ALLERGY
(Diagnosis, Diagnostics, Immunodiagnosis,
Immunodiagnostics, Pathogenesis, Vaccines & Drugs)
ABSTRACTS
1132. Birmingham PK. Suresh S.Latex allergy in children:
diagnosis and management.
Indian
Journal of Pediatrics. 66(5):717-24,
1999 Sep-Oct.
Abstract
Latex allergy is an
increasingly common condition, in both children and health care workers who provide care for them. Subpopulations
at particular risk include children
with spina bifida, children undergoing
multiple surgical procedures, and health care workers in the operating theatre. Chemical additives in latex gloves
can cause an irritant or allergic
contact dermatitis. Latex proteins are responsible for most of the immediate IgE-mediated hypersensitivity
allergic reactions. Symptoms range
from rhinitis, conjunctivitis and urticaria to anaphylaxis and death. A latex-directed history is the
primary method of identifying latex
sensitivity, although both skin and serum testing is available and increasingly accurate. (Latex avoidance
should be used in all individuals with
a positive skin or blood test or a positive history). The most important preventive measure for patients
with or at risk for latex allergy is
minimizing direct patient exposure to latex products, most notably latex gloves. Recent operating room
studies indicate simple preventive
measures can dramatically reduce intraoperative reactions. Preoperative prophylaxis with
antihistamines and steroids have not been shown to be necessary or effective.
Treatment of an allergic reaction
begins with immediate removal of any identified source of latex in
direct patient contact. Treatment is
similar to anaphylaxis from other causes, and may require the use of
epinephrine. Everyone caring for the patient at risk for latex allergy must be
involved in making their medical environment safe.
1133.
Blumenthal MN. Genetics of asthma and allergy. Allergy & Asthma
Proceedings. 21(1):55-9, 2000 Jan-Feb.
Abstract
Asthma and allergies are
complex conditions involving multiple steps and pathways, which are influenced
by both genetic and environmental factors.
The genes involved in these processes are just being identified.
Most likely asthma is a result of
several genes and their interaction with other genes as well as the
environment. Management involves the proper diagnosis, modulating the genetic
and environmental factors involved as well as interfering with the activated
pathways. Using this approach will lead to a more rational method of managing
individuals with allergies and asthma.
1134.
No Abstract
1135.
Furuichi H. Yamashita K. Okada M.
Toyoshima T. Hata Y. Suzuki S. Itano T. Shishibori T. Tokumitsu
H. Kobayashi R.
Identification of tranilast-binding protein as 36-kDa
microfibril-associated glycoprotein by drug affinity chromatography, and its
localization in human skin. Biochemical & Biophysical Research
Communications. 270(3):1002-8,
2000 Apr 21.
Abstract
To elucidate the molecular mechanism involved in the suppression
of keloids and hypertrophic scars by tranilast, we investigated the target
protein of tranilast in bovine skin and aorta. A specific tranilast-binding
protein was isolated from both tissues by drug affinity chromatography and was
identified as 36-kDa microfibril-associated glycoprotein (36-kDa MAGP). Binding
of 36-kDa MAGP to tranilast seemed to be specific since 36-kDa MAGP could be
eluted from the drug affinity column by tranilast itself and also binding of
36-kDa MAGP to other anti-allergy drugs
(amlexanox and cromolyn) is significantly weaker than that to tranilast. Light
and electron microscopic immunohistochemistry detected the protein at the
periphery of elastic fibers in normal human skin. In hypertrophic scar tissue,
however, 36-kDa MAGP was located on small bundles of microfibrils. These findings
provide support for the concept that elastogenesis occurs in scar tissue and
36-kDa MAGP might be one of the targets for tranilast. Copyright 2000 Academic
Press.
1136.
Graft DF. Venom immunotherapy:
when to start, when to stop.
Allergy
& Asthma Proceedings. 21(2):113-6,
2000 Mar-Apr.
Abstract
Over the past 25 years, major advances have been made in the
diagnosis and treatment of insect
sting allergy. Controlled clinical trials have demonstrated the efficacy of venom immunotherapy (VIT) in the
prevention of subsequent systemic reactions in allergic individuals. We have
refined our criteria for selection of patients for VIT. Studies on selections
of venoms, rush immunotherapy, and interval between VIT injections have been
performed. Finally, much work has been done to try to define criteria for the
discontinuation of VIT.
1137. Gruchalla RS. Approach to the
patient with multiple antibiotic sensitivities. Allergy & Asthma Proceedings. 21(1):39-44, 2000 Jan-Feb.
Abstract
Allergists sometimes are asked to evaluate patients who have
experienced multiple adverse drug
reactions. By the time the patient reaches the allergist, the referring physician, as well as the patient,
often are frustrated. Each seeks a
quick and simple answer regarding the particular drugs the patient may safely receive. Unfortunately, however, in
most instances, simple answers cannot
be given. Currently we have limited
knowledge of the mechanisms and of the clinically-relevant drug metabolites responsible for many of the
reactions demonstrated and, for these
reasons, we have few valid diagnostic tests that are able to provide clear-cut answers for our patients who
present with multiple drug
"allergies." Despite these limitations, using accurate and
complete historical information along
with limited diagnostic testing, logical and
practical management approaches can be devised. In addition, due to
new exciting data that are being
generated from basic research studies in drug allergy, the mechanisms
underlying the immunopathology of many drug reactions are becoming more clear.
Through the acquisition of scientific information of this type, it is hoped
that valid diagnostic tools soon will be developed so that definitive answers,
desired by both the patient and the referring physician, can be provided.
1138. Jarzab
J. Gawlik R. Immune complexes IgE/IgG
in airborne allergy: increase during pollen season. Journal of Investigational
Allergology & Clinical Immunology.
10(1):24-9, 2000 Jan-Feb.
Abstract
In the present study we addressed the question of IgE/IgG immune
complex serum level in 92 patients with respiratory allergy in relation to
their clinical status. Twenty patients with allergy to insect stings and
22 healthy volunteers were also
investigated. IgE/IgG immune complexes and IgG anti-IgE antibodies were
estimated using double antibody solid-phase immunoassays in IgG serum fractions
isolated by protein A affinity chromatography or in fractions obtained by
Sephacryl S-300 gel filtration. Three people (14%) from the control group, two
patients (10%) with insect allergy and 41 patients (45%) from the group with
airborne allergy exhibited an increased serum level of IgE/IgG immune complexes
(chi2, p<0.05). IgG anti-IgE serum level was also significantly higher in
the examined group of patients with
airborne allergy than in the control group. None of the factors analyzed,
including the kind of allergic disease, the type of inhalant allergen (pollen
or house dust antigens), the severity of allergy judged from the frequency and
intensity of symptoms for 1 year preceding blood sampling and the symptoms
exhibited during blood sampling, showed a statistically significant relation to
the level of IgE/IgG immune complexes or IgG anti-IgE, when the whole group of
patients with respiratory allergy was analyzed. A distinct difference between patients
investigated during and outside of the pollen season was found in patients with
isolated pollen allergy. The latter exhibited an increase of IgE/IgG immune
complexes (57% vs. 29%) significantly more often, which indicates the possible
involvement of IgE/IgG immune complexes in the pathogenesis of pollen allergy.
1139.
Jeske AH. COX-2 inhibitors and dental pain control.
Journal of the Greater Houston Dental Society. 71(4):39-40, 1999 Nov.
Abstract
Celecoxib (CELEBREX) and rofecoxib (VIOXX) appear to offer the
following advantages: reduced incidence
of gastric ulceration during long-term
administration; little or no effect on platelet aggregation; longer clinical duration of action than aspirin,
acetaminophen and ibuprofen. However,
in the context of the management of dental pain and inflammation, the following points and disadvantages
should be considered: no greater
effectiveness than conventional NSAIDs (e.g., ibuprofen) for dental pain; greater cost than conventional NSAIDs
(especially those available in generic forms); not available over-the-counter;
possible inadequate duration of action for postoperative dental pain (see
references 6 and 7); similar contraindications and drug interactions to less
expensive, equally effective conventional non-selective NSAIDs. At this time,
celebrex and rofecoxib cannot be recommended over conventional, non-selective
NSAIDs as first-choice drugs for pain and inflammation in dentistry.
Practitioners are cautioned against selecting any new drug based on
"clinical trials of one", in which both the dentist and the patient
know the drug being prescribed, (as opposed to double-blind studies), usually
in the context of considerable "hype" about the drug (based on
comments about the fact that the agent being tried is "new") and
strong placebo reinforcement based on the dentist's enthusiasm for the new
product, which does not usually accompany the prescription of older, routinely
prescribed drugs. Finally, such
"clinical trials of one" invariably involve close follow-up about the
outcome of the treatment, which is usually not done with more common, older
drugs, and which only introduces further bias into the interpretation of the
effectiveness of the drug by both the patient and the dentist. Anaglesic drugs
should be selected on the basis of controlled, double-blind, randomized
clinical trials which utilize a
reasonable, dentally-related pain model. The older NSAIDs, such as ibuprofen, naproxen, diflunisal and others,
remain first-choice drugs for the treatment of mild-to-moderate pain in
dentistry in patients lacking the contraindications for such drugs. As proposed
by this author several years ago, the
major contraindications to NSAIDs can be remembered by the "SAAB Rule", an acronym which
stands for "Stomach problems", Aspirin Allergy" and
"Bleeding problems", in addition to pregnancy and hepatic/renal disease.
1140. Little
SA. Longbottom JL. Warner JO. Optimized preparation of
Aspergillus fumigatus extracts for allergy diagnosis. Clinical &
Experimental Allergy. 23(10):835-42,
1993 Oct.
Abstract
Extracts of Aspergillus fumigatus are required for the measurement
of specific antibodies that are important indices in the diagnosis of allergic
bronchopulmonary aspergillosis (ABPA). This study investigated the effect of
different culture conditions on the production and release of antigenic and
allergenic proteins of A. fumigatus. Increasing the incubation temperature from
25 degrees C to 37 degrees C altered the production of proteins by the mycelium
which resulted in the release of a greater number of proteins that reacted with
precipitating antibodies. Static sporulating cultures produced a much wider
antigenic spectrum than shake cultures although the number of precipitating
proteins (5 and 3 respectively) and major IgE binding proteins (5 and 3
respectively) was not greatly altered. The widest range of proteins bound by
precipitating antibody or IgE from ABPA serum were released into the culture
filtrate during 28 day static incubation at 37 degrees C. The resultant
extract proved useful for screening
patients for specific IgE and will provide a
starting material for the identification of individual antigens or allergens.
1141.
Masuda K. Sakaguchi M. Fujiwara S.
Kurata K. Yamashita K. Odagiri T.
Nakao Y. Matsuki N. Ono K.
Watari T. Hasegawa A. Tsujimoto H. Positive reactions to common
allergens in 42 atopic dogs in Japan. Veterinary Immunology &
Immunopathology. 73(2):193-204, 2000
Feb 25.
Abstract
Clinically important allergens for the diagnosis and treatment of
atopic dermatitis vary geographically.
In order to identify the most prevalent
allergens in atopic dogs in Japan, 42 dogs with a clinical diagnosis
of atopy were tested using both in vivo
(intradermal skin test (IDST)) and in
vitro (antigen-specific IgE assay) allergy tests. Allergens used for
IDST included 26 allergen extracts from
eight allergen groups: trees, weeds, grasses, house dust mites (HDM), molds,
foods, epithelia, and arthropods. Immunodot assay was used to measure
antigen-specific IgE against 24
allergens from these eight groups and against fish such as cod and
sole. In the 42 dogs, the most common
positive allergen reaction was to HDM on both IDST (29/42 dogs or 69%) and in
vitro testing (23/42 or 54.8%). The second most frequent positive allergen
reaction was to Japanese cedar pollen (21/42 or 50.0% for IDST and 7/42 or
16.7% for in vitro testing). In both tests, less than 20% of dogs had positive
reactions to molds or foods. Positive reactions to cat epithelia were
frequently found on IDST, but rarely found on in vitro testing. Agreement
between the two tests was found in 26
instances: HDM (21 dogs), Japanese cedar pollen (five dogs) and wheat (one
dog). In this study, the two most common allergens involved in atopic
dermatitis in dogs in Japan were HDM and Japanese cedar pollen.
