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PubMed1974

Candida precipitins in pregnant women: validity of the test systems used.

Sera from 200 pregnant women, with symptoms suggestive of vaginitis and harbouring yeast in the vagina, were examined for precipitating antibodies to three antigens of C. albicans, using a gel double diffusion test. A high overall incidence of precipitin-positive sera (47.5%) was found compared with an incidence of 18% in the unselected pregnant population previously studied (Stanley, Hurley, and Carroll 1972). Using the clinicopathological criteria of Carroll, Hurley, and Stanley (1973), a final aetiological diagnosis of C. albicans mycosis was reached in 75 cases and precipitins were demonstrated in 64%. Forty-eight women harbouring C. albicans responded favourably to a single course of antifungal treatment, and probably had mycotic vaginitis. The incidence of precipitins in this group was 42%. C. albicans was isolated from a further 55 of 62 patients, in whom the incidence of precipitins was 32%.;Booking' sera were investigated from 50 of the 200 women studied. Sixty-four per cent of women had symptoms of vaginitis at booking and 32% were precipitin positive. Twenty-eight per cent had precipitins on both occasions, and a further 24% acquired candida precipitins during pregnancy. None of the seven newborn with oral or skin thrush had precipitins to C. albicans.The results indicate that the detection of precipitating antibodies to C. albicans, particularly to all three of the antigens described in this paper, would be a useful additional criterion in the diagnosis of candida vaginitis, particularly if the vaginitis were persistent, recurrent, or unresponsive to therapy. The sensitivity of the test system used was 64%, and its specificity 87%; as such, the test is valid and may be reasonably useful as a screening procedure.

Antigens↗

PubMed1981

Characterization of the glycoprotein antigens which mediate the Schistosoma japonicum circumoval precipitin reaction.

The circumoval precipitin test is a serological test used for diagnosis of schistosomiasis japonica. Soluble egg antigens of Schistosoma japonicum block the formation of the circumoval precipitin by serum from infected humans. Consequently, circumoval precipitin inhibition was used to monitor purification of the soluble egg antigens of S. japonicum. Crude egg antigens were separated into protein and glycoprotein fractions by lectin chromatography on concanavalin A Sepharose. The glycoprotein fraction produced two intense precipitin lines upon immunodiffusion analysis with human chronic infection sera. The protein fraction produced two faint precipitin lines which did not cross-react with those of the glycoprotein fraction. The glycoprotein fraction contained 90% of the circumoval precipitin inhibitory activity. Isoelectric focusing of (125)I-labeled concanavalin A Sepharose fractions revealed at least four groups of potential S. japonicum antigens, termed JAG I, II, and III, and a JAG IV complex. These had isoelectric points ranging from 3.2 to 6.7. In these respects, the S. japonicum egg antigen glycoproteins are similar to those of Schistosoma mansoni. The glycoproteins were further separated by diethylaminoethyl ion-exchange chromatography. On immunodiffusion analysis it was found that one of the strong Ouchterlony precipitin lines was associated with glycoproteins that did not adsorb to diethyl-aminoethyl columns, whereas the second Ouchterlony precipitin was heterodisperse, being present in the first, second, and third of the four peaks eluted from the diethylaminoethyl column. Immunoelectrophoresis of the diethylaminoethyl fractions demonstrated that the antigen present in highest concentration in soluble egg antigen glycoproteins, JAG II, was extremely heterodisperse in its behavior on diethylaminoethyl columns. This is unlike the S. mansoni antigens which can be easily separated by diethylaminoethyl ion-exchange chromatography.

Animals↗

PubMed1964

Micro diffusion precipitin tests for enteroviruses and influenza B virus.

Middleton, G. K., Jr. (Bowman Gray School of Medicine, Winston-Salem, N.C.), H. G. Cramblett, H. L. Moffet, J. P. Black, and H. Shulenberger. Micro diffusion precipitin tests for enteroviruses and influenza B virus. J. Bacteriol. 87:1171-1176. 1964.-A simple micro precipitin gel diffusion test has been adapted to the study of viral antigens. As far as is known from a review of recent literature, this is the first use of the ECHO viruses in precipitin tests and the first attempt to demonstrate by the gel diffusion technique precipitins in a patient's serum after natural virus infection rather than artificial immunization. The principal value of this technique in virology is the rapid identification or qualitative analysis of viral antigen preparations by use of pooled or specific hyperimmune sera. Virus concentrations of 10(7)tcid(50) per 0.1 ml are required for reliable results, but only 0.015 ml of serum is necessary for each test. Virus-serum precipitin reactions were type-specific except for reciprocal precipitation of ECHO 1 and ECHO 8 by their hyperimmune sera. No viral antigens have been found common to two or more virus types among those tested. Precipitins for viral antigens occur frequently in serum of patients after a viral infection and are readily detected by micro precipitin gel diffusion tests. However, this precipitin test remains at present a tool for virus and antigen identification and offers an approach for research appraisal of host response to infections.

