[Exercise-induced pathophysiological changes in asthmatic children. IX. The density distribution profiles and ultrastructural characteristics of peripheral eosinophils after exercise]

To investigate the role of eosinophilis in the mechanisms of EIA we determined the changes in the density distribution profiles and ultrastructure of peripheral eosinophils from children with asthma after exercise. The subjects were 20 asthmatic children consisting of 12 EIA-positive patients and 8 EIA-negative patients and 6 normal children. Fifteen, 30 and 60 minutes after exercise, the number of hypodense eosinophils (< 1.0825 g/ml) in the EIA-positive group was significantly higher than in the EIA-positive group. In the ultrastructural findings, before exercise the ratio of the area of specific granules to the area of cytoplasm per cell (the ratio SG/C) was significantly higher in the EIA-negative patients than in the EIA-positive patients even before exercise, and the ratio of the degranulated area to the area of cytoplasm per cell (the ratio D/C) was significantly higher in the EIA-positive group than in the EIA-negative group. Thirty minutes after exercise, the ratio D/C had clearly increased in the EIA-positive group. These results suggested that eosinophils in the EIA-positive group were already activated before exercise. It will be necessary to further study the factors activating eosinophils which play some roles in EIA.

Incidence of latex allergy in atopic children in Japan

Many cases of latex-induced intraoperatived anaphylaxis have been reported in Europe and the U.S. but not in Japan. We measured latex-specific IgE antibody in sera from the 108 atopic children with high serum IgE levels (over 1,000 U/ml). All of them were diagnosed to have asthma, atopic dermatitis and/or food intolerance. Eleven (10.2%) out of 108 patients were found to have latex-specific IgE by RAST, and 6 of them were positive for latex antigen by skin test. Most of the children did not realize that they were allergic to latex until we discovered it. This data suggest that we should be cautious about latex allergy when atopic children have to be operated upon.

[Specific IgE antibody titers to hen's egg white lysozyme in allergic children to egg]

Hen's egg white lysozyme (HEL) is one of the minor allergen in hen's egg white. HEL is commonly used to treat disease of respiratory tract, because it have the effect to dissolve mucopolysaccharide and anti-inflammatory action. We examined specific IgE antibody titers (IgE-HEL) in patients with egg allergy and allergic patients to other antigen than egg. Results indicated that 16.37 +/- 29.56 (PRU/ml) (mean +/- SD) of IgE-HEL was found in 30 out of the 39 allergic patients to egg, and 23 (66.7%) out of the 39 patients studied showed RAST scores of more than 2. On the other hand, 1.08 +/- 0.92 (PRU/ml) of IgE-HEL in 12 out of the 44 allergic patients to other antigen than egg, and 5 (11.4%) out of the 44 patients studied showed RAST scores of more than 2. Moreover, we treated a patient who developed anaphylaxis after taking HEL. 1.0 (PRU/ml) of HEL-IgE was found in this patient. These results suggest that we should be careful in treating allergic patients with HEL.

Preventive effect and duration of action of disodium cromoglycate and procaterol on exercise-induced asthma in asthmatic children

We evaluated the preventive effect and duration of action of disodium cromoglycate (DSCG) and procaterol nebulizer solutions on exercise-induced asthma (EIA) in 14 asthmatic patients. Disodium cromoglycate solution prevented EIA one hour after inhalation in 11 out of 14 (78.6%), and in some patients after four (36.5%) and eight hours (15.4%). The preventive effect and duration of action of DSCG depended on the severity of EIA in each subject. Procaterol solution had a greater effect than DSCG at any time point in the study. With both drugs, however, the effect decreased four and eight hours after inhaling and was related to the severity of the EIA.

Effect of inhaled beclomethasone dipropionate on bronchial responsiveness in patients with asthma

We investigated the effect of 300 micrograms of inhaled beclomethasone dipropionate (BDP) daily on bronchial responsiveness to methacholine and pulmonary function of 22 subjects with asthma in a single-blind, crossover study. The severity of bronchial hyperresponsiveness lessened significantly during treatment with BDP (P < .01). No significant changes occurred in FEV1 or in the control value of airway conductance. We conclude that a 300-micrograms total daily dose of BDP is an efficacious treatment for patients with asthma. Because suppression of adrenal function and systemic adverse effects can occur in asthmatic patients treated with inhaled corticosteroids, especially children, long-term treatment with inhaled steroids should employ minimal daily doses necessary.

