Extended evaluation of diagnostic skin testing practices in Orange County, California.

In an effort to evaluate conformity with published guidelines for diagnostic allergy skin testing in their locality, a committee of members of the Orange County (California) Society of Allergy and Clinical Immunology surveyed their membership for the number, identity, and rates of sensitization of aeroallergens in a selected patient population. Test data were analyzed on patients who were judged appropriate to undergo immunotherapy. Complete test results of 271 patients were obtained from one third of local allergy specialists. A total of 115 different aeroallergen extracts were identified. By category, tree pollen allergens (32) were followed in declining order by weed pollens (28), molds (22), environmentals (18), and grass pollen extracts (15), for the total of 115. The average number of aeroallergens used by a practice in a comprehensive evaluation was 77 (range, 47-114). When only unequivocally positive reactions were considered (3+ equivalent or greater), Bermuda grass pollen extracts elicited the highest rate, 85%, and the environmental, rat dander, was the lowest at 1.8%. At least 20% of the patients reacted strongly on skin tests to 97% of the extracts. The disparity between the recommendations of a maximum of 30 aeroallergens for a comprehensive evaluation and actual practice procedures merits efforts at resolution.

Hierarchy of globin complexes. The quaternary structure of the extracellular chlorocruorin of Eudistylia vancouverii.

The molecular dimensions of the extracellular, hexagonal bilayer chlorocruorin of the polychaete Eudistylia vancouverii, determined by scanning transmission electron microscopy (STEM) of negatively stained specimens, were diameter of 27.5 nm and height of 18.5 nm. STEM mass measurements of unstained, freeze-dried specimens provided a molecular mass (Mm) of 3480 +/- 225 kDa. The chlorocruorin had no carbohydrate and its iron content was 0.251 +/- 0.021 wt%, corresponding to a minimum Mm of 22.4 kDa. Mass spectra and nuclear magnetic resonance spectra of the prosthetic group confirmed it to be protoheme IX with a formyl group at position 3. SDS/polyacrylamide gel electrophoresis, reversed-phase chromatography and N-terminal sequencing suggested that the chlorocruorin consists of at least three chains of approximately 30 kDa and five chains of approximately 16 kDa; the two types of subunits occur in the ratio 0.26:0.74(+/- 0.08). Complete dissociation of the chlorocruorin at neutral pH in the presence of urea or guanidine hydrochloride, followed by gel filtration, produced elution profiles consisting of three peaks, B, C and D. Fractions B and C consisted of the approximately 16 kDa chains and fraction D consisted of the approximately 30 kDa subunits. Mass measurements of particles in STEM images of unstained, freeze-dried fractions B and C provided Mm of 208 +/- 23 kDa and 65 +/- 12 kDa, respectively, in agreement with 191 +/- 13 kDa and 67 +/- 5 kDa obtained by gel filtration. Particles with Mm = 221 +/- 21 kDa were also observed in STEM images of unstained, freeze-dried chlorocruorin. These results imply that the chlorocruorin structure, in addition to the approximately 30 kDa linker subunits that have 0.26 to 0.47 heme groups/chain, comprises approximately 65 kDa tetramers and approximately 200 kDa dodecamers (trimers of tetramers) of globin chains. The stoichiometry of the tetramer and linker subunits calculated from molar amino acid compositions was 34 +/- 4 and 43 +/- 9. The complete dissociation of the chlorocruorin was accompanied by a 50 to 75% loss of the 55 +/- 14 Ca2+/mol protein, and was decreased to approximately 35% by the presence of 10 to 25 mM-Ca2+. Reassociation of dissociated chlorocruorin was maximal in the presence of 2.5 to 5 mM-Ca2+. The dodecamer and/or tetramer subunits in the absence or presence of Ca2+ exhibited very limited (less than 10%) reassociation into hexagonal bilayer structures, only in the presence of the linker subunit.(ABSTRACT TRUNCATED AT 400 WORDS)

Improvement in aspirin-sensitive asthmatic subjects after rapid aspirin desensitization and aspirin maintenance (ADAM) treatment.