Animals↗

PubMed1989

Steep gradients of inert substances as supports for precipitin reactions.

Precipitin reactions were conducted in the wells of micro titer plates and the light "absorbance" at 405nm plotted as a function of the neg log2 dilutions of the antigens using the Titertek Multiscan apparatus. The procedure followed was to incorporate antibody in 20% sucrose and to diffuse the mixture into serial two-fold dilutions of antigen overlaid on the sugar-antibody columns in the wells. Where the antigen met its antibody in equivalence precipitin bands formed. The bands of precipitates remained suspended. The precipitates formed by mixing the antibody sugar mixture with the serial two-fold dilutions of the antigen were also recorded in the Titertek Multiscan apparatus. Tobacco mosaic virus and its IgY type antibody produced simoidal precipitin curves with the layering as well as the mixing techniques. The haemocyanin of the whelk and its IgY antibody yielded a precipitin diagram with the layering technique which gave evidence to three antigens. The three antigens in the haemocyanin was confirmed by two dimentional Laurell-electrophoresis. Semi-purified human colostral dimeric IgA and its IgY antibody produced a precipitin diagram which showed evidence of four of five antigens. With the mixing technique a single precipitin maximum was obtained preceded by a prozone. Rabbit Ig and its IgY antibody gave a precipitin curve with two maxima. The precipitin curve obtained when the reagents were mixed had one peak preceded by a prozone.

Animals↗

PubMed1987

Serum precipitins against microbes in mouldy hay with respect to the geographical location of the farm and to the work of farmers.

This study was based on a sample of 3,065 farmers from a larger survey population of 12,056 Finnish farmers. Data were gathered in a postal survey conducted by the Social Insurance Institution of Finland. Serum precipitins were determined by a microplate method of immune diffusion. The antigen panel consisted of mycelial antigens of Micropolyspora faeni, Thermoactinomyces vulgaris, Aspergillus fumigatus, and Aspergillus umbrosus. Geographical variation in the prevalence of precipitins was statistically significant, evidently due to climatic differences. The more intensive the cattle raising, the more commonly were precipitins found in the sera of farmers. For participation in animal tending (cattle, pigs, or poultry) or in plant cultivation work only, the prevalence of precipitins was largest among farmers who tended cattle or swine. According to earlier studies, serum precipitins to Thermoactinomyces vulgaris are associated with farmer's lung. Precipitins to this microbe were most commonly found in farmers who tended pigs and were also very common in farmers who worked only in plant cultivation. These findings imply that farmer's lung may also develop among pig farmers and grain producers. Precipitins to Thermoactinomyces vulgaris were clearly related to the type of grain drier used on the farm. The study failed to identify detailed tasks in farming associated with large prevalence of precipitins, probably owing to considerable overlap in the exposure encountered in different tasks.

Agriculture↗

PubMed1984

Reactivity of alkali-soluble, water-soluble cell wall antigen of Coccidioides immitis with anti-Coccidioides immunoglobulin M precipitin antibody.

