Changes in serum interferon-gamma, interleukin-4, and interleukin-12 cytokine levels in anti-histamine type 2-treated allergic rhinitis patients.

OBJECTIVES/HYPOTHESIS: Markedly elevated immunoglobulin E (IgE) synthesis characterizes allergic diseases. Interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) regulate IgE synthesis. It has been shown that immunotherapy and histamine type 2 (H2) receptor antagonists induce a clinical improvement, decrease IgE antibodies, and increase T-cell subsets, which express a suppressor function. In addition, immunotherapy brings about a reduction in the amount of IL-4 in T-cell clones of allergic individuals. The purpose of this study was to investigate the profile of cytokines IFNgamma and IL-4 that occurs in vivo in anti-H2-treated patients with allergic rhinitis (AR). METHODS: Enrolled were 65 AR patients with sensitivity to a single allergen, the Parietaria, 36 of whom were randomly assigned to treatment with ranitidine at a dosage of 1 mg/kg per day intravenously for 20 days, and 29 to placebo treatment. RESULTS: A comparison of the serum cytokine values recorded before and after anti-H2 treatment showed a significant increase in INF-gamma serum level (P = .003) and a decrease in IL-4 (P = .016). Negligible variations were found in the placebo-treated group. CONCLUSION: H2 antagonists probably induce their effects by enhancing the amount of IFN-gamma and by reducing IL-4 cytokines, which, respectively, induce a decrease and an increase in the IgE synthesis.

Suppressor T cell subsets in allergic rhinitis patients.

Lymphocyte T cell subsets, total and Parietaria IgE levels were studied in 68 allergic rhinitis patients. In treated patients we observed an increase in the lymphocyte T cell subsets, which express a suppressor function, defined by several monoclonal antibodies, i.e., CD8, CD8 + CD11b-, CD4 + CD62L+, CD4 + CD45RO. This increase was significant for T suppressor cells, CD8 + CD11b- (p < 0.046) and T memory cells, CD4 + CD45RO (p < 0.013), whereas a slight decrease was observed in the control group. A decrease in total serum IgE levels was observed in anti-H2 treated patients; only a slight increase was noted in placebo groups; and no variations were found in Parietaria levels in either group. In vitro culture of T lymphocyte clones, T memory cells, from atopic subjects produces IL-4, which induces an increase in IgE synthesis. An increase in T memory cells, observed in the treated group, should have accompanied an increase and not a decrease in total serum IgE levels, if the in vivo data correlated with those in vitro. Consequently, the behaviour of lymphocytes in vivo is not homologous to in vitro data.

Comparison of SPT and NPT in the ascertainment of nasal mucosa as shock organ.

The Skin Prick Test (SPT) is the principal tool in allergic diagnosis, but in allergic rhinitisan immunological disease which affects 12% of the total population-the Nasal Provocation Test (NPT) allows more reliable results to be obtained. In our study a positive response to NPT has been found in four subjects with a history of symptoms suggesting allergic rhinitis, who had a negative SPT. Subjects with a positive SPT for two or more inhalant antigens have a significantly reduced number of antigen responses to NPT. Moreover, in two cases, the antigen than induced a positive response to NPT was different from the antigen that induced positive SPT. So. NPT is a reliable way of diagnosing allergic rhinitis. A more specific and reliable ascertainment of the antigen responsible for allergic reaction avoids unnecessary and ineffective immunotherapeutical attempts based on false assumptions.

The role of H2 antagonists in perennial allergic rhinitis.

The biological effects of anti-H2 in allergic reactions are dose dependent: low doses enhance, and high doses significantly decrease the reaction of hypersensitivity. The administration of cimetidine H2 antagonist to 20 perennial allergic rhinitis patients brought about an abatement in the symptoms and a decrease in the total serum immunoglobulin E (IgE) levels in 72% of treated patients, but no variation was perceived in placebo-treated patients. These results strengthen the hypothesis of anti-H2-induced immunoregulatory effects and suggest a possible way of inhibiting IgE synthesis in vivo.

[Herpes of the larynx. Apropos of 3 cases]. / Herpès du larynx. A propos de trois cas.

Herpes laryngis is a rare inflammatory disease, caused by herpes simplex (HSV) or herpes zoster virus (HZV). Three cases of acute viral laryngitis are described. The first case of laryngitis is caused by HZV, with involvement of VII., VIII., IX. and X. cranial nerves. In the second and third cases, caused by HSV, only the laryngeal mucosa is involved. Laryngeal symptoms, diagnostic criteria and therapeutic results are described.

Immunoglobulin E distribution in atopic nasal mucosa.

The distribution of B lymphocytes and immunoglobulins G, A, M, and E in nasal mucosa was studied in frozen biopsy sections of nasal turbinate from 16 allergic patients and 8 controls. The immunoperoxidase technique was used with monoclonal and polyclonal antibodies. Comparative analyses of serum immunoglobulin levels were also performed. Few B lymphocytes were observed in the nasal mucosa linings in specimens from allergic and non-allergic patients. In both groups, high positivity for IgG and IgA was observed in the nasal mucosa linings in the specimens. IgM concentration was minimal in both groups. IgE was absent in the nasal turbinate specimens of nonallergic subjects, but was present discontinuously in low concentrations in 7 of the 16 allergic patients. There was no significant difference between allergic and nonallergic patients in the tissue and serum IgG, IgA, and IgM concentrations found. IgE was detected slightly in the nasal mucosa of patients with high IgE serum concentrations (greater than 1000 IU/mL) as well as in patients with very low IgE serum concentration readings. This result raises some doubt on the hypothesis concerning the local production of IgE.

