for childhood asthma or allergic rhinitis in a population of kindergarten and school-age children.
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  • 66
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In studies of asthma in children, a common method is for the parents to complete questionnaires about their child's asthma symptoms. With longitudinal studies of asthma, children reach an age when they can complete the questionnaire themselves. The aim of this paper was to compare the prevalence of asthma symptoms as well as the agreement between responses to an asthma questionnaire completed by teenagers and their parents. As a part of the Obstructive Lung Disease in Northern Sweden Study (OLIN) pediatric study, where 3345, 13–14-yr-old children completed an asthma questionnaire, 294 (84%) randomly selected parents also completed the questionnaire, which included the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. There were no significant differences in the prevalence of wheeze in the last 12 months, ever asthma, or physician diagnosed asthma as reported by the parents compared with the teenagers. However, the teenagers reported a significantly higher prevalence of wheeze during or after exercise. The absolute agreement was generally very high while the level of agreement (kappa-value) was slightly lower. The highest results in both absolute agreement and kappa-value, were reached by the questions on diagnosis of asthma (98.9% and 0.93), use of asthma medicines (95.5% and 0.78), and whether the child ever had had asthma (97.2% and 0.86), respectively. In conclusion, the agreement between the parents’ and the teenagers’ responses to the asthma questionnaire was good. The change in methodology from parental to self-completion of the questionnaire did not affect the results in the study.
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  • 67
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Sesame is a major allergen in countries where it is a common food. It was noted that an increasing number of members of the UK charity, the anaphylaxis campaign, were reporting allergy to sesame. This study, sought to examine features of sesame allergy among members of the Anaphylaxis Campaign (which supports those at potentially life-threatening risk from allergies) focusing on clinical symptoms and features of the foods implicated. A physician-designed questionnaire was sent by post to 400 members of the Anaphylaxis Campaign who reported avoidance of sesame. Two hundred and eighty replies were received (70%). Twenty-three replies (7%) were excluded and 96 replies (24%) came from subjects who avoided sesame but had never reacted to it. One hundred and fifty people (54%) reported 288 reactions to sesame. 89% of reactive subjects reported other atopic diseases and notably 84% were also nut/peanut allergic. One in six (17%) had suffered potentially life-threatening symptoms, with 65% of severe reactions happening on first known exposure. The age of first reaction ranged from 6 months to 65 yr. The majority of reactions reported (91%) involved foods or dishes which had sesame as a deliberate ingredient, rather than sesame as an accidental contaminant. Respondents represented a well-informed and highly selected group of people at risk from potentially life-threatening allergies. Sesame should be identified clearly as an ingredient and separately from nuts and peanuts when it may be an allergen contaminant. People at potential risk need clear allergy diagnosis and informed guidance to enable them to avoid this key allergen more easily.
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  • 68
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Developmental changes during infancy and childhood can affect drug pharmacokinetics (PK), i.e., absorption, distribution, metabolism, and renal excretion. This, in turn, influences optimal dosing, efficacy, and safety. To date, of the 40 H1-antihistamines available worldwide, only 11 have been studied in children using a PK approach. Here, we provide the pediatricians’ perspective on the population PK of levocetirizine, the pharmacologically active enantiomer of cetirizine, in very young children who received oral cetirizine, and describe the factors that influence levocetirizine PK in this population. In a prospective, randomized, double-blind, parallel-group, placebo-controlled study, very young children received oral cetirizine 0.25 mg/kg twice daily for 18 months. Plasma levocetirizine concentrations were measured in timed, sparse blood samples collected at steady-state (3, 12 and 18 months after commencement of treatment) for the purpose of monitoring safety, and levocetirizine population, PK parameters were derived by using non-linear mixed effects modeling. In 343 children (age 14–46 months, body weight 8.2–20.5 kg), a total of 943 blood samples were obtained. Compliance with cetirizine dosing was documented. The population PK model used predicted that with increasing body weight, levocetirizine oral clearance would increase by 0.044 l/h/kg, and levocetirizine volume of distribution would increase by 0.639 l/kg. Levocetirizine PK were not influenced by eosinophilia, sensitization to allergens, allergic disease, gastroenteritis/diarrhea, or concomitant ingestion of other medications. This population PK model predicts that in very young children, the oral clearance of levocetirizine will be rapid and will increase as body weight and age increase, therefore, levocetirizine dosing should be based on body weight and age in this population. Compared with older patients, on a mg/kg basis, relatively higher doses may be needed, and twice-daily dosing may be necessary, as previously reported for the related racemic H1-antihistamine cetirizine.
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  • 69
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study describes the cross-sectional prevalence of symptoms associated with eczema (chronic itchy rash), asthma (wheeze), and allergic rhinitis (rhinoconjunctivitis) in 1026 subjects between 18.5 and 23 months old (median age is 21 months) in Singapore. The first 2 yr cumulative prevalence of chronic itchy rash, wheeze, and rhinoconjunctivitis were 22.1% (n = 227), 22.9% (n = 235), and 8.4% (n = 86) respectively. In total, 42.2% (414 of 979) reported ever having any of these symptoms. Eczema, although prevalent, was diagnosed only in 34.4% (n = 78) of children with chronic itchy rash. Children with this eczematous rash were also more prone to wheeze (cOR = 2.0, 95% CI: 1.2–3.0) and rhinoconjunctivitis (cOR = 2.0, 95% CI: 1.4–2.8). Similarly, subjects who reported rhinoconjunctivitis and chronic itchy rash were 2.4 times (95% CI: 1.6–3.6) and 1.4 times (95% CI: 1.0–2.0) more at risk of wheezing respectively. Family history of allergy was a significant risk factor for chronic itchy rash (aOR = 1.8, 95% CI: 1.3–2.4) and wheeze (aOR = 1.7, 95% CI: 1.3–2.4). Thus, symptoms related to allergy were already prevalent during the second year of life. Significant proportions of these symptoms are likely to be due to true atopy as strong relationship with familial history and comorbidity with other potential allergic symptoms were observed.
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  • 70
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To examine the relationship between prenatal exposure to mite, cat and dog allergens and total serum IgE at birth in newborns at high risk of asthma. In the homes of 221 newborns with at least one first-degree relative with asthma, concentrations (ng/g dust) of allergens of house dust mite (mite), cat and dog were measured at the fourth to sixth month of pregnancy in dust samples from the maternal mattress and living room. At day 3–5 after birth, total IgE was measured in capillary heel blood. A total number of 174 blood samples were available (11 mothers refused newborn's blood sampling, and in 36 cases the blood sample was too small for analysis). In 24% of the newborns, total IgE was elevated (cut-off value 0.5 IU/ml). A significant dose response relationship was found between increasing mite allergen levels [divided in quartiles ng/g dust (qrt)] and the percentage of elevated IgE: first qrt (0–85 ng/g) 13%; second qrt (86–381) 19%; third qrt (382–2371) 26%; fourth qrt (≥2372) 42%, respectively, p = 0.01. This relationship remained significant after adjusting for passive smoking, maternal and paternal mite allergy, socio-demographic factors, birth characteristics and (breast) feeding practice in the first week of life. In high-risk newborns, prenatal exposure to mite allergens, but not to cat and dog allergens from dust of the living room and of the maternal mattress was associated with total serum IgE at birth.
    Type of Medium: Electronic Resource
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    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    ISSN: 1399-3038
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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