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PubMedDate not supplied

Extended evaluation of diagnostic skin testing practices in Orange County, California.

In an effort to evaluate conformity with published guidelines for diagnostic allergy skin testing in their locality, a committee of members of the Orange County (California) Society of Allergy and Clinical Immunology surveyed their membership for the number, identity, and rates of sensitization of aeroallergens in a selected patient population. Test data were analyzed on patients who were judged appropriate to undergo immunotherapy. Complete test results of 271 patients were obtained from one third of local allergy specialists. A total of 115 different aeroallergen extracts were identified. By category, tree pollen allergens (32) were followed in declining order by weed pollens (28), molds (22), environmentals (18), and grass pollen extracts (15), for the total of 115. The average number of aeroallergens used by a practice in a comprehensive evaluation was 77 (range, 47-114). When only unequivocally positive reactions were considered (3+ equivalent or greater), Bermuda grass pollen extracts elicited the highest rate, 85%, and the environmental, rat dander, was the lowest at 1.8%. At least 20% of the patients reacted strongly on skin tests to 97% of the extracts. The disparity between the recommendations of a maximum of 30 aeroallergens for a comprehensive evaluation and actual practice procedures merits efforts at resolution.

Adult↗

PubMedDate not supplied

Importance of allergic etiology in nasal polyposis.

Sensitization to environmental allergens in nasal polyposis was evaluated in an in vitro study conducted on 90 patients undergoing polypectomy by measuring total and specific IgE for a panel of common allergens and levels of IgG, IgA and albumin in serum, and nasal secretions (NSe). Fifty healthy individuals were chosen as a control group. Total IgE concentrations were higher in patients with nasal polyps than in controls. RAST was positive in serum in 34 (38%), in NSe in 29 (32%), and exclusively in NSe in 10 patients (11%). Allergens most frequently involved were mites and cat dander. No differences were found between the study and control groups for serum and NSe IgA, albumin, and serum IgG, whereas IgG in NSe were significantly higher in patients with nasal polyps. Subjects with positive RAST only in NSe had significantly lower secretory IgA than did controls. Our data indicate that in nasal polyposis: 1) sensitization to aeroallergens is relatively common; 2) a local production of specific IgE may occur, especially for perennial allergens; 3) prolonged exposure to these allergens gives rise to chronic nasal inflammation, with altered local production of immunoglobulins.

Adolescent↗

PubMedDate not supplied

Atopy and systemic reactions to hymenoptera stings.

To evaluate whether atopy is a risk factor for systemic reactions to hymenoptera stings, we compared the atopic status of two groups of subjects. The first group included 93 patients (59 males), mean (+/- SD) age: 42.3 +/- 17.2 yrs with a history of anaphylactic reactions to hymenoptera stings. The second was a control group of 712 subjects (379 males), mean (+/- SD) age: 42.0 +/- 9.6 years recruited at a public health care center. The protocol included a standardized questionnaire about symptoms suggestive of atopy, i.e. medical diagnosis of asthma, perennial rhinitis or hay fever, and skin tests to common aeroallergens, i.e. house dust mites, cat danders, and grass pollens. The percentage of subjects with atopic symptoms was comparable in the two groups (32.2% for the patient group and 28.5% for the control group). Similarly, 22.6% of patients and 36.8% of controls exhibited at least one positive skin prick test. Lastly, 15.1% of patients and 18.5% of controls (a nonsignificant difference) had at least one symptom of atopy and at least one positive skin test. These findings show that atopy is not a risk factor for systemic reactions to hymenoptera stings.

Adult↗

PubMedDate not supplied

Practical approaches to the treatment of atopic dermatitis.

Atopic dermatitis is a chronic pruritic cutaneous disease that occurs in 0.5% to 1% of the general population and affects almost 10% of all children. Since this is a disease that is associated with both a very high level of total IgE and a high incidence of allergic respiratory disease, it behooves the practicing allergist to become familiar with the diagnosis and treatment of atopic dermatitis. This following discussion will focus on the identification of major and minor clinical features of the disease and review the spectrum of immune dysregulation that is frequently seen with these patients. The primary focus of this review will be directed at the identification of treatment options available to allergists within the published practice guidelines of the American Academy of Dermatology and practice guidelines that are currently being developed by the American Academy of Allergy & Immunology. Atopic dermatitis is an "itch which rashes and not a rash which itches" and therefore, any patient treatment program should address the multiplicity of potential trigger factors that provoke this itching. These factors include heat, humidity, and perspiration, in addition to the ingestion of certain food allergens and the topical exposure to both dust mite antigen and animal dander. Recent studies suggest that the pathogenesis of allergic disease entails a complex inflammatory process in which the TH2 lymphocyte might play a major role in shifting the immune response in favor of disease. Accordingly, recent immunomodulating treatments, such as interferon gamma and cyclosporine, might offer therapeutic options to the physician beyond the standard topical forms of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMedDate not supplied

Specific immunotherapy in asthma.

