Phylogenetic aspects of hypersensitivity: immediate hypersensitivity reactions in flatfish.
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A patient had a chronic hand eczema, presumably as a manifestation of atopy. Treatment resistance appeared due to handling certain foods that produced burning and stinging in the chronically eczematous skin and not in otherwise normal skin. Selected tests for delayed hypersensitivity and for immediate hyper sensitivity on intact skin of the back produced negative results, but on chronically inflamed skin of the arm and back, application of the pertinent foods produced a wheal and flare response. On intact skin, scratch tests with the foods produced positive results. Intradermal tests with commercial antigens were negative. Avoidance of these foods, as contactants, led to resolution of the dermatitis. Reappraisal of the role of immediate-type hypersensitivity in chronic hand eczema is important.
Diseases in which immediate hypersensitivity (IH) reactions occur, (asthma, allergic rhinitis and eczema) are very common in Australia although their overall prevalence is unknown. Until recently the clinical investigation of IH has been undertaken almost exclusively by allergists using scratch tests. The discovery of Ige by Ishizaka et al. in 1966 resulted in a rapid increase in the understanding of the processes involved in IH reactions and, although much remains unclear, respiratory physicians,immunologists and epidemiologists are becoming increasingly involved in investigating the IH reactivity of individuals and populations. In this review the immunological basis of IH reactions is briefly presented; the role of skin tests in their assessment is evaluated and the relationship between IH and clinical allergic disease is discussed in terms of patient management.
Eighty-six children aged three to 14 years were skin-tested for immediate hypersensitivity to antigens which are seasonal (grass pollens) or non-seasonal (car, dog, house-dust mite) in occurrence. Children who reached the age of three months during a time of environmental exposure to grass pollen demonstrated a significantly increased incidence of immediate hypersensitivity reactions to three grass pollens, as compared with children born at other times of the year. No significant difference was found in their reactions to the non-seasonal antigens. These findings indicate a relationship between the time of birth and the subsequent development of immediate hypersensitivity in childhood. It is suggested that infants are particularly susceptible to sensitization when presented with antigen around three months of age.
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The cholinergically innervated human eccrine sweat gland is a readily available organ permitting the assessment in allergic patients of cholinergic reactivity with few or no adrenergic influences. The sweat responses of four matched groups (male allergic, female allergic, male control, and female control) to intradermal Mecholyl from 0.1 mug to 100 mug was compared; the 45 male and 45 female allergic patients demonstrated statistically significant increases in sweat responses to essentially all concentrations of Mecholyl examined. No difference in the sweat responses of patients with allergic rhinitis alone was compared with patients with both allergic rhinitis and allergic asthma was noted. Five patients with intrinsic asthma most closely resembled the allergic groups in their responses and 8 patients with vasomotor rhinitis sweated at or below the control groups. The increased sensitivity of allergic patients to cholinergic stimulation as measured by eccrine sweat responses suggest that this hyperresponsiveness may be one of the underlying defects in allergic disease.
Crude cockroach extract elicited positive skin tests in 50% of patients with positive and in 4% with negative environmental history for cockroach exposure, suggesting a possible role of cockroach in perennial atopic disease. Three major allergens in crude American and German cockroach extracts have been identified using sequential purification steps on Sephadex G-75, diethylaminoethyl (DEAE) cellulose, and agarose gel electrophoresis. Cr-I elicits positive skin tests in 70% of patients sensitive to the crude extracts. It has a molecular weight of approximately 25,500 daltons, is highly acidic, and resists boiling for four hours. Boiling in 4 N acetic acid completely abolishes its allergenicity. The purified allergen elicits positive skin tests at a concentration of 3 mug/ml and is capable of inducing greater than 50% histamine release from sensitive leukocytes at 0.05 ng/ml. A second antigen, Cr-II, elicits positive skin tests also in approximately 70% of cockroach-sensitive individuals, has a molecular weight of approximately 63,000 to 65,000 daltons, and has similar heat stability and acid hydrolysis characteristics to Cr-I. A third, less well-characterized antigen, Cr-III, has a molecular weight less than 10,000 daltons and elicits positive skin tests in 30% of individuals sensitive to the crude extract.
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We report the finding of anomalous responses in the skin of atopic individuals when prick tested with serial dilutions of cocksfoot grass pollen extracts. Each pollen extract was standardized using RAST inhibition activity related to the WHO standard for IgE. 75% of the patients gave a larger weal area with an allergen concentration of 1:10(5) than with the next higher concentration, i.e. 1:10(4). Possible mechanisms whereby a larger skin weal is elicited with a lower concentration of allergen are discussed. This is not a rare finding and can be observed in patients undergoing routine skin testing in the clinic, even where extracts are diluted over a relatively narrow concentration range.
ICI 74,917, a potent inhibitor of IgE-mediated passive cutaneous anaphylaxis (PCA) in the rat, exhibited tachyphylaxis in that pre-dosing sensitised rats with a high dose of compound reduced the inhibitory effect on rat PCA of a second dose given at challenge. This phenomenon was most apparent when the pre-dose-challenge dose interval was 15--60 min. Similar findings were obtained using antigen-induced histamine release in vitro from rat peritoneal cells. In these respects, ICI 74,917 was similar to disodium cromoglycate (DSCG) although DSCG appeared less effective in inducing tachyphylaxis than ICI 74,917. There was no evidence in vivo or in vitro that a high dose of either DSCG or ICI 74,917 enhanced the activity of a second low dose of either drug given at challenge.
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The results of a study of some humoral and cellular immunological reactions to antigens of the myocardium and connective tissues of cardiac vlaves, as well as to those of the haemolytic Streptococcus in rheumatic patients are presented. Antibodies to 4 antigens were deter mined, to cellular form of immunity was examined by the method of leucocytes migration inhibition. The studies have indicated that in rheumatism, hupersensitivity of a delayed and non-delayed type manifests itself. The activity of the inflammatory process, its severity, the nature and severity of carditis are to a great extent reflected by the connective tissue antibodies to the basic substance, especially to the structural glycoprotein of the valves. In cases of the most unfavourable clinical forms of the rheumatic process the signs of streptococcal sensitization and autoallergy to both musclular and connective tissue cardiac structures are especially vivid.
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