Annals of allergy最新文献

Background: Cough variant asthma is defined as a persistent nonproductive cough with minimal wheezing or dyspnea. The uncontrolled coughing may interfere with sleep, work, and social activities. Cough precipitating fecal or urinary incontinence can be extremely distressing. The diagnosis is established within 1 to 2 weeks by a trial of prednisone, 30 mg a day. The cough will be controlled within that time and subsequent management can consist of inhaled corticosteroids.

Objective: To evaluate the course of ten patients with cough variant asthma and their response to inhaled corticosteroids.

Methods: Retrospective analysis of the presentation, diagnosis, course, and response to oral and inhaled steroids in ten patients with cough variant asthma.

Results: Ten patients whose chief complaint was persistent debilitating cough for periods of 2 months to 20 years underwent a diagnostic and therapeutic trial of prednisone as previously described. At a mean follow-up period of 28 months all were free of debilitating cough. Eight of ten patients were still receiving inhaled steroids and two needed low dose alternate day oral steroid therapy. Two patients had complete remission of symptoms. None required daily inhaled or oral bronchodilators and there were no hospital admissions for respiratory symptoms.

Conclusions: Inhaled corticosteroid therapy after a diagnostic trial of oral steroids is effective for long-term control of cough variant asthma.

Background: Psyllium-containing laxatives are used by 4 million Americans daily. Dietary supplements for the management of hypercholesterolemia and for prevention of colon cancer make up additional uses of this plant fiber.

Objective: To assess a patient in an HMO practice with allergic cutaneous and respiratory findings associated with chronic psyllum ingestion and review information on psyllium hypersensitivity.

Methods: Clinical and laboratory evaluation of the patient and literature review through MEDLINE.

Results: Two years after initiating regular psyllium-containing laxative use a 40-year-old woman presented with a pruritic macular, papular, and urticarial rash involving the entire body including the palms, soles, and oropharynx sparing only the face. There was an associated sensation of chest and throat tightness and lip swelling. The signs and symptoms resolved upon discontinuance of the psyllium and recurred immediately after the patient initiated a challenge test. The total serum IgE was elevated and the modified RAST for psyllium-specific IgE was positive (Plantago ovata antigen).

Conclusions: The allergens in psyllium appear to be protein in nature and derived from the inner seed endospore and embryo rather than from the husk itself. The patient described herein was sensitized and challenged via ingestion.

Background: Systemic sclerosis is an autoimmune disease that is associated with excessive fibroblast proliferation and collagen deposition in various tissues. Interleukin-6 (IL-6) is produced by fibroblasts, activated T and B lymphocytes, which maybe involved in the pathogenesis of systemic sclerosis.

Objective: This study was performed in order to determine whether IL-6 could be detected specifically in collagen-stimulated peripheral blood mononuclear cells from patients with systemic sclerosis.

Methods: We clinically evaluated seven patients with systemic sclerosis for disease duration and organ involvement and analyzed in vitro the ability of their peripheral blood mononuclear cells and those of disease-free controls, in the presence of concanavalin A, human type I collagen, and the mast cell mediator, heparin to secrete IL-6 spontaneously by a sensitive ELISA.

Results: Interleukin-6 production by nonspecific stimulation with concanavalin A did not differ between patients with systemic sclerosis and controls; however, collagen stimulation significantly increased IL-6 production in patients with systemic sclerosis; mean 1728 pg/mL versus a mean of 386 pg/mL in controls P = < .05). Collagen-stimulated IL-6 levels > 2000 pg/mL were obtained in 86% of patients with systemic sclerosis compared with none in the controls. In patients with systemic sclerosis with a shorter disease duration, greater spontaneous as well as collagen- and heparin-stimulated IL-6 production was observed, whereas decreased IL-6 levels were noted with longer disease duration (> 21 years).

Conclusions: The results of this study suggest that peripheral blood mononuclear cells from patients with systemic sclerosis are specifically sensitized to human type I collagen to produce increased levels of IL-6, which may play a role in the pathogenesis in this fibrotic disorder.

Objective: The purpose of this review is to familiarize the reader with the genetic aspects, clinical manifestations, diagnostic techniques and management of the primary ciliary dyskinesia syndrome. Further, this article illustrates some unusual features of this syndrome and discusses some speculative hypotheses concerning its pathogenesis and clinical presentation.

Data sources: The bibliography includes references in English as well as some references of historical interest in German. Both human and veterinary literature are quoted. Sources included computerized bibliographic searches of recent literature and reviews of literature.

