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The current management of a primary IgE-mediated peanut allergy consists of the two basic pillars “exposure prophylaxis” with avoidance of the allergen and “emergency therapy” with short-term treatment of an acute allergic reaction after accidental ingestion. Accidental reactions are common despite attempted avoidance. The severity of an allergic or even anaphylactic reaction after accidental ingestion is difficult to assess prior to reaction. In addition, reaction thresholds may vary depending on the accompanying augmentation factor. Therefore, every peanut allergic patient should receive individual dietary counseling as well as instructions for the use of the emergency kit and a structured patient education program (anaphylaxis group training), if necessary. For the first time, since fall 2021 a causal treatment option with a drug for oral immunotherapy will now be available for 4‑ to 17-year-old peanut-allergic children and adolescents. The oral immunotherapy with peanut protein as defatted powder of Arachis hypogaea L., semen (peanuts) leads to desensitization with a good efficacy record and an acceptable safety profile. Other treatment options with different therapeutic approaches are also under development and will probably expand the range for treatment in the coming years.

Background: Positive bronchodilator reversibility (BDR) is a diagnostic criterion for asthma. However, patients with asthma may exhibit negative BDR test. Aim: To describe frequency of positive and negative BDR in patients with severe asthma and associations with phenotypic characteristics. Methods: Positive BDR was defined as FEV1 increase > 200 ml AND > 12% upon testing with a short-acting beta-agonist (SABA). Results: Out of 2013 patients included in the German Asthma Net (GAN) severe asthma registry, 793 had data on BDR. Hereof, 250 (31.5%) had a positive and 543 (68.5%) had a negative BDR test. Comorbidities significantly associated with negative BDR were gastro-esophageal reflux (GERD) (28.0% vs 40.0%, p

Background: Bronchodilator reversibility is a diagnostic criterion for asthma. However, patients with asthma may exhibit irreversible obstruction eg due to long-standing uncontrolled disease with airway remodeling or beta-2 receptor down-regulation. Aim: This study aims to describe frequency of negative bronchodilator reversibility in patients with severe asthma and associations with other phenotypic characteristics. Methods: Bronchodilator testing was performed according to guideline recommendations, with patients being advised to pause interfering treatments before testing. Significant bronchodilator reversibility was defined as FEV1 increase > 200ml AND > 12% upon SABA inhalation. Results: Bronchodilator reversibility results were available from 793/ 2013 patients included in the registry. Hereof, 250 (31.5%) had significant reversibility, while 543 (68.5%) were classified irreversible. Comparing patients with reversible and irreversible obstruction, sex (52% vs 56%), mean age (49.6 vs 50.0 years), smoking history (non: 57.2% vs 56.1%; active: 2.8% vs 2.2%; ex: 40% vs 41.7%), COPD comorbidity (5.2% vs 7.2%) and BMI (27.2 vs 27.5kg/m2) were similar in both groups. Comorbidities significantly associated with irreversible obstruction were GERD and EGPA(p

Background: The relevance of the age of asthma onset for type 2 biomarker expression in severe asthma is incompletely understood. Methods: Data of 1512 patients documented in the German severe asthma registry (GAN) were analysed according to age of asthma onset (severe early-onset asthma, SEA: age of onset

Patients with asthma should be vaccinated against COVID-19. This includes patients with severe asthma. Treatment with a biological for asthma is no contra-indication for vaccination against COVID-19.Für Patienten und Patientinnen mit Asthma wird eine Impfung gegen COVID-19 empfohlen. Dies gilt auch für Patienten und Patientinnen mit schwerem Asthma. Die Behandlung des schweren Asthmas mit einem Biologikum ist keine Kontraindikation für eine Impfung gegen COVID-19.

ZusammenfassungPräsentiert wird der Fall eines 8 Jahre alten Mädchens mit Schielen, Doppelbildern und Nystagmus bei akuter partieller Okulomotoriusparese. Auffällige MRT-Untersuchung mit zahlreichen intrakraniellen Veränderungen mit Dissemination in Raum und Zeit. In der Liquordiagnostik Nachweis intrathekaler Antikörpersynthese mit oligoklonalen Banden. Bei hochaktiver multipler Sklerose Beginn mit einer Steroidtherapie und darauffolgendem schnellen Symptomrückgang. Progress nach 3 Monaten bei Nichtbeginn der empfohlenen immunmodulierenden Therapie.

