Allergic Population Research Articles

Irritant Rhinitis in Allergic, Nonallergic, Control and Chronic Fatigue Syndrome Populations

ABSTRACTBackground: Irritation symptoms after exposure to “nonspecific” stimuli are often attributed to nonallergic rhinitis (vaso-motor rhinitis). This is a heterogeneous syndrome of exclusion based on nasal symptoms with negative allergy skin tests.Method: Control (n = 114) and Chronic Fatigue Syndrome (CFS, n = 120) subjects scored the severity of nasal congestion and rhinorrhea sensations that they attributed to 9 irritants. The sum was the “Irritant Rhinitis Score” (IRS maximum 72). A positive IRS of > 19 defined “Irritant Rhinitis.” Demographic, allergy skin test and other assessments were done to characterize the Irritant Rhinitis population.Results: Irritant Rhinitis was present in 11% of control and 47% of CFS subjects. In multivariate analysis, positive IRS was correlated with a history of rhinitis complaints, systemic complaints such as fatigue, sensations of congestion and rhinorrhea induced by meteorological conditions, tobacco smoke, odors, perfumes, and other volatile materials, and diagnos...

Ragweed in the Czech Republic

During the last years, a well documented expansion ofragweed (Ambrosia artemisiifolia L., Ambrosia trifida L.) over the Mediterranean andtemperate Europe has been in progress. The currentdistribution of ragweed plants in the Czech Republicis summarized and the ragweed pollen concentration asmonitored by 12 pollen stations in the country isdiscussed. The present situation in the ragweed pollensensitization among children and adults with pollenallergy in Brno is described. So far no dangerousexpansion of ragweed plants in our country has beenobserved. Ragweed pollen concentration is occasionallysignificant in the Brno station only, other pollenstations are reporting insignificant amounts ofragweed pollen during August-September periods,although there has been a steady increase in ragweedpollen concentration in the Prague area over the lastfive years. Skin prick tests and/or specific IgEmeasurements with ragweed allergen were performed on94 children with pollen allergy in the Brno region in1995 and on 206, 210 and 229 adult allergic patientsin 1995, 1996 and 1997, respectively. Positive skinreaction or positive specific IgE to ragweed was foundin 22% children and in 25% (1995), 19% (1996) and 25% (1997) adults with pollen allergy. It isconcluded that ragweed does not seem to represent anyimminent major threat to the allergic population inthe Czech Republic until now, however, it remains apotentially very dangerous allergen.

Specific IgE to cross-reactive carbohydrate determinants strongly affect the in vitro diagnosis of allergic diseases

Background: Cross-reacting carbohydrate determinants (CCDs) are antigenic structures shared by allergenic components from taxonomically distant sources. The case history of a patient with a great discrepancy between skin test and specific IgE results led us to investigate the role of these determinants in his specific case and in an allergic population. Objective: We sought to determine the role of CCDs in causing false-positive and clinically irrelevant results in in vitro tests. Methods: The involvement of CCDs was studied by specific IgE inhibition by using glycoproteins with a known carbohydrate structure. Direct and inhibition assays were performed by commercially available systems, in-house ELISA, and the immunoblotting technique. The binding to the periodate-oxidated carbohydrate structure of glycoproteins and allergenic extracts was also evaluated. A comparative study between skin test and specific IgE responses to the antigens studied was carried out in 428 consecutive allergic subjects. Results: All the tests performed suggested that cross-reacting carbohydrate epitopes were the cause of false-positive specific IgE results in one of the commercial systems and the high reactivity in all the solid-phase in vitro tests. None of the cross-reacting carbohydrate allergens yielded a positive skin test response. Periodate treatment caused variable degrees of reduction of IgE binding to the different antigens studied, indicating that CCDs played a different role in each of them. About 41% of patients allergic to pollen had specific IgE for a glycoprotein, without a positive skin test response to the same molecule. Conclusions: CCDs must be taken into account when evaluating the clinical relevance of positive results in in vitro specific IgE assays, at least in the diagnosis of patients with pollen allergy. Commercial systems should be carefully assessed for the ability to detect specific IgE for carbohydrate determinants to avoid false-positive or clinically irrelevant results. (J Allergy Clin Immunol 1999;103:1005-11.)

