Respiratory allergy to algae: clinical aspects.

A comprehensive investigation was done to evaluate the allergenic algae in the Delhi area. Results of 4,000 skin tests performed on 400 patients suffering from naso-bronchial allergy and 300 skin tests on 30 healthy persons with 10 common algae isolated from the Dehli atmosphere are presented and compared. Positive skin reactions (1+ to 3+) to algae extracts ranged from 25.7% with Lyngbya major extract to 1.7% with Oscillatoria simplicissima extract; in healthy non-allergic volunteers there were no positive skin reactions. The Prausnitz-Küstner (PK), bronchial provocation and conjunctival tests were negative in patients with negative skin reactions; in patients with positive skin reactions PK was positive in 70.9%, bronchial provocation in 50% and conjunctival in 48.5%. Levels of total IgE in patients with naso-bronchial allergy were higher, ranging from 1,225 international units per ml to 1,550 international units per ml, while in healthy volunteers the values were less than 885 international units per ml.     

Rhinoconjunctivitis and occupational asthma caused by Diplotaxis erucoides (wall rocket).

Wall rocket (Diplotaxis erucoides) is a common Crucifera plant that grows in European and American vineyards and olive groves. We present the cases of 2 farmers with rhinoconjunctivitis and asthma related to wine-growing tasks during D erucoides pollination (March-April). The aim of this work was to demonstrate that occupational symptoms were caused by D erucoides pollen sensitization. Cutaneous tests, specific IgE measurements, conjunctival and bronchial provocation tests, and peak-flow measurements during working days were performed.     

Occupational respiratory allergy to roe deer.

BACKGROUND: Although scattered reports have been published on roe deer allergenicity, no systematic studies of allergenicity or possible cross-reactions have appeared. OBJECTIVES: To describe 2 patients with occupational roe deer allergy, demonstrated by positive skin and conjunctival provocation test results, and to note cross-reactions to other animal (mainly cow) allergens. METHODS: Two workers at animal rehabilitation centers were sensitized to roe deer. One patient had a history of rhinoconjunctivitis and the other a history of rhinoconjunctivitis and probable asthma. Both patients underwent skin testing with a standard battery of inhaled and epithelial allergens and with roe deer hair and dander extract and conjunctival provocation tests with roe deer hair extract. Immunodetection for IgE (both patients) and IgE immunoblot inhibition tests to determine inhibitory effect (1 patient) were also performed. RESULTS: The results of skin tests and conjunctival provocation tests showed that both patients were sensitized to roe deer allergens. In one patient specific IgE to roe deer extract was detected, and this extract completely inhibited IgE binding to cow hair and dander extract in immunoblotting tests. Specific IgE to roe deer proteins could not be demonstrated in the other patient. CONCLUSIONS: Our results suggest that roe deer epidermal derivatives can cause occupational respiratory disease in exposed workers and that allergy to this species should be considered in individuals who present with similar symptoms and exposure histories. Immunoblot inhibition studies suggested the possibility of cross-reaction between roe deer proteins and cow proteins.     

Asymptomatic skin sensitization to birch predicts later development of birch pollen allergy in adults: a 3-year follow-up study

