Showing papers in "Allergy in 1986"

Errors in inhalation technique and efficiency in inhaler use in asthmatic children.

Abstract: 256 asthmatic children receiving regular inhalation therapy demonstrated how they used their inhalers. Pulmonary function measurements (PFM) were made before and after the demonstrations, and errors in technique were recorded. 242 children had reversible airway obstruction on the day of study. In only 109 (45%) did the inhalation result in an increase in FEV1 greater than or equal to 15% (efficient technique). An efficient inhalation technique was found in 46% of children who demonstrated a pressurized aerosol, 59% who demonstrated a tube spacer aerosol and 46% who demonstrated a rotahaler, and the frequency of efficient technique varied from 17% to 84% between six different groups of instructors. 87% of children controlled and 25% not controlled with PFM at the time of prescription had an efficient technique. Children under 6 years had a more inefficient and a more faulty technique than older children, but otherwise age did not influence the result. Neither was time since instruction of any importance for efficiency or number of errors. The errors recorded that seem to influence efficiency most were: coordination problems, rapid inspirations, ceasing to inspire when the aerosol was fired, and inhalation through the nose. The results emphasize the paramount importance of clear instructions and control of inhalation technique at the time the treatment is prescribed.

A double-blind, multicenter immunotherapy trial in children, using a purified and standardized Cladosporium herbarum preparation. I. Clinical results.

Abstract: A double-blind histamine placebo controlled immunotherapy trial was performed to investigate the clinical effect of a purified and standardized Cladosporium herbarum allergen preparation. Thirty children with a clinical history suggesting mould-induced asthma and/or rhinoconjunctivitis were included. The diagnosis was confirmed by positive skin prick test and Phadebas RAST as well as positive bronchial and/or conjunctival provocation test to Cladosporium herbarum. Immunotherapy was given for 10 months in a double-blind manner to randomized groups with either Pharmalgen/Cladosporium herbarum preparation or histamine placebo. Allergic side effects to injections were common, especially during the peak of the mould season (July-September in Scandinavia). In the active group, 13/16 patients experienced general reactions during the first 10 months of treatment. After 6 months of treatment, eye, nose and bronchial symptom scores and peak expiratory flow rates were similar for the groups, maybe because most of the children were also sensitive to many other allergens, including Alternaria alternata. However, medication scores were significantly lower in the treated group (P less than 0.01). Bronchial (P less than 0.01) and conjunctival sensitivity (P = 0.01) were significantly reduced in the Cladosporium-treated group but not in the placebo group after 10 months of treatment. This is the first double-blind clinical trial showing the clinical efficacy of immunotherapy in children with mould-induced asthma.

Diagnosis and immunotherapy of mould allergy. V. Clinical efficacy and side effects of immunotherapy with Cladosporium herbarum.

Abstract: A placebo-controlled, double-blind study of immunotherapy with the mould species Cladosporium was performed in 22 adult asthmatics. The diagnosis of Cladosporium allergy was based on a combination of bronchial provocation test and daily symptom score in the Cladosporium season. An aqueous preparation of a potent, biologically standardized and purified extract was used in a clustered dose-increase regimen. The clinical efficacy was evaluated by a combination of symptoms (asthma score + peak flow) and consumption of antiasthmatic medication. The mean changes in symptoms and medication consumption over a 10-week registration period (peak Cladosporium season) in 1982 after 5-7 months of immunotherapy were compared with the corresponding 1981 pretreatment 10-week period. A significant (P = 0.03) difference in terms of "improved", "unchanged" and "deteriorated" patients in favour of Cladosporium treatment was found. Approximately 80% in the Cladosporium group showed improved/unchanged symptoms contrary to 30% of the placebo treated. Side effects were observed frequently but only in the Cladosporium-treated. About 70% experienced a large local reaction and 100% had episodes of asthma during dose-increase phase. Only a few severe systemic reactions occurred. Based on the clinical efficacy of the treatment we consider immunotherapy with Cladosporium feasible for highly specialized clinics.

