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Notes: Blood eosinophils, and serum levels of the eosinophil proteins, eosinophil cationic protein (ECP) and eosinophil protein X (EPX) were measured in childhood asthma. Seventeen patients mean age 11–9 years who were symptomatic with asthma, were enrolled in a study examining the eosinophil counts and eosinophil proteins at the onset of study and after treatment in relation to changes in their baseline forced expiratory volume at 1 second (FEV1) and % predicted FEV1. The patients with symptomatic asthma were compared with 17 patients mean age 12.0 years with asymptomatic asthma maintained on daily inhaled steroid and 13 patients, mean age 12.0 years, without asthma but with urticaria who served as non-asthma controls. Patients with symptomatic asthma did not have significantly higher initial eosinophil counts compared with those with asymptomatic asthma (0.43 × 109/1 vs 0.26 × 109/1, P= 0.09) but had higher serum ECP levels (28.9 μ/1 vs 18.5 μg/1). Both asthma patient groups had significantly higher serum ECP levels (P〈0.01) than the controls (9.8 μg/1). After therapy consisting of increased dose of inhaled steroids and/or oral steroids, patients in the symptomatic asthma group demonstrated a significant rise in FEV1 (1.67 1/sec at Visit 1 vs 2.08 1/ sec at Visit 2, 1〈0.01). A similar rise was seen for % predicted FEV1. Patients in the asymptomatic asthma group showed no significant change in FEV1 between visits (2.23 1/sec vs 2.37 1/sec), which was verified with the % predicted FEV1, Patients in the symptomatic asthma group showed a significant decrease in ECP level following treatment (28.9 μ/1 to 9.6 μ/1. P〈0.001) while the values in the asymptomatic group did not change (18.6 μ/1 to 15.2 μ/1 not significant). There was a significant correlation between the initial ECP level in the symptomatic asthma group and the change in the FEV| with treatment. Serum EPX levels showed similar trends but there was no significant correlation between the initial EPX levels and the changes in FEV1. Neither did blood eosinophil counts show such a correlation. This data suggests that the changes in serum ECP levels correlate with the changes in lung function subsequently to anti-inflammation therapy.

Notes: Thirty children with hay fever were studied with in vivo and in vitro tests during rush hyposensitization with Timothy pollen. Clinical assessment was made with the aid of diaries during one season before, and three seasons after, the start of the immunotherapy. When the serum level of IgE increased more than 10% during the first week of the therapy, symptoms were mostly alleviated during the following seasons. An alleviation was rarely found in children with decreasing or unchanged serum IgE levels. No predictive information as to the clinical effect of the immunotherapy was obtained from skin or provocation tests, nor from Timothy-specific antibodies of the IgG or IgE classes. It is proposed that serum IgE determinations should be performed before, and 1 week after, the start of rush hyposensitization in order to find probable therapeutic failures.

Notes: Ten patients who developed severe generalized reactions following a honey-bee sting were investigated for the presence of specific IgE and IgG antibodies, and for lymphocyte reactivity following in-vitro honey-bee venom (HBV) stimulation. Five of the patients (high responders) showed high HBV-specific IgE and IgG levels, whereas the other five patients (low responders) showed low HBV-specific IgE and IgG levels. Mononuclear cells from the high responder group incorporated significant amounts of 3H-thymidine when activated with pure bee venom, whereas insignificant lymphocyte proliferation was observed in the low-responder group. It is concluded that, amongst HBV-sensitive patients, a group of low responders exists in whom the mechanism of anaphylaxis cannot be explained.

Notes: The reproducibility of skin prick test using histamine dihydrochloride 1, 5, and 10 mg/ml was tested by three nurses in five non-atopics in a double-blind trial. The variations day-to-day, within-day, between and for the same tester were calculated. Seventy-five percent of wheal reactions obtained by histamine 1 mg/ml were 〈 15 mm2. With histamine 5 mg/ml there were only a few wheals 〈 15 mm2 and none at all with bistamine 10 mg/ml. The mean coefficient of variation of wheals 〉 15 mm2 was between 20–30%, in contrast to figures between 30-60% with wheals 〈 15 mm2. No significant day-to-day or within-day variation was shown concerning histamine wheal areas. It is suggested that histamine dihydrochloride 10 mg/ml should replace histamine dihydrochloride 1 mg/ml as the positive reference in routine skin prick tests and biological standardization.

Notes: The clinical significance of mould allergens in Phadebas RAST® panel was investigated in 121 asthmatic children. They were selected from a total population of 1649 patients. The patients were distributed into four groups, based on the combination of positive or negative skin prick tests (SPT) together with symptoms suggestive or not of mould sensitivity. Mould-specific IgE antibodies were investigated using the original RAST panel (Alternaria, Aspergilius, Candida, Cladosporium, Mucor and Penicillium) and a set of 10 additional mould-allergen discs (Aureobasidium, Batrytis, Currularia, Epicoccum, Fusarium, Helminthosporion, Phama, Rhizopus, Stemphylium and Trichoderma). The set of additional RAST dises revealed patients with mould-reaginic antibodies not found with the original RAST panel. This occurred in four of 49 (8.2%) RAST positive (class 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:01054538:ALL85:ges" location="ges.gif"/〉2) patients. The allergens most frequently positive were Cladosporium (in 28% of the patients). Candida (28%) and Helminthosporium (26%). A remarkable degree of simulataneous reactivity to almost all moulds rested was observed. Patients with multiple (〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:01054538:ALL85:ges" location="ges.gif"/〉 7) mould sensitization were effectively pinpointed using any duplicate combination of Aureabasidium, Botryts, Candida, Cladesporium, Helminthosporium, Pencillium and Stemphylium.

