Annals of allergy最新文献

Background: We have cared for an unusual patient with serum IgE concentrations of up to 150,000 IU/mL who did not have the hyper-IgE syndrome.

Objective: Our objective in this study was to compare the regulation of in vitro IgE synthesis in this patient with results reported for in vitro IgE production by patients with the hyper-IgE syndrome.

Methods: We utilized an enzyme-linked immunosorbent assay to measure in vitro IgE production under varying conditions. In vitro cytokine production including IL-2, IL-4, IL-6, and interferon-gamma also was evaluated as was expression of the IgE receptor molecule CD23.

Results: B cells from this patient produced high concentrations of IgE. The patient was found to produce very high levels of interleukin-4 (IL-4) in vitro, to have high levels of soluble CD23 in his serum, and to have cells that were inconsistently responsive to the effect of IL-4 on IgE synthesis.

Conclusions: Patients with elevated production of IL-4 may have increased serum IgE concentrations without having the hyper-IgE syndrome syndrome.

The aim of this study was to compare the relative effect of (1) a single dose of a rapid release theophylline, (2) treatment for 1 week with a sustained release theophylline, and (3) placebo after a washout period of at least 2 weeks on bronchial hyperresponsiveness to methacholine and on exercise-induced bronchoconstriction in 14 mildly asthmatic children. A dose of rapid release theophylline increased geometric mean (GM) PC20 (mg/mL) for methacholine from 0.25 to 0.85 (P < .001) at a mean (+/- SD) serum theophylline concentration of 9.5 +/- 2.5 mg/L (52.3 +/- 14.24 mumol/L). After 1 week on a slow release theophylline, GM PC20 increased to 0.41 (P < .01) at a mean serum theophylline concentration of 13.63 +/- 4.7 mg/L (74.9 +/- 25.8 mumol/L), (P < .01) compared with rapid release theophylline. The difference in PC20 between both theophylline treatments was statistically significant (P < .05). No significant changes in PC20 were noted after placebo compared with baseline values. During baseline and after placebo mean maximum FEV1 fall (MMFF) after exercise was 40 +/- 19.9% and 31.7 +/- 15.5%, respectively (n.s.). After a dose of rapid release theophylline, MMFF on exercise test was 8.7 +/- 8.2% (mean serum theophylline concentration 10 +/- 3.2 mg/L (55.4 +/- 17.82 mumol/L)), P < .001 compared with baseline and placebo. After 1 week of treatment with slow release theophylline, MMFF was 26.2% +/- 18.3 (mean serum theophylline concentration 12.2 +/- 3.9 mg/L (67.43 +/- 21.5 mumol/L)) (P = .01 and P = .30 compared with baseline and placebo, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Background: Proteins eluting from surgical gloves and other medical rubber products elicit immediate local and systemic hypersensitivity reactions in latex-allergic subjects but detailed knowledge about the amount and allergenic potential of these proteins is scanty.

Objective: To protect latex-allergic people and to diminish the risk of sensitization, adequate methods are needed to measure and monitor the allergen content of surgical latex gloves.

Methods: Extracts of six surgical and one household latex glove brand were studied. Bradford and Lowry methods were used for total protein measurements. Sera from 17 latex-allergic patients were used as a source of latex IgE antibodies. Allergen content of extracts was studied in vitro by immunoblot, crossed radioimmunoelectrophoresis and immunospot methods, and in vivo by skin prick testing in 35 latex-allergic patients.

Results: The total protein concentration of the glove extracts varied from 3 to 337 micrograms/g glove. The Bradford method gave lower values than the Lowry method. Immunoblotting showed allergenic rubber proteins in four of the seven glove brands. Ten proteins in two surgical and six proteins in one household glove brand bound latex IgE antibodies in a heterogeneous manner. The results from crossed radioimmunoelectrophoresis and immunospot assays were mostly in line with immunoblotting findings. Extracts from five of the seven glove brands elicited positive prick tests; in all five also the presence of allergens could be shown by in vitro tests. Prick test reactivity and total protein concentration were not directly correlated.

Conclusions: In vitro assays showed considerable variation in the total protein and allergen contents of different latex glove brands. The amount of protein eluting from the gloves did not always correlate with their allergenicity in skin prick tests indicating that total protein measurement is not a sufficient method to monitor the allergenic properties of latex gloves.

The diagnostic performance of three commercial assay kits [Phadezym RAST (PhRAST), Pharmacia CAP system (CAP), and multiple chemiluminescent assay (CLA-MAST)] for measuring serum-specific IgE was evaluated and compared using intradermal skin testing or skin prick testing as reference standards. Serum samples were obtained from allergic patients who were tested with either intradermal skin tests or skin prick tests (96 and 49 subjects, respectively). Six different allergen extracts were tested: Dermatophagoides pteronyssinus, Candida albicans, Aspergillus, short ragweed, Bermuda grass, and cockroach mix. Results showed that when using intradermal skin testing as a reference standard, the CLA-MAST had the lowest sensitivity (75%), specificity (80%), and efficiency (85%) but the Pharmacia CAP system achieved the highest sensitivity, specificity, and efficiency (86%, 94%, and 91%, respectively). When compared with these two relatively new assays, the Phadezym RAST had medium sensitivity (80%), specificity (92%), and efficiency (88%). In contrast, when using skin prick testing as a reference standard, the highest specificity was achieved by Phadezym RAST (95%), followed by Pharmacia CAP system (90%), and MAST (81%). As for the sensitivity of each test, the Phadezym RAST was the lowest (60%) and Pharmacia CAP system reached the highest sensitivity (79%); and for the efficiency test, the score was 87% for CAP, 83% for Phadezym RAST, and 75% for MAST. These results suggest, therefore, that the CAP system is the preferred test and provides a useful guide for prescription of environmental control and immunotherapy in unselected patients.