BACKGROUND: The skin prick test is the allergologic test of choice, but asymptomatic skin sensitization to aeroallergens is common. However, no data in the literature describe the clinical phenotype of asymptomatic sensitized adults. OBJECTIVE: The purposes of this investigation were to provide a clinical characterization of skin test-positive subjects without symptoms and to ascertain the predictive values of common allergologic tests. METHODS: Asymptomatic adults with positive skin prick test results for birch (n = 15), nonatopic control subjects (n = 25), and birch pollen-allergic patients (n = 6) were followed through use of daily diary cards during 3 consecutive birch pollen seasons. At inclusion and at the 3-year follow-up visit, conjunctival and nasal challenges, intradermal late-phase reaction evaluation, and measurement of specific IgE were performed. RESULTS: Asymptomatic sensitized subjects defined a clinically significant phenotype between nonatopic and allergic subjects in terms of specific IgE levels and susceptibility to conjunctival provocation testing. Sixty percent (n = 9) of the asymptomatic sensitized subjects developed clinical allergy. This was associated with an initial birch skin prick test weal diameter of > or =4 mm, a positive conjunctival provocation test result, and specific IgE of > or =CAP class 2, as well as with the presence of other allergies. Specific IgE of > or =CAP class 2 was 87.5% predictive for allergy development, whereas a negative conjunctival provocation test result was 100% negatively predictive. Nasal provocation testing possessed no additional prognostic information. No changes in clinical phenotype were seen in nonatopic or birch-allergic subjects. CONCLUSION: Asymptomatic skin sensitization is a risk factor for later allergy development. At risk is any subject with target organ sensitivity, an elevated specific IgE level, and/or a skin prick test weal diameter of >4 mm.     

Occupational rhinoconjunctivitis and bronchial asthma due to Acalypha wilkesiana allergy.

BACKGROUND: Acalypha wilkesiana, or copperleaf, is a plant of the Euphorbiaceae family. Although it is widely known as an outdoor ornamental plant, no cases of A. wilkesiana allergy have been reported to date. OBJECTIVE: To describe a patient with occupational respiratory allergy to A. wilkesiana. METHODS: Extracts from A. wilkesiana leaves and flowers were used for skin prick testing, specific conjunctival and bronchial challenge tests, and in vitro studies. These studies range from A. wilkesiana specific IgE determination to sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunodetection of A. wilkesiana protein bands in patient serum samples and immunoblot inhibition by preincubation with Salsola kali and Chenopodium album pollen extracts. RESULTS: Our patient had positive skin prick test reactions to A. wilkesiana leaf and flower extracts; negative reactions were found in a control group of 20 atopic patients. On immunodetection of A. wilkesiana extracts in patient serum samples, as many as 9 different IgE-binding proteins, with apparent molecular weights of 16 to 86 kDa, were revealed. Preincubation with S. kali and C. album pollen extracts completely inhibited IgE binding to the A. wilkesiana extract. Specific bronchial challenge resulted in a spirometric 30% decline in forced expiratory volume in 1 second with respect to baseline 1 minute after 1:100 (vol/vol) A. wilkesiana extract solution inhalation; 2 atopic controls had negative bronchial challenge test results. CONCLUSION: Acalypha wilkesiana is a new etiologic agent for IgE-mediated occupational respiratory allergy.     

Relationship between the results of bronchial, nasal and conjunctival provocation tests in patients with asthma

Skin tests and bronchial, nasal and conjunctival provocation tests with pollen and animal dander allergens were performed in thirty patients with atopic asthma. In vivo test results were compared only when the same batch of allergen had been used. A nasal reaction was mostly elicited at a lower concentration of allergen than was needed to elicit a bronchial reaction (P < 0·01). Positive nasal reactions were often obtained when the corresponding bronchial tests were negative. The conjunctiva reacted to lower concentrations than the bronchi in a third of the instances of testing, with most of these being tests with mugwort allergen (P < 0·05). A positive skin test in cases with a negative bronchial challenge test was often accompanied by a positive nasal test and in some cases by a positive conjunctival test. It is concluded that nasal or conjunctival provocation tests do not replace bronchial challenge tests. In an asthmatic patient who gives no reaction to bronchial challenge with a particular allergen, a positive skin test may reflect a nasal allergy.     