Oral immunotherapy of children with rhinoconjunctivitis due to birch pollen allergy. A double blind study.

Abstract: Thirty children with rhinoconjunctivitis due to birch pollinosis were treated in a double blind manner for 10 months with enteric-coated capsules containing either a birch pollen preparation (n = 14) with doses up to 1.4 X 10(6) biologic units per day or placebo (n = 16). Compared with the placebo group the actively treated children had less symptoms during the birch pollen season after 3 months of therapy (P = 0.035). Skin prick reactions decreased significantly more in the active group than in the placebo group after 10 months (P = 0.01). Conjunctival sensitivity was lower in the active group than in the placebo group after 3 months of treatment (P = 0.01) but not after 10 months. Compared with the placebo group the treated children more often increased their levels of IgG (P = 0.007) and pre-seasonal IgE (P = 0.001) against birch. There was a seasonal increase of IgE antibody level against birch in the placebo but not in the treatment group (P less than 0.001). None of the treated children developed asthma, compared with five of the untreated children. No general reactions occurred and few side effects were seen during the treatment period. We conclude that in children with birch pollinosis oral immunotherapy with high doses of a biologically potent preparation in enteric-coated capsules is effective, easy to perform, economic and safe.

Allergen-specific IgE antibodies against antigenic components in cow milk and milk substitutes.

Abstract: Crossed radioimmunoelectrophoresis (CRIE) was used to study the presence of serum IgE against antigenic components of cow milk in 21 selected milk-allergic patients. The amount of each IgE specificity was estimated by a scoring system. The milk-allergic children had mainly IgE against alpha-lactalbumin, beta-lactoglobulin, albumin and immunoglobulin, the four major proteins of bovine whey, as well as IgE against three casein components. A serum pool from 1000 normal adults had IgE against the same whey protein, but in smaller amounts, and no IgE against the casein components. Eight cow milk-based formulae, commonly used for infant feeding, and goat milk were studied by the same method. It was found that six of the milk substitutes did not differ significantly from cow milk in antibody binding, but the two hydrolysed casein products, Nutramigen and Pregestimil, consisted of such small molecules that the rabbit antisera could not precipitate the hydrolysed proteins in the gels on the CRIE plates. It was therefore not possible to study their IgE binding, if any, by this method.

Demonstration of microorganisms and dust in schools and offices. An observational study of non-industrial buildings.

Abstract: "The sick-building syndrome" (WHO) is reported with increasing intensity in non-industrial places of work, such as schools, kindergartens, and offices, all of which have a heavy load of traffic (people). The construction of these buildings (e.g. flat roofs) often leads to water damage with subsequent microbial growth. Further, reduced cleaning budgets in connection with the wide use of needle-felt carpets, as well as ventilation systems not regularly maintained, will lead to pollution by dust and microorganisms. A systematic registration of dust and microbial parameters has been carried out since 1980 in buildings with indoor climate complaints, in order to elucidate the possible influence of these factors.

Enzyme-Linked Immunosorbent Assay for Determination of Major Excrement Allergens of House Dust Mite Species D. pteronyssinus, D. farinae and D. microceras

Abstract: Species-specific enzyme-linked immunosorbent assays (ELISA) for major excrement allergens (Dp42, Df6 and Dm6) of D. pteronyssinus, D. farinae and D. microceras in house dust were established, using immunoabsorbed, monospecific rabbit antibodies, coupled to horse radish peroxidase. The limit of detection was 13, 4 and 38 ng/ml, respectively. The coefficient of variation for the entire procedure, including dust sieving (212 micron) and extraction was 5-16% for allergen levels above 1000 ng/g dust. Allergen concentration by ELISA correlated well with the number of mite bodies identified and counted by microscopy in 31 dusts (r = 0.88, 0.86 and 0.82 for combined Dermatophagoides sp., D. pteronyssinus and D. farinae group, resp.) Dermatophagoides allergen was recorded in 21/22 mattress dusts (median: 26,000 ng/g; maximum: 290,000 ng/g). D. pteronyssinus allergen occurred in largest amounts (median 7,500 ng/g) followed by D. microceras (median 650 ng/g) and D. farinae (median 240 ng/g).

