Immunologic and clinical responses to parenteral immunotherapy in peanut anaphylaxis--a study using IgE and IgG4 immunoblot monitoring.

BACKGROUND: Specific desensitisation to food allergens, which produce anaphylaxis after ingestion, has not been considered as a treatment for food allergy until recently. The purpose of this study was to assess if a parenteral immunotherapy program, using a partially characterised crude peanut extract, could induce a state of immunological tolerance in a patient who exhibited anaphylaxis, asthma and urticaria on exposure to peanut and other legumes. A further aim was to measure the serum antibody responses to the immunotherapy. METHODS AND RESULTS: We report the successful desensitisation towards all of the legumes tested of a male patient on parenteral immunotherapy using a partially characterised peanut extract. The immunologic parameters measured during treatment included specific IgE and IgG4 for peanut, soybean, pea and lentil extracts. Immunoblots of specific IgE and IgG4 were made before and after therapy. The antibody response followed the same pattern seen in successful desensitisation of patients with bee venom anaphylaxis. The IgG4 levels increased strongly from a low pre-treatment level in proportion to the antigen dose received. The antigen-specific IgE levels gradually fell from a high pretreatment level, but remained significantly elevated. Immunoblotting for specific IgE and IgG4 demonstrated that acquisition of clinical tolerance after therapy was associated with declines in the number and intensity of bands in IgE blots and the development of more bands of increasing density in the IgG4 blots. CONCLUSIONS: Parenteral immunotherapy may offer an alternative treatment to lifelong dietary restriction and epinephrine injections in patients who exhibit life-threatening IgE-mediated anaphylaxis to peanut. Cross desensitisation to other legumes appears to have occurred in this study. The quality and potency of the extract used is an important factor in achieving the desired acquisition of clinical tolerance. In our patient this tolerance correlated with his ability to maintain high levels of specific IgG4, which acted as a marker of protection against anaphylaxis. The use of IgG4 immunoblotting may provide an improved level of discrimination in the assessment of correlation of clinical efficacy with the immunologic response.

Ocular and orbital trauma from water balloon slingshots. A clinical, epidemiologic, and experimental study.

PURPOSE: The authors report the findings of 17 patients with ophthalmic injuries produced by launched water balloons; they determine water balloon kinetic energies in experimental and theoretical studies. METHODS: Six case summaries are presented; one case report was retrieved from the literature; ten injuries were reported to the Consumer Product Safety Commission. Energies were determined by field trials and calculations. RESULTS: Injuries included periorbital edema and ecchymoses, orbital contusions and hematomas, maxillary sinus hematomas, facial hypesthesia, eyelid lacerations, subconjunctival hemorrhages, corneal edema and abrasions, hyphemas, traumatic iritis, iris sphincter ruptures, iris atrophy, angle recession, iridodialysis, traumatic cataract, vitreous hemorrhages, retinal hemorrhages, macular hole formation, optic atrophy, and bony orbital wall fractures. Epidemiologic analysis revealed that children and young adults, more often males, were injured, most commonly in the warm weather months. In field trials, maximum water balloon velocities ranged from 38 to 41 m/sec (85-92 mph) with kinetic energies from 176 to 245 joules; by calculation, maximum velocities ranged from 42 to 54 m/sec (95-121 mph) with kinetic energies from 141 to 232 joules. In a field demonstration, a slingshot-launched water balloon exploded a watermelon. CONCLUSION: Energies are comparable to or greater than those experienced with a variety of common objects, including some rifle bullets that are known to cause serious ophthalmic injuries. These energies are far in excess of those required to perforate a cornea, rupture a globe, or fracture the bony orbit. This study demonstrates the serious and potentially vision- and life-threatening injuries inflicted by these "toys."

Ocular and orbital trauma from water balloon slingshots: a clinical, epidemiological, experimental, and theoretical study.

PURPOSE: To report the clinical findings of 17 patients with ocular/orbital injuries produced by launched water balloons; to determine water balloon kinetic energies in experimental and theoretical studies. METHODS: Six case histories are presented, 1 case was retrieved from the medical literature, and 10 cases were reported to the National Injury Information Clearinghouse of the United States Consumer Product Safety Commission. The energies were determined by field trials and calculations. RESULTS: Injuries included orbital contusions and hematomas, facial hypesthesia, eyelid lacerations, subconjunctival hemorrhages, corneal edema and abrasion, hyphemas, traumatic iritis, iris sphincter ruptures, iris atrophy, angle recession, iridodialyses, traumatic cataract, vitreous hemorrhages, retinal hemorrhages, macular hole formation, optic atrophy, and bony orbital wall fractures. Epidemiological analysis revealed that children and young adults, more often males, were injured, most commonly in the warm weather months (May through September). In field trials, maximum water balloon velocities ranged from 38 to 41 m/sec (85 to 92 mph) with kinetic energies from 176 to 245 J; by calculation, maximum velocities ranged from 42 to 54 m/sec (95 to 121 mph) with kinetic energies from 141 to 232 J. In a field demonstration a 300-g water balloon launched horizontally from a distance of 20 ft exploded a 12-kg watermelon. Classic physics calculations are presented to explain the complex bio-mechanical interactions between the water balloon and the eye. CONCLUSION: Kinetic energies of launched water balloons are comparable to or greater than kinetic energies experienced with a variety of common objects, including file bullets, which are well known to cause serious ocular and orbital injuries. In addition, these energies are far in excess of those required to perforate a cornea (0.7 to 1.7 J), rupture a globe (1 to 5.3 J), or fracture the bony orbit (1.8 to 14.7 j). Thus, this study demonstrates the serious and potentially vision- and life-threatening injuries inflicted by these "toys."

Gainsharing: a few questions, and fewer answers.

Gainsharing is an important organization development intervention, yet many of the basic questions have not been answered. This paper addresses these questions by developing a conceptual model and using the model to review the case study literature on gainsharing . The plans varied in terms of structural factors, implementation factors, and situational factors, and a majority were successful. Gainsharing impact was found in five key areas: organizational effectiveness, individual quality of work life, ideas and innovation, labor-management cooperation, and pay. Relevant research is briefly reviewed and several unanswered questions are identified for future research.