Biomedical subjects
D I Bernstein
Publications and source records attributed to D I Bernstein.
Mediastinal and supraclavicular lymphadenitis and pneumonitis due to Chlamydia trachomatis serovars L1 and L2.
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Serologic analysis of first-episode nonprimary genital herpes simplex virus infection. Presence of type 2 antibody in acute serum samples.
Acute serum samples from patients with nonprimary first-episode genital herpes were evaluated for the presence of type-specific antibody to herpes simplex virus type 1 and type 2. A standard microneutralization assay and western blot analysis, which identified the response to individual polypeptides of type 1 and type 2 herpes, were performed in both unadsorbed serum samples and serum samples adsorbed with either type 1 or type 2 antigens to remove cross-reacting antibodies. Of 24 serum samples examined, seven were found to contain only type 1 antibodies, 11 had type 2 antibodies alone, and six serum samples had both type 1 and type 2 antibodies. It is believed that a majority of the 17 patients whose acute serum samples already contained type 2 antibody were experiencing their first clinically apparent recurrence of a previous asymptomatic type 2 infection. Physicians should, therefore, acknowledge that patients with first-episode nonprimary herpes 2 infection may not have had a recent sexual contact with a herpes simplex virus-infected partner.
Heterogeneity of specific-IgE responses in workers sensitized to acid anhydride compounds.
Acid anhydride compounds cause IgE-mediated respiratory sensitization in the workplace. In this study reaginic responses in four workers sensitized to phthalic anhydride (PA), hexahydrophthalic (HHPA), or himic anhydride (HA) were determined by direct RAST by use of PA-human serum albumin (HSA), HPPA-HSA, and HA-HSA methylcellulose disc substrates. RAST inhibition of binding to anhydride-HSA substrates was done with various concentrations of sodium salts, lysine, and HSA conjugates of PA, HHPA, HA, and trimellitic anhydride (TMA) in order to characterize cross-reactivity and specificity of humoral responses in these workers. Molar concentrations of anhydride bound to lysine and HSA carriers were assayed by protein hydrolysis followed by gas chromatographic analysis. Significant direct RAST binding against PA-HSA, HHPA-HSA, and HA-HSA was found in all four workers. PA-HSA-IgE binding in one PA-sensitive worker (no. 1) was inhibited significantly by PA-HSA alone and not by sodium PA or PA lysine. In contrast, another PA-sensitized worker (no. 2) exhibited 50% inhibition of PA-HSA binding by PA-HSA (1 X 10(-9) M), PA-lysine (7 X 10(-8) M), and NaPA (1 X 10(-7) M); no inhibition of PA-HSA by heterologous HHPA-, HA-, or TMA-inhibitory reagents was found in either of the PA workers. RAST binding to HHPA-HSA in the HHPA-sensitive worker was inhibited by HHPA-HSA alone.(ABSTRACT TRUNCATED AT 250 WORDS)
Local ocular anaphylaxis to papain enzyme contained in a contact lens cleansing solution.
This is a case report of a patient who developed IgE-mediated sensitization and subsequently ocular angioedema and conjunctivitis from papain contained in a commercial contact lens cleansing solution. Serum-specific IgE and positive cutaneous prick tests to papain and chymopapain were detected. When the lens solution containing papain was stopped, there was resolution of her allergic symptoms. Recognition of this route of papain-induced sensitization may be important in those patients undergoing chemonucleolysis with chymopapain who may be at greater risk to develop a systemic allergic reaction after injection of this enzyme.
The effects of acyclovir on antibody response to herpes simplex virus in primary genital herpetic infections.
