Biomedical subjects
Publications and source records attributed to B Wüthrich.
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In a 37-year-old worker employed in a coffee roastery who suffered from work-related rhinoconjunctivitis, allergologic investigations demonstrated sensitization to the dust of the green, unroasted coffee bean. This particular allergy is uncommon in Switzerland. The case is discussed and the literature on the subject is reviewed.
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Levels of soluble IL-2 receptors, IL-6, soluble CD23, soluble CD14 and ECP (eosinophilic cationic protein) were measured as markers of T-cell, B-cell, monocyte and eosinophilic leucocyte activation in 26 patients with atopic dermatitis (AD) on admission to (A) and at discharge from (D) the Department of Dermatology in Zurich. The serum levels of sIL-2R, IL-6, sCD23, sCD14 and ECP were significantly elevated in AD patients in comparison with the normal values of healthy donors. A significant decrease in sIL-2R (p = 0.0093) and in sCD14 (p = 0.0134) levels was demonstrated between A and D, correlating with the improvement in the skin intensity score (SIS). In addition, a significant correlation of the sCD14 levels and the SIS at A was demonstrated (p = 0.0415). These results also incriminate monocytes in the pathogenesis of AD, indicating that, besides sIL-2R and ECP, SCD14 could also be a possible marker for the disease activity.
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We report the case of a 25-year-old housewife, a native of Mexico City, with rhinitis and asthma induced by exposure to fallow deer in an animal park close to her home. In the literature, we could find only one previous case. The patient presented a polyvalent IgE sensitization in prick skin tests and RAST to several animals' dander and epithelia, but RAST inhibition experiments showed a cross-reactivity only between fallow deer and horse allergen extracts.
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To evaluate the correlation with the clinical activity of atopic dermatitis (AD) we investigated prospectively cellular and serological parameters such as eosinophils, eosinophil cationic protein (ECP), soluble IL-2 receptor (sIL-2R), soluble CD23 (sCD23) and lactate dehydrogenase (LDH) in peripheral blood of 37 AD patients on admission to and discharge from the Department of Dermatology at the University Hospital in Zurich. On admission the actual clinical skin condition as measured by the skin intensity score (SIS) was significantly correlated with eosinophils (p less than 0.005), ECP (p less than 0.05) and sIL-2R (p less than 0.001). During the observation period a significant improvement in the clinical status as measured by the SIS was observed in all AD patients (p less than 0.001). A significant decrease in sIL-2R (p less than 0.005), which was most pronounced in the group of AD patients receiving systemic steroids, together with a decrease in eosinophils and ECP but not in sCD23 and LDH could be demonstrated between admission and discharge. In addition, a slight but significant increase in peripheral blood lymphocytes (p less than 0.005) and monocytes (p less than 0.01) was noted. Comparing the 'extrinsic' (n = 32) and the 'intrinsic' (n = 5) types of AD no significant differences with regard to the above mentioned parameters were found. Our data indicate that cellular and serological parameters such as eosinophils, ECP and sIL-2R reflect the clinical activity of AD and may therefore give further insights into the pathogenesis of this disease.
Two double-blind clinical pharmacology studies were performed in atopics in order to compare the inhibitory effects of cetirizine (CTZ) 2 HCl and terfenadine (TER) on histamine and antigen-induced skin reactions. In the first study, the subjects took single intakes of CTZ 10 mg and TER 60 mg. In the second study, they took CTZ 10 mg once a day and TER 60 mg b.i.d. for 3 weeks. CTZ was more effective than TER in inhibiting histamine skin reactivity. CTZ and TER were equally effective in inhibiting antigen-induced reactions. There was no tachyphylaxis, either for CTZ or for TER.
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CASE REPORT: After uneventful induction of general anesthesia, severe hypotension and cardiac arrest developed in a 39-year-old, non-atopic man following infusion of 20% mannitol 80 min after the beginning of anesthesia. It caused a systolic blood pressure of 40 mmHg during a period of 10 min and tachycardia followed by ventricular fibrillation. Immediate resuscitation measures, i.e., external cardiac compression, rapid infusion of 3,000 ml crystalloid and 1,000 ml colloid, central-venous application of suprarenin (2.4 mg total), lidocaine (100 mg), sodium bicarbonate (100 mmol), and two defibrillations, could alleviate the life-threatening reaction. The patient recovered a few hours later without any further sequelae. ALLERGOLOGIC INVESTIGATIONS: Allergologic studies with all drugs involved revealed a positive and specific reaction in an intradermal skin test to 1:100 diluted mannitol, as did in-vitro leucocyte histamine release to 20% and 2% mannitol. For all the other drugs, skin tests and leucocyte histamine release were negative or unspecific. Available RAST determinations to thiopental and suxamethonium were also negative. The total IgE level was normal. CONCLUSIONS: Reflecting the hypotension induced by histamine, the hematocrit rose from 0.4 to 0.5 even though the patient received a large amount of fluid before and during resuscitation. This can be explained by marked sequestration of plasma in the interstitial compartment, leading to hypovolemia. The clinical course and test results suggest that mannitol was the agent responsible for the anaphylactoid reaction.
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229 patients who showed an immediate-type allergy to one or more specific foodstuffs diagnosed from 1983 to 1987 at the Allergy Unit of the Department of Dermatology, Zurich University Hospital, have been studied. Of these predominantly adult patients, 66 (28.8%) were male and 163 (71.2%) female. 70.7% of the food allergic patients also showed one or more atopic manifestations, in particular 53.3% a pollinosis. The food-induced symptoms included involvement of the skin (rashes, urticaria, angioedema) (46.4), the respiratory tract (asthma, rhinorrhea) (24.1%) and the gastrointestinal tract (21.8%). 14.4% reacted with anaphylactic shock. Generally the patients showed involvement of two or more organs. In only 7% of all cases was food allergy responsible for a chronic allergic condition such as urticaria, asthma or intestinal symptoms. Concerning diagnostic procedures, a careful case history and various techniques of skin testing, particularly with raw foods, are helpful. RAST was negative in more of the half of the diagnosed cases. Confirming previously published work, food allergens were mainly found among vegetables, such as celery with 44.5%, followed by carrots (14.4%) and spices (16.6%). In these cases there were cross-reactivities between birch or mugwort pollens. Cheese and milk allergies (14%) were present in patients without previous atopic manifestations. We confirm that the so-called "celery-carrot-mugwort-spice-syndrome" is more frequent in females (81.4%) than in males. In 24 cases celery-spice sensitization was responsible for severe anaphylactic reactions.
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Among the perennial rhinitides three forms should be distinguished because of therapeutic and prophylactic consequences: allergic, nonallergic eosinophilic (NARES syndrome) and nonallergic non-eosinophilic (vasomotor) rhinitis. Their distinction is based on history as well as on clinical criteria and allergy tests, necessitating an optimal collaboration between the general practitioner, the otorhinolaryngologist and the clinical immunologist. The therapeutic approach to the three forms is outlined.