1142.
Nja F. Roksund OD. Svidal B.
Nystad W. Carlsen KH. Asthma and
allergy among schoolchildren in a mountainous, dry, non-polluted area in
Norway.Pediatric Allergy & Immunology.
11(1):40-8, 2000 Feb.
Abstract
The aim of this study was to assess prevalence of asthma and
allergy in the non-polluted mountain area of Upper Hallingdal, Norway. All
schoolchildren (7-16 years) who in a previous questionnaire survey (n = 1177)
reported 'sometime' asthma were enrolled in group I (n = 80), the 59 who
reported asthma-like symptoms in the past 12 months formed group II, and 77 of
the healthy controls were randomly selected as group III. All 216 children
underwent clinical examination, skin prick test, spirometry, bronchial
provocation (PD20 metacholine) and treadmill exercise test. Subsequently they
were reclassified as (1) healthy, never had asthma or symptoms, (2) symptoms
not confirmed as asthma, (3) previous asthma, now healthy, (4) current asthma.
Lifetime asthma prevalence was 10.2%. Based upon clinical examination, the
specificity and sensitivity of the questionnaire for asthma diagnosis were 88
and 74%, respectively. Forced vital
capacity was significantly higher among the asthmatics (group 4 versus 1),
whereas forced expiratory volume in one second (FEV1) and forced expiratory
flow at 50% of vital capacity were similar in all groups. More than 10%
reduction in FEV1 following treadmill-run was found in 20% of children.
Children with current asthma compared to controls had significantly; lower mean
values of PD20 (9.1 versus 16.5 micromol), higher eosinophil cationic protein
(13.4 versus 7.7 micromol) and more frequent sensitization to animal dander
(56% versus 10%). In conclusion, despite a favorable climate, little mite
sensitization and low outdoor pollution, asthma prevalence was surprisingly
high in Upper Hallingdal. Sensitization
to animal dander was the most important contributing factor for current asthma.
1143.
Paramesh H. Practical approach to recurrent respiratory infections. Indian
Journal of Pediatrics. 63(2):181-7,
1996 Mar-Apr.
Abstract
Respiratory diseases are a major cause of morbidity and mortality
in developing countries. Recurrent respiratory infections in children pose a
great challenge to the pediatrician where he has to exercise his clinical
acumen and methodical approach for correct diagnosis and treatment. It is a
fact that children should suffer 7 to 8 upper respiratory infections per year
until they are 5 years of age when their immune status reaches adult level. In
this situation, it is essential to find out whether the frequencies are
abnormal. Whenever a child has the following problems, then only it needs to be
investigated.--(a) repeated bacterial pneumonias;(b) a child less than 3 months
old having repeated respiratory infections;(c) a child of 9 months old without
a history of exposure infections; (d) infections complicating into
bronchiectasis and; (e) in a child where there is no history of allergy or
asthma. Once the problem is established
as a true recurrent respiratory infection, the clinician should pose
questions--whether it is chronic, acute or recurrent, to find out the site of pathology,
seriousness of the problem, response to previous medications, to establish the
possible diagnosis which fall into six categories--congenital anamolies,
aspiration syndrome, genital disorders, immunological diseases, immune
deficiency disorders and allergic diseases. The author discusses quoting some
examples for various categories avoiding non pulmonary causes for recurrent
respiratory infections in children.
1144.
Pascual CY. Crespo JF. Perez PG.
Esteban MM.Food allergy and intolerance in children and adolescents, an
update. European Journal of Clinical Nutrition. 54 Suppl 1:S75-8, 2000 Mar.
Abstract
Epidemiological surveys demonstrate that rapid increase in
allergic diseases is a real phenomenon. In developed countries they are about
the commonest chronic diseases, reaching between 15% and 30% of the population.
Adverse reaction to food can be divided into toxic reaction and non-toxic
reactions. The non-toxic reactions are divided into non-immune mediated and
immune mediated, these are considered food allergic reactions. We showed our
experience in a 4 y survey,
individualized by food allergens during the first two years of life. In
Spain egg white protein is the most common allergen followed by cow's milk and
peanuts. These three food items represent half of the sensitizations in
children under 2 y of age. After 4 y sensitivities to vegetable allergens such
as nuts, fruits and legumes are most frequent. The diagnosis of food allergy is
still problematic, even in the case of atopy or IgE mediated hypersensitivity.
There is a lack of standardized diagnostic procedures; the only test accepted
as 'gold standard' for confirmation of food allergy and in general for food
intolerance, is a properly performed double blind placebo-controlled oral food
challenge. Negative results should be
always followed by an open food challenge. This test should only be conducted in patients with a good medical
condition and in a clinic or hospital
setting, and only if trained personal and equipment for treating systemic
anaphylaxis are present. Contraindications to a challenge test are limited to
those situations that can be hazardous for the patient in relationship to the
studied food. The treatment of food allergy and intolerance is avoiding the
implicated food as long as necessary, until tolerance appears. Prevention of
food allergy is the first goal of every pediatric allergologist. Controlled
trials of food allergy prevention have been performed only in high allergic
risk children.
1145.
Punnonen J. Molecular breeding of allergy vaccines and antiallergic cytokines.
International Archives of Allergy & Immunology. 121(3):173-82, 2000 Mar.
Abstract
Molecular breeding, also called DNA shuffling, is a technology
that enables the generation of large libraries of novel genes and vectors, from
which improved variants can be selected based on functional properties. In a
common format, it involves recursive recombination and mutation, performed by
random fragmentation of related DNA sequences, followed by reassembly of the
fragments in a self-priming polymerase chain reaction. As in natural evolution,
the technique takes advantage of crossovers, deletions, insertions, inversions
and point mutations of genes to generate large pools of related sequences.
Molecular breeding can be used to generate improved variants of proteins used
as therapeutics, such as vaccine
antigens, growth factors and immunomodulatory molecules. Moreover, the
technology can be applied to evolve entire viruses or vectors, including DNA
vaccines. Cytokines downregulating allergic immune responses and allergens are
attractive targets for evolution by molecular breeding. This review describes
approaches to generate chimeric allergens with T cell epitopes from multiple
allergen homologues, while reducing the recognition by preexisting IgE. In
addition, the results and applications of molecular breeding in the evolution
of improved antiallergic cytokines are discussed. Copyright 2000 S. Karger AG,
Basel
1146.
Spaite DW. Karriker KJ. Seng M.
Conroy C. Battaglia N. Tibbitts
M. Salik RM.
Training paramedics: emergency care for children with special
health care needs. Prehospital
Emergency Care. 4(2):178-85, 2000
Apr-Jun.
Abstract
OBJECTIVE: To enhance knowledge and comfort related to the
emergency care of children with special
health care needs (CSHCN) through an innovative continuing education program for paramedics. METHODS: A
self-study program presenting in-depth
information about common problems that affect the assessment and management of a child's airway, breathing,
circulation, disability, and
environment (ABCDEs), regardless of the child's diagnosis, was developed. This program used a manual, a
video, practice mannequins, and skills
evaluations to teach skills to paramedics employed at a municipal fire department. RESULTS: Pre- and
posttraining surveys found that the
paramedics were significantly more comfortable with the assessment and management of CSHCN after the
completion of the self-study program,
with a pretraining average of 2.83 and posttraining average of 4.20 on a five-point Likert-type scale,
t(37) = 12.87, p < 0.001. A skills
evaluation showed that skills performance varied widely across 21
skills, ranging from skills mastery to
low skills knowledge. On the posttraining
survey, between 74% and 94% of the paramedics rated each topic
(tracheostomies, indwelling central venous catheters, cerebrospinal fluid shunts, gastrostomies, child abuse, and
latex allergy) as applicable to their practices as paramedics. CONCLUSION:
Given the growing population of CSHCN, it is important to provide specialized
education to increase an EMS provider's preparedness to respond to emergency
situations involving children with special health care needs.
1147. Tokunaga
T. Yamamoto T. Yamamoto S. How BCG led to the discovery of
immunostimulatory DNA. Japanese Journal of Infectious Diseases. 52(1):1-11, 1999 Feb.
Abstract
The concept of immunostimulatory DNA was borne in a long series of
studies on BCG-mediated tumor resistance. DNA purified from BCG inhibited the
growth of various syngeneic animal tumors, augmented NK cell activity and
induced IFN-alpha/beta and -gamma from mouse spleen cells and human PBL.
Extending the lines of study, we found two biologically remarkable facts that
(i) DNAs from invertebrates, but not from vertebrates and plants, showed the
above-mentioned biologic activities, and (ii) the activities were completely
dependent on particular base sequences having CpG motifs but in a senseless
manner. Details of those early studies carried out mainly in the 1980's have
been reviewed in the first part of this paper. In the middle part of this
review, the results of toxicity and pharmacology studies and clinical trials of
BCG- DNA, performed by other groups in Japan in the late 1980's, were
introduced. Since a large amount of DNA
had never been administered repeatedly into experimental animals or human, those experiences obtained seem to be
worthwhile to introduce. Research interests of immunostimulatory DNA were
galvanized in 1995 by the report of Krieg et al. showing murine B cell activation
with bacterial DNA containing CpG motifs. Within a short period of time, a huge
number of papers have been published in this field, and the study has expanded
rapidly and largely. Now, it includes a number of research fields, for example,
host-defense mechanisms against infection, allergy, autoimmune diseases,
cytokine networks, plasmid vaccination, and therapeutic application of certain
diseases. This paper reviewed briefly recent advances of immunostimulatory DNA
research. The response of higher animals against immunostimulatory DNA must be
the most primitive but important mechanism for self-nonself discrimination
against foreign DNA. By utilizing
immunostimulatory DNA or controlling this primitive response, it seems possible to offer many beneficial
means to human health. For instance, more potent peptide- or plasmid- vaccines
could be developed by the use of immunostimulatory DNA. On the other hand, many
study results suggest that immunostimulatory DNA works either beneficially or
harmfully for the hosts. We assume that further extensive and careful studies
are required.
1148.
Yeang HY. Prevalence of latex allergy may be vastly overestimated when
determined by in vitro assays. Annals of Allergy, Asthma, &
Immunology. 84(6):628-32, 2000 Jun.
Abstract
GROUND: The prevalence of latex-specific IgE computed from the
results of serologic assays is commonly thought to reflect, to a greater or
lesser extent, the prevalence of latex allergy and its implied risk. OBJECTIVE:
The study examines how imperfect test specificity of in vitro assays influences
the precision of latex allergy prevalence that it estimates. METHODS: Various
models encompassing a range of hypothetical test sensitivity and specificity
values are investigated to gauge their influence on the estimate of latex
allergy prevalence. The models examine these interactions in situations of high
or low allergy prevalence. RESULTS: Serologic latex diagnostic assays with test
specificity within the range of those of commercially available assays can
greatly overestimate prevalence where the true prevalence is low (eg, of the
order of one in 100 or one in 1,000). A formula to correct for errors in prevalence estimates arising from imperfect
test sensitivity and specificity of an in vitro assay is presented. CONCLUSION:
While serologic assays for latex IgE pose few hazards to the patient and are
useful for confirming the diagnosis of latex allergy, the test results may
vastly overestimate the true prevalence of latex allergy and its associated
risks in situations where latex allergy is actually rare.