Relationship between allergic status and specificity of IgG antibody to inhaled allergens: the grass pollen model.

We have previously reported that IgG antibodies from healthy individuals and patients suffering from non-seasonal mite allergy bind to different sets of epitopes on Der p 1, allowing almost complete discrimination of the populations. To confirm this observation in a seasonal allergy model where a clear relationship between allergic symptoms and exposure to the offending agent is established. To investigate whether the pattern of modified specificity is related to the differences in IgG subclass hierarchy usually exhibited by nonallergic and allergic populations. The capacity of individual sera from patients allergic to grass pollen and healthy individuals, including grass pollen-sensitized subjects, to prevent the binding of pooled IgG, IgG1, and IgG4 fractions from grass pollen-allergic patients and healthy individuals to solid-phase bound grass pollen antigen was evaluated in enzyme-linked immunosorbent assay (ELISA) using streptavidin-biotin technology. Specificity controls were performed using sera from patients allergic to cat dander and house dust mite. The capacity of sera to prevent the antigen binding of allergic IgG averaged 84 +/- 5% for allergic sera and 53 +/- 6% for healthy sera (P < 0.001 by one-way anova). Conversely, using the antigen-binding capacity of healthy control IgG as reference, percentage inhibitions averaged 46 +/- 9% in grass pollen-allergic subjects compared with 80 +/- 4%, 82 +/- 2% in healthy individuals, and mite- and cat-allergic patients, respectively, resulting in two well-separated populations (P < 0.0001 by one-way anova). Similar results were found regardless of whether pooled IgG1 or IgG4 were used. Together with previous data, our results define a new type of humoral signature in the immune response to inhaled allergens. Allergic and healthy status differ not only in the presence or absence of specific IgE antibody but also in the preferential expression of distinct IgG specificities that are better correlated with clinical manifestations and are unrelated to subclass distribution.

Ophthalmic manifestations of allergic fungal sinusitis

PURPOSE: To highlight allergic fungal sinusitis as a cause of ophthalmic and sinus problems by identifying the profile of the patient with allergic fungal sinusitis and presenting a successful treatment approach.METHODS: Six consecutive cases of patients with ophthalmic manifestations of allergic fungal sinusitis were reviewed. Ophthalmic findings, sinus involvement, mycology, immune response, imaging studies, and treatment were examined. The characteristics of this patient group with ophthalmic manifestations of allergic fungal sinusitis were compared with those of the general group of patients with allergic fungal sinusitis.RESULTS: All six patients had proptosis. One had symptomatic diplopia and one had visual loss. Imaging studies, fungal characterization, and immune profiles were similar to the reported allergic fungal sinusitis population. After treatment there was no recurrence of ophthalmic or sinus symptoms at a mean follow-up of 34 months (range, 8 to 48 months). There were no complications of treatment.CONCLUSIONS: Initial diagnosis of allergic fungal sinusitis requires suspicion on the part of the ophthalmologist. Proptosis is the most common ophthalmic sign. Differentiation from invasive forms of fungal sinus disease is crucial, because systemic antifungal medication and extensive surgical tissue debridement are not required in allergic fungal sinusitis. Treatment consists of extirpation of the allergic mucin and fungus, sinus aeration, and systemic and topical corticosteroids.

Textile dye contact dermatitis in an allergic population.

Textile dye contact dermatitis in an allergic population.

Occupational allergy in saffron workers.