Mechanisms of pancreatic islet cell destruction. Dose-dependent cytotoxic effect of soluble blood mononuclear cell mediators on isolated islets of Langerhans.

Abstract: Supernatants of peripheral blood mononuclear cells from healthy human donors stimulated with recall antigen (purified protein derivative of tuberculin) or lectin (phytohaemagglutinin) markedly inhibited the insulin release from isolated human and rat islets of Langerhans, and decreased rat islet contents of insulin and glucagon in a dose-dependent manner. A maximal effect on islet function was obtained with supernatant concentrations down to 5%. Supernatants of mononuclear cells stimulated with tuberculin were more potent than supernatants produced by lectin stimulation. Culture medium reconstituted with tuberculin or phytohaemagglutinin did not impair islet function. Electron microscopy demonstrated that supernatants were cytotoxic to islet cells. The cytotoxic mononuclear cell mediator(s) was non-dialysable, sensitive to heating to 56 degrees C, labile even when stored at -70 degrees C, but stable when lyophilised.

Exercise-induced bronchoconstriction. Seasonal variation in children with asthma and in those with rhinitis.

Abstract: Standardized exercise challenge tests, symptom scores and whole-blood eosinophil and basophil counts were made before and during the pollen season in 32 children suffering from hay fever (n = 16) or hay fever and asthma (n = 16). All participants developed rhinitis symptoms during the season. The hay fever group showed in addition a significant seasonal increase in cough score (but in no other asthma symptom) and in circulating eosinophils (P less than 0.01); mean exercise-induced bronchoconstriction (EIB) did not change despite a slight increase in a few subjects. The asthma group showed seasonal increases in EIB (P less than 0.001), asthma symptom score (P less than 0.002), and total eosinophil count (P less than 0.001). The increase in the latter was significantly higher (P less than 0.05) than that in the hay fever group. The relative basophil count remained unchanged in both groups. In conclusion, the hay fever group and the asthma group could be clearly distinguished with respect to EIB during natural pollen exposure. The significantly higher increases in EIB and circulating eosinophils observed in the asthma group might possibly be due to greater pollen antigen sensitivity in the asthmatics.

Predictors of Atopic Disease: Cord Blood IgE and Month of Birth

Abstract: The cumulated incidence of atopic disease before 7 years of age was highly influenced by the cord blood IgE concentration and moderately influenced by the month of birth: obvious atopic disease was more than twice as common in children with high cord blood IgE and born in May than in children with a similar IgE and born in November (P less than 0.05). There was no similarly increased risk for atopic disease among those born in May with low cord blood IgE. Environmental factors thus seem important merely for a high risk population. The findings lend support to family planning when there is especially high genetic risk for atopic disease.

Immunotherapy with yellow jacket venom. A comparative study including three different extracts, one adsorbed to aluminium hydroxide and two unmodified.

Abstract: Thirty-two patients with previous systemic allergic reaction to yellow jacket stings were randomly allocated to three groups receiving immunotherapy with different preparations of yellow jacket venom: 1) extract adsorbed to aluminium hydroxide (Alutard®-SQ), 2) Pharmalgen® extract or 3) non-adsorbed extract from Allergologisk Laboratorium (ALK aq.). Regular examinations showed a decrease in skin prick test size in nearly all patients. Specific IgE-antibody (RAST and CRIE scores) showed a similar, but not significant tendency to decrease in all three groups. Specific IgG-antibody increased considerably in the Alutard group only; after 2 years, however, no difference could be detected between the three groups. During dose increase, patients treated with ALK aq. generally had smaller local reactions to injections than those treated with Pharmalgen. Few systemic reactions occurred in all three groups. Nineteen patients treated for 21/2–31/2 years were challenged in-hospital with stings from yellow jackets. No systemic and only minor local reactions occurred. Consequently, with the dose regimens applied all three extracts seem effective even though no common changes in either specific IgE or IgG could be demonstrated.

