Prevention of atopic dermatitis in high-risk neonates via different types of moisturizer application: A randomized, blinded, parallel, three-group, phase II trial (PAF study)

BACKGROUND

The effectiveness of moisturizers in preventing infant atopic dermatitis (AD) remains unclear. We previously showed that using 2e moisturizer of commercial moisturizer (Shiseido Japan Co., Ltd.) at least once a day significantly prevented AD in infants as compared with as-needed petroleum jelly. This trial aimed to determine the effectiveness of twice- or once-daily application of Fam's Baby moisturizer (Fam's Inc.) in preventing AD compared with once-daily 2e moisturizer.

METHODS

This trial was a single-centre, three-parallel-group, assessor-blinded, superiority, individually randomized, controlled, phase II trial that was conducted from 25 August 2020 to 28 September 2021. We randomly assigned 60 newborns with at least one parent or sibling who has AD to receive Fam's Baby moisturizer twice daily (Group A) or once daily (Group B), or 2e once daily (Group C) in a 1:1:1 ratio until they were 32 weeks old. The primary outcome was the time of AD onset.

RESULTS

Atopic dermatitis was observed in 11/20 (55%), 5/20 (25%) and 10/20 (50%), infants in Groups A, B and C, respectively. Cumulative incidence values for AD according to the Kaplan-Meier method showed that infants in Group B tended to maintain an intact skin for a longer period than those in Group C (median time, not reached [NR] vs. 212 days, log-rank test, p = 0.064). Cox regression analysis showed that the risk of AD tended to be lower in Group B (hazard ratio with group C as control, 0.36; 95% confidential intervals: 0.12-1.06). No serious adverse events occurred in any of the enrolled infants.

CONCLUSION

Fam's Baby moisturizer may better prevent AD than 2e. Further large-scale trials should be performed to confirm the efficacy of Fam's Baby moisturizer in preventing AD in infants.

Combination of heat-killed Lactiplantibacillus plantarum YIT 0132 (LP0132) and oral immunotherapy in cow's milk allergy: a randomised controlled trial

Safer and more effective cow milk (CM)-oral immunotherapy that does not induce allergic reactions has not yet been standardised. We sought to explore the efficacy and feasibility of a combination of heat-killed Lactiplantibacillus plantarum YIT 0132 (LP0132) and oral immunotherapy for treating IgE-mediated cow milk allergy (CMA). We conducted a 24-week, double-blind, randomised (1:1), two-arm, parallel-group, placebo-controlled, phase 2 trial of LP0132 intervention for treating IgE-mediated CMA in children aged 1-18 years (n=60) from January 29, 2018 to July 12, 2019 in Tokyo, Japan. Participants were randomly assigned to the LP0132 group receiving citrus juice fermented with LP0132 or to the control group receiving citrus juice without. Both groups received low-dose slow oral immunotherapy with CM. The primary outcome was improved tolerance to CM, proven by the CM challenge test at 24 weeks. Secondary outcomes were changes in serum biomarkers of serum-specific β-lactoglobulin-IgE (sIgE) and β-lactoglobulin-IgG4 (sIgG4). Exploratory outcomes included changes in serum cytokine levels and gut microbiota composition. A total of 61 participants were included. Finally, 31 children were assigned to the LP0132 group and 30 to the control group, respectively. After the intervention, 41.4 and 37.9% of the participants in the LP0132 and control groups, respectively, showed improved tolerance to CM. In serum biomarkers after the intervention, the sIgG4 level was significantly higher, and interleukin (IL)-5 and IL-9 were significantly lower, in the LP0132 group than in the control group. In the gut microbiome, the α-diversity and Lachnospiraceae increased significantly in the LP0132 group, and Lachnospiraceae after the intervention was significantly higher in the LP0132 group than in the control group. In conclusion, low-dose oral immunotherapy with modulating gut microbiota might be a safer and more effective approach for treating cow's milk allergy.

