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Investigations of the allergens of cocksfoot grass (Dactylis glomerata) pollen.

The pollen of cocksfoot grass (Dactylis glomerata) is an important cause of allergic reactions in man. Preliminary studies, which established that constituents of an extract of this pollen could be separated, and then recovered efficiently, by size-exclusion chromatography on TSK G3000 SW, have been extended. A comparative examination has been made by this procedure of cocksfoot pollen extracts from different sources and of several batches of extract from one source. The recovery and distribution of biological activity has been assessed by the radioallergosorbent test, and the results have been used for the selection of fractions for further investigation by chromatography and electrophoresis. Two constituents active in the radioallergosorbent test have been purified from the extracts.

Allergens↗

Down-regulation of IgE and IgG4 antibodies to tetanus toxoid and diphtheria toxoid by covaccination with cellular Bordetella pertussis vaccine.

Pertussis (P) toxin acts as adjuvant for IgE formation against simultaneously administered Ags in animal models. P vaccination may also have an adjuvant impact on IgE formation against coadministered diphtheria (D) and tetanus (T) Ags in humans. Sera of 103 D-T-P-immunized and 319 D-T-immunized children aged 2 years were analyzed for IgE, IgG4, and IgG to D and T (radioallergosorbent test), total IgE and IgE against common inhalant allergens (CAP radioallergosorbent test fluoroenzyme immunoassay). Fewer D-T-P- than D-T-immunized children had sera positive for T-IgE (12.6 vs 53.6%, p < 0.001), T-IgG4 (71.6 vs 89.2%, p < 0.001), D-IgE (31.0 vs 70.5%, p < 0.001), and D-IgG4 (85.2 vs 93.4%, p = 0.039). Suppression of T-IgE was not dependent on the cutoff chosen for a positive test result, but was dependent on the proportion of D-T immunizations given with P. The risk for sensitization to common environmental allergens did not differ (odds ratio 0.953, 95% confidence interval 0.815-1.114). No significant differences between D-T- and D-T-P-immunized children were found with regard to T-IgG or D-IgG. In summary, IgE and IgG4 (but not IgG) serum levels to coadministered D- and T-Ags are suppressed among P-immunized children as compared with nonimmunized children. These results suggest that the presence of a microbial product during Ag exposure can down-regulate an IgE/IgG4 response in humans.

BCG Vaccine↗

Clustered sensitivity to fungi: anaphylactic reactions caused by ingestive allergy to yeasts.

BACKGROUND: Respiratory allergy to environmental molds is relatively common, and fungal allergen-specific reactivity seems to cluster in certain persons. However, generalized reactions caused by ingested fungi have seldom been described. OBJECTIVE: To describe a mold-sensitized patient who developed multiple anaphylactic reactions after ingesting a yeast preparation widely used by the food industry as flavoring in, for example, powdered and ready-made sauces. METHODS: Skin prick tests and serum IgE tests were performed with inhalant and food allergens, including molds and yeasts, 2 pasta sauces consumed by the patient, individual sauce ingredients, and a food-quality yeast extract. Radioallergosorbent test inhibition was used for specificity studies. RESULTS: Skin prick and serum IgE test results were positive to several molds (Cladosporium herbarum, Alternaria alternata, Aspergillus fumigatus, and Penicillium notatum), baker's yeast (Saccharomyces cerevisiae), Malassezia furfur, and champignon and to the 2 pasta sauces, the yeast ingredient, and a food-quality yeast extract. Radioallergosorbent test inhibition studies confirmed that the sauces contain cross-reacting yeast and mold allergens. CONCLUSIONS: This patient has a clustered sensitization to fungi characterized by allergy to environmental fungal allergens and to yeast extracts used in the food industry. Yeasts should be considered as possible ingestive allergens in mold-allergic patients.

Adult↗

Immediate type hypersensitivity to common moulds. Comparison of different diagnostic materials.

Extracts of five common atmospheric moulds (Alternaria, Aspergillus, Cladosporium, Mucor and Penicillium) obtained from different manufacturers were compared by means of skin prick testing and, partly, with the radioallergosorbent test. Considerable differences were found between the extracts with respect to positive tests found in mould-allergic individuals and controls. A purified allergen preparation of Cladosporium herbarum was superior to the crude allergen extracts. The results suggest that the allergen contents of the extract differed both with respect to total allergenic potency and to allergenic composition.

