Progress on allergen immunotherapy during pre-pregnancy, pregnancy, and lactation periods / 中华围产医学杂志

Allergen immunotherapy (AIT), also known as allergen vaccine desensitization, is currently the only treatment that can change the natural course of allergic diseases. AIT for pregnant women is a protective factor for neonatal allergies. Existing findings suggest that AIT should not be started during pre-pregnancy, pregnancy, or lactation periods, but can be continued if has already been started before; unexpected pregnancy during AIT does not require termination; AIT shows no obvious adverse effects on fetuses, infants, and young children. The latest evidence on the effectiveness and safety of AIT during pre-pregnancy, pregnancy, and lactation periods were reviewed.

Penicillin desensitization in allergic pregnant women with syphilis. Report of two cases / Desensibilización a penicilina en mujeres embarazadas alérgicas. Informe de dos casos

ABSTRACT Syphilis during pregnancy has a high risk of congenital transmission with disastrous fetal consequences. Penicillin (PNC) is the only effective antimicrobial for the treatment of pregnant women with syphilis. Chilean guidelines do not consider desensitization to PNC in these women. We report two cases of pregnant women aged 32 and 23 years, with immediate allergy to PNC and syphilis who were safely and successfully desensitized using a four-hour intravenous protocol in the critical care unit and who subsequently received benzathine G PNC. An electronic survey was conducted among approximately 100 Clinical Pharmacists (CP) in the country. Of these, 16 answered and 13 reported having experience in drug desensitization, in at least five cases with PNC and none reported deaths or cardiorespiratory arrest. Desensitization to PNC can be carried out safely and in Chile, this alternative should be incorporated to the management of pregnant women with syphilis and immediate allergy to PNC, instead of using erythromycin.

La sífilis durante el embarazo tiene un alto riesgo de transmisión congénita con consecuencias desastrosas para el feto. La penicilina (PNC) es el único compuesto efectivo para el tratamiento de sífilis en una mujer embarazada.. En Chile, ante alergias de tipo inmediata, no se considera la desensibilización a la PNC en mujeres embarazadas por norma ministerial. Se comunican dos casos de mujeres embarazadas con alergia tipo inmediata y sífilis durante la gestación que fueron desensibilizadas a este compuesto con un protocolo endovenoso de 4 horas en la unidad de pacientes críticos, sin observar complicaciones, recibiendo posteriormente PNC G Benzatina. Se efectuó una encuesta electrónica a farmacéuticos clínicos del país que incluyó más de 100 profesionales. De ellos, 16 contestaron y 13 declararon poseer experiencia en desensibilización de fármacos, en al menos cinco casos con PNC y ninguno reportó muertes o paro cardiorrespiratorio. La desensibilización a PNC puede ser efectuada en forma segura en embarazadas con alergia de tipo inmediata a PNC que cursan con sífilis. En Chile se debería incorporar esta alternativa en el manejo de mujeres embarazadas con sífilis y alergia inmediata a PNC en lugar de solo considerar por norma el uso de eritromicina.

Loss of tolerance 5 days after discontinuing sulphonamide introduced via desensitization in delayed reaction / Perda da tolerância 5 dias após suspensão de sulfonamida introduzida através de dessensibilização por reação tardia

ABSTRACT The fixed drug eruption is a non-immediate hypersensitivity reaction to drug, characterized by recurrent erythematous or violaceous, rounded, well-defined border plaques, which always appear in the same location every time the culprit drug is administered. The usual practice is to avoid the drug involved and to use a structurally different drug. However, there are situations in which there is no safe and effective therapy. In such situations, desensitization is the only option. We describe the case of a patient who presented fixed eruption due to sulfamethoxazole-trimethoprim, who underwent successful desensitization, but required a repeat procedure twice due to relapse after inadvertent full-dose reintroduction. In non-immediate hypersensitivity reaction to drug, the indication is controversial and there is no technical standardization. Furthermore, the time at which such tolerance is lost after discontinuing the drug involved is unknown. In severe non-immediate reactions of types II and III, desensitization is contraindicated. The patient underwent desensitisation to sulfamethoxazole-trimethoprim three times − the first with recurrence of lesions and the second and third without manifestations, all concluded successfully and with no premedication.

