Determining an association between having a medical home and uncontrolled asthma in US school-aged children: a population-based study using data from the National Survey of Children's Health

INTRODUCTION

The American Academy of Pediatrics and the American Academy of Family Physicians believe that infants, children, and adolescents benefit from having a medical home, characterized by accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. Several studies suggest that patients with asthma benefit from having a medical home. However, no national study has been conducted examining the relationships between having a medical home and asthma control in school-aged children with asthma. The purpose of this study was to examine the hypothesis that having an adequate medical home is protective against uncontrolled asthma in children.

METHODS

To test this hypothesis, cross-sectional data from the 2003-2004 National Survey of Children's Health were analyzed. Analyses entailed creating the variables "medical home" as well as "uncontrolled asthma" from multiple variables. Multivariate analysis was performed using children with uncontrolled asthma as the dependent variable.

RESULTS

The logistic regression model performed yielded that school-aged children with uncontrolled asthma were more likely to: speak a primary language other than English (OR, 1.069; 95% CI, 1.045-1.093); live in households with incomes<100% of the federal poverty level (FPL) (OR, 1.826; 95% CI, 1.810-1.842); not have health insurance (OR, 2.296; 95% CI, 2.263-2.330); live in rural rather than metropolitan areas (OR, 1.275; 95% CI, 1.262-1.287); and be non-Caucasian (OR, 2.067; 95% CI, 2.050-2.085). Multivariate analysis also yielded that children with uncontrolled asthma were more likely to have a medical home (OR, 1.138; 95% CI, 1.128-1.148).

CONCLUSIONS

After controlling for possible confounding variables, this study did not detect an association between having a medical home and asthma control for children with asthma aged 5 to 17 years. Additional research should examine the relationship between variables, such as poverty, place of residence, health insurance status, and the medical home, not only in the instance of uncontrolled asthma, but for other childhood health conditions.

Who is providing and who is getting asthma patient education: an analysis of 2001 National Ambulatory Medical Care Survey data

Patient education in asthma management is important; however, there is little known about the characteristics of patients receiving asthma education or how often primary care physicians provide it. The objective of the study was to identify the characteristics of patients receiving asthma education. It was a cross-sectional study using 2001 National Ambulatory Medical Care Survey data. The study included 1230 physicians providing office-based ambulatory medical care in the United States. Patients in the study (weighted n=11,279,952) were those diagnosed with asthma based on International Classification of Diseases, 9th Revision code receiving care from a pediatrician, internist or a family physician. Main and secondary outcome measures were asthma education ordered or provided. Multivariate analysis indicated that asthma patients receiving education were more likely to have office visits >20 min [odds ratio (OR) = 3.934], be seen for an acute reason (OR = 2.268), be seen in follow-up rather than an initial visit (OR = 1.780), live in rural rather than metropolitan areas (OR = 1.507), have public rather than private insurance (OR = 1.276) and be seen in privately owned practices (OR = 1.248). Bivariate analyses indicated that patients seeing family physicians were more likely than those seeing internists or pediatricians to receive education. Patient education was not uniformly provided. Family physicians provided more asthma education than either pediatricians or internists. Future research should investigate the quality of education provided.

Student responses to the gross anatomy laboratory in a medical curriculum

Working with cadavers, whether through active dissection or by examination of prosected specimens, constitutes a potential stressor in medical education although there is no consensus on its effect. Some reports have suggested that it creates such a strongly negative experience that it warrants special curricular attention. To assess the issue for ourselves, we administered surveys to the freshman medical students taking the Anatomical Sciences course in the problem-based Alternative Curriculum (A.C.) at Rush Medical College for four consecutive years. We found that although a vast majority of students expressed a positive attitude toward the experience, both before and after taking the course, there remains a small percentage of students for whom human dissection may initially be a traumatic experience. We offer explanations for our findings, comments on disparate results from other studies and suggestions for appropriate responses by anatomy faculty, who must address these student needs.

