Bengt Kjellman

Allergy in early and late onset of atopic dermatitis

The main criteria of atopic dermatitis (AD) are based on symptoms and signs such as pruritus and age-related typical distribution and morphology of the eczema (1). AD is frequently associated with other atopic manifestations, e.g. asthma and allergic rhinoconjunctivitis (ARC), clinical allergies to, for example, pollen and danders and positive tests for allergy, e.g. RAST. AD often starts in infancy and early appearing AD and a family history of atopic disease are possible means of selecting infants at high risk for future allergy (2 , 3). In this study we have analysed if an onset of AD before two years of age implies a heavier allergy trait than AD with a later onset, by re-evaluating data from our previous prospective studies on sensitization in infants and children (2-4). One cohort of 84 girls was unselected with regard to family history of atopy (NR, normal risk), and they were followed from birth with interviews, examinations and tests at ages 3 and 8 months, and 2 ,4 ,7 and 12 years (2, 4). The initial cohort consisted of 86 children. Two nonatopic children died between 7 and 12 years. The remaining 84 children reported for all follow-up evaluations. Another cohort consisted of 115 children selected from families with atopic diseases in at least two close relatives or with single heredity and cord blood IgE 80.9 kUjl (HR, high risk) (3). The initial cohort comprised 121 children but the parents of 6 children objected to the venepunctures before or at the first follow-up examination. The remaining 1 15 children were followed from birth with interviews, examinations and tests at ages 3,6 and I8 months, and 2 and 4 years. The mothers of 65 of the 11 5 HR children were on restricted diets during lactation. The criteria of atopic manifestations and clinical allergy have been described in detail previously (2, 3). Briefly, AD was defined exclusively on the basis of its dermatological manifestations, i.e. chronic or chronically relapsing, non-infectious dermatitis of typical morphology and distribution, based on the suggestions of Hanifin 8.1 Rajka (1). Three or more episodes of bronchial obstruction were regarded as athma. Rhinitis was considered allergic if it appeared at least twice after exposure to a particular allergen. Positive exposure to an allergen was defined as an obvious reaction within 1 h on at least two occasions. The two cohorts of children were divided in three subgroups each: (group I) children with onset of AD before two years of age (12 NR children, 37 HR children); (group 11) children with onset of AD after two years of age (14 NR children, 10 HR children); and (group 111) children who did not develop AD during the period of follow-up (58 NR children, 68 HR children). IgE antibodies were determined by Phadebas Rast (Pharmacia Diagnostics AB, Uppsala, Sweden). Only IgE antibody concentrations 2 0.35 PRUjml, i.e. RAST class level 1 or higher, were regarded as positive. RAST was performed against the following allergens: egg white, cow’s milk, mite ( D . pteronyssimus), birch, timothy and mixed animal danders (cat, cow, horse, dog). The subgroups of NR and HR children were evaluated with regard to the cumulative frequencies of asthmajARC, clinical allergy to pollen or danders, positive RAST to egg white or cow’s milk, and positive RAST to inhalants. Since the samples were small and the expected frequencies were sometimes less than 5, Fisher’s exact test (two-tailed) was used to analyse possible differences between the subgroups of children. The results are shown in Table 1. For NR children the cumulative frequencies of all the markers of allergy were significantly higher in children with AD before two years of age than in children with onset of AD after two years and in children without AD. Children with onset of AD after two years did not differ from children without AD. In the HR group children with onset of AD before two years of age differed significantly from children with onset after two years only for a higher frequency of positive RAST to food antigens. Children with onset of AD before two years of age had higher frequencies of all markers of allergy than children without AD, while children with onset of AD after two years had a significantly higher frequency than children without AD only with regard to a positive RAST to inhalants.