The humoral response to herpes simplex virus (HSV) was examined in 21 patients with primary HSV infection who were participating in a placebo-controlled trial of oral acyclovir as therapy for first-episode genital herpes. A standard microneutralization assay and a western blot analysis, which detects the antibody response to individual polypeptides of HSV types 1 and 2, were used. Placebo-treated, HSV type-2-infected patients typically responded to HSV type-2 polypeptides that had molecular masses of 125, 84, 68, 59, 46, and 40 kilodaltons. Treatment with acyclovir diminished the humoral response both to HSV, as measured by the type-specific neutralizing-antibody titer, and to specific polypeptides, especially those with molecular masses of 50-100 kilodaltons, a range that includes polypeptides with molecular masses corresponding to those of glycoproteins D and E of HSV.
Predicting anaphylaxis to chymopapain.
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Clinical reactions and antibody responses to influenza vaccines. A comparison of split or subunit vaccines in children and young adults.
The reactogenicity and immunogenicity of a trivalent split-product influenza vaccine and a trivalent subunit influenza vaccine were studied in 67 children and young adults. Subjects received two doses of either vaccine given one month apart. The reactogenicity of the two vaccines was similar. After the second dose of the split-product vaccine, the prevalence of hemagglutination-inhibiting (HAI) antibody titers of 20 or more was as follows: A/Brazil/78, 73%; A/Bangkok/79, 100%; and B/Singapore/79, 73%. Similar data for the subunit vaccine recipients were 78%, 100%, and 74%, respectively. The HAI antibody responses to the A/Brazil/78 and B/Singapore/79 antigens of both vaccines were relatively poor in those subjects who were initially seronegative (HAI antibody titer less than 5) to the specific antigen.
Mealworm asthma: clinical and immunologic studies.
Mealworms are larvae of the Tenibrio molitor (Tm) beetle and are widely used as fishing bait. Four of five bait handlers in a warehouse who were exposed to particulates of Tm exoskeletons reported immediate-onset asthma, rhinitis, or contact urticaria while unwrapping and packaging the larvae. Positive cutaneous prick tests to Tm extract were detected in all four symptomatic workers. Specific IgE against Tm antigens of 14.6% and 22.5% were found by the RAST method in the two workers with Tm-induced asthma. Specificity of Tm-IgE binding was confirmed by RAST inhibition of 73%, 58%, and 37% by 2 X 10(-1), 2 X 10(-2) and 2 X 10(-3) dilutions of Tm antigen. No significant inhibition of Tm-IgE binding by mite and cockroach antigen or by extracts of three other larval species of the Diptera and Lepidoptera orders, to which the workers were also exposed, was detected. Bronchial provocation challenge with Tm antigen performed in the two workers with asthma exhibited an immediate fall in FEV1 of more than 20% at provocation-dose dilutions of 2 X 10(-3) and 2 X 10(-5), respectively. In the latter worker, pretreatment with disodium cromoglycate inhibited the bronchial response to 2 X 10(-4) dilution of Tm antigen. This study demonstrates that inhaled particulates from Tm exoskeletons are potent sensitizers and elicit IgE-mediated occupational asthma. Allergenic cross-reactivity between orders of insects was not observed. This occupational setting serves as a model for the prospective study of insect allergy.
The relationship of airborne trimellitic anhydride concentrations to trimellitic anhydride--induced symptoms and immune responses.
Eighteen workers exposed to trimellitic anhydride (TMA) powder were evaluated in 1979. Twelve of these workers were available for longitudinal study until 1982. Annual clinical evaluations and serum radioimmunoassays for total antibody binding and specific IgE binding to 125I-TM-HSA were performed. In 1979, five workers had antibody against TM-HSA. Of these, three workers were diagnosed with the late respiratory systemic syndrome (LRSS) and one worker with TMA-induced allergic rhinitis. The LRSS workers had significantly elevated total antibody binding of 125I-TM-HSA and the worker with rhinitis had significantly elevated specific IgE binding of 125I-TM-HSA per milliliter of serum. Although TMA handling was intermittent throughout the year, average airborne dust concentrations from 1974 to 1978 at job stations of the two heaviest TMA-exposed occupations, operator and assistant operator, were 2.1 and 0.82 mg/m3, respectively. After local exhaust ventilation had been improved, average airborne dust concentrations of TMA at the two latter job stations fell to levels of 0.03 and 0.01 mg/m3, respectively, in 1982. The decrease in TMA exposure coincided with a gradual fall in total antibody binding of 125I-TM-HSA per milliliter in 1982 and symptomatic improvement in the three individuals with the LRSS. The continuous low-level exposure of the worker with TMA rhinitis was sufficient to elicit a rise in specific IgE against TM-HSA from 1.1 ng of 125I-TM-HSA bound per milliliter in 1979 to 2.12 in 1982.(ABSTRACT TRUNCATED AT 250 WORDS)
The relationship of total serum IgE and blocking antibody in trimellitic anhydride--induced occupational asthma.
