RAST Score Research Articles

アレルギー性鼻炎重症例に対するアルゴンプラズマ鼻粘膜焼灼術の治療効果

OBJECTIVES: Argon plasma coagulation (APC), performed as an outpatient procedure, is used to treat severe allergic rhinitis (AR) that is unresponsive to drug therapy. The purpose of this study was to determine the therapeutic effects of APC on patients with perennial AR (PAR) or seasonal AR (pollinosis), and to confirm complications after APC. METHODS: We performed bilateral APC under local anesthesia on 387 patients with PAR or Japanese cedar pollinosis at our clinic between November 2007 and August 2012. Postoperative changes in nasal symptoms including sneezing, nasal discharge and nasal obstruction, and intranasal findings were evaluated using a visual analogue scale (VAS) and the nasal grading score respectively, according to the Practical Guidelines for the Management of Allergic Rhinitis in Japan in 2013. RESULTS: In patients with PAR, the mean VAS scores of nasal symptoms improved in 6 months after APC. The severity of RAST scores to house dust, cauterized level, and nasal septum deviation did not show significant influence on the improvement of nasal obstruction after APC. In patients with pollinosis, the mean VAS score of nasal symptoms showed an improvement of 40-60% for one season after APC. Our data also indicated that the most proper time for APC in seasonal AR was for 2 months before the pollen dispersion. As regards to major postoperative complications, atrophy of the inferior turbinate (8%) and epistaxis (3%) were observed. The patients more than 40 years old and/or with RAST scores less than class 3 to house dust were found as significant high risk factors of inferior turbinate atrophy after APC. CONCLUSIONS: These results indicated that the APC is a useful treatment for patients with AR.

Polymorphisms of the CYP2C19 gene in Japanese patients with aspirin-exacerbated respiratory disease

Polymorphisms of the CYP2C19 gene in Japanese patients with aspirin-exacerbated respiratory disease

Factors influencing patterns of airway response after allergen challenge in patients with bronchial asthma

We examined patterns of airway response of thirty nine asthma patients who had positive responses on allergen inhalation tests. Six types of inhaled allergens were used: house dust mite, animal, pollen, plant, mold, and others. Three patterns of responses were found: isolated immediate asthmatic response (IAR), immediate and late response (Dual), and isolated late asthmatic response (LAR). No relationship was found between the pattern of response and pulmonary function, airway sensitivity, IgE RIST titers, numbers of eosinophils, or concentration of inhaled antigens. Animal antigens tended to cause a dual response, and molds did only rarely. Ten of 39 challenged patients had an isolated LAR, half of which were caused by mold antigen inhalation. RAST scores were lower in isolated LAR than in other responses. Changes in the number and proportion of peripheral leukocytes during the challenge tests were also studied. Total leukocyte count had increased significantly in the isolated LAR group by 24 hours after the inhalation. These results suggest that the pattern of airway response after inhalation depended in part on the type of inhaled antigen, and that non-IgE mediated immune reactions have some role in the isolated LAR.

EFFECTS OF THE NOVEL SYMBIOTIC IMMUBALANCE AS A FOOD SUPPLEMENT IN RELIEVING CLINICAL SYMPTOMS OF JAPNESE CEDAR POLLINOSIS: A PILOT STUDY

SUMMARY 1Probiotics have been suggested to have potential for treating food allergy in small children. Although oral probiotics have been studied extensively in animals and humans for various allergies, their effects on the prevention and/or treatment of pollinosis have not been adequately investigated. 2The aim of the present study was to examine the effects of the novel symbiotic food supplement ImmuBalance (a koji fungus (Aspergillus oryzae) and lactic acid bacteria (Pediococcus parvulus and Enterococcus faecium) soybean fermentation product; Nichimo Co. Ltd, Tokyo, Japan) on the prevention and treatment of allergic reactions in Japanese cedar pollinosis (JCP) during the pollen season. 3An open-label pilot study on seven individuals with JCP was conducted. Each participant received oral administration of 1.0–2.0 g ImmuBalance daily for 3 months, which contained 1.8 ¥ 1010/g heat-killed lactobacteria. Six participants (four men, two women; 26–55 years of age) completed the 3 months of supplementation. One participant was excluded from the study because the JCP-specific IgE in RAST scores was lower than 2 UA/mL. The clinical severity of JCP in past year for each participant was self-evaluated on a five-point scale from 0 to 4, in accordance with the guidelines of the Nasal Allergy Clinic 2002, Japan. 4Self-evaluated overall average symptom scores (1.7 ± 0.8) in the peak pollen season showed significant improvement compared with the past year (3.5 ± 0.5; P = 0.001). Furthermore, the average scores for sneezing and runny nose in the peak pollen season showed significant improvement compared with the past year. The scores for swelling and colour of the mucosa and snivel in the nasal cavity did not increase significantly in the peak pollen season compared with baseline. 5Our studies suggest that dietary ImmuBalance may be effective in the prevention and treatment of JCP. The underlying mechanisms of action and the possibility of a randomized, placebo-controlled trial are being investigated.

