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Biomedical subjects

K E Harris

Publications and source records attributed to K E Harris.

At least 37 records · Page 2Linked to original sources
PubMed1996

Idiopathic anaphylaxis: long-term follow-up, cost, and outlook.

To determine the efficacy of oral corticosteroids, antihistamines, and sympathomimetics in treating patients with idiopathic anaphylaxis, the charts of 225 patients diagnosed with idiopathic anaphylaxis from 1971 to 1990 treated at a single center were reviewed. Sixty-one patients (34 females and 27 males) were available for long-term follow-up. Ages ranged from 10 to 68 years with an average of 39 years. Patients with frequent episodes were treated with a protocol of oral corticosteroids, antihistamines, and sympathomimetics. Patients with infrequent episodes were treated for acute episodes only. The number of emergency room visits, hospitalizations, intensive care unit admissions, and length of time in remission were recorded. Sixty-five percent of patients with infrequent episodes and 91% of patients with frequent episodes of idiopathic anaphylaxis went into remission. Significant decreases in emergency room visits occurred for the idiopathic anaphylaxis-generalized-frequent group (P < 0.016), the idiopathic-anaphylaxis-generalized-infrequent group (P < 0.0001), and the idiopathic anaphylaxis-angioedema-infrequent group (P < 0.039). Significant decreases in the number of hospitalizations (P < 0.022) and intensive care unit admissions (P < 0.009) occurred for the idiopathic anaphylaxis-generalized-infrequent and frequent groups, respectively. Overall, an estimated $184 740 was saved with the treatment program, for 546 patient-years. Idiopathic anaphylaxis can be controlled and remission induced in most patients. An estimated $11 million per year can be saved for patients in the USA on the basis of the estimated prevalence in this country.

Adolescent↗
PubMed1995

Idiopathic anaphylaxis. An attempt to estimate the incidence in the United States.

BACKGROUND: Idiopathic anaphylaxis has been described and classified, and increasing numbers of cases are being seen in the United States and abroad. Treatment regimens have been shown to be effective in prophylactic management. There is no available information about the number of cases in the United States. METHODS: We attempted to determine the number of cases of idiopathic anaphylaxis in the United States by mailing a questionnaire to all graduates (for the last 31 years) of the Northwestern University Allergy-Immunology Fellowship training program. RESULTS: Response to the questionnaire was 100%, and 633 cases were reported by this survey of 75 allergists. The current total number of identified cases of idiopathic anaphylaxis from all reports of cases in the United States is 1020. CONCLUSIONS: By extrapolation of the cases of idiopathic anaphylaxis reported by the allergists surveyed to the approximately 4000 allergists in the United States, the estimated number of cases in the United States is between 20,592 and 47,024. Idiopathic anaphylaxis is potentially fatal, represents a source of major medical health care costs, causes anxiety to patients and families, occurs in pediatric and adult populations, and is controlled by appropriate regimens. The estimated number of cases emphasizes the need for careful attention to idiopathic anaphylaxis by physicians.

Anaphylaxis↗
PubMed1995

Undifferentiated somatoform idiopathic anaphylaxis: nonorganic symptoms mimicking idiopathic anaphylaxis.

BACKGROUND: Northwestern University's Division of Allergy and Immunology has had experience with the diagnosis and treatment of more than 350 patients with idiopathic anaphylaxis (IA). In 1992 we reported a group of patients with IA whose presentations mimicked IA, but IA and other organic causes were later excluded. Psychologic factors were suspected as the underlying problem. These patients were classified as IA-variant. Management of these cases was extremely difficult. There was significant morbidity and high and unnecessary costs. OBJECTIVE: We aim to distinguish the nature of this disease and to highlight the evaluation and treatment of this group of patients. METHODS: Their cases are reviewed and reported. RESULTS: Common features included (1) presenting symptoms mimicking IA, (2) no objective findings that correlated with 1, (3) no response to the therapeutic regimen for IA, (4) meeting the Diagnostic and Statistical Manual of Mental Disorders criteria for undifferentiated somatoform disorder, and (5) significant wasted health care expenditure. CONCLUSIONS: This group of patients were better defined as having undifferentiated somatoform-IA. An algorithm was proposed to expedite the diagnosis of the disease so that with early recognition of the disease, unwarranted repetitive consultations, tests, and inappropriate therapy can be avoided.

Adult↗
PubMed1994

Immunologic cross-reactivity of acid anhydrides with immunoglobulin E against trimellityl-human serum albumin.