There is a growing appreciation of asthma as an inflammatory disease. Immunotherapy may play a role in modulating immunologic responses including inflammatory mediator production from cells involved in asthma. Studies of pollen-sensitive asthma have demonstrated beneficial effects of specific immunotherapy for grass, birch, and ragweed pollen-induced asthma. However, risk of systemic reactions exists, especially when specific immunotherapy is administered during the specific allergen season. House dust mite immunotherapy has benefitted asthmatic children more than adults. Patients having unstable pulmonary function may be at the highest risk of having systemic reactions to such immunotherapy. Animal dander immunotherapy and immunotherapy for molds including Clasdosporium and Alternaria may improve selected asthmatic patients. Avoidance of the offending allergen is still, however, the preferred mode of treatment of allergic asthma.

Adult↗

PubMed1979

The most important allergens in allergic rhinitis.

The distribution of allergens, found on thorough allergy work-up in a series of 770 patients with seasonal and perennial nasal symptoms, is reported. The percentages of positive reactions to grass, tree, and herb pollens were equally high (30--40%) but, clinically, pollens from grasses (Timothy, Alopecurus, Kentucky Blue and Meadow fescue), birch and mugwort (Artemisia) were the most important. In the Nordic countries house dust is evidently the commonest causative agent in perennial rhinitis but the heterogenous composition of house dust makes it difficult to determine potent allergenic factors. Sensitivity to house dust was present in 44% of the patients; a positive reaction to mite extract in only 10%. Animal danders were not found to be great importance in allergic rhinitis (13--18%). Reactions to moulds were observed in 9% of the patients.

Allergens↗

PubMed2000

[The role of fungal allergy in bronchial asthma].

Fungus is known to be one of the causative allergens inducing bronchial asthma as are housedustmites, pollen and pet dander. Outdoor airborne fungi such as Cladosporium, Alternaria, Penicillium and Aspergillus are important inducing IgE antibody formation. In addition to these common fungi, the indoor fungi Aspergillus restrictus, Neurospora and Eurotium are important allergenic fungi which have recently been identified. The yeast Candida albicans, is a common commensal of the human oral and vaginal mucosae and gastrointestinal tract and part of the normal flora, is known as one of the main allergens causing bronchial asthma. We examined the allergenicity of mannan (Mn) as a cell-wall constituent and acid protease (CAAP) as a secreted enzyme of C. albicans. We previously reported cases of atopic asthma caused by CAAP and stressed the role of CAAP as an important allergen in mucosal allergy to C. albicans 9). The levels of the antibodies to these antigens in the sera of asthmatic patients who showed positive immediate intradermal response to crude C. albicans (n=86) were measured. Anti-Mn IgE and IgG antibody levels were measured by liquid-phase assay (AlaSTAT). Anti-CAAP and anti-crude C. albicans IgE and IgG antibody levels were measured by RAST and AlaSTAT. Anti-Mn A and anti-Mn B IgE antibody titers were strongly correlated (r=0.87), while anti-Mn A and anti-CAAP IgE titers were not correlated. However, all of the anti-Mn A IgE positive sera and all of the anti-CAAP IgE positive sera were positive for IgE to crude-C. albicans. This indicates that both Mn and CAAP are C. albicans-related allergens. Titers of IgG antibodies to Mn A and crude C. albicans were highly correlated (r=0. 90). Results of inhibition assays performed using other fungal antigens as inhibitors showed that Mn is a cross reactive allergen among different fungi and that CAAP is a C. albicans specific allergen causing human mucosal allergic reaction.

Allergens↗

PubMed2001

Allergen-derived T cell peptide-induced late asthmatic reactions precede the induction of antigen-specific hyporesponsiveness in atopic allergic asthmatic subjects.

Allergen-derived peptides can induce T cell tolerance in naive and Ag-primed mice. This is preceded by transient T cell activation. In humans, intradermal administration of short allergen-derived T cell peptide epitopes provokes IgE-independent isolated late asthmatic reactions (LARs) in sensitized subjects. In this study, we determine whether, as in mouse models, such peptides produce hyporesponsiveness to rechallenge with peptides, or whole allergen, either clinically or in terms of in vitro T cell responses. We found that a second injection of cat allergen (Fel d 1)-derived T cell peptides was associated with a marked reduction, or absence, of the LAR, and that up to 40 wk was required for return to baseline values. The cutaneous late-phase reaction to whole cat dander was also inhibited, even in subjects who did not experience an initial LAR. These observations were associated with a significant decrease in peptide- and whole allergen-induced proliferation of PBMCs and the production of IL-4, IL-13, and IFN-gamma in cultures. Thus, allergen-derived peptides induce tolerance to subsequent peptide injection in the target organ (the lung), reduce late-phase cutaneous responsiveness to whole allergen, and alter in vitro T cell reactivity.

