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Background • Highly concentrated cranberry juice has long been considered to have protective properties against urinary tract infections (UTIs), on the basis of its content of cranberry proanthocyanidins, with A-type interflavan bonds. Objective • This study intended to evaluate the benefits of a highly concentrated cranberry juice for the prevention of repeated episodes of UTI in uncircumcised boys. Design • The study was a randomized, controlled trial. Setting • The study took place at Taipei City Hospital, Renai and Zhongxing Branches (Taipei City, Taiwan). Participants • Participants were 55 uncircumcised boys and 12 circumcised boys, aged 6 to 18 y, with histories of uncomplicated UTI, who were patients at the hospital. Intervention • The uncircumcised boys were randomly divided into 2 groups: (1) group 1 (n = 28) took 4 oz (120 mL) daily of cranberry juice for 6 mo; and (2) group 2 (n = 27), the negative control group, drank a placebo juice for 6 months. The circumcised boys in group 3, a positive control group, also drank a placebo juice for 6 mo. Outcome Measures • The time to UTI (ie, to the appearance of symptoms plus pyuria) was the main outcome. Asymptomatic bacteriuria, adherence to the treatment, and adverse effects were assessed at monthly visits. Results • After 6 mo of a prophylactic treatment with cranberry juice, the incidence of bacteriuria, mainly Escherichia coli, as shown in urine cultures at ≥1 × 105, were 25% (7/28), 37% (10/27), and 33.3% (4/12) in groups 1, 2 and 3, respectively. The comparisons of the rate of prevention of a recurrence of UTI between group 1 and group 2 and between group 1 and group 3 showed that group 1 had fewer recurrent episodes of UTI. No children withdrew from the study. No adverse events or side effects were recorded. Conclusions • Cranberry juice may reduce the number of repeated episodes of UTI in uncircumcised boys and may have beneficial effects against the growth of Gram-negative bacterial pathogens. Its preventive benefits against UTI in the uncircumcised boys were even higher than those of circumcision for the circumcised boys. [ABSTRACT FROM AUTHOR]

Background. An autoimmune etiology has been suggested in up to one-third of cases of chronic idiopathic urticaria (CIU), in which it has been proposed that a subset of cases are associated with thyroid autoimmunity. The objective of our present study was to verify the prevalence of thyroid antibodies in the patients with CIU. Methods. Sixty patients aged 12-51 years, who met criteria for CIU, and 40 aged-matched healthy controls (18 males and 22 females) were participated in this study. Serum anti-thyroid antibodies (ATAs), thyroid hormones, total immunoglobulin E (IgE), and food allergen-specific IgE antibodies were measured. The CIU group was treated with anti-H1 and anti-H2 histamines for 3 weeks. Results. The total ATA positive rate was 27.3% (33% males and 25% females) in the CIU group. The prevalence of anti-thyroglobulin antibodies, anti-TSH-receptor antibodies, and anti-thyroid peroxidase antibodies were 16.6%, 83.3%, and 8.3%, respectively. The thyroid hormones, T3, and T4, and the TSH were within the normal limits. The radioallergosorbent test was negative for food allergens, and only 18% of the patients had a total IgE concentration >200 IU/mL. Conclusion. ATAs were found in 27% of the patients with CIU, but these antibodies did not dysregulate thyroid hormone secretion nor did they mediate any clinical manifestations. [ABSTRACT FROM AUTHOR]

