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PubMed1991

Children with atopic eczema. II: Immunological findings associated with dietary manipulations.

A group of 91 children with atopic eczema entered a study where clinical and immunological features were compared before and after a food elimination diet, and after double blind randomized food challenges in which a food was given for several days at a time. Eczema improved significantly during the diet and became worse on food challenges. The clinical outcome of food elimination could not be predicted by the initial skin prick test results, serum immunoglobulins, total or food-specific IgE, or complexed IgG or IgE. There was a tendency for patients whose eczema did not improve after food elimination to have higher initial serum IgG levels, without a corresponding increase in skin infections. The radioallergosorbent test to soy gave a higher result in those who improved on diet. No significant changes in serum or complexed immunoglobulins occurred over the period of food elimination or subsequent food challenge. Results of food challenges could not be predicted by initial serum immunoglobulin levels. A history of spring/summer exacerbations of eczema correlated with positive skin prick tests to silver birch pollen, but not to grass pollen. Serological tests did not help in planning food diets in atopic eczema, and the immunological studies did not delineate any particular mechanism by which foods might exacerbate eczema.

Adolescent↗
PubMed2002

Increase of allergen-specific immunoglobulin E antibodies from 1973 to 1994 in a Finnish population and a possible relationship to Helicobacter pylori infections.

BACKGROUND: The prevalence of atopic diseases--hayfever, asthma and eczema--has increased over the past decades. The increase may be associated with decreased rates of infections such as measles, hepatitis A, tuberculosis, toxoplasmosis, and, as recently suggested, Helicobacter pylori gastritis. OBJECTIVE: Since the increase of atopy has been mainly based on clinical studies, we wanted to study the prevalence of allergen-specific Immunoglobulin (Ig)E antibodies in two cross-sectional, adult population-based serum samples two decades apart. Since the sera had been tested for H. pylori antibodies, we also had a chance to look for a possible relationship between these two findings. METHODS: We determined the prevalence rate of allergen-specific serum IgE antibodies against birch and timothy pollen, and cat and dog epithelium allergens by the radioallergosorbent test in a 15-54-years-old Finnish population using 326 sera collected in 1973 and 319 sera collected in 1994 from randomly selected subjects. RESULTS: From 1973 to 1994 allergen-specific IgE prevalence rates and IgE antibody levels rose. In 1994, the prevalence rate of positive findings in 15-24-year-old population had increased from 11 to 38% (3.5-fold increase, P = 0.0001, OR 5.12, CI 95% 2.32-11.3). In older 10-year age groups similar trends did not reach significance, but the overall change was significant with all three cut-off levels of allergen-specific IgE analysed. The percentage of IgE-positive persons rose mainly in the subgroup with no H. pylori antibodies. In 1994 21% of the H. pylori-negative subjects had IgE antibodies compared with 5% of the H. pylori-positive subjects (in 1973 11% in both subgroups). CONCLUSIONS: IgE-based evidence for an increase in IgE-mediated allergy was uncovered. The increase occurred mainly in the subgroup with no antibodies to H. pylori, which support the hypothesis that H. pylori could be one of the microbes counteracting atopy.

Adolescent↗
PubMed1998

[Asthma in young children: a different approach to treatment by the family physician vs the pediatrician, a follow-up of symptoms over a period of 1 to 2.5 years].

OBJECTIVE: To compare the therapeutic approaches to asthmatic symptoms in young children of general practitioners and paediatric pulmonologists, and to investigate the outcome of asthma in young children. DESIGN: Retrospective, descriptive. SETTING: Paediatric pulmonology outpatient clinic, University Hospital, Groningen, the Netherlands. METHOD: Charts of all 91 children younger than 2 years of age who were newly referred for recurrent cough and wheeze (asthma) between January 1, 1994, and September 30, 1995, were reviewed. Data were collected on clinical characteristics, drugs prescribed by the general practitioners, results of laboratory tests, and treatment prescribed by the paediatric pulmonologists. All children were followed up for periods of 12 to 30 months. RESULTS: Sixty-one children (67%) had been treated with antibiotics or with oral anti-asthma drugs by their general practitioners. No child had a positive radioallergosorbent test for inhaled allergens. Paediatric pulmonologists most commonly prescribed inhaled corticosteroids and bronchodilators to these patients. After 12-30 months of follow-up, 48 patients (53%) had no further symptoms. The only factor statistically significantly related to persistence of asthmatic symptoms during follow-up was aggravation of complaints by weather influences (odds ratio: 4; 95% confidence interval: 1-12). CONCLUSION: The common practice of prescribing antibiotics and oral anti-asthma drugs to young children in general practice is contrary to recent consensus reports on the treatment of asthma. Even in young children referred to specialists with asthmatic symptoms, such symptoms are commonly transient. Aggravation of symptoms by weather influences, which may be an expression of bronchial hyperresponsiveness, is a risk factor for persistence of symptoms.

