Annals of allergy最新文献

We studied the binding activities of IgE and IgG antibodies in patients with allergy to cow milk proteins, against different alpha-casein preparations: alpha-casein treated with urea, hydrochloric acid, sodium hydroxide, or sodium dodecyl sulfate (SDS); or heat-denatured alpha-casein. The binding activities of IgE and IgG antibodies to these denatured alpha-casein preparations were compared with those to native alpha-casein. The binding activities of IgE and IgG antibodies to these denatured alpha-casein preparations were similar to those to native alpha-casein although the binding activities of IgG antibodies to these denatured alpha-casein preparations were relatively heterogeneous compared with those of IgE antibodies. Since modifications of alpha-casein did not alter the ability of alpha-casein to react with these antibodies, IgE and IgG antibodies to alpha-casein in sera from patients with allergy preferentially bind to the antigenic determinants associated with primary protein structures.

Objective: The goal of this review is to report the epidemiology and risks associated with tobacco smoking. It also suggests reasons and measures to achieve a smoke-free society.

Data sources: References are limited to the English language and human subjects. All are publications from either the United States or the United Kingdom and extend back to the past 50 years. Sources include computerized databases and bibliographies of recent articles and books.

Study selection: Papers were selected on the basis of their timeliness, credibility of their data, explanation of important findings, extrapolation of clinical data from large patient populations, and clarification of controversial issues. Approximately 60% of the articles initially reviewed are included in the bibliography.

Results: Tobacco smoking continues to affect the lives of millions of Americans. The risks of cardiovascular diseases, cancer, and respiratory diseases are significantly increased in both the smoker and in those exposed to environmental tobacco smoke.

Conclusions: Understanding the consequences of tobacco smoking is necessary to effectively mobilize the appropriate political, social, and medical resources to combat this most important health issue.

Background: The immunogenic activity of B. pertussis infection has been described in various laboratory, animal, and clinical studies. There is, however, no information on the impact of pertussis on allergies in the total population.

Objective: To compare the prevalence of allergic sensitization and allergic rhinitis in children with and without previous pertussis infection.

Methods: A population-based, cross-sectional study was carried out on 13,937 10-year-old children in the western (Munich and Southern Bavaria) and eastern parts of Germany (Leipzig and the region around Halle). A total of 11,969 questionnaires (85.9%) given to the parents were collected. Data from 9,484 German children (questionnaire and skin prick tests with six different allergens) were analyzed.

Results: Pertussis was much more common in the western than in the eastern part of Germany. The adjusted odds ratio for any allergic sensitization after pertussis was only slightly increased in western Germany with 1.3 (95% confidence limits 1.2 to 1.5) and in eastern Germany with 1.5, (1.2 to 1.8) but not for allergic rhinitis with 1.0 (0.7 to 1.4) and in Eastern Germany 1.3 (0.8 to 1.9).

Conclusions: Infection with pertussis seems to have only a weak influence on allergic sensitization and does not explain the observed differences in allergic sensitization between western and eastern Germany.

Background: Rapid venom immunotherapy regimens have been developed to provide safe protection to individuals who have experienced Hymenoptera anaphylaxis by administering greater than 50 micrograms of venom over two to three hours on treatment day 1. A rapid venom immunotherapy protocol which consisted of administration of a cumulative dose of 58.55 micrograms of each venom on treatment day 1 followed by an accelerated build-up over 3 weeks to a final maintenance dose of 100 micrograms per venom was developed by our group in 1984.

Objective: We report our 10-year cumulative experience with this rapid venom immunotherapy regimen.

Methods: Seventy-seven venom-allergic patients received a cumulative dose of 58.55 micrograms per venom on treatment day 1 in an ambulatory care setting. Rapid venom immunotherapy was assessed for safety. A cost analysis was performed to compare rapid venom immunotherapy to a modified rush immunotherapy regimen.

Results: Four patients (5.2%), experienced mild systemic reactions consisting of diffuse urticaria on day 1. Treatment was otherwise well tolerated. Resting events occurred in 21 patients, a mean number of 12 months (range: 3 days to 48 months) after treatment, without systemic reactions.

Conclusions: This experience confirms that rapid venom immunotherapy is safe to administer in an ambulatory setting and should be considered especially for patients during the stinging insect season when rapid protection is required.