The alkali-soluble, water-soluble cell wall antigen of Coccidioides immitis (C-ASWS) mycelia and spherules was shown to react with anti-Coccidioides immunoglobulin M (IgM) precipitin antibody, both in the classical tube precipitin test and in the immunodiffusion assay for tube precipitin antibody (IDTP). The reactions obtained between C-ASWS and reference IgM precipitin antibody were identical to the reaction obtained when reference coccidioidin (CDN) was used. Definitive proof that C-ASWS extracts contain antigenic determinants that are reactive with IgM tube precipitin antibody was obtained by solid-phase immunoadsorption. Elution of reference IDTP antiserum over a column containing mycelium C-ASWS coupled to Sepharose 4B completely adsorbed precipitin antibody; i.e., reactivity in the IDTP was demonstrable in the column eluate but not in the column effluent fraction. The antigenic composition of C-ASWS extracts was evaluated and compared with that of CDN by two-dimensional immunoelectrophoresis against burro anti-CDN. The results established that both mycelium and spherule C-ASWS contain antigenic determinants in common with only one antigen present in CDN. The latter, designated antigen 2, is a large polymer which is predominant among the antigenic components in CDN. On a dry weight comparison, antigen 2 determinants were most concentrated in spherule C-ASWS, followed by mycelium C-ASWS and reference IDTP antigen. The finding that C-ASWS extracts are reactive with IgM tube precipitin antibody and are antigenically identical to antigen 2 in CDN suggests that antigen 2 is the biologically active component of CDN in tube precipitin assays.

Cell Wall↗

PubMed1973

California arbovirus (La Crosse) infections. II. Precipitin antibody tests for the diagnosis of California encephalitis.

Precipitin antibodies to California group arboviruses were studied by double agar gel immunodiffusion (ID) and counterimmunoelectrophoresis (CEP). Forty children with California encephalitis (CE), 12 patients with other forms of meningoencephalitis, and 120 residents of endemic CE areas were tested. Precipitin antibodies were detected only in the 40 patients with CE, whereas hemagglutination-inhibiting, neutralizing, and complement-fixing antibodies were also found in persons without a history of CE. Precipitin antibodies did not persist for more than a year, in contrast to the other three antibodies which may be detected for 2 or more years. Of the children with CE, 36% had precipitin antibodies in their acute sera by CEP and 44% by ID. Precipitin responses were subtype-specific, and the patients reacted most strongly with La Crosse virus. The results indicated that precipitin techniques would be useful for the early detection of CE in some patients and that the presence of precipitin antibodies in a patient with acute central nervous system infection is strongly suggestive of CE. In addition, precipitin tests can be used to distinguish the California subtype responsible for CE in a given area.

Antibodies, Viral↗

PubMed1994

Farmer's lung precipitins in Doubs (a department of France): prevalence and diagnostic value.

In a French region where farmer's lung (FL) is common, we determined the prevalence of FL precipitins in dairy farmers and analyzed the relation between the presence of FL precipitins and the clinical probability of the disease. All the exposed dairy farmers of both sexes (n = 2555) from five districts of the Doubs department were asked to respond to a medical and professional questionnaire. A total of 1763 (69%) farmers agreed to participate. Precipitins tests were conducted in 551 (31%) farmers who showed any respiratory symptom and in a random sample of 100 asymptomatic farmers. Serum for each farmer was analyzed by both double diffusion and immunoelectrophoresis against Micropolyspora faeni (MF) and extracts of moldy hay (HE) from Doubs. The 651 farmers were then divided into four groups (G 1-4) with a decreasing probability of FL (G1: typical FL symptoms; G4: asymptomatic farmers). The estimated prevalence of precipitins in the whole population was as follows: 1) by double diffusion, against HE: 83%, against MF: 27%; 2) by immunoelectrophoresis, against HE: 26%, against MF: 19%. There was a close "linear" relation between the prevalence of precipitins detected by immunoelectrophoresis against HE and the symptoms: 51% in G1, 36% in G2, 29% in G3, and 13% in G4. Precipitins detected by immunoelectrophoresis were also related to exposure and geography (more immunization in tableland area than in plain or mountain area). Presence of precipitins detected by double diffusion was not related to symptoms, exposure, or geography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1987

Precipitins against microbes in mouldy hay in the sera of farmers with farmer's lung or chronic bronchitis and of healthy farmers.

