IgG subclasses in wheezing infants

The wheezing infant is a common but difficult patient to approach diagnostically. The prevalence of IgG subclass antibody deficiency in wheezing infants is still controversial. We studied serum concentration of IgG subclasses in 38 wheezing infants (aged 6–24 months who had not received systemic steroids before investigation) and in 30 healthy age matched control (aged 6–24 months). The prevalence of one or more IgG subclass deficiency was 31.6% in wheezing infants and 26.7% in controls. There was no significant difference in prevalence of IgG subclass deficiency between patients and controls (p>0.05). The mean concentration of IgG subclasses in patients were compared with controls. There was no significant difference in mean serum concentration of IgG1, G2 and G3 subclasses. But there was a trend towards higher concentrations of IgG4 in wheezing infants and this difference for IgG4 was significant (p<0.01). However, IgG subclass deficiency was found in 25% and 36.4% of wheezing infants who had experienced from two to four and five or more wheezing episodes in two years, respectively (p>0.05). These findings suggest that wheezing in infancy is not associated with IgG subclass deficiency and in wheezing infants low IgG subclass levels do not increase the frequency of wheezing.     

Serum immunoglobulins and immunoglobulin G subclasses with recurrent wheezing

In this study serum immunoglobulins (Ig) and IgG subclasses were measured in 42 patients (ranging 9 month-6 year) with recurrent wheezing and in 37 healthy children determined the relationship between serum Igs and recurrent wheezing. Patients were divided into two groups according to the age [9 month-2 year (n: 15), and 2–6 year (n: 27)]. In the patients placed in 9–24 month age group, serum lgG₄ level was found to be lower than controls (p<0.05). But there was not a significant difference in mean serum concentrations of total IgG, IgA, IgM, IgE, IgG₁ lgG₂ and lgG₃ subclasses between the groups (P>0.05). In the 25 month-6 year age group the mean IgE level was increased compared to the control while lgG₃and lgG₄ levels were decreased (p<0.05). On the other hand, in the 9–24 month age group there was no significant difference between the patients and controls for IgG subclasses deficiency (P>0.05). However, significant difference in IgG subclasses deficiency was present between the patients and controls in the 25 month-6 year group (P<0.001). In conclusion, our findings suggest that wheezing in childhood may be associated with low lgG₃and /or lgG₄, and in older children high IgE level may be a part of pathogenetic mechanism in patients with recurrent wheezing.     

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??Abstract??Wheezing in infants is common and the differential diagnosis is broad. For recurrent wheezing?? especially colds and without other causes?? a parental history of asthma?? and physicians diagnosis of eczema or atopic dermatitis?? and eosinophilia will increase the probability of a subsequent asthma diagnosis.Because objective measures of lung function are challenging to perform in infants?? clinical signs and symptoms thus suggest the diagnosis of asthma.     

Cytomegalovirus infection and wheezing in infants

Background: Bronchial asthma‐like symptoms such as wheezing are commonly associated with respiratory tract infection including respiratory syncytial virus (RSV) infection in infants. No study on the association of wheezing with cytomegalovirus (CMV) infection in infancy has been reported, although CMV infection has been observed to play some role in prolonged and intractable wheezing in limited cases. Methods: The present study investigated 40 hospitalized infants who presented with first‐episode wheezing between October 2003 and September 2004. Nasopharyngeal aspirates were tested for RSV, and serum antibodies against CMV were measured. As controls, age‐matched infants with no wheezing were examined for CMV serostatus. Results: RSV‐antigen was detected in 21 subjects (53%), and seven (18%) were considered primary CMV infection serologically. Primary CMV infection was found more often in the wheezers than in the controls although the difference was not statistically significant (P = 0.06). The incidence of splenomegaly was significantly higher in wheezers with CMV infection (86%) than in those with RSV infection or without either infection. The duration of wheezing, fever, and radiographic and laboratory findings during hospitalization were not significantly different. Conclusions: CMV infection based on serologic diagnosis should be considered in infants with first wheezing episode and particularly those with splenomegaly.     

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??Abstract??Wheezing is common clinical symptoms in early childhood with respiratory diseases.In this paper,epidemidogy,risk factors and trend in development will be described.     