Clinical and immunologic evaluations were performed on workers who manufacture trimellitic anhydride (TMA), a chemical used widely in the plastics industry. Serum samples of 29 workers exposed to TMA dust and fumes were assayed for total IgE, as well as specific IgE and total antibody binding to radiolabeled trimellityl human serum albumin (TM-HSA). Fifteen workers were determined to have significant specific IgE to TM-HSA (greater than or equal to 1 ng of 125I-TM-HSA bound per milliliter). Of these 15 individuals, seven workers had immediate asthma and rhinitis and positive cutaneous prick tests and eight were nonasthmatic and skin test negative. Mean peak total serum IgE was significantly higher in the prick test positive group (p less than 0.02) and higher than in 12 exposed asymptomatic IgE antibody-negative workers (p less than 0.001). Total serum IgE followed rises and falls in TM-HSA--Specific IgE binding, correlating to the onset of allergic symptoms in all seven workers. Total antibody binding of 125I-TM-HSA, as determined by the ammonium sulfate precipitation technique, was higher in the skin test-negative group of eight (mean 12,062 ng per milliliter 125I-TM-HSA bound) than in the seven symptomatic skin test-positive workers (mean 2930, p less than 0.004). Determinations of total antibody divided by specific IgE (both in nanograms of 125I-TM-HSA bound per milliliter) or blocking ratios clearly discriminated the seven skin test-positive workers with TMA-induced asthma (range 10 to 666) from the eight skin test-negative workers (range 1580 to 16,000).(ABSTRACT TRUNCATED AT 250 WORDS)
Pseudo-toxic-shock syndrome due to a drug reaction.
A case is reported of a 13-year-old girl who had an illness initially thought to be toxic shock syndrome but subsequently noted to be a toxic reaction to the anticonvulsant, carbamazepine. The patient was never hypotensive but she was febrile and had a desquamative rash and involvement of three organ systems. Staphylococcus aureus was recovered from the patient's blood and vagina.
Rubella immunity in older children, teenagers, and young adults: a comparison of immunity in those previously immunized with those unimmunized.
Because rubella continues to be a common illness in adolescents and young adults and because it has been suggested that booster rubella immunizations should be performed, we studied antibody prevalence in 459 predominantly adolescent patients in a pediatric group practice. Rubella antibody (PHA titer greater than or equal to 1:13.5) in previously immunized patients (89.6% of 385) was significantly more common than antibody in unimmunized patients and patients with a questionable history of immunization (70.3% of 74) (P less than 0.005). Twenty-three seronegative patients with a documented history of prior immunization were reimmunized and 22 had an IgG (secondary) antibody response and only one an IgM (primary) antibody response. Since all but one of our patients with previous immunization had a secondary immune response following revaccination, it seems likely that the level of protection in previously vaccinated individuals is considerably greater than 90%. Attention today should be directed at finding and immunizing unvaccinated teenagers and young adults and not in major booster vaccine programs.
Clinical and immunologic evaluation of trimellitic anhydride-and phthalic anhydride-exposed workers using a questionnaire with comparative analysis of enzyme-linked immunosorbent and radioimmunoassay studies.
