Showing papers in "Annals of allergy in 1984"

Cord blood IgE determination for allergy prediction--a follow-up to seven years of age in 1,651 children.

Abstract: Among 1,651 children, 80.2% of those with high cord blood IgE concentrations (greater than or equal to 0.9 kU/l) developed atopic disease before six years of age. Only 3.5% of children with no atopic disease showed high neonatal IgE concentrations. Of children with early-developing and long-lasting symptoms, 93.7% showed high cord blood IgE concentrations.

Relationship between atopy and bronchial responsiveness to histamine in a random population

Abstract: Although there are theoretical reasons to suggest that atopy might predispose to non-allergic bronchial hyperresponsiveness, previous studies have yielded conflicting results. We assessed this by determining the atopic status and bronchial responsiveness to inhaled histamine in 400 randomly selected college students. An atopy score was determined as the number of "+"s from a standard battery of seven allergy prick skin tests each graded from + to +, and the atopic status was graded as non-atopic (no +'s) mildly atopic (1 to 4 +'s), moderately atopic (5 to 8 +'s), or markedly atopic (greater than 8 +'s). Non-allergic bronchial responsiveness to inhaled histamine was measured with a standardized histamine inhalation test from which the histamine provocation concentration producing a 20% FEV1 fall (PC20) was calculated. The prevalence of bronchial hyperresponsiveness to histamine (PC20 less than or equal to 8 mg/ml) was 10.3% in the entire population. There was a progressive increase from 6.1% in the non-atopic group to 33% in the markedly atopic group (p less than 0.001). In 43 subjects with both measurable atopy score (greater than or equal to 1) and PC20 (less than or equal to 16 mg/ml), a regression of atopy score vs. log PC20 produced a small (r = -0.36) but significant (p less than 0.02) correlation. These data indicate a significant relationship exists between atopic status and increased non-allergic bronchial responsiveness to histamine. Although cause and effect cannot be inferred from this study, it is hypothesized that atopy is one factor, among others, which predisposes to non-allergic bronchial hyperresponsiveness.

Multitest CMI for standardized measurement of delayed cutaneous hypersensitivity and cell-mediated immunity. Normal values and proposed scoring system for healthy adults in the U.S.A.

Abstract: The Multitest CMI system, a disposable device that simultaneously applies seven standardized preloaded antigens and diluent control, is a major advance for measurement of delayed type hypersensitivity (DTH) in assessment of cell-mediated immunity (CMI). The system was tested in 402 healthy adults, aged 17 to 92 years, to determine normal values for incidence and size of DTH responses. Incidence of positive responses to individual antigens varied from 85% to 46%, with great variability related to age and sex. To better assess CMI, a two-part score based on 48-hour readings was employed. The mean number of positive antigens ranged between four and five, and the mean sum of their mm induration ranged between 18 and 25, with both scores increasing with advancing age. A statistical zone of reduced DTH scores (hypoergy) was identified. The Multitest CMI system appears to be a practical means of reproducibly assessing CMI in subjects with immunologic, metabolic, infectious, or neoplastic disorders. The scores in our population may serve as reference values to which results from any tested adult can be compared.

Allergens in hymenoptera venom XII: how much protein is in a sting?

Abstract: DONALD R. HOFFMAN, Ph.D., and ROBERT S. JACOBSON, M.S.The protein content of insect venoms was determined using a Coomassie blue dyebinding assay as well as the Lowry phenol assay. The Lowry method tended togive excessively high values with many of the venoms because of the presence oflow molecular weight phenolic compounds and other inteifering substances. Usingthe dye binding method honey bee stings were found to contain 59

Mast cell mediators with emphasis on intestinal mast cells.

Abstract: Mast cells occur throughout most tissues although they are more prevalent in areas which come into contact with the external environment such as the skin, lungs, and gastrointestinal tract. The physiologic role of this cell is not known; however, it has a recognized pathophysiologic role as an effector cell in immediate hypersensitivity reactions. Such mast cells, when activated by either immunologic or non-immunologic stimuli, both release and generate chemical mediators such as histamine and leukotrienes which then act on surrounding tissues. Depending upon the site of mast cell degranulation, a variety of clinical findings ensue. For example, mast cell degranulation in the lungs may lead to wheezing, while mast cell degranulation in the gastrointestinal tract may lead to vomiting and diarrhea. It is now recognized that not all mast cells are identical. The best example of this mast cell heterogeneity is found in the gastrointestinal tract. There is evidence that certain gastrointestinal mast cells both contain and generate mediators either distinct from or differing in quantity from those of mast cells found at other sites. Such observations suggest that a knowledge of these differences is required to understand gastrointestinal diseases in which mast cell activation plays a part.

