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PubMed1995

Good allergy practice--standards of care for providers and purchasers of allergy services within the National Health Service. Royal College of Physicians and Royal College of Pathologists.

Allergic diseases affect at least 15% of the population and are the cause of much ill-health. 'Clinical immunology and allergy', the term used by the Department of Health in England and Wales for this area of specialization, is recognized as a separate specialty of medicine under the National Health Service. Many organ-based hospital consultants (e.g. chest physicians) have allergy as a special interest or subspecialty. Allergists deal largely with 'itch, sneeze, cough and wheeze' and so are experts in: summer hay fever (seasonal, allergic, conjunctivorhinitis); perennial rhinitis (symptoms of a 'permanent cold'); allergic asthma (including occupational asthma); allergy to stinging insects (especially wasps and bees); allergy to drugs; allergy-related skin disorders, i.e. urticaria, angioedema, atopic eczema and contact dermatitis; food allergy and food intolerance; anaphylaxis (acute generalized allergic reaction); evaluating the role of allergy in non-specific/polysymptomatic illness. Children with allergic disease should be under the overall care of a paediatrician since the progression of allergies in children differs from that in adults. Good allergy practice involves teamwork by doctors, nurses and dietitians. The investigation of allergy patients includes skin tests and challenge procedures (e.g. food allergy tests) as well as various specialized laboratory investigations. Good clinical practice by providers and the effective use of allergy services by purchasers should improve prognosis and cut costs of treatment in allergic disease.

Adult↗
PubMed1987

Diagnosis and immunotherapy of mould allergy. VI. IgE-mediated parameters during a one-year placebo-controlled study of immunotherapy with Cladosporium.

The IgE-response was evaluated by skin prick test, bronchial provocation test and RAST in a 1-year placebo-controlled double-blind immunotherapy study. Eleven adult asthmatics were treated with a Cladosporium allergen preparation and 11 comparable patients received histamine placebo. The bronchial sensitivity (PC20) decrease greater than 0.5 log step in 8/11 (73%) Cladosporium-treated versus 3/11 (27%) in the placebo group. Corresponding figures for skin prick test sensitivity was 10/11 (91%) and 1/11 (9%) respectively. Circulating IgE showed a temporary boost in the Cladosporium group and then values approaching the pretreatment value. Only minimal and insignificant changes were found in the placebo-treated patients. Changes in IgE-reactivity were not related to allergen dose, clinical efficacy or to the occurrence of side effects. Some interrelation between changes in skin prick test, bronchial provocation test and RAST was found indicating a differentiated effect of immunotherapy on various IgE compartments. In spite of the pathogenetic role of IgE in allergic diseases, changes in IgE-reactivity do not seem directly involved in the mechanisms underlying the clinical efficacy of immunotherapy but might be of importance in a complex interaction with other immunological parameters.

Adult↗
PubMed1979

The immunological basis of immediate hypersensitivity.

IgE is a homocytotropic antibody which binds to the surface of the mast cell. Antigen with affinity for IgE triggers conformational change at the cell surface, resulting in the release of chemical mediators from the mast cell granules. The mediators histamine, slow reacting substance of anaphylaxis and eosinophil chemotactic factor cause smooth muscle contraction, increased capillary permeability, eosinophil attraction and increased glandular secretions. The release of mediators from the mast cell granules is controlled by intracellular levels of cyclic nucleotides. In particular, elevated cyclic AMP inhibits mediator release. Adrenergic, cholinergic and prostaglandin receptors all influence mediator release. The characteristic immunopathology of immediate hypersensitivity reactions is a result of local or systemic mediator release. Such reactions include anaphylaxis, asthma, allergic rhinitis, urticaria and angioedema. Similar immunopathology may sometimes result from mechanisms not involving IgE or histamine mediators. Routine investigation of patients with immediate hypersensitivity should include eosinophil counts and IgE levels in blood and secretions, and immediate hypersensitivity skin tests. RAST testing is not routine. Therapeutic principles of these reactions include restoration of inhibitory levels of cyclic nucleotides, antagonism of mediator effects and immunological manipulation of the IgE mediated allergic reaction.

Adrenal Cortex Hormones↗
PubMed2005

Effect of delayed graft function in hypersensitized kidney transplant recipients.