ASSESSMENT OF LUNG FUNCTION ON HEALTHY CHILDREN USING AN ELECTRONIC SPIROMETER AND AN AIR‐FLOWMETER BEFORE AND AFTER INHALATION OF AN ADRENERGIC RECEPTOR STIMULANT

Abstract. VC measured with a Monaghan electronic spirometer equipped with a backflow valve is significantly lower (about 4%) than when measured with the same spirometer without such a valve. The measurements of FEV1.0 were not influenced by the valve. 73 healthy children were investigated with the Monaghan spirometer equipped with the backflow valve and normal reference data were established. The results were very similar to those obtained in an investigation of healthy children with the same spirometer about one year earlier. Reference data on children for a simple flow meter, Airflometer (Glaxo Ltd.), are given. The data correlated very highly to the FEV1.0 values obtained by the Monaghan spirometer. After inhalation of salbutamol healthy children had a small and significant increase of FEV1.0 and of the Airflometer value but not of VC. The deviations of the differences were small. A 6% increase of VC and 10% increase of FEV1.0 were taken as normal upper limits after inhalation of salbutamol. Corresponding increase of the Airflometer values was 15 arbitrary units for children with body heights 116–145 cm and 21 units for children with body heights 146–175 cm.

Regional lung function studied with Xe133 in children with pneumonia

Pneumonia is still a common disease especially in children and old people. The virus etiology is conspicuous. Pneumococcic pneumonia is, however, nowadays perhaps as usual as before the antibiotic era [22], and the incidence of staphylococcic pneumonia is said to have risen in recent years [12]. It is well known that in pneumonia resolution is sometimes delayed and non complete. In Eaton-agent pneumonia as in virus pneumonia pulmonary dysfunction can exist for a long time after the acute stage [7, 91. In order to achieve sensitive methods of evaluation of the pulmonary function bronchospirometry, lobar spirometry and methods for investigation of regional lung function with radioactive gases have been developed. Some of these methods were recently discussed in an international symposium [21]. Experience from bronchospirometry investigation in adults indicates that regional decrease in lung function may exist in spite of normal spirometry findings [ 11. It would be of great interest to know to what extent pneumonia in childhood gives permanent impairment of regional lung function. As bronchospirometry and This study was supported by grants from the Swedish National Association against Heart and Chest Diseases. lobar spirometry are almost impossible to perform in children, methods using radioactive gases would be preferable for such studies. For that reason in a present study of pneumonia in children the regional lung function has been investigated with radioactive xenon (Xe133). The experiences from this method in childhood have been good and a preliminary report will here be presented.

Bronchial asthma and recurrent pneumonia in children. Clinical evaluation of 14 children.

Bronchial asthma is sometimes complicated by more or less extensive pulmonary atelectasis [l, 4, 16, 17, 331 and in patients with an asthmatic attack of 24 hours or more an intercurrent penumonia is sometimes found [27]. Atelectasis may predispose to organic bronchial changes. The connection between atelectasis and bronchiectasis has been the subject of many investigations [3, 10, 12, 181. In childhood, penumonia seems to be the chief predisposing factor to bronchiectases and more common than bronchial asthma per se [9, 12, 141. It is thus clear that obstinate pneumonia can give rise to later chest disease. Furthermore, even if clinical and roentgenological examination show nothing remarkable, function studies may reveal impairment of pulmonary function long time after the acute stage of a pneumonia [5 , 7, 23, 321. It is well known that penumonia may be secondary to organic defects of the bronchi or to diseases such as mucoviscoidosis and a defective immune response, in which conditions asthmatic symptoms are sometimes seen. Such pneumonia is prone to relapse. As mentioned above, bronchial

EVALUATION OF THREE SPIROMETERS ON HEALTHY CHILDREN

ABSTRACT. Two electronic spirometers (Dräger Spirotron and Monaghan M403) and one wedge bellows spirometer (Vitalograph) were compared with a Bernstein spirometer. Healthy children, 30 girls and 31 boys, were investigated. The regression lines of VC and FEV1.0 in relation to the body height to the third power are very close and the S.D. values around the lines are very similar. The correlation coefficients of the regression lines are high for all the spirometers. An analysis of the paired differences showed slight differences of the mean values. The S.D. of paired differences was for VC 4.6–6.6% and for FEV1.0 4.8‐6.2%. The PEFR values obtained by the two electronic spirometers deviated substantially and highly significantly from the values obtained by the Wright peak flow meter.

