Allergic skin testing: A clinical investigation

Forty patients were administered a total of 2,395 skin tests in order to assess the effects of method, concentration, diluent, manufacturer, and mixtures on patient reaction to inhalant extract solutions. The prick method was found to be superior to the scratch method. The intracutaneous technique exhibited the greatest degree of specificity. Patients reacted at a higher level to higher concentrations of extract solution, descending to a lower level of reaction to lesser concentrations of extract solution. Patient reactions were variable to aqueous vs glycerin solutions. Clear differences in the potency of extract solutions produced by manufacturers A, B, and C were evident. Specifically, the products of manufacturer C were least potent. The results illustrate the possibility of a dilution factor existing in mixtures of extract solutions, producing a decrease in their potency when compared to the potency of their individually administered components. A technique with the potential for wide acceptance and clinical applicability is proposed.     

Serum prostaglandin levels in asthmatic patients.

Levels of serum prostaglandins E and F were measured by radioimmunoassay in 40 asthmatic patients and healthy subjects. Levels of both prostaglandins--E and F--were significantly higher in asthmatic patients than in normal control subjects. The prostaglandin F/prostaglandin E ratio was significantly higher in asthmatic patients than in normal control subjects.     

Recertification in allergy and immunology: an historical review with special emphasis on the 1983 examination

Recertification offers a method of evaluating a diplomate's cognitive knowledge of allergy and immunology. In 1983 candidates for the American Board of Allergy and Immunology recertification examination were offered the entire certifying examination but were informed that they would, for recertification purposes, be held responsible only for a subset of questions judged to be particularly clinically relevant. All 40 candidates elected to take the entire certifying examination. Differences between the performance of certifying and recertifying candidates on the recertifying questions were small. Except for the five-choice questions, the differences in performance between the two groups on the remaining questions were also small in an absolute sense. Recertification performance was not related to the time of original certification. Ninety-eight percent of the candidates completed a questionnaire after the examination. Ninety percent stated that they would encourage their colleagues to participate in the recertification process.     

Role of amines in anaphylactic contraction of guinea pig isolated smooth muscle

The possible role of acetylcholine (ACh,) histamine (His), and 5-hydroxytryptamine (5-HT) in the contractile response to ovalbumin (Oval) of ileal and tracheal muscle from sensitized guinea pigs was examined. Antagonists to these agents (atropine, mepyramine and methysergide, 5-benzyloxygramine, or 5-HT tachyphylaxis, respectively) were employed singly or in combinations. Care was always taken to ensure specificity of blockade. Results indicate that about half of the peak magnitude of the oval-induced contraction is absent in the presence of a specific inhibitory concentration of mepyramine. This finding suggests that His plays a considerable role in the oval-induced contraction. Contrary to previous reports, similar evidence was not obtained of a role for ACh and 5-HT in the Oval-induced contraction. The source of the agonists released by Oval was also investigated. Pretreatment with compound48/80 almost completely eliminated the Oval-induced contraction of ileal muscle while reducing the tracheal contraction about one-half. It would appear that the Oval-induced ileal contraction involves primarily agonists released from mast cells in the preparation whereas tracheal contraction is only partly dependent on mediators from mast cells.     

A double-blind evaluation of the use of nebulized metaproterenol and isoproterenol in hospitalized asthmatic children and adolescents.

This study compared two beta-adrenergic agents in the treatment of severe asthma of children and adolescents. Thirty patients admitted to Children's Orthopedic Hospital and Medical Center with acute asthma were treated with either isoproterenol 0.05% (iso) or metaproterenol 0.5% (meta) nebulized in physiologic saline and delivered with O2 in addition to intravenous hydration, aminophylline, and corticosteroids. Vital signs, blood gases, and pulmonary function were monitored frequently. No adverse reactions to the study drugs were encountered. Pulse rates increased similarly after treatments with both drugs. Patients treated with meta had somewhat higher rates than those treated with iso. Diastolic blood pressure decreased significantly from admission in the meta group compared to the iso group. For FVC and FEV1, the meta group had greater percentage increases from admission than the iso group at all times, with the difference being significant (p less than 0.05) at 1 and 12 hr. The same trend occurred for FEF 25%-75%. Though iso seemed to cause greater increases in flow immediately after administrations, these changes were transient compared to improvement caused by meta. Thus, meta seemed to be more effective than iso in reversing bronchospasm as measured by certain pulmonary function parameters.     

The presence of IgE on the surface of lymphocytes in nasal polyps

The presence of IgE-bearing lymphocytes in nasal polyps was correlated with the patients' atopic status. Following surgical removal, the polyp tissue was treated with hyaluronidase and a single-cell suspension was obtained. Lymphocytes were isolated by gradient centrifugation, and the fluorescent antibody technique was used to study the presence of various immunoglobulin markers on the surface of lymphocytes. The presence of IgE-bearing cells was correlated with serum IgE levels, history of allergy, and skin test reactions. Patients with a positive atopic history had intermediate to high serum IgE levels. There was no correlation between IgE level and skin reactivity in these patients. Good correlation was obtained between the number of IgE-bearing cells in nasal polyps and serum IgE levels in atopic patients. The IgE-bearing cells represented 10 to 40 per cent of total immunoglobulin-bearing lymphocytes. No IgE-bearing cells were detected in five of six patients with a negative atopicf history and negative skin tests. Thus IgE may be synthesized within nasal polyps of atopic patients, and the polyps in atopic patients may have a different etiology from those in nonatopic patients.     

