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[Test of human basophil degranulation. The interpretation and analysis of variability factors in the absence of antigen].

The human basophil degranulation test (TDBH) is performed using a concentrated cell suspension enriched for polymorphonuclear basophils. This preparation is placed in wells on a glass slide with an allergen solution of decreasing concentration. After incubation the cells are fixed in the wells and stained with toluidine blue. Preparations containing fewer metachromatic basophils than in control preparation of the same cell suspension without antigen contain degranulated basophils and in this way a degranulation index can be calculated. By considering the variability in the number of basophils between duplicate control wells from the same cell suspension, it can be shown that the test can be considered to be positive only if the number of degranulated basophils equals or exceeds 50% of the total number of basophils. This variance can be attributed to the subjectivity of the reader, and to differences in the differential cell counts from well to well. On the other hand, the presence of atopic allergy had no effect on the basophil counts.

Adolescent↗

[Increased sensitivity to Candida in patients with bronchial asthma].

As many as 86 children aged 3 to 14 years with bronchial asthma were examined using mycological, immunological and allergological methods including the prick-test, basophil degranulation test (direct Shelley's test) and leukocyte migration inhibition test with Candida antigen. As far as the patients living in the vicinity of a microbiological factory are concerned, hypersensitivity to Candida was detected in 83.3% of cases, primarily that of the delayed type (37%). In children with verified candidiasis, hypersensitivity to Candida fungi was also detectable in 83.3% of cases, but in the majority of patients (47%), it was of the immediate type. In the control group, allergic candidiasis was diagnosed in 20% of cases. Clinically, bronchial asthma associated with allergic candidiasis was characterized by refractory, lingering obstructive bronchitis amenable to antimycotic drugs.

Adolescent↗

Use of automatic counting of basophil leukocytes: correlation of basophil degranulation with histamine release.

The sensitivity of leukocytes from allergic donors towards specific allergen was studied using the basophil degranulation test. In this test, basophil leukocytes were counted with the Technicon Hemalog D. A good correlation was found between the results of the basophil degranulation test and the results of the histamine release test on leukocytes of the same patient. The basophil degranulation test, using the Hemalog D, was found to be a simple method for in vitro assessment of the sensitivity of allergic patients to specific allergen.

Allergens↗

Does basophil releasability contribute to bronchial hyperreactivity in asthma?

Histamine inhalation test and basophil degranulation test in polymxin B were performed in 21 atopic asthmatic patients. Basophil degranulation in vitro was observed in 11 patients. Positive results of the degranulation test occurred with simular frequency in patients with high and low PC20. No significant correlation between PC20 and the magnitude of degranulation was found (r = 0.09).

Asthma↗

Clinical significance of specific IgE determination on nasal secretion.

The clinical use of RAST on the nasal secretions was investigated in seventeen atopic patients, with asthma or rhinitis, who had shown at a first diagnostic screening, some difficulties in the identification of the responsible allergen(s). The results of the skin tests, of the RAST on the serum and on the nasal secretions and of the specific provocation test (bronchial or nasal) were compared. In some cases the basophil degranulation test was performed. The results of the RAST on the nasal secretions were in perfect agreement with the provocation test. The skin tests and the RAST on the serum showed many discrepancies, particularly for Dermatophagoides, epidermal derivatives of cat and dog and moulds, and less frequently for Graminaceae and other pollens. It is concluded that RAST analysis on nasal secretions is useful in clinical diagnosis of allergy especially for Dermatophagoides, epidermal derivatives and moulds. Most false positive results were observed with the RAST on serum; in fifteen cases it was positive, while all the other tests, basophil degranulation test included, were negative. The data suggest that IgE may have a low affinity for basophil receptors.

Adolescent↗

Case report: recurrent anaphylactic shock to radiographic contrast media. Evidence supporting an exceptional IgE-mediated reaction.