Efficacy and safety of nedocromil sodium 2% ophthalmic solution b.i.d. in the treatment of ragweed seasonal allergic conjunctivitis

The efficacy and safety of twice-daily nedocromil sodium 2% ophthalmic solution and vehicle were compared in the treatment of ragweed seasonal allergic conjunctivitis. Two separate multicenter, randomized, double-masked, placebo-controlled studies were subjected to a combined analysis. Following a one-week baseline period during the beginning of the ragweed pollen season, 189 patients with seasonal allergic conjunctivitis received either nedocromil sodium or vehicle b.i.d. for eight weeks. Efficacy was evaluated by patient diary cards and clinical eye examinations. Safety was assessed by reports of adverse events. Compared with vehicle, nedocromil sodium produced significantly greater decreases in summary symptom score (p = 0.005), itch (p = 0.005), tearing (p = 0.004), overall eye condition (p = 0.001), and clinician-evaluated conjunctival edema (p = 0.018), and significantly better (p = 0.001), and patient (p = 0.001) opinions of treatment effectiveness at the peak pollen period. Additionally, the superiority of nedocromil sodium compared to vehicle approached statistical significance in redness reduction (p = 0.087) and clinician-evaluated conjunctival injection (p = 0.087). There were no serious treatment-related adverse events in either treatment group. In summary, nedocromil sodium 2% ophthalmic solution b.i.d. was found to be effective and to have a favorable safety profile in the treatment of seasonal allergic conjunctivitis.

The Chicago Asthma Consortium: a community coalition targeting reductions in asthma morbidity

The problem of asthma in Chicago remains a complex one, and it is too early to know whether any programs and efforts have had a discernible effect, but the Chicago Asthma Consortium continues to expand its membership and to define its mission. The successes have come from harnessing the passion of the individual members to move the projects forward. As the focus of the consortium moves to addressing system-wide problems in asthma care and the delivery of that care, the consortium is undertaking the construction of a guide for future efforts. In this way, the consortium will fulfill its vision of creating a comprehensive, community-wide plan for the management of asthma, impacting on the unacceptable current levels of morbidity and mortality of the disease.

Problem based learning: development of a new strategy for effective continuing medical education

The major format for Continuing Medical Education (CME) in the United States is the large group lecture. To test the hypothesis that the problem based learning (PBL) model for medical student education could be successfully adapted for use in CME with practicing primary care physicians (PCPs), PBL adaptations were developed for experiments with both small (5-10 participants) and large (10-40 participants) groups of learners. Approximately 90% of participants in PBL for CME meetings enjoyed and enthusiastically accepted these education models. Physicians who participated in these programs developed the motivation to change their clinical practice behavior; the frequency of this motivation (30%, 65%, and 85% of participants) was directly linked to the length of the program (1, 2, or 3 hours, respectively). This end-of-program motivation to change practice behavior transferred into actual change as measured both by self-report and by direct measurement of prescription writing. In a completely separate experiment, PBL-based CME programs were provided to PCPs participating in a pediatric asthma disease state management project in a Midwestern health maintenance organization; in the very first year of implementation, the project resulted in a significant decrease (P < 0.03) in utilization of urgent care, with a concomitant 75% decrease in the average cost of urgent care services. Finally, 300 CME educators learned how to teach using the PBL for CME format; outcomes such as acceptance of the model, and end-of-program motivation to change practice behavior in programs given by these teachers (beta results) matched those observed in the initial experiments (alpha results). Taken together, these results suggest that for CME, the large group lecture format can be replaced by the small and large group PBL formats.

Urticarial skin lesions and polymyositis due to lymphocytic vasculitis

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Conversion from twice- to once-daily extended-release theophylline treatment in patients with reversible airway obstruction

This multicenter, randomized, investigator-blinded, parallel group study compared the effects of converting patients from a q12h extended-release theophylline preparation (Theo-Dur) to a q24h extended-release product (Uni-Dur). Patients (n = 133) first received open-label Theo-Dur treatment with dosage titrated to achieve peak serum theophylline concentrations of 10-20 micrograms/ml. Patients then were randomized to continue Theo-Dur (n = 64) or to convert to Uni-Dur (n = 60) with peak serum theophylline concentrations maintained in the desired range. Pulmonary function tests were performed during the open-label and blinded periods; patients maintained diaries and performed peak flow measurements before each dose of study treatment. Adverse events were recorded throughout the study. Respiratory status during blinded treatment was rated as the same or improved compared with open-label treatment by > 87% of evaluable patients and physicians, regardless of treatment group. There were no significant differences in mean peak serum theophylline concentrations at baseline, at the final evaluation, or at any point during the study. Few dosage adjustments were necessary (5/52, Uni-Dur; 9/57, Theo-Dur). There were no significant changes in pulmonary function test results or patient diary entries between the open-label and blinded periods. Headache and nausea were the most commonly reported adverse events. In conclusion, converting patients from twice- to once-daily theophylline treatment resulted in no significant changes in any measures of pulmonary function, and there were no significant differences between the groups during the blinded treatment period.

