ABSTRACT
In general, specific immunotherapy with hymenoptera venoms can be considered as safe, but occasionally there are patients who cannot reach the maintenance dose due to repeated systemic reactions (RSR) or who suffer from RSR during maintenance therapy. In a multicenter retrospective study comprising seven departments in Germany, Austria and Switzerland 23 patients with RSR were reported from approximately 3000 patients treated with hymenoptera venoms (bee and wasp venom to approximately equivalent frequency). From these, 22 were allergic to bee venom and only one to vespid venom. In general the clinical symptoms of RSR were milder than the initial reaction. But 4/23 (18%) exhibited cardiovascular reactions up to full shock. Neither anamnestic details, reactivity in skin tests or in vitro tests revealed a special pattern of patients with RSR. In some patients, however, an extremely high reactivity in the skin test was found and may indicate the possibility of further RSR.
Subject(s)
Arthropod Venoms/adverse effects , Hypersensitivity/etiology , Immunotherapy , Adolescent , Adult , Anaphylaxis/etiology , Animals , Bee Venoms/adverse effects , Child , Female , Humans , Hymenoptera , Male , Middle Aged , Retrospective Studies , Skin Tests , Wasp Venoms/adverse effectsSubject(s)
Hospital Design and Construction , Hospitals, Teaching , Hospitals, University , Humans , SwitzerlandABSTRACT
In a population of 24 insect sting allergy patients undergoing venom immunotherapy the basophil degranulation test (BDT) in the patient sera ("unwashed" BDT) and with washed leukocytes ("washed" BDT) after incubation with bee and wasp (yellow jacket) venom was performed before and during treatment. Venom specific IgE and IgG antibodies, detected by means of RAST, were also monitored. The "unwashed" BDT usually became negative within 6-9 months of beginning immunotherapy, whereas the IgE-RAST was still clearly positive. This was attributed to the blocking influence of the venom specific IgG antibodies induced by the venom therapy. In fact, at this time the BDT with "washed" blood leukocytes, i.e. after elimination of the serum antibodies, was generally still positive. Only during further immunotherapy did cellular sensitization in the "washed" BDT gradually disappear, whereas the IgE-RAST usually turned out weakly positive. A third of the patients showed simultaneously negative results of "unwashed" and "washed" BDT, independently of venom specific IgE and IgG levels. These findings suggest a specific reactivity change of the blood basophils (cellular desensitization) induced by the immunotherapy. The BDT can be used as an immunological parameter for IgG-monitoring of the course of venom immunotherapy and--in addition to skin tests and IgE-RAST--as a further criterion for deciding to stop venom therapy if it turns negative with the washed cells.
Subject(s)
Basophils/immunology , Bee Venoms/immunology , Desensitization, Immunologic , Insect Bites and Stings/therapy , Wasp Venoms/immunology , Adolescent , Adult , Child , Cytoplasmic Granules/immunology , Female , Humans , Immunoglobulin E/immunology , Immunoglobulin G/immunology , Insect Bites and Stings/blood , Male , Middle AgedABSTRACT
In 98 patients with a suspected immediate type allergy to hymenoptera stings, skin tests (ST) with venom extracts, RAST determinations of venom specific serum IgE antibodies and basophil degranulation tests (BDT) with unwashed leukocytes were performed. BDT is a technically simple in-vitro method for detecting cell fixed IgE without risk for the patient. The specificity of BDT was investigated in a group of 10 controls not allergic to insect stings, of whom 7 were atopics. A good correlation could be demonstrated between BDT and the histamine release test (HRT), which was performed in the Institute for Allergy and Clinical Immunology, Inselspital, Bern. For the detection of a sensitization to insect venoms, ST with venom extracts were the most sensitive, followed by RAST and BDT; in patients whose allergic sting reactions dated back some time BDT was more frequently positive than RAST, which measures excessive serum IgE and not cell bound IgE responsible for the clinical symptomatology. As BDT--in the presence of patient serum--reflects the influences of different humoral (specific IgE, specific IgG) and cellular factors ("releasability"), it seems more appropriate to the actual clinical allergy situation than ST or RAST. Some case reports are presented to illustrate this. However, BDT does not represent an alternative to ST or RAST but a significant complement in diagnostically unclear cases and an aid in deciding to start specific venom immunotherapy, if history, ST and RAST are not sufficient. An appropriate score system ist proposed.
Subject(s)
Basophils/immunology , Bee Venoms/immunology , Hypersensitivity, Immediate/diagnosis , Insect Bites and Stings/complications , Adult , Female , Histamine Release , Humans , Hypersensitivity, Immediate/etiology , Male , Middle Aged , Radioallergosorbent Test , Skin Tests , Wasp Venoms/immunologyABSTRACT
RAST investigations on the sera of 27 patients suffering from celery allergy showed specific IgE to mugwort and birch in 15 cases; sensitization to mugwort or birch alone only occurred in 5 and 7 cases, respectively. Positive RAST results were also obtained with several spices. We found a relationship between spice and celery allergy.
