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Biomedical subjects

A Oehling

Publications and source records attributed to A Oehling.

177 records · Page 10Linked to original sources
PubMedDate not supplied

Perforation of the nasal wall and hyper-IgE syndrome.

Hyper-IgE syndrome is basically characterized by recurrent infections, chronic eczematous lesions, specific IgE antibodies against Staphylococcus aureus and markedly high serum IgE values. We present the case of an 11-year-boy with no relevant personal or family history, who came to our Department with highly pruriginous papulovesicular skin lesions of 3 years' duration. He presented marked obesity (+4 SD) and micropapulovesicular lesions in the trunk and extension areas of the limbs. The rest of the physical exploration was normal. Complementary studies revealed peripheral eosinophilia, increase in globular sedimentation rate and IgE values of 20,000 IU/ml, a nonspecific reaction to skin tests, and a skin biopsy compatible with atopic dermatitis. Three months later, he presented eczematous lesions in the trunk and limbs, perforation of the nasal wall due to staphylococcal abscess (diagnosed by biopsy), bilateral maxillary sinusitis and IgE values of 59,238 IU/ml. The differential diagnoses are discussed, as well as new diagnostic-therapeutic possibilities.

Abscess↗
PubMedDate not supplied

Reliability of histamine release test in dust mite allergy: influence of the degree of sensitization.

The histamine release test has been proven to be a very useful method for in vitro diagnosis of IgE-mediated allergy to inhalant and food allergens, as well as for the immunotherapy follow-up of the allergic patient. The aim of the present study was to assess the influence of the degree of sensitization in allergic patients sensitive to Dermatophagoides pteronyssinus on their dose-response curves in histamine release tests. To achieve this aim, we studied 109 D. pteronyssinus allergic patients and 25 healthy control subjects. Intracutaneous skin test, D. pteronyssinus-specific and total IgE quantitations, and histamine release tests were carried out in all the patients. In the case of the histamine release test, five D. pteronyssinus extract concentrations were used (2822.5, 282.25, 28.22, 2.82 and 0.28 UBE/ml), and two patterns of histamine release in sensitive patients were found: one with maximal histamine release at the highest antigen concentration (group I) and the other with maximal release attained at lower concentrations (group II). A sensitization score was designed, after the results from specific IgE and intracutaneous skin tests. There were significant differences (p < 0.05) in antigen-specific and total IgE levels, and in papule diameters and sensitization scores, between the control group and groups I and II. Both groups showed significantly higher (p < 0.05) histamine releases than the control group in response to anti-IgE antibodies. When stimulating the cells with anti-IgE antibodies, histamine release in group II was higher than in group I, although this difference was not significant. Finally, the best correlation between sensitization score and antigen-specific histamine release was found at the 2.82 UBE/ml concentration (r = 0.84, p < 0.001).

Adolescent↗
PubMedDate not supplied

Specific IgE determination in the diagnosis of beta-lactam allergy.

Allergic reactions to beta-lactams are the most frequent adverse reactions to drugs, but conventional methods of detection of beta-lactam specific IgE detect only a low number of positivities. In this study we evaluated the diagnostic reliability of one of these methods (CAP FEIA, Pharmacia) which has been proven very useful in inhalant and food specific IgE determinations. We studied specific IgE to penicillin G, penicillin V, amoxicillin and ampicillin in 1078 patients who had been diagnosed with an adverse reaction to beta-lactams, and out of this group, in a selected subgroup of 149 patients with a very suggestive clinical history of beta-lactam anaphylactic reaction. Also, positivity of specific IgE was studied in a group of 58 patients with a clinical history of immediate hypersensitivity to beta-lactams and with positive skin tests, and positivity of skin tests was studied in a subgroup of 13 patients with positive specific IgE. To increase the sensitivity of IgE determinations, we concentrated 5-fold the sera from six selected patients. In the first group we found that penicillin G specific IgE was positive in 28% of the cases when considering a cutoff > or = class 1, and 6% when considering a cutoff > or = class 2. For penicillin V, positivities were 9% (> or = class 1) and 4% (> or = class 2). In the second group, we found 31.81% sensitivity and 88.57% relative specificity of CAP FEIA with respect to the skin test. In the group of 58 patients with a clinical history of immediate hypersensitivity to beta-lactams, we found a disagreement between skin testing and specific IgE determination in 28.2%, and a positive agreement in 9.4% of the cases. After sera concentration, there was a significant increase (p < 0.001), from 0.58 to 1.61 kU/l, in beta-lactam specific IgE. Our results suggest that skin testing offers greater reliability and sensitivity than beta-lactam specific IgE determination by CAP FEIA.

