J. Forster

Allergenicity of α-caseins from cow, sheep, and goat

The allergic potential of α‐caseins from bovine, ovine, and goats milk sharing more than 85% identical amino acids was compared. Caseins were purified by anion‐exchange chromatography and used for a specific IgE and IgG ELISA with diluted human sera. Sera were from 17 children with immediate‐type allergy to cows milk, from 59 children with atopy but without food allergy, and from 27 healthy children without atopic disease. The sera of cows milk‐allergic children showed a significantly higher IgE and IgG binding to α‐caseins from all three species than the sera of the other groups. All groups showed an increased antibody binding to bovine a‐casein compared to the sheep and goat proteins, but the differences were significant only in the groups of atopic children and of healthy controls. Furthermore, inhibition of the IgE binding to bovine α‐casein with α‐casein from cow, goat, and sheep revealed that the a‐caseins from these species are highly cross‐reactive, on the basis of the small differences in their primary structure. In conclusion, the milk of goat and sheep harbor an allergic potential and is not suitable for the nutrition of milk‐allergic patients.

Prospective population-based study of viral lower respiratory tract infections in children under 3 years of age (the PRI.DE study).

Population-based incidence data from Europe on the disease burden of lower respiratory tract infections (LRTI) due to respiratory syncytial viruses (RSV), parainfluenza viruses (PIV) and influenzaviruses (IV) are lacking, especially with respect to the disease burden. In a 2-year prospective multicentre study of children aged <3 years in Germany, we registered population-based cases as outpatients (n=2386), inpatients (n=2924), and nosocomially-acquired (n=141). Nasopharyngeal secretions were tested for viral RNA. The annual incidence for physician visits per 100 children for all LRTI was 28.7, RSV 7.7, PIV 3.8 and IV 1.1. Annual hospitalisation rates per 105 children were for all LRTI 2941, RSV 1117, PIV 261 and IV 123. Annual nosocomial cases per 105 hospital days were for all LRTI 79, RSV 29, PIV 9 and IV 1.5. All five children (0.27%) who died had an underlying disease and four were nosocomially acquired. Conclusion:xa0Hospitalisation rates due to lower respiratory tract infections in healthy children were similar to those reported elsewhere; the rates for outpatient visits were approximately ten times higher.

Study on the Prevention of Allergy in Children in Europe (SPACE): allergic sensitization in children at 1 year of age in a controlled trial of allergen avoidance from birth

Several studies have demonstrated that early intervention may modulate the natural course of atopic disease. Our objective was to prevent sensitization to house‐dust mite and food allergens, as well as the development of atopic symptoms during infancy, by the combination of an educational package and the use of mite allergen‐impermeable mattress encasings. A multicentre European, population‐based, randomized, controlled study of children at increased atopic risk [Study on the Prevention of Allergy in Children in Europe (SPACE)] was performed in five countries (Austria, Germany, Greece, the UK, and Lithuania), and included three cohorts – schoolchildren, toddlers, and newborns. We report on the newborn cohort. A total of 696 newborns were included from Austria, the UK, and Germany. Inclusion criteria were: a positive history of parental allergy; and a positive skin‐prick test or specific immunoglobulin E (IgE) (IgEu2003≥u20031.43u2003kU/L) against at least one out of a panel of common aeroallergens in one or both parents. At 1u2003year of age, the overall sensitization rate against the tested allergens [dust‐mite allergens: Dermatophagoides pteronyssinus and Dermatophagoides farinae (Deru2003p and Deru2003f)] and food allergens (egg, milk) in the prophylactic group was 6.21% vs. 10.67% in the control group. The prevalence of sensitization against Deru2003p was 1.86% in the prophylactic group vs. 5% in the control group. In conclusion, we were able to demonstrate, in a group of newborns at risk for atopic diseases, that the sensitization rate to a panel of aero‐ and food allergens could be effectively decreased through the use of impermeable mattress encasings and the implementation of easy‐to‐perform preventive measures.

Effect of mite‐impermeable mattress encasings and an educational package on the development of allergies in a multinational randomized, controlled birth‐cohort study – 24 months results of the Study of Prevention of Allergy in Children in Europe

Background Sensitization to house dust mite (HDM) is an important risk factor for the development of asthma and allergic disease in childhood. Higher levels of HDM allergen are linked to increased sensitization to HDM.

Natural variation in mite antigen density in house dust and relationship to residential factors

To investigate the year‐to‐year variation of mite antigen density (Der p I, Der f1) in dust from mattresses and the relevance of residential factors for antigen load, information derived from an epidemiologic study including two surveys carried out in the households of a cohort of elementary school children (n= 1291) was analysed.

Occurrennce and impact of community‐acquired and nosocomial rotavirus infections — a hospital‐based study over 10 y

The need for a rotavirus vaccine in any particular country depends primarily on the number of hospitalized cases. Since only limited data are available for Germany, we undertook a retrospective hospital‐based analysis in order to gather further information. From 1987 through 1996, a total of 3618 inpatients were hospitalized with a diagnosis of gastroenteritis (ICD 9). In 892 (25%) of them the causative organism wasa rotavirus. During the same period, 1886 (out of 8383; 22%) stool speciment tested in the hospital laboratory were obtained from rotavirus‐positive inpatients. In 49.2% the infection was community‐acquired, and in the remainder of nosocomial origin. Infants under 4 months of age(n=709; 38%) predominated among both the nosocomial and community‐acquired infections. Premature neonates made up 26% of the nosocomial, but only 2% of the community‐acquired cases of diarrhoea. The winter peak (January) was most pronounced in the age group 4‐12 months, but in those more than 1 y old the peak came a month later. The median hospitalization time for community‐acquired cases was 4 d (mean 5.9 d).The mortality was 0.1%. Rotavirus infection must therefore be regarded as a considerable burden, particularly with regard to infants and young children. Furthermore, the morbidity due to nosocomial infection with the rotavirus, analysed here in a long‐term observational study, is unexpectedly high. □Hospital‐based study, nosocomial infection, rotavirus