Allergic conjunctivitis to chamomile tea

Eye washing with chamomile tea is a folk remedy used by the general public to treat conjunctivitis and other ocular reactions. Chamomile is also found in many cosmetic products. Some cases of contact dermatitis (but not reactions of type I) were reported following its topical applications. We present seven hay fever patients that suffered from conjunctivitis; two of them also had lid angioedema after eye washing with chamomile tea. All seven patients had positive skin prick tests to the chamomile tea extract, Matricaria chamomilla pollen and Artemisia vulgaris pollen extracts. Positive conjunctival provocations were also observed in all the patients with the chamomile tea extract. In contrast, no symptoms were observed after oral challenges with this infusion. IgE activity against chamomile tea and Matricaria and Artemisia extracts (composite pollens) was detected by ELISA in the seven patients' sera. A cross reactivity among the above extracts was observed by an ELISA inhibition study. In all cases, the IgE activity to chamomile tea could fully be absorbed by Matricaria pollen extract. Skin prick tests and conjunctival provocation tests also performed in 100 hay fever controls revealed a positive immediate skin response to Artemisia in 15 patients, eight of them also to Matricaria pollen and five of them to Chamomile tea as well. Only two of the last patients had a positive conjunctival response. The results were negative in the rest of the controls. We conclude that the chamomile tea eye washing can induce allergic conjunctivitis. Matricaria chamomilla pollens contained in these infusions are the allergens responsible for these reactions.     

Comparison of conjunctival and nasal provocation test in allergic rhinitis to house dust mite

BACKGROUND: Nasal allergen provocation tests (NPTs) are useful in confirming the diagnosis of allergic rhinitis, if data obtained by clinical history, skin tests and specific IgE determinations are not conclusive. Since NPTs are laborious, conjunctival provocation tests (CPTs) appear as an attractive alternative. The concordance of CPTs and NPTs with house dust mite allergen extract in sensitized and nonsensitized subjects should be evaluated. METHODS: 50 otherwise healthy subjects with self-reported house dust mite allergy and positive skin prick tests and serum specific IgE to Dermatophagoides pteronyssinus and 45 sex- and age-matched healthy controls without allergic symptoms were included. For NPTs, 100 microl allergen extract [10,000 allergy units (AU/ml)] were applied to the less congested nasal cavity. A clinical symptom score and active anterior rhinomanometry were employed to assess the response. For CPTs, 50 microl low-concentrated D. pteronyssinus extract (1,000 AU/ml), and if negative, 50 microl normally concentrated extract (10,000 AU/ml) were applied to the lower conjunctival sac. The response was assessed employing clinical symptom scores. RESULTS: NPTs and CPTs yielded concordant results in 90% of the subjects successfully tested (Cohen's kappa = 0.78, p < 0.0001). The diagnostic efficacy of the CPT, with the NPT as the reference method, was 89%, whether or not conjunctival symptoms had been reported in addition to rhinitis symptoms. Both techniques were judged almost equally uncomfortable. CONCLUSION: CPTs are an acceptable alternative to NPTs in patients with allergic rhinitis to house dust mite, even if they have no conjunctival symptoms.     

Mesquite pollen—an aeroallergen in asthma and allergic rhinitis

Skin reactions to mesquite pollen extract occurred in 62% of 100 consecutive patients tested at an adult allergy clinic despite absence of the plant within about a 50-mile radius. Radioallergosorbent test (RAST) studies confirmed that the skin tests represented specific IgE antibodies to the mesquite pollen. Nasal, conjunctival, and bronchial challenges indicated that mesquite provoked symptoms in a specific manner. The pollen was trapped at a considerable distance from its source. Mesquite surveys and climatologic data suggested a route and method of transport. Mesquite pollen is a potent allergen capable of evoking immediate hypersensitivity reactions in a susceptible population remote from the plant source.     

