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Biomedical subjects

A W Burks

Publications and source records attributed to A W Burks.

At least 19 recordsLinked to original sources

Allergenicity of peanut and soybean extracts altered by chemical or thermal denaturation in patients with atopic dermatitis and positive food challenges.

Peanuts and soybeans are two of the six most common foods to cause food hypersensitivity reactions in children. We used the serum of 10 patients with atopic dermatitis and positive double-blind, placebo-controlled, food challenges to peanut and two patients with atopic dermatitis and positive double-blind, placebo-controlled, food challenges to soybean to investigate the change in IgE-specific and IgG-specific binding to these proteins altered by either chemical or thermal denaturation. We used IgE- and IgG-specific ELISA-inhibition analyses to compare these effects on the crude peanut and crude soy extracts, as well as on the major allergenic fractions of both proteins. Heating the soy proteins at various temperatures and time intervals did not significantly change the IgE- or IgG-specific binding of the soy positive pooled serum. When the peanut proteins were subjected to similar heating experiments, the IgE- and IgG-specific binding did not change. When these same proteins were treated with enzymes in the immobilized digestive enzyme assay system used to mimic human digestion, the binding of IgE to the crude peanut and crude soy extracts was reduced; 100-fold for peanut and 10-fold for soybean. Therefore it appears that thermal denaturation of peanut and soybean protein extracts does not enhance or reduce IgE- and IgG-specific binding activity. Chemical denaturation appears to minimally reduce the binding of these proteins.

Adolescent

Identification and characterization of a second major peanut allergen, Ara h II, with use of the sera of patients with atopic dermatitis and positive peanut challenge.

Peanuts are frequently a cause of food hypersensitivity reactions in children. Serum from nine patients with atopic dermatitis and a positive double-blind, placebo-controlled, food challenge to peanut were used in the process of identification and purification of the peanut allergens. Identification of a second major peanut allergen was accomplished with use of various biochemical and molecular techniques. Anion exchange chromatography of the crude peanut extract produced several fractions that bound IgE from the serum of the patient pool with positive challenges. By measuring antipeanut specific IgE and by IgE-specific immunoblotting we have identified an allergic component that has two closely migrating bands with a mean molecular weight of 17 kd. Two-dimensional gel electrophoresis of this fraction revealed it to have a mean isoelectric point of 5.2. According to allergen nomenclature of the IUIS Subcommittee for Allergen Nomenclature this allergen is designated, Ara h II (Arachis hypogaea).

2S Albumins, Plant

Diagnostic approaches to the patient with suspected food allergies.

Adverse food reactions may be secondary to food allergy (hypersensitivity) or food intolerance. The clinical manifestations of food allergies depend on the target organ affected. Gastrointestinal, respiratory, and cutaneous symptoms are the most common of the clinical responses. The medical history, physical examination, and various in vivo or in vitro tests are useful in the diagnostic evaluation. Double-blind, placebo-controlled food challenges are the standard for diagnosis of food allergies. Presumptive diagnosis of food allergy based on patient history and on results of skin test or radioallergosorbent test is no longer acceptable, except in cases of severe anaphylaxis after an isolated ingestion of a specific food. Unless the physician provides an unequivocal diagnosis of food allergy, people will continue to alter their eating habits on the basis of misconceptions of food allergy.

Dermatitis, Atopic

Effect of soy protein ingestion on total and specific immunoglobulin G concentrations in neonatal porcine serum measured by enzyme-linked immunosorbent assay.

