[Decision making in diagnosis and therapy].
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Biomedical subjects
Publications and source records attributed to A Helbling.
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BACKGROUND: Basidiospores are an important cause of respiratory allergy in mold-sensitive atopic subjects. Collection of the large amounts of spores required for extract preparation is tedious and difficult. A desirable alternative could be mycelium grown in vitro if it is allergenically similar to spores. METHODS: Therefore this study compared the allergen contents of Psilocybe cubensis spore and mycelium extracts by different techniques with the use of pooled sera from subjects who had skin test and RAST results that were positive to P. cubensis spores. RESULTS: Isoelectric focusing immunoprints revealed six common IgE-binding bands at isoelectric points 4.7, 5.0, 5.5, 5.6, 8.7, and 9.3. Two additional bands at isoelectric points 3.9 and 5.7 were detected only in the spore extract. Sodium dodecylsulfate-polyacrylamide gel electrophoresis immunoblots exhibited six common IgE-binding bands at 16, 35, 487, 52, 62, and 76 kd; 20 and 40 kd bands were present only in the spore extract. Although RAST and isoelectric focusing inhibition demonstrated that P. cubensis spore and mycelium extracts share many allergens, spores were allergenically more potent than mycelium. CONCLUSION: The results indicate that mycelium is a useful source of P. cubensis allergen, even though several spore allergens were not detected in mycelium.
High atmospheric concentrations of basidiospores occur in various parts of the world. Ganoderma basidiospores are distinctive, easily identifiable in aeroallergen surveys, and widely abundant. Previous studies showed that Ganoderma basidiospores caused respiratory allergies. Thus, we investigated various extracts (spore, cap, and/or mycelial) of G. meredithae, G. lucidum, and G. applanatum for allergen components. Analyses included radioallergosorbent test (RAST) inhibition and IgE blots from isoelectric focusing (IEF) and SDS-PAGE. RAST inhibition with spores and caps of G. meredithae and G. lucidum showed that spores inhibited caps better than caps inhibited spores. Species differences were minor. Coomassie blue (CB) staining of IEF gels detected at least 23 protein bands (pI 3.6-6.6) in caps of G. meredithae and G. lucidum. G. meredithae spore extracts contained 17 of these (pI 3.6-5.0, 6.6). Spores and caps of G. meredithae contained 13 and 11 allergen bands, respectively, on IEF blots. SDS-PAGE of G. meredithae spore and cap showed one and four bands, respectively, by CB staining, but IgE blots showed 13 bands in cap and 17 in spore. Culture mycelia of G. lucidum and G. applanatum attained significant and essentially constant RAST activity by day 4. Activity was also present in culture supernatant by day 4. Blots of mycelium and supernatant detected a single allergen in day-8 mycelia and subsequently six allergen bands in day-16 mycelia and eight in day-16 supernatant (one appeared as a doublet). These data show that Ganoderma extracts contain a complex mixture of allergens. Differences among species were minor; spores and mycelia are apparently better sources of allergens than caps.
Previous studies established that Psilocybe cubensis contains potent allergens, and that a significant percentage of atopic subjects were sensitized to P. cubensis spores. The objective of this study was to identify P. cubensis spore allergens using isoelectric focusing (IEF) and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) immunoprinting. Coomassie blue staining of IEF gels detected approximately 20 bands between pI 3.6 and 9.3. Immunoprints obtained with 15 P. cubensis skin test- and RAST-positive sera revealed 13 IgE-binding bands; the most reactive were at pI 5.0 (80%), 5.6 (87%), 8.7 (80%) and 9.3 (100%). SDS-PAGE resolved 27 proteins ranging from about 13 to 112 kD. SDS-PAGE immunoprints conducted with 11 skin test- and RAST-positive sera demonstrated 18 IgE-binding bands; most sera reacted to 16 (82%), 35 (100%) and 76 kD (91%) allergens. Both electrophoretic procedures demonstrated a single allergen (at pI 9.3 and 35 kD) that reacted with all sera tested. This study corroborates the allergenic significance of P. cubensis spores and identifies the allergens of greatest importance.
