Thymomodulin in management of food allergy in children.

We studied 44 children, 7 months to 14 years old (15 males and 29 females), diagnosed for food allergy from the symptomatology, anamnestic data information, physical examination, determination of IgG/IgA/IgE plasmatic levels, and the application of the Prick test and RAST. The anamnestic data revealed a high prevalence of cow's milk feeding during the first 6 months of life, and a high incidence of allergies in the family, the mother being the most frequently affected relative. The children had a low IgA plasmatic level (56.78 +/- 6.3 mg%) and a high IgE plasmatic level (389 +/- 35 U/ml). RAST proved to be positive only in 28% of the subjects; the Prick test showed a better correlation with the symptomatology. The children were divided into groups A and B and submitted to an exclusion diet for 6 months, group B receiving oral Thymomodulin. At the end of this treatment period, a better food tolerance was achieved in the group of children treated with Thymomodulin combined with the exclusion diet. The oral challenge which induced a relapse of clinical symptomatology in 68% of the subjects in group A, induced it in only 29% of the subjects in group B. Furthermore, clinical manifestations were less severe in group B. In the group B children, the IgE plasmatic level showed a significant decrease (228 +/- 6 U/ml) (p less than 0.005), and the IgA plasmatic level rose to 98.35 +/- 8 mg% (p less than 0.01). No modifications were observed in the other immunological parameters studied. It is concluded that oral Thymomodulin combined with an exclusion diet was very effective in preventing food allergy relapses.

[A thymus extract (thymomodulin) in the prevention of childhood asthma]. / Un estratto di timo (Timomodulina) nella profilassi dell'asma infantile.

41 children aged 2-12 years affected with bronchial asthma, have been treated orally with a thymus extract for three months (sep.-oct.-nov. 1980); a further period of treatment has been repeated during the month of March 1981. The following immunologic tests have been performed before therapy, 2 months after therapy withdrawal and 12 months after the second therapeutical discontinuance: plasmatic immunoglobulins (P. Ig), C3-C4 complement's factors, E-rosette forming cells (both active and total), surface immunoglobulins (IgS), PHA lymphocyte stimulation. Periodic anamnestic and clinical controls of patients revealed a significant reduction of asthmatic attacks during the months of observation, in comparison with the crises remarked in the same period of the previous year (the mean number of crises per child being 6 and 0.7 respectively before and after treatment, P less than 0.001). The immunologic tests, despite the clinical results, did not show significant modifications at the 1st control. Nevertheless the control carried out 12 months after the second therapeutical withdrawal demonstrated: IgG and IgM plasmatic levels significantly increased (1097 +/- 63 vs 906 +/- 45 and 122 +/- 10 vs 104 +/- 10 respectively, P less than 0.02) while IgE, C3-C4 plasmatic levels significantly decreased (232 +/- 57 vs 396 +/- 71, 132 +/- 6 vs 162 +/- 7, 22 +/- 2 vs 30 +/- 2 respectively, P less than 0.005). No side effects have been seen in all the patients treated.

[Is it possible to improve the prognosis of congenital nephrosis?]. / E' possibile migliorare la prognosi della nefrosi congenita?

Two cases of congenital nephrotic syndrome (C.N.S.) with a prolonged survival are related. The AA. outline some clinical and immunological features which are already known but not currently employed to therapeutic ends. Probably due to metabolic disorders, the biological and clinical hypothyroidism is a prominent problem which worsens either poor skeleton maturation or neurological development of these patients; adequate doses of thyroid hormone produced a marked increase of the muscular tone, skeleton maturation and neuropsychological development in both patients. Periodic plasma administration (2-3 times monthly) during the first year of life, and a great care to avoid all extra-family contacts and infections in the same period, resulted to be the prevalent reason of the prolonged survival of these children (the plasma acting as a source of proteins and immunoglobulins). The immunologic assessment demonstrated in both children as marked depression of T-cells number and function, besides a hypogammaglobulinemia. This aspect of the immunocompetent system is similar in C.N.S. and nephrotic syndrome of the aged children and perhaps could approach the pathogenesis of the two diseases. The cases related demonstrate that a better assistance is possible and necessary in order to obtain the longest survival of these patients and therefore the best results in dialitic treatment and in transplantation programs.

[Diagnostic and therapeutic problems in lupus nephritis]. / Il problema diagnostico e terapeutico della lupus-nefrite.

