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A clinical and immunologic study of workers with trimellitic-anhydride-induced immunologic lung disease after transfer to low exposure jobs.

The objective of the study was to determine the clinical and immunologic status of trimellitic anhydride (TMA) workers who have had immunologic lung diseases and who have been moved to lower exposure jobs. Twenty-nine consecutive workers with TMA-induced immunologic lung diseases who had been moved to low exposure jobs for more than 1 yr were studied retrospectively. Pulmonary symptoms were obtained by physician-administered questionnaire. Immunologic studies were performed using radioimmunoassay. Spirometry and chest film were obtained. Workers with late asthma (LA) (n = 3), late respiratory systemic syndrome (LRSS) (n = 8), or both LRSS and asthma rhinitis (A/R) (n = 6) had improved symptoms, improved pulmonary functions, and lower total antibody against TM-HSA. Five of the 12 workers with A/R had improved symptoms, improved pulmonary functions, and lower IgE against TM-HSA, whereas seven continued to have moderate to severe symptoms, abnormal pulmonary functions, and elevated IgE against TM-HSA. There were no chest film findings in any group that were definitely attributed to TMA. Although TMA workers with LA or LRSS improve when moved to lower exposure jobs, only half of workers with A/R improve; elevated IgE against TM-HSA appears to be a marker for the subpopulation of workers with A/R that does not improve.

Adult↗

Effect of okadaic acid on immunologic and non-immunologic histamine release in rat mast cells.

We have studied the effect of the protein phosphatase (PP) inhibitor, okadaic acid (OKA) on histamine release elicited by immunologic and non-immunologic stimuli in peritoneal and pleural rat mast cells. When cells were stimulated with antigen (egg albumin), OKA strongly inhibited histamine release. This finding suggests that PP1 and PP2A substrates mediate immunoglobulin E-(IgE) dependent secretion in mast cells. In contrast, after non-immunologic activation of mast cells with different drugs, such as the neuropeptide growth hormone releasing factor (GRF) and the cytostatic agents Adriamycin, navelbine and mitoxantrone, there is no effect of OKA on histamine secretion. These results indicate that IgE-dependent secretion is mediated by substrates of PP1 and PP2A, whereas following non-immunological stimuli, they activate pathways that lead to protein phosphorylation; these proteins are not substrates of PP1 and PP2A.

Albumins↗

Diagnosis and management of rhinitis: complete guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. American Academy of Allergy, Asthma, and Immunology.

This document contains complete guidelines for diagnosis and management of rhinitis developed by the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology and the Joint Council on Allergy, Asthma and Immunology. The guidelines are comprehensive and begin with statements on clinical characteristics and diagnosis of different forms of rhinitis (allergic, non-allergic, occupational rhinitis, hormonal rhinitis [pregnancy and hypothyroidism], drug-induced rhinitis, rhinitis from food ingestion), and other conditions that may be confused with rhinitis. Recommendations on patient evaluation discuss appropriate use of history, physical examination, and diagnostic testing, as well as unproven or inappropriate techniques that should not be used. Parameters on management include use of environmental control measures, pharmacologic therapy including recently introduced therapies and allergen immunotherapy. Because of the risks to patients and society from sedation and performance impairment caused by first generation antihistamines, second generation antihistamines that reduce or eliminate these side effects should usually be considered before first generation antihistamines for the treatment of allergic rhinitis. The document emphasizes the importance of rhinitis management for comorbid conditions (asthma, sinusitis, otitis media). Guidelines are also presented on special considerations in patients subsets (children, the elderly, pregnancy, athletes and patients with rhinitis medicamentosa); and when consultation with an allergist-immunologist should be considered.

Diagnosis, Differential↗

Progression of cardiac allograft vascular disease as assessed by serial intravascular ultrasound: correlation to immunological and non-immunological risk factors.

OBJECTIVE: To characterise the severity and progression of cardiac allograft vascular disease (CAVD) in a large patient cohort, and to evaluate possible immunological and non-immunological risk factors for progression. DESIGN: A prospective observational study using intravascular ultrasound. SETTING: Two university hospitals. PATIENTS AND MAIN OUTCOME MEASURES: Changes in focal plaque, lumen, and total vessel area (worst site method) were assessed at baseline and after 12.1 (2.8) months (mean (SD)) of follow up in a cohort of 96 patients (79 male, 17 female; mean age 48.7 (9.6) years; time post-transplant 26.0 (32.4) months). RESULTS: Overall, the mean (SD) intimal index of worst sites increased by 6.7 (8.8)%. The increase in the first 12 months was 7.5 (9.4)%, v 5.9 (8.0)% after the first year (NS). Analysing immunological and non-immunological risk factors (age, underlying disease, sex, donor age, immunosuppression, cytomegalovirus, rejection episodes, cholesterol), low density lipoprotein (LDL) cholesterol was found to be the most important predictor of severe progression (as defined by an increase in intimal index of >/= 15% (p = 0.01). CONCLUSIONS: Progression of CAVD is characterised by a continuing increase in intimal hyperplasia, especially within the first year after heart transplantation. LDL cholesterol is an important predictor of major progression.