Bronchial hyperresponsiveness changes after 5 months of regular procaterol inhalation therapy in asthmatic children

It is well known that procaterol has more potent antiallergic properties than previous beta-stimulants. Thirteen children with asthma who could be controlled for 2 months with a regular procaterol aerosol given 4 times/day (10 micrograms/dose) were studied. Histamine challenges were performed before and an average of 5 months after the consecutive treatment. No significant differences were seen in peak expiratory flow values. PC20 increased significantly from 132.9 +/- 127.7 micrograms/ml to 762.4 +/- 1205.7 micrograms/ml after 5 months. These results suggest that asthmatic children who can be controlled with regular use of the beta-stimulant procaterol are likely to have a decreased bronchial hyperresponsiveness.

Adrenal function of children with bronchial asthma treated with beclomethasone dipropionate

The function of the hypothalamic-pituitary-adrenal (HPA) axis was investigated in nine asthmatic children treated by inhalation of beclomethasone dipropionate (300 micrograms/day) for 12 weeks. The trial was designed as a prospective study. The 24-hour urinary free cortisol, serum cortisol, response to ACTH, and nocturnal serum cortisol followed by 20-minute sampling were measured before and after the study period. No significant changes were found, suggesting that inhaled beclomethasone, in a daily dose of 300 micrograms, does not cause suppression of the HPA axis.

[Clinical significance of IgG4 antibody determination in children against egg white, milk, soybean and Dermatophagoides farinae]

The measurement of IgE and IgG4 antibodies against egg white, milk, soybean and Dermatophagoides farinae was performed by FAST (fluorescence allergosorbent test) using 21 serum samples obtained from non-allergic children and 160 serum samples from atopic children with bronchial asthma and/or atopic dermatitis. Their antibody levels were evaluated for any association with disease severity and for clinical significance in establishing diagnosis. It was found that children with bronchial asthma showed lower levels of IgE antibodies against egg white, milk and soybean and higher levels of IgE antibodies against Dermatophagoides farinae compared with those of children with atopic dermatitis, while both groups showed higher levels of egg white and milk-specific IgG4 antibodies compared with non-allergic children. These IgE and IgG4 antibody levels revealed a tendency to correlate with disease severity in patients with atopic dermatitis, while this was not observed in patients with bronchial asthma. The contribution percentages of IgG4 antibody determination, together with IgE antibody determination, in retrieving causal allergens were 71% for egg white, 70% for milk and 48% for soybean allergy, implying their diagnostic value in establishing clinical diagnosis.

Oxatomide modifies methacholine- and exercise-induced bronchoconstriction in asthmatic children

Oxatomide is a potent inhibitor of both the release and effects of allergic mediators and is similar to calcium antagonists in chemical structure. It prevents histamine release by inhibiting not only the increase in calcium intake, but also intracellular calcium release. We investigated its effect on methacholine-induced and exercise-induced bronchoconstriction in asthmatic children. Methacholine challenges were performed after oral administration of 0.88 mg/kg oxatomide or placebo in nine asthmatic children in a double-blind placebo-controlled study. Respiratory thresholds were improved in seven patients and log PC20 in the oxatomide group (6.65 +/- 1.34 micrograms/mL) was significantly higher than that in the placebo group (5.74 +/- 1.04 micrograms/mL) (P < .05). Exercise challenges were performed after oral administration of 1.5 mg/kg oxatomide or placebo in eight asthmatic children in a double-blind placebo-controlled study. Oxatomide produced acute bronchodilatation with 6.1% improvement on an average in FEV1. The mean maximal % fall obtained by oxatomide was 13.5%, while that by placebo was 22% (P < .05). These results indicate that oxatomide reduces nonspecific bronchial hyperresponsiveness.

Relationship between arterial blood gas tensions and a clinical score in asthmatic children

In order to evaluate the severity of acute asthma in young children, we used the clinical scoring system devised by Mitsui. This scoring system is constructed by reference only to clinical symptoms and signs such as dyspnea, wheezing, auscultation of rales, speech impairment, cyanosis, and mental status. All patients were less than 5 years old. The clinical scores had a statistically significant correlation with PaO2. High scores definitely were associated with hypoxemia but low scores did not exclude hypoxemia. Scores showed good correlation with the values of PaCO2 compared with the values of PaO2. Scores under 3 were associated with PaCO2 values less than 40 mmHg; scores over 7, with PaCO2 over 40 mmHg. Reproducibility was good, and there was a good relationship between scores and blood gas tensions in individuals. Rales correlated with PaO2. Dyspnea and cyanosis had good correlation with PaCO2.

