Vaccination against Haemophilus influenzae type b and atopy in east German schoolchildren.

INTRODUCTION: Although routine childhood immunisations are known to prevent severe diseases there is an ongoing discussion on possible side effects in later life. In this paper we investigated the association of Haemophilus influenzae type b (Hib)-vaccination and atopic diseases and allergic sensitisation in children in Eastern Germany. METHODS: From 1998-1999 a cross-sectional survey of school children aged 5 to 14 years on long-term health effects of air pollution was conducted in three regions of Eastern Germany. Atopic outcome was defined by parental reporting of wheezing and doctor's diagnosed asthma (including asthma-like bronchitis), hay fever and eczema. Specific serum IgE against 5 aeroallergens were analysed by RAST-technique. Vaccination status was assessed by vaccination records from the respective local health authorities. Analysis is restricted to 1943 children with complete information on age, gender, place of residence, parental education and 1676 children with available blood data. RESULTS: Lifetime prevalence were 4.9% for asthma, 21.1% for wheezing, 6.6% for hay fever, 11.4% for eczema. 32% of the children had at least one specific IgE RAST>0. Hib-vaccination coverage was 42 % overall, 93 % in 5-7 yr olds, 59 % in 8-10 yr olds and 11 % in 11-14 yr olds. Odds Ratios adjusted for age, gender, place of residence, and parental education were 1.86 (1.05-3.32) for asthma, 1.55 (0.95-2.54) for hay fever, 1.03 (0.70-1.50) for eczema and 1.25 (0.94-1.67) for at least 1 specific IgE RAST>0. CONCLUSION: We found little evidence for an association between Hib-vaccination and some atopic outcomes and causality cannot be ascertained. Our findings do not give sufficient support to question the value of Hib vaccination given the substantial contribution of mass immunisations to public health. Specific research on possible long-term effects of vaccines is needed to enable final conclusions on this topic.

Allergens and endotoxin on mothers' mattresses and total immunoglobulin E in cord blood of neonates.

The current authors examined whether mite and cat allergen and bacterial endotoxin levels in dust of the mothers' mattresses were associated with cord blood immunoglobulin (Ig)E (CB-IgE) levels in newborns. Data from 1,332 term and normal weight neonates, from an ongoing birth cohort study, influences of life-style related factors on the immune system and the development of allergies in childhood (LISA), with complete information on exposure to biocontaminants in mattress dust and CB-IgE were analysed. Two thirds of CB-IgE were undetectable (<0.35 kU x L(-1)). Thus, 0.35 and 0.45 kU x L(-1) (4th quartile) were chosen as cut-offs. Nonparametric smoothing (generalised additive models) showed statistically significant confounder-adjusted associations between elevated CB-IgE levels (> or = 0.45 kU x L(-1)) and log-transformed exposures to cat (linear), mite (inverse u-shaped), and endotoxin (u-shaped). After adjustment for covariables, elevated CB-IgE levels (logistic regression using the 1st-4th quartiles of exposure) were positively associated with high cat-allergen exposure and medium exposure to mite allergen, but were inversely associated with exposure to endotoxin. The associations were similar, but somewhat weaker, when 0.35 kU x L(-1) was used as cut-off. These results, showing an association between prenatal allergen and endotoxin exposures and immunoglobulin E production, suggest that the development of foetal immune responses may be affected.

[Environmental surveys in the areas of Bitterfeld, Hettstedt and a comparative area in 1992-2000]. / Umweltmedizinische Untersuchungen im Raum Bitterfeld, im Raum Hettstedt und in einem Vergleichsgebiet 1992-2000.

