Relapsing anaphylaxis to bee sting in a patient treated with beta-blocker and Ca blocker.
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Biomedical subjects
Publications and source records attributed to S Kivity.
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Six patients are described with a history of cold-related urticaria in whom standard tests (water-immersion and ice-cube) did not induce symptoms. Only total-body cold exposure induced generalized urticaria. Systemic cold urticaria should, therefore, be included in the differential diagnosis of cold-dependent allergic disorders.
Erythromycin and other antibiotics have been used empirically in the treatment of patients with chronic obstructive pulmonary disease (COPD). We studied whether this empirical role of antibiotics might not be related to a possible direct effect on respiratory glycoconjugate (RGC) secretion. The effect of erythromycin on RGC secretion and hypersecretion was studied in an in vitro preparation of human airways that were secreting [3H]glucosamine respiratory glycoconjugate (RGC), and on a human endometrial adenocarcinoma cell line secreting a glycoconjugate (tumor glycoconjugate = TGC) chemically similar to the RGC secreted by the airways. Erythromycin at 10(-5) M reduced RGC secretion by 35 +/- 4% (n = 9, p less than 0.001) in both human airways and the adenocarcinoma cells, and was increasingly active in the pharmacologic range of 10(-7) to 10(-4) M. The inhibitory effect of erythromycin was maximal within 16 h and was still evident 34 h after incubation. Erythromycin was noted to reduce both spontaneous (baseline) and stimulated RGC secretion (by histamine and methacholine) from airways in culture. The blocking effect appeared to be more selective for histamine than methacholine. These effects were not associated with any toxicity to the tissues and were not associated with the inhibition of protein synthesis. Dexamethasone also inhibited RGC release in both assay systems and exhibited dose-related effects in the physiologic ranges (10(-9) to 10(-5) M). When administered together, erythromycin and dexamethasone had an additive inhibitory effect on RGC secretion (68.0 +/- 3.0%, n = 7, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
The effect of caffeine on exercise-induced bronchoconstriction was examined in ten patients with bronchial asthma. Placebo and caffeine 3.5 mg/kg and 7 mg/kg were given two hours before exercise. Spirometry was taken at one and two hours following caffeine and at 5, 15, and 30 minutes following exercise. Caffeine significantly improved baseline FEV1 and prevented exercise-induced bronchoconstriction only at a dose of 7 mg/kg. Caffeine was well tolerated by the patients. These data suggest that only high doses of caffeine significantly prevent a postexercise drop in FEV1.
The effectiveness of a sodium cromoglycate isoosmolar solution (288 mOsmol/L) versus hypoosmolar commercial solution (40 mOsmol/L) was studied in 14 asthmatic children with exercise-induced asthma. The mean FEV1 after exercise in patients pretreated with a sodium cromoglycate hypotonic solution compared with FEV1 at rest was -2% +/- 10%. The mean FEV1 after exercise in patients pretreated with an isotonic solution compared with FEV1 at rest was 3% +/- 6%. This statistically significant difference (P less than .01) proves that the effectiveness of sodium cromoglycate can be improved by raising the osmolarity to isotonic levels.
We evaluated the airway effect of inhaled verapamil by comparing it to aerosolized sodium cromoglycate. Airway hyperreactivity was assessed using inhaled hypertonic saline. Sodium cromoglycate prevented bronchoconstriction in all the patients. Inhaled verapamil induced significant bronchial constriction in two patients. The combination of verapamil with sodium cromoglycate was as effective as sodium cromoglycate. It was concluded that inhaled verapamil is not effective in preventing bronchoconstriction induced by hypertonic saline.
The relationship between recurrent croup and bronchial asthma was evaluated by measuring bronchial hyperreactivity (methacholine challenge), physiologic parameters of upper airway obstruction, and skin response to environmental allergens. Patients with recurrent croup (n = 10) had a significantly higher degree of airway hyperreactivity and atopy than healthy children (n = 15), but significantly less than the patients with bronchial asthma (n = 30). No physiologic signs of upper airway obstruction could be detected at rest or following methacholine. It is suggested that bronchial asthma and recurrent croup share a few characteristics.
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The statistical data for asthma mortality in Israel from 1960 to 1986 are presented. From the analysis of the data it is clear that the asthma mortality rates in Israel were among the lowest reported (for the general population as well as for the 5 to 34-year age group), although a trend toward increase was seen during 1982 to 1986.
