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Biomedical subjects

L Bielory

Publications and source records attributed to L Bielory.

85 records · Page 5Linked to original sources
PubMed1985

Cutaneous manifestations of serum sickness in patients receiving antithymocyte globulin.

We have prospectively evaluated the cutaneous manifestations of serum sickness in thirty-five patients treated with horse antithymocyte globulin for bone marrow failure. Twenty-one patients (21/35) were treated with antithymocyte globulin (15 mg/kg/day) for 10 days, and fourteen of thirty-five patients were treated with antithymocyte globulin (15 mg/kg/day) for 14 days and then every other day for an additional 14 days. Clinical evidence of serum sickness developed in thirty patients and included fever and malaise (100%), cutaneous eruptions (93%), arthralgias and myalgias (67%), gastrointestinal complaints (67%), and lymphadenopathy (13%). Cutaneous findings consisted of morbilliform eruptions (n = 19), urticaria (n = 1), or a combination of these two reaction patterns (n = 8). Cutaneous manifestations of serum sickness began on day 7 +/- 1 and lasted for 12 +/- 2 days for the group as a whole. Biopsies of lesional skin revealed mild perivascular lymphohistiocytic infiltrates by light microscopy in these leukopenic patients. Direct immunofluorescence microscopy of lesional skin from patients with serum sickness demonstrated immunoreactants in seven of nine subjects (78%). Immunoreactants were confined to the walls of dermal blood vessels and consisted of IgM (7/9), C3 (6/9), IgE (5/9), and IgA (4/9). IgG (horse or human) was not identified in any of these specimens. Twenty-one patients (21/28) also developed an erythematous eruption on the sides of the fingers, toes, palms, and soles 12 to 48 hours prior to their morbilliform eruption. This study describes the cutaneous manifestations of human serum sickness occurring during therapy with horse antithymocyte globulin, documents a cutaneous sign of serum sickness, and suggests that the cutaneous eruptions associated with human serum sickness are immunologically mediated.

Antilymphocyte Serum↗
PubMed1985

A study of human serum sickness.

Twelve patients with bone marrow failure, who were undergoing therapy with daily intravenous infusions of horse antithymocyte globulin, were studied for the development of serum sickness. Eleven of 12 patients developed typical signs and symptoms of serum sickness 8-13 days after the initiation of treatment. These included fever, malaise, cutaneous eruptions, arthralgias, gastrointestinal disturbances, and lymphadenopathy. Eleven of 12 patients developed high levels of circulating immune complexes during serum sickness. All 12 patients also had concomitant decreases of serum C3 and C4 levels. In addition to urticarial and/or morbilliform eruptions, 8 of 11 patients also developed a serpiginous band of erythema along the sides of the fingers, hands, toes, or feet as an early cutaneous sign of serum sickness. Direct immunofluorescence of lesional skin biopsies during serum sickness revealed deposits of immunoglobulin or complement in the walls of small cutaneous blood vessels in 3 of 5 patients. These findings indicate that circulating immune complexes play a central role in the pathophysiology of human sickness.

Animals↗
PubMed1984

A prospective clinical and immunologic analysis of patients with serum sickness.

We prospectively evaluated the clinical and immunologic features of serum sickness in 12 patients with bone-marrow failure treated for 10 days with intravenous infusions of horse antithymocyte globulin. Eleven of the 12 patients had signs and symptoms of serum sickness 8 to 13 days after beginning therapy with antithymocyte globulin. Eleven patients (including 10 of 11 with signs and symptoms of serum sickness) acquired circulating immune complexes, with peak levels occurring at 10 to 12 days. Serum C4 and C3 levels fell precipitously, with nadirs on the 10th day. Plasma levels of C3a anaphylatoxin were elevated in the four patients in whom it was measured. Eight of the 11 patients with signs and symptoms of serum sickness had a characteristic serpiginous erythematous and purpuric eruption on the hands and feet at the junction of palmar and plantar skin. Direct immunofluorescence of skin lesions revealed immune deposits (IgM, IgE, IgA, or C3) in the blood vessels of three of five patients. This study documents the immunopathology of serum sickness in human beings and describes a cutaneous marker for the disease.

Adolescent↗
PubMed1983

Antithymocyte globulin reacts with many normal human cell types.

Antithymocyte globulin (ATG) is frequently effective therapy for aplastic anemia. Its mechanism of action is often assumed to be upon a lymphocyte inhibitor of hematopoiesis. However, specificity for T lymphocytes would not be anticipated from consideration of the method of preparing ATG. In fact, using flow microfluorometry and fluorescence immunohistochemistry, we have found that ATG binds to virtually all circulating lymphocytes, granulocytes, and platelets, as well as to bone marrow cells. Extensive absorption of ATG with either granulocytes or lymphocytes does not eliminate reactivity with the opposite cells, indicating that ATG recognizes some distinct antigens on each cell type. Treatment of cells with ATG blocks the binding of monoclonal antibodies directed against either lymphocyte differentiation or histocompatibility antigens. ATG also binds to visceral tissues, including thymus and testis cell membranes and the nuclear and cytoplasmic components of tonsil, kidney, liver, breast, lung, and intestine. In vitro cytotoxicity of ATG was demonstrated for both T and non- T lymphocytes and platelets. Despite its name, ATG is not specific for a particular cell type, and it would be premature to conclude that its effect is mediated through a specific lymphocyte population.