[Changes in serum levels of specific and total IgE in patients with allergic rhinopathy treated with H2 antagonists]. / Variaciones de las IgE específicas y de las IgE totales serosas en individuos afectos de rinopatía alérgica tratados con H2 antagónicos.

A study has been made of the effects of H2 antagonists in patients with perennial allergic rhinitis with sensitivity towards a single allergen: parietaria. During two years of observation. The patients underwent three cycles of treatment "a la demande". In 70% of the cases an improvement was observed in the symptomatology and a decrease in total serum IgE, while specific IgE remained unvaried. Subsequent treatments showed results overlapping the first, with further improvements.

Histamine 2 antagonists in allergic rhinitis. Relationship of clinical response and serum concentrations of total and specific IgE antibody levels.

During a double-blind clinical trial of a histamine (H2) antagonist (ranitidine) in monitoring allergic rhinitis, the clinical response, total serum IgE levels, and Parietaria IgE antibody levels were measured. Ranitidine induces an improvement in scores of subjective and objective symptoms, a decrease in total serum IgE levels, and no significant variations in Parietaria IgE antibody levels. Since H2 antagonists seem to induce these improvements by acting on suppressor T cells bearing H2 receptor, as shown in our previous studies, it is hypothesized that the lymphocytic subset that regulates the total IgE synthesis is not the same as that governing specific IgE synthesis.

[The diffuse lymphatic system of the nasal mucosa in allergic rhinitis]. / Le système lymphatique diffus de la muqueuse nasale dans la rhinopathie allergique.

Morphologic and immunologic study were performed on the mucosa associated lymphoid tissue (MALT) of patients with allergic rhinitis. Scraping from 14 healthy subjects and 36 allergic ones were used. Besides ordinary hystological methods immunohistochemical ones wilk polyclonal antibodies were employed to study IgG, IgA, IgM, IgE and monoclonal antibodies used for B and T lymphocyte and subset T-suppressor cell identification. In a comparison between normal and allergic mucosa, the morphopathology show an accentuated edema and a slight fibrosis. Among the IgG, IgA and IgM do not show any substantial differences in the samples in normal or in allergic subjects; white traces of IgE are found in allergic patients, but are totally absent in normal ones. In the lymphocyte populations does not show any substantial changes between the two groups. Was also analyzed the mechanism and the majority of the factors by which were obtained the results.

[Changes in serum immunoglobulins in allergic rhinitis induced by histamine H2 antagonists]. / Les modifications des immunoglobulines sériques dans la rhinite allergique provoquées par les H2 antagonistes de l'histamine.

The authors discuss their double-blind experiments on 40 allergic rhinitis affected patients, aged 15 to 50 years. Twenty were treated with H2 antagonists (Cimetidine) and twenty with placebo. The clinical assessment of the effectiveness of the treatment was carried out on a range of subjective and objective parameters taken before and after treatment. The IgE, IgA, IgG and IgM serum rate was measured. An improvement in the symptomatology was noted in 15 of the 20 Cimetidine treated patients and none in the placebo group. The results have shown a significant percentage decrease in the total serum IgE values after treatment, compared to initial ones, while no significant change was observed in the values of IgA, IgG and IgM. This decrease in IgE is thus a specific class. As it has been demonstrated that a subpopulation of lymphocyte T suppressors acts selectively on IgE producing B cells, the authors believe that only on these elements, carriers of H2 membrane receptors, can Cimetidine act to induce a decrease in total serum IgE levels and therefore a reduction in degranulation processes.

[Comparison of the efficacy of two H2 antagonists of histamine in allergic rhinitis. Considerations on the mechanism of action]. / Comparaison de l'efficacité de deux H2 antagonistes de l'histamine dans les rhinites allergiques. Considérations sur le mécanisme d'action.

A random study has been made on perennial atopic rhinitis patients divided into two homogeneous groups and treated with HH2 antagonists of different chemical structure: Cimetidine and Ranitidine. An identity of clinical and humoral results was noted in the two groups. This leads us to believe that the effects induced by the two drugs are linked to the properties of H2 antagonists and not to other potential action as hypothesised for Cimetidine by Drazen. The improvement in all subjective and objective parameters, decrease in total serum IgE, the delayed onset of clinical improvement and its duration in time, suggest that the vascular type action mechanism hypothesised by some Authors is quite secondary to the immunomodulatory one. H2 antagonists in fact induce, together with the clinical improvement and the total serum IgE decrease, a modulatory effect on the T-lymphocyte subsets with a variation in the OKT4/OKT8 ratio towards the latter subset that identifies the suppressor cells. Since lymphocyte histamine receptors are uniquely present on suppressor T-cell, it is on these the H2 antagonists would act, modulating the suppressive function positively.

Histamine2 antagonists in allergic rhinitis. Possible role in the control of cellular immune reaction.

We studied effects of monoclonal antibodies on lymphocyte subpopulations in patients with allergic rhinitis treated with histamine2 antagonists. The OKT4/OKT8 ratio after treatment showed a statistically significant decrease compared with initial values, the expression of a relative increase in the OKT8 subpopulation containing the suppressor fraction. In control patients no significant variations were observed. These results confirm our hypothesis that histamine2 antagonists act in allergic rhinitis by modulating the activity of T-suppressor lymphocytes reduced in atopic patients.

Objective tinnitus due to peritubal myoclonus. A case report.

A case of bilateral peritubal myoclonia with objective tinnitus in a 5-year-old child, under general anesthesia for phimosis surgery, is reported. After having shown the etiology, pathogeny and symptomatology of the peritubal myoclonic syndrome, the use of impedansometric research consisting of a spontaneous variation of 'compliance' is emphasized. The authors discuss the significance of differential diagnosis with the spontaneous variations of 'compliance' of vascular, respiratory and muscular origin.