Early identification of atopy in the prediction of persistent asthma in children

The long-term solution to the asthma epidemic is thought to be prevention, and not treatment of established disease. Atopic asthma arises from gene-environment interactions, which mainly take place during a short period in prenatal and postnatal development. These interactions are not completely understood, and hence primary prevention remains an elusive goal. We argue that primary-care physicians, paediatricians, and specialists lack knowledge of the role of atopy in early life in the development of persistent asthma in children. In this review, we discuss how early identification of children at high risk is feasible on the basis of available technology and important for potential benefits to the children. Identification of an asthmatic child's atopic status in early life has practical clinical and prognostic implications, and sets the basis for future preventative strategies.

Intestinal microflora of Estonian and Swedish infants

The intestinal microflora of 1-y-old healthy Estonian (n = 27) and Swedish infants (n = 29) was studied by quantitative culture of faecal samples. The major differences were high counts of lactobacilli and eubacteria in the former and increased numbers of clostridia in the latter babies. Bifidobacteria and anaerobic cocci prevailed equally in both groups, while eubacteria and enterococci were the major microorganisms in many Estonian infants and bacteroides and clostridia in many Swedish infants. The microflora of the Estonian infants was in many aspects similar to the flora prevailing in infants of western Europe in the 1960s. The results suggest a shift in the intestinal microflora among infants in western industrialized countries.

A comparison of the development of antibody responses to the polysaccharide antigen (Candida albicans mannan) in atopic and healthy infants and children

BACKGROUND

Defective antibody response against bacterial polysaccharide antigens is known to be associated with recurrent pyogenic infections. The role of childhood allergy as a risk factor for repeated infections with capsulated micro-organisms has been controversial.

OBJECTIVE

To compare the development of polysaccharide specific antibody responses in atopic and healthy infants and children.

METHODS

The antibody responses against a common polysaccharide antigen, Candida albicans mannan, were studied longitudinally in 18 atopic and 19 non-atopic children over the first 5 years of life. Determinations of IgA, IgG and IgM antibodies were carried out by enzyme-linked immunosorbent assay and IgE antibodies by nitrocellulose-based radioallergosorbent test.

RESULTS

The polysaccharide specific antibody responses were similar in both groups, except that anti-mannan IgM levels were higher at 5 years in the atopic children (P < 0.05, student's t-test).

CONCLUSION

Atopic children are not more susceptible to bacterial infections on the basis of poorer ability to produce antibodies against polysaccharide antigens.

High anti-IgE levels at birth are associated with a reduced allergy prevalence in infants at risk: a prospective study

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

Patterns of breast feeding and weaning in the United Arab Emirate

Two-hundred urban high and urban average mothers and 86 rural mothers in Dubai were interviewed to obtain baseline data about the duration of breast feeding and weaning patterns. The median duration of breast feeding was 4.5, 5, 9 months in urban high, urban average and rural groups, respectively.

Oral immunotherapy in birch pollen hay fever

Previous controlled trials with oral administration of allergen have not demonstrated any treatment effect in patients with allergic rhinoconjunctivitis or asthma. In the present double-blind, placebo-controlled trial, we have tested the effect of oral immunotherapy in adult patients with birch pollinosis. Thirty-nine patients completed this 18-month study comprising two birch pollen seasons. The patients received enterosoluble capsules daily, and the actively treated patients reached a cumulated dose of 280 times 10(6) biologic units of birch pollen extract, which is about 200 times higher than the dose used in conventional subcutaneous immunotherapy. We found a significant decrease in eye symptom scores and conjunctival sensitivity to birch pollen, as determined by conjunctival provocation test, as well as a numerical but nonsignificant decrease in nasal symptom scores, nasal sensitivity as determined by nasal provocation test, and antiallergic medication. The treatment was safe, and only a few slight side effects were observed. We thus conclude that our study demonstrates a clinical effect of oral immunotherapy in birch pollinosis.

Prevention of chromosomal breakage in Fanconi's anemia by cocultivation with normal cells

The frequency of aberrations in cultured lymphocytes from patients with Fanconi's anemia was significantly reduced when the cells were cocultivated with normal human lymphocytes. The results suggest that most of the chromosomal aberrations observed in cultured cells from Fanconi patients arise during cultivation and that the presence of normal cells prevents chromosomal damage by means of a hitherto unknown mechanism.

Polymorphonuclear leucocyte function during pregnancy

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