Multi-centre comparison of ABBOTT MATRIX Aero to Pharmacia Standard RAST, Modified RAST and skin puncture tests

ABBOTT MATRIX Aero is an enzyme immunoassay which measures specific IgE antibodies to 14 individually calibrated airborne allergens using a single serum specimen. In this study, ABBOTT MATRIX performance was evaluated in comparison to the results of skin puncture test and the Standard and Modified RAST procedures. The ABBOTT MATRIX demonstrated overall sensitivity of 89% vs. Standard RAST and Modified RAST, with specificity greater than 92% vs. both methods. ABBOTT MATRIX sensitivity vs. skin test (71%) exceeded that of the Standard and Modified RAST procedures (62% and 67% respectively). Positive results reported by ABBOTT MATRIX but not RAST were corroborated by skin test results for 3 of 5 allergens evaluated. All in vitro systems demonstrated specificity of approximately 90% vs. skin test. The ABBOTT MATRIX system provided results which compared favorably with the results of skin test and RAST, but required less hands-on time to obtain quantitative specific IgE measurements to multiple allergens.

Complement factor I deficiency with recurrent aseptic meningitis

Patients with deficiency of the complement regulatory protein factor I typically present with systemic pyogenic bacterial infections, including meningitis. We report a novel case with total deficiency of factor I in serum and plasma; the patient experienced nine consecutive episodes of aseptic meningitis within a 2-year period. There was no history of previous bacterial sepsis. Aseptic meningitis recurred despite attempted penicillin prophylaxis. Each episode resolved rapidly without sequelae, with or without antibiotic treatment. Serum complement profiles showed persistently low levels of C3, factor B, and factor H and undetectable factor I protein. Family complement studies could not be performed. Except for a minimally increased titer of antinuclear antibody, no other immunologic abnormality was detected. Results of an oral ibuprofen challenge were negative. We conclude that deficiency of factor I may predispose to aseptic, as well as pyogenic bacterial, meningitis.

Efficacy and safety of nedocromil sodium ophthalmic solution in the treatment of seasonal allergic conjunctivitis

To assess the efficacy and safety of twice-daily administration of nedocromil sodium 2% ophthalmic solution, we performed a multicenter study involving 140 patients with seasonal allergic conjunctivitis. Subjects had a history of seasonal allergic conjunctivitis and positive results of a skin test to ragweed. The trial coincided with the peak ragweed pollen season at five treatment centers. Patients treated with nedocromil sodium had improvements in symptoms with statistically significant reductions recorded for eye itching (P less than or equal to .04), conjunctival injection (P less than or equal to .001), and overall disease severity (P less than or equal to .001) as compared to the placebo-treated group. Adverse events were minor and transient. We concluded that nedocromil sodium 2% ophthalmic solution administered twice daily is effective in relieving major symptoms associated with seasonal allergic conjunctivitis.

SCH 434: a new antihistamine/decongestant for seasonal allergic rhinitis

In a double-blind, multicenter study, we compared the effects of SCH 434 (Claritin-D; Schering Corp., Kenilworth, N.J.), a new sustained-release, combination antihistamine/decongestant medication, with the effects of its individual components and placebo in 435 patients with seasonal allergic rhinitis. SCH 434 contains 5 mg of loratadine, a nonsedating antihistamine, and 120 mg of pseudoephedrine as the decongestant component. Administered twice daily in this study, SCH 434 effected a 50% decrease in total symptom scores at day 4 and was significantly (p less than or equal to 0.03) more effective than the components alone or the placebo. Loratadine or pseudoephedrine alone, with 43% and 33% decline in symptom scores, respectively, also was more effective than placebo (p less than 0.05). As expected, pseudoephedrine alone was more effective than loratadine (p less than 0.01) in relieving nasal stuffiness; SCH 434 was more effective (p less than or equal to 0.01) than placebo and loratadine in relieving nasal stuffiness. All treatments were safe and well tolerated, although insomnia and dry mouth were noted in a significant number of patients who received either SCH 434 or pseudoephedrine. No serious side effects were noted. The incidence of sedation did not differ significantly among the four treatment groups. We conclude that SCH 434 is a safe and effective treatment for symptoms of seasonal allergic rhinitis. The combination drug (SCH 434) was better than its components for some, but not all, symptoms.