The purpose of this study was to determine whether workers sensitized by one acid anhydride, trimellitic anhydride (TMA), would possibly react immunologically to two other acid anhydrides, phthalic anhydride (PA) or maleic anhydride (MA). We studied serum samples from four workers with TMA asthma and immunoglobin E (IgE) against TMA conjugated to human serum albumin (TM-HSA). In enzyme-linked immunosorbent assay (ELISA) cross-inhibition studies, TM-HSA inhibited IgE binding to TM-HSA, but when 100 times more P-HSA or M-HSA was used, no significant inhibition occurred. However, in ELISA studies of P-HSA and M-HSA, we saw binding of specific serum IgE. Finally, in passive transfer studies in rhesus monkeys with serum from an individual with antibodies to all three acid anhydrides, the following titers were obtained: TM-HSA (1:32), P-HSA (1:8), M-HSA (negative). We conclude that cross-inhibition studies may not be the best method for determining whether an individual sensitized to one antigen will react to a related antigen. The determination of biologic reactivity in a rhesus monkey model of passive cutaneous transfer makes it likely that biologic reactivity would also occur in a human sensitized to TMA and then exposed to another anhydride such as PA.

Animals↗
PubMed1994

A naturally occurring model of immunoglobulin E antibody-mediated hypersensitivity in laboratory animals.

A naturally occurring model of immunoglobulin E (IgE) antibody-mediated hypersensitivity in canine and rhesus monkey species to environmental allergens is described. Cutaneous responses to a dust mite mix (Dermatophagoides farinae/pteronyssinus) and to four storage mite extracts (Aleuroglyphus ovatus, Blomia tropicalis, Chortoglyphus sp., Lepidoglyphus destructor) occurred in the canine species. Rhesus monkeys had IgE antibody-mediated hypersensitivity to dust mite on cutaneous challenge, but to a lesser degree than the canine species. Biologic relevance was verified by eliciting positive airway challenges in both species. The IgE antibody-mediated basis of these responses was confirmed by passive transfer technique. Demonstration of dust mite allergy provides a naturally occurring model of IgE antibody-mediated hypersensitivity in the canine and rhesus monkey species. Storage mite IgE antibody-mediated hypersensitivity exists in the canine species.

Aerosols↗
PubMed1993

Evaluation of a worker with possible formaldehyde-induced asthma.

BACKGROUND: We describe the evaluation of a worker with clinical symptoms compatible with bronchospasm caused by formaldehyde exposure. METHODS: The worker was evaluated by means of enzyme-linked immunosorbent assay, cutaneous tests, and methacholine and formaldehyde inhalation challenges. The worker's serum was injected intradermally into the skin of a normal rhesus monkey to determine whether hypersensitivity could be transferred from human to primate. RESULTS: An enzyme-linked immunosorbent assay showed that the worker had positive IgE and IgG titers to formaldehyde-human serum albumin. The worker had a positive cutaneous test for formaldehyde-human serum albumin, and this cutaneous reactivity was transferred to a rhesus monkey through the worker's serum. The worker had a negative methacholine challenge at 25 mg/ml and negative formaldehyde inhalation challenges at 0.3, 1, 3, and 5 ppm for 20 minutes. It is possible that the worker would have had a positive result if a higher concentration of F were used for the challenge, but it is more probable that the worker's symptoms were not caused by immunologically mediated asthma. We have studied individuals exposed to formaldehyde, their clinical syndromes, and serologic results for a decade. This worker is the one subject with the most compatible history and immunology, but the worker had a negative challenge. CONCLUSION: Immunologically mediated asthma caused by formaldehyde is extremely rare, if it exists at all.

Asthma↗
PubMed1993

Passive transfer of IgE-mediated cutaneous reactivity in heterologous species.

The transfer of cutaneous hypersensitivity was performed in humans, monkeys, and dogs, using the Prausnitz-Küstner (PK) reaction. Quantitative endpoint titrations were used to study reactions resulting from sera from allergic humans, monkeys, and canines. IgE antibody from dogs sensitized human and rhesus monkey skin. IgE antibody from humans and rhesus monkeys did not sensitize canine skin. The Fc receptors on primate mast cells must have broader stoichiometric adaptation for IgE Fc receptors than the analogous Fc receptors on canine mast cells.

Animals↗
PubMed1993

Algorithms for the diagnosis and management of idiopathic anaphylaxis.

A major approach to the prevention of anaphylaxis due to exposure to an allergen is avoidance of the allergens. In cases of idiopathic anaphylaxis (IA), the method of management must first be pharmacologic control of the acute episode of IA and then the prevention of recurrent episodes. The appropriate management requires diagnosis, classification, and immediate initiation of a treatment regimen that will control and then induce a remission in patients with IA of the frequent (F) type. The classification and management of IA are reviewed and algorithms are presented for initial and long-term management of patients with IA.

