Nonallergic rhinitis with eosinophilia (NARES syndrome). Clinical and immunologic presentation.

Fifty-two patients with perennial nasal symptoms of sneezing paroxysms, profuse watery rhinorrhea, and pruritus of the nasopharyngeal mucosa in an "on-again-off-again" symptomatic pattern have been clinically and immunologically characterized. Historically, age at onset of symptoms showed equal distribution from the first through the fifth decades, and the duration of symptoms at diagnosis ranged from 3 mo to 40 yr (mean 9 yr). Trigger factors associated by the 52 patients with the acute onset of nasal symptoms were none or unknown in 22 (42%), weather changes in 16 (31%), odors in eight (15%), and noxious or irritating substances in six (12%). No patients had a history or physical examination consistent with nasal polyposis, bronchial asthma, current sinusitis, nor otitis media. Fifty percent had a negative family history for either chronic rhinitis or bronchial asthma. Nasal secretion smears revealed marked eosinophilia during symptomatic periods. Intradermal skin tests were negative in 49 patients. Serum radioallergosorbent test (RAST) confirmed immediate hypersensitivity skin tests in two of the three patients with positive skin tests. Mean total eosinophil count was 218/mm3. Quantitative immunoglobulins were normal in all patients. Mean serum IgE was 74 IU/ml. Methacholine bronchial challenge was negative in 37 of 37 patients tested. An open aspirin challenge was negative in 13 of 13 patients tested. Spontaneously collected nasal secretions or 0.9% saline nasal washes were analyzed for percent eosinophils, total protein, IgG, IgA, IgE, and RAST to six perennial aeroallergens in 31 of the 52 patients. Neither elevated total IgE nor evidence of specific IgE was found in the study patients' nasal secretions. This report describes 52 patients with symptoms similar to those seen in perennial allergic rhinitis. A characteristic pattern of symptomatic presentation and a paucity of the in vivo and in vitro findings associated with IgE-mediated nasal disease distinguishes this homogeneous disorder from perennial allergic rhinitis.

Skin testing in farmers' lung disease.

Intradermal skin tests with a culture filtrate antigen of Micropolyspora faeni grown on a synthetic medium were performed on patients with farmers' lung disease (FLD) and well farmers with and without antibodies to a panel of FLD antigens. Seventy-five percent of the FLD patients, 79% of the well farmers with M. faeni antibody, and 5% of well farmers without M. faeni antibody had a 2+ or greater intradermal immediate skin-test reaction. Prausnitz-Küstner (P-K) reactions were positive using serum of M. faeni immediate skin test-positive FLD patients. IgG-rich fractions from a staphylococcal protein A-Sepharose column of such serum contained the sensitizing factor whereas IgG-depleted fractions did not. M. faeni-specific IgE could not be detected in serum by a polystyrene radioimmunoassay. Positive late-onset (6-hr) skin tests occurred only in FLD patients and farmers with precipitating antibody. Biopsy specimens of the 6-hr reactions revealed a generalized dermal and perivascular polymorphonuclear infiltrate with deposits of immunoglobulin and complement about blood vessels. The skin-sensitizing factor noted in FLD patients and well farmers with antibody is not disease specific. This factor appears to be associated with the IgG-rich fraction of serum, and its role in the pathogenesis of FLD is unclear.

Bronchial hyperreactivity to methacholine in farmers' lung disease.

Methacholine inhalation challenges were performed in five groups: 14 patients with history of farmers' lung disease (FLD), nine well farmers with precipitating antibodies to Micropolyspora faeni antigen, II normal subjects, 12 asthmatic patients, and 10 patients with interstitial lung disease (ILD) other than hypersensitivity pneumonitis. After calculating the mean areas under the dose-response curves, FLD patients had a significantly greater degree of methacholine sensitivity than did well farmers with M. faeni antibody and normals. However, the methacholine sensitivity of FLD patients was indistinguishable from a group of patients with ILD and significantly less than the asthmatic group. Fifty percent of patients with FLD had positive methacholine challenges (greater than or equal to 20% decrease in their 1-sec forced vital capacity [FEV1] from the control FEV1). Hyperirritable airways was a common finding in FLD.

Tumor immunity induced by preimmunization with BALB/c mouse myeloma protein.

Prior sc immunization of BALB/c mice with 1 mg isolated M component of MOPC-11 mouse myeloma resulted in significant relative immunity to subsequent sc or ip challenge with 10(4) living cells from the same plasmacytoma. However, challenges of 10(5) and 10(6) tumor cells overcame immune status engendered by preimmunization with M component. Despite evidence for the specificity of the immunity induced by one isolated M component as opposed to another, no clear cytotoxic antibody, cell-mediated tumor-cell lysis, or predominance of either humoral or cell-mediated immune mechanisms were demonstrated. These findings were compatible with a relatively slight tumor-specific antigenicity of M components expressed on tumor surfaces, compared with the tumor specificity of other tumor-related, cell-surface antigens.