Dried fruit hypersensitivity and its correlation with pollen allergy.

A group of 102 patients (children and adults) with hypersensitivity to dried fruits and dermo-respiratory pathology underwent "in vivo" tests (skin tests) and "in vitro" tests (histamine release test, specific IgE) using a battery of foods and neumoallergens. We assessed immunoglobulin (IgG, IgA, IgM, IgE) levels as well as the complement (CH50), its components (C3, C4) and the possible presence of circulating immune complexes. Of the dried fruits the almond was the most sensitizing (89%, 87% and 68% of correlation between the clinical history and "in vivo" tests--skin tests--and "in vitro" tests--histamine release test and RAST--, respectively). As regards the other sensitizations, a hypersensitivity to peach was detected in 47% of the cases. As for the association between food allergy and pollen hypersensitivity, the highest percentages were for tree pollen (51%) followed by weeds (27%) and grasses (25%). The complement values did not show significant differences when they were compared with the control population. The statistical study correlating the clinical history with the results of the diagnostic methods--agreements between two or three tests--was positive (p greater than 0.05) for almond and peanut whereas it was negative (p less than 0.005) for hazelnut.

Angioedema, rhinitis and asthma provoked by fishing bait (Eisenia foetida).

The Eisenia foetida is an earthworm that is used as fishing bait in river fishing. We report a case of facial angioedema, rhinitis and asthma in an amateur fisherman who used this worm (Eisenia foetida) as fishing bait when fishing in rivers. However, the manifestations of dermo-respiratory hypersensitivity did not arise when he used other fishing bait (Tenibrio molitor and Marphysa sanguinea) in open-sea fishing. "In vivo" and "in vitro" tests using a battery of the usual neumoallergens and food (fish) were negative. Consequently, extracts of Eisenia foetida, Tenibrio molitor and Marphysa sanguinea were prepared. Skin tests, nasal challenge, histamine release curve and levels of specific IgE were positive when using an extract of Eisenia foetida. These parameters, however, were negative for beetle larvae (Tenibrio molitor) and marine worm (Marphysa sanguinea). The allergo-immunological study was also negative for the group of healthy and atopic controls when using these three extracts of fishing bait. The rarity of the allergen responsible for this dermo-respiratory picture stresses the need to include, on occasions, not only insects but also worms in the battery of the usual neumoallergens.

[Variations in the level of S antigen auto-antibodies and their relation to the development of retinitis pigmentosa (autosomal recessive genetic form)]. / Variation des titres d'auto-anticorps anti-antigène S et corrélation avec la durée d'évolution du processus de rétinite pigmentaire (forme génétique autosomique récessive).

A group of 40 patients with retinitis pigmentosa (autosomal recessive) were studied. The levels of soluble retinal antigen (S antigen of human origin) auto-antibodies were measured by means of the enzyme-linked-immunosorbent assay. The results obtained were compared with those of a control population of 100 healthy subjects (p less than 0.001). A statistically significant correlation (r = 0.451, p less than 0.01) was observed when comparison was made between the anti-S levels and the time elapsed from the moment of retinitis pigmentosa diagnosis.

Dermato-respiratory allergy induced by a marine worm (Marphysa sanguinea) used as fishing bait.

A case of rhinitis, asthma, and angioedema in a fisherman from the Mediterranean coast who used marine worm (Marphysa sanguinea) as fishing bait is described. Skin tests, nasal challenge, levels of specific IgE antibodies, and histamine release test showed that this cutaneous and respiratory response was induced by allergens of the Marphysa sanguinea.

Evaluation of immune parameters (including specific IgG4) during immunotherapy.

A group of 26 patients with allergic asthma and rhinitis, exclusively sensitized to house dust and mites, underwent immunotherapy with an extract of Dermatophagoides pteronyssinus (Allpyral) for a period of 36 months. Every 6 months we carried out a clinical examination and assessed IgE levels, specific IgE to house dust and mites, histamine release curve to house dust and mites, CD3+ CD4+ CD8+ lymphocyte subpopulations, anti-Dermatophagoides pteronyssinus specific IgG and anti-Dermatophagoides pteronyssinus specific IgG4. The results did not show any significant differences in the IgE levels pre therapy and those monitored every 6 months. However, the anti-Dermatophagoides pteronys-sinus specific IgE generally registered a decrease during hyposensitization when compared with the levels obtained before the therapy. The histamine release curve to house dust and mites registered superior histamine release percentages pre immunotherapy to those obtained after 36 months of treatment. The T subpopulations did not show any statistically significant differences at any of the times they were monitored. The assessment of anti-Dermatophagoides pteronyssinus specific IgG did not yield any significant differences in the levels pre, during or at the end of the hyposensitizing period. The study of the levels of anti-Dermatophagoides pteronyssinus specific IgG4 showed a mean overall increase between 6 and 24 months of immunotherapy. When separately comparing these increases in specific IgG, with the clinical course no relationship was found between the increase in these antibodies and levels of the "in vivo" assessment scale.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergic contact dermatitis from 3-(aminomethyl)-pyridyl salicylate.

