Positive Skin Test Reactions Research Articles

In vitro T-lymphocyte response and house dust mite–induced bronchoconstriction

Background: There is considerable evidence that T cells may play an important role in asthma. The purpose of this study was to determine whether the responsiveness of T lymphocytes to mite allergen stimulation in vitro is a determinant of bronchial response to house dust mite (HDM) allergen challenge in subjects who are allergic to HDM. Methods: Peripheral blood was taken from seven healthy nonatopic subjects and 23 subjects with positive skin test reactions to HDM. Of the subjects in the latter group, 16 had an asthmatic reaction on inhalation challenge with HDM extract (HDM-responders), whereas the remaining seven had a negative reaction (HDM allergic). The proportion of subsets of T lymphocytes and their activation and the amount of IL-2, IL-4, IL-5, and interferon-γ released in the supernatants with and without stimulation with the HDM extract were determined. Results: Without stimulation, the proportions of subsets of T lymphocytes and their activation were similar between groups. When stimulated with the HDM allergen, the proportion of CD4 +CD25 + cells from HDM responders was significantly higher than those in the control group. Comparison within groups of cell cultures with and without stimulation with the mite allergen showed that the proportion of CD4 +, CD4 +CD25 +, CD4 +/CD8 +, and CD3 +HLADR + cells were significantly increased in HDM responders with stimulation; there was a trend for CD4 +CD25 + cells to be increased in the HDM-allergic subjects; no increase in any T-lymphocyte subsets was found in the control subjects. The release of IL-5 was significantly greater in HDM responders than in the other two groups. The severity of the immediate asthmatic reaction was significantly associated with the degree of nonallergic bronchial hyperresponsiveness and the amount of IL-5 released but not with the level of specific IgE to the mite allergen or subsets of T lymphocytes with and without stimulation. Conclusion: The findings suggest that responsiveness of T lymphocytes to allergen challenge in vitro may play a role in determining the bronchial response to the allergen in vivo. (J A LLERGY C LIN I MMUNOL 1996;98:922-31.)

Immediate Hypersensitivity to Human Recombinant Granulocyte-Macrophage Colony-Stimulating Factor Associated with a Positive Prick Skin Test Reaction

Recombinant human granulocyte-macrophage colony-stimulating factor (rhu GM-CSF), also known as sargramostim, is used to accelerate myeloid recovery following bone marrow transplantation or cytotoxic chemotherapy. "Anaphylactic" reactions to sargramostim have been reported on a limited basis and are poorly characterized. It is the purpose of this report to describe an adverse reaction to sargramostim treatment involving palmar itching, urticaria, angioedema, and throat tightness and to demonstrate the utility of prick skin testing to determine type I sensitization. Prick skin testing with 100 and 250 micrograms/mL sargramostim and 300 micrograms/mL rhu G-CSF (filgrastim) was performed in the patient and four control subjects. The patient experienced an immediate wheal and flare reaction with both concentrations of sargramostim while the control subjects demonstrated no reaction. There was also no reaction with filgrastim (rhu G-CSF) in either group and the patient subsequently tolerated filgrastim therapy. Prick skin testing with rhu GM-CSF and rhu G-CSF may be useful to demonstrate type I sensitization. Additional studies are needed to determine the incidence and prevalence of skin test reactions in larger numbers of patients with cytokine therapy exposure.

Adverse reactions to local anesthetics: Analysis of 197 cases

Adverse drug reactions to local anesthetics are frequently reported. However, little is known about the underlying mechanisms. Therefore we investigated 177 patients with a history of 197 events after application of these drugs. The diagnostic approach included prick and intracutaneous tests, provocative challenge tests with causative and unrelated local anesthetics, and in selected cases, radioimmunoassays to detect specific IgE. In addition, tests were performed with preservatives, including sodium metabisulfite and parahydroxybenzoic acid ester. Results of prick and intracutaneous tests with local anesthetics were all negative. Only three patients reacted after subcutaneous challenge with the causative drug (local anesthetics of the amide type). Although one patient showed a delayed-type response to mepivacaine, two patients had immediate-type reactions to articaine and lidocaine. However, in both cases no specific IgE could be detected. In five patients with positive skin test reactions to preservatives, challenge test results remained negative. Two immediate-type reactions were not IgE-mediated. In only one of 197 reported adverse reactions were we able to prove delayed-type allergic response. Therefore true allergic reactions caused by local anesthetics are extremely rare.