Allergens↗

PubMed1998

Powered dust respirator helmets in the prevention of occupational asthma among farmers.

OBJECTIVES: This study investigated the value of powered dust respirator helmets in the treatment of farmers with occupational asthma. METHODS: The study population consisted of 33 asthmatic agricultural workers, 24 with occupational asthma induced by cow dander or grains, 2 with other forms of atopic asthma, and 7 with nonatopic asthma. The efficiency of a powered dust respirator helmet with a P2-class filter in preventing asthmatic symptoms was assessed for 1 year. Morning and evening peak expiratory flow rates and daily symptoms of the subjects were monitored for 3 months without the use of the helmet and for 10 months with the helmet. RESULTS: Objective evidence of protection was obtained for farmers with occupational asthma. The morning peak flow rate increased and the variation in daily peak flow rate and the symptoms of cow-barn rhinitis diminished significantly during the helmet period. In the group of farmers with nonatopic asthma there was no improvement in peak flow rate or symptoms of asthma, although some of these farmers also seemed to benefit from helmet use. CONCLUSIONS: The results of this study suggest that especially dairy farmers with occupational asthma benefit from the use of a powered dust respirator helmet.

Adult↗

PubMed1999

Trends in allergies among children in a region of former East Germany between 1992-1993 and 1995-1996.

A lower prevalence of asthma and allergies has been reported among children and adults living in the area of former East Germany compared with those living in West Germany. After German reunification in 1990, the East German population rapidly adopted a western lifestyle. Therefore, this study examined if the prevalence rates of allergic diseases, symptoms, and sensitisation and asthma have increased among East German children since German reunification. - Children aged 5 to 7 years living in the region of Sachsen-Anhalt, East Germany were examined in two cross-sectional studies during 1992-93 (n = 769, response rate 84.0%) and 1995-96 (n = 725, response rate 74.6%). Sensitisation was assessed by specific immunoglobulin E measurements against five common aeroallergens using the CAP-FEIA technique. After adjustment for sex, parental education, season of examination, day care attendance, breast feeding, environmental tobacco smoke exposure, cat dander exposure, and several indoor factors, an increase in the prevalence of self-reported, physician-diagnosed allergies (OR 1.44, 95% CI 1.01-2. 06), but not in allergic sensitisation (OR 0.85, 95% CI 0.62-1.16) was found. The only evidence of an increase in allergies of the self-reported increase in the prevalence of physician-diagnosed allergies is likely due to changes in physician diagnostic patterns and the heightened public awareness of allergic diseases. - In conclusion, there were no significant changes in the prevalence of asthma, allergic rhinitis, or self-reported symptoms of allergic diseases.

Adult↗

PubMed1976

[Value of specific IgE levels in the etiological diagnosis of asthma].

The authors report a study of skin and inhalation tests and of specific IgE in 76 control subjects and 180 patients with allergic asthma. There is a remarkable correlation between the skin tests and the R.A.S.T. in pollinosis (96% of correlation) and in the respiratory allergy to Dermatrophagoides pteronyssinus (120 patients and 87.5% of correlation). It is good in the allergy to animal dander (82% of correlation) but poorer in the respiratory allergy to house dust (62% of correlation). The comparative study of inhalation tests and R.A.S.T. confirms that the degree of correlation depends on the quality of the allergens and on the patients selection. With the extract of house dust (101 cases) the correlation is only of 61.9%, whereas it reaches 95% with a purified extract of Dermatophagoides pteronyssinus (38 cases). The comparison between the treshold of allergenic sensitivity and the group of R.A.S.T. shows that to one group of high R.A.S.T. usually corresponds a low treshold of bronchial sensitivity (D.L.A.L. less than 100 gamma of extract of D. pt. in 22 patients having a R.A.S.T.D. pt. of group 3 or 4). Besides being valuable in characterizing allergens, the R.A.S.T. when confronted to the case history, to skin and inhalation tests, provides supplementary information leading to a more precise allergological diagnosis. In respiratory allergies caused by well known allergens (pollen, Dermatophagoides pteronyssinus), the R.A.S.T. could be substituted to skin and inhalation tests, when in agreement with clinical data. In doubtful cases, the inhalation tests would still keep their value and the confrontation of different techniques is necessary.

