Cow's milk allergy in adults is rare but severe: both casein and whey proteins are involved.

BACKGROUND: Studies on cow's milk allergy (CMA) in adults are scarce. Little is known about the clinical symptoms, eliciting doses (ED), and allergens involved. OBJECTIVE: The aim of this study was to analyse the clinical symptoms, ED and allergen recognition in adult CMA patients, compared with cow's milk (CM)-sensitized, but tolerant controls. METHODS: Adult CMA patients were evaluated by standardized questionnaires (n=30), skin prick tests (SPTs) and specific IgE for CM allergens (n=18), and a double-blind placebo-controlled food challenge (DBPCFC, n=10). A control group (n=25) of CM-sensitized, but tolerant adults was included. RESULTS: The majority of CMA patients (20/30, 67%) reported severe symptoms. In all patients participating in DBPCFC, CMA was confirmed. ED for subjective symptoms (0.3-300 mg CM protein) were significantly lower than that for objective symptoms (300-9000 mg CM protein). The severity of CMA by history and ED was not correlated with SPT or IgE. Patients had higher SPT reactivity than controls for CM, alpha-lactalbumin and beta-lactoglobulin (P=0.002, P=0.014 and P=0.004) but not for casein. Specific IgE to CM tended to be higher (P=0.068) and IgE to casein was higher in patients than that in controls (P=0.016). No difference was observed for IgE to alpha-lactalbumin and beta-lactoglobulin. CONCLUSION: Adult CMA is severe in nature. ED are low, starting from 0.3 mg CM protein. Patients with CMA recognize the same major allergens (casein and whey proteins) as controls, but display a stronger SPT and IgE reactivity.

Does skin prick test reactivity to purified allergens correlate with clinical severity of peanut allergy?

BACKGROUND: Recognition of specific peanut allergens or the diversity of IgE binding to peanut allergens may play a role in the elicitation of severe allergic reactions. OBJECTIVE: To investigate whether sensitization to individual allergens Ara h 1, Ara h 2, Ara h 3 and Ara h 6 is correlated with clinical severity. METHODS: The reactivity of purified peanut allergens was measured by skin prick test (SPT) and by IgE immunoblot in 30 patients. The results were related to the clinical reactivity by history, and in 25 of them to the eliciting dose (ED). RESULTS: The majority of patients recognized Ara h 2 and Ara h 6. Patients with severe symptoms had a higher SPT response to Ara h 2 and Ara h 6 at low concentrations (0.1 micro g/mL) and to Ara h 1 and Ara h 3 at higher concentrations (100 micro g/mL), compared with patients with mild symptoms. They also recognized a greater number of allergens and showed a higher cumulative SPT response compared with patients with mild symptoms. No significant differences were observed between patients with a low or high ED. CONCLUSIONS: Ara h 2 and Ara h 6 appeared to be more potent than Ara h 1 and Ara h 3. Both SPT reactivity to low concentrations of Ara h 2 and Ara h 6 and to higher concentrations of Ara h 1 and Ara h 3 were shown to be indicative of severe symptoms.

Computer-assisted myelography in degenerative abnormalities of the cervical vertebral column.

In 19 patients with symptoms suggestive of a cervicobrachial syndrome due to degernative lesions of the cervical spine, a CT scan was made after intrathecal administration of metrizamide. The images thus obtained supply adequate information on the extent of bone apposition, if any, on the degree of displacement and compression of the spinal cord, and on the condition of the intervertebral foramina. A CT scan is indicated in the case of discrepancy between myelographic findings and clinical diagnosis. In the case of recurrent postoperative symptoms, too, CT scans have proved to supply valuable information.

Importance of computer-assisted myelography in diseases affecting the vertebral column.

Of a series of 20 patients in whom CT scans revealed lesions of the vertebral column, 6 cases are discussed which confirm the efficacy of this method of investigation. Good information is obtained in particular on pathological processes in which optimally exact localization is required preoperatively and in tumor relapses. CT scanning is also indicated when myelography proves to be impossible, e.g., due to adhesions. Computer-assisted myelography, however, does not yet seem suitable to be used as a routine procedure.