Risk factors for wheezing in infants born in Cuba

1. Silvia Josefina Venero Fernández*, 
2. Ramón Suárez Medina*, 
3. Esperanza de la C. Mora Faife*,
4. Gladys García García*, 
5. Ileana del Valle Infante*, 
6. Liem Gómez Marrero*,
7. Gladys Abreu Suárez**, 
8. José González Valdez**, 
9. Dania Fabré Ortiz⁺,
10. Hermes Fundora Hernández*, 
11. Andrea Venn PhD^{^}, 
12. John Britton FRCP^{^},
13. Andrew W Fogarty DM^{^} and 
14. the HINASIC (Historia Natural de la Sibilancia en Cuba/National History of Wheezing in Cuba) Study Group⁺⁺

+Author Affiliations

1. * Instituto Nacional de Higiene, Epidemiología y Microbiología, Infanta No 1158 e/ Llinás y Clavel, Código Postal 10300, La Habana, Cuba.
2. ** Hospital Universitario Pediátrico Docente Centro Habana, La Habana, Cuba.
3. ⁺ Hospital Pediátrico Docente “Juan Manuel Márquez”. La Habana, Cuba.
4. ^{^} Nottingham Biomedical Research Unit, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK
5. ⁺⁺ full list of collaborating researchers at the end of the manuscript

1. To whom correspondence should be addressed. Correspondence and requests for reprints to MSc.Silvia Josefina Venero Fernández: Address: Infanta No 1158 e/ Llinás y Clavel, Código Postal 10300, La Habana, Cuba. Office phone: (537) 878 8479, Email: silviavf@inhem.sld.cu

• Received May 9, 2013.
• Revision received May 30, 2013.
• Accepted June 7, 2013.

Abstract

Background: Cuba is a unique country, and despite limited economic development has an excellent health system. However, the prevalence of asthma symptoms in children in Havana, Cuba, is unusually high.

Aim: Since early life exposures are critical to the aetiology of asthma, we have studied environmental influences on the risk of wheeze in Cuban infants.

Design: Cross-sectional study.

Methods: A random sample of 2032 children aged 12-15 months living in Havana was selected for inclusion in the cohort. Data were collected using questionnaires administered by researchers.

Results: Of 2032 infants invited to participate, 1956 (96%) infants provided data. The prevalence of any wheeze was 45%, severe wheeze requiring use of the emergency services was 30%, and recurrent wheeze on three or more occasions was 20%. The largest adjusted risk factors for any wheeze were presence of eczema (odds ratio OR 2.09; 95% confidence intervals 95% CI: 1.48-2.94), family history of asthma (OR 2.05; 95% CI: 1.60-2.62), poor ventilation in the home (OR 1.99; 95% CI: 1.48-2.67), attendance at nursery (OR 1.78; 95%CI: 1.24-2.57), male sex (OR1.52; 95% CI: 1.19-1.96) and the number of smokers in the house (p<0 .03="" 1.17-2.31="" 1.64="" compared="" for="" home="" household.="" in="" more="" no="" or="" p="" smokers="" the="" three="" to="" trend="">

Conclusion: We have identified several risk factors for any wheeze in young infants living in modern day Cuba. As the prevalence of smoking in the home is high (51%), intervention studies are required to determine effective strategies to improve infant health.

Keywords

• wheeze
 
• infants
 
• recurrent wheeze
 
• risk factor
 
• Cuba

• © The Author(s) 2013. Published by Oxford University Press on behalf of the Association of Physicians.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

This Article

1. QJM (2013)doi: 10.1093/qjmed/hct143First published online: July 3, 2013

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Characteristics of allergic colitis in breast-fed infants in the absence of cow’s milk allergy

World J Gastroenterol. 2013 June 28; 19(24): 3824-3830. Published online 2013 June 28. doi: 10.3748/wjg.v19.i24.3824.

Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.

Characteristics of allergic colitis in breast-fed infants in the absence of cow’s milk allergy

Kriszta Molnár, Petra Pintér, Hajnalka Győrffy, Áron Cseh, Katalin Eszter Müller, András Arató and Gábor Veres.

