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Immunity in tumours of the skin. Studies on cell-mediated immune reactions.

Cell-mediated immunity (CMI) was investigated in a series of patients with epithelial tumours of the skin and with Kaposi's sarcoma. In all 53 patients the peripheral blood lymphocyte count showed no substantial difference from the control values. The blasts count after phytohaemagglutinin stimulation in 30 patients ranged from 40-50% with no noticeable difference from the control values. Intradermal tests with the staphylococcal antigen, PPD-tuberculin and streptokinase-streptodornase carried out in 59 patients proved negative in a significant number of cases, mainly those of Kaposi's sarcoma. The non immune inflammatory response to chemical irritant (benzalkonium chloride) was more often negative (17 of 59 cases) than in controls (5 of 30 subjects). The DNCB sensitization test carried out in 28 patients was negative in 5 cases (2 cases of late basal-cell epithelioma, 2 cases of advanced squamous-cell carcinoma and 1 case of Kaposi's sarcoma). The findings do not thus indicate the presence of a gross CMI defect in the material studied, which would be borne out by all the tests employed. The sometimes discordant results of the various tests suggest the existence of partial CMI defects in certain tumours, but mainly in Kaposi's sarcoma. Such partial defects, encountered even in early neoplasms, coexist, in some cases, with failure of inflammatory response to chemical irritants.

Adult↗

Clinical, histopathological and immunological effects of exposure of canine skin to Malassezia pachydermatis.

The effects of the daily application for 7 days of suspensions of Malassezia pachydermatis to normal canine skin were evaluated in 10 beagle dogs. Four out of six dogs challenged without occlusion developed transient lesions generally characterized clinically by mild erythema with papules and histologically by mild epidermal hyperplasia and a superficial perivascular dermatitis. Saline-treated control sites showed no clinical signs. In four dogs challenged with occlusion, skin lesions occurred at both yeast and saline-treated sites; erythema and papules were more severe at the yeast-treated sites in three dogs. Occlusion induced more persistent lesions, which resolved within 24 days. Population densities of the yeast were highest at day 8 and declined rapidly following cessation of application. Peripheral blood mononuclear cell proliferation indices following M. pachydermatis exposure in vitro and serum concentrations of M. pachydermatis-specific IgG antibodies did not vary significantly during the study. Delayed (24 h) intradermal test reactivity to M. pachydermatis antigens developed in all eight dogs with clinical signs following yeast exposure. This study suggests that the resistance of healthy canine skin to infection by M. pachydermatis is mediated by local delayed hypersensitivity responses and, or innate epidermal immune mechanisms.

Animals↗

[Anaphylactoid shock caused by chlorhexidine gluconate].

We report two cases of anaphylactoid shock caused by chlorhexidine gluconate. Both patients had skin flare, severe hypotension and increased airway pressure during cannulation of an antibacterial IVH catheter containing chlorhexidine gluconate after skin sterilization with chlorhexidine gluconate. In case 1, we did not identify the mechanism and causative drugs. In case 2, an intradermal test to chlorhexidine gluconate was positive 2 months later. Then we confirmed that the anaphylactoid shock was caused by chlorhexidine gluconate. We should bear in mind the risk of anaphylactoid shock when we use chlorhexidine gluconate or the IVH catheter containing the bactericide.

Adult↗

Specific skin tests in subjects with chronic bronchitis exposed to pigeons.

We have studied the diagnostic reliability of the specific skin tests done in 30 subjects who presented with chronic bronchitis (CB) as the only clinical manifestation related to exposure to pigeons and in 21 subjects with CB and known risk factors. Additionally, two control groups were included (24 asymptomatic subjects exposed and sensitized to pigeons and 10 subjects not exposed and not sensitized to pigeons). The skin prick tests with pigeon serum were negative in all the subjects tested. The intradermal skin tests showed an immediate positive reaction in 16 of the 30 CB-affected patients and in six of the control group of exposed asymptomatic subjects (chi square: 3.376) (P < 0.1; nearly significant); after 6 h, a positive reaction was recorded in 14 of the CB-affected patients and in three subjects of the control group (chi square: 5.187) (P < 0.005). A delayed reaction was seen in 10/30 CB patients and in only three of the 24 subjects of the control group (chi square: 2.218) (nonsignificant). In the group of the 21 CB patients with known risk factors and not sensitized to pigeons, only two patients showed immediate skin reactivity; the remaining readings were negative. Lastly, in the control group of 10 unexposed, nonsensitized subjects, the intradermal skin tests in the different readings were negative. Our results show that although the skin tests with pigeon serum have low sensitivity, they can be a useful supplement in distinguishing cases of CB attributable to chronic pigeon exposure from those cases attributable to another cause, especially in the consideration of immediate and late readings.

