Showing papers in "Annals of allergy in 1986"

Intracellular calcium release induced by histamine releasers and its inhibition by some antiallergic drugs.

Abstract: When rat mast cells loaded with fluorescent Ca2+ indicator Quin 2 were exposed to either compound 48/80 (0.1 micrograms/mL) or substance P (2 microM) at 37 degrees C for 30 seconds in a Ca-free medium, a marked increase of Quin 2 fluorescence was noticed, indicating that Ca2+ was released from the intracellular Ca store. The pixel values of the whole cell image were displayed in a three dimensional projection. When mast cells were exposed to 48/80, the fluorescent increase was reflected as an increase of height and spreading of the image. When 0.01 to 1 mM of db-cAMP was pretreated for five minutes, an increase of Quin 2 fluorescence was inhibited in a dose-dependent fashion. Theophylline pretreatment also showed a preventive effect at 1 to 5 mM. A marked inhibition of the Quin 2 signal was induced by pretreatment with 0.01 mM of terfenadine (63.4% inhibition) or ketotifen (26.6% inhibition). Disodium cromoglycate also showed a similar inhibitory effect. In the measurement of the order parameters of liposomes, the addition of either terfenadine or ketotifen into the lipids increased the parameter value, indicating they provide the membrane stabilizing action.

Diagnosis and management of allergic bronchopulmonary aspergillosis.

Abstract: Early diagnosis and treatment is essential for patients afflicted with bronchopulmonary aspergillosis (ABPA). Inflammatory damage to the airways may be significantly reduced through use of corticosteroids. Without treatment, bronchiectasis causing permanent anatomic alteration of the airways may occur. ABPA should be considered in any asthmatic who requires oral corticosteroids and has recurrent pulmonary infiltrates. Evaluation should include determination of total serum IgE, which generally exceeds 1000 ng/mL in patients with ABPA. Disease categorization of ABPA patients may be made according to radiographic and clinical considerations into five stages. The treatment choice for ABPA is prednisone, although inhaled corticosteroids including beclomethasone dipropionate may also be used in long-term asthma management. Successful therapy of ABPA is typically associated with a decline in total serum IgE, subsequent exacerbations often being associated with elevation in total serum IgE. Allergen avoidance is essential for the ABPA patient, as exposure to heavy concentrations of fungi may precipitate disease exacerbation.

Mycoplasma pneumoniae is a frequent cause of exacerbation of bronchial asthma in adults.

Abstract: The possible role of infection with Mycoplasma pneumoniae (MP) in exacerbation of bronchial asthma in adults was studied in 95 patients hospitalized due to acute asthma. Twenty (21%) of these patients had evidence of a recent MP infection as determined by the presence of high levels of MP-specific IgM antibodies. In addition, high levels of both IgM and IgG but not IgA serum immunoglobulins were observed in the MP-infected group as compared to a control group of 20 non-MP-infected asthmatics. Five out of 20 MP-infected asthmatics exhibited rheumatoid factor (RF) in their sera while patients in the control group were all negative for RF. It is concluded that MP infection may be significant in exacerbation of asthma in adults.

Prospective survey of local and systemic reactions to immunotherapy with pollen extracts.

Abstract: To assess the relative risk of local and systemic reactions to injections of pollen extracts and to examine the predictive value of these local reactions for systemic reactions, a prospective survey of local and systemic reactions was performed from October 1981 to June 1983 at a large military allergy clinic. Four hundred and sixteen patients received 26,645 injections of pollen extracts. Of the total, 25,508 injections (95.7%) were not associated with reactions, 1,055 injections (4.0%) were associated with local reactions (669, less than 2 cm in diameter; 279, 2 to 5 cm; and 107 greater than 5 cm), and 82 injections (0.3%) were associated with systemic reactions. Seventy patients experienced 82 systemic reactions. Of these, 25 (36%) had no prior local reactions. Eighteen males and 52 females had systemic reactions. The sensitivity of local reactions as a predictor of systemic reactions was 64%, the specificity was 1.2%, the positive predictive value was 12%, and the negative predictive value was 14%. Proportionally, more women than men experienced systemic reactions, P less than 0.05. We made the following conclusions. Most injections of pollen extracts were not associated with local or systemic reactions. The majority of reactions were local. The presence of local reactions was not helpful in predicting which patients would develop systemic reactions. Women appeared to be at greater risk for systemic reactions than men.

