The impact of prednisone in life-threatening idiopathic anaphylaxis: reduction in acute episodes and medical costs.

Two patients with frequent episodes of well documented life-threatening idiopathic anaphylaxis were studied. Despite prior treatment with antihistamines and self-administered epinephrine, both patients continued to have episodes of anaphylaxis. At the time of presentation to the Northwestern University Allergy Service, prednisone and antihistamines with or without sympathomimetics were started. Described in this report are the substantial reductions in the frequency of hospitalizations, emergency room visits, and anaphylactic episodes after our medical management was instituted.

Soluble copolymers of yellow jacket, yellow hornet and white faced hornet with human albumin for venom immunotherapy.

Soluble polymers have been prepared by polymerizing human serum albumin (HSA) with either yellow jacket venom (YJV), yellow hornet venom (YHV) or white faced hornet venom (WFHV). The venom-albumin polymer preparations were fractionated on Sephacryl S-300 to have a molecular weight range higher than catalase (2.4 x 10(5) daltons). Rabbits were immunized with either yellow jacket venom-albumin polymer (YJVAP), yellow hornet venom-albumin polymer (YHVAP) or white faced hornet venom-albumin polymer (WFHVAP). Rabbits immunized with venom-albumin polymer (VAP) produced IgG antibody to VAP and venom, as measured by enzyme-linked immunosorbent assay (ELISA). Experiments to demonstrate antigenic completeness and absence of new antigenic determinants in the polymer were performed using WFHVAP. IgG against WFHVAP was completely inhibited by a mixture of WFHV and HSA demonstrating the absence of new antigenic determinants in WFHVAP. IgG against WFHV in sera from patients receiving maintenance doses of WFHV immunotherapy was completely inhibited by WFHVAP, demonstrating antigenic completeness. We have previously described similar results with bee venom-albumin polymer and wasp venom-albumin polymer. We now conclude that VAP preparations of all five clinically relevant hymenoptera venoms have potential value in the treatment of hymenoptera anaphylaxis.

The laboratory evaluation of IgE antibody to metabisulfites in patients skin test positive to metabisulfites.

An immediate-type hypersensitivity reaction has been proposed as one possible mechanism in which metabisulfites (MBSs) cause reactions. As demonstrated with certain occupational chemicals, we proposed that MBS might conjugate with human proteins, such as human serum albumin, and then cause an immunologic response. Because we had identified no reactions to MBS at the Northwestern Allergy Service, we used sera from four patients reported elsewhere as having positive skin tests and positive oral challenges to sulfites. We attempted to demonstrate, both in vitro by ELISA and in vivo by passive cutaneous transfer to monkey, evidence for IgE-mediated hypersensitivity to MBSs. Our results demonstrated that there is evidence of IgE antibody by passive transfer for one patient studied, but no evidence of IgE antibody by ELISA to an MBS-albumin conjugate in any of the four patients. This study illustrates the complexities involved in the evaluation and mechanism of MBS-induced disease and the caution with which results must be interpreted.

The management of patients with sulfonamide allergy.

To illustrate the variety of clinical strategies that may be used in treatment of patients allergic to sulfa medications, we report the management of eight sulfa allergic patients, seven of whom required readministration of the sulfa drug. Slow oral readministration of a sulfonamide over the course of four weeks was successful in two patients who had a history of cutaneous reactions to sulfa use and did not require sulfa urgently. Rapid oral or intravenous readministration of a sulfonamide was attempted unsuccessfully in three patients, each of whom urgently needed continuation of a sulfa drug. Occasionally a sulfa drug must be continued despite the presence of a cutaneous drug eruption secondary to that drug. In four patients, including two of the patients in whom rapid test dosing of a sulfonamide had been unsuccessful, treatment of the sulfa reaction with corticosteroids and antihistamines permitted continued sulfa administration. Readministration of a sulfonamide should not be attempted in patients who previously have had reactions such as Stevens-Johnson syndrome unless essential for survival of a patient.

Six-year clinical and immunologic follow-up of workers exposed to trimellitic anhydride.

We report a 6-year study from 1979 through 1985 of workers exposed to trimellitic anhydride (TMA) in three groups of volunteers. Twenty-nine percent of workers (5/17) originally studied had immunologically induced respiratory disease. Subsequent to this evaluation, increased environmental control of TMA exposure was instituted. Since that time, there have been decreasing clinical symptoms and decreasing levels of antibody against TMA conjugated to human serum albumin. These long-term studies originally used radioimmunoassays, but enzyme-linked immunoassays against TMA-conjugated proteins are now demonstrated to be equally appropriate and are more cost-effective. With appropriate clinical and immunologic studies, immunologic airway reactions to TMA may be identified and then prevented by environmental control to decrease inhalation exposure to TMA. This is likely applicable to certain other chemical antigens that immunize by inhalation.