A rare case of anaphylaxis to iodinated contrast media is reported. The patient underwent two anaphylactic shocks to intravenous administration of radiocontrast agents. Specific IgE were suspected on the basis of positivity of intradermal tests and human basophil degranulation tests. The passive sensitization of basophils from donors was performed, comparing native and heated serum. Results agreed with the hypothesis of IgE antibodies, since heating 56 degrees C during two hours prevented the degranulation. Considering the chemical structure, iopamidol was thought to be innocuous. Two opacification procedures were further performed with iopamidol without any incident.

Aged↗

[Changes in plasma histamine and catecholamines levels after injection of chymopapain in chemonucleolysis].

Because pruritus, erythema and tachycardia are observed in some patients during chemonucleolysis, a prospective study was designed to investigate the plasma levels of histamine and catecholamines occurring after an injection of chymopapain. Thirteen patients (11 men and 2 women), mean age 38 +/- 11 years, were studied. They all had negative prick skin tests, human basophil degranulation tests (HBDT) and radio-absorbent tests (RAST) to chymopapain. The patients were premedicated with 100 mg hydroxyzine and 3 g tranexamic acid. Sedation was carried out using 0.1 mg.kg-1 droperidol and 0.02 mg.kg-1 phenoperidine. The nucleosus pulposus was visualized with 3 ml of contrast medium (lopamiron 300); 2 ml of chymopapain were then injected. Blood samples were obtained at T1 (after the contrast medium, but before the chymopapain), and then 5, 10, 15, 20 and 30 minutes after the chymopapain. The usual haemodynamic parameters were recorded at the same times. Four patients had clinical signs (group I), whereas the other nine (group II) did not. There was an increase in histamine levels in three patients from group 1, as well as in two in group II (up to 33 nmol.l-1). However, mean histamine and catecholamines levels were comparable in both groups at all times, and between times, of sampling. There therefore was no relationship between clinical signs and the release of histamine or catecholamines. The premedication with an antihistamine may have protected the patients, but the signs reported by four patients may also be due to the chymopapain itself.

Adult↗

[Mercury contact dermatitis].

Eight female patients with contact allergy to Mercury were studied with the L. T. T. and the Histamine degranulation test of basophiles. In the eight cases the L. T. T. was specific. P. H. A. (an inspecific lymphocyte stimulator lectin) and the Histamine degranulation basophile test, were used as controls. Thirty subjects were used as controls. All of them were negative to the patch test with mercury at 0,5% in petrolatum. No atopic antecedents were among them and their families. No once case of lymphocyte activity to mercury was observed. Mercury acetate solutions at: 12,5 ng/ml. 25 ng/ml and 5 ng/ml were employed. This salt was the unique useful for the L. T. T. practice. Extremely difficulties for the solubilization of mercury bichloride, mercury oxide, phenyl mercury and ammoniated mercury, impaired the L. T. T. with these salts.

Adolescent↗

Severe retinochoroidopathy: variations of humoral and cellular immunity to S-antigen in a longitudinal study.

Ten patients with birdshot retinochoroidopathy, six with isolated retinal vasculitis and eight with Behçet's disease were treated with cyclosporine for one to three years. Autoantibodies to several retinal proteins, circulating lymphocyte subsets and cellular reactivity to S-antigen were evaluated repeatedly during this period. Autoantibody titers were similar in patients and in controls. However the serum content of antibodies to IRBP or S-antigen was lessened during inflammatory periods in some patients. In some sera, antibodies reacted with enzyme digested S-antigen preparations by immunoblot, whereas the same sera were negative for the native protein. A decrease of the CD4+ subpopulation of peripheral blood lymphocytes was associated with relapses of ocular inflammation in birdshot retinochoroidopathy. In this disease and in idiopathic retinal vasculitis, the positive lymphocyte stimulation test and basophil degranulation test with S-antigen were significantly most frequent in the period preceding a relapse of ocular inflammation. These tests could therefore be of predictive value for relapses occurring within the next few months.

Adult↗

[Immuno-allergologic evaluation in case of anaphylactoid incidents during anesthesia].