1539. Akdis
CA. Blaser K. Regulation of specific
immune responses by chemical and structural modifications of allergens.
[Review] [103 refs] International Archives of Allergy & Immunology. 121(4):261-9, 2000 Apr.
Abstrct
Specific immunotherapy (SIT) is an
efficient treatment of allergic diseases to defined allergens. Despite being
used in clinical practice since early in this century, more rational and safer
regimens are required, because SIT is faced with the risk of anaphylaxis and
standardization problems of allergen-extract-based treatments. A better
understanding of the pathogenesis of allergy and of the mechanisms of SIT has
led to various approaches to overcome these problems. Knowledge of the
influence of IgE-facilitated antigen presentation on allergen-specific Th2
responses increased the efforts to generate non-IgE-binding allergens. The
current principal approach to allergen modification is to modify B cell
epitopes in order to prevent IgE binding and effector cell cross-linking while preserving T cell epitopes to retain
the capacity of inducing tolerance. In this way, the modified allergen will be
directed to T cells by a phagocytosis/pinocytosis-mediated antigen uptake
mechanism, bypassing IgE cross-linking and IgE-dependent antigen presentation.
Accordingly, a differential regulation of allergen-specific T cell cytokine patterns
and IgE:IgG production was demonstrated by modifications of the
three-dimensional structure of allergens because of linearity in T cell
epitopes and conformation dependence in B cell epitopes. In this context,
chemically modified allergen extracts with low IgE-binding capacity have been
developed to reduce anaphylactic side effects since the early 1980s. The
progress of recombinant techniques for producing allergens and allergen derivatives has led to a dramatic
improvement in the ability of developing
novel vaccines for the treatment of allergy. This has enabled mutation or
deletion of decisive amino acids in B cell epitopes and fractionation or
oligomerization of allergens by genetic engineering as fruitful approaches to
generate hypoallergenic vaccines. Moreover, non-IgE-binding short T cell
epitope peptides and single-amino-acid-altered peptide ligands represent
potential candidates for future SIT. Copyright 2000 S. Karger AG, Basel
1540.
Ballmer-Weber BK. Vieths S. Luttkopf D.
Heuschmann P. Wuthrich B. Celery
allergy confirmed by double-blind, placebo-controlled food challenge: a
clinical study in 32 subjects with a history of adverse reactions to celery
root. Journal of Allergy & Clinical Immunology. 106(2):373-8, 2000 Aug.
Abstract
GROUND: Celery root is a
frequent cause of food allergy in pollen-sensitized patients. Because of
problems in blinding challenges with fresh vegetables and the risk of
anaphylactic reactions, no double-blind, placebo-controlled, food challenges
(DBPCFCs) with celery have been published so far. OBJECTIVE: The aim of the
study was to confirm the clinical relevance of celery as a food allergen by
DBPCFCs and to evaluate current diagnostic procedures in patients with true
allergy. METHODS: DBPCFCs were
performed in 32 patients with a history of an allergic reaction to celery. The
patients underwent skin prick tests (SPTs) with celery extracts, crude celery,
and different pollen extracts.
Specific IgE for celery was determined by using the CAP method. RESULTS:
Twenty-two of 32 patients had a positive DBPCFC result. Two patients reacted to
placebo, and 8 patients did not respond to the challenge. Of the nonresponders,
4 reacted to an open provocation with celery. The sensitivity of CAP
determination for specific IgE (> or =0.7 kU/L) to celery in patients with a
positive DBPCFC result was 73%, 48% to 86% for
SPTs (> or =3 mm) with commercial extracts, and 96% for
prick-to-prick tests with crude celery. The positive predictive value of the
SPT and CAP tests was between 87% and 96%, whereas the specificity and negative
predictive values were poor. CONCLUSION: This study confirms the importance of
celery as a food allergen for use in DBPCFCs. The SPT and CAP methods proved to
be reliable for the diagnosis of a relevant allergy to celery in regard to
sensitivity and positive predictive value but not to specificity and negative
predictive value.
1541.
Bischhoff SC. Mayer JH.
Manns MP Allergy and the gut. [Review] [100 refs] International Archives
of Allergy & Immunology.
121(4):270-83, 2000 Apr.
Abstract
There have frequently
been doubts as to the relevance of food allergy, in particular as far as the involvement of the intestinal tract is
concerned. Several studies, however,
have confirmed the existence of allergic reactions in the gut, with an
estimated prevalence of about 1-2% in adults. Clinical symptoms are unspecific
and include nausea, vomiting, abdominal pain, cramping and diarrhea. Intestinal
mast cells, as well as intestinal eosinophils, have been shown to be involved
in the pathogenesis of food-allergy-related enteropathy. In addition to
classical IgE-dependent degranulation, further agonists have been demonstrated
for mast cell activation, for example IL-4. The methods used to confirm the
diagnosis of intestinal allergy are still insufficient. Until now, blinded oral
challenge procedures with food antigens have been accepted as the 'gold
standard' in diagnosing food allergy, although these tests have practical
problems. Therefore, new test systems have been developed, such as endoscopic
provocation tests, that may improve diagnostic procedures. Elimination diet
still presents the main basis of therapy. Aspects to be focused on in the
future are the role fo IgE-independent allergic mechanisms in intestinal
allergy, the impact of cross-reactivity with other allergens and the
relationship to other inflammatory bowel diseases such as Crohn's disease,
ulcerative colitis, celiac disease and irritable bowel syndrome. Copyright 2000
S. Karger AG, Basel [References: 100]
1542.
Briassoulis
G. Hatzis T. Mammi P. Alikatora A.
Persistent anaphylactic reaction after induction with thiopentone and
cisatracurium. Paediatric Anaesthesia.
10(4):429-34, 2000.
Abstract
A 6-year-old boy
presented for surgery for phimosis. The anaesthetic technique included intravenous induction with thiopentone
and neuromuscular blockade with
cisatracurium. Severe persistent bronchospasm and central cyanosis followed the
administration of these drugs. A continuous i.v. infusion of epinephrine at 0.2
microg. kg(-1) x min(-1) was necessary to break the severe refractory bronchial
hyperresponsiveness. There was no previous exposure to anaesthetic drugs and no
definite family history of allergy. Through increased serum eosinophil cationic
protein, tryptase and histamine levels and IgE levels specific to cisatracurium, we demonstrated an IgE-mediated
anaphylactic reaction to cisatracurium in the child's first exposure to this
new neuromuscular blocking agent. Anaphylactic reactions to new anaesthetic
drugs may be challenging to recognize and treat during general anaesthesia in
children. The pathogenesis, diagnosis and management of life threatening
persistent allergic reactions to intravenous anaesthetics are discussed.
1543. Chapman
SW. Bradsher RW JR. Campbell GD Jr. Pappas PG. Kauffman CA.
Practice guidelines for the management of patients with blastomycosis.
Infectious diseases society of America. Clinical Infectious Diseases. 30(4):679-83, 2000 Apr.
Abstract
Guidelines for the
treatment of blastomycosis are presented; these guidelines are the consensus
opinion of an expert panel representing the National Institute of Allergy and
Infectious Diseases Mycoses Study Group and the Infectious Diseases Society of
America. The clinical spectrum of blastomycosis is varied, including
asymptomatic infection, acute or chronic pneumonia, and extrapulmonary disease.
Most patients with blastomycosis will require therapy. Spontaneous cures may
occur in some immunocompetent individuals with acute pulmonary blastomycosis.
Thus, in a case of disease limited to the lungs, cure may have occurred before
the diagnosis is made and without treatment; such a patient should be followed
up closely for evidence of disease progression or dissemination. In contrast,
all patients who are immunocompromised, have progressive pulmonary disease, or
have extrapulmonary disease must be treated.
Treatment options include amphotericin B, ketoconazole, itraconazole,
and fluconazole. Amphotericin B is the treatment of choice for patients who are
immunocompromised, have life-threatening or central nervous system (CNS)
disease, or for whom azole treatment has failed. In addition, amphotericin B is
the only drug approved for treating blastomycosis in pregnant women. The azoles
are an equally effective and less toxic alternative to amphotericin B for
treating immunocompetent patients with mild to moderate pulmonary or extrapulmonary disease, excluding CNS
disease. Although there are no comparative trials, itraconazole appears more
efficacious than either ketoconazole or fluconazole. Thus, itraconazole is the
initial treatment of choice for nonlife-threatening non-CNS blastomycosis.
1544. Fiocchi
A. Restani P. Riva E. Beef allergy in children. [Review] [26 refs] Nutrition.
16(6):454-7, 2000 Jun.
Abstract
Beef allergy was poorly
known before the '90s. Since then, a number of papers appeared elucidating the
nature, epidemiology, and symptoms of beef allergy in children allergic to
cow's milk and children suffering from atopic dermatitis. It is now clear that
beef allergy is not an infrequent occurrence, with an incidence between 3. 28%
and 6.52% among children with atopic dermatitis, its incidence may be as much
as 0.3% in the general population. A diagnosis of beef allergy must be
supported by skin prick tests, RASTs, and challenges. The specificity and
sensitivity according to type of test and the type of extract, however, remains
to be evaluated. Despite the fact that other allergens can be sensitizing, the
major beef allergen is bovine serum albumin (BSA). Beef-sensitive children are
also sensitized to ovine serum albumin, as well as to other serum albumins;
therefore, the use of alternative meats in beef-allergic children must be
carefully evaluated on an individual basis. Because industrial heat processing
is more efficient than domestic cooking in reducing reactivity in beef-sensitive children, freeze-drying
and homogenization may support the introduction of processed beef into the diet
of beef-allergic children. [References: 26]
1545. Jacquet
A. Haumont M. Massaer M. Daminet
V. Garcia L. Mazzu P. Jacobs P. Bollen
A. Biochemical and immunological characterization of a recombinant precursor
form of the house dust mite allergen Der p 1 produced by Drosophila cells.
Clinical & Experimental Allergy.
30(5):677-84, 2000 May.
Abstract
GROUND: The major house
dust mite allergen Der p 1 elicits strong IgE
antibody responses in patients suffering from mite allergy. OBJECTIVE:
This study reports the expression and characterization of a recombinant
precursor form of Der p 1 secreted as ProDer p 1 from insect cells. METHODS:
The cDNA coding for ProDer p 1 was cloned downstream to the gp67 signal
peptide, starting from commercial cDNA encoding Der p 1 and PCR-amplified
ProDer p 1 genomic fragment. ProDer p 1, expressed in Drosophila cells and
purified from culture medium, was compared to Der p 1 isolated from mite
culture, in terms of glycosylation, enzymatic activity as well as IgG- and
IgE-binding capacity. RESULTS: Sequence analysis of the genomic clone of ProDer
p 1 revealed that, besides two introns in the mature Der p 1 coding sequence,
two introns were also present in the propeptide coding sequence. ProDer p 1 was
purifed to homogeneity by a combination of ion-exchange, hydroxyapatite and gel
filtration chromatographies. The precursor form of Der p 1 could be processed
in vitro into mature Der p 1 under acidic and reducing conditions. Carbohydrate
analysis clearly indicated that ProDer p 1 expressed from insect cells was
glycosylated and that glycan structures were located only in the prosequence.
ProDer p 1 displayed a similar immunoreactivity towards IgE, monoclonal and
polyclonal IgG antibodies compared to natural Der p 1. Specific activity
measurements using synthetic substrates clearly indicated that, contrary to
natural Der p 1, ProDer p 1 was totally enzymatically inactive. CONCLUSIONS:
The expression of an enzymatically inactive and highly antigenic ProDer p 1
zymogen molecule could be a suitable strategy for the development of in vitro
diagnosis test as well as for specific immunotherapy.