2 patients with acute allergic contact dermatitis from 3-(aminomethyl)-pyridyl salicylate are described. Both patients were females with histories of urticaria and showed cross-sensitization to substances of the para group. Clinical manifestations included eczema, angioedema and respiratory effects. In 1 patient, airborne elicitation was suspected. A lymphocyte transformation test confirmed the allergy, with an extremely high response index. 35 normal controls were negative.

"In vivo" and "in vitro" evaluation of four antihistamines (astemizole, azatadine, mequitazine, terfenadine).

A group of 32 patients with perennial allergic rhinitis sensitized exclusively to house dust and mites were evaluated for "in vivo" modifications (skin tests for histamine, house dust and mites) and "in vitro" alterations (seric IgE, specific IgE, histamine release curve to different concentrations of Dermatophagoides pteronyssinus and histamine release curve to this pneumoallergen after incubation with H1 receptor antagonists) to four antihistamines (astemizole, azatadine, mequitazine and terfenadine). The patients were divided into 4 groups of 8 and the "in vivo" and "in vitro" tests were performed on days -1, +15 and +30 of administration of these drugs. The reduction in the size of the wheal (prick test) for histamine when comparing days -1 and +15 and -1 and +30 was 69% and 79% (astemizole), 64% and 71% (azatadine), 69% and 64% (mequitazine) and 61% and 64% (terfenadine), respectively. The difference in the mean size of the wheal in mm2 for house dust, Dermatophagoides pteronyssinus and farinae was statistically significant (p less than 0.001) except when comparing the results obtained for mequitazine on days -1 and +15. This was also the case on days -1 and +30 for terfenadine. The values of the serum IgE and specific IgE did not attain statistical significance (p greater than 0.05) in the various tests carried out. After incubation with H1 receptor antagonists an inhibition curve of the histamine release in the presence of Dermatophagoides pteronyssinus was obtained. The inhibition of this curve on day -1 was higher for terfenadine and mequitazine than for azatadine and astemizole.(ABSTRACT TRUNCATED AT 250 WORDS)

Evolution time and longitudinal studies of the anti-S-antigen antibody titers in retinitis pigmentosa.

Sixty-six patients with retinitis pigmentosa (forma simplex) and 37 control patients were studied for titers of anti-S-antigen auto-antibodies by means of the enzyme-linked immunosorbent assay technique (ELISA). A longitudinal study showed a positive significance (P less than 0.01) which demonstrated the uniformity of the data obtained. Comparison of the anti-S-antigen titers of the patients and controls revealed a statistically significant difference (P less than 0.001) between both populations. The relationship between the time of evolution of retinitis pigmentosa and the anti-S-antigen titers also showed a statistically significant difference (P less than 0.005). These results show both a rise in the anti-S-antigen antibody titers in relation to the evolution time of retinitis pigmentosa and a uniformity in the data obtained in the anti-S-antigen antibody longitudinal study carried out.

Hypersensitivity to wheat flour in bakers.

Eleven bakers and 4 pastry cooks with hypersensitivity to wheat flour underwent skin tests to flours (wheat, barley, rye, oats), pollens (wheat, barley, rye, oats, grasses), mites (dermatophagoides pteronyssinus, dermatophagoides farinae), molds (alternaria, aspergillus) and weeds (parietaria judaica). The levels of serum immunoglobulins (IgG, IgA, IgM and IgE) were studied and the values of specific IgE (RAST) in the presence of wheat flour and the histamine release test for wheat flour, grass pollens, mites, molds and weeds were assessed. All the patients underwent a nasal challenge test to wheat flour. The results demonstrated the existence of cross reactions between the extracts of barley and rye flour with wheat flour (15/15) as well as between the pollens of cereals and cereal flours. The levels of specific IgE (PRU greater than .35) and the percentages of histamine release (greater than 10%) were positive in 14/15 cases. The nasal challenge test was positive for all the 15 patients under study. Of the patients studied, 11 received immunotherapy for periods ranging from 12 to 18 months. Of these patients, 9/11 continued working in the same occupation whereas the 2 who left their jobs in the industry corresponded to the cases of severe asthma which were polysensitized (flour, mites, molds).

