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Biomedical subjects

J W Georgitis

Publications and source records attributed to J W Georgitis.

At least 55 records · Page 3Linked to original sources
PubMed1985

Stinging insect allergy: natural history and modification with venom immunotherapy.

The natural history of stinging insect allergy and its modification by venom immunotherapy was investigated by follow-up observations of patients with histories of venom anaphylaxis and detectable venom-specific IgE. The patients were divided into three categories: (1) receiving venom immunotherapy, (2) declined venom immunotherapy, and (3) terminated venom immunotherapy. One hundred twenty-seven patients were evaluated after 6 mo to 9 yr of venom immunotherapy. Most received top venom doses of 50 micrograms of yellow jacket and/or honeybee venoms every 4 wk. There were 87 restings in 48 patients resulting in two systemic reactions, only one of which could be considered a treatment failure (1%). Fifty-six patients never received venom immunotherapy. In this group there were 40 restings in 28 patients with 14 systemic reactions (35%). In 88 patients who stopped venom immunotherapy, 61 restings in 41 patients led to 11 systemic reactions (17%). Patients with cardiovascular/or respiratory symptoms with initial sting anaphylaxis were at risk for subsequent reactions. With one exception, patients with hives and edema only as the initial reaction either had a similar or no reaction when they were restung. These results confirm the efficacy of venom immunotherapy but also suggest that there are factors other than the presence of venom-specific IgE modulating the occurrence of clinical anaphylaxis.

Adolescent↗
PubMed1985

Venom skin tests in insect-allergic and insect-nonallergic populations.

Intradermal skin tests with varying concentrations of honeybee, yellow jacket, white-faced hornet, yellow hornet, and Polistes venoms were done on 85 patients with histories of insect-sting anaphylaxis and on 56 insect-nonallergic subjects. Positive skin tests (wheal greater than or equal to 5 to 10 mm and flare greater than or equal to 11 to 20 mm) were present in 67 insect-allergic patients at venom concentrations ranging from 0.001 microgram/ml to 0.1 microgram/ml. Seven additional allergic patients had positive skin tests with the 1.0 microgram/ml venom concentration. Twenty-six nonallergic subjects had positive skin tests at the venom concentration of 1.0 microgram/ml, and two patients had positive skin tests at the lower venom concentrations (0.001 to 0.1 microgram/ml). These results confirm venom skin tests as a highly sensitive method of detecting venom-specific IgE in the evaluation of patients with stinging-insect hypersensitivity. Since a large percentage of insect-nonallergic subjects reacted to the 1.0 microgram/ml concentration, clinical judgment and further in vitro testing should be considered in the evaluation of patients who react only at this venom concentration.

Antibodies, Anti-Idiotypic↗
PubMed1985

Local nasal immunotherapy: efficacy of low-dose aqueous ragweed extract.

In previous studies preseasonal local nasal immunotherapy (LNIT) with moderate doses of aqueous ragweed extract (mean total dose 59 micrograms of AgE and 139 micrograms of AgE) was an effective treatment for ragweed hay fever; however, local adverse reactions during therapy were common. This study evaluated the clinical and immunologic responses to LNIT by use of lower doses of aqueous ragweed extract in order to minimize these adverse reactions. Patients were administered preseasonal LNIT for 7 wk and received a mean total dose of 4.7 micrograms of AgE. During the ragweed season, symptom/medication scores (SMS) of the treated patients were equivalent to SMS of untreated patients. Serum ragweed-specific IgE and nasal secretory ragweed-specific IgA rose slightly in the treated patients but not to the extent observed in previous studies. After the ragweed season treated and untreated patients had a substantial increase in serum ragweed IgE antibody titers. No correlation could be found between antibody responses and SMS. This study indicates that LNIT with lower doses of aqueous ragweed extract is clinically ineffective.

Administration, Intranasal↗
PubMed1985

Insect sting anaphylaxis in patients without detectable serum venom-specific IgE.

