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Bacterial allergy in nasal polyposis. A new method for quantifying specific IgE.

OBJECTIVES: To determine (1) if bacteria-specific serum IgE levels can be more effectively measured by first absorbing competing IgG antibodies from serum and (2) if patients with chronic paranasal sinus disease exhibit a high positive prevalence of bacteria-specific serum IgE. DESIGN: A modified radioallergosorbent test method was employed wherein each serum sample was absorbed with recProtein A to remove competing non-IgE antibodies, and purified proteins extracted from 16 individual bacteria were used as potential allergens. PARTICIPANTS: Twenty-four patients with nasal polyposis and 14 with chronic sinusitis, all refractory to conventional medical therapy and requiring endoscopic sinusotomies, were tested. Tested as controls were 10 subjects with chronic allergic rhinitis, without a history of chronic sinus disease, and possessing total serum IgE and inhalant-specific IgE levels equal to or higher than the patient group. RESULTS: (1) Pretreatment of serum samples with recProtein A resulted in an increase of bacteria-specific radioallergosorbent test sensitivity. (2) Seventeen of 24 patients with polyps, eight of 14 with chronic sinusitis, and one of 10 with chronic allergic rhinitis were determined to be IgE positive when tested with this assay. CONCLUSIONS: (1) Bacteria-specific serum IgE can be quantified; (2) most patients with nasal polyposis and/or chronic sinusitis possess bacteria-specific IgE in their serum, while subjects with only allergic rhinitis do not; and (3) multiple bacterial species isolated from chronically infected sinuses are capable of inducing IgE-mediated sensitization.

Antibodies, Bacterial↗

Allergy test results of a rural and small-city population compared with those of an urban population.

The frequency of sensitization to environmental antigens changes in different regions. As such, the pattern of sensitivity to common allergens was studied at multiple sites across central Pennsylvania, an area composed of small cities and rural communities, to determine uniqueness of allergies in populations from this area in contrast to allergies as determined by skin testing in large urban centers. The study reported was undertaken to determine allergen variation from an urban population compared with a rural population of a Northeastern state so that environmental avoidance and immunotherapy can be more precisely prescribed. Patient charts were retrospectively reviewed to determine sensitivity to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae), cockroach, Penicillium, Aspergillus spp, dog, cat, timothy grass, ragweed, oak, and Alternaria tenuis at five sites in Pennsylvania. All of these sites were classified as "small city" or "rural" for the study. One hundred patient records were examined at each site for the results of allergy testing by the prick puncture, radioallergosorbent test (RAST), or intradermal methods. These small-city and rural data were pooled and compared with that of the National Cooperative Inner-City Asthma Study (NCI-CAS), which included 1286 patients from urban environments. The prevalence of allergy to both species of dust mites, dog, timothy grass, and ragweed was significantly greater in the pooled rural group than in the NCICAS inner-city patients (P < .05). In contrast, sensitivity to cockroach antigens and Alternaria was significantly greater in the NCICAS urban population than in the pooled rural group (P < .05). No statistically significant difference was found between the NCICAS and the pooled rural patients in reference to Penicillium, cat, and oak (P > .05).

Animals↗

Prevalence of respiratory symptoms and increased specific IgE levels in West-African workers exposed to isocyanates.

Respiratory symptoms and immunological effects from chronic exposure to isocyanates (toluene diisocyanate) were studied in a cross survey of workers from West African factories producing paints and polyurethane foam. A questionnaire, a pulmonary function test, immunoglobulin E (IgE) levels, radioallergosorbent test (RAST) and an atmospheric sample to quantify isocyanate exposures were carried out in the workplace for each worker. Ninety-six workers, of whom 44 had occupational isocyanate-induced asthma, were included in the study. Twenty-four viral-infected subjects were excluded from the immunological study. Specific antibodies to isocyanates were detected in two of the symptomatic individuals. This low proportion appeared to be a common feature of this disease. The prevalence of isocyanate-induced asthma in a West African working population appears to be significant in the context of chronic human exposure, as current data are based on excessive acute exposure due to an accident as seen in India.

Adult↗

Differences between specificities of IgE and IgG4 antibodies: studies using recombinant chain 1 and chain 2 of the major cat allergen Felis domesticus (Fel d) I.

