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Biomedical subjects

K Juntunen-Backman

Publications and source records attributed to K Juntunen-Backman.

At least 37 records · Page 2Linked to original sources
PubMed1994

Bronchial asthma and hyperreactivity after early childhood bronchiolitis or pneumonia. An 8-year follow-up study.

OBJECTIVE: To determine the infantile risk factors and long-term outcome up to 8 to 10 years of age for bronchial asthma and hyperreactivity in children with early-childhood bronchiolitis or pneumonia. DESIGN: Prospective follow-up of three groups of children. SETTING: University hospital providing primary hospital care and outpatient consultations for all pediatric patients in a defined area. INTERVENTIONS: None. PATIENTS: The study groups consisted of 62 children with early-childhood bronchiolitis, 29 children with early-childhood pneumonia with no wheezing, and 52 control children. METHODS: Infantile risk factors were prospectively registered until 2 years of age. Clinical examination, performed 7 to 8 years later, included recording of atopic and asthmatic symptoms from the preceding 12 months. The methacholine inhalation challenge test was used to assess bronchial hyperreactivity, and mean midexpiratory flow results were used to assess bronchial obstruction. MAIN RESULTS: Bronchial asthma was present in nine (15%) of the 62 children from the bronchiolitis group, compared with 7% in the pneumonia group and 2% in the control group. Bronchial hyperreactivity indicated by methacholine inhalation challenge was far more common; it was present in 62% of the bronchiolitis group and in 45% of the pneumonia group. Both groups differed significantly from the control group. Decreased mean midexpiratory flow values were observed in 29% and 21% of the bronchiolitis and pneumonia groups, respectively. All 10 asthmatic patients had bronchial hyperreactivity, but only 20% of hyperreactive children had asthma. An analysis of infantile risk factors disclosed only one, an early onset of wheezing, with a significant effect on bronchial hyperreactivity at school age. Elevated IgE values measured during infancy were associated with the development of clinical asthma. CONCLUSIONS: The risk of bronchial asthma was increased after infantile bronchiolitis. Moreover, bronchial hyperreactivity was increased after both infantile bronchiolitis and pneumonia. Methacholine inhalation challenge was a sensitive but nonspecific test for diagnosing bronchial asthma. Both bronchiolitis and pneumonia resulting in hospitalization in early childhood distinguish a group of children with an increased risk for long-term lung function abnormalities and pulmonary illnesses.

Asthma↗
PubMed1994

Beta-lactoglobulin secretion in human milk varies widely after cow's milk ingestion in mothers of infants with cow's milk allergy.

BACKGROUND: Cow's milk proteins secreted in human milk may cause cow's milk allergy (CMA) even during exclusive breast-feeding. We studied beta-lactoglobulin levels in human milk of mothers of infants with CMA. We also studied intestinal absorption of macromolecules in the same mothers to see whether it is related to the secretion of beta-lactoglobulin in human milk. METHODS: CMA was verified with oral challenge in 46 of 55 infants assessed. beta-Lactoglobulin levels were assessed in human milk from 53 of 55 mothers of the infants before (basal sample) and 1 and 2 hours after an oral cow's milk load, which was given after a 24-hour milk-free diet. beta-Lactoglobulin was determined by an ELISA with a detection limit of 0.002 microgram/L. The 6-hour urine recovery of a high-molecular-weight polyethylene glycol (PEG) 3000 was assessed after an oral load of PEG in 45 of 55 mothers. RESULTS: beta-Lactoglobulin was found in the 1- or 2-hour samples in 75% of the mothers. beta-Lactoglobulin levels were increased in the 1- or 2-hour samples as compared with the basal levels in about half of the mothers. The respective levels were decreased in one third of the mothers whose basal beta-lactoglobulin levels were higher than in the others. beta-Lactoglobulin was found in none of the three human milk samples in 15% of the mothers. After an oral load of a high-molecular-weight PEG 3000, the 6-hour urine recovery of PEG was similar in the mothers of the infants with CMA and the mothers of infants without CMA. Neither was the urinary recovery of PEG related to the beta-lactoglobulin levels in human milk. CONCLUSIONS: The results support the view that beta-lactoglobulin in human milk may contribute to, but does not alone explain, the development of CMA in breast-fed infants.

