RATIONALE: Limited knowledge regarding food allergy mortality is available in the medical literature and often only a partial medical history is described. We sought to collect cases of death due to food allergy in Israel. METHODS: We investigated cases that were published in the media. The parents and when feasible, physicians, who treated the final event were interviewed. No medical records were obtained for any of these cases. RESULTS: Three cases of death due to CMP ingestion were identified in the last five years. All of these cases involved youngsters (6 year-old girl, 10-year old boy and a sixteen year-old girl) who, while being aware of their allergenicity to CMP, were exposed to hidden allergen (chocolate, "parve" cake and "tomato burekas", respectively). The 6 year old was never evaluated by an allergist for her CMA and potential asthma nor was an automatic epinephrine injection (AEI) prescribed. The 10 year-old had history of asthma but was not followed by an allergist or pulmonologist. He too, was never prescribed an AEI. Finally, the 16 year-old had a history of asthma, and while a AEI was prescribed, it was not used during her anaphylactic attack. A significant feature of these cases was the presence of asthma in each of these children. CONCLUSIONS: Death due to food allergy in Israel is often due to CMP and is not adequately reported. Patients at risk are not adequately evaluated by allergists, given AEI or treated properly for asthma.

We present a case of left ventricular thrombus in a child with a normal functioning left ventricle. The diagnosis was made by 2-dimensional echocardiography after 2 episodes of systemic emboli. Hereditary protein C deficiency diagnosed in the patient provides the probable pathogenesis of the thrombus formation. Systemic emboli necessitates cardiac examination, and in cases of unusual thrombi, hereditary or acquired thrombophilic risk factors should be considered.

Early-life experiences, including maternal interaction, profoundly influence hormonal stress responses during adulthood. In rats, daily handling during a critical neonatal period leads to a significant and permanent modulation of key molecules that govern hormonal secretion in response to stress. Thus, hippocampal glucocorticoid receptor (GR) expression is increased, whereas hypothalamic CRH-messenger RNA (mRNA) levels and stress-induced glucocorticoid release are reduced in adult rats handled early in life. Recent studies have highlighted the role of augmented maternal sensory input to handled rats as a key determinant of these changes. However, the molecular mechanisms, and particularly the critical, early events leading from enhanced sensory experience to long-lasting modulation of GR and CRH gene expression, remain largely unresolved. To elucidate the critical primary genes governing this molecular cascade, we determined the sequence of changes in GR-mRNA levels and in hypothalamic and amygdala CRH-mRNA expression at three developmental ages, and the temporal relationship between each of these changes and the emergence of reduced hormonal stress-responses. Down-regulation of hypothalamic CRH-mRNA levels in daily-handled rats was evident already by postnatal day 9, and was sustained through postnatal days 23 and 45, i.e. beyond puberty. In contrast, handling-related up-regulation of hippocampal GR-mRNA expression emerged subsequent to the 23rd postnatal day, i.e. much later than changes in hypothalamic CRH expression. The hormonal stress response of handled rats was reduced starting before postnatal day 23. These findings indicate that early, rapid, and persistent changes of hypothalamic CRH gene expression may play a critical role in the mechanism(s) by which early-life experience influences the hormonal stress-response long-term.

Acta PaediatricaVolume 89, Issue 8 p. 1018-1020 Life-threatening laryngeal burns in toddlers following hot liquid aspiration D Rosen, D Rosen Pediatric Intensive Care Unit1Search for more papers by this authorS Avishai-Eliner, S Avishai-Eliner Pediatric Intensive Care Unit1Search for more papers by this authorA Borenstein, A Borenstein Plastic Surgery Unit Kaplan Medical Center Rehovot, affiliatesd with the School of Medicine, Hebrew University and Hadassa, Jerusalem, IsraelSearch for more papers by this authorA Leviav, A Leviav Plastic Surgery Unit Kaplan Medical Center Rehovot, affiliatesd with the School of Medicine, Hebrew University and Hadassa, Jerusalem, IsraelSearch for more papers by this authorE Tabachnik, E Tabachnik Pediatric Intensive Care Unit1Search for more papers by this author D Rosen, D Rosen Pediatric Intensive Care Unit1Search for more papers by this authorS Avishai-Eliner, S Avishai-Eliner Pediatric Intensive Care Unit1Search for more papers by this authorA Borenstein, A Borenstein Plastic Surgery Unit Kaplan Medical Center Rehovot, affiliatesd with the School of Medicine, Hebrew University and Hadassa, Jerusalem, IsraelSearch for more papers by this authorA Leviav, A Leviav Plastic Surgery Unit Kaplan Medical Center Rehovot, affiliatesd with the School of Medicine, Hebrew University and Hadassa, Jerusalem, IsraelSearch for more papers by this authorE Tabachnik, E Tabachnik Pediatric Intensive Care Unit1Search for more papers by this author First published: 02 January 2007 https://doi.org/10.1111/j.1651-2227.2000.tb00427.xCitations: 10AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume89, Issue8August 2000Pages 1018-1020 RelatedInformation