Adolescent↗

Immunoglobulin-mediated hypersensitivity in response to long-term treatment with gonadorelin hydrochloride (Factrel) in a female patient.

Recently a patient with severe hypogonadotropic hypogonadism who was given luteinizing hormone-releasing hormone (Factrel) through an infusion pump developed a wheat-and-flare reaction at the sites of injection. Treatment with luteinizing hormone-releasing hormone was discontinued and the immune response was characterized. Skin testing by skin prick test was positive for luteinizing hormone-releasing hormone but negative for vehicle. Radioallergosorbent testing was performed with allergic (patient serum with an elevated serum immunoglobulin E concentration and allergic to inhalant allergens including ragweed pollen) and nonallergic controls. Radioallergosorbent testing was negative for luteinizing hormone-releasing hormone-reactive immunoglobulin E antibodies. Radioimmunoassay of serum of the allergic patient antibody to luteinizing hormone-releasing hormone was positive only for immunoglobulin E. Maximum binding occurred at a dilution of 1:10. Sera from nonallergic and unchallenged patients were negative. It is concluded that this patient developed hypersensitivity reactions caused by IgE antibody to luteinizing hormone-releasing hormone.

Adult↗

Melaleuca tree and respiratory disease.

BACKGROUND: The role of Melaleuca quinquenervia tree as a source of allergen(s) and respiratory irritant(s) is controversial. OBJECTIVE: Determine whether Melaleuca tree pollen or odor is medically important. METHODS: A 2-year aeroallergen survey and skin test (ST) results of 1,017 subjects were reviewed. Sixteen subjects were selected based on positive Melaleuca pollen extract (MPE) STs. Double-blind nasal challenges with MPE were performed on six subjects. Single-blind bronchial challenges with MPE were performed on four. To evaluate the irritant effect, 11 subjects received 34 different Melaleuca odor challenges (blossoms, bark, and leaves) through a closed system for up to 30 minutes. Four inhaled an odor from cajeput oil (derived from Melaleuca leaves) for 1 hour. Spirometry was performed before and after odor challenges. Radioallergosorbent test using MPE was compared with MPE STs in 15 subjects. RESULTS: The aeroallergens survey revealed insignificant numbers of Melaleuca pollen. Ninety-seven of 1,017 subjects were a 2+ or greater intradermal MPE ST. One of 6 double-blind nasal challenges and 1 of 4 single-blind bronchial challenges using MPE were positive in subjects with positive MPE STs. All 38 odor challenges with blossoms, bark, leaves, and cajeput oil were nonreactive. The MPE radioallergosorbent test correlated with MPE ST results. CONCLUSIONS: The Melaleuca tree is not a significant source of aeroallergen. The Melaleuca odor is not a respiratory irritant. MPE antigen(s) has been shown to cross-react with pollen extracts from a proven aeroallergen (Bahia grass pollen) possibly explaining the few cases of positive MPE STs with positive nasal/bronchial challenges.

Allergens↗

Anaphylactic shock following banana ingestion.

A 15 1/2-year-old girl experienced anaphylactic shock, asthma, angioedema, and urticaria after eating a banana. Reagin-mediated hypersensitivity was demonstrated by direct skin tests, passive transfer tests, and the radioallergosorbent test.

Adolescent↗

In vivo and in vitro correlates of food allergy.

Sera of 86 patients clinically sensitive to foods were tested by passive sensitization of human and/or monkey lung (127 tests) and the radioallergosorbent test (RAST) (72 tests), using whole-food antigens; the results were compared with skin (prick) testing. Results of the prick test correlated with history in 76% of cases; lung sensitization correlated with history in 37% and with prick test in 57%; and RAST correlated with history in 54% and prick test in 72%. It is concluded that a very large percentage of adverse reactions to foods are IgE-mediated. The prick test is of use in diagnosis, particularly when combined with RAST; the lung sensitization test is technically impractical and not a reliable indicator. The best diagnostic method is careful history with food challenge and withdrawal and rechallenge; the latter is safe except in patients with a history of violent reaction.

Adolescent↗

The role of ragweed pollen in autumnal asthma.