Sensitization to Zygophyllum fabago pollen. A clinical and immunologic study

Zygophyllum fahago is a herbaceous plant found widely in the Mediterranean area. There are no previous reports of its allergenicity. An aerobiologic and clinical survey was conducted in Murcia, southern Spain, to determine the quantity of airborne pollen and establish the possible role of this pollen as a cause of allergic symptoms. With a Hirst volumetric trap, we determined the atmospheric concentrations of this pollen in 1993, 1994,1995, and 1996. Of 1180 patients tested, 181 (15,34%) had a positive skin test. To determine its allergenicity, we divided 47 patients into three groups: in group 1, all the patients had symptoms of rhinoconjunctivitis plus asthma; in groups 2 and 3, rhinoconjunctivitis. In group 1, we performed a bronchial provocation test (BPT): in groups 2 and 3, we performed nasal provocation (NPT) and conjunctival provocation (CPT) tests, respectively, SDS-PAGE was used to characterize the antigenic fractions and RAST inhibition to determine cross-reactivity with other pollens. The pollen dispersion period is from May to September (445 grains/m³), BPT was positive in 13 of 15 patients, NPT in 14 of 16 patients, and CPT in 13 of 16 patients. RAST inhibition revealed cross-reactivity with Mercurialis, Ricinus, Olea. and Betula. SDS-PAGE identified 25 IgE antibody-binding components, five of which (60, 65, 41, 38, and 15.5/14,7 kDa) were recognized by 40% of the sera. By SDS-PAGE immunoblotting with sunflower antiprofilin rabbit serum and affinity chromatography we established that the Z. fahago extract has profilin. This study shows that this pollen becomes airborne and elicits an IgE response which triggers respiratory symptoms in allergic subjects.     

Clinical pharmacology of H1-antihistamines in the skin

BACKGROUND: Birch pollen is a common allergen in northern, central, and eastern Europe. Earlier studies of specific immunotherapy using birch pollen extract were not placebo-controlled or were only preseasonal. Long-term, placebo-controlled studies with subcutaneously administered standardized birch pollen extract are lacking. OBJECTIVE: The aim of this study was to evaluate the effect of immunotherapy with birch pollen extract on airway symptoms and use of medication in adult birch pollen-allergic patients in a double-blind, placebo-controlled trial. METHODS: Forty-nine patients with histories of birch pollen allergy from the upper and lower airways, positive skin prick test and conjunctival provocation test results, and in vitro specific IgE to birch pollen (Betula verrucosa ) extract were included. Immunotherapy with birch pollen extract was given during 2 consecutive years in a double-blind, randomized, placebo-controlled study. Clinical symptom scores from the upper and lower airways and use of rescue medication were registered throughout the pollen season. RESULTS: Forty-six patients reached the maintenance dose and were maintained on that dose during the 2-year study. The median symptom scores during the 1997 and 1998 seasons were 1.3 and 2.6, respectively, in the specific immunotherapy group and 2.1 and 4.3, respectively, in the placebo group. The differences between the groups were significant (P =.05 in 1997 and P =.005 in 1998). The placebo group used significantly more rescue medication during both seasons than the specific immunotherapy group (P =.004 for 1997 and P =.004 for 1998). CONCLUSION: Specific immunotherapy with birch pollen extract is an effective and safe treatment for reducing clinical allergy symptoms and medication use in birch pollen-allergic patients during the pollen season.     

Immunological studies in vitro and in vivo of children with pollenosis given immunotherapy with an aqueous and a glutaraldehyde-treated tyrosine-adsorbed grass pollen extract

Ten patients treated with an aqueous Timothy grass pollen extract and given monthly maintenance doses were compared to ten patients given a glutaraldehyde-treated tyrosine-adsorbed grass pollen extract as five weekly injections pre-seasonally. There were four non-treated controls. Both treated groups showed equivalent increases of total IgE, Timothy-specific IgE and IgG, but the concentrations of Timothy-specific IgG antibodies were sustained only in the patients receiving maintenance therapy. An increase of IgE and RAST titres during the pollen season were obtained in all three groups. No consistent changes were seen in the results of leucocyte histamine release tests and naso–conjunctival provocation tests from spring to autumn. A Sepharose-protein A technique was used for the estimation of Timothy-specific IgG antibodies. The results obtained with this technique correlated excellently with those of the Farr technique and a double-antibody technique.     

Assessment of sensitization to holm oak (Quercus ilex) pollen in the Mérida area (Spain)

Sensitization to Quercus ilex (holm oak) was studied in 760 patients with clinical suspected sensitization to aeroallergens. Prick tests with commercial extracts of Q. ilex proved positive in 27 patients; none were monosonsitive. Nasal and conjunctival provocation tests and specific IgE (RAST) performed with Q. ilex extracts in these patients were negative in all hut one patient, who exhibited specific IgE: liter by RAST) of 7 PRU ml (class 3). We conclude that Q. ilex pollen, though obtained in considerable quantities by our collector, docs not cause allergies in our area.     

