[Treatment and prevention of allergy to cow's milk proteins].
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Biomedical subjects
Publications and source records attributed to F Muñoz-López.
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The characteristics of bronchial asthma revised: in puberal age and adolescence ave the value of hyposensitization therapy, significance of the age of onset of asthma, regional lung function and growth in asthmatic children. It is point out de news perspectives in treatment and psycosocial implications.
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A 4-year-old girl with hepatic cirrhosis was found to have alpha1-antitrypsin deficiency. The method of FAGERHOL detected that she is a heterozygous carrier of the Pi SZ type. Investigations with the light and the electron microscope and immunofluorescence tests confirmed the diagnosis. The values of alpha1-antitrypsin and trypsin inhibitory capacity gave intermediate values. The fact that in the patient, the Z allele was combined with an S allele may have contributed to the severity of the illness.
Serum IgE levels have been measured in a group of 55 healthy children from 2 to 10 years of age. The IgE mean value increases with the age but no sexual differences have been found. The numerical distribution of the different genotypes observed in the unselected population, follows the Hardy-Weinberg law, which describes the segregation of two alleles at a single locus.
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After presenting the case of a male patient who was diagnosed as suffering from the Wiskott-Aldrich syndrome at the age of 4 months, we review the main clinical (infections, bleeding and eczema), immunological (deficiency of IgM, normal IgG, elevated IgA and IgE, deficiency of total T lymphocytes, normal T4 levels, decreased levels of T8, diminished response to phytohemagglutinin and partial depletion of the lymphocyte population in biopsies of lymph nodes and spleen) and haematological (thrombocytopenia, dysmegakaryocytosis, decreased half-life and decreased granulation in the protoplasm of megakaryocytes) manifestations of this syndrome. In general, our aim is to carry out an up-to-date review of the syndrome, and to include comments on the diagnostic and therapeutic aspects.
Serum concentrations of immunoglobulin E (IgE) were measured in 31 children with bronchial asthma and in 55 healthy children. Among the asthmatic children, 70% had elevated IgE levels, 83% had a low titre of histamine-latex agglutination and 80% had blood eosinophilia over 3%. All asthmatic children showed hypersensitivity to one or more allergens; the highest incidence of hypersensitivity was to house dust (38% of asthmatic children), followed by pollens (25%) and vegetable fibers (19%). No relation was observed between serum IgE concentration and the intensity of cutaneous reaction or the number of sensitizing allergens. No significant difference was observed in serum IgE concentration in asthmatic children submitted hyposensitization therapy compared with those who had not received such treatment. It is concluded that IgE determination may be valuable for differential diagnosis between allergic and non allergic asthma and that IgE measurement should be considered as a complementary test in the investigation of allergy.
24 cases of selective IgA deficiency were found among 2,650 children studied in an immuno-Allergy service. The population studied must therefore be considered highly selected. The Amman and Hong criteria were used as a basis for diagnosis (Table 1). Even though they are currently being revised, they are still on some practical value. Statistically, the incidence of selective IgA deficiency in this study is higher (0.905%) than in other publications. Respiratory symptoms were the most important. Only one case presented digestive symptoms (resembling coeliac disease), and no cases with autoimmune disease were found, although the possibility of its occurrence later on cannot be dismissed. A cytogentic analysis was performed in 8 cases and interesting results were found. Five cases showed an increase in heterochromatic material in the paracentric region (1qh+, 2qh+, 16qh+ and Yqh+). These polymorphic variations are present in the general population without any apparent clinical significance, even though their presence in several clinical has been described. However, in this study the frequency seems higher than in the general population. In 2,051 cases studied for other reasons, the frequency of occurrence of polymorphic traits was 3.12%, while in the cases studied by us the incidence amounted to 62.5%, a highly significant proportion. Our data do not try to establish a relationship between the chromosomal alterations and the etiology of the IgA deficiency, even through some relationship may in the future be found to exist.
Newborns present a certain degree of immunological immaturity, which makes them highly susceptible to infection. As interleukin-2 (IL-2) is a cytokine that increases the immune response, we performed this study with the object of determining whether there are differences in the serum levels of IL-2 in healthy newborns and those affected by neonatal sepsis in order to establish if there is an increase in the production of IL-2 in systemic neonatal infection. We studied three groups of newborns: group 1-20 healthy full-term newborns; group 2-19 healthy preterm newborns; and group 3-11 infected newborns. The study was performed before the seventh day of life. IL-2 levels were determined by radioimmunoassay (RIA). Covariant analysis showed no significant differences in IL-2 values between the healthy groups (1 + 2) and the infected group (3) (p = 0.7814).
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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.
Immunotherapy is an empirical treatment with proven clinical efficacy. Different results have been found when comparing the levels of the subclasses for immunoglobulin G and the clinical development during immunotherapy. A follow up study was carried out for one year on the IgG subclasses in 21 asthmatic children of both sexes and ages ranging from 8 to 11 years. The children were sensitized to Dermatophagoides Pteronyssinus and had undergone immunotherapy treatment. The clinical and analytical evaluation were carried out before treatment was started and later every four months. In terms of clinical evolution, the children were separated into two groups. The levels of IgG1 show different evolution in terms of a good or not good clinical evolution with a p of 0.056. Levels of IgG2 showed no differences. IgG3 shows a disorderly distribution. A continuous increase in IgG4 levels was observed from the start of immunotherapy though no differences in terms of clinical evolution were recorded. With the results obtained, it can be concluded that the gradual increase of IgG4 together with an early rise in IgG1 levels are related to the clinical efficacy of immunotherapy.
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