Serum immunoglobulin E levels in human immunodeficiency virus‐infected children with pneumonia

Elevated serum immunoglobulin E (IgE) levels have been reported in association with human immunodeficiency virus (HIV) infection in adults, but there is little information in children. The aim of the present study was to compare serum IgE levels in HIV‐positive and ‐negative children hospitalized with pneumonia in South Africa and to investigate whether IgE may be useful as a marker of specific infections or prognosis in HIV‐infected children. History, examination, blood tests, and induced sputum or bronchoalveolar lavage were carried out. Of 122 children [45% female, median age 8 months (3–20 months)], 81 were infected with HIV. A history of allergy or asthma was present in three children (two of whom were HIV positive). Serum IgE was higher in HIV‐infected children [83 (33–147) vs. 29 (6–113) IU/l; p = 0.011] as was immunoglobulin G (IgG) [49 (37–63) vs. 27.5 (23–34) g/l; p < 0.001]. CD4 lymphocytes [600 (330–1210) vs. 1900 (1500–3030) cells/µl], percentage CD4 cells [13.6 (9.4–20.3) vs. 40.1 (31.1–44.9)] and CD4 : CD8 ratio [0.3 (0.2–0.4) vs. 2 (1.4–2.8)] were lower in HIV‐positive children (p < 0.001 for all). Bacteremia occurred in 12 (10%) children; other specific pathogens identified included Mycobacterium tuberculosis in eight (7%) and Pneumocystis carinii in nine (7%). There was no correlation with CD4 count, CD4 : CD8 ratio, or the presence of specific pathogens, and IgE level. In‐hospital mortality (11%) did not correlate with IgE levels. HIV‐infected children with pneumonia have higher serum IgE compared with seronegative patients. In HIV‐positive children, IgE levels did not correlate with the degree of immunosuppression or with outcome.     

Correlation of serum antigen and antibody concentration with clinical features in HIV infection.

Serum antigen and antibody values were studied in 164 infants and children infected perinatally with HIV. HIV antigens p17, p24, gp41, and gp120 were determined in sera by immunoblot and antigen capture assays. Lymphocyte blast transformation, serum immunoglobulins, and circulating immune complexes were also evaluated. Altogether 50 patients had HIV antigens measured: 31 (62%) patients had p17 antigen in the serum and 29 (58%) had p24 antigen present. In 19 (38%) and nine (18%) patients, respectively, gp120 and gp41 were detected. All four HIV antigens were detected in seven (14%) patients. There was a positive correlation between the concentration of each HIV sequential specimens were outcome. When sequential specimens were analysed, 120 (73%) patients had p24 antigen present. Patients with stage P2B and P2D (Centers for Disease Control classification) had the highest concentrations of p24 antigen with a mean of approximately 200 pg/ml. Altogether 70% of patients with a p24 antigen concentration of greater than 30 pg/ml eventually died or had severe clinical disease within six to 24 months. Infants under 15 months of age with a p24 antigen concentration as low as 5 pg/ml also did poorly. Increased immunoglobulins and decreases in mitogenic responses and absolute CD4+ lymphocyte counts were more prevalent in patients with raised p24 antigen. Raised concentrations of circulating immune complexes were seen in the symptomatic phase of the disease whereas in the terminal stage of the disease raised serum antigen and a decrease in circulating immune complexes and absolute CD4+ lymphocyte count were evident. Loss of p24 and/or p17 antibody as well as a decreasing ELISA optical density for HIV antibody also signalled progression of the disease.     

Soluble CD30 serum levels in atopic dermatitis and bronchial asthma and its relationship with disease severity in pediatric age

