Cat Epithelium Research Articles

Bovine serum albumin contained in culture medium used in artificial insemination is an important anaphylaxis risk factor

To analyze the cause of the anaphylactic reaction after a standard artificial insemination process in a patient diagnosed with asthma. Case report. Residencia Sanitaria Virgen de la Arrixaca (Murcia, Spain) and University of the Basque Country (Vitoria, Spain). A 30-year-old woman with a previous medical history compatible with respiratory allergy who suffered an anaphylactic reaction after an artificial insemination with spermatozoids in capable medium (Upgraded B2 INRA medium; Laboratories CCD, Paris, France). Cutaneous tests and specific IgE levels to inhalant allergens, grass and Olea pollens, and insemination medium were performed. Specific IgE levels to mammal epithelia and bovine serum albumin (BSA). Skin prick tests were positive for inhalant allergens such as mites, cat, dog, horse, and rabbit epithelia, grasses and Olea pollens, and the insemination medium. The beta-lactamic tests were negative. The determination of specific IgE demonstrated positive values to mammal epithelia and mammal serum albumins including BSA. We report a case of an anaphylactic reaction to the BSA included in the insemination culture medium induced by a subclinical sensitivity to serum albumins of mammal epithelia. A previous testing with the medium is recommended and specific testing might be needed in women who have a history of animal epithelium allergies.

Letter to the Editor

The authors (Choo, Caroline, Harlin, Papas, Holden) of Morphologic changes in cat epithelium following continuous wear of orthokeratology lenses: A pilot study appearing in your March issue (31, 2008, 29–37) should be congratulated on conducting a study using an animal model to show the corneal changes induced by a contact lens fitted along the principles of orthokeratology (OK). It is of utmost importance that we visualize on a cellular level the effects of this refractive error correcting modality so that we one day will be able to design a better strategy for the prevention of corneal infection in patients fitted with OK lenses. Indeed, I welcome more research utilizing the advantages of histology.

Importance of animal epithelia as house dust allergens

Among sera from 379 patients with atopy tested with the radio-allergo-sorbent test (RAST) for domestic dust and house-dust mite (Dermatophagoides pteronyssinus), 104 were positive only for house dust. Positive results for both house dust and house-dust mites were obtained in 130, while in 145 the RAST result was positive only for house-dust mites. 104 sera, negative for house-dust mites, were tested by RAST for specific IgE against epithelia from cats, dogs, guinea-pigs, horses and cattle, as well as cockroaches (Blatella germanica). A positive RAST result for at least one of these animal epithelia was obtained in 89.5% of sera, for cockroaches in 7.7%. Cat epithelia were of special importance with respect to both rate and degree of sensitization. Except for dog epithelia, sensitization (as demonstrated with RAST) against the other domestic animal epithelia was more frequent than the history had indicated. After immune-adsorption of its homologous specific IgE with cat epithelia, but not after adsorption with epithelia of dog, guinea-pig, horse and cattle, inhibition of the house-dust RAST level in 60-80% was demonstrated in pool-sera. This finding proves that sensitization to cat epithelia, in addition to house-dust mites, can be the cause of a positive house-dust RAST reaction; cat epithelia are an important allergen of inhalation allergies caused by house dust.

Morphologic changes in cat epithelium following continuous wear of orthokeratology lenses: A pilot study

To investigate the sequence of morphologic changes over time in cat epithelium during continuous wear of orthokeratology lenses. Four 2-year-old female cats were used; one served as a no lens wear control and three wore custom designed Paragon CRT lenses for myopic and hyperopic correction in the right and left eyes, respectively. Lenses were worn continuously and animals were euthanased after 4h, 8h and 14 days. Corneal tissue was fixed then stained with hematoxylin and eosin for histologic evaluation and measurement of epithelial thickness. Average epithelial thickness of control eyes in the centre (38+/-1 microm) and mid-periphery (3.0 mm from the centre, 38+/-2 microm) of the cornea was similar. Epithelial thickness in myopic corrected eyes showed progressive thinning in the centre and progressive thickening in the mid-periphery with increased lens wearing time. Hyperopic corrected eyes showed the opposite pattern of progressive epithelial thickening in the centre and thinning in the mid-periphery with lens wearing time. The epithelium appears to play a major role in the changes induced by orthokeratology lenses. The epithelial effects were dependent on time and lens design. Further studies are needed to determine the mechanisms responsible for these changes.