Parietaria judaica and dermo-respiratory allergy in Barcelona: a study of 250 cases.

The wide geographical distribution of parietaria in southern and western Europe is responsible for the high incidence of pollinic hypersensitivity. Our centre detected the existence of hypersensitivity to parietaria judaica in 250 patients (12.15%) out of a group of 2.057 patients. Exclusive consideration of the pollinic patients in this group 980/2,057 showed that the parietaria is the spore responsible for 25.5% of these patients. The most common symptomatology was rhinoconjunctivitis (41.2%) and the least frequent, the dermic picture (1.2%). The diagnostic methodology of these 250 patients included: anamnesis, rhinoscopy, rhinomanometry, skin tests, respiratory function, immunoglobulin levels (IgG, IgA, IgM, IgE), specific IgE and histamine release test. All patients were subjected to immunotherapy using parietaria judaica extracts. The overall evolution following immunotherapy was favourable in more than 80% of the patients, which confirms the suitability of the pareitaria judaica extract in the diagnosis and treatment of this pollinosis.

Diagnosis of allergy to peach. A comparative study of "in vivo" and "in vitro" techniques.

In our particular Mediterranean region, extensive plantations of peach trees (prunus persica) give rise to processes of peach hypersensitivity. This datum together with the scarcity of literature and the use of disparate methods of diagnosis prompted us to select the peach as an example of hypersensitivity to a fruit, and to examine the clinical symptoms, skin tests, specific IgE antibodies (RASTR) and histamine release in a group of 25 patients with peach allergy. The results showed a good concordance between clinical history and skin tests (78%) and between RASTR (82%) and histamine release (74%) when comparison was made with the clinical history. The concordance between skin tests and RASTR histamine release was 94%. On the application of a statistical study to the different data collected, and on analysing all the concordances and possible combinations between "in vivo" and "in vitro" tests, the skin tests were not found to be superior to the RASTR (p less than 0.001) or to the histamine release test (p less than 0.001), in terms of peach allergy diagnosis. Both the RASTR and the histamine release test were found to be equally valid (p less than 0.001) in "in vitro" peach diagnosis. These findings demonstrate the perfect and complete diagnosis of peach allergy with the methodology used.

[Immunologic parameters in chronic urticaria]. / Estudio de algunos parámetros inmunológicos en la urticaria crónica.

Urticaria and angioedema are common disorders that affect approximately 1/5 of the population at some stage in their lives. Although the clinical diagnosis of this disorder is made without difficulty, its etiology and pathogenesis remain obscure. Extensive clinical studies and the application of different laboratory techniques seldom manage to detect the etiology of chronic urticaria or determine its supposed pathogenic mechanism. Thus, a large number of causal agents have been held responsible for the symptoms of chronic urticaria and/or chronic urticaria and angioedema and for the variety of immunologic and nonimmunologic factors involved in its pathogenesis. The controversial laboratory findings in this type of patients prompted us to undertake this study on 48 subjects with chronic urticaria and/or angioedema. We studied the levels of serum immunoglobulins (IgG, IgA, IgM and IgE), the haemolytic activity of the complement (CH50), the levels of the complement components (C1 inhibitor, C3 and C4), the possible presence of circulating immune complexes and the percentages of the T lymphoid subpopulations (using OKT3, OKT4 and OKT8 markers) and the B population. The results obtained showed an alteration of the complement (CH50) and of some of its components (C3 and C4) as well as of the cytotoxic/suppressor lymphocyte subpopulation (OKT8).

[The histamine liberation test as a diagnostic parameter and its possible modification following specific immunotherapy]. / El test de liberación de histamina como parámetro diagnóstico y su posible modificación post inmunoterapia específica.

