385 Increased Expression in Cd30+ and Cd57+ Molecules on Cd4+T-cells in Atopic Asthmatic Children: A Preliminary Report

N. E. Martinez-Jimenez, E. Rojas-Ramos; Clinical Immunology and

Allergy, ISSSTE, Mexico, D.F., MEXICO.

RATIONALE: In this study we performed the frecuency of surface

markers on CD4+ T cells with IL-4 production in peripheral blood of

atopic asthmatic children.

METHODS: Cross sectional study trial was carried out in 17 atopic asth-

matic children and 12 healthy children as controls. The proportion of the

peripheral mononuclear cells and surface molecules was studied by flow

cytometry to identify surface molecules in CD4+ T cells (CD30, CD57,

CD154, CD62L, and CD28), and IL-4. The analysis was performed on

PBMC after PMA-Ionomycin stimulation, to examine IL-4 and INF-�

production.

RESULTS: CD4+ CD30+ (median; 1.7, percentiles 25-75; 1.3-2.2), and

CD4+ CD57+ (median; 3.3, percentiles 25-75; 2.2-4.4) T cells showed an

increased production and correlationship with IL-4 production in atopic

asthmatic children.

CONCLUSIONS: Although CD4+CD30+ T cells in peripheral blood

have been observed in atopic dermatitis patients, in this work we identi-

fied similar cellular population in respiratory atopic diseases, and also

CD57+ T cells, these cells seems to corresponds of CD4 T cells which

expressing IL-4 under stimuli. That expressing markers could correspond

early activation in atopic asthma and manifestation of asthma severity.

Funding: UNAM

386 Screening Asthma among Allergic Rhinitis Patients withPeak Expiratory Flow Measurments

M. Herrag; Pulmonary Medecine, Hospital, Rabat, MOROCCO.

RATIONALE: We aimed to study atopic status, prevalence of asthma

and the benefit of using peak expiratory flow (PEF) follow-up in the diag-

nosis of asthma at allergic rhinitis (AR) patients.

METHODS: We examined 160 (43%male, 72%female, mean age of 32

years) all AR patients had never been assessed for asthma. Their allergic

status determined by skin prick tests. All of the subjects filled a question-

naire for presence of asthma like symptoms. Pulmonary function tests

(PFT) and 2 weeks PEF measurements (two times daily) were determined

for the patients who defined asthma like symptoms.

RESULTS: Positive skin prick tests to grass were present at 71 patients,

to tree at 51 patients, to mite at 46 patients and to epidermal mixture at

26 patients (79.8%, 57.3%, 51.7% and 29.2% respectively.) Nasal polyps

were present in 25 AR patients (28.1%). 36 subjects (41%) defined asthma

symptoms in their questionnaires. PFTs results of these 36 subjects were;

4 obstructive (11%), 32 normal (89%). 32 subjects who defined asthma

symptoms and had normal PFT values, underwent 15 days PEF follow-up.

16 (50%) subjects had 20% diurnal variable positive PEF follow-up.

16 (+) PEF patients defined reduced in their respiratory symptoms after a

3 month low dose inhaler steroid therapy.

CONCLUSIONS: AR and asthma often coexist in the same patients,

even though PFTs had been detected normal, allergic rhinitis patients

should undergo PEF follow-up for the determination of asthma and cre-

ation of better strategies for the integral treatment.

387 Prevalance of Pulmonary Nocardiosis in Allergic Bron-chopulmonary Disease ( Raised Ige Level)

R. S. ABDUL; NATIONAL ALLERGY & ASTHMA CENTRE,

KARACHI, PAKISTAN.

RATIONALE: The basic aim of study is to emphasize that theses infec-

tions are curable with antibiotic therapy and prognosis depends on the

rapidity of diagnosis and early treatment.

METHODS: This is the prospective study carried out in 20 months 127

patients are selected from different family physicians and the main reason

for referral was increase in severity of dyspnea in patients of preexisting

allergic bronchopulmonary disease.

RESULTS: 17 patients found to be positive for Nocardia asteroids 14

patients was observed for Type IV cutaneous hypersensitivity, sputum cul-

ture are positive in all cases and diagnosis is confirmed by Bronchoalveolar

lavage. Mean age of patients fall between 42 - 55 years of age. All patients

have raised IgE levels ( > 400) and history of allergic disease in past. Nine

patients found to be on oral corticotherapy for over year.2 patients died due

to delayed diagnosis and 1 patient have CNS complications.

CONCLUSIONS: Result reveled that pulmonary Nocardiosis needs

greater attention by family physician in differential diagnosis of allergic

bronchopulmonary disease on oral corticotherapy and there should be

close collaboration between clinician and medical microbiologist. Pro-

longed treatment with Trimethoprim-sulfamethoxazole is effective.

KEY WORDS: bronchoalveolar lavage, corticosteroid, IgE

388 Timeliness of Diagnosis of Asthma in Children and Asso-ciated Factors

W. E. Molis1, H. Kita1, L. A. Lee2, R. J. Maki2, R. Smith3, T. Chang2, A.

Weaver4, V. Pankratz4, R. M. Jacobson2, G. A. Poland5, Y. J. Juhn2; 1Divi-

sion of Allergic Diseases, Mayo Clinic Rochester, Rochester, MN, 2Pedi-

atric and Adolescent Medicine, Mayo Clinic Rochester, Rochester, MN,3Mayo Medical School, Mayo Clinic Rochester, Rochester, MN, 4Depart-

ment of Health Sciences Research, Mayo Clinic Rochester, Rochester,

MN, 5Internal Medicine, Mayo Clinic Rochester, Rochester, MN.

RATIONALE: Delay in diagnosis may prevent children with asthma

from accessing therapeutic and preventive health services; this delay and

its associated factors have not been studied. We hypothesized that asthma

severity at the time of presentation and physician specialty are associated

with timeliness of diagnosis of asthma.

METHODS: Study subjects were obtained from a convenience sample of

876 children, aged 5 to 12 years, who were enrolled in the Rochester Fam-

ily Measles Project. We conducted comprehensive medical record reviews

for these children to determine their asthma status by applying predeter-

mined criteria for asthma. Univariate analyses were conducted to identify

factors associated with delay between the time when a patient meets the

criteria for asthma and time of diagnosis of asthma by physicians. Statis-

tical significance was tested at a two-tailed � error of 0.05.

RESULTS: Of 876 children, 277 children met the criteria for asthma.

Median duration from time asthma criteria were met to asthma diagnosis

was 0 days (mean: 168.9 days, range: 0-3984 days) and the duration was

not normally distributed. Severity of asthma at the time of presentation

approached statistical significance (p=0.06), and certainty of asthma (i.e.

patient met definite versus probable asthma criteria) was significantly

associated with timeliness of asthma diagnosis (p<0.0001). However, spe-

cialty of the evaluating physician (p=0.65) was not associated.

CONCLUSIONS: Because certainty of asthma ascertainment during

evaluation for asthma is associated with timeliness of asthma diagnosis,

careful assessment of the patient’s previous history is warranted regard-

less of specialty setting and, perhaps, severity of presentation.

Funding: Mayo Foundation Institutional Grant

J ALLERGY CLIN IMMUNOL Abstracts S99VOLUME 117, NUMBER 2

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