Study of optical emission spectroscopy using modified Boltzmann plot in dual-frequency synchronized pulsed capacitively coupled discharges with DC bias at low-pressure in Ar/O2/C4F8 plasma etching process

We consider the corona model and local thermal equilibrium approximations of a real plasma to measure the electron temperature (T_e) and density (n_e), respectively, using the optical emission spectroscopy (OES) method in dual-frequency pulsed capacitively coupled plasmas (CCPs) in a reactive mixture of Ar/O₂/C₄F₈ at a low operating pressure. The operation conditions such as DC continuous and synchronized were used for the study and plasma characterization for the intended plasma application such as high aspect ratio etching (HARE). We show that the present plasma conditions are dominated by a corona balance rather than the supremacy of multi-step excitation. This fact has enabled us to utilize the modified Boltzmann plot technique to evaluate the T_e values. In the second method, we simultaneously used the Boltzmann and Saha equations to determine the n_e value using the line intensity ratio and the value of T_e. Time-resolved measurements of T_e and n_e were performed for completeness, and the insight of the pulsed discharge was investigated. Time evolution of n_e and T_e using the OES method revealed a similar trend in the change of plasma parameters, indicating electron impact ionization during the pulse on phase. It was seen that n_e in the afterglow speedily decreased within a short time of ∼5 μs. Analysis suggests the formation of afterglow plasmas, which are composed of positive and negative ions with very low electron density. The results revealed that the DC-synchronized operation could be useful for plasma application such as HARE due to different plasma characteristics. It also suggests the production of ion-ion plasmas by the effective utilization of negative ions in the afterglow phase. The corona balance condition was validated in our experiments, and the results were compared with the existing literature.

Non‐invasive transcriptomic analysis using mRNAs in skin surface lipids obtained from children with mild‐to‐moderate atopic dermatitis

Background

Specimens for analysing the molecular pathology of skin disease are generally obtained through invasive methods, such as biopsy. However, less burdensome methods are desirable for paediatric patients. We recently established a method that comprehensively analyses RNA present in sebum (skin surface lipid–RNAs: SSL‐RNAs) using a next‐generation sequencer. Using this method, biological information can be obtained from the skin in a completely non‐invasive manner.

Objectives

To verify the applicability of the SSL‐RNA method for analysis of paediatric skin and analyse the molecular pathology of mild‐to‐moderate atopic dermatitis (AD) in children.

Methods

We collected sebum specimens from the whole faces of 23 healthy children and 16 children with mild‐to‐moderate AD (eczema area and severity index (EASI) score: 5.9 ± 2.6) ranging in age from 6 months to 5 years, using an oil‐blotting film. We then extracted SSL‐RNAs from the samples and performed an AmpliSeq transcriptomic analysis.

Results

The expressions of genes related to keratinization (LCE, PSORS1C2, IVL and KRT17), triglyceride synthesis and storage (PLIN2, DGAT2 and CIDEA), wax synthesis (FAR2), ceramide synthesis (GBA2, SMPD3 and SPTLC3), antimicrobial peptides (DEFB1) and intercellular adhesion (CDSN), all of which are related to the skin barrier, are lower in children with AD than in healthy children. The children with AD also have higher expression of CCL17, a Th2‐cytokine and an increased Th2‐immune response as demonstrated by a gene set variation analysis. Moreover, KRT17 and CCL17 expression levels are significantly correlated with the EASI score.

Conclusions

Molecular changes associated with abnormal immune responses and the epidermal barrier in children with mild‐to‐moderate AD can be determined using the SSL‐RNA method. This non‐invasive method could therefore be a useful means for understanding the molecular pathology of paediatric AD.

