Annals of allergy最新文献

We attempted to clarify the relationship between circulating endothelin-1 levels and bronchial hyperreactivity in asthmatic patients. Sixty-two asthmatic patients were studied for plasma endothelin-1 levels during acute asthma. The relationship between plasma endothelin-1 levels and pulmonary function (FEV1/FVC) was examined in 17 patients. Twelve patients were studied for changes in plasma endothelin-1 levels during methacholine inhalation tests. Plasma endothelin-1 levels during acute asthma correlated with the severity of acute asthma defined with the Clinical Asthma Evaluation Score, and those during the methacholine challenge test correlated with the grade of bronchoconstriction (P < .01). A significant negative correlation was observed between plasma endothelin-1 levels and FEV1/FVC ratio (P < .01). These results suggest that circulating endothelin-1 levels may reflect the severity of acute asthma.

The purpose of this study was to assess the frequency of reported food-induced symptoms, and of food allergy or intolerance in 169 allergic patients monosensitized to grass pollen and in a control group of 50 patients who were monosensitized to Dermatophagoides. This study clearly demonstrates that patients with grass pollen-allergic respiratory disease report adverse food reactions more frequently than patients allergic to Dermatophagoides. This increased incidence is due to a high percentage of adverse reactions to some vegetable foods, especially peanut, garlic, tomato, onion; and fruits, such as peach; and animal foods, such as egg (white) and pork. By separating the food-allergic patients from the food-intolerant patients, the number of subjects with food intolerance was higher than that of the patients with food allergy. Crossreactivity between pollen allergens and fruits and vegetable allergens may explain the association between pollen allergy and food allergy, but not the higher incidence of food intolerance. An increased intestinal permeability to macromolecules may be hypothesized as part of a primary defect in permeability in "atopic (pollen allergic?) constitution."

Objective: Common variable immunodeficiency is a heterogeneous syndrome characterized by humoral immunodeficiency, recurrent bacterial infections, and a variety of immunologic abnormalities. The goal of this article is to review the pathogenesis, clinical manifestations, diagnosis, and management of common variable immunodeficiency.

Data sources: References are limited to the English language literature. Sources include computerized databases and bibliographies of recent articles and books.

Study selection: References that made important contributions to our understanding of the pathogenesis, clinical manifestations, diagnosis, and treatment of this disease were selected for inclusion in this review.

Results and conclusion: Common variable immunodeficiency is an idiopathic state of immune dysregulation that results in impaired antibody synthesis and the development of recurrent bacterial infections. This syndrome is also associated with a variety of autoimmune and neoplastic disorders. Effective management of these patients includes intravenous immunoglobulin replacement, vigorous treatment of infections, and readiness to promptly evaluate and treat unusual autoimmune and neoplastic complications should they appear.

Background: Exposure to natural rubber latex medical gloves poses risks to latex-sensitive patients and medical workers. Preliminary studies have shown that the latex allergen contents of these gloves vary widely.

Objective: To study long-term trends in latex allergen levels of disposable medical gloves prospectively, and to identify lower allergen gloves for purchase by our medical center.

Methods: Extractable total latex allergen was measured by solid-phase inhibition immunoassay. Allergen contents of gloves were expressed in allergy units (AU)/mL relative to a raw latex standard assigned an arbitrary potency of 100,000 AU/mL.

Results: For gloves in use during July, 1993, extractable allergen levels ranged from < 10 to 5,500 AU/mL among nine lots of examination gloves, from < 10 to 2,300 AU/mL among 13 lots of surgical gloves, and from < 10 to 1,000 AU/mL among five lots of chemotherapy, autopsy, or utility gloves. Among ten lots of examination gloves purchased on two occasions between July, 1993 and January, 1994, the allergen levels in two of the three private label brands were more variable (6- to 40-fold) than in the other eight brands tested (0- to 2-fold).

Conclusions: Extractable allergen levels in latex medical gloves remain highly variable, particularly among some private label brands. Use of synthetic gloves or lower allergen latex gloves should lessen exposure of latex-sensitized patients and health care workers to latex aeroallergens.

