We found no clinical or immunological effect of the probiotic bacteria used in infants with AD. Our results indicate that oral supplementation with these probiotic bacterial strains will not have a significant impact on the symptoms of infantile AD.

Some patients with severe asthma cannot be controlled with high doses of inhaled steroids (ICS), which may be related to ongoing environmental allergen exposure. We investigated whether 10 weeks of high altitude allergen avoidance leads to sustained benefits regarding clinical and inflammatory markers of disease control in adolescents with persistent asthma despite treatment with high dose ICS. Eighteen atopic asthmatic adolescents (12–18 yr, 500–2000 µg ICS daily) with established house dust mite allergy, participated in a parallel‐group study. Quality of life (PAQL), lung function, bronchial hyperresponsiveness (BHR) to adenosine and histamine, induced sputum and urine samples were collected repeatedly from 10 patients during a 10‐week admission period to the Swiss Alps (alt. 1560 m) and at 6 weeks after return to sea level. Results were compared with those in eight patients, studied in their home environment at sea level for a similar time period. Throughout the study, asthma medication remained unchanged in both groups. During admission to high altitude, PAQL, lung function, BHR to adenosine and histamine, and urinary levels of eosinophil protein X (U‐EPX), leukotriene E4 (U‐LTE4) and 9α11β prostaglandin F2 (U‐9α11β PGF2) improved significantly (P < 0.05), with a similar tendency for sputum eosinophils (P < 0.07). Furthermore, the changes in PAQL and BHR to adenosine and histamine were greater in the altitude than in the control group (P < 0.05). At 6 weeks after renewed allergen exposure at sea level, the improvements in PAQL (P < 0.05), BHR to adenosine (P < 0.07) and histamine (P < 0.05), as well as U‐EPX (P < 0.05) and U‐LTE4 (P < 0.05) were maintained. A short period of high altitude allergen avoidance, on top of regular treatment with ICS and long‐acting β2‐agonists, results in improvement of asthma, as assessed by clinical and inflammatory markers of disease severity. These findings indicate that short‐term, rigorous allergen avoidance can improve the long‐term control of severe asthma over and above what can be achieved even by high doses of inhaled steroids.

Background-Guidelinesfor asthma management focus on treatment with inhaled corticosteroids and on home recording of peak expiratory flow (PEF). The eVect of maintenance treatment with inhaled corticosteroids on PEF variation and its relation to other parameters of disease activity were examined in 102 asthmatic children aged 7-14 years. Methods-During 20 months of treatment with inhaled salbutamol, with or without inhaled budesonide (600 µg daily), forced expiratory volume in one second (FEV 1 ), the dose of histamine required to provoke a fall in FEV 1 of more than 20% (PD 20 ), the percentage of symptom free days, and PEF variation were assessed bimonthly. PEF variation was computed as the lowest PEF as a percentage of the highest PEF occurring over 14 days, the usual way of expressing PEF variation in asthma selfmanagement plans. For each patient using inhaled corticosteroids within subject correlation coeYcients ( ) were computed of PEF variation to the percentage of symptom free days, FEV 1 , and PD 20 . Results-PEF variation decreased significantly during the first two months of treatment with inhaled corticosteroids and then remained stable. The same pattern was observed for symptoms and FEV 1 . In contrast, PD 20 histamine continued to improve throughout the whole follow up period. In individual patients predominantly positive associations of PEF variation with symptoms, FEV 1 , and PD 20 were found, but the ranges of these associations were wide. Conclusions-During treatment with inhaled corticosteroids the changes in PEF variation over time show poor concordance with changes in other parameters of asthma severity. When only PEF is monitored, clinically relevant deteriorations in symptoms, FEV 1 , or PD 20 may be missed. This suggests that home recording of PEF alone may not be suYcient to monitor asthma severity reliably in children.

This study examined the safety of sputum induction and the relation between sputum cell counts and clinical parameters in adolescents with severe persistent asthma.Within 5 days, induced sputum and reversibility in forced expiratory volume in one second (FEV1), quality of life, provocative concentration causing a 20% fall in FEV1 (PC20) of adenosine monophosphate and histamine, exercise-induced bronchoconstriction, overall asthma severity index, and blood eosinophils were collected in 20 atopic adolescents with moderate-to-severe persistent asthma (12±18 yrs of age, FEV1 65±110% of predicted, on 500±2,000 mg inhaled steroids daily).FEV1 was reversible by 13.32.3% pred. After sputum induction, FEV1 was still increased by 9.02.6% pred as compared to the pre-salbutamol baseline. Sputum contained, median (range): 12.4 (0.4±59.5)% squamous cells, 47.3 (6.8±84.0)% macrophages, 39.0 (4.6±84.8)% neutrophils, 4.8 (1.0±12.4)% lymphocytes, 0.4 (0±10.8)% eosinophils and 3.6 (0±23.4)% bronchial epithelial cells. Sputum eosinophils showed a trend towards a significant association with the overall asthma severity index (r=0.46, p=0.06) and correlated inversely with baseline FEV1 (r=-0.51, p=0.03).In conclusion, sputum can be induced safely in adolescents with moderate-to-severe persistent asthma, if pretreated with b 2 -agonists. Despite relatively low sputum eosinophil counts in these patients on inhaled steroids, the association of eosinophil numbers with baseline forced expiratory volume in one second and asthma severity index favours a role of induced sputum in monitoring adolescents with severe asthma. Eur Respir J 1999; 13: 647±653.

Although home recording of peak expiratory flow (PEF) is considered useful in managing asthma, little is known about the relationship of PEF variation to other indicators of disease activity. We examined the relationship of PEF variation, expressed in various ways, to symptoms, atopy, level of lung function, and airways hyperresponsiveness in schoolchildren with asthma.One hundred and two asthmatic children (aged 7-14 yrs) recorded symptoms and PEF (twice daily) in a diary for 2 weeks after withdrawal of all anti-inflammatory maintenance medication. PEF variation was expressed as amplitude % mean, as standard deviation and coefficient of variation of all recordings, and as low % best (lowest PEF as percentage of the highest of all values).Atopy and level of forced expiratory volume in one second (FEV1) % predicted were not significantly related to PEF variation. The provocative dose of histamine causing a 20% fall in FEV1 (PD20) and symptom scores were significantly, but weakly, related to PEF variation. The index, low % best, proved easy to calculate and effective in identifying a short-term episode of reduced PEF.We conclude that peak expiratory flow variation in children with stable, moderately severe asthma is significantly, but weakly, related to symptoms and airways hyperresponsiveness. These three phenomena, therefore, all provide different information on the actual disease state. Expressing peak expiratory flow variation as low % best is easy to perform and appears to be clinically relevant.