Cancer incidence in 13811 patients skin tested for allergy.

AIM: Several studies have shown a negative correlation between cancer and atopy-related diseases. There are also a few reports of a positive relationship. We wanted to further evaluate these relationships in a prospective study. SUBJECTS AND METHODS: The incidence of malignant diseases among adult patients with atopy-related diseases (asthma, rhinitis, urticaria, eczema etc; n = 13811), who had been skin prick tested in 1976-1999 was compared with the incidence in the general population. Expected cancer incidence from the date of skin prick testing up to 1999 was obtained from cause-, sex-, calendar-year-, and 5-year-age-group specific incidence rates for the county. These rates were calculated from cancer incidence and population counts obtained from the Swedish Cancer Register. The 95% confidence intervals (CIs) for cause-specific standardized incidence ratios (SIRs) were calculated. Skin prick tests were performed with Dermatophagoides pteronyssinus, horse, dog, cat, timothy, mugwort, birch, and Cladosporium. Patients having one or several positive skin prick test reactions (> or = 2+) were regarded as atopics. RESULTS: 119 cases of cancer occurred among 6224 atopic individuals (SIR 1.0) compared with 216 cases (SIR 0.94, CI 0.82-1.08) among 6358 non-atopics. There was a slight excess of Hodgkin's lymphoma cases among atopic men (SIR 4.03, 95% CI 1-10.3), and of non Hodgkin lymphoma cases among atopic women (SIR 4.52, 95% CI 1.23-11.6). However, a large number of comparisons were made which can have caused random findings. CONCLUSIONS: The results showed no associations between atopy or allergic symptoms, and subsequent cancer risk, but supported the theory that type-I allergy is not related to cancer risk.

Self-reported food hypersensitivity in Sweden, Denmark, Estonia, Lithuania, and Russia.

AIM: The main aim of the study was to describe the differences between some Northern countries regarding what foods, according to the patients, elicit hypersensitivity symptoms. METHODS: At the participating clinics, patients with a history of food hypersensitivity (n = 1139) were asked to fill in a questionnaire in which 86 different foodstuffs were listed. Skin-prick tests (SPT) were performed with common inhalant allergens. RESULTS: The foods that were reported as eliciting symptoms differed between countries. In Russia, Estonia, and Lithuania; citrus fruits, chocolate, honey, apple, hazelnut, strawberry, fish, tomato, egg, and milk were most often reported as causes of hypersensitivity. In Sweden and Denmark; birch pollen (BP) related foods, such as nuts, apple, pear, kiwi, stone fruits, and carrot were the most common causes. In all countries, children, more often than adults, had symptoms of allergic reaction to citrus fruits, tomato, strawberry, milk, egg, and fish. Most patients (95%) reported hypersensitivity to several foodstuffs (median: eight foods). The most common symptoms were oral allergy syndrome and urticaria. Severe symptoms were most common with fish, shellfish, nuts, and milk. Slight symptoms were most common with rice, coriander, poppy seed, lingonberry, corn, caraway red currant, and fig. Earlier well-known correlations, such as that between BP sensitization and some fruits and vegetables, as well as that between mugwort and some spices, were conoborated. Positive correlations were found between self-reported hypersensitivity to crustaceans and SPT with horse. A negative correlation was seen between hypersensitivity to crustaceans and SPT with BP. CONCLUSIONS: The foodstuffs that often are reported to cause food hypersensitivity, differ between Sweden/Denmark on one side and the Baltic States and Russia on the other. BP-related foods dominate in Scandinavia, whereas some mugwort-related foods are of more importance in Russia and the Baltic States.

The hazards of kissing when you are food allergic. A survey on the occurrence of kiss-induced allergic reactions among 1139 patients with self-reported food hypersensitivity.

