Allergic pathogenesis in chronic bronchitis.

Chronic bronchitis is a disease related to numerous etiologic factors: infections, climate influence, air pollution, cigarette smoking, etc. From a pathogenetic point of view, chronic bronchitis is generally considered as the phlogistic resultant of various irritative conditions, with a characteristic neutrophil component in the phlogistic pattern. Microbic involvement has up to now been considered a very important factor, with consequent wide utilization of antibiotic agents in basic therapy. Considerations of clinical nature induced us to consider unsatisfactory such pathogenetic concepts based on neutrophil phlogosis, while the involvement of an allergic mechanism became more acceptable. In order to solve this problem, we have carried out hitological studies on postmortem material from the respiratory tract of individuals whose death was attributable to chronic bronchitis or to concurrent chronic bronchitis. Results of our study conducted up to now on 60 cases may be summarized as follows: Bronchitis with lymphomonoplasmacytoid phlogosis of immunoallergic type (60%), bronchitis with neutrophil phlogosis of irritative-infective type (20%); bronchitis with mixed allergic-neutrophil phlogosis (20%). Lymphocytes, monocytes and plasma cells are directly involved in allergic tissue reactions, both of immediate and delayed type because they release active substances such as hsitamine, bradyquinine, quinine, etc., which will their multiple pharmacodynamic actions are responsible of various anatomic and functional changes in hypersensitivity. Infiltration of the bronchial mucosa with lymphomonoplasmacytary cells in chronic bronchitis, has a pattern of mixed allergic phlogosis of immediate and delayed type. Prophylaxis and management of chronic bronchitis should therefore be set up on new bases, with the various treatments used for hyperactive pathology.

Allergy and experimental chronic broncho-pneumopathy.

House dust is a mixture of specific and non-specific stimulating factors. More particularly it contains a wide range of irritating factors, antigens, responsible for the production of immediate and delayed allergic reactions, moulds, microbes, etc. It may therefore be understood that inhalation of house dust induces in the respiratory tract of treated rats various reactive pictures. These pictures are, however, dominated by immuno-allergic reactions. Immuno-allergic reactions are manifested by the dominant increase in plasma cells and lymphocytes. This increase generally occurs in the vicinity of connective tissue macrophages containing numerous dust granules, as if macrophagic digestion formed more active antigens from the dust. Sometimes in the proximity of these plasma cell aggregates, mast cells in the degranulation phase are observed. The release of histamine, serotonin, etc. which occurs with mast cell degranulation produces the intense tissue edema which is observed in these areas. An infiltration with eosinophils is also observed here probably drawn to the site on account of their protective, enzymatic, antihistaminic action. The morphological picture thus indicates the co-existence of two allergic reactive movements: one of the immediate type, the other of the delayed type linked to specific allergens of the mixture of antigens present in house dust. The stimulus of the inhalation of house dust also includes the possible action of microbes, irritants, etc. which produce regressive changes in the tissue, attract polymorphs and stimulate the proliferation of fibroblasts so that more or less wide area of tissue undergo a fibrous transformation. Such changes may be found in the pulmonary parenchyma as well as in the bronchial mucosa. The concordance of these findings with those of chronic bronchitis in man appear sufficiently important to attribute, a predominantly allergic pathogenesis to both pathological conditions. This concept obviously does not exclude other etiopathogenetic factors which under certain environmental or constitutional conditions, may in various degrees be also included in the overall picture of respiratory tissue reactivity.

Alternaria allergy: a three-year controlled study in children treated with immunotherapy.

In this prospective controlled study, 39 children with Alternaria-induced asthma and/or rhinitis were followed-up over a 3-year period. Skin tests and RAST were positive to Alternaria tenuis only. All children were treated with specific Alternaria immunotherapy. The long-term results have shown that immunotherapy was successful in 80% of the children given more than 80.000 PNU. By contrast, the outcome of 40 selected controls also followed during the same period who did not receive immunotherapy was almost exactly the opposite. In addition to demonstrating the clinical effectivity of specific Alternaria immunotherapy, the authors stress the relationship between successful results, highest tolerated doses, and larger cumulative dosage, which is irrespective of the duration of the therapy.

[Therapy of allergic rhinitis in childhood]. / Zur Therapie der allergischen Rhinitis im Kindesalter.

Allergic rhinitis is the most common of all allergic disorders. After summarising the clinical features and diagnostic approach with regard to differential diagnosis, we will discuss the therapeutic modalities. As with all long-term therapy measures, it is essential to persuade both the child and the parents to participate in the treatment and to get their co-operation.

Month of birth and grass pollen or mite sensitization in children with respiratory allergy: a significant relationship.

This report describes a retrospective analysis of the month of birth distribution of 2124 children with respiratory allergy in the Rome district between 1964 and 1985, in comparison with the total live births in the same district over the same period. Of the 2124 children, 1685 had positive skin tests and/or RAST only to mites, and 439 only to grass pollen (P much less than 0.001). A significant relationship was found between grass or mite sensitization and the month of birth. A high proportion of children born in June-September had mite allergy (P less than 0.005), and even higher was that of those born in March-May with grass sensitivity (P much less than 0.005), compared with the total live birth distribution in the Rome district in the same years as the children examined. These results are consistent with the idea that allergy may be associated with a period of susceptibility to sensitization in early infancy.

Systemic mastocytosis in a 5-year-old child: successful treatment with disodium cromoglycate.