婴幼儿反复、持续吼喘58例病因分析

目的提高临床儿科医师对婴幼儿反复吼喘的鉴别诊断能力。方法对临床持续吼喘≥4周或反复吼喘≥3次、年龄≤3岁的58例住院患儿进行病因分析。结果58例中诊断为婴幼儿哮喘26例,气管、支气管软化10例,气管、支气管狭窄9例,异物4例,支气管肺发育不良2例,胃食管返流4例,其他原因3例。结论婴幼儿出现反复吼喘最多见原因为婴幼儿哮喘;小婴儿必须排除先天性因素的可能性,6个月以内的小婴儿持续或反复吼喘最多见原因为先天性气道或肺发育异常疾病。     

婴幼儿喘息与呼吸道病毒感染及过敏的关系

目的探讨婴幼儿喘息与呼吸道病毒感染及过敏的关系。方法选择反复喘息(哮喘和喘息性支气管炎)患儿152例、毛细支气管炎(毛支)患儿191例、肺炎患儿101例,取鼻咽分泌物进行7种常见呼吸道病毒检测,同时取血筛查过敏原。结果3组患儿病毒检测总阳性率为60.4%,各组患儿病毒检测阳性率差异有显著性(P<0.01),但均以呼吸道合胞病毒(RSV)为主,其他病毒阳性率很低。所有患儿食物过敏阳性率为25.5%,吸入过敏原阳性率仅5.6%。3组患儿的过敏原阳性率差异有显著性(P<0.05或0.01),反复喘息组显著高于毛支组和肺炎组(P均<0.05),而后两组间差异无显著性。结论RSV是诱发婴幼儿喘息和喘息反复发作的主要病原;过敏是婴幼儿反复喘息发生的重要危险因素,而呼吸道合胞病毒感染的发生与患儿是否存在过敏无关。     

Immunoglobulin G subclasses in human colostrum, milk and saliva

Previous studies have suggested local production of IgG4 in human colostrum and mature milk. We extended these observations to examine all IgG subclasses in mammary secretions and in saliva, a mucosal secretion. In human colostrum and milk, the geometric mean percentages of IgG contributed by IgG2 were 44% and 43%, respectively, and by IgG4, 6% in both. These percentages are significantly increased compared to the contributions in matched plasma, 29% for IgG2 and 2% for IgG4. The contribution of IgG1 (47%) and IgG3 (less than 4%) were decreased compared to plasma which contained 64% IgG1 and 6% IgG3. Similarly, in salivary secretions the percentages of IgG contributed by IgG2 and IgG4 were increased compared to serum while the percentage of IgG1 was decreased. IgG3 was not measurable in any saliva specimen by the technique used. These data demonstrate that IgG subclass distribution in two separate mucosal secretions is uniquely different from that in matching plasma or serum.     

Risk factors in wheezing infants

BACKGROUND: Some lifestyle factors may be important for the occurrence of wheezing and there are considerable differences around the world. METHODS: Risk factors of wheezing were examined in 38 children (aged 6-24 months). Results were compared with healthy age-matched controls. RESULTS: Family history of atopy, asthma and eczematoid dermatitis, and parental and pregnancy smoking were all reported as being substantially more common in wheezing infants than in controls (P < 0.05 for each parameter). Living conditions showed that the incidence of wheezing in infants was more common in households with wooden floor coverings compared with controls, which used plastic floor coverings (P < 0.05). They also showed that 55.3% of wheezing infants and only 20% of controls were living in moist dwelling environments (P < 0.05). With regard to bedding, the incidence of wheezing in infants was higher in households using synthetic materials compared with controls (P < 0.05). A history of in utero and environmental tobacco smoke exposure was associated with increased risk of recurrent wheezing. Odds ratio and logistic regression analysis were done with presence of wheezing as the dependent variable and all risk factors of interest as independent variables. Family history of atopy, high household humidity levels, parental smoking and wooden floors used in the home were significant risk factors for wheezing. Skin test positivity and gastroesophageal reflux were determined in wheezing infants as 18.4 and 13.2%, respectively. CONCLUSION: Recurrent wheezing in infancy may be associated with many environmental and genetic factors. It is possible that allergen avoidance merely delays rather than prevents the development of allergic disorders.     

喘息婴幼儿鼻咽分泌物嗜酸粒细胞与血清特异性IgE的关系分析

目的 探讨婴幼儿喘息时鼻咽分泌物涂片中嗜酸粒细胞计数及与血清特异性IgE的关系.方法 选择2002-2004年收治的1个月～3岁的喘息及支气管肺炎患儿223例,分为3组,其中反复喘息(包括婴幼儿哮喘和喘息发作≥2次)组76例,毛细支气管炎组65例,支气管肺炎(无喘息症状)组82例.吸取鼻咽分泌物1ml进行嗜酸粒细胞计数,并测定血清特异性IgE的水平.结果 反复喘息组鼻咽分泌物嗜酸粒细胞计数明显高于其他两组,差异有统计学意义(P=0.000);反复喘息组血清食物变应原(fx5E)的阳性检出率及吸入性变应原(Phadiatop)阳性检出率均明显高于其他两组,差异有统计学意义(P=0.000),毛支组和支气管肺炎组之间差异则无统计学意义;血清特异性IgE与鼻咽分泌物嗜酸粒细胞计数之间存在显著正相关;鼻咽分泌物嗜酸粒细胞水平在同时存在喘息和特应性的患儿最高,在既没有喘息也无个人特应性的患儿最低,有喘息或血清IgE一项者介于两组之间.结论 鼻咽分泌物嗜酸粒细胞计数方法操作简单、无创、快速,费用低,且能在一定程度上反映哮喘的病理特征,与血清特异性IgE之间呈正相关,可以在临床进一步推广应用.     