Regional lung function studied with 133Xe and external detectors (radiospirometry) in children without cardiopulmonary disease.

Regional lung function was studied in 12 children without cardiopulmonary disease. 133Xe was used as a tracer and external detectors were employed. Perfusion, ventilation and functional residual capacity of an apical field and a basal field of each lung were measured. The results agreed closely with those obtained in healthy adults, studied with the same technique.

Red Cell Glucose‐6‐Phosphate Dehydrogenase and Glutathion Stability in Neonatal Hyperbilirubinaemia

Between March 1961 and March 1962 the activity of G‐6‐P‐D of the erythrocytes from normal and jaundiced newborns was assayed with the aid of a semiquantitative screen test. During the latter half of the investigation, Beutlers GSH Stability Test was also used. The material consisted of normal, non‐icteric newborns and of newborns with varying degrees of hyperbilirubinaemia of unknown aetiology. Sixteen out of these had maximal serum bilirubin values of 20 mg/100 ml or more and 62 had serum bilirubin values between 15 and 20 mg/100 ml. No certain case with deficient G‐6‐P‐D activity in the erythrocytes has been found.

PEAK EXPIRATORY FLOW RATE Reference Values for Swedish Children

Abstract. Reference values for the peak expiratory flow rate assessed by the Wright‐McKerrow peak flow meter have been established for Swedish children. The material consisted of 143 boys and 132 girls. We recommend the sexes be considered together. The equation of the regression line is 72.14 height3 + 96.12. The coefficient of correlation is 0.93 and the residual standard deviation 13.7 %.

Prognosis and lung function in children with bronchial asthma and recurrent pneumonia.

Bronchial asthma in children is often complicated with recurrent pneumonia and/or atelectasis (2, 5 , 11). A previous clinical study of 14 children with this symptom complex showed the frequency of asthmatic attacks to decrease with increasing age (5) . Investigation of the overall lung function in these 14 children showed subclinical bronchial obstruction, overinflation of the lungs and abnormal unevenness of ventilation (6). An investigation of the regional lung function suggested regional impairment of lung function, due to sequelae after the recurrent pneumonia. The present study concerns a reinvestigation of the 14 children performed 4 years after the previous studies. The purpose was to find out the further course of the disease and with the help of renewed clinical examinations and lung function studies try to estimate the prognosis in children with bronchial asthma and recurrent pneumonia.

Serum Leucine Aminopeptidase in Icterus of the Newborn

Leucine aminopeptidase is a proteolytic enzyme that hydrolyzes aminoacid amides, dipcptides, and polypeptictes as well as genuine albumin3 [ao]. The enzyme could be shown to occur in most tissues and body fluids [la] Increased beruin activity is established in intraor extrahepatically conditioned bile stasis [I, 10, 11, 161, and moderately increased values can be demonstrated in liver parenchymal disease [l, 7 , 13, 16, 231. Most authors are of the opinion that the clinical value of this enzyme determination is comparable to the determination of alkaline phosphatases 110, 13, 14, 151 whereas others find the serum aminopeptidases more often and earlier increased than alkaline phosphatases in cholestatic conditions [I, 9, 161. In pregnancy serum leucine aminopeptidase values rise gradually and reach their peak in partus [3, 191. The enzyme activity in umbilical cord blood has been found to be somewhat higher than in serum from adolescents but lower than that of the mother [4, 51. A group of American researchers in 1961 and 1983 presented reports concerning the determination of serum leucine aminopeptidase as it differential diagnosis between neonatal hepatitis and biliary atresia [17, 181. The authors considered that the test was a very sensitive index of cholestasis. The purpose of the present ~7ork was to study the level of leucine aminopeptidase in serum of nemborn infants M ith different type and degree of icterus. As comparison the normal values in children, in cord blood and in normal newborn infants were established.