Showing papers in "Clinical & Experimental Allergy in 1977"

Bronchial reactivity to inhaled histamine: a method and clinical survey.

Abstract: An easy and safe dose-response histamine-inhalation test is described, to measure the level of non-specific bronchial reactivity. The test was performed in 307 subject. Non-specific bronchial reactivity was increased in 3% of presumed normal subjects, in 100% of active asthmatics and in 69% of asymptomatic asthmatics with previous symptoms only at times of exposure to clinically relevant allergens. It was also increased in 47% of patients with cough and no other chest symptoms, in 40% of patients with rhinitis and vague chest symptoms not by themselves diagnostic of asthma, and in 22% of patients with rhinitis and no chest symptoms. The patients with asthma were studied when their asthma was well controlled and when their minimum drug requirements had been established. The mean level of bronchial reactivity increased with increasing minimum drug requirements. The level of bronchial reactivity also showed a strong negative correlation with the forced expiratory volume in 1 sec (FEV1). Atopic subjects, with or without asthma, showed a significant positive correlation between the level of bronchial reactivity and atopic status as indicated by the number of positive allergy skin tests.

Allergen‐induced increase in non‐allergic bronchial reactivity

Abstract: Summary Non-allergic bronchial hyper-reactivity is a feature of most patients with asthma. We have measured non-allergic bronchial reactivity to inhaled histamine and methacholine in thirteen asthmatic subjects before and after allergen inhalation in the laboratory. The allergen inhalation produced mild early asthmatic responses (19–40% FEV1 fall) in all thirteen, additional definite late asthmatic responses (17–29% FEV1 fall) in four, and equivocal late asthmatic responses (5–11% FEV1 fall) in five. Following allergen inhalation, non-allergic bronchial reactivity increased in seven for up to 7 days. The seven included all four with definite late asthmatic responses and three of the five with equivocal late asthmatic responses. We conclude that allergens make asthma worse, partly through non-allergic mechanisms, and that avoidance of allergens is important in reducing non-allergic bronchial hyper-reactivity.

Proper use of skin tests with food extracts in diagnosis of hypersensitivity to food in children

Abstract: This study was undertaken to determine the proper use of skin tests with food extracts in diagnosis of hypersensitivity to food in children. Cutaneous reactions evoked by graded amounts of food extracts were compared with results of double-blind food challenge and in vitro release of histamine from leucocytes. A 3 mm or greater weal reaction in skin tests by puncture technique using food extracts of 1:20 w/v concentration was found to indicate the degree of hypersensitivity likely to be associated with clinically significant hypersensitivity reactions to food. Proper use of this simple technique will facilitate accurate diagnosis of food hypersensitivity in children by identifying the group among whom all positive reactions to food challenges will be found. Nevertheless, double-blind food challenge is essential to establish a diagnosis of symptomatic hypersensitivity to food.

Asthma induced by sulphur dioxide, benzoate and tartrazine contained in orange drinks

Abstract: Of 272 patients with asthma, thirty (11%) gave a history of exacerbations occurring after ingestion, solutions of orange orange drinks. Fourteen of these were given provocation tests by drinking, on separate occasions of sulphur dioxide, sodium benzoate and tartrazine, which are present in all orange drinks. Eight reacted to sulphur dioxide with a fall in FEV1, four to sodium benzoate and one to tartrazine, and four did not react to any of these agents. Three of the benzoate patients were also sensitive to sulphur dioxide. The sulphur dioxide sensitive patients were predominantly young, with extrinsic asthma. The benzoate sensitive patients were predominantly middle-aged and the proportion with intrinsic asthma was higher. Prior inhalation of sodium cromoglycate by four patients inhibited the reaction to these substances. Sulphur dioxide has not previously been reported to cause exacerbations of asthma when ingested as a food preservative. It is used as a preservative in a wide range of acidic beverages and foods, and should be considered as possibly causal in patients suffering from apparently cryptogenic asthma, and asthma seemingly due to food allergy.