The aim of this study was to determine which precipitins against four antigens in 2,440 farmers are associated with the occurrence of farmer's lung (FL). The antigen panel consisted of mycelial antigens of Micropolyspora faeni, Thermoactinomyces vulgaris, Aspergillus fumigatus and Aspergillus umbrosus. As reference groups we used healthy farmers and those with chronic bronchitis. For the occurrence of precipitins against the four antigens there was a statistically significant difference between farmers with FL and healthy farmers but not between farmers with chronic bronchitis and healthy farmers. In a stepwise logistic linear regression analysis, farmers with FL and chronic bronchitis were compared to healthy farmers with respect to precipitins to the four antigens. Precipitins against Thermoactinomyces vulgaris differentiated farmers with FL (p less than 0.05) but not farmers with chronic bronchitis from healthy farmers. In Finland the occurrence of FL seems to be associated mainly with precipitins against Thermoactinomyces vulgaris, not with precipitins against Micropolyspora faeni as in Great Britain, and not with precipitins of Aspergillus umbrosus, which occurred most frequently in the sera of Finnish farmers. This association is in accordance with the exposure to spores of airborne moulds in farmers' work environment, where spore concentrations of Thermoactinomyces vulgaris have been measured to be about six times higher than those of Micropolyspora faeni.

Antibodies, Bacterial↗

PubMed1982

Precipitins to an aflatoxin-producing strain of Aspergillus flavus in patients with malignancy.

Serum samples from 121 patients in whom malignant disease had been diagnosed, were assayed for precipitins to fungal isolates from leukemia-associated environments. Control sera were from age-, sex-, and race-matched patients with no history of malignant disease. Sera from 36 (30%) malignancy patients and seven (6%) controls yielded a precipitin band to an aflatoxin-producing Aspergillus flavus isolate from a leukemia-associated house (x2 = 222, p less than 0.05%). No significant numbers of precipitins were obtained to either of the other fungal isolates from that and another such house. Although A. fumigatus has frequently been incriminated as a source of infection in patients with malignancy, only 9% of malignancy patients had a precipitin response to it, as did 1.6% of controls. Also, the presence of the precipitins to A. flavus was not connected with past radiation or immunosuppressive therapy. However, among patients with precipitins to A. fumigatus there was a higher death rate in the year following the study. Precipitins to A. flavus may be related to heavy environmental exposure possibly leading to aflatoxin exposure which may contribute to development of malignancy though immunosuppressive effects.

Adolescent↗

PubMed1983

"Haysickness" in Icelandic horses: precipitin tests and other studies.

Blood samples were taken from 18 healthy horses (Group A), 15 horses clinically diagnosed to have "haysickness" ("farmer's lung") (Group B), 10 closely related horses (Group C) and 14 inbred horses (Group D). Precipitins in sera were measured by double gel diffusion test against Micropolyspora faeni, Thermoactinomyces vulgaris, Aspergillus fumigatus, Alternaria, Penicillium and Rhizopus species. In Group A, all the horses were precipitin negative except one with a faint reaction to Rhizopus species. In Group B all had precipitin against M faeni. One horse also had precipitins against Rhizopus species and another against A fumigatus. In Group C, seven of the 10 horses had precipitins against M faeni. Of these, five had a history of respiratory signs, but two horses with a faint reaction had no such history. In Group D, four out of 14 horses had positive precipitin tests against M faeni. Of these four horses, three also had a faint reaction to A fumigatus and one a faint reaction to Alternaria species. All were asymptomatic. These results indicate that "farmer's lung" in man and "haysickness" in horses are of the same origin. However, further studies are necessary to substantiate the diagnostic or prognostic value of these precipitin tests in equine practice. The question of whether hereditary factors play a role in causing this disease also warrants further studies.

Alveolitis, Extrinsic Allergic↗

PubMed1985

Factors influencing the development of serum precipitins to farmer's lung antigen in Quebec dairy farmers.

A total of 888 randomly selected dairy farmers participated in an epidemiological study to evaluate the prevalence of precipitins to farmer's lung antigens, and the socioeconomic factors associated with their presence. Precipitins were present in 75 farmers (8.4%) (65 to Micropolyspora faeni, seven to Aspergillus spp, two to both Aspergillus and Micropolyspora faeni, and one to Aspergillus and Thermoactinomyces vulgaris). The titres ranged from a dilution of 1/32 to a concentration of X 2 (Ouchterlony's double diffusion method). In the study population there were 544 who had never smoked, 146 ex-smokers, and 198 smokers. Sixty nine precipitin positive subjects were either never smokers or ex-smokers; only six were smokers. The negative relationship between cigarette smoking and precipitins was highly significant (p = 0.004). Factors positively associated with positive precipitin reactions were: size of farm, time spent in the barn, and the presence of a family member previously diagnosed as having farmer's lung disease. Interestingly, positive precipitin reactions were not associated with any of the following: use of silos, hay conditioners, or hay dryers; the presence or quantity of mouldy hay; or the presence of respiratory symptoms. It is concluded that precipitin analysis is not useful as a screening method for farmer's lung, though it can be of diagnostic value in acute farmer's lung disease.

