Zuzana Rennerova

Immunomodulatory effect of pleuran (β-glucan from Pleurotus ostreatus) in children with recurrent respiratory tract infections

OBJECTIVES Recurrent respiratory tract infections (RRTIs) represent a very important problem in daily clinical practice because of their significant contribution to morbidity in children. Several natural nutritional supplements have been used in the prevention of RRTIs, but the clinical efficacy of only a few preparations is supported by scientific evidence. MATERIALS AND METHODS In a double-blind, placebo-controlled, randomised, multicentre study, we have observed a group of 175 children (aged 5.65 ± 2.39 years) with more than 5 respiratory infections that occurred during the 12 months prior to the beginning of the study. Children were randomised into an active group, treated with Imunoglukan P4H® syrup (with pleuran-β-glucan from Pleurotus ostreatus and vitamin C), or a placebo group (vitamin C only). During the 3 visits, within a 12-month period, questionnaires were completed, and blood samples were examined for immune parameters. RESULTS In the active group, 36% of the children did not suffer from any respiratory infections throughout the treatment, compared to 21% in the placebo group (p<0.05). Imunoglukan P4H® also significantly decreased the frequency of flu and flu-like disease and the number of lower respiratory tract infections. Imunoglukan P4H® treatment resulted in a statistically significant modulation of humoral and cellular immunity. CONCLUSIONS Results from this study demonstrate that Imunoglukan P4H® is effective in the prevention of RRTIs in children. Furthermore, our results also revealed complex immunomodulatory activity of this product. This is the first double-blind, placebo-controlled study in children with RRTIs that has addressed the preventive effects of pleuran on morbidity caused by respiratory infections.

β-Glucans in the treatment and prevention of allergic diseases.

β-glucans are a group of biologically active polysaccharides of natural origin with a proven pleiotropic immunomodulation effect. Their efficacy has been confirmed in the therapeutic treatment and prevention of various infectious diseases, secondary immune defects and also of oncologic disorders. Allergic diseases are one of the most frequent diseases and their prevalence continues to increase. They develop as a consequence of dysregulation of the immune system, especially when there is failure in the equilibrium of the response of TH1/TH2 lymphocytes towards TH2. New therapeutic approaches in the treatment of immunopathological conditions (e.g. allergic or oncologic) are directed to restoring the equilibrium among different T lymphocyte subpopulations. Based on in vitro experiments, and also on animal and human clinical studies, there is much evidence for the importance of β-glucans in the treatment and also prevention of allergic diseases; this opens new perspectives on the use of this widespread and popular group of natural substances.

Anti-allergic effect of Pleuran (β-glucan from Pleurotus ostreatus) in children with recurrent respiratory tract infections.

Recurrent respiratory tract infections (RRTIs) present a very important problem in paediatric praxis. As true immunodeficiencies are rare, one of the most important factors assumed to contribute to increased respiratory morbidity is atopy. Several preparations of natural origin have been used for the prevention of RRTIs, and some of the most effective immunomodulators are biologically active polysaccharides – e.g. ß‐glucans. In our randomised, double‐blind, placebo‐controlled study, we investigated the prevalence of atopy in a group of children with RRTIs and the potential anti‐allergic effect of pleuran (ß‐glucan isolated from Pleurotus ostreatus) on basic laboratory markers of allergic inflammation. We confirmed that atopy may be an important factor contributing to the increased respiratory morbidity in children with RRTIs. The active treatment with pleuran resulted in a significant reduction of peripheral blood eosinophilia and stabilised the levels of total IgE in serum. This was more evident in atopic subjects. Pleuran showed a potential anti‐allergic effect. This previously non‐described effect could expand the application of this natural immunomodulator also as a complementary adjuvant therapy in allergic patients. Copyright

Reproducibility of food atopy patch tests over time in the general child population.

Background  The atopy patch test (APT) is no longer an experimental method; it is increasingly being used as a standard diagnostic tool for the characterization of patients with aeroallergen‐ and food‐triggered disorders. Some technical aspects of this test still remain to be answered. We aimed to study the reproducibility of this test over time in the general child population.