A study of serum antibodies to isolated milk proteins and ovalbumin in infants and children

Abstract: Summary Serum antibodies to cow milk proteins and ovalbumin were measured quantitatively. Food hypersensitivity of the immediate type was determined to be present or absent by skin tests and double-blind food challenges. Elevated levels of antibodies to milk proteins in sera characteristic of infants fed cow milk were found to decline with age, so that sera from children who were 6 to 15 years of age (inclusive), not hypersensitive to food, had significantly lower levels than the infants. In contrast, sera from age-matched children, who were shown to have hypersensitivity to some food, were found to have levels of antibodies to milk proteins as elevated as in infancy. Hypersensitivity was not necessarily to milk but often to some other food. This persistence of greater antibody production to milk throughout childhood in those hypersensitive to some food indicates a fundamental difference from those without hypersensitivity to food, either in permeability, in immunological reactivity of the gut or in development of immunological unresponsiveness. Implications for pathogenesis of clinical disorders are discussed.

Asthma due to inhaled chemical agents—epoxy resin systems containing phthalic acid anhydride, trimellitic acid anhydride and triethylene tetramine

Abstract: Summary Six workers with a diagnosis of occupational asthma and one with chronic bronchitis were examined for sensitivity to epoxy resin systems and certain of their components. In six cases the chemical agent responsible for their symptoms was identified by careful inhalation challenge testing, simulating their exposure at work and thus providing a precise aetiological diagnosis. In one worker asthma followed exposure to triethylene tetramine fume; four were sensitive to acid anhydrides, three to phthalic acid anhydride as a fume or powder and one to trimellitic anhydride. One worker thought to be sensitive to toluene di-isocyanate gave negative reactions to this and positive reactions to a phthalic acid anhydride epoxy resin and another thought to have asthma from acid anhydride fumes was found to be sensitive only to toluene di-isocyanate. Immediate, non-immediate or combined asthmatic reactions were elicited.

Specific and total serum IgE measurements in the diagnosis of penicillin allergy. A long term follow-up study.

Abstract: Sera from 204 patients with acute or former reactions following penicillin treatment were investigated by RAST with specificity for benzylpenicilloyl and phenoxymethyl-penicilloyl. The IgE antibody levels were followed up for of more than 2 years. Positive results could be observed at the time of the acute reactions and the weeks following; later months or years in many cases. Occasionally negative RAST results occurred within 30 days; on the other hand high levels of specific IgE persisted for years in some patients. Total serum IgE measured by RIST and the RAST results showed similar patterns, with mean levels of 568 u/ml between 0 and 30 days after the penicillin allergic reaction, 286 u/ml between 30 days and 1 year, and 195 u/ml in cases after 1 year corresponded well with the observed decline in specific IgE. Skin tests performed with penicilloyl-polylysine in 118 patients showed an overall correlation of 91-5% with the RAST results. Differences between the two test systems were observed in patients with a long interval between the test and the last allergic attack. None of the patients with proved penicillin allergy had atopic diseases or a history of atopy. On the basis of these findings it is suggested that the determination of both circulating specific IgE and total IgE should be of great value for diagnostic purposes during acute drug reactions and in the months immediately afterwards.

Comparison of salbutamol Rotahaler with conventional pressurized aerosol.

Abstract: Salbutamol in a powder aerosol from the Rotahaler insufflator was compared, with equal doses of the conventional pressurized aerosol by dose-response curves and in a 1 month open trial, in the treatment of asthma patients with good inhalation technique. Results were not significantly different in either study. A further group of asthma patients, who were known to be incapable of using pressurized aerosols effectively, were shown to benefit from treatment with the Rotahaler. This device should increase the value of the sympathomimetic drugs to the minority of asthma patients who cannot use conventional aerosols correctly.

