Childhood asthma perception in Turkey under real-life environment (CAPTURE) study.

Successful management of asthma requires good communication between patients and the healthcare team. The background and expectations of a patient inevitably influence the success of any partnership. A questionnaire-based survey was performed to obtain data on the perception of the impact of asthma in daily life among children (age-range 6-14 years) and adolescents (age-range 15-20 years). A total of 756 patients (384 children, 372 adolescents) were randomly selected from 11 Turkish cities and interviewed face-to-face. Of the total study population, 71.3% received regular follow-up and 75.9% currently took asthma medication. Almost 50% reported that asthma affected their lives significantly. Even though half of the patients had symptoms at least once a week, one-third were not receiving regular prophylactic treatment. Exercise produced asthma symptoms in 45.5% of children and 27.4% of adolescents. The finding that asthma continues to be a major health problem clearly indicates an urgent need for further management programs in Turkey.

Coexistence of common variable immunodeficiency and autoimmune polyglandular syndrome type 2.

A six year-old boy with common variable immunodeficiency developed insulin dependent diabetes mellitus, autoimmune thyroiditis, and total alopecia leading to the diagnosis of autoimmune polyglandular syndrome type 2. Previously unreported co-occurence of these two entities may be explained by strong autoimmunity and HLA association of both conditions.

Comparison between the use of adsorbed and aqueous immunotherapy material in Dermatophagoides pteronyssinus sensitive asthmatic children.

BACKGROUND: dermatophagoides pteronyssinus (Der PI) is the major allergen which causes allergic asthma and perennial rhinitis. The extracts of Der PI may be used in treatment of patients who are unresponsive to pharmacological treatment and avoidance of allergens. The success of immunotherapy (IT) depends on the selection of appropriate patients and allergens as well as a regular follow up. OBJECTIVE: three different groups of IT materials and a placebo were tested on 34 patients with Der PI sensitive asthma. Clinical evaluations of allergen challenge and in vitro immunologic tests were made on the patients before, on the 6th month and at the end of the second year of IT. The results were compared to the placebo treated group. RESULTS: there were no significant differences among the groups in regard to age, sex and duration of illness. The time required for reaching the maintenance dose for group I (Alutard), II (APSI retard Ca) and III (Greer ) was 15.40 +/- 0.69, 18.2 +/- 4.0 and 108 +/- 33 weeks, respectively. Even though there was some significant difference between those receiving aqueous IT and the placebo (p < 0.05), there was a greater significant difference between those receiving adsorbed IT and placebo (p < 0.00001). Also there was a significant difference between the I and II groups receiving adsorbed IT. There was no significant difference in the maximum tolerated doses between group I and II (p > 0.05), but significant differences was found between group III and the other two groups (p < 0.05). Specific IgE levels were not changed by IT. There were no differences in the side effects scores among the groups (p < 0.05). The maximum tolerated dose of the diluted skin prick test (DSPT) solution increased significantly after 6 months and two years treatment as compared to the dose before specific immunotheraphy (SIT). Significant differences were found between group III and group I or group II as well as between the groups under treatment and that group given a placebo (p < 0.05). The maximum tolerated dose with the bronchial provocation test (BPT) increased significantly after IT (p < 0.05). The differences between the groups under treatment and that given a placebo were significant (p < 0.05). A significant increase was detected in the levels of the Der PI specific IgG4 after IT (p < 0.01). The difference between the treatment groups and the placebo group was significant. There was a significant difference between group I and the other groups (p < 0. 05) but differences between group II and III was not significant (p > 0.05). No significant correlation was found between (1) spIgE and the symptom medication score (SMS) (2) sp IgE and spIgG4 (3), DSPT and BPT. A significant positive correlation was found between the maximum tolerated dose with DSPT and increase in spIgG4 (r = 0.33, p = 0.046). A negative correlation was found between SMS and spIgG4 (p = 0.012, r = -0.42) after IT. CONCLUSION: SIT with Der PI is an effective and reliable treatment in allergic asthmatic children. Adsorbed extracts may be preferable to in childhood because of effectively, safety, tolerability and, fewer numbers of injection. The best IgG4 response and velocity of maintenance doses achieved was found in group I. Easy, cheap and safe parameters such a SMS and DSPT can be useful for a follow-up of SIT. Further investigation is required to determine which one of the products is the best.

Peak expiratory flow in healthy Turkish children.

