Asthma and IgE antibodies induced by chromium and nickel salts.

Metal plating with chromium and nickel has secured an occupational relation with asthma for which an allergic basis has been postulated but not confirmed. A worker who developed de novo asthma after plating with nickel and chromium but not other metals was subjected to inhalational challenge and immunoserologic tests to evaluate this association. He developed acute asthma to chromium sulfate and a biphasic asthma-like response to nickel sulfate. Radioimmunoassays incorporating the challenge materials revealed specific IgE antibodies to the provocative agents but not to another metal, gold, which he could tolerate. The findings support the postulates that bronchial reactivity can be specifically induced by fumes of metallic salts, even in a previously nonallergic individual, and that an IgE type I immunopathogenic mechanism is involved.

Pulmonary disease in workers exposed to papain: clinico-physiological and immunological studies.

Of the twenty-three employees at a pharmaceutical plant manufacturing a new product containing papain, twelve had respiratory symptoms of cough, wheezing, dyspnoea, or chest paint. Most were studied with in-depth interviews by a doctor, extensive pulmonary function tests, and immunoserological tests for IgE and precipitating antibodies specific for papain, as well as total IgE antibodies to common natural allergens. There were significant correlates (all P values < 0.05) between the presence of specific IgE antibodies to papain and decreases of FEV1, FEF75--85, TLC, RV, and response to bronchodilators as percentage change from baseline for all spirographic flow rates. Atopic workers developed pulmonary symptoms and antipapain antibodies significantly sooner after papain exposure than did the others. Duration of exposure had no effect on symptomatology, pulmonary function, or immunological response. However, those judged to have the greatest amount of dust exposure per work-day had significantly more pulmonary symptoms (P < 0.005). Papain produced lung diseases by acting as an inhalant allergen rather than a proteolytic enzyme. Papain is a potent sensitizer in humans for the production of respiratory disease. The pulmonary reactions, based on physiological data, seem to involve small airways, alveolar, and interstitial lung tissue in an inflammatory rather than destructive manner, and thus resemble bronchitis and interstitial lung disease rather than pulmonary emphysema or typical bronchial asthma.

Papain-induced asthma--physiological and immunological features.

Increasing reports of respiratory disease associated with exposure to papain prompted clinical, physiological, and immunological studies of the supervisor of a meat tenderizer factory who developed asthma after long-term contact with papain dust. His symptoms were worse at work and better on weekends and vacations. Bronchial inhalation challenges produced both immediate and late asthma to papain but not to the other ingredients in the food product. Immunological studies revealed the presence of specific IgE antibodies by direct and passive transfer skin tests and the radioallergosorbent test, and specific precipitating antibodies by immunodiffusion tests. These findings are indicative of a dual type I and III hypersensitivity. Papain acting as an allergen in an occupational setting is a risk factor for eliciting asthma even in a nontropic individual.

Prevalence of Aspergillus and Candida precipitins in renal dialysis and transplant patients.

Serum precipitin tests to Aspergillus and Candida antigens were used to define the rate of infectivity with these fungal organisms in patients on renal dialysis and after kidney transplantation. A total of 58 studies in 53 consecutive patients, of whom 41.5% were post-transplant an average of 14.6 months, failed to detect significantly more precipitin activity than in a normal population. The specificity of this non-immunoreactivity was supported by the absence of clinical or post-mortem evidence of fungal invasion. Since serum precipitins develop despite immunosuppressive therapy, and cases of fungal invasion in transplant recipients may occur sporadically in clusters, monitoring of renal transplant patients with these relatively simple tests should detect endemic occurrences of aspergillosis and candidiasis.

Allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis, a syndrome associated with asthma, manifests with transient pulmonary infiltrates and eosinophilia and can progress to severe proximal bronchiectasis, bronchocentric granulomatosis and pulmonary fibrosis. Early recognition and treatment should favorably influence these complications. Use of the precipitins test with Aspergillus antigens as a screening procedure has identified 99 possible cases in California over a 50-month period. At least 44 cases have been confirmed; and demographic analysis shows that a preponderance of them involved patients less than 35 years old, occurred in farming and rural communities and were discovered in the months of September through February.

Allergic bronchopulmonary aspergillosis caused by Aspergillus ochraceus.

A case with the characteristics of allergic bronchopulmonary aspergillosis is described. The species of Aspergillus involved, A. ochraceus, has not previously been found in this disorder. The organism had antigenic properties distinct from five other species of Aspergillus most commonly associated with allergic bronchopulmonary aspergillosis. The patient had immediate skin test, immunodiffusion, and radioallergosorbent reactivity to the species. Four per cent of 112 serum samples from others suspected of having allergic bronchopulmonary aspergillosis had precipitins to A. ochraceus only. It may be necessary in some cases to prepare and test extracts of the patient's Aspergillus isolate in order to confirm the diagnosis.

Deposits of immunoglobulin and complement in the pulmonary tissue of patients with "heroin lung".

Pulmonary tissues from six patients who died with a clinical diagnosis of "heroin lung" (heroin-induced pulmonary edema) were examined with the light microscope and electron microscope. Immunofluorescent microscopic analysis revealed multifocal granular alveolar septal deposits of IgM in all patients, C3 complement in five patients, IgG in four patients, fibrinogen in three patients, and IgA in two patients. IgM, IgG, IgA, and C3 complement were eluted from the lungs of these addicts with citrate buffer with a low pH. No deposition of albumin was found in any of the specimens. These findings are believed to represent the first report of immune complexes in the alveolar capillary membrane in patients with heroin-induced pulmonary edema. Electron-microscopic studies revealed a proteinaceous plasma-like fluid in the alveolar spaces, thereby confirming the heroin induced pulmonary edema. Mechanisms of transport of edematous fluids from alveolar capillaries to alveolar spaces in lungs from heroin addicts are considered.

Mesquite pollen--an aeroallergen in asthma and allergic rhinitis.

Skin reactions to mesquite pollen extract occurred in 62% of 100 consecutive patients tested at an adult allergy clinic despite absence of the plant within about a 50-mile radius. Radioallergosorbent test (RAST) studies confirmed that the skin tests represented specific IgE antibodies to the mesquite pollen. Nasal, conjunctival, and bronchial challenges indicated that mesquite provoked symptoms in a specific manner. The pollen was trapped at a considerable distance from its source. Mesquite surveys and climatologic data suggested a route and method of transport. Mesquite pollen is a potent allergen capable of evoking immediate hypersensitivity reactions in a susceptible population remote from the plant source.

A potential diagnostic method for food allergy: clinical application and immunogenicity evaluation of an elemental diet.

The use of a simple, hypoallergenic elemental diet would appear well suited for diagnosing food allergy. Vivonex was used in 21 patients (5 to 40 years old) suspected of food allergy or those who had failed to respond to the usual management of inhalant allergy. To study immunogenicity, five New Zealand rabbits were immunized with Vivonex, milk, and egg and were evaluated for the production of precipitin and passive cutaneous anaphylactic antibodies, the latter was evaluated in three Hartley guinea pigs. The clinical study was conducted over a 2- to 3-week period with evaluation of symptom and medication scores, physical examination, and hematological and biochemical measurements made before and after the Vivonex trial, which was a minimum of 1 week. No consistent, significant improvement of allergic manifestations were seen while patients received Vivonex. On the other hand, there were no serious side effects noted either clinically or by laboratory measurements, although four patients discontinued the study because of Vivonex palatibility. Vivonex was not immunogenic by either the precipitin reaction or passive cutaneous anaphylactic response. Although Vivonex did not prove helpful in these severe, refractory allergic individuals, we were encouraged by its safety and acceptance in the outpatient setting. Further studies in young allergic children who are more likely to have clear-cut food sensitivity are being planned.

Incidence of serum antibodies to several Aspergillus species and to Candida albicans in cystic fibrosis.

The incidence of serum IgE antibodies to several species of aspergillus and the incidence of serum precipitins to these species and to Candida albicans were determined in 22 children with cystic fibrosis, 17 children with bronchial asthma, and 18 control subjects. IgE antibodies were found in 50 per cent of the patients with cystic fibrosis and in 29 per cent of the patients with bronchial asthma; none was found in the control subjects. Precipitins to aspergillus species were present in 59 per cent of the patients with cystic fibrosis, 35 per cent of the patients with bronchial asthma, and 11 per cent of the control subjects. Greater differences were noted when the total number of precipitin bands in each group was compared. There was a trend for the more severe cases of cystic fibrosis (based on the Shwachman-Kulczycki score) to have a greater incidence of precipitins and a lower frequency of IgE antibodies to aspergillus than the milder cases. Candida precipitins were found more frequently in patients with cystic fibrosis (45 per cent) than in patients with bronchial asthma (18 per cent); none was found in the control group. The potential role of fungal hypersensitivity in cystic fibrosis and the therapeutic implications are discussed in light of these findings.

Bacterial precipitins and their immunoglobulin class in atopic asthma, non-atopic asthma, and chronic bronchitis.

In a study of groups of patients with atopic (extrinsic) asthma, non-atopic (intrinsic) asthma, and chronic bronchitis, no difference could be detected in the numbers having precipitating antibodies against species specific antigens from Staphylococcus aureus or Streptococcus pneumoniae compared to suitably matched control subjects. Precipitating antibodies against species specific antigens from Haemophilus influenzae, demonstrated in this investigation by double diffusion in agar gel, were found much more frequently in patients with chronic mucopurulent or obstructive bronchitis (50%) than in either asthmatic subjects (6%) or normal controls (6%) (P = less than 0.0005). While the precipitating antibody demonstrated in these patients against the extracts of Str. pneumoniae and Staph. aureus was in the IgG class alone, IgM and IgA antibody were detected against the species specific but not the non-species specific antigens of H. influenzae. These results underline the importance of H. influenzae as an infecting agent in chronic bronchitis and suggest that the finding of precipitins against the species specific H1 and H2 antigens of this bacterium denotes infection either concurrently or in the recent past. There is no evidence to suggest from this study that infection with Staph. aureus, Str. pneumoniae or H. influenzae is any more common in asthmatics as a group compared to controls or between patients with the non-atopic (intrinsic) and atopic (extrinsic) form of the disease.

High incidence of precipitins in sera of heroin addicts.

We analyzed sera of 50 consecutively hospitalized heroin-abuse patients for precipitins against several antigens. Forty-seven addicts had precipitins against extracts from moldy hay, and 34 against extracts from bagasse. Thirty-six showed precipitin bands against extracts from one or more of the following: Aspergillus, Micropolyspora faeni, and Thermoactinomyces vulgaris. These findings were significantly different from those of a control population (P less than .0001 for all antigens tested). The recent culture identification of bacteria and fungi from street heroin suggests that the addicted population may be injecting antigenic material intravenously, with subsequent antibody formation.