Monitoring children on sustained-release therapy by salivary theophylline levels

The serum-saliva theophylline level ratio was measured in 19 chronically asthmatic children after their conditions were stabilized on a sustained-release theophylline preparation. Simultaneous serum and saliva samples were collected at 0, 4, 6, and 10 hours after theophylline dose and measured by high-pressure liquid chromatography. The mean ratio for the group of 1.52 +/- 0.64 approximated the mean ratio from previous reports. However, the correlation coefficient (r = .80) was lower, and the interpatient and intrapatient variability (25% and 23%) much higher, than in previous reports. The possible mechanism of these findings in relation to sustained-release preparations are discussed. These data question the use of salivary theophylline determinations to monitor therapy. Dosage should be based on serum measurements.

Partial reversal of the cellular immune defect in common variable immunodeficiency with indomethacin

We administered indomethacin (25 mg q.i.d.) to two patients with common variable immunodeficiency and measured the effect on their depressed cellular immune responses. The in vitro response of both patients' lymphocytes to phytohemagglutinin increased during indomethacin administration. Both patients were anergic to skin testing before treatment and responded to two of four skin tests during treatment with indomethacin. Thus indomethacin administration in vivo appears to enhance the cellular immune respone, paralleling its previously described effects in vitro.

Immune-complex-mediated glomerulonephritis and pulmonary hemorrhage simulating Goodpasture syndrome

Two female children whose clinical presentations and renal light-microscopic findings were consistent with Goodpasture syndrome are described. Immunopathologic studies demonstrated granular deposition of immunoglobulins and complement, suggesting that the renal disease was mediated by circulating immune complexes and not by anti-glomerular basement membrane antibody. Anti-GBM antibody was absent in both patients. These patients represent the first report in children of idiopathic nephritis due to immune complexes with associated pulmonary hemorrhage. The findings raise some doubt as to the accuracy of previous reports of Goodpasture syndrome in children, and also demonstrate the diagnostic and therapeutic importance of evaluation the renal immunopathology in the child with nephritis and pulmonary hemorrhage.