Notes: 42 patients with confirmed hypersensitivity to honey bee (HBV) and/or yellow jacket (YJV) were treated with the respective venoms (7 with HBV, 5 with YjV and 30 with both venoms). Treatment tolerance, skin tests (ST), specific IgE- and specific IgG-antibodies were monitored before, after 3, 6, 12, 24 and 36 months. 21 patients had ash and 21 a conventional treatment schedule. Maintenance dose was 100 μg. Adverse effects occurred as large local (8 patients), slight systemic (12 patients) and moderate to severe systemic reactions (4 patients). Of 24 re-exposed patients 17 had no reaction at all, six a markedly decreased and one an unchanged reaction. After 3 years of treatment ST became negative in nine of 31 patients on HBV and in seven of 26 patients on YJV. RAST became negative in three of 30 patients on HBV and 17 of 29 patients on YJV treatment. Both ST and RAST became negative in five HBV- and 10 YJV-treated patients. Loss of venom hypersensitivity according to diagnostic tests may correspond to actual desensitization and enable discontinuation of immunotherapy.

Notes: Monomethoxy polyethylene glycol (mPEG) modified honey bee venom (HBV) immunotherapy (IT) has been studied in 14 patients allergic to honey bee venom. Doses could be increased more rapidly and higher doses were reached compared to regular venom immunotherapy. No general side effects were seen, although large local swellings found somewhat more often than with regular HBV. Most patients could easily be switched from the modified to the unmodified venom. Eight patients experienced and tolerated field stings. Skin testing showed a decreased allergenicity of the mPEG-HBV. The mean HBV-specific IgE level was below pretreatment level already after only weeks of IT. The HBV-specific IgG response was very good.

Notes: Antibody responses to honey bee venom (HBV) were studied in 13 patients during a 4-month course of immunotherapy with monomethoxy polyethyleneglycol (mPEG) modified venom. There was a rise of HBV-specific IgG antibodies as measured by IgG-RAST in all patients and a slight decrease of IgE antibody in most of them. The IgG-antibody responses during mPEG-HBV treatment as examined by crossed radio-immunoelectrophoresis were directed to phospholipase A, hyaluronidase, acid phosphatase and to another allergen, antigen 1. Thus, despite a high degree of mPEG- modification of HBV, the immunogenicity of the most important HBV allergens was retained.

Notes: Thirty children with rhinoconjunctivitis due to birch pollinosis were treated in a double blind manner for 10 months with enteric-coated capsules containing either a birch pollen preparation (n= 14) with doses up to 1.4 × 106 biologic units per day or placebo (n= 16). Compared with the placebo group the actively treated children had less symptoms during the birch pollen season after 3 months of therapy (P = 0.035). Skin prick reactions decreased significantly more in the active group than in the placebo group after 10 months (P = 0.01). Conjunctival sensitivity was lower in the active group than in the placebo group after 3 months of treatment (P = 0.01) but not after 10 months. Compared with the placebo group treated children more often increased their levels of IgG (P= 0.007) and pre-seasonal IgE (P= 0.001) against birch. There was a seasonal increase of IgE antibody level against birch in the placebo but not in the treatment group (P 〈 0.001). None of the treated children developed asthma, compared with five of the untreated children. No general reactions occurred and few side effects were seen during the treatment period. We conclude that in children with birch pollinosis oral immunotherapy with high doses of a biologically potent preparation in enteric-coated capsules is effective, easy to perform, economic and safe.

Notes: Oral immunotherapy (IT) was evaluated in a pilot study in two centres in children aged 8–15 years with allergic rhinoconjunctivitis. High doses (up to 20 × 106 BU monthly) of a defined freeze-dried birch pollen extract administered in enteric-coated gelatine capsules were given either daily for seven consecutive days every month or once weekly. Symptom scores, as assessed by sneezing, dripping and blockage of the nose, and redness, itching and swelling of the eyes, were significantly lower in treated patients compared to untreated, or placebo treated controls after 3 to 5 months of therapy. In all the 16 treated, but only in three of eight untreated patients, the scores were lower during the pollen season 1982 than during the pollen season preceding the treatment period, despite comparable pollen counts during the two seasons. One year after beginning treatment the reactivity in conjunctival provocation tests was decreased about 10-fold (P 〈 0.001) in the patients receiving more than 2 × 105 BU monthly compared to about two-fold in patients receiving lower doses, or placebo. Increased levels of IgE antibodies directed against birch pollen were recorded in the serum and saliva of most patients after 3–4 months of active IT. In contrast, IgG antibody responses were poor in most of the patients. Side effects, particularly from the gastrointestinal tract, appeared in all treated children. In one of t hem a systemic reaction occurred during IT. The study indicates that properly performed oral IT with a potent birch allergen extract in enteric-coated capsules may be effective.