BACKGROUND: According to a few case reports, kissing can induce symptoms due to food allergy. OBJECTIVE: We wanted to investigate the occurrence of kiss-induced allergic symptoms and other social inconveniences among patients with self-reported food hypersensitivity. METHODS: A questionnaire was answered by 1139 patients (1-84 years old, mean age 29 years, 393 males and 746 females) who considered themselves to be food allergic. RESULTS: 12% of the patients experienced allergic symptoms when in close contact with (e.g., kissing) a person who had eaten a nontolerated food prior to the contact. Some case histories suggested that the symptoms only appeared if the food intake had occurred immediately before the kiss. In addition, the questionnaires showed that 55% had problems in daily life finding tolerable food, 44% were afraid of a severe reaction from eating nontolerated food, 13% could experience symptoms when sitting beside a person who was eating such a food, and 17% could experience symptoms in the kitchen when someone else was preparing such food. CONCLUSIONS: What other people eat can influence the quality of life of food-allergic patients.

Frequency of patients with acute asthma in relation to ozone, nitrogen dioxide, other pollutants of ambient air and meteorological observations.

OBJECTIVE: To study the association of the daily frequency of registration of patients with acute asthma at the emergency department of a central hospital in the south-west of Sweden with levels of air pollution and meteorological observations. METHODS: A retrospective longitudinal study was made of asthma patients taken from a hospital registry. This information was correlated with measurements of ozone, nitrogen dioxide, sulphur dioxide, toluene, temperature and relative humidity. Patients were from the catchment area of the Central Hospital of Halmstad containing around 120,000 inhabitants. A total of 4127 visits of patients with acute asthma to the emergency department at the Central Hospital of Halmstad were registered during a period of 1247 days from January 1990 to May 1993. The differential optical absorption spectroscopy (DOAS) technique was used to monitor levels of air pollutants over a distance of 1000 m in the central part of the town of Halmstad. Data on temperature, relative humidity, precipitation, wind speed and wind direction for the time period were supplied by the Swedish Meteorological and Hydrological Institute (SMHI). RESULTS: There were many statistically significant correlations between the levels of air pollutants and the meteorological measurements and a strong negative correlation between ozone and nitrogen dioxide. There was a statistically significant effect on asthma visits in children of low temperature and high nitrogen dioxide levels, and on asthma visits in adults of high temperature and high levels of ozone. CONCLUSIONS: There was a different reaction pattern in children and adults with asthma regarding temperature and ozone/nitrogen dioxide. The strong correlations between temperature and air pollution and between the levels of ozone and nitrogen dioxide made the true relation between asthma, air pollution and temperature hard to evaluate statistically.

Skin prick tests with standardized extracts of inhalant allergens in 7099 adult patients with asthma or rhinitis: cross-sensitizations and relationships to age, sex, month of birth and year of testing.

The results of skin prick tests (SPTs) performed between 1981 and 1992 on 7099 adult patients with asthma and/or rhinitis were retrospectively analyzed. Standardized Soluprick extracts of Dermatophagoides pteronyssinus, animals and pollen, and unstandardized extracts of Cladosporium++ and chironomids (red mosquito larvae, Chir), were used. The proportion of atopics (patients with positive SPT results) was 44 percent, decreasing from 61 percent in patients 14-20 years old to 18 percent in patients 61-70 years old. The decrease with age was most pronounced with timothy, cat and horse allergens. In the whole patient group, timothy, cat and birch gave the highest number of positive SPTs. Positive SPTs with dog and Chir were more common in asthmatics than in patients with rhinitis, whereas pollen allergy was more common in patients with rhinitis. Sensitization against D. pteronyssinus, timothy and Chir was more common in men than in women. Of the atopic patients, 65 percent were sensitized against several allergens and 35 percent had a mono-allergy, most frequently to D. pteronyssinus (7.4 percent) and timothy (70 percent). The proportion monoallergies/multi-allergies was higher in older patients than in younger ones. The degree of atopy, expressed as the sum of plusses of the test results with eight allergens for each patient, was higher in younger patients than in older ones. The size of the wheals induced by the positive histamine control increased with age, and the histamine-induced wheals were larger in men than in women and larger in non-atopics than in topics. Strong correlations were found between test results with cat, dog and horse. A greater proportion of the patients with an isolated pollen allergy were born in February-May than was to be expected. The proportion of positive SPTs with mugwort (Artemisia), in relation to positive SPTs with other pollen allergens, decreased from 1981 to 1992. It can be concluded that sensitization to various inhalant allergens is influenced by age, and to a lesser extent by sex, and that pollen sensitization is influenced by the month of birth. During a 12-year period, sensitization to mugwort showed a decrease, as compared to other pollen allergens.

