Tuberculin responses in children with allergic diseases.

BACKGROUND: The prevalence of allergic disorders has been increasing over the last 30 years, especially in developed countries. One factor associated with this rise may be the decline of many childhood infections. We investigated tuberculin responses in allergic children in order to see the development of delayed-type hypersensitivity reactions to tubercule bacillus infection. METHODS: The study sample was composed of 106 allergic and 100 nonallergic children vaccinated with bacille Calmette-Guerin (BCG). The standard Mantoux test was applied to all children. The reactions were read after 72 h by measuring the diameter of the wheal. RESULTS: The wheal size was 6.29 +/- 5.09 mm (mean +/- SD) in allergic children, and 2.79 +/- 2.96 mm in nonallergic children. The difference between the two groups was significant (P < 0.001). In children with a single BCG scar, the mean purified protein derivative (PPD) wheal size for allergic children was 4.77 +/- 4.79 mm, and for nonallergic children it was 2.48 +/- 3.19 mm. The mean PPD wheal sizes in allergic and nonallergic children who had been vaccinated twice were 8.35 +/- 4.80 mm and 3.33 +/- 2.44 mm, respectively. This difference was statistically significant (P < 0.05). In 27.35% of the allergic children and 6% of the nonallergic children, the positive tuberculin responses (PPD > or = 10 mm) were recorded. The difference was significant (P < 0.05). CONCLUSIONS: Our results showed that response to tuberculin in BCG-immunized allergic children is higher than in BCG-immunized nonallergic children.

Evaluation of immunotherapy by nasal antigen challenge.

BACKGROUND: Nasal antigen challenge test is used to evaluate the allergic conditions within different diagnostic procedures. OBJECTIVE: This study was conducted to evaluate the efficacy of immunotherapy (IT) in an objective and simple way in children with perennial allergic rhinitis. METHOD: This study was a double-blind, placebo-controlled procedure. Nineteen patients (mean age 10 +/- 6 years) were treated only with IT and 17 patients (mean age 11 +/- 5 years) constituted the control group without any treatment. The patients were evaluated at the beginning and at 3 and 6 months of IT. Nasal provocation reactions were evaluated and scored at 5-, 10-, and 30-minute intervals. RESULTS: In the IT group, mean clinical scores and mean nasal provocation scores decreased significantly between the initial value and at 3 and 6 months of IT, whereas there was no significant change in the value for the control group. There were no significant differences among the 5-, 10-, 15-, and 30-minute evaluations within both the IT and control groups. CONCLUSION: The efficacy of IT in perennial allergic rhinitis may be assessed by the nasal antigen challenge test in a simple and objective way within a 5-minute period.

The effect of passive smoking on pulmonary function during childhood.

Passive smoking, especially of maternal origin, is known to influence adversely the development of children's pulmonary function. In this study, the effect of parental smoking on the pulmonary function of 360 primary school children aged 9-13 (mean 10.8 +/- 0.7) years was investigated. Information on parental smoking history was collected using a questionnaire, and spirometric measurements were performed on the children. All spirometric indices were lower in children who had been passively exposed to parental tobacco smoke than those not exposed. The percentage of households in which at least one parent smoked was 81.5%. This figure was significantly lower for mothers (27.5%) than for fathers (79%). Paternal smoking was associated with reduced levels of forced expiratory flow between 25-75% of vital capacity, peak expiratory flow, and flow rates after 50% and 75% of vital capacity expired (p < 0.05). Maternal smoking did not have statistically significant adverse effects on children's pulmonary function. This result might be due to the low occurrence of either pre- or post-natal smoking among mothers and confirms that, in our population, the main target group for antitobacco campaigns should be fathers.

Efficacy of salmeterol in the treatment of childhood asthma.

The aim of the clinical study reported here was to investigate the efficacy of salmeterol, a new long-acting selective beta 2-agonist, in patients with bronchial asthma. Twenty-four children with moderate asthma were enrolled in the longitudinal study, consisting of a run-in period of 2 weeks followed by a treatment period of 4 weeks. Maintenance treatment consisted of inhaled corticosteroid and disodium cromoglycate, or both, at the same daily dose throughout the study. During the run-in period, the patients continued to inhale salbutamol when needed and some of them (37%) also received theophylline. They were subsequently treated with salmeterol 50 micrograms twice daily and prn salbutamol for 4 weeks. Efficacy was evaluated using symptom scores and pulmonary function tests including forced vital capacity parameters, pulmonary volumes, airway resistance and specific airway conductance that were measured sensitively by a whole body plethysmograph. As a result, salmeterol produced significant improvement in morning and evening peak expiratory flow rates, vital capacity, airway resistance, conductance and asthma symptoms versus salbutamol and theophylline. Adverse reactions were judged to be mild and few.

Acute haemorrhagic oedema of infancy: a case report.

Acute haemorrhagic oedema of infancy (AHOI) is not a clinically well-recognized disease. We present the case of a 10-month-old girl with AHOI, and compare the clinical, histopathological and immunohistological features of this acute purely cutaneous leukocytoclastic vasculitis with those of the more frequent Henoch-Schönlein purpura. AHOI should be regarded as a separate clinicopathological entity for correct prediction of prognosis and prevention of unnecessary treatment.