Salmeterol added to inhaled corticosteroid therapy is superior to doubling the dose of inhaled corticosteroids: a randomized clinical trial.

This randomized, double-blind, double-dummy, parallel group clinical trial compared the efficacy and safety of adding salmeterol xinafoate to concurrent inhaled beclomethasone dipropionate therapy with doubling the dose of beclomethasone dipropionate in patients experiencing symptoms on low-dose beclomethasone. Salmeterol added to low-dose beclomethasone was superior (p < or = 0.05) to doubling the dose of beclomethasone in improving peak expiratory flow (PEF) and forced expiratory volume in 1 sec (FEV1), and in reducing symptoms of asthma, sleep loss, nighttime awakenings, and use of albuterol. Both treatment regimens had comparable safety profiles. In asthma patients inadequately controlled despite the use of low-dose inhaled corticosteroids (i.e., less than 400 microg per day), the addition of salmeterol may be a more effective treatment option than doubling the dose of inhaled corticosteroids.

Isolation of spore specific allergens from Alternaria.

Extracts of Alternaria alternata spores and mycelia were prepared. Crossed immunoelectrophoresis showed the presence of at least 40 antigens in these extracts. Analysis of seven commercial extracts by CIEP and isoelectric focusing showed many fewer components and a high degree of variability. Eight of the antigens in the spore extract demonstrable by CIEP were not present in mycelia extracts. This spore-specific fraction was isolated by solid phase immunoadsorption and shown to be potent antigenically and allergenically. The extracts of mycelia, spore and spore-specific fraction demonstrated strong reactivity with 92 Alternaria sensitive patients by both RAST and skin test. About half of the patients were significantly more reactive to spore and/or spore-specific than the mycelia. Many of the spore antigens are either common to or cross-reactive between spore and mycelia but there are a minimum of eight spore-specific antigens, at least one of which is a strong allergen.

Correlation of IgG and IgE antibody levels to honey bee venom allergens with protection to sting challenge.

A group of 25 honey bee venom allergic patients were treated with commercial honey bee venom at a monthly maintenance dose of 100 micrograms for approximately one year. At the end of one year 24 patients were intentionally challenged and one was accidentally challenged. Three patients experienced significant systemic reactions to challenge and three experienced minor reactions. Sera obtained before commencing therapy, at maintenance and before challenge were tested by radioallergosorbent test (RAST), double antibody technique and protein A RAST for IgE and IgG antibody levels to all five known honey bee venom allergens. All of the treatment failures experienced at least a two-fold rise in IgG antibody against phospholipase. The ratios of IgG to IgE antibodies in the pre-challenge specimens were analyzed by a graphical method. Four patients had inadequate responses to at least three of the five allergens and three of these patients were those who experienced severe reactions to challenge. Sixteen patients had adequate responses to all five allergens, four patients to four allergens and one patient to three allergens; three of these patients experienced minor or local reactions to challenge and the remainder no reaction. No single allergen identified only the three severe reactors but three allergens identified all three reactors. The diagnostic efficiency of the criteria used for assessing protection was 0.96. The only non-correlating case was classifying a single nonreactor as at risk. No patients were misclassified as protected.

Venom immunotherapy: comparison of "rush" vs "conventional" schedules.

Twenty-three patients aged five to 52 years with good clinical histories of severe systemic reactions to hymenoptera stings confirmed by skin tests and RAST levels were treated with specific insect venoms. A more conventional, slow, bi-weekly schedule was used to determine whether they could be as successfully treated as those in earlier studies employing the "Rush desensitization" approach. It was also hoped these subjects would experience fewer untoward reactions. Comparisons of IgG (anti-hyaluronidase and phospholipase) levels pretreatment and after top dose (100 mcg) in all cases showed greater than three-fold rise, indicating protection. RAST IgE rose in most cases and plateaued by six months. Nineteen patients were restung to verify protection. Untoward reactions to injections were low (13%) and easily controlled. The authors conclude that the use of specific freeze dried insect venoms in a slow dose schedule is safe and effective in protecting severely sensitized individuals.