IgE and monoclonal antibody binding by the mite allergen Der p 7

The recently characterized group 7 house dust mite allergens give positive skin-test reactions in 53% of allergic patients. This study was performed to compare the IgE binding activity of natural and recombinant Der p 7, to measure the binding in allergic sera in comparison to major allergen Der p 2 and characterize the response by competitive inhibition with monoclonal antibodies. IgE anti Der p 2 and Der p 7 antibodies against the recombinant allergens and monoclonal binding activities were measured by a solid phase radioimmune assay. A competitive binding assay showed that rDer p 7 inhibited 91% of IgE-binding to natural Der p 7 in 2 sera and 73% in a further two. The IgE binding of rDer p 2 and Der p 7 from 41 sera was then compared. Of the sera 88% and 46% respectively showed positive binding. All of the 19 sera which bound Der p 7 also bound Der p 2 but 11 (58%) had bound IgE to Der p 7 as high or higher than the binding to Der p 2. These sera were mostly high responders to both allergens. A panel of six monoclonal antibodies produced against either rDer p 7 or rDer f7 was used for epitope analysis. All of these reacted with each allergen by enzyme linked immunosorbent assay (ELISA) and immunoblotting. Two patterns of cross inhibition of monoclonal antibody binding were observed and of five monoclonal antibodies tested, four could inhibit the binding of IgE (WH9, WH22, WP8 and HD19) while one (WH14) could not. Although Der p 7 only reacts with 50% of allergic sera it often has a high IgE binding activity and may be more important than the major Der p 2 allergen in a high percentage of subjects. The combined competitive inhibition experiments show the IgE response is directed at several specificities.

Positive tuberculin skin test reactions among house staff at a public hospital in the era of resurgent tuberculosis

Background: The number and significance of tuberculin skin test reactions were compared with self-reported baseline values among house staff working in a public hospital. High-risk medical specialties, locations, and infection control practices were examined. Methods: House staff interviews, tuberculin skin test applications, review of employee health service records, and environmental monitoring of high-risk areas were performed. Results: Among house staff self-reported as having negative tuberculin skin test status, 46.2% (95% CI 27.0% to 65.4%) of internal medicine house staff, compared with 4.8% (95% CI 4.3% to 13.9%) of house staff from other areas ( p < 0.005), had positive results on a repeat tuberculin skin testing before graduation. These differences were not entirely explained by the use of surgical masks, year of training, or previous vaccination with bacille Calmette-Guérin. Most skin test reactions (69%) occurrred among house staff who had not been vaccinated with bacille Calmette-Guérin. Increased skin reactivity probably represented excess conversions from unprotected exposure. Tuberculosis transmission was facilitated by delays in diagnosis, inadequate isolation facilities, and suboptimal ventilation. House staff did not comply with recommended tuberculosis surveillance because of time constraints, fear, and misunderstandings about tuberculin skin test interpretations in light of previous bacille Calmette-Guérin vaccination. Conclusions: House staff in high-exposure settings with suboptimal environmental controls are at increased risk for tuberculosis infection. Participation in surveillance programs can be increased by enlisting the participation and advocacy of respected medical colleagues, screening house staff differentially according to exposure and job classifications, and more accurately interpreting subsequent test results from baseline two-step testing.

Structural and antigenic studies of cockroach allergens and their relevance to asthma.