Pollen seasons: forecasts of the most important allergenic plants in Finland.

Abstract: Occurrence of airborne pollen in Finland has been studied for 10 years in Turku (southern Finland), 8 years in Oulu, 4 years in Kuopio (central Finland) and 7 years at Kevo (northern Lapland). Observations on the pollen seasons of alder, birch, grasses and mugwort are presented. All these pollens occur in south and mid- Finland in quantities capable of causing allergy symptoms. Except for birch pollen, allergenic pollens occur in far lower concentrations than in central Europe. In northern Lapland only birch and pine pollen concentrations are high. Pollens may occur without signs of local flowering when there are southerly winds. This finding suggests that long-distance transport is an essential contributing factor to the occurrence of pollens. There are wide year-to-year variations in the start of pollen seasons and the quantities of pollens. The variations in the start of birch and grass pollen seasons could very much depend on the mean temperature in April. However, a forecasting model based on this and other spring-time temperature parameters often fails to give sufficiently accurate forecasts.

Clinical and immunological effects of oral immunotherapy with a standardized birch pollen extract.

Abstract: Oral immunotherapy (IT) was evaluated in a pilot study in two centres in children aged 8-15 years with allergic rhinoconjunctivitis. High doses (up to 20 X 10(6) BU monthly) of a defined freeze-dried birch pollen extract administered in enteric-coated gelatine capsules were given either daily for seven consecutive days every month or once weekly. Symptom scores, as assessed by sneezing, dripping and blockage of the nose, and redness, itching and swelling of the eyes, were significantly lower in treated patients compared to untreated, or placebo treated controls after 3 to 5 months of therapy. In all the 16 treated, but only in three of eight untreated patients, the scores were lower during the pollen season 1982 than during the pollen season preceding the treatment period, despite comparable pollen counts during the two seasons. One year after beginning treatment the reactivity in conjunctival provocation tests was decreased about 10-fold (P less than 0.001) in the patients receiving more than 2 X 10(5) BU monthly compared to about two-fold in patients receiving lower doses, or placebo. Increased levels of IgE antibodies directed against birch pollen were recorded in the serum and saliva of most patients after 3-4 months of active IT. In contrast, IgG antibody responses were poor in most of the patients. Side effects, particularly from the gastrointestinal tract, appeared in all treated children. In one of them a systemic reaction occurred during IT. The study indicates that properly performed oral IT with a potent birch allergen extract in enteric-coated capsules may be effective.

Lowered glutathione-peroxidase activity in asthmatic patients with food and aspirin intolerance.

Abstract: In analogy with findings from animal experiments, people with low glutathione-peroxidase (GSH-Px) activity could be expected to have altered sensitivities to effects of drugs, chemicals and possibly food. We have investigated GSH-Px activity in 12 patients with intrinsic asthma and food and aspirin intolerance. Ten of the 12 patients had very low or low GSH-Px activity and the frequency of low GSH-Px activity in this group was statistically significant (P less than 0.001) compared with the control material of age- and sex-matched healthy individuals. Our finding of lowered GSH-Px activity in patients with aspirin intolerance may indicate the involvement of hitherto unknown mechanisms in the pathogenesis of asthmatic disorders.

Inhibition of leukotriene (SRS-A)-mediated acute lung anaphylaxis by azelastine in guinea pigs.

