Mechanism of topical glucocorticoid treatment of hay fever: IL-5 and eosinophil activation during natural allergen exposure are suppressed, but IL-4, IL-6, and IgE antibody production are unaffected

BACKGROUND

Allergic rhinitis is traditionally defined as an IgE- and mast cell-mediated hypersensitivity reaction. Allergen challenge models suggest that cytokines and eosinophil mediators may also play roles. However, the causal relationship among inflammatory cells, their products, and patients' symptoms during natural allergen exposure has not been established.

OBJECTIVE

We sought to elucidate the mechanisms of seasonal allergic rhinitis and the beneficial effects of topical glucocorticoids.

METHODS

Thirty patients with ragweed-induced hay fever and a strongly positive serologic test response for ragweed IgE antibody received budesonide nasal spray or placebo in a randomized, parallel, double-blind study. Nasal wash fluids and sera were collected before and during the hay fever season. The levels of inflammatory mediators and allergen-specific immunoglobulins were measured by immunoassay. The activation markers on blood eosinophils were quantitated by flow cytometry.

RESULTS

Compared with placebo-treated patients, budesonide-treated patients had strikingly reduced symptoms. In the placebo group, nasal symptoms correlated with nasal lavage fluid eosinophil-derived neurotoxin and IL-5 levels. At the season peak, the budesonide-treated group had significantly lower nasal fluid eosinophil-derived neurotoxin, IL-5, and soluble intracellular adhesion molecule-1 levels. In the treated group eosinophil expression of CD11b was suppressed at the season peak. In contrast, levels of IL-4 and IL-6 in nasal fluid and the seasonal increases in serum ragweed-specific IgE and nasal fluid IgA antibodies did not differ between groups.

CONCLUSION

Eosinophilic inflammation plays a critical role in seasonal allergic rhinitis symptoms. One of the therapeutic effects of glucocorticoids is to suppress this inflammation.

Role of the beta 3-adrenergic receptor locus in obesity and noninsulin-dependent diabetes among members of Caucasian families with a diabetic sibling pair

Obesity and insulin resistance are important risk factors for the development of noninsulin-dependent diabetes (NIDDM) and are prevalent among predisposed first degree relatives of diabetic individuals. Recent molecular screening and analysis of a common missense mutation of the beta 3-adrenergic receptor gene suggested this locus as a strong candidate for increased obesity, earlier age of diabetes onset, and insulin resistance. To test the hypothesis that the beta 3-adrenergic receptor locus affects diabetes susceptibility, obesity as measured by body mass index, and components of the insulin resistance syndrome, we examined the role of this region in families ascertained for two or more NIDDM siblings. Linkage analysis was conducted using both parametric and nonparametric analyses, including multipoint sibling pair analysis. We found no evidence for linkage to NIDDM as a dichotomous trait and no evidence for linkage to body mass index, waist/hip ratio, insulin levels, or glucose levels as quantitative traits or to reported age of onset among NIDDM individuals. The Trp64 Arg missense mutation was present in 11% of the population. The mutation was not associated with NIDDM, and Arg64 carriers did not have earlier NIDDM onset, higher body mass index, or higher waist/hip ratio than Trp64 homozygotes. Among relatives, Arg64 carriers had significantly lower fasting glucose levels and lower waist/hip ratios than Trp64 homozygotes, but no characteristics of the insulin resistance syndrome. We conclude that the beta 3-adrenergic receptor locus does not play an important role in NIDDM susceptibility or in the insulin resistance syndrome among members of families with a strong predisposition to NIDDM.

Impact of fat reduction on micronutrient density of children's diets: the CATCH Study

BACKGROUND

The purpose of this study was to examine the impact of fat reduction on vitamin and mineral density in the diets of groups of children who participated in the CATCH school-based intervention study for 2 1/2 years.

METHODS

Twenty-four-hour dietary recalls were collected on 1,182 children residing in four states and with diverse ethnic backgrounds, at baseline when they were in third grade and again at follow-up when they were in fifth grade.

RESULTS

With a 2.4% reduction in total fat intake from baseline levels in the intervention group, mean changes in vitamin and mineral intakes per 1,000 kcal of this group were small yet significant compared with the control group. As mean fat intake decreased, the nutrient density of most vitamins and minerals increased; the sole exceptions were vitamin E and sodium. Mean intake of all vitamins and minerals studied exceeded 2/3 of the RDA at both baseline and follow- up for both the intervention and the control groups. No significant differences were noted between treatment groups for the percentages of children meeting 2/3 or more of the RDA at both baseline and follow-up periods.

