V. Graff-Lonnevig

Immunotherapy with cat- and dog-dander extracts: IV. Effects of 2 years of treatment

Thirty-five patients (20 children and 15 adults) with animal-dander asthma completed 2 years of immunotherapy with partly purified and standardized cat- or dog-danger extracts. The first year of the study was performed double-blind with a placebo-treated control group. These 15 patients were transferred to active treatment for a second year. All patients were followed by use of the skin prick test (SPT), allergen and histamine bronchial challenges, and tests for allergen-specific IgE, IgG1, and IgG4 levels. In the group treated with active extracts for 2 years (group A), the previously reported decrease in bronchial responsiveness to cat extract (p less than 0.001) and histamine (p less than 0.01) was even more pronounced after the second year. After 1 year of active treatment in the original placebo group (group B), a significant decrease in the bronchial responsiveness to cat extract was noted (p less than 0.001). The responsiveness to histamine was decreased only in the patients treated with cat-dander extracts (p less than 0.05). A significant decrease in the SPT (p less than 0.001) and an increase in the allergen-specific IgE (p less than 0.001) and IgG4 (p less than 0.001) was also noted in patients (group B) treated with cat-dander extracts. The side effects in the two groups (A and B) were negligible, except for some systemic side effects, especially among the children during the initial phase of immunotherapy. The symptoms were mild and responded promptly to treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunotherapy with partially purified and standardized animal dander extracts: I. Clinical results from a double-blind study on patients with animal dander asthma

Forty-one patients (21 adults and 20 children) with cat dander-or dog dander-induced asthma were selected for immunotherapy with standardized and partially purified cat- or dog-dander extracts by use of a double-blind protocol. Based on sex, age, clinical history, results of bronchial challenge, and crossed radioimmunoelectrophoresis studies, the patients were stratified in matched pairs, and the treatment alternatives were distributed randomly among the pairs. Twenty-two patients treated with allergen (15 with cat allergen and seven with dog allergen) and 17 patients receiving placebo therapy completed the first year of treatment. In the cat allergen-treated group, the bronchial sensitivity toward cat and histamine decreased (p less than 0.001 and p less than 0.05, respectively). Measured by bronchial challenge, the cat allergen-treated patients could tolerate 11 times more allergen at the end than at the start of the study, and they also demonstrated a tendency toward less pronounced symptoms after exposure to cat and dog allergens. No significant changes were observed in the dog allergen treated- or placebo-treated groups. The adverse effects in general were negligible except for some systemic side effects during rush hyposensitization, especially among the children, but these were mild and responded promptly to treatment.

Immunotherapy with cat- and dog-dander extracts

Abstract Thirty-five patients (20 children and 15 adults) with animal-dander asthma completed 2 years of immunotherapy with partly purified and standardized cat- or dog-danger extracts. The first year of the study was performed double-blind with a placebo-treated control group. These 15 patients were transferred to active treatment for a second year. All patients were followed by use of the skin prick test (SPT), allergen and histamine bronchial challenges, and tests for allergen-specific IgE, IgG1, and IgG4 levels. In the group treated with active extracts for 2 years (group A), the previously reported decrease in bronchial responsiveness to cat extract ( p p p p p p p

Long-term treatment with beclomethasone dipropionate aerosol in asthmatic children with special reference to growth.

Thirty‐one children, 19 boys and 12 girls, aged 3.4–10.8 years, with severe perennial bronchial asthma were treated with beclomethasone dipropionate aerosol (BDA) for 16–40 months. The dose was initially 400 μg a day and was gradually reduced to the lowest level giving control of symptoms. Earlier steroid or ACTH‐treatment in six children was stopped during the BDA‐treatment. At the start of the treatment the mean deviation of height compared with normal values for Swedish children was −0.10 s.d. for the boys and −0.51 s.d. for the girls. At the end of the observation period the deviation was −0.22 s.d. and −0.58 s.d., respectively. The increase in deviation was not significant. Bone age was also slightly retarded before beclomethasone treatment but this deviation was not accentuated during the observation period. It is concluded that treatment with BDA does not retard growth or skeletal maturation in children. The number of acute admissions to hospital was reduced by more than 50% during the first year of treatment.

Immunotherapy with cat- and dog-dander extracts: III. Allergen-specific immunoglobulin responses in a 1-year double-blind placebo study