In case of an anaphylactoid accident, immunological and allergological investigation is to be performed in two parts: immediately after the accident (plasma histamine determination, C3 immunoelectrophoresis, basophil count) and four to eight weeks afterwards, investigating for anaphylaxis (intradermal tests, human basophil degranulation test, Prausnitz-Küstner test) and for risk factors (anomalies of histamine release and hyperreactivity to histamine, atopy, spasmophilia, drug allergies, previous administration of the involved substances). The investigation allows the involved mechanism as well as the responsible drug to be ascertained, thus allowing to manage the anaesthetic procedure in the light of the findings.

Anaphylaxis↗

Tests for allergy to housedust.

In an attempt to find a satisfactory combination of method and antigen extract for tests of hypersensitivity to housedust, variations of skin test, RAST, histamine release and basophil degranulation tests have been used to test efficacy of five commonly used extracts of housedust or its components. The Lincoln Multitest for skin prick tests in its present form induced too much trauma for type-I hypersensitivity tests, though it has advantages for comparison of several extracts. Histamine release and two versions of basophil degranulation tests all gave good results but not consistently. RAST gave the best correlation between all extracts, but neither the in vivo nor in vitro tests gave perfect concordance with sensitivity in all patients and all extracts.

Adult↗

[Study of allergy to general anesthetics and muscle relaxants using the lymphoblast transformation test].

This study aims to test the lymphocyte response in normal subjects and patients who presented an anaphylactoid shock to various anaesthetic and muscle relaxant drugs, by using the lymphoblast transformation test (LTT). The results show that, although the LTT is a specific test, which can be carried out in vitro, it is badly adapted to the biological diagnosis of anaphylactic drug accidents on the whole, because of a possible non specific lymphoblastic transformation in controls or, on the contrary, of false negative results in anaphylaxis. As a consequence of this, and some comparative studies, the diagnosis of drug induced anaphylaxis must rely on skin tests, human basophil degranulation test (HBDT) and the Prausnitz-Küstner test.

Adult↗

[Impact of the development of anesthesia protocols on the incidence of peri-anesthetic anaphylactoid reactions].

INTRODUCTION: What impact does the use of new drugs and latex gloves it have on the frequency and the severity of peri-anaesthetic anaphylactoid reactions? Does the evolution of in vitro techniques does represent a progress in the imputability of the substances at the origin of the shock? THE METHODS: They include the letter from the anaesthetic doctor, the questioning by the allergologist, skin tests (Pricks, IDR) with the anaesthetic substances and the latex according to the GERAP protocol and the biologic tests (Human Basophilic Degranulation test (TDBH), Radio ImmunoAssay (RIA), leukotrienes E4 assay (LTC4), Flow Cytometry (CMF)). THE RESULTS: 386 patients were explored (289 women and 88 men, mean age 41.5 years). The muscle relaxants are the first cause of anaphylaxis 77%. Muscle relaxants cross allergy is found in 55.1%. The Latex, tested since 1989 with Allerbio and Stallergenes extracts, is responsible for 25 shocks with one death and 15 with grade III or IV. Preventive antibiotherapy, since consensus meeting of 1992, seems responsible of 17 accidents. 116 TDBH, 216 RIA, 17LTC4 and 47CMF. TDBH are made concordant with skin tests in 48.2% against, 71.2% for the RIA. CONCLUSION: The experience of 17 years of allergo-anaesthetic consultation confirms the first row for the muscles relaxants for the target of anaphylactic shock, but the imputability of Vecuronium and Rocuronium increases to the detriment of the Suxamethonium. The Latex is in the second row, but the target questioning, the systematic use of Prick tests and "latex free" surgery room limit its increase which should change down. The antibiotherapy occupies the third row and might increase. 54 accidents have remained unexplained.

Adult↗

[Probable allergy to polyvidon, responsible for a reaction to iodinated contrast medium: a case of asthma after hysterosalpingography].

A case of asthma induced by a iodinated medium (ICM) is reported. The ordinary ICM for urography were well tolerated. The suspected drug included polyvidon (PVP). Skin test, human basophil degranulation tests and leukocyte histamine release are negative for meglumine ioxitalamate, and positive for PVP. PVP is a macromolecule, used in different drugs, and as a clarifying agent of alcohols. An IgE-dependent allergy to PVP is postulated.

