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Biomedical subjects

U Wahn

Publications and source records attributed to U Wahn.

At least 127 records · Page 7Linked to original sources
PubMed1998

Vocal cord dysfunction in three children--misdiagnosis of bronchial asthma?

Vocal cord dysfunction (VCD) is a paradoxical function of the vocal cords, leading to intermittent predominantly inspiratory dyspnea, but with no response to bronchodilator and anti-inflammatory drug therapy. We report on three children with VCD: 1) A 12-year old boy, who was treated for many years for bronchial asthma and who presented with inspiratory dyspnea and a functional reduction of the inspiratory and expiratory flow-volume curve, 2) a 13-year old girl who was also treated for bronchial asthma on a long-term basis and in whom the paradoxical vocal cord movement could be demonstrated by laryngoscopy, and 3) a 17-year old girl who, besides clinical symptoms of bronchial asthma in her anamnesis, suffered from an intermittent severe inspiratory dyspnea, refractory to bronchodilator treatment. Laryngoscopy proved the diagnosis of VCD. No patient showed a deterioration on discontinuation of their antiasthmatic therapy. VCD is best diagnosed by assessment of the vocal cords during laryngoscopy. The following therapeutic measures are helpful: 1) Demonstration of diagnosis (e.g. videodocumentation of laryngoscopy) and reassurance of patients and parents, 2) speech therapy, and 3) psychological intervention and/or psychotherapy. Our three cases point to a differential diagnosis of recurrent dyspnea in children and adolescents which may be overlooked. It is important to question earlier diagnoses, and to objectively evaluate the type of dyspnea.

Adolescent↗
PubMed1998

Quality of life in patients with cystic fibrosis and their parents: what is important besides disease severity?

BACKGROUND: Cystic fibrosis is the most common inherited disease with a fatal outcome in industrialised nations. With the improvement in life expectancy, supporting patients and their families in adapting to life with this chronic progressive disease has become increasingly important. The aim of the present study was to investigate the relationship between health related quality of life (HRQOL) in this population, severity of disease, and cognitive/behavioural factors such as subjective health perception and ways of coping. METHODS: A sample of 89 adolescent and adult patients with cystic fibrosis and 125 parents of younger patients with cystic fibrosis completed questionnaires on health related quality of life and on ways of coping with the illness. Parents were asked to fill out the questionnaires regarding their own quality of life and coping. Multiple regression analyses were performed to examine the relationship between different predictor variables and quality of life. RESULTS: After accounting for the impact of disease severity and hours of treatment per day, the subjective health perception of patients significantly explained variance in their quality of life. Ways of coping were also significantly correlated with HRQOL. In parents the most important factor in explaining variance of HRQOL seems to be the coping style, whereas disease severity of the child and subjective health perception did not show any influence. CONCLUSIONS: The findings support the important role of cognitive and behavioural factors in specific subjective health perception and ways of coping in the adaptation to this severe chronic disease, both in patients themselves and in parents. The results call for a careful assessment of issues of coping and professional support for families of patients with cystic fibrosis in the early course of disease.

Adaptation, Psychological↗
PubMed1998

Changes in blood leukocyte distribution during double-blind, placebo-controlled food challenges in children with atopic dermatitis and suspected food allergy.

BACKGROUND: The development of clinical reactions to food antigens is associated with cellular changes. The aim of this study was to determine whether the clinical outcome of double-blind, placebo-controlled food challenges would correlate with changes in blood leukocyte distribution. METHODS: Double-blind, placebo-controlled food challenges were performed in 17 children with atopic dermatitis sensitized to hen's egg or cow's milk and in 9 children with atopic dermatitis but not sensitized to food. Blood leukocyte distribution and lymphocyte subsets were determined prior to and 24 h after challenges. RESULTS: In food-sensitized children the numbers of leukocytes and lymphocytes decreased significantly after allergen challenge independent of the clinical outcome of the provocation (p < 0.002 in both cases). This decrease was seen in T (CD3+) and B (CD19+) cell subsets (p<0.007 and p<0.0005, respectively). The CD4/CD8 ratio increased (p<0.04). The number of memory cells (CD45R0) dropped (p<0.02 for CD4 and p<0.004 for CD8) and there was a loss of L-selectin (p<0.003 for CD4 and CD8). No changes in thrombocytes, neutrophils, eosinophils and basophils were observed. None of these changes were seen in the sensitized patients during placebo challenges or in the non-sensitized group of children. CONCLUSION: Changes in the leukocyte distribution after allergen challenge seem to be associated with sensitization, but not with the clinical outcome of the oral food challenge. They reflect important changes in the immune system in response to allergens, but are not useful in monitoring double-blind, placebo-controlled food challenges.