This study was conducted on 1359 healthy, non-smoking Turkish children (727M, 632F) with a mean age of 11.7 +/- 3.4 (6-17) years, in order to determine the normal values of peak expiratory flow (PEF) in Turkish children and to compare various peak-flow meters (PEFMs). PEF values increased with age and height in boys and girls. The relative increase in boys was significantly higher at puberty (p < 0.01). The values of Turkish children were found to be similar to those of Europeans. The results obtained from the three PEFMs were closely correlated.

The modification in measles vaccination age as a consequence of the earlier decline of transplacentally transferred antimeasles antibodies in Turkish infants.

The maternal antibodies are gradually decreased at 9 to 12 months in infants. We determined the elimination period of maternal measles antibodies in 34 infants whose mothers had had a history of natural measles previously. Seropositivity rates at sixth and nine months of age were found to be 61.8% and 3.4%, respectively. The very low passive antibody at nine months of age may suggest the measles vaccination could be carried out earlier than just before the critical age of antibody level.

Measles antibody response in vaccinated children.

The incidence of measles has declined in our country since the routine administration of measles vaccination was initiated. However, measles outbreaks have been observed even among previously vaccinated children. The objective of this study was to evaluated the measles antibody response of children vaccinated at nine months of age. Measles-specific IgG antibodies were determined by enzyme-linked immunosorbent assay. Of 345 children tested, 20.3 percent were immunologically measles-susceptible. When measles-specific antibody titers were analyzed with respect to the elapsed time since prior vaccination, the result was found to be insignificant (p > 0.05). These data suggest that the underestimated seropositivity rate of measles antibody may be related to both primary vaccine failure and inappropriate vaccination age.

An infant with severe leucocyte adhesion deficiency.

A case of severe leucocyte adhesion deficiency occurred in a 6 1/2-month-old boy whose parents were first-degree cousins. Evidence of the disease first became apparent with the late separation of the umbilical cord on the 20th day and with the later development of omphalitis. The most specific finding was the very low levels of CD18 and CD11, 0.44 and 0.15%, respectively. The boy died from sepsis which occurred as an extension of necrotic lesions on the ear and in the gluteal area.

Inhalant allergens: as a cause of respiratory allergy in east Mediterranean area, Turkey.

Inhalant allergens were identified by analyzing the positive skin tests of 614 respiratory allergic patients. The important indoor allergens causing skin test positivity were house dust, Dermatophogoides pteronyssinus, cockroach, mosquito and Dermatophogoides farinea. Johnson grass, cultivated wheat, rye, orchard, and cultivated corn were among important grass pollens. Animal allergens like cow hair, cat and dog dander, bird and chicken feathers and horse hair caused skin test positivity in our allergic patients. Weeds and garden plants were also among important inhalant allergens in this region. Common cocklebur, narcissus, rose, mugworth, and daisy caused skin test positivity in decreasing frequencies. Carob, willow, poplar, olive and cypress pollens were among important inhalant allergens causing skin test positivity that may be important cause of respiratory allergy in this region.

The frequency of IgG subclass deficiency in children with recurrent respiratory infections.

We studied the frequency of IgG subclass deficiency in 61 children (ages 1-7 years, mean 3.8 years) with recurrent respiratory tract infections by using the radial immunodiffusion method. The overall frequency of IgG subclass deficiency was found to be 39.3 percent (24 patients). Among 26 children who had major immunoglobulin abnormalities, we found IgG subclass deficiency in 11 patients (42.3%). In children with normal immunoglobulin levels, the frequency of IgG subclass deficiency was 37.1 percent (13 patients).

Do parental smoking and history of allergy influence cord-serum IgE?

The associations between parental smoking habits during pregnancy, family history of allergy, and IgE levels in cord-serum IgE (cIgE) were investigated prospectively in 1251 infants. Mean cIgE levels were similar in infants with positive and negative family history of allergy (0.50 and 0.54 kU/l, respectively). In infants with a positive family history of allergy whose mothers smoked more than 10 cigarettes a day, however, the mean cIgE level was significantly higher (0.78 kU/l) than that in infants of nonsmoking mothers (p = 0.011). Similarly, the mean cIgE level was significantly higher in boys (0.61 kU/l) than in girls (0.51 kU/l) of nonsmoking parents (p = 0.03). However, in infants of smoking parents, there was no significant difference in the mean cIgE level between boys and girls. A total of 178 (14%) mothers and 477 (38%) fathers were current smokers, and in 128 (10%) cases, both parents were active smokers. The mean cIgE level tended to be slightly higher in infants of smoking mothers, especially when the mother consumed more than 10 cigarettes a day (0.63 vs 0.54 kU/l) (p > 0.05). Thus, cIgE levels were higher only in genetically prone babies whose mothers consumed more than 10 cigarettes a day.