[Study of liver function in babies with atopic dermatitis by using 13C-methacetin breath test]

We measured serum GOT levels in babies with atopic dermatitis and food allergy. Two hundred and fourteen babies (133 male, 18 female, under 2 years of age) who first visited the Department of Allergy in the National Children's Hospital were examined. Their serum GOT levels were higher than normal; the younger they were, the higher the serum GOT levels were. We carried out the 13-methacetin breath test (MBT) on 11 babies with atopic dermatitis and high serum GOT levels as well as 5 normal babies to estimate their hepatic microsomal function. 13C-methacetin was administered (0.5 mg/kg) orally, and breath was collected at 30 minutes before and immediately before administration. After administration it was collected at 15 minute intervals for the first hour and 45 minute intervals for 90 consecutive minutes afterwards. The level of 13CO2 in their breath was determined with a mass spectrometer. The peak level of 13CO2 excretion (%dose/hr) in the atopic babies with high serum GOT levels was lower and the time required for 13CO2 excretion to reach its maximum level was longer than in normal babies. Also their 13CO2 clearance rate (%/hr) was lower. These results suggested that there was some relationship between atopic dermatitis and liver dysfunction in babies.

[Basic research into the measurement of eosinophil cationic protein (ECP) in blood samples]

Eosinophil cationic protein (ECP), which is one of the eosinophil granule proteins, can now be measured with a radioimmunoassay kit. However, the level of ECP in blood samples is affected by the method of treatment of the samples. We investigated the effect on ECP level of a variety of treatment methods to establish the fundamental condition for the measurement of ECP level in blood samples. ECP levels in serum or heparin plasma increased time-dependently until 2 hr. This increase was considered to be due to active in vitro release of ECP from eosinophils. Serum ECP level at 1 hr was temperature-dependent, being higher at 37 degrees C than at 25 degrees C. On the other hand, ECP level in EDTA plasma did not change significantly during a 3 hr period, and this level of ECP was considered to be that which had been released into the blood in vivo. ECP levels were always in the order of serum greater than heparin plasma greater than EDTA plasma. Though there was a positive correlation between serum ECP level and peripheral blood eosinophil count, the degree of correlation was not strong (r = 0.46, 6, 0.05 greater than p less than 0.01). This suggests that the serum level of ECP, or the "releasibility" of ECP from eosinophils, may reflect the activation of eosinophils.

The stimuli releasing histamine from murine bone marrow-derived mast cells (BMMC). 3. Effect of coculture with 3T3 fibroblasts on the histamine releasability of BMMC

Murine bone marrow-derived mast cells at 3 wk in culture were further cultured in the absence (N-BMMC) or presence (F-BMMC) of 3T3 fibroblasts in the medium containing LI-3, and were examined for their functional responses to either histamine releasing stimuli such as compound 48/80 or an inhibitor of histamine release, disodium cromoglycate. After 3 weeks in coculture with 3T3 fibroblasts, the mast cells increased their histamine content greater than 10 fold, and greater than 10% of the cells changed histochemically to become safranin positive. F-BMMC released approximately 10% histamine when challenged with compound 48/80 or substance P, whereas N-BMMC failed to do so. Furthermore, when the sensitized cells were challenged with DNP-HSA antigen, histamine release from F-BMMC but not from N-BMMC was inhibited by preincubation with disodium cromoglycate. We also examined changes in intracellular Ca2+ ([Ca2+]i) in the cells when challenged with compound 48/80. A transient increase in [Ca2+]i was observed on stimulation with the compound in F-BMMC but not in N-BMMC. Taken together, our results indicate that the interleukin 3-dependent cultured murine mast cells change functionally, as well as histochemically, into in vitro counterparts of connective tissue mast cells when cocultured with 3T3 fibroblasts and may be useful tools for analyzing the mechanisms involved in degranulation from connective tissue-type mast cells.