Animals↗
PubMed1994

Familial high serum concentrations of the carboxyl-terminal propeptide of type I procollagen.

We describe a family with an apparently autosomal-dominant trait that caused extremely high circulating concentrations of the carboxyl-terminal propeptide of type I procollagen (PICP). All family members examined had normal values for other biochemical markers of bone formation and degradation and no related clinical abnormalities. Furthermore, their serum concentrations of the amino-terminal propeptide of type I procollagen (PINP) were normal. Although PINP and PICP are released from the same precursor molecule, PINP is cleared from the circulation via the scavenger receptor in liver endothelial cells, whereas PICP is cleared via the mannose receptor of these cells. We thus hypothesize that the clearance of circulating PICP is compromised in the affected subjects of this family, the result of either a defective mannose receptor function or an abnormal molecular structure of their PICP.

Adolescent↗
PubMed1993

A 2- to 3-year outcome after bronchiolitis.

OBJECTIVE: To determine the risk factors and short-term outcome until 3 years of age for subsequent wheezing in children with early childhood bronchiolitis or pneumonia. DESIGN: Prospective follow-up of a patient group. SETTING: University hospital providing primary care for all pediatric patients of a defined area. PATIENTS: One hundred twenty-seven children under 2 years of age hospitalized owing to wheezing (n = 83) or pneumonia (n = 44) during 12 months in 1981 to 1982. One hundred eight children completed the prospective follow-up until 3 years of age. INTERVENTIONS: None. MAIN RESULTS: The wheezing and pneumonia groups had equal viral and bacterial etiologic findings. History of wheezing, atopic eczema, and elevated serum IgE levels were more common in patients with wheezing than with pneumonia. Subsequent wheezing was seen after bronchiolitis in 76% (61 of 80) of the children at 1 to 2 years of age and in 58% (44 of 76) at 2 to 3 years of age. The respective figures were significantly lower, 9% (three of 33) and 16% (five of 32), in patients with pneumonia. An analysis of risk factors did not reveal any with a significant effect on subsequent wheezing. CONCLUSIONS: Subsequent wheezing is common after bronchiolitis, but rare after early childhood pneumonia, although caused by the same viruses or bacteria. Atopic diathesis is the host factor associated with initial wheezing. No genetic or environmental risk factor had significant association with later wheezing.

Asthma↗
PubMed1993

Serum eosinophil cationic protein during treatment of asthma in children.

BACKGROUND: Serum eosinophil cationic protein (ECP) is suggested to reflect the degree of bronchial inflammation and hyperreactivity in patients with asthma. We measured serum ECP levels before and 1 and 5 months after treatment with inhaled budesonide (n = 10) or sodium cromoglycate (SCG) (n = 7) in children with asthma. METHODS: The daily dose of budesonide was 800 micrograms/m2 during the first month and 400 micrograms/m2 during the next 4 months. ECP levels were determined by radioimmunoassay. RESULTS: ECP decreased during the 5 months of treatment (p = 0.020 for treatment groups combined; p = 0.049 for the budesonide group; p = NS for the SCG group). The higher the serum ECP level at entry, the more it decreased during treatment, both in the budesonide group (r = -0.697, p < 0.05) and in the SCG group (r = -0.893, p < 0.05). No correlation was found between the ECP level and the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1%) or between changes in these. However, basal pulmonary function was reduced in 8 of 16 subjects only, and FEV1% did not change significantly in either group. Thus the absence of a correlation is understandable. CONCLUSIONS: The clinical value of the sensitive decrease in serum ECP remains to be established.

Administration, Inhalation↗
PubMed1992

Diet in infancy and bronchial hyperreactivity later in childhood.

