Predictors of positive food challenge outcome in non-IgE-mediated reactions to food in children with atopic dermatitis.

BACKGROUND: Atopic dermatitis is frequently associated with food allergy. In general, clinically manifested food allergy is regarded as IgE mediated. However, there are some children with food allergy for whom IgE hypersensitivity cannot be proven. OBJECTIVE: The aim was to evaluate the percentage of children with positive double-blind, placebo-controlled food challenge (DBPCFC) results but without any proof of IgE sensitization and to characterize this subgroup of children. METHODS: Two hundred eight DBPCFCs were performed in 139 children (median age, 13 months) with atopic dermatitis and suspected food-related clinical symptoms. All children were subjected to skin prick tests (SPTs), determination of specific IgE, and atopy patch tests. RESULTS: One hundred eleven (53%) of 208 oral food challenge results were assessed as positive. Positive challenge results were separated into 2 groups according to IgE positivity: negative SPT and negative specific IgE results in serum (group A, n = 12) and positive SPT, specific IgE, or both results in serum (group B, n = 99). The atopy patch test results; the distribution of early, late, or both clinical reactions; the age of the children; and the total IgE levels all showed no significant differences between the 2 groups. However, wheat challenge results were more often positive among the apparently non-IgE-sensitized children, and hen's egg challenge results were more often positive in the sensitized group (P < .05). CONCLUSION: Around 10% of positive DBPCFC results are not IgE mediated. Therefore not the proof of specific IgE but the suspicion of food-related symptoms should be the indication to perform oral food challenges, especially in the case of wheat. Otherwise, some children will not receive diagnoses for food allergy and be denied the benefits of a specific diet.

Effects of dexamethasone on proliferation, chemotaxis, collagen I, and fibronectin-metabolism of human fetal lung fibroblasts.

Premature infants at risk for bronchopulmonary dysplasia (BPD) are often treated with dexamethasone (Dex), which has been shown to suppress inflammatory processes in the lung. To elucidate a possible direct influence on the fibroproliferative component of the disease, we studied the effects of Dex in therapeutic and supratherapeutic dosages (5-50 nmol/L) on proliferation, chemotaxis, procollagen I, and fibronectin metabolism of human fetal lung fibroblasts in vitro. Proliferation was inhibited by Dex in a dose-dependent manner. Chemotactic activity in response to conditioned medium of human fetal fibroblasts also showed a dose-dependent inhibition after pretreatment with Dex. The amount of procollagen I C-terminal propeptide and fibronectin per cell in the cell culture supernatant was increased in the presence of Dex. Our results show that Dex does not uniformly suppress the fibroproliferative activity of human fetal lung fibroblasts, which may explain in part the unsatisfactory long-term effects of Dex treatment in BPD.

[Residual caries and prosthetic treatment]. / Rezidualni karijes i zubi u protetskoj obradi.

The aim of this study was to assess the extent to which residual caries causing pulpal lesions may affect the prosthetic treatment success. Two hundred and twenty-three teeth were observed prior to prosthetic grinding and 15 months after the prosthetic appliance cementation. Study subjects were divided into three groups: group I consisting of 75 intact teeth, group II including 95 teeth where old fillings were removed, and group III with 53 teeth where old fillings were not removed prior to grinding for prosthetic treatment. Results showed pulp to be affected by disease in 24 or 10.76% of cases in total. Intact teeth were affected in 5 or 6.67% of cases, and those with replaced fillings in 8 or 8.24% of cases. These results were statistically significant (P greater than 0.05). Differences in pulp damage between the group with removed fillings and that where the existing fillings were not removed, and between the group where fillings were not removed and that of intact teeth, were statistically significant (P less than 0.05), suggesting that undetected residual caries under old fillings should be added to the known and described causes leading to failure of prosthetic dental treatment. Therefore, it appears quite desirable to replace old fillings prior to prosthetic treatment of the teeth.