Allergic reactions to cockroach (CR) were first described over 30 years ago by Bernton and Brown, amongst patients presenting to their allergy clinic in New York (1). These observations were followed up by several groups, notably by Dr. Kang and colleagues in Chicago in the 1970’s, and it is now well established that CR cause IgE antibody responses; that these responses are often associated with asthma; and that the prevalence of CR asthma in some populations in the U.S. is comparable to that of other common aeroallergens, such as dust mite, cat, and pollens (2, 3). Atopic individuals who live in CR infested housing become sensitized by inhalation of potent CR allergens and produce vigorous IgE antibody (ab) responses. There is a strong association between the development of IgE ab to CR and asthma. In some towns and cities in the U.S., up to 60% of house dust allergic, asthmatic patients become sensitized to CR (2–6). Allergic reactions to CR are not confined to urban or inner city populations, but occur wherever housing conditions sustain extensive cockroach infestation. For example, in Louisville, Kentucky, no differences were found between the prevalence of CR allergy in patients living in inner city or rural areas, with ∼40% prevalence of positive skin test reactivity in both groups being reported in a 10 year retrospective study (7). IgE ab to CR is an important risk factor for Emergency Room admission with asthma and is most commonly found among lower socio economic groups living in sub-standard housing, which in the U.S. often comprise a high proportion of minority groups (African Americans and Hispanics (8–9).KeywordsAllergy Clin ImmunolHouse DustAspartic ProteaseRecombinant AllergenGerman CockroachThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

A major allergen involved in IgE mediated cockroach hypersensitivity is a 90 kD protein with multiple IgE binding domains.

The role of the cockroach as an etiologic agent of respiratory allergic disorders is well documented (1–3). Positive skin test reactivity to whole body cockroach extracts is second only to the house dust mite of the indoor allergens; however, the identification of clinically relevant antigens and an understanding of the immunobiology of cockroach-induced asthmatic reactions is just beginning (4). The prevalence of asthma induced by cockroach exposure has been coupled with the identification of major cockroach allergens ranging in molecular weight from 6,000 to 100,000 daltons (5–10). In earlier experiments, we documented the in vitro translation of RNA from German cockroaches for the presence of IgE-binding proteins (11). In this report, we describe the isolation of a cDNA clone from a cDNA library derived from the German cockroach (Blattella germanica) encoding a major allergen, Bla g 90 kD.KeywordsAllergy Clin ImmunolMajor AllergenIndoor AllergenGerman CockroachCockroach AllergenThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preventive therapy for tuberculosis in HIV infection

An increasing incidence of tuberculosis has been recorded in areas where both human immunodeficiency virus (HIV) and Mycobacterium tuberculosis are prevalent. 98% of HIV-associated tuberculosis cases occur in developing countries, most notably sub-Saharan Africa. This trend has led to the consideration of tuberculosis prevention therapy for HIV-infected patients. The efficacy of isoniazid for this purpose has been demonstrated in numerous clinical trials, but its application has been limited by concerns about hepatotoxicity, non-adherence, drug resistance, and costs. Recommended is the approach adopted in the US of providing a six-month course of isoniazid to those with a positive tuberculin skin test reaction and epidemiologic risk factors; for those already infected with HIV, 12 months of treatment is suggested. Rifampicin preventive therapy is recommended for those infected by isoniazid-resistant bacilli. Needed are studies to assess operational feasibility, cost-benefits, the use of life-long isoniazid preventive therapy in areas of high tuberculosis transmission, and alternative regimens such as short-course multidrug treatment.

Anacardium occidentale (cashew) pollen allergy in patients with allergic bronchial asthma

Background: The cashew tree grows in abundance in the hills and plains of Goa, India. Because of the financial yield, more and more trees are being planted each year. The cashew tree flowers once a year between January and March, but pollination is mostly entomophilous. Objective: For the first time, a study was conducted to establish the possible role of the cashew pollen in triggering allergic asthma. Methods: A stock solution of pollen extract was prepared with the standard weight/volume method for intradermal skin tests and a bronchial provocation tests (BPTs). The protein content of the antigen, estimated with the use of Folin phenol reagent and a spectrophotometer, was 28.72 mg/ml. Ten healthy volunteers and 65 subjects with allergic asthma, as documented by previous positive skin test reactions to various pollens, were studied. Results: Of the 65 patients, 26 (40%) had positive skin test reactions in various grades. BPTs were performed in 22 of the 26 patients after their baseline peak expiratory flow volume was assessed. Twenty (90.9%) patients had a positive BPT result, and the majority of patients had grade III and grade IV reactions. None of the control subjects (n = 10) had positive responses to either intradermal tests or the BPT. Serum IgE levels, estimated by ELISA, were high in patients with positive skin test responses and showed a linear correlation with cutaneous sensitivity. Control subjects showed normal levels of IgE (39.0 ± 7.87 IU/ml). Conclusions: This study provided us with knowledge of an additional pollen, Anacardium occidentale, which could trigger an asthmatic response in allergic individuals. (J ALLERGY CLIN IMMUNOL 1995;95:501-4.)