Two bakers with bronchial asthma and two with rhinoconjunctivitis are described. Prick and RAST tests were positive with wheat flour in all of them, but the challenge test (nasal or bronchial) with wheat flour extract was positive only in one asthmatic baker. The prick test, RAST, and nasal or bronchial challenge done with alpha amylase extract (a glycolytic enzyme obtained from Aspergillus oryzae and used as a flour additive) were positive in all four patients. Our results support previous data indicating that alpha amylase used in bakeries is an important antigen that could cause respiratory allergy in bakers. It can function as sole causative allergen or in addition with other allergens used in the baking industry.

Background: Only a few groups have reported on idiopathic anaphylaxis. We analyzed our experience with idiopathic anaphylaxis, especially in regards to prognosis.

Methods: Thirty-seven patients with the diagnosis of idiopathic anaphylaxis were retrospectively identified by a medical records search from 1989-1992. Thirty-five patients were evaluable and a telephone questionnaire was conducted to determine the current treatment and course of their idiopathic anaphylaxis since their initial evaluation.

Results: Patient ages ranged from 26 to 71 years (mean 48), 72% were women, and 43% were atopic. Frequent episodes of idiopathic anaphylaxis (> 5/year) occurred in 31%. At follow-up (mean 2.5 years), 21 patients (60%) had resolution of idiopathic anaphylaxis, and the frequency of anaphylaxis was decreased in nine, increased in two, and the same in three patients. Only three patients were still having frequent episodes and two required chronic glucocorticoids. Patients with frequent idiopathic anaphylaxis treated with only antihistamines and adrenergics underwent remission or improvement as frequently as those treated with chronic glucocorticoids.

Conclusions: These results are similar to other reports of idiopathic anaphylaxis and indicate a generally favorable prognosis. Some patients with frequent idiopathic anaphylaxis improved without the need for glucocorticoids. Well controlled studies may be required to analyze the role of glucocorticoids in this disease.

Background: Latex IgE-mediated allergy is an important medical problem, but its clinical characteristics and association with food allergies are not well defined.

Objective: Our objectives were to determine the clinical features of latex-allergic patients, and latex-associated food hypersensitivities.

Methods: A prospective study was performed in our outpatient clinic. It consisted of a clinical questionnaire, skin prick tests with aeroallergens and foods, skin test with a latex extract, determination of total and specific IgE by CAP/RAST methods, and RAST inhibition. Latex and food allergies were diagnosed on the basis of a suggestive clinical history and a positive skin test with the corresponding allergen.

Results: Twenty-five patients were diagnosed as having latex allergy. Their mean age was 33 +/- 9.0 years, with female predominance (23:2). There were nine greenhouse and six hospital workers. Latex-induced reactions included systemic anaphylaxis in nine patients (36%). Average total IgE was 161 kU/L, and it was within normal limits in 16 cases. Latex skin prick tests had excellent diagnostic precision with no adverse reactions, and CAP for latex diagnostic sensitivity was 80%. Forty-two food allergies were diagnosed in 13 of our patients (52%), and 23 of these consisted of systemic anaphylaxis. The most frequent food hypersensitivities were to avocado (9), chestnut (9), banana (7), kiwi (5) and papaya (3). Through RAST-inhibition, cross-reactivity among latex, avocado, chestnut, and banana was demonstrated.

Conclusions: In our experience, latex allergy affects middle-aged women in certain professions at increased risk. Our data suggest the existence of a "latex-fruit syndrome," because 52% of our latex allergic patients had allergies to certain fruits.

Background: Approximately 10 to 15 million Americans are scuba divers. The prevalence of scuba diving and asthma makes it likely some asthmatics will be interested in scuba diving and some scuba divers will have asthma. Conditions present during scuba diving may provoke airway obstruction in asthmatic patients. Further, asthmatic patients may, in theory, face a greater than normal risk of pulmonary barotrauma from lung overdistension on ascent through the water column.

Objective: The purpose of this paper is to review the theoretical issues underlying the prohibition against scuba diving for asthmatic patients as advanced by most major diving organizations in the United States and critically examine the relevant accident data.

Methods: All reports that dealt with asthma and diving, and all available American accident data including both fatal and nonfatal accidents were reviewed.

Results: Actuarial data on the risk of scuba accidents attributable to asthma do not define several important variables likely to affect accident risk during scuba diving. Despite these limitations, careful review indicates the risks of serious morbidity or mortality during scuba diving appears to be inconsequentially elevated in subjects whose asthma was not characterized.

Conclusions: Additional data are needed to define accurately risks of diving in subjects with different forms of asthma, however, the available data suggest asthmatic patients with normal airway function at rest, and with little airway reactivity in response to exercise or cold air inhalation, have a risk of pulmonary barotrauma similar to that of normal subjects.