Chicken serum albumin (Gal d 5*) is a partially heat-labile inhalant and food allergen implicated in the bird-egg syndrome

BACKGROUND: Chicken serum albumin (alpha-livetin) has been implicated as the causative allergen of the bird-egg syndrome. However, the clinical relevance of sensitization to this allergen has not been confirmed by specific challenge tests and environmental sampling. We investigated whether chicken albumin can be detected in air samples collected in a home with birds, and whether sensitization to this protein may cause respiratory and food allergy symptoms. The heat resistance of chicken albumin and the possible cross-reactivity with conalbumin were also investigated. METHODS: We studied eight patients with food allergy to egg yolk who also suffered from respiratory symptoms (rhinitis and/or asthma) caused by exposure to birds. Sensitization to egg yolk and bird antigens was investigated by skin and serologic tests. Hypersensitivity to chicken albumin was confirmed by specific bronchial, conjunctival, and oral provocation tests. RESULTS: All patients had positive skin tests and serum IgE against egg yolk, chicken serum, chicken meat, bird feathers, and chicken albumin. The presence of airborne chicken albumin in the domestic environment was confirmed. Specific bronchial challenge to chicken albumin elicited early asthmatic responses in six patients with asthma. An oral challenge with chicken albumin provoked digestive and systemic allergic symptoms in the two patients challenged. IgE reactivity to chicken albumin was reduced by 88% after heating at 90 degrees C for 30 min. ELISA inhibition demonstrated only partial cross-reactivity between chicken albumin and conalbumin. CONCLUSION: Chicken albumin (Gal d 5) is a partially heat-labile allergen that may cause both respiratory and food-allergy symptoms in patients with the bird-egg syndrome.     

Diagnostic Tests in Allergy to Green Coffee

Twenty-two coffee roastery workers with work-related symptoms of various degree from the eyes, nose or bronchi were tested with partly purified water-soluble extract from dust of green coffee beans (GCB). Eighteen persons had a positive prick test, eight a positive bronchial provocation test and seven a positive nasal provocation test. Fourteen had a positive methacholine test, indicating unspecific bronchial hyperreactivity. Specific IgE antibodies to GCB extract were found in sera of 11 workers and to castor bean (CB) extract in 16. The workers measured their lung function with an air flow meter, three times a day for 1 week, and the values were lower in the second half of the week for the workers with IgE antibodies to GCB, but not for the others. It is concluded that the case history, prick test, RAST, and simple lung function tests for one or a few weeks are the best tools when investigating occupational allergy. When the allergen is unknown, but the occurrence of an IgE-mediated allergy is suspected, serial lung function measurements and determinations of total serum IgE, in addition to taking a careful case history, are valuable methods with which to start the investigation.     

Wheat allergy: a double-blind, placebo-controlled study in adults

BACKGROUND: Wheat is believed to be an uncommon cause of food allergy in adults; the number of studies that address IgE mediated wheat allergy in adults is all too few. OBJECTIVE: Determine how many subjects with a history of wheat allergy have real allergy by double-blind, placebo-controlled food challenge; identify the symptoms manifested during the challenge; determine the lowest provocation dose; determine the performance characteristics of wheat skin prick test and specific IgE; identify subjects with real wheat allergy for potential immunoblotting studies. METHODS: Patients underwent skin test with commercial wheat extract; specific wheat IgE was determined. Subjects were challenged with 25 g wheat. Subjects who were positive to raw wheat challenge underwent cooked wheat challenge. RESULTS: Thirty-seven double-blind placebo-controlled wheat challenges were performed on 27 patients. A total of 13 of 27 (48%) patients had a positive result. Eleven subjects with positive raw wheat challenge underwent cooked wheat challenge: 10 were positive. The provocation dose range was 0.1 to 25 g. Twenty-seven percent of the subjects allergic to wheat had a provocation dose that was < or =1.6 g. CONCLUSION: Wheat causes real food allergy in adults. More than a quarter of the patients allergic to wheat reacted to less than 1.6 g wheat. Specific IgE was more sensitive than skin test for wheat; however, specificity and predictive values were low for both tests. Thus, these tests should not be used to validate diagnosis of wheat allergy.     