Kriszta Molnár, Petra Pintér, Áron Cseh, Katalin Eszter Müller, András Arató, Gábor Veres, 1^st Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary

Hajnalka Győrffy, 2^nd Department of Pathology, Semmelweis University, 1091 Budapest, Hungary

Author contributions: Molnár K and Pintér P contributed equally to the writing of this paper; Veres G designed the research; Arató A and Veres G enrolled the patients; Molnár K, Pintér P, Cseh Á and Müller KE performed the analyses; Győrffy H analyzed the histological data; Molnár K, Pintér P and Veres G wrote the paper; Arató A critically reviewed the paper.

Correspondence to: Gábor Veres, MD, PhD, 1^st Department of Pediatrics, Semmelweis University, Bókay u 53, 1083 Budapest, Hungary. veres.gabor@med.semmelweis-univ.hu

Telephone: +36-20-8258163 Fax: +36-1-3036077

Received October 4, 2012; Revised February 5, 2013; Accepted March 23, 2013;

Abstract AIM: To investigate the characteristics of mucosal lesions and their relation to laboratory data and long-term follow up in breast-fed infants with allergic colitis. METHODS: In this study 31 breast-fed infants were prospectively evaluated (mean age, 17.4 wk) whose rectal bleeding had not ceased after a maternal elimination diet for cow’s milk. Thirty-four age-matched and breast-fed infants (mean age, 16.9 wk) with no rectal bleeding were enrolled for laboratory testing as controls. Laboratory findings, colonoscopic and histological characteristics were prospectively evaluated in infants with rectal bleeding. Long-term follow-up with different nutritional regimes (L-amino-acid based formula or breastfeeding) was also included. RESULTS: Iron deficiency, peripheral eosinophilia and thrombocytosis were significantly higher in patients with allergic colitis in comparison to controls (8.4 ± 3.2 μmol/L vs 13.7 ± 4.7 μmol/L, P - 0.001; 0.67 ± 0.49 G/L vs 0.33 ± 0.17 G/L, P - 0.001; 474 ± 123 G/L vs 376 ± 89 G/L, P - 0.001, respectively). At colonoscopy, lymphonodular hyperplasia or aphthous ulceration were present in 83% of patients. Twenty-two patients were given L-amino acid-based formula and 8 continued the previous feeding. Time to cessation of rectal bleeding was shorter in the special formula feeding group (mean, 1.4 wk; range, 0.5-3 wk) when compared with the breast-feeding group (mean, 5.3 wk; range, 2-9 wk). Nevertheless, none of the patients exhibited rectal bleeding at the 3-mo visit irrespective of the type of feeding. Peripheral eosinophilia and cessation of rectal bleeding after administration of elemental formula correlated with a higher density of mucosal eosinophils. CONCLUSION: Infant hematochezia, after cow’s milk allergy exclusion, is generally a benign and probably self-limiting disorder despite marked mucosal abnormality. Formula feeding results in shorter time to cessation of rectal bleeding; however, breast-feeding should not be discouraged in long-lasting hematochezia. Keywords: Rectal bleeding, Breast-feeding, Allergic colitis, Colonoscopy, Amino-acid formula

Core tip: Rectal bleeding is a common problem in otherwise healthy breast-fed infants; our primary aim was to find characteristic lesions at colonoscopy and determine the cessation of rectal bleeding when administering different nutritional regimes (L-amino-acid based formula or breast-feeding). Our secondary aim was to find correlations between laboratory data, severity of mucosal lesions and cessation of rectal bleeding in allergic colitis infants with no cow’s milk allergy. Abstract Full Text PDF (868K) Contents Archive

Letter to the Editor

Interleukin-6 and statin therapy: potential role in the management of COPD

Robert P Young and Raewyn J Hopkins

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Respiratory Research 2013, 14:74 doi:10.1186/1465-9921-14-74

Published: 17 July 2013

Abstract (provisional)

We read with interest the article by Ferrari and colleagues, showing in a small prospective study of chronic obstructive pulmonary disease (COPD) patients, that interleukin-6 (IL-6) is a useful biomarker predicting worsening exercise tolerance and greater mortality [1]. We outline below the significance of this finding and its potential impact on the future management of COPD.

