Clinical significance of skin test and specific IgE measurement for the prediction of immediate type hypersensitivity reaction to horse antithymocyte globulin / 천식및알레르기

BACKGROUND: Horse antithymocyte globulin (ATG) is a useful treatment for aplastic anemia and for bone marrow transplantation from HLA-mismatched donors. Mortality due to anaphylactic reaction to horse ATG has been reported. We evaluated the clinical significance of skin test and specific IgE measurement for the prediction of immediate type hypersensitivity reaction to horse ATG. SUBJECTS AND METHODS: The study subjects consisted of 25 patients who received horse ATG. Underlying diseases of the 25 patients included aplastic anemia (n=20), leukemia (n=3), lymphoma (n=1), and Gaucher's disease (n=1). Skin prick test was done on these patients using undiluted ATG solution (Upjohn, USA) with duplication. Specific IgE to ATG was detected by enzyme-linked immunosorbent assay and immunoblot analysis. RESULTS: Skin prick test was positive in 7 (28%) of 25 patients. None of the patients showing negative skin prick test experienced immediate type hypersensitivity reaction to ATG. All patients showing positive skin prick test received desensitization before the administration of a full dose of ATG. However, 3 of 7 patients showing positive skin prick test experienced immediate type hypersensitivity reaction; one of them died of anaphylaxis. Specific IgE measurement using enzyme-linked immunosorbent assay was not useful in predicting immediate type hypersensitivity reaction to ATG because of nonspecific bindings. Specific IgE measurement using immunoblot analysis was only positive in the one patient who died of anaphylaxis. CONCLUSION: Skin prick test was clinically useful in the prediction of immediate type hypersensitivity reaction to horse ATG, but specific IgE measurement was not. Further studies might be needed to develop an in vitro test for the prediction of immediate type hypersensitivity reaction to horse ATG.

Presence of circulating autoantibodies against bronchial epithelia cell in patients with nonatopic asthma

Allergic response to common environmental agents has been regarded as a main pathogenetic mechanism of bronchial asthma. However, allergic sensitization (atopy) can not be detected in a siginificant number of adult asthmatic patients. The etiology of nonatopic asthma has not yet been defined. To evaluate the possible involvement of autoimmune response against bronchial mucosa in the pathogenesis of nonatopic asthma, we performed indirect immunofluorescence staining of fresh frozen human bronchial mucosa tissue using serum samples from patients with atopic and nonatopic asthma, healthy controls, and patients with systemic lupus erythematosus. On immunostaining, circulating IgG autoantibodies against bronchial mucosa were detected in 2 (9.1%) of 22 patients with nonatopic asthma and in none of 22 patients with atopic asthma and of 22 healthy controls. IgG autoantibodies from the two patients with nonatopic asthma predominantly stained the cytoplasmic membrane of basal cells in bronchial epithelium. Serum samples from 10 patients with systemic lupus erythematosus immunostained the nucleus of epithelial cells in whole layer of bronchial epithelium. This study showed the presence of circulating IgG autoantibodies against the bronchial epithelial cell in a small portion of patients with nonatopic asthma. Further studies may be necessary to evaluate the possible involvement of autoimmune mechanism in the pathogenesis of nonatopic asthma.