Differentiation of IgE-dependent and IgE-independent reactions in children with bronchial asthma on the basis of TOP CAST Paediatric Allergen Mix test

PURPOSE

TOP CAST Paediatric Allergen Mix test is a new cellular in vitro test based on evaluation of leukotrienes synthesised by basophils under the influence of specific allergens. The aim of the study was evaluation of applicability of this test as screening examination in diagnosis of atopic asthma in children.

MATERIAL AND METHODS

The study was carried out on a group of 30 children (56.7% boys and 43.3% girls) aged 6-15 yrs (mean age 8 years and 9 months, SD = 2.1) with diagnosed bronchial asthma. In children qualified for the study clinical symptoms, subject examination as well as functional examination of the respiratory system (obturation with positive reversibility test) confirmed the disease. All the children had skin prick tests performed with the most popular aero- and troph-allergens, which results were expressed (+) according to the Skandinavian scale. In 15 cases asthma had atopic origin: in 11 children--mites were responsible for the contraction of bronchi, in 3 cases--tree-pollens allergens and in 1 case--grass pollens. In 15 next cases non-atopic asthma was diagnosed. The control group consisted of 10 children without clinical manifestations of asthma and negative results of the above tests. Test TOP CAST Paediatric Allergen Mix with mixture of 21 inhalatory and food allergens was performed according to the producer's procedure.

RESULTS

Statistically significant differences of the values of released leukotrienes were noted at allergen concentration of both 100 ng/ml and 10 ng/ml in children with diagnosed atopic asthma compared to those with non-atopic asthma and control group. The sensitivity of TOP CAST Paediatric Allergen Mix test was 80% at both allergen concentrations while the specificity was higher (90%) at the lower concentration. There was also correlation between the number of released leukotriens and IgEc in the examined group of children, however, no statistically significant differences were observed between the concentration of the released leukotrienes and the size of the wheal and the number of positive skin prick tests.

CONCLUSIONS

1. TOP CAST Paediatric Allergen Mix test is a good screening method in differentiation of atopic and non-atopic background of bronchial asthma in children. 2. At the present evaluation stage of this test, it may be applied as complementation of routine tests in allergological practice.

Fluticasone propionate in asthma: a long term dose comparison study

BACKGROUND

Few dose ranging studies have investigated optimal dosing with inhaled corticosteroids in children with asthma.

AIMS

To compare the efficacy and tolerability of fluticasone propionate 100 or 200 microg twice daily in children with moderate to severe asthma for one year.

METHODS

One year, randomised, double blind, parallel group, multicentre study. Children aged 4-11 years (n = 528) with moderate to severe asthma who had previously received high dose inhaled corticosteroids were given fluticasone propionate 100 or 200 microg twice daily for the 52 week treatment period. Efficacy (exacerbations, lung function, and symptoms) and tolerability (adverse events and cortisol levels) were measured.

RESULTS

There was a non-significant decreased risk of experiencing an exacerbation at any time with fluticasone propionate 200 microg twice daily compared with fluticasone propionate 100 microg twice daily. This difference reached significance among patients with more severe asthma (defined by previous inhaled corticosteroid dose >800 microg/day). Daily record card morning peak expiratory flow (PEF) in the total population improved significantly more with the higher dose of fluticasone propionate (between group difference, weeks 1-52: 11.4 l/min). Clinic visit mean PEF improved from baseline with both doses, but the response was significantly greater with the higher dose (between group difference, week 52: 17.8 l/min). Both doses were equally well tolerated and overnight urinary cortisol concentrations were unchanged or slightly increased during treatment with either dose.

CONCLUSION

This long term dose comparison study shows that treatment with fluticasone propionate 200 micro g twice daily may offer benefits over a lower dose, particularly in children with more severe asthma.

[Evaluation of combined therapy efficacy with disodium cromoglycate and salmeterol in children with atopic bronchial asthma]

Clinical observations of disodium cromoglycate with salmeterol were analyzed in children with atopic bronchial asthma. The efficacy of the therapy were monitored by clinical score of symptom and values of PEF. Authors suggest that observed improvement in clinical score symptoms were caused by salmeterol.