Currently available methods for home mold surveys. II. Examples of problem homes surveyed.

Results of mold surveys in seven homes are reported. The advantages and disadvantages of the different techniques for mold evaluation are illustrated. No one sampling technique is adequate for detection of endogenous mold problems. Ideally, one should incorporate direct Scotch tape imprints, direct cultures of suspected material, Andersen sampling and a rotorod study to obtain an accurate assessment of the endogenous mold population.

Currently available methods for home mold surveys. I. Description of techniques.

A number of techniques have been developed for detecting and evaluating endogenous mold exposure. The authors suggest that if a mycologist is available the evaluation should include sampling for viable mold spores using a volumetric device (Andersen sampler), sampling for both viable and non-viable spores using the rotorod impaction sampler and Scotch tape imprints of appropriate material. If a mycologist is not available, a limited survey using the rotorod impaction sampler and direct Scotch tape imprints can be performed. By using appropriate reference material, the allergist should be able to identify most spores present. If an unusual mold is encountered, or if the physician doesn't have the time to do the evaluation himself, the material can be sent to a trained mycologist for definitive identification.

Factors of importance in determining the prevalence of indoor molds.

The concentration of molds isolated in 68 homes of allergic patients in southern California using the Andersen volumetric sampler varied from a minimum of 36 to a maximum of 5,984 isolate/M3 air sampled. The most frequently isolated included Cladosporium, Penicillium species. Alternaria, Sterile (Non-sporulating) Mycelium, Epicoccum, Aspergillus species, Aureobasidium and Dreschlera. Statistically significant higher mold isolates were associated with high shade and high levels of organic debris near the home and poor landscaping and landscape maintenance. Low concentrations of mold isolates were associated with the presence of a central electrostatic filtration system and good compliance with dust controls. The viable mold spore levels were lower in homes where the electrostatic filtration unit was operated continuously rather than intermittently. No statistically significant correlations could be made between indoor mold isolates and any of the following: number and age of the occupants, age and size of home, month of survey or the presence of indoor plants.

Diagnosis of honey bee venom allergy.

Studies using both an optimized RAST assay and intradermal skin testing with whole bee venom indicate that both methods should be used for diagnosis. RAST and skin test are of similar sensitivity but each misses some patients found positive by the other. Correlation between the tests was 91% with an additional 5% only RAST positive and 4% only skin test positive.

Reliability of salivary theophylline as a guide to plasma theophylline levels.

Simultaneous saliva and plasma theophylline levels in 12 chronic asthmatic children were measured by high pressure liquid chromatography following administration of a theophylline preparation. In five subjects, simultaneous plasma and salivary theophylline were measured one week later. A strongly positive correlation between plasma and salivary theophylline levels was found at all time periods tested. There was no substantial difference in the plasma-saliva theophylline ratio determined one week later. A predicted plasma level was compared with the observed value. The proportionality of predicted to observed plasma theophylline levels using either the entire study group mean plasma-saliva ratio or each individual's ratio was approximately 1.00 with 9% variability. When a previously reported plasma-saliva theophylline ratio was used for comparison, the predicted plasma theophylline was 15% above the observed plasma level.

Micro-scale method for theophylline in body fluids by reversed-phase, high-pressure liquid chromatography.

We describe a micro-scale method for determining serum theophylline. The chromatography system includes a muBondapack C18 column and acetonitrile, 70 ml/liter of sodium acetate buffer (10 mmol/liter, ph 4.0) as the mobile phase. Test serum or plasma, 30 mul, is mixed with an equal quantity of a solution containing the internal standard, beta-hydroxyethyltheophylline in acetonitrile/sodium acetate buffer (20 mmol/liter, pH 4.0), 7/43 by vol. After the precipitate is removed by centrifugation, the mixture is chromatographed and the amount of theophylline calculated from the ratio between peak heights for theophylline and the internal standard. Advantages include easy sample preparation, involving only addition of internal standard and centrifugation before injection, long column life, and the suitability of the internal standard, which is adjusted to a peak height equivalent to 20 mg of theophylline per liter for easy computation of results.