Sixty-seven atopy-prone children (atopic family group, AFG) and 52 children with no family history of atopy (NAFG) were followed for 10 years. During infancy, the mothers of the newborn AFG children were advised to adjust their infants' diet, with a view toward minimizing the risk of atopy, and not to keep pets. Pulmonary function tests, methacholine inhalation challenge (MIC), and skin prick tests (SPT) were done in order to evaluate the bronchial reactivity and skin reactivity in the two groups. A pathological result in MIC was found in 20 (30%) of the AFG children and in 10 (19%) of the NAFG children. Such results of MIC were more common in the children with positive SPT results than in those without (67% vs. 24%). In regard to the diet consumed in infancy, MIC was pathological in 23% of children with and in 36% without prophylactic diet in infancy. For MIC, using the new, Spira electro 2 dosimeter equipment, the sensitivity was 75% and specificity 97%, but the predictive value for diagnosing bronchial asthma was only 25%. The important advantage of our method is that the degree of bronchial reactivity can be estimated by responses to increasing provocative doses. Our observations confirm that the new method is suitable for detecting bronchial asthma in clinical practice but it seems not to be optimal for epidemiological studies. We concluded that later bronchial hyperreactivity can not be diminished by avoiding home pets or providing a hypoallergenic diet during infancy.

Age Factors↗
PubMed1992

Effects of inhaled budesonide on serum markers of bone metabolism in children with asthma.

The effects of inhaled glucocorticoids on serum markers of bone formation were evaluated in asthmatic children. Serum total alkaline phosphatase (AP), bone alkaline phosphatase (BAP), osteocalcin, and the novel marker of bone formation, carboxypropeptide of type I procollagen (PICP), were measured. In the cross-sectional part, long-term glucocorticoid users were compared with sodium cromoglycate (SCG) users. In the boys (n = 16), but not in the girls (n = 11), PICP was significantly lower in the glucocorticoid users than in the SCG users. PICP correlated positively with BAP (n = 54; groups combined, r = 0.29, p < 0.05). In the longitudinal part, the effects of inhaled budesonide or SCG, both used for the first time, were evaluated before and after 1 and 5 months of treatment. The budesonide dose was 800 micrograms/m2/day for 1 month and thereafter half of that. The SCG dose was 30 mg/day throughout the study. Only during budesonide use did osteocalcin and PICP decrease, the median osteocalcin by 8% at 1 month (p < 0.05) and by 6% at 5 months (n = 15), and PICP by 5% at 1 month (p < 0.05) and by 28% at 5 months (n = 7, p < 0.01). AP and BAP did not change significantly. Decreased PICP suggests decreased bone formation rate. PICP might be clinically useful as a marker of early adverse effects of glucocorticoids on bone.

Administration, Inhalation↗
PubMed1991

Changes in carbohydrate and lipid metabolism in children with asthma inhaling budesonide.

In a longitudinal study, antiasthmatic and metabolic effects of budesonide inhalations in initially high (800 micrograms/m2/day for 1 month) and subsequently lower (400 micrograms/m2/day for 4 months) dosage were evaluated in nine children with asthma, aged 5 to 10 years. The FEV1 increased significantly after high dosage (median, 96.5% versus 105.5%; p = 0.0339). After lower dosage, FEV1 was still higher than at the baseline (106% versus 96.5%; p = 0.0339). Clinically, no additional beta2-agonist was needed after 2 weeks of treatment. Serum high-density lipoprotein cholesterol increased significantly by 22% after high dosage (medians, 1.18 versus 1.44 mmol/L). A significant decline to 1.31 mmol/L was observed when the dose was reduced (overall, p = 0.0319). The treatment had no significant effect on serum total cholesterol, on serum triglycerides, on the ratio of high-density lipoprotein to total cholesterol, on the body mass index, or on glucose tolerance. The high dosage increased significantly the ratio of serum insulin to blood glucose, calculated from the areas under the incremental 2-hour curves in the glucose tolerance test (medians, 17.3 versus 23.2 mU/mmol). After lower dosage, the ratio declined significantly to 13.5 mU/mmol (overall, p = 0.0164). No significant changes were observed in plasma cortisol in the 2-hour adrenocorticotropic hormone test. The antiasthmatic effect of budesonide inhalations in a dose of 800 micrograms/m2/day for 1 month was accompanied by detectable changes in lipid and carbohydrate metabolism. These metabolic changes were reversible, and the antiasthmatic effect could be maintained by a dose of 400 micrograms/m2 for 4 months without significant systemic effects. This dose is safe and efficient in the maintenance treatment of childhood asthma.

