Redecoration of apartments promotes obstructive bronchitis in atopy risk infants--results of the LARS Study

Findings by other authors indicate that exposure to chemical emissions from indoor paint is related to asthma symptoms in adults. In their first years of life children are receptive to obstructive airway diseases. The aim of this study was to investigate the influence of redecoration of the apartment on airway symptoms in infants during the first two years of life. The Leipzig Allergy Risk Children Study (LARS) is a birth cohort study with the following inclusion criteria: double positive family atopy anamnesis, cord blood IgE > 0.9 kU/l, or low birth weight between 1500-2500 g. Within the context of LARS, 186 parents of risk children completed a questionnaire on the respiratory symptoms of their children and the redecoration of their apartment at the end of the first and second year of life. A total 22% of the children suffered from obstructive bronchitis once or more during their first year, and 11% experienced this condition during their second year of life. Redecoration of the apartment had a significant influence on the appearance of obstructive bronchitis in the first (OR 4.1 95% CI 1.4-11.9) and in the second year of life (OR 4.2 95% CI 1.4-12.9). (The OR are adjusted for cord blood-IgE > 0.9 kU/l, birth weight < or = 2500 g, male sex and double positive parental atopy anamnesis, dampness, smoking or pet in the apartment). Simultaneous contamination from redecoration activities and additional exposures such as smoking, a pet or dampness in the apartment increased the risk for obstructive bronchitis in the first year (OR 9.1; 95% CI 2.3-34.8) as well as in the second year (OR 5.1; 95% CI 1.6-15.6). Our data suggest that redecoration of the apartment is associated with the development of acute inflammations, but not with a chronic influence on the airways in atopy risk infants. At an exposure to more than one environmental factor, pronounced effects were seen.

Increased incidence of allergic sensitisation and respiratory diseases due to mould exposure: results of the Leipzig Allergy Risk children Study (LARS)

To investigate mould effects on health, the concentration of mould spores in air and dust was determined during a prospective cohort study. Clinical outcome was estimated by questionnaires and determination of specific IgE antibodies and intracellular cytokine production of T cells. A significant association was observed between the incidence of respiratory tract infections and exposure to Penicillium spores. Moreover, Aspergillus exposure was found to be associated with allergic rhinitis or related symptoms. In addition, T cells of children exposed to Aspergillus showed a significantly lower content of TH1 cytokines (IFN-gamma, TNF-alpha, IL-2) producing cells. Our data suggest that mould exposure is associated with several effects on health, depending on the species involved.

Enhanced in vivo IgE production and T cell polarization toward the type 2 phenotype in association with indoor exposure to VOC: results of the LARS study

The association between indoor exposure to volatile organic compounds (VOC), prevalence of allergic sensitization and cytokine secretion profile of peripheral T cells was studied in 3 year old children of the LARS study (Leipzig Allergy Risk Children Study) to investigate the role of VOC exposure as a risk factor for the development of atopic disease. Indoor VOC exposure was measured over a period of 4 weeks in infants' bedrooms using a passive sampling system. Specific IgE antibodies to food, indoor and outdoor allergens were measured by the Pharmacia CAP system and correlated to VOC exposure (n = 120). In addition, cytokine producing peripheral T cells (interleukin(IL)-4, interferon(IFN)-gamma) were measured in a subgroup of 28 children by means of intracellular cytokine staining. For the first time we were able to show that exposure to alkanes (C6, C9, C10) and aromatic compounds (toluene, o-xylene, m + p-xylene, 2-, 3- and 4-ethyl-toluene, chlorobenzene) may contribute to the risk of allergic sensitization to the food allergens milk and egg white (Odds ratios between 5.7 and 11.2). Moreover, significantly reduced numbers of CD3+/CD8+ peripheral T cells were found in children exposed to alkanes (C9-C13), naphthalene and chlorobenzene. Exposure to benzene, ethylbenzene and chlorobenzene was associated with higher percentages of IL-4 producing CD3+ T cells. Both an increase in IL-4 producing type 2 T cells and a reduction of IFN-gamma producing type 1 T cells may contribute to a type 2 skewed memory in response to allergens. Therefore, we suggest exposure to VOCs in association with allergic sensitization to be mediated by a T cell polarization toward the type 2 phenotype.

Associations between duration of breast-feeding, sensitization to hens' eggs and eczema infantum in one and two year old children at high risk of atopy

Through a cohort study, factors for the development of atopic disorders among children at high-risk of atopy were investigated by means of anamnesis, lifestyle factors and laboratory parameters. 475 high-risk children were selected out of the whole population of infants born within one year in the City and District of Leipzig. These 475 had an increased cord blood IgE (> 0.9 kU7l), double positive atopic family history (parents/siblings) or low birthweight (1500-2500 g). Questionnaires are answered regularly by the parents and the children are clinically examined annually.

