The SIgA and IgA quantification by radial immunodiffusion was carried out in the saliva of 449 normal individuals, whose ages vary from 1 day to 32 years old. SIgA was determined in an agar plate containing purified serum against SIgA of human colostrum and the IgA in commercial plates containing serum anti IgA. The SIgA values grouped in different age groups were much variable, allowing only to establish minimum critical values for each group. In the saliva of 71 patients IgA was dosed by both methods. The set of obtained data showed significant correlation (p less than 0.05). The dosage of standardized quantities of SIgA and IgA in conventional plates containing serum anti IgA, allowed to establish corresponding values similar to precipitation ring diameter. In this way, it was possible to establish a "critical value" for salivary IgA by the use of conventional plates. Thus, the IgA quantitative determination by radial immunodiffusion with antibody against serum IgA was carried out in saliva samples of normal and atopic individuals (asthma and/or rhinitis). The patients' ages varied from 1 month to 32 years old. The obtained values were grouped according to defined age group. We observed non-measurable values in 70% of the children aged less than 1 month; from then on, the values were increasing, reaching adult levels from the 6th year on. We did not observe differences between the salivary IgA levels of normal and atopic children. In children aged less than 6 months breast and/or bottle feeding (natural, mixed or artificial) there were no differences between the IgA levels observed in saliva.

Adolescent↗

PubMedDate not supplied

[Serum levels of immunoglobulins (G, A, M and E) in patients with respiratory allergy].

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Adolescent↗

PubMedDate not supplied

Maximum bronchodilator effect of pirbuterol and procaterol administered as sprays with and without an aerochamber.

OBJECTIVE OF THE STUDY: To determine the maximal bronchodilator dose of procaterol and pirbuterol administered by inhalation with an without an aerochamber (Aerocâmera) to children with acute bronchial asthma attacks. TYPE OF STUDY: Prospective. 18 children (6-15 years of age) with acute bronchial asthma attacks (FEV1 < 80% of the predicted value) received pirbuterol (N = 10) or procaterol (N = 8) by metered-dose inhaler, one puff every 5 minutes, for a total of five doses. During another acute attack, the same patient received the same medication with the aid of a spacer (Aerocâmera). Clinical evaluation and pulmonary function tests were performed 5 minutes after each inhaled dose. RESULTS: For both drugs, maximal bronchodilation was obtained after the second dose. No significant side effects were observed even after procaterol doses of 50 micrograms or pirbuterol doses of 1000 micrograms. The results were unaffected by the use of the spacer. CONCLUSIONS: The doses that induced maximal bronchodilation were 400 micrograms pirbuterol and 20 micrograms procaterol. Although the spacer did not change the results, it is a valuable aid for patients who have difficulty in using the metered-dose inhaler (M.D.I.).

Administration, Inhalation↗

PubMedDate not supplied

Study of the effects of treatment with theophylline on the cognitive process and behaviour of children with bronchial asthma.

The effects of theophylline (T) on cognitive and emotional aspects were evaluated in nine children with mild bronchial asthma (7-14 years). The study was double blind crossover against placebo (P) for a period of 30 days for each. The children admitted to the study had an average IQ (80-101) and were able to perform pulmonary function studies (PFS). On days 0, 30 and 60 patients were evaluated by psychological tests (Wisc, Bender, Complex Figure A. Rey and Miss Goodenough/Machouver). PPS an T serum levels were performed on days 15 and 45. During the T period all patients had T serum levels greater than 5 mcg/ml (5 to 22). The final evaluation showed no changes in the psychological tests. Behaviour alterations were not reported by the parents. In conclusion, in this group of patients there was no influence of T on the asthmatic children's behavior. These results are in agreement with the recent data published by Schlieper et al. (J. Pediatr. 118: 449-455, 1991).

Asthma↗

PubMedDate not supplied

Cartilage-hair hypoplasia syndrome: immunological evaluation of two cases.

PURPOSE: Immunological evaluation of patients with cartilage-hair hypoplasia. TYPE: Prospective and retrospective studies. PLACE: Division of Allergy, Clinical Immunology and Rheumatology-Dept. of Pediatrics-"Escola Paulista de Medicina". PATIENTS: Two children with cartilage-hair hypoplasia syndrome. METHODS: Clinical and immunological evaluation. Humoral immunity (immunoglobulin levels, poliovirus antibodies, etc.) and T cell immunity (in vitro cultured lymphocytes stimulated with PHA, Con A and PWN, total T cell and subset determination) were studied. RESULTS: Cellular immunodeficiency and hypogammaglobulinemia were observed in one patient and normal values in the other. CONCLUSIONS: Immunological evaluation (cellular and humoral) should be performed in all patients with cartilage-hair hypoplasia.

Antibody Formation↗

PubMedDate not supplied

Interleukin-4 and soluble CD23 serum levels in asthmatic atopic children.

