Cutaneous late-phase response in food-allergic children and adolescents with atopic dermatitis

Food hypersensitivities contribute to disease exacerbation in a sub-group of children with atopic dermatitis (AD). It has been shown that only selected foods are capable of causing clinical reactions when ingested, whereas other foods, to which the patient is equally sensitive by skin-prick testing, may be tolerated. The purpose of this study was to examine the cutaneous late-phase response (LPR) to food antigens in food-allergic patients with AD and to determine if the skin reacted differently to ‘relevant foods’ (foods eliciting positive skin-prick tests and positive oral challenges) than to ‘non-relevant foods’ (foods eliciting positive skin tests but negative oral challenges). Using blister chambers adfixed to the skin, six children with AD were challenged epicutaneously with foods to which they had previously been shown to be sensitive. Histamine and PGD2 were measured hourly for 10–12 hr in parallel with quantitation of the cellular traffic. There appeared to be no difference in any of the measured parameters between relevant foods and non-relevant foods, and the patterns of the LPR cells and mediators were similar to those previously described with aero-allergens in patients with respiratory allergy. Histamine rose to 13.0±24 ng/ml (P < 0.005) during the first hours, declined to < 1 ng/ml by the fifth hour, and then rose a second time to 6.72 ± 3.4 ng/ml (P < 0.05) during the 12th hour. PGD2 rose to an average of 312 pg/ml (P < 0.05) during the first 3 hr followed by a decline to baseline. The cellular traffic was similar to that observed during the LPR in atopic adults without AD. Neutrophils peaked at 11.2 ± 6.8 × 10⁴ cells but did not reach significance because of background traffic in the control chambers. Eosinophils were significantly increased (P < 0.05) and rose to 2.52 ± 1.7 × 10⁴ cells. Mononuclear ceils (P < 0.05) and basophils (P < 0.38) were also increased but less than either neutrophils or eosinophils. These studies suggest that selectivity in gastrointestinal antigen absorption or differential antigen processing, transport and/or clearing may explain the differences in clinical reactivity to ingested food allergens.     

Hepatic Glycogen Storage Disease: CLINICAL AND LABORATORY FINDINGS IN 23 CASES

Clinical and laboratory findings and the results of enzyme studiesmade on tissue samples from 23 children with hepatic glycogenstorage disease are described. Two-thirds of the patients had glycogenosis associated withdeficiency of glucose-6-phosphatase, amylo 1,6-glucosidase,or hepatic phosphorylase. No enzyme defect could be found toaccount for excessive glycogen deposition in the others, whowould have been incorrectly diagnosed as suffering from oneof the recognized enzyme deficiencies, if samples of affectedtissue had not been examined for specific enzyme activities. The treatment of glycogen storage disease has been limited toregulating the blood sugar level and preventing hypoglycaemia.In most patients this was achieved by simple dietary management.Two children who did not respond to dietary control have beentreated with diazoxide.     

TEST-MEAL IN THE DIAGNOSIS OF MALABSORPTION IN INFANCY

A test-meal containing 2 g of glucose per kg body weight (minimum of 20 g), 0.5 g of D-xylose per kg, 8 ml of standardized cream (12% fat) per kg and 7 500 IU of vitamin A palmitate per kg was administered through a nasogastric tube. During the next 10 hours capillary blood samples were obtained and analysed for glucose, D-xylose, triglycerides, and vitamin A using microanalytical methods. The results in 16 normal infants aged 1 to 20 months are reported. The results for all parameters determined, except D-xylose, were comparable to those previously reported using single tolerance tests. The variability related to age was pronounced for glucose, triglycerides and vitamin A. In patients with malabsorption syndromes (cystic fibrosis, extrahepatic biliary atresia, intrahepatic cholestasis, and gluten-induced enteropathy) the results were also comparable with those earlier observed using single tolerance tests. A combined test-meal has certain advantages over the examinations now used in infants with symptoms suggesting a malabsorption syndrome: a series of tolerance tests is avoided, and it is therefore easier to follow the absorption of fat and carbohydrates during the course of a disease and during a therapeutic regimen.     

Fractured condyle artifact

A patient treated for routine dental care had a medical history of temporoman-dibular joint trauma. A pretreatment panoramic radiograph showed evidence of a fractured condyle; however, further radiographic testing showed no fracture and that the original fracture seen was an artifact. This artifact may have been caused by superimposition of ear cartilage over the mandibular condyle during radiography. By coincidence, the patient was injured in an area that fit the original radiographic observation of a condylar fracture. However, it would be rare to find a condyle with the distal portion fractured at the angle indicated on the radiograph, and unusual for such a condition to remain undetected for 9 years. Remodeling of the bone would have been expected, and this would affect the appearance of the supposed fracture.