Seroprevalence of Chlamydia pneumoniae in asthmatic children from Northern India.

Serum from children with chronic persistent asthma was subjected to C. pneumoniae IgG antibody determination. C. pneumoniae IgG serology suggestive of persistent infection was significantly higher in chronic persistent asthma group than in the control group. Seropositivity was significantly more in moderate and severe persistent groups than in the control subjects. There was no evidence of acute C. pneumoniae infection (IgM serology done in duplicate) in acute exacerbations.

Clinico-immunologic evaluation of allergy to Himalayan tree pollen in atopic subjects in India--a new record.

Exposure to local pollen allergens has a direct bearing on the prevalence of allergic symptoms among the inhabiting atopic population. The populations in the Himalayas and around it are exposed to a variety of pollen grains from trees growing in the region, but the pollen-population interaction has not been clinically investigated. Himalayan tree pollen from five different taxa, i.e. Alnus nitida (AN), Betula utilis (BU), Cedrus deodara (CD), Mallotus phillipensis (MP) and Quercus incana (QI) were evaluated for their allergenicity in the Indian population by in vivo (skin prick test) and in vitro (ELISA) clinico-immunological methods. The presence of specific IgE against these tree pollen in the sera of skin test positive patients was taken as evidence for sensitization to these pollen. The average skin positivity in atopic populations recorded at different allergy centers in India varied from 2.2% against AN, to 4.7% against MP pollen. Significantly raised specific IgE against these pollen were observed in the sera of hypersensitive patients. The sensitization pattern to Himalayan tree pollen in these atopic populations varied. It was concluded that skin prick test positivity and raised IgE antibodies specific to AN, BU, CD, MP and QI established Himalayan tree pollen as important sensitizers in the atopic populations of India. A high incidence of skin sensitivity was observed to pollen antigens of Cedrus deodara, Mallotus phillipensis and Quercus incana in patients of Chandigarh residing in the hills and foothills of the Himalayas while Alnus nitida, Betula utilis and Cedrus deodara were important sensitizers in Delhi patients. The skin sensitization pattern against these pollen was in accordance with the level of exposure to these pollen of the subjects residing in that part of the country.

Nitric oxide metabolites in induced sputum: a noninvasive marker of airway inflammation in asthma.

OBJECTIVE: This study was designed to examine for nitric oxide (NO) metabolites in induced sputum as a marker of airway inflammation in asthmatic children. DESIGN. Prospective interventional SETTING: Pediatric Allergy and Asthma Clinic of a tertiary care referral hospital in Northern India. SUBJECTS: Twenty-one children with asthma who were not receiving corticosteroids for the preceding 3 months and 10 healthy controls were enrolled. METHODS: Hypertonic saline-induced sputum was obtained at study entry in controls, and at study entry and after 6 weeks of inhaled corticosteroid (ICS) therapy in asthmatic children. Fresh expectorated sputum was treated with dithiothreitol and cytospinned for cell count. NO metabolites were measured in the supernatant by the modified Griess reaction. RESULTS: Asthmatic children, compared with controls, had significantly higher concentration of NO metabolites (22.4 +/- 209.69 vs 39.2 +/- 15.9 (moL/L, P <0.01) and a higher percentage of eosinophils (15.3 +/- 12.0 vs 0.8 +/- 1.1%, P <0.01) in induced sputum. Both NO metabolites and eosinophil percentage declined following treatment with ICS for 6 weeks (P <0.01). CONCLUSION: The study confirms that the level of NO metabolites is increased in the tracheobronchial secretions of asthmatic children and decreases following ICS therapy. Measurement of NO metabolites in induced sputum may be useful for monitoring airway inflammation in children with asthma.

Pneumonic presentation of brucellosis.

Brucellosis is a rare disease in children. Lung involvement is an uncommon presentation of brucellosis. The authors are presenting a child with brucellosis, who presented with predominant pulmonary involvement. It was an eight-year-old child who was referred to us a case of non-resolving pneumonia. Brucella agglutination test was suggestive of brucellosis. He responded to the combination of doxycycline and rifampicin.

