No abstract available.
Chromosome Aberrations* ; Ethylene Oxide* ; Lymphocytes* ; Transferases*

PURPOSE: Food protein-induced enterocolitis syndrome(FPIES) is a symptom complex of severe vomiting and diarrhea which is known as a food-related gastrointestinal hypersensitivity disorder without evidence of IgE-mediated sensitivity. We described the clinical characteristics of FPIES in young infants. METHODS: Twenty-eight patients, aged 7 to 120 days, were included who were diagnosed as FPIES by clinical criteria and food challenges. The clinical and laboratory features on admission and the findings from endoscopic biopsies were investigated. Food challenges with milk and soy were performed. RESULTS: Nineteen patients(67%) were admitted with diarrhea, four(15%) with vomiting and five (18%) with both vomiting and diarrhea. Fourteen patients(50%) were ill enough to require evaluation for sepsis but with negative results. Leukocytosis was noticed in twenty(71%), acute phase reactants increased in eighteen(64%), metabolic acidosis was observed in seventeen(61%) and hypoalbuminemia in twelve(43%). Duodenal biopsy specimens showed edema and acute inflammation in all patients. Villus atrophy was found in sixteen patients(57%) with no significant correlation between the degree of villus atrophy and the symptom severity. Diarrhea was elicited in 64% of total food challenges, vomiting and diarrhea in 25%, vomiting only in 7%. Shock state was developed in 25% of challenges. CONCLUSION: Our results suggest that food-related gastrointestinal hypersensitivity can cause a syndrome similar clinically to severe infection and FPIES should be suspected in young infants who have protracted diarrhea with or without vomiting.
Acidosis ; Acute-Phase Proteins ; Atrophy ; Biopsy ; Diarrhea ; Edema ; Enterocolitis* ; Humans ; Hypersensitivity ; Hypoalbuminemia ; Infant ; Inflammation ; Leukocytosis ; Milk ; Sepsis ; Shock ; Vomiting

PURPOSE: The most significant fact about wheezing in early infancy is that it is very common. Until recently, despite its high prevalence and hints of subsequent long- term morbidity, the natural history of early infancy wheezing has been incompletely understood. We evaluated the outcome of the patients who experienced wheezing during first year of life until 5 years of age and the prognostic factors for later development of asthma. METHODS: 72 infants less than 1 year old age who were hospitalized with wheezing-associated respiratory infection over a period of 12 months from 1994 to 1995 were included. After the first wheezing episode, the patients were followed-up prospectively until 5 years of age. The recurrent wheezing episodes were registered at 1-2, 2-4, and after 4 years of age. The frequency of wheezing episodes was assessed in relation to the later asthma at 5 years of age. Total serum IgE, the presence of atopic dermatitis, family history of allergic disease, RSV infection on first admission were investigated and compared between two groups of children who had asthma and who had no more asthma at 5 years of age. These early findings were also evaluated as risk factors for later development of asthma. RESULTS: 28(38%) of the 72 patients with bronchiolitis before 1 year old age suffered from subsequent wheezing until 5 years of age. The prevalence of atopic dermatitis(39% vs 14%, P<0.05), total serum IgE(98.5+/-3.7 IU/mL vs 13.6+/-3.5 IU/mL, P<0.001), frequency of repeated wheezing episodes(6.4+/-2.7 vs 3.4+/-2.9, P<0.001) were significantly higher in patients with later asthma than in patients with no more asthma at 5 years of age. RSV infection showed no association with the later development of asthma. CONCLUSION: The risk for later asthma is increased after bronchiolitis in early infancy. Early atopic findings and frequently repeated wheezing episodes are significant risk factors for developing asthma in later childhood.
Asthma* ; Bronchiolitis* ; Child ; Dermatitis, Atopic ; Follow-Up Studies* ; Humans ; Immunoglobulin E ; Infant* ; Natural History ; Prevalence ; Prospective Studies ; Respiratory Sounds ; Risk Factors