A review of the SLE in the paediatric age in performed to underline the peculiarity of the disease in children: age, frequency, symptomatology, renal histology, clinical course, therapy and correlated side effects are reported according to literature data. The A.A. describe six cases of lupus nephritis, observed in the last few years, which confirm the diagnostic difficulties and the wide variety in the evolution of the disease. A favourable course of the disease was obtained in three cases, with corticosteroid and immuno-depressive treatment (used in association and/or alternatively); a fourth case developed some therapeutic complications among which an avascular bilateral bone necrosis, leucopenia, alopecia and herpes zoster. In two cases the SLE led to chronic renal failure owing to many relapses of the disease, enhanced by therapeutic break or dosage reduction. A careful surveillance of these patients is of fundamental importance in the management of the disease in order to obtain the longer survival and the lesser side effects.

[Alport syndrome: 15-year follow-up in 28 cases]. / La sindrome di Alport: follow-up di 15 anni in 28 casi.

Twenty-eight patients aged from 18 mo. to 23 y. (at the onset of the diseases) affected by Alport's syndrome (AS), were studied during last 15 years. The mean time of observation was 10 +/- 0.7 years. Two cases progressed to renal failure at 15 and 21 years respectively, while 26 patients have normal renal function within the 2a decade of life. The diagnosis of hereditary nephritis (AS) was based on the following criteria: Existence of affected kindred. Perceptive deafness. Basal membrane ultrastructural abnormalities. A late exact diagnosis was made in some patients without ascertainable familiarity and without early ultrastructural glomerular study. Perceptive deafness occurred chiefly after 6-8 years of life, increasing the diagnostic difficulties. Isolated hematuria was present in 18 cases (64%) and associated proteinuria (or NS) in 10 (36%). Recurrent otitis media worsened the hearing loss in 5 cases (17.83%). An immuno-allergologic study was carried out because of the great frequency of allergic diseases, respiratory mainly. A significative decrease of plasmatic and secretory IgA was observed in those patients who underwent to recurrent otitis media. The features suggestive of AS in our patients, in addition to the familiarity, were gross haematuria in childhood and diffuse GBM splitting and splintering. Heavy proteinuria and nephrotic syndrome associated to early deafness and to male sex indicate a poor prognosis; but several females also can be affected by serious course of the disease.

[Study of factors affecting the renin-angiotensin-aldosterone system in the premature infant]. / Studio dei fattori che influenzano il sistema renina-angiotensina-aldosterone (RAA) nel bambino prematuro.

Renin-angiotensin-aldosterone system (RAA), Na-K dietary intake and Na-K urinary excretion in 36 premature babies have been investigated. The plasmatic renin activity (PRA) and plasmatic aldosterone level (P-aldo) resulted significantly increased in comparison with children previously studied, 20 days - 23 months old (p less than 0,01). P-aldo demonstrated, in premature babies, a negative correlation with Na-K intake and urinary excretion (p less than 0,001 and less than 0,01 respectively); in the groups nourished with maternal milk or "adapted" formulae P-aldo mean value was significantly more elevated than in the group nourished with formulae "unadapted" (p less than 0,01). A different Na dietary intake seems to be the most important factor influencing P-aldo level also in premature babies. No correlation between PRA - electrolyte excretion was found in any group. The main factor influencing PRA seems to be the age of infants as well as, probably, other hemodynamic mechanisms.

[Arterial hypertension in childhood. Study of a school population]. / L'ipertensione arteriosa in età pediatrica. Studio di una popolazione scolastica.

Most Authors fix the upper limits of normal blood pressure at 90 degrees percentile according to age. Nevertheless in their investigations different instruments were used and they often didn't relate in detail the position of the subject during the measurement. Other factors, influencing blood pressure values, have been often left out: relation with meals, room temperature, pain, drugs, stress, etc. The prevalence of hypertension in pediatric age in literature is 0,6 - 12,4% with several intermediate values. The first very important research concerning the hypertension in pediatric age was carried out by Londe et Coll., conducted among 1593 children (785 males and 798 females); they estimated mean values and percentiles according to age and sex. In the present study the A.A. saw 346 children (161 females and 185 males), 11-15 years old, observed at school, in a comfortable room. Pressure measurement was done twice in the same morning with half an our interval. Systolic pressure, 4 degrees and 5 degrees Korotkoff tones, was noticed. 11% of the children had systolic pressure values under 50 degrees percentile, 35,3% between 50 degrees and 90 degrees percentile and 43,1% had values equal or greater than 90 degrees percentile at the first measurement. The third group went down to 30,6% (106 cases) at the control (after an half an hour). This reduction shows the importance of the emotional factors in the P.A. variations. The 106 children who had systolic and/or diastolic values equal or greater than 90 degrees percentile were controlled again after a week. 92 maintained the same values. They were called for the third sitting 1-6 months later. 45 subjects agreed to our invitation and it was possible to point out that high blood pressure values persisted in 31 children (that is 8,9% of all examined cases). Following correlations were observed: body weight-blood pressure values (either systolic or diastolic ones) and so cutaneous plica-pressure values (p less than 0,01); moreover 50% of the 31 hypertensive children had hypertensive parents; the most frequent subjective symptom (13 cases) was cephalalgia. None of the studied school children showed either clinic or biochemical abnormal data, so that it was possible to define their hypertension as "essential".