Predictors of pulse oximetry data failure

BACKGROUND

Pulse oximeters have been reported to fail to record data in 1.12-2.50% of cases in which anesthesia records were handwritten. There is reason to believe that these may be underestimates. Computerized anesthesia records may provide insight into the true incidence of pulse oximetry data failures and factors that are associated with such failures.

METHODS

The current study reviewed case files of 9,203 computerized anesthesia records. Pulse oximetry data failure was defined as the presence of at least one continuous gap in data > or = 10 min in duration in a case. A multivariate logistic regression model was used to identify predictors of pulse oximetry data failure, and a modified case-control method was used to determine whether extremes of blood pressure and hypothermia during the procedure were associated with pulse oximetry data failure.

RESULTS

The overall incidence of cases that had at least one continuous gap of > or = 10 min in pulse oximetry data was 9.18%. The independent preoperative predictors of pulse oximetry data failure were ASA physical status 3,4, or 5 and orthopedic, vascular, and cardiac surgery. Intraoperative hypothermia, hypotension, hypertension, and duration of procedure were also independent risk factors for pulse oximetry data failure.

CONCLUSIONS

Pulse oximetry data failure rates based on review of computerized records were markedly greater than those previously reported. Physical status, type of surgery, and intraoperative variables were risk factors for pulse oximetry data failure. Regulations and expectations regarding pulse oximetry monitoring should reflect the limitations of the technology.

Allergic constitution and immunological condition of children infected with giardia lamblia

In the group of 81 children infected with Giardia lamblia, the chosen parameters of cellular and humoral immunity as well as the effect of allergic costitution on the clinical picture of giardiasis were evaluated. Both cellular and humoral immunity disorders were found in patients with a chronic form of infestation. An allergic constitution coexisting with giardiasis promotes the chronicity of this parasitosis and a progressing allergization.

Major and minor surgery at a rural African hospital

Surgical operations performed at Ombo Hospital in Western Kenya from January to December 1989 were studied and annual surgical rates were calculated based on the estimated catchment area population. The total annual rate of major surgery at this church-supported hospital was 207 operations per 100,000 people. This rate is similar to those at other East African hospitals while rates in industrialized countries are 20-35 times higher. The most common major procedures were Caesarean section, laparotomy, hernia repair and salpingectomy. The 1989 rate of minor operations at the hospital was 1286 per 100,000 people with tooth extraction, wound suture, incision and drainage, evacuation of the uterine cavity and closed reduction of fracture as the most frequent procedures. Major operations were performed exclusively by doctors while minor surgery was carried out mainly by clinical officers, nurses and other auxiliary staff.

[Evaluation of the combined action of muscarinic receptor antagonists and beta receptor agonists on reactivity of basophils isolated from blood of patients with atopic bronchial asthma]

The study aimed at evaluating effects of selective M1 receptors antagonist-pirenzepine-and selected beta-receptor-agonists-orciprenaline or salbutamol, given alone or in combination, on histamine release from basophils isolated from patients with atopic asthma. Histamine concentration in the cells was assayed with spectrofluorimetric technique described by Shor and modified by Scov and Norn, using anti-IgE and metacholine as liberators. It was showed, that pirenzepine inhibits histamine release caused by both anti-IgE and metacholine. In the latter case this inhibitory effect was more significant. Beta-sympathicomimetics acted conversely, significantly inhibiting immunological histamine release. This effect was weaker, if metacholine was used. Combination of these agents increased protective effect of pirenzepine on histamine release induced by metacholine.

[Usefulness of testing histamine release from isolated human basophils in anti-allergic and anti-asthmatic drug assessment]

Histamine release from isolated human basophils test was used to evaluate an activity of: histamine receptors H1 and H2 blockers, agonists of beta-receptors, calcium channel blocking agents, hydrocortisone, and disodium cromoglycate (Intal). The study involved 84 patients hospitalized for the bronchial asthma. Basophils were isolated with Day's technique modified by Shov and Norn. Histamine was measured with Shov's spectrofluorimetric technique. It was found that histamine release from isolated human basophils may be used in both evaluation of the mechanism of action and efficiency of drugs used in allergic diseases therapy.