Suppression of histamine-induced wheal response by loratadine (SCH 29851) over 28 days in man

Abstract: Five groups of 12 healthy volunteers each received in double-blind, randomized fashion oral b.i.d. doses of 10, 20, or 40 mg loratadine, 12 mg chlorpheniramine maleate (CTM), or placebo for 28 days. Histamine and saline were injected intradermally into opposite arms at baseline and at specified times following treatment on days 1, 3, 7, 14, 21, and 28. Notable suppression of adjusted wheal formation (histamine-induced minus saline-induced) occurred within two hours after the first dose of each active treatment on day 1. In general, throughout the treatment period, suppression of adjusted wheal formation by all doses of loratadine was significantly greater than by placebo. Suppression by 10 mg loratadine was comparable to CTM, and 20 and 40 mg loratadine were significantly greater than CTM. Suppression of wheal formation by loratadine during the treatment period and during five days posttreatment were dose related. The continued effectiveness of loratadine throughout the 28 days suggests that tolerance to loratadine did not develop in this study. Sedation occurred in 8 of 12 subjects receiving CTM, 1 of 12 receiving 10 mg loratadine, and 1 of 12 receiving placebo.

Methotrexate in the treatment of steroid-dependent asthma.

Abstract: A 63-year-old woman with refractory psoriatic arthritis and asthma, requiring intermittent steroid therapy, was treated with methotrexate (MTX). Her arthritis responded rapidly and it was noted that her asthma required no further steroid therapy. Six patients with established steroid-dependent asthma were then treated with 7.5 to 15.0 mg of MTX per week, after protocols used to treat psoriasis and rheumatoid arthritis. Five patients reduced their steroid usage while on MTX. Side effects were minimal while taking MTX. It was concluded that MTX may have a role in reducing cortisone requirements in steroid-dependent asthma.

Increase of respiratory allergy to the pollens of cypresses in the south of France.

Abstract: A form of pollen allergy, which is uncommon in most parts of the world and in other Mediterranean countries where cypresses are abundant (Italy, Spain, Greece), with the exception of Israel, has become a problem since 1975 in our area. We have found 111 cases since 1975 compared with only a few cases from 1950 to 1975. The period of pollination is between mid-February and the end of March. Diagnosis has been made by skin tests and, in some instances, by RAST with good correlation. In almost all the cases, cross-reactivity has been found between the members of the Cupressaceae family with Cupressus sempervirens, the commonest cypress in the South of France, associated most often with this allergy. Clinically, allergy was of the oculo-nasal type with the association, in a few cases, of asthma or spasmodic cough. The unexpected increase of a particular allergy in a given population of atopic people raises several general problems. In this particular case it seems to us that the larger number of cypresses, which have been recently grown, is not the only explanation of the phenomenon.

Serum immunoglobulins and secretory IgA deficiency in tonsillectomized children.

Abstract: We studied serum immunoglobulin patterns in 65 children aged 2 to 10 years before and 1 to 4 months after tonsillectomy and adenoidectomy, and secretory IgA (sIgA) levels in 46 children aged 3 to 10 years before and 1 month after the same operation. Serum immunoglobulin and sIgA values were normal prior to surgery, and significantly lower afterwards. The data emphasize the importance of palatine tonsils not only in the synthesis of monomeric immunoglobulins but also in the synthesis of dimeric immunoglobulins in secretions. Although more long-term, follow-up studies supporting our results are needed, we suggest that a post-adenotonsillectomy drop in immunoglobulin and sIgA levels may predispose children to a constellation of disorders. We recommend, therefore, that serum immunoglobulins and sIgA levels be determined in all children before and after surgery.

The effect of running training on exercise-induced asthma.

Abstract: A running training program had no effect upon the severity of exercise-induced asthma, however, it appeared as if the children benefitted not only from a decrease in the frequency and duration of asthma in daily life, but also by improvement in self-confidence and ability to participate in group activities.