RESUMO A erupção fixa por drogas é uma reação de hipersensibilidade a medicamento não imediata, caracterizada por placas eritematosas ou violáceas, arredondadas, recorrentes, de bordas bem definidas e que aparecem sempre na mesma localização cada vez que o medicamento culpado é administrado. A prática habitual é evitar a droga envolvida e utilizar um medicamento estruturalmente diferente. Contudo, há situações em que não há terapêutica segura e eficaz. Em tais situações, a dessensibilização é a única opção. Descrevemos o caso de um paciente que apresentou erupção fixa por drogas por sulfametoxazol-trimetoprim, tendo sido submetido à dessensibilização com sucesso, mas necessitou repetição do procedimento duas vezes, por recidiva da reação após reintrodução inadvertida em dose plena. Em reação de hipersensibilidade a medicamento não imediata, a indicação é controversa e não há padronização técnica. Além disso, não se conhece o tempo durante o qual essa tolerância é perdida após a suspensão da droga envolvida. Nas reações não imediatas graves e dos tipos II e III, a dessensibilização está contraindicada. O paciente foi submetido a dessensibilização ao sulfametoxazol-trimetoprim por três vezes − a primeira com recorrência de lesões, e a segunda e terceira sem manifestações, sendo todas concluídas com sucesso e sem uso de pré-medicação.

Successful desensitization of pemetrexed-induced anaphylaxis in a patient with malignant mesothelioma

No abstract available.

Successful desensitization of pemetrexed-induced anaphylaxis in a patient with malignant mesothelioma

No abstract available.

Vigilancia de la efectividad y seguridad de las vacunas VALERGEN en el tratamiento del asma / Surveillance of the effectiveness and safety of the VALERGEN vaccines in the treatment of asthma

Fundamento: la inmunoterapia es la única estrategia terapéutica para cambiar el rumbo de la fisiopatología de las enfermedades alérgicas, de aquí la importancia del estudio de su aplicación, las posibles reacciones adversas y su efectividad en dichas enfermedades. Objetivo: evaluar la efectividad y seguridad de las vacunas VALERGEN en el tratamiento del asma. Métodos: se realizó un estudio observacional de cohorte en pacientes con diagnóstico de asma intermitente, persistente leve y moderada a los que se les indicó la administración de las vacunas VALERGEN tanto por vía sublingual como por vía subcutánea. Se estableció un sistema de seguimiento prospectivo activo de los pacientes asmáticos vacunados, se empleó el método de farmacovigilancia monitoreo de eventos adversos en una cohorte. Se tomó una muestra de 100 pacientes que cumplieron los criterios de selección. Los datos se recolectaron a través de cuestionarios. Para el análisis de los mismos se utilizó estadística descriptiva e inferencial. El procesamiento de la información se realizó mediante el paquete estadístico SPSS versión 15.0. Los resultados obtenidos fueron ilustrados en tablas y gráficos. Resultados: se encontró un predominio de pacientes con disminución de síntomas de asma y de la medicación con el uso de inmunoterapia, resultado que mostró una alta significación estadística (p=0,000). Los eventos adversos que más se presentaron fueron el habón >5cm, eritema, rinitis y la asociación de rinitis y asma, estos predominaron en el grupo etáreo de cinco a nueve años, sexo femenino, vía subcutánea, con la mezcla de Dermatophagoides pteronyssinus y Blomia tropicalis (VALERGEN DP + VALERGEN BT) y con concentración de 20 000 UB/ml. Conclusiones: la inmunoterapia con vacunas VALERGEN propicia una evolución clínica favorable en la mayoría de los pacientes, con un bajo índice de eventos adversos, lo que confirma su efectividad y seguridad en el tratamiento del asma.