[Control of house dust mites and mite allergens by special mite-preventive futon]

We studied the effect of a recently-developed special mite-preventive futon (bedding) on mite population and mite allergen contents (Der I and Der II) in asthmatic children and their families (23 sets) for 2 years. 1. The number of mites (vacuumed samples) in the 124 sets of futon for 2 years was 6.4 (SD +/- 8.8) in average in the mite-preventive futon which was significantly smaller than the number (about 1/10) in the control futon: 70.0 (SD +/- 99) (p less than 0.001). 2. Follow-up studies were made on the mite population about 2 years (3, 6, 9 12 and 27 months afterwards). The numbers of mites in all the mite-preventive futon was always 1/10 or less than that of in the control futon (p less than 0.01). 3. The mite allergens (Der I and Der II) were measured in the cotton stuffing of the futon used for 2 years. The mite allergen counts in the mite-preventive futon averaged about 1/24 of those in the control futon. 4. Airborne mite allergens (Der I and Der II) obtained by beating the futon were measured. The ratio of the mite allergen count in the mite-preventive futon to the control futon was found to be 1:22-264. These results indicate that the special mite-preventive futon always inhibit mite infestation at least 1/10 of that in the ordinary (control) futon and that the count of mite allergens in the cotton stuffing and in the airborne particles was even lower in the mite-preventive futon.

Prevention of asthma by ketotifen in infants with atopic dermatitis

To evaluate the prophylactic effect of ketotifen against the onset of asthma we selected 121 infants with atopic dermatitis, without any history suggestive of asthma (cough and/or wheezing). Sixty-one children received ketotifen twice daily. Those who weighed less than 14 kg received 0.8 mg; 14 kg or more, 1.2 mg. Sixty children, a placebo syrup indistinguishable from the active syrup. Both groups were followed for 1 year, with bimonthly evaluations. The criteria for onset of asthma were two different episodes of wheezing treated with bronchodilator drugs. Both groups were comparable regarding age, sex, weight, onset, and duration of atopic dermatitis and age at the onset of asthma. During the 1 year study, asthma was observed in eight children of the ketotifen group (13.1%) and in 25 children of the placebo group (41.6%) (P less than .001). Side effects were negligible and routine laboratory tests disclosed no significant alterations. Ketotifen is a very useful drug for prevention of asthma in children with atopic dermatitis and total IgE more than 50 IU/mL.

[Evaluation of allergen-specific IgE antibody and total IgE with a new IgE detection system named FAST: fluorescence allergosorbent test]

The measurement of IgE antibodies and total IgE was performed with FAST (fluorescene allergosrobent test) system using 171 serum samples obtained from normal donors and 789 serum samples obtained from patients with various allergic diseases. These were collected by departments of internal medicine, pediatrics, otorhinolaryngology and dermatology at 17 institutes in Japan. In addition to a comparative study with RAST, skin tests and provocation tests were also performed to establish a clinical diagnosis. Simultaneous measurements were made and an excellent correlation with RAST was observed with a concordance rate of 85.7% and correlation coefficient of 0.848. The specificity determined in the normal serum samples was 95.5% by RAST and 93.1% by FAST. The sensitivity determined in the samples, of which etiological allergens were identified clinically, was 82.3% by RAST and 85.3% by FAST. Among them, the sensitivity of skin test and provocation test were 92.4% and 94.7%, respectively. The concordance rate with clinical diagnosis was as high as 89.7% for both RAST and FAST. The normal upper limit of total IgE by cumulative 95% value was calculated to be 250 IU/ml for adult subjects. These results indicated the clinical usefulness of the FAST system in evaluating IgE antibodies and total IgE.

Wheat-dependent exercise-induced anaphylaxis: inhibition by sodium bicarbonate

We present a case of wheat-dependent exercise-induced anaphylaxis, in which pretreatment with sodium bicarbonate inhibited reappearance of anaphylactic symptoms following wheat and exercise provocation. Decrease in blood pH relative to elevation in plasma histamine levels was also inhibited. These results suggest possible efficacy of pretreatment with sodium bicarbonate as a preventive measure in patients with exercise-induced anaphylaxis.

[Relationship between arterial blood gas tensions and a clinical scoring system in asthmatic patients]

We evaluated the relationship between blood gas tensions and a clinical scoring system in pediatric asthma patients, who were divided into two groups according to their ages (under 5 years and over 6 years). The clinical score was derived from Mitsui, which was constructed using reference only to clinical symptoms and signs. The clinical scores had a statistically significant correlation with PaO2, PaCO2, SaO2 and pH in both groups. However there were fluctuations between clinical score and blood gas tensions. A low clinical score did not exclude hypoxemia. There were no statistical differences between the two groups, but subjects under 5 years old showed better correlation. This scoring system is useful to evaluate the degree of asthma attack, especially severe attack, both in younger (under 5 years) and older (over 6 years) asthmatic patients.