RESULTS

In the first and second year of life there has been a statistically significant correlation (p < 0.0001) between increased cord blood IgE and increased total IgE. At the age of one year we found eczema infantum in 51 out of 323 high-risk children. There was a significant association (p = 0.0001) between sensitization against hens' eggs and eczema. Infants who had been exclusively breast-fed > or = 5 months were more frequently sensitized to hens' egg and an eczema infantum was to diagnose more frequently. Significant differences in this respect were found within the risk groups, depending on family history of atopy and cord blood IgE. The duration of breast-feeding showed no correlation with sensitization to hens' eggs or atopy in two-year-olds.

Effects of indoor painting and smoking on airway symptoms in atopy risk children in the first year of life results of the LARS-study. Leipzig Allergy High-Risk Children Study

INTRODUCTION

The Leipzig Allergy High-Risk Children Study (LARS) is a prospective nested cohort control study about the influence of chemical indoor exposure in dwellings on the health outcome of atopy-risk children during the first years of life.

DESIGN AND METHODS

475 premature children and children with allergic risk factors have been selected out of the 1995/1996 birth cohort in the city of Leipzig. Twenty-five volatile organic compounds (VOC) were measured in the infant's bedrooms using passive sampling systems for 4 weeks after birth. The babies underwent a medical examination at the age of six weeks and 1 year. The parents answered a questionnaire.

RESULTS

Correlations between VOC exposures and infections were calculated by multiple logistic regression. Selected VOC show a direct association to actually painted dwellings (OR = 2.4; 95% Cl 1.1-5.3). An increase of risk of pulmonary infections was observed in infants aged 6 weeks if restoration (painting OR 5.6; 95% Cl 1.3-24.0) or flooring connected with painting had occurred during the pregnancy period. Higher concentration of styrene (> 2.0 micrograms/m3, indicator for flooring) elevated the risk of pulmonary infections in six-week-old infants (OR = 2.1; 95% Cl 1.1-4.2). Environmental benzene > 5.6 micrograms/m3 increased the risk of airway infections in six-week-old babies (OR = 2.4; 95% Cl 1.28-4.48). Smoking in the dwelling (OR = 2.0; 95% Cl 1.1-3.5) as well as restoration (OR = 1.9; 95% Cl 1.1-3.5) are also risk factors of the development of wheezing in the one-year-old child.

CONCLUSIONS

The data give indications in order to prevent allergies and chronic lung diseases in atopy risk children exposure to chemicals from indoor air should be minimised from birth on.

[Iatrogenic Cushing syndrome and mutatio tarda caused by dexamethasone containing nose drops]

Nasal steroid drops can produce iatrogenic Cushing's syndrome if the recommended dose is exceeded. We now report a 19-year-old male patient for whom dexamethasone nasal drops were prescribed because of nasal obstruction. He had been using these drops for more than 5 years, with a daily dexamethasone dose of 0.7-1.0 mg. It is likely that significant amounts of dexamethasone were swallowed and absorbed by the patient's gastrointestinal tract. As a consequence, the patient developed Cushing's syndrome with panhypopituitarism, growth retardation, osteoporosis and hypertension. A boyish size of the larynx resulted in a fundamental speaking frequency of a child. After discontinuing the intranasal use of the of dexamethasone and adjusting doses of hydrocortisone over 3.5 months a normalization of endocrine function occurred with the beginning of puberty and normal sexual changes. These findings show that the use of nasal steroid drops particularly in children should be limited to a short period and drugs with a low absorption dose employed.

Toxicity screening of liposomes

Phospholipids are the major components of most liposomes. Extensive testing of these naturally occurring compounds has revealed them to be remarkably safe for pharmaceutical use. Addition of other constituents to liposomes in order to alter stability or kinetics can result in an increase in toxic potential, particularly on parenteral administration of liposomes. This paper describes some simple in vitro cellular tests for direct toxicity of liposomes, particularly following intravenous (i.v.) or topical administration, including tests for haemolysis, thrombosis and cytotoxicity. In addition, an in vivo test for the effects on phagocytosis and for pyrogenicity are described, together with a brief outline of the requirements for the further toxicity testing of liposomal drugs at a later stage of development.

[Experiences with the use of an intravascular 6 French endosonography catheter in vivo]

Further progress in intraluminal sonography has led to the development of a 6 French ultrasound imaging catheter. This report demonstrates in vivo results using this new technique in a swine. Intraluminal echographic images obtained from the aorta and iliac arteries were of good quality. Artifacts such as image distortion were related to the 20 Mhz mechanically rotating tip motion and caused a loss of image quality. Atherosclerotic lesions could be visualized. The characteristics of the echo image of an atherosclerotic lesion related to the composition of corresponding histological sections of the lesion. Intraluminal sonography may develop into a new diagnostic tool, further enhancing progress in atherosclerosis research and improving the evaluation of coronary arteries and perivascular structures. Combined use with balloon angioplasty might also improve invasive therapeutic procedures.