Anti-Interleukin 6 Receptor Monoclonal Antibody Therapy Reduced Serum Interleukin 4 and IgE Production in Castleman's Disease.

Multicentric Castleman's disease (MCD) is an atypical lympho- proliferative disorder which is closely associated with dysregulated overproduction of interleukin-6 (IL-6). In the previous report, we showed that the humanized anti-IL-6 receptor monoclonal antibody, tocilizumab (formerly called MRA), was therapeutically effective for the patients with MCD and the safety profile was acceptable relative to the clinical benefit. We also found that serum IgE levels were elevated in some patients with Castleman's disease, which also decreased by IL-6 blocking therapy, suggesting that IL-6 may be involved in IgE production in vivo. To examine whether or not IL-6 serves as a regulator for IL-4, a major class switching factor for IgE, in vivo, we analyzed serum IL-4 as well as IgE levels in patients with MCD before and after the blockade of IL-6 actions utilizing humanized anti-IL-6 receptor monoclonal antibody in the 4-month clinical trial. Twenty-eight patients with MCD were enrolled and received intravenously 8 mg/kg of tocilizumab every two weeks for a total of 4 months. In fifteen of twenty-eight patients, 5–20 mg/day of prednisolone was used 4 weeks prior to study dosing, but the dosage of each patient was not changed during treatment. Serum IL-4 and IgE levels as well as inflammatory markers were monitored. This study complied with all provisions of the Declaration of Helsinki and was conducted in accordance with Good Clinical Practice guidelines. All patients gave written informed consent before participating in this study. Tocilizumab treatment improved the systemic inflammatory manifestations and laboratory markers such as CRP and fibrinogen as we previously reported. Before tocilizumab treatment, serum IL-4 and IgE levels were elevated (median 14.9 pg/mL, range 2.8–228 pg/mL and median 995 IU/mL, range 12–8000 IU/mL, respectively, n=28). Serum IL-4 levels gradually decreased by tocilizumab treatment (median 8.0 pg/mL, range 2.0–257 pg/mL at 6 weeks, n=28, p<0.005 vs. pretreatment; median 6.0 pg/mL, range 2.0–75.6 pg/mL at 16 weeks, n=28, p<0.0001, respectively). Serum IgE levels also significantly decreased at 6 weeks but not at 16 weeks (median 590 IU/mL, range 6–7000 IU/mL at 6 weeks, p<0.005; median 605 IU/mL, range 5.9–16000 IU/mL at 16 weeks, n.s, respectively). In association with the decrease in serum IL-4 and IgE levels, disease activity of atopic dermatitis improved in the patients with atopic dermatitis. IgE RAST scores for Japanese cedar also significantly decreased. IL-6 has been reportedly to direct the differentiation of IL-4-producing T helper cell 2 (Th2), in vitro, but the in vivo action of IL-6 has been controversial. Our findings clearly indicate that IL-6 regulates the IL-4 production, in vivo, and may serve as a regulator not only for B cell differentiation but also for class switching to IgE.