Sensitization to the flower of saffron, a plant commonly grown in Spain for commercial purposes, and its clinical significance as an occupational allergen were studied. The prick test and RAST, with saffron pollen, stamen, and pistil extracts, were used to evaluate the cutaneous and specific antibody responses in the studied population. Provocation tests in patients with clinical findings were used to verify the implication of saffron components in these symptoms. Fifty saffron workers were evaluated. Three of them were sensitized to saffron pollen and stamen proteins, giving prick and RAST positive values. One patient presented asthma, showing a positive bronchial provocation test, and two patients rhinoconjunctivitis, showing positive conjunctival provocation tests. Of a general allergic population of 237, 10 patients also presented cutaneous test and IgE positive to saffron. Saffron allergens (from pollen and stamens) were characterized by SDS-PAGE immunoblotting. A relevant allergen of 15.5 kDa with profilinic nature was detected and further purified by high-resolution gel filtration chromatography. No allergenic components were demonstrated in pistils. Cross-reactivity of saffron extracts was evaluated by RAST inhibition with respect to other pollen species commonly causing sensitization in the same area of study. A significant degree of cross-reactivity was demonstrated between saffron and Lolium, Salsola, or Olea. The identification of the protein components involved in the cross-reactions was investigated by blot inhibition.

Diminution of T cells with γδ receptor in the peripheral blood of allergic asthmatic individuals

T cells are shown to regulate allergy and asthma. They are heterogeneous by virtue of surface receptor subtypes (alpha beta and gamma delta receptors), however, their pathophysiological roles in asthma are unclear. The present study employed flow cytometric analysis to compare the size of T-cell subsets and eosinophils present in the peripheral blood of healthy, allergic and allergic asthmatic individuals. Current results demonstrated that the percentages of gamma delta T cells declined from 4.1% in healthy to 3.2% in the allergic subjects and to a significantly lower (P = 0.01) 2.4% in allergic asthmatics. The absolute numbers of circulating gamma delta T cells also were diminished in a similar fashion such that healthy individuals had a significantly higher mean cell count (91.8 x 10(3)/mL) than did allergic asthmatics (47.8 x 10(3)/mL) (P = 0.0266). In contrast, alpha beta T cells were comparable in the healthy, allergic, and allergic asthmatic populations (65.3%, 65.8% and 69.4%, respectively); the differences were not statistically significant. On a populational basis, the proportion of individuals having both gamma delta T cells < or = 4.1% and eosinophils > or = 2.1% was the lowest in the healthy population (30.8%), but was elevated in the allergic group (85.7%) as well as in the allergic asthmatic group (86.6%). However, on an individual basis, those who had reduced gamma delta T cells did not have consistently higher eosinophil counts or IgE level. It was concluded that no significant correlation existed between the levels between gamma delta T cells and eosinophils or between gamma delta T cells and IgE present in the peripheral blood. This report, for the first time, documents that allergic asthmatics have reduced gamma delta T cells with reciprocally elevated eosinophil numbers in their peripheral circulation. However, it does not indicate that the reduction of gamma delta T cells directly correlates with the predominance of eosinophils of IgE levels in the diseased populations. The pathophysiological role of gamma delta T cells in allergic diseases awaits further exploration.

