PubMed Health⌕ Search

Biomedical subjects

L Grammer

Publications and source records attributed to L Grammer.

17 recordsLinked to original sources
PubMed1998

Utility of antibody in identifying individuals who have or will develop anhydride-induced respiratory disease.

OBJECTIVE: To define the utility of serum antibody against trimellitic anhydride (TMA) in predicting which individuals employed, at Amoco Corporation, in the manufacture of TMA have or will develop immunologically mediated respiratory disease, such as asthma, due to exposure to TMA. METHODS: In 1990 we initiated a clinical and immunologic cross-sectional study of 181 subjects exposed to TMA for at least 1 year who had not been diagnosed with an immunologic respiratory disease. We then clinically and immunologically followed 119 of these subjects for the next 5 years to determine whether they would develop an immunologic respiratory disease due to TMA exposure. RESULTS: Of the 16 individuals with IgE against TMA conjugated to human serum albumin (TM-HSA) in 1990, 3 had immediate asthma and another 6 developed asthma during the 5-year follow-up. Of the 165 individuals without IgE against TM-HSA, none had immediate asthma in 1990 and only 1 of 102 individuals followed for 5 years developed asthma. Of the 44 subjects with IgG against TM-HSA, 6 had an immunologic respiratory disease in 1990 and 2 more developed it in the ensuing 5 years. Of the 137 subjects without IgG against TM-HSA, none had an immunologic respiratory disease in 1990 and none of the 80 subjects followed for 5 years developed it. CONCLUSIONS: Development of antibody against TM-HSA, both IgE and IgG, is predictive of subjects who have or will develop immunologically mediated respiratory disease due to TMA exposure. The absence of antibody is a potent negative predictor.

Adult↗
PubMed1996

Outcome of specific bronchial responsiveness to occupational agents after removal from exposure.

A decrease in specific bronchial responsiveness (SBR) could occur after removal from exposure to an agent causing occupational asthma as a result of loss of immunologic and/or nonspecific bronchial reactivity (NSBR). We studied 15 subjects with occupational asthma (eight to a high- and seven to a low-molecular-weight agent, isocyanate in all instances), proved by specific inhalation challenges (SIC) done 2 yr or more before. Subjects were reexposed in the same way as in the initial SIC: for subjects who did not react, the exposure was increased until either an asthmatic reaction occurred or a maximum of 2 h was reached. NSBR was assessed before and after SIC. Subjects had a decrease in their SBR if the total dose of agent necessary to induce asthmatic reaction was greater by twofold compared with the initial SIC. There was a significant improvement in NSBR in seven of 15 subjects. Nine of 15 subjects (60%) had a decrease in their SBR. Only one had a complete loss of SBR. Changes in NSBR, molecular weight of the offending agent, decrease of antibody level against offending agents, or duration of exposure at work did not explain the decrease in SBR. We conclude that after removal from exposure to the offending agent a majority of subjects (60%) show a decrease but a persistence of SBR to high- and low-molecular-weight agents.

Asthma↗
PubMed1991

Reassessment of the temporal patterns of bronchial obstruction after exposure to occupational sensitizing agents.

Typical asthmatic reactions after exposure to common or occupational allergens have been classified as isolated immediate, early late, late, and dual (Pepys and Hutchcroft, 1975). Atypical reactions can also occur, but their temporal behavior and frequency are unknown. We analyzed 69 bronchospastic reactions after exposure to three types of occupational sensitizers in the laboratory: isocyanates, western red cedar, and IgE sensitizing agents. Graphs of the reactions were presented to three observers in a blind, randomized way. Reactions were defined as follows: (1) typical patterns, that is, isolated immediate, early late, late, and dual, as put forward by Pepys and Hutchcroft, and (2) atypical patterns including progressive (onset, during, or minutes after exposure, progressing to a maximum reaction 5 to 6 hours later) and square waved (similar to a dual reaction but with only partial recovery [less than 10%] between the immediate and late falls in FEV1). Some curves were also analyzed by polynomial regression. The three observers agreed in 59/69 cases (86%), and a consensus was reached after discussion for the remaining subjects. Fifteen of 63 (22%) reactions were atypical. IgE-mediated reactions and reactions to red cedar were, respectively, mainly of the immediate and late types. The distribution of reactions to isocyanates, however, was significantly different (chi-square, 6.1; p = 0.01), the "progressive" pattern occurring in 7/23 instances (30%). There was a satisfactory concordance between visual assessment and polynomial fit analysis in distinguishing dual from square-waved reactions. We conclude that isocyanates frequently cause atypical progressive bronchospastic reactions that are rarely observed after exposure to IgE agents and western red cedar.