Anti-Asthmatic Agents↗
PubMed2003

Recombinant birch allergens (Bet v 1 and Bet v 2) and the oral allergy syndrome in patients allergic to birch pollen.

BACKGROUND: IgE cross-reactivity between pollen and food allergens represents the molecular basis for oral allergy syndrome (OAS). OBJECTIVE: To evaluate specific IgE for Bet v 1 and Bet v 2 in the serum of patients sensitized to birch pollen and to identify whether IgE antibodies to Bet v 1 and Bet v 2 were predictors of OAS. METHODS: Thirty-three patients with skin prick test results and radioallergosorbent assay test results positive to birch pollen, 12 (36%) of whom had OAS symptoms, were enrolled in the study. Serum levels of specific IgE were determined by the fluoroenzyme immunoassay technique. RESULTS: The t test revealed significantly higher serum IgE levels against Bet v 1, Bet v 2, and birch pollen in the 12 symptomatic patients with respect to those without OAS (32.4 vs 12.4 kU/L, 7.6 vs 1.3 kU/L, and 42.3 vs 17.3 kU/L, respectively). Attempts to establish a threshold value of serum IgE antibirch pollen and the appearance of OAS revealed that a level of 20 kU/L or more yields an efficiency of the test equal to 70%. CONCLUSIONS: In our study, quantitative birch specific IgE level proved useful in predicting clinical allergy symptoms with birch exposure.

Adult↗
PubMed2001

Hospital admissions and readmissions for asthma in the age group 0-4 years.

SUMMARY. Childhood rates for admission and readmission for asthma are highest under the age of 5 years. From a registration study in 0-4-year-olds, 100 patients (68 male) were admitted to hospital for asthma and followed for 1 year, yielding a total of 136 admissions. To examine factors that may play a role in admissions and readmissions, histories and laboratory tests for atopic status at initial presentation, and clinical data on admission were evaluated. Age groups 0-1 year (n = 54) and 2-4 years (n = 46) were analyzed separately, of whom 20 (37%) and 9 (20%) patients, respectively, had at least one readmission. In the age group 2-4 years, patients with antibodies against inhalant allergens, determined by radioallergosorbent test (RAST), had a significantly higher risk of readmission (RR = 1.54; 95% CI, 1.22-1.95). In the age group 0-1, year prevalence of sensitization to inhalant allergens was low (20% vs. 72% in age group 2-4 years) and constituted only a slight risk (P = 0.097) for readmission. A history of eczema showed a negative association in the age group 0-1 year. Treatment of the first admission did not differ between children only admitted once and those requiring readmission. In both age groups, clinical features at admission did not differ significantly between first and subsequent admissions, and neither did length of stay. Number of readmissions were higher in the age group 0-1 year than in the age group 2-4 years (27/81 (33%) vs. 9/55 (16%), P = 0.028), with no indication of a lower threshold for admission. In the age group 0-1 year, 60% of the readmissions occurred within 2 months of first hospitalization. Moreover, in the age group 0-1 year a trend was observed that inhaled steroids were prescribed less frequently on discharge following first admission in those children who were readmitted than in the children who had a first admission only (4/20 (20%) vs. 15/34 (44%), P = 0.073). More "aggressive" therapy with anti-inflammatory drugs and close medical follow-up after discharge seem to be indicated.

Adrenal Cortex Hormones↗
PubMed1976

Diagnostic procedures in immunodermatology.