Maternal deprivation (MDep) of neonatal rats significantly influences the hypothalamic–pituitary–adrenal (HPA) axis. This study hypothesized that GR-mRNA modulation constituted an early, critical mechanism for the acute effects of MDep on neuroendocrine stress-responses. GR-mRNA hybridization signal in hippocampal CA1, hypothalamic paraventricular nucleus (PVN) and frontal cortex was significantly reduced immediately following 24 h MDep. In amygdala, cingulate cortex, PVN and CA1, apparent gender-dependent MDep effects on GR-mRNA expression were observed, without significant differences in absolute levels. Thus, rapid, region-specific MDep effects on GR-mRNA expression in HPA-regulating areas are shown, consistent with involvement of GR-expression in mechanisms of MDep influence on HPA tone.

Background: Leukotrienes are bronchoactive mediators secreted by inflammatory cells in the respiratory mucosa on exposure to asthma triggers. Objective: We investigated the effect of montelukast, a leukotriene receptor antagonist, on the release of leukotrienes in the respiratory mucosa of children with persistent asthma. Method: Twenty-three children aged 6 to 11 years with moderately severe asthma were treated in a cross-over design starting, after a 2-week run in period, with either montelukast (n = 12) or cromolyn (n = 11) for 4 weeks with a 2-week washout period between treatments. Twelve of them were then treated with either montelukast or beclomethasone for 6 months. The use of β2-agonists was recorded on a diary card. The concentration of leukotriene C4 (LTC4) was measured by HPLC in nasal washes obtained before and at the end of each treatment period. Eosinophilic cationic protein (ECP) was measured in the nasal washes by RIA. Results: The LTC4 concentration significantly decreased in the children treated for the first 4 weeks with montelukast, from 5.03 ± 1.17 to 1.42 ± 0.33 ng/mL (P < .005), and a nonsignificant increase was noted in children treated with cromolyn, from 3.37 ± 1.11 to 5.88 ± 2.17 ng/mL (P = .17). ECP concentration also decreased in the children receiving montelukast (P = .12). The concentration of LTC4 remained low after 3 and 6 months of treatment with montelukast (0.8 ± 0.7 and 1.0 ± 0.3 μg/mL) and was lower than with beclomethasone. Children treated with montelukast required significantly fewer β2-agonists (P < .04), Conclusion: Montelukast reduces the concentration of leukotrienes in the respiratory tract of children with persistent asthma parallel to reduction in ECP and clinical improvement. This effect was not observed when the same children were treated with cromolyn. (J Allergy Clin Immunol 1999;104:1162-7.)

Brainstem auditory evoked potentials (BAEPs) were measured in 11 young patients with cystic fibrosis (CF). Though none had clinical evidence of neurological impairment, all had various abnormal components of brainstem auditory evoked potentials (BAEPs). Abnormal BAEPs may be attributed to nutritional deficiencies including deficiencies of vitamins E and B6. As patients with CF are often deficient in vitamin E despite daily supplementation and normal serum levels, the authors suggest that the abnormal BAEPs demonstrated in the present study may reflect prolonged intracellular vitamin E deficiency. This finding suggests that BAEP studies may be useful in the neurological evaluation of patients with CF.