Immunotherapy in allergy to dog. Immunologic and clinical findings of a double-blind study.

Abstract: Twenty-seven dog-allergic asthmatic children with no pets in the home were included in the study. The clinical trial was performed as a double-blind study using a commercial standardized aluminum hydroxide-bound dog dander and hair extract or histamine-placebo. The patients were randomized into the active treatment or the placebo group on the basis of the RAST (e5) and the provocation test with aqueous dog dander and hair extract. The good clinical response of immunotherapy with dog dander and hair extract has been reported earlier. The specific immunotherapy resulted in an increase in the serum level of antigen-specific IgG antibodies (P less than .01) and a decrease in the skin sensitivity to dog extract (P less than .001) in the active treatment group when compared with the placebo group. The treatment was well-tolerated. No systemic reactions occurred and local reactions were mild. The results show a good immunologic response with a standardized dog dander and hair extract. There were no major changes in the course of bronchial asthma in either group. After 1 year of immunotherapy the subjects had no symptoms on a dog-exposure of short duration. This must be carefully emphasized when considering the indications for immunotherapy.

Cross-reactivity between the pollens of Cupressus sempervirens (common cypress) and of Cryptomeria japonica (Japanese cedar).

Abstract: A clinical and immunologic study was performed comparing a group of French patients allergic to the pollens of cypress (Cupressus sempervirens, which belongs to the Cupressaceae family) and a group of Japanese patients allergic to the pollens of Sugi (Cryptomeria japonica, which belongs to the Taxodiaceae family). By skin testing, RAST, and RAST inhibition, clear cross-reactivity was detected between the two pollens. No cross-reactivity was detected between the pollens of Cupressus sempervirens and Sugi and the Pinaceae family. In addition, one can speculate that an antigen in Cupressus sempervirens is cross-reactive with SBP, the major allergen of Sugi, suggesting that there is a closer relationship between the Taxodiaceae family and the Cupressaceae family than between these two families and the other families of the gymnosperms. This finding throws new light on the taxonomy of the gymnosperms.

Serum IgE levels in patients with inflammatory bowel disease.

Abstract: The role of allergy in the pathogenesis of inflammatory bowel disease (IBD) is unclear. The present study was performed to evaluate serum levels of IgE and other immunoglobulin classes in patients with IBD. Patients with IBD had significantly elevated serum levels of both IgG and IgM in the presence of normal levels of IgA. Serum concentration of IgE, as well as the prevalence of patients with "high IgE" were significantly increased in IBD. Among patients with IBD, those with Crohn's disease or those in relapse had the highest levels of IgE. The possibility that allergy plays a pathogenic role in a subset of IBD is discussed.

Specific IgE response before and after rush immunotherapy with a standardized allergen or allergoid in grass pollen allergy.

Abstract: Allergen extracts contain a wide variety of allergenic determinants and the sensitization of allergic subjects is extremely heterogeneous. Specific immunotherapy is usually performed with multiple component extracts and it is therefore important to determine whether this treatment may elicit the onset of newly developed IgE sensitivities. By means of nitrocellulose immunoblotting technique, the IgE sensitivities of 20 patients were characterized before and after specific immunotherapy. Ten patients had a rush immunotherapy with a standardized orchard grass pollen extract and ten others underwent a rush immunotherapy with a 6-grass pollen allergoid. The allergenic profiles of the patients before and after immunotherapy were qualitatively similar. In some patients an increase of orchard grass pollen-specific IgE was observed and the allergenic profile was quantitatively different. These results suggest that rush immunotherapy with either an aqueous non-modified extract or an allergoid does not elicit the onset of new IgE sensitivities. Multicomponent allergenic extracts may therefore be used in the treatment of patients.

The clinical and immunologic efficacy of immunotherapy with modified ragweed extract (allergoid) for ragweed hay fever.