Immediate and late onset asthma from occupational exposure to soybean dust

Abstract: Most patients sensitive to soybean experience gastrointentinal symptoms, urticaria, angioedema, and asthma after ingestion. However, we report here a previously non-allergic patient who developed immediate and late onset asthma after breathing soybean flour used in the manufacture of food supplements. She exhibited positive immediate and late skin test sensitivity as well as a positive bronchial challenge to a soybean flour extract. In contrast to another patient with an anaphylactic response after soybean ingestion, the radioallergosorbent test (RAST) to soybean antigen was negative in our patient.

Respiratory allergy and month of birth

Abstract: Summary A total of 476 patients with respiratory allergy were interviewed to establish whether the season of birth influenced the type of allergy experienced. Patients with perennial symptoms did not differ from the general population of the U.K. in the distribution of their months of birth. Patients with summer seasonal symptoms attributable to grass pollen sensitivity were more likely to have been born in December to February than in August to November. This trend was most significant in female patients who did not have associated perennial symptoms and who developed symptoms early in life. Other significant differences were also noted between groups of patients complaining of the same symptoms. More males than females had summer seasonal symptoms whereas more females than males had perennial symptoms. Patients who had both perennial symptoms and summer seasonal exacerbations had a higher incidence of a positive family history of atopy and developed symptoms earlier in life than those patients who had summer seasonal or perennial symptoms only.

Fungal antigens as a source of sensitization and respiratory disease in Scottish maltworkers

Abstract: Mycological and serological studies were carried out as part of a survey of respiratory disease in Scottish maltworkers. 70% of stained sputum smears from 574 workers showed the presence of higher plant cells and/or myclelia, and the spores of common environmental fungi. Penicillium spp. (90%), Rhizopus stolonifer (48%) and yeasts (53%) were the dominant fungi in 699 sputum cultures, and showed a similar proportional distribution in 327 samples of grain, malt, culms and dusts from fifty-six maltings. 57% of 711 men were serologically positive for fungi, 22% for Aspergillus fumigatus, 20% for A. clavatus, 10% for A. niger, 16% for Cladosporium herbarum and over 3% for Rhizopus stolonifer, 6% of 132 men were positive for Penicillium cyclopium. No precipitating antibodies to antigens from Alternaria tenuis, Aureobasidium pullulans, Candida albicans, Geotrichum candidum, Rhodotorula glutinis or Trichoderma viride were detected in tests of forty sera. Sera from the 5.2% of men with symptoms of extrinsic allergic alveolitis showed increased reactivity to mycelial antigens from Aspergillus clavatus. The fungus was cultured from 21% of maltings, 7% of all environmental samples and from the sputa of 8% of maltworkers.

IgE, parasites and asthma in Tanzanian children.

Abstract: It has been claimed that parasitic infestation suppresses the development of asthma. Eight Tanzanian schoolchildren in whom asthma was confirmed by the demonstration of exercise-induced bronchospasm were found in an ascaris-endemic area of rural Tanzania. Faecal parasites were found equally commonly in the children with asthma and the ninety-seven non-asthmatic controls. The prevalence of asthma (3·3%) in the school under study was comparable with that found in developed countries.

Immunoglobulin E specific to wheat and rye flour proteins

Abstract: We have used the radioallergosorbent test (RAST) to determine IgE antibodies specific to wheat flour proteins in the sera of seven groups of patients. In some cases rye-specific IgE was also determined. Wheat and rye RAST scores showed a good correlation, presumably due to cross-reactions. Among bakers with asthma, positive scores, 0.5-3, occurred with a prevalence of 43%, and among children with eczema, scores in the range 0.5-4 were found with a prevalence of 54%. A score of 0.5 was a marginal value which was also occasionally encountered with sera from patient groups with no history of immediate hypersensitivity to wheat or rye. These groups included adults and children with allergic rhinitis and asthma, children from the general population and children with coeliac disease. The RAST appeared useful in the diagnosis of allergy to inhaled flour dust among bakers. Among children with eczema, positive wheat and rye RAST results were a common finding, which only occasionally could be linked to strong and unequivocal reactions to the foods in question. Both in bakers and children with eczema, wheat and rye RAST results showed good agreement with intracutaneous skin test results.