Airway inflammation is a key feature of upper and lower respiratory allergic diseases, such as allergic rhinitis and asthma. Characteristically, histological alterations such as goblet cell hyperplasia, mucus hypersecretion, loss of epithelial barrier function, airway infiltration and structural changes such as basal membrane thickening and airway smooth muscle hyperplasia. These inflammatory signs are often obvious already early in life and may be accompanied by structural changes (remodeling) occurring in early lifetime. This review focusses on the main mechanisms underlying the development of airway inflammation and remodeling and discusses the question which factors contribute to the persistence of airway inflammation in chronic allergic airway disease.

Die allergische Rhinitis (AR) ist mit einer globalen Pravalenz von ca. 20 % die haufigste Immunerkrankung uberhaupt und stellt eine der haufigsten chronischen Erkrankungen im Kindes- und Jugendalter dar. Typische Symptome sind Rhinorrho, Niesreiz, Pruritus, nasale Obstruktion und okulare Symptome. Typische Komorbiditaten sind andere Erkrankungen des atopischen Formenkreises, wie Asthma bronchiale, atopische Dermatitis, und Nahrungsmittelallergien, einschlieslich orales Allergiesyndrom (OAS), sowie die chronische Rhinosinusitis, die Otitis media mit Ausfluss („otitis media with effusion“, OME) und hyperplastische Adenoide. Die Behandlung beruht auf 4 Eckpfeilern: Aufklarung des Patienten, Allergenkarenz, Pharmakotherapie und spezifische Immuntherapie. Die medikamentosen Therapieoptionen der AR sind vielfaltig und beinhalten derzeit v. a. den Einsatz von topischen Glukokortikosteroiden, Antihistaminika und Leukotrienrezeptorantagonisten. Die aktuellen Leitlinien empfehlen intranasale Glukokortikoide und systemische Antihistaminika als effektive und sichere Primartherapie. Nicht alle Patienten erreichen damit eine gute Symptomkontrolle, sodass neue Behandlungswege und -strategien gefunden werden mussen. Aktuelle Weiterentwicklungen beinhalten Substanzen wie neuartige Antihistaminika nicht nur gegen den H1-Rezeptor, nasale Glukokortikosteroide in Form von Pro-Drugs sowie ein Kombinationsnasenspray, das die Gabe von Antihistaminikum und Glukokortikoid vereint. Auch bei der allergenspezifischen Immuntherapie (AIT), dem einzigen kausalen Therapieansatz, konnten in den letzten Jahren grose Fortschritte erzielt werden. Neben der AR konnen sich Allergien im Hals-Nasen-Ohren(HNO)-Bereich auch in Form von Paukenergussen, Ekzem und oralem Allergiesyndrom (OAS) manifestieren.

The present guideline is a new version and an update of the guideline for the diagnosis and treatment of asthma, which replaces the previous version for german speaking countries from the year 2006. The wealth of new data on the pathophysiology and the phenotypes of asthma, and the expanded spectrum of diagnostic and therapeutic options necessitated a new version and an update. This guideline presents the current, evidence-based recommendations for the diagnosis and treatment of asthma, for children and adolescents as well as for adults with asthma.Die vorliegende Leitlinie ist eine Neufassung und Aktualisierung der Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma, welche die bisher für den deutschen Sprachraum gültige Version aus dem Jahr 2006 ablöst. Die Fülle an neuen Erkenntnissen zur Pathophysiologie und zu den Phänotypen von Asthma und das erweiterte Spektrum an diagnostischen und therapeutischen Möglichkeiten bei dieser Erkrankung machte eine Neufassung und Aktualisierung notwendig. Es werden sowohl für Kinder und Jugendliche als auch für Erwachsene mit Asthma die aktuellen, Evidenz-basierten diagnostischen und therapeutischen Empfehlungen dargelegt.