Prostaglandin D2 metabolite is not a useful clinical indicator for assessing atopic dermatitis

Prostaglandin D₂ (PGD₂ ) plays an important role in atopic dermatitis (AD), and 11,15-dioxo-9α-hydroxy-2,3,4,5-tetranorprostan-1,20-dioicacid (PGDM) is a major metabolite of PGD₂ . We investigated the relationship between urinary PGDM levels and severity of paediatric AD. In total, 31 patients with AD and 21 healthy controls (HCs) without AD were recruited, and urinary PGDM levels were measured. Of the 31 patients with AD, 14 were reassessed for urinary PGDM after topical steroid therapy. There was no difference in urinary PGDM levels between patients with AD and HCs. Although there was a significant positive correlation between the SCORing Atopic Dermatitis (SCORAD) index and the serum level of thymus and activation-regulated chemokine (TARC), the urinary PGDM levels did not correlate with either SCORAD or serum TARC. Moreover, both SCORAD and serum TARC were significantly improved by topical steroid therapy; however, urinary PGDM levels were not changed. In conclusion, the level of urinary PGD₂ metabolites in children with AD is substantially the same as that in HCs even if the disease is severe.

Sequentially addressable dielectrophoretic array for high-throughput sorting of large-volume biological compartments

Droplet microfluidics has become a powerful tool in precision medicine, green biotechnology, and cell therapy for single-cell analysis and selection by virtue of its ability to effectively confine cells. However, there remains a fundamental trade-off between droplet volume and sorting throughput, limiting the advantages of droplet microfluidics to small droplets (<10 pl) that are incompatible with long-term maintenance and growth of most cells. We present a sequentially addressable dielectrophoretic array (SADA) sorter to overcome this problem. The SADA sorter uses an on-chip array of electrodes activated and deactivated in a sequence synchronized to the speed and position of a passing target droplet to deliver an accumulated dielectrophoretic force and gently pull it in the direction of sorting in a high-speed flow. We use it to demonstrate large-droplet sorting with ~20-fold higher throughputs than conventional techniques and apply it to long-term single-cell analysis of Saccharomyces cerevisiae based on their growth rate.

P183 Arterial stiffness was inversely associated with left ventricular diastolic function in indigenous Papuan populations

Background

Age-related increase in systolic pressure is known to be absent in indigenous Papuan populations, partially because of their life-long low-sodium and high-potassium diets.

Purpose

The aim of this study was to investigate the age-related change in left ventricular (LV) systolic and diastolic function and the relationship with arterial hemodynamics among the indigenous Papuan highland people. 

Methods

Indices of arterial hemodynamics were measured using oscillometric brachial cuff-based sphygmomanometer (Mobil-O-Graph). Brachial-ankle pulse wave velocity (baPWV) was measured using a semiautomatic device (form ABI/baPWV). LV systolic and diastolic function was evaluated by 2-dimensional echocardiography and tissue-Doppler imaging using Vivid iq.

Results

A total of 81 native Papuans (median age 42 years, 47% women) were enrolled in this study. None of the subjects took any medicines, particularly antihypertensive drugs. All participants presented in sinus rhythm. With ageing, LV mass index remained unchanged, and LV ejection fraction increased, but mildly reduced (40–50%) in 3 participants. Transmitral E-wave velocity slightly decrease but the change was not significant. Transmitral A-wave velocity markedly increased (ρ=0.60, P &lt; 0.001) and E/A ratio decreased with age (ρ=-0.52, P &lt; 0.001). Age-related change of E-wave deceleration time was not significant. Septal e′ (ρ=-0.60, P &lt; 0.001) and lateral e′ decreased (ρ=-0.53, P &lt; 0.001) and average E/e′ increased with age (ρ=0.44, P &lt; 0.001). Left atrial volume index did not change significantly with age. In multivariate regression analysis, baPWV was independently associated with E/e" ratio both before and after adjustment for age, sex, body mass index, mean arterial pressure, and heart rate; however, indices of wave reflection including augmentation index and reflection magnitude were not associated with E/e′. Only age and heart rate were inversely associated with E/A ratio. 

Conclusion

LV systolic function was preserved in indigenous Papuan populations; however, LV diastolic function decreased with ageing. Age-related arterial stiffening, not wave reflection, was inversely related to LV diastolic function.