IgE- and IgG4 antibodies were compared for reactivity with recombinant chain 1 and chain 2 of the cat allergen Felis domesticus (Fel d) I. Recombinant chain 1 and chain 2 were coupled to sepharose and tested in IgE- and IgG4 radioallergosorbent test (RAST) experiments. Substantial IgE- and IgG4 binding was found. The fraction of Fel d I-specific antibody that bound to the recombinant chains was calculated. For chain 1, the mean value of this fraction was 0.30 for IgE and 0.23 for IgG4 (P = 0.05). For chain 2, the mean value of this fraction was 0.19 for IgE and 0.13 for IgG4 (P = 0.02). These results indicate that differences in fine specificity exist between IgE and IgG4 antibodies. Moreover, these findings support our results with chemically prepared peptides derived from these two chains and suggest that the B cells producing IgE antibodies are more likely to recognize a less 'native' form of Fel d I, compared with IgG4.

Adolescent↗

Hypersensitivity to common tree pollens in New York City patients.

Testing for tree pollen hypersensitivity typically requires the use of several tree pollens. Identifying patterns of cross-sensitivity to tree pollens could reduce the number of trees used for testing. The goal of this study was to relate reported tree pollen levels to hypersensitivity patterns. Three hundred seventy-one allergy patients were tested serologically for hypersensitivity toward prevalent tree pollens in the surrounding New York area over the years 1993-2000. Specific tree pollens that were examined included oak (Quercus alba), birch (Betula verrucosa), beech (Fagus grandifolia), poplar (Populus deltoides), maple (Acer negundo), ash (Fraxinus americana), hickory (Carya pecan), and elm (Ulmus americana). Statistical analysis of the levels of hypersensitivity was performed to identify correlations and grouping factors. Pollen levels, obtained from published annual pollen and spore reports, were characterized and related to the prevalence of hypersensitivity for the various trees. The highest prevalence of hypersensitivity (score > or = class 1) was for oak (34.3%), birch (32.9%), and maple (32.8%) tree pollens. Lower prevalences were observed for beech (29.6%), hickory (27.1%), ash (26%), elm (24.6%), and poplar (20.6%) trees. Significant correlations were observed between oak, birch, and beech radioallergosorbent test scores. Factor analysis identified two independent pollen groups with oak, birch, and beech consisting of one group and the other five tree pollens constituting the other group. Peak pollen counts clearly were highest for oak, birch, and maple trees. The peak pollen counts corresponded roughly to seropositivity prevalences for the tree pollens. When elm, poplar, and beech test scores were not used to identify patients who were allergic to tree pollens, only 1 of 106 patients with any positive tree radioallergosorbent test score was missed. It is concluded that in the New York City area, hypersensitivity to tree pollens most often is manifested with allergy to oak, birch, and maple tree pollens. Identifying beech, poplar, and elm hypersensitivity adds little toward identifying patients who are allergic to tree pollens. This may relate in part to cross-reactive epitopes. These data suggest that these three trees can be eliminated from testing with only a < 1% loss of sensitivity.

Adolescent↗

Oilseed rape and bronchial reactivity.

OBJECTIVES: To investigate atopy and changes in symptoms, peak flow rate, and bronchial reactivity in people complaining of symptoms during the oilseed rape flowering season. METHODS: 37 people who had given positive answers to questions about the presence of symptoms in relation to the flowering season of oilseed rape and 24 controls with no such symptoms were studied, although not all took part in all parts of the study. All had been previously identified in a cross sectional survey of a random sample of a rural population. Atopy was assessed by means of skin prick tests, total immunoglobulin E (IgE), and radioallergosorbent test (RAST) assays. Bronchial reactivity (PC20) was measured by histamine challenge. Total IgE and bronchial reactivity were measured both before and during the oilseed rape flowering season. Day to day changes were monitored by subjects who kept a record of their symptoms and peak flow morning and evening, starting before the flowering season and continuing during it and into the grass pollen season. RESULTS: Only two cases, of 23 tested, showed evidence of allergy to oilseed rape and only 10 of 23 tested, including these two, were atopic. Eye, nasal, and headache symptoms increased in the season in cases, which validated the questionnaire used in the previous cross sectional survey. 12 of 16 cases tested and seven of 15 controls showed a seasonal fall in PC20; the fall in the cases was significantly greater than in the controls. Peak flow charts showed no evidence of fall or of increased variability during the season. CONCLUSIONS: People who complained of symptoms in relation to the flowering of oilseed rape were rarely allergic to the plant and fewer than half were atopic. Nevertheless, they usually showed increased bronchial reactivity during the season, which may have been due in some cases to other allergens but in others to non-specific irritant effects of the air. Whether these are due to chemicals released by the crop, to rising summer ozone levels, or to other factors remains unclear.