This study was conducted to assess the long-term safety of fluticasone propionate 50 micrograms twice daily (100 micrograms/day) or 100 micrograms twice daily (200 micrograms/day) administered via a dry powder inhaler in children aged 4-17 years with moderately severe asthma. A total of 257 patients received open treatment for 12 months. Of these, 110 had not received treatment with fluticasone propionate in any prior study. The remaining 147 patients had completed one of two previous short-term inhaled fluticasone propionate studies. In all, 132 patients (51%) reported 273 adverse events, the pattern of which was as expected in an atopic population with asthma; only 26 (10%) of these reports were considered either certainly, probably or possibly related to study treatment. The events most commonly reported either as a single or multiple diagnosis were: asthma and related events (25%), upper respiratory tract infection (13%), and rhinitis (6%). For most patients who reported a worsening of asthma, additional therapy was all that was required to control symptoms, and they continued in the study. There was a low incidence (2%) of pharmacologically predictable adverse events. Eight patients (3%) withdrew from the study because of an adverse event, five of which events (one each of hypertension, hoarseness and asthma and two of oral candidiasis) were recorded as being possibly or probably drug-related. Sixteen adverse events reported by 15 patients (6%) were classified as serious but none was considered to be related to the study drug. Of these reports 10 ( patients; 4%) were exacerbations of asthma requiring hospital admission; the other six adverse events were unrelated to asthma.(ABSTRACT TRUNCATED AT 250 WORDS)

Pediatric PulmonologyVolume 18, Issue 2 p. 119-121 Case Report Recurrent cyanotic spells caused by a segmental intramural cyst of the upper trachea B. Klin MD, B. Klin MD Department of Pediatric Surgery, Assaf Harofeh Me dical Center, The Sackler Faculty of Medicine, Tel Aviv UniversitySearch for more papers by this authorC. Springer MD, C. Springer MD Department of Pediatric Pulmonology, Hadassah University Hospital, Ein-Kerem, JerusalemSearch for more papers by this authorM. Segal MD, M. Segal MD Department of Pathology, Assaf Harofeh Me dical Center, The Sackler Faculty of Medicine, Tel Aviv UniversitySearch for more papers by this authorG. Eshel MD, G. Eshel MD Pediatric Intensive Care, Assaf Harofeh Me dical Center, The Sackler Faculty of Medicine, Tel Aviv University; Ein-Kerem, JerusalemSearch for more papers by this authorE. Tabachnik MD, E. Tabachnik MD Department of Pediatrics, Kaplan Hospital, Rehovot, IsraelSearch for more papers by this authorDr. I. Vinograd MD, Corresponding Author Dr. I. Vinograd MD Department of Pediatric Surgery, Assaf Harofeh Me dical Center, The Sackler Faculty of Medicine, Tel Aviv UniversityDepartment of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, P.O.B. Beer Yaakov 70300, IsraelSearch for more papers by this author B. Klin MD, B. Klin MD Department of Pediatric Surgery, Assaf Harofeh Me dical Center, The Sackler Faculty of Medicine, Tel Aviv UniversitySearch for more papers by this authorC. Springer MD, C. Springer MD Department of Pediatric Pulmonology, Hadassah University Hospital, Ein-Kerem, JerusalemSearch for more papers by this authorM. Segal MD, M. Segal MD Department of Pathology, Assaf Harofeh Me dical Center, The Sackler Faculty of Medicine, Tel Aviv UniversitySearch for more papers by this authorG. Eshel MD, G. Eshel MD Pediatric Intensive Care, Assaf Harofeh Me dical Center, The Sackler Faculty of Medicine, Tel Aviv University; Ein-Kerem, JerusalemSearch for more papers by this authorE. Tabachnik MD, E. Tabachnik MD Department of Pediatrics, Kaplan Hospital, Rehovot, IsraelSearch for more papers by this authorDr. I. Vinograd MD, Corresponding Author Dr. I. Vinograd MD Department of Pediatric Surgery, Assaf Harofeh Me dical Center, The Sackler Faculty of Medicine, Tel Aviv UniversityDepartment of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, P.O.B. Beer Yaakov 70300, IsraelSearch for more papers by this author First published: August 1994 https://doi.org/10.1002/ppul.1950180212Citations: 10AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume18, Issue2August 1994Pages 119-121 RelatedInformation