Although carrot allergy is not well recognized in North America, the celery-carrot-mugwort-spice syndrome is well known in Europe. In the current study, cross reactivity of carrot, stalk celery, and spices, all members of the Apiaceae and birch pollen was assessed with serum from a patient reporting raw carrot-induced, raw stalk celery-induced, or spice-induced laryngeal edema and bronchospasm. By RAST inhibition, some cross-reactivity was demonstrated between raw carrot and stalk celery and other members of the Apiaceae. Immunoprint inhibition revealed common allergic epitopes on a 17-kD band shared by carrot, celery, and birch pollen. The results suggest that subjects sensitized to carrot may also have allergic reaction to other vegetables of spices of the Apiaceous family. Furthermore, carrot hypersensitivity can be associated with birch pollen allergy.
Venom immunotherapy (VIT) for Hymenoptera allergy is accepted as safe and effective. However, widely varying success rates and frequencies of side effects are reported. Differences between various Hymenoptera species could account for these diverging results. We therefore analyzed 205 patients with a history of systemic allergic reactions to either honeybee (148 patients) or yellow jacket stings (57 patients) during VIT. All patients had a positive skin test to the respective venom before VIT, were monitored for side effects of VIT, and submitted to a sting challenge while they were receiving VIT. Patients with honeybee-venom allergy had a higher sensitivity in both skin tests (p less than 0.05) and RAST (p less than 0.001) than patients with yellow jacket-venom allergy. They developed systemic side effects to VIT injections significantly more often (41% versus 25%; p less than 0.01) and also reacted more frequently to the sting challenge (23% versus 9%; p less than 0.01) than patients with yellow jacket-venom allergy. We conclude that results obtained from studies on the allergy to one Hymenoptera venom cannot be extrapolated to allergies to other Hymenoptera venoms.
To identify the allergenic components of honey we studied 22 patients with a history of systemic allergic symptoms following honey ingestion. The group of honey-allergic patients was compared with three control groups: 10 subjects sensitized to artemisia, 10 with honey bee venom allergy and 10 without a history of atopy or bee sting reactions. The allergological tests included skin tests and RAST with three different kinds of Swiss honey (dandelion, forest and rape), pollen of compositae species, celery tuber, extract of bee pharyngeal glands, honey bee venom and bee whole body extract. The results show that 3/4 of honey-allergics are sensitive to dandelion honey and 13 of 22 also to compositae pollen. Nine of the honey allergic patients were sensitized to honey bee venom, 3 also to bee pharyngeal glands and to bee whole body extract. Analysis of diagnostic tests and RAST inhibition studies suggest that besides compositae pollen other allergens, most likely of bee origin are important. In honey allergics primary sensitization may be due either to the honey itself, to airborne compositae pollen or even to cross-reacting bee venom components.
In 86 patients with a history of severe systemic reactions (SRs) to honeybee stings confirmed by a positive skin test and/or RAST to honeybee venom (HBV), immunotherapy (IT) with HBV was stopped after 3 to 10 years. All patients had tolerated well a honeybee sting during IT and were resubmitted to a sting 1 year after VIT was stopped. At the latter time, 15 patients (17%) developed an SR and 71 did not. There was no difference between the two groups regarding age, sex, IT duration, severity of the SR before treatment, as well as diagnostic tests with HBV (skin tests, RAST, and specific IgG) before the challenge. Patients with a relapse of their allergy had, however, developed allergic SRs to IT injections more frequently than patients with lasting protection (p less than 0.001). SRs to the sting challenge (CH) after IT was stopped occurred more frequently in those patients in whom efficacy of IT had previously been confirmed by lacking responses to a field sting than in patients who had tolerated an intentional CH during the injection period (p less than 0.025). Indeed, the incidence of relapse after venom IT was stopped was only 9.6% in patients who had previously tolerated an intentional CH. It is concluded that well-tolerated HBV IT may be stopped after at least 3 years, provided its efficacy has been documented by a CH without SR.
Bronchial asthma is as frequent among high performance athletes as in the general population. We requested information from 2961 athletes of national or international level about these matters and received 2060 answers. From these, we identified 146 athletes (7.1%) with exercise-related deep respiratory airways symptoms. Athletes subject to hay fever (42%) suffer significantly more often (p less than 0.001) from such symptoms during exercise. 80% of these 146 cases had an insufficient diagnostic investigation and/or were treated with medicines unsuited to their needs or even not treated at all. Of particular interest, athletes who additionally had hay fever also received inadequate treatment, even though it is well known that they are subject to enhanced bronchial irritability during the pollen season. As a rule, athletes with exercise-related respiratory problems should be advised to abstain from smoking, especially if they suffer from an atopy-like illness, such as hay fever.
