Biomedical subjects
Publications and source records attributed to F Wortmann.
Following introductory remarks concerning the generally observed increasing morbidity and its socio-medical consequences, some particular and clinically important aspects of pollen biology are stressed. Further points discussed are: the importance of IgE-mediated late-phase reactions in pathogenesis,: diagnostic procedures,: symptomatic therapy and hyposensitization.
A discussion of possible future trends in the application of allergology to clinical practice is presented. Using the implications of antibody multispecificity as a basis, we compare the immune system and the sense of smell and examine the similarities between the immune system and the nervous system.
A recapitulation of the indications and contraindications for such treatment is followed by a short discussion of the different extracts now available. Here the dangers inherent in the new, highly purified extracts, especially for the inexperienced, are stressed. A short review of essential points follows for the composition of the extracts, for their dosage and concerning the importance of a sufficient duration of the treatment as well as of additional "flanking" procedures. The discussion of possible reasons for side effects, their treatment and their avoidance is followed finally by a list of possible reasons for failure of specific hyposensitization.
As an introduction a survey is given of the great changes the biotope "household" has undergone during the last decades which had quite important consequences regarding the composition and quantity of the allergens found there. Organic substances are of primary importance among the inhalation-allergens: especially animals (insects (housedust mites!) and pets), but also moulds and organic dusts. Inorganic substances, like fumes of cleansers or of formaldehyde, act more as primary irritants and only rarely cause real allergies. Among contact-allergens on the contrary, inorganic substances like metals, cleansers and the like are more often the cause of dermatitis than organic material, but juices of fruits, vegetables and sometimes also of meat or fish can provoke real allergic sensitizations.
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Atopy is defined as that familial form of increased reactivity which is characterized by a probably genetically determined, spontaneously occurring preferential production of IgE as a response to the natural exposure to allergens normally present in the environment, and whose clinical manifestation as a disease is additionally dependent on a non-immunologically conditioned increase in reagibility of the tissues. An attempt is made to show how many different factors must cooperate to produce atopic disease, and how these factors are mutually influenced by their actions. The implications of this definition of atopy are discussed with reference to prophylaxis and treatment in clinical practice.
Comparison of basophil degranulation test (BDT) with radioallergosorbent test (RAST) in 50 patients with anamnestically certain or probable hymenoptera allergy yielded practically equal results. In patients who had experienced their allergic reaction a long time ago, BDT seemed to react positively over a longer period of time than RAST. As BDT is technically easy to perform and moderate in price, it is suited to substitute RAST.
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A second clinical trial of the compound Ro 6-0787, which is a specific monovalent penicilloyl hapten inhibitor of allergic reactions to penicillin has been conducted by investigators from 9 different European groups in 90 patients allergic to penicillin. The effect of a combined Ro 6-0787-penicillin therapy was considered as clinically successful in the large majority of cases, since treatment with penicillin could be pursued or resumed without allergic manifestation in 42 from 46 cases (91 percent). The effect of Ro 6-0787 alone on acute allergic manifestations after interruption of penicillin therapy was more difficult to evaluate but was nevertheless considered satisfactory in 17 from 26 patients (65 percent). A depression of skin hypersensitivity to PPL and/or penicillin and penicillin derivatives sometimes persisting for weeks and months was obvious in numerous allergic patients submitted to combined Ro 6-0787-penicillin treatment. A depressing effect on antipenicillin antibody titers detected by passive hemaglutination was also manifest in some patients. Failure to suppress allergic manifestations was reported in 11 cases, among which some may have been due to insufficient dosage of inhibiting hapten. The overall tolerance of Ro 6-0787 in allergic patients has been very good. Nevertheless, the major obstacle to a wider general use of Ro 6-0787 at the present time appears to be the occurrence of positive skin reactions to that compound in approximately 5 percent of patients allergic to penicillin. It is not yet ascertained whether the occasional positive skin reactions and urticaria to Ro 6-0787 may have been due to aggregation, or incomplete dissolution of the compound or whether it reflects hypersensitivity to another antigenic determinant. With the reservation that patients with positive skin test to Ro 6-0787 have for the time being to be excluded from combined treatment, this monovalent hapten certainly offers a new possibility to resume and/or pursue penicillin therapy in patients demonstrably allergic to that drug.
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25 years of experience have proven oral hyposensitization to be an effective and safe method for specific treatment of respiratory allergies in children up to the age of 10-12 years. For pollinosis aqueous extracts or pollen powder are used. Results after at least two cures are comparable to those observed after subcutaneous hyposensitization. In house-dust asthma oral hyposensitization is performed either with commercially available extracts or with extracts prepared from the patient's own house-dust. The way to collect such dust samples, their use in testing and the preparation of extracts from it are described. Long-term results with oral hyposensitization of children with house-dust asthma are good.