Abstract: A double-blind study comparing formaldahyde modified ragweed allergen (allergoid) and placebo in the treatment of allergic rhinitis was carried out. Twenty ragweed-sensitive patients were studied, ten receiving 10,710 PNU of allergoid pre-seasonally and ten receiving placebo injections. Daily symptom score sheets were kept by each patient during August and September of 1983. A significant difference in average daily symptom scores (P = 0.01) between the two groups was noted. Significant differences were also observed in symptom scores for individual weeks during the ragweed season. Post-treatment allergen-specific IgG blocking antibody was significantly higher (P = 0.001) in the treatment group compared to pre-treatment levels and when compared to the control group (P = 0.01). No significant local or systemic reactions occurred. The results suggest that the dosage protocol used in this study is appropriate as an initial treatment schedule in clinical practice.

Skin test and radioallergosorbent test with extracts of larval and adult midges of Tokunagayusurika akamusi Tokunaga (Diptera: Chironomidae) in asthmatic patients of the metropolitan area of Tokyo

Abstract: Prick test and radioallergosorbent test to extracts of larval and adult midges, Tokunagayusurika akamusi (Tokunaga) were done in randomly selected asthmatic patients in the metropolitan area of Tokyo, Japan. Thirty-eight percent of 303 asthmatic patients were prick-test positive to either larval or adult midges, and 32.4% of 105 asthmatic patients were positive to either extracts by RAST, while only one out of 20 normal individuals was positive to RAST. These positive rates in the asthmatic patients were the second to the positive rates of prick test and RAST using mite antigen. Antigens from midges seem to be the second important allergens in the metropolitan area of Tokyo.

A recent increase in asthma mortality in the northwestern United States.

Abstract: Epidemiologic studies have suggested a recent increase in asthma mortality in New Zealand and the United States. Vital statistics were used to calculate asthma mortality rates for Washington and Oregon from 1972 through 1983, adjusting for the nosologic redefinition of asthma in 1979. Between 1977 and 1983, age-adjusted mortality from asthma increased 82% in these two states. The combined age-specific asthma mortality rates for Washington and Oregon showed that the increase was concentrated in the greater than or equal to 75 age group, in which mortality increased from 4.7 to 12.0 per 100,000 between 1977 and 1983. A significant increasing trend in the proportion of death certificates listing a cardiac dysrhythmia along with asthma as a cause of death was observed overall, in the State of Washington alone, and in decedents 75 or more years of age. The same trend was not statistically significant in Oregon or among younger decedents. This increase in asthma mortality may be due to a change in therapy such as an increased reliance on beta-agonists and theophylline preparations in combination, a change in the clinical definition of asthma, or other as yet unrecognized factors. Further investigation of these findings is warranted.

Selective IgA deficiency.

Abstract: Selective IgA deficiency is the most common form of immunodeficiency. Certain select populations, including allergic individuals, patients with autoimmune and gastrointestinal tract disease and patients with recurrent upper respiratory tract illnesses, have an increased incidence of this disorder. These patients have the unique ability to form various antibodies and auto-antibodies including anti-IgA antibodies. Failure of terminal differentiation of the B lymphocyte is the primary defect in IgA deficiency. Treatment should be directed toward the underlying disease associated with this immune disorder. These patients should be advised of the consequences of improperly administered blood or blood products.

IgE-mediated allergy to peanut, cow's milk, and egg in children with special reference to maternal diet.

Abstract: Nineteen children with IgE-mediated allergy associated with strongly positive prick skin tests and RASTs to peanut or cow's milk and/or egg were studied. Seventeen of the children had been breast fed, ten had been exclusively breast fed for a minimum of 5 months. Reactions to these foods occurred on first exposure to the food in all but one instance, suggesting that in 18 instances sensitization had occurred antenatally or via the breast. A retrospective inquiry indicated that most of the mothers had had a generous intake of the food(s) to which their children were sensitized, but mothers of sensitized children did not consume more of these foods than the mothers of non-sensitized children; moreover, avoidance of the foods (peanut in two instances and egg in one) did not ensure freedom from sensitization to peanut and/or egg. Breast feeding by itself cannot be guaranteed to protect against the development of food allergy.

The effect of birth season on pollenosis.