Adult↗

Clinical and immunologic outcome of 42 individuals with trimellitic anhydride-induced immunologic lung disease after transfer to low exposure.

The purpose of this study is to determine the clinical and immunologic status of trimellitic anhydride (TMA)-exposed employees who have had immunologic lung disease and who have been moved to lower-exposure jobs. In a case series design, 42 consecutive employees with TMA-induced immunologic lung disease were studied after they had been moved to low-exposure jobs for more than 1 year. Pulmonary symptoms were obtained by physician-administered questionnaire. Immunologic studies were performed using ELISA techniques. Spirometry and chest films were obtained annually. Employees with late asthma (n = 4), late respiratory systemic syndrome (LRSS) (n = 13), or both LRSS and asthma (n = 4) had improved symptoms, improved pulmonary functions, and lower IgE against TM-HSA. Fourteen of 21 employees with asthma had improved symptoms, improved pulmonary functions, and lower IgE against TM-HSA. The 7 who did not improve with transfer to low-exposure jobs did improve with transfer to jobs with no TMA exposure. There were no chest film findings in any group that were definitely related to TMA. Most individuals who develop TMA hypersensitivity syndromes improve with transfer to low- exposure jobs, but occasionally, individuals require transfer to a no-exposure job.

Adult↗

The influence of iodine on the immunological properties of thyroglobulin and its immunological complexes.

Several papers described different immunological properties of thyroglobulin (Tg) after iodination. The influence of iodine-iodide solution on the immunological properties of hTg and its immunological complexes with autoantibodies (aAbs) were studied. Human Tg coated to polystyrene plates, incubated for 30 min with iodine-iodide solution at concentration from 1 to 200 microM at pH 9.0 lost its ability to bind aAbs. Preincubation with iodine (2 microM), decreased aAbs binding by 50%. Tg epitope inactivation induced by iodine depended on the buffer pH and the presence of carbonate ions. The binding of rabbit Tg-antibodies to iodine pretreated Tg was only slightly changed. Thyroglobulin preincubation with iodine solutions decreased aAbs binding from all tested sera (67) of patients with autoimmune thyroid disease (AITD). Excess of iodide (0.2 M KJ) or equimolar concentration of diiodotyrosine protects the Tg molecule from iodine induced inactivation. Immunological complexes of Tg with aAbs dissociate at low iodine concentrations. The results suggest that a product of iodine disproportionation reaction induces changes in the Tg molecule and Tg-aAb's complexes leading to complex dissociation or epitope inactivation.

Antigen-Antibody Complex↗

Clinical Immunology - a Distinct Area of Immunology.

At academic institutions, clinical immunologists are developing training programs and continuing education programs to meet the needs of physician-immunologists and of organ-based specialists with an interest in immunology. Successful interaction between clinical immunology and organ-based subspecialties is important. Training in both the organ subspecialty and in clinical immunology is necessary for appropriate medical care of most immune-released diseases. Although individual countries differ in their approaches to training, examination and certification, there has been substantial progress toward establishing clinical immunology as a clinical subspecialty or as an area of special qualification.

Journal Article↗

Deduction of the fraction of immunologic and non-immunologic failure in cadaver donor transplants.

We utilized the UNOS Registry graft survival records to determine the fraction of graft failures attributable to immunological or non-immunological factors. Ten-year graft survival of HLA-identical sibling donor grafts was 77% excluding deaths, diabetics, Black recipients, recipients older than age 50, and those who required post-transplant dialysis. With similar exclusions, 10 year graft survival from living HLA-mismatched donors was 66%. To account for the overall 60% graft failures at 10 years for all cadaver donors, we deduced that 38% of the failures were due to immunological reactions against non-HLA factors as seen in HLA-identical sibling grafts; 18% of failures were due to HLA factors, as seen in mismatched living donor grafts; and the remainder of 43% was attributable to non-immunological factors.

Age Factors↗

Immunological methods in the diagnosis of monoclonal gammopathies. The prognostic impact of the immunological data.