Adult↗

PubMed1975

Incidence of serum precipitins against organic-dust antigens in different populations by counterimmunoelectrophoresis.

The incidence of serum antidust and antifungal precipitins was determined by counterimmunoelectrophoresis in 317 atopic and nonatopic subjects of three geographic areas (north central, southern, and western United States). The selected lyophilized crude antigens employed were from house dust, Micropolyspora faeni, Candida albicans, Alternaria tenuis, Aspergillus fumigatus, Puccinia coronata, Cantharellus cibarius, and Amborsia trifida. Antidust precipitins were detected with high frequency in atopic and nonatopic subjects of each geographic area (48 to 71 percent of different population subgroups). Precipitin reactions were generally intense and often multiple, in keeping with the marked heterogeneity of the crude dust antigen employed. Antidust precipitins were also present in serum fractions precipitated with ammonium sulfate and in IgG-rich fractions obtained by gel filtration (Sephadex G-200) and diethylaminoethyl-cellulose chromatography. Precipitins against crude somatic fungal and actinomycetic antigens were detected with considerably less frequency in all populations surveyed, considerably less frequency in all populations surveyed, and antiragweed precipitins were not detected. Our results suggest that prolonged environmental exposure to diverse, ubiquitous organic dusts results in a "normal" serum precipitating-antibody response. They also extend our previous finding of a high precipitin response against organic dusts in residents of the Gulf south area compared to other geographic areas.

Antibodies, Fungal↗

PubMed1987

Serum precipitins against microbes in mouldy hay with respect to age, sex, atopy, and smoking of farmers.

This study was based on a sample of 3,065 farmers from a larger survey population of 12,056 Finnish farmers. Data were collected in a postal survey conducted by the Social Insurance Institution of Finland. Serum samples for determination of precipitating antibodies were taken at local health centres. Precipitins were determined by the method of microplate immune diffusion. The antigen panel consisted of mycelial antigens of Micropolyspora faeni, Thermoactinomyces vulgaris, Aspergillus fumigatus, and Aspergillus umbrosus. Precipitins to any one of the four microbes were detected in 8.6% of the sera. The most common causes of positive precipitin tests were Aspergillus umbrosus and Thermoactinomyces vulgaris, which agrees with previous findings reported from Finland. In general, the precipitins were more prevalent among women, which corresponds to local cultural traditions, and in older farmers. The prevalence of precipitins did not differ between non-atopic and atopic (defined as past or present co-existence of atopic dermatitis including infantile eczema and/or hay fever or other allergic rhinitis) subjects. In contrast, the prevalence of precipitins was about 1.5-2 times larger among non-smokers than among smokers, which confirms the findings in previous reports. In future studies on occurrence of precipitins, the data should be controlled with respect to age, sex, and smoking.

Adult↗

PubMed1976

[Precipitin Reactions Between Host Organ Extracts And Antisera For Paragonimus And Clonorchis]

Precipitin reaction between host organ extracts and antisera for Paragonimus and Clonorchis were studied to know whether the antigens from two species of trematodes have common characters with those of host organs. The brain, lung, heart, liver and muscle of rat and rabbit were extracted in 0.1% saline solution by freezing-thawing technique. For immunization of rabbit, the extracts of Paragonimus and Clonorchis was emulsified with equal amount of Freund's adjuvant and 1.0 ml of the mixture was injected subcutaneously once every 10 days for 5 times, and 3 days after the last immunization, antisera were prepared. Precipitin bands by agar-gel double diffusion methods were examined between organ extracts of rabbit or rat and Paragonimus or Clonorchis antisera. The results could be summarized as follows: 1. Precipitin bands were appeared between extracts of liver, heart and muscle of rat and anti-Clonorchis rabbit sera but not appeared against brain and lung. 2. Precipitin bands were appeared between extracts of lung, muscle and liver of rat and anti-Paragonimus rabbit sera but not appeared against brain and heart. 3. Precipitin bands were appeared between extracts of liver and muscle of rabbit and anti-Clonorchis rabbit sera but not appeared against brain, heart and lung. 4. Precipitin bands were appeared between extracts of lung and muscle of rabbit and anti-Paragonimus rabbit sera but not appeared against liver. 5. The extracts of Paragonimus westermani showed precipitin bands against liver and brain of rat and liver of rabbit in agar-gel double diffusion.