Anaphylaxis↗
PubMedDate not supplied

Diagnostic reliability considerations of specific IgE determination.

Total IgE determination constitutes a good method for the screening of atopic diseases, though its actual value is controversial because normal values of total IgE do not exclude the existence of atopic disease, and high values of total IgE are not pathognomonic of atopy by themselves. The first step in identifying an atopic individual as such, after doing his anamnesis, can be carried out by means of total IgE determination. Most atopic individuals have high IgE values, but a normal result must be carefully interpreted: age and season-related variations must be considered. In general, atopic patients with IgE values greater than 1000 Ul/ml, always have positive specific IgE against some allergen. Antigen-specific IgE will be the next step in the in vitro identification of the responsible allergen. Nowadays, there are more than 400 characterized allergens available for in vitro diagnostic tests and several useful methodologies for specific IgE determination. Specific IgE results obtained with the different methods vary significantly, with absolute agreement in 55-65% of the cases, differences in one IgE class in 20-30% of the cases and differences in more than two classes in 5-10%. The specificity of the anti-IgE antibody used in the assay is of critical importance because any contaminant antibody can render unspecific results. On the other hand, it must be pointed out that there is a compromise between specificity and sensitivity, such that an increase in the sensitivity of a technique leads to a decrease in its specificity. It cannot be said that there is one method which is better than the others; it is better to examine them individually, allergen by allergen. Thus, specific IgE determination varies depending on the type of allergen. In general terms, for inhalant allergens, specificity and sensitivity of the methods are within the range of 85-95%, but these values (especially the specificity) decrease in the case of food allergens, and they are still lower when the allergen is a beta-lactamic drug. There is a good correlation between clinical history and specific IgE against inhalant allergens, and a lower correlation in the case of food allergens. Due to the fact that most food allergens are not standardized, the definitive diagnosis of food hypersensitivity is achieved by means of provocation tests. Nevertheless, negative specific IgE (7-18% of the cases) does not rule out a sensitization against the tested allergen, and a positive specific IgE without symptoms must be carefully interpreted because it can be due to a low degree of sensitization, unable to express clinical symptoms at this moment, but useful in the future as a guide on the disease course. In the evolutive period of the disease, specific IgE levels can be modified in a natural way (in beta-lactam allergy, 50% of the cases with specific IgE become negative after a year), or as an effect of the treatment (e.g., after immunotherapy in the case of Hymenoptera venom allergy), or it can remain positive for a long time, as in the case of pollinosis. On the other hand, the cutoff of the method, and subsequently the range of values to be considered as positive, will depend on the allergen studied. While inhalant allergens (with the exception of some molds) offer relatively high mean values of specific IgE, food and drug allergens yield less significant values. In general, a class greater than 2 is interpreted as clinically significant, class 1 as dubious or negative (depending on the allergen) and class 0 as negative. In the interpretation of the results, the possible presence of IgG and anti-IgE antibodies, capable of modifying the results, will be taken into account. When comparing the diagnostic reliability of specific IgE with respect to other allergologic diagnostic methods, we find a significant and positive correlation of this technique with skin tests (but never greater than 90-95%) and with the histamine release test.

Antigens↗
PubMedDate not supplied

Antigen-specific sulphidoleukotriene production and histamine release in pollinic patients.

We studied sulphidoleukotriene (sLT) production, by means of CAST-ELISA (Bühlmann) in 92 atopic (54 pollinic and 38 non-pollinic) patients, and in 9 control subjects, after antigenic stimulation of peripheral blood leukocytes with 20 ng/ml and 2 ng/ml of Lolium perenne pollen extract, in the presence of IL-3. Antigen-specific stimulation of leukocytes from pollinic patients studied during the pollen season led to a sLT production significantly higher (p = 0.03 at 2 ng allergen/ml) than in those studied out of the pollen season. Histamine release was also significantly higher in pollen season than out of the season (p = 0.04 at 20 ng allergen/ml and p < 0.001 at 2 ng allergen/ml). There was a significant positive correlation between sLT production and histamine release (r = 0.67 at 2 ng allergen/ml and r = 0.57 at 20 ng/ml, both p < 0.001), and between sLT production and skin test results (r = 0.5 at 2 ng allergen/ml and r = 0.46 at 20 ng allergen/ml, both p < 0.001). We found that sLT production was lower, although not significantly, in patients older than 40 years, and histamine release was significantly (p = 0.02) higher in women than in men at 2 ng allergen/ml. We conclude that sLT production in pollinic patients is higher when antigenic pressure is increased in the environment, and that sLT quantification by CAST-ELISA might be useful for evaluation of this sensitization, with analogous results to the histamine release test.

Adolescent↗
PubMedDate not supplied

Abuse of therapy with corticosteroids in the asthmatic patient and the deficient control of suprarenal function. Indication of therapy with ACTH.

The use of corticosteroids, either oral, parenteral or as aerosol, means a great step forward in bronchial asthma treatment. Nevertheless, given the abuse of their administration, we find more and more frequently, cases of corticodependent bronchial asthma, due to a deficient control in the clinical evolution. For this reason, we performed a study with 39 patients diagnosed with corticodependent intrinsic bronchial asthma. Basal cortisol determination was performed in all, and all of them followed posttreatment with ACTH, antibiotics and mucolytics, as well as follow up of respiratory function parameters and clinical evolution. We found a mean increase in cortisol levels of 488% (basal: 2.49 +/- 0.33 micrograms/dl; posttreatment: 14.59 +/- 2.9 micrograms/dl). Regarding the respiratory function tests, FEV1 improved from 59.38 +/- 4.23% to 68.52% +/- 4.28% (15.4% increase); MEF50 went from 28.62 +/- 3.47% to 35.9 +/- 3.81% (25.4% increase) and MEF25-75 improved from 28.89 +/- 3.47% to 37.05 +/- 3.93% (28.2% increase). Clinical symptomatology and medication improved in general, going from an initial punctuation of 8.5 to a posttreatment score of 7.47. In general, 50% of the patients studied improved from the clinical point of view, only 47.2% had a discrete improvement, and only one patient got worse. Side effects with ACTH treatment appeared in 28.2% of the cases, mainly peripheral edemas, especially in the lower extremities. In conclusion, with patients undergoing lengthy corticosteroid therapy, control of their suprarenal function is absolutely necessary. If a glandular insufficiency appears with low levels of plasmatic cortisol, we advise treatment with ACTH in association with antibiotics.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Bacterial immunotherapy in bronchial asthma.

Nowadays, bacterial etiology is probably the least considered and most controversial in the etiopathogenesis of bronchial asthma. It was in the first decades of this century when several authors insisted on the close relation between infection and asthmatic response. This is why, since antibiotics have appeared, many renowned authors insist on the basic treatment of the infection with antibiotics. Also, the need of immunotherapy with bacterial antigens is being emphasized, considering the importance of this factor in bronchial asthma. Nevertheless, there are some detractors who, in our opinion, do not base their criteria on experience or precise data which support the rejection of the bacterial infectious factor as a causal triggering factor. It has been in the last decade when several authors, Norn among them, confirm the importance of the bacterial antigen, and especially its potentiating role on the inhalant allergens. On the other hand, in the last decade the symptomatic treatment of asthma by means of bronchodilators and corticosteroids is being fomented. That is, the maintenance of the asthmatic patient is being fomented instead of his consequent treatment, fighting the infection. According to our long experience and the positive number of cases obtained, again we insist on the need to treat bronchial asthma with bacterial immunotherapy. Therefore, it is necessary to study this aspect more in depth in order to reach a real knowledge of all of the above.

