Hypersensitivity to aeroallergens in children with atopic dermatitis.

Atopic dermatitis (AD) is a chronically relapsing, inflammatory skin disease characterized by severe itch, rash and dry skin. Hypersensitivity to aeroallergens is found in 40%-50% of children with AD and it is the cause of intensive skin lesions. The aim of the study was to assess the presence of hypersensitivity to aeroallergens in AD children. The study included 114 children (56 boys and 58 girls), median age 27.5 months, who had been diagnosed with AD according to Hanifin and Rajka criteria. The severity of the disease was assessed by the SCORAD index. To recognize hypersensitivity to aeroallergens, the following parameters were analyzed: medical history, values of absolute eosinophil count, total IgE antibodies, specific IgE antibodies to aeroallergens, and results of the skin prick test for aeroallergens. A moderate form of the disease was present in 61.4% of study children, with a median SCORAD index score of 28.5 points; 12.3% of study children showed hypersensitivity to aeroallergens (history of hypersensitivity to aeroallergens in 27.2%, increased absolute eosinophil count in 53.5%, increased total IgE antibodies in 56.1%, positive skin prick test in 20.2%, and positive specific IgE antibodies to aeroallergens in 12.3% of children). The most common aeroallergens responsible were house dust in 6.1% and Dermatophagoides pteronyssinus in 3.5% of children with AD. Hypersensitivity to aeroallergens was recorded in the same number of children with mild and severe forms of the disease and in 5.7% of children with a moderate form. In conclusion, the presence of hypersensitivity to aeroallergens in children with AD is significant. By discovering and removing the aeroallergens responsible, it is possible to achieve reduction in the intensity of skin lesions and frequency of exacerbations.

Clinical characteristics and estimation severity of the atopic dermatitis in children.

Clinical characteristics of Atopic Dermatitis (AD) in children were analyzed, and severity of illness was estimated using SCORAD point system index and Three Item Severity score (TIS) index. The research was done at the Clinic for Children Diseases in Tuzla. The inclusion criteria were: diagnosis of AD according to Hanifin and Rajka criterions, age up to 15. The exclusion criteria were: not meeting the criteria for an AD diagnosis, over 15 years of age, usage of anti-histamines in the last 5 days and/or usage of corticosteroids in the last 4 weeks, and diagnosis of other illnesses that do not have atopic foundation. The analysis included: clinical characteristics, parameters of both score systems and correlation of SCORAD and TIS indices. The conditions of research were met by 261 children (128 boys and 133 girls), with median age of 16.8 +/- 5.4 months. The early occurrence of AD changes (before the second year of life) were present in 51.3% of children, the positive anamnesis for AD was found in 17.2% of children, changes in AD typical localization in 96.6% of children, oversensitivity to food in 47.5% and airborne allergens in 12.3% of children. The values of SCORAD index were ranging from 14-92 (median 37.1 +/- 18.06) and a significant correlation of the parameter to the total value of SCORAD index (distribution p = 0.0002; intensity p = 0.001; subjective symptoms p < 0.0001). The values of TSI index were ranging from 1-8 (median 4.3842.03) with the significant correlation of parameter to the total value (for erythema p < 0.0001; for edema p < 0.0001; and for excoriation p = 0.0007). When comparing the SCORAD and TIS index values, we found significant correlation (r = 0.531; p < 0.0001). TIS index as a simplified SCORAD index is reliable for the quick estimate of illness in daily medical work, but in clinical research SCORAD index offers a much more detailed and reliable estimate.

[Humoral immunity in children with immunodeficiency and immunosuppression]. / Humoralna imunost u djece sa imunodeficijencijama i imunosupresijom.

The objective of the study was to determine the immunological characteristics of immunodeficiency and immunosuppression in children and to estimate the type of disorder within the immunological system. In the prospective study with 90 patients included, all were separated into three groups (30 patients per group) of which the first group was formed of patients with immunodeficiency; the second group of patients who were receiving the immunosuppressive therapy for autoimmune diseases for more than 6 months; and the third group being the control group formed of patients with uncomplicated bacterial infections. The follow-up parameters were gathered using questionnaire on personal and family anamnesis of patients with immunological parameters: humoral unspecific immunities (CRP, C3, C4, IL1 and IL2), humoral specific immunities (IgG, IgM, IgA and IgE) and cellular specific immunity. Concentrations of medium values of CRP in patients with immunodeficiency and on immunosuppressive therapy, statistically are significantly lower than in patients from the control group (p < 0.05). Individually increased concentrations of CRP within the groups are the indicator of acute inflammatory process and of relapse of basic disease in patients with autoimmune diseases. The concentrations of IL1 are lower than standard values in the test. in 28 patients (93%) with immunodeficiency and in 26 (87%) patients with immunosuppression. Increased concentrations in 2 (7%) patients with immunodeficiency are sign of acute inflammatory process, and 4 (14%) patients with immunosuppression and increased concentrations have shown signs of inflammation and relapse of basic disease. Concentration of IL2 in 1 (3%) patient from immunosuppressed group was increased (iatrogenic immunosuppressant). There is no statistically significant difference in concentrations of medium values of C3 and C4 complements among the studied groups of patients (p > 0.05). Concentrations of IgG in group of patients with immunodeficiency are statistically and significantly lower at medium and individual values (p < 0.001), as well as the concentrations of IgM and IgA (p < 0.05) comparing to other studied groups. Concentrations of IgE above 4.500 IU/ml were found in 3 (10%) patients with Hyper IgE syndrome. Results of our study have shown the possibility of evaluation of the level and the scale of disorder of the immunological system in children.