Report from the fifth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)

This is the report from the fifth meeting of the Harmonising Outcome Measures for Eczema initiative (HOME V). The meeting was held on 12-14 June 2017 in Nantes, France, with 81 participants. The main aims of the meeting were (i) to achieve consensus over the definition of the core domain of long-term control and how to measure it and (ii) to prioritize future areas of research for the measurement of the core domain of quality of life (QoL) in children. Moderated whole-group and small-group consensus discussions were informed by presentations of qualitative studies, systematic reviews and validation studies. Small-group allocations were performed a priori to ensure that each group included different stakeholders from a variety of geographical regions. Anonymous whole-group voting was carried out using handheld electronic voting pads according to predefined consensus rules. It was agreed by consensus that the long-term control domain should include signs, symptoms, quality of life and a patient global instrument. The group agreed that itch intensity should be measured when assessing long-term control of eczema in addition to the frequency of itch captured by the symptoms domain. There was no recommendation of an instrument for the core outcome domain of quality of life in children, but existing instruments were assessed for face validity and feasibility, and future work that will facilitate the recommendation of an instrument was agreed upon.

Thermo-Sensitive Release Behavior of 5-Fluorouracil from Chitosan-Gel Microspheres Coated with Lipid Multilayers

In order to provide a device that would release anticancer drugs in response to temperature, chitosan microspheres with immobilized 1-[N-(5- aminopentyl)urea]-5-fluorouracil (Ap-5FU) and coated with dipalmitoyl phosphatidyl choline (DPPC) multilayers were prepared. The chitosan-DPPC- chitosan microspheres were prepared by coating chitosan-DPPC microspheres with polyelectrolyte complex membrane of chitosan. Good distributive stability of microspheres in aqueous solution was achieved with the DPPC multilayers coating. When chitosan was crosslinked with glutaraldehyde, Ap-5FU was si multaneously immobilized to the microspheres by means of Schiffs base forma tion. In physiological saline media, free 5FU released from the microspheres was detected, but the 5FU derivative was not. The release rate of 5 FU from the microspheres was decreased by coating with DPPC multilayers, and further depressed by the formation of polyelectrolyte complex membrane. The thermo- sensitive release behavior of 5FU from chitosan-DPPC microspheres and chitosan-DPPC-chitosan microspheres was observed in vitro across the phase transition temperature ( T m) of the DPPC multilayer (41.4 ° C).

Total serum IgE level influences oral food challenge tests for IgE-mediated food allergies

Probability curves predicting oral food challenge test (OFC) results based on specific IgE levels are widely used to prevent serious allergic reactions. Although several confounding factors are known to affect probability curves, the main factors that affect OFC outcomes are currently unclear. We hypothesized that an increased total IgE level would reduce allergic reactivity. Medical records of 337 and 266 patients who underwent OFCs for 3.5 g boiled hen's egg white and 3.1 ml raw cow's milk, respectively, were examined retrospectively. We subdivided the patients into three groups based on total IgE levels and age by percentile (<25th, 25-75th, and >75th percentiles), and logistic regression analyses were performed on each group. Patients with higher total IgE levels were significantly less responsive. In addition, age did not significantly affect the OFC results. Therefore, total IgE levels should be taken into account when predicting OFC results based on food-specific IgE levels.

Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME)

This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6-7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure.

Cedar and cypress pollen counts are associated with the prevalence of allergic diseases in Japanese schoolchildren

BACKGROUND

Patients allergic to pollen have been known to become more symptomatic during pollen season compared with the nonpollen season. However, there are few studies regarding whether higher exposure to pollen might increase the prevalence of allergic diseases.

METHODS

An ecological analysis was conducted to evaluate whether pollen exposure is associated with the prevalence of allergic diseases in schoolchildren. Pollen count data of Japanese cedar (Cryptomeria japonica) and Japanese cypress (Chamaecyparis obtusa), which are the major pollen allergens in Japan, were obtained from each prefecture. The prevalence of allergic diseases in schoolchildren in each prefecture was based on a nationwide cross-sectional survey using the International Study of Asthma and Allergies in Childhood questionnaire.