Recurrent Respiratory Infections in Children – Definition, Diagnostic Approach, Treatment and Prevention

Paediatric respiratory tract infections are one of the most common reasons for physician visits and hospitalisation, and are associated with significant morbidity and mortality. Respiratory infections are common and frequent diseases and present one of the major complaints in children and adolescents. The role of physicians and other healthcare providers has expanded from merely treating disease to implementing measures aimed at health maintenance and disease prevention (Bellanti, 1997). Respiratory infections (RI), mainly involving the upper airways, are common in children and their recurrence constitutes a demanding challenge for the paediatricians. There are many children suffering from so-called recurrent respiratory infections (RRI). The child with recurrent respiratory infections presents a difficult diagnostic challenge. It is necessary to discriminate between those with simply-managed cause for their symptoms such as recurrent viral infections or asthma, from the children with more serious underlying pathology such as bronchiectasis or immune dysfunction. Many different disorders present this way, including cystic fibrosis, various immunodeficiency syndromes, congenital anomalies of respiratory tract, but in some children lung damage could follow a single severe pneumonia or can be the consequence of the inhalation of food or foreign body (Couriel, 2002). According to the epidemiological studies it was estimated that around 6% of the children younger than 6 years of age present RRI. In developed countries, up to 25% of children aged < 1 year and 18% of children aged 1-4 years experience RRI (Bellanti, 1997). Moreover, ENT infections represent the most frequent pathologies in children aged from 6 months to 6 years. Although the etiologic agents responsible for RRI are not always readily identifiable, viral agents are typically the main cause. The real task for the paediatricians is to discriminate the normal children with high respiratory infections frequency related to an augmented exposure to environmental risk factors from the children affected by other underlying pathological conditions (immunological or not), predisposing to infectious respiratory

Variations in exhaled nitric oxide in children with asthma during a 1-week stay in a mountain village sanatorium.

Knowing about spontaneous variations in the fractional concentration of exhaled nitric oxide (FENO) could improve monitoring of airway inflammation in asthmatic children. We aimed to assess FENO variations (expiratory flow 50 mL/sec) in subjects maintained in similar environmental conditions. We tested spirometry and FENO in symptom-free asthmatic children (9 corticosteroid-naive, 8 corticosteroid-treated) during a 1-week stay in a countryside sanatorium and in their healthy relatives (n = 12) staying in the immediate neighborhood on summer holiday (total 29 children, M/F:14/15, 5.8-16.8 yrs). Testing sessions were repeated every 12 hours (8:00 am, 8:00 pm) for 2 days and again on day 7. Measurements were defined as reproducible when they agreed with an intraclass correlation coefficient (ICC) above 0.60; deviation from mean differences was assessed by the coefficient of repeatability (CR = 2 SD). Lung function remained constant throughout the week in all groups. Baseline FENO levels in corticosteroid-naive asthmatic children tended to decrease at the end of the week (from 13.9 ppb, 95% CI 12.2-19.1 to 9.2 ppb, 95% CI 5.8–15.9, p = 0.057). No differences were found between nocturnal and diurnal FENO. Within-session reproducibility for two FENO measurements was high (ICC 0.99 in all groups and CR, 0.9 to 1.3 ppb). Between-session FENO reproducibility at 12 hours and 24 hours was still high for each group but decreased markedly after 6 days in corticosteroid-naive asthmatic children (ICC 0.79 and CR 9.6 ppb at 24 hours vs. ICC 0.13 and CR 20.8 ppb after 6 days), whereas it decreased slightly in corticosteroid-treated asthmatics (from ICC 0.89 and CR 3.1 ppb to ICC 0.88 and CR 3.0 ppb) and healthy children (from ICC 0.79 and CR 4.8 ppb to ICC 0.65 and CR 5.7 ppb). In conclusion, in healthy subjects and in asthmatic children receiving therapy with inhaled corticosteroids (but not in corticosteroid-naïve subjects), FENO measurements are reproducible across a week.

Side Effects of Food Atopy Patch Tests

A topy patch test (APT) has recently left experimental grounds and is increasingly used as a standard diagnostic tool for characterizing patients with aeroallergen-triggered disorders and food-triggered disorders (especially atopic dermatitis). There are only a few reports on the side effects of APT, and no results are available for the potential sensitizing risk of this test. According to the position paper of European Academy of Allergology and Clinical Immunology, aluminium cups of 12-mm diameter placed on hypoallergenic tape are recommended. 1 There are no reports on the suitability of alternative materials such as rectangular plastic cups.