CD30 is a transmembrane molecule that may be expressed on a proportion of activated T-lymphocytes and has been reported to be a marker of Th2 phenotype. A soluble form of CD30 (sCD30) is released by CD30+ cells in vivo. Our objective was to evaluate serum sCD30 levels in children with atopic dermatitis (AD) or bronchial asthma and to investigate its relation to disease severity. This study included of 60 infants and children, of whom 18 had AD, 22 had bronchial asthma and 20 were healthy matched subjects. Severity of AD was assessed according to the objective Scoring Atopic Dermatitis (obj-SCORAD) index. Laboratory investigations included complete blood count, serum total immunoglobulin E (IgE) and serum sCD30 by ELISA. Serum levels of sCD30 in AD (77.7+/-27.9 U/ml) and asthmatic patients (49.2+/-21.5 U/ml) were significantly increased compared with the control group (18.2+/-7.0 U/ml) (t=8.8, p<0.0001; t=6.4, p<0.0001, respectively). In patients with AD, sCD30 levels were shown to correlate with obj-SCORAD (r=0.96, p<0.0001). Patients with moderate persistent asthma had significantly elevated sCD30 levels than those with mild persistent asthma (t=3.4, p<0.01). In addition, sCD30 was inversely correlated to peak expiratory flow rate (r=-0.78, p<0.0001). Levels of sCD30 did not correlate with age, disease duration or serum total IgE (p>0.05). In conclusion, serum sCD30 levels correlate with the severity of AD and bronchial asthma. It appears to be an additional objective marker that may be useful for follow up and may help to improve research and management of these diseases.     

Ferritin levels in pediatric HIV-1 infection

Ferritin is an acute phase protein which is often elevated in acute and chronic inflammation, as well as in neoplastic disease. In adults with human immunodeficiency virus (HIV) infection, elevated serum ferritin levels indicate advanced or progressive disease. In the present study, ferritin levels were evaluated in 88 HIV-infected children. Ferritin levels greater than 100ng/ml were found in 93% of patients with advanced disease. Increasing levels always accompanied or closely preceded rapid disease progression. Serum ferritin levels may prove to be a useful marker to monitor disease progression and therapeutic efficacy in HIV-infected children.     

SERUM IMMUNOGLOBULIN E IN ATOPIC AND NON-ATOPIC CHILDREN AGED 6 MONTHS TO 5 YEARS

ABSTRACT. In order to obtain serum IgE reference values for small children we measured the total serum IgE concentration at the ages of 6 months, 1, 3, and 5 years in 66 healthy, non-atopic children who were followed from birth to 5 years of age. From this reference group we had excluded children with symptoms or signs of atopy during the follow-up period, as well as children with blood or nasal smear eosinophilia or positive skin prick tests. We also studied serum IgE levels in groups of children having latent atopy, symptomatic atopy, or severe atopic disease. We suggest that in the definition of reference values the upper limit of normal should be replaced by a zone of uncertainty, lying between the 95th and 97.5th percentiles. Serum IgE is a useful test with high specificity but low sensitivity in the differentiation between atopy and non-atopy. Thus high levels suggest atopy, while normal or low values yield little information. A normal serum IgE level does not necessarily exclude atopic disease.     

鼻炎与支气管哮喘发病的关系

目的探讨小儿鼻炎与支气管哮喘发病的关系。方法鼻炎患者130例分成2组,单纯鼻炎组60例,鼻炎并哮喘组70例,分析两组年龄、性别、既往湿疹史、毛细支气管炎史、吸烟家族史、哮喘家族史、变应原检测、外周血总IgE及嗜酸性粒细胞(EOS)计数等方面的差别。并用Logistic回归分析进一步确定鼻炎患者发生哮喘的危险因素。结果将两组比较,发现既往毛细支气管炎史、哮喘家族史、母亲哮喘及变应原屋尘、粉尘螨阳性在鼻炎并哮喘组中更多见。此外,外周血总IgE和EOS计数在鼻炎并哮喘组高于单纯鼻炎组。Logistic回归分析发现,外周血总IgE和EOS计数增高是鼻炎并哮喘的重要的危险因素。结论若鼻炎患者存在既往毛细支气管炎史、哮喘家族史、变应原检测阳性,尤其是外周血总IgE和EOS计数增高者,应视为哮喘的前驱表现,需及早防治。     

Serum carotenoids and atopy among children of different ethnic origin living in Germany