An imbalance between Th1 and Th2 cells is involved in allergic rhinitis (AR) that may be improved by probiotics. To test the efficacy of the probiotic Lactobacillus paracasei subsp. paracasei LP-33, a double-blind, placebo-controlled, randomized trial was carried out in patients with AR to grass pollen treated with loratadine and presenting altered quality of life. Subjects with persistent AR, symptomatic during the grass pollen season, and a positive skin test or specific immunoglobulin E to grass pollens were included by general practitioners (GPs). All received loratadine for 5 weeks. The primary end point was the improvement in Rhinitis Quality of Life (RQLQ) global score at the fifth week of LP-33 consumption compared with placebo (in addition to loratadine). Secondary end points included nasal and ocular symptoms (individual and total symptom scores), visual analogue scale and time of first exacerbation of the symptoms when loratadine was stopped. A total of 425 subjects were included. Using intent-to-treat analysis, the RQLQ global score decreased significantly more in the LP-33 group than in the placebo group (P=0.0255, difference=−0.286 (95% confidence interval (CI): −0.536; −0.035)). No significant differences were noted for the change of the rhinitis total symptom score 5 global score between groups (P=0.1288, difference=−0.452 (95% CI: −1.036; 0.132)). Significant differences in ocular symptoms (RQLQ) were observed between groups (P=0.0029, difference=−0.4087 (95% CI: −0.6768; −0.1407)). This study performed by GPs shows that LP-33 improves the quality of life of subjects with persistent AR who are currently being treated with an oral H1-antihistamine. Whereas nasal symptoms had not changed, ocular symptoms had consistently improved.

Intracranial laceration due to traumatic birth injury is an extremely rare event affecting approximately one newborn per a population of 4.5 million. However, depending on the mode of injury, the resulting brain damage may lead to lifelong sequelae, for example, cerebral palsy for which there is no cure at present. Here we report a rare case of neonatal arterial ischemic stroke and cerebral palsy caused by fetal traumatic molding and parietal depression of the head during delivery caused by functional cephalopelvic disproportion due to a “long pelvis.” This patient was treated by autologous cord blood mononuclear cells (45.8 mL, cryopreserved, TNC2.53×10e8) with a remarkable recovery. Active rehabilitation was provided weekly. Follow-up examinations were at 3, 18, 34, and 57 months. Generous use of neonatal head MRI in case of molding, craniofacial deformity, and a sentinel event during parturition is advocated to enhance diagnosis of neonatal brain damage as a basis for fast and potentially causative treatment modalities including autologous cord blood transplantation in a timely manner.

Introduction Tiotropium (TioR) a demontre une securite et une tolerance comparable au placebo chez l’adulte avec asthme leger a severe symptomatique et l’adolescent avec asthme modere a severe symptomatique. Une etude de Ph 2 a montre que TioR (etait un bronchodilatateur bien tolere dans le groupe d’âge 6–11 ans . Nous presentons ici les resultats de la premiere etude de phase III sur la securite et la tolerance du TioR (add-on de traitement chez des enfants avec asthme severe symptomatique. Methodes Essai randomise, en double aveugle sur 12 semaines, realise chez l’enfant de 6–11 ans presentant un asthme severe symptomatique. Les patients recevaient TioR 5 μg (2 × 2,5 μg/j) ou TioR 2,5 μg (2 × 1,25 μg/j) vs placebo (pboR ; 2 bouffees) et en add on de traitement, soit une forte dose de corticosteroides inhales (CSI > 400 μg budesonide ou equivalent), soit un LABA et/ou LTRA, soit une dose moy de CSI (200-400 μg budesonide ou equivalent) et deux autres traitements (LABA et/ou LTRA et/ou theophylline LP). Les patients devaient avoir des antecedents d’asthme datant > 6 mois et etre symptomatiques avant la randomisation objective par un ACQ ≥ 1,5 en moy. Critere principal Effets indesirables collectes pour evaluer la securite et la tolerance de TioR. Resultats 401 patients ont ete randomises and 400 patients ont ete traites ; 130 patients par TioR 5 μg, 136 par TioR 2,5 μg, 134 par pboR. Les caracteristiques initiales des patients, etaient comparables entre les groupes. 69,8 % de garcons, âge moyen : 9,0 ± 1,6 ans , duree moy de traitement : 86,1 ± 9,1 jours. L’incidence des effets indesirables a ete comparable entre les groupes traites, avec une incidence faible des effets indesirables graves : aucun deces declare et des effets indesirables lies : au medicament ; a l’arret du traitement. L’asthme, la diminution du volume expiratoire de pointe et la rhinopharyngite sont les effets les plus frequemment signales et se produisant plus rarement avec TioR versus placebo. Conclusion Chez les enfants âges de 6–11 ans presentant un asthme severe symptomatique, la securite et la tolerance du TioR (associe a au moins un CSI) est comparable au placebo.