Background: immunotherapy is the sole therapeutic strategy used to change the direction of physiopathology of allergic illnesses, hence the importance of this study, its application, the possible adverse reactions and its effectiveness in these conditions. Objective: to evaluate the effectiveness and safety of the VALERGEN vaccines in the treatment of asthma. Methods: an observational study of cohort was carried out in patients with diagnosis of mild to moderate persistent and intermittent asthma on which the administration of the VALERGEN vaccines were indicated by sublingual route or subcutaneously. An active prospective approach of the patients with asthma was used and the method of pharmacosurveillance monitoring of adverse events in a cohort was established. A sample of 100 patients fulfilling the selection criteria was conformed. The data were gathered through questionnaires. The analysis of data was done using descriptive and inferential statistics. The prosecution of information was carried out by means of the statistical package SPSS version 15.0. The obtained results were illustrated in charts and graphics. Results: a prevalence of patient with decreased asthma symptoms was found and also the need for medication with the use of immunotherapy, this result that showed a high statistical significance (p=0,000). The adverse events presented more often were, the weal >5cm, erythema, rhinitis and the rhinitis association and asthma, these prevailed in the ages from 5 to 9 years, feminine sex, subcutaneous route, with the mixture of Dermatophagoides pteronyssinus and Blomia tropicalis (VALERGEN DP + VALERGEN BT) and with concentration of 20 000 UB/ml. Conclusion: immunotherapy with VALERGEN vaccines provides a positive clinical evolution in the majority of the patients, with a low rate of adverse events which confirms its effectiveness and safety in the treatment of asthma.

Induction of Bronchial Tolerance After 1 Cycle of Monophosphoryl-A-Adjuvanted Specific Immunotherapy in Children With Grass Pollen Allergies

PURPOSE: Subcutaneous allergen-specific immunotherapy (SCIT) is a well-established and clinically effective method to treat allergic diseases, such as rhinitis and asthma. It remains unclear how soon after initiation of an ultra-short course of grass pollen immunotherapy adjuvanted with monophosphoryl lipid A (MPL)-specific bronchial tolerance can be induced. METHODS: In a prospective study of 69 children double-sensitized to birch and grass pollens (51 males, average age 11.1 years), development of bronchial tolerance after 1 cycle of SCIT for grass was evaluated. In all the patients, the bronchial allergen provocation test (BAP) was performed before and after treatment. According to the results of the first BAP, the patients were divided into 2 groups: those showing a negative BAP with a decrease in FEV1 of or =20% (SAR with allergic asthma [SAR and Asthma] group, n=22). All the patients received MPL-adjuvanted, ultra-short course immunotherapy for birch, but only those with a positive BAP to grass received MPL-SCIT for grass. RESULTS: After the pollen season, the BAP in the SAR group remained unchanged, while it was improved in the SAR and Asthma group (decrease in FEV1 of 28.8% vs 12.5%, P<0.01). The IgG4 levels increased after SCIT (median before SCIT 0.34 to 11.4 after SCIT), whereas the total and specific IgE levels remained unchanged. CONCLUSIONS: After 1 cycle of MPL-SCIT, specific bronchial tolerance may be significantly induced, whereas in patients without SCIT, bronchial hyperactivity may remain unchanged.

Influence of specific immunotherapy in allergic rhinitis children with different level of skin prick test with dermatophagoides allergens / 中国耳鼻咽喉头颈外科

OBJECTIVE To observe the efficacy of specific immunotherapy (SIT) with Alutard and NHD in children with allergic rhinitis due to different level of skin prick test (SPT) with dermatophagoides farinae (DF) and dermatophagoides pteronyssinus (DP). METHODS A total of 178 children with persistent allergic rhinitis were included in this study. Their age ranged from 6 to 12 years. They were divided into 3 groups according to level of SPT. Group 1: The level of skin index (SI) of DF is greater than that of DP, Group 2: The level of SI of DF is equal to that of DP and Group 3: The level of SI of DF is less than that of DP. The children in each group were randomly divided into 2 subgroups: Alutard group and NHD group. The children were given SIT with Alutard or NHD for one year. Symptom and medication scores were recorded and analyzed. RESULTS After receiving therapy for 3 months and 6 months, symptom and medication scores of the Group 1 and 2 in the NHD group were lower than those in the Alutard group (P0.05). CONCLUSION The efficacy of SIT with Alutard and NHD is different in children with allergic rhinitis with different levels of SPT due to DF and DP after 3 and 6 months, but is similar after 9 and 12 months. SIT with Alutard and NHD is effective in treating children with allergic rhinitis.

