J. Gary Wheeler

Severe community-acquired pneumonia due to Staphylococcus aureus, 2003-04 influenza season

S. aureus community-acquired pneumonia has been reported from 9 states.

Atopic dermatitis and food hypersensitivity reactions

OBJECTIVE To determine the role of food hypersensitivity in atopic dermatitis and to determine whether patients with atopic dermatitis who had food hypersensitivity could be identified by screening prick skin tests using a limited number of food allergens. STUDY DESIGN Patients with atopic dermatitis attending the Arkansas Childrens Hospital Pediatric Allergy Clinic underwent allergy prick skin testing to a battery of food antigens. Patients with positive prick skin tests underwent double-blind, placebo-controlled food challenges. RESULTS One-hundred sixty-five patients were enrolled and completed the study. Patients ranged in age from 4 months to 21.9 years (mean 48.9 months). Ninety-eight (60%) patients had at least one positive prick skin test. A total of 266 double-blind, placebo-controlled food challenges were performed. Sixty-four patients (38.7% of total) were interpreted as having a positive challenge. Seven foods (milk, egg, peanut, soy, wheat, cod/catfish, cashew) accounted for 89% of the positive challenges. By use of screening prick skin tests for these seven foods we could identify 99% of the food allergic patients correctly. CONCLUSIONS This study confirms that most children with atopic dermatitis have food allergy that can be diagnosed by a prick skin test for the seven foods.

Immune and Clinical Impact of Lactobacillus acidophilus on Asthma

BACKGROUND Animal and human studies have suggested that yogurt containing live active bacteria leads to improved immune and clinical responses. Specific benefits of yogurt containing L. acidophilus on allergic asthma have been hypothesized but not studied. METHODS In a crossover double-blinded design, the effect of live active yogurt (225 g twice daily) with or without L. acidophilus was studied in 15 adult patients with moderate asthma. Immune and clinical parameters were measured before and after the two 1-month crossover phases. RESULTS No significant changes were noted in peripheral cell counts, IgE, IL-2, or IL-4 when comparing the two diets to each other. Concanvalin A-stimulated lymphocytes from patients who consumed yogurt containing L. acidophilus produced borderline elevated interferon gamma levels (P = .054). No differences were noted in mean daily peak flows or changes in spirometric values. Quality of life indices were unchanged when comparing the two groups. CONCLUSIONS Yogurt containing L. acidophilus generated trends in the increase in interferon gamma and decreased eosinophilia; however, we were unable to detect changes in clinical parameters in asthma patients in association with these modest immune changes.

Serum sickness–like reactions to cefaclor: Role of hepatic metabolism and individual susceptibility☆☆☆★★★

In an effort to explain the increased incidence of serum sickness-like reactions (SSLR) in patients receiving cefaclor, we used an in vitro murine microsomal system as a surrogate for in vivo hepatic drug biotransformation. Lymphocytes from three groups of subjects were exposed to a nonselective mixture of cefaclor metabolites. After an 18-hour incubation of lymphocytes with these metabolites, cells were examined for viability by trypan blue exclusion. The subject groups consisted of patients with a previous history of SSLR after cefaclor therapy (n = 19), patients who experienced adverse reactions to cefaclor suggestive of immediate hypersensitivity (n = 11), and control subjects who had previously tolerated at least two courses of cefaclor therapy without adverse effect (n = 9). Additionally, immediate family members of six subjects with cefaclor-associated SSLR were studied. Lymphocyte killing was 100% greater than baseline (i.e., a non-drug-containing control) in subjects with SSLR compared with those with immediate hypersensitivity reactions (4% cell death above baseline; p < 0.001) and nonaffected control subjects (6% cell death above baseline; p < 0.001). Family studies were consistent with a pattern of maternal inheritance; five of six mothers who had not received cefaclor had a positive (i.e., > or = 35% cell death above baseline) in vitro cytotoxic response. Other studies confirmed the requirement for biotransformation of the parent drug to elicit cell death, demonstrated specificity of the reaction to cefaclor, illustrated a lack of cross-reactivity to cephalexin in subjects with SSLR to cefaclor, and verified the reproducibility of the reaction over time in an affected subject. Our findings indicate that cefaclor associated SSLR may be a unique adverse drug reaction that requires biotransformation of the parent drug and may result from inherited defects in the metabolism of reactive intermediates. Furthermore, this condition can be retrospectively confirmed with an in vitro lymphocyte-based cytotoxicity assay.