Long-term Outcome

There are no studies that relate early childhood wheezing to school-age asthma, and relatively few cohort studies have examined the natural history of school-age asthma. Most studies have been conducted on hospitalized or hospital clinic patients, thus leading to possible bias in selection of more severely ill patients. Many were also retrospective in design, thus raising important questions about loss to follow-up. Almost no studies have incorporated a physiologic test of airway reactivity, although several have examined skin-test reactivity. No universally accepted definition of asthma was used in most of the investigations. Finally, no studies have concurrently examined all known main pediatric risk factors such as respiratory infection, active and passive cigarette smoking, and allergen sensitization and exposure and their relationship to the natural history of disease. Twoparticular areas in the natural history of early childhood asthma are poorly understood. First, the fate of wheezy infants and the factors predicting which of these children go on to develop school-age asthma is unclear. Second, we do not know whether early childhood factors such as symptoms, lung function, and airway responsiveness influence the natural history of school-age asthma, specifically maximal-attained FE~, and the presence of chronic symptoms in early adulthood (15-20 yr of age). Almost 40% of children wheeze in the first 3 yr of life, yet the predictors of who will continue to wheeze in later Childhood are unclear. Early childhood lower respiratory illness is a risk factor for later childhood asthma and lower levelsof FE~ (71). Early childhood lower respiratory illness may be a risk factor for adult chronic obstructive pulmonary disease (COPD) (4, 72, 73). Between 30 and 70% of school-age children with doctordiagnosed asthma can expect a marked improvement in their condition or to become symptom-free by early adulthood (72, 74-76). Significant disease will persist in approximately 30% of patients (77). School-age boys with asthma appear to have a better longterm (adult) prognosis than school-age girls (74-76, 78, 79). The incidence of school-age asthma is greater in males until puberty and increases in females after puberty (80, 81).Over 80% of school-age asthmatics have positive skin test reactivity (14, 74-79,82). Children of school age who have continuous respiratory symptoms will have lower levels of lung function and a worse prognosis, as measured by lower levels of pulmonary function (83-85). Airway reactivity in the absence of asthma is associated with differences in lung function growth in school-age children, specifically reductions in FEV2575 in both males and females, larger vital capacities in males, and reduced FE~ in females. Pulmonary function in school-age children with mild asthma has a high tracking correlation and is reasonably predictable. Tracking of lung function also occurs in early childhood (86-89). Available data suggest that adult doctor-diagnosed asthma is associated with an accelerated decline in lung function and, hence, the development of COPD (90-93). The presence of atopic dermatitis in school-age children is associated with more persistent symptoms of wheeze (74-76, 78, 79, 94-97). Wheezing only with respiratory illness is associated with improved lung function and reduced symptoms in early adulthood (71, 72, 98), though one risk factor for wheezing lower respiratory illnesses is low lung function soon after birth (12, 13, 52).

Treatment of seasonal allergic rhinitis with once-daily intranasal fluticasone propionate therapy in children

