Discontinuation of bee venom immunotherapy in children and adolescents.

Sixty-six patients with a history of systemic allergy reactions to bee stings, positive skin prick test to less than or equal to 100 micrograms/ml bee venom, and positive radioallergosorbent test (RAST) results were given venom immunotherapy. IgE and IgG antibodies to bee venom were measured by RAST and enzyme-linked immunosorbent test (ELISA), respectively. IgE and IgG anti-bee venom levels rose initially, but subsequently fell during immunotherapy. In 31 patients in whom specific IgE fell to low (less than 6% counts bound) or unmeasurable levels, immunotherapy was discontinued, and sting challenge was carried out 1 to 3 years later. All patients tolerated sting challenge well. The specific IgE and IgG antibody levels did not change significantly after treatment was stopped. Our data suggest that hyposensitization treatment can be stopped when specific IgE serum concentrations have fallen to low or unmeasurable levels and specific IgG antibody values are maintained, and that in a considerable number of patients venom immunotherapy has a lasting therapeutic and immunologic effect.

Clinical features and management of nifedipine overdosage in a patient with renal insufficiency.

Overdosage with 280 mg nifedipine, verified by plasma nifedipine levels, led in a 23-year-old female patient with advanced renal insufficiency to features of marked vasodilation. Despite profound hypotension and preexisting anemia, tissue perfusion was adequately maintained. Neither cardiac conductance disturbances nor myocardial depression occurred. There was no evidence for major organ or organ system toxicity. The patient was successfully treated with intravenous calcium. Hemoperfusion did not significantly influence the clinical course. The recovery was uneventful. No late sequelae were observed.

Venom-specific IgE and IgG antibodies as a measure of the degree of protection in insect-sting-sensitive patients.

Venom-specific IgE and IgG antibodies were measured in the sera of bee-venom-sensitive patients during a 3-year hyposensitization period. The level of specific IgG antibodies initially increased, and 2 months after the start of therapy, this increase was on average five-fold. A concomitant but non-significant increase in specific IgE antibodies was also observed initially. Later during the treatment period specific IgE antibodies showed a continuous decline and after 3 years the level was one third of the pre-treatment level. Venom-specific IgG antibodies, however, remained above the pre-treatment level. The disappearance of the severe allergic reactions was related to the level of both IgE and IgG antibodies as demonstrated in seventy-six bee sting challenges. In patients with specific IgG antibody levels above 400 u/ml, no severe reactions were observed even if the patient had levels of specific IgE antibodies of RAST class 3 or 4. These data suggest that the relationship between venom-specific IgE and IgG antibodies permits an evaluation of the state of immunity to insect stings.

Chronic renal failure due to unilateral renal agenesis and total renal dysplasia (= aplasia). Report of three cases.

Three adult patients with unilateral renal agenesis/total dysplasia (= aplasia) and with an early chronic renal failure are presented. One patient had renal agenesis without ureter bud and ureteric ostium on one side, and reflux pyelonephritis on the other; one had small compact total renal dysplasia (= aplasia) on one side, while chronic uric acid nephropathy (chronic renal disease as a cause of gout) was diagnosed on the other; the third patient had a total large multicystic dysplasia on one side, and on the other a segmental large multicystic dysplasia. Radiological steps and radiodiagnostic criteria are discussed and the combination of urogenital and extraurogenital anomalies is referred to.

Urinary protein patterns and preeclampsia.

A retrospective study of urinary protein patterns, as determined by SDS-PAA-disc-electrophoresis was performed in 107 patients in third trimester of pregnancy because of preeclampsia. The aim was to determine whether the protein patterns allow a differentiation between nephropathies associated with genuine toxaemia of pregnancy and those in which toxaemia was superimposed on preexisting renal glomerular or tubular disease. The magnitude and type of proteinuria was related to the mean arterial pressure (MAP). 47% of all patients showed a mixed protein pattern independent of the MAP-severity. This form of proteinuria is probably associated with a genuine toxaemia of pregnancy. It was not possible to determine if pure glomerulopathies whose frequency rose with MAP, had already been present before pregnancy. In a third of the 22 patients followed-up post-partum pathological protein patterns or increased protein excretion was detected. This implies that 35% of the nephropathies were present before pregnancy. However, differentiation between preexisting and toxaemia associated nephropathy was not always possible. SDS-PAA-analysis of urinary protein should be carried out in earlier stages of pregnancy in cases of increasing MAP and proteinuria.

The prognostic significance of specific IgG antibodies in insect sting allergy.

Specific IgG antibodies against bee venom and bee venom components were studied in the serum of 40 bee-sting patients, 60 bee keepers, and 31 control subjects. The highest titres were observed in successfully hypothesized patients and in bee keepers. Subclass-typing in bee-sting allergic patients showed the highest antibody levels in subclass IgG2, followed by IgG3, IgG 4 and IgG1. During hyposensitization, a rise in specific IgG antibodies in all subclasses and against bee venom and all its components was found. The allergic reaction to bee stings disappeared with the rise of specific IgG antibodies, as demonstrated by a bee-sting challenge. After 6 months of hyposensitization therapy, the specific IgG antibodies remained above, and the specific IgE antibodies fell below, the pretreatment levels.

Immunological studies on bee-keepers: specific IgG and subclass typing IgG against bee venom and bee venom components.

Specific IgE antibodies against bee venom and its components were studied in 23 bee-keepers. The highest IgG serum levels were observed for whole bee venom followed by phospholipase A. The serum levels of specific IgG antibodies against melittin and MCD-peptide were lower, the lowest serum levels being observed for apamin. After a 5 month absence from bee-keeping a fall in the serum levels of IgG antibodies was observed in all the bee-keepers studied. The investigation of the IgG subclass antibodies 1-4 against bee venom and phospholipase A demonstrated the highest serum levels for IgG 4 and IgG 2, the lowest levels were observed for IgG 1. The lowest IgG serum levels were associated with the least effective protection to bee stings. These findings support the concept that specific IgG antibodies prevent the development of allergic symptoms after bee sting.