Immunoglobulin G Subclasses and Lymphocyte Subpopulations and Function in Osteomyelitis and Septic Arthritis

ABSTRACT. We investigated serum IgA, IgG, IgM and IgG subclass concentrations, complement activity, lymphocyte subpopulations, Iymphocyte responses to mitogens and natural killer cell cytotoxicity in 15 children who had had osteomyelitis and septic arthritis and in a group of control subjects. IgG subclass concentrations below the fifth percentile for age occurred in 4 patients. We found isolated deficiencies of IgGI and IgC3 and combined deficiencies of IgG2/IgG3/IgC4 and IgG2/IgG4. Concentrations of IgA and of IgG tended to be below the mean for age. The percentage of Leu-11 + cells was reduced in patients. Other immunological parameters studied were normal. These findings suggest that although most patients who have had osteomyelitis and septic arthritis do not have low immunoglobulin concentrations, impaired antibody production may be a predisposing factor in at least a few such children.     

Serum immunoglobulin G subclasses and serum immunoglobulin A in acute bronchiolitis in infants

Serum IgG subclasses and Serum IgA were studied in 43 infants with acute bronchiolitis and 20 healthy infants. IgG subclasses were determined by a capture ELISA and IgA was quantified by turbidimetry. IgG1 concentrations were significantly lower in infants with bronchiolitis than in normal infants. The other IgG subclasses and IgA did not differ between the groups. The subgroups of infants with bronchiolitis who had previously suffered from otitis media or bronchitis, had significantly lower IgG2 than the other infants with bronchiolitis. The same was found for infants with bronchiolitis who had suffered from three or more lower respiratory tract infections. In infants who had suffered from upper or lower respiratory infections before the acute bronchiolitis, IgA was significantly higher than in infants without previous respiratory infections. Ten infants with bronchiolitis (23%) had IgGl deficiency, that is values below the lower reference limit calculated in a population of healthy Norwegian infants. No healthy infants had any IgGl deficiency. No infant with bronchiolitis had IgG2 or IgG3 deficiency. The low IgGl values found in infants with acute bronchiolitis, may be one cause for infants to be more susceptible to RS virus infections.     

Intractable wheezing in infants with nasopharyngeal reflux

Two infants with intractable wheezing and moist cough were referred to Chiba Municipal Kaihin Hospital. Their symptoms were persistent even after the usual treatment for respiratory disease. No definite etiological agents were detected. They usually gagged while feeding and barium swallow tests revealed nasopharyngeal reflux and cricopharyngeal incoordination. One of the patients had remarkably high titers of IgE and IgE RAST of cow's milk before she received treatment with thickened formula. She also had peripheral eosinophilia and nasal eosinophilia. These findings were thought to be caused by nasopharyngeal reflux. Four months after therapy commenced, those titers and symptoms were greatly reduced. The clinical and roentgenographic findings in these infants, and their response to therapy, strongly support a causal relationship between nasopharyngeal reflux and wheezing. Therefore, nasopharyngeal reflux should be considered when a baby has intractable wheezing, even when there is no developmental problem.     

婴幼儿喘息诊治进展

婴幼儿喘息是一种异质性疾病,可分为婴幼儿暂时性喘息、非过敏性持续性喘息和过敏性喘息(即哮喘).婴幼儿暂时性喘息主要与先天性支气管肺发育不良等因素有关,非过敏性持续性喘息主要与病毒感染引起的炎症有关,这一炎症参与的细胞主要是嗜中性粒细胞和淋巴细胞,而哮喘参与的细胞主要是嗜酸性粒细胞.婴幼儿期喘息的发作次数不是诊断哮喘的理想指标,婴幼儿期哮喘的诊断应重视过敏性疾病的遗传背景、个人过敏性疾病史、实验室过敏指标的检查及对支气管扩张剂治疗的反应.在不能明确婴幼儿喘息类型的情况下,联合应用激素、β2肾上腺素能受体激动剂、白三烯受体调节剂和组织胺H1受体阻断剂治疗是一个有效的选择.     