Rühl R, Taner C, Schweigert FJ, Wahn U, Grüber C. Serum carotenoids and atopy among children of different ethnic origin living in Germany.
Pediatr Allergy Immunol 2010: 21: 1072–1075.
© 2010 John Wiley & Sons A/S
Journal compilation © 2010 Blackwell Munksgaard The manifestation of atopy in early life is thought to be influenced by the diet. We hypothesized that the previously reported lower prevalence of atopy among Turkish immigrant children in Germany might be related to a different pattern of serum carotenoids. Serum carotenoid concentrations were measured in pre‐school children of different ethnic origin from Berlin, D. German children (D, N = 49) were compared to Turkish children with well (TR‐D, N = 32) or weak cultural adaptation (TR‐TR, N = 41). Serum levels of pro‐vitamin A carotenoids (α‐ and β‐carotene, β‐cryptoxanthin) and non‐pro‐vitamin A carotenoids (lutein, zeaxanthin, lycopene) were measured by high performance liquid chromatography. Serum IgE to common inhalant allergens was measured by immunoassay. Median levels of pro‐vitamin A carotenoids were lower in Turkish children if compared to German children: D 135μg/L, TR‐D 100μg/L (p = 0.025), TR‐TR 82μg/L (p = 0.001). By contrast, median levels of non‐pro‐vitamin A carotenoids were not higher in German children. The ratio of pro‐vitamin A to non‐pro‐vitamin A carotenoid median levels was highest among D (2.05), lower among TR‐D (1.32; p = 0.001) and lowest among TR‐TR (1.26; p < 0.001)). A higher ratio was not significantly associated with atopy (atopic 1.79, non‐atopic 1.36; p = 0.067). Pro‐vitamin A carotenoids are higher in children originating from a cultural population with a higher prevalence of atopy, but atopy seems not to be directly related to the current carotenoid serum levels in children at school age. The distinct pattern of carotenoid levels among Turkish migrant and German children indicates changed nutrition patterns with acculturation.     

Immunological manifestations of HIV-infected children

This cross-sectional study of stable HIV-infected children was designed to document the immunological manifestations of paediatric HIV infection and to determine whether inexpensive markers of immunosuppression could be identified. Investigations included lymphocyte count and subset analysis, levels of total protein, albumin, immunoglobulins, beta-2 microglobulin and neopterin. The median age of the 74 children studied was 16.5 months and 76% and 39% had subnormal percentage CD4+ counts and absolute CD4+ counts, respectively. According to the Centers for Disease Control (CDC) guidelines, 85% were moderately or severely immunosuppressed. The majority had elevated neopterin, beta-2 microglobulin, IgG, IgM and IgA concentrations. The IgG concentration correlated positively with total globulin, IgG1 and IgG3 concentrations. On bivariate analysis, the absolute CD4+ count correlated positively with total lymphocyte count (r = 0.28 < 0.48 < 0.64) and negatively with total IgG concentration (r = -0.47 < -0.27 < -0.04), IgG1 concentration (r = -0.51 < -0.31 < -0.08), and neopterin concentration (r = -0.49 < -0.28 < -0.04). There was no correlation between CD4+ count, total globulin or beta-2 microglobulin concentration. On multiple linear regression analysis only the total lymphocyte count correlated with CD4+ count. Furthermore, on bivariate analysis total lymphocyte count correlated positively with absolute CD8+ count (r = 0.82 < 0.88 < 0.92). In conclusion, although there was a positive correlation between absolute CD4+ count and total lymphocyte count, the clinical significance is questionable as the total lymphocyte count correlated more strongly with the absolute CD8+ count.     

Micronutrients and T-cell subsets: a comparison between HIV-infected and uninfected, severely malnourished Rwandan children

OBJECTIVE: To determine the levels of CD4+ cells and micronutrients in HIV-infected and uninfected severely malnourished children. DESIGN: Cross-sectional study in two centres. SETTING: Children admitted to the malnutrition units in Kigali and Butare, Rwanda. PATIENTS: A total of 112 children aged 2 months to 5 years presenting with severe malnutrition (weight for height Z- score -3 SD +/- oedema). Fifty-two (46.4%) were HIV-infected. METHODS: CD4+ counts, selenium, zinc and copper levels were measured. The percentage of CD4 cells was calculated as a proportion of total lymphocyte count. RESULTS: The mean age of the 52 HIV-infected children (18 months) was lower than of the 60 uninfected children (26 months) (p=0.01). Six (11.5%) of the HIV-infected had oedematous malnutrition compared with 50% of the uninfected group. The mean (SD) CD4+ count was 1054 (780) in the HIV-infected and 1579 (721) in the uninfected group (p=0.001). The CD4+ count was also significantly lower in the HIV-infected group than in the uninfected group for the ages <12 mths (p=0.09), 12-24 mths (p=0.045) and >36 mths (p=0.001). In HIV-infected children, 17% had severe immunosuppression (<15% CD4+ cells), 33% moderate (15-24%) and 50% had none (>25%) compared with 9%, 12% and 80% in the HIV-uninfected group, respectively (p<0.001). Approximately one-third in both groups had low levels of selenium and zinc and 77% had raised levels of copper. In multivariate analysis there was significant correlation between selenium and CD4+ (r=0.36, p<0.001) in HIV-infected children and no correlation of zinc and copper to CD4+ %. In HIV uninfected children, CD4+ % was related to selenium (r=0.282, p=0.03) and to zinc (r=0.264, p=0.047) but not to copper. CONCLUSIONS: In severely malnourished children with HIV infection, low CD4+ levels are associated mainly with HIV infection. There was no significant difference in levels of selenium, zinc and copper between HIV-infected and uninfected children.     