[Importance of immunoglobulins and nutrition in infections in neonates]. / Znacaj imunoglobulina i ishrane u infekcijama novorodencadi.

The purpose of the study was an estimation of the immunoglobulin serum and the way of nutrition of a new-born child at the beginning of bacterial infections during the first month of life. 120 new-born children (infantiles) of both sexes was prospectively studied, who were born in the Gynecology-obstetrician clinic in Tuzla, in the period from March-May 2000 year. On the base of mothers SES during the pregnancy, new-born children were separated in two groups. Group A was formed of 60 new-born children (32 female and 28 male), mothers had good SES during the pregnancy, and concentration of serum immunoglobulin G (IgG) examined from cords blood, from 10.02 to 17.58 g/L (X 14.48 g/L +/- 1.87). Group B was formed of 60 new-born children (27 female and 33 male), with bad mothers SES and with concentration of IgG from 6.80 to 13.01 g/L (X 10.62 g/L +/- 1.49). Immunoglobulins M and immunoglobulins A were negative in both groups of children. During the first month of life it was studied the way of nutrition and health condition of each new-born child. New-born children with bad mothers SES during the pregnancy, with low values of IgG and who were on the artificial food (nutrition), were showing with the significant difference (p < 0.001) in bacterial infections, comparing with the group who had good IgG. The new-born children with natural nutrition, despite the lower concentration of IgG, were protected from severe bacterial infections.

[Effect of the pregnant woman's socioeconomic status on serum immunoglobulin levels in the neonate]. / Uticaj socio-ekonomskog statusa trudnice na nivo serumskih imunoglobulina novorodenceta.

Serum concentration of immunoglobulin G (IgG) of new-born child, at the birth, which reach the concentration of an adult persons, are the origin of mother and transferred by active and passive transport, by placenta. Immunoglobulin M (IgM) and Immunoglobulin A (IgA), do not pass the placenta because of their structure. Main condition for passing of IgG are normal period of pregnancy and regular function of placenta. Social-economic status (SES), and also immunologic status of a pregnant woman, an affect on the immunological status of new-born child. 120 pregnant woman and 120 of their new-born children were studied. Pregnant woman were at age of 18-34 years, and during the pregnancy they were healthy. Gestational age of new-born children was from 38 to 40 weeks, and birth weight was from 3000 grams to 4000 grams. The new-born children were from monofertile pregnancies, without visible anomalies and signs of intrauterine suffer. They were divided into 2 groups, 60 patients in every group, in comparison of SES families of a mother, in which she lived during the pregnancy. From every new-born child at the birth, from the blood of a navel it was determined the concentration of serum IgG, IgM and IgA. The values of IgG from the group with bad SES, were significantly lower (p < 0.001), in compare with a group with good SES. There was not statistically important difference between middle values of mentioned parameters among the different sex in the studied groups. Concentrations of IgM in new-born children were below the level of determination or just above it, so they could not be analysed anymore. Immunoglobulins A were not found in both groups, A and B groups.

[The Stevens-Johnson syndrome--personal experience]. / Sindrom Stevens-Johnson--nasa iskustva.

Stevens-Johnson syndrome is a disorder of the skin and mucous membranes and a severe bullous forms include systemic toxic effects. In this study, we have analyzed our experiences according to ages, sex, incidence, ethological irritable factors, differential diagnosis, clinical treatment, in children with Stevens-Johnson syndrome at the Pediatric Clinic in Tuzla. In the period January 1997-May 2002, we treated 14 patients with this syndrome. All patients were male, ages from 11 months to 11.6 years (average 4.5 years). As irritable factors were detected antiepileptics (Phenobarbitol and Tegretol) in 10 children (71.44%), antibiotics (Procain Penicillin and Cephalexin) in 3 children (21.42%), and reason was stayed unknown in 1 child (7.14%). The problem in differential diagnosis usually was toxic epidermal necrolisis (TEN) and graft versus host disease (GvHD). All patients demanded treatment in the pediatric intensive care unit supporting with specialists immunologists, ophthalmologists, dermatologists, infectologists. Treatment included, besides vital volume support, systemic administration of corticosteroids, antibiotics and intensive local therapy lesions of skin and mucous membranes, specially eyes in special sterile conditions. Outcome and results of our medical treatment of all patients were good.