Immunological data are extremely important for the diagnosis of monoclonal gammopathies (MG). During the 1977-1998 period, 160 MG cases were diagnosed in our laboratory. Out of the 130 multiple myeloma (MM) cases, 70 (53.85%) met the strictly immunological criteria; in the rest of the cases, the immunological data had to be corroborated with the bone marrow cytology and bone X-ray data. We tried to assess retrospectively the prognostic impact of the immunological data on the 60 cases that were treated and followed at the Hematology Dept. of the Cancer Institute, Cluj. The following parameters were found to have a favorable prognostic impact on survival: IgG monoclonal component, kappa light chains, response to therapy with plateau phase achievement, Salmon Durie stages I and II at diagnosis.

Antineoplastic Agents↗

Advances in asthma, allergy and immunology series 2004: basic and clinical immunology.

This review highlights some of the most significant advances in basic and clinical immunology that were published from August 2002 to December 2003, focusing on manuscripts that appeared in the Journal. Articles selected were those considered most relevant to Journal readers. With regard to basic immunology, this report includes articles describing FcepsilonRI expression in mucosal Langerhans cells and type II dendritic cells, mechanisms of TH1 and TH2 regulation, the role of Foxp3 in the development of CD4+CD25+ regulatory T cells, and the increasing importance of Toll receptors in immunity. Articles related to clinical immunology that were selected include the first report of lymphocyte subsets values from a large cohort of normal children; the description of new genetic defects in primary immunodeficiencies; a description of the complications of gene therapy for X-linked severe combined immunodeficiency; a report of 79 patients with hyper-IgM syndrome; a report of the mechanism of action and complications of intravenous immunoglobulin; a report of new approaches for immunotherapy; and an article on advances in HIV infection and management, including a report of defensins, small molecules with anti-HIV properties. Also summarized is an article that studied the immune system during a prolonged stay in the Antarctic, a model for human studies on the effect of environmental conditions similar to space expeditions.

Allergy and Immunology↗

IMMUNOLOGIC INCOMPETENCE OF IMMUNOLOGICALLY RUNTED ANIMALS.

1. Adult (A x C(57)Bl/1)F(1) hybrids regularly show runt disease when injected with adult spleen cells from A strain donors. This also occurs when A strain spleen cells are administered to adult C(3)H mice made tolerant of A strain tissue in the neonatal period. 2. Mice undergoing the graft versus host reaction fail to form antibodies to an intraperitoneal challenge of T(2) bacteriophage. This phenomenon was observed well before any of the other overt signs of runting had occurred. Further, inhibition of antibody production to T(2) phage by graft versus host reaction initiated at an interval following antigenic stimulation is demonstrated. 3. The basis for the immunologic incompetence of the host with respect to T(2) phage is presumed to be the attack of immunologically competent donor cells on the lymphoid cells of the recipient. 4. The failure of the injected parent strain cells to respond to the antigen used may imply immunologic commitment of these cells.

Animals↗

Drug interactions involving immunologic agents. Part II. Immunodiagnostic and other immunologic drug interactions.

This two-part review addresses pharmacists' need for information about immunologic drug interactions. Reports of interactions involving vaccines, immune globulins, and immunodiagnostic reagents are widely dispersed and, therefore, difficult to access. In the conclusion of this two-part article, immunodiagnostic drug interactions as well as interactions involving interferons and other biologic-response modifiers are discussed, as are epinephrine interactions that affect treatment of immunologic-induced anaphylaxis. Host factors of groups and individuals relating to the clinical significance of proposed interactions are covered, such as those involving influenza vaccine with theophylline, warfarin, or phenytoin, and other combinations. Vigilance by all pharmacists is needed to detect previously unreported immunologic drug interactions and further assess known interactions.

Drug Interactions↗

The 34th Annual Meeting of the German Society of Immunology with participation of the Polish Society of Experimental and Clinical Immunology.

The 34th Annual Meeting of the German Society of Immunology was held in Berlin on 24 - 27 September 2003. This meeting, organised for the first time in cooperation with the Polish Society for Experimental and Clinical Immunology, gathered 1200 participants, mostly from central Europe. The programme comprised > 30 symposium lectures and > 750 oral and poster presentations. The main concept of this meeting was based on the rule of ABC--Applied, Basic and Clinical immunology. The state-of-the-art lectures devoted to immuno-based therapies provided by experts in the particular fields discussed some well-known therapeutic approaches. However, several workshop presentations demonstrated novel approaches employing biological therapies. These lectures are the focus of these meeting highlights.

Allergy and Immunology↗

[Immunology in medical practice. XXI. Laboratory tests for immunologic diseases].

Clinical immunology has gained its firm place in health care. There are now established laboratory tests giving insight into the functioning of the immune system in the normal and diseased individual. The laboratory diagnostic tests are related to immune deficiencies, infectious diseases, allergic diseases, autoimmune diseases (both generalized and organ-specific ones), the HLA system and malignancies of immune cells. In this review the application of a number of laboratory tests in the diagnosis of immunological diseases is discussed. In the Netherlands a laboratory specialist, the 'medical immunologist' deals with the development, implementation and performance of the immunological diagnostic tests in health care.