Abstract: Azelastine hydrochloride, chemically known as l(2H)-phthalazinone, 4-[(4-chlorophenyl)methyl] -2-(hexahydro-l-methyl-lH-azepine-4-yl)-, monohydrochloride, is a novel, orally effective, long-acting, antiallergic/antiasthmatic agent. The ability of azelastine and selected antiallergic drugs to inhibit SRS-A (leukotriene)-mediated acute lung anaphylaxis in guinea pigs (Konzett-Rossler method) was investigated. Azelastine and ketotifen were administered p.o. 2 and 24 h before antigen challenge; disodium cromoglycate (DSCG) was administered i.v. immediately before antigen challenge. The oral dose of azelastine required to inhibit leukotriene-mediated allergic bronchospasm by 50% (ID50: mg/kg) was 0.063 at 2 h and 0.120 at 24 h. Ketotifen at a dose of 0.05 to 10 mg/kg at 2 and 24 h, p.o., as well as DSCG at a dosage of 0.3 to 10 mg/kg at 0 min, i.v., produced weak, inconsistent and nondose-related antianaphylactic effects. Azelastine is an orally effective and long-acting inhibitor of in vivo synthesis and/or release of leukotrienes.

Clinical history, skin prick test and RAST in the diagnosis of birch and timothy pollinosis.

Abstract: The diagnostic efficacy of clinical history (CH), skin prick test (SPT) and RAST was estimated in relation to nasal and conjunctival provocation tests (NPT, CPT) in 69 patients with seasonal rhinoconjunctivitis. The extracts used were freeze-dried, and biologically standardized birch and timothy allergen preparations matched to the extracts on Phadebas RAST discs. Based on single determinations the sensitivity, specificity and predictive values were calculated. There were highly significant (P less than 0.001) correlations between all parameters: NPT, CPT, CH, SPT and RAST. For birch the combination of SPT and RAST made the PTs superfluous as both sensitivity and specificity then reached 100%. With timothy the sensitivity was 97% and with the addition of CH 100%. However, the specificity was only 79% through combining CH, SPT and RAST. The present study using the same standardized allergen preparation in all tests showed a good correlation between indirect test results and provocation tests.

Human IgE synthesis in vitro. Detection with monoclonal antibodies.

Abstract: Using monoclonal anti-human IgE antibodies recognizing the D epsilon 1 or D epsilon 2 epitope, we have developed a sandwich radioimmunoassay (RIA) to determine IgE in human cell cultures. With the help of this assay, various methods of measuring an actual de novo IgE synthesis were compared. It was necessary to subtract performed IgE from released IgE in the culture supernatant and the IgE associated to the cultured cells, in order to determine a net IgE synthesis which would reflect de novo synthesized IgE. Using this differential in vitro IgE assessment, no net IgE synthesis could be demonstrated in culture conditions which lead to strong IgG synthesis. Actual net in vitro IgE antibody production was only found in approximately 30% of cell cultures from atopic donors. This spontaneous IgE synthesis did not correlate to the serum IgE levels of the patients. However, correlations were found between serum IgE levels and amount of performed, released or cell-associated IgE of the cultures.

Long-term safety and efficacy of budesonide nasal aerosol in perennial rhinitis. A 12-month multicentre study.

Abstract: A long-term safety study of intranasally administered budesonide, a topical glucocorticoid, has been performed. 104 patients with perennial rhinitis, allergic or non-allergic, participated in a multicentre study in seven ENT-clinics utilising an identical protocol. A budesonide dosage of 400 μg/day was used as starting dose, but the patients were at liberty to reduce the daily dose to 200 μg. The patients were observed at intervals up to 12 months. At the entry and follow-up visits the following parameters were recorded: rhinoscopic findings, nasal symptom scores, blood chemistry, hematology, urinalysis and determination of plasma cortisol levels before and after stimulation with ACTH (Synacthen®). Nasal biopsies taken from 50 of the patients at the beginning and completion of the study were examined in a blinded way by an indepndent pathologist. The analysis revealed no histopathological changes of the nasal mucosa. At rhinoscopy no signs of atrophy or Candida were reported. Lividity of the nasal mucosa was significantly reduced during the trial, which was also the case for nasal congestion and secretion. All nasal symptom parameters assessed by the patients were significantly reduced from baseline during the follow-up period. No clinically significant changes in the hematological and blood chemistry parameters were observed. Plasma cortisol analysis before and after challenge with ACTH revealed no influence on the hypothalamic pituitary adrenal axis. No tachyphylaxis was observed; on the contrary, there was a clear tendency for reduction of the daily dose of budesonide necessary to keep the patients symptom-free. The present study suggests that intransal budesonide in the dose of 400 μg/day is a safe and valuable addition to our therapeutic armory for perennial rhinitis.