Immunotherapy in allergy to dog: a double-blind clinical study

Abstract: Twenty-seven asthmatic children allergic to dog were included in the study. Their allergy to dog was confirmed by positive results from the skin prick, radioallergosorbent and provocation tests. The subjects were randomly assigned to active and placebo groups. Fifteen subjects received immunotherapy with a commercial standardized aluminum hydroxide-bound dog dander extract and 12 subjects received placebo injections containing histamine. After one year's therapy the conjunctival sensitivity to dog dander extract had decreased significantly (p less than 0.001) in the active treatment group compared to the placebo group. The hyposensitization effect was already observable after six to eight months of treatment. The decrease in bronchial sensitivity was less marked than that in conjunctival sensitivity and statistically not significant. Immunotherapy was observed to be safe and effective. No systemic adverse reactions occurred and local reactions were mild.

A volumetric-aerobiologic study of seasonal fungus prevalence inside and outside dwellings of asthmatic-patients living in northeast netherlands

Abstract: Air sampling with an Andersen sampler was carried out over a period of 21 mo, in 28 houses of asthmatic patients with an allergy for moulds. Inside, the livingroom, bedroom, and kitchen were studied, and an additional outside sample was always taken. Indoors, Penicillium showed the highest concentration, especially in the autumn and winter months, while Aspergillus and yeasts were also found frequently. The outside air was dominated by Cladosporium and Alternaria during summer months and Botrytis, Aspergillus, Mycelia sterilia and Basidiomycetes all year round. The patients showed high sensitisation towards Aspergillus, irrespective of the concentrations of the airborne fungi.

Increased hospitalizations for asthma among children in the Washington, D.C. area during 1961-1981.

Abstract: Hospital admissions for childhood asthma to three university affiliated hospitals in the Washington D.C. area (Children's Hospital National Medical Center, CHNMC, Prince George's General Hospital, PGGH, and Holy Cross Hospital, HCH) for the period 1961-1981 increased at least three to 18 fold. The over-all population of children less than or equal to 14 years of age increased, at most, only 1.5 fold by 1970, and thereafter decreased gradually until the end of the study. This increase in pediatric asthma hospitalizations has occurred despite significant improvements in the ambulatory management of the asthmatic child. In particular, the amount of specific anti-asthmatic medication prescribed for these patients has grown markedly. The increased hospitalization is most likely due to an increase in the occurrence of severe asthma in children, particularly black children.

A clinical evaluation of N-5' with perennial-type allergic rhinitis--a test by the multi-clinic, intergroup, double-blind comparative method.

Abstract: N-(3,4-dimethoxycinnamoyl) anthranilic acid (N-5'), a new orally useable mast cell stabilizer, was investigated for its efficacy, safety and usefulness in the treatment of 302 patients with perennial nasal allergy by an intergroup, double-blind comparative test using disodium cromoglycate (DSCG) and an inactive placebo as control. The results indicated that N-5', as a mild mast cell stabilizer, was comparable to DSCG in efficacy and minimum in side effect.

The relevance of anti-food antibodies for the diagnosis of food allergy.

Abstract: All individuals are exposed to large amounts of potentially immunogenic food proteins. Most people respond by producing IgG, IgA, or IgM antibodies. The presence of such antibodies in serum is a normal, but not necessarily physiologic phenomenon. In certain groups of individuals, such as young infants, persons with a selective IgA deficiency and patients with inflammatory gastrointestinal disorders, especially high levels of such antibodies are commonly found despite complete tolerance to intake of the food in question. Obviously the finding of IgG, IgA or IgM antibodies to food proteins in serum is of limited clinical relevance. The presence in serum of IgE antibodies to food antigens is not uncommon in some patients with atopic dermatitis, although the clinical relevance of the antibodies for the dermatitis is not always clear. Young, atopic children have low levels of such antibodies as a normal, transient phenomenon. High concentrations of IgE antibodies not only to classical food antigens such as egg, fish, cow's milk, nuts, shellfish, peanuts and cereals but also to less typical allergens such as celery, some spices and other vegetables often indicate a pronounced food allergy that can give rise to a serious reaction upon contact. In contrast to the case with non-IgE antibodies, the presence of IgE antibodies in serum is a non-physiologic state of clinical relevance.