Adolescent↗

Prevalence of IgE-mediated hypersensitivity in children with adenotonsillar disease.

OBJECTIVE: To determine the prevalence of allergy in children with severe adenotonsillar disease and to determine if the persistence of symptoms following tonsillectomy may be related to the allergic state. DESIGN: A prospective study of a cohort of 108 patients. SETTING: Academic tertiary referral medical center. PARTICIPANTS: Consecutive children scheduled to undergo tonsillectomy for obstructive hypertrophy or recurrent infection were eligible to enroll in this study. Over a 17-month period, 108 patients enrolled. One-year follow-up data were obtained on 78% of patients. A group of 59 age-matched controls was used for comparison. INTERVENTION: Radioallergosorbent test analysis was performed on all study patients and controls. The study patients had the following surgical procedures: adenotonsillectomy in 61 cases (55%); adenotonsillectomy-myringotomy tubes in 31 cases (28%); tonsillectomy in 14 cases (13%); tonsillectomy-tubes in one case (< 1%); and adenotonsillectomy-unilateral tube in one case (< 1%). OUTCOME MEASURE: Detection of allergy and postsurgical outcome. RESULTS: Allergy was detected by radioallergosorbent test analysis in 23 (21%) of the study group and 12 (20%) of the control group. Fourteen patients (17%) reported obstructive symptoms unchanged or worse 1 year following surgery. Three of these children were allergic. Sixteen patients (21%) reported allergic symptoms unchanged or worse following surgery. Three of these children were allergic. In six patients (7%), asthma developed following tonsillectomy. None of these children were allergic. CONCLUSIONS: The prevalence of allergy in children with severe adenotonsillar disease is the same as that of age-matched controls. No relationship was detected between resolution of symptoms following tonsillectomy and the presence of allergy. We found no increased prevalence in the development of asthma following tonsillectomy in the allergic child.

Adenoidectomy↗

Allergens in bee venom. I. Separation and identification of the major allergens.

Honeybee venom was separated into seven fractions by gel filtration on Sephadex G-75. Allergenic activities of these fractions were assessed by the paper disc radioallergosorbent test (RAST) with a panel of sera from 24 individuals who had systemic reactions to bee stings, 7 who had large local reactions, and 10 control subjects who had reactions of 5 cm or less following bee stings. Three fractions were identified by enzyme or direct hemolytic activity. Twenty-nine of 31 sera from patients having either systemic or large local reactions to bee stings were positive when radioallergosorbent tested with whole bee venom; 22 were positive to phospholipase A, and 28 were positive to both fractions 1 and 2. Thirteen sera combined most strongly with fraction 1, 12 sera most strongly with fraction 2, hyaluronidase, and three sera about equally with fractions 1, 2, and 3. Reactions with other fractions were much weaker. Fractions 1 and 2 were potent inhibitors of RAST with whole venom in the sera reacting most strongly with fractions 1 or 2, respectively. Fraction 3, phospholipase A, and commercial bee venom phospholipase A were significantly less potent inhibitors with the sera tested. In the cases in which IgE antibody bindings to fractions 1, 2, and 3 were of similar magnitude, inhibitions of RAST using the various fractions both on the discs and as inhibitors demonstrated substantial cross-reactivity between the fractions. These results strongly indicate that by using RAST with human sera from bee sting-sensitive individuals, fraction 1, the high molecular materials, and fraction 2, hyaluronidase, are the major allergens in honeybee venom. Phospholipase A appears to be of secondary importance.

Allergens↗

Allergic reactions to measles-mumps-rubella vaccination.

