摘要:

The purpose of this study was to determine whether a new ultrafiltrated whey hydrolysate infant formula, Profylac®, could be administered safely to children with cow milk protein allergy/intolerance. Profylac has a stated molecular weight of<8 kD and at least 30, 000 times reduced antigenicity which is controlled by a combination of ELISA‐techniques and immunochemical methods. The study comprised 66 children with cow milk protein allergy/intolerance diagnosed by controlled elimination/ challenge procedures. The children were aged 1 month‐14. 5 years, median 1% years and 15 were below 1 year. Thirty‐five of these children had proven IgE‐mediated reactions (cow milk protein allergy). Sixty‐one of the children had at least two different symptoms and 31 had concomitant allergies to other foods and/or inhalants. All 66 children underwent and tolerated open, controlled challenges with Profylac. A total of 64 children continued having Profylac daily for at least 3 months and 58 for at least 6 months after challenge. Nine of the children older than 1 year did not like the taste and only had Profylac in minor amounts. No side effects were registered. Fifteen of the infants were below 1 year of age, and this group was compared with an age matched group of 16 infants challenged with and fed an extensively hydrolysed casein hydrolysate, Nutramigen®. All the infants in these two groups accepted and tolerated Profylac and Nutramigen, respectively, and no side effects were registered. Among the 35 patients with IgE‐mediated reactions 6% (2/35) had positive skin prick tests and 11% (3/28) had specific IgE class 2 against Profylac, 2 of the latter before intake of Profylac. None of the patients with non‐IgE‐mediated reactions had a positive skin prick test or specific IgE against Profylac. The study provides 95% confidence that this product is tolerated by at least 95% of children with cow milk protein allergy/intolerance and by 90% with IgE‐mediated reactions. We conclude, that this ultrafiltrated whey hydrolysate is generally safe to feed to children with verified adverse reactions to cow milk protein, including children with IgE‐mediated reactions. The taste of the product was widely accepted, a

ISSN:0905-6157    

DOI:10.1111/j.1399-3038.1993.tb00067.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

For newborn children both elevated serum IgE levels in the cord blood and a positive family history of atopic disease have been shown to be risk factors for the manifestation of atopic diseases. In adult patients with atopic dermatitis,in vitrointerferon‐γ (IFN‐γ) production is reduced and a negative correlation with serum IgE levels has been shown. We have now raised the question if newborn infants at risk for the development of atopic disease have similar abnormalities of cytokine production at birth.In vitroproduction of interleukin 2, interleukin 6 and interferon‐γ by peripheral blood mononuclear cells was measured in 53 newborns: 21 had cord blood IgE levels above 0. 9 kU/1, 21 had a positive family history, 7 had both elevated IgE and a positive family history; 18 newborns with no identitiable risk for atopic disease served as controls. Umbilical cord blood mononuclear cells were stimulated with PHA or monoclonal antibody OKT3.In vitroproduction of interleukin 2 and 6 was comparable in all groups. Compared to controls IFN‐γ production of peripheral mononuclear cells (PBMC) from newborns with elevated cord blood IgE was not different, but PMBC from newborns with a familial risk showed a significant decrease in PHA induced IFN‐γ production (p<0.005, U‐test). No correlation between umbilical cord blood IgE and diminished IFN‐γ production was found in newborns with or without a positive family history. We conclude that immunoregulatory abnormalities in newborns of atopic families are detectable already at birth and are unrelate

ISSN:0905-6157    

DOI:10.1111/j.1399-3038.1993.tb00068.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Wiskott Aldrich syndrome, a combined cellular and humoral X‐linked immunodeficiency, is generally considered to be rare. The aim of this study was to ascertain the true prevalence in the paediatric population in Western Australia, describe the clinical features, and summarise the current literature on this unusual condition. All cases of Wiskott Aldrich syndrome presenting to Princess Margaret Hospital in Perth during the period from January 1960 to January 1990 were identified by a retrospective review of case records and by interviewing hospital immunology, haematology and general clinical staff. Nine cases of Wiskott Aldrich syndrome are described, demonstrating that the prevalence of Wiskott Aldrich syndrome in Western Australia is nine times that expected from previous reports. Death occurred in a number of patients before the correct diagnosis was recognised. The clinical features in this group are quite variable. Low isohaemagglutinins, elevated IgE, blunted DTH skin multitest, and very low CDS numbers are however consistent features. Wiskott Aldrich syndrome may be more prevalent than previously recognised, and should be considered in males with thrombocytopenia and infectio