Most immunologic diseases are caused by the derailment of the humoral or cellular pathways of the immunologic defense system. This derailment results from numerous factors such as the inability of the patient to remove the pathogen; the consumption, defect, or deficiency in any component of these pathways, and the overproduction of any of the components. To diagnose these immunologic disorders one has to detect the pathogen and the reactions caused by it and to determine the cause of its nonclearance. The immunofluorescence techniques has been invaluable in detecting both the antigen that causes the disease and the reactions initiated by the antigen, such as the production of antibodies and the activation of the complement system. The immunoperoxidase technique has also been used for these purposes in certain instances. For detecting the circulating immune complexes which occur as intermediates in the chain of reactions initiated by the antigen, various physiochemical and biologic techniques have been used. However, none of these tests seems to be totally reliable for determining whether circulating immune complexes are present. The consumption of complement was detected by hemolytic estimations and radial immunodiffusion or rocket electrphoresis. These techniques were also useful in detecting the hereditary deficiencies in immunoglobulins and components of classical and alternative pathways of complement activation. Since these techniques cannot be used to estimate IgE, the radioallergosorbent test was used to measure such levels in the atopic patients. Cellular hypersensitivity was detected with skin tests together with methods which assess the ability of lymphocytes to produce mediators in response to antigen. Many of these mediator assays, however, are not suitable for this purpose. A satisfactory substitute appears to be to determine the factor in antigen-stimulated, lymphocyte culture supernatants which activates macrophages to take up radiolabeled colloidal gold or radiolabeled glucosamine. In contact allergic dermatitis, an increase in the IgD-bearing lymphocytes and granulocytes has also been correlated with cellular hypersensitivity. Lymphocytes and polymorphonuclear leukocytes coated with antibodies mainly directed against nuclear antigens of the basal layer cells of the noninvolved epidermis have invariably been encountered in psoriasis. The use of these findings for diagnostic purposes and for understanding the mechanisms of certain diseases is being explored.

Animals↗
PubMed2002

A hospital-based screening program for natural rubber latex allergy.

BACKGROUND: Natural rubber latex (NRL) allergy has become an important occupational health problem for health care workers, of whom approximately 10% are reportedly sensitized. Some medical facilities have chosen to convert entirely to NRL-free gloves, but others have found this to be financially or logistically unfeasible. OBJECTIVES: The goals of this study were 1) to devise a NRL allergy screening program that could identify sensitized (at-risk) employees for the purpose of providing them with a safe working environment; and 2) to develop a glove conversion plan that would lead to the removal of all NRL gloves from the institution. METHODS: A multidisciplinary University of Maryland Medical System NRL risk team developed a mandatory NRL screening program for all newly hired employees and any existing employees transferring into or within patient care positions. Employees were screened with a clinical questionnaire and a serology for immunoglobulin (Ig)E anti-NRL. Some employees voluntarily received an experimental NRL skin test to evaluate their skin reactivity to NRL. Each employee reporting respiratory or systemic symptoms associated with NRL exposure was evaluated by an allergist. RESULTS: During the 15-month study period from April 1998 to July 1999, 1,795 employees were screened for NRL allergy. Of the whole group, 8% (144 of 1,795) were NRL-specific IgE antibody-positive by CAP radioallergosorbent test (Pharmacia-Upjohn Diagnostics, Kalamazoo, MI) and/or NRL skin test, 57.3% of whom reported symptoms with powdered NRL glove exposure. The NRL IgE-positive rates of nonpatient-care employees (who did not use NRL gloves on a regular basis) and direct patient-care employees was 5.9% and 8.6%, respectively. Most NRL-sensitized employees were successfully accommodated with the use of synthetic gloves and continued to work in the positions for which they were hired. CONCLUSIONS: The University of Maryland Medical System NRL screening program has been successful in identifying at-risk employees and ensuring them a safe working environment during a progressive conversion of the hospital to a NRL-safe environment.

Adolescent↗
PubMed1999

Selective cloning of peanut allergens, including profilin and 2S albumins, by phage display technology.