The aim of the environmental epidemiological study was to determine possible adverse effects on the health of children in the environmentally polluted areas of Bitterfeld and Hettstedt compared to the less polluted area of Zerbst (Eastern Germany). The changes of the health parameters were recorded together with the environmental changes during the time period of 6 years. The study design consisted of three repeated regional cross-sectional studies in 1992/93, 1995/96 and 1998/99. In total, 7,611 questionnaires could be analysed (participation rate: 89%, 75% and 75%). Children living in the most polluted area of Hettstedt had a noticeable higher risk for non-allergic respiratory diseases and symptoms compared to children living in the control area of Zerbst. From 1992 to 1999 a statistically significant decrease in the prevalences of these health outcomes was found. Children without indoor pollutants in their homes had the greatest benefit by the improvement of ambient air quality. The increase in lung function (FVC, FEV1) also underlines the improvement of the respiratory health. Children living in the polluted areas reported allergies more often (physician's diagnosis, allergy specific antibodies). The prevalence of asthma, the bronchial hyperreactivity and atopic eczema was increased within the observational period of 6 years. An increased prevalence was also shown for more severe allergic sensitisation (RAST classes > 17.5 kU/l), while the prevalence of hay fever increased slightly on a non-significant level. The burden with lead and cadmium was higher in children living in polluted areas and decreased during the study period except for 1997 where the lead concentration in blood increased according to the higher lead concentration in settled dust in Hettstedt at that time.

Allergic sensitization and diet: ecological analysis in selected European cities.

It has been postulated that the prevalence of atopic diseases and their increase over time are associated with regional differences in diet and trends. The results of an ecological correlation study comparing the mean daily intake of selected dietary constituents and the prevalence of allergic sensitization in adults in Europe is presented. Prevalence data from the European Community Respiratory Health Survey (ECRHS) were used. For eight out of 37 ECRHS centres (including 3,872 subjects), comparable dietary data could be obtained. The effect for each dietary constituent was modelled using logistic regression analyses with a term for over dispersion. Inverse associations between the prevalence of allergic sensitization and the energy adjusted intake of fruit were found (odds ratio (OR) = 0.68, p = 0.034). Furthermore OR for energy adjusted intake of vitamin A (OR = 0.73, p = 0.057), vitamin C (OR = 0.83, p = 0.338) and riboflavin (OR = 0.72, p = 0.077) were consistently < 1, but confidence intervals were wider. Daily intake of monounsaturated fatty acids (energy adjusted) was positively associated with sensitization prevalence (OR = 1.59, p = 0.035). These results support the hypothesis that a high intake of monounsaturated fatty acids might promote the development of allergic sensitization.

Gas cooking, respiratory health and white blood cell counts in children.

The use of gas stoves has been associated with respiratory symptoms of chronic airway inflammation and higher rates of respiratory infections. We used data from a 1992/93 survey of 2,198 East German school children (aged 5 to 14) to assess whether gas cooking increases respiratory symptoms and is associated with a chronic inflammatory process reflected by an increase in white blood cell (WBC) count in children who do not exhibit signs of an acute respiratory infection. We found increases for the respiratory symptoms 'cough without cold' [odds ratio (OR) = 1.68; 95% confidence interval (CI), 1.18-2.39], 'cough in the morning' (OR = 1.58; CI, 1.23-2.04) and 'cough during the day or at night' (OR = 1.42; CI, 1.13-1.78) in children living in homes with gas ranges, but lifetime prevalence of asthma, bronchitis, wheeze, and the prevalence of acute infections were not affected. Furthermore, we examined WBC levels in a subgroup of 1,134 children for whom blood samples were available and who did not suffer from an acute infection. We observed small increases in the risk of having WBC counts above the 75th or 90th percentile (8300 or 9800 cell counts per microliter) when children were exposed to gas cooking after adjustment for age, gender, and passive smoking (OR = 1.30; CI, 0.98-1.73, and OR = 1.38; CI, 0.91-2.10). The strongest effect estimates for chronic inflammation were found for those children likely to have been exposed at higher levels, that is when stoves had no fans, in smaller homes, and for children spending more time indoors.

The central part of the mouse immunoglobulin kappa locus.