1546. Kronqvist
M. Johansson E. Magnusson CG. Olsson S. Eriksson TL.
Gafvelin G. van Hage-Hamsten M. Skin
prick test and serological analysis with recombinant group 2 allergens of the
dust mites L. destructor and T. putrescentiae.
Clinical & Experimental Allergy.
30(5):670-6, 2000 May.
Abstract
GROUND: The dust mites
Lepidoglyphus destructor and Tyrophagus
putrescentiae are important sources of allergen in farming environments.
The major allergens of the dust mites L. destructor and T. putrescentiae have
been cloned and expressed as recombinant proteins. OBJECTIVE: To evaluate the
use of recombinant group 2 allergens of L. destructor (rLep d 2) and T.
putrescentiae (rTyr p 2) in skin prick test (SPT), and serological analysis in
sensitized and non-sensitized farmers chronically exposed to dust mites.
METHODS: Skin prick test with rLep d 2, rTyr p 2 and the corresponding
commercial extracts was performed in 44 farmers sensitized to L. destructor
and/or T. putrescentiae, and 38 control farmers. IgE and IgG subclass
antibodies to the recombinant allergens were analysed by RAST and ELISA,
respectively. RESULTS: Out of the 44 subjects
positive in SPT to L. destructor and/or T. putrescentiae extract, 26
(59%) displayed a positive SPT to one or the other of the recombinant
allergens, whereas 21 (48%) were
positive to both. Significant correlations were registered between the sizes of the weals induced by rLep d 2 and
rTyr p 2 and the corresponding RAST values (P < 0.001). A majority of
subjects positive in SPT to the recombinant allergens had detectable IgG4
antibodies, and the levels were significantly higher in the dust mite
sensitized group than in the controls (P < 0.05). No such differences were
found in the IgG1 values (P > 0.05). The results obtained with rLep d 2 and
rTyr p 2 correlated relatively well with each other with respect to SPT, RAST
and IgG4, suggesting that the allergens have similar or shared IgE epitopes.
All the control subjects had a negative SPT and RAST to rLep d 2 and rTyr p 2.
CONCLUSION: Recombinant group 2 allergens from the dust mite L. destructor and
T. putrescentiae represent useful tools for
diagnosis of dust mite allergy.
1547.
Lin RY. Schwartz LB. Curry A. Pesola GR. Knight RJ.
Lee HS. Bakalchuk L. Tenenbaum C. Westfal RE. Histamine and tryptase levels in patients with acute
allergic reactions: An emergency department-based study. Journal of Allergy
& Clinical Immunology. 106(1 Pt
1):65-71, 2000 Jul.
Abstract
GROUND: Emergency
department visits for acute allergic reactions are common. Although the diagnosis and classification of these
allergic reactions is primarily empiric, it is not always clear whether certain
signs and symptoms constitute systemic mediator release syndromes, such as
anaphylaxis, and thus may warrant more aggressive therapy or follow-up.
OBJECTIVE: We sought to determine associations between various clinical signs
and symptoms with both plasma histamine levels and serum tryptase levels in
adult patients presenting to an emergency department with acute allergic
syndromes. The clinical correlates of
raised beta-tryptase levels were also investigated. METHODS: Ninety-seven adult
emergency department patients were prospectively studied by using a
questionnaire, physical examination, and serum-plasma sampling. Plasma
histamine and serum total and beta-tryptase levels were determined. Clinical
groupings were compared for mediator levels by using simple and multivariate
analysis. RESULTS: Elevated levels of plasma histamine (>10 nmol/L) and
serum total tryptase (>15 ng/mL) were observed in 42 and 20 patients,
respectively. Detectable beta-tryptase (>/=1 ng/mL) was observed in 23
patients, including 15 of the patients with elevated total tryptase levels.
Suspected food allergy incidences and
the duration of reaction were similar in patients with increased histamine
levels and in patients with increased tryptase levels. Increased total tryptase
levels, histamine levels, or both were observed in some patients who did not
have airway, cardiovascular, or abdominal signs. Histamine levels correlated
better with clinical signs than tryptase levels. Histamine elevations (>10
nmol/L) were observed more frequently in patients characterized by the
following clinical signs in univariate analysis: the presence of urticaria,
more extensive erythema, abnormal abdominal findings, and wheezing. Total
tryptase increases were observed more frequently only in patients with
urticaria. Histamine levels correlated with initial heart rates. In
multivariate analysis the extent of urticaria was the best single predictor of
plasma histamine levels and of either an elevated histamine or tryptase level.
Detectable beta-tryptase levels were observed in some patients who had neither
elevated total tryptase nor elevated histamine levels. Unlike patients without
detectable beta-tryptase levels, patients who had detectable beta-tryptase
levels had a significant correlation between total tryptase and histamine
levels (P <.05). CONCLUSIONS: Raised histamine and, less commonly, raised
tryptase levels are observed in almost 50% of patients presenting to emergency
departments with acute allergic reactions. Some cases associated with systemic
mediator release do not have classical features of severe anaphylaxis, such as
hypotension or tachycardia. The lack of total tryptase elevations in many
patients with elevated plasma histamine
levels suggests basophil involvement. The clinical utility of beta-tryptase
determinations in the evaluation of acute allergic reactions needs further
study.
1548. Lucarelli
S. Corrado G. Pelliccia A. D'Ambrini
G. Cavaliere M. Barbato M. Lendvai D. Frediani T. Cyclic vomiting syndrome and
food allergy/intolerance in seven children: a possible association. European
Journal of Pediatrics. 159(5):360-3,
2000 May.
Abstract
Cyclic vomiting syndrome
(CVS) is characterized by repeated unpredictable, explosive and unexplained bouts of vomiting. The episodes have a
rapid onset, persist over a number of hours or days, and are separated by
symptom-free intervals. Despite the recent interest in this disorder, its
aetiology, pathogenesis and even its target organ remain unknown. The purpose
of this study is to investigate the role played by food allergy in CVS. The
report concerns eight children (five male, three female), mean age 8 years
(3-13 years), suffering from CVS for 2 years at least. The diagnosis of CVS was
based on characteristic history, normal physical examination and negative
laboratory, radiographic, neurological and
endoscopic studies. Despite the absence of clinical signs typical of
food allergy, skin prick tests were
positive in six of the eight patients (75%). Specific IgE were present in 4/8
(50%) of the patients. Skin tests and specific IgE were positive for cow's milk
proteins, egg white and soya. IgE levels were higher than the mean + 2SD in 5/8
(63%) of the patients. A double blind
placebo controlled food challenge (DBPCFC) was carried out on seven of the
eight patients who displayed clinical improvement after an elimination diet for
cow's milk (and other foodstuffs indicated by positive skin tests). The DBPCFC
was positive in all seven children. Clinical follow-up revealed a state of
well-being over the 6 months of observation. CONCLUSION: It appears reasonable
to suggest that food allergy plays a role in cyclic vomiting syndrome.
1549. Mates
JM. Perez-Gomez C. Olalla L.
Segura JM. Blanca M. Allergy to
drugs: antioxidant enzymic activities, lipid peroxidation and protein oxidative
damage in human blood. Cell Biochemistry & Function. 18(2):77-84, 2000 Jun.
Abstract
Reactive oxygen species
lead to lipid peroxidation and specific oxidation of some specific enzymes,
proteins and other macromolecules, thus affecting many intra- and intercellular
systems. Recently, antioxidant functions have been linked to anti-inflammatory
properties. Cell defences against toxic oxygen include antioxidant enzymes. We
studied the enzymic antioxidant capacity in human blood of both erythrocytes
and mononuclear cells from patients suffering from an allergic reaction to
different drugs. We determined superoxide dismutases (SODs), glutathione
peroxidase (GSHPx) and catalase (CAT) activities in each cell type. We also
determined the extent of thiobarbituric acid reactive substances (TBARS) and
the oxidative damage to proteins, in order to study the correlation between the
cellular enzymic activities, the oxidative status and the allergic reaction. In mononuclear cells from
allergic patients, SODs and CAT
activities were enhanced compared with controls. Conversely, a decrease in
GSHPx activity was found. In erythrocytes, higher values for CAT, GSHPx and
SODs activities were found in allergic patients. TBARS were also enhanced in
both types of cells, and the carbonyl content of serum was equally increased.
The respective enzymic imbalances in mononuclear cells and erythrocytes,
namely, GSHPx/SOD and CAT/SOD, and their consequences are discussed. To our
knowledge, this is the first global study of antioxidant enzyme determinations,
including TBARS level and carbonyl content, in patients suffering from
allergies to drugs. Copyright 2000 John Wiley & Sons, Ltd.
1550. Motala
C. Kling S. Gie R. Potter PC. Manjra A.
Vermeulen J. Weinberg EG.
Green R. Guideline for the management of chronic asthma in
children--2000 update. Allergy Society of South Africa Working Group. South
African Medical Journal. 90(5 Pt 2):524-8,
530, 532 passim, 2000 May.
Abstract
OBJECTIVE: To increase
awareness of asthma and diagnose asthma early in children. To make recommendations regarding management of
chronic childhood asthma in a country with diverse cultural, socio-economic and
educational characteristics. The guideline should be used by health
professionals involved in the treatment of asthma at all levels of care.
OPTIONS: Various management options were considered. Ideal treatment includes
use of the new generation inhaled corticosteroids (fluticasone, budesonide),
housedust mite intervention for asthma control using impermeable covers for
pillows and mattresses, and if needed use of inhaled long-acting beta 2
agonists (LABAs) and leukotriene receptor antagonists (LRAs). Alternative
therapeutic approaches for situations
where resources are limited include simple housedust mite control
measures (e.g. airing mattresses and bedding), avoidance of exposure to passive
smoking, use of lower doses of beclomethasone than recommended by other
guideline documents and/or sustained-release (SR) theophylline as preventer
treatment and use of plastic bottles as cheap spacer devices. OUTCOMES: The
main potential outcomes considered were: to reduce morbidity and mortality by
correct diagnosis of asthma, to achieve the best quality of life for the child
with asthma, to minimise side-effects from medication and to prevent
development of permanently abnormal lung function. EVIDENCE: Current
international guideline documents for
diagnosis and management of childhood asthma were evaluated. Clinical
studies before 1998 pertaining to the various aspects of management of
childhood asthma were reviewed, including controlled studies on the use of
inhaled corticosteroids in children
with asthma, randomised controlled trials on the use of LRAs and two studies
evaluating the efficacy of LABAs. Current data on the anti-inflammatory effects
of SR theophylline were also reviewed as well as a randomised controlled trial
on the benefits of SR theophylline as adjunct treatment in childhood asthma.
The benefit of simple spacer devices, based on well-conducted local studies
(published in an international peer-reviewed journal) was also considered.
VALUES: The South African Childhood Asthma Working Group (SACAWG) committee
members, appointed by the Allergy Society of South Africa (ALLSA), were
selected to represent the interests of health professionals involved in the care of childhood asthma and
to co-opt other colleagues with expertise relevant to the guideline. The
committee was divided into six task groups headed by a chairperson--each task
group had to review critically the previous SACAWG guideline (for deficiencies
and obstacles to implementation), review current trends in asthma management
(evidence-based where available) and submit proposals and recommendations to
their respective chairperson. The hairperson then compiled a report for
discussion by the SACAWG executive committee. The executive group convened a
meeting to discuss the recommendations and obtain consensus. An editorial board
was appointed to compile the final report. Cultural factors, patient
preferences, cost, availability and education were considered important.