There is increased evidence about the deleterious effect of delayed graft function (DGF) in both short- and long-term kidney graft outcome. Among the mechanisms involved in the production of DGF, immune factors play a role, especially in the level of hypersensitization. From the 1389 patients transplanted at our hospital until November 2004, it has been found that the presence of moderate and high levels of sensitization, as measured by panel-reactive antibodies, is a risk factor for suffering from DGF. Further, DGF was associated with poor graft survival, and the risk was even higher when DGF was combined with moderate/high panel-reactive antibodies. Recent data demonstrate the usefulness of intravenous immunoglobulins in the management of hypersensitized patients in terms of short-term outcome. It remains to be demonstrated whether this therapy is able to ameliorate the higher ischemic injury that kidneys undergo from these immunologically high-risk patients.

Desensitization, Immunologic↗
PubMedDate not supplied

[Advantages of hyposensitization with a high dose of allergoid in pollen allergy].

Grass and rye pollen sensitive children were hyposensitized with glutaraldehyde-modified, tyrosine-adsorbed grass and rye allergoid. We evaluated the clinical efficacy and immunological changes associated with the administration of 3100 NOON-Units (NU) with 3 injections in 15 patients (group A) and 9100 NU with 6 injections in 13 patients (group B) preseasonally. No systemic side effects during therapy were observed. In patient's assessments, a clinical improvement was reported; however, group B achieved better symptom and medication scores. The latter group obtained slightly higher specific IgG levels than group A after two seasons of treatment, whereas the co-seasonal increase of specific IgE was higher in group A. Hyposensitization with grass and rye allergoid is a safe therapy, a better clinical and immunological effect being observed in a high dose regimen.

Child↗
PubMedDate not supplied

Immunologic and clinical responses to parenteral immunotherapy in peanut anaphylaxis--a study using IgE and IgG4 immunoblot monitoring.

BACKGROUND: Specific desensitisation to food allergens, which produce anaphylaxis after ingestion, has not been considered as a treatment for food allergy until recently. The purpose of this study was to assess if a parenteral immunotherapy program, using a partially characterised crude peanut extract, could induce a state of immunological tolerance in a patient who exhibited anaphylaxis, asthma and urticaria on exposure to peanut and other legumes. A further aim was to measure the serum antibody responses to the immunotherapy. METHODS AND RESULTS: We report the successful desensitisation towards all of the legumes tested of a male patient on parenteral immunotherapy using a partially characterised peanut extract. The immunologic parameters measured during treatment included specific IgE and IgG4 for peanut, soybean, pea and lentil extracts. Immunoblots of specific IgE and IgG4 were made before and after therapy. The antibody response followed the same pattern seen in successful desensitisation of patients with bee venom anaphylaxis. The IgG4 levels increased strongly from a low pre-treatment level in proportion to the antigen dose received. The antigen-specific IgE levels gradually fell from a high pretreatment level, but remained significantly elevated. Immunoblotting for specific IgE and IgG4 demonstrated that acquisition of clinical tolerance after therapy was associated with declines in the number and intensity of bands in IgE blots and the development of more bands of increasing density in the IgG4 blots. CONCLUSIONS: Parenteral immunotherapy may offer an alternative treatment to lifelong dietary restriction and epinephrine injections in patients who exhibit life-threatening IgE-mediated anaphylaxis to peanut. Cross desensitisation to other legumes appears to have occurred in this study. The quality and potency of the extract used is an important factor in achieving the desired acquisition of clinical tolerance. In our patient this tolerance correlated with his ability to maintain high levels of specific IgG4, which acted as a marker of protection against anaphylaxis. The use of IgG4 immunoblotting may provide an improved level of discrimination in the assessment of correlation of clinical efficacy with the immunologic response.

Adolescent↗
PubMedDate not supplied

Humoral immune responses to recombinant tree pollen allergens (Bet v I and Bet v II) in mice: construction of a live oral allergy vaccine.

Recombinant tree pollen allergens (recombinant Bet v I and recombinant birch profilin, Bet v II) were purified and used to immunize BALB/c and B6D2F1 mice with Al(OH)3 to elicit a specific IgE response. Serum from immunized mice was then used to detect immunoblotted natural tree pollen allergens. The onset of the humoral immune response was monitored using antimouse IgE, IgG1, IgG2a/b, IgG3 and IgA. In both strains, a specific and long-lasting IgE response could be elicited with both recombinant allergens. Mice immunized continuously with recombinant Bet v I + Al(OH)3 showed a significant decrease of specific IgE antibodies indicating that continuous application of allergens can reduce specific IgE responses. The possibility of inducing a different type of immune responses is indicated by the fact that mice fed with Bet v I expressed in apathogenic Salmonella strains showed a Th1 immune response to Bet v I accompanied by specific IgG2a/b without detectable IgG1 or IgE. Recombinant allergens can hence be used to decrease or even modulate specific IgE responses in vivo.

Adjuvants, Immunologic↗