Bronchial asthma, nasal polyps, and aspirin sensitivity: Samter's syndrome

The historic triad of bronchial asthma, nasal polyposis, and intolerance to aspirin and related chemicals, recently designated as Samter's syndrome, is an inflammatory condition of unknown etiology and pathogenesis. The condition is probably acquired, perhaps secondary to a viral infection, but a hereditary factor may be important in some patients. Most patients with this syndrome are adults, with an occasional case being identified in a teenager or older child. Although not every patient will have the fully developed syndrome, the typical patient will have all three of the classic features. Many patients with Samter's syndrome also have a marked eosinophilia of both bronchial and nasal secretions as well as the circulating blood. Approximately 10 per cent of the patients have urticaria and/or angioedema, alone or in combination with respiratory inflammation. The diagnosis usually can be established easily on the basis of the history and physical examination, and only rarely in clinical practice is it necessary to perform a confirmatory aspirin challenge test. As with all allergic diseases, the cornerstone of treatment is environmental control with avoidance of respiratory irritants, aspirin, and aspirin-like medications. Management of upper airway disease requires careful prescription of medication supplemented by judicious selection of surgery. A variety of medications, including bronchodilators and corticosteroids, can be used to treat the bronchial symptoms. The results of current research are expected to lead to better understanding followed by further improvements in treatment for patients with Samter's syndrome.

IgE-mediated sensitivity to Trichophyton rubrum in a patient with chronic dermatophytosis and Cushing's syndrome

Persistent Trichophyton rubrum infection has been observed previously in association with Cushing's syndrome. In this article, we demonstrate IgE-mediated sensitivity to Trichophyton in a patient with chronic dermatophytosis secondary to Cushing's syndrome. Cell-mediated immunity was absent, but Trichophyton extract produced an immediate skin response and also stimulated a concentration-dependent histamine release from basophils of the patient. After adrenalectomy, cell-mediated immunity to Trichophyton was restored, and infection was confined to the nails. Skin and leukocyte sensitivity to Trichophyton extract persisted and was even more pronounced than the sensitivity before adrenalectomy. RAST measurement confirmed the presence of Trichophyton-specific IgE after adrenalectomy. These results provide further evidence that IgE-mediated inflammatory events may be initiated by Trichophyton infection.

Sulindac inhibits bumetanide-induced sodium and water excretion

In an open-label pilot study, we investigated the effect of sulindac on bumetanide-induced diuresis. Nine healthy volunteers were placed on diets with a standard sodium and potassium content. Each volunteer received 1 mg bumetanide orally, and blood and urine samples were collected during an 8-hour period. Urinary losses were replaced isovolumetrically with intravenous normal saline solution. Creatinine clearance and sodium and potassium excretion were compared with and without sulindac pretreatment (200 mg administered orally b.i.d. for 5 days). Sulindac pretreatment resulted in a 22% decrease in the mean cumulative sodium excretion after 3 hours (p less than 0.05) and a 21% decrease in the mean urine flow rate after 2 hours (p less than 0.05). The results suggest that sulindac has an effect on the kidney similar to that of other nonsteroidal agents.

The molecular basis for genetic deficiency of the second component of human complement

Genetic deficiency of the second component of complement (C2) is the most common complement-deficiency state among Western Europeans and is frequently associated with autoimmune diseases. To examine the molecular basis of this deficiency, we established cultures of blood monocytes from four families with C2-deficient members. Using a hemolytic-plaque assay, [35S]methionine metabolic labeling of proteins in tissue culture and immunoprecipitation, RNA extraction and Northern blot analysis, and DNA restriction-enzyme digestion and Southern blot analysis, we found that C2 deficiency is not due to a major gene deletion or rearrangement but is the result of a specific and selective pretranslational regulatory defect in C2 gene expression. This leads to a lack of detectable C2 mRNA and a lack of synthesis of C2 protein. The approach used in this study should prove useful in examination of other plasma protein deficiencies, especially those in which the deficient gene is normally expressed in peripheral-blood monocytes or tissue macrophages and in which ethical considerations preclude the use of liver or other tissue for study.

