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Results for “Bronchial Provocation Tests”

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PubMed1999

Treatment of late-onset asthma with fluconazole.

BACKGROUND: Although the etiology of intrinsic or late-onset asthma is generally not known, some cases are associated with overt dermatophyte infection and immediate hypersensitivity to proteins derived from fungi of the genus Trichophyton. OBJECTIVE: We sought to test the efficacy of oral antifungal treatment for Trichophyton-induced asthma by using fluconazole in a placebo-controlled trial. METHODS: Eleven patients with severe or moderately severe asthma were randomized to treatment with fluconazole 100 mg daily or placebo for 5 months (phase 1); during the following 5 months, all patients received active drug (phase 2). Subjects were evaluated by skin tests, bronchial provocation tests, and measurement of serum antibodies to Trichophyton species antigens. Clinical response was monitored by changes in peak flow values measured during a 2-week period at the end of each phase and by changes in bronchial sensitivity, symptoms, and steroid requirements. RESULTS: At the end of the first 5 months of active treatment, there was a highly significant decrease in bronchial sensitivity to Trichophyton (P =.012) and in oral steroid requirement (P =.01). At the end of phase 2, mean peak expiratory flow rates increased in 9 of 11 patients. An improvement in symptoms, peak flow, and steroid use was maintained up to 36 months after starting fluconazole in patients who continued to receive treatment. CONCLUSION: The results show that fluconazole can be useful in the treatment of patients with severe or moderately severe asthma who have dermatophytosis. These findings are consistent with the argument that proteins derived from fungi on the skin and nails can contribute to allergic disease.

Adult↗
PubMed1984

Occupational asthma due to poultry mites.

The possible role of the northern fowl mite (NFM) in occupation-related respiratory disease of poultry workers was examined. The study population included 16 poultry workers with workplace-associated asthma and rhinitis, 27 atopic individuals with similar symptoms but no occupational exposure to poultry, and 12 asymptomatic nonatopic poultry-exposed controls. Ten of the 16 atopic poultry workers had immediate wheal-and-flare reactions to NFM, as compared with two of 27 non-poultry-exposed controls (p less than 0.001). In cutaneous testing with five poultry-related antigens, the NFM was the most reactive. On skin tests, four atopic poultry workers were positive for NFM and negative for Dermatophagoides farinae; four workers were negative for NFM and positive for D. farinae. Radioallergosorbent test (RAST) showed specific IgE levels for NFM, with positive RAST scores in 60% of poultry workers having positive skin tests. A provocative bronchial test with NFM extract in a poultry worker having positive NFM skin test and RAST score resulted in an immediate 25% reduction in the FEV1 and a 62% fall in forced expiratory flow volume at 25% of vital capacity. Collectively, the established presence of NFM in the poultry workplace, associated clinical histories, positive cutaneous tests, positive specific-IgE assays, and positive bronchial challenge combine to establish a role for NFM in occupational allergic respiratory disease of poultry farmers.

Adolescent↗
PubMed1976

Relation between skin tests, inhalation tests, and histamine release from leucocytes and IgE in house-dust mite allergy.

This study was concerned with the correlation between skin test, bronchial provocation test, and histamine release from leucocytes and the serum level of total and allergen-specific IgE in patients atopic to house-dust mite allergen (Dermatophagiodes pteronyssinus) as measured by an intracutaneous skin test. It is concluded that, assuming a positive provocation test to be evidence of allergy, estimation of the allergen-specific IgE concentration in the serum will not offer any major advantages over the intradermal skin test in determining the clinical significance of house-dust mite allergy.

Asthma↗
PubMed1998

House dust mite control measures in the management of asthma: meta-analysis.

