The Angiotensin-Converting-Enzyme-Induced Angioedema.

The bradykinin B2 receptor antagonist icatibant is effective in angiotensin-converting enzyme inhibitor-induced angioedema. The drug is not approved officially for this indication and has to be administered in an emergency situation off-label. Corticosteroids or antihistamines do not seem to work in this condition. The effectiveness of C1-esterase-inhibitor in angiotensin-converting enzyme-induced angioedema must be verified in a double-blind study.

Primary mucosal CD30-positive T-cell lymphoproliferative disorders of the head and neck rarely involving epiglottis: clinicopathological, immunohistomchemical and genetic features of a case.

A case of primary mucosal CD30-positive T-cell lymphoproliferative disorder of the head and neck rarely involving epiglottis in a 59-year-old male was reported. Histologically, the ulcerative mucosa was affected by sheets of mixed inflammatory infiltration, with scattered large atypical lymphoid cells arranging in an individual or small clusters with focal epidermotropism. Immunohistochemically, tumor cells were uniformly immunoreactive to antibodies against CD2, CD3, CD7, CD43, CD4, TIA-1, with a heterogeneous expression of CD30, but negative for CD20, CD79a, CD21, CD8, CD56, ALK, EMA, granzyme B. Epstein-Barr virus encoded RNA (EBER) were detected. Genetically, T-cell receptor (TCR) γ gene showed an oligoclonal rearrangement. This first case developing in epiglottis demonstrates mucosal CD30-positive T-cell lymphoproliferative disorders are characteristic of a broad clinicopathologic spectrum similar to the counterpart in the skin with a favorable prognosis.

[Cellular immunity in 3 siblings with cancers of the upper aerodigestive tract]. / Die zelluläre Immunität bei drei Geschwistern mit Karzinomen des oberen Aerodigestivtraktes.

Although the number of carcinomas of the upper aerodigestive tract is increasing, there are not many reports in the literature about familial occurrence. Epidemiological studies have shown that the major causative factors are tobacco and alcohol abuse. But the possibility of an endogenous susceptibility is also discussed. A possible explanation is failure of the immune defense system. The author was able to examine immunologic patterns in three siblings with cancer of the upper aerodigestive tract. The results obtained so far indicate normal numbers of lymphocyte subpopulations in the peripheral blood, but with impaired function.

Response to immunization with Haemophilus influenzae type b polysaccharide-pertussis vaccine and risk of Haemophilus meningitis in children with the Km(1) immunoglobulin allotype.

In experimental animals, immune responses to certain antigens are regulated by immunoglobulin allotype-linked genes. In an effort to detect such genes in humans, we examined the antibody responses of 74 healthy children with different Km(1) or Gm(23) allotypes to a Haemophilus influenzae type b vaccine (type b polysaccharide capsule-pertussis vaccine). The anticapsular antibody responses of black or white children with the Km(1) allotype were 4.6- to 9.5-fold higher than those of children who lacked this determinant (P less than 0.004). No significant differences were found in antibody response with respect to the Gm(23) allotype. The frequencies of Km(1) and Gm(23) also were examined in 170 patients with Haemophilus meningitis, 71 patients with epiglottitis, and 173 control children. Km(1) was detected less frequently in black patients with meningitis (38%) than in those with epiglottitis (81%, P less than 0.002) or in controls (66%, P less than 0.0007). The relative risk of meningitis thus was 3.2-fold lower among black children with the Km(1) allotype than in those who lacked this allotype (odds ratio = 0.3, 95% confidence interval 0.2 to 0.6). However, the risk of meningitis was not decreased in white children with the Km(1) allotype (odds ratio = 1.0). There were no significant differences in the frequency of Gm(23) among the patient groups and controls. The Km(1) allotype but not the Gm(23) thus defines a subpopulation of children of both races who are high responders to this vaccine, and black children but not white children with the Km(1) allotype are at decreased risk of developing Haemophilus meningitis. These data indicate that in blacks, genes associated with Km(1) may affect immune response to a prototype type b Haemophilus vaccine, and perhaps interact with another factor related to race to affect susceptibility to Haemophilus meningitis.

Effect of previous infection on antibody response of children to vaccination with capsular polysaccharide of Haemophilus influenzae Type b.

Children who had recovered from meningitis, orbital cellulitis, or epiglottitis caused by Haemophilus influenzae type b were immunized with capsular polysaccharide vaccine derived from that bacterium; some healthy siblings and adults who had not had H. influenzae infections were also vaccinated. Of 10 children who had had H. influenzae meningitis previously, only one had an antibody response to the vaccine. One child with prior H. influenzae orbital cellulitis also failed to respond. None of the children had detectable H. influenzae polysaccharide antigen in their bloodstream at the time of immunization. Two children who had had H. influenzae epiglottitis and six of seven controls without histories of H. influenzae infections responded immunologically to the vaccine. One of eight vaccinees under two years of age showed a response, and eight of 12 over two years responded well (P = 0.02). All four nonresponders over the age of two years had had H; influenzae meningitis or cellulitis. Children who had had H. influenzae meningitis responded less well to the polysaccharide vaccine than did other recipients of the vaccine; this difference could not be explained solely on the basis of age;