This report describes vancomycin anaphylaxis and successful desensitization. A 35-year-old woman who tolerated vancomycin initially, developed generalized urticaria and respiratory distress when the drug was readministered. Symptoms recurred following infusion of vancomycin at a lowered rate and dose despite premedication with antihistamines and corticosteroids. Intradermal skin tests with vancomycin were positive at a concentration of 0.1 micrograms/mL. Control subjects reacted at a concentration of 10 micrograms/mL or greater. A rapid 1-day desensitization protocol was unsuccessful. The patient then was "desensitized" by sequential increments in intravenous vancomycin doses over 13 days. After the full therapeutic dose was tolerated, there was a loss of skin test reactivity to vancomycin. We conclude that desensitization to vancomycin is possible and may be the only means to treat an allergic patient adequately when there are no viable therapeutic alternatives.

Background: Rush immunotherapy, while having many potential benefits, is associated with an increased incidence of systemic reactions.

Objective: To determine whether pretreatment with medications reduces the rate of systemic reactions during rush immunotherapy and to identify predictors of such reactions if possible.

Methods: We conducted a double-blind, placebo-controlled study of 22 allergic children ages 6 to 18 years who received rush immunotherapy. Active treatment consisted of a combination of H1 and H2 histamine antagonists and a corticosteroid in gelatin capsules given prior to administration of rush immunotherapy whereas placebo patients received lactose. Rush immunotherapy consisted of eight injections of increasing doses of a mixture of allergens to which each patient was skin-reactive over 1 1/2 days. Serial skin tests and peak expiratory flow rate measurements were performed during the procedure. Following the initial series of injections, patients were followed for 8 weeks and had blood drawn at 2-week intervals for measurements of specific IgG and IgE.

Results: Systemic reactions were observed in 3 (27%) active and 8 (73%) placebo patients (Fisher's exact test: P = .047). The mean time for systemic reactions was 63 minutes after a previous injection. The most common dose causing a systemic reaction was 0.3 mL of 1:1000 (wt/vol). The best predictors of development of a systemic reaction were degrees of skin sensitivity to the extract before and after premedication. Local reactions were not associated with subsequent systemic reactions. Specific IgG rose by 2 weeks while specific IgE did not change significantly during the 8-week follow-up period. Pretreatment did not change the number of systemic reactions seen with subsequent injections.

Conclusions: Premedication significantly reduces the incidence of systemic reactions during rush immunotherapy and is therefore recommended. Degree of skin sensitivity to the injected extract may eventually prove to be a clinically useful predictor for the development of systemic reactions.

Background: Anaphylaxis to latex or muscle relaxant drugs has been demonstrated in the perioperative period but there are no reports of a patient with anaphylaxis to both of these substances.

Methods: We report a patient with meningomyelocele who was initially thought to have anaphylaxis to latex during induction of anesthesia. After recurrence of anaphylaxis following removal of latex as the suspected agent, the muscle relaxant vecuronium was found to be the actual etiology.

Results: Skin testing to several muscle relaxants and other anesthetic medications confirmed a hypersensitivity to vecuronium. Skin testing and subsequent physical contact with latex also established a hypersensitivity to this substance.

Conclusions: This report demonstrates the need to scrutinize closely every notation in the anesthesia record when evaluating perioperative anaphylaxis and to consider that hypersensitivity to more than one substance may be present.

Dermatophagoides mites were abundant in the beds of asthmatic patients of Calcutta, India, comprising more than 60% of the total mites isolated in the present study. The patients' bed dust harbored significantly more dense (P < .02) mite populations as compared with bed dust samples of control subjects. The patients' sera contained significantly higher (P << .001) IgE concentrations than the sera of the controls and the sera of 92% patients were found to have elevated IgE levels of more than 300 U/mL. Eighty-five and 82% of patients responded positively to Dermatophagoides mite allergen by radioallergosorbent test (RAST) and skin prick test respectively, highlighting the importance of these mites in producing house dust allergy in Calcutta and its surrounding areas. The results indicate that with a tenfold increase in mite density in the patients' bed dust, the group mean serum IgE level increased considerably (P < .05). The increase in the total serum IgE and in the frequency of positive RASTs and prick tests to Dermatophagoides for allergic asthmatic patients correlated quite well with the increase in the specific mite density in their beds.