Basic and clinical aspects of atopic dermatitis.

Abstract: The history of atopic dermatitis is replete with many disparate theories The most enduring is the allergic causation theory but definitive, convincing evidence remains elusive Elevated IgE synthesis is well established and reflects abnormal immune regulation The basic mechanism for the regulatory defect remains conjectural Cellular immune functions, including delayed cutaneous hypersensitivity, in vitro lymphocyte transformation and chemotaxis are reduced in atopic dermatitis However, these abnormalities fluctuate with the clinical condition and may be secondary phenomena A number of physiologic and pharmacologic abnormalities in atopic dermatitis are not clearly understood Recent studies of patients leukocytes have shown that the diminished cyclic AMP responses are a consequence of increased catabolism by elevated cyclic AMP-specific phosphodiesterase This high enzyme activity correlates well with elevated IgE synthesis and histamine release by cultured leukocytes Both of these functions can be reduced by phosphodiesterase inhibitors in vitro These new investigations provide fresh insight into the pathogenesis of atopic dermatitis and offer possible new therapeutic approaches Basic studies of biochemical abnormalities may help define the defective molecular site that accounts for the many immune and physiologic abnormalities that have been described in atopic dermatitis and the other atopic conditions

Aeroallergens of the southeast Missouri area: a report of skin test frequencies and air sampling data.

Abstract: Aeroallergens in the Southeast Missouri area were identified by analyzing the positive skin tests of eight hundred seventeen patients and five years of air sampling. The important trees, grasses and weeds are enumerated. Reactivity levels of house dust, feathers and Dermatophagoides farinae exceeded all others. First among the fungi was Epicoccum purpurascens .

The mucosal immunologic network.

Abstract: As with all immune responses, those in the gastrointestinal tract can be categorized as both humoral and cellular. I shall review the structural and anatomic basis for the cellular circuitry underlying the mucosal immune network, and review the T cell compartment in the epithelium, including its possible function and the relationship between these lymphoid cells and structures and intestinal mast cells.

Biphasic systemic anaphylactic reaction: three illustrative cases.

Abstract: We report on three patients with early mild systemic reactions triggered by administration of rabies vaccine, immunotherapy with rye grass extract, or yellow jacket sting. After appropriate treatment, these early cutaneous and respiratory symptoms improved considerably, but then flared up three and one half to four hours later. All three patients had specific IgE antibodies against their offending allergen.

IgG4: non-IgE mediated atopic disease

Abstract: This review article attempts to define the role of IgG4 in allergic disease. Evidence from the literature suggests that IgG4 antibodies may act as sensitizing as well as blocking antibodies. The mechanism(s) of the dual properties of this immunoglobulin sub-class in this disease is discussed in relation to the various immunopharmacologic (target cell) and immunological (lymphocyte) pathways. It is clear that availability of IgG4 myelomas and the development of monoclonal antibodies to IgG4 is essential for further research in this area. Preliminary findings suggest that IgG4 antibodies may be important in certain types of food allergic reactions. More work should be done to analyze pediatric populations for IgG4-RAST to a variety of food allergens.

A mononuclear cell derived histamine releasing factor (HRF) in asthmatic patients. Histamine release from basophils in vitro.

Abstract: Mononuclear cells from asthmatic patients produced a histamine releasing factor (HRF). Mononuclear cells produced this factor in culture spontaneously but significantly much more following specific allergen stimulation. This factor released histamine from both sensitized and unsensitized basophils in vitro. Mononuclear cells from healthy subjects produced HRF only after nonspecific mitogen/phytohemagglutinin stimulation. Asthmatic patients on immunotherapy with essential benefits failed to produce HRF.

The spectrum of gastrointestinal allergies to food.