[Asymptomatic microhematuria]. / La microematuria asintomatica.

Microscopic haematuria is an urinary finding more and more frequently observed in routine analysis in childhood; the diagnostic problems, most of which unresolved, are yet the principal questions of concern. We have studied 123 patients during five years from 1975 to 1980, and followed them for 1-8 years (mean 4 years). Our experience allowed us to consider "normal" or without remarkable pathologic significance a urinary finding less than or equal to 5.000 RBC/m' at the Addis count. Such findings were pointed out in 55 cases (44%); 27 patients (22%) had 5-10.000 RBC/m', 34 cases (27,6%) presented 10-50.000 RBC/m' and 7 cases (5,7%) had more then 50.000 RBC/m'. The familiar background, the clinical, biological and immunological data, the roentgenographic investigations and the renal biopsy carried out in the 4 groups of patients, led us to the following conclusions: 1) 26% of the 123 cases had a "unexplained;; microscopic haematuria with complete lack of anamnestic data, symptomatology and with normal biological findings. 2) in 65,8% of the cases it was possible to discover frequent upper respiratory tract infections (and allergy in 5,6% of them). 3) in 26% of the patients we discovered a previous or actual genito-urinary (10,5% and 15,5% respectively) infection: 9,4% of 96 urography demonstrated a variable degree of nephro-urological abnormalities. 4) 23 children (18,7%) was selected for renal biopsy, primarily by the hypocomplementemia and positive anti-DNA ab. test, and secondly by elevated degree of microhematuria. The histological and immunohistochemical studies demonstrated the presence of mesangial proliferation glomerulonephritis with IgG-IgA-C3 deposits in 7 cases (30% of the cases biopsied and 5,6% of the total), 69,6% of the cases had only minimal charges with negative immunofluorescence. 5) A mean follow-up of 4 years in two groups of patients (less than or greater than 6 years of age) has demonstrated that microscopic haematuria remains unchanged in 18-19% of both groups. A more marked improvement or normalization has been documented in the children more than 6 years aged (p less than 0,001) while a worsening has been observed in the children less than 6 years aged (p less than 0,005), with a statistically significant difference between the two groups considered.

[Correlation between plasma IgE and IgA in infant nephrosis and nephrotic syndrome]. / Correlazioni fra IgE e IgA plasmatiche nella nefrosi infantile e nella sindrome nefrosica.

A study on IgE - IgA plasmatic level has been carried out in the acute phase and in remission of minimal changes nephrosis (MCN) and in glomerulonephritis with nephrotic syndrome (NS). The results obtained are the following: 1) Mean values of Ig classes were impaired in comparison with the normal values of children of the same age, both in MCN and in NS. 2) IgE were increased, particularly in children over 6 years in the MCN acute phase; the values decreased within normal after the remission was achieved. 3) IgA, on the contrary, were decreased in the subjects over 6 years, in the MCN acute phase. 4) No significant correlation was found between the two Ig classes. 5) The modifications of the Ig plasmatic level during the remission, after corticosteroid therapy was characterized by IgE reduction; IgA were only slightly, but not significantly, decreased in the same phase.

[Evaluation of atopy risk factors during the first year of life. Multicentric study]. / Valutazione dei fattori di rischio di atopia nel 1 degree anno di vita. Ricerca policentrica.

The AA studied 406 newborn babies during the 1st year of life in order to verify the correlation between atopy risk factors and the appearance of early symptoms, particularly gastroenteric (GE). The results obtained did not demonstrate a significant difference concerning the blood cord IgE level and subsequent appearance of food allergy symptoms, whereas positive familiarity showed a better correlation. No significant difference was observed between breast--or formula--fed infants, or between those weaned before or after the 5th month of life. The comparison of dietary regimen adopted during the 1st quarter in the asymptomatic and atopic children respectively, demonstrated that the presence of predisposing factors influences the appearance of GE symptoms much more than the diet in itself. An allergologic study, randomly performed by Prick-test in 156 cases and by RAST in 200 cases, showed a prevalent, positive response with RAST technique in symptomatic children.