Rex-dependent exclusion of lambdoid phages. III. Physiology of the abortive infection

Rex-dependent exclusion of Ren^? and Red^? lambdoid phages resembles the exclusion of T4rII- phages in that phage adsorption and DNA injection are unaffected, whereas protein and DNA syntheses are inhibited after a period of normal synthesis. As in exclusion of T4rII^?, exclusion of λ Rem^? phages requires the presence of monovalent ions. A novel observation in this exclusion system is that the excluded superinfecting phage must replicate in order to provoke the turn off of phage early protein synthesis that is seen during the abortive infection. The similarities between Rex-dependent exclusion and other superinfection systems and the possible relationship between exclusion and membrane function are discussed.     

Tartrazine and the prostaglandin system.

The effect of tartrazine on prostaglandin production was evaluated in several in vitro systems in order to elucidate the interrelationship between aspirin-sensitive asthma and tartrazine. Unlike the nonsteroidal anti-inflammatory drugs, tartrazine did not inhibit cyclooxygenase activity in sheep seminal vesicles, guinea pig lung microsomes, and human platelets. Tartrazine had no effect on the activation of acyl hydrolase, which is the rate-limiting step in prostaglandin production. The major metabolite of tartrazine, sulfanilic acid, also had no inhibitory effect on the sheep seminal vesicle cyclooxygenase. In view of these findings, if there is a cross-sensitivity between tartrazine and aspirin in aspirin-sensitive asthmatics, it is unlikely to be on the basis of prostaglandin inhibition.     

A longitudinal record study of renal function in patients treated with lithium

We reviewed hospital charts of 62 patients receiving long-term lithium therapy in an attempt to see if renal function deteriorated in association with lithium treatment. We found no association between duration of lithium treatment of up to four years and change in BUN or creatinine or the development of proteinuria. There was a nonsignificant tendency for cases showing a rise in BUN from index to follow-up to have had a chart record of lithium intoxication, but these same cases tended to have a lower follow-up creatinine. There was a tendency for older patients to have higher BUN and creatinine at follow-up than at index, but there was no association between this and duration of lithium treatment.     

Effect of deep inspiration on airway conductance in subjects with allergic rhinitis and allergic asthma

We measured specific airway conductance ($\text{Gaw}\text{Vtg}$) in a body plethysmograph before and after a deep inspiratory maneuver in 8 subjects with allergic rhinitis and 8 subjects with allergic asthma. In hay fever subjects deep inspiration had no effect on $\text{Gaw}\text{Vtg}$ if it was performed in the control state; however, when methacholine-induced bronchoconstriction was present, deep inspiration transiently increased $\text{Gaw}\text{Vtg}$. In asthmatic subjects deep inspiration was followed by a transient fall in baseline $\text{Gaw}\text{Vtg}$ in the control state; however, when bronchoconstriction was present, deep inspiration was followed by small and variable changes in $\text{Gaw}\text{Vtg}$ in 7 subjects and marked improvement in $\text{Gaw}\text{Vtg}$ in 1 subject. In asthmatic subjects the bronchoconstrictor response to deep inspiration performed in the control state is thought to be due to reflex changes in bronchomotor tone mediated by cholinergic (vagal) nerve pathways. Like asthmatic subjects, hay fever subjects also possess cholinergic-mediated airway hyperreactivity compared with normals. Our results indicate that, in spite of their increased airway reactivity, hay fever subjects respond more like normal subjects than like asthmatic subjects after a deep inspiratory maneuver.     

Incidence of exercise-induced asthma in children

The incidence of exercise-induced asthma (EIA) was studied in 134 asthmatic and 102 nonasthmatic atopic children and compared to that in 56 nonatopic children. Pulmonary function tests measuring forced vital capacity (FVC) and 1-sec forced expiratory volume (FEV₁) were performed on each child prior to and serially for 20 min following free running exercise. The incidences of EIA among the asthmatic and atopic nonasthmatic children were 63% and 41%, respectively. This phenomenon is widespread among allergic children and cannot be accurately predicted from the history. A simple and easily performed outpatient procedure is described for the diagnosis of EIA.     

An agent that releases basophil and mast cell histamine but blocks cyclooxygenase and lipoxygenase metabolism of arachidonic acid inhibits immunoglobulin E-mediated asthma in rhesus monkeys

An inhibitor of the lipoxygenase and cyclooxygenase pathways of arachidonic acid metabolism, BW755C, was evaluated with the rhesus monkey model of IgE-mediated asthma. BW755C was found to release histamine from human and rhesus peripheral blood leukocytes and rhesus bronchial lavage cells. BW755C did not induce a rhesus airway response but inhibited antigen-induced airway changes in pulmonary resistance and dynamic compliance. The results demonstrated that a lipoxygenase and cyclooxygenase inhibitor that is a histamine releaser may inhibit some pulmonary function abnormalities of an IgE-mediated response and suggested that histamine has a minor role as a stimulator of airway reaction in this model. This was supported by studies showing failure of the histamine H1 blocker pyrilamine maleate to inhibit the antigen-induced airway response. Although BW755C has been shown to be a lipoxygenase and cyclooxygenase inhibitor, it is not established that the inhibiting action of this agent on an antigen-induced airway response is due to an effect on arachidonate metabolism in the lung.