Twenty workers exposed to trimellitic anhydride (TMA) powder an phthalic anhydride (PA) fumes concurrently were evaluated by questionnaire and serum antibody studies. The study group was divided into high-an low-exposure groups on the basis of job descriptions and intensity of daily exposure. The questionnaire, which was designed to identify symptoms compatible with TMA-associated rhinitis, asthma, late respiratory systemic syndrome, and irritant responses, was administered to 18 of 20 workers. Total antibody binding was determined by the ammonium sulfate assay, and specific IgG and IgE binding was measured with an enzyme-linked immunosorbent assay (ELISA) to both PA-human serum albumin (PA-HSA) and TMA-human serum albumin (TM-HSA) conjugates. Specific IgE to TM-HSA was measured with the polystyrene-tube radioimmunoassay (PTRIA). The questionnaire identified nonirritant, immunologic symptoms caused by TMA primarily in the high-exposure group. Specific IgG, IgE, and total antibody binding to TM-HSA and PA-HSA were found exclusively in the high-exposure workers. One worker was identified with PA-associated rhinitis, high total antibody binding, and specific IgG and IgE to PA-HSA by means of the ELISA. The ELISA was as sensitive as the PTRIA in detecting the presence of specific IgE to TM-HSA. The present study demonstrates that an itemized questionnaire, combined with ELISA IgG and IgE determinations, may be a sensitive method for identifying workers who have or are at risk for developing TMA-induced respiratory symptoms.
Influenza immunization in children and young adults: clinical reactions and total and IgM antibody responses after immunization with whole-virus or split-product influenza vaccines.
Clinical reactions and hemagglutinating-inhibiting (HAI) antibody responses to recent whole-virus and split-product influenza vaccines were studied in 168 children and young adults. The subjects initially received a monovalent vaccine, followed one month later by a trivalent preparation. The reactogenicity of whole-virus and split-product vaccines with an equivalent hemagglutinin content was similar except in the youngest age (6 to 36 months) group in which the whole-virus preparation was more reactogenic. The whole-virus vaccines were more immunogenic, especially in subjects who were previously unprimed (preimmunization HAI antibody titer, less than 5). In these subjects, the geometric mean titers of HAI antibody wee significantly higher after vaccination with whole-virus vaccines than the split-product vaccines. Specific IgM antibody was found more frequently after vaccination with whole-virus vaccines (34%) than after split-product vaccines (11%).
Clinical reactions and serologic responses after vaccination with whole-virus or split-virus influenza vaccines in children aged 6 to 36 months.
The reactogenicity and immunogenicity of whole-virus and split-product influenza vaccines were studied in 77 children between the ages of 6 and 36 months. Subjects initially received monovalent vaccine containing either A/USSR/77 (H1N1) antigen in 1978 or A/Brazil/78 (H1N1) antigen in 1979. One month later a trivalent preparation was given which contained the respective H1N1 antigen plus A/Texas/77 (H3N2) and B/Hong Kong/72 antigens. Temperatures of greater than or equal to 37.8 C (greater than or equal to 100 F) were observed more commonly after initial vaccination with whole-virus vaccine (35%) than after split-product vaccine (14%). No child had a temperature of greater than or equal to 39.4 C (103 F) or a febrile convulsion. The trivalent vaccines were more reactogenic than the monovalent vaccines although none of the reaction indices exceeded 0.9. The whole-virus vaccine appeared to be more immunogenic, especially in those children who were initially seronegative (preimmunization hemagglutination-inhibiting antibody titer (less than 5). Only 50% of children vaccinated with split-product vaccines with initial hemagglutination-inhibiting titers of less than 5 achieved titers of greater than or equal to 20 to the H1N1 antigen after two doses of vaccine compared with 97% in similar whole-virus vaccine recipients. The degree of antibody response to the A/Texas/77 component of the vaccines was greater than the response to the A/Brazil/78 or A/USSR/77 antigens.
Coccidioidomycosis in a neonate; maternal-infant transmission.
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Fetomaternal apects of immunization with RA27/3 live attenuated rubella virus vaccine during pregnancy.
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