Diagnosis and immunotherapy of mould allergy. IV. Relation between asthma symptoms, spore counts and diagnostic tests.

Abstract: Twenty-four adult asthmatics with autumnal asthma and positive bronchial provocation test to the mould species Cladosporium were evaluated by daily symptoms scores during 11 weeks in the peak mould spore season. A significant association with fluctuation in Cladosporium spore count was found regarding the relative weekly symptom score (mean of subjective asthma and peak flow scores), relative use of antiasthmatic medication and the combined (total) score (mean of symptom and medication scores). The median weekly symptom, medication, and total scores were positively correlated to Cladosporium spore count, but only significantly so in the medication score. Eighteen patients were allergic to both Cladosporium and Alternaria, but asthma symptoms were not associated to Alternaria spore counts; on the contrary, a negative correlation indicated that Alternaria only played a minor role in eliciting asthma. Neither mugwort nor house dust mites seemed to be of importance. The results of diagnostic tests (bronchial provocation test, quantitative skin prick test, RAST and histamine release) were correlated to the mean absolute symptom score of the spore season. The highest correlation to asthma score, peak flow score, medication score, and the combined score was found with the bronchial provocation test. The data indicate that autumnal asthma, to a high degree, is elicited by Cladosporium spores, and further, that the specific allergic diagnosis can only be established by a combination of positive diagnostic tests and careful recording of symptoms elicited by the causative allergen.

Onset of penicillin rashes: relation between type of penicillin administered and type of immune reactivity.

Abstract: In 90 patients with clinical symptoms of penicillin allergy, the onset of the skin reaction was related to the type of penicillin administered (small- or broad-spectrum) and to the type of immune reactivity. Early onset reactions (urticaria, Quincke's edema, Arthus-reactions) were frequently seen after the use of benzylpenicillin, while late onset reactions, mostly macular papular rashes, were mainly seen after the use of aminopenicillins. The clinical symptoms of penicillin hypersensitivity were not related to one single type of immunological (cellular or humoral) reactivity.

A prospective study on the safety of immunotherapy in children with severe asthma.

Abstract: One hundred and six of 503 (21%) consecutive children with asthma, who from 1979 to 1983 commenced hyposensitization therapy, were prospectively studied on the safety of immunotherapy. More than 80% of the patients completed therapy without side effects. Thirteen patients were withdrawn from hyposensitization due to moderate and predictable, but intolerable, side effects such as asthma/rhinitis, urticaria and subcutaneous nodules and hypersensitivity to aluminium. However, more alarming was the outcome in six children, who after an uneventful course of immunotherapy and after several months on maintenance therapy, suddenly, 5 to 20 min (mean 10 min) following an earlier tolerable allergen injection, developed severe, anaphylactic reactions, in three of them nearly fatal. Mould extracts were responsible for the most frequent and serious side effects (Alternaria iridis/alternata, 3 patients, Cladosporium herbarum, 8 patients). Furthermore, serious, but not immediately life-threatening, anaphylactic reactions occurred in two children treated with Phleum pratense. On the other hand, hyposensitization with Dermatophagoides pteronyssinus was very well tolerated.

Characterization of the in vitro effects of glucocorticosteroids on NK cell activity.

Abstract: The NK cell activity of mononuclear cells as well as monocyte-depleted, Percoll-fractionated, NK cell-enriched effector cells against K 562 target cells was inhibited by methylprednisolone (MP) and hydrocortisone (HC) in a dose-dependent manner. The effector/target cell conjugate formation was studied in a single cell agarose assay, and it was shown that MP and HC partly inhibited the NK cell activity by inhibition of the adhesion of effector cells to target.