Study selection: Selection of papers was made based on their historic importance in the definition and characterization of the disease, and on reviews of large bodies of novel or interesting information. Some review papers were not included to avoid repetition.

Results: Although the incidence of primary ciliary dyskinesia is low, the inclusion of this condition in the differential diagnosis of chronic and recurrent sinobronchial disease in children and older individuals is very common. Primary ciliary dyskinesia should be suspected in individuals who present chronic respiratory symptoms already in the neonatal period, develop profuse, chronic mucopurulent rhinorrhea, and chronic otitis media and sinusitis. Chronic cough, obstructive lung disease, and bronchorrhea associated with the aforementioned manifestations should also make clinicians suspect this syndrome. Male sterility is almost universally present and situs inversus is present in 50% of affected persons. The diagnosis of primary ciliary dyskinesia is clinical and is confirmed by studies of ciliary motility and ultrastructure of the respiratory mucosa. Management is directed to microbial suppression by frequent antibiotic administration, and to clearing of retained secretions.

Conclusions: The diagnosis of primary ciliary dyskinesia requires familiarity with the clinical picture and the specific techniques of identification. Although the basic mechanism of disease is known, the molecular genetics of primary ciliary dyskinesia and the causes for the phenotypic variability remain to be explained. Future research should be directed to the identification of the gene(s) responsible for the manifestations of the disease and to effective methods of activation, in vivo, of dysfunctional cilia.

The association of IgA deficiency with SLE is clearly established but occurs in only a small percentage of patients. Several hypotheses address the relationship between the two disease processes but the common link remains undetermined. It is important to investigate the diagnosis of IgA deficiency in patients presenting with SLE in order to provide the most appropriate treatment. This patient not only represents a rare presentation of SLE but highlights the uncommon occurrence with IgA deficiency and brings forth valuable teaching points of both diseases.

Background: Food allergies are frequent in the general population. There are however, few studies of immunologic responses among workers in the confectionary industry.

Objective: To assess immunologic and clinical findings of workers in a confectionary plant.

Methods: Immunologic (skin tests and serum IgE) and respiratory findings (symptoms and lung function) were studied in a group of 71 confectionary workers (mean age: 35 years and mean exposure: 11 years).

Results: Skin prick testing with food extracts used in the manufacturing of candies and pastries demonstrated that the most frequent positive skin reaction occurred with extracts of cacao (31%), followed by reactions to chocolate (9%), cocoa (6%), hazelnut (6%), and sugar (2%). Increased serum IgE levels were found in 13.0% and increased IgM serum levels in 52.1% of these confectionary workers. The prevalence of asthma (26.1%) and dyspnea (26.1%) in workers with positive skin tests was significantly higher than in workers with negative skin tests (asthma: 2.0%, P = .004; dyspnea: 4.1%, P = .001). There was a high prevalence of acute respiratory symptoms during the work shift, but no significant association with immunologic tests was found. Similarly, both skin test positive and skin test negative workers exhibited significant across shift changes in lung function; however, no significant differences in baseline lung function or across-shift changes were noted between skin test positive and negative workers. Pre-shift administration of disodium cromoglycate (DSCG) significantly diminished across-shift reductions in FEF50 and FEF25 for both skin test positive and skin test negative workers.

Conclusions: These data suggest that exposure to environmental factors in confectionary plants is associated with frequent respiratory symptoms of an irritative nature. Specific skin testing may be useful in characterizing confectionary workers at risk for the development of occupational asthma.

Background: Controversy exists regarding allergic reactions to measles, mumps, and rubella (MMR) vaccine in egg-allergic patients. To date there have been only isolated reports describing egg-allergic patients with anaphylaxis to MMR vaccine.

Objective: Our study was designed to monitor possible adverse reactions in egg-allergic children receiving MMR vaccine.

Methods: Initially prick and intradermal testing with MMR vaccine was carried out. The first 120 children were screened in this fashion, with frequent irritant reactions occurring with skin testing but no subsequent reactions when full-strength vaccine was administered. The subsequent 380 children received the undiluted MMR vaccine without prior skin testing.

Design: Over an 8-year period, MMR vaccine was given to 500 egg-allergic children in outpatient setting.

Results: No anaphylactic reactions were observed in any of the 500 children immunized with MMR vaccine. Five children showed minor rashes within two hours of administration of the MMR vaccine.

Conclusions: It is therefore felt the previously reported adverse reactions to MMR vaccine represent reactions to other vaccine components rather than the suspected egg antigens. The presence of egg allergy should therefore not be considered a contraindication to MMR immunization.