At the present state of analysis the central part of the kappa locus comprises four contigs of together 1.2 Mb and contains 55 Vkappa genes. It is flanked by the 3' part of the locus with 22 Vkappa genes in 0.4 Mb (T. Kirschbaum et al., Eur. J. Immunol. 1998. 28: 1458-1466) and the 5' part with 63 Vkappa genes in six contigs of together 1.5 Mb (F. Röschenthaler et al., accompanying report). The 5' and the central regions have one large contig in common. A part of the central region is linked to the 3' region resulting in a 1.1-Mb contig. The structure of the contigs was established mainly by the analysis of overlapping cosmid clones derived from genomic DNA and yeast and bacterial artificial chromosomes (YACs and BACs) and by PCR techniques. Pulsed-field gel electrophoresis of YAC digests indicated that three gaps between the contigs of the central region are 10-40 kb in size, comprising together about 90 kb. Internal duplications in this part of the locus and rearranged YACs were the major problems of the structural work. Structural details are to be found on the Internet at http://www.med.uni-muenchen.de/biochemie/zach au/kappa.htm. In a concluding section of the report the mouse kappa locus is compared to the human one and some aspects of the evolution of the kappa locus are discussed.

[Housing conditions and allergic sensitization in children]. / Wohnbedingungen und allergische Sensibilisierung im Kindesalter.

Genetic predisposition and indoor exposure to allergens-especially during the very early childhood years are major factors for the development of allergic diseases later in life. The present study analyzed the association between allergic sensitization in children aged 5 to 14 years and residing since birth in homes of different building types. A cross-sectional study of 811 children aged 5 to 14 years who resided in the same home since birth investigated indoor factors using a questionnaire and allergic sensitization assessed by skin prick test. The prevalence of allergic sensitization was compared between children who lived since birth in five different building types. After adjustment for age, gender, parental education and study area the odds of allergic sensitization were higher among children who lived in prefabricated concrete slab buildings built after 1970 (OR 1.56, 95% CI: 1.02-2.38) and among children who lived in new brick buildings (OR 1.75, 95% CI: 0.88-3.47) than among children who lived in old brick buildings. Moreover, the odds of pollen sensitization was higher among children who lived in the new building types (prefabricated slab buildings: OR 1.68, 95% CI: 1.04-2.72; new brick buildings: OR 1.48, 95% CI: 0.64-3.42) while living in timber-framed houses was associated with a higher odds of sensitization against mites (OR 1.63, 95% CI: 0.77-3.44). The step by step inclusion of single indoor factors like type of heating, numbers of building storeys, number of persons per room, environmental tobacco smoke, use of gas for cooking purposes, dampness of the home or visible moulds in the logistic regression model only marginally changed the odds ratios. Modern living conditions are associated with a higher odds of allergic sensitization.

Reperfusion effects on the magnesium-procaine arrested rabbit heart.

Rabbit hearts were subjected to cardiac arrest induced by injecting 3 isotonic cardioplegic solutions each of which contained in combination with procaine-HCl one of 3 different magnesium compounds. A period of 40 min arrest was followed by reperfusion of 15 min. A regular sinus rhythm returned after washout of the cardioplegic solution. The pattern of the essentially unaltered myocardial ultrastructure correlated with the well-preserved high-energy phosphate stores. The effects of magnesium and procaine on cell permeability and the consequences of the different fusion are discussed. The study stresses the importance of an adequate period of postischemic reperfusion of the heart in an unloaded state in support of myocardial recovery. The studies presented herein suggest further investigations of various concentrations of magnesium and procaine combined with different amounts of calcium in perfusates for the preservation of the heart and possibly of other organs.

[Organ preservation by heavy water (D2O). Morphological and biochemical studies on heart and liver (author's transl)]. / Organkonservierung durch Schweres Wasser (D2O): Morphologische und biochemische Untersuchungen an Herz und Leber.

The tissue H2O of rabbit heart and rat liver was partially exchanged in situ with D2O. In rat liver, the loss of ATP, resulting from normothermic ischemia, was decreased after perfusion with D2O. The maximal protective effect was found when the proportion of D2O in the water of the liver tissue was 0.20. In both organs the protective effect of D2O could be correlated with a marked decrease in severe ischemic damage of cellular organelles, in particular mitochondria. D2O also increased the protective action of Mg-ions in the heart.