Administration, Oral↗
PubMed1997

Evidence for linkage of chromosome 12q15-q24.1 markers to high total serum IgE concentrations in children of the German Multicenter Allergy Study.

Linkage of asthma and high total serum IgE levels to chromosome 12q15-q24.1 has been recently described. To evaluate this region further in regard to total IgE responsiveness, we genotyped 52 unrelated German children with persistently "high" total serum IgE (selected from a noninterventional prospective multicenter cohort study) and their parents. We carefully defined a most extreme IgE phenotype and analyzed it as a dichotomous trait. We tested for linkage between high total IgE concentrations and nine polymorphic microsatellite markers on chromosome 12q15-q24.1 using the transmission/disequilibrium test. Evidence for linkage and allelic association for high total IgE was observed for four markers in this region. This study demonstrates the value of using extreme phenotypes in genetic analysis of a complex quantitative trait.

Child, Preschool↗
PubMed1997

[Economic aspects in treatment of cystic fibrosis with chronic pulmonary pseudomonas infection. Ambulatory intravenous therapy in comparison with inpatient treatment].

BACKGROUND: Due to limited resources within the health service and the continuous discussion on cost containment, economic criteria should also be considered when assessing therapy concepts. Particular results in terms of economic efficiency reserves are to be expected from a transfer of care from the in-patient to the out-patient sector. METHODS: In a prospective, direct cost recording of all relevant uses of resources, the direct and indirect costs of the treatment of 14 patients with cystic fibrosis (CF) were included in the cross-over-design. The quality of life was recorded at least once for each patient using the EuroQol. In-patient intravenous antibiotic therapy carried out during the block of out-patient care served as one of the disqualification criteria when selecting patients. RESULT: Over an observation period of nine months, the average direct cost recorded were DM 35,706 for out-patient and DM 40,143 for in-patient treatment (+15%). As far as indirect costs are concerned, the losses of production in the national economy recorded for in-patient treatment were 80% higher. CONCLUSION: The direct and indirect costs for in-patient CF-therapy are in total higher than for out-patient care. Whether these cost advantages have to be "bought" with lower medical effectiveness needs to be demonstrated by further clinical studies. In the sense of the disease management approach, the results of this study should be used to help rationally weigh up the costs of out-patient care against alternative treatment concepts.

Adolescent↗
PubMed1997

In vitro release of eosinophil cationic protein from peripheral eosinophils reflects disease activity in childhood Crohn disease and ulcerative colitis.

UNLABELLED: The aim of this study was to compare in vitro release of eosinophil cationic protein (ECP) from peripheral blood eosinophils during active phases of childhood Crohn disease (CD) and ulcerative colitis with phases of remission. Ten children with CD and nine children with ulcerative colitis were investigated during 55 and 56 clinical visits, respectively. Each patient was investigated during at least one phase of clinically active disease and one phase of remission. Disease activity was assessed by means of the Paediatric Crohn Disease Activity Index (PCDAI) in Crohn disease and according to the clinical activity index of Rachmilewitz in ulcerative colitis. On an intra-individual basis, in vitro ECP release was significantly higher (P < 0.001) during active phases of CD and ulcerative colitis than in phases of remission (CD:median: 24.5 microg/l, range 16.0-61.2 versus median: 5.7 microg/l, range 2.0-16.7; ulcerative colitis: 14.8 microg/l, 8.3-39.8 versus 4.9 microg/l, 2.0-9.9). On an inte-individual basis, in CD and ulcerative colitis a strong and highly significant correlation was observed between disease activity indices and in vitro release of ECP from peripheral eosinophils (r = 0.89, P < 0.0001 and r = 0.82, P < 0.0001, respectively). CONCLUSION: These results show that in vitro ECP release from peripheral eosinophils reflects disease activity in both CD and ulcerative colitis and therefore can be used as a new appropriate laboratory parameter for assessment of disease activity in chronic inflammatory bowel disease.

Adolescent↗
PubMed1997

Sensitization to hen's egg at the age of twelve months is predictive for allergic sensitization to common indoor and outdoor allergens at the age of three years.