Study of prolonged hyposensitization with D. pteronyssinus extract in allergic rhinitis

Abstract: Sixty-six Chinese patients with rhinitis, with or without asthma, were randomly allocated to a course of injections either with E. pteronyssi-us extract or placebo. The course consisted of 18--22 weekly injections, followed by monthly maintenance injections with the highest concentration for 1 year. Progress was evaluated by a patient's daily diary and monthly assessments by the physician, by comparisons of skin and nasal challenge tests and by the specific serum IgE concentration, before treatment, at the end of the weekly course, and once during the maintenance course. No improvement was detected at the end of the weekly course, but during maintenance there was a consistent benefit to the patients receiving the D. pteronyssinus extract both in the diary and the physician's assessment, especially the former. There was no consistent change in the skin or nasal challenge tests and there was a trivial fall in the serum IgE levels in the patients on the extract. Adverse reactions were much more common in the patients on the extract, but most were trivial. The different methods of assessment used and the role of hyposensitization with D. pteronyssinus are discussed.

Specific IgE antibodies in nasal secretion from patients with allergic rhinitis and with negative or weakly positive RAST on the serum

Abstract: Nasal secretions from eighteen patients with allergic rhinitis with a positive case history, intradermal test and nasal provocation test, but with negative or only weakly positive RAST (radioallergosorbent test) on the serum against a total of thirty-five allergens, were studied. In the RAST an immunosorbent-purified anti-IgE with DE2 specificity was used, which raised the detection limit. Nasal secretion was collected by washing the nasal mucosa with 0-9% and 18% NaCl solution respectively, and the latter secretion was also luophilized and concentrated. In ten cases RAST was slightly positive on the nasal secretion, and in three of the concentrated secretions the RAST value was higher than on the serum. In none of the serum or nasal secretion samples was RAST positive according to the cut off value for a positive result defined by the reference system used in Phadebas Rast. From these results it is concluded that RAST analyses of nasal secretion from patients with allergic rhinitis is of no appreciable value in routine clinical allergological diagnosis. However, the increased sensitivity of RAST obtained with isotope-labelled anti-DE2 may be useful in the serological diagnosis of patients with low grade allergy having low levels of IgE antibodies in serum.

Pulmonary hypersensitivity to Alternaria and Aspergillus in baker's asthma

Abstract: Summary In two cases of baker's asthma pulmonary hypersensitivity was found to the fungi Alternaria and Aspergillus. Provocative bronchial challenge revealed a dual response; an immediate and an Arthus type hypersensitivity to Aspergillus in the first case. A primary binding assay revealed high titres of anti-Aspergillus antibody in the serum. In the second case intradermal and bronchial challenge suggested an immediate type I hypersensitivity response to Alternaria. The suspected organisms were present in the room air of the bakeries. It is suggested that an immunological response to these airborne fungi may have contributed to the pathogenesis of baker's asthma.

The effect of orally administered sodium cromoglycate on symptoms of food allergy

Abstract: Summary A comparison was made between the effects of sodium cromoglycate (SCG) and placebo on symptoms of food allergy in twenty children. Both the clinician's and patient's preferences and the clinician's evaluation of the specific response to challenge showed a significant benefit from SCG. A striking effect on skin symptoms was seen in some children and the recorded mean score for skin symptoms was lower after 2 weeks’ treatment with sodium cromoglycate. However, the differences detected from the mean symptom scores were not statistically significant. Neither were there any significant changes in the IgE, IgG, IgA and IgM food allergen antibody levels related to the treatment.