OBJECTIVE: To determine whether patients with asthma who are sensitive to mites benefit from measures designed to reduce their exposure to house dust mite antigen in the home. DESIGN: Meta-analysis of randomised trials that investigated the effects on asthma patients of chemical or physical measures to control mites, or both, in comparison with an untreated control group. All trials in any language were eligible for inclusion. SUBJECTS: Patients with bronchial asthma as diagnosed by a doctor and sensitisation to mites as determined by skin prick testing, bronchial provocation testing, or serum assays for specific IgE antibodies. MAIN OUTCOME MEASURES: Number of patients whose allergic symptoms improved, improvement in asthma symptoms, improvement in peak expiratory flow rate. Outcomes measured on different scales were combined using the standardised effect size method (the difference in effect was divided by the standard deviation of the measurements). RESULTS: 23 studies were included in the meta-analysis; 6 studies used chemical methods to reduce exposure to mites, 13 used physical methods, and 4 used a combination. Altogether, 41/113 patients exposed to treatment interventions improved compared with 38/117 in the control groups (odds ratio 1.20, 95% confidence interval 0.66 to 2.18). The standardised mean difference for improvement in asthma symptoms was -0.06 (95% confidence interval -0.54 to 0.41). For peak flow rate measured in the morning the standardised mean difference was -0.03 (-0.25 to 0.19). As measured in the original units this difference between the treatment and the control group corresponds to -3 l/min (95% confidence interval -25 l/min to 19 l/min). The results were similar in the subgroups of trials that reported successful reduction in exposure to mites or had long follow up times. CONCLUSION: Current chemical and physical methods aimed at reducing exposure to allergens from house dust mites seem to be ineffective and cannot be recommended as prophylactic treatment for asthma patients sensitive to mites.

Allergens↗
PubMedDate not supplied

Storage mites as a cause of bronchial asthma in Denmark.

From October 1982 to July 1983, 133 consecutive patients complaining of allergic symptoms were prick-tested with three storage mites (Acarus siro, Lepidoglyphus destructor, Tyrophagus putrescentiae) and two housedust mites (Dermatophagoides pteronyssinus and Dermatophagoides farinae). A total of 60 patients (45%) had a positive prick-test for one or more of the storage mites. A mutual positive correlation was found between the prick-test results for the two house-dust mites as well as for the three storage mites. No significant correlation was found between house-dust mites and storage mites. Four cases of allergy to storage mites are presented. The diagnosis of storage mite allergy was based on the clinical history, prick-test, bronchial provocation test and the finding of storage mites in the environment of the patient. Our study suggests that allergies to storage mites could be rather frequent in the Danish population.

Adult↗
PubMed1980

[Therapy of mite asthma (author's transl)].

House dust allergy is a well known cause of bronchial asthma. VOORHORST and his team found, that the house dust mite is the most important allergen of house dust. We found in 17.2% of our patients a sensitization to house dust or house dust mite. The value of history, skin tests, bronchial provocation tests with house dust and RAST with mite allergen and house dust is discussed. Finally the results of hyposensitization with Migen in 52 patients are reported.

Adolescent↗
PubMed1994

[A new test of specific bronchial provocation with powder allergens in diagnosis of allergic diseases].

The value of the Melillo method of the specific Bronchial Provocation Test (sBPT) using house dust mite allergen was examined. The studies were carried out on 33 mild asthma patients, found to be sensitive to house dust mite by the case history and positive skin test with Dermatophagoides pteronyssinus. The lung function tests of most of the patients were within normal range. A positive bronchial response to allergen was observed in 26 persons (79% of patients examined), dual reaction in 16, only early reaction in 8 and isolated late reaction in only 2. In 7 persons with a positive skin test, sBPT was negative. This test has the great advantage of not requiring special equipment.

Adolescent↗
PubMed1976

[Bronchial antigen provocation tests with the use of whole body plethysmography].

Bronchial provocation tests are performed in order to reproduce the symptoms of extrinsic bronchial asthma. The bronchial obstruction induced hereby can be demonstrated by plethysmographic measurement of specific airway resistance, which is superior to spirometric parameters with regard to sensitivity and effort independence. A rise of specific airway resistance above 20 cmH2O X sec ("dyspnoea threshhold") can be used as the criterium of a positive result. In contrast to forced expiratory manoeuvres no spirometry induced asthma can occur. Automatic evaluation by electronic data processing is possible.

Aerosols↗
PubMedDate not supplied

[Allergic risk factors in wood working].