Acari↗

PubMed1976

Demonstration of reactivity to airborne and food allergens in cutaneous vasculitis by variations in fibrinopeptide A and other blood coagulation, fibrinolysis and complement parameters.

In a 32-year-old woman and a 40-year-old man with cutaneous vasculitis, etiological allergic responses to foods and airborne allergens were found. During provocation tests, observations were made on blood levels of fibrinopeptide A(FPA) and coagulation factors, fibrinogen degradation products (FDP) and serum complement components. Skin biopsies were taken for microscopic and immunofluorescence analysis. In case 1, anaphylactoid allergy to milk and reaginic and anaphylactoid hypersensitivity to grass pollens were found. Dermal provocations with grass pollens gave arthralgia, hematomas, serum C3 fluctuation, factor VII reduction and fibrinolysis. During peroral milk challenge, transient increases in FPA and FDP levels were observed before symptoms appeared. In case 2, anaphylactoid hypersensitivity responses to bacteria, animal danders, foods and pollens were found. Two inhalations with sheep-wool extract resulted in a typical skin eruption. The first also gave an early reduction of C3 and then FPA liberation. Nasal birch-pollen test gave an increase of FPA in the latent period and then typical nodules. At least no low molecular weight FDP were detected during provocations. In patients with vasculitis reactions to exogenous allergens, FPA and FDP estimations after provocations may discriminate harmful from innocuous allergens and reveal individual response patterns in coagulation and fibrinolysis systems.

Adult↗

PubMed1999

Prevention of allergic eye disease by treatment with IL-1 receptor antagonist.

PURPOSE: To determine the impact of interleukin-1 (IL-1) inhibition using IL-1 receptor antagonist (IL-1Ra) in a mouse model of allergic eye disease. METHODS: A/J mice sensitized and challenged with cat dander in the eye were treated with topical IL-1Ra or vehicle alone. Control mice were treated with IL-1Ra or vehicle but sensitized and challenged with phosphate-buffered saline alone. Immediately after the final allergen challenge, the mice were observed for behavioral changes and assessed for lid injection and chemosis. The animals were then killed, eyes and attached lids were removed for either RNA extraction or histology, and draining lymph nodes were removed for either RNA extraction or in vitro stimulation assays. Differences in chemokine message between experimental and control groups-were determined by RNase protection assays. RESULTS: Treatment with IL-1Ra in allergen-challenged animals significantly reduced allergen-induced changes in photosensitivity (60%, P = 0.0002), chemosis (50%, P = 0.0151), and injection (86.7%, P = 0.0068) compared with vehicle-treated controls. Interleukin-1Ra reduced the number of degranulated mast cells and caused a significant reduction in the number of eosinophils infiltrating the conjunctival matrix (P<0.001) after allergen challenge. Examination of chemokine mRNA taken from the conjunctiva and draining lymph nodes by RNase protection assay showed a profound decrease in the production of a number of C-C chemokines. CONCLUSIONS: These findings suggest that IL-1Ra is suppressing allergic eye disease by a down-modulation of the recruitment of eosinophils and other inflammatory cells essential for the immunopathogenesis of ocular atopy.

Allergens↗

PubMed1999

Chemokine RANTES in atopic dermatitis.

Chemokines play a key role in inflammatory diseases. The aim of this study was to estimate chemokine RANTES in the sera of patients with atopic dermatitis (AD) and to analyze the correlation between RANTES serum level and the immunological and clinical parameters of the disease. Serum levels of RANTES (ELISA; R&D Systems), total IgE and specific IgE (FEIA; Pharmacia CAP System) were estimated in 24 patients with AD, 28 patients with pollinosis (PL) and 22 healthy nonatopic subjects (HC). The division of the AD group into a pure AD (pAD) subgroup, without a coexisting respiratory allergy, and a subgroup of patients with AD and a respiratory allergy (AD+AO) was done according to Wütrich. Levels of RANTES were higher in the AD group than in the HC group and the PL group. RANTES levels did not differ among subgroups with various clinical scores and between the pAD and AD+AO subgroups. There were no correlations between levels of RANTES and total IgE. Significant positive correlations between serum levels of RANTES and Dermatophagoides farinae and cat dander-specific IgE were found in the AD group. We conclude that the serum level of chemokine RANTES differs patients with AD from patients with PL. The increase of RANTES concentration in the serum of patients with AD depends neither on a clinical picture nor an IgE system.

Adolescent↗

PubMed2000

[Children with asthma followed up for 21 years. Reduced severity, but patients seldom grow out of asthma by adulthood].