Crossbred neonatal pigs from spring and summer farrowings were used to evaluate the systemic humoral immune response in porcine serum after ingestion of soy protein. At 10 to 12 d of age (average BW 3.8 kg), pigs were randomly allotted to three treatment groups according to litter, weight, and sex. Treatments were intermittent gavage feedings two or three times daily for six consecutive days with nonfat dry milk (NFDM) or textured vegetable protein (TVP) and a nongavaged control group. Pigs were weaned at 20 to 22 d of age (average BW 5.7 kg) and fed a corn-soybean meal-based starter diet. Total serum immunoglobulin G (IgG) and IgG concentrations specific for soy protein were measured by ELISA. Blood samples were taken at 1 d of age after colostrum intake and at 4-d intervals from the beginning of treatment to 31 d of age. When averaged from d 1 to 31, spring-farrowed pigs had greater (P less than .005) total IgG and soy-protein-specific IgG concentrations than did summer-farrowed pigs (8.70 vs 6.51 mg/mL and 1.59 vs .55 micrograms/mL, respectively). Total serum IgG concentrations changed with time (P = .005); they initially decreased, then recovered after weaning. These changes were independent of treatment, sex, or farrowing season. Soy-protein-specific IgG concentrations also changed with time (P = .003); however, this trend was dependent on season (P = .014). Summer-farrowed pigs exhibited a more rapid and severe decrease in serum IgG concentrations specific for soy protein than did spring-farrowed pigs.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral

Identification of a major peanut allergen, Ara h I, in patients with atopic dermatitis and positive peanut challenges.

Peanuts are among the most common causes of immediate hypersensitivity reactions to foods. Serum from nine patients with atopic dermatitis and a positive double-blind, placebo-controlled, food challenge to peanut were used to begin the process of identification and purification of the major peanut allergens. Identification of a major peanut allergen was accomplished by use of anion-exchange column chromatography, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, ELISA, thin-layer isoelectric focusing, and IgE-specific immunoblotting. Anion-exchange chromatography revealed several fractions that bound IgE from the serum of the challenge-positive patient pool. By measuring antipeanut-specific IgE in the ELISA and in IgE-specific immunoblotting, we identified an allergenic component with two Coomassie brilliant blue staining bands by sodium dodecyl sulfate-polyacrylamide gel electrophoresis with a mean molecular weight of 63.5 kd. Examination of this fraction by the IgE antipeanut ELISA with individual serum and by the ELISA-inhibition assay with pooled serum, we identified this fraction as a major allergen. Thin-layer isoelectric focusing and immunoblotting of this 63.5 kd fraction revealed it to have an isoelectric point of 4.55. Based on allergen nomenclature of the IUIS Subcommittee for Allergen Nomenclature, this allergen is designated, Ara h I (Arachis hypogaea).

Allergens

Molecular analysis of X-linked agammaglobulinemia with growth hormone deficiency.

To address the relationship between the gene (or genes) that causes the syndrome of X-linked hypogammaglobulinemia with isolated growth hormone deficiency and the gene responsible for typical X-linked agammaglobulinemia (XLA), we have used cytogenetics, examination of X chromosome inactivation patterns in potential carriers of the defect, and linkage analysis to study two unrelated families in which the affected males had isolated growth hormone deficiency and immunologic findings indistinguishable from those of typical XLA. A deletion could not be demonstrated in either family by G-banded karyotypes or flow cytometric analysis of metaphase chromosomes. Studies of X inactivation showed that mothers of affected boys from both families exhibited selective use of a single X chromosome as the active X chromosome in B cells but not T cells. This pattern is the same as that seen in obligate carriers of typical XLA. Linkage analysis demonstrated the most likely location for this gene (or genes) to be the midportion of the long arm of the X chromosome between DXS3 and DXS94. This segment of the X chromosome, which constitutes approximately 5% of the total X chromosome, encompasses the gene for XLA. These findings are consistent with the combination of XLA and growth hormone deficiency being caused by a small, contiguous, gene deletion syndrome involving the gene for XLA or an allelic variant of the gene for typical XLA.

Agammaglobulinemia

Egg hypersensitivity and measles-mumps-rubella vaccine administration.

