ISSN:0954-7894    

DOI:10.1111/j.1365-2222.1987.tb02014.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SummaryIn order to explore the relationship between bronchial hyperresponsiveness (BHR) to inhaled histamine, respiratory symptoms and diagnosed asthma in children, we undertook a cross‐sectional study of 2363 Australian schoolchildren aged 8–11 years. The methods used included a self‐administered questionnaire to parents, which was shown to have a high degree of repeatability, and a histamine inhalation test to measure bronchial responsiveness (BR). The study showed that 17.9% of children had BHR, defined as a 20% fall in FEV1at a provoking dose of histamine (PD20FEV1) of less than 7.8 μmol. The distribution of PD20FEV1appeared to be continuous. Most children with PD20FEV1values<1.0μmol had symptoms of asthma. However, 6.7% of children had BHR without symptoms or a previous diagnosis of asthma and 5.6% had had a diagnosis of asthma but had no BHR. Although there was a good association between BHR and respiratory symptoms, questionnaire data of wheeze and diagnosed asthma do not reflect accurately the level of BHR in the community. We conclude that cross‐sectional studies of BR to identify children with BHR probably do not reflect the prevalence of asthma in populations of children. However, the strong association between BHR and symptoms, particularly in children with severe and moderate BHR, suggests that measurements of BR in populations are useful for defining a group of children whose airways behave differently from those of the majority. Prospective studies are needed to define the level of BHR that is associated with important

ISSN:0954-7894    

DOI:10.1111/j.1365-2222.1987.tb02015.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SummaryIn a cross‐sectional study of 2363 schoolchildren living in two rural areas of New South Wales, we used a questionnaire to collect details of sex, area of residence, social class, early respiratory illness (ERI), parental history of asthma and recent upper respiratory tract infection (URTI), and we used skin‐prick tests to measure atopic status. The relative importance of these factors on the likelihood of children having bronchial hyperresponsiveness (BHR) was assessed using a linear modelling analysis. The extent to which these factors affected the severity of BHR was also examined. We found that social class or recent URTI had no association with BHR, that sex and area of residence (inland or coastal) had a small association and that a history of early respiratory illness, a history of asthma in either parent, and atopic status had an important association with BHR. Atopic status was the most important factor. The proportion of children with atopy, with ERI or with parental asthma increased as the severity of BHR increased. The odds ratio for moderate or severe BHR doubled if either ERI or parental asthma was present in addition to atopy and there was a six‐fold increase if all three factors were present together. The identification of these risk factors makes it possible to predict which children in the community are most likely to have BHR, and which children are at high risk for having more severe levels o

ISSN:0954-7894    

DOI:10.1111/j.1365-2222.1987.tb02016.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SummaryTwo populations of schoolchildren, one living in an area where the predominant allergens are house dust mites and the other in an area where the predominant allergens are pollens, were studied to investigate in more detail the associations between atopy, bronchial hyperresponsiveness (BHR) and symptoms of asthma. The prevalence of atopy (39%) was the same in both towns but the prevalence of BHR was higher in the inland ‘pollen’ area (19%vs15%). Atopic children had an increased risk of having BHR and, to a lesser extent, respiratory symptoms, diagnosed asthma and hay fever. The risk of BHR was further increased in children atopic to both pollens and house dust mites, and in children with a high index of atopy (derived from the number and size of the skin reactions to four allergen groups). In addition, the relationship between atopy and BHR was quantitative in that the severity of BHR increased with the severity of atopy. We conclude that there is not a direct causal relationship between atopy and BHR but there may be a common mechanism involved in their development. It appears that, within the atopic population, the type of allergen to which the individual is sensitized, the quantity of aeroallergen present in the environment and the degree of atopy, as measured by the number and size of the skin reactions, are all factors that may interact to increase the risk of

ISSN:0954-7894    

DOI:10.1111/j.1365-2222.1987.tb02017.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SummaryThe laser Doppler flowmeter is a new instrument that reflects a different physiological parameter other than rhinomanometry for examining the vascular bed of the nasal mucosa. Mucosal blood flow in allergic rhinitis may be an important, but so far little studied, factor. Laser Doppler flowmetry was used to study nasal mucosal microcirculation in seven asymptomatic patients with allergic rhinitis. Topical provocation with birch pollen extract showed a statistically significant dose–dependent increase in blood flow. The method seems useful as anin–vivomodel for studying allergic rhini

ISSN:0954-7894    

DOI:10.1111/j.1365-2222.1987.tb02018.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SummaryThe effect of topical dermal anaesthesia on the immediate allergic skin reaction was evaluated in a double‐blind, randomized, placebo‐controlled study. Twenty‐one patients with strictly seasonal allergic rhinitis, confirmed by a positive skin test for the respective pollen allergen, were studied in the pollen‐free winter months. Skin‐prick tests for one pollen allergen and histamine were performed after pre‐treatment of the skin for 1 hr with an emulsion of lidocaine and prilocaine (EMLA®) and the equivalent vehicle on different test sites. The skin‐prick tests were made with a preloaded standardized test needle (Phazet®). The area of the induced weal‐and‐flare reaction was measured and subsequently calculated with the help of a digitizer served by a microcomputer. The topical dermal anaesthesia induced a reduction of the flare response to histamine by 49% (P<0.01) and allergen by 21% (P<0.05). No reduction of the histamine‐ and allergen‐induced weal response were noted. Our findings indicate that the treatment did not affect the allergen‐induced release of inflammatory mediators and the vascular leakage induced by these mediators. However, this study seems to confirm earlier suggestions that the flare response is partly mediated through neural reflex activity as it was ameliorated by topical anaesthesia. Furthermore, from a clinical point of view, this study shows that it is possible to perform a valid skin test, without any associated itching and pain, if only the weal response is taken into account n i the evaluati