Analysis of skin testing and serum‐specific immunoglobulin E to predict airway reactivity to cat allergens

When the clinical history is not conclusive, it may be difficult to make an accurate interpretation of the value of skin tests and serum-specific IgE to cat allergens in asthma cases. To analyse the diagnostic efficiency of skin testing (ST) and serum-specific IgE to cat allergens, based on the results of bronchial-specific challenge with cat epithelium. Sixty-four asthma patients (49 with cat exposure and 15 without) who did not clearly relate their asthma symptoms to cat exposure and had a positive skin prick testing and/or a positive cat dander-specific IgE determination (CAP-system) underwent intradermal skin tests and specific bronchial challenge with cat epithelium. The results were analysed by receiver operating characteristics curves (ROC curves) and logistic regression. Sensitivity, specificity, positive predictive values and negative predictive values were calculated for different cut-off points. Twenty-seven patients (42.2%) had a positive bronchial-specific challenge. The area under the ROC curve for serum-specific IgE quantification is 0.85, which makes a good diagnostic tool out of this test. Intradermal ST predicts the outcome of the bronchoprovocation test better than skin prick testing (area under the ROC curve of 0.74 vs. area under the ROC curve of 0.54, respectively). The logistic regression analysis shows that the estimated probability of a positive bronchial challenge is > or =93% if CAP values are > or =17 kU(A)/L, whereas if CAP values are less than 0.35 kU(A)/L the estimated probability of a positive bronchial challenge is 16%. When the intradermal skin test is negative, the estimated probability of a positive bronchoprovocation test is 9%, being the test that better identifies patients with a negative bronchoprovocation test. Levels of serum-specific IgE to cat allergens and intradermal ST can be used to diagnose and treat more accurately asthmatic patients sensitized to cat epithelium when there is uncertainty about cat epithelium causality.

Allergic Asthma and Rhinitis Caused by Household Rabbit Exposure: Identification of Serum-Specific IgE and Its Allergens

Although rabbits are common domestic pets, severe respiratory allergic reactions to rabbits in households are unusual. Ory c 1, a 17-kDa glycoprotein found in saliva and fur, has previously been identified as a major rabbit allergen. In this report, we describe the cases of three patients with rabbit allergy who presented with asthma and/or rhinitis while living in households with detectable levels of serum-specific IgE and major IgE binding components. Three patients with rabbit allergy and 18 unexposed nonatopic healthy controls were enrolled. Enzyme-linked immunosorbent assays (ELISA) for serum-specific IgE and IgG4 to rabbit epithelium and inhibition ELISA were performed followed by sodium dodecye sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and IgE immunoblotting. All three patients with rabbit allergy had high serum-specific IgE antibody levels compared with controls. The results of the inhibition ELISA showed significant inhibition with the addition of rabbit epithelium, whereas no significant inhibition was noted with the addition of cat and dog epithelia. Two IgE-binding components with molecular weights of 16 kDa and 67.5 kDa were identified by IgE immunoblotting. In conclusion, rabbit exposure may induce IgE-mediated bronchial asthma and/or rhinitis in domestic settings.