Affektkrampfe sind eine haufige Ursache fur plotzliche Bewusstseinsverluste im Sauglings- und Kleinkindesalter. Wir berichten uber einen 10 Monate alten Jungen, der wiederholte lebensbedrohlich erscheinende Ereignisse mit Bewusstlosigkeit, Augenverdrehen, versteiften Extremitaten, perioraler Zyanose und uberwiegender Blasse am ubrigen Korper darbot. Wahrend der Langzeit-EKG-Aufzeichnung (EKG: Elektrokardiogramm) kam es zu 2 affektgebundenen Ereignissen, bei denen jeweils ein Sinusarrest von 10–11 s Dauer nachgewiesen werden konnte. Deshalb wurde im Alter von 1 Jahr ein Herzschrittmacher implantiert, was die vollstandige Behebung der klinischen Symptomatik zur Folge hatte.

BACKGROUND As diagnostic methods for primary ciliary dyskinesia are not generally available, we tested whether clinical criteria allow to preselect patients with a high probability of this disease, who should be further investigated in a specialized centre. PATIENTS AND METHODS In patients with chronic cough we compared parameters of the case history with the finding of a reduced ciliary beat frequency (CBF). Data sheets of 323 patients (133 females, 190 males) aged 1 week through 40 years (median age 4.5 years) were available for analysis. Of these patients 46 (14%) had a reduced CBF. RESULTS In this group the following features were found significantly more frequently compared to patients with normal CBF: neonatal respiratory disorder (odds ratio (OR) 9.0; 95% confidence interval (95% CI) 3.2;25), situs inversus (OR 8.1; 95% CI 2.5;26), retention of airway secretions (OR 6.7; 95% CI 2.4;19), recurrent pneumonia (OR 4.1; 95% CI 1.8;9.5), bronchiectasis (OR 3.5; 95% CI 1.2;11), asthma with poor response to treatment (OR 2.4; 95% CI 1.1;5.3). At least one of these potential indicators was present in 91% of the patients with reduced CBF. CONCLUSIONS In patients with chronic cough specific parameters of the case history indicate a high probability of a reduced ciliary beat frequency which is an indicator for primary ciliary dyskinesia. If none of these findings is present, a reduced CBF is highly unlikely.

Summary Background The treatment of allergic asthma by specific immunotherapy (SIT) is hampered by potential side-effects. Objective The aim of this study was to study the effect of omalizumab, a monoclonal anti-IgE antibody, in combination with SIT in patients with seasonal allergic rhinoconjunctivitis (SAR) and co-morbid seasonal allergic asthma (SAA) incompletely controlled by conventional pharmacotherapy. Methods A randomized, double-blind, placebo-controlled, multi-centre trial was performed to assess the efficacy and safety of omalizumab (Xolair®) vs. placebo in combination with depigmented SIT (Depigoid®) during the grass pollen season. Omalizumab or placebo was started 2 weeks before SIT; the whole treatment lasted 18 weeks. Primary endpoint was daily ‘symptom load’, the sum of daily scores for symptom severity and rescue medication use. Results A total of 140 patients (age 11–46 years) were randomized; and a total of 130 finished the study. Combination therapy reduced the symptom load by 39% (P=0.0464, Wilcoxon test) over SIT monotherapy. This difference was mainly due to reduced symptom severity (P=0.0044), while rescue medication use did not change significantly. Combination therapy also improved asthma control (Asthma Control Questionnaire, P=0.0295) and quality of life in the case of asthma (Asthma Quality of Life Questionnaire, P=0.0293) and rhinoconjunctivitis (Rhinoconjunctivitis Quality of Life Questionnaire, P=0.0537). Numbers of patients with ‘excellent or good’ treatment efficacy according to ratings of investigators (75.0% vs. 36.9%) or patients (78.5% vs. 46.1%) were markedly higher in the combination group than under SIT alone. Conclusion Combination of omalizumab with SIT for treatment of patients with SAR and co-morbid SAA was safe and reduced the symptom load in a statistically significant and clinically meaningful manner.