ISSN:0905-6157    

DOI:10.1111/j.1399-3038.1993.tb00069.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Fifty‐two asthmatic children aged 4 to 13 years (mean 9. 6) were enrolled in this open 12‐month study of budesonide, 200 meg bid, administered by tube‐spacer inhaler (INHALETE® ASTRA DRACO). The aim of the study was to assess long‐term safety, as well as efficacy, of budesonide in children whose asthma was not adequately controlled by their current therapy. Children attended the clinic every three months for assessment of lung function and height. In addition, an adrenal function test and routine clinical chemistry and haematology were performed. Parents completed diary cards once each week, recording the child's PEF, asthma symptoms, β2‐agonist consumption and other medication (no prophylactic drugs or other inhaled steroids were allowed and oral steroids were used for emergency treatment only). There were significant increases in all clinic lung function tests (baseline to last visit) and in diary card PEF (first 3 months vs last 3 months). These were accompanied by decreases in asthma symptoms and use of β2‐agonists or other medication. There was no indication that growth was affected by study treatment and basal adrenal function (basal cortisol) did not change significantly throughout the study. The adrenal response to Synacthen had actually increased significantly by the end of the study. No serious adverse events were associated with budesonide treatment. In conclusion, regular budesonide therapy was associated with a significant improvement in lung function and symptoms over one year. Budesonide was well‐tolerated by the children and appeared to have no adverse influence on either growth or

ISSN:0905-6157    

DOI:10.1111/j.1399-3038.1993.tb00070.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Oral disodiumcromoglycate (DSCG) has been used for many years in the prevention of food allergic reactions. The reported effectiveness varies widely and little is known about the mode of action. The aim of this study was to evaluate the effect of DSCG pretreatment (2 x 100 mg) on intestinal permeability (IP), as measured with a sugar absorption test (SAT), in relation to the clinical response during food challenge in 30 children suspected of cow's milk allergy. In the SAT the urinary Lactu‐lose/Mannitol (L/M) ratio was measured after oral administration of these compounds. DSCG pretreatment did not alter the number of clinically positive challenges. Children with clinically positive challenges showed a significant increase in the L/M ratio with placebo pretreatment as compared to children with clinically negative challenges (p = 0.0008). This difference was reduced to nonsignificant levels after DSCG pretreatment (p = 0.07). We conclude that DSCG in this dosage probably reduces the local intestinal response but does not prevent the extra‐intestinal reacti

ISSN:0905-6157    

DOI:10.1111/j.1399-3038.1993.tb00071.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Eosinophil count (EC) were obtained from 312 newborns with and 172 without family history of atopy (FHA). The EC were higher in infants with than without FHA. Elevated EC were recorded in babies of parictaria sensitive mothers born in the spring, as compared to other seasons. The predictive value of EC with regard to development of atopic diseases up to 18 months of age was prospectively studied in 103 newborns with FHA. Using 5 × 108cells/1 as cut‐off level the predictive allergy value was 41%. Elevated EC appears to be a marker of atopy in newbor

ISSN:0905-6157    

DOI:10.1111/j.1399-3038.1993.tb00072.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

In patients with allergic asthma and rhinitis high numbers of hypodense eosinophils (HE) have been demonstrated. In a previous study we reported that asthmatic and healthy children had more HE than their adult counterparts. We assumed that this might, in part, he due to the presence of immature eosinophils in children. To distinguish between immature and activated eosinophils, determination of eosinophil cationic protein (ECP) might be interesting as it is known that high serum levels of ECP are associated with increased activation of eosinophiis. In this study we determined (he levels of ECP in scrum in asthmatic and healthy children and adults trying to distinguish activated from immature eosinophils. We found that ECP levels were not increased in children (healthy and asthmatic) compared to adults (healthy and asthmatic). This supports the hypothesis that increased numbers of HE in childhood are, at least in part, immature eosinophils. Nevertheless, we could confirm that inflammation was present in children because soluble interleukin‐2‐receptor (slL‐2R), a marker of lymphocyte activation, was higher in asthmatic children as compared to healthy children. IL‐6, a marker of macrophage/monocyte activation, was not different in the different patient groups. We conclude that although signs of inflammation are present in childhood asthma, the increased numbers of HE in children are in part due to the presence of immature eosi

ISSN:0905-6157    

DOI:10.1111/j.1399-3038.1993.tb00073.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Asthmatic attacks continue to be a major cause of referral to the emergency room (ER), despite currently available effective treatments. We have prospectively evaluated 100 consecutive children who were referred to the ER with acute asthma and were followed by their primary physicians. Only 46% were able to recognize acute attacks, and 26% had the knowledge and skills for self‐management. The prophylactic therapy recommended was usually appropriate, but the compliance was poor and mean serum theophylline levels (STL) was 6. 8 μg/ml, with subtherapeutic values (<10 μg/ml) in 44 (88%). We studied an additional group of 50 consecutive children who were on a routine follow‐up in the hospital asthma clinic. All were examined periodically and were instructed on the disease. The compliance of these children was much better and STL were within the therapeutic range in 73%, significantly higher than in the ER patients (p<0.001). Their need for ER treatment or hospitalization was much lower than the former group. Poor compliance is a major factor causing referral of asthmatic children to ER, and careful education can improve patient compliance with reduced referral and subsequent hospitaliz

ISSN:0905-6157    

DOI:10.1111/j.1399-3038.1993.tb00074.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0905-6157    

DOI:10.1111/j.1399-3038.1993.tb00075.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY