Safety and efficacy of specific immunotherapy with standardized allergenic extracts adsorbed on aluminium hydroxide.

Specific immunotherapy (SIT) with standardized allergenic extracts is the only specific treatment of allergic patients. In order to evaluate the safety, side effects, and efficacy of SIT with standardized extracts adsorbed to aluminium hydroxide manufactured by Stallergènes S.A., a prospective multicenter open study was performed in Switzerland. Fifteen patients suffering from seasonal or perennial rhinoconjunctivitis with or without asthma were included in the trial and received a total of 442 injections with standardized mix of grass pollens (n = 8) or house dust mites (n = 7) over one year. Low incidence of local reactions was noted (7%). Subcutaneous nodules (granuloma) following injections were not recorded. Only a few systemic reactions (one mild rhinitis, one mild asthma attack, one worsening of eczema) were recorded. No anaphylactic reactions requiring adrenaline were recorded. No admission to the hospital was required. Global appreciation of the physicians and the patients after the first year of treatment showed a good efficacy of SIT: Only two patients (13%) did not improve. A worsening of the symptoms was not observed. In order to assess the efficacy, skin reactivity and conjunctival reactivity to allergen challenge were compared before and after one year of treatment as well as immunologic parameters (such as specific IgE, specific IgG4) in blood samples. A significant decrease in skin reactivity (p = .001) and in conjunctival reactivity (p = .01) was observed. Specific IgE level decreased for both types of allergens but to a significantly greater extent for grass pollen allergen (p = .03). Specific IgG4 level increased significantly for grass (p = 0.01) and for mites (p = 0.04). Specific immunotherapy appears to be a valuable tool in the efficient management of the allergic respiratory diseases.

Mycological control and surveillance of biological waste and compost.

This paper presents some recent developments regarding current work on hygienic aspects, in particular the presence and dispersion of fungi (e.g. Aspergillus fumigatus), of biological waste and compost.

PAF acether release on antigenic challenge. A method for the investigation of drug allergic reactions.

This study describes an in vitro method to evaluate a PAF acether release test (PART) from white blood cells after antigenic challenge. PAF acether activity of the supernatant was tested by platelet aggregation. The aggregating power was abolished by using SRI 63-441 (Sandoz), a PAF acether inhibitor. This method was applied to 57 patients with allergic or pseudo-allergic reactions to drugs by using different drug protein conjugates. The results of PART were evaluated in relation to the clinical history (score of imputability) and to other tests (skin tests, lymphocyte transformation tests (LTT), IgE-RAST). A good correlation was found between the release of PAF acether and a high predictability score: sensitivity 75%, specificity 83.8%. PART also correlated with skin tests (75% agreement, n = 60), with LTT (67.7% agreement, n = 74) and in 65.6% of cases with positive penicillin IgE-RAST (n = 32). This method brings a new possibility for the investigation of drug-allergic and pseudo-allergic reactions.

[The role of various forms of ribomunyl in recurrent respiratory tract infections]. / Place des différentes formes de ribomunyl dans les infections récidivantes des voies aériennes.

Ribomunyl was administered in an open clinical trial for the treatment of chronic repetitive infectious diseases of the upper respiratory tract. Two groups of patients were treated with either Ribomunyl aerosol (n = 19) or with Ribomunyl aerosol and injections (n = 17); a third group of 17 patients, serving as a control group, did not receive treatment with either form of Ribomunyl. The treatment lasted two months and was followed by an observation period of another four months. The patients treated with Ribomunyl showed a distinct improvement compared to the untreated group. Ribomunyl was generally well tolerated. Plasma antibodies determined before, during and after the trial showed a clear-cut relationship between the increase in plasma antibody levels and improvement of clinical picture.

Chronic asthma and rhinitis due to Candida albicans, epidermophyton, and trichophyton.

Asthma and rhinitis due to Candida albicans is well known. Trichophyton and Epidermophyton are not usually considered as causal agents for these diseases. During the years 1982 and 1983 all of the cases of chronic asthma or rhinitis exhibiting a positive immediate skin response (greater than or equal to 10 mm) to one of these three antigens were selected for this study (60 asthma and 75 rhinitis). They all went through nasal and bronchial provocation tests with the specific antigen. Late reactions were also registered. A RAST was performed in some of the patients reacting to Candida albicans. Following inhalation challenge with antigens, an immediate response was obtained in 91 cases (asthma 30, rhinitis 51). A dual response was observed in 17 cases of asthma and in 13 cases of rhinitis. A RAST-Candida albicans was done in 64 cases. Results were positive in 52 patients. In 46 cases there was a correlation between the RAST and the provocation tests. Hyposensitization treatment was given to 92 patients. After 2 years of treatment, a good to excellent response could be observed in almost 60% of the treated cases. A rough estimation of the incidence of immediate bronchial and nasal hypersensitivity among patients with chronic asthma and rhinitis to the three yeasts gives the approximate figure of 8% to 10%.

Irritable bowel syndrome and hypersensitivity to food.

Food hypersensitivity as a cause of irritable bowel syndrome was investigated by means of exclusion diet and blind provocation. Twelve atopic and twelve non-atopic individuals entered into the study. Skin prick testing with 20 foods and food additives and RAST specific for food only, were done in all cases. Serum IgE level was also measured. In 14 patients one or several food or additives were shown to induce the typical symptoms of IBS. In at least nine cases of atopy, an IgE-mediated mechanism could be incriminated. Among other potential pathogenetic mechanisms, the presence in the intestinal tract of yeast (Candida albicans, Geotrichum candidum) seems to be of major importance. Yeast apparently favor the development of allergic as well as pseudo-allergic reactions, at least in some patients. Finally, at least in atopic patients complaining of IBS, it is of importance to search for a food component. Dramatic clinical improvements can result from the introduction of an adequate exclusion diet.

[Asthma and bacterial infections]. / Asthme et infections bactériennes.

Known for many years, the relationship between bronchial asthma and bacteria are complex. Nevertheless they certainly are part of the several pathogenetic mechanisms of that disease. The recent discovery of specific IgE antibodies to several species of bacteria introduces new insights in the classification of these mechanisms. A careful consideration of the clinical symptoms remains a priority in analyzing the part played by bacteria in inducing bronchospasms. However, some laboratory procedures and especially the bronchial provocation tests with the specific antigen are of importance, bringing elements in accord with the immediate, late or delayed reaction. It is a basic requirement to have all these informations available to decide whether an hyposensitization therapy with bacterial extract is really needed. This will be done only in case of immediate type of reactions likely to be IgE mediated. Non specific polyvalent immunotherapy with a mixture of bacterial extract or derivates is sometimes indicated in cases of chronic infections of the upper and lower respiratory tract. Finally, some patients are reacting with an acute bronchospasm to minute doses of endotoxins. Therapy with bacterial extracts should be avoided in those patients.