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The combined effect of oral nifedipine and aerosolized sodium cromoglycate on the airway response to inhaled sodium chloride at increasing concentrations was randomly studied in 10 patients with bronchial asthma. Nifedipine (20 mg) protected the airways in 6 of the 10 patients, and sodium cromoglycate (20 mg) in all the 10 patients. Following both drugs, the airway response to hypertonic saline was further reduced when compared to each drug on its own. It is concluded that the combination of nifedipine with sodium cromoglycate might be of benefit in the treatment of difficult asthmatic patients.
Inhalation of distilled water (DW) frequently induces bronchoconstriction in asthmatic patients. We compared the degree of refractoriness to repeated inhalation of DW to that of repeated exercise challenge in 14 asthmatics. Refractoriness was seen following inhalation of DW. The maximum drop in FEV1 (% of predicted) following the first challenge was 31 +/- 13% and the maximal drop following the second challenge was 18 +/- 9% (P less than .01). The pattern of the airway response seen during 45 minutes following repeated inhalation of DW and exercise was similar. Cross refractoriness was also seen when inhalation of DW followed exercise challenge. It was concluded that both stimuli probably share a common mechanism of action on the airway.
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Food-associated, exercise-induced urticaria-angioedema is increasingly being recognized. We studied five atopic individuals in whom ingestion of food was followed by exercise-induced urticaria-angioedema. The combined effect of food and exercise on skin wheal response to compound 48/80 and histamine was studied. Symptoms could be reproduced in only four of the patients who performed strenuous exercise after ingestion of food to which they were skin sensitive. When symptoms appeared, that is, after a combination of food and exercise challenge, there was a marked increase in the wheal response to compound 48/80 (greater than 200%) and not to histamine. Food or exercise challenge alone did not induce any significant change in the skin reactivity to compound 48/80 or to histamine. It was concluded that mast cell releasability could be increased when the patient was subjected to combined factors.
It has been shown that alveolar macrophages (AM) are able to modulate lymphocyte proliferation in vitro. The purpose of this study was to evaluate the effect of AM on the proliferation of autologous peripheral lymphocytes (APL) in patients with interstitial lung disease (ILD) compared to controls. Thirty patients were investigated: eight with idiopathic pulmonary fibrosis (IPF), nine with sarcoidosis(SA), seven with rheumatoid arthritis (RA) and six controls (CO). AM and APL were co-cultured at an increasing macrophage/lymphocyte ratio: 1%, 10%, 20% and 50%. A dose-dependent effect was observed and related to the number of AM added to APL, enhancing at low ratios and suppressing at high ratios. Suppression of proliferation by 50% AM differed in the four groups tested: 94.6% (92-98) in IPF, 73.0% (49-100) in SA, 43% (25-57) in RA, 32.4% (22-41) in the CO (P less than 0.01, P less than 0.05, and P0.05 respectively, compared to CO). Suppressive cell activity of AM from patients with ILD was higher than suppressive cell activity of the CO group. Suppression with 10% of AM in ILD group was 18% (2.2-62) compared with 2.58% (-13-17) in the CO group (P less than 0.05). 20% AM in ILD group showed 35% (3-76) suppression in comparison with 9.76% (-11-27) in the control group (P less than 0.01), 50% AM in ILD have a suppressive activity of 71% (25-100) in contrast to 32.4% (22-41) in control (P less than 0.01). In conclusion, AM from patients with interstitial lung diseases have a significantly stronger suppressive effect on the proliferation of autologous peripheral lymphocytes than controls. This is a new aspect of the study of activation of AM in these kinds of disorders.
This study was designed to establish IgE values in different allergic diseases in an Israeli population and healthy controls. The geometric mean IgE in the control group was 41 IU/mL (range = 15 to 111 IU/mL) and in the atopic group 142 IU/mL (range = 36 to 556 IU/mL). The highest values were found in patients with asthma plus allergic rhinitis plus atopic dermatitis and asthma plus atopic dermatitis. The lowest values were from patients with urticaria. There was a gradual increase in IgE levels from 4 to 10 years and then a gradual decrease. IgE was significantly higher in males, particularly in the 21 to 40-year age group and above 60 years. There was no difference in IgE levels in the various ethnic groups. There was a correlation between IgE levels and the number of positive skin tests. Peripheral eosinophilia was found in one-third of the patients with low IgE and in 2/3 of the patients with IgE above 500 IU/mL. An IgE of 120 IU/mL or more was found in 56% of patients with asthma in addition to other atopic diseases. Only 10% of normal controls had an IgE value of 120 IU/mL or more. These results are similar to those reported from European and North American countries.
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