Sensitization to Airborne Allergens in Children with Respiratory Symptoms

Allergy is one of the most common causes of respiratory symptoms in children and youth. Evaluate the presence and the type of allergic sensitization in a paediatric population with respiratory symptoms. We studied 564 consecutive children, 5 months to 17 years of age, with a male to female ratio (M/F) = 1.4, referred to our outpatient clinic in a 12-month period retrospectively. Patients were arbitrarily divided into four groups (grs) according to their age: gr1 = 5 months to 4 years old (181 patients), gr2 = 4 to 7 years (201 patients), gr3 = 7 to 10 years (96 patients), and gr4 = 10 to 17 years (86 patients). Sensitization to house dust mites, pollens, animal dander, and molds was determined by skin prick testing. Sensitization to at least one class of allergen occurred in 304 of the 564 patients (53.9%, M/F ratio = 2.0); the percentage of allergic patients increased with age as follows: 29.8% (54 patients) of the patients in gr1, 55.2% (111 patients) in gr2, 68.8% (66 patients) in gr3 and 84.9% (73 patients) in gr4 (chi(2) = 84.1, P < .01). In the entire allergic population and in gr1 to gr3, the most common positive allergic reaction was to house dust mites (P < .01, chi(2) test each comparison). In contrast, gr4 patients showed a nearly equal percentage of sensitization to pollens and to house dust mites (79.5% and 78.1% respectively) (chi(2) = 0.0, P = >.1). Sensitization to only one class of allergen occurred in 51.3% of the allergic patients and the percentage of these monosensitized patients tended to decrease from gr1 to gr4 (chi(2) = 15.2, P < .1). In the monosensitized group, sensitization to house dust mites was the most frequent in gr1 to gr3 (age <10 years) as in the whole sample. In gr4, the frequency of sensitization to house dust mites was similar to that of sensitization to pollens. On the contrary, within the patient group sensitized to two or more allergens (polysensitized patients), sensitization to house dust mites was as frequent as sensitization to pollens already in gr2 as compared with monosensitized patients. In children with respiratory symptoms, the percentage of allergic individuals was high and increased with the age of the patients. This phenomenon was associated with an age-related enhancement in the ratio of polysensitized to monosensitized patients and with an age-related increase in the frequency of sensitization to seasonal allergens (ie, pollens).

Cytokine priming of human basophils: description of allergen 'nonreleasers'.

Interleukins 3 and 5 and GM-CSF enhance histamine release from basophils triggered by various stimuli. In this report, we describe a subset of allergic patients whose basophils release histamine in response to allergen only when primed with cytokine. In the absence of cytokine, there is no detectable response to allergen. These patients, who represent 4-13% of the allergic population, cannot be distinguished by skin test reactivity or severity of allergic symptoms. Allergen nonreleasers tend to have lower titers of allergen-specific IgE than the majority of atopic subjects, but this difference is not significant (average titer of 29.8 for nonreleasers vs. 188 for typical allergies; p = 0.15). They release histamine normally with anti-IgE and with fMLP, indicating that basophils are responsive to signalling through the IgE receptor, and there is no intrinsic defect in degranulation. Thus, in these patients, the IgE-mediated release of inflammatory mediators from basophils is dependent on, rather than merely enhanced by, T cell cytokines. The relationship between these patients and the previously described anti-IgE 'nonreleasers' is discussed.

Antigen sensitivity evaluated by tear-specific and serum-specific IgE, skin tests, and conjunctival and nasal provocation tests in patients with ocular allergic disease.

The potential for ocular allergic patients to have a site-specific antigen sensitisation was investigated using various diagnostic tests of allergen sensitivity in subjects with allergic conjunctivitis (AC: n = 135), vernal keratoconjunctivitis (VK: n = 20), rhinoconjunctivitis (n = 20) or rhinitis (N = 10). In the AC and VK patients, skin tests and conjunctival provocation tests (CPT) were performed, and the levels of specific IgE in serum and in tears were identified. A subgroup of 36 patients was also challenged with a nasal-specific provocation test (NPT). Results showed a poor correlation between skin test results and tear-specific IgE, and also between serum-specific IgE and tear-specific IgE in both AC and VK patients (K < 0.3). CPT and tear IgE were significantly correlated (K = 0.5) in the ocular allergic population. In patients with rhinoconjunctivitis or rhinitis, and in 10 normal subjects, results of CPT and NPT were in 100% agreement. Conversely, in patients with only conjunctivitis, little correlation was found between the results of CPT and NPT (K = 0.3). Tear-specific IgE was the only positive diagnostic sign of antigen sensitivity in 35% of VK patients and 30% of AC patients. These results suggest that the conjunctiva can be a uniquely sensitised target organ in allergic patients.