Asthma↗

[Effects of disodium cromoglycate on the clinical manifestations of true and pseudo food allergies in adults (author's transl)].

The effects of disodium cromoglycate (DSCG) administered orally were compared in two groups of patients: 7 patients with urticaria, angioneurotic oedema, asthma or anaphylaxis due to type I allergy to 9 foodstuffs confirmed by skin tests, human basophil degranulation tests or Prausnitz-Küstner tests, and 9 patients with chronic urticaria and digestive disorders due to non-specific histamine reactions following food absorption. DSCG in aqueous solution was given in daily doses of 300 mg increased, if necessary, to 600 or 900 mg. After one month treatment was interrupted for 15 days, then replaced by a placebo for one month. Complete remission, lasting for up to 45 days after DSCG was discontinued, was observed in 5/7 patients of the first group, but in only 1/9 patients of the second group. The drug was well tolerated by 12/16 patients. Four patients presented with allergic or digestive reactions which obliged to withdraw treatment in two.

Adolescent↗

Detection of antifood IgE by in vitro tests and diagnosis of food allergy.

The diagnosis of IgE-dependent food allergy relies on the demonstration of specific IgE by prick tests or biological tests. A radioimmunoassay (RAST Phadebas) is completed by several immuno-enzymatic methods: RAST Phadezym, FAST, MAST-CLA, AlaSTAT, etc. The allergen is bound to solid or liquid phases, by different binding agents. Various enzyme-substrate systems, and several systems for expression are used (RIA, fluorescence, chemoluminescence, colorimetry, etc.). Another aspect of modern technics is the trend towards high automated processes. A second group of tests aims to detect the release of mediators from sensitized basophils: leucocyte histamine release test, human basophil degranulation test and a leucocyte leukotriene release test. The specificity of tests for detection of anti-food IgE is lessened by numerous cross reactivities between pollens, fruit, and vegetable. The study of the sensitivity of such tests needs strictly standardized food challenge tests in order to firmly establish the diagnosis of food allergy. Multiscreen tests have to be assessed, in order to validate their efficacy for detecting frequency allergens. Whatever the test to be used, its positivity means only sensitization, and food challenge tests are mandatory to recognize true food allergy, as latent sensitization to food is a current phenomenon in atopic children. The possibility of reliable diagnosis of food allergy by using challenge tests makes now possible and advisable to set up quality controls for all biological tests applied to the detection of antifood IgE, thanks to the possibility to dispose of reference sera.

Adult↗

[Diagnostic and predictive importance of the blast transformation test and basophil activation test in retinal vasculitis].

22 patients suffering from Birdshot retinochoroidopathy (10), idiopathic vasculitis (6) and Behcet disease (6) and treated by cyclosporine were tested at regular intervals during 11 to 38 months by the lymphocyte stimulation test (LST) and basophil degranulation test (HBDT) with S retinal antigen. These two tests were found frequently positive especially during acute inflammation for the LST. However HBDT was positive in all the patients before relapse of acute inflammation which is in favor of its predictive value and its involvement in the triggering of inflammation at the basophiles or at the local mast cell level.

Basophil Degranulation Test↗

Simultaneous anaphylaxis to thiopentone and a neuromuscular blocker: a study of two cases.

Two women experienced anaphylactoid reactions after induction of general anaesthesia. Prick tests, intradermal tests (IDT), human basophil degranulation tests (HBDT) and a quaternary ammonium sepharose radioimmunoassay were undertaken several weeks later and repeated together with a leucocyte histamine release (LHR) test after 4 months. Anaphylaxis to suxamethonium was documented by four tests in patient 1 and to pancuronium by four tests in patient 2. Anaphylaxis to thiopentone was shown with IDT, HBDT and LHR in both women. It was concluded that simultaneous anaphylaxis to thiopentone and a neuromuscular blocker had occurred in these patients.

Adult↗