Administration, Inhalation↗
PubMed1991

Asthma, allergic rhinitis and atopic eczema in Finnish children and adolescents.

The parents of 3649 Finnish children and adolescents were interviewed in 1980 to evaluate the prevalence of bronchial asthma, allergic rhinitis and atopic dermatitis. The same group was interviewed 6 years later to determine the incidence of new cases of bronchial asthma in the 1980s. Age- and sex-matched samples were taken from three areas, southern, eastern and northern Finland to allow assessment of possible regional differences in prevalences and incidences. The prevalences of atopic eczema, allergic rhinitis and asthma were 1.7%, 6.0% and 4.3%, respectively. These figures are similar to those found in previous studies in Scandinavia and Finland over 10 years ago. The prevalence of atopy was highest (6.4%) in southern Finland, which is the most urbanized area of our country. The prevalence of asthma was highest (3.3%) in northern Finland. This is still low when compared with the incidences in other European countries. THe prevalences of asthma and atopy were lowest in eastern Finland which is the most agrarian area. The incidence of asthma was 1.5 cases/1000 individuals/year, but regional differences were shown.

Adolescent↗
PubMed1990

Bronchial epithelial inflammation in children with chronic cough after early lower respiratory tract illness.

We studied the ultrastructural findings in biopsies from the main carina of seven school-aged children who had had chronic cough for at least 3 months and who all had a history of early lower respiratory illness (LRI). They had their first LRI between birth and 7 yr of age (range, 5 to 11 yr). The cross-sectional area of the epithelium was quantified by point counting for the percentage area of intercellular spaces (ICS) denoting edema, and the numbers of both inflammatory cells (leukocytes, including eosinophils, and mast cells) and ciliated cells. The children (excluding the one using inhaled steroids) demonstrated nearly 17- and more than sevenfold increases in the mean area of ICS and number of inflammatory cells per epithelial area, respectively, and a nearly three-fold decrease in the mean number of ciliated cells per epithelial area compared with the biopsy specimens from the orifice of the right upper lobe bronchus of two healthy adults. In the children, the increase in inflammatory cells (greater than 91% were lymphocytes) was more prominent in the children with two LRI before the age of 1 yr. Our findings imply a close association of early LRI and later epithelial inflammation during chronic cough. Allergic mechanisms in the epithelial inflammation cannot be ruled out as six of the patients had, either alone or in combination, signs of atopia, positive family history of allergic rhinitis or asthma, and eosinophils or mast cells in the epithelium.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Atopy in children with and without a family history of atopy. I. Clinical manifestations, with special reference to diet in infancy.

The influence of a family history of atopy on atopic morbidity, and relationships between diet in infancy and allergic manifestations at the ages of one and five years were prospectively studied in 91 children. A control group consisted of 72 children with no family history of atopy. At the age of one year, atopic manifestations were found in 19% of 163 children, in 23% of those with a family history of atopy and in 14% of those with no such history. Skin problems were more common in children with a family history of atopy (43%) than in the control children (19%). Of the children with a family history of atopy, 23% had prolonged rhinorrhoea during infancy. The corresponding figure in children with no family history of atopy was 10%. Prolonged rhinorrhoea during infancy correlated with parental smoking only in children with a family history of atopy (47% vs. 18%). At the age of five years, atopic disease was found in 17% of 128 children, 24% of those with a family history of atopy and 9% of those with no such history. Atopic eczema was more common in children with a family history of atopy, irrespective of the diet consumed during infancy. Atopic signs were found in about half of all the children with a family history of atopy. If atopy had been present in the family, the child usually exhibited the same manifestation. Onset of atopic manifestations was not prevented or delayed.