Effect of subcutaneous immunotherapy on serum levels of human beta defensin-2 in children with allergic rhinitis / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the effect of subcutaneousimmunotherapy(SCIT) on levels of the serum human beta defensin-2 in children with allergic rhinitis. METHODS 30 cases of children with allergic rhinitis who were treated by SIT were selected as the treatment group, 20 cases of healthy children as the control group. Serum HBD-2 concentration of the control group was tested. Serum HBD-2 concentration of the treatment group was tested at three different time points: before SCIT, half a year after SCIT and one year after SCIT. And total nasal symptom scores(TNSS) and medication scores were recorded at each time point. RESULTS The serum HBD-2 concentration of the control group, that of the treatment group before SIT, half a year after SIT and one year after SIT were 4.62[4.08; 4.87], 3.74[3.37; 4.61], 4.62[4.13; 5.54], 4.79[4.45;6.19]ng/ml. The HBD-2 concentration gradually increased after SCIT. The TNSS of the treatment group before SCIT, half a year after SCIT and one year after SCIT were 7.43±2.15, 4.17±2.16, 4.20±1.92, The medication scores of the treatment group before SCIT, half a year after SCIT and one year after SCIT were 1.25[0.75; 1.38], 0.25[0; 0.75, 0.25[0; 0.75].There was no correlation (all P>0.05) between the serum HBD-2 concentration and TNSS or medication scores of the treatment group. CONCLUSION The serum levels of HBD-2 in patients with allergic rhinitis were lower than those in normal persons. The specific immunotherapy raised the serum HBD-2 levels of allergic rhinitis patients.

Oral antiplatelet agent hypersensitivity and cross-reactivity managed by successful desensitisation

Oral platelet aggregation inhibitors are widely used for the treatment and prevention of cardiovascular diseases, including coronary stent thrombosis. Premature discontinuation following percutaneous coronary intervention would pose a grave risk of in-stent thrombosis, acute myocardial infarction and eventual death. Although they share the same mechanism of adenosine diphosphate P2Y12 platelet receptor inhibition, they belong to either the chemical class of thienopyridines (clopidogrel, prasugrel, and ticlopidine) or cyclopentyl-triazolo-pyrimidines (ticagrelor and cangrelor). This case describes the first documented cross-reactive hypersensitivity of clopidogrel towards both its fellow thienopyridine, prasugrel, as well as the structurally dissimilar ticagrelor, and its subsequent successful desensitisation.

Alergia a la leche y al huevo: diagnóstico, manejo e implicaciones en América Latina / Milk and egg allergy: Diagnosis, management and implications for Latin America

La sensibilización a alimentos y el desarrollo de alergias alimentarias viene aumentando en todo el mundo, siendo la leche de vaca y el huevo de gallina los principales alimentos implicados. En la mayoría de los países latinoamericanos no existen guías de manejo y cuando se elaboren deberán adaptarse a las condiciones de la población de cada región. En el presente artículo presentamos una revisión del manejo de la alergia alimentaria a la leche y al huevo útil para el personal de salud de todos los niveles, así como algunas consideraciones de los factores presentes en los países latinoamericanos.

Sensitization to food allergens, as well as the development of food allergies, is increasing worldwide, and cow´s milk and hen´s eggs are the main implicated foods. In most Latin American countries there are no management guidelines on the aforementioned topics; at their creation, such guidelines should be adapted to the conditions of the population in each region. This paper presents a review of the management of food allergy to milk and eggs useful for health personnel at all levels and some considerations of the factors found in Latin American developing countries.

Eficacia de la inmunoterapia subcutánea con extractos de ácaros en adultos asmáticos / Effectiveness of subcutaneous immunotherapy with mite extracts in asthmatic adults