Algorithms↗
PubMed1992

IgE-mediated rhesus monkey asthma: natural history and individual animal variation.

This report reviews the 20 years of experience with naturally occurring allergy in dogs and allergic rhesus monkeys. The primate model of allergy is characterized by IgE-mediated cutaneous and respiratory responses to Ascaris antigen. Individual assessments of these monkeys have been carried out over several years and separate populations which are analogous to human IgE-mediated allergic populations defined. These populations are as follows: (1) monkeys which have persistent and consistent IgE-mediated cutaneous and asthmatic responses to Ascaris antigen; (2) monkeys which have cutaneous and airway reactivity to Ascaris antigen but in which the airway reactivity subsides and disappears analogous to a spontaneous remission human asthma, and (3) finally, there is a group of animals with cutaneous reactivity but no asthma analogous to humans with a similar absence of asthma. Within these groups the animals, like humans, have individual variations of severity.

Animals↗
PubMed1992

Malignant idiopathic anaphylaxis: three additional cases and extended evaluation.

Northwestern University's Division of Allergy and Immunology (NUAI) has evaluated and treated 225 patients with idiopathic anaphylaxis (IA) over a period of 16 years. Four patients have been identified with malignant IA. The term "malignant" is used to identify those patients with the most severe form of IA that is resistant to standard therapy. The diagnosis of malignant IA is made in patients with IA whose controlling oral corticosteroid dose was not able to be reduced below 60 mg of prednisone (or its equivalent) every other day or 20 mg of prednisone (or its equivalent) every day without an exacerbation of IA. Presented here is the long-term evaluation of one patient as well as three additional patients with malignant IA managed by our service. At the time of this report we have had no deaths due to IA in patients treated with pharmacologic regimen.

Adrenal Cortex Hormones↗
PubMed1991

Outcome of prophylactic therapy for idiopathic anaphylaxis.

OBJECTIVE: To determine the efficacy of a prophylactic regimen (prednisone, H1 blockade, and sympathomimetic amine therapy) in patients with idiopathic anaphylaxis. DESIGN: Clinical trial before and after treatment. SETTING: Referral-based allergy clinic at a major medical center. PATIENTS: Fifty-three patients with a history compatible with idiopathic anaphylaxis for at least 6 months before presentation to the allergy service and with subsequent management by the service for at least 6 months. INTERVENTIONS: Patients with frequent life-threatening symptoms were treated with a prophylactic regimen. Patients with infrequent episodes of idiopathic anaphylaxis were only treated acutely for each episode of anaphylaxis. MEASUREMENTS AND MAIN RESULTS: The results favored prophylactic treatment with prednisone for patients who were classified as generalized-frequent in the clinical outcome measures of frequency (per patient per year) of episodes (mean before treatment, 7.31 +/- 6.46; after treatment, 3.61 +/- 4.73; P less than 0.02) and emergency room visits (mean before treatment, 1.94 +/- 3.42; after treatment, 0.21 +/- 0.44; P less than 0.005) and for patients classified as angioedema-frequent in the frequency of episodes (mean before treatment, 14.93 +/- 15.89; after treatment, 2.58 +/- 2.18; P less than 0.003) and emergency room visits (mean before treatment, 0.76 +/- 1.01; after treatment, 0.07 +/- 0.11; P less than 0.025). No statistically significant difference was found for patients classified as generalized-infrequent in the frequency of episodes (mean before treatment, 2.01 +/- 1.30; after treatment, 1.36 +/- 1.79) or of the emergency room visits (mean before treatment, 0.56 +/- 0.71; after treatment, 0.32 +/- 0.75) or for patients classified as angioedema-infrequent in the frequency of episodes (mean before treatment, 1.94 +/- 1.55; after treatment, 2.03 +/- 2.16) or of emergency room visits (mean before treatment, 0.27 +/- 0.44; after treatment, 0.37 +/- 0.59). CONCLUSIONS: Prophylactic treatment with prednisone and H1 antihistamines with or without sympathomimetic amines improves clinical outcome in patients who are classified as idiopathic anaphylaxis-angioedema frequent and idiopathic anaphylaxis-generalized frequent.

Adolescent↗
PubMed1991

Serum IgE and IgG to formaldehyde-human serum albumin: lack of relation to gaseous formaldehyde exposure and symptoms.

