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Biomedical subjects

J J Herman

Publications and source records attributed to J J Herman.

12 recordsLinked to original sources
PubMed1985

Short-term holding room treatment of asthmatic children.

We undertook a randomized trial to compare holding room treatment vs hospitalization of patients with childhood status asthmaticus. Two thirds of 51 patients were discharged from a holding room within 24 hours (mean 11.8 +/- 4.61 hours); the others required hospitalization. One third of 52 hospitalized patients received less than or equal to 1 day of intravenously administered therapy, and two thirds received less than 2 days of therapy (mean 45.6 +/- 12 hours). There were no statistically significant differences in recurrence rates between the two groups in the 28 days following status asthmaticus. For patients receiving less than or equal to 1 day of therapy, the holding room cost was $526 +/- $226 vs $1439 +/- $339 for hospitalized patients (P less than 0.001). Thus, holding room therapy for childhood status asthmaticus is both medically and economically effective.

Aminophylline↗
PubMed1983

Intractable sneezing due to IgE-mediated triethanolamine sensitivity.

Sneezing has been commonly recognized as part of the nasal allergic reaction in response to pollen and inhalant allergens; isolated intractable sneezing is an unusual presentation in allergic patients. An 8-yr-old white girl developed intractable sneezing in the fall while walking past an area where fresh roofing tar was being prepared. Her personal and family histories were negative for allergic disease or symptoms. Positive physical findings were boggy nasal mucosa; pollen and inhalant skin tests were negative. Response to topical cromolyn and beclomethasone administered intranasally was only partial; antihistamines were little help. Upon careful review of history, exposure to clothes washed in Miracle White Laundry Soil and Stain Remover correlated to symptoms; removal from clothing by extensive washing relieved the sneezing, which recurred upon exposure. Prick test was positive to triethanolamine at 10(7)M to 10(-4)M and not to other ingredients of this product. Investigation demonstrated dose-dependent leukocyte histamine release (25% to 27% specific release) to triethanolamine (10(-4)M to 10(-7)M); this release (50% at 10(-5)M) was inhibited by preincubation with cromolyn sodium (5 X 10(-6)M). Passive cutaneous anaphylaxis was demonstrated to triethanolamine (10(-7)M to 10(-4)M); specific IgE to triethanolamine was demonstrated by polystyrene tube radioimmunoassay. Controls had no histamine release or specific IgE. Thus exposure to triethanolamine caused IgE-mediated intractable sneezing.

Child↗
PubMed1983

Allergic reactions to measles (rubeola) vaccine in patients hypersensitive to egg protein.

We evaluated two children with allergy to egg-white protein (ovalbumin) who had generalized urticaria, angioedema, and respiratory difficulty after immunization with live rubeola vaccine. In both patients, serum IgE reactive with ovalbumin-related antigens in the vaccine was demonstrated. Subsequent evaluation of 24 children with ovalbumin allergy revealed that those who had positive ovalbumin skin tests, but no clinical reaction to egg white, were skin test negative on prick and intradermal testing with measles vaccine and were safely immunized. They had no detectable IgE directed against the rubeola vaccine, although IgE directed at ovalbumin was present. Six patients who had severe allergic hypersensitivity reactions on exposure to ovalbumin had IgE antimeasles vaccine antibody and had positive reactions after intracutaneous or intradermal testing with the vaccine. These patients were safely immunized with increasing volumes (0.05 ml increments every 20 minutes) of measles vaccine to receive the full dose. These studies suggest that children with severe allergic hypersensitivity to egg white should be screened with an intracutaneous test prior to immunization with measles vaccine; however, children who have positive skin tests but no clinical reaction to ovalbumin exposure are at minimal risk for hypersensitivity reactions to measles immunization, as previously reported.

Anaphylaxis↗
PubMed1983

Fatal cardiovascular disease and cutis laxa following acute febrile neutrophilic dermatosis.

Acute neutrophilic dermatosis (Sweet syndrome) is a benign self-limited disease in adults. A child with apparent evolution of acute neutrophilic dermatosis to postinflammatory cutis laxa and elastolysis then developed fatal vascular involvement. One other patient with postinflammatory cutis laxa with aortic regurgitation and sudden fatal unrecognized occlusive coronary arterial disease is discussed. If cardiovascular symptoms or signs develop during the course of Sweet syndrome or postinflammatory cutis laxa, a thorough investigation is warranted to rule out potentially fatal coronary arterial disease. Coronary bypass surgery may be the only effective treatment for the severely fibrosed proximal coronary arterial system.

Acute Disease↗
PubMed1983

Use of intravenous isoproterenol for status asthmaticus in children.