Antigen-Antibody Reactions↗
PubMedDate not supplied

The role of atypical organisms in asthma.

Atypical organisms (Chlamydia pneumoniae, Mycoplasma pneumoniae) have been recently linked to asthma in various ways: an infection with these organisms may precede asthma onset, exacerbate asthma, or make asthma control more difficult. Their ability to elicit a TH2 response and promote airway inflammation may be the common pathway in the development of an atopic inflammatory response. This article presents a summary of the evidence that infection with Chlamydia pneumoniae or Mycoplasma pneumoniae may play a significance role in asthma.

Adolescent↗
PubMedDate not supplied

Therapeutic targets in allergic eye disease.

The objective of this article is to provide an overview of the present state of treatment of ocular allergy. Immuno-ophthalmology arose in the portion of this past century when investigators uncovered the uniqueness of the lens proteins and that it could induce an immunological response otherwise know as phacoanaphylaxis. Further studies have shown many similarities between the eye and other organ systems, but one of the most profound problems was the spring "catarrh" that involved the eyes and nose, i.e., rhinoconjunctivitis. Treatment over the past 10 years has expanded with the better understanding of the allergic response at the conjunctival surface. Allergen immunotherapy remains a cornerstone of treatment. In fact, the very first report of the use of immunotherapy in 1911 "measured the patient's resistance during experiments ... of pollen extracts to excite a conjunctival reaction" (Noon L, and Cantar BO, Lancet 1572-1573, 1911).

Anti-Allergic Agents↗
PubMedDate not supplied

Complementary medicine for the allergist.

The objective of this article is to provide a historical overview of the present state of complementary and alternative medicine (CAM) in the treatment of atopic disorders. The evolution of medicine in the United States has been in flux with the advent of newer technologies, new designs in managed care, and integrating the cultural differences into a complex multidisciplinary health care delivery process. There have been several herbal modalities that contain various anti-allergy and asthma components with effects on bronchodilation, congestion, pulmonary function tests, and antagonism of asthma mediators such as histamine and PAF, corticosteroid levels, and clearance of mucus. In the field of allergy, asthma, and immunology, the popularity of CAM is more widespread than other common chronic medical problems. Overall, CAM use has created a $15-billion-a-year industry in dietary supplements alone. This has been especially fueled by the deregulation of the "herbal" industry by the congressional passage of the Dietary Supplement Health and Education Act of 1994. It would appear that our specialty would clearly benefit from expanding its knowledge base about these entities because "allergies" are high on the list of patients seeking CAM. This will prepare us to better coordinate the future possibilities and to "doctor" (i.e., teach) our patients about the risks and benefits of these modalities.

Allergy and Immunology↗
PubMedDate not supplied

Immunology of the eye.

The eye is one of the major targets of allergic disorders, accounting for over 20% of the conditions presenting to the allergist. It is also a major target organ of many systemic immunologic reactions (e.g., cytotoxic antibody mediated-cicatricial pemphigoid, immune complex or cell mediated-vasculitis, uveitis). The allergist/immunologist is uniquely trained to assist the ophthalmologist in the systemic immunologic evaluation and treatment of suspected hypersensitivity allergic and immunologic disorders.

Conjunctivitis↗
PubMedDate not supplied

Long-acting ACE inhibitor-induced angioedema.

Angioedema is a known adverse reaction of the angiotensin converting enzyme (ACE) inhibitors. Although current investigations are in progress, the exact pathogenesis of ACE inhibitor-induced angioedema is still unclear. Most cases of angioedema we have seen remitting from the short-acting ACE inhibitor, captopril, have presented with mild angioedema, controlled with antihistamines and glucocorticosteroids. In contrast, the angioedema induced by the long-acting ACE inhibitors have been serious. Our five patients developed angioedema from either lisinopril or enalapril. Three of five patients presented with severe angioedema requiring intubation, and one of these patients had a tracheostomy. One patient with a history of mild angioedema secondary to captopril subsequently required intubation for his enalapril-induced angioedema.

Aged↗
PubMedDate not supplied

Allergic and immunologic pediatric disorders of the eye.

Numerous allergic and immunologic disorders occur in the eyes and frequently present to nonophthalmologists. This article presents a review of ocular immunology, as well as the specific ocular and systemic disorders that are frequently seen. Also included is a discussion of some of the more common ocular disorders in the differential diagnosis of conjunctival inflammation. The treatment of these disorders is presented.

Angioedema↗