Fatal panniculitis

The Weber-Christian syndrome (relapsing nodular panniculitis) displays a clinical spectrum varying from short, self-limited, or intermittent disease episodes to persistent disease with fatal outcome. Inflamed adipose tissue is exclusively subcutaneous in some patients and is both subcutaneous and perivisceral in others. Inflammation of fat may induce a focal cutaneous or a systemic extracutaneous histiocytic proliferative response in which hemophagocytosis may be a frequent characteristic. Major causes of death--sepsis, hepatic failure, hemorrhage, and thrombosis--are identical in the patients with and without the systemic histiocytic proliferation. Inflammation in fat, of and by itself, may be associated with significant morbidity and mortality, regardless of specific histopathology or inciting factors.

Panniculitis associated with cutaneous T-cell lymphoma and cytophagocytic histiocytosis

A 36-year-old woman had a 6-year history of recurrent panniculitis with development of an angiocentric and angiodestructive cutaneous T-cell lymphoma (CTCL) of the helper cell phenotype. She subsequently developed a rapidly progressive fatal syndrome characterized by cytophagocytic histiocytosis and hyperlipidaemia. Cytophagocytic histiocytosis has previously been reported in association with panniculitis, malignancy and infection, but not with CTCL and the precise relationship between panniculitis, CTCL, cytophagocytic histiocytosis and hyperlipidemia is unclear.

Decreased C5b67-inhibitor activity in two families with hereditary functional deficiency of the eighth component of complement

In addition to its role in hemolysis and host defense against Neisseria infection, the eighth component of human complement (C8) is one of several plasma proteins that are C5b67-inhibitors (C5b67-INH). The recent identification in our laboratory of two new families with hereditary deficiency of C8 provided an opportunity to study further the role of C8 as a C5b67-INH. Based on mixing and reconstitution experiments, the deficiency of C8 seemed to be due to a selective lack of the C8 beta-chain in one family and the C8 alpha-gamma subunit in the other family. Sera from individuals homozygous for the C8 abnormality were substantially deficient in C5b67-INH activity as well as totally deficient in hemolytic activity. Sera from control individuals possessed approximately 2500 C5b67-INH U/ml, whereas sera from the C8-deficient individuals had markedly depressed C5b67-INH activity, with a mean of only 428 U/ml. C5b67-INH activity was completely reconstituted in C8-deficient serum by the addition of purified human C8. We conclude that C8 constitutes the substantial majority of the C5b67-INH activity of normal human serum.

Decreased C5b67-inhibitor activity in two families with hereditary functional deficiency of the eighth component of complement

In addition to its role in hemolysis and host defense against Neisseria infection, the eighth component of human complement (C8) is one of several plasma proteins that are C5b67-inhibitors (C5b67-INH). The recent identification in our laboratory of two new families with hereditary deficiency of C8 provided an opportunity to study further the role of C8 as a C5b67-INH. Based on mixing and reconstitution experiments, the deficiency of C8 seemed to be due to a selective lack of the C8 beta-chain in one family and the C8 alpha-gamma subunit in the other family. Sera from individuals homozygous for the C8 abnormality were substantially deficient in C5b67-INH activity as well as totally deficient in hemolytic activity. Sera from control individuals possessed approximately 2500 C5b67-INH U/ml, whereas sera from the C8-deficient individuals had markedly depressed C5b67-INH activity, with a mean of only 428 U/ml. C5b67-INH activity was completely reconstituted in C8-deficient serum by the addition of purified human C8. We conclude that C8 constitutes the substantial majority of the C5b67-INH activity of normal human serum.

Frequency of anaphylactoid reactions during intravenous urography with radiographic contrast media at two different temperatures

One hundred randomly selected patients undergoing routine excretory urography were assigned in double-blind fashion by alternate entry pairs to receive radiographic contrast media at 37 degrees C (Group I) or room temperature (Group II). There were three anaphylactoid reactions and five nonanaphylactoid reactions in Group I, and five anaphylactoid and eight nonanaphylactoid reactions in Group II, differences that were not statistically significant. No differences were detected between reactors and nonreactors. Thus, in this study, infusion temperature had no effect on the frequency of adverse reactions to radiographic contrast media during excretory urography.