BACKGROUND: Peanut kernels contain many allergens able to elicit IgE-mediated type 1 allergic reactions in sensitized individuals. Sera from sensitized patients recognize variable patterns of IgE-binding proteins. The identification of the IgE-binding proteins of peanut extract would faciliate improvement of diagnostic and immunotherapeutic approaches as well as development of sensitive test systems for the detection of hidden peanut allergens present as additives in various industrial food products and the investigation of their stability during processing of food products. METHODS: We applied the pJuFo cloning system based on the phage surface display of functional cDNA expression products to clone cDNAs encoding peanut allergens. Sera (n = 40) of peanut-allergic individuals were selected according to case history, radioallergosorbent test and immunoblot analysis to demonstrate IgE binding towards the newly identified recombinant allergens. RESULTS: In addition to the known allergens Ara h 1 and Ara h 2 we were able to identify four allergens with estimated molecular weights of 36, 16, 14.5 and 14 kDa. Three of them formally termed Ara h 4, Ara h6 and Ara h 7 show significant sequence similarities to the family of seed storage proteins and the fourth (Ara h 5) corresponds to the well-known plant allergen profilin. Immunoblotting of the six expressed recombinant allergens with 40 patients sera shows 14 individual recognition patterns and the following frequency of specific IgE binding: Ara h 1 was recognized by 65%, Ara h 2 by 85%, Ara h 4 by 53%, Ara h 5 by 13%, Ara h 6 by 38% and Ara h 7 by 43% of the selected sera. CONCLUSIONS: All of the selected peanut-positive sera can detect at least one of the six identified recombinant allergens which can be used to establish individual patients' reactivity profiles. A comparison of these profiles with the clinical data will possibly allow a further insight into the relationship between clinical severity of the symptoms and specific IgE levels towards the six peanut allergens.

2S Albumins, Plant↗
PubMed2003

Prospective study of mustard allergy: first study with double-blind placebo-controlled food challenge trials (24 cases).

BACKGROUND: Mustard allergy accounts for 1.1% of food allergies in children. However, double-blind placebo-controlled food challenge trials (DB PCFCs) have not yet been proposed. OBJECTIVE: To carry out DB PCFCs to determine the real frequency of mustard allergy in patients sensitized to mustard. METHODS: A prospective study was conducted in 30 subjects aged 3-20 years presenting positive prick tests to ground mustard seeds (Brassica nigra), mustard flour (B. juncea), metabisulfite-free strong mustard seasoning (B. juncea) and a commercialized allergenic extract (B. nigra). Twenty-seven subjects were screened for mustard-specific immunoglobulin E (IgE). PCFCs were carried out either DB or single blind (SB) with up to 1340 mg of metabisulfite-free seasoning. RESULTS: The mean diameter of the wheal induced by prick tests with the allergenic extract was lower (n.s.) than that induced by the native mustard products: 5.8 mm (1.5-15) vs 6.9 mm (0.5-18) for B. nigra ground seeds, 7.8 mm (1-20) for B. juncea flour and 9.7 mm (3-20) for the strong mustard seasoning. The diameter of the wheal induced by the allergenic extract was significantly different from that induced by the mustard seasoning (P < 0.005). The mean of mustard specific-IgE values was 8.7 KU/l (0.35-72.4). Seven of 30 food challenges were considered positive. Mean prick test results in the positive and negative PCFC subgroups were 5.5 mm vs 5.9 mm for the commercialized extract, 10.9 mm vs 5.8 mm for B. nigra ground seeds (P < 0.01), 9.9 mm vs 7.1 mm for B. juncea flour (n.s. P > 0.25) and 11.5 mm vs 9.1 mm for the metabisulfite-free mustard seasoning (n.s. P > 0.1). Mean specific IgE values determined by CAP system radioallergosorbent test (Phadebas Pharmacia) were higher but not significantly so (P > 0.25) in the subgroup with mustard allergy (12.3 K/l vs 7.6 KU/l). CONCLUSIONS: About 23.3% of the sensitized subjects were allergic to a routine dose of mustard. Positive prick tests and the presence of specific IgE were not predictive. SB PCFC or DB PCFC is required before recommending avoidance diets.

Abdominal Pain↗
PubMed1984

Allergen- and anti-IgE-induced histamine release from whole blood.

The release of histamine by allergen and anti-IgE from whole blood was observed in 34 asthmatic subjects with a positive skin test to house dust. The time course of histamine release showed that the release by allergen and anti-IgE peaked after 15 min incubation. There was no significant difference in the time course of the release from whole blood between allergen and anti-IgE. Anti-IgE-induced histamine release correlated to a certain extent with the serum IgE level. Histamine release by house dust, on the other hand, correlated with the radioallergosorbent test score. A striking difference was present in the dose-response slope between allergen and anti-IgE. The maximum percent release correlated with the dose-response slope by allergen, but not by anti-IgE. The amount of histamine release induced by anti-IgE paralleled the amount of the release by house dust in the cases sensitive to the allergen; less sensitive basophils to anti-IgE were less sensitive to house dust.