[Influence of pirenzepine on bronchial reactivity evaluated by the methacholine provocation test in a double-blind study of patients with bronchial asthma]

A double blind study was carried out on the effect of pirenzepine on bronchial reactivity assessed by metacholine provocation. The study was carried out on 19 patients with bronchial asthma. Bronchial provocation tests was performed according to the method of Ryan et al using the DeVilbis 646 nebuliser coupled to the Rosenthal--French dosimeter. Spirometric parameters were assessed using Vitalograph. The results show a significant protective effect of pirenzepine on bronchial spasm induced by metacholine.

[Effect of fenoterol, ipratropium bromide and their combination--Berodual--on pulmonary ventilation in patients with asthma]

The study aimed at evaluating FVC, FEV1, and FMF25-75% following and inhalation of fenoterol, ipratropium bromide and Berodual in 10 patients with the bronchial asthma. Berodual may be inhaled directly from the metered dose inhaler or with added tube spacer. Spirometry was performed after a single deep inspiration of each drug in the consecutive days, and after 5, 15, 30 and 60 minutes as well as 2, 3, 4, and 5 hours following the inhalation. The differences at each time point were compared with baseline values and expressed as percentage of the increase. The obtained results were analysed statistically. It was shown that bronchodilatory action of Berodual, being both beta 2-agonist and anticholinergic agent, is the most pronounced. The highest values of the measured spirometric parameters followed Berodual inhalation with the aid of tube spacer but the differences compared with Berodual applied with the metered dose inhaler were not statistically significant.

[Effect of cimetidine and ranitidine on bronchial reactivity in patients with asthma]

The results of studies on the effect of cimetidine and ranitidine on the bronchial reactivity in a group of 10 patients with atopic bronchial asthma are discussed. The patients received 800 mg of cimetidine daily for 6 days and, after a three-day interval, 300 mg of ranitidine daily for a further 6 days. Bronchial reactivity was determined with the histamine test, according to Spector and Farr, before the administration of each drug and on the third and sixth days of each course of the treatment. A comparison of the effect of cimetidine and ranitidine on the bronchial reactivity in the same patients revealed that a 3-day exposure to each of the two drugs, cimetidine enhanced bronchial reactivity to a greater extent than ranitidine; the difference between the action of the two drugs being statistically significant (p less than 0.05). Bronchial reactivity was found to increase significantly after a 6-day treatment with each of the drugs but no statistically significant differences were noted comparing the effect of these drugs.

Comparison of the effects of cimetidine and ranitidine in histamine provocation tests in atopic asthma

The effects of cimetidine and ranitidine on the bronchial reactivity in the group of 10 patients with atopic bronchial asthma are presented. The patients received 800 mg of cimetidine daily for 6 days and, after a three-day interval, 300 mg of ranitidine daily for a further 6 days. Bronchial reactivity to histamine was determined before the administration of each drug and on the third and sixth days of each course of treatment. A comparison of the effect of cimetidine and ranitidine on the bronchial reactivity of the same patients revealed that after 3 days' exposure to each of the two drugs, cimetidine enhanced bronchial reactivity to a statistically (p less than 0.05) greater extent than ranitidine. Bronchial reactivity was found to increase significantly after 6 days of treatment with each of the drugs but no statistically significant differences were noted on comparing the effect of these drugs. The results seem to indicate that H2 receptor antagonists may cause bronchoconstriction in some patients with bronchial asthma. The blocking effect depends on the type of the drug used and is connected with the chemical structure of the compounds.

[Comparative study of the T- and B-cell immunity systems in human and animal embryogenesis]

Data are presented on the spleen and thymus structure, time of appearance of the lymphocytes and their heterogeneity in the liver, thymus, spleen, lymph nodes and blood of human foetuses with hemochorial placenta (3 to 34 weeks) and of the minipigs foetuses with epitheliochorial placenta (32 to 95 days). In both foetuses the first T- and B-lymphocytes are found in liver, T-lymphocytes are then found in thymus and later in spleen and lymph nodes whereas B-lymphocytes are found, after liver, in spleen. Kinetics of T- and B-lymphocytes during embryogenesis is described. Reaction of the minipig lymphocytes to mitogens was demonstrated.

