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Biomedical subjects

G M Halpern

Publications and source records attributed to G M Halpern.

At least 37 records · Page 2Linked to original sources
PubMed1991

Systemic allergic reactions to corticosteroids.

Allergic anaphylactic (type I) reactions to corticosteroid medications are uncommon; however, a number of well-documented cases have been reported. We present a review of the literature, and report on two patients who suffered anaphylaxis after injections of corticosteroids. The first patient, a registered nurse, was finally found to be sensitive to all corticosteroid preparations containing carboxymethylcellulose, as well as the pure carboxymethylcellulose. The second patient had positive skin tests to hydrocortisone, hydrocortisone sodium succinate, methylprednisolone sodium succinate, and suxamethonium. Both patients were tested on two occasions; four normal subjects were tested in parallel, and did not elicit any positive skin reaction. In patients with systemic severe reactions to injectable corticosteroids, we recommend careful and comprehensive skin testing with most available corticosteroids, as well as the components of the injectables.

Adult↗
PubMed1991

In vitro diagnosis in asthma: the state-of-the-art.

"In vitro assays in asthmatic patients have been exploring the "allergic" component of asthma. Solid-phase IgE tests can supplement or replace skin tests. Histamine release and determination are performed with automated, or RIA/ELISA; however, these assays are still research oriented. More recently, tryptase has been investigated, and the serum levels of this enzyme correlate well with mast-cell activation. But asthma is a multifactorial/facetted syndrome, and these assays provide minimal and specific informations which may just focus on limited etiological aspects of an elusive malady".

Allergens↗
PubMed1990

Effects of low concentrations of arachidonic acid derived mediators on the membrane potential and respiratory burst responses of human neutrophils as assessed by flow cytometry.

Hypaque-Ficoll purified (95%) neutrophils (PMN) from normal healthy subjects were assessed for FMLP-elicited membrane potential (delta psi) responses and dichlorofluorescein (DCF) fluorescence (a measure of intracellular hydrogen peroxide production) using flow cytometry and appropriate fluorescent probes. Superoxide (O2) production was measured spectrophotometrically as the superoxide dismutase-inhibitable reduction of cytochrome C. The modulatory effects of dilute solutions of the arachidonic acid-derived inflammatory mediators LTB4, LTC4, LTD4, PGE1, PGE2 and PGF2 alpha (10(-9)-10(-5) M) were assessed in these systems. While LTB4 enhanced the proportion of cells depolarizing to the chemoattractant N-formyl-methionyl-leucyl-phenylalanine (FMLP) 2-3x with a maximum effect in the 10(-9)-10(-8) M range, LTC4 and LTD4 showed no such enhancement except at high concentrations (10(-6) M). Unlike LTB4, LTC4 and LTD4 were unable to enhance FMLP mediated PMN O2 or DCF responses at any concentration tested, implying a divergence between the effects of the leukotrienes on membrane potential and oxidant responses. Pre-incubation of PMN with prostaglandins E1 or E2 led to a dose dependent inhibition of the proportion of depolarizing PMN in response to FMLP; PGF2 alpha did not show such an effect. The present data indicate that LTB4, in addition to being a powerful direct neutrophil activator, may act in a priming capacity by increasing the proportion of subsequently FMLP responsive cells, while PGE's inhibit. These modulatory effects appear relatively specific for LTB4 and the E-series prostaglandins.

Drug Interactions↗
PubMed1990

Chronic urticaria.

Urticaria affects 15% to 20% of the population once or more during a lifetime. Chronic urticaria is a frequent recurrent eruption over a period greater than 6 weeks; the cause remains a mystery in more than 75% of cases. Urticaria and angioedema may be produced by immunologic or nonimmunologic means. Urticarial vasculitis, contact urticaria, mastocytosis, physical urticarias, dermatographism, cholinergic urticaria, localized heat urticaria, cold urticaria, aquagenic urticaria, and vibratory angioedema all require specific evaluation and treatment. Chronic idiopathic urticaria is usually controlled by antihistamines; depending on the circadian rhythm of the eruption, sedative or nonsedative antihistamines are prescribed. Some patients will require a combination of H1 and H2 antagonists, or even parenteral corticosteroids.

Angioedema↗
PubMed1990

[Current concepts in the treatment of asthma (in the United States)].

The practice of medicine, in the United States, is regulated by different concepts when compared to France. Anti-asthmatic medications are very similar to the ones available in Western Europe, except the combinations (e.g. Berodual/Duovent), and the 200 mcg Beclomethasone MDls. Environmental control is emphasized, as well as a smoke-free environment. Immunotherapy is not recommended, although actively prescribed for generating income. For the last few years, American and French concepts -and problems-regarding asthma are coming closer.

Adrenal Cortex Hormones↗
PubMed1988

Serum sickness with acquired precipitating antibodies during rush immunotherapy (2 cases).

Serum sickness can be induced by several heterologous proteins. Two patients undergoing rush immunotherapy developed clinical symptoms of serum sickness. One patient received a mite and grass pollens mixture and the second patient a wasp and yellow-jacket venoms mixture. Precipitating antibodies against some allergens used for immunotherapy were found in their serum during the disease but not in the sera drawn before immunotherapy and two and three months after. Pathologic findings showed a leukocytoclastic vasculitis. Pathogenesis of this complication is discussed.

Antibodies↗
PubMed1987

Non-IgE antibody mediated mechanisms in food allergy.