Breast Feeding↗
PubMed1987

Safe immunization of allergic children against measles, mumps, and rubella.

A series of 135 subjects (134 children and one adult) with documented or suspected systemic allergy were prick-tested before a measles, mumps, and rubella (MMR) vaccination. Atopic eczema was documented in 68, asthma in 47, and cow's-milk allergy in 11 examinees; eight children were evaluated because of severe systemic reactions following diphtheria-pertussis-tetanus, measles, or inactivated polio (Salk) vaccinations. In one child, there was only a suspicion of general allergy. The undiluted MMR prick test gave negative reactions in 126 cases (93%). The highest rate of nonreactivity was observed in those with atopic eczema (96%) and in children with asthma (91%) or cow's-milk allergy (82%). All examinees with systemic reactions after other vaccinations also had negative prick-test reactions. A total of 122 (95%) of the 129 examinees were eventually vaccinated with MMR. No untoward reactions developed, except mild generalized urticaria or fever in two vaccinees. We conclude that at least 95% of children with common forms of systemic allergy can be vaccinated safely with MMR and, in general, that allergic diseases should not interfere with execution of the vaccination programs.

Adolescent↗
PubMedDate not supplied

Follow-up of nutritional status and dietary survey in children with cow's milk allergy.

The nutritional status of children with cow's milk allergy was followed during an elimination diet in 19 children (9 boys and 10 girls) beginning at the mean age of two years (range 0.6-4.1 years). The cow's milk allergy had been verified in hospital by a challenge test at a mean age of 0.9 years (range 0.2-1.9 years). Weight, height and laboratory indices to test protein, mineral and vitamin status were measured at three follow-up visits at three-month intervals. In addition to cow's milk allergy all these children had some other food allergies, and six of the 19 children were allergic to soy protein. Only two of the 19 children were given a soy-based formula. In the diets of the other children, cow's milk was replaced by increasing amounts of other foodstuffs and supplementary calcium. At the beginning of the study the relative heights of the children were slightly retarded (-0.6 SD) and remained unchanged during follow-up (-0.8 SD at the end of the study). The relative weights were found to be decreased during follow-up (p less than 0.05). There was a significant reduction in serum prealbumin values; eight of the 19 children showed abnormally low values. Low serum zinc values were seen in 12 children. Serum iron concentration was low in two children and two had high serum alkaline phosphatase values. Seven-day food recording indicated that dietary intake of energy was below the recommendation in some children, but protein intake was high. Some children had low intakes of riboflavin.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗
PubMedDate not supplied

Atopy in childhood and diet in infancy. A nine-year follow-up study. I. Clinical manifestations.

A national program for the prevention of atopy in children has been in progress in Finland since 1979. Its aim is to prevent or at least to reduce atopic symptoms in childhood. Since the start of the program we have followed a group of 119 children with and without a family history of atopy. Half the atopy-prone children kept to the diet intended to prevent atopy, i.e., breast-feeding prolonged up to age 3 months and introduction of solid food and formulae based on cow's milk after age 3 months. All children were examined at ages 5 and 10 years. In addition to clinical examination and interview, skin-prick tests using eight common inhalant allergens were performed. At age 9 to 10 years, 38 of the 119 children (32%) exhibited at least one atopic illness (bronchial asthma, allergic rhinitis, allergic conjunctivitis, atopic eczema or food allergy). Forty percent of children with family histories of atopy had atopic illness, independent of diet in infancy. The occurrence of atopic manifestations in the children of nonatopic families was 21%. Only half the children who had atopic symptoms at age 12 months had symptoms 9 years later. Asthma, allergic rhinitis, and positive skin-prick test results at age 5 years, however, correlated well with the subsequent occurrence of respiratory allergy. Our observations indicate that the preventive measures in early infancy intended to reduce the risk of atopy had no influence on atopic manifestations 9 years later.

Child↗