For a long time, pharmacological therapy of allergic diseases such as asthma or rhinitis was mostly based on symptomatic treatment with corticosteroids, sympathomimetic drugs and anti-histamines. Due to the increased understanding of the basic mechanisms underlying the development of allergic diseases, several novel strategies have been expounded in the last years aiming to intervene directly in the relevant processes of the immunologic cascade. The first of such compounds reaching the market is now applicable in form of anti-IgE antibody (omalizumab) for treatment of severe allergic asthma, but due to the unique anti-allergic efficacy, other intriguing indications are more than likely. This review will summarize the basic mode of action and the pharmacodynamics of a treatment with anti-IgE and will discuss the current evidence.

Immunglobulin E (IgE) besitzt eine Schlusselrolle als Vermittler allergischer Reaktionen gegenuber Nahrungsmittel- oder Umweltallergenen, die bei der klinischen Auspragung allergischer Symptome der Atemwege (allergische Rhinokonjunktivitis, Asthma bronchiale), der Haut (Urtikaria, atopische Dermatitis) und des Magen-Darm-Trakts (Nahrungsmittelallergien) von besonderer Bedeutung sind. Der rekombinante, humanisierte Antikorper Omalizumab, der seit 2005 in Deutschland fur die Behandlung des schweren allergischen Asthma bronchiale fur Kinder ab 12 Jahren zur Verfugung steht, hat fur besondere Problemfalle seine therapeutische Wirksamkeit und – nach derzeitiger Datenlage – auch bei jungeren Kindern seine gute Vertraglichkeit belegt. Anti-IgE bietet uber das Asthma bronchiale hinaus interessante Perspektiven fur bisher schwer behandelbare, komplexe allergische Krankheitsbilder mit hohem Leidensdruck.

A recent trial has demonstrated short-term benefits of a new minimal invasive procedure of surfactant administration in spontaneously breathing preterm infants ≥ 26 weeks (less invasive surfactant administration, LISA).To assess safety as well as short- and long-term outcomes of the LISA procedure in preterm infants between 23-28 weeks of gestation.Preterm infants born between 23+0 and 28+6 weeks gestational age during 2 periods, 18 months before (Period 1, n=44) and 18 months after introduction of LISA (Period 2, n=53), were analyzed for neonatal outcomes. 52% of discharged infants were assessed for neurodevelopmental outcome at corrected age of 3 years.In Period 2, 66% of the preterm infants needing surfactant were treated by the new method of LISA. In this period, fewer patient had to be ventilated during the first 3 days of life (42 vs. 77%, p0.0005) and overall (55 vs. 77%, p=0.02). The median duration of mechanical ventilation was 2 vs. 3 days (p=0.056). Survival without BPD was 68% in period 1 and 74% in period 2 (p=0.29). In period 2, fewer infants received antibiotics after the third day of life (43 vs. 66%, p=0.04), systemic glucocorticoids were less frequently used (7.5 vs. 23%, p=0.04), and more infants received doxapram (34 vs. 2.3%, p0.0001). Mental Developmental Index (89 vs. 98, p=0.16) and Physical Developmental Index (83 vs. 91, p=0.03) at 3 years improved between the 2 periods.Implementation of the LISA method on a neonatal ward was safe and feasible and was associated with less need for mechanical ventilation in infants24 weeks. As our study was retrospective the observed trends for better pulmonary and neurocognitive outcomes should be interpreted with caution until results from randomized trials on the LISA procedure are available.

