Effect of immunotherapy on sCD23 levels in patients allergic to Hymenoptera venom.

BACKGROUND: sCD23 is the designation given to the low affinity IgE receptor. The soluble fragment of this receptor (sCD23) participates in the regulation of IgE synthesis. OBJECTIVE: The purpose of this study is to examine the effect of a venom immunotherapy regimen on sCD23 levels. METHODS: We measured sCD23 levels by ELISA in Hymenoptera venom-allergic patients (positive skin tests and a history of systemic reactions to Hymenoptera sting) in serial sera collected over a course of venom immunotherapy with a mean duration of 54 months. Mean pre-sCD23 and post-sCD23 levels were compared using a Student's two-tailed t test. RESULTS: sCD23 levels were found to be unchanged over the course of venom immunotherapy. CONCLUSIONS: This is the first longitudinal study that has been done. It suggests that while both immunotherapy and sCD23 are known to be involved in the regulations of IgE synthesis in the atopic patient, the immunomodulation seen in venom immunotherapy is not mediated through sCD23 in any simple regulatory manner.

Pathophysiology and management of VIPoma: a case study.

PURPOSE/OBJECTIVES: To review the pathophysiology and clinical treatment of VIPomas, neuroendocrine tumors that secrete vasoactive intestinal polypeptide, and VIPoma syndrome. DATA SOURCES: Published clinical treatments and case studies in the medical literature and case study data from a patient's medical record. DATA SYNTHESIS: VIPomas are rare neuroendocrine tumors that cause a syndrome of life-threatening symptoms. Clinical management is complex, yet little information is available in the medical and nursing literature to guide the clinician. CONCLUSIONS: Information about the pathophysiology and management of the disease may facilitate care of these patients. IMPLICATIONS FOR NURSING PRACTICE: A case study presentation provides an example of the care required by one patient with VIPoma. The nurse has an important role in assessing, educating, and caring for the patient with VIPoma. Interventions include managing complex fluid and electrolyte imbalances, chemotherapy administration and management of side effects, activity and rest alterations, safety issues, altered social roles, and educational needs regarding medications, central lines, and follow-up care.

Cyclosporine and tacrolimus: a comparison of immunosuppressants used for liver transplantation.

The life expectancy of transplant patients has dramatically increased because of the development of cyclosporine to combat graft rejection. More recently, tacrolimus has been approved and is expected to further enhance survival. This paper compares these two medications and explores the role of the critical care nurse in monitoring outcomes and preventing side effects in patients with these immunosuppressants.

In vitro release of soluble CD23 by human lymphocytes in ragweed-sensitive versus nonatopic patients following stimulation with ragweed antigen E.

BACKGROUND: Soluble CD23 is the proteolytic cleavage product of the low affinity receptor (FcERII). Functions of CD23 and its soluble products may include upregulation of IgE production and stimulation of B lymphocyte growth. METHODS: Soluble CD23 was quantitated in supernatants of lymphocytes from nine ragweed-sensitive and eight nonatopic subjects stimulated in vitro by antigen E (amb Al), crude ragweed extract, and pokeweed mitogen (PWM). RESULTS: Although PWM stimulation produced no significant difference between groups, sCD23 release was significantly elevated in the cells of nonatopic patients stimulated with antigen E and crude ragweed extract (P less than .05). CONCLUSIONS: This finding supports the concept of separate pathways of activation by antigen and mitogen for sCD23 release and suggests ragweed-sensitive and nonatopic patients have fundamental differences in the response of sCD23 release to ragweed antigen stimulation.

Serum IgE in patients with human immunodeficiency virus infection.

BACKGROUND: Dysregulation of IgE synthesis has been noted in the past in several immunodeficiency states. More recently, analysis of IgE synthesis and atopy in patients who are infected with the human immunodeficiency virus (HIV) has been conflicting. OBJECTIVE: To determine whether IgE dysregulation occurs in HIV-infected patients and if so, whether this dysregulation is antigen-specific and accompanied by any significant changes in T and B cell markers. METHODS: Thirty-six HIV-infected patients were enrolled in the study. Twenty-nine patients completed the study. All patients completed an allergy questionnaire and physical examination. Interval visits occurred every 3 months. Blood was obtained at baseline and every 3 months for total IgE, antigen-specific IgE to eight environmental allergens and lymphocyte markers. Study was not blinded. RESULTS: Analysis of results at baseline and 1 year revealed a subset of patients who had marked elevations in serum IgE protein. This increase was not accompanied by any detectable antigen-specific IgE to the measured allergens nor was any significant change noted in lymphocyte markers. Student's paired t tests were used for data analysis. CONCLUSION: In a subset of patients with HIV infection, acquired dysregulation of IgE synthesis occurs that results in increased circulatory levels of IgE protein not attributable to atopic allergens or associated with detectable changes in lymphocyte markers.