BENEFITS, HARMS AND COSTS: Proper treatment should enable most children with asthma to lead normal or near-normal
lives. The guideline could be implementable at all levels of care. The risk of
systemic effects due to inhaled corticosteroids should be minimised in children
with mild to moderate persistent asthma (risk of systemic effects is more
likely at daily beclomethasone doses exceeding 400 micrograms or the equivalent
dose of other inhaled corticosteroids). Promotion of simple environmental
control measures and use of inhaled beclomethasone and/or SR theophylline
should make treatment more widely available and more affordable and improve
adherence to treatment. Alternative
cheap plastic bottle spacer devices will increase availability and assist with
overcoming the problem of incorrect inha
1551. Pham
TS. Rudner EJ. Peanut allergy. [Review]
[34 refs] Cutis. 65(5):285-9, 2000 May.
Abstract
Peanut allergy is acute
and severe with symptoms of immediate hypersensitivity. This allergy is very
common, affecting 1% of preschoolers. The incidence has increased with
succeeding generations, and is possibly due to the increasing exposure of
children to peanuts at a young age. Diagnosis is via history, skin prick test,
and serum IgE level. The mainstay of therapy is avoidance. Treatment of
anaphylaxis includes epinephrine and antihistamines. Children usually will not
outgrow this food allergy. Novel treatment with rush immunotherapy and
enzyme-potentiated desensitization is not currently acceptable. We describe a
27-month-old Asian boy with a typical presentation of peanut hypersensitivity.
A good understanding of the epidemiology of this illness is necessary for
treatment and prevention. [References: 34]
1552. Primeau
MN. Kagan R. Joseph L. Lim H. Dufresne C.
Duffy C. Prhcal D. Clarke A. The psychological burden of peanut
allergy as perceived by adults with peanut
allergy and the parents of peanut-allergic children. Clinical &
Experimental Allergy. 30(8):1135-43,
2000 Aug.
Abstract
GROUND: Peanut-allergic
patients are affected by a condition which forces them and their families to
exercise extreme dietary vigilance and experience constant uncertainty
throughout their lives. OBJECTIVE: To compare the quality of life and family
relations of children and adults with a peanut allergy to that of children and
adults with a rheumatological disease. METHODS: Patients with a confirmed
diagnosis of peanut allergy or a rheumatological disease completed (for
children less than 18 years, by proxy) self-report questionnaires regarding the
impact of their condition on their quality of life and family relations. A
vertical visual analogue scale and the Impact on Family Questionnaire (IFQ)
served as outcome measures. RESULTS: One hundred and fifty-three
peanut-allergic children were compared with 69 children with a rheumatological
disease while 37 peanut-allergic adults were compared with 42 adults with a
rheumatological disease. The parents of peanut-allergic children, compared to
the parents of children with a rheumatological disease, reported that their
children had significantly more disruption in their daily activities. Furthermore,
the parents of peanut-allergic children reported more impairment in the
familial-social dimension of the IFQ. Conversely, adults with a chronic
rheumatological disease reported more disruption in their family relations than
peanut-allergic adults. CONCLUSION: Given the considerable disruption in daily
activities and family relations reported by the parents of peanut-allergic
children, accurate diagnosis of peanut allergy is essential. Our work should
make health care professionals dealing with children with confirmed peanut allergy more aware of the support that these
families may require. Furthermore, we hope to motivate food industries to offer
more 'peanut free' products to decrease the dietary restrictions of these
patients while minimizing their potential for accidental ingestion.
1553. Rance
F. Dutau G. Abbal M. Mustard allergy
in children. Allergy. 55(5):496-500,
2000 May.
Abstract
GROUND: Mustard allergy
is not well known. This study aimed to assess
its clinical features and other associated allergies, and to define skin
prick tests (SPT), specific IgE, and dose response by oral food challenge.
METHODS: Our study investigated 36 children with positive mustard SPT. The
diagnosis of mustard allergy was based on open or single-blind,
placebo-controlled food challenge (SBPCFC). We compared the subjects to 22
controls. RESULTS: The initial clinical features were atopic dermatitis
(51.8%), and urticaria and/or angioedema (37%). Fifteen children were allergic
(positive SBPCFC) and 21 children were nonallergic (negative SBPCFC). Symptoms
after mustard ingestion started under 3 years of age in 53.3% of the subjects.
There was no significant difference in the food allergies and associated
inhalant allergen sensitizations between the two groups. In the allergic group,
the mean wheal diameter for mustard SPT was 8.8 mm and the median concentration
of mustard serum (s) IgE 14.8 kU/l. The mean cumulative reactive dose were 153
mg. CONCLUSIONS: Allergic reactions to
mustard started early in life. Clinical symptoms were not severe in children.
Mustard should be included in screening tests of food allergy in children.
1554.
Ryan EJ. Nilsson L.
Kjellman N. Gothefors L. Mills KH. Booster immunization of children
with an acellular pertussis vaccine enhances Th2 cytokine production and serum
IgE responses against pertussis toxin but not against common allergens.
Clinical & Experimental Immunology.
121(2):193-200, 2000 Aug.
Abstract
Acellular pertussis
vaccines (Pa) protect against severe pertussis in children. However, serum
antibody responses decline quickly after immunization. Studies in animal models
suggest that cell-mediated immunity also contributes to protection against
Bordetella pertussis, and it has already been demonstrated that Pa induce T
cells that secrete type-1 and type-2 cytokines in children. In this study we
examined the persistence of the T cell response and the effect of booster
immunization in 4-6-year-old children. Cell-mediated immunity to B. pertussis
antigens was detected in a high proportion of children more than 42 months
after their last immunization. Peripheral blood mononuclear cells (PBMC) from
the majority of children secreted
interferon-gamma (IFN-gamma) and a smaller proportion IL-5, in response to specific antigen stimulation in vitro.
However, following booster immunization, significantly higher concentrations
of IL-5, but not IFN-gamma, were
produced by PBMC in response to B. pertussis antigens. Furthermore, plasma IL-4
and IL-5 concentrations were increased, whereas IFN-gamma concentrations were reduced following booster
immunization. It has been suggested that childhood immunization with
Th2-inducing vaccines may predispose some children to atopic disease. Although
we found that pertussis toxin (PT)-specific IgE was significantly increased
after booster immunization in both atopic and non-atopic children, the levels
of IgE to common allergens and the prevalence of positive skin prick test were
unaffected by the booster vaccination. Thus, despite the enhancement of type-2
responses to B. pertussis antigens, booster vaccination with Pa does not appear
to be a risk factor for allergy.
1555. Sainte-Laudy
J. Sabbah A. Drouet M. Lauret MG. Loiry M. Diagnosis of venom allergy by flow
cytometry. Correlation with clinical history, skin tests, specific IgE,
histamine and leukotriene C4 release. Clinical & Experimental Allergy. 30(8):1166-71, 2000 Aug.
Abstract
GROUND: Potent allergens
such as hymenoptera venoms are capable of
inducing severe and life threatening clinical reactions. Percentage of
false negative results obtained by the usual diagnostical methods is comprised
between 10 and 25%. OBJECTIVE: Evaluation of the sensitivity and the
specificity of cellular tests and particularly evaluation of a new flow
cytometric method. METHODS: Forty-five allergic patients having experienced a
local, a systemic reaction or an anaphylactic shock and 10 controls having
undergone hymenoptera stings without clinical reactions were selected on the
basis of the clinical history, skin tests and specific IgE. Three cellular
tests were performed on the same cell suspensions and in the presence of 2
ng/mL of rIL3: histamine release (RIA),
leukotriene C4 release (ELISA) and basophil activation test (flow cytometry after double anti-IgE FITC,
anti-CD63 PE labelling). RESULTS: As
compared to the clinical history, sensitivities of skin tests, specific
IgE, flow cytometry, histamine release and leukotriene release were,
respectively; 85%, 88%, 100%, 89% and 100%. Flow cytometric analysis of
basophil activation showed a significant decrease of the mean fluorescence
density and number of IgE positive cells and a significant increase of the
number of CD63 positive cells. The 10 controls tested by flow cytometry were
negative. CONCLUSION: As compared to the clinical history and to the other
parameters tested here, flow cytometry showed a high sensitivity and a high
specificity. The excellent correlation observed between this method and the
other cellular tests such as histamine and leukotriene release are in favour of
the specificity of flow cytomery and in favour of the use of this method for
venom allergy diagnosis.
1556. van
Ree R. Aalbers M. Kea O.
Marco De La Calle FM. Sempere
Ortells JM. Villalba M. Rodriguez R. Aalberse RC. A sensitive monoclonal antibody sandwich ELISA for
the measurement of the major olive pollen allergen Ole e 1. International Archives of Allergy &
Immunology. 122(3):224-8, 2000 Jul.
Abstract
GROUND: Olive pollen is a
major cause of inhalant allergy in countries
around the Mediterranean sea. The major allergen of olive pollen is Ole
e 1. Measurement of the major allergen content of allergen products for
diagnosis and therapy is becoming an essential element of standardization
protocols. This study aimed at the development of a monoclonal antibody (mAb)
sandwich ELISA for Ole e 1. METHODS: Balb/c mice immunized with Ole e 1 were
used for the production of mAbs. Screening of mice and hybridomas was performed
in a RIA with radiolabeled purified Ole e 1. Purified mAbs were used as
catching and/or (biotinylated) detecting antibodies in sandwich ELISA. RESULTS:
Four mAbs (IgG1kappa) directed to nonoverlapping epitopes on Ole e 1 were
obtained: 1A12, 5C1, 10A12 and 3H8. Both 1A12 and 10A12 were successfully used
for affinity purification of Ole e 1 from olive pollen extract. Two sandwich
ELISAs were developed, with 1A12 and 10A12 as catching, and 5C1 and 3H8 as
detecting antibodies, respectively. Both catching and detecting antibodies were
used in similar concentrations, ranging from 60 to 100 ng/well. For both
ELISAs, the sensitivity was
approximately 1 ng/ml of Ole e 1. The measuring range was from 1 to 25 ng/ml.
No significant differences were observed, when the performance of both ELISAs
in standardization of olive pollen extracts was compared. CONCLUSIONS: Two
sensitive sandwich ELISAs for the major olive pollen allergen Ole e 1 were
developed. They will prove to be useful tools in allergen standardization
protocols. Copyright 2000 S. Karger AG, Basel.
1557. Verma
J. Singh BP. Gangal SV. Arora N. Sridhara S. Purification and partial
characterization ofa 67-kD cross-react ive allergen from Imperata cylindrica
pollen extract. International Archives of Allergy & Immunology. 122(4):251-6, 2000 Aug.
Abstract
GROUND: Grass pollens are
known to induce type I allergic reactions in a large number of genetically
predisposed individuals. Earlier studies have recognized Imperata cylindrica
(Ic) pollen as an important source of
aeroallergen which contained 7 IgE binding proteins in the MW range of
85-16 kD. OBJECTIVES: To isolate, purify and characterize a cross-reactive
allergenic protein from Ic pollen extract for diagnosis and therapy of grass
pollen allergy. METHODOLOGY: Ic pollen extract was fractionated using DEAE
Sephadex A-50, Sephadex G-200 and Mono Q column. Allergenic activity of the
fractions was checked by ELISA, skin tests, ELISA inhibition and immunoblot
using sera of Ic-sensitive patients. A 67-kD protein was purified to
homogeneity from Ic-VIII. The allergenic determinants of this protein were
identified by SDS-PAGE and immunoblot after CNBr treatment. RESULTS: Among Ic
fractions, Ic-VIII was highly potent by
ELISA, skin tests and showed cross-reactivity with 4 other tropical grasses by
immunoblot and ELISA inhibition. The subfraction Ic-VIIIe1 of Ic-VIII showed a
band at 67 kD on SDS-PAGE. On CNBr treatment, it gave 7 peptides, 3 of which
were found to be allergenic. CONCLUSION: A 67-kD protein (Ic-VIIIe1) was
isolated, purified to homogeneity and partially characterized. It showed
cross-reactivity with tropical grasses tested and contained at least three
allergenic determinants. Copyright 2000
S. Karger AG, Basel.
1558. Yip
L. Hickey V. Wagner B. Liss G. Slater J.
Breiteneder H. Sussman G.