IL-4 is an essential mediator of IgE synthesis; it also upregulates the expression of the low affinity receptor for IgE (CD23) and its release in soluble form (sCD23). The involvement of IL-4 and sCD23 on the IgE synthesis control has been observed in experimental studies. IL-4 and sCD23 serum levels in asthmatic atopic children were determined in order to investigate a possible correlation between these factors and IgE levels. IL-4, total sCD23 and Dermatophagoides pteronyssinus specific IgE were determined in the serum of 19 asthmatic atopic children (aged 7 to 14) and in 13 age-matched controls. Since sCD23 may present an age-dependent variation, sCD23 and IL-4 serum levels were evaluated in 20 "wheezy babies." IL-4 serum levels were significantly higher in patients as compared to controls, whereas there was no significant difference between them concerning sCD23 levels. sCD23 levels were, however, significantly higher among "wheezy babies" as compared to atopic and nonatopic children. There was no correlation between IL-4 and sCD23 serum levels, nor between any of these factors and IgE levels in all groups. In conclusion, the enhanced IL-4 levels suggest that atopic patients have a preferential activation of Th2 subset. CD23 expression is markedly influenced by age.

Adolescent↗

PubMedDate not supplied

Comparative performance for immediate hypersensitivity skin testing using two skin prick test devices.

Fifty-five patients were skin-tested by Multi-Test (M) and needle prick test (NPT) to compare the reproducibility of the methods. We used 6 allergenic extracts: Dermatophagoides pteronyssinus, Dermatophagoides farinae, dog epithelium, cat pelt, American cockroach and mixed molds. A glycerosaline and a positive control (histamine 1 mg/ml) were performed in both methods. Statistically significant differences in histamine and Dermatophagoides farinae wheal reactions between the two methods (M > NPT) were found, with no differences with the other allergenic extracts. We concluded that the two methods are similar with respect to determining the immediate hypersensitivity, but the Multi-Test is better accepted by children.

Adolescent↗

PubMedDate not supplied

Non-specific nasal provocation in children with chronic allergic rhinitis.

Twenty-three children with chronic allergic rhinitis (Group A) and eleven normal non-atopic subjects (group C) were submitted to non-specific nasal provocation tests with histamine (0.03; 0.06; 0.125; 0.25; 0.5; 1.0; 2.0 and 4.0 mg/ml), and one week later with methacholine (0.025; 0.1; 0.25, 0.5; 1.0; 2.5; 5.0 and 10.0 mg/ml). Measurements of total nasal resistance were performed by active anterior rhinomanometry (Berger, S.A.) and symptoms were recorded. Challenges were carried out in the morning with all children in an acclimatized room (25 degrees C/77 degrees F). Concentrations of the tested drugs were increasingly instilled, and after 5 min were followed by total nasal resistance, FEV, and FVC measurements. Considering as positive those tests in which total nasal resistance had a 100% increase, we observed that both histamine and methacholine caused an increase in total nasal resistance as instilled drug concentration rose; histamine provocations were significantly more positive among group A than group C patients (91% sensitivity, 80.8% positive predictive value). This was not observed with methacholine (55% sensitivity, 75% positive predictive value). In neither provocation was there correlation between the concentration that induced a positive response and symptoms. There were no changes in spirometric values during the tests. Nasal provocations with histamine and methacholine are safe and well tolerated. Histamine seems to be more adequate for differentiating children with allergic rhinitis from normal controls.

Adolescent↗

PubMedDate not supplied

Methotrexate in the treatment of corticodependent asthmatic children.

Methotrexate has been used as an anti-inflammatory agent in chronic asthma. We evaluated the action of methotrexate in eight corticodependent severely asthmatic children (more than 10 mg of prednisone per day for at least one year). The patients (3 males and 5 females; aged 8 to 14 years) received a single weekly dose of 0.6 mg/kg methotrexate (maximum 25 mg) and folic acid (15 mg/day for 5 days in the week). The children were examined and had their pulmonary function test evaluated weekly. As the study progressed, the dose of prednisone was reduced and maintained till the next evaluation if the patient's symptoms were under control. After the 3rd month of treatment, we observed a significant reduction in the dose of prednisone and maintenance of the spirometric parameters. At the end of the trial, in 4 patients it was possible to reduce the basal prednisone dose 56% or more. In the remaining 4, one did not show any benefit and in the other 3, it was possible to obtain an average reduction of 40% of the basal prednisone dose. The total mean reduction was 55.9%. This oral corticoid reduction was not associated with clinical or pulmonary function deterioration, except in one patient. The patients were submitted to white blood cell count, hepatic transaminases, urine tests and other determinations at least once a month. There were no changes in biochemical tests. The side-effects were nausea, vomiting and abdominal pain. In conclusion, methotrexate given to severely corticodependent asthmatic children permitted a reduction in the daily intake of prednisone, reducing the severe side-effects of chronic corticotherapy.