Circulating elevated levels of soluble CD23, interleukin-4, and CD20+CD23+ lymphocytes in atopic subjects with elevated serum IgE concentrations.

Circulating IgE protein levels, leukocyte counts, lymphocyte subsets, IL-4, and soluble CD23 levels were quantitated in 43 atopic and 19 nonatopic subjects. Mean values of IgE protein levels, total eosinophil counts, CD20+CD23+ cells (B cells with low-affinity IgE receptor), IL-4 and sCD23 levels were elevated in atopic patients compared with nonatopic controls. The results suggest that sCD23, IL-4, and CD20+CD23+ lymphocytes may play a role in the increased production of IgE in atopic subjects in a manner similar to that observed by other investigators in prior in vitro studies.

Application of Orem's conceptual framework to patients with hypercalcemia related to breast cancer.

Breast cancer is the most common malignancy in women in the United States. Although the disease itself may be chronic in nature, it may give rise to oncologic emergencies, such as hypercalcemia, superior vena cava syndrome, or spinal cord compression. If these emergencies are not prevented or treated promptly through early detection, premature death or disability may occur. Because it presents with general symptoms, hypercalcemia may be difficult to diagnose; however, early recognition and intervention may reverse the sequelae of this condition, and prevent recurrence. This article will focus on the pathophysiology, epidemiology, nursing assessment, and intervention in a case study of this oncologic emergency based on the Orem model.

Diagnosis and management of acute promyelocytic leukemia with disseminated intravascular coagulopathy: a case study.

One of the less common leukemias, acute promyelocytic leukemia, is associated with disseminated intravascular coagulopathy (DIC). If patients are able to survive the DIC, there is hope for long-term survival in complete remission and a chance for cure. This case study reviews the disease, risk factors, treatment, and nursing care required by this patient population and compares it to the existing literature.

The clinical and immunologic efficacy of immunotherapy with modified ragweed extract (allergoid) for ragweed hay fever.

A double-blind study comparing formaldahyde modified ragweed allergen (allergoid) and placebo in the treatment of allergic rhinitis was carried out. Twenty ragweed-sensitive patients were studied, ten receiving 10,710 PNU of allergoid pre-seasonally and ten receiving placebo injections. Daily symptom score sheets were kept by each patient during August and September of 1983. A significant difference in average daily symptom scores (P = 0.01) between the two groups was noted. Significant differences were also observed in symptom scores for individual weeks during the ragweed season. Post-treatment allergen-specific IgG blocking antibody was significantly higher (P = 0.001) in the treatment group compared to pre-treatment levels and when compared to the control group (P = 0.01). No significant local or systemic reactions occurred. The results suggest that the dosage protocol used in this study is appropriate as an initial treatment schedule in clinical practice.

Allergens in yellow jacket venom as determined by sephadex fractionation, enzyme and RAST assays.

Yellow jacket venom (YJV) was fractionated on Sephadex G-50 and G-75 resulting in 9 fractions. These fractions were examined for enzyme and RAST activity using sera from 10 patients with known positive YJV RAST. Enzyme activity was found in four fractions. Enzymes associated with significant RAST activity were acid phosphatase, hyaluronidase, phospholipase A and phospholipase B. DNAase activity was found in one of the fractions associated with phospholipase A and B. Positive RAST activity was found in 8 of 9 fractions. The RAST patterns and relative RAST activities among the patients' sera examined were quite variable. The heterogeneity of the antibody response to the YJV fractions among the sera studied suggests that testing and treatment could not be successfully carried out in all patients using one or two predominant venom antigens.

Comparison of venom and whole-body rast and intradermal testing in vespid-sensitive patients.

14 patients clinically hypersensitive to vespid sting by history, 6 patients with large local reactions and 10 control subjects were skin tested with serial two- and tenfold dilutions of venom and whole-body extract of yellow jacket, wasp, and white-faced hornet antigens. Radioallergosorbent test determinations with the same antigens were also made. Determination of minimal reactive dose by skin testing distinguished control and hypersensitive patients groups for all three antigens using either venom or whole body extract. Yellow jacket venom skin testing detected 12 of 14 patients considered clinically hypersensitive. This was not the case with the other two venoms, possibly because most of the patients were yellow jacket sensitive, or any of the whole-body extracts. The Radioallergosorbent test was less useful than venom skin testing in detecting patients considered clinically sensitive.

Clinical comparison of skin testing and the radioallergosorbent test in dog-sensitive patients using mixed and breed-specific antigens.

A study of clinical history, intradermal test end points and RAST values with six different dog antigens was made in 20 patients and 5 control subjects. Skin testing was found to be more useful clinically than the RAST. Considerable variability among mixed epidermal extracts was noted. There was no apparent advantage to testing with three individual-breed extracts studied, compared to the most potent mixed epidermal antigen. The results of this study suggest that further efforts toward standardization of potency, methods of preparation and, possibly, breed composition of dog allergenic extracts are required to develop improved allergens for clinical use.