Effect of immunotherapy on eosinophil activation in pollen sensitive children.

Immunotherapy is a well documented method for treatment of children with allergic airway diseases and allergic rhinitis. The aim of this investigation was to establish the effect of immunotherapy on the presence and activation state of eosinophils in pollen sensitive patients, measured by eosinophil counts and their degranulation product in serum, eosinophil cationic protein in comparison with the (specific) IgE concentration in pollen sensitive patients. In both groups intra-individual variations in (specific) IgE concentrations, due to increase of pollen exposure, were not observed. Blood eosinophil counts and serum ECP concentrations showed consistent results after starting immunotherapy. Overall release of ECP per eosinophil remained also unaffected after the start of immunotherapy. Results of ECP concentrations and eosinophil counts in the subjects' group did not show any deviation when compared with the control subjects' group. It is concluded that the laboratory parameters are not helpful in monitoring the efficacy of immunotherapy in patients with seasonal rhinitis.

Measurement of IgE antibodies against purified grass pollen allergens (Lol p 1, 2, 3 and 5) during immunotherapy.

BACKGROUND: IgE titres tend to rise early after the start of immunotherapy, followed by a decline to pre-immunotherapy levels or lower. OBJECTIVES: We were interested to know whether the early increase in IgE antibodies includes new specificities of IgE, and whether these responses persist. METHODS: Sera of 64 patients undergoing grass pollen immunotherapy were tested for IgE against four purified grass pollen allergens: Lol p 1, 2, 3, and 5. At least two serum samples were taken, one before the start of therapy and one between 5 and 18 months after the first immunization (mean: 10 months). RESULTS: The mean IgE responses to Lol p 1, 2 and 3 showed a moderate but not significant increase. In contrast, the mean IgE response to Lol p 5 showed a significant decrease of > 30%. IgE against total Lohum perenne pollen extract moderately increased (> 20%), showing that a RAST for total pollen is not always indicative for the development of IgE against its major allergens. For > 40% of the patients it was found that IgE against one or more of the four allergens increased, while IgE against the remaining allergen(s) decreased. For 10 sera the ratio of IgE titres against at least two allergens changed by at least a factor of 5. The changes in specific IgE also included conversions from negative (< 0.1 RU) to positive (0.6 to 5.0 RU) for five patients. For two patients, the induction of these 'new' IgE antibodies against major allergens was shown to result in a response that was persistent over several years. CONCLUSION: Although active induction of new IgE specificities by immunotherapy was not really proven, the observations in this study indicate that monitoring of IgE against purified (major) allergens is necessary to evaluate changes in specific IgE in a reliable way.

Bronchopulmonary sequestration associated with an aneurysm of the aberrant artery.

We describe a patient with an intralobar bronchopulmonary sequestration of the right lower lobe associated with a true aneurysm of the aberrant artery. Both findings were suspected before operation. The patient was treated successfully by resection of the right lower lobe with the sequestered lung tissue and aneurysm.

[Serious psychological side effect in children taking high doses of deptropine]. / Ernstige psychische bijwerkingen bij kinderen door gebruik van hoge doseringen deptropine.

Since 1986 the Netherlands Centre for Monitoring of Adverse Reactions to Drugs has received 16 reports concerning psychic effects attributed to the use of deptropine citrate (Brontine) in children ranging from one to ten years of age. Within 1 to 3 days after starting treatment with a daily dose of 0.6-3 mg, hallucinations appeared in 7 children, aggressive behaviour and/or agitation in 6 children, ataxia in 2 children, and anxiety in 1 child. In none of these cases could another cause be found. In one patient symptoms persisted during the whole 15-month period of treatment. All patients recovered rapidly after discontinuation of deptropine citrate. As it probably concerns a dose-dependent effect and because most patients had been prescribed a daily dose of 0.06 mg/kg body weight, it is strongly advised to exceed the recommended daily dose of 0.03 mg/kg body weight as little as possible.

Newly generated IgE antibodies to Dermatophagoides pteronyssinus in children are directed against components distinct from Der p I and Der p II.

The specificity of newly generated IgE antibodies (Abs) to the house dust mite, Dermatophagoides pteronyssinus, in longitudinal serum samples from 18 young children with an increased risk for IgE-mediated allergy was studied. The first IgE Ab response to house dust mite was detected early in life (mean age, 32 months; range, 11 to 60 months). For 83% of the children, more than half of the newly generated IgE Ab response to house dust mite was directed against components distinct from the major allergens, Der p I (Pl) and Der p II (DpX). These results suggest that the early IgE Ab response to house dust mite is induced by components distinct from the major allergens, Der p I and Der p II.

[A patient with the homozygote form of familial hypercholesterolemia]. / Een patiënt met de homozygote vorm van familiaire hypercholesterolemie.

The history of an 11 year old boy with homozygous familial hypercholesterolemia with therapeutic response to cholesterol lowering drugs is presented. Symptoms, laboratory diagnosis and therapeutic problems are discussed.

Relationship between IgG1 and IgG4 antibodies to foods and the development of IgE antibodies to inhalant allergens. II. Increased levels of IgG antibodies to foods in children who subsequently develop IgE antibodies to inhalant allergens.

In the present investigation we have tested the hypothesis that children with a high IgG antibody response to foods have an increased risk of developing IgE antibodies to inhalant allergens. Sera from 106 children with an increased risk of developing IgE-mediated allergy were analysed. During the follow-up, in 54 of these children IgE antibodies to inhalant allergens appeared. A positive/negative IgG1 and IgG4 anti-food score was determined as described previously: sera from age-clustered unselected children were tested for the levels of IgG1 and IgG4 antibodies to common foods. For each IgG RAST and each age group, the 75-percentile was chosen as cut-off value. Each antibody level was thus converted into a positive (higher than the 75-percentile of the age group) or negative value. The number of positive tests was used as the score. High-risk children with a high IgG1 anti-food score more often developed inhalant-specific IgE antibodies than high-risk children with low IgG1 titres: 50% of the children with a high IgG1 anti-food score developed IgE antibodies to grass pollen. Fifty per cent of the children with a high and 14% of the children with a low IgG1 anti-food score developed IgE antibodies to cat dander. For the prediction of the development of IgE anti-mite (house dust mite), the IgG4 anti-food scores appeared less useful than the IgG1 anti-food scores; 46% of the IgG4 high responders versus 22% of the IgG4 low responders acquired IgE anti-mite, whereas for IgG1 these percentages were 73 and 19, respectively.

[Cannabis poisoning in a young child; don't ask about drugs]. / Cannabis-intoxicatie bij een peuter; naar drugs wordt niet gevraagd.

A 14-month-old girl was admitted as an emergency case with an acute neurological disorder. As clinical examination did not lead to a diagnosis, intoxication was presumed. Urine analysis revealed cannabis metabolites. The parents thought it possible that the girl had taken a piece of hashish from a table. We stress the point that taking the history of children with no previous signs of illness of longer standing should include questions about pharmaceutical products and drugs taken by the parents.

[The effect of lowering the hematocrit on polycythemia and thrombocytopenia in congenital cyanotic heart defect]. / Het effect van de verlaging van de hematocriet op polycythemie en trombocytopenie bij een congenitaal cyanotisch corvitium.

The clinical history of a 15 year old girl with Down's syndrome and a complete atrioventricular septal defect undergoing blood-letting and plasma administration as a palliative treatment of polycythaemia and thrombocytopenia. A clear clinical improvement and a rapid increase of the thrombocyte count has been observed. The palliative treatment has to be continued with intervals after the therapeutic trial.