BACKGROUND: Specific predictors for atopic sensitization in early infancy are prerequisites for preventive intervention studies. OBJECTIVE: To identify predictors of allergic sensitization to common aeroallergens in infancy, 1314 children in five German cities were followed up from birth (1990) to the age of 3 years. METHODS: Blood samples were taken from cord blood and at follow-up visits at the ages of 1, 2, and 3 years. Total serum IgE and specific IgE antibodies to common food and inhalant allergens were determined. RESULTS: Among our study population, risk factors for sensitization to indoor and/or outdoor allergens at the age of 3 years were a positive family history, the presence of hen's egg-specific IgE antibodies (> or = 0.35 kU/L), and increased log- [total IgE] levels at the age of 12 months. Elevated cord blood IgE was not associated with sensitization to inhalant allergens at the age of 3 years. Egg-specific IgE greater than 2 kU/L in combination with a positive family history of atopy was a highly specific (specificity, 99%) and predictive (positive predictive value, 78%) marker for sensitization to inhalant allergens at 3 years of age. CONCLUSIONS: Hen's egg-specific IgE at the age of 12 months is a valuable marker for subsequent allergic sensitization to allergens that cause asthma, allergic rhinitis, and atopic dermatitis.

Allergens↗
PubMed1997

Severe allergic reactions to foods are predicted by increases of CD4+CD45RO+ T cells and loss of L-selectin expression.

OBJECTIVE: The aim of the study was to determine whether the clinical outcome of double-blind, placebo-controlled food challenges of patients with atopic dermatitis would be associated with changes in lymphocyte functions. METHODS: Peripheral blood mononuclear cells were prepared from 19 children with atopic dermatitis and stimulated in vitro with the suspected allergen (cow's milk, hen's egg), tetanus toxoid, and pokeweed mitogen. After 14 days in culture, quantitative and qualitative distribution of cell surface marker expression was assessed by flow cytometry, and results were compared with the clinical outcome of a subsequent oral food challenge. RESULTS: After stimulation with the allergen, a significant increase of CD4+CD45RO+ T cells (p < 0.05) was detected selectively for patients showing severe clinical reactions. This increase was not detected for patients with mild or no reactions or in six nonatopic control subjects. Increased expression of CD45RO was paralleled by a significant decrease in L-selection expression (p < 0.05) for the same patient group. CONCLUSION: The combined assessment of CD4+CD45RO+ and CD4+L-selectin+ expression on T cells was more sensitive for the prediction of the clinical outcome of the food challenge (p < 0.01) than measurement of cytokines or immunoglobulins in cell culture supernatants. These data indicate that a shift in lymphocyte functions may predict the development of severe allergic reactions in food-sensitized children with atopic dermatitis.

Acute Disease↗
PubMed1997

Indoor allergen exposure is a risk factor for sensitization during the first three years of life.

BACKGROUND: The purpose of the study was to investigate the influence of environmental allergen exposure on allergic sensitization in infancy and early childhood. METHODS: A cohort of 1314 newborns was recruited and followed up prospectively at the ages 12, 24, and 36 months. The levels of major mite (Der p 1 and Der f 1) and cat (Fel d 1) allergens were determined from domestic carpet dust samples by sandwich ELISA. Specific serum IgE antibodies to mite and cat allergens were determined by CAP fluoroimmunoassay (Pharmacia). Logistic regression was used to assess the effects of allergen exposure, age, family history, and cord blood IgE simultaneously on the risk of sensitization. RESULTS: Children, who had been found to be sensitized at least once during the first 3 years of life, were found to be exposed to significantly higher house dust mite (median, 868 ng/gm vs 210 ng/mg; p = 0.001) and cat (median, 150 ng/gm vs 64 ng/gm; p = 0.011) allergen concentrations in domestic carpet dust compared with the group without sensitization. In homes with low (< or = 25th percentile) dust concentrations, the risk of sensitization to mite (1.6%), and cat (2.0%) is low, compared with 6.5% for mite and 6.3% for cat if the domestic exposure is above the 75th percentile. The dose-response relationships between allergen levels and sensitization indicate that the increase in sensitization risk at low allergen levels is more pronounced in cat allergy (p = 0.002) than in mite allergy (p = 0.026). In the group with a positive family history, lower mite and cat allergen concentrations are needed to achieve specific sensitization compared with the group with a negative family history. CONCLUSION: Our data indicate that avoidance measures in the domestic environment aimed at the primary prevention of allergen-driven sensitization should be introduced at the earliest possible stage, if possible during infancy.