Background. Acute bronchiolitis frequently causes wheezing in infants and young children, although its relationship to asthma remains unclear. We hypothesized that serum lipoxin A4 levels may be used as an early predictive biomarker of subsequent asthma in young children with acute bronchiolitis. Methods. We recruited 69 children who were divided into 3 groups: 47 children younger than 24 months with acute bronchiolitis as an experimental group (Group 1); 11 children aged 2-24 months with viral acute gastroenteritis as a non-allergic control group (Group 2); and 11 children older than 24 months with physician-diagnosed asthma exacerbations as an asthma control group (Group 3). We determined white blood cell counts, eosinophil counts, and serum levels of C-reactive protein, interleukin-4, interleukin-5, prostaglandin E2, tumor necrosis factor-alpha, and lipoxin A4. Results. The mean serum levels of lipoxin A4 in the groups with acute bronchiolitis (1), acute gastroenteritis (2), and asthma (3) were 0.0430±028, 0.0540±015, and 0.0510±031 ng/ml, respectively. When compared by t-tests, there were no significant differences between Groups 1 and 2, or Groups 1 and 3 ( p>0.05), despite a significant difference between Groups 2 and 3 ( p=0.0392). In a final regression model, serum lipoxin A4 levels were positively correlated with age, female gender, white blood cell counts, and interleukin-5 levels in all patients, while asthma patients had lower serum lipoxin A4 levels compared to the other two groups. Conclusion. Serum levels of lipoxin A4 cannot be used as an early predictive diagnostic marker for asthma in young children with acute bronchiolitis. [ABSTRACT FROM AUTHOR]

Background: The efficacy of the combination of leukotriene receptor antagonist (LRA) and H1 antihistamine was similar to the synergistic regimen of H1 and H2 antihistamine for treatment of chronic idiopathic urticaria (CIU). However, the effective rates of these two regimens were only 53.3% and 63.3%, respectively. Method: A total of 50 with two combined therapeutic regimens treatment ineffective patients were evaluated. Patients were single blinded and randomly assigned to one of two medication groups that received the following regimens for 4 weeks: Group A ( n = 30), combination of LRA, H1 antihistamine and H2 antihistamine. Group B ( n = 20) continued with the previously taken two combination regimens. The treatment efficacy was measured by daily urticaria activity score (UAS) of wheal and itch. A positive therapeutic response was defined as a reduction to <25% of baseline weekly UAS, while a relapse was a return to >75% of baseline weekly UAS. Results: At the end of 4 weeks, the UAS response to treatment of Group A was decreased from 35.2% to 21.2%, and the Group B was persisted with 33.9% as before the treatment. Conclusion: The combination of LRA, H2 antihistamine and H1 antihistamine is promising for the refractory CIU cases, which were refractory for two combined therapeutic regimens. [ABSTRACT FROM AUTHOR]

Background: Acute bronchiolitis frequently causes wheezing in infants and young children, although its relationship to asthma remains unclear. We hypothesized that serum lipoxin A(4) levels may be used as an early predictive biomarker of subsequent asthma in young children with acute bronchiolitis., Methods: We recruited 69 children who were divided into 3 groups: 47 children younger than 24 months with acute bronchiolitis as an experimental group (Group 1); 11 children aged 2-24 months with viral acute gastroenteritis as a non-allergic control group (Group 2); and 11 children older than 24 months with physician-diagnosed asthma exacerbations as an asthma control group (Group 3). We determined white blood cell counts, eosinophil counts, and serum levels of C-reactive protein, interleukin-4, interleukin-5, prostaglandin E(2), tumor necrosis factor-alpha, and lipoxin A(4)., Results: The mean serum levels of lipoxin A(4) in the groups with acute bronchiolitis (1), acute gastroenteritis (2), and asthma (3) were 0.0430.028, 0.0540.015, and 0.0510.031 ng/ml, respectively. When compared by t-tests, there were no significant differences between Groups 1 and 2, or Groups 1 and 3 (p0.05), despite a significant difference between Groups 2 and 3 (p=0.0392). In a final regression model, serum lipoxin A(4) levels were positively correlated with age, female gender, white blood cell counts, and interleukin-5 levels in all patients, while asthma patients had lower serum lipoxin A(4) levels compared to the other two groups., Conclusion: Serum levels of lipoxin A(4) cannot be used as an early predictive diagnostic marker for asthma in young children with acute bronchiolitis.

Some children less than four years old have Epstein-Barr virus (EBV)-induced infectious mononucleosis (IM). Because primary EBV infection in infants and young children is usually asymptomatic or subclinical, EBV infection diagnosis may not be easy among young children. To illustrate the clinical characteristics and diagnostic procedures for EBV infection in young children, the authors report herein three cases of primary EBV infection in two-year-old children with an evaluation of their initial clinical symptoms. The results showed that the common initial clinical manifestations are puffy eyelids and hepatosplenomegaly, and that these signs suggest a tentative diagnosis of IM. In conclusion, EBV capsid immunoglobulin (Ig)M antibodies and atypical lymphocytes are useful diagnostic measurements in very young children with symptoms suggestive of IM.