Subject(s)
Condiments/adverse effects , Dermatitis, Atopic/diagnosis , Food Hypersensitivity/diagnosis , Radioallergosorbent Test , Radioimmunoassay , Vegetables/adverse effects , Adolescent , Adult , Child , Female , Humans , Immunoglobulin E/analysis , Male , Middle Aged , SyndromeABSTRACT
The basophil degranulation test (BDT) with the plasma of 24 patients undergoing venom immunotherapy was usually negative after only 6 months of treatment. Cellular sensitivity, however, could still be proved by BDT on purified cells, i.e. after removal of the plasma which contained blocking IgG antibodies. In 30% of the cases, we found primary desensitization of the basophils, which means that the IgG antibodies did not have any influence on the test results.
Subject(s)
Basophils/immunology , Bee Venoms/immunology , Desensitization, Immunologic , Insect Bites and Stings/immunology , Cytoplasmic Granules/immunology , Follow-Up Studies , Humans , Immunoglobulin E/analysis , Immunoglobulin G/analysisABSTRACT
Chironomus larvae seem to be the principal sensitizer in fish food allergy. In addition, a variety of other Arthropoda species that are used as fish food can induce immediate hypersensitivity. Attention is drawn to this polyvalent sensitization by presenting the case history of a 27-year-old patient who kept fish and who suffered from allergic asthma bronchiale. He showed strongly positive reactions in skin tests for Chironomus and Culex larvae, as well as several kinds of Crustacea species, such as Daphnia and brine shrimps.
Subject(s)
Animal Feed/adverse effects , Asthma/etiology , Fishes , Respiratory Hypersensitivity/etiology , Adult , Animals , Female , Humans , Hypersensitivity, Immediate/etiology , Intradermal TestsABSTRACT
From the end of 1979 to June 1985 an inhalative allergy to silk wastes was diagnosed in the allergy station of the Dermatological Clinic of the University of Zurich in 118 patients, 54,2% of whom were women. Usually, bed quilts advertised as filled with "wild silk" were the cause of the sensitization. Occupational exposure to silk materials was found in only 4 cases. Average age at the time of first appearance of symptoms was 30.5 years, and sensitization time from first exposure to appearance of symptoms was 8.5 months. Monovalent sensitization was found in 44.1%. In most cases exposure prophylaxis sufficed to avoid symptoms. "Wild silk", unlike cultivated (mulberry Bombyx mori) silk, is the product of wild silk moths of the genus Antheraea feeding on oak leaves. Silk wastes are a byproduct of silk manufacturing, consisting of short silk threads (e.g. the end or the beginning of the cocoons), and make highly suitable filling material. During further silk processing the allergenic components, especially sericin, are eliminated by boiling off and degummed. For closer identification of the allergen(s), various kinds of raw and cleaned mulberry and wild silk were tested in sensitized patients by skin and RAST tests. The filling content of different bed quilts was investigated by the Swiss Textile Industry Test Institute. None consisted entirely or mainly of wild silk, and all contained a predominant portion of cultivated silk. The aggressive potency of the "wild silk" bed quilts is due to the insufficiently cleaned and degummed mulberry and wild silk wastes. Contamination of the silk wastes by an insect of the genus Anthrenus was also found.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Asthma/etiology , Respiratory Hypersensitivity/etiology , Textiles , Adult , Bedding and Linens , Byssinosis/etiology , Female , Household Articles , Humans , Male , Radioallergosorbent Test , Respiratory Hypersensitivity/diagnosis , Skin TestsSubject(s)
Bees , Desensitization, Immunologic , Hymenoptera , Insect Bites and Stings/immunology , Wasps , Adolescent , Adult , Child , Female , Humans , Immunoglobulin E/analysis , Immunoglobulin G/analysis , Male , Middle AgedABSTRACT
Celery is a frequent food allergen: not only raw, but also cooked and as a spice it can produce various reactions of immediate type, from oral contact urticaria to anaphylactic shock. Most celery-allergic patients suffer from hay fever and show a skin sensitization to mugwort. An associated allergy to several spices is quite common, and therefore the term "celery-mugwort-spice-syndrome" has been proposed. The authors have investigated 35 patients, 85% of them women, in whom a current celery allergy of varying severity was diagnosed during the first 8 months of 1984. A positive skin test to celery was seen in 16 patients who denied any symptoms from it. Thorough skin testing and RAST screening with different celery preparations, other foodstuffs and mugwort-pollens were performed on all patients. The modified prick test with native celery-root proved to be the best method for detecting celery sensitization, showing a positive result in 88.6%. The scratch test with celery-salt was positive in 70.5%, intracutaneous testing with commercial extract in 63.5% and the RAST with celery-sticks in 66% of the patients. Sensitization to mugwort was absent in 8 patients only. The mugwort-sensitive group frequently showed a positive test to ragweed-pollens, a common plant in North America, and this appears to indicate cross-reactivity amongst the family of the Asteraceae. Cross-reactivity amongst the Apiaceae is the cause of the many positive results obtained with carrot, parsely, anise, fennel and caraway, the carrot allergy being of clinical importance in 50% of cases, including one with a history of anaphylactic shock after ingestion of raw carrots.(ABSTRACT TRUNCATED AT 250 WORDS)