After an account on wood working schedule and on the main and most noxious chemical constituents of these materials, we consider 55 subjects working in touch with wood, on whom allergological researches have been performed through skin tests and bronchial provocation tests. The sensitivity to wood dust have been found in 10 cases (18.2%), in particular towards woods of obece, lanan, mahogany and samba. Skin tests have revealed 1 positivity to balsam of Perù and 3 to isocyanate (TDI). The bronchial provocation tests have pointed out 1 positive reaction to Mansonia's and ramin's wood and 2 to TDI. The results suggest that the respiratory manifestations due to wood's dust on subjects professionally exposed, have to be prevalently imputed to exotic woods, even if the irritant factors assume a not minor importance. It is discussed the possible role of isocyanates in this pathology.

Bronchial Provocation Tests↗
PubMed1994

[Clinical significance of cat allergens in adult asthmatics--a study of inhalation provocation tests].

We performed a bronchial provocation tests on 40 adult cat sensitive asthmatics to study the clinical significance of cat allergens. Immediate asthmatic responses (IAR) and/or late asthmatic responses (LAR) were provoked in 29 out of the 40 cases. IAR alone was provoked in 12 cases (30%), LAR alone in 7 cases (17.5%), dual asthmatic responses (DAR) in 10 cases (25%), and no asthmatic response in 11 cases (27.5%). There was no statistical significance in the following parameters among the groups: age, baseline of FEV1.0% and of %MMF, RAST score to cat epithelium and log value of PC20 in acetyl-choline airway hyperreactivity tests. The frequency in contact history with cat was lower in LAR alone (14%) than in the other two groups (78% in DAR, 70% in no asthmatic response). High RAST scores and low PC20 values were more frequent in DAR than in the other groups. Asthmatic responses were found in 15 out of 22 cases (68.2%) with a cat contact history and in 10 out of 16 cases (62.5%) without a contact history. These prevalence rates were the same. We concluded that cat allergens were an important factor not only for child asthmatics but also for adult asthmatics.

Adult↗
PubMed1975

Reaginic bronchial allergy and the occurrence of reagins against mites in a representative sample of a local Swedish population.

This study involves an investigation of 185 subjects, aged 35--54 years, a representative sample of persons with chronic obstructive lung disease in a local Swedish population. Bronchial asthma was diagnosed in 86 persons, chronic bronchitis in 69 and a combination of bronchial asthma and chronic bronchitis in 30. Reaginic bronchial allergy as a provoking factor was considered as definite when the case history, an intracutaneous test, a bronchial provocation test and a radioallergosorbent test were all positive with regard to one and the same allergen. This was found in 28% of the asthmatics. In 16% of the asthmatics, the diagnosis of reaginic bronchial allergy was not supported by all the four diagnostic criteria used but was considered as probable since the case history or the bronchial provocation test was positive in association with a positive RAST or intracutaneous test with the same allergen. Reaginic (IgE) antibodies in serum to mites (Dermatophagoides pteronyssinus) were found in 20 subjects, 18 of whom also had a positive intracutaneous test for house dust. Four of these 20 subjects had definite and 12 had probable reaginic bronchial allergy. One of the remaining four subjects had chronic bronchitis without asthma. The percentage of definite reaginic bronchial allergy may possibly be increased when reliable bronchial provocations with mite allergen can be performed. Increased IgE levels in serum were found in only eight of the 51 asthmatics with reaginic bronchial allergy and in two of the 65 other asthmatics.

Adult↗
PubMedDate not supplied

Cockroach asthma: case report and literature review.

Among the different antigens, insects play an important role in the induction of allergic reactions. We report on a 12-year-old boy with family history of atopy, who developed symptoms of rhinitis and perennial asthma since the age of 5. Patient's symptomatology increased during pollination and kept close relationship to domestic antigens. A skin and inhalation test with an extract of domestic dust was positive. An investigation about potential allergens was initiated and the patient mentioned that was a significant amount of cockroaches at his home. Skin tests, RAST and bronchial provocative tests with a cockroach extract gave positive results. Bronchial provocative tests with a cockroach extract gave immediate and late responses, as has been evidenced by different authors. Immunotherapy has been successfully employed, partly due to the difficulties inherent to an efficient way of preventing insect contact. Improvement of symptomatology correlates well with blocking antibody production and the reduction in white cell sensitivity to the antigenic system. Finally, the potential relevance of cockroach hypersensitivity in our country be underlined. Cockroach sensitivity should be considered in every patient with perennial asthma, in which the usual allergens have been excluded.