This 40 year old patient was involved in a car accident which resulted in a thoracic trauma with fracture of the sternum and the left radius. The ECG showed a complete right bundle branch block and a left anterior fascicular block (= bifascicular block). These electrocardiographic findings and an elevated CK-MB fraction after thoracic trauma were indicative for the diagnosis of myocardial contusion. The ECG was normal after 24 hours, the CK-MB after two days. The patient left the hospital after one week. Five weeks later, a control examination showed no cardiological abnormalities.
This enquiry covers 2961 active Swiss athletes of national or international standing in 68 different sports. Of these, 2060 (70%; 1507 males, 552 females) answered the questionnaire. 347 athletes (16.8%) indicated they suffered from hay fever, 204 of them (59%) needing medication during the pollen season. 25% took antihistamines, 20% various nasal decongestants, 19% Similasan, a homeopathic drug, and 11% various eye drops. 6% received injections of depot corticosteroid preparations. 50% of the athletes obtained these medications on prescription. 146 athletes (7.1%) complained of lower respiratory tract symptoms, 77 of them mentioning asthma attacks and 47 continuous dyspnea. The enquiry shows that the incidence of hay fever in highly trained athletes is as high as in the general Swiss population. The same is true of asthma. A considerable proportion of allergic athletes are inadequately informed as to both antiallergic therapy and doping regulations.
Thirty-three patients with histologically verified urticaria pigmentosa were studied for coexisting atopic disease by means of history, skin prick testing with five common inhalants and serological investigation for total IgE and specific IgE antibodies to five common inhalants. The prevalence of atopy in urticaria pigmentosa was similar to that observed in the normal Swiss population, both on the basis of history (7/33 = 21%) and of positive skin prick tests to common inhalants (12/33 = 36%). However, total serum IgE levels were significantly lower (geometric mean value 16.8 kU/l) than in a control group of 52 Swiss blood donors of comparable age and sex distribution (geometric mean value 43.0 kU/l, t = 2.93, P less than 0.005). Specific IgE antibodies to common inhalants were also observed less frequently in urticaria pigmentosa patients than in controls, although this difference was not statistically significant. Low total and specific IgE values in patients with urticaria pigmentosa may be explained by increased absorption of circulating IgE to abundant tissue mast cells.
Sixty-seven patients with a history of severe systemic reactions following honey bee stings were treated by immunotherapy (IT) with honey bee venom. During maintenance therapy all were submitted to a sting challenge under clinical conditions. 15 developed mostly minor symptoms of a systemic reaction while 52 showed only a local swelling at the sting site. Phospholipase A2-specific IgE, IgG and IgG subclass serum antibodies were estimated in samples obtained before IT and immediately before the challenge. Specific IgE decreased in reactors and in non-reactors. There was no difference between the two groups at any time. Specific total IgG, IgG1 and IgG4 increased in both reactors and non-reactors during IT. An early increase of specific IgG1, was observed while specific IgG4 remained elevated throughout the treatment. Specific total IgG was higher in reactors than non-reactors before the challenge, specific IgG1 higher in reactors before treatment and specific IgG4 higher in reactors than non-reactors both before treatment and before challenge. In the individual patient, no single antibody estimation or combination of various antibodies was predictive of the outcome of a sting challenge.
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In amyotrophic lateral sclerosis (ALS), respiratory problems are usually late complications. However, ALS may occasionally present with exertional dyspnea as the primary symptom, as was the case in the patient reported here. On the basis of this case and the literature, the diagnostic and therapeutic aspects of the neurologic causes of dyspnea are discussed. Where there is a discrepancy between severity of blood gas alterations, changes in lung volume determinations and severity of dyspnea, a neuromuscular disorder must be considered in differential diagnosis.
The most important pollens causing pollinosis in Zurich include hazel (Corylus), alder (Alnus) and birch (Betula) in spring, grasses--including rye--in summer, and mugwort (Artemisia) in autumn. Investigations on airborne pollen of Zurich were conducted from 1981 to 1984, and assessed with special reference to threshold concentrations. The results show that sorrel (Rumex) and plantain (Plantago) also belong to the most important pollens and should therefore be included in the test spectrum for allergological examinations. The pollen of ash (Fraxinus), oak (Quercus), beech (Fagus) and plane tree (Platanus) was regularly found in high percentages during these years. Hence the clinical relevance of these tree pollens should not be underestimated, because successful diagnosis and therapy depends mainly on the use of the relevant strain of pollen.
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