Fundamento: la inmunoterapia alergeno específica constituye el único tratamiento capaz de modificar el curso natural de las enfermedades alérgicas, tiene efecto multiorgánico y duradero a largo plazo después de suspender su administración y se han probado sus efectos preventivos, tanto en la prevención de nuevas sensibilizaciones como en la progresión de la rinitis al asma. Objetivo: evaluar la eficacia de una nueva pauta de inmunoterapia subcutánea con extractos alergénicos de ácaros en adultos asmáticos. Método: se realizó un ensayo clínico fase II, abierto, aleatorizado en 50 pacientes con diagnóstico de asma bronquial leve o moderada, sensibles a ácaros del polvo por prueba de Prick .La población objeto de estudio estuvo constituida por 200 pacientes con antecedentes patológicos de asma bronquial y edades entre 18 y 50 años, que acudieron a la consulta de Alergología del Hospital Universitario Manuel Ascunce Domenech, desde mayo de 2011 a mayo de 2012. A los mismos se les administró inmunoterapia subcutánea con extractos de ácaros (Dermatophagoides pteronyssinus, y Blomia tropicalis) a concentraciones de 20 UB/ml, 200 UB/ ml, 2 000 UB/ml y 20 000 UB/ml en el primer grupo, según el esquema propuesto por el BIOCEN, se alcanzó la dosis de mantenimiento en 13 semanas a intervalos semanales. El segundo grupo recibió pauta convencional de 16 semanas. Resultados: en la evaluación de la eficacia se comprobó una reducción de los síntomas clínicos y del consumo de medicación al final del tratamiento en ambos grupos pero de manera significativa en el grupo estudio (p=0,020). La reactividad cutánea a los ácaros disminuyó significativamente en el grupo estudio con respecto al grupo control. Conclusiones: se demuestró un alto grado de eficacia de esta pauta más acortada con extractos de ácaros, lo que garantiza una adhesión al tratamiento superior a la pauta de 16 semanas con frecuencia bisemanal.

Background: allergen-specific immunotherapy is the only treatment capable of modifying the natural course of allergic diseases; it has multiple organ and long term effect after stopping its administration and its preventive effects have been tested, both in the prevention of new sensitizations and in the progression of rhinitis to asthma. Objective: to evaluate the effectiveness of a new subcutaneous immunotherapy schedule with mite extracts in asthmatic adults. Method: a phase II, open, randomized clinical trial was conducted in 50 patients with diagnosis of mild or moderate bronchial asthma, sensitive to dust mites by Prick test. The study population was constituted by 200 patients with a pathological history of bronchial asthma and aged between 18 and 50 years, who were treated in the Allergology consultation at the University Hospital Manuel Ascunce Domenech, from May 2011 to may 2012. They were given subcutaneous immunotherapy with mite extracts (Dermatophagoides pteronyssinus and Blomia tropicalis) at concentrations of 20 ml/UB 200 UB / UB/ml 2 000 and 20 000 ml/UB/ml in the first group, according to the schedule proposed by BIOCEN, it was reached the maintenance dose in 13 weeks at weekly intervals. The second group received conventional schedule of 16 weeks. Results: it was found a reduction of clinical symptoms as well as in medication consumption at the end of the treatment in both groups, but significantly in the study group (p=0,020). Skin reactivity to mites significantly decreased in the study group regarding the control group. Conclusions: a high degree of effectiveness of this new schedule with mites’ extracts was demonstrated, this guarantees a greater adhesion to treatment, which it is far superior to the previous 16-week schedule with a twice-weekly frequency.

Desensibilización rápida en pacientes con hipersensibilidad a aspirina sometidos a angioplastía coronaria: Reporte de cuatro casos / Rapid aspirin desensitization in patients with a history of aspirin hypersensitivity requiring coronary angioplasty: Report of four cases

Background: Aspirin use is necessary after a coronary angioplasty. It should not be used in patients with a history of hypersensitivity. However, rapid desensitization protocols have been reported to allow its use in such patients. One of these protocols consists in the administration of progressive doses of aspirin, from 1 to 100 mg in a period of 5.5 hours, in a controlled environment. We report four male patients aged 45,49, 59 and 73 years with a history of aspirin hypersensitivity, who were subjected to a coronary angioplasty. In all, the rapid aspirin desensitization protocol was successfully applied, allowing the use of the drug after the intervention without problems.

Effect of desensitization treatment for highly sensitized uremic patients before kidney transplantation / 中华器官移植杂志