OBJECTIVE: Immunization of egg-allergic children against measles, mumps, and rubella (MMR) is often deferred or even denied, although the safety of this vaccination has been clearly shown. Moreover, the majority of severe allergic reactions have occurred in egg-tolerant vaccinees. Other allergenic vaccine components have been sought, and gelatin has been suggested as one cause of allergic adverse events. The aim of this study was to further characterize the actual allergenic vaccine components. METHODS: Serum samples from 36 recipients of MMR vaccine with anaphylaxis, urticaria with or without angioedema, asthmatic symptoms, or Henoch-Schönlein purpura were analyzed by CAP System radioallergosorbent test (RAST) and immunospot methods to detect the allergenic vaccine component. To evaluate the correspondence between the findings in the CAP System RAST or the immunospot and clinical symptoms, histories of allergies and present hypersensitivity symptoms were assessed. RESULTS: Of the 36 participants, 10 were demonstrated to be allergic to gelatin. Seven of them had persistent allergic symptoms, possibly attributable to foods containing gelatin or cross-reactive allergens. The results of the immunospot suggested concomitant allergy to gelatin and egg, chicken, and feathers, as well as cow's milk, or they reflected allergen cross-reactivity. CONCLUSIONS: Although severe allergic adverse events attributable to MMR vaccination are extremely rare, all serious allergic reactions should be further assessed to detect the likely causative vaccine component, including gelatin. The current recommendation for immunization of egg-allergic persons according to standard MMR vaccination schedules is reinforced. measles, mumps, and rubella vaccine, immunization, adverse effects, allergic reactions, gelatin allergy, CAP System, radioallergosorbent test, immunospot, immunoglobulin E.

Adolescent↗

[Immediate allergic reaction to natural latex with special reference to surgical gloves].

There is an increasing incidence of contact urticaria (CU) and systemic reactions to rubber products. 34 patients are presented: Most were atopic (22/34) and women (29/34). 24 worked in the medical field. 13 patients showed signs of hand dermatitis. In 31 patients, rub and/or pricktests with liquid latex in different dilutions and with latex gloves led to positive reactions. The allergen(s) appear in part to be watersoluble: 23 of 31 patients revealed positive test reactions to an aqueous glove extract. In two patients, urticarial test reactions to TMTD, Mercapto-Mix, and PPD-mix were considered as possible contributing factor of CU. Scratch tests with corn-starch were negative in all patients. 17 of 29 sera showed RAST (radioallergosorbent test) class 0 using latex allergen disks. SDS-PAGE (sodiumdodecylsulfate-polyacrylamide-electrophoresis) determined protein bands of less than or equal to 14 kD (not allergen specific) and approximately 28 kD. The Western Blot detected the 28 kD protein as allergen in the sera of three patients. Isoelectric focusing (IEF) proved no protein bands. Immunoprinting performed with sera of five patients presented allergen bands in an pH range between 3.8 and 4.55. This shows that radiostaining (immunoprint) is more sensitive than the Coomassie Blue staining. Although three sera showed RAST class 0, immunoblotting detected allergen bands. In these cases the immunoblot appears to be more sensitive than the RAST. A cross reactivity between latex and banana could not be established. Alternative gloves are Neolon (neoprene) or Elastyren (styrene-butadiene polymer).

Adult↗

[Latex allergy in children: description of two cases].

Here we present two cases of latex hypersensitivity. The clinical manifestations were conjunctivitis, urticaria, angioedema and dermatitis. The patients presented positive skin prick test (SPT) to latex with a commercial extract and by pricking through a latex surgical glove. Radioallergosorbent test (RAST) to latex and patch testing to common additives and to latex were negative. Skin prick tests with fruits (banana, kiwi, pineapple, apricot, avocado, grape) were positive but children presented no symptoms after ingestion of these fruits. These case reports are presented to heighten awareness of the potential of latex allergy also in children.

Age Factors↗

Deer ked-induced occupational allergic rhinoconjunctivitis.