Because reports have described egg-sensitive individuals in whom anaphylaxis developed after measles vaccination, current recommendations include delaying administration of egg-derived vaccines until skin testing can be performed. Specifically, the 1988 Red Book recommends skin testing via scratch, prick, or puncture with 1:10 dilution of the vaccine and, if the result is negative, intradermal testing is suggested. The purpose of this study was to evaluate the likelihood of reaction to measles-mumps-rubella (MMR) vaccine in patients with documented egg sensitivity and to delineate the efficacy of skin-prick testing (SPT) to MMR as a predictor of hypersensitivity to the vaccine. Egg sensitivity was documented by initial SPT to egg and then, if possible, double-blind placebo-controlled food challenge (DBPCFC). Patients with a positive DBPCFC to egg or a history of anaphylactic egg sensitivity had a SPT with the MMR vaccine and then were given the MMR vaccine. Additionally, children with atopic dermatitis who had been previously proven egg sensitive via DBPCFCs were evaluated retrospectively for sensitivity to the MMR vaccine. Sixteen children with a history of egg sensitivity underwent SPT to egg, with a positive result 3 mm greater than the negative control found in 12 patients. Eight of these children had a positive DBPCFC to egg. The SPT to MMR vaccine was negative in all 16 children; vaccine administration followed with no resultant systemic problems. Three children had a local reaction at the site of injection. Twelve additional children with atopic dermatitis and egg sensitivity were reviewed. Each child had a positive SPT and DBPCFC to egg.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool

Antibody response to milk proteins in patients with milk-protein intolerance documented by challenge.

To evaluate the role of specific antibody response to milk proteins in patients with milk-protein intolerance, allergen-specific IGE, IgG, and IgG4 to these proteins were measured by ELISA. Bovine casein, gamma globulin (GG), beta-lactoglobulin, and lactalbumin were the milk proteins used. Antibody production to these proteins were analyzed in 18 patients who underwent milk-protein challenges (eight positive and 10 negative) and in five normal children used in the analysis. ELISA results for specific IgE, IgG, and IgG4 to these specific proteins demonstrated no statistically different response to the four milk proteins among the three patient groups by multivariate analysis. When the specific antibody results from the positive challenge group, the negative challenge group, and the normal group were combined, the IgE and IgG4 to GG and the IgG to casein were significantly higher (p less than 0.01) than the corresponding specific antibody to the other proteins tested. The IgG or IgG4 to GG would differentiate the positive from the negative challenge group (p less than 0.05) but were not significantly different from the normal control group. Contrary to previously published studies, these results indicate IgG specific for the milk proteins are not increased in patients with milk-protein intolerance. The data also support the concept that IgE and IgG4 are not elevated in these patients. Therefore, there appears to be no pathogenic role for these specific immunoglobulins in milk-protein intolerance.

Antibody Formation

Enzyme-linked immunosorbent assay and immunoblotting determination of antibody response to major component proteins of soybeans in patients with soy protein intolerance.

To evaluate the role of food-specific antibody response to soy protein and its fractions in patients with soy protein intolerance, allergen-specific IgG and IgE to these proteins were measured by enzyme-linked immunosorbent assays (ELISAS) and immunoblotting. A crude soy extract and the 7S, 11S, and whey fractions were isolated from commercial defatted soy flakes. Of 23 patients who underwent standardized soy challenges, seven were positive. The ELISA results showed no statistically different responses between the challenge-positive and challenge-negative groups in IgG or IgE specific to either the crude soy extract or the 7S, 11S, and whey fractions (p greater than .3 for all variables). In comparing the soy-positive patients, the level of IgE specific for 7S and 11S was significantly different compared with whey; the level of IgE specific for crude soy extract and 7S was significantly different compared with whey. The immunoblots reveal that IgG and IgE are present in varying amounts to multiple fractions of the soy protein. The study does not provide evidence for a pathogenic role of serum food-specific antibodies in soy protein intolerance.

Antibody Formation

Elevated interleukin-1 release by human alveolar macrophages during the adult respiratory distress syndrome.