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Research

A qPCR-based metric of Th2 airway inflammation in asthma

Nirav R Bhakta, Owen D Solberg, Christine P Nguyen, Cindy N Nguyen, Joseph R Arron, John V Fahy and Prescott G Woodruff

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Clinical and Translational Allergy 2013, 3:24 doi:10.1186/2045-7022-3-24

Published: 17 July 2013

Abstract (provisional)

Background

Using microarray profiling of airway epithelial cells, we previously identified a Th2-high molecular phenotype of asthma based on expression of periostin, CLCA1 and serpinB2 and characterized by specific inflammatory, remodeling, and treatment response features. The goal of the current study was to develop a qPCR-based assay of Th2 inflammation to overcome the limitations of microarray-based methods.

Methods

Airway epithelial brushings were obtained by bronchoscopy from two clinical studies comprising 44 healthy controls and 62 subjects with asthma, 39 of whom were studied before and after a standardized 8 week course of inhaled corticosteroids (ICS). The qPCR-based expression of periostin, CLCA1 and serpinB2 were combined into a single metric.

Results

In asthma, the three-gene-mean of periostin, CLCA1 and serpinB2 correlated with FeNO (r = 0.75, p = 0.0002), blood eosinophils (r = 0.58, p = 0.003) and PC20 methacholine (r = -0.65, p = 0.0006), but not total serum IgE (r = 0.33, p = 0.1). Higher baseline three-gene-mean correlated with greater improvement in FEV1 with ICS at 2, 4 and 8 weeks (all p - 0.05). By ROC analysis, the area under the curve (AUC) of the three-gene-mean for FEV1 improvement with ICS at 4 and 8 weeks was 0.94 and 0.87, respectively, which are higher than the AUCs of FeNO, blood eosinophils, IgE or PC20. Th2 airway inflammation as measured by this three-gene-mean also had predictive capacity for an improvement in symptoms.

Conclusions

The three-gene-mean of periostin, CLCA1 and serpinB2 in airway epithelial brushings identifies Th2-high and low populations, is correlated with other Th2 biomarkers, and performs well for prediction of FEV1 improvement with ICS. The three-gene-mean provides a measurement of Th2 airway inflammation that is clinically relevant and that can serve as a valuable tool to evaluate non-invasive biomarkers to predict treatment responses to existing and emerging asthma therapies.

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Allergic proctocolitis: the clinical evolution of a transitory disease with a familial trend. Case reports

Einstein (São Paulo)

Print version ISSN 1679-4508

Einstein (São Paulo) vol.11 no.2 São Paulo Apr./June 2013

http://dx.doi.org/10.1590/S1679-45082013000200017 

CASE REPORT

Allergic proctocolitis: the clinical evolution of a transitory  disease with a familial trend. Case reports

Ulysses Fagundes-Neto^I; Arnaldo José Ganc^II

^IUniversidade Federal de São Paulo, São Paulo, SP, Brazil
^IIUniversidade Federal de São Paulo, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

Correspondence

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ABSTRACT

Allergic colitis is a clinical manifestation of food allergy during the first months of life. It is estimated that genetic factors play a role in the expression of this allergic disease. This case report described the clinical progress of infants who were cousins from two distinct family groups with allergic colitis. Five infants under six months of age and of both sexes were studied, with a diagnosis of allergic colitis characterized clinically and histologically by (1) rectal bleeding; (2) exclusion of infectious causes of colitis; (3) disappearance of symptoms after elimination of cow's milk and dairy products from the child's and/or the mother's diet. Patients were submitted to the following diagnostic investigation: complete blood count; stool culture; parasitologic examination of stools; rectoscopy or colonoscopy; and rectal biopsy. Patient age varied from 40 days to six months; three were males. All patients presented with complaints of intense colic and rectal bleeding. The colonoscopy showed presence of hyperemia of the mucosa with microerosions and spontaneous bleeding upon the procedure. Microscopy revealed the existence of colitis with eosinophilia >20 e/HPF. Patients were treated with a hypoallergenic formula and showed remission of symptoms. After one year of age, all were submitted to an oral challenge with a milk formula and presented food tolerance. Allergic colitis is a disease with evident genetic inheritance and a temporary character.

Keywords: Colitis; Eosinophilia; Gastrointestinal hemorrhage; Food hypersensitivity; Infant; Case reports

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• Arch Med Sci
• v.9(3); Jun 20, 2013
• PMC3701966

Arch Med Sci. 2013 June 20; 9(3): 555–560.