Following insect sting anaphylaxis, twenty-five patients of over 500 evaluated, did not have detectable serum venom-specific IgE. Twenty-two were evaluated within 1 year of the reaction, fifteen within 6 months. Anaphylaxis occurred in six patients after their first sting exposure. The clinical features of the sting reaction were typical of the reaction occurring in insect-allergic patients with serum venom-specific IgE. Eleven of the twenty-five patients had negative venom skin tests. These observations suggest that a non-IgE mechanism may be responsible for a minority of insect sting reactions.

Adolescent↗
PubMed1984

Further evaluation of local intranasal immunotherapy with aqueous and allergoid grass extracts.

In a double-blind study, 45 grass-allergic patients received local nasal immunotherapy (LNIT) with either aqueous mixed-grass extract, formaldehyde-treated, mixed-grass extract (allergoid), or histamine placebo. Twenty-four patients received LNIT for a second successive year, and 21 patients received LNIT for the first year. The aqueous extract-treated patients had significantly lower symptom-medication scores than either allergoid- or placebo-treated subjects. There was no difference in symptom-medication scores in patients receiving allergoid and placebo treatment or in patients receiving 1 and 2 yr of LNIT. The aqueous extract stimulated a rise in serum grass-specific IgE. There was no serum or local antibody response after allergoid-extract treatment. Postseasonal rises in serum-IgE titers were observed in all three groups. These data suggest that LNIT with aqueous mixed-grass extract significantly reduces the symptoms of allergic rhinitis. The allergoid grass extract was ineffective in the second year of treatment. No cumulative effect of LNIT could be demonstrated in successive years of therapy.

Administration, Intranasal↗
PubMed1984

Natural history of large local reactions from stinging insects.

In ongoing studies of the natural history of stinging-insect allergy, 133 patients with large local reactions have been evaluated over 8 yr; 79 patients returned for reevaluation. Based on RAST analysis with honeybee and vespid venoms, patients were divided into RAST-positive and RAST-negative groups. Sixty-six patients were RAST-negative with positive venom skin tests in 58%. Seventy-five testings in this group led to no systemic reactions and 74 large local reactions. At follow-up RASTs remained negative, and the incidence of positive skin tests was unchanged. Sixty-seven patients had detectable serum venom-specific IgE covering a wide range in antibody titers, indistinguishable from patients with systemic reactions. Twenty-four of 67 patients received venom immunotherapy (VIT). RAST titers decreased similarly in the VIT and untreated groups. There were 55 testings resulting in 40 recurrent large local reactions occurring in equal incidence in treated and untreated patients. One systemic reaction occurred in an untreated patient. In reviewing 118 patients with sting anaphylaxis, a previous large local reaction occurred in five. These results suggest that after repeat stings, patients with large local reactions tend to have subsequent large local reactions, regardless of the presence of venom-specific IgE or immunotherapy. There is small risk of anaphylaxis. Determination of serum venom-specific IgE by RAST or skin tests does not aid in treatment or in predicting prognosis. Thus skin tests are not necessary in patients who have had large local reactions, and venom immunotherapy is not indicated.

Desensitization, Immunologic↗
PubMed1984

Use of pharmacokinetic profile in evaluating patients with repeatedly low theophylline concentrations.

Assessment of individual pharmacokinetics has been helpful in the evaluation of patients with persistently low serum theophylline concentrations and poorly controlled asthma. This paper presents seven cases where pharmacokinetic profiling specifically identified the etiology for low theophylline concentrations. Pharmacokinetic profiles were done following oral or intravenous dosing of theophylline. Serial blood samples drawn over 12 hours were assayed for theophylline concentrations using HPLC. Serum half-life (t1/2), clearance (Cl), volume of distribution (VD) and time-to-peak concentration were determined for each subject. In this series, three patients exhibited rapid theophylline clearance, two had predictable theophylline pharmacokinetics, and two presented with unique pharmacokinetics. These cases illustrate a wide range of pharmacokinetic behavior seen in clinical practice. To evaluate patients with persistently subtherapeutic theophylline concentrations, determination of individual pharmacokinetic profiles should be performed before prescribing high doses of theophylline (greater than 30 mg/kg/day).

