Pirkko Arjomaa

Low colostral IgA associated with cow's milk allergy.

ABSTRACT. During a nutritional study of 198 infants, seven became allergic to cows milk. The seven infants showed acute cutaneous manifestations during cows milk challenge tests in hospital and six had increased levels of IgE cows milk‐specific antibodies. Neither in the development of the levels of immunoglobulins G, A and M, nor in that of the cows milk‐specific antibodies of these isotypes did these seven patients differ from the remaining infants. Beta‐lactoglobulin content and levels of cows milk‐, and beta‐lactoglobulin‐specific antibodies and of immunoglobulins A, G and M were measured in samples of colostrum and milk from the mothers of the seven infants with cows milk allergy and from a comparison group (non‐atopic mothers of non‐atopic infants). The milk of the mothers whose infants became allergic to cows milk contained less IgA through the lactation: 95% confidence intervals of the groups did not overlap. The difference was most marked in the colostrum. All other measurements were similar in the two groups. This suggests that an infant is more likely to develop cows milk allergy if the mothers colostrum had a low total IgA content.

Risk Factors for Infantile Recurrent Otitis Media: Atopy but Not Type of Feeding

ABSTRACT: We followed 183 infants from birth to 2.3 yr of age. Of these infants 28 had recurrent otitis media (ROM), defined as five or more separate episodes of otitis media (OM) during the first 2 yr of life or four such episodes during their 2nd yr. The OM presented during their 1st yr (early-onset ROM) in 12 infants and during their 2nd yr (2nd yr ROM) in 16. Eighty infants had no OM and served as a comparison group. Regarding type of feeding, the infants with early-onset ROM did not differ from their age-matched pairs in the comparison group either 1 month before the first OM or at the time of first episode of OM. Exclusive breast-feeding did not prevent OM and early weaning was not a risk factor for ROM. Atopy was associated with ROM with a relative risk of 1.9 (95% confidence limits 1.2–3.2). It was particularly prevalent among the infants with early-onset ROM, in 67 versus in 25% in the comparison group (p < 0.01). During, the 2nd yr daily contact with five or more children was associated with ROM with a relative risk of 2.1 (1.3–3.3). The infants with 2nd-yr ROM were in daily contact with more children than the comparison group (mean 11 versus 5; p < 0.001). Parental smoking was more frequent among the infants with ROM than in the comparison group (54 versus 33%; p < 0.05). In the infants with early-onset ROM plasma concentration of IgM antibodies to cows milk was highest at the age of 9 months, and the concentration of IgE was highest at the ages of 9 and 12 months. In conclusion atopy, not the type of feeding, is a risk factor for early-onset ROM, and daycare outside the home for ROM during the 2nd yr.

Surfactant proteins in the diagnosis of fetal lung maturity. I. Predictive accuracy of the 35 kD protein, the lecithin/sphingomyelin ratio, and phosphatidylglycerol.

The concentration of the major surfactant protein with a molecular weight of 35 kD was determined in 469 amniotic fluid specimens from 284 pregnancies by the two-site simultaneous immunoassay with monoclonal antibodies. The predictive accuracy of the 35 kD protein was compared with that of the lecithin/sphingomyelin ratio and phosphatidylglycerol (the lung profile). Immature levels of 35 kD protein (less than 0.6 micrograms/ml) predicted 59% of all cases of respiratory distress syndrome (RDS) with an accuracy of 91%, and mature levels of 35 kD protein (greater than 3.0 micrograms/ml) predicted 68% of all infants who did not have RDS with an accuracy of 100%. The overall accuracy of the 35 kD protein in predicting the risk of developing respiratory distress syndrome was similar to that of the lung profile. In addition, testing with 35 kD protein improved the predictive value of an indeterminate lung profile (lecithin/sphingomyelin ratio of 1:1.9 and no phosphatidylglycerol) from 52% to 74%. The present results show that the lecithin/sphingomyelin ratio, phosphatidylglycerol, and 35 kD apoprotein have additive effects in improving the accuracy of the diagnosis of lung maturity.

Inositol supplementation in respiratory distress syndrome: Relationship between serum concentration, renal excretion, and lung effluent phospholipids

Inositol or placebo was given to 48 small preterm infants with respiratory distress syndrome (mean birth weight 1365 g, gestational age 30.1 weeks) between 48 hours and 10 days of age. The dose of inositol, 40 mg/kg every 6 hours, was at least as high as amounts received in full preterm human milk feedings. Serum inositol concentration increased between days 2 and 3 from a mean of 566 mumol/L to 823 mumol/L in the infants given supplement and fell from 451 mumol/L to 292 mumol/L in the controls. On day 16, serum inositol values remained higher in the infants given supplement than in those given placebo (mean 334 mumol/L vs 146 mumol/L, P = 0.014). The infants who developed bronchopulmonary dysplasia had significantly higher renal inositol clearance, lower inositol intake, and lower serum inositol concentrations. Inositol supplementation increased the saturated phosphatidylcholine/sphingomyelin ratio in tracheal aspirates. According to these results, supplementation with inositol in preterm infants leads to a rise in serum inositol concentration and improvement in the surfactant phospholipids. Inositol deserves further study as a dietary supplement for immature preterm infants who do not receive full human milk feeds.