Institution of latex safe environment significantly improves RAST and Symptoms' score in health care workers: Six year follow up study in a tertiary care center

Institution of latex safe environment significantly improves RAST and Symptoms' score in health care workers: Six year follow up study in a tertiary care center

トロンボキサンＡ２受容体きっ抗薬の好酸球への影響

(Background) Ramatroban, which is a thromboxane A2 receptor antagonist, has been demonstrated to improve nasal obstruction. Ramatroban was reported to suppress eosinophil aggregation in the nasal mucous membranes. In this study, we investigated whether ramatroban has an effect on the symptoms of allergic rhinitis and action on eosinophil.(Method) In the present study, ramatroban was administered for one month to 20 patients with perennial allergic rhinitis that was otherwise untreated. We assessed RAST scores, ECP in serum and nasal discharge, the total number of eosinophils and the rate of necrosis in nasal discharge, the number of eosinophils in blood, and changes in self-reported symptom scores after treatment with ramatroban.(Result) After one month of treatment, all three of the major symptoms, sneezing, rhinorrhea and nasal obstruction had clearly decreased. Significant difference in RAST scores was observed after treatment with ramatroban. The amount of eosinophils in nasal discharge did not significantly differ after treatment with ramatroban, but the rate of necrosis of eosinophils was decreased.(Conclusion) All nasal symptoms were improved. Nevertheless, the amount of eosinophils in nasal discharge did not significantly differ, although the rate of necrosis of eosinophils was decreased. This study suggests that ramatroban contributed to preventing local necrosis of eosinophils.

Comparison of 2 RAST scoring methods in assessing hypersensitivity to oak and birch pollen

Rationale Allergen specific IgE measured by the Immunocap™ system is typically reported in KIU/mL as well as in percent of a single standard (ASM system). Abnormal results in one scoring system may coexist with normal results in the other system. Methods 184 patients evaluated for allergic disease underwent serological testing for specific IgE. Results for pollens of the Fagales trees, oak ( Quercus alba) and birch ( Betula verrucosa) were examined with respect to RAST class scores using the CAP™ KIU/mL system and with the alternative scoring system (ASM). Results For both tree pollens, there were 11% more patients who had positive RAST scores utilizing the ASM system compared with the CAP system. High and very high CAP™ scores (>=levels 3) correlated well with ASM class (>=4 scores). However moderate (level 2) CAP™ scores could be either ASM RAST class 2 or 3, and negative (level 0) CAP™ scores were mostly ASM RAST class 0 but sometimes were class 1. Considering all patients with either oak or birch positive RAST scores, the proportion of RAST scores which were discordantly positive for only one Fagales tree was similar utilizing the 2 scoring methods. Conclusions For 2 tree pollens which characteristically elicit strong IgE responses, a higher proportion of positive results are noted when RAST results are scored using the ASM system, mostly due to ASM class 1 increases.

Analysis of Highly Expressed Genes in Monocytes from Atopic Dermatitis Patients

Background: Monocytes, macrophages, and antigen-presenting cells (APCs) are key effectors of both innate and acquired immune responses. Such cells have been implicated in the pathogenesis of some inflammatory diseases. Differential gene expression in CD14-positive cells from patients with atopic dermatitis (AD) was studied using real-time quantitative RT-PCR to measure transcription levels of selected genes. Methods: PBMCs were prepared by Ficoll gradient separation from 30 AD patients (the anti-mite-specific IgE RAST score: 0.75 to >100 UA/ml) and 10 healthy adult individuals (the RAST score: <0.34–0.37 UA/ml) and CD14-positive cells were selected. A total of 64 genes was selected for study from groups of genes with different molecular function. Results: Genes involved in MHC class I antigen presentation, such as β₂-microglobulin, subunits of an immunoproteasome and ATP-binding cassette transporter TAP2 were expressed at higher levels in the AD patients than in the healthy controls. The genes for Toll-like receptors, CD36 and IFNγ receptor were also upregulated in the AD patients. These genes are involved in MHC class I antigen presentation, recognition of bacterial pathogens and apoptotic cells. Conclusions: The upregulation of genes suggests that circulating monocytes in AD patients may be primed to differentiate into effector cells by conditions associated with AD. The upregulation of genes may prove to be a useful marker for AD.