GB virus C infection in children with perinatal human immunodeficiency virus infection

BACKGROUND: GB virus C (GBV-C) infection occurs in 20-40% of human immunodeficiency virus (HIV)-infected adults, and coinfection is associated with improved HIV disease outcome. METHODS: To determine the prevalence of GBV-C infection in children who were perinatally infected with HIV, we conducted a cross-sectional prevalence survey in a cohort of perinatally infected HIV-positive children selected from a large, multicenter observational protocol. A blood specimen was obtained and tested for GBV-C viremia with the use of a qualitative GBV-C RNA assay and screened for past GBV-C infection with enzyme-linked immunosorbent assay to detect antibodies to the GBV-C envelope protein E2 (E2 Ab). RESULTS: The 354 children who participated in the substudy were relatively healthy, with a median CD4 of 784 cells/mm and median HIV-1 viral load of 1055 copies/mL. The prevalence of GBV-C viremia was 20 of 353 or 5.7% (95% confidence interval, 3.5-8.6%), and the prevalence of E2 Ab was 12 of 354 or 3.4% (95% confidence interval, 1.8-5.8%). GBV-C viremic patients were older than patients without past GBV-C infection (median age, 12.8 years versus 10.7 years). Median CD4 lymphocyte counts were highest in subjects without GBV-C infection and lowest in those with E2 Ab. CONCLUSIONS: GBV-C prevalence rates are lower in children with perinatal HIV infection than those reported for HIV-infected adults. With the exception of evidence that GBV-C viremic children had lower rates of Centers for Disease Control and Prevention HIV disease category C disease before GBV-C testing, we did not find evidence of improved HIV disease outcome in coinfected patients, but the number of HIV/GBV-C-coinfected children was small.     

Serum tumor necrosis factor alpha, interleukin 1-beta, p24 antigen concentrations and CD4+ cells at various stages of human immunodeficiency virus 1 infection in children.

We measured the serum concentrations of tumor necrosis factor (TNF-alpha), interleukin 1-beta (IL-1-beta), p24 antigen, CD4+/CD8+ cells and immunoglobulins in 35 children at various stages of human immunodeficiency virus infection. Serum TNF-alpha concentrations were significantly higher in children with lymphocytic interstitial pneumonitis and in children with mildly symptomatic illness than in asymptomatic children or children with acquired immunodeficiency syndrome. In addition serum IL-1 concentrations were significantly higher in patients with lymphocytic interstitial pneumonitis than in asymptomatic, mildly symptomatic, or acquired immunodeficiency syndrome patients. Children with lymphocytic interstitial pneumonitis had the highest serum TNF-alpha and IL-1 concentrations. Among symptomatic children serum TNF-alpha concentrations correlated positively with those of IL-1, and both were inversely related to the amount of p24 antigen. TNF-alpha values in excess of 50 pg/ml were observed more frequently among patients with CD4+ cell count greater than 400/mm3 than in those with CD4+ cell count less than 400/mm3. We did not find any association between elevated TNF-alpha concentrations and cachexia, opportunistic infections or progressive encephalopathy.     

Correlation of CD4 count, CD4% and HIV viral load with clinical manifestations of HIV in infected Indian children