Renal transplantation in a patient with hereditary deficiency of the second component of complement

The HLA haplotype A 10,B18 has been associated with hereditary deficiency of the second component of complement(C2). In an effort to detect individuals homozygous for C2 deficiency, a thorough audit of HLA serotyping results in 3,100 individuals was performed, and a single patient homozygous for the A10, B18 haplotype was identified. Detailed complement studies in this patient's serum and plasma revealed previously undetected selective absence of C2 antigen and haemolytic activity, and a hereditary basis for this deficiency was indicated by half-normal levels of C2 haemolytic activity in both of his children. The patient was of special interest in that he had previously developed renal failure which was treated by cadaver kidney transplantation. C2 antigen was undetectable in serum and plasma samples taken prior to and up to 9 months following transplantation. This experience suggests that HLA serotyping can be a valuable screening technique for the detection of individuals with C2 deficiency, and that renal transplantation does not reconstitute normal levels of C2.

Inherited deficiency of the ninth component of complement in man

A 76-year-old man was found to have low (33% normal) serum complement (C) hemolytic activity, although C3 and C4 protein levels were normal. Further evaluation of his serum and plasma indicated that all C components were present in normal or elevated amounts except for C9, which was undetectable by both antigenic and functional assays. Addition of purified human C9 led to full restoration of the hemolytic activity. Family studies demonstrated that the deficiency was inherited as an autosomal codominant trait and was not linked with alleles at the HLA-A or HLA-B loci. The patient had no history of recurrent or unusual infections and no evidence of autoimmune disease. The availability of serum totally lacking in C9 permitted an investigation of the lytic capacity of the C5b-8 segment of the C attack mechanism, which was pursued in kinetic studies on the hemolysis of erythrocyte intermediates. These studies indicated that hemolysis occurred approximately 100 times slower in patient than in normal serum, using either EA or EAC1-7 intermediates as target cells. Serum bactericidal activity also was slower in patient serum, occurring at a rate about 1/35 that observed in normal serum. These studies provide direct independent evidence that cytolysis of erythrocytes and bacteria can be mediated by C5b-8, and allow a quantitative estimation of the increment in the rates of these reactions provided by normal serum levels of C9. The presence of readily detectable though slow hemolytic activity of C9-deficient serum may account for the difficulty in identifying individuals with this defect.

Inherited deficiency of the ninth component of complement in man

A 76-year-old man was found to have low (33% normal) serum complement (C) hemolytic activity, although C3 and C4 protein levels were normal. Further evaluation of his serum and plasma indicated that all C components were present in normal or elevated amounts except for C9, which was undetectable by both antigenic and functional assays. Addition of purified human C9 led to full restoration of the hemolytic activity. Family studies demonstrated that the deficiency was inherited as an autosomal codominant trait and was not linked with alleles at the HLA-A or HLA-B loci. The patient had no history of recurrent or unusual infections and no evidence of autoimmune disease. The availability of serum totally lacking in C9 permitted an investigation of the lytic capacity of the C5b-8 segment of the C attack mechanism, which was pursued in kinetic studies on the hemolysis of erythrocyte intermediates. These studies indicated that hemolysis occurred approximately 100 times slower in patient than in normal serum, using either EA or EAC1-7 intermediates as target cells. Serum bactericidal activity also was slower in patient serum, occurring at a rate about 1/35 that observed in normal serum. These studies provide direct independent evidence that cytolysis of erythrocytes and bacteria can be mediated by C5b-8, and allow a quantitative estimation of the increment in the rates of these reactions provided by normal serum levels of C9. The presence of readily detectable though slow hemolytic activity of C9-deficient serum may account for the difficulty in identifying individuals with this defect.

Inherited deficiency of second component of complement and HLA haplotype A10,B18 associated with inflammatory bowel disease

A patient with inflammatory bowel disease and sacroiliitis had haplotypes A10,B18 and Aw32,b18 at the major histocompatibility locus. Serum total complement and C2 hemolytic complement activities were undetectable; levels of the remaining C1-C9 components were normal. The parents, both siblings, and a child each had half-normal levels of C2 and either the A10,B18 or the Aw32,b18 hla haplotype. In a second unrelated family, an only child and both parents developed inflammatory bowel disease. The father and child had HLA haplotype A10,B18, but, along with the mother, each had normal serum levels of hemolytic C and C2. Homozygous C2 deficiency, often in association with the A10,B18 haplotype, has previously been linked with various autoimmune diseases and with propensity to infection. Our findings suggest that C2 deficiency or this haplotype also may predispose to inflammatory diseases of the intestine.