RESULTS

After omitting three prefectures where pollen data were not available, data of 44 prefectures were analysed. The prevalence of allergic rhinoconjunctivitis in children aged 6-7 years was positively associated with both cedar and cypress pollen counts (P = 0.01, both), whereas the prevalence of allergic rhinoconjunctivitis in children aged 13-14 years was positively associated with only cypress pollen counts (P = 0.003). Furthermore, the prevalence of asthma was positively associated with cedar pollen counts in 6- to 7-year-old children (P = 0.003) but not cypress pollen counts in either age group.

CONCLUSIONS

There are ecological associations between pollen counts and the prevalence of allergic diseases in Japanese schoolchildren. Further studies are needed to determine whether the difference between the effects of cedar and cypress pollens is attributable to pollen counts or allergenicity.

Resistance exercise enhances cognitive function in mouse

Physical exercise has been shown to increase adult neurogenesis in the hippocampus and to enhance synaptic plasticity. It has been demonstrated that these neuroprotective effects can be observed following aerobic exercise. However, it remains unknown whether plasticity molecules, such as brain-derived neurotrophic factor (BDNF) and cyclic AMP response element-binding protein (CREB), are expressed in the hippocampus following resistance exercise. We applied voluntary progressive-resistance wheel exercise (RE) for 14 days, and measured BDNF and CREB in the hippocampus. The Morris water maze was also performed to estimate learning and memory. Furthermore, we measured RE effects on mammalian target of rapamycin (mTOR) and 70-kDa ribosomal protein S6 kinase (p70S6K) mediating muscle protein synthesis in the soleus. As a result, we found that RE enhanced cognition and elevated BDNF and CREB expressions in the hippocampus. Also, RE activated the mTOR-p70S6K signaling pathway in the soleus. We found that phosphorylated mTOR and p70S6K were significantly positively correlated with BDNF expression. Our results indicated that resistance exercise drove the protein synthesis signaling pathway in the soleus and enhanced hippocampal synaptic plasticity-related molecules. These results suggest the beneficial effects of resistance exercise on cognitive function.

The crystal polymorphism of calcium carbonate is determined by the matrix structure in quail eggs

Two calcified structures, the eggshell and sperm-associated body (SB), are present in the eggs of the Japanese quail, Coturnix japonica. X-ray diffractometry showed that calcium carbonates take the form of calcite in the eggshell and aragonite in the SB. The aim of the present study was to identify the factors that determine the morphology of calcium carbonate crystals. The matrix of EDTA-treated eggshell was a meshwork of vesicles, 200 to 500 nm in diameter, connected by fine fibers or fibrous sheets. The matrix of SB cortex was a radiation of rod-shaped projections approximately 130 nm in width. In vitro crystal formation was achieved by adding dissociated matrix substances to test solutions. When eggshell matrix material was added, formation of calcite crystals, which had many vesicular holes on their surface, was observed. When SB matrix material dissociated by sonication was added, rhombohedral calcite crystals formed at protein concentrations of 100 microg/mL or lower, and elongated and bundled crystals formed at concentrations of 150 microg/mL or higher. When SB matrix material dissociated by pipetting was added, aragonite crystals formed. These observations indicate that the matrix structure is the principal factor in determining the crystal polymorphism of calcium carbonate.

Development and validation of a questionnaire measuring quality of life in primary caregivers of children with atopic dermatitis (QPCAD)

BACKGROUND

Disease-specific health-related quality of life (HRQoL) instruments for primary caregivers of children with atopic dermatitis are useful in evaluating the efficacy of treatment in clinical practice and study. However, no such scale has been available in Japan.

OBJECTIVES

To develop and validate a self-administered instrument specifically designed to measure quality of life in primary caregivers of children with atopic dermatitis (QPCAD).

METHODS

This study consisted of three successive phases: the item generation phase, pilot test phase and validation phase. In the item generation phase, questionnaire items were derived from 33 qualitative interviews with primary caregivers. In the pilot test phase, the face and content validity of the preliminary scale were assessed (n = 33). In the validation phase, the questionnaire was finalized and assessed in terms of statistical performance (n = 416).