It is generally accepted that the allergic reaction depends on the levels of specific IgE, on the concentration of blocking antibodies and on the capacity of the basophils to release mediators. The fact that in the histamine release test (HRT) all of the elements intervening in an allergic reaction (antigens, IgE, basophils and mononuclear cells of a lymphoid origin) have been found, has led some authors to consider it as the most suitable method of "in vitro" diagnosis. This is a reflection of what biologically occurs "in vivo". Furthermore, the HRT can be used as a control parameter following immunotherapy, permitting us not only to quantify the level of blocking antibodies but also to study the possible presence of a control mechanism of histamine release. Accordingly, in a group of 50 patients with extrinsic asthma we carried out a HRT, skin tests (prick test) and Rast with house dust, Dermatophagoides pteronyssinus and Dermatophagoides farinae. In another group comprising 74 subjects with extrinsic allergic asthma (45 with perennial allergic rhinitis) we performed a HRT with aeroallergens. This group was subjected to immunotherapy (dust with mites) for a year. Following this treatment another HRT was carried out with house dust, Dermatophagoides pteronyssinus and Dermatophagoides farinae. With regard to our results in the first group we obtained 80% agreement in the HRT/prick test/Rast for house dust and Dermatophagoides pteronyssinus and 78% agreement for Dermatophagoides farinae.(ABSTRACT TRUNCATED AT 250 WORDS)

Immune complexes in retinitis pigmentosa.

In a group of 46 patients with retinitis pigmentosa (RP), we studied the levels of IgM, the presence of a rheumatoid factor (RF), the circulating immune complexes (CIC) and the alterations in the complement system. Our results showed increased IgM levels in two patients (226 and 260 mg/dl), the presence of RF in three patients (205, 187 and 80 IU/ml), the existence of CIC in 43.5% of the subjects, reduced levels of the complement components C3 and C4 (p less than 0.001) and of the haemolytic activity CH50 (p less than 0.001) when compared with a control group consisting of 100 healthy subjects. We found a statistically significant correlation between the values of C3 and CIC (p less than 0.01), C4 and CIC (p less than 0.01) and between CH50 and CIC (p less than 0.001).

Immune complexes in retinitis pigmentosa.

In a group of 46 patients with retinitis pigmentosa (RP) we studied the presence of circulating immune complexes (CIC) and the alterations in the complement system. Our results showed the presence of CIC in 43.5% of the patients studied, reduced levels of the complement components C3 and C4 (p less than 0.001), and of the haemolytic activity CH50 (p less than 0.001) when compared with a control group consisting of a 100 healthy subjects. We found a statistically significant correlation between the values of C3 and CIC (p less than 0.01), C4 and CIC (p less than 0.01), and between CH50 and CIC (p less than 0.001). These findings indicate that the CIC may play a role in the pathogenesis of primary retinitis pigmentosa.

T cell subsets in allergic respiratory disease using monoclonal antibodies.

Fifty patients with perennial allergic rhinitis and extrinsic allergic asthma were studied to determine the relative percentages of OKT3+, OKT4+ and OKT8+ cells as well as the OKT4+/OKT8+ ratios. The percentages of the OKT3+ cells (66 +/- 7) were reduced when compared with those of 50 healthy controls (72 +/- 6), (p less than 0.001). The mean values and deviations of the OKT4 marker produced no statistically significant differences between the patient group (44 +/- 6) and the control group (44 +/- 6). A reduction in the OKT8+ marker in the patient group was registered (20 +/- 6), (p less than 0.001). The OKT4+/OKT8+ ratio was, as a result, raised in the patient group (2.3 +/- 0.6) in relation to the control group (1.6 +/- 0.3). The reduction in the OKT3+ cells together with the imbalance in the subset inducer-helper/cytotoxic-suppressor in allergic respiratory disease could lead to non-regulation of B cells and to hyperproduction of IgE.

Cell mediated immunity in perennial allergic rhinitis.

The authors studied a group of 72 patients with perennial allergic rhinitis. The following parameters were determined: the distribution of T total and T active and B lymphoid populations, non-specific T suppressor activity induced by concanavalin-A, response indices to stimulation by phytohaemagglutinin and pokeweed mitogen and levels of serum IgE. Comparison with 100 healthy controls showed a diminution with respect to the T total lymphoid subpopulation (p less than 0.001) and the suppressor activity (p less than 0.001). There was no significant change regarding the T active and B values and the lymphoproliferative response to the phytohaemagglutinin and pokeweed mitogen. A correlation was seen between the IgE levels (elevated in 62.5% of patients) with the T suppressor activity which was statistically significant (p less than 0.01).