BACKGROUND: Deer keds (elk fly) have not previously been described as a cause of respiratory or conjunctival sensitization. OBJECTIVE: To report a case of IgE-mediated allergic rhinoconjunctivitis from occupational exposure to deer ked. METHODS: Skin prick testing (SPT) was performed with pollens, animal danders, mites, molds, and deer ked. The serum deer ked-specific IgE level was examined in ImmunoSpot and radioallergosorbent test assays, and deer ked IgE-binding fractions and their specificities were examined in immunoblot and immunoblot inhibition assays. Nasal provocation testing (NPT) and conjunctival provocation testing (CPT) were performed to detect the association between deer ked sensitization and rhinoconjunctival symptoms. Both SPT and NPT were performed with deer ked whole-body extract, whereas CPT was performed with deer ked wing. RESULTS: The results of SPT, NPT, and CPT were positive for deer ked. In laboratory tests, serum deer ked-specific IgE antibodies were demonstrated in radioallergosorbent test and ImmunoSpot assays. In immunoblot, IgE-binding bands were demonstrated at 17, 33, 70, and 85 kDa, which were clearly inhibited with deer ked extract but not with the control extract. CONCLUSIONS: Occupational IgE-mediated rhinoconjunctival allergy to deer ked was confirmed in this patient.

Adult↗

IgE-mediated sensitization in seafood processing workers.

Occupational-related allergic sensitization has been reported in fishery workers. The aim of this study was to investigate the prevalence, work-related symptoms, and possible risk factors in this occupationally exposed population in Greece. Sixty-four fish and seafood processing workers were compared with 60 controls regarding sensitization to seafood allergens. All participants underwent skin-prick tests (SPTs) with cod, sardines, shrimp, spiny lobster, crabs, salmon, mussels, and trout plus negative and positive control. The level of specific IgE (radioallergosorbent test) was evaluated in subjects with positive SPTs. Sensitization criteria were both SPTs and the corresponding positive radioallergosorbent test. Atopic status was tested with SPTs to seven common inhalant allergens. Potential risk factors for IgE sensitization were investigated using logistic regression analysis. Twenty-three of 64 workers (35.9%) were sensitive to at least one of the seafood allergens tested, and the prevalence in the control group was 10% (6/60; odds ratio, 5.049; 95% CI, 1.884-13.533). The prevalence of sensitization in allergen species tested in the fishery workers group was shrimp, 12.5%; spiny lobster, 10.9%; mussels, 7.8%; crabs 3.1%; cod, 3.1%; sardines, 1.6%; salmon, 1.6%; and trout, 1.6%. Presence of atopy (p = 0.02), intensity (p = 0.03), and duration of exposure (p = 0.03) was found as potential risk factors for IgE sensitization. Four of 64 (6.25%) workers reported work-related symptoms. Occupational exposure to fish and seafood significantly increases the likelihood of sensitization in seafood allergens and atopy, duration, and intensity of exposure may represent potential risk factors in seafood processing workers.

Adult↗

Increased sensitization to aeroallergens in competitive swimmers.

Chlorine is used to disinfect swimming pools or as a constituent of other disinfection reagents. Pulmonary diseases are occasionally observed after exposure to chlorine. In 14 competitive swimmers and in 14 matched control subjects, we searched for clinically manifest allergies, subclinical sensitization to aeroallergens, imbalance of the cellular immune system, and bronchial hyperresponsiveness. Conjunctival or respiratory symptoms were found in 11 swimmers (2 cases of conjunctivitis, 4 rhinitis, 2 rhinoconjunctivitis, 1 laryngitis, and 2 bronchitis) and in 3 controls. Sensitization to aeroallergens was confirmed in 9 swimmers by skin test and in 11 swimmers by radioallergosorbent test (RAST), compared to findings in 4 and 5 controls, respectively. An altered cellular immune system, (i.e., imbalance in T-cell system, B-cell system, or natural killer cells) was detected in 7 swimmers and only 2 controls. Bronchial hyperresponsiveness to methacholine was seen in 11 swimmers and 5 controls. This higher incidence of allergic diseases and subclinical sensitization to aeroallergens, disorders of the cellular immune system, and bronchial hyperresponsiveness in competitive swimmers compared with control subjects could be due to repeated exposure to chlorine in swimming pools.

Adolescent↗

Penicillin allergy: anti-penicillin IgE antibodies and immediate hypersensitivity skin reactions employing major and minor determinants of penicillin.