Analysis of Natural History of Japanese Cedar Pollinosis

Background: The marked increase in the incidence of Japanese cedar (Cryptomeria japonica; JC) pollinosis is a social problem in Japan. Elucidation of its natural history is, therefore, essential. Methods: Cross-sectional and vertical-sectional studies were performed regarding the effects of aging on sensitization to Japanese cedar pollen (JCP) and development of JC pollinosis by measuring serum IgE titers to JCP and by oral examination of residents of the Maruyama Town, Chiba, Japan from 1995 to 2001. We also studied the incidence of its spontaneous remission and the background factors. Results: In a vertical-sectional study, the serum IgE titer to JCP was strongly influenced by the amounts of pollen scattered. An increase in age by 6 years did not reduce the IgE titer to JCP in subjects in their 40s. However, in subjects aged 60 or more, annual differences in the JCP count did not affect serum IgE titer to JCP, which remained low even after a season with a high pollen count. In subjects with JC pollinosis aged over 40 showing a CAP RAST score of more than 2 to JCP in 1995, spontaneous remission of JC pollinosis was observed in 16.1% over a period of 6 years. Factors affecting spontaneous remission include sex, age at the time, serum IgE titer to JCP and age at first onset of JC pollinosis. Conclusions: The CAP RAST score was strongly associated with spontaneous remission in the multivariable model.

Clinical characteristics of so called eosinophilic otitis media

Objective: Although ‘eosinophilic otitis media’ is not as uncommon a condition as was previously believed, its cause and pathogenesis are not yet fully understood. The purpose of this study was to describe the clinical characteristics in patients with ‘eosinophilic otitis media’ to clarify its pathogenesis. Methods: Seven adult patients with persistent and intractable otitis media with viscous middle ear effusion containing many eosinophils, who were also under treatment for bronchial asthma, were studied. The following examinations were conducted: nasopharyngeal endoscopy, pure-tone audiometry, eustachian tube function test, temporal bone CT scan, blood analysis, bacterial and fungal culture of middle ear effusion, histological study of the middle ear and nasal specimens, and measurement of eosinophilic cationic protein (ECP) in middle ear effusion. Results: Some patients had persistent perforation with papillomatous granulation tissue arising from the mesotympanic mucosa, and all the patients had nasal polyposis. The pure-tone audiometry showed the mixed-type of hearing loss in all the patients, and the hearing level deteriorated progressively during the course in some patients. The eustachian tube function was not always poor but was patulous in some cases. The most severely diseased areas were in the eustachian tube and mesotympanum by temporal bone CT images. All the seven patients had the high levels of total serum IgE, but the RAST scores were negative in three patients and low grade in three patients. The accumulation of eosinophils was observed in middle ear effusion, middle ear mucosa and nasal polyps, and the eosinophils were highly activated with degranulation. High level of ECP was also recovered from middle ear effusion. Conclusions: Active eosinophilic inflammation occurs in the entire respiratory tract, including the middle ear in these patients. From our present investigation, we propose the criteria and clinical characteristics of ‘eosinophilic otitis media’.

Anaphylactic Reactions to Aprotinin Reexposure in Cardiac Surgery

Aprotinin, a serine proteinase inhibitor, reduces bleeding during cardiac surgery. As aprotinin is derived from bovine lung, it has antigenic properties. This investigation examined the incidence of anaphylactic reactions in patients reexposed to aprotinin and the relation to preformed antiaprotinin immunoglobulin (Ig)G and IgE antibodies. This prospective observational study conducted at five centers in Germany evaluated patients undergoing repeat cardiac surgery reexposed to aprotinin between 1995 and 1996. Antiaprotinin IgG and IgE antibody measurements, using a noncommercial enzyme-linked immunosorbent assay and an immunofluorescence assay, respectively, were performed preoperatively and postoperatively. An anaphylactic reaction was defined as major changes from baseline within 10 min of aprotinin administration of systolic pressure 20% or greater, heart rate 20% or greater, inspiratory pressure greater than 5 cm H2O, or a skin reaction. In 121 cases (71 adults, 46 children), a mean aprotinin reexposure interval of 1,654 days (range, 16-7,136 days) was observed. Preoperative antiaprotinin IgG (optical density ratio > 3) and IgE antibodies (radioallergosorbent test [RAST] score < 3) were detected in 18 and 9 patients, respectively. High concentrations of each (IgG, optical density ratio > 10; IgE, RAST score > or = 3) were detected in five patients. Three patients (2.5%; 95% confidence interval, 0.51-7.1%) experienced an anaphylactic reaction after aprotinin exposure, followed by full recovery; these patients had reexposure intervals less than 6 months (22, 25, and 25 days) and the highest preoperative IgG concentrations of all patients (P < 0.05). Assay sensitivity was 100%, as no anaphylactic reactions occurred in IgG-negative patients (95% confidence interval, 0.0-3.1%); assay specificity was 98%. Preoperative IgE measurements were quantifiable in two of three reactive patients and in three nonreacting patients. Quantitative detection of antiaprotinin IgE and IgG lacks specificity for predictive purposes; however, quantitation of antiaprotinin IgG may identify patients at risk for developing an anaphylactic reaction to aprotinin reexposure.