Clinical history, physical examination, evolution and imaging findings (Colour Doppler sonography, MRI if available) are of pivotal importance in the diagnostic pathway of an infantile vascular anomaly. Histopathology with specific stains and markers is contributive in difficult cases. Differentiation between vascular tumors (hemangioma) and vascular malformations is now well known and integrated into the ISSVA classification. We report here a 6-months-old boy, who presented with a localized cutaneous and expansive vascular birthmark in the left cheek and developed bleedings at the age of 18 months. Diagnostic features of a hemangioma were not evident, and the final diagnosis of a venous malformation was confirmed by histopathology.

Introduction: Trisomy 13 (Patau syndrome) is one of the most common autosomal trisomies and is characterized by craniofacial dysmorphologies as well as cardiac and central nervous system abnormalities. Life expectancy is reduced. Most of the children die within the first days and months after birth. However, approximately 10% of the children with total trisomy 13 survive beyond 1 year. In up to 50% of the cases, Patau syndrome is accompanied by epilepsy. Typical features are an early onset and a generally good seizure control. Common types of seizures are infantile spasms and myoclonic jerks. EEG recordings show nonspecific findings, although photosensitivity has been an often reported EEG feature. Recent studies show that the epilepsy can just be poorly controlled by antiepileptic medication in the presence of photosensitivity. Method: We describe a 13-month-old boy with a partial trisomy 13q21.1qter who was born at 36 weeks with a distinct growth retardation. Postnatally, a malalignment-ventricular septum defect and an infundibular pulmonary stenosis plus a tracheo- and laryngomalacia as well as postaxial hexadactyly became apparent. Furthermore, a pronounced cognitive and motoric retardation developed over the course of time. At the age of 7 months, myoclonic jerks occurred. The EEG revealed multifocal and generalized sharp and (poly-) spike waves. Photosensitivity was not detected. Initial treatment with sultiam and ethosuximide failed to improve the epileptic situation. The introduction of valproate decreased the frequency of seizures significantly. Summary: For our patient, semiology and EEG findings match data in literature for children with total trisomy 13. However, despite the absence of photosensitivity, the epilepsy seems difficult to treat. For patients with trisomy 13 and epilepsy, valproate is the first-line treatment. Keywords: trisomy 13, epilepsy, EEG, photosensitivity, valproate.

Exposure early in life to organic dusts containing immunomodulatory components such as endotoxins and immunizing components such as aeroallergens may greatly influence whether subsequent encounters with allergens lead rather to sensitization or unresponsiveness. We investigated the effects of endotoxin in the context of allergen-mediated immune responses in a murine model of allergen sensitization. Systemic sensitization with ovalbumin induced high serum levels of allergen-specific IgE, predominant Th2-type cytokine production, eosinophilic airway inflammation and in vivo airway hyperreactivity. Endotoxins were either applied systemically prior to sensitization, or via the airways prior to airway challenges, or by repeated inhalation during the first weeks of life prior to subsequent sensitization. Different effects of endotoxins on allergen-induced immune responses may be attributed to differences in dosing, route of application, time relationship with allergen sensitization and the concurrent exposure to endotoxin and allergen. The results of these studies may help to define the effects of endotoxin on allergen-mediated immune reactions and to further delineate the important interrelationships between environment and disease development. Finally, this may lead to new strategies in the prevention and treatment of allergic diseases.

