The prevalence of asthma and allergic diseases has been increasing particularly in children over the last decades in Western countries. The German reunification allowed to study the effect of 40 years of different environmental and social development on asthma and allergy prevalence in two genetically homogenous populations. In children and young adults, the prevalence of asthma, hay fever and skin test reactivity to common aeroallergens was considerably higher in West Germany as compared to East Germany. The increased prevalence in asthma was explained by the higher allergic sensitization in West Germany.
Exposure to SO2, particulate matter and cars was associated with bronchitis, nonspecific respiratory symptoms and decrements in pulmonary function, but not with asthma and allergy. Atopy was found to be the major factor associated with the inception of asthma. Children who had lived during their first three years of life in East German living conditions and had thereafter been exposed to a rapid Westernization of their environment and lifestyle, showed increased atopy and hay fever while bronchitis decreased, but asthma and bronchial hyperresponsiveness remained unchanged. This points toward a period during early life which determines the development of asthma and which seems to differ from the factors responsible for allergic sensitization.
Since East European living conditions were similar to those in the West decades ago, the same factors could be responsible for the increased allergic sensitization in West Germany and the secular increase in atopic diseases and asthma in the West.
Factors associated with the more modern life style may account for this difference, while the increased levels of SO2 and dust exposure in East Germany were obviously no risk for the development of childhood asthma or allergic sensitization.

View full abstract

Respiratory syncytial virus (RSV) infection is common among infants and young children. RSV infection is often present during a first wheezing episode, bronchiolitis, and later with subsequent recurring episodes of wheezing. It is still a matter of debate however, whether RSV infection is one of the causative triggers of asthma. In animal models it is known that specific portions of RSV proteins induce T-cell (CD4+ T cell or CD8+ T cell, Th₁ or Th₂) subset responses. We saw 344 cases of RSV infection at Chiba Children's Hospital. Among these 344 cases, 35.5% were diagnosed as already having asthma. Children with concurrent RSV infections had the following characteristic; RSV infections occurred to a greater degree in older children, particularly in the three year old age group. Children in this age group exhibited various clinical manifestations which included high frequencies of pneumonia and febrile episodes during acute RSV infections.
Recent literature has revealed that RSV infection induces the production of proinflammatory cytokines and eosinophilic chemotatic factors even in the lower respiratory tract of infants and young children. These facts would suggest that there may be a link between asthma and RSV infection.

View full abstract

Fifteen children (8 boys, 7 girls) were studied on symptoms of exercise-induced anaphylaxis (EIAn), urticaria, dyspnea and loss of consciousness. The causative foods were wheat in 4 cases, crustaceans in 3 cases, grape in 2 cases, and wheat and soybean in one case, but not identified in 2 cases. Six children began to have EIAn under 10 years of age.
They have more frequent family and past histories of major allergic diseases and higher serum IgE levels. The provocation tests with food and exercise to patients showed rash and wheeze but no significant rise of plasma histamine level.
We conclude that the children with EIAn could join acitivities such as lunch, physical activity and sport clubs at school with good medical advice.

View full abstract

Sixteen egg-hypersensitive subjects with high IgE antibody titers for egg white and ovomucoid (OM) were divided into two groups of outgrow (n=9) and persistence of egg hypersensitivity (n=7). Egg hypersensitivity was judged based on the results of double-blinded placebo-controlled food challenges with freeze-dried egg white antigens. We measured specific IgE antibodies for ovomucoid (OM) third domains with (D3 CHO) or without carbohydrate (D3) at the time of the first challenge, and compared the titers between the both groups. The subjects with positive results to the follow-up challenge showed significantly higher specific IgE antibodies for D3 and D3CHO than the subjects with negative challenges. The sensitivity, specificity and accuracy for a predictiton of outcome of egg hypersensitivity of specific IgE antibody titers to D3 and D3CHO were 100%, 71.4% and 87.5%, and 88.9%, 71.4% and 81.3%, respectively. These results indicated that specific IgE antibodies for D3 with or without CHO gave a useful diagnostic tool for a predictition of outgrow of hen's egg hypersensitivity.

View full abstract

We reported 6 cases of severe atopic dermatitis with hypoalbuminemia. They were infant and all male. In 2 of them serum albumin levels were 1.23g/dl and 1.84g/dl. These 2 infants were given intravenous albumin transfusion therapy. However in the other patients, serum albumin reached to normal levels after skin treatment with steroid ointment. The possible causes for hypoalbuminemia were mainly increasing loss of protein through the skin and partly decreasing protein supply by food intolerance in infants. The risk factors for these severe dermatitis were bacterial skin infections, sensitivity for multiple allergens, and inadequate therapy. We concluded that patients' education and avoidance from these risk factors are important to prevent severe atopic dermatitis with hypoalbuminemia.

View full abstract

The effects of β₂-agonist inhalation and aminophylline intravenous drip as initial treatments for acute exacerbations of asthma were compared in 62 asthmatic children with intermediate to mild attack who could be treated at the outpatient department. The subjects were divided into three groups,
(1) aminophylline drip single group, (2) β₂-agonist inhalation single group, and (3) combined group. The pulmonary function and clinical score were investigated. The combined group showed a higher improvement rate of the pulmonary function than the β₂-agonist inhalation single group, which was especially marked in the small airway. When aminophylline intravenous drip is combined with β₂-agonist inhalation, the finding indicates the possibility that the arithmetic effect may be seen with the bronchial dilation effect by the addition of aminophylline in the small airway. Although there was no difference of the clinical score among the three groups, the early improvement in the small airway suits the purpose of long-term asthmatic management. We concluded that the therapy of conventional β₂-agonist inhalation combined with aminophylline intravenous drip was considered useful and safe as an initial treatment for asthma used at pediatric outpatient departments.

View full abstract

Contributory factors were analyzed of 153 patients died of bronchial asthma from 1990 to the end of 1998.
95 males and 58 females (M:F=1.6:1), from 0 to 28 years of age, have been registered. This is consistent with the mortality rate previously published by the Ministry of Welfare of Japan. The mean age was 12.4 and more than half of them died between 11 and 19 years of age.
Asthma death was not confined exclusively to severe cases: the percentage was as low as 28.3%. The dead was also classified into moderate (21.7%) and mild (18.4%) in clinical severity of the last year of their life. They are considered to have died of sudden and unexpected severe asthmatic attacks.
91 among 150 patients (58.3%) died at medical center, 27 patients (18.0%) at home, and 19 patients (12.7%) on the way to hospital. The variety of the place of death of the remaining patients suggested the necessity of taking the diversity of life style into consideration.
Unexpected sudden exacerbation (69%) and the delay in the consultation with their doctors (69%) were considered to be the two main contributory factors to their death, suggesting the necessity of proper evaluation of the severity of asthmatic attacks and the importance of education of patients in the prevention of asthma death.
Over dosage or excessive dependency on medicine were considered to be one of the main causes of their death in 20 patients and negligence of taking medicine in 22 patients. These data suggested that more appropriate guidance should be given to the kinds, usage and dosage of medicine, especially those of β stimulants and corticosteroids.

View full abstract