The role of H2-receptors in bronchial reactivity in atopic asthma

The aim of the present study was to evaluate lung function and bronchial reactivity during therapy with the H2-blockers, cimetidine and ranitidine, in order to determine the role of H2-receptors in the bronchial response of asthmatic patients. Bronchial reactivity was evaluated by the histamine provocation test before, and 3 or 6 days after administration of cimetidine (800 mg per day) or ranitidine (300 mg per day). It was shown that after 6 days treatment, an increase in bronchial reactivity occurred in 85% of the patients treated with cimetidine and in 64% of the patients treated with ranitidine. These results seem to confirm the presence of H2 receptors in the bronchial tree of asthmatic patients. Blockade of these receptors causes an increase in bronchial reactivity and potential exacerbation of the asthmatic symptoms.

Changes in the arrangement of the microtubule system of murine peritoneal cells after an antigenic stimulation

We determined two characteristic morphological patterns typical for the organization of microtubule systems of murine peritoneal macrophages and lymphocytes. A small number of both cell types formed uropods with an axial bundle of microtubules. This number remains practically unchanged during 48 h of cultivation in non-antigenic environment but grows rapidly in the presence of an antigen.

The influence of cimetidine and ranitidine on basophil histamine release and bronchial reactivity in asthmatic patients

Anti-IgE induced histamine release from isolated basophils after Cimetidine and Ranitidine administration was evaluated in 22 patients with atopic bronchial asthma. The histamine provocation test after Ranitidine treatment in 10 patients with atopic bronchial asthma and 10 patients with peptic ulcer was also performed. Investigations in vitro revealed that Cimetidine and Ranitidine in low concentrations had an inhibitory effect whereas in concentrations of over 10(-6) M and 10(-4) M, respectively, they enhanced histamine release. Investigations in vivo after administration of Ranitidine showed that it does not cause marked changes in the bronchial reactivity in patients with bronchial asthma and any change in patients with peptic ulcer. These preliminary studies seem to suggest that in patients with atopic bronchial asthma and concomitant peptic ulcer Ranitidine is preferable to Cimetidine in the treatment of digestive tract disorders.

Escape from dexamethasone-induced ACTH and cortisol suppression by corticotrophin-releasing hormone: modulatory effect of basal dexamethasone levels

The response of ACTH and cortisol to corticotrophin-releasing hormone (CRH) after pretreatment with various doses of dexamethasone was investigated in five healthy subjects. The five subjects participated in six experiments. In each experiment 200 micrograms ovine CRH was administered as an i.v. bolus injection at 0900 h after pretreatment with respectively: (A) 1 mg dexamethasone orally at 2300 h in the evening before CRH injection, (B) 2 mg dexamethasone orally at 2300 h in the evening before CRH injection, (C) 4 mg dexamethasone orally at 2300 h in the evening before CRH injection, (D) 2 mg dexamethasone orally at 2300 h in the evening before CRH injection, followed by 2 mg dexamethasone orally 1 h before CRH, (E) no dexamethasone and (F) 1 mg dexamethasone orally 1 h before CRH injection. In spite of overnight suppression with a single dose of dexamethasone CRH elicited cortisol rises in all individuals (experiments A-C). Dexamethasone pretreatment in experiment D abolished the CRH-induced stimulation of the pituitary-adrenal axis. There was a significant and negative correlation between the basal dexamethasone levels (i.e. the dexamethasone levels immediately before CRH administration) in the experiments A-D and the areas under the individual ACTH (R = -0.62; P less than 0.01 by Spearman's rank correlation test) and cortisol (R = -0.81; P less than 0.001 by Spearman's test) curves, i.e. the lower the basal dexamethasone levels, the greater the rise in ACTH and cortisol levels after CRH administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunologic histamine release from isolated human basophils during specific immunotherapy

Anti-IgE- and antigen-induced histamine release from basophils isolated from 20 atopic patients sensitive to grass pollen allergens was evaluated. The studies were made before and after short-term immunotherapy with Pollinex. It was shown, that after hyposensitization a significant decrease on anti-IgE and specific antigen-induced histamine release from basophils occurs.