Skin testing versus radioallergosorbent testing for indoor allergens

BackgroundSkin testing (ST) is the most common screening method for allergy evaluation. Measurement of serum specific IgE is also commonly used, but less so by allergists than by other practitioners. The sensitivity and specificity of these testing methods may vary by type of causative allergen and type of allergic manifestation. We compared ST reactivity with serum specific IgE antibodies to common indoor allergens in patients with respiratory allergies.Methods118 patients (3 mo-58 yr, mean 12 yr) with allergic rhinitis and/or bronchial asthma had percutaneous skin testing (PST) supplemented by intradermal testing (ID) with those allergens suspected by history but showed negative PST. The sera were tested blindly for specific IgE antibodies by the radioallergosorbent test (Phadebas RAST). The allergens were D. farinae (118), cockroach (60), cat epithelium (90), and dog epidermal (90). Test results were scored 0–4; ST ≥ 2 + and RAST ≥ 1 + were considered positive.ResultsThe two tests were in agreement (i.e., either both positive or both negative) in 52.2% (dog epidermal) to 62.2% (cat epithelium). When RAST was positive, ST was positive in 80% (dog epidermal) to 100% (cockroach mix). When ST was positive, RAST was positive in 16.3% (dog epidermal) to 50.0% (D. farinae). When RAST was negative, ST was positive in 48.5% (cat epithelium) to 69.6% (D. farinae). When ST was negative, RAST was positive in 0% (cockroach) to 5.6% (cat epithelium). The scores of ST and RAST showed weak to moderate correlation (r = 0.24 to 0.54). Regardless of history of symptoms on exposure, ST was superior to RAST in detecting sensitization to cat epithelium and dog epidermal.ConclusionFor all four indoor allergens tested, ST was more sensitive than RAST. When both tests were positive, their scores showed poor correlation. Sensitizations to cat epithelium and dog epidermal are common, even in subjects who claimed no direct exposure.

Skin Prick Test Reactivity to Supplemental Enzymes in Cystic Fibrosis and Pancreatic Insufficiency

ABSTRACTBackground:Patients with cystic fibrosis and pancreatic insufficiency take supplemental pancreatic enzymes of porcine or plant origin on a daily basis.Objective:The frequency of immediate skin prick hypersensitivity reactions to such enzymes and the correlations to gastrointestinal symptoms and nutritional status were assessed in a single center prospective descriptive study.Methods:Skin prick tests using five different freshly prepared porcine pancreatic enzyme preparations, one enzyme preparation of fungal origin, porcine meat and cat epithelia were performed in patients with cystic fibrosis and pancreatic insufficiency and in healthy control subjects.Results:Positive skin tests in the 48 patients with cystic fibrosis were no more frequent than in 21 control subjects. No correlations with the frequency of gastrointestinal symptoms, nutritional status and lung function were found.Conclusion:Although immediate hypersensitivity reactions to pancreatic enzyme preparations in subjects with cystic fibrosis are not common, individuals with possible allergic reactions to supplemental enzymes should be identified by skin prick tests and in unclear cases by double‐blind placebo‐controlled provocation tests.

Skin Prick Test Reactivity to Supplemental Enzymes in Cystic Fibrosis and Pancreatic Insufficiency

Patients with cystic fibrosis and pancreatic insufficiency take supplemental pancreatic enzymes of porcine or plant origin on a daily basis. The frequency of immediate skin prick hypersensitivity reactions to such enzymes and the correlations to gastrointestinal symptoms and nutritional status were assessed in a single center prospective descriptive study. Skin prick tests using five different freshly prepared porcine pancreatic enzyme preparations, one enzyme preparation of fungal origin, porcine meat and cat epithelia were performed in patients with cystic fibrosis and pancreatic insufficiency and in healthy control subjects. Positive skin tests in the 48 patients with cystic fibrosis were no more frequent than in 21 control subjects. No correlations with the frequency of gastrointestinal symptoms, nutritional status and lung function were found. Although immediate hypersensitivity reactions to pancreatic enzyme preparations in subjects with cystic fibrosis are not common, individuals with possible allergic reactions to supplemental enzymes should be identified by skin prick tests and in unclear cases by double-blind placebo-controlled provocation tests.