Thirty-nine ragweed-allergic seasonal asthmatics were studied from 1972 to 1974. After quantitative skin tests, antigen E-induced leukocyte histamine release, quantitative inhalation bronchial challenge with ragweed extract to determine PD35 (provocation dose of allergen causing 35% decrease in specific airways conductance), and radioallergosorbent test (RAST) determinations were done, patients were paired based on PD35 values and randomly assigned to treatment or placebo groups, receiving either aqueous ragweed extract or placebo prior to the 1973 ragweed season. Treated patients received a mean cumulative dose of extract equivalent to 11.7 microng antigen E (4,180 protein nitrogen units [PNU]). Twenty-nine patients were followed through the ragweed season with daily symptom diaries and biweekly physician examinations. Severity of disease was not predictable by PD35 data, skin tests, leukocyte histamine release, or radioallergosorbent test (RAST) values. Although all patients were ragweed-allergic by objective tests, only 13/29 had asthma symptoms correlating with ragweed counts. Mold spore counts were related significantly to symptoms in some patients. Asthma and hay fever symptoms correlated significantly in 24/29 patients. This dose of immunotherapy caused no significant difference to be found in asthma or hay fever symptoms in treated versus placebo patients for the 1973 reporting period as determined by physician evaluations or daily symptom diaries. No patients showed significant improvement in PD35 values after treatment in 1973. Similar findings were obtained for a smaller group of patients followed through the 1974 ragweed season who received a mean dose of 31.2 microng antigen E (11,140 PNU). The failure of these patients to show a response to immunotherapy could be due to a combination of the relatively low dose of ragweed extract and their sensitivity to other allergens.

Airway Resistance↗

Melittin: an allergen of honeybee venom.

The presence of serum IgE antibodies to melittin was tested by the radioallergosorbent test (RAST). Melittin, the principal protein of honeybee venom, was isolated by gel filtration on Sephadex G-75 and covalently bound to cyanogen bromide-activated microcrystalline cellulose. The melittin preparation was homogenous by immunoelectrophoresis with the use of rabbit antiserum to whole honeybee venom and by polyacrylamide electrophoresis in gels containing 1% sodium dodecyl sulfate. Elevated serum IgE antibodies to melittin (three times greater than binding by normal sera) were found in 7 of 24 honeybee venom-sensitive persons and in 5 of 20 nonsensitive beekeepers. In one venom-sensitive patient a particularly high titer of IgE antibody was found. The reaction between solid-phase melittin and IgE antibody could be inhibited by fluid-phase melittin but not by phospholipase A (PLA). Similarly, the reaction of IgE antibody with solid-phase PLA was inhibited by PLA but not by melittin. In passive transfer skin tests with the sensitive patient's serum, positive wheal-and-flare reactions were obtained in 3 nonallergic recipients following melittin challenge; appropriate controls were negative. These results indicate that melittin is an allergen in some honeybee venom-sensitive patients and in an occasional patient melittin may be a major allergen.

Allergens↗

Immunologic-mediated eustachian tube obstruction: a double-blind crossover study.

Eight subjects with seasonal allergic rhinitis confirmed by positive skin tests and serum radioallergosorbent test to ragweed or timothy grass pollen were identified. A double-blind provocative antigen challenge was performed with intranasal insufflation of 50 mg of dry pollen to which the subject was either sensitive (ragweed or timothy) or not sensitive (pine). Before and after pollen insufflation, measurements of nasal function by nasal rhinomanometry and eustachian tube (ET) function by the nine-step tympanometry test were performed for up to 14 days. The ability to dilate the ET was documented in 14 of the 16 ears of the eight subjects before challenge. Within 30 min after antigen challenge transient obstruction of the ET associated with inability to dilate upon swallowing was observed in all 14 ears. Clinical symptoms of allergic rhinitis, including rhinorrhea and nasal obstruction, were produced in all subjects. ET function changes were reversible in three of 14 ears within 2 hr but persisted for more than 3 days in six of the ears. As a control, insufflation of pine pollen did not alter ET function or rhinomanometric values or produce clinical symptoms in the eight subjects. These findings suggest an allergic basis for ET obstruction and possibly for the development of otitis media with effusion.

Adolescent↗

Cross-reacting and species-specific determinants on a major allergen from Dermatophagoides pteronyssinus and D. farinae: development of a radioimmunoassay for antigen P1 equivalent in house dust and dust mite extracts.

