Zusammenfassung
Der Consensus Report zur Spezifischen Immuntherapie bei IgE-vermittelten allergischen Erkrankungen im Kindes- und Jugendalter ist einerseits aufgrund des zunehmend größeren Angebotes ...an Allergenpräparaten entstanden. Andererseits besteht die ethische Verpflichtung Kinder und Jugendliche mit Allergenpräparaten zu behandeln, die auch in Studien an Kindern und Jugendlichen getestet worden sind (EU Regulative). Neben einer Auflistung aller in Österreich für den Gebrauch an Kindern zugelassener Allergenpräparate folgt eine differenzierte und kritische Betrachtung der Studienlandschaft. Neue Studien an Kindern sind zu fordern, gleichzeitig ist auch ein deutlicher Nachholbedarf in der Anwendung dieser sehr effektiven Behandlungsform IgE-vermittelter Allergien festzuhalten.
It is generally accepted that the increased prevalence of atopic disease is due to a disturbed balance of T‐helper (Th)1/Th2‐type immunity. Upon stimulation by the Th1‐type cytokine interferon ...(IFN)‐γ, human monocytes/macrophages release large amounts of neopterin. Thus, the determination of neopterin concentrations is an indirect measure of the levels of IFN‐γ and allows us to monitor Th1‐type immune response. We evaluated whether neopterin concentrations in the neonatal cord blood could be a valuable marker predicting atopic disease in early childhood and whether there is a difference in actually determined urinary neopterin concentrations in children with and without atopic disease. Five hundred and five children born during 1997–1999 were enrolled, with cord blood neopterin data available at birth. The International study of asthma and allergies in childhood (ISAAC) questionnaire was used to assess the prevalence of wheezy bronchitis (asthma), atopic dermatitis and allergic rhinitis. Morning urinary samples were collected and urinary neopterin concentration was measured by high‐pressure liquid chromatography. By the average age of 6 yr, the prevalence of atopic disease in the last 12 months was 31%. There was no significant correlation between cord blood and urinary neopterin concentrations at age 6 yr, and between cord blood neopterin and later atopic disease. Urinary neopterin concentrations were significant lower in children with a family history of atopic disease (p = 0.02). In this study, cord blood neopterin concentration was not a predictor for atopic disease in early childhood. Family history of atopic disease was associated with lower urinary neopterin levels at age 6 yr, which might mirror a Th1/Th2 imbalance.
Recent publications suggest that long-acting beta-2 agonists (LABAs) increase the risk for death in asthma. The American Food and Drug Administration (FDA) published a relevant alert in 2005. In the ...currently valid Austrian consensus guidelines for drug therapy of bronchial asthma in children and adolescents, LABAs are only recommended as add-on therapy in those patients whose asthma is not sufficiently controlled by inhaled corticosteroids (ICS) alone. LABAs have no established role in earlier steps of the therapeutic algorithm; consequently, the prescription of ICS-LABA combinations for initial treatment of paediatric asthma is not supported by these consensus treatment guidelines.
Background: Atopic disease is associated with skewing of immune responses away from a TH1 toward a TH2 profile. Previous studies have implicated this cytokine imbalance in the development of disease. ...However, it is not known whether normalization of this imbalance is conversely associated with disease resolution.Objective: To further delineate the role of reduced TH1 and increased TH2 cytokine production in the pathogenesis of atopic disease and to determine whether disease resolution is associated with alteration of cytokine profiles, we investigated cytokine responses in a cohort of adult patients with asthma followed from childhood.Methods: A cohort of wheezy children and control subjects aged 7 to 10 years were recruited from 1964 to 1967. Subjects were reevaluated every 7 years to monitor the outcome of childhood asthma. At the 42-year follow-up, 89 subjects from this cohort were evaluated for mitogen and house dust mite (HDM)-induced TH1 (IFN-γ) and TH2 (IL-4, IL-5, and IL-13) cytokine responses. Cytokine responses were compared in patients with ongoing asthma, patients with resolved asthma, and control subjects.Results: Patients with severe ongoing asthma had significantly reduced HDM-induced IFN-γ production compared with that of control subjects and patients with resolved asthma. In contrast, HDM-induced IFN-γ production in patients with resolved asthma was equivalent to that seen in control subjects. Patients with ongoing and resolved asthma produced significantly higher levels of IL-5 in response to HDM compared with that seen in control subjects, with levels being equivalent in patients with active and resolved asthma. HDM-induced IL-13 production was significantly increased in the patients with resolved asthma when compared with that seen in the control subjects. PHA-induced cytokine responses did not parallel HDM-induced responses.Conclusion: Patients with persistent and severe atopic asthma have a reduced HDM-induced TH1 response, whereas those with resolved asthma do not. This suggests that reduced HDM-induced IFN-γ production might be an important factor contributing to ongoing severe asthma and that normalization of allergen-induced TH1 responses might be important for disease resolution. The finding that all subjects with a history of asthma displayed increased HDM-induced TH2 (IL-5 and IL-13) cytokine responses, irrespective of the presence or absence of asthma, suggests that increased TH2 responses reflect the presence of the atopic state per se rather than being specifically linked to asthma. (J Allergy Clin Immunol 2002;110:450-6.)