Adult↗
PubMed1989

Specific serum antibodies against isocyanates: association with occupational asthma.

Although increased levels of specific IgE and/or IgG antibodies have been documented in individual cases of occupational asthma caused by common types of isocyanates (hexamethylene diisocyanate [HDI] and diphenylmethane diisocyanate [MDI]), the frequency among workers with occupational asthma is still unknown. The sera of 62/65 workers referred for specific inhalation challenges with isocyanates were analyzed for the presence of specific antibodies to the relevant isocyanate. Most workers (39, 63%) were exposed to HDI, some to MDI (17, 27%), and a few to toluene diisocyanate (six, 10%). Specific inhalation challenges were positive in 29 subjects, eliciting either immediate (seven), early late (two), late (13), or dual (seven) reactions. Specific inhalation challenges were more often positive in those subjects with increased nonspecific bronchial responsiveness. Twenty-nine subjects demonstrated increased levels of specific IgE and/or IgG antibodies to isocyanates in the absence of antibodies against human serum albumin (increased IgE only, no subject; IgG only, 20; both IgE and IgG, nine subjects). Although there was a loose association between the results of specific inhalation challenges and levels of specific IgE, the association was much better with the level of specific IgG. Indeed, 21 of the 29 subjects (72%) with positive challenges had increased levels of specific IgG, whereas 25 of the 33 subjects (76%) with negative challenges had normal levels of antibodies. The association was significant with both HDI and MDI. The levels of antibodies were not significantly associated with the type of temporal reaction.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies↗
PubMed1988

The use of epinephrine in the treatment of older adult asthmatics.

Three subcutaneous doses of 0.3 mL 1:1,000 epinephrine were given 20 minutes apart to 95 adult asthmatics 15 to 96 years old during 108 asthma exacerbations. Patients with a history of recent myocardial infarction or of angina were excluded from our study. Heart rhythm and rate, blood pressure, respiratory rate, and clinical response were prospectively evaluated before, during, and after the administration of epinephrine. There was no significant difference in the occurrence of ventricular arrhythmias between patients less than 40 and more than 40 years old. The mean systolic and diastolic blood pressures, mean heart rate, and mean respiratory rate decreased with treatment in the older population. Our results suggest that epinephrine is safe to use in acute asthmatics of any age.

Acute Disease↗
PubMed1986

Insulin allergy.

While immunologic responses to insulin such as cutaneous reactivity and antibody against insulin are common significant clinical problems related to those immunologic reactions are uncommon. Immunologic responses that have been described included Gell and Coombs type I, II, and IV. The antigen may be the result of any of several factors: insulin as a heterologous protein, altered tertiary structure of insulin, presence of non-insulin protein contaminants, or pharmaceutical formulation additives. IgE mediated local reactions are the most common and almost always subside spontaneously. IgE mediated anaphylaxis is the most important immunologic problem; it can be managed safely and successfully by temporary reduction in dose or by insulin desensitization. Other systemic immunologic reactions, insulin resistance and serum sickness, are extremely rare and respond to corticosteroid therapy.

Anaphylaxis↗
PubMed1981

Seasonal variation of IgE antibody specific for ragweed antigen E (IgE-a-AgE) from the basophil surface in patients with ragweed pollenosis.

Seasonal elevation in total serum IgE and IgE antibody specific for antigen E (IgE-a-AgE) are well recognized in patients with ragweed pollenosis. We found that the ratio of specific IgE-a-AgE to total IgE in plasma was the only measure predictive of the number of specific IgE-a-AgE molecules per basophil. Although both total and specific IgE rose with season, the ratio did not change, the number of IgE-a-AgE molecules per basophil did not change, and histamine release in response to AgE did not increase.

