Alf Backman

PROLONGED BREAST-FEEDING AS PROPHYLAXIS FOR ATOPIC DISEASE

54 babies who had been solely breast-fed for more than 6 months, 77 babies who had been breast-fed for 2--6 months, and 105 babies who had been weaned to cows-milk-based formulas at less than 2 months were followed for the first 3 years of life. All the babies had the same pattern of solid food intake until 1 year of age. Compared with formula feeding, prolonged breast-feeding resulted in a lower incidence of severe or obvious atopic disease particularly in babies with family history of atopy.

EFFECT OF DISODIUM CROMOGLYCATE ON SEASONAL ALLERGIC RHINITIS

Abstract Insufflation of disodium cromoglycate was compared with placebo insufflation in the prophylaxis of seasonal allergic rhinitis. The results of a double-blind trial in 27 patients suggest that insufflation of 10 mg. disodium cromoglycate into each nostril four times a day readily controls the symptoms of allergic rhinitis and considerably reduces the need for antihistamine therapy. The treatment is easy and well tolerated. No side-effects were noted in this trial.

Safe Immunization of Allergic Children Against Measles, Mumps, and Rubella

A series of 135 subjects (134 children and one adult) with documented or suspected systemic allergy were prick-tested before a measles, mumps, and rubella (MMR) vaccination. Atopic eczema was documented in 68, asthma in 47, and cows-milk allergy in 11 examinees; eight children were evaluated because of severe systemic reactions following diphtheria-pertussis-tetanus, measles, or inactivated polio (Salk) vaccinations. In one child, there was only a suspicion of general allergy. The undiluted MMR prick test gave negative reactions in 126 cases (93%). The highest rate of nonreactivity was observed in those with atopic eczema (96%) and in children with asthma (91%) or cows-milk allergy (82%). All examinees with systemic reactions after other vaccinations also had negative prick-test reactions. A total of 122 (95%) of the 129 examinees were eventually vaccinated with MMR. No untoward reactions developed, except mild generalized urticaria or fever in two vaccinees. We conclude that at least 95% of children with common forms of systemic allergy can be vaccinated safely with MMR and, in general, that allergic diseases should not interfere with execution of the vaccination programs.

Secretory otitis media and allergy. With special reference to the cytotoxic leucocyte test.

This study is an investigation on whether allergy, and especially food allergy, is more common in patients with secretory otitis media (SOM) than in others. At the same time, the effectiveness of the cytotoxic leucocyte test (CLT) as an aid in the diagnosis of food allergy was also studied. The material comprised 90 patients: 69 suffering from secretory otitis media and 21 without the disease as controls. Patients were studied using allergy history, ear status, tests for nasal and blood eosinophilic cells, total IgE, skin tests for 20 allergens, RAST for milk and wheat, immunoglobulin A, G and M, precipitating antibodies for milk and gluten, Mantoux test, and the CLT for 23 allergens. Allergy was found in 20% of the SOM patients and 10% of the control patients; the difference was not statistically significant. The best methods for verifying allergy were history, skin tests, and tests for nasal eosinophilic cells. Laborartory tests could not verify objectively that food allergy was more common among SOM patients than controls, although 16% of the SOM patients compared with none of the controls had a history of food allergy. Of the tests used, the CLT correlated best with a history of allergy, but the results of the different tests were not in accordance with each other.

Clinical trial of a two per cent solution of DSCG in perennial rhinitis.

The value of Disodium cromoglycate (DSCG) in the treatment of both seasonal and perennial rhinitis has been studied with a powder formulation applied to the nose by means of a specially designed insufflator (4, 5). Nasal provocation studies have been carried out using an aqueous solution of DSCG at a concentration of 2 per cent (7, 10). These studies have demonstrated a significant protection of the nasal mucosa against a subsequent challenge with either grass or birch poilen. In one study (10), the investigator assessed the duration of protection by repeated antigen challenges following a single dose of DSCG. The results showed that one dose of DSCG (approximately 1.6 mg) protected the nasal mucosa for at least 4 h. Consequently we decided to investigate the clinical effectiveness of a 2 per cent solution of DSCG administered as a fine spray 6 times daily during the waking hours.

Children's Atopy and Mastocytosis in the Nasal Smear

Nasal secretion samples from 473 children aged 0–15 years were studied in order to evaluate the role of mast cells in the nasal smear in different types of atopy and food allergy. The occurrence of eosinophils in the nasal secretion and in the blood, and susceptibility to upper respiratory infection were recorded. A mast cell count of more than 20 cells per slide was indicative of atopy and there was a clear correlation between eosinophilia and mastocytosis in the nasal smear. No type of allergy seemed to be significantly predominant in the total material, but in young children aged 0–3 years mastocytosis was clearly related to food allergy. The examination of nasal smears for mast cells is a valuable test in diagnosing atopy in children and especially food allergy among young children. However, the test is not reliable enough to be used as a single screening test.

Cytotoxic leukocyte reaction.

Blood samples from 49 subjects were submitted to cytotoxic leukocyte tests, which were read double-blind by two laboratory technicians. The results were identical in 78% of the tests and the statistical error of the method was 0.46. In a group of 32 subjects, the cytotoxic test was repeated on 3 consecutive days. Deviations in the results occurred in 18--20% of the tests, the statistical errors varying between 0.38 and 0.43. In a series of serum samples (75 subjects) with positive leukocyte reactions to food antigens, various in vitro procedures were carried out in connection with the cytotoxic test. The following observations were made: In 42 of 58 tests, a positive leukocyte reaction was transferred with the reactive serum to cells from non-reactive subjects. After heating of the reactive serum (56 degrees C, 2 h) and washing of the cells, reactivity was no longer observable in 44 out of 52 tests. Treatment with EDTA consistently blocked expected cytotoxic reactions in 36 tests. DSCG inhibited expected reactions in 45%, antihistamine in 93%, and cortisone in 20% of the tests.

On Tuberculosis of the Bones and Joints of BCG Vaccinated Children

No harmful effect of BCG vaccination has been found in the present group of 17 cases of bone and joint tuberculosis occurring in adequately vaccinated subjects. In these cases the disease has taken a mild course; however, the number is too small to permit of any definite conclusions. In only 2 of the cases a strong exposure had occurred, in the others only a slight one, or exposure was not detected.

HISTAGLOBIN TREATMENT OF ALLERGIC CONDITIONS IN CHILDREN

In a series of investigations by Parrot (7) and Benda & Urqttia (2) it was shown that the serum of normal subjects possesses a certain histamine-binding capacity which the allergie patient lakks. This histamine-binding capacity can be assessed by three different methods : histaminophylaxis (the capacity of the serum to protect a guinea-pig against induced histamine shock), histaminopexis (the capacity of the serum to protect isolated guinea-pig intestine in Ringer-solution against histamine-induced contractions) and a latex-flocculation reaction allowing determination in vitro of the histamine-binding capacity of the serum. After numerous experiments it was found that the serum histamine-binding capacity of allergic patients can be improved by treatment with a gammaglobulin—histamine combination called Histaglobin\ This preparation consists of 6 mg/ml of gammaglobulin and 0,075 microgr/ml of histaminedihydrochloride. According to the above-mentioned authors, these components form a complex antigen leading to the formation of a specific antibody to histamine. This theory has not been proved, however, and another group of investigators maintain that the effect of Histaglobin is entirely pharmacologic and not immunologic (8). Anyhow, the therapeutic effect of Histaglobin is good, according to the available literature, ( i , 3, 4, 5, 6, 9, 10 and 11)