Fifty-five subjects were studied to determine if the presence of IgE or IgG antibodies to formaldehyde (F)-human serum albumin (HSA) was associated with exposure to gaseous F or with respiratory or conjunctival symptoms from such exposure. The study population included cohorts exposed to F in the workplace, smokers, and normal subjects. IgE antibody specific for F-HSA was detected by ELISA in three subjects; immediate-type skin testing was negative in two of these subjects, and not interpretable because of dermatographism in one subject. One of these subjects had a history of respiratory symptoms when the subject was working in a histology laboratory that contained ambient F and xylene; a respiratory challenge with F at concentrations of up to 2 ppm failed to produce respiratory symptoms or significant changes in pulmonary function. Serum from the three subjects with IgE to F-HSA by ELISA failed to passively transfer skin reactivity to F-HSA to rhesus monkey recipients. These three subjects and two other subjects had IgG to F-HSA by ELISA, although this was of generally low titer. We could not define a relationship between the presence of antibodies and (1) a history of F exposure or (2) a history of adverse respiratory or conjunctival symptoms from F. This study is a continuum of 5 years of study in our laboratory attempting to define allergy to gaseous F, and the current study does not support an immunologic basis for respiratory or conjunctival symptoms from gaseous F exposure. Based on the findings of this and our other studies, it is possible that clinical IgE-mediated allergy to gaseous F does not exist, or if it does exist, it is extremely rare.

Adult↗
PubMed1991

Antibodies to toluene diisocyanate in patients with and without dialysis anaphylaxis.

In a majority of patients with anaphylaxis to dialysis, ethylene oxide has been identified as an etiologic agent. In a significant minority of patients sustaining such reactions, the antigen remains unidentified. Conflicting results have been published with regard to isocyanates as a possible antigen. The authors studied 19 hemodialysis patients with anaphylaxis in whom IgE against ethylene oxide-human serum albumin (ETO-HSA) was not identified (Group 1) and 25 peritoneal dialysis patients without anaphylaxis (Group 2). IgE against toluene diisocyanate-human serum albumin (TDI-HSA) was found in one patient in Group 1, and a similar incidence of IgG against TDI-HSA in Group 1 (16%) and Group 2 (12%) was noted. The results do not suggest that IgE against TDI-HSA is an important cause of dialysis anaphylaxis.

Anaphylaxis↗
PubMed1991

Efficacy of ketotifen in corticosteroid-dependent idiopathic anaphylaxis.

To assess the potential benefit of ketotifen in the treatment of patients with corticosteroid-dependent idiopathic anaphylaxis, ketotifen was administered in an open trial to nine patients with idiopathic anaphylaxis who required maintenance prednisone for control of their disease. A double-blind trial was not done for reasons of patient safety. After a period of management with prednisone and establishment of the minimal dose of prednisone that controlled idiopathic anaphylaxis, ketotifen was initiated and cautious reduction of prednisone was attempted. The prednisone requirement was not altered in two patients, but prednisone was either substantially reduced or terminated in seven patients. Of these seven, three patients developed recurrent symptoms of idiopathic anaphylaxis after tapering and discontinuation of ketotifen, and ketotifen had to be resumed. The statistical analysis of prednisone reduction was highly significant (P less than .004) and we conclude ketotifen was of significant benefit in seven of nine patients with corticosteroid-dependent idiopathic anaphylaxis.

Adult↗
PubMed1990

Malignant idiopathic anaphylaxis.

A patient with idiopathic anaphylaxis (IA), classified as generalized IA with frequent episodes, had original episodes in 1985 and has been managed and studied by the authors since 1987. Although her episodes of IA appear to have been controlled by prednisone, progressively larger doses of prednisone have been required. The patient was classified as a patient with corticosteroid-dependent IA, a subset of patients with IA in whom a remission cannot be induced with prednisone and in whom prednisone cannot be stopped. A trial of ketotifen is in progress without definitive effect on prednisone requirement. Because this corticosteroid-dependent patient with IA, which is potentially fatal, cannot be managed on less than 90 mg of alternate-day prednisone, we propose the term malignant IA to categorize such severe cases of IA.

Acute Disease↗
PubMed1990

Clinical and immunologic evaluation of 37 workers exposed to gaseous formaldehyde.

Thirty-seven workers exposed to formaldehyde (F) were evaluated to determine whether any of their respiratory or ocular symptoms were mediated by an immunologic response to F. Because there has never been a case of defined immunologically mediated respiratory or ocular disease as a result of exposure to gaseous F, we used clinical and immunologic criteria developed for immunologic respiratory diseases that result from inhalational exposure to trimellitic anhydride. A clinical assessment included review of a medical summary of history, physical examination, chest x-ray films, and pulmonary function studies. Serologic assessment was made with an ELISA for IgE and IgG to F human serum albumin. The final evaluation for immunologically mediated disease was based on both the clinical and serologic assessments. None of the workers had IgE or IgG antibody to F-human serum albumin or an immunologically mediated respiratory or ocular disease caused by F; however, some of the workers appeared to experience irritant symptoms caused by workplace exposure to F or other irritant chemicals.

Adult↗