An investigation was made of the specific antibody response to individual antigens in 40 patients taking part in a double-blind placebo study of immunotherapy with cat- or dog-dander extracts. Antigen-specific IgE levels were measured by means of CRIE, and the results were expressed as scores. The patients demonstrated IgE specificities toward 1 to 5 antigens. Cat-dander antigens Nos. 4 (cat Ag 1) and 7, and dog antigens Nos. 6 and 13, produced the highest scores, but high IgE binding was also found for dog albumin. After 1 year of treatment, the IgE responses of the two treatment groups (allergen and placebo) were statistically indistinguishable from those before the start of treatment. There was a tendency toward a reduction in score for two of the dander antigens (cat Ag 1 and dog Ag No. 13), and no new IgE specificities appeared. Antigen-specific IgG levels were measured by means of CIE with patient serum incorporated in an intermediate gel, and the results were expressed as plus/minus precipitins. Only two patients had precipitating antibodies before the start of treatment (one against cat albumin and one against cat Ag 1). During the course of treatment, the production of antigen-specific IgGs was observed in 18/22 allergen- and 1/18 placebo-treated patients. For the cat allergen-treated group, the specificities were directed against cat antigens Nos. 2, 3 (cat albumin), 4 (cat Ag 1), and 7, and for the dog allergen-treated group, against dog antigens Nos. 2 (dog albumin), 13, and 20.(ABSTRACT TRUNCATED AT 250 WORDS)

Asthma from childhood to adult age: a prospective study of twenty subjects with special reference to the clinical course and pulmonary function

ABSTRACT. Twenty young men with a mean age 24.9 years, who had moderate to severe asthma during childhood, underwent a follow‐up examination of their clinical status and pulmonary function. Comparison was made with data obtained at a mean age of 10.9 years. Eight of twenty showed a clinical improvement and 12 no change in their asthma. During childhood 12 of 20 boys had been on longterm ACTH or corticosteroid treatment. In the present study no one was given systemic steroid treatment. The static lung volumes (VC, TLC, FRC RV) were within normal limits for children and adults. In spite of clinical improvement, the expiratory flow rates (FEV1, FEV%) were still significantly reduced (p<0.005). Thus, the clinical improvement was not accompanied by a corresponding improvement in expiratory flow rates.

RESPIRATORY FUNCTION, CARDIOVASCULAR DIMENSIONS AND WORK CAPACITY IN BOYS WITH BRONCHIAL ASTHMA

Abstract. Twenty boys with bronchial asthma, aged 8‐13 years, were studied with regard to the size of their respiratory and circulatory organs and to their exercise tolerance. The boys were divided into two groups (A and B) depending on the severity of their subjective symptoms. Normal values were found for TLC, VC and FRC in both groups, whereas the group with the most severe asthma had a slightly increased RV. In both groups THb, blood and heart volumes were normal. A quite normal relationship between these variables was observed as well as with work capacity (W170 and VO2 max) with no intergroup differences. Respiratory rate was lower and ventilation was increased in group B, both in submaximal and maximal exercise. Thus, tidal volume in maximal exercise exceeded 50 per cent of vital capacity in this group. These boys also had the highest blood lactate concentration at submaximal and maximal exercise. In half of the boys asthma‐like attacks were elicited by the exercise. The symptoms subsided without treatment shortly after work. The frequency and intensity of attacks were similar in the two groups.

Juvenile Pemphigus Vulgaris

ABSTRACT. Pemphigus vulgaris is extremely rare in childhood. Only 35 cases of juvenile pemphigus vulgaris have been reported in the literature up until to now. During the pre‐steroid era, the outcome of the disease was usually regarded as fatal. Today, the prognosis has improved because of the possibility of early diagnosis by immunoflourescent techniques, determination of antibodies against epidermal intercellular substance and early therapy with systemic steroids. A case of juvenile pemphigus vulgaris with a favourable outcome in a 13‐year old girl is described.

Comparison of the Protective Effect of Ketotifen and Disodium Cromoglycate on Exercise‐Induced Asthma in Asthmatic Boys

Fourteen hoys with a mean age of 12.2 years were studied with respect to the protective effect of ketotifen on exercise‐induced asthma (EIA) in comparison with disodium cromoglycate (DSCG). All had a positive history of EIA and a post‐exercise fall in FEV1 of more than 20%. A double blind cross‐over technique was used with a 1 week wash‐out period between the two treatment alternatives. Both drugs gave some, but not significant protection for EIA and no differences between the two active substances tested were found. Great individual differences in the response to the two drugs were noted.

Asthma from childhood to adulthood—A follow-up study of 20 subjects with special reference to work capacity and pulmonary gas exchange

Twenty men with a mean age of 24.9 years, who had moderate to severe asthma during childhood, underwent a follow-up examination of their physical fitness, working capacity, maximal oxygen uptake, and pulmonary function during and after physical work. Comparison was made with similar data obtained at the age of 10.9 years. The young men had a normal physical working capacity with a normal oxygen uptake of 3.65 +/- 0.56 L/min. The respiratory parameters and the arterial blood gases during work demonstrated values as in healthy individuals, and no differences between groups with mild and severe asthma during childhood were observed. The alveolar-arterial oxygen difference was normalized, compared to that at 10.9 years. Only a few subjects still had exercise-induced asthma with a postexercise fall of greater than 20% in FEV1 compared to childhood. The mean FEV1 values for the whole group after exercise were lowered and had not returned to the baseline level even after 20 minutes. Oxygen pressure (tension), arterial, measured during 20 minutes after work, demonstrated continuously decreasing values. This might reflect a persisting disturbance in the pulmonary ventilation perfusion relationship caused by the underlying asthma disease.