Surfactant proteins in the diagnosis of fetal lung maturity

The major surfactant protein with a molecular weight of 35 kd and also saturated phosphatidylcholine and phosphatidylglycerol were analyzed in specimens of amniotic fluid; 68 were from cases of maternal diabetes, 41 from preeclampsia or maternal hypertension, 26 from premature rupture of the fetal membranes, and 45 from normal pregnancies. The relationship between the individual surfactant components was studied after covariance adjustment for the length of gestation. In severe early-onset preeclampsia, the 35 kd surfactant protein/saturated phosphatidylcholine ratio was significantly higher than in the other pregnancies. In diabetic pregnancies (classes B to D without preeclampsia), the phosphatidylglycerol/saturated phosphatidylcholine ratio was lower than in the other pregnancies. Isolated surfactant complex showed similar abnormalities. In severe early-onset preeclampsia and insulin-dependent diabetes without vascular disease, the phosphatidylglycerol/saturated phosphatidylcholine ratio correlated negatively with fetal growth. In four samples of amniotic fluids from cases of severe early-onset preeclampsia, the 35 kd protein falsely predicted lung maturity. All had abnormally high 35 kd protein/saturated phosphatidylcholine ratios (greater than 2 SD of controls). According to the present results, the 35 kd protein may give a false mature test result in severe preeclampsia.

Purification of a hydrophobic surfactant peptide using high-performance liquid chromatography

A 4- to 6-kDa hydrophobic peptide (SP4-6) was purified from human pulmonary surfactant. Sep Pak Florisil cartridges removed most of the lipids and the 18-kDa peptide. Analytical wide-pore reversed-phase HPLC column separated a single peptide that contained no detectable lipids (less than 1 nmol/2.5 micrograms protein). N-terminal analysis indicated that this peptide was pure, but the N-terminal amino acid was blocked. The peptide was capable of restoring the in vitro surface properties of synthetic phospholipids, which is characteristic of native lung surfactant.

Carnitine during Prolonged Breast Feeding

ABSTRACT. To assess carnitine levels during prolonged sole breast feeding we measured serum and breast milk carnitine concentrations in 37 lactating mothers and their healthy term infants from birth to the age of 1 yr. The number of solely breast-fed infants decreased to 31 at 2 months of age, to 28 at 6 months, and to seven at 9 months, because formula and/or solid food was added when there was not enough breast milk. In mothers the mean serum carnitine increased from 35 to 50 μmol/liter during the first 2 months after delivery and remained unchanged thereafter. Irrespective of the type of feeding, the mean serum carnitine in infants increased from 29 to 59 μmol/liter during the first 2 months, remained unchanged during 2-9 months, and decreased to the mean level of mothers thereafter. The mean carnitine concentration of breast milk was high (106 μmol/liter) immediately after delivery. During the first 2 months the mean carnitine concentration of milk decreased to the mean serum level of mothers and remained unchanged thereafter. The carnitine concentrations of serum and breast milk did not correlate, however. The mean daily carnitine intake of the breast-fed infants was 5.7 μmol/kg at 4 months of age, 4.7 μmol/kg at 6 months, and 6.0 μmol/kg at 9 months whereas the mean daily carnitine intake of the infants receiving formula was 28.9 μmol/kg at 1 month of age and 30.7 μmol/kg at 2 months. The serum concentration of carnitine in our infants did not correlate with carnitine intake. Our results indicate that serum carnitine concentrations are maintained during prolonged sole breast feeding.

Levels of IgA and cow milk antibodies in breast milk vs. the development of atopy in children. Low colostral IgA associated with cow milk allergy.

Little attention has been paid to the possibility that the immunoprotection conferred by breast milk may vary from mother to mother and that in some cases the milk may even be deficient in protective factors, which might result, for instance, in the development of food allergy. An earlier study showed that milk samples from mothers whose infants showed symptoms suggestive of cow milk (CM) allergy had low total IgA contents and low levels of IgA antibodies to cow milk1.

Determination of trimethoprim in pediatric samples by high-performance liquid chromatography

We describe and evaluate modifications to a known high-performance liquid chromatography assay of trimethoprim. The sensitivity, specificity and wide range of linearity (0.11-690 mumol/l) of this method make it suitable for analysing samples with large variations in volume and concentration. We have used it to study the pharmacokinetics of trimethoprim in children, including newborns. Automated injection is a useful option if the sample volume is not limited. The recovery (at 3.44 mumol/l) of the method was 99.8% with a coefficient of variation of 6.8% for manually injected samples. The corresponding results for automated injection were 97.9% and 12.8%.

20. MOTHERS OF INFANTS WITH COW'S MILK ALLERGY VS. CONTROLS HAVE LESS IgA ANTIBODIES TO COW'S MILK PROTEIN IN MILK AND PLASMA

During a follow-up of 198 infants from birth to age 12 months, 7 developed allergy to cows milk. In 2 of these eczema appeared even during exclusive breast feeding (at ages 1 and 5 months), and in the others shortly after the introduction of cows milk (between ages 3 and 10 months). The allergy was verified by test challenge in hospital. Of the 7 infants, 6 had supranormal plasma levels of IgE, and IgE antibodies to cows milk. In the development of total and anti-cows milk IgA, IgG and IgM plasma levels the 7 infants did not differ from the others. IgA antibodies to beta-lactoglobulin were lower in the mothers of the 7 infants than in the other mothers in colostrum and in milk 4 months post partum (p=0.05). There was no such difference in milk beta-lactoglobulin concentrations. The total IgA levels in milk were also lower in the 7 mothers throughout lactation; the difference was significant at 4 and 6 months post partum. The levels of IgG and IgM cows milk antibodies were low in breast milk and showed no such difference. Plasma levels of IgA cows milk antibodies were also lower in the mothers of the 7 infants than in the other mothers. We infer that inmunoglobulins in breast milk may influence the infants immune responses to food antigens.