Beezhold D. Skin prick test reactivity to recombinant latex allergens.
International Archives of Allergy & Immunology. 121(4):292-9, 2000 Apr.
Abstract
GROUND: Allergy to latex has become a serious and increasingly
common health problem, particularly
for healthcare workers and patients who undergo frequent surgical procedures.
Testing for latex allergy currently involves in vitro tests and skin prick
testing using crude preparations of natural rubber latex (NRL). To date, 10
latex proteins have received designation as allergens (Hev b 1 to Hev b 10)
and, except for Hev b 4, have been cloned as recombinant proteins. Our aim was
to compare the skin prick test (SPT) reactivity of six recombinant latex
allergens with SPT reactivity to natural rubber latex proteins in known
latex-allergic individuals. METHODS: Six recombinant proteins were expressed in
Escherichia coli, and tested as the intact fusion proteins (Hev b 2, 5, 6, 8) or as purified proteins (Hev b 3 and 7).
SPT with the six recombinant latex allergens was performed using 10-fold serial
dilutions on 31 latex-allergic subjects
to determine the level of reactivity to each recombinant allergen.
Latex-specific IgE was determined using the AlaSTAT assay. RESULTS: All six
recombinant allergens were reactive by SPT in at least 1 latex-allergic patient
but not in any of the control patients. The frequency of sensitization to the
various recombinant allergens was similar to previous studies using the native
proteins isolated from NRL. The minimal level of protein for a positive skin
test was 70 pg/ml for NRL and 1 ng/ml
for one recombinant allergen (Hev b 7). In our patients, the use of a
combination of recombinant latex allergens Hev b 5, 6 and 7 diagnosed latex
allergy with 93% sensitivity and 100% specificity. CONCLUSION: Recombinant latex allergens are clinically reactive,
can be produced in a standardized manner, and could potentially provide safe,
sensitive and specific reagents for the diagnosis of latex allergy. Copyright
2000 S. Karger AG, Basel Date: 27-Feb-2001 Name: absapr Database: Medline
<January 2000 to December 2000>
2055. Asero R. Bottazzi G. Nasal polyposis: a study of its association with airborne allergen hypersensitivity. Annals of Allergy, Asthma, & Immunology. 86(3):283-5, 2001 Mar.
Abstract
BACKGROUND: Despite the frequent presence of clinical symptoms such as sneezing and itching, elevated histamine and IgE in extracellular polyp fluids, tissue eosinophilia, and degranulated mast cells, allergy is not considered an important cause of nasal polyposis. OBJECTIVE: To investigate the prevalence of immediate skin reactivity to airborne allergens in patients with nasal polyposis. METHODS: Sixty-eight patients with nasal polyposis and 36 controls with chronic sinusitis were submitted to skin prick tests (SPTs) with a large series of seasonal and perennial airborne allergens including: grass, mugwort, ragweed, pellitory, plantain, birch, hazel, olive, cypress, house dust mites, cat and dog dander, and thirteen molds (Alternaria, Aspergillus, Cladosporium, Penicillium, Candida, Trichophyton, Fusarium, Curvularia, Botrytis, Pullularia, Rhizopus, Mucor, Helminthosporium). RESULTS: Forty-three of 68 (63%) patients with nasal polyposis versus 6 of 35 (17%) controls were positive on SPT with airborne allergens (P < .001). A comparison with 1,128 subjects with respiratory allergy seen from 1996 to 1999 showed a markedly higher prevalence of sensitivity to Candida albicans (19 of 43 [44%] vs 8 of 1,128 and 2 over black square]; and 2 over black square]; [1 and 2 over black square] and 2 over black square]%]; P < .001) and to house dust mites (12 of 43 [28%] vs 154 of 1,128 and 2 over black square]; and 2 over black square]; [1 and 2 over black square] and 2 over black square]4%]; P < .05) among allergic patients with polyps. Altogether, 30 of 43 (70%) patients versus 215 of 1,128 (19%) controls were sensitive to at least one perennial airborne allergen (ie, mold, mite, or animal dander) on SPT (P < .001); in contrast, 26 of 43 (60%) patients versus 942 of 1,128 (84%) controls were sensitive to seasonal airborne allergens (P < .005). A review of the clinical histories of SPT-positive patients revealed the presence of obstructive rhinitis and chronic rhinorrhea only in most cases, whereas acute symptoms, such as sneezing and itching, were reported only by a minority of subjects. CONCLUSIONS: A clinically slight respiratory allergy, particularly to perennial airborne allergens, might play a relevant role in the pathogenesis of nasal polyposis, probably through the induction of a long-lasting inflammation of the nasal mucosa.
2056. Bengtsson A. Lundberg M. Avila-Carino J. Jacobsson G. Holmgren A. Scheynius A. Thiols decrease cytokine levels and down-regulate the expression of CD30 on human allergen-specific T helper (Th) 0 and Th2 cells. Clinical & Experimental Immunology. 123(3):350-60, 2001 Mar.
Abstract
The thiol antioxidant N-acetyl- L-cysteine (NAC), known as a precursor of glutathione (GSH), is used in AIDS treatment trials, as a chemoprotectant in cancer chemotherapy and in treatment of chronic bronchitis. In vitro, GSH and NAC are known to enhance T cell proliferation, production of IL-2 and up-regulation of the IL-2 receptor. The 120-kD CD30 surface antigen belongs to the tumour necrosis factor (TNF) receptor superfamily. It is expressed by activated T helper (Th) cells and its expression is sustained in Th2 cells. We have analysed the effect of GSH and NAC on the cytokine profile and CD30 expression on human allergen-specific T cell clones (TCC). TCC were stimulated with anti-CD3 antibodies in the presence of different concentrations of GSH and NAC. Both thiols caused a dose dependent down-regulation of IL-4, IL-5 and IFN-gamma levels in Th0 and Th2 clones, with the most pronounced decrease of IL-4. Furthermore, they down-regulated the surface expression of CD30, and the levels of soluble CD30 (sCD30) in the culture supernatants were decreased. In contrast, the surface expression of CD28 or CD40 ligand (CD40L) was not significantly changed after treatment with 20 m M NAC. These results indicate that GSH and NAC favour a Th1 response by a preferential down-regulation of IL-4. In addition, the expression of CD30 was down regulated by GSH and NAC, suggesting that CD30 expression is dependent on IL-4, or modified by NAC. In the likely event that CD30 and its soluble counterpart prove to contribute to the pathogenesis in Th2 related diseases such as allergy, NAC may be considered as a future therapeutic agent in the treatment of these diseases.
2057. Choquet-Kastylevsky G. Vial T. Descotes J. Drug allergy diagnosis in humans: possibilities and pitfalls. [Review] [57 refs] Toxicology. 158(1-2):1-10, 2001 Feb 2.
Abstract
Due to the potential hazards of drug allergies, an early and reliable diagnosis is crucial. The use of in vivo tests is not recent but, because of the hazards of skin testing in patients with a history of anaphylaxis, they had been abandoned for a while. Recent reevaluations have shown that for some drugs, e.g. antibiotics-reliable skin tests can ensure the diagnosis of drug allergy in up to 70% of cases. Many in vitro tests based on well-defined mechanisms, e.g. the basophil degranulation test have been used for the diagnosis of totally unrelated allergic mechanisms. It is almost impossible to interpret their validity as diagnosis tools. Nevertheless, other tests, e.g. the lymphocyte transformation test which have been evaluated in well-conducted recent studies, seem to have a good predictive value. Their use is still restricted to clinical trials or research studies. A reliable clinical approach as well as a detailed examination of the drug intake remains obligatory to diagnose drug allergy. Available in vivo and in vitro tests are sometimes used to confirm the diagnosis. The sensitivity and specificity of these tests is evaluated in clinical studies. Research to improve the existing tests and to develop new diagnostic tools is still of paramount importance. [References: 57]
2061. Larsen GL. Differences between adult and childhood asthma. [Review] [43 refs] Disease-A-Month. 47(1):34-44, 2001 Jan.
Abstract
During the last 2 decades, we have gained new insights into the pathogenesis of asthma; consequently, new therapeutic agents and approaches to therapy have emerged. Nevertheless, significant gaps remain in our understanding of this disease. Important new treatment issues affect childhood (the usual time of asthma onset), and researchers have recently described increases in asthma incidence in children. Yet, most clinical studies have been performed with adults, and our knowledge about major determinants of childhood asthma remains incomplete. Major challenges in pediatric asthma include methods of easily assessing lung function and noninvasive methods of assessing asthma's inflammatory nature. Research that addresses the mechanisms responsible for disease onset is also critical to decrease the prevalence of asthma. What we know about adult asthma cannot be used in the treatment of children without further study, but it is now clear that effective treatment should begin during childhood. (J Allergy Clin Immunol 2000;106:S153-7.) [References: 43]
2062. Leff AR. Regulation of leukotrienes in the management of asthma: biology and clinical therapy. [Review] [64 refs] Annual Review of Medicine. 52:1-14, 2001.
Abstract
Leukotrienes (LTs) are the ultimate synthetic product resulting from the intracellular hydrolysis of membrane phospholipid at the nuclear envelope in inflammatory cells. Activated cytosolic phospholipase (cPLA2) catalyzes the production of arachidonic acid, which is converted by cyclooxygenases into leukotriene A4 (LTA4) and subsequently into the chemotaxin LTB4, which has no direct bronchoconstrictor activity. In certain inflammatory cells, LTA4 is converted into the cysteinyl leukotriene (cysLT) LTC4, which is converted into LTD4 and finally to LTE4 after extracellular transport. All cysLTs occupy the same receptors and are extremely potent bronchoconstricting agents that are pathogenetic in both asthma and allergy. With the identification of the structure of the cysLT receptor, antileukotriene therapies have been developed that either (a) inhibit synthesis of leukotriene (through 5-lipoxygenase inhibition) or (b) block the cysLT receptor. Preliminary investigations indicate that corticosteroids also may partially block the synthesis of cysLT and that cysLTs may be chemotactic for other inflammatory cells, e.g. eosinophils, by a mechanism that has not yet been defined. Currently, anti-LT therapies are approved by the US Food and Drug Administration (FDA) only for patients with asthma. These drugs generally are moderately efficacious agents, although they are highly efficacious in aspirin-induced asthma (AIA). In other forms of asthma, inhaled corticosteroid (ICS) therapy has been more effective than anti-LT therapy in improving air flow obstruction. However, anti-LT agents are additive to beta-adrenoceptor and ICS in their effects. Accordingly, anti-LT therapies are used frequently as supplemental treatments in asthmatic patients whose asthma is not optimally controlled by a combination of other drugs, including long-acting beta-adrenoceptor drugs and ICS agents. The growth of leukotriene receptor antagonists (LTRAs) has been extraordinary in the United States. The exceptional safety of these agents and their ease of administration as tablets taken once or twice daily has spurred this growth. In the past year, the high-affinity cysLT receptor has been cloned. This holds forth the promise of a second generation of LTRA agents of even greater efficacy and possibly greater duration of action. [References: 64]
2063. Lewis SA. Pavord ID. Stringer JR. Knox AJ. Weiss ST. Britton JR. The relation between peripheral blood leukocyte counts and respiratory symptoms, atopy, lung function, and airway responsiveness in adults. Chest. 119(1):105-14, 2001 Jan.