Animals↗
PubMed1987

An investigation on in vivo allergenicity of Artemisia annua leaves and stems.

Pollen of Artemisia annua is considered to be one of the most important allergens in autumnal hay fever in China, just as ragweed is in North America. In order to clarify the allergenicity of non-pollen containing components of the plant, Artemisia annua leaves and stems were collected and extracted before pollination time. The extracts of these pollen-free plant components were studied for allergenic activities using skin prick tests, intradermal tests, intranasal challenge and bronchial provocation tests. In 52 subjects sensitive to Artemisia pollen, 92.3% gave positive responses in skin prick tests, 100% gave positive responses in intradermal tests, 66.7% gave positive responses in intranasal challenge and 59.3% gave positive responses in bronchial provocation tests. Negative results to skin prick tests, intradermal tests and bronchial provocation tests were revealed in 30 seasonal asthmatics who gave negative responses to the pollen skin tests. Strict placebo control showed all negative tests in non-atopic adult human volunteers. We concluded that pollen-free plant extracts did have in vivo allergenic activities. Analysis of the plant allergenic components in vitro will be the subject of further studies.

Adolescent↗
PubMed1986

Diagnosis and immunotherapy of mould allergy. IV. Relation between asthma symptoms, spore counts and diagnostic tests.

Twenty-four adult asthmatics with autumnal asthma and positive bronchial provocation test to the mould species Cladosporium were evaluated by daily symptoms scores during 11 weeks in the peak mould spore season. A significant association with fluctuation in Cladosporium spore count was found regarding the relative weekly symptom score (mean of subjective asthma and peak flow scores), relative use of antiasthmatic medication and the combined (total) score (mean of symptom and medication scores). The median weekly symptom, medication, and total scores were positively correlated to Cladosporium spore count, but only significantly so in the medication score. Eighteen patients were allergic to both Cladosporium and Alternaria, but asthma symptoms were not associated to Alternaria spore counts; on the contrary, a negative correlation indicated that Alternaria only played a minor role in eliciting asthma. Neither mugwort nor house dust mites seemed to be of importance. The results of diagnostic tests (bronchial provocation test, quantitative skin prick test, RAST and histamine release) were correlated to the mean absolute symptom score of the spore season. The highest correlation to asthma score, peak flow score, medication score, and the combined score was found with the bronchial provocation test. The data indicate that autumnal asthma, to a high degree, is elicited by Cladosporium spores, and further, that the specific allergic diagnosis can only be established by a combination of positive diagnostic tests and careful recording of symptoms elicited by the causative allergen.

Adolescent↗
PubMed1986

Occupational allergy to honeybee-body dust in a honey-processing plant.

We studied a honey-plant employee who developed severe asthma coincident with the seasonal honey-packing process. Symptoms correlated with duration of exposure inside the plant during the honey pack and improved in other environments during that season. The patient was asymptomatic inside the plant at other times of the year. Skin tests to seasonal outdoor aeroallergens were negative, as were inhalation challenges with two insecticides used inside the building during the honey pack. Skin test, RAST, and bronchial provocation test with honeybee whole body extract were positive. We used high-volume air samplers to collect ambient airborne particles on filter sheets outside the patient's home and inside the honey plant, both during and after the honey pack. Skin tests, RASTs, and bronchial provocation tests with eluates from these filters were positive only to eluate from the filter exposed inside the plant during the honey pack. The patient's positive honeybee whole body RAST could be inhibited by preincubation of her serum with this filter eluate but not by preincubation with eluate from a filter exposed outside the patient's home. Collectively, these data support an IgE-mediated, seasonal, occupational sensitivity to honeybee-body dust.

Asthma↗