Involvement of urban living environments in atopy and enhanced eosinophil activity: potential risk factors of airway allergic symptoms.

Airway allergic diseases, such as bronchial asthma and allergic rhinitis, have increased, especially in urban areas. These diseases are characterized by airway inflammation with enhanced eosinophil activity, and the risk of disease development has been shown to increase with the prevalence of atopy. Questionnaires were administered to 426 healthy adult women aged 30-74 years, living in an urban area of Osaka, Japan, to survey individual living environments and airway allergic symptoms such as cough, sputum, and wheezing. Moreover, serum house-dust-mite (Dermatophagoides pteronyssinus, [Der p])-specific immunoglobulin E (IgE) and serum eosinophil cationic protein (ECP) were examined by radioimmunoassay, and the atopic status (atopic sensitization) and enhanced eosinophil activity were assessed as Der p-specific IgE RAST scores of 2-6 and ECP levels of more than 10 ng/ml, respectively. Intensive use of electric air conditioners in hot weather (odds ratio: 2.07 [95% CI: 1.11-3.87]) and mold proliferation in the kitchen (2.77 [1.34-5.73]) significantly increased the risk of atopic sensitization. Poor home ventilation and family smoking appeared to be positively but not significantly associated with atopic sensitization. Personal smoking and intensive use of the air conditioner appeared to be positively related to enhanced eosinophil activity. Atopic status showed significant involvement in the development of wheezing, and the development of cough was significantly associated with enhanced eosinophil activity. The results suggest that some urban styles of living are involved in atopic sensitization and enhanced eosinophil activity in the Japanese urban population, probably due to living conditions, such as indoor dampness and poor home ventilation, caused by tight insulation, which increase exposure to indoor air pollutants, such as respirable mite allergens and tobacco smoke.

Meat allergy: investigation of potential allergenic proteins in beef.

The potential allergenic proteins in beef were investigated. The sera of ten beef-allergic patients suffering from atopic dermatitis and having a positive RAST score to beef, aged 3-18 years, were obtained from Yoshida Hospital in Japan, and five non-allergic individuals were subjected to this study. The sera of the ten patients reacted strongly to a beef extract, but not to pork and chicken extracts by both ELISA and immunoblotting. The sera of the five control subjects did not react to any of these meat extracts. Three bands having molecular masses of approximately 200 kDa, approximately 67 kDa and approximately 60 kDa were observed by immunoblotting after SDS-PAGE. Two fractions of the beef extract from a Sephadex-gel (G-200) filtration column strongly reacted with the sera of the beef-allergic patients by ELISA and immunoblotting: one fraction had the approximately 67 kDa component and the other had the approximately 200 kDa and approximately 60 kDa components. One of them (approximately 67 kDa) was confirmed to be bovine serum albumin (BSA) by an analysis of the N-terminal amino acid sequence. We could not identify the others by sequencing, but the approximately 200 kDa and approximately 60 kDa components were presumed to be glycoproteins. Bovine gamma (BGG:globulin M.W. approximately 160 kDa) is a glycoprotein and has several subunits. The beef-allergic patients showed strong reactivity to the approximately 200 kDa and approximately 60 kDa components of pure BGG by immunoblotting. Inhibition-ELISA showed that pure BGG preparations strongly inhibited the binding of sera from the beef-allergic patients to the beef extract. These results suggest that the approximately 200 kDa, approximately 67 kDa and approximately 60 kDa components in the beef extract had strong allergenicity: approximately 67 kDa was BSA, and approximately 200 kDa and approximately 60 kDa were presumably aggregated BGG and it's heavy chain, respectively.

Effects of ONO-1078 (pranlukast) on cytokine production in peripheral blood mononuclear cells of patients with bronchial asthma.