Objective To explore the feasibility and efficacy of desensitization protocol for highly sensitized renal transplant patients (HSP). Methods Thirty-five HSPs ( HLA class-Ⅰ panel reactive antibody ＞50 %), including 27 patients with a positive T and/or B cell cytotoxicity crossmatch (XM) and 8 patients with a negative T and B cell XM, received plasmapheresis plus intravenous immunoglobulin (PP-IVIG)treatment. Results The positive XM was rendered negative by PP-IVIG treatment in 25 of 27 (92.6 %)HSPs, and subsequent transplantation was performed. Two patients did not receive renal transplants due to persistent positive XM. In 25 patients receiving renal transplants, no hyperacute rejection occurred. There were 8 cases of acute rejection, including 5 cases of acute humoral rejection (AHR). All rejection episodes were reversed. During a follow-up period of 52 ± 26 months, the serum creatinine levels at 12th and 24th month were 112± 18 and 130 ± 38 mol/L respectively. The 1- and 3-year graft survival rate was 96. 0 %and 80. 0 % respectively. Conclusion The desensitization therapy by PP-IVIG is effective for HSP. High rate of AHR is the major defect of this protocol. The short-term graft survival rate after this protocol is acceptable but the long-term survival rate needs to be defined.

Kidney Transplantation in Sensitized Recipients; A Single Center Experience

A successful transplantation, across a positive crossmatch barrier, is one of the most persistent long- standing problems in the field of kidney transplant medicine. The aim of this study was to describe seven consecutive living renal transplantations in recipients with positive crossmatch for donors or positive for donor specific antibodies (DSAs). A preconditioning regimen including plasmapheresis and intravenous immunoglobulin was delivered three times a week until the crossmatch and/ or DSAs became negative. Mycophenolate mofetil and tacrolimus were started two days before the plasmapheresis. The protocol was modified to include administration of anti-CD 20 antibody (rituximab, 375 mg/m(2)) from the patient number 3 through the patient number 7. All seven patients achieved negative conversion of the crossmatch or DSAs, and the kidney transplantations were successfully performed in all cases. Acute cellular rejection occurred in two patients, which were subclinical and controlled with high dose steroid treatment. Antibody-mediated rejection occurred in one patient, which was easily reversed with plasmapheresis. All recipients attained normal graft function during the 7-24 months of follow up. Our study suggests that sensitized patients can be transplanted successfully with desensitization pretreatment.

Diagnostic value of the intradermal tests on inhalant allergens in patients with allergic diseases / 中国基层医药

Objective To explore the diagnesticvalue of the inhalant allergens in patients with allergic disea-ses. Methods The intradermal tests(IT) of 20 types of the inhalant allergens which were supplied by Diagnosis Rea-gent Factory of Beijing Union Hospital were made on 1434 cases with allergic diseases. The samples were divided into two age groups:4～18 year-old(children group,n=318) and 19-80 year-old( adults group,n=1116). Distribution of the inhalant allergens of the two groups was investigated. Results A total of 1434 cases (male :702, female:732) were diagnosed with allergic diseases. There were 8 kinds of allergic diseases. The number of allergic rhinitis was the first place( 1130 cases,78.80% ). The first 9 positive allergens separately were: polyvalent pollen Ⅰ (51.05%),house dust(48.81% ) ,mixed inhalant allergens( 48.61% ), artemisia pollen( 46.86% ), dust mite( 45.19% ) , poly-valent insects(36.82% ) ,spring poLlen Ⅰ(33.99% ) ,ragweed pollen(31.24% ) ,spring pollen Ⅱ (30.68% ). There were 1289 cases(89.89% ) at ]east one type positively on allergens. The 19～40 aged patients were the most in dif-ferent age groups. The difference of positive detection rate of allergens was significant in different quarters ( P<0.01 ). Conclusion The youth and middle aged is easoer to suffer loom allergic diseases. Allergic rhinitis was the most common disease,and polyvalent pollen Ⅰ ,house dust,artemisia pollen,dust mite,ragweed pollen were the main allergens.

Inmunoterapia con veneno de himenópteros: presentación de diez casos clínicos / Immunotherapy against hymenoptera venom: Report of ten patients

Background: Immunotherapy can be used to treat allergic reactions to insect stings, specially bees and wasps. Aim: To report the experience with immunotherapy with aqueous extracts of hymenoptera venoms (bees and wasps). Material and methods: Ten patients aged 6 to 58 years were treated in an allergy center of a University Clinical Hospital. The medical indication for this treatment was, in all patients, anaphylactic reactions after hymenoptera stings. Immunotherapy was carried out using standardized vaccines (Aqueous extracts Venomvac LETI, Spain), applied in a traditional protocol, with subcutaneous injections. This protocol had two phases: a buildup phase (between weeks 1 and 13) and a monthly maintenance phase, from the 13th week. The monthly maintenance dose was 100 fig of hymenoptera specific venom extract. Results: Six patients had adverse reactions of different severity, during the treatment protocols and all had a good response to immediate therapeutic measures. After these events, they followed the protocol without problems. Two patients, treated with bee vaccines, suffered an accidental bee sting during the maintenance phase and they developed only local reactions. Conclusions: The lack of adverse reactions to bee stings in these two patients indicates the acquisition of clinical tolerance.