There has been significant utilization of the technique described by Hamelmann et al. ( Am J Respir Crit Care Med 156: 766–775, 1997) in which a parameter, enhanced pause (Penh), related to airways responsiveness is noninvasively measured by unrestrained plethysmography (UP). Investigating this technique, we sought to answer these questions: 1) How do changes in Penh compare with changes in traditional plethysmographic and lung mechanical parameters? 2) How do UP parameters perform in two different mouse strains? Awake immunized and control BALB/c ( n = 16) and C57BL/6 ( n = 14) mice were placed in the UP chamber and exposed to doses of aerosolized methacholine while the following parameters were measured at each concentration: inspiratory time (Ti), expiratory time (Te), total time (Ttot), Ti/Ttot, peak inspiratory pressure, peak expiratory pressure, Pause, Penh, tidal volume (Vt), Vt/Ti, Vt/Te, and Vt/Ttot. The next day, lung resistance (Rl) and compliance (Cl) were invasively measured in the same animals. For the BALB/c, the parameters with the highest magnitude of correlation coefficient vs. Rl are (in order) 1) Cl, 2) Pause and Penh, 3) parameters of breathing frequency (Te, Ttot, Ti), and 4) parameters related to Vt (inspiratory pressure, expiratory pressure). Flow parameters (Vt/Ttot, Vt/Te, Vt/Ti) and duty cycle parameters (Ti/Ttot) had insignificant correlations. This ordering is significantly different in C57BL/6 mice, in which the parameters with the largest correlations are 1) Cl, 2) parameters of breathing frequency, and 3) flow parameters. Pause, Penh, Vt, and duty cycle parameters had insignificant correlations. These data show that Penh is problematic in the sense that it is strain specific; it behaves very differently in BALB/c and C57BL/6 mice. We suggest that UP parameters largely originate as part of reflex control of breathing processes, rather than in the lung mechanics and conclude that it is inappropriate to use UP parameters in general, and Penh specifically, as substitute variables for invasive mechanical indexes such as Rl.

Each year, thousands of children incur brain damage that results in lifelong sequelae. Therefore, based on experimental evidence, we explored the therapeutic potential of human cord blood, known to contain stem cells, to examine the functional neuroregeneration in a child with cerebral palsy after cardiac arrest. The boy, whose cord blood was stored at birth, was 2.5 years old and normally developed when global ischemic brain damage occurred resulting in a persistent vegetative state. Nine weeks later, he received autologous cord blood (91.7 mL, cryopreserved,5.75×10e8mononuclear cells) intravenously. Active rehabilitation (physio- and ergotherapy) was provided daily, follow-up at 2, 5, 12, 24, 30, and 40 months. At 2-months follow-up the boy’s motor control improved, spastic paresis was largely reduced, and eyesight was recovered, as did the electroencephalogram. He smiled when played with, was able to sit and to speak simple words. At 40 months, independent eating, walking in gait trainer, crawling, and moving from prone position to free sitting were possible, and there was significantly improved receptive and expressive speech competence (four-word sentences, 200 words). This remarkable functional neuroregeneration is difficult to explain by intense active rehabilitation alone and suggests that autologous cord blood transplantation may be an additional and causative treatment of pediatric cerebral palsy after brain damage.

The effects of nebulized IFN-gamma on primary and secondary IgE production and development of airway hyper-responsiveness (AHR) were investigated. BALB/c mice received primary exposure to aerosolized OVA daily for 10 days and developed anti-OVA IgE responses, immediate cutaneous reactivity to OVA, and altered airway function when assayed on day 12. After secondary exposure to OVA challenges on days 30 and 31, these mice developed an amplified IgE response, heightened cutaneous reactivity to OVA and AHR when measured on day 37. Administration of IFN-gamma for 13 days, beginning 3 days prior to and during primary OVA sensitization, resulted in a decrease in anti-OVA IgE, increases in serum anti-OVA IgG2a levels, a decrease in cutaneous reactivity to OVA, and normal airway function when assessed on day 12 after primary sensitization. This treatment also prevented the development of secondary anti-OVA IgE responses and altered airway responsiveness but did not induce a secondary rise in anti-OVA IgG2a in the serum measured on day 37. Treatment with IFN-gamma on days 26 to 30, well after primary responses were established but just prior to secondary OVA challenge, abolished the development of secondary anti-OVA IgE responses, resulted in an increase in anti-OVA IgG2a in the serum, and prevented the development of AHR. In vitro, CD4+ T cells obtained from OVA-sensitized mice treated with either "early" or "late" IFN-gamma inhibited IgE production. Delivery of IFN-gamma to the airways can prevent secondary allergen sensitization even after primary sensitization has been achieved and this effect is mediated by CD4+ T cells.