AIM: To correlate the absolute CD4 count, CD4% and HIV viral load with different clinical manifestations of HIV in antiretroviral-naive children. SETTING: The paediatric and perinatal HIV clinic in a tertiary care hospital over a period of 4 years, from January 1999 to December 2003. MATERIALS AND METHODS: A total of 92 highly active antiretroviral-naive, HIV-1-infected children were enrolled in a cross-sectional study. The clinical manifestations, age, sex and CDC classification of each patient were determined. CD4 count, CD4% and HIV-1 viral load were estimated at presentation and correlated with various clinical manifestations of HIV disease. RESULTS: CD4% was higher in infants (p < 0.001) and lower in children over 5 years of age (p = 0.01). Boys had a higher absolute CD4 count than girls (769 +/- 517 vs 532 +/- 430 cells/mm3, p = 0.02). Patients with lymphadenopathy (n = 43) had a high CD4 count (840 +/- 487 cells/mm3, p = 0.01) whereas patients with HIV cardiomyopathy (n = 4) had low CD4 counts (mean 182 cells/mm3, p = 0.04). In patients with failure to thrive (n = 29), the CD4% was low (14 +/- 9%, p = 0.02) and HIV-1 viral load was high (mean 4.5 x 10(5) copies/ml, p = 0.03). CD4 count, CD4% and HIV viral load did not correlate with the stage of the disease as per the CDC classification. CONCLUSION: HIV viral load, CD4 cell count and CD4% vary with age and disease complications in HIV-infected children. However, CD4 count, CD4% and viral load did not correlate with CDC classification.     

Prediction of allergy from family history and cord blood IgE levels

Screening of total IgE in 1189 cord blood samples was conducted by Phadebas IgE PRIST in a one-year birth cohort 1983-1984 in Viborg. Denmark. 113 children with cord blood IgE levels ≥ 0.5 kU/l and 138 children chosen at random among those with cord blood IgE levels < 0. 5 kU/l were seen at a follow-up at 5 years of age. Based upon history and physical examination a diagnosis of definite atopy or no atopy was established. Allergy (IgE mediated) was defined as atopic disease combined with increased total IgE levels at 5 years of age. The cumulative prevalence of atopic disease was not influenced by cord blood IgE levels or atopic predisposition. Cord blood IgE levels had a low sensitivity as a predictor of atopic disease. A statistically significant correlation between serum levels of IgE at birth and at 5 years was however found (p < 0.001), and a significantly greater number of children with elevated cord blood IgE levels developed allergic disease before 5 years of age (p < 0.01). A cut-off limit of 0. 3 kU/l was superior to the originally suggested limit of 0. 5 kU/l. A total IgE level > 63 kU/l (geometric mean + 1 SD) at the age of 5 years can be regarded as being an elevated level. A cord blood IgE level ≥ 0.3 kU/l in combination with atopic predisposition was predictive of allergic disease, especially allergic bronchial asthma. With regard to allergic disease, the positive predictive value was 26%, the sensitivity 33% and the rate ratio for development of allergic disease 4. In the case of the most serious atopic disease, allergic bronchial asthma, the positive predictive value was 20%, the sensitivity 87% and the rate ratio 68.     

毛细支气管炎患儿血清25-（OH）D3与免疫球蛋白水平的变化

目的：研究毛细支气管炎患儿血清25-（OH）D3与免疫球蛋白水平的变化及临床意义。方法采用酶联免疫法检测35例毛细支气管炎患儿急性期和恢复期及20例健康儿童血清25-（OH）D3水平,速率散射比浊法测定免疫球蛋白含量。结果毛细支气管炎患儿急性期血清25-（OH）D3、IgG及IgA水平明显低于健康儿童组,而血清IgE明显高于健康儿童组,差异均有统计学意义（P＜0.05）。毛细支气管炎患儿恢复期血清25-（OH）D3水平较急性期增高,而IgE水平较急性期降低,差异有统计学意义（P＜0.05）。与健康儿童组比较,毛细支气管炎患儿恢复期血清25-（OH）D3及IgA水平明显降低,而血清IgE明显增高,差异亦有统计学意义（P＜0.05）。毛细支气管炎患儿急性期血清25-（OH）D3水平与IgG、IgA呈正相关（分别r=0.36,P＜0.05;r=0.63,P＜0.01）,与IgE呈负相关（r=-0.72,P＜0.01）。毛细支气管炎患儿恢复期血清25-（OH）D3水平与IgE呈负相关（r=-0.34,P＜0.05）。结论毛细支气管炎患儿血清25-（OH）D3水平降低及免疫球蛋白水平失衡,提示25-（OH）D3及免疫球蛋白在其发病中起重要作用。     

Clinical aspects and allergy-immunologic parameters in 40 children 0-7 years of age with atopic dermatitis]