Regulation of human basophil activation: III. Impairment of the inhibitory effect of Na + on IgE-mediated histamine release in patients with allergic rhinitis

We recently observed that external Na+ inhibited the IgE-dependent human basophil histamine release (HR) in normal subjects. In this article we report differences in the Na+ effect on basophil HR between normal subjects (n = 16) and age matched patients with allergic rhinitis (AR) (n = 18). As expected, in vitro anti-IgE-stimulated basophils from the group with AR released greater amounts of histamine than basophils from the normal group. However, removal of external Na+ (and replacement by N-methyl-D-glucamine) abolished this difference between the two groups. HR in the normal group increased to the same high level as that of the group with AR. By contrast, the release of histamine in the group with AR was not further increased by Na+ removal. Although high releasers were more frequent in the group with AR, the absence of effect after Na+ removal was not due to the high basal release level (in the presence of Na+) because no effect after Na+ removal was also observed with medium releasers. These results strongly suggest that increased basophil HR in populations with AR, and possibly in other allergic populations, is linked to a defect in the inhibitory effect of Na+.

IgE-Mediated Rhesus Monkey Asthma: Natural History and Individual Animal Variation

This report reviews the 20 years of experience with naturally occurring allergy in dogs and allergic rhesus monkeys. The primate model of allergy is characterized by IgE-mediated cutaneous and respiratory responses to Ascaris antigen. Individual assessments of these monkeys have been carried out over several years and separate populations which are analogous to human IgE-mediated allergic populations defined. These populations are as follows: (1) monkeys which have persistent and consistent IgE-mediated cutaneous and asthmatic responses to Ascaris antigen; (2) monkeys which have cutaneous and airway reactivity to Ascaris antigen but in which the airway reactivity subsides and disappears analogous to a spontaneous remission human asthma, and (3) finally, there is a group of animals with cutaneous reactivity but no asthma analogous to humans with a similar absence of asthma. Within these groups the animals, like humans, have individual variations of severity.

Mean wheal diameter in skin tests for castor bean extracts in castor bean allergic workers of eastern Sudan.

The mean wheal diameter by prick test for castor bean (Ricinus communis, Euphorbiaceae) extracts was measured in a castor bean allergic population. Three types of castor bean extracts namely Cimmaron, Pacific and dust (a mixture of Cimmaron, Pacific and hull), were applied at 1/10,000 dilutions with a control solution. The subjects comprised 318 male workers who were divided into four groups with a fifth control group of 63 male workers. The solutions were tested on three subject groups with Cimmaron in the first, Pacific in the second, and dust in the third. All three extracts were applied in the fourth and the control groups. The results have shown that the Cimmaron type gives a larger wheal diameter than Pacific or dust at the same concentration. There were statistically significant differences between the wheal diameters caused by different extracts in the same subjects. The possibility of producing a type of seed containing less amount of allergen could be considered and experimented on by the agricultural research bodies.

Mushroom allergy.

The overall extent of mushroom allergy is not known. It may be very slight (1%) from eating, but could, alternatively, be as prevalent as pollen and mould allergy (10-30% of an allergic population). Aerospora of mushrooms and other woodland fungi, mostly basidiospores, occur in temperature zones in June to November, reaching maximum in August and September in quantities comparable to pollen and mould spores. There are large local and annual variations in species and spore concentrations in different milieus. In SPT and BPT studies about two dozen of these species have been associated with inhalant type I allergy. All species studied so far have yielded positive results. Mushroom allergens have been explored in only two studies. These show that mushrooms are antigenically rich and that a species can have more than one allergen. The difficulties of mushroom allergen research are very substantial because one usually has to rely on naturally growing mushrooms, where allergenic contamination by other allergen sources is frequent. Choice and recognition of species is also difficult. Virtually all known allergenic mushrooms and fungi are universal, growing equally well in Europe and North America. The genus Chlorophyllum occurs only in North America, but its close relatives of the genus Macrolepiota are common also in Europe. Podaxis grows only in desert regions near the equator and is not found in Europe. The majority of the large and more common universal mushroom families has not yet been investigated. The allergenicity of families Cortinariaceae, Russulaceae, Lactariaceae and Boletaceae is totally obscure even though they produce large quantities of spores in the air, particularly in northern Europe.