Adolescent↗
PubMed2003

Immediate allergy to tetanus toxoid vaccine: determination of immunoglobulin E and immunoglobulin G antibodies to allergenic proteins.

BACKGROUND: Adverse reactions to tetanus toxoid (TT) vaccine are mostly mild and limited to the injection site. However, immunoglobulin (Ig)E-mediated reactions may occur, and the incidence of anaphylactic responses to TT immunization is 0.001%. When TT induces an allergic reaction, the potential causative agents can be TT antigens, thimerosal or aluminum phosphate. OBJECTIVE: We studied four children who developed immediate urticaria after TT vaccine, soon after the reaction and 5 years later. METHODS: Skin tests were performed separately with TT vaccine and two vaccine components, thimerosal and aluminum phosphate, and the diagnosis was confirmed by provocation test. IgE and IgG antibodies to TT and their specificities were determined. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting were performed to characterize the antigenic proteins. RESULTS: All four children were immediate skin test-positive to TT, but negative to thimerosal and aluminum phosphate; 3 developed a reaction after intramuscular provocation using increasing doses of TT vaccine; and 1 refused to be tested. All these tests were negative in five controls, all of whom received TT vaccine and developed only local swelling at the site of application 24 hours after vaccine administration. After 5 years the IgG antibodies were still high in all cases and the IgE antibody values fell by 50%. Patients allergic to TT vaccine produced IgE and IgG antibodies, which decreased at different rates but remained for at least 5 years. The pattern of antibody decrease was confirmed by radioallergosorbent test, enzyme-linked immunoadsorbent assay, or immunoblotting assay. IgE and IgG antibodies recognized two proteins derived from TT, of 150 and 50 kDa, corresponding to the intracellular form and to a chain of the extracellular form of the tetanus neurotoxin. CONCLUSIONS: In children with immediate allergic reactions to TT vaccine, antibodies may persist for at least 5 years, requiring evaluation by skin and/or in vitro tests before subsequent treatment.

Adolescent↗
PubMed1996

Codfish allergy in adults. Specific tests for IgE and histamine release vs double-blind, placebo-controlled challenges.

BACKGROUND: At present, several in vitro tests for immunoglobulin E (IgE)-mediated food allergy are available. An estimation of the diagnostic accuracy of the various tests used in predicting clinical sensitivity to codfish in a well-characterized allergic material is necessary. OBJECTIVES: To compare the diagnostic value of four specific IgE tests, and histamine release from basophils (HR) in identifying clinical type I allergy to codfish. As a true diagnosis, double-blind, placebo-controlled food challenges (DBPCFC) were employed. METHODS: Eight clinically codfish-allergic adult patients were investigated together with 30 codfish-tolerant control subjects for evidence of codfish-specific reactivity by Phadebas RAST (PHA), Pharmacia CAP System RAST (CAP), Magic Lite (ML) and HR. To characterize the diagnostic properties of a freshly prepared raw codfish extract, experiments were conducted employing an in-house radioallergosorbent test (RAST), the Maxisorp RAST (MAXI) and HR. Finally, protein profile and IgE-reacting allergens were detected by means of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting. RESULTS: The sensitivities of HR with commercial extract and the three commercially available specific IgE analyses were 0.83 and 1.00 respectively. Specificities were 1.00 (HR) and 0.87-1.00 (specific IgE tests). Freshly prepared codfish extracts improved the sensitivity of HR. SDS-PAGE revealed approximately 29 bands (< 14.3-200 kDa) including a band of 12-13 kDa, and in immunoblotting 18 sera identified 17 IgE-binding bands. The protein migrating at 12-13 kDa was identified in the fresh codfish extract tested with sera from all clinical codfish allergics, while no significant reaction was seen in the control subjects. CONCLUSION: Based on the small number of adult patients included in our study, the in vitro assays with commercial and fresh extracts have high sensitivity and are acceptable for screening for codfish allergy. Specificity of Phadebas, CAP, and our in-house RAST was less than unity, whereas ML and strong binding of IgE to a 12-13 kDa protein completely matches DBPCFC results, and thus seems sufficient for establishing the diagnosis.

Adult↗
PubMed1987

Leukocyte migration inhibition test in children with cow milk allergy.