Most clinical signs and symptoms of systemic mastocytosis (SM) are attributed to histamine release. We report here a 5-year-old male child with SM, who suffered from the age of 4 months from disseminated skin lesions, vomiting, diarrhoea, abdominal pain, flushing, tachycardia, hypotension, somnolence, and transient blindness, triggered by heat and egg ingestion. Oral disodium cromoglycate (DSCG) or placebo were started in a single blind trial at a dose of 100 mg/kg/day in four divided doses. The child was studied for 21 months during the administration of three courses of DSCG, each of 6 months' duration, interspersed with three 1-month courses of placebo. During treatment with DSCG all the systemic manifestations improved, and the histaminaemia decreased. During the placebo periods the symptoms, signs, and histaminaemia recurred.

Intradermal skin tests with Dermatophagoides pteronyssinus in asthmatic children: correlation with specific IgE and bronchial provocation tests.

The purpose of the present study was to compare the results of the skin tests, the specific IgE levels and bronchial provocation tests in a group of sensitive asthmatic children with a Dermatophagoides pteronyssinus extract standardized by the RAST inhibition method. Skin tests showed a positive 'end point' in twelve children of 0.5 U/ml antigen; in eleven 5 U/ml; seven of 50 U/ml; six of 500 U/ml. Specific IgE was present in thirty-three children (92%). A close relationship between positive skin tests and serum IgE levels was found. Bronchial provocation tests were positive in twenty-eight children (78%): eight children with both positive RAST and positive skin tests had negative bronchial provocation tests.

Double-blind crossover trial with oral sodium cromoglycate in children with atopic dermatitis due to food allergy.

Thirty-one children with atopic dermatitis, aged 6 months to 10 years, were selected for this trial. All had historical, clinical, and laboratory evidences that allergy to food was the cause of exacerbations of eczema. Either oral sodium cromoglycate (SCG) or a matching placebo was administered orally for 8 weeks, followed by the alternative treatment for a further 8-week period. During the first 4 weeks of each treatment period, patients remained on an exclusion diet. During the second 4 weeks, the offending food(s) was reintroduced into the diet. The severity of the eczema and the changes in severity as a result of diet or challenge were measured both by the clinician (using body diagrams) and by parents (using a daily diary card). Analysis of the clinician's scoring and the patient's diary card scores demonstrated a statistically significant difference in favour of SCG, especially in the group where the placebo preceded the active treatment. Sodium cromoglycate does seem to reduce the exacerbations of atopic dermatitis caused by food allergens.

Evaluation of long-term oral administration of a sustained release theophylline preparation in children with chronic asthma.

Over a one-year-period 23 children with chronic asthma were given an oral sustained-release theophylline preparation in twice-daily doses. Constant therapeutic theophylline levels were maintained in 18 children for the whole period, while in 5 subjects the values were in almost all instances below the therapeutic range. In both groups, however, a good clinical effect from the preparation was observed. Only two children reported nausea and mild abdominal pains, whereas other two children had serum theophylline levels above 20 micrograms/ml with no side effects. It is concluded that oral sustained-release theophylline preparation is effective in providing therapeutic drug concentrations on a 12 hr dose schedule, thus avoiding the risk of lower compliance observed in children given normal theophylline tablets.

Results of a milk and/or egg free diet in children with atopic dermatitis.

Food allergy plays an important role in the pathogenesis of atopic dermatitis. Exclusion of eggs and milk from the diet of children during the first few months of life has been proven to significantly reduce the severity of eczema in children aged between 2 and 8 years. We studied the efficacy of exclusion of milk and/or egg from the diet of 59 children with severe atopic dermatitis. A detailed personal and family history was obtained. Total and specific IgE levels were determined on one hand, and intracutaneous tests were evaluated on the other. All allergens suspected of being implicated in the genesis of atopic dermatitis were eliminated from the diet. Clinical improvement was observed in 80% of cases after dietary exclusion. The younger children responded best, and the response to diet was not influenced by the severity of the eczema. No relation was observed between the family history of atopy and response to diet. Neither total nor specific IgE titers presented significant differences when the responder groups were compared.

[Blocking antibodies after specific hyposensitization therapy in asthmatic children (author's transl)]. / Valutazione degli anticorpi bloccanti in bambini asmatici trattati con terapia iposensibilizzante specifica.

The Maunsell-test for the evaluation in vivo of a rise in blocking antibodies after specific hyposensitization therapy was perfomed in 27 children with asthma and/or graminaceous rhinitis. The Authors have found a good correlation between blocking antibodies level and clinical improvement.

A three year controlled study in children with pollinosis treated with immunotherapy.

The clinical course of 87 children with pollen induced rhinitis or both rhinitis and asthma was followed in a prospective controlled study over a three year period. All children were treated with specific IT. The long term results have shown that IT was successful in 94% of children with asthma and rhinitis and 90% with rhinitis given more than 80,000 PNU. By contrast, the outcome of 78 selected controls also followed during the same period who did not receive IT was almost exactly the opposite. In addition to demonstrating the clinical effectiveness of IT, the authors stress the relationship among successful results, highest tolerated doses, and larger cumulative dosage which is irrespective of the duration of the therapy. The authors also discuss whether the children in the control group should be injected with placebo solutions or treated with all available medication.

Effectiveness of oral sodium cromoglycate (SCG) in preventing food allergy in children.

The efficacy of oral SCG in preventing food allergy symptoms in children was investigated. Ten children with cow's milk and/or egg IgE-mediated allergy were selected for this study. The subjects were challenged with the offending food before and after a seven-day pre-treatment period with oral SCG (30 mg/kg b.w. per day). Full protection was achieved in six out of eight children with cow's milk allergy and in four of the five children with egg allergy. The mode of action of SCG in the prevention of clinical manifestations of food allergy is discussed.