RESULTS

The QPCAD included 19 items in the following categories: 'exhaustion', 'worry about atopic dermatitis', 'family cooperation' and 'achievement'. The reliability of internal consistency was fair (Cronbach's alpha coefficients 0.66-0.87). The QPCAD subscales and total score were significantly correlated with psychological health, physical health, anxiety, depression and severity score, with mild to moderate correlation coefficients. Test-retest reliability and responsiveness to change in severity were also satisfactory.

CONCLUSIONS

The QPCAD is an appropriate tool for assessing HRQoL of primary caregivers of children with atopic dermatitis in clinical practice and clinical trials.

Breastfeeding and the risk of wheeze and asthma in Japanese infants: the Osaka Maternal and Child Health Study

Epidemiological evidence for an effect of breastfeeding on asthma continues to be inconclusive. The present prospective study examined the relationship between breastfeeding and the risk of wheeze and asthma in Japanese infants. A birth cohort of 763 infants was followed. The first survey during pregnancy and the second survey between 2 and 9 months postpartum collected information on potential confounding factors. Data on breastfeeding, wheeze, and asthma were obtained from questionnaires in the third survey from 16 to 24 months postpartum. Adjustment was made for maternal age, maternal and paternal history of asthma, atopic eczema, and allergic rhinitis, indoor domestic pets (cats, dogs, birds, or hamsters), family income, maternal and paternal education, maternal smoking during pregnancy, baby's sex, baby's older siblings, household smoking in the same room as the infant, and time of delivery before the third survey. By the third survey, the cumulative incidence of wheeze and asthma was 22.1% and 4.3%, respectively. Neither exclusive breastfeeding for 4 months or more nor partial breastfeeding for 6 months or more were materially related to the risk of wheeze. No measurable association was observed between exclusive breastfeeding for 4 months or more and the risk of asthma. Partial breastfeeding for 6 months or more was inversely related to the risk of asthma although the adjusted odds ratio (OR) was not statistically significant. When infants were stratified according to whether there was a negative or positive allergic history in at least 1 parent, a nearly 40% and 60% decrease, respectively, in the ORs were found for exclusive and partial breastfeeding only in infants without a parental allergic history, although the ORs were not statistically significant. The present prospective study showed no statistically significant relationship between breastfeeding duration and the risk of wheeze or asthma in Japanese infants.

Fatty acid intake and asthma symptoms in Japanese children: the Ryukyus Child Health Study

BACKGROUND

It has been hypothesized that increased consumption of n-6 polyunsaturated fatty acids and decreased consumption of n-3 polyunsaturated fatty acids have contributed to the recent increased prevalence of asthma.

OBJECTIVES

The present cross-sectional study examined the association of intake of specific types of fatty acids with the prevalence of asthma symptoms using data from the Ryukyus Child Health Study.

METHODS

Study subjects were 25,033 schoolchildren aged 6-15 years in Okinawa, Japan. Symptoms of wheeze and asthma were defined according to diagnostic criteria from the International Study of Asthma and Allergies in Childhood. Information on dietary factors was collected using a self-administered brief diet history questionnaire for children. Adjustment was made for age, sex, number of siblings, smoking in the household, body mass index, paternal and maternal history of allergic diseases, and paternal and maternal educational level.

RESULTS

Intake of polyunsaturated fatty acids, n-3 and n-6 polyunsaturated fatty acids and linoleic acid (18:2 n-6) was independently associated with an increased prevalence of wheeze--the multivariate odds ratios for the highest quintile were 1.19 (95% confidence interval [CI], 1.05-1.35), 1.17 (95% CI, 1.03-1.34), 1.19 (95% CI, 1.04-1.35), and 1.20 (95% CI, 1.06-1.37), respectively. There was no measurable relationship of consumption of alpha-linolenic (18:3 n-3), eicosapentaenoic (20:5 n-3), docosahexaenoic (22:6 n-3) or arachidonic acid (20:4 n-6) or the ratio of n-3 to n-6 polyunsaturated fatty acids with the prevalence of wheeze. Consumption of total fat, saturated fatty acids, monounsaturated fatty acids and cholesterol were not evidently related to wheeze. No material dose-response association was found between the intake of any of the types of fatty acids considered and the prevalence of asthma.