FC‐51 Comparison of intradermal test and antigen‐specific IgE test in 22 cases of feline allergic dermatitis

The usefulness of the intradermal test (IDT) and the serological allergy test (SAT) for detecting antigen‐specific IgE in allergic cats has not yet been established. In this study, we compared the results of IDT with those of SAT and evaluated the clinical usefulness of the two tests for detecting possible allergens in allergic cats. IDT and SAT using eight antigens were performed on 22 cats with intense pruritus after excluding ectoparasites and performing diet elimination tests. Approximately 50% of the cats reacted to at least one allergen by either IDT or SAT, and 36.4% of the cats reacted on both IDT and SAT. In contrast, seven healthy cats did not show any reactions on IDT or SAT. The most commonly detected allergen in both tests was house dust mites (IDT, 36.4%; SAT, 40.9%). Five cats reacted to one allergen and the others reacted to more than one allergen with IDT. Three cats reacted to one allergen with SAT. The following percentage agreement between the results of the two tests was calculated: house dust mites (86.4%), cat fleas (63.6%), grass mix (86.4%), common mugwort (81.8%), cat epithelia (90.9%), ragweed (86.4%), Japanese cedar (90.9%), and plantain (81.8%). The overall mean percentage agreement was 83.5%. In summary, the present study showed good agreement between IDT and SAT for cats, and SAT may be more sensitive than IDT, but less specific for detecting sensitized allergens. Funding: Self‐funded.

Classification of 190 allergens by cluster analysis based on the IgE binding profiles of 483 consecutive food allergic individuals using an immuno-microarray assay

Rationale Understanding the cross-reactivity between allergenic components is important, and has clinical significance for allergen avoidance and immunotherapy. Most studies on cross-reactivity however are limited to a small number of closely related allergens or patient population. A large dataset however may provide new insights to relationships between diverse groups of allergenic components. Methods An immuno-microarray assay was developed for the rapid quantification of specific IgE to a combination of 190 crude allergens (Ong et al., ICACI 2003). A total of 483 consecutive sera from food allergic patients attending an allergy clinic over a one-year period were screened. Cluster analysis based on positive IgE binding reactions (2SD above negative controls) was conducted separately for extracts of animal- and of plant-origins respectively. Results Among the 53 extracts of animal-origin, IgE binding to mites clustered together, but overlapped into a cluster which mostly composed of seafood allergens. Other groups formed include: 1) casein, egg yolk, hamster, together with epithelia from goose, horse, guinea pig, and chicken/duck feathers; 2) German cockroach, American cockroach, fire ant, budgerigar-, rabbit- and goat-epithelia; 3) mosquito, Vespula spp., Dolichovespula spp., Apis mellifera, and cat epithelia; and 4) pork, rabbit meat, beef, mutton, cow epithelia and dog epithelia. Among extracts of plant-origin, including pollen, fungus, fern, yeast and plant-based foods, 7 large clusters were formed, which were not completely corresponding to their phylogenetic classification. Conclusions A pattern of cross-reactivity and co-sensitization was obtained for our population. It would be interesting to evaluate this pattern in several other diverse populations.

Shrimp ingestion dependent exercise induced anaphylaxis

Rationale Exercise induced anaphylaxis caused by exclusive consumption of shrimp is an uncommon occurrence. Case A 23-year-old male medical student with history of allergic rhinitis experienced generalized pruritis, urticaria, dyspnea, and dizziness during cross-country running. He ate shrimp one hour before exercise and the symptoms developed 30 minutes into exercising. He was rushed to the emergency room, found to have tachycardia and hypotension, and appropriately treated with resolution of symptoms. Similar discrete episodes reoccurred twice after eating shrimp followed by exercise. Exercising on an empty stomach, eating foods other than shrimp, and shrimp ingestion without exercise does not cause any symptoms. Results Skin prick tests (SPT) for inhalants and foods were positive to orchard, Kentucky blue grass, Italian rye, red top, Timothy grass, cat and dog epithelium, house dust mites, trout, tuna, clam, lobster, fish, beef, and pork. SPT for shrimp using commercial extract was negative. Open challenge of selected foods with and without exercising revealed no symptoms. However, open challenge to shrimp followed by exercise reproduced his symptoms of anaphylaxis as previously described. Patient did not manifest symptoms of anaphylaxis with the consumption of shrimp without exercise. Conclusion SPT using commercial shrimp extract was of no value. Moreover, ingestion of other foods to which SPT were positive did not provoke exercise dependent anaphylaxis. Only shrimp intake followed by exercise caused anaphylaxis. This observation should increase awareness regarding shrimp as an exclusive cause of food dependent exercise induced anaphylaxis.