Plasma complement changes during bronchospasm provoked in asthmatic patients

Abstract: Summary Two different groups of asthmatic patients were studied. The first group of seven reagin-mediated asthmatic patients underwent bronchial inhalation challenges with skin test positive antigen (STPA), skin test negative antigen (STNA) and methacholine. Three patients undergoing inhalation challenge with STPA showed a drop in plasma complement. In this group the drop in plasma complement was found only when the patient was challenged with STPA but not with STNA or methacholine. The second group consisted of seventeen patients, seven of whom were intolerant of aspirin (ASA) and ten asthmatic patients who experienced no untoward effects to ASA. The second group of seventeen patients was challenged with oral ASA. Venous blood samples collected during the challenges, showed a decrease in plasma complement in five patients intolerant to ASA. The ASA intolerant asthmatic patients were challenged also with either Maalox® or sodium salicylate. Only patients who ingested sodium salicylate showed a decrease in plasma complement. Activation of the alternative pathway was demonstrated in some patients. These studies demonstrated that complement activation occurred during STPA or aspirin challenges in asthmatic individuals. The role of the complement system is not clear, but it may participate in some of the pathogenetic mechanisms regulating bronchospasm through the mediations of its split products.

IgE mediated hypersensitivity in ageing.

Abstract: Summary The serum IgE concentration is significantly lower in aged as compared with young people. This is more pronounced in males than in females (P 70 years) compared with fifteen young subjects (<40) the specific IgE antibody response to an injection of diphtheria toxoid was significantly reduced (P<0.01). The minimum concentration of anti-IgE antibody able to induce a weal and flare reaction when injected intradermally, was comparable in the two age groups. However, the diameter of the weal reaction was significantly reduced in the aged. It is concluded that the reduced incidence of atopic symptoms in old people might be secondary to an anomaly of both the immune system and the mast cells.

Serological investigations in hymenoptera sting allergy: IgE and haemagglutinating antibodies against bee venom in patients with bee sting allergy, bee keepers and non‐allergic blood donors

Abstract: Summary Specific IgE-antibodies and haemagglutinins to bee venom were determined in fifty-five bee sting allergic patients, fifty-seven bee keepers and fifty-two blood donors without evident allergy to hymenoptera stings. IgE-antibodies were detected by RAST in 70% of allergic patients, 40% of bee keepers and 12% of blood donors. Most bee keepers with detectable IgE-antibodies to bee venom recorded severe local or even general reactions to bee stings. Most blood donors with detectable specific IgE had been stung by hymenoptera in the past. High titres of haemagglutinating antibodies against phospholipase A were found in most bee keepers, occasionally in bee sting allergic patients but only rarely in blood donors. The determination of specific IgE-antibodies to insect venoms by RAST seems to be a valuable method for the diagnosis of hymenoptera sting allergy.

Immunopathology of the bronchial mucosa in 'late onset' asthma.

Abstract: Summary A clinical, pathological and immunological study was made of fifty cases of asthma developing in adult life—twenty-seven females and twenty-three males. The mean age of appearance of asthma was 51 years. In spite of the paroxysmal onset observed in thirty-nine cases, the course was always severe, leading to dependence upon corticosteroid treatment in thirty-six cases. Two-thirds of the subjects had either a personal or familial atopic history, one-third had positive skin tests to routine respiratory allergens, and one-third had a peripheral blood eosinophilia higher than 400 mm3. Total serum IgE was not raised in any case and attempts at hyposensitization were not effective. The titre of serum complement was normal and investigation for autoantibodies was negative in thirty-one subjects. Study of the HLA system in twenty-eight cases showed a significantly raised frequency of antigen HLA9. The bronchial biopsies were examined histologically in thirty-one cases and by fluorescence examination in fifteen. The histological appearance was sterotyped and non-specific. There was some modification of the lining consisting of thickening and irregularity of the basal membrane with evidence of hyperfunction of adjacent mesenchymal tissues. The basal membrane showed thickening, estimated in two cases by electron microscopy to be of 20–30 μm. This was due largely to collagen, which concealed the true basal membrane, the ultrastructure of which was well preserved. Immunofluorescence tests made it possible to show the presence of IgA, IgG and IgM constantly associated with the C3 component of complement. This was localized mainly in the superficial part of the thickened basal membrane and in the cytoplasm of the epithelioid cells. Fibrin showed a different appearance, with irregular fluorescence situated essentially along the base of the superficial epithelial membrane. These immunofluorescence findings are compatible with transudation and also of a local immunological reaction.