Background-The population of Israel consists of immigrants from many different countries. It is not known whether a single nomogram can be used for spirometric values of children of different ethnic descent.Methods-Spirometry was performed in 753 second or third generation Israeli children (7-14 years) of different ethnic groups. Both parents of 503 of the children were of the same ethnic background. Subjects were allocated to six ethnic groups (European, Iraqi, North African, Indian, Yemenite, and Georgian).Results-Standing height contributed most to the prediction of spirometric values (forced expiratory volume in one second, forced vital capacity), whereas sitting height did not contribute further. Statistical analysis showed significant ethnic differences. The Georgians had higher spirometric values for FEV1 than all the other ethnic groups, and higher FVC values than those of the Yemenite, North African, and Indian groups. FVC was lower among the Indian than all other groups.Conclusion-Differences in normal spirometric values were found among second or third generation Israeli children of different ethnic origins. European, North African, Iraqi, and Yemenite children could be characterised by single equation, whereas children of Georgian and Indian descent needed different predicting equations.

One hundred and seven chronically wheezing infants, aged 6 months to 3 years, completed a double‐blind placebo controlled multicenter study. Alter a two‐week baseline period the patients were randomized into two groups receiving twice daily either ketotifen or placebo for a period of 12 weeks. The ketotifen dosage was 0. 5 mg for children younger than one year and 1 mg for the older. During the 12‐week treatment period the patients from the two groups demonstrated gradual improvement of the disease severity parameters, as compared with the baseline period. The amelioration was more marked in the ketotifen treated patients and during the 0‐4, and 4‐8 weeks of treatment a significant decrease was achieved in the percentage of days with a cough (p < 0.04) and in the number of wheezing episodes (p = 0.02). Moreover, a 50% reduction of the days and nights with cough and in the number of wheezing episodes occurred earlier in the ketotifen than in the placebo treated patients, i. e. after 1. 2 vs 4. 6; 4. 4 vs 8. 6 and 5. 2 vs 7. 2 weeks, respectively. It should be stressed that the ameloration of the asthmatic morbidity in the ketotifen group was achieved with a significantly reduced need for the concomitant use of bronchodilators. The principal side effects observed were weight gain and transient sedation. It is concluded that ketotifen may be effective in the amelioration of asthma associated symptomatology and acceleration in the natural tendency for improvement in chronic wheezing infants.

Fluticasone propionate is a synthetic steroid for use by the inhaled route. It's high topical potency and low systemic bioavailability make it suitable for use in asthmatic children. A total of 258 children were randomised in a double-blind study to receive fluticasone propionate (50 μg bd) as the dry powder formulation inhaled via a Diskhaler inhaler, or matched placebo (with current therapy) for 4 weeks throughout which time diary cards were completed. During clinic visits lung function and adrenal function were measured. Fluticasone propionate produced a significantly greater increase in morning peak expiratory flow rate (PEFR) (adjusted mean difference over days 1–28, 17 l/min (95% CI; 10, 24);P<0.001) and evening PEFR (adjusted mean difference over days 1–28, 16 l/min (95% CI; 9, 23);P<0.001). In addition, diary card symptom scores, beta2-agonist rescue and clinic lung function improved significantly on fluticasone propionate. There were few adverse events and basal plasma cortisol remained within the normal range. In conclusion fluticasone propionate at 50 μg bd is superior to placebo (current therapy) in the treatment of childhood asthma with no evidence of adverse effects.

The effect of undernutrition and refeeding on superoxide production by polymorphonuclear cells (PMN) was studied in 11 girls suffering from anorexia nervosa (AN) and 17 age-matched, normal, healthy, control subjects. Superoxide anion production by PMNs from undernourished AN patients was comparable to normal, while a significant decrease in this function was observed during the initial period of refeeding. After a more extended period of refeeding, superoxide production by PMNs from AN patients increased and gradually returned toward normal values. Superoxide production correlated with length of the refeeding period (RF), weight as a percentage of ideal weight for height (W/H%), and rate of weight gain (WG). These results imply that a variety of physiological parameters, including susceptibility to infection, may be altered by refeeding undernourished patients.