ISSN:0954-7894    

DOI:10.1111/j.1365-2222.1987.tb02019.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SummaryTwenty patients with bronchial asthma, on long‐term oral therapy with theophylline, demonstrated an increased number of suppressor T‐cells and impaired graft vs host reaction. Ten asthmatics on other therapy, not including theophylline, as well as ten normal healthy controls, failed to show similar findings. Elimination of suppressor T‐cells corrected the above immunological abnormalities in the theophylline‐treated patients, while addition of serum from theophylline‐treated asthmatic patients to lymphocytes from normal healthy controls, affected the graft vs host reaction of these lymphocytes. We conclude that theophylline induces quantitative as well as qualitative immunological alterations by increasing the number and activity of suppressor T‐cells, which most probably secrete a serum factor, responsible for some of the abnormaliti

ISSN:0954-7894    

DOI:10.1111/j.1365-2222.1987.tb02020.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SummaryThe use of the sting challenge (SC) in insect allergy has brought into doubt the widely held belief that clinical data, specific IgE and the skin test are reliable tools in diagnosis and decision making with regard to therapy. We subjected ninety patients, known to have a systemic reaction to SC, in the Intensive Care Unit. Of these patients, 28% once more showed a systemic reaction; 72% had only a local reaction. No statistically significant difference could be demonstrated between positive and negative SC patients with regard to age; sex; the presence of allergic disease(s)—other than allergy to insects—and the severity of the preceding systemic reaction; the sting site and the related time interval; or specific IgE, IgG1, IgG4, their ratios and the skin test. A negative skin test and/or specific IgE, however, does not exclude the possibility of a recurrent systemic reaction. The long‐term value of the SC appeared to be good since the results of the revision SC remained unchanged. Skin test and specific IgE are useful as diagnostic tools in establishing the insect concerned. SC provides information on the likelihood of a recurrent systemic rea

ISSN:0954-7894    

DOI:10.1111/j.1365-2222.1987.tb02021.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SummaryIn order to investigate the influence of climate and vegetation on the age of onset and clinical picture of hay fever (HF), we examined 116 children with typical HF living in a single climatic area; fifty‐four were from rural farming settlements and sixty‐two from towns and cities. Overall age of onset was low; 72% of rural children developed HF between the ages of 2 years and 4 years compared to only 24% of urban children (P<0.005). At the same time, 57% of rural children had positive skin tests to more than three pollen extracts out of nineteen allergens tested, compared to 19% of urban children (P<0.005). There were no significant differences between the rural and urban groups with regard to the incidence of asthma as part of their HF, nor were there differences in total IgE levels. The results of this study suggest that Israeli children develop hay fever earlier than generally reported in the literature, and that this is most marked in the rural areas. This can be explained by their specific environment, which consists of a basically dry, desert‐like climate where lawns, crops and trees are extensively irrigated, leading to the dissemination into the environment of large amounts of pollen grains, which are not washed away because of the lack of

ISSN:0954-7894    

DOI:10.1111/j.1365-2222.1987.tb02022.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

SummaryIn order to investigate the relationship between the pattern of response (immediate, late and dual) to specific bronchial challenge test with plicatic acid or red cedar extract and the clinical features of asthma, 332 patients with‐asthma induced by western red cedar dust were examined at the time of diagnosis. Specific challenge test induced in thirty‐one patients (9.3%) an isolated immediate reaction, in 144 patients (43.4%) an isolated late reaction and in 157 patients (47.3%) a dual reaction. Patients with a dual reaction had a longer period of exposure to red cedar dust between the onset of the respiratory symptoms and the time of the definitive diagnosis, a lower FEF 25–75% and a greater degree of non‐specific bronchial hyperresponsiveness compared to patients with isolated immediate or isolated late reactions; the difference in bronchial hyperresponsiveness to methacholine among the three groups persisted when the values were adjusted for the different baseline value of FEV1. There was no difference in the prevalence of specific serum IgE antibodies to plicatic acid‐human serum albumin conjugate among the three groups of patients with different type of response to red cedar. Except for the greater degree of non‐specific bronchial hyperresponsiveness, patients with isolated late reactions were not different from those with isolated immediate reactions in other clinical findings. These findings indicate that a dual reaction in patients with occupational asthma due to simple chemical agents is indicative of a greater severity of disease at diagnosis. The pathogenetic mechanism of various types of asthmatic reaction is unknown and it is likely to be different between isolated immediate and isolated lat

ISSN:0954-7894    

DOI:10.1111/j.1365-2222.1987.tb02023.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY