The object of the present paper is to present laboratory and clinical data on 27 children of ages between 6 and 11 years, who in connection with tosillectomy 21/2 years earlier had been found to have low serum and saliva IgA levels, low serum IgE levels, and a considerable lack of IgA and IgE plasma cells in the excised tonsils; correlation between deficiency in IgA and culture of pathogenic bacteria from the tonsils was significant. From a clinical point of view, 22 of the children had benefit of the tonsillectomy and had no longer a tendency towards a development of recurrent infections. The remaining 5 patients continued to complain of recurring respiratory infections; in addition, levels of serum and saliva IgA were low. Furthermore, 4 of these 5 children harboured pathogenic bacteria in their throats. Many of the 27 patients still had low serum IgA and IgE levels as compared with levels in healthy, age‐related controls; in 3 patients, however, the IgE levels in serum had risen considerably parallel with the development of atopic diseases. Saliva IgA was rather constant after tonsillectomy as compared with the preoperative levels, though it had risen in some of the children. As regards serum IgG and IgM, these immunoglobulins had decreased significantly, and the question is raised, whether it might had been due to the tonsillectomy, either by the removal of chronically infected organs or by the removal of important immunological tissue.
A total of 54 children, earlier hospitalized for asthma, were reinvestigated with regard to immunoglobulin formation in serum and saliva. Furthermore, the carrier rate of pathogenic bacteria in their throats was investigated, and in some of the children, who had their adenoids removed, immunofluorescent studies were performed. The study revealed highly reduced levels of serum and saliva IgA in the younger children with asthma. In addition, in these children a connection between recurring respiratory infections and high carrier rate of presumably pathogenic bacteria was observed. Also in the older children, significantly reduced levels of serum and saliva IgA compared with age related controls were found, but these children did not have an increased frequency of pathogenic bacteria or repiratory infections. In addition, low levels of serum IgM were found in the older children with asthma. The results of the study support the theory that low IgA levels facilitate the entrance of pathogenic bacteria through the epithelial surfaces, resulting in an overstimulation of the IgE system and the development of bronchial asthma in the younger children. In the younger as well as in the older patients, a high frequency of atopy among the closest relatives was observed.
A boy and a girl, 10 weeks and 3 years of age, respectively, were admitted to our department with low temperature, dry cough, fatigue and weight loss. In both patients pulmonary X-rays showed diffuse, bilateral, micronodular infiltrations, and sparse signs of fibrosis. Serum IgG and blood eosinophils were abnormally high. After a stay in hospital for 3 weeks, the patients recovered slowly. However, after a few days at home, they were readmitted with the same symptoms. Family histories revealed that the children lived on farms with huge grain magazines and dryers, where moist grain and straw were stored. Massive amounts of mould spores were cultured from the residential areas, and, in addition, the male patient had an elevated titer to Micropolyspora faeni and the female patient, elevated titers to Thermoactinomyces vulgaris, Micropolyspora faeni, Aspergillus fumigatus and Alternaria alternans. The patients and their families moved from the farms and, for approximately a year, have been without lung symptoms. Farmer's disease in infants and small children is extremely rare. However, the incidence may be increasing due to the tendency in latter years to decentralize grain dryers and store moist grain and straw in big magazines, often close to residential areas.
Immunoglobulins in whole saliva, collected unstimulated from 60 healthy children, 4 to 15 years of age, were determined by a modified electroimmuno technique using carbamylation of the samples prior to electrophoresis. This technique, which is generally used for measurement of immunoglobulins in serum, was found to be rapid, precise, and sensitive. The mean (median) for salivary IgA was 5.1 kIU/1, which was significantly higher than values obtained from stimulated or unstimulated parotid saliva by other investigators. The mean value for salivary IgG was 120 IU/1. IgM in saliva was only found in measurable amounts in 5 children.
The tissue types, immunoglobulin levels, and the presence of circulating autoantibodies were investigated in 57 children. Fifteen of these children suffered from bronchial asthma and, in addition, had no or very little IgA in their serum and saliva (Group 1 patients). Another fifteen children with asthma but normal immunoglobulin levels in serum and saliva (Group 2 patients), seven patients with selective IgA deficiency but without allergic diseases (Group 3 patients), and twenty healthy children served as controls. Sixty per cent of the Group 1 patients had the phenotype HLA-A1,B8, whereas this tissue type was found only in 27, 14 and 15 per cent, respectively, of the Group 2 and Group 3 patients and the healthy children. Furthermore, high IgM- and IgE levels were observed in most Group 1 patients, and in five of these patients (33 per cent) autoantibodies were present in the serum. In addition, eczema and glomerulonephritis occurred rather frequently in this group of patients. Conversely, normal immunoglobulin levels and absence of circulating autoantibodies were found in the remaining three groups of children. The results emphasize the heterogeneity of the IgA deficiency syndrome, and the question is raised as to whether the tissue type HLA-A1,B8 observed in most Group 1 patients reflects the abnormal immune reactivity of these patients.
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