Effect of Dietary Ribonucleotides on Infant Immune Status. Part 1: Humoral Responses

The objective of this study was to further explore previously identified effects of supplemental ribonucleotides on infant immune status as measured by antibody responses to routine infant immunizations. Infants were randomized to a milk-based formula with (FN, n = 138) or without (F, n = 147) 72 mg ribonucleotides/L. A cohort of human milk–fed (HMF, n = 192) infants was also followed. Subjects were given Haemophilus influenzae type b (Hib), diphtheria tetanus acellular pertussis, and oral poliovirus vaccinations at 2, 4, and 6 mo of age, and specific antibody responses were assessed at 2, 6, 7, and 12 mo. Growth and safety data were also monitored. Using a two-group repeated measures analysis (RMA), FN-fed infants had significantly higher poliovirus type 1 neutralizing antibody (PV-VN1) responses than F-fed infants (p = 0.045). Using three-group RMA, PV-VN1 responses in HMF infants were not different from FN-fed infants, while HMF-fed infant PV-VN1 responses were significantly higher than F-fed infants at 6 (p = 0.0004) and 12 mo (p = 0.0001). FN-fed infants had responses to Hib Farr, diphtheria, tetanus toxoid, oral poliovirus–specific IgA, and PV-VN3 not significantly different from those of F and HMF infants. Growth, gastrointestinal tolerance, and adverse events were equivalent among the three groups. The FN-associated increase in PV-VN1 response and nonstatistically significant trends toward increased Hib and diphtheria antibody responses were consistent with observations from earlier studies, indicating immune benefits of nucleotide supplementation of infant formula.

A randomized, double-blind, placebo-controlled trial of prophylactic recombinant human granulocyte-macrophage colony-stimulating factor to reduce nosocomial infections in very low birth weight neonates

OBJECTIVE We carried out a randomized placebo-controlled trial in very low birth weight neonates (VLBWNs), comparing the incidence of nosocomial infections after the prophylactic use of recombinant human granulocyte-macrophage colony-stimulating factor (rhu GM-CSF) versus placebo in VLBWNs. STUDY DESIGN VLBWNs (n = 264), weighing 501 to 1000 g, </=72 hours of age were randomly assigned to receive rhu GM-CSF (8 microg/kg/d), administered intravenously (n = 134) over 2 hours daily x 7 days and every other day for 21 days, or placebo (n = 130). The safety, incidence of nosocomial infections, days of absolute neutrophil count >/=4000/mm,3 peripheral blood progenitor studies, and 24-hour polymorphonuclear leukocyte C3bi receptor expression were compared between the 2 treatment groups. RESULTS No (grade III/IV) toxicity or adverse events were associated with rhu GM-CSF. The absolute neutrophil count and absolute eosinophil count were significantly elevated in the rhu GM-CSF group on days 7 (P =.001), 14 (P =.001), and 21 (P =.007) and on days 7 and 28 (P =.012 and P =.001, respectively). However, there was no difference in the incidence of confirmed nosocomial infections between the 2 treatment groups in this trial (40% vs 39%, rhu GM-CSF vs placebo; P = NS). CONCLUSION In a large randomized placebo-controlled trial, prophylactic administration of rhu GM-CSF in VLBWNs does not appear to decrease the incidence of nosocomial infections.

Effect of dietary ribonucleotides on infant immune status. Part 2: Immune cell development.