A prospective study of cancer incidence in a cohort examined for allergy.

In order to assess the association between atopy and cancer risk, a cohort of 6593 skin-prick-tested patients was established. Among atopic subjects, no overall increased cancer risk was found, but the incidence of both breast cancer (standardized incidence ratio (SIR) 2.50, 95% CI 1.01-5.16) and malignant lymphomas (SIR 4.40, 95% CI 1.20-11.3) was significantly enhanced. Atopic subjects with asthma showed a decreased overall cancer risk (SIR 0.73, 95% CI 0.27-1.60), as compared with the other asthmatic subjects (SIR 1.46, 95% CI 1.03-2.04). The cancer risk for subjects with rhinitis was near unity (SIR 1.11), irrespective of whether the subjects were atopic or not. An almost significant risk increase for cancer was observed among subjects with urticaria (SIR 1.70, 95% CI 0.99-2.80). Our results support neither the original hypothesis of an overall cancer protective effect of atopy, nor that of an opposite effect; rather, they strengthen the view that the association between atopic diseases and cancer is complex.

Diagnosis of IgE mediated allergy in clinical practise.

The basis of an allergy diagnosis is the patient's case history. In patients with inhalant allergy, an accurate diagnosis is often received when the case history is supported by the result of skin prick test (SPT) or in vitro-test for allergen specific IgE. IgE screening tests should, in cost-effective clinical routines, preferably be used in patients with a doubtful allergy history, in order to find out which patients do not require allergen specific testing. Determination of allergen specific IgE in the serum could be used when there is suspicion of allergy against only one or a few allergens, whereas SPT should be used when testing with many allergens is necessary. In patients with suspicion of allergy against food stuffs or drugs, test methods are of more limited value than in inhalant allergy and double blind placebo controlled challenge tests often have to be performed in order to get a definitive diagnosis. In insect venom allergy, the history should be supplemented with SPT and determination of venom specific IgE before starting desensitisation therapy.

The behaviour of the mean power frequency of the surface electromyogram in biceps brachii with increasing force and during fatigue. With special regard to the electrode distance.

The present study aims to investigate: a) the relationship between force and mean power frequency of the EMG, and b) how the distance between surface electrodes influences the mean power frequency. The study consisted of three parts: 1) a gradually increasing contraction upto 100% MVC, 2) contractions performed at 5 different levels from 20% upto 100% MVC with rest in between, and 3) an endurance test at 30% MVC. Nine healthy women participated. The elbow was flexed 90 degrees and EMG signals were obtained from the biceps brachii. The surface electrodes were placed so that electrode distances of 10 mm, 20 mm and 30 mm were obtained. The mean power frequency increased upto 60% MVC. Above 60% MVC no change in mean power frequency occurred. No differences in the mean power frequency with respect to the electrode distances existed at each force level. No significant differences were found at each contraction level between the gradually increasing contraction and the stepwise increasing contractions. The mean power frequency decreased linearly during the endurance test without any differences with respect to the electrode distances. It is concluded that the different electrode distances do not affect the mean power frequency-force relationship or the decrease in mean power frequency during fatigue. It is proposed that the increase in mean power frequency, on group level, can be used as an indicator of motor unit recruitment. However, this proposal was found to be complicated when individual analyses were made.

Allergy screening with Phadiatop and CAP Phadiatop in combination with a questionnaire in adults with asthma and rhinitis.