Australian pine (Casuarina equisetifolia) pollen as an aeroallergen

Sixty-seven nasal and bronchial provocation tests were performed with Australian pine pollen extract (APE) on 61 subjects. A positive nasal response was elicited in 10 of 14 (71%) subjects with allergic rhinitis and positive APE skin tests and in none of 23 control subjects with negative APE skin tests. A positive bronchial challenge was elicited in 5 of 10 (50%) extrinsic asthmatics with positive APE skin tests and in none of 20 control subjects with negative APE skin tests. Australian pine pollen-specific IgE was demonstrated by conventional RAST (greater than or equal to + 1) in 6 of 14 (42%) subjects with a positive nasal challenge, and in 4 of 5 (80%) subjects with a positive bronchial challenge. The Australian pine pollen is an aeroallergen.     

Effect of seasonal exposure to pollen on specific bronchial sensitivity in allergic patients

Bronchial provocation tests with aerosol of birch extract were performed before and after pollen season in 11 sensitized subjects. Changes of metacholine bronchial responsiveness and serum-specific IgE level were also assessed. In five patients who did not take steroids to control their symptoms, both early and late asthmatic responses to inhaled allergen were enhanced after season, whereas IgE serum level, but not methacholine sensitivity, was significantly increased. In six patients who needed steroids, neither responses to allergen nor IgE serum level and methacholine sensitivity were significantly changed after season. For the whole group, the increase in immediate bronchial sensitivity to allergen was positively correlated with the increase in specific IgE antibodies. We conclude that seasonal exposure to pollen has, in sensitized patients, a priming effect on bronchial mucosa that may be blunted by steroid treatment. The increased production of specific IgE antibodies appears to be an important mechanism for this priming effect.     

Occupational rhinoconjunctivitis and asthma in a wool worker caused by Dermestidae spp

BACKGROUND: The family Dermestidae belongs to the order Coleoptera. Occupational allergy has been described in museum personnel. A 31-year-old male wool worker presenting rhinoconjunctivitis and asthma episodes probably linked to exposure to Dermestidae-infected wool was investigated. METHODS: Extracts prepared either from insect bodies or from dust from parasitized wool were used for skin prick testing (SPT), conjunctival and bronchial provocation tests and in vitro determinations. RESULTS: SPT and provocation tests were positive to both extracts. PEFR measurement demonstrated the association between the patient's symptoms and occupational exposure to Dermestidae. Specific IgE to both extracts was detected and immunoblotting revealed several protein bands from 5 to 200 kDa that were reactive to IgE from the patient's serum. CONCLUSIONS: Dermestidae exposure in wool workers when handling parasitized wool can be a cause of IgE-mediated rhinoconjunctivitis and asthma.     

Intradermal skin tests with Dermatophagoides pteronyssinus in asthmatic children: correlation with specific IgE and bronchial provocation tests

The purpose of the present study was to compare the results of the skin tests, the specific IgE levels and bronchial provocation tests in a group of sensitive asthmatic children with a Dermatophagoides pteronyssinus extract standardized by the RAST inhibition method. Skin tests showed a positive ‘end point’ in twelve children of 0.5 U/ml antigen; in eleven 5 U/ml; seven of 50 U/ml; six of 500 U/ml. Specific IgE was present in thirty-three children (92%). A close relationship between positive skin tests and serum IgE levels was found. Bronchial provocation tests were positive in twenty-eight children (78%): eight children with both positive RAST and positive skin tests had negative bronchial provocation tests.