Development of food allergies with special reference to cow's milk allergy.

Using strict criteria, the incidence of cow's milk sensitivity is probably 1% to 2% during the first 2 years of life. Although there is a wide spectrum of sensitivity symptoms caused by cow's milk, two major groups of infants are discernible. One group consists of infants who react to small amounts of cow's milk within a few minutes up to one hour, usually with gastrointestinal symptoms or urticaria. These infants are often atopic and have positive findings on skin prick tests and radioallergosorbent test (RAST) reactions to cow's milk allergens. The other group consists of children whose reaction to cow's milk occurs one hour or longer after intake of cow's milk or cow's milk-based formula. These reactions are usually not immunoglobulin (Ig)E-mediated and different immune and nonimmune mechanisms probably cause the symptoms. The risk of developing cow's milk sensitivity seems to be influenced by the atopic constitution of the infant and the age at which cow's milk is introduced. Early exposure to cow's milk increases the risk, not only of adverse reactions to this milk but also of developing allergies to other foods. It is suggested that early introduction of cow's milk may enhance the risk of future respiratory allergies. Allergists are still not in agreement as to whether the weaning process should be rapid or should consist of a gradual change from breast milk to cow's milk in order to minimize the risk of cow's milk allergy.

Serum-levels of lactoferrin, lysozyme and myeloperoxidase in normal, infection-prone and leukemic children.

Serum levels of lactoferrin, lysozyme and myeloperoxidase have been established in 31 healthy children. On average, serum lactoferrin was 330 micrograms/1, serum lysozyme 1638 micrograms/1 and serum myeloperoxidase 174 micrograms/1. Serum myeloperoxidase was, on average, significantly higher in children than in adults (p = 0.01), whereas serum lactoferrin and serum lysozyme were equal to those of adults. In a group of infection-prone children (n = 31), both serum lactoferrin and serum myeloperoxidase, but not the serum lysozyme levels, were significantly lower (p less than 0.001 and p = 0.002, respectively) than those of the reference children in spite of normal intracellular contents and even somewhat higher peripheral blood polymorphonuclear counts. Based on the assumption that serum lactoferrin and serum myeloperoxidase reflect turnover and activity of neutrophil granulocytes, the findings could suggest reduction in these respects and could be one contributing factor to the high infection propensity of these children. Serum levels of the three proteins have also been measured in 10 children with suspected or various forms of manifest leukemia. It is suggested that the levels reflect turnover and stage of maturation of the myeloid and monocytic cells and could, therefore, aid in the understanding and diagnosis of these diseases.

Multiple aneurysms of visceral arteries in a child with polyarteritis nodosa.

A 9-yr-old boy with polyarteritis nodosa presented a ruptured ileocolic arterial aneurysm that was resected and ligated at emergency operation. After angiographic examination showing multiple aneurysms of visceral arteries the inferior mesenteric and the common hepatic arteries were also ligated. One year postoperatively and on steroid medication the child is symptomfree with normal laboratory data.

Is prevention of allergy and asthma possible?

UNLABELLED: Allergy and asthma are common diseases today. Ways to stop the ongoing increase in incidence of these diseases are highly desired. In this review the scientific basis for allergy and asthma prevention is discussed. RESULTS: Although secondary preventive measures are generally regarded as important, the views regarding the possibility of primary prevention vary. There is today only weak evidence that breastfeeding may reduce the risk of developing allergy, and if it does the effect is limited in degree and duration. There is some evidence that prolonged breastfeeding reduces the risk of developing asthma, at least in allergy-risk infants. There is also some evidence indicating that withholding solid foods in children at risk may have a beneficial effect. A dose-dependent risk of becoming sensitized to house dust mite and pet animal allergens has clearly been shown, but to what extent this sensitization is combined with asthma or clinical allergy is less well elucidated. Passive smoking increases the risk of wheezing problems and the indoor environment in damp houses seems to act synergistically with passive smoke. CONCLUSION: Primary prevention is rarely possible, but the risk of developing asthma and allergy may to some extent be reduced by taking certain measures, such as avoidance of tobacco smoke and damp houses. Breastfeeding seems to reduce the risk of wheezing, but as allergy-preventive measures, breastfeeding and avoiding pet animals have only marginal effects.

[Fatal and severe food hypersensitivity. Peanut and soya underestimated allergens]. / Letala och svåra reaktioner av livsmedel. Jordnöt och soja underskattade allergen.

Severe allergic reactions caused by foodstuffs have been reported in Sweden since 1993, 60 cases, five of them fatal, occurring during the first 3-year period. More than 70 per cent of all reactions reported were caused by patients, soya beans, nuts or almonds. In only 13 per cent of reported cases were the patients over 17 years of age. Several severe reactions were caused by soy protein, and mainly in children and adolescents with extremely severe peanut allergy and asthma. In many cases, severe symptoms first appeared more than one hour after soy intake. The report suggests soy allergy to be associated with an underestimated risk of severe reactions.

[Can asthma deaths in young people be predicted and prevented?]. / Kan astmadöd hos unga förutses och förebyggas?

UNLABELLED: In spite of increased asthma prevalence, the mortality in the disease has decreased during the last two decades in Sweden and in some other countries. However, in the age group 15-24 years an increased death rate was noted at the end of the 1980s. Therefore we started a prospective study from 1994 with the aim of trying to analyse the precipitating factors of all deaths in the ages 1-34 years in which the death certificate alleged asthma or anaphylaxis as the main or contributing cause of death. We conducted a confidential telephone enquiry of the next of kin of the deceased using a modified questionnaire developed by the British Thoracic Association. When available, patient records and post mortem protocols were obtained. RESULTS: The mortality in asthma in the ages 1-34 years has decreased from around 5 per million/year to 0.5/million/year over the period 1987-1998. The main preventable factors found in this analysis are undertreatment, non-compliance, psychosocial factors including alcohol/drug abuse, food allergy and inhalation allergy. Lacking awareness of the risks and underestimation of the severity of the asthma both by the physician and the patient seem to be dominating factors.