Asthma↗
PubMedDate not supplied

Skin manifestations and immunological parameters in childhood food allergy.

According to Hansen's contact rule, the digestive system should be considered as the main shock organ, yet in food allergy, this is not the case. Very often specific food triggers clinical manifestations not involving the digestive system; that is, reactions are manifested either in the respiratory system, as asthma or rhinitis, or in the skin. In these cases the BALT (broncho-alveolar lymphoid tissue) and GALT (gastrointestinal lymphoid tissue) units play a basic role in the sensitizations. The purpose of this study was to determine the most frequent skin manifestations of food allergy among children, and the most frequently involved foods. We also thought it interesting to evaluate the diagnostic reliability of the different standard immunological parameters utilized by the study team in food allergy. All patients underwent intracutaneous tests with 12 groups of the most frequent food allergens, as well as serum IgE, antigen-specific IgE against foods, and antigen-specific histamine release tests. Antigen-specific IgG4 determination was performed in some cases. The results obtained confirmed previous studies, the most common manifestations being: angioedema (48%), followed by urticaria (31%) and atopic dermatitis (21%). Regarding the frequency of sensitization to different food allergens, in mono- or polisensitization, fish and egg stand out in our environment. Certain food allergens are more frequently responsible for specific skin manifestations. Thus, for fish sensitization, the most frequent skin manifestation is atopic dermatitis (50%); for egg sensitization, angioedema is the most frequent skin manifestation (50%); and for milk, urticaria (50%). Finally, and in agreement with previous works regarding the diagnostic reliability of in vitro techniques, we found that the histamine release test offered the highest percentage of diagnostic reliability. Only for sensitization to milk proteins did antigen-specific IgE demonstrate higher reliability. Once again, we stress that our main problem is the lower reliability of skin tests against food allergens than against inhalant allergens. We emphasize the importance of food as a major factor in the etiopathogenesis of atopic dermatitis, as well as the need to complement the study, when possible, by means of the in vitro techniques described.

Animals↗
PubMedDate not supplied

Potentiation of histamine release against inhalant allergens (Dermatophagoides pteronyssinus) with bacterial antigens in bronchial asthma.

In the etiopathogenesis of bronchial asthma, the important role of bacterial infection is more evident every day, favoring inflammation and obstruction, that is, triggering an asthmatic response. We gathered 36 patients diagnosed of bronchial asthma with sensitization to Dermatophagoides pteronyssinus and 32 healthy subjects. Histamine release tests against Staphylococcus aureus extract alone or together with D. pteronyssinus were performed, and the results were contrasted with or without the presence of S. aureus in the nasal secretion culture. We found histamine release against S. aureus higher than 10% only at the highest concentration (200 micrograms/ml) and significantly higher in those patients with positive nasal secretion culture. Regarding histamine release against D. pteronyssinus in the presence of S. aureus, we found a release by coincubation significantly higher than the one obtained from the addition of release against S. aureus and release against D. pteronyssinus, both in patients with negative and with positive nasal culture, at concentrations of 20 and 2 micrograms/ml. In conclusion, we observed a potentiation of histamine release against D. pteronyssinus with S. aureus extract in patients with bronchial asthma. These findings support the important role of the bacterial infection in the etiopathogenesis of bronchial asthma and the importance of a treatment against this infection.

Administration, Inhalation↗
PubMedDate not supplied

Study of IgE-dependent sulphidoleukotriene cellular releasability.