The effect of magnesiumaspartate on preservation of the rat liver.

1. Isolated rat livers reperfused with an oxygenated isotonic Mg-aspartate or saline solution and stored 1 h at 36 degrees C, 4 h at 22 degrees C or 12 h at 6 degrees C were reperfused at 37 degrees C 150 min with a Krebs-Henseleit solution containing bovine albumin and erthrocytes gased with a 95% O2-5% CO2 gas mixture. 2. Light- and electronmicroscopic studies revealed minor changes after storage, whereas in the reperfused livers a focal distribution of well preserved and disintegrated hepatocytes was observed. 3. During storage the sum of adenine nucleotides in general decreased markedly paralleled by a significant rise of the lactate/pyruvate and hydroxybutyrate/acetoacetate ratios and pronounced breakdown of glycogen. Oxidative phosphorylation was resumed upon reperfusion resulting in de novo synthesis of ATP and ADP. The lactatelpyruvate and hydroxybutyrate/acetoacetate ratios normalized, whereas a resynthesis of glycogen was missing. 4. No conclusive evidence of a protective Mg-effect as observed in induced cardiac arrest has been obtained, probably due to structural and metabolic differences between the two organs and microcirculatory disorders as has been demonstrated by measurements of oxygen uptake using the multiwire electrode.

[Blood regeneration after blood substitution with dextran 60 or hydroxyethyl starch of an identical volume]. / Zur Blutregeneration nach einem gleichvolumigen Blutaustausch mit Dextran 60 oder Hydroxyäthylstärke

Male rats of the Wistar strain survived an isovolaemic blood volume replacement down to a haematocrit value of 20% using commercial dextran 60 or hydroxyethyl starch. No significant changes of the blood volume have been observed. 14 days after treatment, the blood values were found to be practically within the normal range. As early as 3 days after the blood exchange, a significant increase in reticulocytes has been noted which reached its maximum on the 7th day. In both series the blood regeneration was identical.

[Long term tolerance of highly dosed infusions of hydroxylethylstarch and dextran 60 in normovolemic rabbits]. / Langzeitverträglichkeit hochdosierter Infusionen von Hydroxyäthylstärke und Dextran 60 bei normovolämischen Kaninchen

Normovolemic rabbits were administered 50 ml of 6% hydroxyethyl starch in saline, 6% dextran 60 in saline solutions 5 days a week over a period of 3 weeks. Only 2 rabbits of the hydroxyethyl starch or the dextran treated series and 4 rabbits of the saline series survived 3 weeks. In all 3 series large amounts of fluid in the serous cavities and edema of the lungs due to the overload of fluid have been observed. Severe hydropic changes were found in the liver and kidneys of the hydroxyethyl starch and dextran treated series, but not after prolonged administration of saline alone. According to the findings presented there is no difference between the effects due to the prolonged administration of extremely high doses of hydroxyethyl starch and dextran 60.

[Comparative investigations of hydroxyethyl starch and dextran 60 in Isovolaemic haemodilution and haemorrhagic shock of rats (author's transl)]. / Vergleichende Untersuchungen von Hydroxyäthylstärke und Dextran 60 bei isovolämischer Hämodilution und im Entblutungsschock bei der Ratte

Isovolaemic blood volume replacement down to a haematocrit value of 20% by commercial dextran 60 or hydroxyethyl starch has been survived by male rats of the Wistar strain without significant deviations from the initial blood volume. The haemoglobin and haematocrit values were found to be practically within the normal range 14 days after treatment. In a second series of male rats of the Wistar strain haemorrhagic shock was maintained over a period of 60 min. The 48 hour survival rate amounted to 100% after retransfusion or replacement by hydroxyethyl starch or dextran 60 of the bleeding volume. The kidneys of both series when examined by the light microscopy showed no pathological changes. On the basis of the findings presented hydroxyethyl starch may be considered to be as effective in blood volume replacement as dextran 60.