[Anti-allergic prophylaxis in atopic disease by the study of IgE].
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A method for the detection of specific IgE in human serum is described, using a modified radioimmune assay termed the Inhibition Assay Technique (IAT) The technique is based on the ability of specific IgE to bind with allergen. The difference in total IgE before incubation with the allergen and after incubation with the allergen gives a relative concentration of specific IgE to that particular allergenic substance. The assay has been shown to correlate with both the intradermal skin test as well as the standard RAST now used to determine specific IgE.
Four tests for detection of antibodies to bovine leukemia virus (BLV) were compared. The sera that were tested came from cattle in naturally infected commercial dairy herds, cattle that were infected under experimental conditions, and cattle in an isolated BLV-free herd. The tests that were compared included a radioimmunoprecipitation assay (RIA) with p24 antigen, a RIA with glycoprotein (gp) antigen, an agar-gel immunodiffusion (AGID) test with gp antigen, and a virus-neutralization (VN) test that was based on inhibition of BLV-induced syncytia in cell culture. Results of the 4 serologic tests agreed for 96.8% of the sera from cattle in commercial herds. The gp RIA detected the greatest number of positive sera (188); it was followed in turn by the p24 RIA (187), the VN test (183), and the AGID test (176). The gpd RIA titers of the 12 sera that gave negative AGID results were 175 or less. In RIA, the percentage of precipitation of labeled antigen by positive sera was almost always higher with gp antigen than with p24 antigen. Satisfactory sensitivity in the p24 RIA required the acceptance of a low level of antigen precipitation, 15%, as a positive test. In the gp RIA, however, almost all positive sera precipitated at least 50% of the labeled antigen. Nonspecific precipitation of antigen in the RIA by sera from BLV-free cattle ranged from 4% to 10%. Examination of sequential serum samples from 17 experimentally infected cattle showed that BLV antibody was first detected 2 to 8 weeks after inoculation. In 9 cattle, seroconversion was detected simultaneously by all of the tests. Results from the other 8 cattle indicated that seroconversion could be detected first by p24 RIA, followed by the gp RIA and the VN test. The longest interval between RIA seroconversion and AGID seroconversion was 10 days. Monthly tests of sera from 10 laboratory cattle that were infected by contact exposure showed that 7 animals seroconverted in all tests at the same time. Two cattle were positive first in RIA, but the next month they were also positive in the VN and AGID tests. One animal was positive in the RIA and the VN test for 2 months before antibody was detected by AGID.
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Extract of wheat flour obtained by extraction, centrifugation and dialysis was immunochemically characterized by quantitative immunoelectrophoresis using rabbit antibodies. The analysis revealed wheat flour to be composed of 40 antigens, some of which were immunologically partially identical with antigens of rye flour and of common grass pollen. Furthermore, antigens of the gliadin fraction of wheat flour were identified. 25 bakers with allergic complaints working in and around Copenhagen were clinically tested with wheat flour and related extracts. Among 13 bakers with respiratory complaints (asthma and/or rhinitis), 11 showed positive reactions to wheat flour extract when tested in histamine release from basophil leukocytes radioallergosorbent test and skin test, whereas further 2 were positive in the basophil test only. The ability of the IgE of individual sera to adsorb to the individual antigens of wheat flour was examined by means of crossed radioimmunoelectrophoresis. On the basis of these results, individual allergenic components of wheat flour were identified, three of these with comparatively high affinity and frequency.
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In private practice the majority of patients evaluated by allergists are truly atopic. To assess the clinical value of determining the serum level of immunoglobulin E (IgE) in such patients the records of an individual private allergist were reviewed and all new patients were evaluated. Over an eight year period 7,000 new patients were seen and 5,500 measurements of IgE were performed. An elevated serum IgE value was indicative of the atopic state with few false positives. Successful immunotherapy as determined by patient reports, the decreased use of medications and reduced clinical visits was correlated positively with a decrease in serum IgE levels. This was true regardless of the initial value of the IgE. Unsatisfactory results in immunotherapy were often accompanied by an increase in IgE levels. Serial determinations of serum IgE levels over several years of treatment are of value in the evaluation of allergic patients in private practice.
The clinical practice of modern allergy has a sound foundation in a scientific understanding of the pathogenesis of hypersensitivity disorders. However, several practices continue to be regarded as controversial. Controlled studies have failed to establish the effectiveness of intracutaneous or low-level modified radioallergosorbent titration as a guide to immunotherapy. In addition, controlled studies do not support the clinical usefulness of provocative subcutaneous or sublingual testing procedures of the leukocytotoxicity assay for the diagnosis of food allergy. Food additives have not been clearly shown to influence hyperkinesis, and autogenous urine immunotherapy is without supporting evidence of effectiveness and is potentially harmful. Since allergic diseases are common and the economic impact of medical care for these patients is great, it is important for physicians to understand the basis for these procedures and to advise patients accordingly.
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A limiting factor for the use of some in vitro techniques in the allergological diagnostic (RAST, PRIST, Precipitins) in the pediatric field, was the amount of serum needed for their carrying out, very difficult to obtain, especially in neonatology. In the present report the Authors record the results obtained by using a micromethod on the whole blood, called "Spot Test", which consists in the use of a particular base on which the blood drops are directly absorbed. The "Spot Test" showed the same sensitivity and reproducibility of the allergometric tests performed on the serum, therefore the correlation coefficients "r" for the RAST (r = 0.96), PRIST (r = 0.92) Precipitins (r = 0.89) showed to be highly significant for a close correlation between the two tests. Besides the "Spot test" turned out to be endowed, once the bases disc-blood dried with a stability at room temperature for several months (four months) without losing its sensitivity or specificity. This allows the possible sending of these bases to Specialized Centers without any particular problems of storage.