Environmental factors and eating habits have had a significant impact on the increased sensitization to allergens in children. This study investigated changes in common allergen sensitivities among children in Taipei City, Taiwan. A total of 142 primary schools in Taipei City, which included 25,094 students aged 7-8 years, were surveyed using an ISAAC questionnaire to screen for allergies. For positive responders, serum allergen-specific IgE was confirmed using the Pharmacia CAP system. A total of 1,500 students (5.98%) had confirmed sensitivities to allergens. Dust mite sensitivity among these children was nearly 90%. The prevalences of sensitivities to Dermatophagoides pteronyssinus, D. farinae and Blomia tropicalis were 90.79%, 88.24%, and 84.63%, respectively. Dog dander (29.95%) was the second most common aeroallergen to induce sensitivity. Allergies to cat dander (8.69%) and to cockroach (15.48%) had decreased dramatically compared with previous analyses. Among the food allergens studied, the most common allergens that induced sensitization were (in order of prevalence) crab, milk, egg white, and shrimp (88.08%, 22.45%, 24.23%, and 21.44%, respectively). Mold and pollen sensitization was identified in fewer than 2% of the schoolchildren. Dust mites remain the most common allergen to induce allergic sensitization among children in Taipei City, while cockroach and mold sensitivities have dramatically declined. Food allergens should also be considered as a trigger of respiratory allergy. Except for dust mites, American cockroach and crab, allergens commonly reported to induce sensitization in other Asian counties are not common in Taiwan.

Eicosanoids belong to a diverse family of bioactive fatty acids that play important roles in regulating airway inflammation and reactivity. They are the key mediators of the pathobiology of asthma. Among the eicosanoids, lipoxins (LXs) were the first agents to be identified and recognized as potential anti-inflammatory endogenous lipid mediators. Lipoxins are biosynthesized in vivo at inflammation sites. They result mainly from the interaction between 5 and 15-lipoxygenases (LOs), which are distinct from leukotrienes (LTs) and prostaglandins (PGs) in structure and function. Leukotrienes are potent proinflammatory mediators and directly and indirectly stimulate fibroblast chemotaxis, proliferation, and collagen synthesis. Prostaglandins have both bronchoconstrictive and bronchoprotective effects and the bronchoconstriction mediated by PGD2 and PGF2alpha is only occurred in asthmatic patients but not in healthy subjects. Lipoxins counter-regulate the proinflammatory actions of LTs and activate resolution of the inflammatory response. At least two classes of receptors, CysLT1 receptors and Asprin-triggered lipoxin A4 (ALX) receptors, can interact with lipoxin A4 (LXA4) and LXA4 analogs to mediate their biologic actions. Allergen challenge initiates airway biosynthesis of LXA4 and increases expression of its receptor. In addition, LXA4 affects the release of interleukin-8 by blood mononuclear cells, and ALX affects calcium influx into epithelial cells. Therefore, the pivotal role of LXs is mediating airway homeostasis, and LXs may be part of a novel, multipronged approach for treating human asthma.

Despite advances in drug treatment, outcomes of patients with asthma remain unsatisfactory. Low rates of patient compliance to the prescribed treatment regimen, inadequate physician-patient communication, and inconsistent implementation of evidence-base treatment guidelines are the most important causes. In Taiwan, a national asthma guideline was prepared for publication by the Health Department in 2000. Physician and patient adherence to the guidelines is an important factor the control of asthma. Recently in several articles, researchers have suggested that the under utilization of the asthma guidelines may in part be related to a lack of understanding. In an investigation of the effectiveness of these guidelines, a questionnaire was sent to the doctors practicing in the regional hospitals/medical centers and private clinics. In addition, the nursing groups in the hospitals were included. In conclusion, poor adherence and lack of understanding of the guidelines was found. It clearly indicated a need for further educational programs to the professional health care providers that cause their behavior and concepts of treatment to be too subjective. Consequently, asthma patients did not receive appropriated evaluation or treatment, which may be part of the reason for increasing the asthma-related mortality and morbidity rates in Taiwan.