CONCLUSIONS

CATCH was successful in maintaining mean vitamin and mineral intakes of intervention group children when total dietary fat was reduced.

The effects of the child and adolescent trial for cardiovascular health intervention on psychosocial determinants of cardiovascular disease risk behavior among third-grade students

PURPOSE

The Child and Adolescent Trial for Cardiovascular Health is a multi-site study of a school-based intervention designed to reduce or prevent the development of risk factors for cardiovascular disease. The goal was to change (or prevent) related risk behaviors and the psychosocial variables that theoretically influence those behaviors.

DESIGN

A nested design was used in which schools served as the primary unit of analysis. Twenty-four schools participated at each of four sites (Austin, San Diego, Minneapolis, and New Orleans). Each site had 10 control and 14 intervention schools.

SETTING AND SUBJECT

Ninety-six schools (with more than 6000 students) in the four sites were randomized to three treatment conditions: control, school-based interventions, and school-plus-family interventions. The sample included approximately equal numbers of males and females and was 67.5% white, 13.9% African-American, 13.9% Hispanic, and 4.7% other.

MEASURES

The psychosocial determinants included improvements in dietary knowledge, intentions, self-efficacy, usual behavior, perceived social reinforcement for healthy food choices, and perceived reinforcement and self-efficacy for physical activity.

RESULTS

The findings indicated significant improvements in all the psychosocial determinants measured (p < .0001). The results revealed a greater impact in the school-plus-family intervention schools for two determinants, usual dietary behavior and intentions to eat heart-healthy foods.

CONCLUSIONS

These findings support theory-based interventions for changing selected psychosocial determinants of cardiovascular disease risk behavior among children.

Successful recruitment strategies for school-based health promotion: experiences from CATCH

School-based research designs in the 1990s often require that a large number of schools be recruited to participate in studies. Therefore, effective recruitment and maintenance of schools becomes an important activity for ensuring the integrity of the study design. The Child and Adolescent Trial for Cardiovascular Health (CATCH) is the largest school-based health promotion research project yet undertaken; 96 schools (24 per field site) were successfully recruited and retained for this cardiovascular disease risk reduction project. This article describes general recruitment strategies used at the four CATCH sites, a description of how Social Learning Theory guided these activities, a discussion of logistical considerations, and recommended recruitment strategies for future school-based research.

CATCH: challenges of conducting process evaluation in a multicenter trial

This paper discusses the challenges faced when collecting process evaluation information in a school-based, multicenter field trial. Experiences from the Child and Adolescent Trial for Cardiovascular Health (CATCH) are shared as a means of illustrating the challenges that are presented and ways of meeting the challenges. The scope and magnitude of the trial (96 schools across four sites) and the diverse population participating in the trial (including children and adults representing a cultural and socioeconomic mix) present challenges that are compounded by conducting research in a highly structured school setting. In such a trial, thoughtful consideration must be paid to what data should be collected, how data should be collected, how to collect data on tailored interventions, gaining and maintaining schools' cooperation, collecting data in year-round schools, and assuring data quality.

Dependence on p75 for innervation of some sympathetic targets

The low-affinity neurotrophin receptor p75 binds all neurotrophins with similar affinity. For elucidation of its function, mice bearing a null mutation in the p75 locus were generated. Examination of sympathetic innervation of target tissues revealed that pineal glands lacked innervation and sweat gland innervation was absent or reduced in particular footpads. The absence of adult innervation reflects the failure of axons to reach these targets during development rather than a target deficit. These results indicate that p75 facilitates development of specific populations of sympathetic neurons, for which it may support axon growth.

Using Mental Imagery to Practice a Specific Psychomotor Skill

This study explored the usefulness of mental imagery as a technique for practicing psychomotor nursing skills. Using the specific skill of one-rescuer cardiopulmonary resuscitation (ORCPR) and a control group, several posttest questions addressed mental imagery and the possible improvement of performance proficiency with its use. The findings suggested that subjects were able to clearly perceive a specific psychomotor skill using mental imagery (p = .05). The subjects in this study indicated that mental imagery was a useful and interesting learning technique. No significant differences were noted in the performance of the study and control groups.