THE PREVALENCE AND DIAGNOSTIC VALUE OF SPECIFIC IgE ANTIBODIES TO INHALANT, ANIMAL AND PLANT FOOD, AND FICUS ALLERGENS IN PATIENTS WITH NATURAL RUBBER LATEX ALLERGY.

Background: It is well recognised that natural rubber latex allergy can be associated with serological crossreactivity to plant allergens, especially tropical fruits and Ficus. In contrast, data on the frequency and clinical value of specific IgE antibodies against these allergens remain rare. In addition, little is known about the prevalence and diagnostic value of specific IgE antibodies to classical inhalant and animal allergens in NRL allergic patients.Objective: The purpose of this study was to investigate the prevalence, the sensitivity, and the specificity of these different specific IgE antibodies in patients suffering from NRL allergy.Methods: Serum samples of 42 NRL allergic adults were investigated. All had a history of NRL allergy confirmed by a positive skin test for latex and a positive latex-specific IgE. Samples were analysed for IgE antibodies against 9 plant food allergens (avocado, banana, chestnut, fig, kiwi, papaya, peanut, pineapple and tomato) and Ficus benjamina. A specific IgE quantification for 3 animal food allergens (codfish, cow’s milk, egg’s white) and 8 common inhalant allergens (Dermatophagoïdes pteronyssinus, birch pollen, timothy grass pollen, mugwort pollen, cat and dog epithelium, Aspergillus fumigatus and Cladosporium herbarum) was also performed. Because double blind placebo-controlled challenges could not be considered, for ethical reasons, patient’s food allergy or immediate hypersensitivity for Ficus and inhalant allergens was documented by a standardised questionnaire. Diagnosis of atopy was based on a relevant history and the presence of a specific IgE antibody to at least one classical inhalant allergen. For some IgE determinations presence or absence of cross-reactivity was investigated by CAPinhibition tests.Results: A specific IgE antibody to at least one of the investigated inhalant and animal food allergens was found in respectively 76% and 12% of the serum samples. A plant food-specific IgE antibody was observed in 88% of the serum samples, most frequently to papaya (71%) and least frequently to kiwi (17%). Twentynine percent of the serum samples contained Ficus-IgE. According to the questionnaire and the threshold of 0.35 kUa/L, sensitivity of the plant food IgE antibodies varied between 0% for papaya and 73% for avocado. Specificity varied between 28% for papaya and 91% for kiwi. For Ficus-IgE sensitivity was 20% and specificity 70%. Conclusions: For inhalant and animal food allergens sensitivity and specificity of the IgE quantification correlated generally well with the values obtained in non- NRL allergic adults. Determination of specific IgE to the investigated plant foods and Ficus was not always a sensitive neither a specific test to establish the clinical diagnosis of this allergy.