Abstract
STUDY OBJECTIVES: Eosinophils and neutrophils play major roles, respectively, in the pathogenesis of asthma and COPD, and it is well recognized that levels of these cells in peripheral blood are increased in relation to their pulmonary involvement. However, the relation between peripheral blood cell counts of the other major leukocyte groups and these lung diseases or markers of allergy or airflow obstruction is less clear. We have therefore investigated the association between peripheral blood levels of eosinophils, neutrophils, basophils, monocytes, and lymphocytes and the occurrence of chronic respiratory symptoms, atopy, lung function, and bronchial hyperresponsiveness, and the modifying effect of age, in adults. DESIGN: A cross-sectional general population study. SETTING: Data on > 2,000 British adults, who originally participated in a study of diet and lung health, were analyzed using multiple linear and logistic regression to adjust for potential confounders, including age, sex, and smoking history. RESULTS: We found that, like eosinophils, the peripheral basophil count was increased in relation to asthma and associated symptoms, and to airway hyperreactivity and increased total IgE, but differed from eosinophils in that basophils were unrelated to atopy. Monocytes were predominantly associated with symptoms indicative of obstructive airway disease, in similar relation to neutrophils, but both of these leukocyte counts were also increased in asthma patients in older age groups. Lymphocyte counts were unrelated to any objective or subjective marker of disease. CONCLUSIONS: If peripheral blood cell counts reflect pulmonary involvement of these leukocyte groups, basophils and monocytes may play a distinct role in the pathogenesis of allergic and nonallergic respiratory disease.
2066. Pichler WJ. Predictive drug allergy testing: an alternative viewpoint. [Review] [40 refs] Toxicology. 158(1-2):31-41, 2001 Feb 2.
Abstract
T- and B-cells recognise drugs when bound as haptens to carrier molecules. Recent studies suggest that drugs might also bind in a non-covalent form to MHC-peptide complexes and T cell receptors, and are thereby able to stimulate T cells. This has, however, only been shown for drug-specific T cell clones. Functional analysis revealed that drug-reactive T cells secrete high amounts of IL-5 and are cytotoxic. Cytotoxicity is mediated by drug-specific CD4(+) and CD8(+) cells and, as revealed by the immunohistochemical analysis of drug-induced exanthems, might be involved in the killing of keratinocytes thus explaining the drug-induced exanthem. Further work is needed to clarify the type and exact location of the rather labile drug binding to MHC and T cell receptors, and to evaluate what drug allergies might be caused by such an unusual presentation and immune stimulation. This new model as well as findings from the analysis of clinical drug allergies may have major implications on how to test and predict the allergenic potential of drugs. A change and expansion of currently performed test procedures is required to predict the allergenic potential of drugs. [References: 40]
2067. Sachs B. Erdmann S. Al-Masaoudi T. Merk HF. In vitro drug allergy detection system incorporating human liver microsomes in chlorazepate-induced skin rash: drug-specific proliferation associated with interleukin-5 secretion. British Journal of Dermatology. 144(2):316-20, 2001 Feb.
Abstract
BACKGROUND: Chlorazepate is a benzodiazepine often used for pre-operative anxiolysis. The central metabolite responsible for the pharmacological and probably for the adverse effects of most benzodiazepines, including chlorazepate, is N-desmethyldiazepam. We report a woman who developed a generalized exanthem 1 day after receiving chlorazepate and four other drugs related to anaesthesia for surgery of the larynx. Patch tests pointed to chlorazepate as the culprit drug for the skin rash. OBJECTIVES: The purpose of this study was to detect drug allergy to chlorazepate or a metabolite in vitro by means of the lymphocyte transformation test (LTT), and to determine the concentrations of the T-helper (Th) 2-type cytokine interleukin (IL)-5 and the Th1-type cytokine interferon (IFN) -gamma in the culture supernatants. METHODS: We performed an LTT with peripheral blood mononuclear cells from the patient and a control, employing human liver microsomes containing cytochrome P450 enzymes as a metabolizing system, in parallel cultures. IL-5 and IFN-gamma concentrations in the culture supernatants were assessed by enzyme-linked immunosorbent assay. RESULTS: In the LTT, no T-cell reactivity was observed to the parent compound chlorazepate, whereas coincubation of the drug with human liver microsomes yielded proliferative T-cell reactivity, which was associated with secretion of IL-5 but not of IFN-gamma. CONCLUSIONS: We conclude that addition of a metabolizing system may be advantageous for in vitro detection of T-cell reactivity to drug metabolites in the LTT.
2594.
Barnes C. Tuck J. Simon S.
Pacheco F. Hu F. Portnoy J. Allergenic materials in the house
dust of allergy clinic patients. [see comments]. Annals of Allergy, Asthma, & Immunology. 86(5):517-23, 2001 May.
Abstract
INTRODUCTION: Environmental agents including
animal, fungal, tree, and weed antigens are known to cause allergic rhinitis
and asthma. The following study was performed to measure the antigen
concentration of several of these in house dust of children seen in an allergy
clinic. Comparisons are made between household allergen levels of children seen
for asthma and children seen for other reasons. METHODS: Dust samples were
solicited from patients in a pediatric allergy specialty clinic and other
individuals associated with the clinic. Persons submitting dust were asked to
complete a questionnaire describing their house. Samples were extracted,
centrifuged, and filtered for sterility. Samples were stored in 50% glycerol at
-20 degrees C. Specific antigens for Alternaria, Cladosporium, Aspergillus,
Candida, Dermatophagoides farinae, cat, dog, oak, fescue, ragweed, plantain,
and cockroach were measured using inhibition assays developed with whole antigen
extract. Allergens Der p1, Der f 1, Alt a 1, and Alt a 70 kD were measured
using double monoclonal antibody assays. RESULTS: Significant concentrations of
whole antigen from cat, dog, oak, Alternaria, and Cladosporium were detected.
Between 0.1 and 18 microg of Der f1 and Der p1 per gram of dust were also
measured. Alt a 1 and Alt a 70 kD levels varied between 3.0 and 1000 U/g of
dust. Significant positive correlations were observed in levels of dust mite
and Alternaria allergen for patients with an evaluation of asthma. CONCLUSIONS:
We found measurable levels of fungal antigens (Alternaria, Cladosporium), mite
antigens, and animal antigens (dog and cat) in the majority of dust samples in
this self-selected set of allergy clinic patients. Specific allergens Alt a 1,
Alt a 70kD, and Der p 1 were significantly higher in the homes of asthmatic
patients when compared with patients seen for reasons other than asthma. These
studies support the hypothesis that fungal allergen exposure is an important
component in the pathogenesis of the clinical condition known as asthma.
2595. Crimi E.
Milanese M. Pingfang S. Brusasco V. Allergic inflammation and airway
smooth muscle function. [Review] [13 refs]
Science of the Total Environment.
270(1-3):57-61, 2001 Apr 10.
Abstract
It is widely accepted that airway smooth
muscle (ASM) contraction plays a key role in asthmatic attacks. Whether
abnormalities of contractility or autonomic regulation exist in the asthmatic
ASM is still debated. Studies based on isometric contraction failed to show
differences in the force-generation capability between asthmatic and normal
ASM. Recent studies in vitro have shown that sensitized ASM: (1) shortens more
and more rapidly than normal ASM; and (2) develops a myogenic response to stretching.
The increased velocity of shortening may compromise in vivo the ability of
tidal cycling to reduce airway tone, which would result in an enhanced response
to bronchoconstrictor stimuli. The myogenic response may result in a sustained
bronchospasm after a deep inhalation, a maneuver that in normal individuals
causes bronchodilatation. Although there is no evidence that neural or humoral
abnormalities in the autonomic regulation of ASM tone are central to the
pathogenesis of bronchial asthma, recent data suggest that ASM receptor
dysfunction may develop secondary to airway allergic response. It has been
shown that exposure of passively sensitized human bronchi to allergens in vitro
causes M2- and beta2-receptor dysfunction. Impairment of pre-junctional
M2-autoreceptors may result in an enhancement of neurally mediated
bronchoconstrictor responses, whereas beta2-receptor dysfunction may reduce the
sensitivity to bronchodilator treatment. Airway inflammation, which is a
characteristic feature of bronchial asthma, may alter both the contractile
properties and the autonomic regulation of ASM. These changes may contribute to
the severity of asthma, as they may cause an, imbalance between factors
favoring and opposing airway narrowing. [References: 13]
2596. De Amici M.
Puggioni F. Casali L. Alesina R. Variations in serum levels of
interleukin (IL)-1beta, IL-2, IL-6, and tumor necrosis factor-alpha during
specific immunotherapy. Annals of
Allergy, Asthma, & Immunology.
86(3):311-3, 2001 Mar.
Abstract
BACKGROUND: Cytokine production by T helper
cells is essential for the induction and maintenance of allergic inflammation
in the bronchial mucosa. According to recent views, specific immunotherapy
(SIT) favors the differentiation of T lymphocytes into cells of the Th1 rather
than those of the Th2 subset. OBJECTIVE: To determine whether or not SIT
induces a decrease in the inflammatory reaction by studying eventual variations
in the serum levels of IL-1beta, IL-2, IL-6, and TNF-alpha in allergic subjects
during SIT. METHODS: Serum levels of IL-1beta, IL-2, IL-6, and TNF-alpha were
determined before and after 3, 6, and 9 months of SIT by an immunoradiometric
assay (IRMA) in 11 adults with perennial allergic asthma and/or rhinitis caused
by house dust mites and in 6 nonatopic healthy volunteers. RESULTS: Median
serum IL-1beta and TNF-alpha levels of the patients were significantly higher
at baseline than those of the controls and decreased during SIT to values
similar to or lower (P < .01) after 6 months of SIT for TNF-alpha than those
of the controls. Median serum IL-2, significantly lower at baseline than in the
controls, increased during SIT to a level similar to that of the controls.
Although the median values of IL-1beta and TNF-alpha in the patients tended to
decrease and those of IL-2 to increase during SIT, the differences were not
significant; the correlation coefficients (r) of the serum levels of IL-1beta
IL-6, and TNF-alpha versus duration of SIT were negative, while that of IL-2
was positive. CONCLUSIONS: Decreases in median serum IL-1beta and TNF-alpha
levels during SIT, together with the increases in serum IL-2 and IL-6, compared
with those of the controls furnish evidence supporting a reduction in the
inflammatory response in the course of SIT.
2597. Dogru H. Delibas N.
Doner F. Tuz M. Uygur K. Free radical damage in nasal polyp
tissue. Otolaryngology - Head & Neck Surgery. 124(5):570-2, 2001 May.
Abstract
OBJECTIVE: To investigate whether the free
radical injury in nasal polyp tissue exists or not. STUDY DESIGN: A prospective
study in patients with nasal polyps. METHODS: Polyp specimens were obtained
from 19 patients. Control specimens were acquired from 16 patients who
underwent partial turbinectomy with concha bullosa free of rhinitis, sinusitis,
and allergy, confirmed by endoscopic nasal examination, coronal paranasal sinus
CT scan, and prick test. MDA levels of nasal polyps and control specimens were
measured by using the method of Knudsen et al. RESULTS: The mean MDA levels of
nasal polyps and control specimens were 38.2 +/- 5.1 (33.3-52.2) and 33.9 +/-
1.6 (32.6-37.4), respectively. MDA levels in NP were significantly higher
compared with control specimens (P < 0.01). CONCLUSION: High level of MDA in
nasal polyp tissue that represents FR increase supports the existence of cell
injury in nasal polyp tissue. FRs should be considered in the development and
life cycles of NP which is thought to have multifactorial pathogenesis.