Cellular releasability of mediators, as termed by Lichtenstein and Conroy (1), can be triggered by interaction with allergens, anti-IgE antibodies or other agonists. Genetic factors can also influence the cell releasability. We studied 104 subjects, including 92 atopic patients (62 sensitive to D. pteronyssinus and 54 sensitive to Lolium perenne) and 12 healthy controls. Sulphidoleukotriene (sLT) production was measured after allergen and anti-IgE stimulus with CAST-ELISA, and histamine release using a fluorometric method. We found a significant sLT production after anti-IgE stimulation, higher than in basal conditions with medium alone. The sLT production was also significantly higher in sensitive patients than in healthy controls. We found 14.5% of healthy and atopic subjects to be non-responders to anti-IgE stimulus. We also found a positive and significant correlation between sLT production and histamine release. Moreover, we observed a significant positive correlation between IgE-dependent and antigen-specific sLT release. We also noticed a decrease in sLT production and a decrease in histamine release with aging. Male patients had a sLT production significantly higher than female patients. With respect to clinical diagnosis, the group of patients with rhinitis had the highest mediator production. Finally, pollinic patients studied during the spring had a higher sLT production to anti-IgE than those studied out of this season. We conclude that quantification of sLT production after anti-IgE stimulation is a useful method to study cell releasability of mediators and that such releasability is higher in atopic patients than in healthy donors. We must emphasize the usefulness in allergy diagnosis of relying not only on the use of methods demonstrating the existence of sensitization to an allergen, but also of techniques able to quantify the ability to respond to that allergen. In this way we would be able to evaluate the clinical and immunological evolution of patients and to follow up the efficacy of their treatment.

Adult↗
PubMedDate not supplied

Atopic dermatitis and food allergy.

In order to determine the importance of food sensitization in the etiopathogenesis of atopic dermatitis, we performed a study on 74 patients who fulfilled a previously suggested diagnosis criteria. Of these patients, 17.5% presented allergic rhinitis and 62.2% had associated bronchial asthma. We found that in 64.9% of the patients there was a food sensitization, with milk (36.5%), egg (35.1%) and fish (21.6%) being the most frequently involved. We also observed that 34% of the patients were sensitized to Dermatophagoides pteronyssinus and 24.3% to pollen. These sensitizations were confirmed by means of skin tests, specific IgE and antigen-specific histamine release test. The patients underwent a 3-year follow-up in order to find out the clinical evolution once the causal food was avoided and/or a symptomatic treatment was prescribed. The group of patients with no food sensitization was significantly different from the group with food sensitization: in the first group only 20% of the patients presented a very good clinical evolution (asymptomatic), while in the second group, in 71.4% of the patients the symptoms completely stopped. Nevertheless, in the first year follow-up, we found no significant differences between the two groups. In conclusion, a diet avoiding the causal food combined with a suitable symptomatic treatment, led to an important remission of the skin manifestations in children diagnosed with atopic dermatitis.

Adolescent↗
PubMedDate not supplied

Effect of immunotherapy on allergen-specific production of sulphidoleukotriene and histamine.

Numerous controlled trials have demonstrated the efficacy of specific immunotherapy, although its mechanism is not completely understood. Few studies have addressed the effects of immunotherapy on the release of mediators. We measured in vitro sulphidoleukotriene (sLT) and histamine release after specific stimulus (Dermatophagoides pteronyssinus or Lollium perenne) in a group of patients under immunotherapy (n = 35) and compared the results with those obtained in a group of allergic patients without immunotherapy (n = 57). SLT quantification was carried out by cellular stimulation allergen test (CAST)-ELISA and we measured the amount of histamine release using a fluorometric method. We found a significant (p < 0.05) reduction of allergen-specific mediator release on the group of patients under immunotherapy treatment. When we studied the group of patients sensitive to D. pteronyssinus we also observed a significant reduction in sLT release after the in vitro stimulus with anti-IgE. In vitro sLT production could be a good marker for follow-up immunotherapy. This study provides more evidence to support the immunological and cellular changes induced by immunotherapy.

Adolescent↗