[The effect of sustained-release theophylline granules in the inhibition of exercise-induced asthma]

We studied the protective effect of sustained-release theophylline granules on early or late response in exercise-induced asthma (EIA) in 16 patients ranging in age from 7 to 18 years. A standardized exercise test was examined 2 hours after administration of theophylline granules on one day and after no medication on another day. On both days, the lung functions and the serum theophylline and cortisol concentrations of the patients were examined before exercise and over a period of 8 hours after exercise. On days without medication, early response was seen in 16 patients and late response in 6. On days with medication, the theophylline granules inhibited early response in 13 of the 16 patients and late response in 5 of the 6 patients. This suggests that theophylline preparation is a useful drug for inhibiting the dual responses of EIA.

Airway responses to repeated exercises detected by krypton-81m in asthmatic children

A repeated exercise program was used to test 7 asthmatic children for changes in ventilation. These changes were examined by continuously inhaled Krypton-81m and compared in subjects with positive and negative refractoriness, as defined by forced expiratory volume in 1 second (FEV1). Three of the seven patients showed significant refractoriness (% reduction in FEV1 > 50%). After the first exercise, they showed one or two ventilation defects which improved after the second exercise. The patient with incomplete refractoriness showed similar results. On the contrary, subjects without refractoriness showed several ventilation defects which fluctuated after the second or third exercise program. One defected area improved after the second exercise session, but deteriorated after the third; and another area deteriorated after the second exercise and improved after the third. It was concluded that approximately half of the patients were refractory in view of FEV1, but that they were all refractory in view of regional ventilation 81mKr images.

Interleukin 4-mediated induction of CD4+/CD8+ T cells during infancy

Neonatal human CD4+ T cells will co-express CD8 on their surface following short-term culture with interleukin 4 (IL-4). Adult T cells do not respond in this manner. In this study we examine this phenomenon as a function of age and determine that IL-4 responsiveness decreases with time to approach adult levels at about 2 years. This phenomenon may be relevant to the documented ability of neonatal CD4+ T cells to function as suppressors.

[Study of IgE.IgG4 antibodies on eczema in infants. II. Clinical characteristics of infants with egg white.RAST 4+]

The author made an assessment in his first report, regarding relationship to the degree of skin involvement. As a result, it was suggested that the extent of eczema is a good index for determining the severity of the allergy and also that the severity of the allergy early in the infancy has a good correlation with egg white.specific IgE antibody. Therefore, an assessment had been made this time regarding the clinical characteristics of 32 infants who have strong reactions (egg white.RAST 4+) to egg white. The results were as follows; 1. All the infants with egg white.RAST 4+ had a systemic eczema, and their IgE antibodies showed high values of 445.6 +/- 626.9 IU/ml. 2. There were many cases with positive multiple allergens. Particularly, all the infants with egg white.RAST 1+ - 2+ were negative to rice and wheat, while 7 cases positive RAST score to rice and 9 cases to wheat were seen out of the 32 who showed the RAST 4+ to egg.white early in the infancy (rice; p less than 0.02 and wheat; p less than 0.01). 3. If the growth curves of the group from which egg and milk were completely eliminated are compared with the curves of the healthy infants, the height and head circumference were entirely in the normal range while the weight and Kaup index had a trend of being a little low, though they were within the normal range. 4. Regarding family history of allergies, past histories of atopic dermatitis on the mother's side were observed at a high rate.

[IgE.IgG4 antibody in eczema in infants between 5-7 months of age. I. Relationship to the degree of eczema involvement]

Assessments have been made of serum IgE and IgA value, specific IgE and IgG4 antibody titers to foods, house dust, mite and percent peripheral++ eosinophil count in 191 infants with and without eczema between 5-7 months of age. Eczema patients were divided into 4 groups according to the degree of eczema involvement and laboratory data were compared between these and not eczematous group. The results were as follows; 1) IgE antibody titers were higher as the degree of eczema involvement increased. 2) RAST positive rates to foods increased with the degree of eczema involvement. Positive rate was highest to egg white followed by milk, soybean, wheat and rice. 3) Only 9 cases were RAST-positive to rice or wheat and all of them had IgE antibodies to other allergens tested. 4) A value of 10 IU/ml, which is the lowest measurable value of IgE in infants was considered to be a little too high to speculate allergy to some foods. 5) Specific IgG4 antibodies were positive only to milk. 6) All the 18 cases with positive milk-specific IgG4 antibody were all negative in milk-specific IgE antibody, and conversely all the 14 cases with positive milk-specific IgE antibody were negative in milk-specific IgG4 antibody. From these results, it was concluded that food allergy is related to the degree of eczema involvement in infants between 5-7 months of age.