The objective of this study was to determine whether dietary ribonucleotides alter immune cell phenotypes or function in the first year of life. Newborn term infants in a double-blind, 12-mo, multicenter trial were randomized to cow milk formula groups with (FN, n = 138) or without (F, n = 147) 72 mg/L supplemental ribonucleotides. A nonrandomized HMF cohort (n = 192) was concurrently enrolled. Eighty-eight immune blood cell types were characterized by flow cytometry. Data were analyzed by multivariate ANOVA (MANOVA), ANOVA, and repeated measures analysis (RMA), with adjustments made for multiple comparisons. Ribonucleotide feeding changed subpopulations of T and natural killer (NK) cells. FN had higher numbers and percentages of memory/effector (M/E) cytotoxic/suppressor (CD45R0+CD8+, RMA) T, Fas+ M/E (CD45R0+CD95+CD3+, 6 mo) T, and CD56+CD16− NK cells (CD56+CD16−CD3−CD8−, 12 mo), and higher percentages of M/E helper (CD45R0+CD4+, RMA) T, Tc1 (IFNγ+CD4−CD3+, RMA), total interferon (IFN)γT (IFNγ+CD4+/−CD3+, RMA), Th2 (IL-4+CD4+CD3+, 7 mo), and CD57+ NK-T cells (CD57+CD56−CD3+, 6 mo, 7 mo) compared with F. Percentages of naive helper T (CD45RA+CD4+, 12 mo) and numbers and percentages of CD56+ NK-T cells (CD56+CD16−CD3+CD8−, 2 mo, 6 mo) were lower in FN than F. Percentages of M/E cytotoxic/suppressor, Th2, and CD56+CD16− NK cells in FN were significantly higher than F but were not different from HMF, whereas F was significantly lower than HMF. Ribonucleotide supplementation of infant formula supported increased T-cell maturation and affected immunoregulatory NK cell subsets. These FN-associated immune cell profiles either did not differ from those infants fed HMF or tended to be more like those fed HMF than those fed F.

Serum sickness—like reaction to cefaclor: Lack of in vitro cross-reactivity with loracarbef

A lymphocyte‐based in vitro rechallenge technique was used to examine the potential for cross‐reactivity between loracarbef and cefaclor in children who had had adverse reactions to cefaclor.

Impact of a smoke-free hospital campus policy on employee and consumer behavior.

Objective. Although smoke-free hospital campuses can provide a strong health message and protect patients, they are few in number due to employee retention and public relations concerns. We evaluated the effects of implementing a clean air policy on employee attitudes, recruitment, and retention; hospital utilization; and consumer satisfaction in 2003 through 2005. Methods. We conducted research at a university hospital campus with supplemental data from an affiliated hospital campus. Our evaluation included (1) measurement of employee attitudes during the year before and year after policy implementation using a cross-sectional, anonymous survey; (2) focus group discussions held with supervisors and security personnel; and (3) key informant interviews conducted with administrators. Secondary analysis included review of employment records and exit interviews, and monitoring of hospital utilization and patient satisfaction data. Results. Employee attitudes toward the policy were supportive (83.3%) at both institutions and increased significantly (89.8%) at post-test at the university hospital campus. Qualitatively, administrator and supervisor attitudes were similarly favorable. There was no evidence on either campus of an increase in employee separations or a decrease in new hiring after the policy was implemented. On neither campus was there a change in bed occupancy or mean daily census. Standard measures of consumer satisfaction were also unchanged at both sites. Conclusion. A campus-wide smoke-free policy had no detrimental effect on measures of employee or consumer attitudes or behaviors.

Serum sickness–like reactions associated with cefprozil therapy

Four patients had serum sickness-like reactions during treatment with cefprozil, a new cephalosporin. Two patients had had previous mild reactions associated with cephalosporin therapy. It remains uncertain whether cefprozil-associated serum sickness-like reaction represents a unique or a class-related adverse drug reaction.