Anaphylactic reaction after artificial insemination

Bovine seroalbumin is known as an allergen for human beings, but reactions to it in an artificial insemination procedure are much rarer. We report a case of anaphylaxis after intrauterine insemination (IUI) in which sensitization to bovine serum albumin (BSA) is demonstrated. Report the allergy evaluation performed in a patient who suffered a severe reaction immediately after an IUI procedure. A 33-year-old woman was referred because of an anaphylactic reaction after a second trial of IUI. She developed pruritus, abdominal pain, nausea and vomiting, bronchospasm, and generalized urticaria. She had an atopic medical history of pollen allergy and sensitization to cat epithelium. She had never had trouble with minor surgery and she usually uses latex material. She had never received heterologous sera before. Her husband's semen for the IUI was processed in a standard fluid medium called upgraded INRA B 2 (Laboratoires CCD, Paris, France), which contains amino acids, lipids, vitamins, BSA, penicillin, and streptomycin in addition to inorganic salts. Skin prick tests with the medium and BSA 10 mg/mL were positive. In vitro studies demonstrated an immunoglobulin E binding protein of 60 to 65 kDa and mast cells and basophil activation (CD63 expression) against BSA contained in the medium. Cutaneous and challenge tests with penicillin and streptomycin were negative. We consider the BSA in the semen culture medium to be the factor which triggered the anaphylactic reaction. This case supports the authors who state that media free from heterologous proteins should be used for human application, especially on atopic patients, to avoid sensitization.

Efficacy and safety of a standardized sublingual therapeutic vaccine of cat epithelia extract

Efficacy and safety of a standardized sublingual therapeutic vaccine of cat epithelia extract

Epidemiology, clinical features, and immunology of the "intrinsic" (non-IgE-mediated) type of atopic dermatitis (constitutional dermatitis).

Departmentof Pharmacology, University of Bern, Bern, SwitzerlandKey words: atopic dermatitis; clinical features;constitutional dermatitis; epidemiology; extrinsictype; immunopathology; intrinsic type.Prof. Dr B. Wu¨thrichAllergy Unit, Department of DermatologyUniversity Hospital8091 ZurichSwitzerlandAccepted for publication 22 March 2001

Testes cutâneos de hipersensibilidade imediata com o evoluir da idade

OBJETIVO: avaliacao da positividade aos testes cutâneos de hipersensibilidade imediata em criancas com asma bronquica e/ou rinite alergica em diferentes faixas etarias. CASUISTICA E METODOS: foi observada a positividade aos testes cutâneos de hipersensibilidade imediata, por testes de puntura, frente a diferentes alergenos de mesma procedencia: poeira total e Dermatophagoides sp, Dermatophagoides pteronyssinus, Dermatophagoides farinae e Blomia tropicalis, Penicillium sp, Alternaria alternata, Cladosporium herbarium, Aspergillus fumigatus, grama bermuda, capim de pasto, epitelio de cao, epitelio de gato, penas, Blatella germanica, la. Foram selecionadas 713 criancas divididas em grupos conforme a faixa etaria: grupo I (6 a 11 meses), II (1 a 3 anos e 11 meses), III (4 a 8 anos e 11 meses) e IV (9 a 15 anos). Para analise estatistica utilizou-se o calculo do qui-quadrado. RESULTADOS: o total de diferencas significativas entre os varios grupos foi: I e II = 5; II e III = 5; II e IV = 5; III e IV = 6; I e III = 10 e I e IV = 10 CONCLUSAO: concluiu-se que a positividade ao teste de hipersensibilidade imediata foi maior com o evoluir da idade, havendo positividade ja aos doze meses de vida, sendo esta positividade significativamente maior a partir de quatro anos de idade.

Positive skin test and age

OBJECTIVE: To evaluate positive responses to skin tests for immediate hypersensitivity to allergens in children with asthma and rhinitis at different ages. METHOD: We observed positive skin test reactivity in prick tests using fifteen allergens of same origin (total dust and Dermatophagoides sp.; Dermatophagoides pteronyssinus; Dermatophagoides farinae; Blomia tropicalis; Penicillium sp; Alternaria alternata; Cladosporium herbarium; Aspergillus fumigatus; Bermuda grass; forage grass; dog and cat epithelia; feathers; Blatella germanica and wool). We placed 713 selected patients into different age groups - Group I: 6 to 11 months; Group II: 1 to 3 years and 11 months; Group III: 4 to 8 years and 11 months; and Group IV: 9 to 15 years. We used the chi-square test for statistical analysis. RESULTS: The total significant differences between these groups were: I to II = 5; II to III = 5; II to IV = 5; III to IV = 6; I to III = 10; and I to IV = 10. CONCLUSION: Skin test reactivity is acquired progressively with age, and can be observed as early as at 12 months. Reactivity is significantly more positive from the age of 4 on.