Air Pollution, Indoor↗
PubMed1997

Verrucosis of hands and feet in a patient with combined immune deficiency.

In immunocompromised patients, warts occur frequently and can be extensive. We describe a 24-year-old patient with severe therapy-resistant warts. In addition to human papillomavirus infection, he had chronic sinusitis, candidiasis, and atopic dermatitis. Anergy to delayed-type hypersensitivity skin test reaction, significant CD4 lymphopenia, and diminished in vitro T-cell proliferative response and interferon-gamma production indicated a deficiency of cellular immunity. Extremely low concentrations of serum IgM and IgG2 and a severe deficiency of in vitro IgM production pointed also to a humoral immunodeficiency syndrome. This case represents a combination of cellular and humoral immunodeficiencies that has not been previously described in association with warts.

Adult↗
PubMed1997

Bronchiolitis obliterans organizing pneumonia and chronic graft-versus-host disease in a child after allogeneic bone marrow transplantation.

We report an 8-year-old boy who developed cough and respiratory failure 7 months after bone marrow transplantation (BMT) coinciding with the onset of chronic graft-versus-host disease (GVHD). Lung function data, imaging studies, lung biopsy and bronchoalveolar lavage were consistent with the diagnosis of bronchiolitis obliterans organizing pneumonia. While this has been reported in association with chronic graft-versus-host disease in one adult case previously, we report the simultaneous occurrence of BOOP and chronic GVHD in a child after bone marrow transplantation for the first time.

Adult↗
PubMed1997

Prevalence of latex-specific IgE antibodies in atopic and nonatopic children with type I diabetes.

OBJECTIVE: The potential induction of allergic sensitization to latex from insulin vial tops stimulated an investigation of the prevalence of specific IgE antibodies to latex in serum and the relationship to atopic disease in children with diabetes. RESEARCH DESIGN AND METHODS: In a cross-sectional study, serum samples of 112 children with type I diabetes (age: 15 [5-18] years; diabetes duration: 6 [1-14] years; median [range]) were investigated for total IgE, IgE screening for inhalational and nutritional allergens, and specific IgE antibodies to latex. RESULTS: Specific IgE antibodies for inhalational and/or nutritional allergens was found in 42 (38%) children (atopic group). Seven children (6%) exhibited specific IgE antibodies (0.61 [0.40-3.84] kU/I) to latex in serum although none reported clinical symptoms of latex allergy. All latex-sensitized children were found in the atopic group. This prevalence of latex sensitization of 17% (7/42) in atopic children with diabetes is comparable with the frequency described in atopic children without diabetes. These seven patients had higher serum total IgE antibody levels (328 [113-1,000] kU/I) than atopic patients without latex sensitization (n = 35; 124 [24-857] kU/I; P < 0.05) or patients without atopy (n = 70; 33 [2-339] kU/I; P < 0.001). No differences in age or diabetes duration were observed between either group. CONCLUSIONS: Sensitization to latex is found exclusively in children with atopic sensitization and appears to be related to atopic disease and not to frequent contact to latex through insulin injections. However, atopic patients may be at risk for reactions secondary to latex from insulin vials and syringes.

Adolescent↗
PubMed1997

[Sleep behavior in the first 3 years of life].

A review of the literature on sleeping "disorders" in infants and toddlers shows that sleep problems are very common. We report the results of a German multicenter epidemiological study on a birth cohort (N = 1314). The children had medical examinations at 4 weeks, 3 months, 6 months, 1 year, 18 months, 2 years and 3 years. Most of the information on the sleeping behavior was gathered by structured interview and questionnaires. This paper gives information on the prevalence and the persistence of sleep problems in one to three year old children in Germany. Statistical analysis of correlations between breastfeeding and sleep and the place of sleep are reported. The consequences of sleep problems on the family overall well-being are also examined.

Child, Preschool↗
PubMed1997

Predictability of early atopy by cord blood-IgE and parental history.