Purpose: To evaluate the efficacy and tolerability of intranasally administered fluticasone propionate, 200 μg or 100 μg (half the adult dosage) when administered once daily for 4 weeks to children with seasonal allergic rhinitis. Design and setting: Double-blind, randomized, placebo-controlled, parallel-group clinical study in 10 pediatric outpatient centers. Subjects: Children (n = 249), 4 to 11 years of age, with moderate to severe symptoms of seasonal allergic rhinitis, positive skin test reaction to a local autumn allergen, and a history of seasonal allergic rhinitis. Measurements: Clinician- and patient-rated nasal symptom scores (obstruction, rhinorrhea, sneezing, itching), clinician-rated assessment of overall response to treatment, patient-rated nasal obstruction on awakening, and use of rescue medication. Clinicians questioned patients (or parents) regarding symptoms and adverse events. Morning plasma cortisol concentrations and 24-hour urinary excretion of cortisol and 17-ketogenic steroids were evaluated. Results: Intranasal fluticasone propionate, 200 μg or 100 μg once daily, was significantly more effective than placebo in the treatment of seasonal allergic rhinitis in children. Clinician- and patient-rated symptom scores indicated greater improvement in nasal symptoms, including nasal obstruction on awakening, among patients receiving intranasal fluticasone propionate. Overall response to treatment was also significantly greater in the active treatment groups. The two fluticasone propionate groups were not statistically different. Mean morning plasma cortisol concentrations and 24-hour urinary excretion of free cortisol and 17-ketogenic steroids were similar across all groups both before and after treatment. Conclusions: Intranasal fluticasone propionate, 100 μg (half the adult dose) or 200 μg given once daily for 4 weeks is effective and well tolerated in children 4 to 11 years of age with seasonal allergic rhinitis. (J P EDIATR 1994;125:628-34)

Host factors and environmental determinants associated with skin test reactivity and eosinophilia in a community-based population study.

We examined the relationship of host factors (age, gender) and environmental determinants (smoking status, area of residence) to indicators of allergy (skin test reactivity and eosinophil count) in a random population sample in the Netherlands. Positive skin test reactivity was associated with age (decreasing with increasing age), with male gender (versus female gender), and with urban residence (versus rural residence). Positive skin test reactivity was not associated with smoking. Elevated eosinophil counts were associated with male gender (versus female gender), with urban residence (versus rural residence), and with current smoking (versus never smoking). Elevated eosinophil counts were not clearly associated with age (if adjusted for the age-related effects of skin test reactivity). Additionally, this study specifically demonstrates that skin test reactivity increases with increasing eosinophil count and vice versa, indicating that the two traits are interrelated. Furthermore, this interrelationship was demonstrated to be age-dependent (decreasing with increasing age).

An urban outbreak of visceral leishmaniasis in Natal, Brazil

The epidemiological pattern of visceral leishmaniasis in north-eastern Brazil is changing. The disease was typically seen in rural, endemic areas, but is now occurring as an epidemic in the city of Natal where 316 cases have been reported since 1989; 49% were in children less than 5 years of age. The principle clinical and laboratory findings were weight loss, fever, hepato-splenomegaly, anaemia, leucopenia and hypergammaglobulinaemia. Elevated transaminases and hyperbilirubinaemia were also observed. The diagnosis was confirmed in 87% of cases by identifying amastigotes in aspirates from bone marrow or spleen. Five isolates were identified as Leishmania (L.) chagasi by isoenzyme analysis. The mortality rate was 9%; all deaths occurred during the first week in hospital. One person had concurrent human immunodeficiency virus infection. Among 210 household contacts and neighbours of patients from the endemic area examined for evidence of L. (L.) chagasi infection, 6 additional cases of visceral leishmaniasis were diagnosed. Thirtyeight percent of house-mates and neighbours gave a positive Montenegro skin test reaction, indicating prior subclinical infection.

A Sandwich Enzyme-Linked Immunosorbent Assay (ELISA) for the Quantitation of Selected Peanut Proteins in Foods

A sandwich-type, enzyme-linked immunosorbent assay (ELISA) was developed for the detection of selected peanut proteins in foods. Monoclonal antibodies against a series of allergenic peanut proteins were used as the capture antibody. Food sample extracts were then added, and polyclonal rabbit antibodies directed against roasted peanut proteins were employed as secondary antibodies. The amount of allergen bound to the solid-phase was determined by a biotin and streptavidin-peroxidase system. Radioallergosorbent assay (RAST) inhibition studies of the food extracts were done as a comparison. The coefficient of determination for the ELISA and RAST assays was 0.85. Selected food samples were tested by RAST inhibition at another laboratory for comparison. Skin tests were done with selected samples in peanut-allergic adults, and the results correlated to the ELISA and RAST inhibition results.In other studies, defatted peanut protein (0.01 to 5.0%) were added to vanilla ice cream, then extracted and analyzed using ELISA and skin tests. The sensitivity of the ELISA in ice cream was approximately 40 μg/ml. In six of seven peanut-sensitive adults tested, the lowest level of added peanut protein (0.01%, 21 μg/ml) still caused a positive skin test reaction.