Diagnostic tests in the skin and serum of workers sensitized to Bacillus subtilis enzymes

Abstract: Two allergen pools of commercial detergent enzymes were prepared as skin test reagents: (1) Carlsberg type, composed of three products containing subtilopeptidase A, and (2) BPN type, composed of two products containing subtilopeptidase B and alpha-amylase. In 100 non-exposed controls a reaction suggesting primary irritancy was found at protein concentrations greater than 1 microng/ml intradermally or 1 mg/ml by prick test. Intradermally at 10 microng/ml weals were accompained by less pronounced flare reactions than observed in specifically sensitized enzyme workers. At 100 micronh/ml the reactions were like strong specific reactions. Galse positive prick test reactions occurred irregularly at 10 mg/ml. In 100 sensitized enzyme workers, reactions were elicited at concentrations from 1-0 to 10(-5) microng/ml intradermally and from 1000 to 1 micron by prick test. Intradermal and prick tests correlated well (r=0-84, P less than 0-001). Ratings of symptom severity upon exposure obtained from questionnaires were significantly correlated with skin test reactivity (P less than 0-01). RAST performed on sera collected simultaneously also correlated significantly with symptom scores. PCA tests in monkeys were less sensitive. Standardized test reagents allow diagnostic skin testing by either intradermal or prick test in B. subtilis enzyme sensitive patients. A clear distinction between primary irritant reactions and true sensitization was made on the basis of the concentration required to elicit a reaction.

Tetracycline asthma—a case report*

Abstract: Summary A mechanic working in the antibiotic capsuling section of a pharmaceutical company developed asthmatic attacks 1 year after starting work. His occupation involved exposure to a variety of chemical agents including tetracycline. He developed immediate weal and flare reaction to the intradermal test and an immediate (type 1) asthmatic response to intradermal, inhalation and oral challenge tests with tetracycline. On leaving the tetracycline plant he became symptom free.

The combined use of betamethasone valerate and sodium cromoglycate in the treatment of asthma.

Abstract: Summary A double-blind comparison of betamethasone valerate, sodium cromoglycate and the combination of these two treatments was carried out in twenty-two adult patients with asthma. Regular fortnightly assessments were made in the clinic throughout the study and adrenal function was monitored and found to be normal. All patients measured their peak expiratory flow rates in the morning and evening and monitored their symptoms daily on a record card as well as recording bronchodilator usage. Assessment using these parameters indicated that treatment with betamethasone valerate compared with sodium cromoglycate resulted in an improvement in the patients’ asthma which was statistically significant (P 0.05). In only two patients was the response to the combined therapy significantly greater than to either drug given alone.

Treatment of chronic urticaria with a beta2-adrenergic stimulant.

Abstract: Twenty-four patients with chronic utricaria resistant to conventional therapy were treated orally with terbutaline, a specific beta2 stimulant. This therapy was much more effective than antihistamines. At the dose of 1-25 mg three times a day, there were few side effects. The efficacy was independent of the IgE levels; it seemed greater in idiopathic cases than in cholinergic or pressure induced urticaria.

Intranasal allergen challenge during corticosteroid treatment.