Investigation of efficiency of immunotherapy on allergic rhinitis and analysis of its correlative factors / 中国基层医药

Objective To observe the efficiency of immunotherapy on allergic rhinitis and explore irs correla- tive factors.Methods 185 patients with AR were treated with immunotherapy in this department between 1993 and 2003.Specific allergens were selected through skin test.The patients were given subcutaneous injections with al- lergen extract produced by Xiehe Hospital.The doses were gradually increased to the maintenance dose.The clinical effectiveness evaluation based on the symptoms and signs before and after immunotherapy was judged as marked, moderated and poor response.The possihie factors which affected the efficacy of immunotherapy were selected.These factors included sex,age,illness duration,disease condition,chronic sinusitis,asthma,duration of immunotherapy and reaction condition of the skin test.The correlative factors with efficacy were sifted with multifactorial stepwise re- gression analysis.Results The marked,moderated and poor responses were 22.9 %,51.7 %,and 25.4 % respective- ly.The efficacy of immunotherapy correlated well with the duration of immunotherapy(P

Changes of Serum Cytokines After the Long Term Immunotherapy with Japanese Hop Pollen Extracts

Japanese hop (Hop J) pollen has been considered as one of the major causative pollen allergens in the autumn season. We developed a new Hop J immunotherapy extract in collaboration with Allergopharma (Reinbeck, Germany) and investigated immunologic mechanisms during 3 yr immunotherapy. Twenty patients (13 asthma with rhinitis and 7 hay fever) were enrolled from Ajou University Hospital. Sera were collected before, 1 yr, and 3 yr after the immunotherapy. Changes of serum specific IgE, IgG1 , and IgG4 levels to Hop J pollen extracts and serum IL-10, IL-12, TGF-beta1 and soluble CD23 levels were monitored by ELISA. Skin reactivity and airway hyper-responsiveness to methacholine were improved during the study period. Specific IgG1 increased at 1 yr then decreased again at 3 yr, and specific IgG4 levels increased progressively (p<0.05, respectively), whereas total and specific IgE levels showed variable responses with no statistical significance. IL-10, TGF-beta1 and soluble CD23 level began to decrease during first year and then further decreased during next two years with statistical significances. (p<0.05, respectively). In con-clusion, these findings suggested the favorable effect of long term immunotherapy with Hop J pollen extracts can be explained by lowered IgE affinity and generation of specific IgG4 , which may be mediated by IL-10 and TGF-beta1.

Effect of esmolol on beta-adrenoceptor desensitization during cardiac surgery / 中华麻醉学杂志

II degree, severe liver/kidney function abnormality, diabetes, hypertension, thyroid disease or blood diseases were also excluded. Anesthesia was induced with midazolam 0. 1mg?kg-1, fentanyl 10?g?kg-1 and vecuronium 0.15 mg?kg-1 and maintained with midazolam and fentanyl. In group E esmolol was infused first at rate of 500?g?kg-1 ? min-1 for 4 min, then the infusion was continued at a slower rate of 200?g?kg-1? min-1 until 10 min after aortic declamping. In group C Ringer's solution was infused instead of esmolol. Radial artery and right internal jugular vein were cannulated and BP, HR, CVP were monitored during operation. Arterial and right atrial blood was obtained for blood gas analysis and central venous oxygen saturation ( ScvO2) was recorded before heparinization and 30 min after CPB was terminated. Dopamine/sodium nitroprusside (DA/SNP) ratio was calculated after CPB when blood pressure was stable. In addition, arterial blood samples were taken at the time of heparinizaion (T1), 10 min (T2 ) and 60 min (T3 ) after aortic declamping for determination of cAMP content in isoproterenol-stimulated lymphocytes. Results The DA/SNP ratio was significantly higher in group C than in group E (P