Patients with cystic fibrosis (CF) often exhibit malabsorption despite the use of supplemental pancreatic enzymes. Unabsorbed carbohydrates and amino acids can serve as substrates for large intestine anaerobic fermentation, thus increasing excretion of short-chain fatty acids (SCFA) in the feces. Nine patients with CF on regular pancreatic enzyme supplementations in the age range of 5-11 years and one older patient were studied. Three-day stool samples were collected, as were 72-h food records. Stools were analyzed for gross energy, total nitrogen, fat content, and SCFA concentration. A significant difference was found between CF and normal controls in total caloric excretion due to fat malabsorption. No significant difference was found between CF and normal controls in protein or SCFA excretion. Fat excretion as percentage of fat intake was significantly increased in CF patients: 35.3 +/- 10.2% versus 8.0 +/- 3.0%, respectively. These data suggest that carbohydrate supplementation could be more widely used to increase caloric intake in CF patients without causing secondary osmotic diarrhea.

To test our hypothesis that neutrophil elastase plays a role in airway hypersecretion associated with the allergic late-phase response, using an isolated tracheal segment system in vivo and measuring lysozyme activity in the perfusate of the lumen as a marker of submucosal gland secretion over 8 h, we studied the response of five allergic dogs to ragweed. The dogs were exposed on separate occasions to specific allergen, to allergen, vehicle, and to allergen in the presence of a selective neutrophil elastase inhibitor, ICI 200,355. Allergen exposure caused a marked increase in lysozyme secretion that was significantly increased at 4, 6, and 8 h compared with controls and ICI 200,355-treated dogs. Neutrophil elastase appeared in the perfusate after allergen exposure and was positively correlated with lysozyme secretion at 8 h. These findings suggest that neutrophil elastase plays an important role as a secretagogue in the allergic late-phase response.

SummaryIn the present study we assessed the effect of leukotriene C4 on ciliary beat frequency in vitro. Chicken tracheas were sliced into thin rings and ciliary activity was viewed microscopically. Ciliary beat frequency was measured through an optical fibre by a fast Fourier transformer analyser and recorded on an oscilloscope. Ciliary beat frequency was measured at one fixed point during 30 min at room temperature in RPMI‐HEPES medium alone and in medium containing leukotriene C4 at a range of concentrations (10−6–10−9M). Our results demonstrate that leukotriene C4(10−7 and 10−8M) caused a significant decrease in ciliary beat frequency in all tracheal rings tested (mean decrease of 24%). The specificity and Ca2+ ‐dependency of leukotriene C4 activity was elucidated by the ability of FPL 55712 (SRS‐A specific antagonist), Ca2+ ‐free medium, calcium channel blockers (nifedipine and verapamil) and the calmodulin inhibitor trifluroperazine to abrogate its effect on ciliary beating.

ABSTRACT. The diagnosis of typhoid fever (TF) is usually established by culturing 5. typhi from the blood or by serology. In this report we describe three patients in whom the diagnosis of TF was made by the isolation of 5. typhi from gastric contents, despite negative blood urine and stool cultures. Culture of gastric contents has not previously been recognized as a diagnostic tool in this disease.

The relationship between release of leukotriene C4 (LTC4) from nasal mucosa in vivo and from peripheral blood leukocytes (PBLs) in vitro was examined in 18 patients with untreated rhinitis allergic to the house dust mite, Dermatophagoides pteronyssinus, and in 20 nonallergic control subjects following challenge with the specific allergen. Allergic patients were subjected to intranasal and PBL challenge with D pteronyssinus and a nonrelevant allergen, Artemisia vulgaris. In all allergic patients, intranasal challenge by D pteronyssinus, but not by A vulgaris, resulted in a release of substances from the nasal mucosa that reacted in a radioimmunoassay with antiserum to LTC4. Dermatophagoides pteronyssinus challenge in vitro of PBLs from the same patients, but not A vulgaris challenge, induced release of the same immunoreactive material into the supernatant. By comparison, the nonallergic subjects challenged with D pteronyssinus showed significantly lower LTC4 levels in their nasal secretions and PBL supernatants. The results show that, following specific allergen challenge, the release of LTC4 by the allergic nasal mucosa is similar in extent and nature to that of PBLs, indicating that these procedures can be used as tools to measure the efficacy of topically and systemically administered antiallergic drugs.