Allergy and Immunology↗

Chronic graft loss. Immunological and non-immunological factors.

AIMS: Late loss of kidney grafts is an ongoing problem in the field of transplantation. This is caused by immunological and non-immunological factors, the main immunological driver of rejection is the immune response against HLA molecules that differ between donor and recipient. METHODS: To measure the anti-donor responses that a recipient can mount, we have been quantifying anti-donor T-cell frequencies in recipients of renal transplants for several years. Anti-donor direct and indirect pathway frequencies have been measured in vitro in kidney and heart transplant patients by Limiting dilution analysis and other methods. Further, to elucidate the role of CD4+CD25+ regulatory T-cells, these cells have been depleted in ex vivo assays of cellular function. Antigen specific CD4+CD25+ cell lines are being expanded in vitro with a view to using them in immunotherapeutic strategies. RESULTS: Frequencies of T-cells with direct pathway anti-donor specificity decline in most patients, while those with indirect anti-donor specificity increase in frequency in patients with late graft failure. In keeping with results from experimental models of transplantation tolerance, evidence for allospecific regulatory cells was found in some patients with good, stable transplant function. Interestingly, the regulatory cells appeared to have indirect allospecificity, and no evidence of direct pathway regulation was observed. CONCLUSIONS: The indirect pathway anti-donor alloresponse poses the major threat to long-term transplant survival. Indirect pathway regulatory T-cells arise in some patients. These data are consistent with the hypothesis that tolerance strategies require shrinkage of the direct, and regulation of the indirect, anti-donor response.

Acute Disease↗

[Immunological and non immunological mechanisms in urticaria].

Urticaria involve mast cell activation which could be mediated by immunological or non-immunological mechanisms. Interaction of allergens with the IgE/IgE receptor at the surface of mast cells has been postulated as the main immunologic type of mast cell activation. However, recent experimental and clinical studies have highlighted the existence of other mechanisms involving specific antibodies and T cells. IgG antibodies of different specificities (anti-IgE and/or anti-IgE receptor autoantibodies) have been characterized in a subgroup of patients suffering from chronic "autoimmune" urticaria. Circulating immune complexes may activate mast cells by interaction with the membrane-bound receptor for IgG. Interaction of mast cells with specific T cells could induce mast cell activation. Thus, immune-mediated urticaria appears to be secondary to different types of mast cell activation which could explain the various clinical presentation of the disease.

Arachidonic Acids↗

Concerns about intranasal corticosteroids for over-the-counter use: position statement of the Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology.

The Joint Task Force for the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology was charged with formulating a position paper regarding the potential release of intranasal corticosteroids for over-the-counter use. We took the position that safety issues regarding this proposal would be our sole concern. We reviewed the literature to evaluate the frequency and severity of potential adverse events related to the administration of intranasal corticosteroids. We limited this review to 5 areas: (1) effects on growth, (2) ocular effects, (3) effects on bone, (4) effects on the hypothalamic-pituitary-adrenal axis, and (5) local adverse effects. After review of the available data, we concluded that intranasal corticosteroids should remain prescription-only drugs. Patients receiving an intranasal corticosteroid should be instructed in its use and that use should be monitored by a physician or an appropriately trained medical provider (eg, nurse practitioner or physician assistant) under the direct supervision of a physician. This conclusion was reached based on the evidence that corticosteroids administered by any route, including the intranasal route, have the potential to cause adverse effects in all the areas noted herein. Our conclusion was strengthened by the fact that these adverse effects can be insidious and therefore not evident for many years; there is the potential for overuse; patients could also have access to other forms of topically administered corticosteroids, thus increasing their total dose; and individuals vary in their susceptibility to corticosteroid-induced adverse effects. We were also influenced to take this position knowing that generally reassuring data regarding the use of respiratory tract-administered corticosteroids are based on mean data and that all such studies have shown outliers in whom adverse effects were evident. Thus, as stated, we recommend that intranasal corticosteroids remain prescription-only drugs.

Administration, Inhalation↗

Fuchs' heterochromic cyclitis: an immunological disease or an immunological response?

Over a 10 year period, a large number of immunological investigations were performed on the peripheral blood, iris and aqueous humour of patients with Fuchs' heterochromic cyclitis (FHC). Many immunological aberrations were detected, but it was felt these may indicate a response to a variety of initiating or unrelated factors rather than reflecting a disease of true immunological origin.

Antibodies, Monoclonal↗