Two species of mites of the genus Dermatophagoides are common in house dust and make a major contribution to the allergen content of house dust. As judged by skin tests and the radioallergosorbent test, these mites, D. pteronyssinus and D. farinae, demonstrate extensive cross-reactivity. When the major allergen from D. pteronyssinus, antigen P1, was compared with the equivalent allergen from D. farinae, these two proteins were found to have both species-specific and common antigenic determinants. With specifically purified antibodies directed against the common determinants, we developed a radioimmunoassay for these antigen P1 equivalent proteins in mite extracts as well as house dust extracts. The quantity of allergen in dust from 63 houses (255 samples) was measured, and values ranged from less than 100 to greater than 100,000 ng/gm of fine dust. The correlation between antigen P1 equivalent (ng/gm) and the number of mites per gram of dust (identified by microscopy) was very good (r = 0.74; p less than 0.001). Furthermore, this correlation was not affected by the species of mite in the dust sample. Of 9243 mites identified, 95% were of the genus Dermatophagoides, and of these, 16.4% and 18% could be positively identified as D. farinae and D. pteronyssinus, respectively. When the assay for antigen P1 equivalent was applied to isolated components of mite cultures of both species, significant allergen was found in the mite bodies, cuticles, and their excreta (fecal particles). For the house-dust samples, less than 10% of the allergen measured could be explained by the allergen content of mite bodies. Our results demonstrate that a radioimmunoassay for antigen P1 equivalent can provide an accurate and simple means of assessing the quantity of mite-derived allergen in dust-mite extracts, house-dust extracts, or house dust.

Allergens↗

Allergenicity of cow milk proteins.

The allergenicity and antigenicity of cow milk proteins are age dependent. Because the nonspecific and specific factors inhibiting the passage of cow milk proteins through the epithelial layer of the intestine are deficient at birth, although developing during early infancy, allergy to cow milk may be acquired during the first year of life. Allergic reactivity to cow milk is lost during childhood in the vast majority of cases. This change may depend at least partly on the development of the local immune system of the gut producing antigen-specific IgA antibodies. Circulating IgG antibodies to cow milk proteins are always produced when an infant has cow milk in the diet but are not associated with allergy; their titer is reduced with age. Clinical challenge tests show that most cow milk-allergic patients react to several protein fractions of cow milk. A patient may have IgE antibodies to several fractions of cow milk, measured either by skin testing or by radioallergosorbent test. Likewise, various tests for cell-mediated immunity may show positive reactions to several fractions. No single major allergen is apparent in cow milk, according to either the challenge tests or laboratory procedures: casein, alpha-lactalbumin, and beta-lactoglobulin all show a high proportion of positive reactions.

Animals↗

Monitoring methods of nasal pathology.

The importance of correct clinical and therapeutic monitoring of allergic rhinitis is understandable in the light of the social and economic impact of this pathology: its prevalence is over 10% of the total population all over the world. For the evaluation of the local nasal pathology we include: (1) anterior rhinoscopy, (2) active anterior rhinomanometry, (3) positioned acoustic rhinometry, (4) determination of mucociliary transport time, (5) specific nasal provocation test. Active anterior rhinomanometry allows reliable assessment of the nasal respiratory function, acoustic rhinometry shows the geometry of nasal cavity, mucociliary transport time is an indicator of the mucosa eutrophism. In our experience, the specific nasal provocation test is one of the most important tests in this field. It is more sensitive than the skin test and the radioallergosorbent test (RAST) in the asymptomatic phase and it is able to show organ allergies. In this study we review the importance of this test and the methodology we commonly use.

Adolescent↗

Circulating nerve growth factor levels are increased in humans with allergic diseases and asthma.

Nerve growth factor (NGF) serum levels were measured in 49 patients with asthma and/or rhinoconjunctivitis and/or urticaria-angioedema. Clinical and biochemical parameters, such as bronchial reactivity, total and specific serum IgE levels, and circulating eosinophil cationic protein levels, were evaluated in relation to NGF values in asthma patients. NGF was significantly increased in the 42 allergic (skin-test- or radioallergosorbent-test-positive) subjects (49.7 +/- 28.8 pg/ml) versus the 18 matched controls (3.8 +/- 1.7 pg/ml; P < 0.001). NGF levels in allergic patients with asthma, rhinoconjunctivitis, and urticaria-angioedema were 132.1 +/- 90.8, 17.6 +/- 6.1, and 7.6 +/- 1.8 pg/ml (P < 0.001, P < 0.002, and P < 0.05 versus controls), respectively. Patients with more than one allergic disease had higher NGF serum values than those with a single disease. When asthma patients were considered as a group, NGF serum values (87.6 +/- 59.8 pg/ml) were still significantly higher than those of control groups (P < 0.001), but allergic asthma patients had elevated NGF serum levels compared with nonallergic asthma patients (132.1 +/- 90.8 versus 4.9 +/- 2.9 pg/ml; P < 0.001). NGF serum levels correlate to total IgE serum values (rho = 0.43; P < 0.02). The highest NGF values were found in patients with severe allergic asthma, a high degree of bronchial hyperreactivity, and high total IgE and eosinophil cationic protein serum levels. This study represents the first observation (that we know of) that NGF is increased in human allergic inflammatory diseases and asthma.