No abstract available.
Child ; Humans ; Lung ; Oxygen

No abstract available.
Asthma

Many previous studies have proved that human allergic disease resulted from the formation of antibodies belonging to a unique immunoglobulin isotype termed immunoglobulin E (IgE). Most of IgE- producing plasma cells are found in the lymphoid tissue associated with the gastrointestinal and respiratory tracts. IgE may be found free in the mucosal secretions of these tissues, bound to local mast cells, or distributed by the systemic circulation to mast cells and basophils throughout the body. Total serum IgE concentrations tend to be higher in allergic adults and children compared with non-allergic individuals, but the value of total serum IgE as a screening test for allergic disease is limited. Total serum IgE levels are related to the probability of an individual having detectable allergen-specific IgE. Allergen-specific IgE concentrations vary with a person's age, the degree and duration of the recent allergen or cross-reactive allergen exposure. The value of quantitative assays for allergen-specific IgE has been suggested in recent studies. Serum IgE increases in many non-allergic diseases, including infectious and parasitic diseases. The IgE changes appear to be specific to the infectious agents, whereas non-specific in other diseases. The increased serum IgE in some of these conditions probably results from alterations in immune function. This review summarizes the clinical significance of total and allergen-specific IgE examinations in allergic diseases.
Adult ; Antibodies ; Basophils ; Child ; Humans ; Immunoglobulin E* ; Immunoglobulins ; Lymphoid Tissue ; Mass Screening ; Mast Cells ; Parasitic Diseases ; Plasma Cells ; Respiratory System

No abstract available.

Asthma in childhood is a heterogeneous disease with different phenotypes and variable clinical manifestations, which depend on the age, gender, genetic background, and environmental influences of the patients. Several longitudinal studies have been conducted to classify the phenotypes of childhood asthma, on the basis of the symptoms, triggers of wheezing illness, or pathophysiological features of the disease. These studies have provided us with important information about the different wheezing phenotypes in young children and about potential mechanisms and risk factors for the development of chronic asthma. The goal of these studies was to provide a better insight into the causes and natural course of childhood asthma. It is well-known that complicated interactions between genes and environmental factors contribute to the development of asthma. Because childhood is a period of rapid growth in both the lungs and the immune system, developmental factors should be considered in the pathogenesis of childhood asthma. The pulmonary system continues to grow and develop until linear growth is completed. Longitudinal studies have reported significant age-related immune development during postnatal early life. These observations suggest that the phenotypes of childhood asthma vary among children and also in an individual child over time. Improved classification of heterogeneous conditions of the disease will help determine novel strategies for primary and secondary prevention and for the development of individualized treatment for childhood asthma.
Asthma ; Child ; Humans ; Immune System ; Lung ; Phenotype ; Respiratory Sounds ; Risk Factors ; Secondary Prevention

Croup is a respiratory illness usually caused by acute viral infection of the larynx, trachea, and bronchi, and characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. Croup commonly affects children younger than 6 years of age, with peak incidence between 7 and 36 months. Although the disease is usually self-limited, it may occasionally become life threatening, and can, on rare occasion, lead to respiratory failure.Current Concepts: Treatment of viral croup depends on the severity of symptoms as denoted by Westley croup score (i.e., mild, moderate, or severe). A single dose of oral or intramuscular dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatment for viral croup, irrespective of severity. A single dose of nebulized budesonide (2 mg) is equally effective as systemically administered dexamethasone, and is considered when a patient is unable to take a medicine orally. Nebulized L-epinephrine (1:1,000, 3-5 mL) causes vasoconstriction in the mucosa, rapidly reducing airway edema. Addition of nebulized L-epinephrine is indicated in the patients with croup of at least moderate severity, displaying chest retraction and signs of labored breathing.Discussion and Conclusion: The most effective pharmacological treatments for patients with viral croup are oral or intramuscular dexamethasone, and nebulized L-epinephrine. Especially, corticosteroids can significantly decrease the intensity of croup symptoms and reduce hospital admissions, return visits to emergency department and length of stay in the hospital.

Croup is a respiratory illness usually caused by acute viral infection of the larynx, trachea, and bronchi, and characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. Croup commonly affects children younger than 6 years of age, with peak incidence between 7 and 36 months. Although the disease is usually self-limited, it may occasionally become life threatening, and can, on rare occasion, lead to respiratory failure.Current Concepts: Treatment of viral croup depends on the severity of symptoms as denoted by Westley croup score (i.e., mild, moderate, or severe). A single dose of oral or intramuscular dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatment for viral croup, irrespective of severity. A single dose of nebulized budesonide (2 mg) is equally effective as systemically administered dexamethasone, and is considered when a patient is unable to take a medicine orally. Nebulized L-epinephrine (1:1,000, 3-5 mL) causes vasoconstriction in the mucosa, rapidly reducing airway edema. Addition of nebulized L-epinephrine is indicated in the patients with croup of at least moderate severity, displaying chest retraction and signs of labored breathing.Discussion and Conclusion: The most effective pharmacological treatments for patients with viral croup are oral or intramuscular dexamethasone, and nebulized L-epinephrine. Especially, corticosteroids can significantly decrease the intensity of croup symptoms and reduce hospital admissions, return visits to emergency department and length of stay in the hospital.