Early childhood risk factors for sensitization at school age

Early childhood risk factors for current sensitization were investigated by use of cross-sectional data of a longitudinal study in Southwest Germany. Information was gathered by questionnaires from 1812 families of whom 1470 children 6 to 8 years old were tested by means of a skin prick test (SPT) with seven aeroallergens. Groups with sensitization (n = 201; positive SPT to grass pollens 6.6%, Dermatophagoides pteronyssinus 6.5%, Dermatophagoides farinae 4.4%, cat dander 4.6%, any of the tested allergens 13.7%) are compared with children without sensitization (n = 1269). As risk factors for any sensitization parental atopy (odds ratio [OR]/95% confidence interval [95%CI]: unilateral 1.9/1.3 to 2.6; bilateral 2.8/1.5 to 5.2), low gestational age (1.9/1.1 to 3.2), and male gender (1.6/1.2 to 2.3) are statistically significant in multiple logistic regression. Former cat ownership is significantly related to sensitization to cat dander (2.7/1.4 to 5.5). Breast feeding, maternal smoking habits after the childs birth, prior exposure to pets, and social class are not important. In conclusion, our data suggest parental atopy, low gestational age, and male gender as independent risk factors for sensitization to aeroallergens at school age.

Sensitization to four common inhalant allergens within 302 nuclear families

The coincidence of allergic sensitization was investigated in 302 school‐aged children and their parents. Specific sensitization to four common inhalant allergens (grass and birch pollens, cat dander, Dermatophagoides pteronyssinus) was ascertained by means of skin‐prick tests (SPT) carried out on the complete family unit at the beginning of a 22‐month follow‐up period. The same test procedure was then repeated on the children twice at 11‐month intervals to provide cumulative prevalences of sensitization. A clinical history of atopy in the children (hay fever or asthma; n= 47), which was derived from an interview, is associated with sensitization (positive SPT in 89%). For three allergens (grass and birch pollens, cat dander) sensitization occurs significantly more frequently in the children of mothers who are sensitized to the same allergen (odds‐ratios (ORs), 2.5–4.1). Additionally, in three of the four explanatory models related to a single antigen, maternal sensitization to one of the complementary allergens is of importance (ORs, 2.7–3.7). In contrast to this finding, none of the paternal sensitizations has statistical significance. Based on a reaction to at least one of the four allergens, the childs relative risk to be sensitized is increased in case of maternal (OR, 2.88; P= 0.001) but not of paternal (OR, 1.06; P= 0.83) sensitization. In conclusion, our data indicate that the maternal status is more predictive than that of the father with regard to the childs risk of sensitization.

Prospective population‐based study on rotavirus disease in Germany

The aim of this study was to collect representative data on the incidence and clinical characteristics of community‐acquired acute gastroenteritis (AGE) due to rotavirus (RV) in German children up to 4 y of age. In 20 paediatric practices in 5 German regions every child aged 0–4 y presenting with symptoms of AGE from May 1997 to April 1998 was eligible for inclusion into the study. Stool samples were tested for RV antigen by enzyme‐linked immunosorbent assay and polymerase chain reaction was performed for serotyping. The course of the disease, additional diagnoses and treatment regimen were recorded. Incidences adjusted for month and region of observation were calculated by Poisson regression. Of 15 451 children under observation 3980 (26%) presented with AGE. Of 3156 stool samples available 748 (24%) proved RV positive. The incidence of AGE and RV‐positive AGE was 25.2 and 4.0 per 100 children per year, respectively, with a maximum in February/March 1998. RV‐positive cases were more severe than RV‐negative cases (28% vs 12% severe cases, hospitalization rate 6.2% vs 2.0%, p > 0.001). The predominant genotype of RV isolated was Gl/P[8] (77%), followed by G4/P[8] (17%).

Allergenic epitopes of bovine αs1‐casein recognized by human IgE and IiG

B‐cell epitopes of bovine αs1‐casein, one of the major allergens of cows milk, were identified by a screening method based on synthetic peptides. According to the known amino acid sequence of αs1‐casein, a set of 188 overlapping sequential decapeptides shifted by one amino acid was manually synthesized on polyethylene pins by the 9‐fluorenyl‐methoxycarbonyl (Fmoc) method. Peptides were screened by an enzyme‐linked immunosorbent assay (ELISA) specific for human IgE and IgG. Bound antibodies were detected by successive incubation with up to three polyclonal antibodies, the last one conjugated to horseradish peroxidase. Tested sera were from 15 patients with acute clinical reactions to cows milk and IgE‐specific reactions to bovine a‐casein in the ELISA and immunoblot. Sera from 10 healthy subjects without remarkable reactions to cows milk proteins were used as controls. All sera from allergic subjects showed reactions with three regions of αs1‐casein, corresponding to amino acids 19–30, 93–98, and 141–150. Furthermore, individual sera showed reactions with other parts of the protein. No essential differences in the epitope specificity of IgE and 1gG were found. Inhibition of IgE binding to αs1‐casein with soluble synthetic peptides confirmed the results and revealed peptide CN‐2 as the most inhibiting one.