The pet owner experience.

The sheer frequency of contact with animals poses special problems for the allergist; it is estimated that six to seven percent of the U.S. population suffer from allergies and nearly 25% of the allergic population are sensitive to dogs and cats. That would mean that at least 1.5% of the population is sensitive to dogs and cats, let alone other animals. Considering that over 60% of the country's 85 million households have dogs and/or cats, this poses a problem that should not be ignored. The role of other furred and feathered pets must also be a topic of future research, especially as these animals become more popular. What must be appreciated is that the pet owner experience is so pervasive and of such importance in the lives of people that many people, especially young people, have more contact with animals than even those who work with animals. There is now a great concern for the emotional and economic well-being of those whose occupation involves animal contact, which is most appropriate. It is also time to extend this concern to the many other citizens of this country who share their lives with animals.

Analysis of allergen-specific IgE responses in 341 allergic patients. Associations between allergens and between allergen groups and clinical diagnoses.

An allergic population of 341 patients was studied using 14 different allergen extracts in skin prick tests and radioallergosorbent tests (RAST) in an attempt to identify important allergen sources in the Sydney area and to examine relationships between these diagnostic methods and a number of clinical parameters. A computer based statistical analysis of the data revealed that: (a) male patients showed a significantly higher frequency of skin test reactivity to extracts of house dust and the house dust mite Dermatophagoides farinae; (b) the incidence of positive prick test reactions declined with age; (c) cross-reactive allergenic determinants were found in taxonomically-related extracts (e.g. between different house dust mites, pollens, and fungi); (d) a clear correlation emerged between relative potency using a histamine standard and RAST score which supports the continued use of histamine as a standard in skin prick testing; and (e) important associations between certain allergens and clinical diagnosis emerged (e.g. positive skin test reactions to house dust mites and epithelia but not pollens were associated with asthma).

Leukotrienes and Other Lipid Mediators of Asthma

It is now recognized that, in addition to the preformed mast cell granule mediators, newly generated lipid compounds are likely to be exceedingly important in the mediation of allergic asthma and other atopic diseases. That the initiating event in allergic diseases evokes a far more complex set of biochemical events than those that only lead directly to the release of histamine and other preformed mediators, and that the functional efficacies of the leukotrienes, PGD2, and PAF are significant for allergic pathobiology mandate that the latter compounds will necessarily be subject to efforts for future therapeutic intervention in allergic patient populations.

NASAL RESISTANCE AND NASAL HISTAMINE CHALLENGE IN ALLERGIC SUBJECTS STUDIED BY POSTERIOR RHINOMETRY

Posterior rhinometry allows quantitative measurement of nasal airway resistance and nasal power. We used this research tool in two separate studies. Initially 10 atopic and 6 nonatopic adults had nasal resistance and nasal power measured at 2 hour intervals for 6 hours on two separate days. A computer digital program was used to collect and analyze the data. Statistical analysis showed considerable intra subject and inter subject variability as well as significantly higher mean measurements of nasal resistance in the allergic population. Nonatopic subjects showed very constant lower values for nasal resistance. We then evaluated whether intranasal insufflation of histamine would cause eustachian tube dysfunction (ETD) in atopic adults. These subjects had normal baseline nasal power measurements by posterior rhinometry and normal eustachian tube function by swallow test. All had quantifyable changes in nasal power after a single dose of 0.55 mgm histamine delivered into each nares for 6 seconds. Four of the five atopic subjects had eustachian tube obstruction documented by 9-step tympancmetry within 5 to 20 minutes after peak nasal power was recorded. In both studies, posterior rhinometry was a useful tool to objectively quantify measurement of nasal resistance so that we could document the higher and more variable measurements found in atopic patients and correlate nasal resistance changes caused by histamine with ETD in these patients.

Gypsy moth infestation: Effects on an allergic population

Gypsy moth infestation: Effects on an allergic population