Asthma↗
PubMed1983

Local intranasal immunotherapy for grass-allergic rhinitis.

In a double-blind controlled study, local intranasal immunotherapy was evaluated for the treatment of grass pollenosis. On the basis of serum grass-specific IgE levels, 50 grass-allergic patients were randomly divided into three groups and treated with either an aqueous solution of mixed-grass extract, a formaldehyde-modified mixed-grass extract (allergoid), or a histamine solution (placebo). Intranasal solutions were administered in gradually increasing doses over a preseasonal 10 wk period, adverse local reactions from the aqueous grass extract were frequent during treatment. Few adverse reactions occurred from the allergoid or histamine solutions. During the pollen season, patients receiving both grass extracts had much lower symptom/medication scores than patients receiving placebo. The severity of eye symptoms was the same in all groups. After treatment, serum grass-specific IgE rose in patients receiving aqueous and allergoid extract; no change was noted in patients receiving placebo therapy. Grass nasal secretory-specific IgA titers in each group did not change during the study. The results of this study suggest that local intranasal immunotherapy with either aqueous or allergoid grass extracts is clinically effective for the treatment of grass pollenosis. Adverse reactions associated with the aqueous extract may limit its usefulness. No correlation was present between the secretory immune response and clinical benefit.

Administration, Intranasal↗
PubMed1983

Effect of prolonged venom immunotherapy on serum venom-specific IgE and IgG.

Serum venom-specific IgE and IgG were monitored in twenty-three patients receiving venom immunotherapy for more than 3 years. Two response patterns of IgE antibody were found. Following initiation of therapy, seven patients had a rise in serum venom-specific IgE, peaking at one year, then decreasing. Sixteen patients had a persistent fall in IgE antibody titres following initiation of therapy. At the end of 3 years, levels of serum venom-specific IgE in both groups were comparable. The presence of atopy may have influenced the rising IgE antibody response. Serum venom-specific IgG either rose or remained elevated if the pretreatment titres were high. After several years of therapy, there was generally a decrease in serum venom-specific IgG.

Adolescent↗
PubMed1983

Local nasal immunotherapy for ragweed-allergic rhinitis. III. A second year of treatment.

In 1979, pre-seasonal local nasal immunotherapy (LNIT) was found to be an effective treatment for ragweed hay fever. In 1980, this study was continued to evaluate the clinical and immunologic responses of a second year of LNIT. Patients received either pre-seasonal treatment with an unmodified ragweed extract (RW) or a polymerized ragweed extract (PRW), or no treatment. The results of the second year of treatment were the same as the first year. Adverse reactions were significantly higher in the RW-treated group than in the PRW-treated group (P less than 0.001). Symptom/medication scores (SMS) in the RW-treated group were significantly lower than in the control group (P less than 0.005). Although SMS in the PRW-treated group were lower than in the control group, this difference was not significant. The immunologic response was evaluated by measurements of serum (S) RW-specific IgE and IgG and nasal secretory (NS) RW-specific IgE, IgG, and IgA. After treatment, serum IgE titres and secretory IgA titres rose in the RW-treated patients. Nasal secretory-IgG and NS-IgA titres increased with PRW treatment. The only immunologic response observed in the control group was a rise in S-IgE titres after the ragweed season. There was no substantial difference in immunologic measurements observed in the 1979 and 1980 seasons, except that the pre-treatment NS-IgE level was higher in 1980 (P less than 0.02). No significant correlations were found between antibody response and SMS. This study supports the efficacy of LNIT but does not support the protective role for NS-ragweed-specific IgA or IgG.

Adult↗
PubMed1982

Bioavailability assessment of a liquid prednisone preparation.