Inmunoterapia sublingual con extracto de epitelio de gato. Experiencia personal

Because cats are a common pet in many houses and tourist complexes in the Canary Islands, sensitization to cat epithelium is a frequent problem. A total of 19.2% of patients with intrinsic asthma are sensitized to cat epithelium. In the Canary Islands, the percentage of sensitization among patients with a household cat is 18.1%, which higher is higher than in the rest of Spain (11.9). Many patients with extrinsic asthma sensitized to house dust mites undergo conventional subcutaneous immunotherapy but evolution is unsatisfactory due to sensitization to cat epithelium (whether a cat is present or not). The aim of this study was to evaluate the clinical effectiveness of sublingual immunotherapy with extract of cat epithelium in monosensitized patients with perennial allergic rhinitis and/or bronchial asthma. Forty patients monosensitized to cat epithelium were selected. Of these, 20 were administered sublingual immunotherapy and another 20 received placebo. The following evaluation was carried out in both groups: in vivo and in vitro: symptom score, skin tests, nasal challenge with cat epithelium, specific IgE determination, specific IgG4 and eosinophilic cationic protein. After 1 year of treatment the cumulative dose was 3.6 micrograms of Fe ld I, equivalent to 10 ng/drop. Duration of treatment was 365 days. Our conclusions, based on our patients in the Canary Islands, were the following: 1. Sublingual Fel d I therapy is effective after 1 year of treatment. 2. There were no modifications in IgE, eosinophilic cationic protein or skin tests. 3. An increase in IgG4 occurred which was related to clinical improvement. 4. In general, tolerance was good, except in one patient who presented urticaria and sublingual pruritus. 5. In polysensitized patients, sublingual immunotherapy to cat epithelium is complementary to immunotherapy to dermatophagoides.

Preliminary criteria for the definition of allergic rhinitis: a systematic evaluation of clinical parameters in a disease cohort (I).

The aim of this study is to formulate criteria for the definition of allergic rhinitis. Other studies have sought to develop scoring systems to categorize the severity of allergic rhinitis symptoms but it was never used for the formulation of diagnostic criteria. These other scoring systems were arbitrarily chosen and were not derived by any statistical analysis. To date, a study of this kind has not been performed. The hypothesis of this study is that it is possible to formulate criteria for the definition of allergic rhinitis. This is the first study to systematically examine and evaluate the relative importance of symptoms, signs and investigative tests in allergic rhinitis. We sought to statistically rank, from the most to the least important, the multiplicity of symptoms, signs and test results. Forty-seven allergic rhinitis and 23 normal subjects were evaluated with a detailed questionnaire and history, physical examination, serum total immunoglobulin E, skin prick tests and serum enzyme allergosorbent tests (EAST). Statistical ranking of variables indicated rhinitis symptoms (nasal, ocular and oronasal) were the most commonly occurring, followed by a history of allergen provocation, then serum total IgE, positive skin prick tests and positive EAST's to house dust mite, perennial rye and bermuda/couch grass. Throat symptoms ranked even lower whilst EAST's to cat epithelia, plantain and cockroach were the least important. Not all symptoms, signs and tests evaluated proved to be statistically significant when compared to a control group; this included symtoms and signs which had been considered historically to be traditionally associated with allergic rhinitis, e.g. sore throat and bleeding nose. In performing statistical analyses, we were able to rank from most to least important, the multiplicity of symptoms signs and test results. The most important symptoms and signs were identified for the first time, even though some of these were not included in our original selection criteria for defining the disease cohort i.e. sniffing, postnasal drip, oedematous nasal mucosa, impaired sense of smell, mouth breathing, itchy nose and many of the specific provocation factors.