Respiratory function and immunological reactions in sisal workers.

A cross-sectional study of respiratory function was performed in 50 sisal textile workers in 1972. Twenty of the 50 sisal workers still employed in the sisal mill were reexamined 19 years later. At the time of the initial study there were higher prevalences of all chronic respiratory symptoms in sisal compared with control workers. By the time of the follow-up study a significant increase had occurred in almost all chronic respiratory symptoms among the 20 sisal workers. At the time of the initial study there were similar and statistically significant across-shift reductions of forced vital capacity (FVC) and the 1-s forced expiratory volume (FEV1) on Monday and the following Thursday of the work week. Across-shift reductions in FVC and FEV1 in the 20 sisal workers at the follow-up study were larger than at the first measurement. Two sisal workers out of 20 (10.0%) had a positive skin test reaction to an extract sisal; both related symptoms of occupational asthma. In two sisal workers (10.0%) increased IgE was measured; one of these had symptoms of occupational asthma. Our data suggest that exposure to sisal dust in the textile industry may, in some workers, cause the development of respiratory difficulties. Immunological testing may be of value in identifying such workers at risk for occupational asthma.

Detection of Rochalimaea henselae in Cat-Scratch Disease Skin Test Antigens

One of the diagnostic criteria for cat-scratch disease is a positive delayed-type hypersensitivity skin test reaction to an antigen prepared from purulent material aspirated from a cat-scratch disease-involved lymph node. Polymerase chain reaction coupled with DNA sequence analysis was used to identify organisms found in these skin test antigen preparations that may be responsible for eliciting this response. Two independent sources of cat-scratch disease skin test antigens yielded DNA sequences characteristic of the newly described rickettsia, Rochalimaea henselae. These results coupled with previous serologic data strongly suggest that R. henselae plays a central role in the etiology of cat-scratch disease.

Fluticasone Propionate Aqueous Nasal Spray Is Safe and Effective for Children With Seasonal Allergic Rhinitis

Fluticasone propionate aqueous nasal spray, a new topical corticosteroid preparation, is effective when given as 200 micrograms once daily in patients (> 12 years of age) with seasonal allergic rhinitis. To evaluate the efficacy and safety of fluticasone proprionate aqueous nasal spray in children aged 4 to 11 years with seasonal allergic rhinitis. Multicenter, randomized, double-blind, placebo-controlled, parallel-group. Two hundred fifty children aged 4 to 11 years with moderate-to-severe nasal symptoms, a positive skin test reaction to a late-summer or autumn allergen, a history of seasonal allergic rhinitis, and documentation of an unsatisfactory response to conventional treatment. Children were randomly assigned to receive fluticasone propionate, either 100 micrograms or 200 micrograms, or placebo, given by intranasal spray once daily in the morning for 14 days. Severity of nasal symptoms (obstruction, rhinorrhea, itching, and sneezing) was recorded on visual analog scales by investigators at weekly visits and by patients (or adult guardian) daily in the evening. According to investigator and patient ratings, both fluticasone propionate 100 micrograms/d and 200 micrograms/d lowered total nasal symptom scores when compared with placebo. Both dosages of fluticasone propionate were more effective than placebo on the basis of investigator-rated overall clinical evaluation of efficacy at the end of treatment, with significant improvement (as opposed to moderate or mild improvement, no change or worsening) noted in 21% to 29% of the active-treatment groups vs 9% in the placebo group. There were no significant differences between the two fluticasone propionate dosages in any efficacy measurement. Morning plasma cortisol concentrations and frequency of drug-related adverse events were similar in the fluticasone propionate and placebo groups. In children as young as 4 years, 100 micrograms of fluticasone propionate aqueous nasal spray given once daily is as effective as 200 micrograms given once daily, the usual adult dose for the treatment of seasonal allergic rhinitis. Both fluticasone propionate dosages were well tolerated and neither dosage appears to interfere with the hypothalamic-pituitary-adrenal axis in children.