Diagnosis and immunotherapy of mould allergy. III. Diagnosis of Cladosporium allergy by means of symptom score, bronchial provocation test, skin prick test, RAST, CRIE and histamine release.

Abstract: Thirty-three adult asthmatic patients suspected of mould allergy were investigated by in vivo and in vitro tests in order to establish a specific diagnosis of asthma caused by the mould species Cladosporium. The patients were evaluated by daily symptom scores in the peak Cladosporium season, bronchial provocation test (BPT), skin prick test (SPT), RAST, histamine release from basophil granulocytes (HIST), and crossed radioimmunoelectrophoresis (CRIE), and the results were scored as negative (score 0), equivocal (score 1) or positive (score 2). Based on daily symptom scores and the result of BPT the patients were classified as being manifest allergic (asthma) to Cladosporium (positive allergy), inconclusive or negative. Positive allergy was defined as asthma symptoms oscillating with the spore concentration and a BPT score 2 (positive at allergen concentration less than 10,000 BU). Negative allergy was defined as no asthma symptoms and a negative BPT (score 0) and inconclusive in the case of symptoms and BPT sum of score 1-3. According to the classification a final diagnosis (positive or negative) could be established in 85% of the patients. "False positive" tests were found: for BPT in 27%, SPT 18%, RAST 0%, HIST 18%, and CRIE 0%. The corresponding figures for "false negative" were: BPT 0%, SPT 0%, RAST 27%, HIST 18%, and CRIE 23%. The relative risk of being allergic in spite of a negative test result was 0% for BPT and SPT, and 25-30% with RAST, HIST, and CRIE. In the case of positive test the risk was 90-100%. Excluding BPT, SPT was found to be the optimal single test to predict/rule out clinical allergy. A stepwise combination of positive SPT and positive RAST was found exclusively in patients clinically evaluated as positive, and does not call for an additional BPT. Using a potent allergenic extract a negative SPT excluded clinically important allergy. The primary conclusion of the study, however, is that the final diagnosis of Cladosporium asthma could not be based on a positive BPT alone (due to "false positive"), but only on a combination of clinical symptoms during the spore season and a positive BPT.

Influence of bacterial endotoxins on basophil histamine release. Potentiation of antigen- and bacteria-induced histamine release.

Abstract: The histamine-releasing capability of lipopolysaccharides (LPS) was examined in human leukocyte suspensions. LPS alone did not release histamine, but was found to enhance the histamine release caused by anti-IgE. Also the IgE-mediated histamine release caused by specific antigens (allergens or bacteria) in sensitized individuals was enhanced by LPS. The potentiating effect of LPS was observed in grass pollen and dog dander allergic patients as well as in patients sensitized to E. coli or Staph. aureus bacteria. No potentiation was obtained by exposure to unspecific allergens or bacteria to which the persons were not sensitized. Bacteria can release histamine by immunological or nonimmunological mechanisms, and only the immunological histamine release was found to be potentiated by LPS. It is speculated that endotoxins reinforce release of histamine caused by allergens in allergic patients or by bacteria in persons sensitized to these microorganisms.

Nebulisead Sodium Cromoglycate in the Treatment of Wheezy Bronchitis A Multicentre Double‐Blind Placebo Controlled Study

Abstract: The efficacy of nebulised sodium cromoglycate (SCG) used as a prophylactic treatment of wheezy bronchitis in children aged 1 to 4 years was evaluated in a multicentre double-blind placebo controlled, group comparative study. Fifty-four patients completed the 10-week trial (29 treated with SCG and 25 treated with placebo), preceded by 4-8 weeks baseline. Nebulised SCG did not prove significantly superior to placebo in reducing day wheezing, day coughing, or sleep disturbance due to wheezing or coughing at night. Neither was there significant difference in the use of supportive medicine (beta 2-agonist and theophylline) between the groups. Extra doctor visits, hospital admissions, and parental preference did not show significant difference either.