Adolescent↗

Brief reversible bronchospasm resulting from bichromate exposure.

A 50-y-old male worker developed an asthmatic reaction after exposure to bichromate in a metal-plating plant. Evaluation included skin tests, bronchial provocation tests, and specific radioallergosorbent tests with metal salts. A 49-y-old worker who suffered from hard metal asthma was the control. These workers were not atopic, and they exhibited similar bronchial hyperresponsiveness in methacholine-PC20 (74 mg/ml versus 81 mg/ml, respectively) and IgE titers (129 IU/ml versus 130 IU/ml). Positive intradermal and patch tests to bichromate were found in the subject. A bronchial provocation test with inhalation of .01 % bichromate produced an immediate decrease in forced vital capacity in 1 s, followed by a rapid recovery within 5 min absent any treatment. There was no reaction to cobalt (1% cobalt chloride) or to nickel (2% nickel sulfate) salts. In the control, a positive bronchial provocation occurred (absent chromium) with cobalt and nickel. Administration of a subcutaneous preparation of 1 mg atropine sulfate or of 1 puff of disodium cromoglycate or beta-stimulant reduced bronchial responsiveness to methacholine-PC20, and no asthmatic reaction occurred following inhalation of 1% bichromate. No blocking of asthmatic reaction occurred after pretreatment with beclomethasone dipropionate inhalation. Administration of propranolol, however, potentiated the acute bronchoconstriction induced by bichromate. The 50-y-old worker had evidence of IgE antibody to chromium-conjugated human serum albumin and to chromium-conjugated exchange resin. His serum selectively bound 51Cr, but antibodies specific to cobalt and nickel were absent. These results, if viewed collectively, suggest that bichromate exposure causes brief reversible bronchospasm via alteration of autonomic balance and increased vagal activation.

Antibodies↗

Improving in-vitro tests for the diagnosis of food hypersensitivity.

Food hypersensitivity reactions affect up to 8% of children under 3 years of age and approximately 2.5% of the general United States population. Food allergic disorders may be subdivided into either IgE-mediated or cell-mediated reactions. The diagnostic 'gold standard' of 'symptomatic' food allergies remains the blinded oral food challenge because of the poor specificity of patient histories, skin testing and standard radioallergosorbent tests, and the outcomes of elimination diets. Little progress has been made in the development of in-vitro tests for the diagnosis of cell-mediated food hypersensitivities. However, new developments in in-vitro technologies have improved the capabilities of these tests to diagnose IgE-mediated reactivity and perhaps predict the development of future 'tolerance', i.e. 'outgrowing' the allergy.

Allergens↗

Alternate occurrence of allergic disease and an unusual form of interstitial cystitis.

BACKGROUND: It has been postulated that interstitial cystitis can be induced by an allergy. This is partly based on the observation that many patients with interstitial cystitis also have allergic diseases. In this study, an allergic evaluation was conducted on patients with interstitial cystitis complicated by bronchial asthma, a typical allergic disease. METHODS: Clinical histories were obtained and biopsy specimens from the vesical walls of the study patients were examined histologically. Cutaneous tests and IgE radioallergosorbent tests (RAST) were performed. Further, intravesical provocation tests were carried out using IgE RAST-positive antigens, and histamine release assays were performed on the vesical biopsy specimens using anti-IgE antibodies. RESULTS: Five of 6 patients alternately exhibited symptoms of allergic disease and bladder symptoms. The eosinophil and mast cell counts in the vesical biopsy specimens of these 5 patients were increased. Furthermore, an intravesical provocation test performed using the IgE RAST-positive antigen was positive in 4 patients. The mean vesical biopsy specimen histamine release was 17.7% for patients with interstitial cystitis with bronchial asthma which was significantly higher than that for interstitial cystitis patients without bronchial asthma (8.9%) or the control group (4.5%). The prognosis of patients with interstitial cystitis with allergic complications was relatively good. CONCLUSION: Patients with bronchial asthma exhibited hypersensitivity both generally and locally in the bladder. The alternation phenomenon was observed between the hypersensitive organs.

Adult↗