Studies evaluating adverse effects of oral theophylline on learning and behavior have been performed on children with asthma receiving long-term theophylline therapy. To further differentiate the effects of asthma itself from the drugs used, we evaluated 20 asthmatic children (6 to 12 years of age) who had not received oral bronchodilators for at least 6 months. A double blind, placebo-controlled, parallel format was used with a 4-week theophylline or placebo period preceded by a 2-week baseline. Theophylline serum levels were maintained between 10 to 20 µg/mL. During baseline and treatment periods, the child's home and school behavior/performance were monitored independently by their parents and teachers using standardized report forms. A battery of psychologic tests was administered at the end of baseline and treatment periods. Seven children receiving theophylline were noted to have a change in school behavior and/or performance during their 4 weeks on drug compared to baseline, whereas none of the children receiving placebo were noted to be different (P = .004). Thus, the short-term administration of theophylline to asymptomatic asthmatic children not receiving oral bronchodilators can adversely affect school performance and behavior. Because this population represents the majority of asthmatic children, one needs to use theophylline cautiously in this age group, monitor school performance closely, or seek other treatment modalities.

SummaryUsing Ficoll-Hypaque-separated cells, monocyte chemotaxis was measured by an agarose technique in patients with increased susceptibility to infection, with atopic dermatitis, and in individuals taking aspirin. I n vitro effects of aspirin, hydrocortisone, aminophylline, ephedrine, and diphenhydramine were also studied. Significantly decreased chemotaxis was found in one 9-year-boy with severe mucocutaneous candidiasis and three of 22 patients with atopic dermatitis. In the atopic group of patients greater than 10 years of age, mean monocyte chemotaxis was significantly decreased from the age-matched control group. This decrease did not correlate with serum IgE levels, absolute blood eosinophil counts, or clinical symptom scores. Following aspirin ingestion, mean monocyte chemotaxis significantly decreased whereas neutrophil chemotaxis was unaffected. Using therapeutic concentrations, drug levels of aspirin and aminophylline in vitro caused greater than 35% inhibition of monocyte movement.

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A new clue in the quest for an etiology of the rheumatic diseases may be the newfound association of certain of these disorders with the presence of the genetically inherited histocompatibility antigen, HL-A W27. The frequency of this antigen is 5% to 10% in the general population; by contrast, its frequency is 85% to 90% in adults with ankylosing spondylitis and Reiter's syndrome and 35% to 40% in children with juvenile rheumatoid arthritis. Histocompatibility transplantation antigens are present on the surface of most cells (not erythrocytes) which are capable of inducing a cellular immune response in another of the same species and result in rejection of transplanted tissue or cells.