CONCLUSIONS

The findings suggest that consumption of both n-3 and n-6 polyunsaturated fatty acids, especially linoleic acid, may be associated with an increased prevalence of wheeze.

MEFV mutation analysis of familial Mediterranean fever in Japan

BACKGROUND

Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent attacks of fever with serosal inflammation. FMF gene (MEFV) mutations have been identified primarily in patients from Mediterranean populations. Although several clinical cases have been reported in Japan, there have been few reports to date on mutation analysis. We studied FMF patients and their relatives to examine the clinical and genetic features of this disease in the Japanese population.

METHODS

Twelve Japanese FMF patients who met the Tel Hashomer criteria and a total of 17 relatives from 5 of 10 families underwent molecular genetic studies to detect MEFV mutations. The characteristics of these Japanese FMF patients and geno-phenotypical correlations were examined.

RESULTS

Almost all of our patients had been suffering for a long time from fever of unknown origin and one patient also had systemic amyloidosis. In our 12 FMF patients, we detected the substitutions E84K, L110P, E148Q, R761H and M694I. We also newly diagnosed 2 relatives as having FMF based on clinical symptoms and the existence of FMF mutations. One patient was homozygous for E148Q, the patient with systemic amyloidosis was a homozygote for M694I and 4 patients from 3 families were compound heterozygotes for E148Q and M694I. Three patients in one family were compound heterozygotes for E148Q, L110P and M694I. There were 3 patients who were heterozygous for E84K, L110P-E148Q or M694I and had no other nucleotide changes in the exons of MEFV. On the other hand, 2 relatives who had never experienced symptoms of FMF were homozygous for L110P-E148Q as well as compound heterozygous for E148Q/E148Q-R761H. E148Q and M694I were the most frequently detected substitutions in our study.

CONCLUSIONS

MEFV mutations occur in Japanese FMF patients though FMF is rare in Japan. The identification of MEFV mutations could be a reliable diagnostic test for FMF. The results of genetic analyses on 14 Japanese FMF patients in this study revealed that E148Q and M694I are frequent alleles.

Tuberculin reactivity and allergic disorders in schoolchildren, Okinawa, Japan

BACKGROUND

Bacillus Calmette-Guérin (BCG) vaccination triggers a T-helper type 1 response. Whether BCG vaccination and positive tuberculin reactivity are preventive against allergic disorders remains controversial.

OBJECTIVE

The current cross-sectional study investigated the relationship of BCG vaccination and tuberculin reactivity with the prevalence of allergic disorders using data from the Ryukyus Child Health Study (RYUCHS).

METHODS

Subjects were 5717 schoolchildren aged 8-11 years in Okinawa, Japan. The RYUCHS collected information on symptoms of allergic disorders and potential confounding factors. The outcomes were based on diagnostic criteria from the International Study of Asthma and Allergies in Childhood. Data on BCG vaccination and tuberculin tests were obtained from school records. Allowance was made for grade, sex, sibship size, smoking in the household, paternal and maternal history of asthma, atopic eczema, and allergic rhinitis, and paternal and maternal educational level.

RESULTS

No measurable relationship was found between BCG vaccination in infants and the prevalence of allergic disorders. Among 5567 BCG-vaccinated children, positive tuberculin reactivity (induration >/=10 mm) in the first grade was independently associated with a decreased prevalence of wheeze, asthma, and atopic eczema: the multivariate odds ratios for wheeze, asthma, and atopic eczema were 0.80 (95% confidence interval [CI], 0.67-0.94), 0.78 (95% CI, 0.64-0.95), and 0.77 (95% CI, 0.62-0.95), respectively. The inverse associations were more pronounced in children with a negative parental allergic history than in those with a positive parental allergic history. There was no significant relationship between tuberculin reactivity and allergic rhinoconjunctivitis.

CONCLUSIONS

The findings suggest that positive tuberculin reactivity may be inversely associated with the prevalence of wheeze, asthma, and atopic eczema, but not allergic rhinoconjunctivitis, especially among Japanese children without a parental allergic history.