ONO-1078 (pranlukast) is a leukotriene receptor antagonist developed in Japan. This drug has been shown to be useful in oral treatment of bronchial asthma. The present study was undertaken to assess the effects of this drug on the production of cytokines in the peripheral blood mononuclear cells of patients with asthma under stimulation with specific antigens. Peripheral blood mononuclear cells from mite antigen-positive asthmatic patients (immunoglobulin E RAST score > 3) were incubated for 72 h in the presence of mite antigen (10 microg/mL). The supernatant of the culture was subjected to enzyme-linked immunosorbent assay (ELISA) to quantify interleukin (IL) -4, IL-3, IL-5, and granulocyte macrophage-colony stimulating factor (GM-CSF). Other peripheral blood mononuclear cells from the same patients were incubated for 72 h in the presence of both mite antigen (10 microg/mL) and ONO-1078 (0.5, 1, or 10 microg/mL), followed by ELISA of the supernatant to quantify the cytokines. Production of IL-4, IL-5, and GM-CSF by mononuclear cells under stimulation with mite antigen was markedly suppressed when they were exposed to ONO-1078 at a concentration of 10 microg/mL. The results suggest that ONO-1078 acts directly on peripheral blood mononuclear cells and that blockade of leukotriene receptors on blood mononuclear cells by the cysteinyl-leukotriene receptor antagonist (LTRA) pranlukast (ONO-1078) can dose-dependently inhibit release of immunoreactive TH2-type cytokines (IL-3, IL-4, GM-CSF, and possibly IL-5), but not of the TH1-type cytokine IL-2, when stimulated by mite allergen in vitro. The data may provide clues to the mechanism by which a number of LTRA including zafirulukast and montelukast can reduce airway, sputum and blood eosinophil counts in clinical asthma. It supports animal studies showing that anti-IL-5 antibodies partially block cys-LT-induced airway eosinophilia, suggesting that cys-LTs may cause secondary release of IL-5 from an unknown cell-type. These findings indicate that ONO-1078 suppresses the production of IL-4 (a cytokine that affects IgG antibody production), IL-5, and GM-CSF (cytokines that affect eosinophil activation) by peripheral blood mononuclear cells under stimulation with specific antigens in patients with bronchial asthma. Because of its anti-inflammatory effects, ONO-1078 should be useful in the treatment of bronchial asthma.

Mold testing by RAST and skin test methods in patients with allergic fungal sinusitis

RAST tests have traditionally been considered less sensitive than skin tests during investigation of atopy involving molds. This has been attributed to technical problems such as difficulty in binding the mold antigen to the carrier substrate. Ten patients with proven allergic fungal sinusitis were evaluated for sensitivity to 11 important molds by both RAST and dilutional intradermal testing. A predictable correlation between RAST and skin test scores was observed in many, but not all, cases. Most often this disparity was in the form of greater sensitivity indicated by skin testing than by RAST, sometimes differing by as many as 3 classes. The lack of concordance was not confined to testing for the fungi cultured from the sinuses, nor was it more or less pronounced in the case of dematiaceous fungi. The most likely causes for the disparity noted in this series are subtle differences in antigens used in skin test material and for RAST standards. Skin tests allow for evaluation of delayed and late-phase reactions, a measurement not possible by specific IgE testing with RAST. Delayed skin test reactions were not noted in this series of patients. An additional important finding was the sensitivity of patients with allergic fungal sinusitis to virtually every fungal antigen to which they were tested. (Otolaryngol Head Neck Surg 1999;121:252-4.)

A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy

Background: Skin testing and RASTs are the most commonly used methods for the diagnosis of allergy. Questions remain, however, as to the accuracy of these tests, particularly with regard to the role of intradermal skin tests (IDSTs) in the evaluation of respiratory allergy. Objective: The purpose of this study was to determine the predictive value of skin prick tests (SPTs), IDSTs, and RASTs in the diagnosis of cat allergy. Methods: Patients were challenged with a well-characterized cat exposure model after evaluation by history, SPTs, IDSTs (if SPT results were negative), and RASTs. All patients were evaluated with respect to their upper respiratory responses, although only those patients with asthma were included in the analysis of lower airway responses. Challenge results were considered positive if the mean upper respiratory symptom score was 0.5 or more, the mean lower respiratory symptom score was 0.4 or more, or the maximum fall in FEV 1 value was 15% or more. Results: One hundred twenty patients were evaluated. SPT values were positive in 81 patients; of the remaining 39 patients, IDST values were positive in 26 patients. RASTs were performed in 89 patients; the values were positive in 45 of 51 patients with a positive SPT value and were negative in all patients with a negative SPT value. When any positive challenge outcome was considered, positive challenge results were seen in 38 of 41 patients with a positive SPT score, in 10 of 39 patients with a negative SPT score, in 6 of 26 patients with a positive IDST score, in 4 of 13 patients with a negative IDST score, in 27 of 27 patients with a positive RAST score, and in 12 of 44 patients with a negative RAST score. Conclusion: Although both SPT and RAST values exhibited excellent efficiency in the diagnosis of cat allergy, IDST scores added little to the diagnostic evaluation. (J Allergy Clin Immunol 1999;103:773-9.)