The efficiency of the new screening tests for atopy, Phadiatop and CAP Phadiatop, was studied by comparing their results with a clinical diagnosis of atopy in 100 consecutive adults with asthma and/or rhinitis. Further, the diagnostic efficiency of a combination of Phadiatop and a few standardized questions was studied. The Phadiatop was found to have a specificity of 0.98, and a sensitivity of 0.92 and the CAP Phadiatop a specificity of 0.94 and a sensitivity of 0.96. When the Phadiatop was combined with a few questions, a sensitivity of 1.00 was achieved. It is concluded that Phadiatop and CAP Phadiatop have a higher diagnostic precision than other hitherto used methods for screening of atopic allergy. The place of Phadiatop in a diagnostic flow chart is suggested.

Total IgE influences the relationship between skin test and RAST.

Positive correlations were found between total IgE, skin prick test (SPT) and RAST results with tree pollen allergens. The relationship between SPT and RAST was influenced by the level of total IgE. At each level of atopy, defined according to the strength of SPT, patients with high total IgE had higher RAST values than patients with low total IgE.

Immunological specificity of chloramine-T-induced IgE antibodies in serum from a sensitized worker.

A procedure for the preparation of chloramine-T (CT) conjugates used to assay IgE antibodies was developed using response surface methodology and serum from a subject occupationally exposed to the substance. The conjugates, synthesized by reacting CT with human serum albumin (HSA) and other protein carriers, were used as antigens in a radio-allergosorbent test (RAST). Human serum albumin was found to be a suitable carrier, although other protein carriers also gave specific IgE-binding of a similar extent. The CT-HSA conjugates used in the RAST were characterized by high performance liquid chromatography, electrophoresis, immunodiffusion and ammonium sulphate precipitation. However, no strong correlation was seen between the ability of the conjugates to bind IgE and their physical or immuno-chemical properties. The hapten and carrier specificity of CT-induced IgE antibodies in the subject's serum were studied by direct RAST and RAST inhibition. No existence of new antigenic determinants related to the carrier could be demonstrated. Although HSA as a carrier was altered immunochemically by CT, the IgE antibodies were found to be specific to hapten only. Chloramine-T-specific IgG antibodies could not be demonstrated in the subject's serum.

Hypersensitivity to larvae of chironomids (non-biting midges). Cross-sensitization with crustaceans.

In 2,368 consecutive adult patients with asthma and/or rhinitis the incidence of positive skin prick test (SPT) with a chironomid extract (CHIR) (produced from "red feather mosquito larvae" used as fish food) was 14% (26% in atopics and 4% in non-atopics). RAST with chironomid was positive in 4% of 110 consecutive sera (8% in atopic sera). Significant correlations were found between RAST and SPT results with chironomid and between SPT results with CHIR and with various crustaceans. Correlations were also found reciprocally among SPT results with different crustaceans and between some crustaceans and moluscs (clam and oyster) as well as among RAST results with chironomid, shrimp and crab. Inhibition experiments showed that chironomid extracts inhibited RAST with shrimp, and vice versa. It is concluded that Chironomidae might be allergens of clinical importance in asthma and rhinitis in Sweden, that cross-allergy exists between chironomids and shrimp and that cross-allergy also might occur among chironomids, crustaceans and molluscs.

Changes in the surface electromyogram during increasing isometric shoulder forward flexions.

When using electromyographic techniques in the evaluation of muscular load it is necessary to determine the mathematical relationship between the torque and the amplitude of the electromyographic signal. Isometric gradually increasing contractions up to 100% MVC can then be used. Often more than linear increases for the amplitude (RMS)--force regression have been reported. The present study was designed to test whether changes in power spectral density function take place during a gradually increasing isometric contraction (duration 10 s). Twenty-two clinically healthy females performed an increasing isometric shoulder forward flexion for 10 s using an isokinetic dynamometer. Electromyographic activity was measured in trapezius, deltoid, infraspinatus and biceps brachii using surface electrodes. Mean torque values were determined together with mean power frequency (MPF) and root mean square values (RMS) from the EMG signals for each 256 ms period. The RMS-torque regressions showed higher regression coefficients during the 6th to 9th sec than during the first 5 s. No significant correlation existed between MPF for the four muscles and the torque. A gradual decrease in MPF was generally found from the 6th s. It is concluded that this decrease in power spectral density function might have contributed to the significantly higher regression coefficient for the RMS torque regression at the high output part of the gradually increasing isometric contraction.