2598. Griffiths PD. Getting
vaccines into perspective. Reviews in Medical Virology. 11(1):1-2, 2001
Jan-Feb.
2599. Honigman B.
Lee J. Rothschild J. Light P.
Pulling RM. Yu T. Bates DW. Using computerized data to
identify adverse drug events in outpatients.
Journal of the American Medical Informatics Association. 8(3):254-66, 2001 May-Jun.
Abstract
OBJECTIVE: To evaluate the use of a computer
program to identify adverse drug events (ADEs) in the ambulatory setting and to
evaluate the relative contribution of four computer search methods for
identifying ADEs, including diagnosis codes, allergy rules, computer event
monitoring rules, and text searching. DESIGN: Retrospective analysis of one
year of data from an electronic medical record, including records for 23,064
patients with a primary care physician, of whom 15,665 actually came for care.
MEASUREMENT: Presence of an ADE; sensitivity and specificity of computer
searches for ADE. RESULTS: The computer program identified 25,056 incidents,
which were associated with an estimated 864 (95 percent confidence interval
[CI], 750-978) ADES. Thus, the ADE rate was 5.5 (CI, 5.2-5.9) per 100 patients
coming for care. Furthermore, in 79 (CI, 68-89) ADEs, the patient required
hospitalization, resulting in an estimated rate of 3.4 (CI, 2.7-4.3) admissions
per 1,000 patients. The sensitivity of the search methods for identifying ADEs
was estimated to be 58 (CI, 18-98) percent, and the estimated specificity was
88 (CI, 87-88) percent. The positive predictive value was 7.5 (CI, 6.5-8.5)
percent, and the negative predictive value was 99.2 (CI, 95.5-99.98) percent.
Compared with age and gender-matched controls with no positive screen, patients
with ADEs had twice as many outpatient visits and were taking nearly three
times as many drugs. Antihypertensives, ACE-inhibitors, antibiotics, and
diuretics were associated with 56 (CI, 47-65) percent of ADES. Among ADEs, 23
(CI, 16-32) percent were life-threatening or serious, and 38 (CI, 29-47)
percent were judged preventable. CONCLUSION: Computerized search programs can
detect ADEs, and free-text searches were especially useful. Adverse drug events
were frequent, and admissions were not rare, although most hospitals today do
not identify them. Thus, such detection programs demonstrate
"value-added" for the electronic record and may be useful for
directing and assessing the impact of quality improvement efforts.
2600. Liu T.
Howard RM. Mancini AJ. Weston WL.
Paller AS. Drolet BA. Esterly NB.
Pucar F. Kagan R. Lim H.
Clarke AE. Peanut challenge: a retrospective study of 140 patients. [see
comments]. Clinical & Experimental Allergy. 31(1):40-6, 2001 Jan.
2601. Mari A. Multiple pollen
sensitization: a molecular approach to the diagnosis. International Archives of
Allergy & Immunology. 125(1):57-65,
2001 May.
2602. Nieters A. Brems S.
Becker N. Cross-sectional study
on cytokine polymorphisms, cytokine production after T-cell stimulation and
clinical parameters in a random sample of a German population. Human
Genetics. 108(3):241-8, 2001 Mar.
Abstract
We investigated, in a random sample of a
German population, the association of polymorphisms in the genes encoding the
cytokines interleukin 2 (IL-2), interleukin 4 receptor (IL-4R), interleukin 6
(IL-6), interleukin 10, interferon gamma (IFNG), tumor necrosis factor (TNF)
and intercellular adhesion molecule 1 (ICAM-1) with (1) secreted levels of the
respective proteins after T-cell stimulation and (2) data on selected diseases
obtained from a questionnaire. The scope of this investigation was to further
the understanding of the genetic background of allergies and common colds and
the observed heterogeneity of many immune responses in the human population. In
contrast to previous reports that showed associations of promoter polymorphisms
of cytokine genes with the production of the corresponding protein, we did not
find associations with protein release after T-cell stimulation in vitro. Among
the correlations with the clinical parameters, we observed an increased risk of
allergies (odds ratio, OR= 4.1; confidence interval, CI: 1.6-10.4),
particularly hay fever (OR=5.6, CI: 1.8-17.1) in individuals homozygous for
IFNG 13 CA-repeats. In combination with the TNF wildtype, the risk for hay
fever increased to OR=8.4 (CI: 2.7-25.6). Furthermore, individuals with a
combination of IL2, IL6 and ICAM-1 polymorphisms tended to have higher
frequencies of reported common colds than individuals with the alternate
genotypes. As these are results of an explorative investigation, these findings
require confirmation in material from a different source. If confirmed, these
relationships could contribute to a better characterisation of the genetic
component of allergies.
2603. Pryor JP.
Vonfricken K. Seibel R. Kauder DR.
Schwab CW. Anaphylactic shock
from a latex allergy in a patient with spinal trauma. Journal of Trauma-Injury Infection & Critical Care. 50(5):927-30, 2001 May.
2604. Pucar F.
Kagan R. Lim H. Clarke AE. Peanut challenge: a retrospective
study of 140 patients. [see comments].
Clinical & Experimental Allergy.
31(1):40-6, 2001 Jan.
2605. Salkind AR.
Cuddy PG. Foxworth JW. Is this patient allergic to penicillin? An
evidence-based analysis of the likelihood of penicillin allergy. [Review] [53
refs] JAMA. 285(19):2498-505, 2001 May
16.
2606. Sampson HA. Utility of food-specific IgE concentrations
in predicting symptomatic food allergy. Journal of Allergy & Clinical
Immunology. 107(5):891-6, 2001 May.
2607. Settipane RA. Lieberman P. Update on nonallergic rhinitis. [Review] [93 refs]
Annals of Allergy, Asthma, & Immunology.
86(5):494-507; quiz 507-8, 2001 May.
2608. Suzuki N.
Kudo K. Sano Y. Ito K.
Can Mycobacterium tuberculosis infection prevent asthma and other
allergic disorders?. International
Archives of Allergy & Immunology.
124(1-3):113-6, 2001 Jan-Mar.
Abstract
It is generally considered that tuberculosis
(TB) is a disease which upregulates Th1 cell function. There is a hypothesis
that infection of Mycobacterium tuberculosis may prevent allergic disorders
such as bronchial asthma. However, our clinical experience of patients with TB
somewhat conflicts this hypothesis. Hence, we investigated Th1/Th2 balance in
the peripheral blood of patients with active TB by measuring serum levels of
IgE antibody and by intracellular cytokine assay. We found that serum levels of
IgE in the patients with active TB were significantly higher than in those with
lung cancer or with COPD. In the TB patients, titers of IgE tended to correlate
with disease severity. Intracellular cytokine assay demonstrated that
IFN-gamma-positive cells were significantly decreased in the patients with
active TB compared to normal controls. The ratio of IFN-gamma-positive
(Th1-like)/IL-4-positive (Th2-like) cells was remarkably reduced in the TB
patients (p < 0.0001). This ratio showed a significant negative correlation
with erythrocyte sedimentation rate and with C-reactive protein. Therapy
against TB for 2-3 months did not result in significant changes of the Th1/Th2
ratio. These findings suggest that infection of M. tuberculosis does not
systematically upregulate Th1 cells in some patients, and is unlikely to
prevent allergic disorders like asthma. Copyright 2001 S. Karger AG, Basel
2609. Uchio E.
Matsuura N. Matsumoto S. Kadonosono K. Ohno S. Histamine release test and measurement of
antigen-specific IgE antibody in the diagnosis of allergic conjunctival
diseases. Journal of Clinical
Laboratory Analysis. 15(2):71-5, 2001.
2610. Veres G. Helin T.
Arato A. Farkkila M. Kantele A.
Suomalainen H. Savilahti E.
Increased expression of intercellular adhesion molecule-1 and mucosal adhesion
molecule alpha4beta7 integrin in small intestinal mucosa of adult patients with
food allergy. Clinical Immunology.
99(3):353-9, 2001 Jun.
The mechanisms of adverse reactions to foods
in the gastrointestinal tract are poorly understood. Previous studies of other
atopic diseases and animal models suggest that adhesion molecules and mucosal
lymphocytes may be implicated in the pathogenesis of food allergy (FA). The aim
of our study was to investigate the expression of adhesion molecules and
mucosal lymphocytes in duodena of patients with food allergies and of controls.
Ten patients with FA to cereals (wheat, oats, and rye) or cow's milk and 9
control patients were included in the study. Quantitative analysis and
immunohistochemical stainings for two pairs of adhesion molecules
(intercellular adhesion molecule-1 (ICAM-1), lymphocyte function-associated
antigen-1 (LFA-1), alpha4beta7 integrin, and mucosal addressin cell adhesion
molecule (MAdCAM-1) and lymphocyte markers on endoscopic duodenal biopsy
specimens were performed. The villous structure and density of LFA-1-positive
cells were normal in every biopsy specimen, but the patients had significantly
more alpha4beta7+ cells in the intraepithelial space (P = 0.01). The expression
of ICAM-1 in the lamina propria of patients with FA was also substantially
increased (P = 0.003); however, staining with MAdCAM showed no intergroup
difference. Moreover, we found significantly increased CD4+ and HLA-DR+ cells
in the lamina propria of patients, in comparison to the controls, P = 0.05 and
P = 0.04, respectively. The densities of CD3, CD8, HLA-DP, T cell receptor
alphabeta+ and gammadelta+ cells and IgA-, IgA1-, and IgA2-containing cells did
not differ in the two groups studied. Our results suggest that the increased
expression of ICAM-1 and alpha4beta7 integrin may play an important role in the
pathogenesis of food hypersensitivity and with the elevation of CD4- and
HLA-DR-positive cells reflect a stage of inflammation in the structurally
normal intestines. Copyright 2001 Academic Press.
2611. Walsh GM. Annunziato L. Frossard N. Knol K. Levander S.
Nicolas JM. Taglialatela M.
Tharp MD. Tillement JP. Timmerman H. New insights into the second generation antihistamines. [Review]
[310 refs] Drugs. 61(2):207-36, 2001.
Second generation antihistamines are
recognised as being highly effective treatments for allergy-based disease and
are among the most frequently prescribed and safest drugs in the world. However,
consideration of the therapeutic index or the benefit/risk ratio of the H1
receptor antagonists is of paramount importance when prescribing this class of
compounds as they are used to treat non-life threatening conditions. There are
many second generation antihistamines available and at first examination these
appear to be comparable in terms of safety and efficacy. However, the newer
antihistamines in fact represent a heterogeneous group of compounds, having
markedly differing chemical structures, adverse effects, half-life, tissue
distribution and metabolism, spectrum of antihistaminic properties, and varying
degrees of anti-inflammatory effects. With regard to the latter, there is
growing awareness that some of these compounds might represent useful adjunct
medications in asthma therapy. In terms of safety issues, the current second
generation grouping includes compounds with proven cardiotoxic effects and
others with the potential for adverse drug interactions. Moreover, some of the
second generation H1 antagonists have given cause for concern regarding their
potential to cause a degree of somnolence in some individuals. It can be
argued, therefore, that the present second generation grouping is too large and
indistinct since this was based primarily on the concept of separating the
first generation sedating compounds from nonsedating H1 antagonists. Although
it is too early to talk about a third generation grouping of antihistamines,
future membership of such a classification could be based on a low volume of
distribution coupled with a lack of sedating effects, drug interactions and
cardiotoxicity. [References: 310]
2612. Warner L. Rochat RW. Fichtner RR. Stoll BJ. Nathan L. Toomey KE. Missed opportunities for congenital syphilis prevention in an urban southeastern hospital. Sexually Transmitted Diseases. 28(2):92-8, 2001 Feb.