300 children considered to have had adverse reactions to penicillin were examined. Informed consent was obtained from the parents. Skin tests were conducted by the scratch/prick and intradermal techniques, using benzylpenicilloyl polylysine conjugate and a mixture of minor determinants of penicillin. Specific anti-penicillin IgE antibodies were estimated by the radioallergosorbent test. There was a good correlation between the two methods. The overall frequency of positive tests was 19%. 11 children showed cutaneous reactivity only to the minor determinants mixture. Positive results were found more often in those with accelerated adverse reactions, particularly anaphylaxis, serum sickness, angio-oedema, or urticaria. The validity of penicillin-negative results was confirmed by drug challenge in 56 subjects, only 2 of whom showed a slight skin rash. Of 5 patients with positive tests, inadvertent administration of penicillin produced accelerated urticaria in all. 14 of 42 children with positive tests had lost hypersensitivity to penicillin one year later. In a separate group of 50 children with a history of adverse response to ampicillin, the overall frequency of positive tests was 12%; 38% showed evidence of recent E-B virus infection. It was concluded that penicillin allergy is often overdiagnosed. The diagnosis can be reliably confirmed by skin tests using major and minor determinants of benzylpenicillin and by the radioallergosorbent test; such hypersensitivity is not permanent.

Ampicillin↗

Smoking, atopy, and laboratory animal allergy.

This study examined data from three cross sectional surveys of 296 laboratory workers exposed to small mammals. Four indices of laboratory animal allergy were studied: symptoms suggestive of occupational asthma, symptoms suggestive of any occupational allergy, skin weals to animal urine extracts, and serum binding in radioallergosorbent tests with urine extracts. Pooled data from the three surveys showed an association between smoking and all indices except radioallergosorbent tests; the association was significant for symptoms of occupational asthma. One of the three surveys consistently showed a stronger association of allergy indices with smoking than with atopy (defined on skin tests with non-animal aeroallergens). Associations with smoking persisted after stratifying by atopic status, suggesting that smoking may be a risk factor for laboratory animal allergy.

Adult↗

Sensitivity to the house dust mite and airway hyperresponsiveness in a young adult population.

BACKGROUND: The pathogenic mechanisms of airway hyperresponsiveness (AHR) in asthma are unknown and only a few studies have examined the importance of sensitivity to antigens in AHR in young adults. OBJECTIVE: We investigated the correlation between AHR and sensitivity to specific antigens, atopy, history of childhood asthma and spirometry in a young adult population. METHODS: Based on the results of interviews with 447 students at our university, 308 non-smoker students were classified into six groups. Group 1 comprised subjects with intermittent mild bronchial asthma; group 2, subjects with history of childhood asthma; group 3, subjects with atopic disease, and a RAST score for Dermatophagoides farinae (Def) of > or = 2; group 4, normal subjects with a RAST score for Def of > or = 2; group 5, subjects with cedar pollinosis; and group 6, normal subjects. We measured AHR to methacholine (MCh), spirometry, immunoglobulin E-radioimmunosorbent test (IgE-RIST), IgE-radioallergosorbent test to six common antigens, eosinophil cationic protein (ECP), and eosinophil count in peripheral blood in each subject. RESULTS: Airway hyperresponsiveness to MCh did not correlate with IgE-RIST, eosinophil count, or ECP. The highest AHR to MCh was present in groups 1 and 2 and lowest in groups 5 and 6. Multiple regression analysis showed that sensitivity to Def was the only factor that significantly influenced AHR to MCh. Airway hyperresponsiveness to MCh of groups with a RAST score for Def of 0/1 was lower than groups with a RAST score of 2 to 6. Airway hyperresponsiveness to MCh did not correlate with the degree of positivity to Def antigen among positive sensitized groups (RAST score 2 to 6). CONCLUSIONS: Sensitivity to mite antigen may be important in the pathogenesis of AHR and Def is a major contributing antigen in young adults in Japan. Once asthma occurs, AHR remains positive for a long time even after the disappearance of asthma-related symptoms.

Adult↗

Immunochemical study of the venom from the hornet Vespa orientalis (hymenoptera:Vespinae).

Venom from young (0 to 48 hours after eclosion) Vespa orientalis should presumably be less allergenic and/or antigenic than venom from adult hornets. This point was confirmed by skin tests, by crossed immunoelectrophoresis and by radioallergosorbent test (RAST), using rabbit IgG antibodies and human IgE antibodies. It is suggested that the venom of young hornets could have therapeutic applications.

Allergens↗