Interleukin-1 (IL-1), a modulatory protein with immune and inflammatory functions, is spontaneously released by tissue macrophages in lower concentrations compared with peripheral blood monocytes. Conversely, in idiopathic pulmonary fibrosis, sarcoidosis, and certain inflammatory diseases, increased amounts of IL-1 are released by alveolar macrophages (AM). We examined IL-1 production by AM from patients with adult respiratory distress syndrome (ARDS) and compared it with that in patients with severe pneumonia requiring assisted ventilation, patients with pneumonia requiring parenteral antibiotics, and healthy control subjects. In vitro, ARDS AM released significantly more total IL-1 and IL-1 beta than did ARDS AM in patients with pneumonia and in control subjects. Moreover, after stimulation of these cells with 10 micrograms/ml of lipopolysaccharide (LPS), ARDS AM significantly increased release of IL-1 and IL-1 beta. AM from patients with severe pneumonia also released greater amounts of both IL-1 and IL-1 beta as fresh explants and after LPS stimulation when compared with control subjects. Incubation of AM with 250 U/ml human interferon-gamma (gamma IFN) was associated with less IL-1 beta release. However, stimulating AM from patients with ARDS and severe pneumonia with gamma IFN plus LPS enhanced the release of IL-1 beta compared with that in patients with pneumonia and in control subjects. ARDS AM released significantly more IL-1 beta than did all of the other groups. These results demonstrate that AM from patients with ARDS are capable of releasing significantly greater amounts of IL-1, which may be related to the progression of acute lung injury.

Bronchoalveolar Lavage Fluid

Immune function in patients treated with phenytoin.

Multiple immunologic side effects have been ascribed to phenytoin. Numerous reports in the literature discuss the possible cellular and humoral abnormalities that appear to be present in patients given phenytoin. The most consistent finding is a reduction in serum IgA found in up to 20% of patients. To resolve some of the conflicting studies on cellular immune status, 191 patients taking phenytoin were evaluated initially with an serum IgA determination, and then further immune studies were done on the 11% with IgA values lower than two standard deviations below the mean. Data collected included total lymphocyte counts, lymphocyte population studies, and responses to in vitro mitogen stimulation. Only 2 of 191 patients had serum IgA values less than 5 mg/dL, which is an incidence not significantly different than that in the population at large. The patients with decreased serum IgA values did not have an increased incidence of autoimmune phenomena, allergic disorders, gastrointestinal manifestations, or recurrent upper respiratory tract infections. Their cellular immune status showed no significant variations from control values. Thus it appears that routine monitoring of patients on phenytoin with serum IgA determinations is of limited value, and the immunologic side effects of phenytoin are not expressed as a cellular abnormality.

Adolescent

Allergenicity of major component proteins of soybean determined by enzyme-linked immunosorbent assay (ELISA) and immunoblotting in children with atopic dermatitis and positive soy challenges.

Recent studies have implicated soybeans as one of the major food allergens in children. Serum from eight patients with atopic dermatitis and positive double-blind, placebo-controlled food challenges to soy were used to investigate allergen-specific IgE and IgG antibody to soy protein and its fractions. ELISA and immunoblotting techniques were used for this purpose. A crude soy extract, as well as the 7S, 11S, and whey fractions, were isolated and purified for the in vitro studies from commercial defatted soy flakes. ELISA results demonstrated a statistically significant increased IgE and IgG response to the crude soy extract compared to that of normal control subjects. There was also an increase in IgE specific for 7S and IgG specific for 11S in the atopic group. The immunoblots reveal that IgE and IgG are present in varying amounts to multiple fractions of the soy protein. These results indicate that IgE and IgG specific to crude soy are elevated in patients with positive double-blind, placebo-controlled food challenges to soy but that no one fraction is clearly more antigenic.

Adolescent

Double-blind placebo-controlled trial of oral cromolyn in children with atopic dermatitis and documented food hypersensitivity.

Ten children with challenge-proven egg hypersensitivity and atopic dermatitis were enrolled in a double-blind crossover trial of oral cromolyn sodium. After receiving up to 40 mg/kg/day of cromolyn or placebo for 1 week, patients underwent double-blind placebo-controlled oral food challenges. In the eight subjects who reacted to the food challenge, there was no significant difference in the amount of food allergen eliciting the positive response, the timing of onset until first subjective or objective symptoms developed, symptoms provoked, or the duration of the symptoms in either phase of the study. This study demonstrates no benefit in the treatment of children with atopic dermatitis and food hypersensitivity with oral cromolyn sodium.

Administration, Oral