The usefulness of the leukocyte migration inhibition factor (LIF) test to detect cow milk (CM) hypersensitivity was studied in 40 children with suspected allergy to CM. Hypersensitivity was carefully investigated by oral milk challenges, which gave a final confirmation of cow milk hypersensitivity in 12 subjects, and excluded it in the remaining 28 subjects. Leukocyte migration inhibition was measured using beta-lactoglobulin (BLG), alpha-lactalbumin (ALA), alpha-casein (ACA) and bovine serum albumin (BSA) as antigens. IgA and IgG antibodies to these antigens were measured by an enzyme-linked immunosorbent assay, and IgE antibodies to these antigens and to CM by radioallergosorbent test (RAST). Skin prick test with CM was performed in 38 subjects, and with BLG, ALA, ACA and BSA in 29 subjects. Leukocyte migration was more often inhibited by cow milk antigens in the CM challenge positive (CM+) subjects than in the challenge negative (CM-) subjects. Of the specific milk antigens, ALA was the most potent inhibitor, and gave a positive LIF test result in all CM+ subjects, and significantly (P less than 0.02) less often (15/24) in CM- subjects. Also in the skin prick test and RAST, ALA gave positive results more often than the other milk antigens. BLG, ACA and BSA had an inhibiting effect on leukocyte migration, but the difference between the CM+ and CM- subjects was not statistically significant. Two of the 12 CM+ subjects had no demonstrable IgE antibodies to CM proteins; both of them, however, had a positive LIF test with at least one of the CM antigens.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

House-dust mite content in mattresses in relation to residential characteristics and symptoms in atopic and nonatopic children living in northern Norway.

The occurrence of house-dust mites (HDMs) was investigated in the mattresses of 19 children previously found to be skin prick test (SPT) positive to HDM and in 19 nonatopic children derived from an extensive survey of 424 schoolchildren, all living in northern Norway. Domestic mites were counted and identified microscopically. Mite counts ranging from 10 to 1800 mites per gram mattress dust were found in 10 of the 19 HDM-sensitized children compared to none in the control group, corresponding to an odds ratio of more than 20. Of the 540 domestic mites found, 70 were identified by species. Dermatophagoides pteronyssinus (Dpt) was the only HDM species identified (64 mites), while five were storage mites and one was a Tarsonemus species. Positive radioallergosorbent tests (RAST) to Dpt were demonstrated in 9/10 children with and in 5/9 without mite infestation compared to none in the control group. Elevated IgE levels were also found more frequently in children with mite-infested mattresses than in those without. IgE levels were within normal levels in all 19 children in the control group. Latent atopy was found in four children, three with and one without mite infestation. There was no correlation between the concentration of mites and the degree of sensitization. Poor ventilation, increased humidity, and water leak(s) were associated with the presence of domestic mites in mattresses. As HDM growth is highly dependent on humidity and microhabitat, it should be possible to avoid HDM exposure and allergy in this region.

Animals↗
PubMed2002

Asthma in the elderly: cockroach sensitization and severity of airway obstruction in elderly nonsmokers.

STUDY OBJECTIVES: To test the hypothesis that the presence of sensitization to indoor allergens is associated with increased severity of airway obstruction in elderly subjects with asthma. DESIGN: Cohort study of subjects enrolled in a public hospital asthma clinic. SETTING: Asthma clinic in a municipal public hospital serving an indigent population in New York City. PATIENTS: Subjects aged > or = 60 years with asthma who were enrolled in the Bellevue Hospital Asthma Clinic. Total serum IgE and allergen-specific IgE measurements were performed in a cohort of elderly never-smokers who had asthma (45 patients) who had undergone spirometry before and after bronchodilator (BD) therapy. MEASUREMENTS AND RESULTS: The results of radioallergosorbent tests demonstrated that most subjects (ie, 60%) were sensitized to at least one allergen, with many sensitized to at least one indoor allergen. Cockroach (CR) was the most common allergen to which subjects were sensitized, with 47% displaying an elevated serum-specific IgE level. Fewer subjects were sensitized to dust mite, cat, dog, or ragweed. Subjects sensitized to CR (CR+) had greater reductions in airflow compared to subjects not sensitized to CR (CR-) [64 +/- 4.4% predicted vs 77.1 +/- 4.1% predicted FEV(1), respectively; p < 0.05]. Following BD administration, only 29% of CR+ subjects achieved a normal post-BD FEV(1) compared to 58% of CR- subjects. Lung volume measurements differed between CR+ and CR- subjects, with a greater elevation of functional residual capacity in CR+ subjects. CONCLUSION: In a population of elderly urban patients with asthma, the presence of CR-specific serum IgE is associated with more severe asthma, as reflected by an increase in airway obstruction and hyperinflation.