Twelve ASA-sensitive (AS) asthmatics, including nine over age 35 years and three under age 19, were successfully desensitized to the adverse effects of ASA in an average of 322 min without any serious untoward sequelae. Six subjects (50%) experienced subjective improvement, three (25%) no change, and three (25%) worsening in their asthma while on a daily maintenance dose of ASA (mean = 539 mg) for an average follow-up period of 115 days. Six subjects (50%) were able to discontinue one or more antiasthma medications, including systemic steroid in one (8%) and aerosol steroid in three (25%). The incidence of subjective improvement in asthma status (67% vs. 44%) was higher in those under 19 than in those over 35, and none of the younger vs. 30% of the older subgroup experienced worsening in their asthma. ASA desensitization (AD) followed by an ASA maintenance program (ADAM) therefore appeared to be beneficial in approximately 50% of AS asthmatics. In this study an improvement in postdesensitization peak expiratory flow rate with a repeat ASA challenge appeared to correlate best with subjective improvement in asthma and/or reduction in antiasthma medication requirement after AD. However, the number of subjects studied was relatively small and the conclusions drawn will require confirmation.

Familial angioedema associated with C1 esterase-inhibitor deficiency. A new genetic variant in hereditary angioedema?

In the absence of a positive family history for hereditary angioedema (HAE), both siblings in a family were found to have clinical and laboratory findings similar to those in HAE. Both siblings became symptom free after receiving danazol treatment, accompanied by a subnormal rise in C1 esterase inhibitor and C4 levels. As both siblings and their father share HLA haplotype A2, B7, the influence of other HLA loci on the clinical expression of this disorder should be considered. Although the disorder found in these siblings may be inherited as a recessive disorder, which to our knowledge has never been described before, or may have developed as the result of spontaneous genetic mutation, it is more appropriate to classify these two cases as familial angioedema until proved otherwise.

Incidence of fungal precipitins in patients treated with beclomethasone dipropionate aerosol.

The authors followed the development of serum precipitins to aspergillus and Candida albicans in 14 asthmatic patients placed on beclomethasone dipropionate inhalation at a mean duration of five months. Three sera positive for aspergillus precipitins became negative during treatment. One patient had clinical oropharyngeal candidiasis and another patient's serum became positive for candida precipitin. The authors conclude that the incidence of oropharyngeal candidiasis and candida or aspergillus precipitins are rare among patients treated with beclomethasone.

Large airway constriction in allergic rhinitis.

Extensive pulmonary function tests, including most of the sensitive new techniques capable of detecting small airways obstruction, were performed in 16 asymptomatic patients with allergic rhinitis and 31 normal control subjects. Mean flow rates, lung volumes, and results of tests measuring airways closure, distribution of ventilation, and diffusing capacity for carbon monoxide/alveolar volume did not differ significantly between the groups. Airways resistance (RAW) was significantly higher and specific conductance (SGAW) was significantly lower in subjects with rhinitis. Following administration of nebulized isoproterenol, RAW decreased (p less than 0.001) and SGAW increased (p less than 0.001) to mean values statistically indistinguishable from results obtained in control subjects. Individual results were normal for all tests except RAW and SGAW which were both abnormal in 3 subjects with rhinitis. The results of this investigation indicate that asymptomatic subjects with allergic have large airway (trachea and/or major bronchi) narrowing due to bronchoconstriction and no evidence of diffuse, or small airways, obstruction.

Transcendental meditation and asthma.

A 6-month study with crossover at 3 months was designed to evaluate the possible beneficial effects of transcendental meditation upon bronchial asthma. 21 patients kept daily diaries of symptoms and medications and answered questionnaires at the end of the study and 6 months later. Other measurements included physician evaluation, pulmonary function testing, and galvanic skin resistance. The results indicated that transcendental meditation is a useful adjunct in treating asthma.