Abstract: The purpose of this paper is to examine whether exposure to antigens in the early months of life can increase or decrease subsequent sensitization. With this aim in mind, 304 subjects undergoing hyposensitization were randomly selected in an out-patient study: 207 of them had pollenosis (seasonal asthma, rhinitis, and positive skin tests to grass pollen) and 97, house dust respiratory allergy (perennial asthma and rhinitis with positive skin tests to house dust mites). The results of the study show a statistically significant association (P less than .005) between birth in grass pollen season and pollenosis. The region of birth (north or south Italy) appeared to be a "deterministic" effect modificator; the odds ratio due to the birth season was 5.099 in the northern and 0.997 in the southern Italian regions. The main effect of the region of birth was not significant, neither was sex, age, and the region of birth of the parents (main, polinomial and interaction effects). It is likely that there is a real relationship between the month of birth of atopic subjects and the prevalence of the pollenosis. The precise reason(s) of the different degrees of association between month of birth and pollenosis in subjects born in northern and southern Italy is not clear.

The late asthmatic response to allergen challenge--Part II.

Abstract: Of the 251 patients with bronchial asthma, 61 (24%) developed 83 late asthmatic (bronchus-obstructive) responses (LAR) to the bronchial challenge with allergen (BP). The LAR began within 6 to 12 hours, reached its maximum within 4 to 8 hours, and resolved within 24 to 26 hours after the allergen challenge. All LARs were highly significant in comparison with the control test (P less than .01). The LAR was observed either as an isolated late response (ILAR) in 35 cases (10%) or as a dual late response (DAR) in 48 cases (14%), being a combination of an immediate (IDAR) and a late response (LDAR). The LAR demonstrated six basic patterns. The association of LAR with other diagnostic parameters was as follows: positive disease history in 49 LAR cases (59%); positive late skin response (LSR) in 51 LAR cases (61%); increased total serum IgE in 17 LAR (20%); positive specific IgE in the serum in 24 LAR cases (29%); increased serum concentration of IgG in 55 LAR cases (66%), of IgM in 41 LAR cases (49%), of IgA in one LAR case (1%); increased serum concentration of IgG1 in seven LARs (8%), of IgG3 in 21 LARs (25%), of IgG4 in 43 LARs (52%), the serum concentration of IgG2 increased in two LARs, while it decreased in 45 LARs (54%); increased blood eosinophilia in 42 LAR cases (51%) and blood leukocytosis in 29 LAR cases (35%); increased body temperature in 15 LAR cases (18%); appearance of late bronchial complaints during 83 LAR cases (100%), and of general malaise complaints during 67 LAR cases (81%).(ABSTRACT TRUNCATED AT 250 WORDS)

Psychosocial aspects of acquired immune deficiency syndrome and the primary care physician.

Abstract: Acquired immune deficiency syndrome is now an epidemic in the United States. Multiple factors contribute to the high degree of psychosocial stress experienced by those with HTLV-III infection, regardless of their current clinical status. Family members, friends, and health care professionals all often experience significant stresses associated with HTLV-III infection or AIDS-spectrum illness in the patient. Knowledge about the psychosocial consequences of cancer, of the unique psychosocial stresses experienced by individuals with AIDS-spectrum illness, and of the functional psychiatric syndromes and organic mental disorders common to AIDS can assist the primary care physician as he cares for individuals with HTLV-III infection and AIDS-spectrum illness.

Hypersensitivity to chromated catgut sutures: a case report and review of the literature.

Abstract: Chromated catgut sutures are used extensively in general surgical procedures. Although delayed hypersensitivity reactions to this material are difficult to diagnose post-operatively--ie, they may be interpreted as non-specific complications of surgery--the condition can be readily evaluated by patch testing with chromate or intracutaneous placement of the actual suture material. Multiple reports in the literature suggested that there was an increased frequency of post-operative adhesions, wound dehiscence, infection, and even intestinal obstruction along the line of suture material to which the patient had been sensitized during a previous surgery. Particularly with the widespread availability of fully synthetic suture materials, which appear to be less sensitizing, an increased awareness of chromate hypersensitivity in patients undergoing repeated surgical procedures may decrease the frequency of subsequent inflammatory post-operative complications. We report a patient with a history of multiple abdominal surgical procedures, eosinophilic cystitis surrounding the suture material, prolonged post-operative pain, and inflammatory masses at the sites of previous surgery associated with a positive delayed hypersensitivity skin reaction to patch test chromate and to intradermal chromic catgut.

