Eosinophil cationic protein and specific IgE in serum and nasal mucosa of patients with grass-pollen-allergic rhinitis and asthma.

BACKGROUND: After allergen exposure, IgE-bearing mast cells surface in respiratory mucosa. Eosinophils are also recruited locally by chemotactic mediators; they are the main cell directly involved in the late phase of allergic inflammation. IgE antibody and eosinophil cationic protein (ECP) are routinely determined mainly in serum although they exert their pathogenetic role more directly on mucosal surfaces. METHODS: We performed a comparative study of IgE antibody to grass and ECP on nasal mucosa and blood samples in order to evaluate the relevance of monitoring allergic inflammation in the target organ. Thirty-one patients and 10 nonatopic controls were enrolled in the protocol. Twenty-six subjects allergic to grass, 11 with rhinitis (group 1) and 15 with asthma and rhinitis (group 2), completed the study. Five patients dropped out. Specific IgE to grass and ECP was determined in nasal mucosa by our method based on in situ incubation. RESULTS: Serum IgE to grass did not increase during the pollen peak, as did nasal IgE, in group 1 from before the pollen peak, from 2.3 to 3.2 kU/l (P=0.02), and in group 2 at the pollen peak, from 4.8 to 12.2 kU/l (P=0.01). Serum ECP did not show any significant variation in group 1, but it increased at pollen peak from 6 to 11.2 microg/l (P=0.01) in group 2. Nasal ECP increased significantly in both groups even before the pollen peak. In group 1, ECP values rose from 15 to 39.9 microg/l (P=0.01). In group 2, ECP increase was much higher than in group 1, from 9 to 213 microg/l (P=0.001). Serum eosinophils, like nasal ECP, showed a significant increase of values from before the pollen peak in both groups, without correlation with serum ECP in rhinitic patients. CONCLUSIONS: Both specific IgE and ECP in the nasal mucosa showed a better correlation with allergen exposure than serum evaluations. With an appropriate method, allergic inflammation may be best monitored in the nasal mucosa.

HIV-1: absence of infection in subjects with indeterminate western blot.

The search for specific antibodies against the Human Immunodeficiency Virus type-1 (Ab anti HIV 1), using an immunoenzymatic test and a subsequent confirmation test (Western Blot-WB) in patients who were previously positive or borderline at the first test, singled out from about 12500 tested subjects, fifteen patients with indeterminate WB (WBi) for the presence of an abnormal band. The presence of p24 was predominant in those WBi (about 50%); generally p24 was the only band found. In all serum samples with WBi, the viral antigen p24 (Ag p24) was absent. In 3 subjects with WBi, after at least six months from the first test, not only did the same pattern persist but also the search for VIH-1 DNA sequence using the polymerase chain reaction (PCR) gave a negative result. According to our experience and the literature on the subject, we suggest that patients with low risk of infection and whose WBi does not modify with time have a remote possibility of being infected by HIV.