To assess the relative bioavailability of a recently developed liquid prednisone preparation, prednisolone pharmacokinetics were evaluated after the administration of three separate steroid preparations. On 3 study days, each 2 wk apart, 12 healthy subjects received in random order: prednisone liquid, prednisone tablet, and prednisolone sodium phosphate. Plasma samples were collected over a 12 hr study period and analyzed for prednisolone concentration by high-pressure liquid chromatography. Tablet data demonstrated a time-to-peak concentration of 1.23 +/- 0.68 hr (SD), mean residence time of 5.1 +/- 0.49 hr, and absolute bioavailability (tablet/i.v.) of 97.5% +/-- 17.5%. Liquid data demonstrated a significantly (p less than 0.01) shorter time-to-peak concentration, 0.54 +/- 0.20 hr, and mean residence time 4.6 +/- 0.34 hr, with no significant difference in absolute bioavailability (liquid/i.v.), 88.2% +/- 15.8%. This resulted in significantly (p less than 0.05) higher plasma prednisolone concentrations for the liquid preparation in the first 0.75 hr and significantly lower concentrations after 1.5 hr as compared with the tablet. Prednisolone area under the plasma concentration vs time curve for the liquid prednisone formulation was 90.0% +/- 13.2% of the tablet preparation. Thus prednisone liquid has comparable bioavailability to the tablet, with an earlier peak plasma prednisolone concentration and significantly higher plasma prednisolone concentrations within the first hour of administration.

Administration, Oral↗
PubMed1982

Oral theophylline disposition in cystic fibrosis.

Theophylline absorption and disposition of CF patients have not been systematically studied. To evaluate these factors in CF subjects, seven CF patients were fasted overnight and administered a dose of aminophylline liquid equivalent to 4 mg/kg of anhydrous theophylline. Liver function tests (SGOT, GGT, alkaline phosphatase) were normal in all seven patients. maximum serum theophylline concentrations occurred between 30 and 60 minutes post-dose in all subjects and ranged from 4.8 to 8.6 mcg/ml. These values are similar to those reported in non-CF subjects for a single 4 mg/kg oral dose. The mean serum half-life of 3.5 hours with a range of 1.2 to 5.0 hours is similar to that reported in non-CF populations. The authors conclude that theophylline elimination (half-lives) in CF patients with normal liver function is similar to those of normal and asthmatic patients. CF patients with clinical liver disease may have a decreased clearance and should be carefully monitored.

Administration, Oral↗
PubMed1981

Renal arterial injuries caused by blunt trauma.

Ten patients from the Maine Medical Center with renal arterial injuries caused by blunt trauma are presented and analyzed along with 240 other case reports from the literature. Most patients were under 30 years of age and many were children. Injuries to the left side were more frequent; bilateral injuries occurred in 22 patients. Motor vehicle accidents were responsible for the majority of cases. Arterial thrombosis was the most common finding. Associated abdominal injuries were frequent, but the kidney itself was usually spared. Physical findings, urinalysis, and exploratory laparotomy were not reliable in the detection of arterial injury, but excretory urography and angiography were very accurate. Untreated unilateral injuries usually led to renal atrophy, but most did not cause hypertension; untreated bilateral injuries usually led to chronic renal failure or death. Few attempts at revascularization were successful. Excretory urography is recommended for all patients with blunt abdominal trauma; nonfunction should be investigated by angiography. Immediate bilateral repair is indicated in all cases of bilateral renal arterial injury, but repair of a unilateral injury is indicated only if it is promptly diagnosed in a young, stable patient.

Adolescent↗
PubMed1980

Propagation of sepsis in vascular grafts.

Clinical studies have stated that sepsis tends to remain localized at the point of origin in a patent arterial synthetic graft. We have demonstrated in the pig model that in the acute phase, infection will propagate distally in both thrombotic and patent grafts. The propagation of infection is probably intraluminal. The implication is that total graft excision is necessary for proximal suture-line sepsis in the patent synthetic graft.

Animals↗