Circulating intercellular adhesion molecule-1 (ICAM-1) levels were measured in 48 patients with atopic dermatitis (mild in 29, moderate in 13, and severe in 6) and in 32 controls. Circulating ICAM-1 levels gradually increased with the severity of atopic dermatitis (216 +/- 68 in control, 323 +/- 66 in mild, 376 +/- 92 in moderate, and 555 +/- 93 ng/mL in severe atopic dermatitis, respectively). A significant correlation was observed between serum ICAM-1 and eosinophilic cationic protein levels in patients with atopic dermatitis (r = .71, P < .01). Although a significant positive correlation was observed between serum eosinophilic cationic protein levels and peripheral eosinophil counts (r = .63, P < .01), only a weak correlation was observed between serum ICAM-1 levels and peripheral eosinophil counts (r = .35, P < .05). Changes in serum ICAM-1 levels in ten patients treated with ketotifen for 3 months were also demonstrated. A close correlation was observed between serum ICAM-1 levels and the disease severity (r = .76, P < .01). From these results, we speculate that serum ICAM-1 level may reflect the extent of inflamed tissue in atopic dermatitis.

We report a patient who experienced generalized urticaria and facial angioedema following oral administration of ketoconazole. Skin prick tests with ketoconazole and oral challenge were positive. Conjugates of ketoconazole with human serum albumin were used for the in vitro study, obtaining a positive result in the histamine release test. No significant levels of IgE antibodies to ketoconazole were found by RAST. Controls did not react to any of these tests. These results suggest that the patient developed a type I hypersensitivity reaction to ketoconazole. In this case, skin prick tests with ketoconazole and histamine release test with a conjugate of ketoconazole with human serum albumin were useful in ketoconazole hypersensitivity diagnosis. Finally, skin tests with other imidazole agents were carried out, including metronidazole, ornidazole, and fluconazole that were negative.

Background: Anaphylactic reactions usually occur seconds to minutes after exposure to the relevant antigen. Late onset, biphasic, and protracted anaphylaxis also occur. The incidence of prolonged responses is unknown, but may be common. In all nonfood-related cases, levels of tryptase were not measured during protracted episodes. Tryptase has been shown to be a useful specific indicator of mast cell involvement in anaphylaxis.

Objective: To determine whether mast cell activation, as demonstrated by elevated serum tryptase concentrations, can occur in protracted anaphylaxis.

Methods: Case report; serum tryptase concentrations were measured by radioimmunoassay.

Results: A 33-year-old white man developed hives three days prior to admission. The next day, vomiting, abdominal cramps and bloating, lower lip swelling, wheezing, and a feeling of tightness over his throat and chest were experienced. The gastrointestinal symptoms continued until his hospital admission. One day prior to admission, he developed transient lightheadedness. On admission he had generalized urticaria and abdominal tenderness. Blood pressure of 115/58 mm/Hg rose to 180/60 and heart rate fell from 107/min to 90/min following 2.2 L of intravenous fluids. Serum tryptase levels were elevated at 7.2 ng/mL and 5.1 ng/mL on the first and second hospital days (fourth and fifth days of symptoms). Serum tryptase was < 1.0 ng/mL 5 months later.

Conclusions: The elevated serum tryptase levels at 96 and 120 hours following the onset of symptoms strongly suggest that continued mast cell degranulation can occur during protracted anaphylaxis. This strengthens the argument that mast cell activation is important in the pathophysiology of protracted anaphylaxis.

Background: The relationship between IgE-mediated hypersensitivity and recurrent serous otitis media has not been completely established.

Objective: The purpose of the present study was to examine the prevalence of food allergy in patients with recurrent serous otitis media.

Methods: A total of 104 unselected patients (age range 1.5 to 9 years, mean 4.6 years) with recurrent serous otitis media were evaluated for food allergy by means of skin prick testing, specific IgE tests, and food challenge. Patients who were allergic to food(s) underwent an exclusion diet of the specific offending food(s) for a period of 16 weeks. A non-double blinded food challenge was performed with the suspected offending food(s). Their middle ear effusion was monitored and assessed by tympanometry (Welch Allyn Model 23600) during the pre-elimination, elimination and challenge diet phases.

Results: There was a significant statistical association, by chi-square analysis, between food allergy and recurrent serous otitis media in 81/104 patients (78%). The elimination diet led to a significant amelioration of serous otitis media in 70/81 (86%) patients as assessed by clinical evaluation and tympanometry. The challenge diet with the suspected offending food(s) provoked a recurrence of serous otitis media in 66/70 patients (94%).

Conclusions: The possibility of food allergy should be considered in all pediatric patients with recurrent serous otitis media and a diligent search for the putative food allergen made for proper diagnostic and therapeutic intervention.