Antibody Specificity↗
PubMedDate not supplied

Patients with allergic disease and anti-social behavior: their potential risks to themselves, health care personnel, and other patients.

A series of 7 allergic patients seen by one Allergy Service in a two-year period were identified as being allegedly involved in anti-social activities. They were either seriously ill or mimicked serious illness and by their behavior constituted a potential risk to themselves, other patients or health care personnel. Early identification of such high risk patients protects both patients and health care personnel.

Adult↗
PubMedDate not supplied

Absence of nasal priming as measured by rhinitis symptom scores of ragweed allergic patients during seasonal exposure to ragweed pollen.

A priming effect, increasing responsiveness of the nasal mucosa as measured by nasal patency or resistance, has been reported to occur after nasal challenge on successive days. Because it has been suggested that the priming effect may be of clinical importance, we have studied whether such an effect occurs during natural pollen exposure as measured by symptom-medication scores in 29 patients with ragweed rhinitis. By Wilcoxon's signed rank test, we compared the symptom-medication scores of patients during two 7-day periods, one early in the season and one later, in which the weekly pollen count was approximately 250 grains/m3; we also compared an early and late period during which the weekly pollen count was approximately 500 grains/m3. There were no statistically significant differences in scores between early and late seasonal periods at the same pollen count. We conclude that the priming effect is not a clinically significant phenomenon during natural pollen exposure in allergic rhinitis patients.

Humans↗
PubMedDate not supplied

A clinical and immunologic study of employees in a facility manufacturing trimellitic anhydride.

We conducted a 1-year cross-sectional survey of 474 employees of a large chemical manufacturing complex to relate trimellitic anhydride (TMA) exposure to serologic and clinical outcomes. In 1988-1989, employees were evaluated by history and immunologic assay of total (T) and IgE antibody to trimellityl human serum albumin (TM-HSA). All employees were assigned to a TMA exposure class, from 1 (highest) to 5 (lowest), by an industrial hygienist, independent of the clinical and immunological data. Thirty-two (6.8%) of 474 employees had a TMA immunologic syndrome, 31.6% with an irritant response and 61.6% with no symptoms. Twelve had asthma/rhinitis, 10 had the late respiratory systemic syndrome (LRSS), four had late onset asthma, one had late onset arthralgia, and five had a distant history of LRSS. Included in this survey of the entire work force were 321 new enrollees, who had not joined the previous (1976 to 1988) voluntary surveillance program. Only four (1.3%) of the new enrollee group had a TMA immunologic syndrome. Among new enrollees, there were lower mean total and IgE serum antibody levels in lower exposure classes and a higher percentage with elevated antibody levels in high exposure classes (for T, x2 = 17.5, p = .0016; for IgE, x2 = 76.7, p less than .0001). In the new enrollee population, demographic variables of age, sex, date of hire, and smoking status were examined related to antibody levels. Only current or former smoking was related to elevated total antibody levels.

Antibodies↗
PubMedDate not supplied

ELISA screening tests for specific IgE and IgG antibody in employees exposed to trimellitic anhydride (TMA).

The objective of the study was to determine whether ELISA screening tests could be developed for specific IgE and IgG antibody in surveillance studies of employees exposed to trimellitic anhydride (TMA). Such tests would obviate the need for radiolabeling and disposal of radioactive wastes. The design of the study was a masked comparison of serologic results of ELISA screening tests with the criterion standard radioimmunoassay (RIA) currently used. The participants were 233 employees of a chemical plant that manufactures TMA. When the screening ELISA serologic results for IgG against TM-human serum albumin (TM-HSA) were compared with those of the RIA, the sensitivity was 92%, the specificity was 93%, the positive predictive value was 62%, and the negative predictive value was 99%. When the screening ELISA serologic results for IgE against TM-HSA were compared with those of the RIA, the sensitivity was 100%, the specificity was 91%, the positive predictive value was 31%, and the negative predictive value was 100%. We conclude that ELISA screening tests for antibody to TM-HSA have sufficient sensitivity, specificity, and predictive value to be useful in surveillance studies of employees exposed to TMA.

Chemical Industry↗