Influence of smoke exposure on serum IgE levels of atopic patients.

The effect of environmental tobacco smoke on serum total immunoglobulin E (IgE) of respiratory allergic patients was evaluated in this study. A total of 558 patients with respiratory allergies (311 boys and 248 girls) aged between 1 and 17 years (mean 6.92 +/- 3.81 years) were included. None of the subjects were active smokers. IgE levels were significantly higher in children with smoking parents compared with non-smokers (P < 0.05). Children with smoking mothers were found to have higher levels of IgE than children with smoking fathers. The highest level of IgE was found in children when both parents were smokers (P < 0.005).

Effects of indoor environmental factors on respiratory systems of children.

Effects of indoor environmental factors on children's respiratory system and pulmonary function tests were investigated in this study. A total of 617 primary school children aged between 9-12 years were included. A standard questionnaire, which includes questions about respiratory symptoms and illness, indoor environmental determinants, family history of respiratory diseases, and smoking habits of the parents, was sent to homes of all children and information was obtained from parents. Children with a family history of asthma, bronchitis, or other chest troubles suffered morning and day/night coughs, shortness of breath, wheezing and asthma, bronchitis, or pneumonia more frequently. Children whose mothers smoked complained of blocked-runny nose and sinusitis more frequently. Pulmonary function levels were diminished in passive smokers and in children whose houses were heated by a wood-burning stove. As a result, passive smoking, using a wood-burning stove for heating, and family history of respiratory diseases are to be considered risk factors for the respiratory system.

Effect of specific immunotherapy in Dermatophagoides pteronyssinus allergic children.

The effect of immunotherapy on 21 Dermatophagoides pteronyssinus (Dpt)-sensitive patients (15 children with extrinsic asthma and six children with extrinsic asthma plus allergic rhinitis) aged 8.9 +/- 0.71 years was studied. Their subjective and objective respiratory symptom score was recorded before beginning and after the first year of immunotherapy. The respiratory subjective symptoms, such as cough day/night, running nose, sputum production, sneezing, shortness of breath at night and asthma attacks, decreased significantly from pretreatment level (P < 0.05). The objective symptoms, such as wheezing, dyspnea with prolonged expiration, sibilant rales and retractions score, gradually decreased during treatment (P < 0.01). Total eosinophil count decreased in 76.2% of patients after immunotherapy (P < 0.01). While total immunoglobulin E (IgE) decreased in 81% of patients and specific IgE for Dpt decreased in 90.5% of patients, specific IgG for Dpt increased in 76% of patient (P < 0.001). Our results suggested that rising IgG and falling IgE values do not always coexist in the patients who benefit from immunotherapy.

Mold allergy in Adana, Turkey.

In order to investigate the possible role of molds in respiratory allergy, skin prick tests with the extracts of 19 different fungi were applied to 614 respiratory allergic patients. Indoor mold samples of some of these mold sensitive patients are also presented. Most of the patients (72.6%) had extrinsic asthma while 27.4% having allergic rhinitis. The diagnosis was based on history, clinical examination and skin prick test which was done according to Peppy's method. Aspergillus fumigatus was the most important fungus causing skin test positivity (26.0%). Trichophyton rubrum, Mucor, Penicillium notatum, Aspergillus niger and Alternaria tenius species were also important in decreasing frequencies. A total of 26 species were isolated and Penicillium was the most important one (29.6%). Molds are thought to play an important role as causative agents for allergic rhinitis and asthma.

Neutrophil chemotaxis in children with extrinsic bronchial asthma.

Chemotactic activities of neutrophils were studied in 20 patients with bronchial asthma and 20 healthy matched controls. Chemotaxis studies were performed by the millipore filter technique using modified Boyden chambers. Mean neutrophil chemotactic activities of asthma and control groups were 17.82 +/- 7.87 microns and 14.09 +/- 6.07 microns; mean chemotactic indexes were 2.04 +/- 0.44 and 1.84 +/- 0.60 and mean random migrations were 9.53 +/- 4.61 microns and 7.93 +/- 3.33 microns, respectively. No significant difference was found between the two groups (p > 0.05).