Journal Article↗

PubMed1992

Restricted epitope recognition by precipitin-negative anti-La/SS-B-positive sera.

OBJECTIVE: To determine whether anti-La/SS-B-positive sera that are precipitin negative show a distinct B cell epitope pattern. METHODS: Serum reactivity was tested with recombinant La/SS-B fusion proteins. RESULTS: Among the 18 precipitin-negative anti-La/SS-B-positive sera, reactivity was confined to the full-length recombinant protein (La33.3) in 8 (44%); 5 of 18 (28%) reacted only with La33.3 and with the first 107 N-terminal amino acids (LaA), and 4 (22%) reacted with La33.3, LaA, and the middle region of the La molecule (LaC; amino acids 111-242). One serum reacted with La33.3 and LaC. None of the 18 precipitin-negative sera was positive on a carboxy-terminal fragment (LaL2/3; amino acids 346-408). In contrast, all 26 precipitin-positive anti-La/SS-B-positive sera reacted with La33.3, LaA, and LaC, and 92% reacted with LaL2/3. Rheumatoid factor and serum IgG levels were significantly lower in the precipitin-negative group, providing further evidence of a distinct serologic subset. CONCLUSION: The restricted epitope recognition by these sera may explain the lack of precipitin formation and may represent an early autoantibody response to La/SS-B.

Autoantibodies↗

PubMed1993

Contrasting molecular patterns of MHC class II alleles associated with the anti-Sm and anti-RNP precipitin autoantibodies in systemic lupus erythematosus.

OBJECTIVE: To find evidence of a potential genetic predisposition to the anti-Sm or anti-RNP precipitin autoantibody responses. METHODS: HLA-DR and DQ alleles determined by restriction fragment length polymorphism and/or oligotyping in 49 subjects with either anti-Sm alone or anti-RNP alone were compared with those in 139 race-matched normal control subjects and 59 race-matched lupus patients without anti-Sm and anti-RNP autoantibodies. RESULTS: Black patients with anti-Sm precipitin had increased frequencies of HLA-DR2 and the DQw6-associated DQA1*0102 (P = 0.007, odds ratio [OR] = 6.7) and DQB1*0602 (P = 0.001, OR = 9.1) chain alleles compared with normal black control subjects. Black patients with anti-RNP precipitin showed significant increases in the DQw5-associated DQA1*0101 (P = 0.03, OR = 5.5) and DQB1*0501 (P = 0.002, OR = 23.3) chain alleles compared with lupus patients without anti-Sm or RNP. While patients with anti-RNP precipitin showed an increased frequency of the DQw8-associated allele DQB1*0302 (P = 0.02, OR = 3.7) compared with normal controls, as well as an increased frequency of the DQw5-associated alleles DQA1*0101 and DQB1*0501 (P = 0.05, OR = 4.2) compared with lupus patients without anti-Sm or RNP. There were no specific HLA-DR2 or DR4 subtype associations found with either anti-Sm or RNP precipitin autoantibodies. CONCLUSION: There are distinct patterns of major histocompatibility complex class II allele associations with the anti-Sm versus the anti-RNP precipitin autoantibody responses, and HLA-DQ associations may be more primary than HLA-DR associations.

Alleles↗

PubMed1976

Alternaria IgG precipitins and adverse reactions.

Late reactions consisting of fever, malaise, and swelling at the site, 4 to 6 hr after injections of Alternaria extract occurred in several patients receiving immunotherapy with Alternaria. These patients had in common serum IgG precipitins and exquisite leukocyte histamine release sensitivity to Alternaria. Such precipitins were 3 times more frequent in patients receiving Alternaria immunotherapy than a control group of patients receiving immunotherapy with other antigens. A prospective study revealed that 5 of 23 Alternaria-sensitive persons had precipitins before immunotherapy and another 6 developed precipitins during therapy. Only one of the 23 experienced a late Alternaria reaction. Thus, precipitins to Alternaria are common and do not seem to be the basis for the late reactions we observed. The finding of precipitins does not contraindicate immunotherapy.

Alternaria↗