Abstract: Gastrointestinal food allergies may be defined as clinical syndromes which are characterised by the onset of gastrointestinal symptoms following food ingestion where the underlying mechanism is an immunologically mediated reaction within the gastrointestinal tract. These gastrointestinal symptoms, principally vomiting and diarrhoea, sometimes abdominal colic, may be accompanied by other symptoms outside the alimentary tract. The clinical spectrum of these disorders ranges from acute anaphylaxis (rarely leading to death in infancy) to relatively minor symptoms which are difficult to distinguish from other disorders such as toddler's diarrhoea or psychologic disorders. The same food, e.g. cow's milk, may produce a wide range of clinical manifestations. In the one individual, clinical features may change with age. The incidence of gastrointestinal food allergic disease is greatest in the first year of life and decreases with age. There are, broadly speaking, two categories of clinical syndromes which are related to speed of onset of symptoms: immediate and delayed. Those syndromes which manifest immediately after food ingestion are usually easy to diagnose and specific IgE tests and skin prick tests are frequently positive. Those which have a delayed onset of up to several days are difficult to diagnose, and currently available investigations may be unsatisfactory for routine use. In current clinical practice, gastrointestinal syndromes which can be manifestations of food allergy, may be grouped as follows: 1) immediate syndromes, including anaphylaxis and b) acute vomiting +/- diarrhoea in association with cutaneous and respiratory manifestations; and 2) delayed syndromes, including a) food-sensitive small intestinal enteropathies, b) food-sensitive colitis, c) multiple food allergy +/- enteropathy, and d) infantile colic.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaphylaxis presumed to be caused by beef containing streptomycin.

Abstract: Most adverse reactions to foods have been blamed on proteins derived from the ingested substance. Reports in the literature document that adverse reactions to foods can be caused by contaminants. The youngster reported here had anaphylaxis on four occasions, likely caused by the presence of streptomycin.

Sudden death in adolescent asthma.

Abstract: There has been an increase in mortality from asthma in the adolescent age group in the past several years. Although the exact cause of this is not known, a number of factors probably contribute. We have identified four areas of major concern which we believe place adolescents with asthma at high risk. These include physiological factors such as night-time worsening of disease (or "dipping"), non-compliance with the medical regimen, stress associated with daily living and parental expectation, and depression/suicide with asthma as the modality. Identification of those individuals who are at risk and intervention into the contributory factors may reduce asthma deaths. Language: en

Toxic reactions induced by hymenoptera venom.

Abstract: A man experienced a toxic reaction after being stung simultaneously by 175 yellow jackets. After an initial minor anaphylactoid shock he presented a delayed acute renal failure secondary to intravascular hemolysis and rhabdomyolysis. He completely recovered without sequellae after hemodialysis. A second clinical case of hymenoptera venom-induced toxic reaction is presented. A woman was stung by 65 bees at the same time and she only had minor symptoms of anaphylactoid shock associated with an extensive angioedema. No symptom of acute renal failure, myolysis or hemolysis could be detected.

Insect sting anaphylaxis and beta-adrenergic blockade: a relative contraindication.

Abstract: Severe anaphylaxis is reported in a bee venom-sensitive 31-year-old male while receiving propranolol. His anaphylactic reaction was mainly respiratory and was refractory to emergency treatment. We believe that his use of beta-blockers contributed to the severity of his anaphylaxis and refractoriness to treatment. We suggest that beta-blockers should be contraindicated or alternate medications used in hymenoptera allergic patients.

Epidemiology, incidence and clinical aspects of food allergy.

Abstract: Clinical manifestations of food allergy (FA) include a large variety of symptoms, most of which are gastrointestinal. Among the various clinical conditions, cow's milk protein allergy (CMPA) usually appears during early infancy; therefore, it is predominantly a problem of childhood. As with any type of FA, the diagnosis of CMPA rests mostly on clinical observation rather than on laboratory tests. Our studies confirm that both skin tests and RAST are valuable tools in the diagnosis. In particular, our follow-up study of a group of infants with CMPA demonstrates that the majority of RAST-positive subjects do not tolerate cow's milk after many years, whereas all RAST-negative infants tolerate cow's milk in their second year of life. Accordingly, RAST may be useful either in the diagnosis or in the prognosis of CMPA. It is generally agreed that treatment of FA should center on avoidance diets. This may not be easy in children with multiple allergies. Prophylactic drugs may be very useful. Disodium cromoglycate, for instance, seems to be effective in the prevention of IgE-mediated FA. They may also be needed when symptoms persist, mostly because of lack of compliance with the antigen avoidance diet. Early prophylaxis against FA appears to be best achieved by breast-feeding. Exclusive breast-feeding should be encouraged for as long as possible when there is a family history of allergy.

Allergenicity of food proteins and its possible modification.

