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[Evaluation of the tussicular reaction in bronchial provocative testing with acetylcholine (author's transl)].

A simple method for registration of the tussicular effect in bronchial challenging is described. The results, obtained in this way, are discussed for their informative value. In bronchial challenging with acetylcholine tussicular reaction in all groups of patients is more frequent than broncho constrictive reaction. Evaluated on clinical defined diagnoses respectively anamnestic date there is a good sensibility of the test (index for sensibility 0.85). Till now the date of specifity are not satisfying. It could be solved only by means of longitudinal studies, if these "false-positive" results have an early diagnostive value with regard to beginning functional disturbances in the airways or if they coincide with diagnostic uselessness of the test.

Acetylcholine↗

Diagnosis and immunotherapy of mould allergy. VI. IgE-mediated parameters during a one-year placebo-controlled study of immunotherapy with Cladosporium.

The IgE-response was evaluated by skin prick test, bronchial provocation test and RAST in a 1-year placebo-controlled double-blind immunotherapy study. Eleven adult asthmatics were treated with a Cladosporium allergen preparation and 11 comparable patients received histamine placebo. The bronchial sensitivity (PC20) decrease greater than 0.5 log step in 8/11 (73%) Cladosporium-treated versus 3/11 (27%) in the placebo group. Corresponding figures for skin prick test sensitivity was 10/11 (91%) and 1/11 (9%) respectively. Circulating IgE showed a temporary boost in the Cladosporium group and then values approaching the pretreatment value. Only minimal and insignificant changes were found in the placebo-treated patients. Changes in IgE-reactivity were not related to allergen dose, clinical efficacy or to the occurrence of side effects. Some interrelation between changes in skin prick test, bronchial provocation test and RAST was found indicating a differentiated effect of immunotherapy on various IgE compartments. In spite of the pathogenetic role of IgE in allergic diseases, changes in IgE-reactivity do not seem directly involved in the mechanisms underlying the clinical efficacy of immunotherapy but might be of importance in a complex interaction with other immunological parameters.

Adult↗

Specific IgE estimations by RAST in Japanese asthmatics compared with skin, passive transfer and bronchial provocation tests.

198 asthmatics and twenty healthy persons were studied by RAST and in vivo tests with four common inhalant allergens. (a) Higher RAST classes were elicited with mite (Dermatophagoides farinae) extract and lower classes with other allergens. The agreement between positive RAST and skin or P-K tests was highest with the mite extract. RAST sensitivity was dependent on the kinds of allergens and was most sensitive to mite extract. Positive RAST was most closely related to the prick test reactions. (b) RASTs to house dust and mite extract were examined in terms of the threshold dosage of house dust and also the types of bronchial response (early, dual and late) induced by a certain amount of house dust; higher RAST classes were found in subjects with bronchial response to the dual or early type, elicited by a threshold dosage of diluted extract, while lower RAST classes were found in cases of the late-type response elicited by the threshold dosage of concentrated extract. (c) Changes in IgE antibodies to house dust and mite extract were estimated in patients with positive house dust provocation. A greater increase occurred in cases of dual or early response, a smaller increase in those with a late response. Despite discordances in skin tests and RAST between house dust and mite extracts, the increases in IgE antibodies to mite extracts as well as house dust were observed in all cases, presumably caused by an allergenic identity between the allergens.

Adolescent↗

Brief reversible bronchospasm resulting from bichromate exposure.

A 50-y-old male worker developed an asthmatic reaction after exposure to bichromate in a metal-plating plant. Evaluation included skin tests, bronchial provocation tests, and specific radioallergosorbent tests with metal salts. A 49-y-old worker who suffered from hard metal asthma was the control. These workers were not atopic, and they exhibited similar bronchial hyperresponsiveness in methacholine-PC20 (74 mg/ml versus 81 mg/ml, respectively) and IgE titers (129 IU/ml versus 130 IU/ml). Positive intradermal and patch tests to bichromate were found in the subject. A bronchial provocation test with inhalation of .01 % bichromate produced an immediate decrease in forced vital capacity in 1 s, followed by a rapid recovery within 5 min absent any treatment. There was no reaction to cobalt (1% cobalt chloride) or to nickel (2% nickel sulfate) salts. In the control, a positive bronchial provocation occurred (absent chromium) with cobalt and nickel. Administration of a subcutaneous preparation of 1 mg atropine sulfate or of 1 puff of disodium cromoglycate or beta-stimulant reduced bronchial responsiveness to methacholine-PC20, and no asthmatic reaction occurred following inhalation of 1% bichromate. No blocking of asthmatic reaction occurred after pretreatment with beclomethasone dipropionate inhalation. Administration of propranolol, however, potentiated the acute bronchoconstriction induced by bichromate. The 50-y-old worker had evidence of IgE antibody to chromium-conjugated human serum albumin and to chromium-conjugated exchange resin. His serum selectively bound 51Cr, but antibodies specific to cobalt and nickel were absent. These results, if viewed collectively, suggest that bichromate exposure causes brief reversible bronchospasm via alteration of autonomic balance and increased vagal activation.

Antibodies↗

The effect of ICI 74,917 on asthma and bronchial provocation tests.

A study was made of the protective action of the anti-allergic drug ICI 74,917, a phenanthroline derivative, in specific allergen provocation tests and in combating clinical symptoms in thirteen asthmatic out-patients. It was found that ICI 74,917 was able to diminish allergen-induced bronchoconstriction significantly (P less than 0.01) during both the placebo period and during chronic treatment with ICI 74,917 for 4 weeks. The results obtained during these two periods did not differ significantly. There was not, however, any statistically significant difference in the symptom scores or PEF rates during the treatment with ICI 74,917 or placebo for 1 month. This may indicate that although ICI 74,197 is able to prevent bronchoconstriction in an allergen provocation test, it failed to improve asthma clinically. No signs of the phenomenon of tachyphylaxis were observed in the present study. The Student's t-test was used in the statistical analysis.

Adolescent↗