Abstract: Summary The effect of a corticosteroid drug on type I reactions in the nose was studied in eighteen hay fever patients. They were treated with a daily dosage of 800 μg beclomethasone dipropionate intranasally for 1 week, in a double-blind, placebo-controlled cross-over trial. Allergen challenge on the last day of each treatment period showed that steroid treatment diminished sneezing and rhinorrhoea, but the effect was not statistically significant (P= 0.10). Immediate nasal blockage was unaffected. There is a marked discrepancy between the minor protection offered by beclomethasone dipropionate in type I allergy, as suggested in this study and the marked efficacy of the drug in the treatment of hay fever. It is suggested that two factors may account for this discrepancy. First, the significance of ‘delayed’ reactions for hay fever symptoms. Second, the difference between a single allergen provocation and continuous exposure. It is suggested that a slight steroid inhibition of immediate reactions following allergen provocation is potentiated during natural exposure due to inhibition of the priming of the end-organ.

Correlation between skin tests, inhalation tests and specific IgE in a study of 120 subjects allergic to house dust and Dermatophagoïdes pteronyssinus

Abstract: The radioallergosorbent test was compared with currently accepted allergy diagnostic techniques in seventy-four controls and 120 patients with a clinical history of allergy to house dust and Dermatophagoides pteronyssinus. The results obtained with D. pteronyssinus allergen extract show a close correlation between the size of the cutaneous reactions and the serum level of allegen-specific IgE. On the other hand, highly positive skin tests to house dust were not always correlated with a positive RAST response for house dust. Similar results were found with inhalation tests. When a purified D. pteronyssinus extract was used, a stronger relationship was observed between RAST, cutaneous and inhalation tests. It can be assumed that RAST for house dust is not of value in patients with house dust and mite allergy. Our findings indicate that the correlations between RAST results and other in vivo test results depend on the purity of the allergen extracts and the selection of patients.

IgE, IgG and IgA antibodies in serum and nasal secretion during parenteral hyposensitization.

Abstract: Summary Eighteen adult patients with allergic rhinitis due to Timothy pollen were observed for 36 weeks before, during and after the grass pollen season. Eight patients were treated by parenteral hyposensitization with grass pollen extract, and ten patients who were given no immunotherapy served as controls. Timothy-specific IgE, IgG and IgA antibodies in samples of serum and nasal secretion were quantified by radioimmunological technique. In comparison with the control group, the serum concentration of Timothy-specific IgE antibodies increased significantly (P <0.05) during the preseasonal hyposensitization treatment and then decreased significantly (P <0.05) during and after the pollen season while this therapy was being continued. In the hyposensitized patients the serum concentration of both IgG and IgA antibodies increased highly significantly (P <0.01 and P <0.001, respectively) during immunotherapy. In nasal secretion quantitative changes of the three types of antibodies were usually less pronounced or not detectable at all. The concentration of IgG antibodies, however, showed some increase in the nasal secretion during hyposensitization. These minor increases in allergen-specific IgG and IgA antibodies in nasal secretion might explain why parenteral hyposensitization in allergic rhinitis often does not give complete relief from symptoms.

Phthalic anhydride asthma

Abstract: Summary A patient with occupational asthma caused by phthalic anhydride is described. Inhalation challenges under laboratory control produced immediate and delayed asthmatic responses. Repeat exposure to phthalic anhydride after treatment with cromolyn sodium showed inhibition of the late but not the early bronchoconstrictive, asthmatic response.

Antigens in pigeon breeder's disease: the use of pigeon dropping antigens in detecting antibody activity.

Abstract: Sera from patients with pigeon breeder's disease were analysed for precipitating antibodies by immunodiffusion and immunoelectrophoresis using whole pigeon dropping extract (PDE) and a purified fraction of PDE (PDE1) as antigens. For comparison, sera from asymptomatic pigeon breeders and normal individuals were also tested for precipitating antibodies. Whereas whole PDE formed precipitin lines with normal serum as well as with serum from symptomatic and asymptomatic pigeon breeders, PDE1 formed precipitin lines only with serum from individuals exposed to pigeons, This suggests that whole PDE forms non-specific (non-antigen-antibody reactions) as well as specific precipitin lines, while PDE1 appears to form only specific lines. These data indicate that whole PDE has limited usefulness in studies of pigeon breeder's disease. It is also possible that PDE1 will be useful in studies of this disease.