Mite allergen content in mattress dust of Dermatophagoides‐allergic asthmatics/rhinitics and matched controls

It has been suggested that the mites Dermatophagoides pteronyssinus and D. farinae are important indoor environmental factors facilitating both the sensitization of atopic subjects and asthmatic attacks of house dust-sensitive patients. Contradictory results have been reported about the current exposure to mites or their allergens among patients and control groups of atopic or non-atopic subjects. In order to determine whether there is a difference in mite exposure levels between D. pteronyssinus-sensitized asthmatics and/or rhinitis and control subjects we considered a case-control study of 70 patients with asthma and/or rhinitis and positive skin test reactions to D. pteronyssinus and twice as many control subjects who were matched as to age and sex. The first control subject for each patient was an immediate neighbour of the patient and the second was patient arbitrarily chosen among hospitalized patients. Mite allergen exposure was measured in mattress dust collected under standardized conditions, by measuring Der p I+Der fI content and by performing a semiquantitative guanine determination (Acarex-test). The content of Der p I and Der fI was very high both in the homes of patients and those of healthy individuals: 69% of the total samples contained more than 10 micrograms Der pI+Der fI/g of dust. There was no significant difference between cases and controls with respect to Der p I, Der fI, Der p I+Der fI content and Acare class distributions. The calculated odds-ratios associated with the Acarex test and the mite allergens did not differ significantly from the level 1.0.(ABSTRACT TRUNCATED AT 250 WORDS)

Toxicity and immediate allergenicity of latex gloves

Surgical latex gloves and a natural rubber latex (NRL) catheter were evaluated for biocompatibility by cell culture methods and Type I allergic reactions in operating room personnel using latex gloves. The prevalence of relevant immediate allergy to NRL was 5.2% when using eluates made from different latex gloves as allergens and the skin-prick test methodology. The reliability of a questionnaire in detecting the sensitized persons was limited. Weak positive skin test reactions to surgical latex glove eluates were found to be unreliable as compared with challenging with the corresponding glove. Latex gloves exhibited more toxicity in cell culture than non latex gloves, but, inversely, the toxic catheter gave weak positive skin-prick test reaction in only one sensitized person, confirming that the allergenicity and toxicity of natural rubber products do not refer to the same properties of the products. Catheters exhibiting toxicity in cell culture have earlier been found to cause significant clinical symptoms in operated patients, but in the case of surgical gloves this relationship is not clear. One glove brand with a low content of known sensitizing rubber chemicals caused clear toxicity in cell culture but was well tolerated by the hospital personnel.

Once daily fluticasone propionate is as effective for perennial allergic rhinitis as twice daily beclomethasone diproprionate

Background: Fluticasone propionate aqueous nasal spray, a new potent corticosteroid, is effective when given once or twice daily for seasonal allergic rhinitis. Methods: Fluticasone propionate was compared with beclomethasone dipropionate in a multicenter double-blind, randomized, placebo-controlled, parallel-group study in 466 patients with perennial allergic rhinitis. Adults and adolescents (aged 12 to 71 years) with moderate to severe symptoms, nasal eosinophilia, and a positive skin test reaction (≥ 2+) to a perennial allergen received fluticasone propionate aqueous nasal spray 100 μg twice daily or 200 μg once daily, or beclomethasone dipropionate aqueous nasal spray 168 μg twice daily, or placebo for 6 months. Results: Clinician- and patient-rated scores for nasal obstruction (including obstruction on awakening), rhinorrhea, sneezing, and nasal itching were reduced by the first visit at 7 days after initiation of active treatment and remained lower than those of patients receiving placebo throughout the 6-month treatment period. Nasal eosinophilia was reduced in significantly more patients receiving active treatment. The incidence of adverse events was similar in all four treatment groups except for blood in nasal mucus, which was reported by significantly more patients in the two twice-daily active treatment groups compared with the placebo group. There was no evidence of systemic effects of fluticasone propionate. There were no significant differences between fluticasone propionate given once or twice daily or beclomethasone dipropionate given twice daily for any efficacy or safety evaluation. Conclusions: Fluticasone propionate aqueous nasal spray given once daily in the morning is safe and effective therapy for perennial allergic rhinitis and is as effective as twice daily dosing with fluticasone propionate or beclomethasone dipropionate.