Comparison of improvement in quality of life score with objective parameters of pulmonary function in Indian asthmatic children receiving inhaled corticosteroid therapy.

This prospective, hospital based, descriptive study was designed to compare improvement in quality of life (QOL) score with objective measures of pulmonary function in children with persistent bronchial asthma receiving inhaled corticosteroid (ICS) therapy. QOL score (measured by an indigenous tool), forced expiratory volume in first second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR) and asthma symptom score were measured in 20 newly diagnosed children with persistent asthma- before, during and eight weeks after ICS therapy. There was a significant improvement in all parameters compared at each follow up visit and at termination of the study (p less than 0.05). The magnitude of improvement in QOL was similar to improvement in objective measures of pulmonary function; although these changes were not similar to changes in asthma symptom score. Improvement in QOL score is likely to be a sensitive measurement of functional improvement in asthmatic children on treatment; however subjective sensation of improvement lags behind objective measures.

Atopy and alopecia areata in North Indians.

The study was undertaken with the aim of evaluating the effect of associated atopy on severity and age at onset of alopecia areata in north Indians. Presence of atopy was elicited by detailed history, examination and intracutaneous tests. Chi square test was carried out to evaluate statistical significance. One hundred patients (76 males and 24 females) with alopecia areata were evaluated. Historical evidence of atopy was present in 50 including patients alone (23), patients and first degree relatives (11) and first degree relatives alone (16). Intracutaneous tests were positive in 23 out of 50 patients tested randomly. There was a trend towards increasing frequency of severe alopecia as evidence of atopy became stronger e.g. both patient and first degree relatives with atopy or positive intracutaneous test but the results did not attain statistical significance. Similarly the age at onset and duration of alopecia areata was not significantly related to the presence of atopy. It is concluded that in north Indians with alopecia areata, the presence of atopy is not significantly associated with severe alopecia or onset at younger age.

Cystic fibrosis in North Indian children.

Cystic fibrosis is the most common life threatening, inherited disease of the Caucasians. Ever since the gene for this disease was delineated in 1989, there are about 900 mutations discovered so far. This disease is being reported with increasing frequency from North India now. We present our experience with the diagnosis and management of cystic fibrosis in children seen at Post-Graduate Institute of Medical Education and Research, Chandigarh.

Respiratory allergy.

Allergic rhinitis (AR) and asthma are common respiratory allergic disorders which are increasing globally more in developed countries. Although much has been written about childhood asthma and guidelines published by various international and national fora, not much information is available on AR. This is most common in children, is a significant risk factor for developing asthma, is a common comorbidity with asthma and affects quality of life. This paper highlights the risk factors for developing respiratory allergy asthma and AR, linkages between them and the management issues, particularly in relation to the allergic or allergological aspects as they have important bearing on management of children suffering from respiratory allergy. Specific immunotherapy (SIT) is re-emerging as useful therapy which alone has the potential to modify the natural history of disease and prevent the 'allergic march'. Timely diagnosis, correct management including timely referrals can ensure good quality life for those suffering from respiratory allergies.

Prevention of atopic disorders.

Prevention of sensitization, onset of disease and disease exacerbations is a very important aspect of holistic approach towards allergic disorders. The prevalence of allergic or atopic disorders has increased significantly in children over the last three decades. There are significant variations in prevalence between countries and also within many countries. Environmental factors obviously play a major role. Environmental allergens are responsible for sensitisation, disease and exacerbations of disease symptoms. Preventive strategies at each level are important: Primary prevention is to stop the process of sensitisation and secondary prevention to prevent re-exposures or prolonged exposure in those who have become sensitized while tertiary prevention is to reduce or minimise morbidity. Various allergen avoidance measures are discussed, with reference to India so that physicians can incorporate these in the management not only of atopic patients but also as preventive strategy in high risk families.