Sodium cromoglycate therapy in wheezing infants: preliminary evidence of beneficial outcome at early school age

BACKGROUND: In order to affect the natural course of childhood wheezing and asthma, anti-inflammatory therapy is often prescribed for young wheezing children, but there is lack of long-term follow-up data. METHODS: Eighty-two of the original 100 children, hospitalized for wheezing under the age of 2 years in 1992-1993, were re-examined at school age in 1999. The children had participated in an open, randomized, parallel-group trial including a 4-month intervention with inhaled sodium cromoglycate (SCG) or budesonide (BUD). The baseline data, including data on atopy, eosinophilia and viral etiology, were prospectively collected on admission. RESULTS: At early school age (median 7.2 years), asthma was present in 33 (40%) children. There was less asthma in the original SCG (21%) than in the control group (54%) (OR 0.23; 95% CI 0.07-0.77). The figure was 46% in the BUD group. When the analyses were performed separately for atopic and non-atopic infants, the difference was significant only among atopics. The lowered risk for asthma in the SCG group remained significant in the multivariate logistic regression analysis when adjusted for age, sex and atopy, and further when adjusted for earlier episodes of wheezing and respiratory syncytial virus identification. However, after adjustment for blood eosinophilia, the significance was lost, albeit the risk for asthma remained low (OR 0.21; 95% CI 0.04-1.12). A sensitivity analysis, which was done by including the six drop-outs of the SCG group as unfavorable and the 12 drop-outs of other groups as favorable outcomes in the model, did not change the direction of the result (OR 0.70; 95% CI 0.26-1.89). CONCLUSIONS: An early SCG intervention in infants hospitalized for wheezing was associated with a lowered risk for early school-age asthma, especially in infants with evidence of atopy.     

婴幼儿喘息患者鼻咽分泌物中嗜酸性粒细胞计数染色方法比较

目的 对婴幼儿喘息患者鼻咽分泌物涂片中嗜酸性粒细胞计数的四种染色方法进行比较。方法 62例喘息患儿各取鼻咽分泌物1 ml,制成4张涂片。经Carnoy氏液固定后,分别采用HE、Wright、WrightGiemsa及“1min染色”4种方法进行染色、读片和比较。结果 4种染色检出嗜酸性粒细胞的阳性率分别为77．4％、79．0％、73．8％和75．8％。结论 Wright或Wright Giemsa染色的方法较简便,显色清楚,可作为诊断哮喘的辅助手段。     

Increased serum IL-10/IL-12 ratio in wheezing infants

To investigate the association between various serum markers and atopic symptoms in the first year of life, and to evaluate the prognostic value of these markers for the development of wheezing and skin rash in the second year of life. Data of 86 children on the development of wheezing and skin rash in the first 2 years of life were collected prospectively, making use of parental completed questionnaires, weekly symptom cards, structured interview and physical examination. Serum markers (IL-10, IL-12, IL-13, eotaxin, sE-selectin, sICAM-1, sIL-2R) and total and specific IgE were determined at age 1. Children who developed wheezing in the first year of life had lower serum levels of IL-12 than children without symptoms (median 40.3 pg/ml vs. 49.0 pg/ml, p = 0.01) and a higher serum IL-10/IL-12 ratio (0.41 vs. 0.31, p = 0.001) at age 1. The IL-10/IL-12 ratio increased with an increasing number of wheezing episodes. Levels of sE-selectin in children with wheezing and in children with itchy skin rash in the first year of life were higher than in symptom free children (6.1 ng/ml and 5.9 ng/ml vs. 4.9 ng/ml, p = 0.01 and p = 0.03, respectively). Children who developed wheezing in the second year of life already had increased sICAM-1 levels at age 1. Children who developed wheezing in the first year of life showed a serum cytokine response that is skewed towards a T-helper 2 profile, with lower IL-12 levels and an increased IL-10/IL-12 ratio. Children who developed wheezing in the second year of life had elevated sICAM-1 levels at age 1. Follow-up of the children is needed to evaluate the prognostic value of various serum markers for the development of allergic disease in later childhood.     

Outcome of wheezing in early childhood

In Acta Paediatrica 50 y ago, Boesen published a follow-up of children with "asthmatic bronchitis". Recent reinvestigations of children hospitalized because of wheezing in early childhood are remarkably consistent with Boesen's observations. Conclusion: Young children admitted to hospital because of wheezing have a clearly increased risk of subsequent asthma. Recent studies confirm Boesen's observations of the prognostic importance of eosinophilia and an inverse relation between age at admission with wheezing and risk of subsequent asthma. Allergy or atopic dermatitis is predictive of subsequent asthma, whereas family history of allergy has low predictive value in infants.