Contribution of Stabilizing Agents Present in Intravenous Immunoglobulin Preparations to Modulation of Mononuclear Cell Proliferation In Vitro

Intravenous immunoglobulin (IVIG) preparations have been shown to suppress lymphocyte proliferation in vitro. This study aimed to investigate the effects of an IVIG produced by fractionation/DEAE-Sephadex adsorption on lymphocyte proliferation in vitro , with particular reference to contributions of the stabilizing agents present in the IVIG to the modulation of mononuclear cell proliferation. It was found that glycine significantly inhibited stimulation by the mitogenic lectin phytohaemagglutinin (PHA; 58% inhibition, P <0.01). Glucose and human albumin also reduced the response to PHA but to a lesser extent (20% and 30%, respectively). In further experiments the effects of sucrose and maltose, two disaccharides used as stabilizing agents in IVIG preparations, were studied. Three doses were used (2.5m m , 25m m and 250m m ), representing levels likely to be found in vivo after infusion of IVIG at immunotherapeutic doses, on four different proliferative stimuli. Maltose was found to inhibit proliferation to PHA, anti-CD3 and PMA in a dose responsive manner. Sucrose also inhibited proliferation to these stimuli, but a dose response was not observed. For both sugars, only the highest dose (250m m ) inhibited the proliferative response of mononuclear cells to PMA and a calcium ionophore (ionomycin). The repurified IgG component of the IVIG preparation did not inhibit PBMC responses to PHA in this system. Kinetic analyses, in which the sugars were added 24h after proliferative stimuli, indicated that both sugars still inhibited responses to PHA, and, to a lesser extent, PMA, but only maltose inhibited the anti-CD3 response. These findings show that stabilizing agents currently found in commercial IVIG preparations make a significant contribution to modulating mononuclear cell proliferation and need to be considered when assessing the immunomodulatory role of IVIG in vitro.     

Patterns of pesticide usage by cereal crop farmers in Western Australia

In Western Australia there has been an increase in the use of herbicides in recent years due to a change in farming practices. This change, together with more general public concern over exposure to chemicals, has resulted in farmers expressing concern over the possible long term health effects from exposure to herbicides. As part of a long term study of the possible health effects from such exposure, a survey was carried out to establish the extent of pesticide use within the cereal farming community of Western Australia. Of the 9,408 properties surveyed, 2,921 responses were received which represents a 32.2% response rate. The results indicate that a wide range of chemicals are used as insecticides, fumigants, seed dressings, seed pickles, herbicides, and rodent poisons. At the time of the survey in 1985, products containing prespruf and 1,1,1-trichloro-2,2-bis (p-chlorophenyl)ethane (DDT) were the most popular insecticide, and products containing diquat, diclofop-methyl, chlorsulfuron and glyphosate as active ingredients represented the four most popular herbicides.     

Mortality of fire fighters in Western Australia

All except 17 (1.7%) of 990 fire fighters employed by the Western Australian Fire Brigade between 1 October 1939 and 31 December 1978 were successfully followed up to 31 December 1978. Mortality from all causes was less than expected (SMR 0.80 with 95% confidence interval 0.67 to 0.96). There was evidence of the healthy worker effect but none that mortality increased with increasing duration of employment. A small proportional excess of deaths from road traffic accidents ( SPMR 1.66) appeared to be unrelated to fire service. Deaths from other accidents, poisonings, and violence were significantly less than expected (SMR 0.35 with 95% confidence interval 0.10 to 0.90) and may indicate an effect of training and experience on accident proneness. There was no evidence of increased mortality from cardiovascular or respiratory disease, or from any other cause.     

Raised serum levels of CD8, CD25 and beta 2-microglobulin in common variable immunodeficiency.

Soluble CD8, soluble CD4, soluble CD25 (IL-2 receptor), beta 2-microglobulin and the cytokine tumour necrosis factor-alpha (TNF-alpha) were measured in sera from patients with common variable immunodeficiency (CVI). Levels of soluble CD8, soluble CD25 and beta 2-microglobulin but not of soluble CD4 and TNF-alpha were raised significantly above levels in normal sera. Sera from patients with X-linked agammaglobulinaemia, who are also antibody deficient, did not show this marked elevation. The raised levels of soluble CD8, soluble CD25 and beta 2-microglobulin in CVI, correlated with the extent of the defects in the B lymphocytes assessed in vitro, as well as with the clinical severity of the disease. The selective release of these molecules into sera may indicate that abnormal cellular activation occurs in most CVI patients. It is also possible that the raised levels of these soluble molecules play a part in the immunodeficiency.     

Practical management of antibiotic allergy in adults

This review looks at the main issues around immediate hypersensitivity and the role and limitations of testing. The majority of literature on antibiotic hypersensitivity relates to β-lactam antibiotics, mainly because of the heavy usage of this class of drugs. Concerns around cross-reactivity always worry clinicians, particularly in the emergency situation. Reasonable data now exist in relation to β-lactam antibiotics and derivatives, which enable appropriate risk management to be undertaken. The available literature for other classes of antibiotics is also discussed.