BACKGROUND: Atopic family history and cord blood IgE have been used as predictors of atopic disease in newborns for about 20 years, but at least for cord blood IgE the sensitivity has been shown to be very low. The objective of this paper was to evaluate whether parental history and cord blood-IgE were more accurate predictors for the appropriate atopic phenotypes in the infants rather than for any atopy. METHODS: A total of 1314 newborn infants was recruited in six German obstetric departments in 1990 and followed-up for 2 years. Four hundred and ninety-nine (38%) were at high risk for atopy with at least two first degree atopic family members and/or elevated cord-blood IgE concentrations. RESULTS: The cumulative incidence of atopic dermatitis over the first 2 years of life (AD24) amounted to 20.1%, and there was a significant association with AD history of the mother (OR 2.5, 95%CI 1.46-4.26) and of the father (OR 3.53, 95%CI 1.90-6.54). The cumulative incidence of recurrent wheezing in the first 2 years of life (RW24) amounted to 16.1%, and was positively associated with asthma history (OR 2.11, 95%CI 1.33-3.60) and sensitization history (OR 1.64, 95%CI 1.34-2.36) of the mother, but with neither for the father. RW24 was less prevalent in girls than in boys (OR 0.64, 95%CI 0.47-0.89). Thirty-one per cent of infants were sensitized (CAP test value > 0.35 kU/L) against at least one of nine food or inhalative allergens (S24) and this was significantly associated with cord blood-IgE value (OR 2.43, 95%CI 1.69-3.49), and sensitization history of the mother (OR 1.64, 95%CI 1.18-2.41). Using multiple logistic regression analysis, the prediction of AD24 by AD of parents, of RW24 by asthma of parents, and of sensitization by cord blood IgE was of low accuracy. CONCLUSION: The predictive capacity of parental history and cord blood IgE is not high enough to recommend them as screening instruments for primary prevention. The majority of atopic manifestations and of sensitization occur in infants with no demonstrable risk at birth.

Adult↗
PubMed1997

The natural course of sensitisation and atopic disease in infancy and childhood.

A number of epidemiological studies indicate that the prevalance of allergic airway diseases has been increasing over recent decades, especially in western industrialised countries, for reasons which are not yet completely understood (1, 2, 3). Changes in life style or an increase in indoor allergen exposure due to higher indoor temperature and humidity have been suggested as potential determinants, although evidence for both hypotheses is indirect (4). During the last years we have been following a birth cohort born in 1990 in order to understand the influence of the major genetic and environmental determinants, which are modulating the development of allergic sensitisation and the incidence of atopic symptoms. Sensitisation to indoor allergens has been demonstrated to be one of the major risk factors for the development of asthma in childhood (5, 6, 7, 8). Several cross-sectional studies in older children indicate that specific sensitisation to house dust mites is related to dust mite allergen concentrations in mattress dust (9, 10). Exposure threshold levels for several indoor allergens have been proposed, but individuals vary widely in their susceptibility to levels of exposure, and no absolute value has been identified which could generally ensure minimum risk.

Age Factors↗
PubMed1996

Stimulation of IgE and IgA production by CD45RA T helper cells in atopic patients.

The role of CD45RA T cells on allergen-dependent lymphocyte functions was analyzed in atopic patients. As compared with age-matched nonatopic controls, atopic patients exhibited a significantly (p < 0.01) increased frequency of CD45RA T cells in peripheral blood. Concentration of serum IgE correlated with increases in this T cell subset. In contrast to nonatopic controls, not only CD45RO but also CD45RA T cells from atopic patients provide help for allergen-stimulated IgE and IgA production, and they act in a synergistic fashion. Transwell coculture experiments revealed that optimal production of IgE and IgA required physical contact of CD45RA T cells with B cells. Freshly prepared and in vitro-activated CD45RO and CD45RA T cells from atopic patients showed an increased expression of CD40 ligand when compared with nonatopic individuals. In addition, CD45RA (and CD45RO) T cells from atopic individuals produced IL-4, IL-5, and IFN-gamma when stimulated with mitogens. Whereas stimulation of normal lymphocytes with tetanus Ag was followed by conversion of the CD45RA to the CD45RO phenotype, T cells from atopic donors did not acquire the CD45RO isoform to the same degree despite T cell activation. In atopic patients, addition of IL-4 to anti-CD3/anti-TCR stimulated CD45RA T cell prevented the shift towards the CD45RO phenotype. These data indicate that a subset of CD45RA T cells plays a unique role as effector T cells regulating IgE and IgA production in atopic patients.

Allergens↗