[Use of intranasal beclomethasone dipropionate for allergic rhinitis].
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Biomedical subjects
Publications and source records attributed to G M Halpern.
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By using discs coated with allergens (RAST, Pharmacia) anti-human gammaglobulin goat antibodies, we could demonstrate specific IgG on sera whose IgE had been destroyed by heating at 56 degrees C for 4 hours. A detailed protocol is given. Preliminary results demonstrate absence of specific IgG in untreated patients with pollen allergy, and conversely presence of these IgG in patients treated with immunotherapy against pollens; most patients with epithelia, food and/or mould allergies had specific IgG prior to immunotherapy.
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We have studied the level of blocking antibodies in patients consulting for reagin-mediated allergies. This determination is, in our opinion, important to follow the course of treatment and the natural history of reagin-mediated diseases, treated by immunization.
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The IgG4 is the predominant antibody response in patients receiving chronic exposure to high doses of antigen, and this seems to be true for immunotherapy as well. The duration and the dose of immunotherapy (IT) seems to increase specific IgG4 levels, but this increase does not seem to be related to the clinical response, seasonal exposure, duration of disease, and IgE antibody levels. The measurement of IgE and IgG4 antibodies to allergens did not predict the clinical effect of immunotherapy in our study. However, it indicated that the patients were continuing to receive the allergenic extracts and that the extract used in vivo, although produced by a different manufacturer, was closely resembling the one used for coating plastic wells in the FAST assay. The increase of antibody titres demonstrate that long term monitoring of IT administration may be accomplished by these in vitro tests, although individual patients may exhibit different responses in time but similar clinical results. Longitudinal studies on a cohort of atopic subjects may help define more precisely doses and timings required to achieve useful indications on both compliance with IT injections and predictivity of its outcome.
Hymenoptera therapy with honeybee venoms has been practiced for the past ten years. A variety of studies have evaluated the short term effects of this therapy. This study focuses on the long term effects using venom specific IgE and IgG4 determinations. Results from the study indicate that after venom immunotherapy there is a rapid and prolonged rise in specific IgG4. This continues for several years, but after four or five years the specific IgG4 response seems to wane.
The duration of the antigenic stimulation is a critical issue, but probably more important are the relevance and the purity of the allergen(s). A significant level of IgG4 antibodies has been detected as early as 3 months after initiating immunotherapy with hymenoptera venoms; in our patients, grass pollens, being more "pure", were able to induce an IgG4 response earlier than house dust mites or molds. The cumulative dose of allergen is also an important issue.
IgG4-anti-IgE antibodies have been identified in normal nonatopic subjects, as well as in allergic patients. Their potential role remains controversial. We studied 44 Chinese children with allergic symptoms, and measured their IgG4-anti-IgE serum levels using a modified IgG4 FAST assay. The levels of IgG4-anti-IgE antibodies did not correlate with clinical status. The usefulness and relevance of these measurements remain questionable in allergic patients.