Purification and characterization of a major allergen from the house dust mite Dermatophagoides farinae.

Abstract: A major allergen from an extract of the house dust mite, Dermatophagoides farinae, was shown to be extremely heterogenic with respect to charge. A slightly basic component of this allergen with a pI of 8, was purified by isoelectric focusing in two steps. The purified component, denoted antigen 19/20 IIa, seemed to be representative for the allergenic activity of the major allergen. The amino acid analysis suggested that antigen 19/20 IIa had a molecular weight of 9400 and contained one residue of galactosamine. SDS polyacrylamide gel electrophoresis did indicate a somewhat higher molecular weight of 14,500. Antibodies against the purified component cross-reacted with a crude extract of the mite Dermatophagoides pteronyssinus.

Basophil histamine release in cord blood. Regulatory role of IgE.

Abstract: Thirty-two cord blood samples were studied for histamine releasing capability by using a sensitive glass microfibre-based histamine analysis Histamine was obtained after challenge with anti-IgE in 24 of the 32 samples However, the net release in cord blood was only 25 % of that in adult blood and no relationship was found between histamine release response, total IgE in cord plasma, and a family history of atopic diseases The low histamine release in cord blood seemed to be associated with the immunological IgE receptor complex activation and not with an immature basic cell function, since the calcium ionophore A23187 which bypasses the receptor complex induced identical histamine release curves in cord and adult blood Furthermore, when comparing the results of passive sensitization of basophils from new-born and adult persons, the new-born basophils possessed a significant fraction of free IgE receptors, whereas in adults most of the receptors were occupied by IgE

Long‐Term Changes in Inhalant Allergy in Asthmatic Children

Abstract: In a representative cohort of 55 asthmatic schoolchildren the progress of the allergy per se was followed up prospectively for 8 years. Judged by clinical data, skin prick tests and RAST, a large majority of the children retained their allergies to pollen and animal danders. These allergens were predominant, whereas allergy to mites and moulds was less frequent. Serum IgE levels showed a strong tendency to remain high. Positive RAST and skin prick tests were also found in a substantial number of children with normal serum IgE concentrations.

Birch Pollen Asthma in The Netherlands

Abstract: The occurrence of birch pollen asthma is related to high birch pollen concentrations in the air, and therefore this type of asthma is rather common in Scandinavia. High birch pollen concentrations are rare in The Netherlands, but in the spring of 1984 extremely high levels were reached, whereas the concentrations of alder and hazel pollen were very low. During this period nine pollinosis patients known to the allergist developed asthmatic complaints. The appearance and disappearance of the asthmatic symptoms in these patients showed strong correlation with the course of the birch pollen concentration in the air, which strongly suggests that birch pollen asthma can occur in The Netherlands, The significance of this finding may be that this type of asthma can be observed regularly when the birch pollen concentrations are very high. This may also hold for other western European countries.

Collection of house dust for analysis of mite allergens. Allergen-reducing effect of a self-administered procedure.

Abstract: To assess allergen-reducing effect of dust collection from mattresses, patients were asked to vacuum clean the entire surface of their mattresses for 5 min with their household cleaners at specified intervals ranging from 1-21 days. Ten patients performed four collections, nine patients only two. Amounts of dust, concentrations and amounts of major allergens from Dermatophagoides pteronyssinus (Dp42), Dermatophagoides microceras (Dm6), and Dermatophagoides farinae (Df6) were determined. The first sampling caused a statistically significant reduction in the absolute amounts of allergens in a following sample. The same tendency was seen in dust weight but not in concentrations of allergens. At intervals of 1 or 3 weeks no consistent changes could be registered. Differences were small and good reproducibility of the sampling and analysing procedure could be assumed. Since the self-administered procedure is much cheaper and easier to handle than sampling done by technicians with special equipment, it can be recommended for sequential analysis of allergen exposure.