Adolescent↗

PubMedDate not supplied

Diagnostic value of nasal provocation testing and rhinomanometry in allergic rhinitis.

We studied 32 patients, aged 7 to 17 years, with clinical symptoms of perennial allergic rhinitis, isolated (n = 21) or associated with asthma (n = 11), all of them with positive skin test and specific serum IgE for Dermatophagoides pteronyssinus (Dpt). The control group consisted of 10 children aged 7 to 16 years, with no personal or family history of allergy and with negative skin tests and negative specific serum IgE for mites. Total and specific IgE measurements in nasal secretion and nasal provocation testing (NPT) were also performed with increasing concentrations of Dermatophagoides pteronyssinus (Dpt) extracts. The nasal response was evaluated using a clinical score and active anterior rhinomanometry. The levels of total and specific IgE in nasal secretion were higher in patients with allergic rhinitis than in individuals from the control group. The NPT presented a significant correlation with clinical symptoms, skin tests and specific serum IgE. None of the individuals from the control group presented a positive NPT. No generalized reactions or bronchial response at the immediate phase of NPT were observed. The NPT constitutes a safe, dependable investigative procedure of nasal reactivity to a specific allergen, presenting a good sensitivity and specificity when compared to the other methods classically used in allergy studies.

Adolescent↗

PubMedDate not supplied

[Zinc, pregnancy and the fetus].

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Animals↗

PubMedDate not supplied

Lysine-vasopressin in the evaluation of the hypothalamic-pituitary-adrenal axis in children with allergic rhinitis treated with intranasal beclomethasone dipropionate or oral prednisone.

One of the complications of steroid therapy is the hypothalamic-pituitary-adrenal (HPA) axis' suppression, particularly in children where this can lead to growth suppression and other well known complications. Although there are a large number of studies on suppression of the HPA axis with the use of topical steroids, the subject is still controversial. We measured the HPA axis function in 3 groups of allergic children treated with: 1) intranasal beclomethasone dipropionate (BDP) 400 micrograms/day for 4 weeks or 2) BDP 800 micrograms/day for 4 weeks and 3) oral prednisone, 1 mg/kg/day for 2 weeks. The HPA response was obtained after lysine-vasopressin (LVP) stimulation. LVP acts on the pituitary or hypothalamus level, stimulating the whole axis. Peripheral blood samples through an intravenous line were obtained for serum cortisol measurement at zero, 30, 60, and 90 minutes after the intravenous injection of LVP, before and after the treatment period. Our results showed no suppression of the HPA axis in children medicated with BDP at either 400 micrograms/day or 800 micrograms/day. On the other hand, there was a suppression of the HPA axis after prednisone treatment (p < 0.05). During the LVP test some side effects, possibly due to systemic vasoconstriction, were noted such as abdominal pain, nausea and vomiting, and transient hypertension. In conclusion, intranasal BDP at the dose of 400 or 800 micrograms/day during 4 weeks did not induce HPA axis suppression. The LVP test is efficient to demonstrate HPA hypofunction or suppression and it produced only mild to moderate transient side effects. However, due to the side effects observed, a safer test such as urinary free cortisol (24 hours), should be used in the investigation of the HPA axis.

Administration, Intranasal↗

PubMedDate not supplied

Specific sensitization to Dermatophagoides pteronyssinus and cutaneous reactivity to histamine in Brazilian children.

The immediate hypersensitivity cutaneous test is a recognized method for etiologic diagnosis of allergic diseases. It is easily conducted, painless and can be quickly interpreted, making it deal for use with children. However, its low positivity in infants limits its use this population. The purpose of our study was to evaluate the skin reactivity to atopic and non-atopic children of different ages to increasing concentrations of histamine and to an extract of Dermatophagoides pteronyssinus (Dpt). Atopic children (A, n = 217) and non-atopic children (C, n = 198), under 15 years of age were grouped by age and administered skin prick tests. Increasing concentrations of histamine (1, 9, 81 and 243 mg/ml) and Dpt (10,000 AU/ml) were applied to the forearm. Skin reactions were recorded after 15 minutes and expressed as the mean of the largest wheal and its midpoint perpendicular diameter. Cutaneous reactions were observed in the early phases of life with a progressive increase observed in both groups. Significant differences were noted between the two groups starting at 48 months of life. As the concentration of histamine was increased, we observed a higher level of cutaneous reactivity in younger children. Comparative analysis of cutaneous reactivity to the histamine solution (1 mg/ml) and the Dpt extract showed parallelism between them and wheals with diameters larger than 3 mm after 12 months of age. We concluded that the skin prick test with Dpt is reliable in atopic children after 1 year of age. Reactivity to higher concentrations of histamine was observed after 3 months of age for all children. However, considering all age groups, the skin reactivity in atopic children to histamine (1 mg/ml) was more precocious when compared to controls.

Adolescent↗