IgE抗体よりみた徳島県南における花粉症

In the southern part of the Tokushima Prefecture, the RAST positive rate for eight pollen antigens was measured in 309 patients with allergic rhinitis between January 1996 and March 1997. The RAST positive rate for cedar pollens and cypress pollens was 72.2 and 59.2%, respectively. The RAST positive rate for two other pollens, orchard-grass pollen and mugwort pollen, was less than 30%, and that for the remaining four pollens, from short ragweed, oak, Japanese white birch and Japanese alder, was less than 20%. Therefore, most patients with pollinosis in Tokushima were allergic to cedar and cypress pollen. Furthermore, the RAST positive rate for dust mites among the 309 patients was 43%. Regarding the age distribution of these patients was concerned, occurence peaked, among teens. The RAST score for cedar pollens was the highest at 4, and that of all the other antigens was less than 2.Of 223 patients who were allergic to cypress pollens, five patients were only allergic to cypress pollens, but the remaining patients were also allergic to cedar pollens.

Correlation between antigen-specific IL-2 response test and provocation test for egg allergy in atopic dermatitis.

The antigen-specific interleukin-2 response (AIR) test using lymphocytes is effective in searching for the antigen which causes allergic diseases and understanding their disease activity. The correlation between the raw egg oral provocation test and egg white antigen-specific interleukin-2 (IL-2) response test was investigated in 123 children with infantile atopic dermatitis and 13 children with bronchial asthma. Among the 83 who showed positive reactions to provocation, 75 also reacted positively to the AIR test (sensitivity, 90.4%), while among the 53 children who showed negative responses to antigen provocation, 45 produced negative responses to the AIR test (specificity, 84.9%). The specificity of egg white IgE RAST score and skin-prick test are 88.7 and 81.3% which are comparable to that of the AIR test. However, their sensitivity was low (38.6 and 66.7%). In the patterns of symptom developed in the provocation AIR displayed late and delayed type allergic responses in addition to the immediate type which RAST reflected. The RAST-negative group composed of 98 patients included 51 (52.0%) who exhibited positive reactions to the provocation test. Among these 44 responded positively to the AIR test (86.3%). The AIR test is effective for screening egg white antigen as part of the tests for antigens responsible for allergic diseases and as a test to ascertain the relevant antigens, and that the conditions that could not be diagnosed by RAST can be detected by the AIR test.

Regulation of peripheral blood mononuclear cell responses to Dermatophagoides farinae by substance P in patients with atopic dermatitis.

Neuropeptides mediate stress-induced cutaneous inflammation such as atopic dermatitis. The effect of substance P on proliferation and cytokine mRNA expression of peripheral blood mononuclear cells in response to Dermatophagoides farinae (Der f) was studied in atopic dermatitis patients with positive RAST scores to Der f. Upon stimulation with Der f peripheral blood mononuclear cells from patients proliferated in a B7-dependent (CD80- and CD86-dependent) manner, while those from the patients with negative scores, nonatopic eczematous dermatitis patients or normal individuals, did not. Based on the reactivity of normal individuals, atopic dermatitis patients with a stimulation index greater than 1.8 were tentatively defined as high responders, who comprised two-thirds of the patients. Proliferation in high responders was associated with upregulation of IL-2 mRNA expression and induction of IL-5 mRNA expression. Substance p at 10(-10) to 10(-8) M promoted the Der f-induced proliferation when added at the start of culture and upregulated IL-10 MRNA expression while downregulating IL-5 mRNA expression. Our results suggest that substance P modifies immune responses of atopic T cells to Der f by promoting proliferation and altering cytokine profiles, and thus modulates the clinical manifestations of atopic dermatitis.