Correlation between asthma severity and serum IgE in asthmatic children sensitized to Dermatophagoides pteronyssinus.

BACKGROUND: We undertook this study to test the possible correlation between serum concentration of total and specific IgE antibodies and asthma severity in asthmatic children sensitized to the house dust mite Dermatophagoides pteronyssinus. METHODS: The study included 157 asthmatic children aged 5-15 years (8 +/- 3 years). Clinical diagnosis was based on personal and family history, physical examination, pulmonary function testing and skin tests. Asthma severity was determined according to GINA guidelines. In vitro tests included serum concentration of total and specific IgE. RESULTS: All asthmatic children had elevated serum concentration of total IgE. The children with elevated serum concentration of total IgE also showed an increased serum concentration of specific IgE. Asthma of higher higher severity was present in patients with total IgE concentration >288.0 kIU/L (AUC = 0.736) and specific IgE to Dermatophagoides pteronyssinus >44.1 kIUA/L (AUC = 0.843). Intermittent asthma was present in 76.9% of children with specific IgE concentration <44.1 kIUA/L. The positive predictive value suggested with 79.2% probability that a child with a concentration of specific IgE to Dermatophagoides pteronyssinus >44.1 kIUA/L would have a more severe form of asthma. CONCLUSIONS: Asthmatic children with higher asthma severity have a higher serum concentration of both total IgE (>288.0 kIU/L) and specific IgE to Dermatophagoides pteronyssinus (>44.1 kIUA/L), respectively.

Thrombopoietin and interleukin-6 in children with pneumonia-associated thrombocytosis.

BACKGROUND: The aim of this study was to investigate why some, but not all, children develop thrombocytosis during the course of pneumonia. METHODS: The retrospective study included 40 healthy children and 75 children with pneumonia: 17 patients with platelet count within the reference values, i.e., platelet count 450 x 10(9)/L. Erythrocyte sedimentation rate, leukocyte and platelet counts, and concentrations of hemoglobin, C-reactive protein, interleukin-6 and thrombopoietin were determined in the blood of patients and control groups of children. RESULTS: Patients with thrombocytosis were slightly younger (3.0 +/- 1.8 years and median 2.5 years, respectively) than patients with normal platelet count (3.8 +/- 2.4 years and median 4 years, respectively). Additionally, according to clinical and radiological findings, pneumonia in children with thrombocytosis had a more severe and protracted course. Serum thrombopoietin concentrations were found to be 91.2 +/- 41.7 ng/L (range: 14.3-166.7 ng/L) in patients with normal platelet count (313 +/- 70 x 10(9)/L, range: 206-428 x 10(9)/L). In patients with thrombocytosis (581 +/- 131 x 10(9)/L, range: 450-830 x 10(9)/L) serum thrombopoietin ranged from 63.6 to 1115.9 ng/L (526.6 +/- 268.4 ng/L). In these patients both concentration of hemoglobin (114 +/- 12 g/L) and iron (4.3 +/- 1.3 micromol/L) significantly decreased as compared with the control group. CONCLUSIONS: Study results suggested the possible development of reactive thrombocytosis in children with pneumonia. As platelets are involved in inflammatory reaction, reactive thrombocytosis might be part of the mechanism of defense. Reactive thrombocytosis may develop as a sequel of either anemia or inflammatory reaction (or both).

[Bronchial impairment of main bronchus by aspiration of ferrous sulphate tablet]. / Ostecenje glavnog bronha uzrokovano aspiracijom tablete zeljeznog sulfata.

The late occurrence of broncial impairment in two children who had aspirated ferrous sulphate tablet ih presented. Local release of cytotoxic oxidant radicals led up to tissue necrosis and consequently to bronchial stenosis and obliteration. Bronchoscopy in the first child confirmed total obliteration of the left main bronchus eleven months after aspiration of iron tablet, and pulmectomy had to be done. In the second child five months after aspiration of iron tablet bronchoscopy confirmed severe stenosis of the right main bronchus and atelectasis of the right lung lobe. Reventilation of right lung has been achieved one month after administration of antibiotics, metilprednisolon and physical therapy. The patient underwent laser therapy (few times) and baloon dilatation in the University Clinic in Graz, but it did not hold passability of the right bronchus. Reventilation of the right middle and lower lobe (but not upper lobe) has been achieved by insertion of endobronchial stent in the main right bronchus. Formation of granulomatous tissue at stent borders necessitated further laser therapy and baloon dilatation. Treatment of this child must be continued.