Forty children with atopic dermatitis were evaluated for history, clinical features and allergologic-immunologic parameters. Lichenoid skin lesions were found in 67.5%, follicular lesions in 57.5%, and eczematoid lesions in 50% in children. 25% of children suffered from associated food allergy, 15% from respiratory atopy, and 5% from contact urticaria. The diagnostic efficiency to show specific sensitization was 93% for Pediatric Phadiatop, 90% for Food-Multidisc (fx5 Pharmacia), 88% for skin tests (Prick), 73% for elevated total serum IgE, 65% for Phadiatop, and 60% for family history. The classification of atopic dermatitis into an extrinsic type with specific sensitizations to allergens and into an intrinsic type without specific sensitizations appears to be useful because specific sensitizations significantly correlate with severer skin condition and disease course.     

Helicobacter pylori and specific immunoglobulin E antibodies to food allergens in children

OBJECTIVES: It has been suggested that chronic Helicobacter pylori infection may increase gastric permeability, predisposing infected children for the development of food allergies. We assessed the presence of food-specific immunoglobulin (Ig)E antibodies in H. pylori positive children and controls. METHODS: We measured specific IgE values to six major food allergens (Pharmacia CAP-system) in a group of school-aged Caucasian (n = 36) and non-Caucasian (n = 38) children with a known H. pylori status. All children had undergone upper gastrointestinal endoscopy because of abdominal complaints. RESULTS: Among H. pylori positive children (mean age, 8.8 years; range, 5-15 years, 25 female, 26 male), 33% (17 of 51) had an elevated food-specific IgE level to at least one of the food allergens tested. Unexpectedly, the majority of those with elevated serum food-specific IgE levels (12 of 17) were to cow's milk. Among H. pylori negative children (mean age, 9.3 years; range, 5-15 years, 13 female, 10 male), 26% (6 of 23) of the children had an elevated serum IgE level to at least one of the food allergens tested, and 9% (2 of 23) were positive to cow's milk. The difference in the number of children with an elevated serum IgE level for cow's milk in H. pylori positive and negative children was not significant. The severity of gastritis did not correlate with the presence of food-specific IgEs. CONCLUSIONS: H. pylori infection had no effect on the manifestation of specific IgE to major food allergens in school-aged children. An IgE response to cow's milk was common among these school-aged children.     

Human immunodeficiency virus-infected adolescents: a descriptive study of older children in New York City, Los Angeles County, Massachusetts and Washington, DC

BACKGROUND: Children infected with HIV are entering adolescence with challenging and changing medical and social needs. Through chart review we describe certain medical and social characteristics of adolescents who acquired HIV as children. METHODS: HIV-infected children 12 years of age and older in 1995 were monitored through the Pediatric Spectrum of HIV Disease study from four US sites. In addition to standard 6-month medical chart reviews, a special chart abstraction in 1997 collected available psychosocial and sexual history information. RESULTS: A total of 131 adolescents HIV-infected as children were studied: 52 infected perinatally; 44 infected through a contaminated blood transfusion; 30 through receipt of contaminated blood products for hemophilia; and 5 with unknown transmission mode. Mean age at last medical contact was 15.5 years, 67% were Hispanic or African-American, 12% were employed, 66% attended regular school, 66% knew their HIV status and 48% (8% for the perinatally infected) lived with their biologic mother. Information on sexual activity showed that 18% had sexual relations, 28% did not and for 53% sexual activity was not recorded in the medical chart. Four percent used illicit drugs, which along with sexual activity showed a positive association with age. Forty-two percent had an AIDS-defining opportunistic infection, and 56% had a recent CD4+ lymphocyte count <200 cells/microl. CONCLUSIONS: Adolescents in this study represent a heterogeneous group of surviving HIV-infected children some of whom are sexually active and potential sources of HIV transmission. Clinicians who treat HIV-infected and high risk adolescents face the challenges of providing care and prevention services appropriate to adolescent development.     