Food sensitivity or intolerance is not necessarily based on the Type I allergic reaction. Non-IgE antibody reactions, complement-dependent reactions, enzyme deficiencies such as lactase and non-immunologic histamine release (such as with some sea foods) have been described. Even the detection of specific antibodies on their own does not necessarily indicate that a given symptom is due to that antibody. Food allergy nevertheless exists. It is important that those observers fortunate enough to see many cases document their observations carefully and eventually publish them for the education of their less fortunate colleagues. Is food allergy more common in infants and young children? What happens as they grow older? How often is atopic eczema due to food allergy? Why are some foods more likely to be implicated than others? Does a negative RAST result eliminate the diagnosis or a positive one confirm it? Until the answers to these and other questions are known, the mainstay of diagnosis will be the history, and that of treatment will be the elimination diet.

Animals↗
PubMed1987

Long-term IgG4 determinations in hymenoptera-sensitive treated patients.

Honey bee and vespid venom immunotherapy have been practiced for the past 10 years. Several studies have evaluated the short-term effects of this therapy. The current study evaluated the long-term effects using venom-specific IgG4 determinations. Forty-six patients ranging in age from 3 to 67 years were followed for periods up to 6 1/2 years. All patients included in the study demonstrated Hymenoptera sensitivity on intradermal testing using 0.2 mL of venom extract at concentrations of 0.01 microgram/mL, 0.1 microgram/mL, or 1 microgram/mL. IgE-specific venom antibody levels were tested and found to be elevated. During the first year following institution of venom immunotherapy, 46/46 patients demonstrated an increase in venom-specific IgG4. After the first year of treatment, values reached a plateau. The IgG4 venom-specific antibodies remained relatively constant over the second and third years of the study. Thirty of the 46 patients were followed for more than 3 years. All of the 30, treated greater than 3 years with continuous immunotherapy, demonstrated a gradual decline in IgG4 levels. Despite very low or negligible levels of venom-specific IgG4 antibodies, six patients accidentally stung were still clinically protected. This study suggests that long-term immunity is not mediated in the same manner as that of short-term protection.

Adolescent↗
PubMed1986

Blocking IgG antibodies after rush immunotherapy with mites.

The synthesis of blocking antibodies has been demonstrated in ten patients undergoing rush immunotherapy (R-IT) with mite extracts: basophil degranulation performed on washed cells (Allergolam technique) did not differ significantly before and 10.8 (+/- 6.8) months after R-IT. Preincubation of allergen (100, 25, 10, and 5 micrograms/mL) with individual serum collected before R-IT did not decrease degranulation, but degranulation was significantly decreased when the allergen was incubated 30 minutes at 37 degrees C with individual serum collected after R-IT or with the IgG-fraction of a pool of sera collected in 22 treated patients. A linear correlation between the mean of degranulation and the log allergen concentration was observed in the two latter groups. The antigen neutralizing capacity of the IgG-fraction was studied on basophils of 11 "allergic donors." Antigen neutralizing capacity clearly increased with time of incubation with the allergen (15, 30, and 60 min), but was also significant without preincubation, eg, for 10 and 5 micrograms/mL allergen concentrations. These results indicate that the improvement of asthma usually noticed 2 months after R-IT is probably due, essentially, to blocking antibodies, since the sensitivity of the basophils is not modified significantly.

Adolescent↗
PubMed1985

Correlation of allergy test results obtained by IgE FAST, RAST, and prick-puncture methods.

Prick skin testing and IgE FASTTM results were compared in eight atopic patients, using a comparable class system. Identical results were found in 53.5% of the cases; a total of 85.7% of the results were within one class difference. Sera from 436 patients were assayed for specific IgE to 94 allergens for a total of 436 test comparisons using IgE FASTTM and modified RAST. Identical results were found in 41.7% of cases; a total of 81.4% of the tests differed by one class or less. The IgE FAST showed good correlation both with prick testing and modified RAST. IgE FAST appears to be a valid non-radioactive, time-efficient method for detecting specific IgE to common inhalant and environmental allergens.

Allergens↗
PubMed1985

The effect of white wine upon pulmonary function of asthmatic subjects.

The potential toxicity of ingested metabisulfite is a source of great concern to patients with asthma. This problem is of particular interest to the wine industry because potassium metabisulfite has been used for centuries to sterilize the mold and bacteria found in barrels or tanks as part of fermentation. Although there have been many observations on the influence of wine in asthmatics, the vast majority reflects anecdoctal case reports. Because of the relationship of metabisulfite to wine, we challenged a group of 25 asymptomatic, normal individuals and 25 patients with asthma with 4 oz of white wine containing 160 mg% of metabisulfite. Pulmonary function tests were performed immediately before, and 20 minutes and one hour after drinking the wine. Of the asthmatics who completed the study, seven of 24 decreased their FEV1 more than 10% at 20 minutes, and five of 23 decreased their FEV1 more than 10% at one hour. Furthermore, four patients decreased their FEV1 from 23% to 36%. Two patients felt symptomatic and one required treatment with a metered aerosolized dose of Alupent. These two symptomatic patients were further studied to identify the mechanism involved by drinking in a blinded fashion either a "model wine solution," prepared on the chemists shelf without metabisulfite, or a "model wine solution" prepared with metabisulfite. One patient became symptomatic when he drank either "wine".(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