Kemal NİŞLİ, Ülker ÖNEŞ, Nermin GÜLER, Zeynep TAMAY

Hışıltılı sütçocuklarında RSV antikorları, lökotrien E4 ve total IgE düzeyleri

Amaç: Hışıltılı sütçocuklarında RSV infeksiyonları ile lökotrien E4 ve total IgE'nin ilişkisinin gösterilmesi. Yöntem: Çalışma kapsamına, İ.Ü. İstanbul Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Pediatrik Allerji Bilim Dalı'na hışıltı epizodu ile başvuran 6-24 ay arasında 40 sütçocuğu alındı. Aynı yaş grubunda Sağlam Çocuk Polikliniği'nden izlenen, atopi öyküsü olmayan 38 sütçocuğu kontrol grubunu oluşturdu. İlk hışıltı epizodunu geçiren 15 hasta (1. grup), üç ve daha fazla hışıltı geçiren 25 hasta (2. grup) olarak ikiye ayrıldı. Hasta ve kontrol grubu serum LTE4, total IgE, RSV IgM ve IgG açısından incelemeye alındı. Bulgular: İkinci grupta, birinci gruba nazaran total IgE anlamlı düzeyde yüksek saptandı. İlk hışıltı epizodunu geçiren hastaların % 46'sında RSV IgM pozitifliği saptandı. İkinci grupta ise geçirilmiş RSV infeksiyonunu gösteren RSV IgG pozitifliği % 52 olarak saptandı. Tüm hasta ve kontrol grubunda serum LTE4 düzeyleri tespit edilebilir en düşük düzey olan 31 pg/mL'nin altında bulundu. Sonuç: Tekrarlayan hışıltılı sütçocuklarında total IgE ve RSV IgG'nin yüksek saptanması, atopi ile ilişkisini düşündürmektedir.

Anahtar Kelimeler:

İmmünoglobulin E, İmmünglobulin G, Süt çocuğu, Lökotrien E4, Solunum sinsityal virüsleri, Solunum sesleri, Antikorlar, viral

RSV antibodies, leukotrien E4 and total IgE levels in wheezy infant

Aim: To investigate the relationship between RSV infections and serum levels of LTE4 in wheezy infants. Methods: Forty children aged 6 to 24 months and referred to the Pediatric Allergy Department for one or more than three wheezy episodes and 38 healthy children with no history of atopy in the same age group were enrolled in the study. The patients were classified into two groups according to the number of wheezy episodes they had. The first group consisted of 15 patients who experienced their first episode. There were 25 patients in the second group who had three or more attacks previously. Serum levels of LTE4, total IgE, RSV IgG and IgM antibodies were measured in all children. Results: Serum levels of total IgE were higher in the patient group with recurrent attacks in respect to the first group. RSV IgG antibodies were detected 52 % in second groups. All samples measured less than the lowest LTE4 standard, 31pg/mL. Conclusion: Detection of high levels of T. IgE and presence of RSV IgG antibodies with recurrent wheezy attacks can reflect the development of atopy in childhood.

Keywords:

Immunoglobulin E, Immunoglobulin G, Infant, Leukotriene E4, Respiratory Syncytial Viruses, Respiratory Sounds, Antibodies, Viral,

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1. Ertem E, Tana R, Çöker M. Akut bronşiolit ve respiratuar sinsisyal virüs. T Klin Pediatri 1996; 5:60-2.
2. Mcintosh K. Infections due to respiratory synctia] virus. In: Behrman RE, Kliegman R, eds. Nelson Textbook of Pediatrics. Philadelphia: WB Saunders Co,1992: 814-6.
3. Foucard T, Sjöberg O. A prospective 12-year follow-up study of children with wheezy bronchitis. Acta Pediatr Scand 1984; 73:577-83.
4. Kuikka L, Reijonen T, Remes K, et al. Bronchial asthma after childhood wheezing. Acta Pediatr 1994; 83:744-8.
5. Martinez FD, Wright A, Taussig L, et al. Asthma and wheezing in the six years of life. N Engl J Med 1995; 332:133-8.
6. McConnochie K, Roghmann K. Bronchiolitis as a possible cause of wheezing in childhood: new evidence. Pediatrics 1984; 74:1-10.
7. Morgan WJ, Martinez FD. Risk factors for developing wheezing and asthma in childhood. Ped Clin North Am 1992; 39:1185-203.
8. Noble V, Murray M, Webb MSC, et al. Respiratory status and allergv nine to 10 years after acute bronchiolitis. Arch Dis Child 1997;76:315-9.
9. Asano K, Lilly C, O'Donnel W, et al. Diurnal variation of urinary LTE4 and histamine excretion rates in normal subjects and patients with asthma. J Allergy Clin Immunol 1995; 96:643-51.
10. Balfour-Lynn I, Valman H, Wellings R, et al. TNF and leukotriene E, production in wheezy infants. Clin and Exp Allergy 1994; 24:121-6.
11. Byrne P. Leukotrienes in the pathogenesis of asthma. Chest 1997:3:27-34.
12. Drazen J. Effects of cysteinyl leukotrienes on human airways. In: Holgate S, Dahlen S, eds. SRS-A to Leukotrienes. London: Blackwell Science 1996: 189-200.
13. Henderson W. The role of leukotrienes in inflammation. Ann Intern Med 1994; 12:684-97.
14. Hutchinson A. Mechanisms for production and inhibition of leukotriene biosynthesis. In: Holgate S, Dahlen S, eds. SRS-A to Leukotrienes. London: Blackwell Science 1996: 139-49.
15. Samuelsson B, Dahlen SE, Lindgren J, et al. Leukotrienes and Lipoxins, structures, biosynthesis and biological eftects. Science 1987; 237:1171-6.
16. Wennergren G, Hansson S, Engström I, et al. Characteristics and prognosis of hospital-treated obstructive bronchitis in children aged less than two years. Acta Pediat 1992; 81:40-5.
17. Burrows B, Martinez F, Halonen M, et at. Association of asthma with serum IgE levels and skin-test reactivity to allergens. N Engl J Med 1989; 320:271-7.
18. Duff A, Pomeranz E, Gelber L, et al. Risk factors for acute wheezing in infant and children: viruses passive smoke and IgE antibodies to inhalant allergen. Pediatrics 1993; 92:535-40.
19. Volovitz B, Faden H, Ogra P. Release of LTC4 in respiratory iract during acute viral infection. J Pediatrics 1988; 112:218-22.
20. Shindo K, Fukumura M, Miyakawa K. Plasma levels of LTE4 during clinical course of asthma and the effect of oral prednisolone. Chest 1994; 105:1038-41.
21. Sampson A, Castling DP, Green CP, et al. Persistent increase in plasma and urinary leukotrienes after acute asthma. Arch Dis Child 1995; 73: 221-5.