The use of continuous drip iv isoproterenol was studied to determine its efficacy and indications in lower doses in severe asthma. Thirty-seven patients (6 months to 16 yr) received iv isoproterenol with asthma score of 6 (mean 6.8) or greater indicating PCO2 of 60 torr or higher or a PCO2 of 55 (mean 58.4) torr or greater without response to therapeutic levels of aminophylline, corticosteroids, and aerosolized isoetharine as well as appropriate oxygen. The initial dose of isoproterenol was 0.05 microgram/kg X min; if there was no response in PCO2, the continuous drip was increased by increments of not more than 0.05 microgram/kg X min every 15-20 min; iv aminophylline was continued by continuous infusion at therapeutic levels. The isoproterenol was infused until the PCO2 less than or equal to 40 torr and maintained at that dose for an equal time, then decreased over an interval equal to the response and maintenance time. There was complete response in 34 patients (mean dose 0.2 microgram/kg X min; mean response time 1.3 h, range 0.2-3.2 h). One patient had a partial response but the isoproterenol was discontinued with reversal of an arrhythmia; a 2nd patient had initial resolution but had rebound bronchospasm when the isoproterenol was abruptly discontinued. Thus, iv isoproterenol at lower initial and responding dose is effective for reversing increased PCO2 and impending respiratory failure in status asthmaticus in children, but the limitations and complications must be closely monitored.

Acute Disease↗
PubMed1982

Eosinophil diamine oxidase activity in acute inflammation in humans.

Eosinophil diamine oxidase, histaminase, activity was assayed in acute inflammatory states and correlated to disease activity. Correlation to serum and urine histamine, metabolites of histamine and granulocyte histamine metabolizing enzymes was also studied. Using a radiochromatagraphic assay, diamine oxidase, histaminase, activity was determined in human peripheral blood eosinophils from patients with acute inflammatory states including active asthma, cold-induced urticaria and parasitic infestation; eosinophils from non-active asthmatic patients and normals were used as controls. Eosinophils were purified over a metrizamide discontinuous (16-30%) gradient. Total eosinophils were purified over a metrizamide discontinuous (16-30%) gradient. Total eosinophil histaminase activity was increased two- to three-fold in patients with active disease and returned to lower levels in eosinophils from patients without active disease or with treated disease. Thus, the induction of eosinophil histaminase might be a control mechanism for the inflammation induced by histamine during these acute inflammatory states.

Acute Disease↗
PubMed1981

The Sweet syndrome in children.

Two children are described with the Sweet syndrome (acute febrile neutrophilic dermatosis), a rare skin disorder usually seen in middle-aged women. Typical features include spiking fever, neutrophilic leukocytosis, raised painful erythematous plaques and nodules reflecting a cutaneous dermal infiltrate composed of polymorphonuclear leukocytes and rapid resolution in response to systemically administered corticosteroid. The eruption is believed to represent a hypersensitivity reaction to antecedent infection or concurrent malignancy.

Child↗
PubMed1980

Specific modulation of complement-dependent human granulocyte function by imidazole acetic acid.

Because imidazole acetic acid (IAA), a product of histamine catabolism was shown to inhibit histaminase release from human polymorphonuclear leukocytes (PMNs), the effect of this compound on other neutrophil functions was investigated. IAA at concentrations of 10(-10) or more inhibited histaminase release induced by particle-bound C3b, the larger fragment of the activated form of the third component of complement. Release of histaminase induced by aggregated IgG, phorbal myristate acetate (PMA), formyl-methionyl-leucyl-phenylalanine (FMLP) and calcium ionophore was not affected by IAA. In addition IAA had no effect on release of beta-glucuronidase, myeloperoxidase, and lysozyme or on phagocytosis and superoxide generation. IAA did modestly inhibit neutrophil chemotaxis. These findings suggest a highly specific modulating effect of the histamine catabolite IAA on complement-mediated PMN function.

Acetates↗
PubMed1979

Complement-dependent histaminase release from human granulocytes.

The role of particle-bound complement proteins in the induction of noncytotoxic enzyme release from human granulocytes was investigated with the use of sera genetically deficient in complement and highly purified complement components. Release of histaminase, one of two important histamine catabolizing enzymes, and beta-glucuronidase from polymorphonuclear leukocytes was solely dependent on particle-bound C3b (the larger cleavage product of the third component of complement) when fluid-phase complement was excluded. The extent of enzyme release was a function of particle-bound C3b input, was reduced by exposing the particles to C3b inactivator, and was blocked by fluid-phase C3b. Phagocytosis of the C3b-coated particles was not required for enzyme release from neutrophils. In contrast, phagocytosis of "opsonized" particles was required for noncytotoxic release of histaminase and arylsulfatase from eosinophils; other proteins, as well as C3b, were able to opsonize particles for induction of enzyme release from eosinophils. These studies suggest a dual role for complement (particularly C3) in modulating vascular permeability phenomena, i.e., release of vasoactive mediators by the action of C3a and C5a, and release of the corresponding enzymes that inactivate the mediators by C3b.

Amine Oxidase (Copper-Containing)↗