The course of asthma severity, clinical allergies, allergic sensitization, lung function, changes in living conditions and social outcome were studied prospectively in 55 asthmatic children for 21 years, from a mean age of 9 to 30 years. Asthma severity improved, but only 16 percent were in remission at the final follow-up. After adolescence, clinical improvement continued among males but not among females. Lung function showed a similar gender difference with respect to clinical course. Generally, clinical allergies and sensitization to pollens and animal danders persisted in adulthood. In adulthood, asthma severity and degree of bronchial hyperresponsiveness correlated with the extent of sensitization to furred animals.

Adolescent↗

PubMed2000

[Sensitization to common airborne allergens in school children with bronchial asthma].

The main purpose of the paper was to assess the prevalence of atopy in the population of preadolescent children in Krakow on the basis of allergic skin testing to airborne allergens and to look into the relationship between atopy and chronic asthma-like respiratory symptoms. The field study was carried out in 1998 among 311 children being the subgroup of the cohort of 1044 children included in the 3-year follow-up in Krakow. The health assessment accounted for the standardised interviews and skin prick testing to 11 common airborne allergens. In the total, the positive allergic reaction at least to only one allergen was found in 32.5% children, and it was more prevalent in boys than in girls (40.4% vs 28.1%). Allergy only to indoor allergens was present in 9.7% children, allergy only to outdoor allergens in 9.7%, and allergy both to outdoor and indoor allergens was confirmed in 13% persons. Most frequently, allergy was established to house mites: Dermatophagoides pter. (16.2%), Dermatophagoides farinae (12.0%) and to cat dander (11.4%). Asthma-like symptoms occurred in 11.0% of children and asthma diagnosed by physician in 7.8% of the sample under the study. The results of this study proved that the prevalence of asthma was about twice so high in boys than in girls. The risk of asthma-like symptoms and/or asthma diagnosed by physician increased significantly with the number of positive allergic tests to airborne allergens (OR = 1.30; 95% CI: 1.11-1.52) and atopy in mother (OR = 1.84; 95% CI: 1.03-3.37).

Air Pollutants↗

PubMed2000

The evaluation of allergens and allergic diseases in children.

Knowing the incidence of allergic diseases and their relationship with allergens is a crucial requirement for therapeutic judgment. We present our experience on the incidence, clinical features and allergens of the allergic diseases detected by multiple allergosorbent chemiluminescent assay (MAST-CLA) in children from 1997 to 1999 at the Taipei Veterans General Hospital. The incidence of bronchial asthma, allergic rhinitis and atopic dermatitis are significantly different when stratified by age groups. Among the enrolled 2008 patients, 980 (48.8%) patients have positive MAST-CLA results. Of these, 562 (57.3%) are male and 418 (42.7%) are female. A significant increase among patients with positive allergens is also found when stratified by age group. Inhalant allergen is the major allergen detected in our patients. House dust mites Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df), cockroaches, feathers, and dog dander show the highest incidence in the 7- to 12-year-old group. In the fungal group, Aspergillus and Penicillium also show a significant difference in the incidence among different age groups. Pollen allergens, on a whole, show significant difference in incidence among different age groups. The food allergen group shows variable significant difference in incidence. Crab, milk, and egg white show the highest significant incidence in the 2- to 6-year-old group. These results suggest that the incidence of allergens detected in allergic diseases varies among different age groups.

Adolescent↗

PubMed1997

Allergic sensitisation to common environmental allergens in adult asthmatics in Hong Kong.

The relationship between immediate skin reactivity to common allergens and adult asthma is not well defined. We retrospectively evaluated the profile of allergen sensitisation to common environmental allergens in 666 adult asthma patients at an asthma clinic in a teaching hospital in Hong Kong. Four hundred and seventy-one asthmatics (70.7%) were atopic; there were more males than females, although the difference did not reach statistical significance. The skin test positively rate decreased significantly with age so that asthmatics aged 35 years and older were four to six times less likely to be atopic and eight to 12 times less likely to be allergic to Dermatophagoides pteronyssinus, compared with young asthmatics aged 15 to 24 years (P<0.001). Inhalant allergy was more common than food allergy and of the inhalants, indoor allergens, including house dust mite and cockcoach were more important than outdoor allergens. The allergens most frequently associated with positive skin tests were D. pteronyssinus (62.2%), D. farinae (60%), cockroach (40.7%), cat dander (24.0%), and royal jelly (16.8%). In conclusion, allergen sensitisation is common in adult asthmatics in Hong Kong, and allergen avoidance should be included as part of the preventive strategies for controlling the disease in the community.

Journal Article↗