A hypereosinophilic syndrome mimicking rheumatoid arthritis

A 58 year old white man presented with an articular syndrome that appeared clinically to be rheumatoid arthritis with nodules. Lack of response to therapy, and laboratory and pathologic data failed to confirm the diagnostic impression. The patient's course over the ensuing seven years was compatible with the hypereosinophilic syndrome. The articular involvement represented soft tissue and synovial fibrinoid degeneration with eosinophilic infiltration. This is the first reported case of articular involvement in the hypereosinophilic syndrome and adds it to the list of processes that can cause hand deformity resembling rheumatoid arthritis.     

Nasal challenge testing in grass pollen hay fever.

Nasal sensitivity to rye grass pollen allergens was evaluated by provocation testing in patients with hay fever due to grass pollen using measurements of nasal airways resistance (NAR), a reproducible system for delivery of allergen, and stringent criteria for allergen storage. Reproducibility was assessed in 24 subjects with hay fever by nasal provocation with serial dilutions of Lolium perenne allergens on 3 occasions: during the grass pollen season, immediately after the season, and in early winter. Threshold doses of allergen required to double the saline control NAR or to provoke persistent sneezing and rhinorrhea were slightly higher 1 mo after the pollen season, but there was no significant differences between threshold doses during the pollen season and 8 mo later. When the threshold doses during challenges were exceeded, there were late reactions in 4 of 24 patients. Normal subjects and patients with perennial rhinitis and with negative skin tests to L. perenne extract were unresponsive in nasal challenge tests.     

How Does the Gus Schumacher Nutrition Incentive Program Work? A Theory of Change

Increased fruit and vegetable (FV) intake is associated with decreased risk of nutrition-related chronic diseases. Sociodemographic disparities in FV intake indicate the need for strategies that promote equitable access to FVs. The United States Department of Agriculture’s Gus Schumacher Nutrition Incentive Program (GusNIP) supports state and local programs that offer nutrition incentives (NIs) that subsidize purchase of FVs for people participating in the Supplemental Nutrition Assistance Program (SNAP). While a growing body of research indicates NIs are effective, the pathways through which GusNIP achieves its results have not been adequately described. We used an equity-focused, participatory process to develop a retrospective Theory of Change (TOC) to address this gap. We reviewed key program documents; conducted a targeted NI literature review; and engaged GusNIP partners, practitioners, and participants through interviews, workshops, and focus groups in TOC development. The resulting TOC describes how GusNIP achieves its long-term outcomes of increased participant FV purchases and intake and food security and community economic benefits. GusNIP provides NIs and promotes their use, helps local food retailers develop the capacity to sell FVs and accept NIs in accessible and welcoming venues, and supports local farmers to supply FVs to food retailers. The TOC is a framework for understanding how GusNIP works and a tool for improving and expanding the program.     

Articular manifestations of polymyositis and dermatomyositis.

Nine patients with polymyositis or dermatomyositis associated with arthritis without antinuclear antibodies have been studied. In eight patients a mildly inflammatory nonerosive arthritis occurred coincident with early manifestations or before the appearance of symptomatic muscle disease. Hands, wrists and knees were prominently involved. This arthritis responded to corticosteroids given for the myositis. One patient had erosive arthritis and periarticular calcifications associated with acute inflammation that seemed to diminish with colchicine therapy. Synovial biopsy specimens showed surface fibrin deposition, focal loss of lining cells and mild inflammation--findings similar to those in scleroderma. By electron microscopy tubuloreticular structures were found in vascular endothelium in synovium, as in other tissues in polymyositis. All patients surprisingly had pulmonary manifestations suggesting the possibility that the condition in this group of patients may represent a distinctive subset of polymyositis.     

Primary interaction between antibody and components of Alternaria. I. Immunology and chemical characteristics of labeled antigens.

Components were isolated from Alternaria tenuis and its culture filtrate, and were radiolabeled with 123-I. The labeled antigenic components had a high polysaccharide content as determined by staining patterns following electrophoresis in polyacrylamide gels and by inactivation with sodium metaperiodate. A primary binding test was employed to detect and measure serum antibodies to the components from A. tennuis. This procedure was more sensitive in detecting antibodies that bound to antigens than were comparable tests dependent upon precipitin types of reactions. The labeled components of A. tenuis cross-reacted or shared antigens with 3 other species of molds: Stemphylium sp., Curvularia sp., Aspergillus fumigatus, but not with a variety of other fungal and nonfungal materials.     

Allergy to murine antigens in a biological research insitute

Symptomatic and immunologic responses to allergens from laboratory mice were studied in a research institute. Subjects who had been exposed to mice and 50 unexposed subjects were studied by questionnaire and by prick tests with seven prevalent aeroallergens and allergens from mouse urine and pelts. Of the 121 exposed subjects. 39 (32.2%) had respiratory, ocular, or cutaneous symptoms after exposure to mice; occurrence of these symptoms correlted with positive skin tests to purified mouse urinary proteins (MUP) and pelt allergensfrom CBA/H mice. Serum levels of IgG antibodies correlated with the frequency of mouse exposure. In subjects with seasonal allergic rhinitis, nasal symptoms from exposure to mice, positive prick tests to MUP, and IgE antibodies to MUP were significantly more prevalent. The possibility of genetic influences on susceptibility to mouse allergy were also suggested by a negative association between the incidence of HLA-DRW6 and positive prick-test responses to urinary proteins from C57BL and BALB/c mice among the 54 subjects who were exposed to mice and tested for DR locus antigens (p = 0.05). However, no significant differences in any of the loci studied culd be shwn in subjects with and without nasal symptoms from exposure to mice.     

Arthritis in acute hepatitis and chronic active hepatitis. Pathology of the synovial membrane with evidence for the presence of Australia antigen in synovial membranes

Arthritis seen in the prodrome of acute viral hepatitis and as an early manifestation of chronic active hepatitis has been studied in two patients. Both patients had very low levels of serum complement and circulating Australia antigen which suggested the possible mechanism of immune complex deposition in some tissue injury. The synovial effusion in acute hepatitis was inflammatory, but neither synovial membrane showed more than rare inflammatory cells. Evidence for Australia antigen in the synovium was obtained by direct immunofluorescence and by electron microscopic identification of 200 to 250 Å and 400 to 600 Å particles in vessel endothelium, synovial lining cells and other deep synovial cells. Cell injury in synovial cells containing virus-like particles suggests that direct virus effect on the synovium may be the mechanism for production of arthritis.     

Variability of Alternaria alternata: Biochemical and immunological characteristics of culture filtrates from seven isolates

Biochemical variability of culture filtrates from the common allergenic mold Alternaria alternata was studied. Differences between culture filtrates from 7 different isolates and between 4 batches of culture filtrate from the same isolate were observed, suggesting the unreliability of presently employed biochemical methods in the routine standardization of mold allergens and the possibility of difficulties in developing standard techniques for their purification. Dextranases, cellulases, and agarases, found in one culture filtrate, may be a further source of problems in laboratory techniques employing A. alternata. The proportions of nitrogen: carbohydrate: dialyzed dry weight were different in culture filtrates from each isolate. Polysaccharides in culture filtrates from 3 of the 7 isolates contained glucose, mannose, xylose, galactose, and a fifth, unidentified sugar. Polysaccharides from one isolate lacked xylose, and the fifth sugar was not demonstrable in 4 of the isolates. Despite the biochemical differences, extensive antigenic cross-reactivity between different isolates was found in precipitin studies and inhibition of antibody binding.