Published online 2012 October 30. doi:  10.5114/aoms.2012.31387

PMCID: PMC3701966

Expression of IL-7 receptor in human peripheral regulatory T cells

Maciej Ciebiada,1 Karolina Kasztalska,1 Małgorzata Gorska-Ciebiada,2 Marcin Barylski,3 and Pawel Gorski1

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Abstract

Introduction

Regulatory T cells (Tregs, CD4 + CD25high Foxp3+) play a crucial role in allergy and other inflammatory diseases. However, the isolation of viable Tregs on the basis of intracellular expression of specific Forkhead Box Protein P3 (Foxp3) is difficult. In this study we checked if the expression of IL-7 receptor (CD127) on the Tregs could be a useful marker for isolation of viable Treg Foxp3+ cells.

Material and methods

Twenty-five patients sensitized to grass pollen with allergic rhinitis (AR) and ten healthy subjects were included. We compared Foxp3 expression in different CD4+ T cell subsets by flow cytometry and we assessed the relationship between the expression of Foxp3 and CD127 within regulatory T cells.

Results

Within the CD4+ lymphocytes 3.68 ±2.0% showed expression of Foxp3, 51.82 ±8.03% of CD4+CD25highwere Foxp3 positive (Foxp3+), whereas 82.12 ±5.4% of CD4+CD25highCD127low were Foxp3+. High intracellular expression of Foxp3 correlated with low superficial CD127 expression (r = 0.42, p = 0.017). There were no significant differences regarding the analysed markers between AR patients and healthy controls.

Conclusions

Regulatory T cells may be purified from the fresh peripheral blood as viable regulatory Foxp3 bright cells using CD4, high expression of CD25 and low expression of CD127 antigen.

Keywords: allergy, cytokines, inflammation, rhinitis, regulatory lymphocytes

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Heterozygous Alterations of TNFRSF13B/TACI in Tonsillar Hypertrophy and Sarcoidosis

Clinical and Developmental Immunology
Volume 2013 (2013), Article ID 532437, 5 pages
http://dx.doi.org/10.1155/2013/532437

Research Article

Heterozygous Alterations of TNFRSF13B/TACI in Tonsillar Hypertrophy and Sarcoidosis

Matthaios Speletas,¹ Ulrich Salzer,² Zoe Florou,³ Efthimia Petinaki,³ Zoe Daniil,⁴ Fotini Bardaka,⁴ Konstantinos I. Gourgoulianis,⁴ Charalampos Skoulakis,⁵ and Anastasios E. Germenis¹

¹Department of Immunology and Histocompatibility, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
²Centre of Chronic Immunodeficiency (CCI), University Medical Center Freiburg and University of Freiburg, Hugstetterstrabe 55, 79106 Freiburg, Germany
³Department of Microbiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
⁴Respiratory Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
⁵ENT Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece

Received 24 March 2013; Revised 12 June 2013; Accepted 19 June 2013

Academic Editor: Nima Rezaei

Copyright © 2013 Matthaios Speletas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

TNFRSF13B/TACI defects have been associated with CVID pathogenesis and/or phenotype, especially the development of benign lymphoproliferation and autoimmunity. Our purpose was to investigate the role of TNFRSF13B/TACI defects in the pathogenesis of two common lymphoproliferative disorders, namely, sarcoidosis and tonsillar hypertrophy (TH). 105 patients (71 with sarcoidosis and 34 with TH, including 19 without infectious causative and 15 due to Haemophilus influenzae) were analyzed forTNFRSF13B/TACI defects. Two out of 19 TH patients without infectious cause (10.5%) and 2 patients with sarcoidosis (2.8%) displayed rare TNFRSF13B/TACI defects (I87N, L69TfsX12, E36L, and R202H, resp.). Both mutations identified in TH patients have been assessed as deleterious for protein function, while the patient with the R202H mutation and sarcoidosis exhibited also sIgG4D. Our study further supports the notion that TNFRSF13B/TACI defects alone do not result in CVID but may be also found frequently in distinct clinical phenotypes, including benign lymphoproliferation and IgG subclass deficiencies.

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