Abstract: All food proteins, taken via the oral route, are likely to be allergenic to some degree, but this usually leads to no untoward effects. Over the last decade excellent immunoassay methods have been developed that are suitable for measuring anti-food protein antibodies of different isotypes. General systemic and local tissue sensitivity to food antigens may also be measured by appropriate methods. All the circumstances (e.g., amount of ingestant, conditions in the gut, selective immunodeficiencies, gut permeability and genetic factors) determining heightened allergic responses are not yet fully understood. Allergic disease "caused by" food allergens may take on a variety of forms depending on the organ(s) bearing the brunt of the reactions: the gut itself, the skin, the lungs, joints or the entire body. Factors governing the severity of disease include the level of sensitization, the antibody isotype, the type of allergic sensitivity and again the extent of antigen absorption from the gut. Among the foods discussed are cow's milk and other formulae based on soya, chicken meat and hydrolysed casein for infant feeding. A test in guinea pigs to screen for potential oral sensitizing capacity of infant feeds is discussed, as is the effect of heat treatment of milks to reduce their sensitizing capacity. The antigenicity of cereal proteins per os in human adults and in laboratory animals is also dealt with.

Mold allergy: a three year investigation (1980-1982) of the airborne fungal spores in Naples, Italy

Abstract: The purpose of the study was to examine the seasonal changes of the most important anemophilous species of molds, mainly those of allergenic interest. A spore-mold calendar for Naples, Italy was developed by continuous sampling over a 3-year period (January 1980-December 1982). The results reveal the climatic conditions are favorable for the growth of some fungi with dry spores in Naples and very high atmospheric concentrations of mold spores are to be found in summer months, particularly those of Cladosporium. Allergic sensitization with skin test reactivity and clinical signs of sensitivity to inhaled fungal spores is nevertheless found infrequently and generally not correlated with the seasonal patterns of presence of the spore molds in the atmosphere.

Anaphylaxis to penicillin in a frozen dinner.

Abstract: A case of violent anaphylaxis apparently due to penicillin "hidden" in a frozen dinner is described. Steps helpful in investigating such cases are briefly discussed.

Delayed hypersensitivity responses of cancer patients to recall antigens using a new "Multitest" applicator.

Abstract: Testing of delayed-type hypersensitivity to recall antigens is acknowledged to be a useful assessment of cell-mediated immunity in cancer patients. The conventional method, however, has suffered from a lack of standardized antigens and variability owing to the method of application of the recall antigens. The Multitest-CMI system by the Merieux Institute offers an alterative. It employs standardized antigens and a single-stroke applicator, which is simpler to use and presumably subject to less variation. The present study compares the conventional and Multitest batteries done over an 8-month period in 403 cancer patients. The results suggest that the Multitest is easier to administer and is tolerated better by patients than the conventional method. Furthermore, the Multitest can detect recall antigen anergy or reactivity and correlates well in degrees of reactivity to the individual test battery. Consequently, Multitest-CMI can be substituted for the conventional battery in skin testing for immunocompetence in cancer patients.

The immune response of the mammary gland and its significance for the neonate.

Abstract: The immune response of the mammary gland is dominated by local production of secretory IgA antibodies (SIgA) These milk antibodies, amounting to about 05-1 g/day throughout lactation, are directed against food proteins and microorganisms often present in the intestine This is presumably explained by the enteromammaric link: after antigenic exposure in the Peyer's patches of lymphoid cells they home to various exocrine glands, including the mammary gland Similarly, lymphoid cells from the bronchial mucosa, may contribute to the antibody-producing cell population in the mammary gland SIgA antibodies against common foods like cow's milk and soy proteins are regularly found in milk if such proteins are part of the mother's diet It is possible, but unproven, that milk antibodies can decrease the exposure of the infant's intestinal mucosa to foreign food proteins introduced during continued breast-feeding Milk SIgA antibodies do not prevent intestinal colonization by microorganisms, against which the milk antibodies are directed The SIgA antibodies are thought to exert protection primarily by preventing contact between the microorganisms and the mucosal membranes In this manner, human milk blocks attachment of otitis media-causing strains of pneumococci and H influenzae to retropharyngeal cells, possibly explaining why breast-feeding may prevent otitis media Milk antibodies have anti-attachment capacity, but there is also low molecular weight material in the milk with this capacity It probably consists of analogues to the oligosaccharide receptor for pneumococci on the retropharyngeal cells(ABSTRACT TRUNCATED AT 250 WORDS)