Total IgE in urban Black South African teenagers: The influence of atopy and helminth infection

Total IgE levels are usually elevated in allergic diseases, being highest in atopic eczema, followed by atopic asthma and allergic rhinitis. Genetic factors are believed to play a role in total IgE levels, with higher levels seen in Black African subjects. Total IgE is also raised in parasite infection. Thus, the higher total IgE levels in Black Africans could be because of environmental rather than genetic factors. Few studies have investigated the usefulness of total IgE levels in the evaluation of atopy in Black Africans. The objective of this study was to determine the total IgE levels in unselected urban Black African high school children and to correlate this with atopy and ascaris sensitization. Atopic status was assessed by means of specific allergen sensitization (skin prick tests to eight inhalant and four food allergens), self-reported asthma and bronchial hyper-responsiveness measured by methacholine challenge. Ascaris sensitization was assessed by means of ascaris IgE measured by CAP-RAST. Total IgE levels were markedly skewed toward the left and were not distributed in a Gaussian or a log-normal distribution. Skin prick tests were positive for aeroallergens in 32.3% of subjects. Thirty four percent had elevated ascaris IgE. Total IgE was higher in atopic vs. non-atopic subjects and correlated with the number of positive skin prick tests, self-reported asthma and bronchial hyper-responsiveness. Subjects without allergy (or) atopy had a median total IgE of 80–90 kU/I. In addition total IgE correlated with ascaris IgE. Subjects with no ascaris sensitization had median total IgE of 77.1 kU/l. Subjects with neither atopy/asthma nor ascaris sensitisation had a median total IgE of 69.9 kU/I, similar to the levels seen in people of other genetic origins. This study suggests that helminthic infection rather than genetic differences, may be the major determining factor of IgE levels in certain populations.     

Immunological evaluation of 60 children with AIDS

OBJECTIVE: The immunologic defects that occur in children with HIV infection are important tests to both diagnosis and therapeutic response. The objective of this study was to verify the immunologic abnormalities in 60 children with AIDS, in Florianópolis, Santa Catarina State, Brazil. METHODS: Serum immunoglobulin levels were determined by nephelometry and compared to a normal pattern for Brazilian children. The lymphocyte T helper (CD4+) and the lymphocyte T suppressor (CD8+) count and percentage, and the ratio between them, determined by commercial flow cytometry, were compared to a pattern for healthy children of HIV-positive mothers. RESULTS: The mean serum IgG levels was higher in the children with AIDS (p<0.005). The mean serum IgM levels was higher in the children with AIDS in the age group between 13 and 108 months (p<0.005). The CD4+ lymphocytes count was below the inferior limit of the 95% confidence interval of the median reference values to each group of age in 50 (84.7%) of the 59 determinations. The CD4+ lymphocytes percentage was much lower than the percentages of reference. The graph curve of the medians of the ratio between lymphocytes CD4+ and CD8+ to each group of age was below the fifth percentile of the graph curve of the medians of reference. CONCLUSIONS: The hypergamaglobulinemia and the lymphocyte T CD4+ count and percentage are sensitive indicators of HIV infection, observed in the present study. Immunologic evaluation of the HIV-positive children is recommended, including those younger than 18 months of age.     

Absolute CD4+ T-lymphocyte count as a surrogate marker of pediatric human immunodeficiency virus disease progression

BACKGROUND: Traditionally in pediatric HIV, the CD4+ T-lymphocyte percent is used to monitor disease progression because of the variability in absolute CD4+ T-lymphocyte numbers. Because of the high cost of equipment, sophisticated and delicate technology, most laboratories in resource-limited settings use simple protocols that enumerate only the absolute CD4+ T-lymphocyte counts. We assessed the use of absolute CD4+ T-lymphocyte count as a surrogate marker of pediatric HIV disease progression. METHODS: We analyzed the CD4+ T-lymphocytes and HIV viral load over a 10-year period (1996-2006) of 97 HIV-infected children enrolled in the Yale Prospective Longitudinal Pediatric HIV Cohort using generalized linear mixed models. Both CD4+ T-lymphocytes and HIV viral load were assessed at baseline and every 2-3 months. The modeling approach used in this study allows the intercept and the rate at which outcome variables change over time to vary across participants. RESULTS: We determined that absolute CD4+ T-lymphocytes count was just as reliable at monitoring pediatric HIV as CD4+ T-lymphocyte percentage. Antiretroviral treatment, regardless of the regimen used, was associated with higher CD+ T-lymphocytes count (P < 0.01). Race was significantly associated with CD4+ T-lymphocytes counts (with lower values for blacks compared with nonblacks; P < 0.01). The presence of other infections was associated with lower CD4+ T-lymphocyte count (P = 0.01) and higher viral load (P < 0.01), respectively. CONCLUSIONS: In situations where determination of CD4+ T-lymphocyte percentages is not readily available, the absolute count may provide an affordable and accessible laboratory surrogate marker of HIV disease progression in children.