Aged↗
PubMed1992

Abnormal humoral immune response to mucosal antigenic stimulation in patients with lung cancer.

Previous studies have suggested an inverse relationship between atopy and cancer of mucosal surfaces. Atopy is classically assessed by detecting specific immunoglobulin E (IgE) antibodies against inhalant allergens. However, Platts-Mills recently proposed that atopy is the ability of an organism to recognize and to respond to limited doses of allergens presented at the mucosal level by producing not only IgE, but also immunoglobulin A and immunoglobulin G (IgG) antibodies. The authors compared the prevalence of atopy in 103 patients with lung cancer (a model of mucosal cancer), 51 patients with chronic obstructive pulmonary disease matched for age, sex, and smoking habits with patients with lung cancer, and 102 healthy control subjects. The authors investigated whether the IgG response to antigens presented at the mucosal level, exacerbated in atopic subjects, might inversely be decreased in patients with lung cancer. Serum IgE antibodies against five common inhalant allergens (Dermatophagoides pteronyssinus [Der p1], Aspergillus fumigatus, grass pollen, and cat and dog danders) were detected through a radioallergosorbent test assay. Serum IgG antibodies against allergens naturally presented at the mucosal level (respiratory mucosa with Der p1 and digestive mucosa with betalactoglobulin [BLG] and soya proteins [SP]) were measured through a solid phase enzyme-linked immunosorbent assay test. Atopic status was assessed in 19 patients (18.4%) with lung cancer, 9 patients (17.6%) with chronic obstructive pulmonary disease (COPD), and 18 healthy control subjects (17.6%). Distributions of specific IgG levels were represented on frequency histograms after natural logarithmic transformation and showed reduced levels of anti-Der p1 and anti-BLG IgG in the cancer population compared with the control populations but similar levels of anti-SP IgG. Influence of sex, age, smoking habits, histologic type of cancer, and its extent could be excluded. The authors' results show no difference in the prevalence of atopy between the three groups. They document a selective, rather than general, defect in the immune response initiated at the mucosal level in patients with lung cancer, the most frequent mucosal cancer in man.

Administration, Inhalation↗
PubMed1997

Seroimmunological characteristics of Korean workers exposed to toluene diisocyanate.

Since type I allergy caused by specific IgE antibodies may play principal roles and IgG antibody-mediated reactions have been thought to be involved in some parts of the pathogenesis, this study was performed to investigate the role of IgE- or IgG-mediated hypersensitivity reactions in development of toluene diisocyanate (TDI) asthma in Korean workers. For 81 TDI spray painters, self-administrative questionnaires and direct interviews on respiratory symptoms, chest auscultation, and measurements of forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1.0) were performed. The TDI concentration in their working environments was measured. Levels of serum IgE and IgG specific to TDI were estimated by radioallergosorbent test (RAST) and ELISA using p-tolyl isocyanate-human serum albumin (TMI-HSA) as the antigen. When sputum, cough, and dyspnea aggravated by work or wheezing existed, when FVC or FEV1.0 was less than 80% of the normal reference value, or when IgE RAST for TDI was positive, the peak expiratory flow rate (PEFR) was recorded four times per day for over 2 weeks. If decrease of PEFR was over 20% of baseline PEFR and changing pattern of PEFR was closely related to workshift in time, then a diagnosis of TDI asthma was made. Changing patterns of PEFR of 8 (9.9%) workers corresponded to the diagnostic criteria of TDI-related occupational asthma. Levels of the specific IgE were increased in 9 (11.1%) of the 81 subject workers and in 3 (37.5%) of the 8 PEFR-positive workers. Levels of the specific IgG were increased in 9 (11.1%) workers, and in only 1 (12.5%) of the asthmatics sensitive to TDI. Neither elevated TDI-specific IgE levels nor PEFR test positivities were associated with increased IgG levels. The mean titer of the PEFR-test-positive workers was slightly lower than that of the PEFR-negative workers and that of the IgE RAST-positive workers lower than that of the test-negative workers, but there was no statistical significance. These results suggest that IgG is not deeply involved in the pathogenesis of TDI-induced occupational asthma in Korean workers.

Adult↗