Surface EMG recordings during maximum static shoulder forward flexion in different positions.

This study investigated how position in the range of motion influences the power spectral density function during static shoulder forward flexion. 23 healthy females (20-30 years) volunteered as subjects. They performed maximum static shoulder forward flexions in three positions: 45, 65 and 90 degrees of shoulder flexion. An isokinetic dynamometer was used and the subjects were seated in a specially constructed chair to enable adequate fixation. The elbow was extended and the hand pronated. Electromyographic (EMG) signals (using surface electrodes) were obtained from the descending part of the right trapezius, the anterior portion of the right deltoid, the right infraspinatus and the common belly of the right biceps brachii. The four EMG-signals and the torque and shoulder angle were analyzed by computer. For each 256 ms, mean power frequency, root mean square value and mean torque were calculated. At each of the three positions four 256 ms periods were analyzed and the data are presented as their means. In the trapezius and the biceps brachii the mean power frequency did not change between the three positions. Deltoid and infraspinatus had significantly higher mean power frequencies at 90 degrees than at 45 degrees of flexion. Different factors behind the change in mean power frequency are discussed. The need to standardize the range of motion when studying dynamic fatiguing contractions is emphasised.

Biological equilibration of allergen preparations: methodological aspects and reproducibility.

A method for biological equilibration (BE) of allergen reference preparations using the skin-prick test (SPT) method and histamine HCl 10 mg/ml as reference substance (reference method), was evaluated. The precision was low for weals less than 10 mm2. The slope (log weal area/log concentration) of allergen and histamine did not vary significantly between investigators and allergens. The median slopes were 0.39 (n = 384) and 0.34 (n = 397), for allergen and histamine, respectively (P less than 0.01). The concentration of allergen eliciting a weal of the same size as that of histamine HCl 1 mg/ml (Chl) in the median sensitive patient, 1000 Biological Units/ml (BU/ml), did not vary significantly between clinics/geographical regions (grasses, mites and moulds). As BE is repeatable between regions, BUs estimated by this method are generally valid. A high correlation (r = 0.91, P less than 0.001) was found between the median Chl as estimated with histamine 1 and 10 mg/ml as reference substance, respectively. Thus, this reference method for BE is valid. The precision of the SPT method with histamine HCl 1 mg/ml is not as good as with 10 mg/ml, which is therefore recommended as the reference concentration.

Selection of patients for biological standardization as exemplified by standardization of mugwort, goosefoot and English plantain pollen allergen extracts/preparations.

The biological activity of a partly purified, biochemically/immunochemically characterized mugwort pollen allergen preparation and crude pollen extracts of mugwort, goosefoot and English plantain was determined by means of skin prick test (SPT). The patient inclusion criteria with mugwort were a well-defined positive clinical history and a positive SPT. Symptoms related to goosefoot/English plantain pollens are difficult to define, as these weeds flower during the grass pollen season. Thus patients tested with these allergens did not fulfill the most important inclusion criterion for so-called biological standardization. To elicit a wheal of the same size as that produced by histamine 1 mg/ml required 100 to 10,000 times more material from these weeds, than from mugwort and other pollen allergen extracts investigated earlier. One thousand Biological Units/ml (BU/ml) corresponded to 8.3 micrograms dry weight (dw/ml) of the crude and 1.8 micrograms dw/ml of the purified mugwort pollen allergen preparation. Only 7/22 goosefoot-and English plantain-tested patients were positive at conjunctival or nasal challenge. All three weeds showed a similar composition with 5-10 allergens by CIE/CRIE analysis and 10-13 by immunoblotting analysis. One dominating allergen (approx. 15,000 d), could be identified for each weed species by protein gel blot after separation by SDS g-PAGE. There was no other explanation for the difference in biological activity than the criteria of selection. If there is no obvious clinical history, which is the main patient inclusion criterion in biological standardization, then additional criteria should be used.