Double-blind crossover trial with oral sodium cromoglycate in children with atopic dermatitis due to food allergy.

Abstract: Thirty-one children with atopic dermatitis, aged 6 months to 10 years, were selected for this trial. All had historical, clinical, and laboratory evidences that allergy to food was the cause of exacerbations of eczema. Either oral sodium cromoglycate (SCG) or a matching placebo was administered orally for 8 weeks, followed by the alternative treatment for a further 8-week period. During the first 4 weeks of each treatment period, patients remained on an exclusion diet. During the second 4 weeks, the offending food(s) was reintroduced into the diet. The severity of the eczema and the changes in severity as a result of diet or challenge were measured both by the clinician (using body diagrams) and by parents (using a daily diary card). Analysis of the clinician's scoring and the patient's diary card scores demonstrated a statistically significant difference in favour of SCG, especially in the group where the placebo preceded the active treatment. Sodium cromoglycate does seem to reduce the exacerbations of atopic dermatitis caused by food allergens.

Aeroallergen exposure in the elementary school setting

Abstract: Ten elementary schools in southern California were surveyed to identify and quantitate allergens present in the school environment. The Anderson sampler was used to quantitate viable molds. Pollens and non-viable molds were determined by roto rod techniques. Statistically significant differences existed between indoor and outdoor mean counts for molds and pollens identified by roto rod techniques. Viable mean mold spore counts inside schools compared favorably to local homes. House dust mites were found in considerably lower concentrations in the schools than in homes in the same area. Results indicate that the school interior is a protective environment for individuals sensitive to mold, pollens, and house dust mites.

Hypersensitive reactions to mosquito bites in congenital agammaglobulinemia.

Abstract: A 6-year-old girl with congenital agammaglobulinemia exhibited severe delayed onset cutaneous reactions to mosquito bites with scar formation. The bites were not associated with immediate reactions accompanied by itching. The patient had non-detectable IgE levels (less than 0.2 IU/mL) in addition to absence of three other major classes of immunoglobulins, but showed normal T cell functions. Immunologic and histopathologic examination of the skin lesions revealed that this unusual reaction may be caused by a delayed type hypersensitivity response.

The immediate asthmatic response to allergen challenge.

Abstract: One hundred and three bronchial asthma patients with a suspected allergic component developed 133 positive immediate asthmatic (bronchus-obstructive) responses (IARs) to bronchial challenge with allergen (BP). The onset of IAR was within 10 minutes, the maximum within 45 minutes, and the resolution of the response within 120 minutes after the challenge. All IARs were highly significant in comparison with the control test (p less than .01). The association of IAR with other diagnostic parameters was the following: positive disease history in 82 IAR cases (= 62%); positive immediate skin response in 91 IAR cases (= 68%); increased total serum IgE in 54 IAR cases (= 41%); positive specific IgE in the serum in 59 IAR cases (= 44%); increased serum concentration of IgG in 36 IAR cases (= 27%), of IgM in 17 (= 13%), and of IgA in 3 IAR cases (= 2%); increased blood eosinophilia in 36 (= 27%) and blood leukocytosis in 19 IAR cases (= 14%); increased bronchial reactivity to histamine in 74 of 103 patients with IAR (= 72%); body temperature increased during nine IAR cases (= 7%); and 131 IAR cases (= 98%) were accompanied by bronchial and 62 (= 47%) by general malaise complaints. The IAR showed a very good reproducibility and significant dose-response relationship (P less than .01). In conclusion, the IAR is an important diagnostic parameter for the allergic component due to immediate hypersensitivity in the bronchial tree. The correlation of other diagnostic parameters with IAR was not satisfactory. They should therefore be regarded as diagnostic supplement only.(ABSTRACT TRUNCATED AT 250 WORDS)