Idiopathic anaphylaxis (IA): suggested theories relative to the pathogenesis and response to therapy.
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Anaphylaxis↗
Biomedical subjects
K E Harris
Publications and source records attributed to K E Harris.
Substance P and IgE-mediated allergy. I. Transient increase in airway responsiveness to allergen in primates.
Studies of IgE-mediated asthma in rhesus monkeys have shown that the animals have individual characteristics analogous to the individuality of human asthmatic patients. In the current study we evaluated the effect of aerosolized substance P (SP) and an allergen, ascaris antigen (A), on monkeys that had cutaneous and/or airway reactivity to A. When SP and A were aerosolized sequentially in the same experiment in two monkeys that had had IgE-mediated airway responses that had disappeared with time and in one monkey that had only had cutaneous reactivity to A, an airway response to A occurred. Furthermore, on subsequent challenges, the airway response persisted in the absence of SP exposure. In two other monkeys, SP and A given sequentially in the same experiment induced airway responses to A using a concentration of A that was too dilute to give a reaction in either monkey in previous experiments. The airway response to dilute A then persisted for months in the absence of further SP exposure. We conclude that bronchial challenge of SP in combination with allergen induces an immediate response that would not occur with allergen alone and that this heightened airway response to allergen persists for months as a result of interaction of the neurokinin SP and an IgE-mediated immunologic reaction in the airway.
Aerosols↗
Substance P and IgE-mediated allergy. II. Reduction of rhesus IgE antibody after aerosol exposure to substance P and allergen.
Experiments were designed to evaluate the effect of aerosolized Substance P (SP) and ascaris antigen (A) on airway responses of rhesus monkeys that had IgE antibody against A. During the course of these experiments, a totally unplanned and unexpected observation was made: this was a decline in IgE antibody, as determined by quantitative end-point dilution titers, in the group of animals that had received aerosolized SP and A. Our experience with this species of primate over 2 decades had shown that IgE-mediated cutaneous reactivity persists in the monkeys (as in man) for years with little change. The decline in IgE antibody titers in monkeys occurred over a few weeks to months, was related to the aerosol exposure to SP and A, and has persisted with minimal to moderate rise in IgE antibody. Although these results had to be analyzed retrospectively, the changes were significant by statistical analysis. This serendipitous observation suggests a possible means of reducing IgE antibodies therapeutically in primates. A theory of why primates may develop IgE antibody to antigens absorbed through mucosal surfaces is proposed.
Aerosols↗
Evolution of patient care, education, and research in asthma by one academic team of investigators over 35 years: the Northwestern University Medical School Division of Allergy-Immunology experience (Part Two).
This report reviews approximately 35 years of patient care, teaching, and research an asthma in one academic unit at Northwestern University Medical School. Historical perspectives are summarized on the delivery of care for asthma, therapeutic regimens for asthma we believed in (and were wrong), and diagnosis and management in the last decade of this century. Particular problems, such as potentially fatal asthma and assessment and management of such problems, are discussed. Finally, certain aspects of our basic research programs and their relevance to asthma are briefly reviewed. Part One of this article appeared in the May-June issue of this journal.
Adrenal Cortex Hormones↗
Evolution of patient care, education, and research in asthma by one academic team of investigators over 35 years. The Northwestern University Medical School Division of Allergy-Immunology Experience: Part One.
This report reviews approximately 35 years of patient care, teaching, and research on asthma in one academic unit at Northwestern University Medical School. Historical perspectives are summarized on the delivery of care for asthma, therapeutic regimens for asthma we believed in (and were wrong), and diagnosis and management in the last decade of this century. Particular problems, such as potentially fatal asthma and assessment and management of such problems, are discussed. Finally, certain aspects of our basic research programs and their relevance to asthma are briefly reviewed. An outline of contents is shown in Table I.
Asthma↗
Fatal and near fatal idiopathic anaphylaxis.
OBJECTIVE: To document that idiopathic anaphylaxis may have a fatal or near fatal outcome. DESIGN: Review of selected cases seen personally by authors during the past 16 years. SETTING: University faculty practice and private practices. PATIENTS: All cases of idiopathic anaphylaxis seen by the authors are not presented, but 10 cases were selected to demonstrate two fatalities and eight cases of near fatalities. RESULTS: Two fatal cases had expired before emergency service therapy. Eight near fatal cases responded to acute therapy and subsequently were controlled. Remission of idiopathic anaphylaxis was then induced. Idiopathic anaphylaxis may be fatal or potentially fatal and must be treated to prevent a fatal outcome. CONCLUSIONS: The documentation of fatalities and near fatalities should help patients and their physicians accept intense management of idiopathic anaphylaxis that will result in control and induction of a remission in idiopathic anaphylaxis.
Adolescent↗
Idiopathic anaphylaxis.
Anaphylaxis is an acute, life threatening event that can progress extremely rapidly. External allergens as causations have been identified over the last century. The most recently identified type of anaphylaxis is not caused by any external allergen and has been termed Idiopathic Anaphylaxis (IA). Two major types are Generalized or Angioedema with airway obstruction. IA is also classified by frequency of episodes and response to therapy. Therapy consists of acute emergency therapy and induction of remissions using prednisone, beta agonists, and H1 blockers. Control and remission are usually induced. IA occurs at all ages, and pediatric and geriatric IA are often special problems, as is a psychogenic form where no true reactions occur. Although appropriate management of IA, in general, has a good prognosis, several problems exist. Among these are failure to accept IA as an entity or in an individual case by physicians and patients. A different problem occurs when the recommended treatment is used and there is control of IA, but only with persisting high doses of prednisone. This is corticosteroid dependent IA. The lack of defined mechanisms that will lead to improved therapies and wider acceptance of IA as an entity remains a major problem. Undifferentiated Somatoform IA is a serious management problem for physicians.
Anaphylaxis↗
Changing patterns in academic allergy-immunology.
In evaluation of the current Allergy-Immunology (AI) Program of the Department of Medicine at Northwestern University Medical School and in planning for the future, it appeared that our assessment of changes in the AI program since its inception might be of value to other AI academic programs. Further, we might receive suggestions from other academic AI programs, and we request such advice.
Allergy and Immunology↗
Using test dose challenges to restore essential therapy in patients with idiopathic anaphylaxis and pharmacophobia: report of a patient with idiopathic anaphylaxis and statin phobia.
Idiopathic anaphylaxis (IA) is a well-documented condition in which anaphylaxis occurs in the absence of an identifiable precipitant. However, many patients with IA find it difficult to accept this diagnosis and continue to search for an external cause. It is not uncommon for these highly anxious patients to discontinue essential medications that they feel are responsible for the reaction despite reassurance from their physicians to the contrary. In extreme cases, these patients may develop an actual phobia to preexisting medications and avoid them despite adverse consequences to their health. To illustrate this concept, we report a case involving a female patient with familial hypercholesterolemia who experienced a single episode of IA and developed a "statin phobia," falsely implicating her medication (lovastatin) for the reaction. After 5 years of failed therapy with other antihyperlipidemic agents, the patient finally agreed to undergo test dosing to a similar statin agent atorvastatin. On successful completion of the test, she resumed therapy with atorvastatin and her low-density lipoprotein (LDL) levels were reduced by 50% over 5 months. We conclude that patients with a confirmed diagnosis of IA who manifest phobic responses to beneficial medications should be reassured of the diagnosis promptly by their physician. When reassurance fails and the medication is essential to the patient's health, test dose challenges may be conducted to reintroduce the drug to the patient's regimen.
Anaphylaxis↗