Adolescent↗

[Immuno-allergologic evaluation in case of anaphylactoid incidents during anesthesia].

In case of an anaphylactoid accident, immunological and allergological investigation is to be performed in two parts: immediately after the accident (plasma histamine determination, C3 immunoelectrophoresis, basophil count) and four to eight weeks afterwards, investigating for anaphylaxis (intradermal tests, human basophil degranulation test, Prausnitz-Küstner test) and for risk factors (anomalies of histamine release and hyperreactivity to histamine, atopy, spasmophilia, drug allergies, previous administration of the involved substances). The investigation allows the involved mechanism as well as the responsible drug to be ascertained, thus allowing to manage the anaesthetic procedure in the light of the findings.

Anaphylaxis↗

cis-Urocanic acid does not inhibit mitogen induced lymphocyte transformation in man.

Urocanic acid (UCA) is a photoreceptor in the epidermis which absorbs UVB. To elucidate the role of UCA as an immunomodulator in the mechanism of immune suppression which occurs after UV irradiation in human, we studied the effect trans-UCA as well as that of its UV induced cis-isomer (cis-UCA) on mitogen induced lymphocyte transformation and on delayed type responses elicited by intradermal testing of a standardized battery of microbial antigens. No inhibitory effect was seen either in vitro or in vivo. Our negative results, both in vivo and in vitro, suggest that if UCA and UCA photoproducts exert an immunomodulatory effect, their effect should be analysed by a more subtle evaluation of the immune system.

Double-Blind Method↗

Evaluation of the clinical and allergen specific serum immunoglobulin E responses to oral challenge with cornstarch, corn, soy and a soy hydrolysate diet in dogs with spontaneous food allergy.

Fourteen dogs with known clinical hypersensitivity to soy and corn were maintained on a limited antigen duck and rice diet until cutaneous manifestations of pruritus were minimal (78 days). Sequential oral challenges with cornstarch, corn and soy were then performed. Subsequently, the dogs were fed a diet containing hydrolysed soy protein and cornstarch. Throughout the study period the dogs were examined for cutaneous manifestations of pruritus and, additionally, serum was collected for measurement of allergen-specific and total immunoglobulin (Ig)E concentrations. Intradermal testing with food antigens was performed prior to entry into the study and after 83 days. A statistically significant clinical improvement was measured between days 0 and 83. Significant pruritus was induced after oral challenge with cornstarch, corn and soy (P = 0.04, 0.002, 0.01, respectively) but not with the hydrolysed diet (P = 0.5). The positive predictive value of the skin test for soy and corn allergy was reduced after feeding a soy and corn free diet. Although increases in soy and corn-specific serum IgE concentrations were measured in individual dogs post challenge they were not statistically significant and could not be used to predict clinical hypersensitivity.

Animal Feed↗

Influence of retinoid Ro 10-9359 on cell-mediated immunity in vivo.

26 patients with psoriasis and 23 patients with other dermatoses were treated for 28 days with oral retinoid Ro 10-9359. Intradermal tests to seven recall antigens were carried out before and after therapy. Dinitrochlorobenzene (DNCB) sensitization was started at the initiation of retinoid therapy and challenge tests made after 28 days. There was a significant increase in the reactions to recall antigens in all groups after 28 days' retinoid therapy. The reaction to DNCB was increased only in the non-psoriatic group compared with controls. These results demonstrate that the retinoid Ro 10-9359 stimulates cell-mediated immunity in vivo.

Dinitrochlorobenzene↗

Delayed type hypersensitivity in atopic dermatitis.

Three different aspects of delayed type hypersensitivity in atopic dermatitis (A.D.) were studied. (a) Intradermal testing demonstrated that positive reactions to bacterial vaccines were distinctly lower in patients with A.D. (b) Patch testing in patients with A.D. compared to tests in patients with anal eczema showed a striking difference in results concerning the substances to which positive reactions were found. (c) Patients with A.D. (n = 18), atopics without A.D. (n = 10), patients with contact dermatitis (n = 10), and normal controls (n = 10), were patch tested with various human dander (H.D.) fractions after stripping the stratum corneum with skin tape. Only patients with A.D. showed positive reactions, the maximum response being at 24-48 hours. There was no difference in reaction pattern between partially purified H.D. subfractions. Histopathological examination revealed an eczema-reaction. Patch testing within the same patient groups with purified house dust mite allergen P1 demonstrated similar results. Although this finding argues against a specific role of H.D. allergen in A.D. it may at least be concluded that H.D. preparations have the capacity to provoke immediate as well as delayed type skin reactions.

Adolescent↗

The immunologic response to tobacco antigens in smokers. III. Type III hypersensitivity skin reactions and specific serum precipitins to four different tobacco extracts in patients suffering from coronary artery disease.

In a population of 70 patients suffering from coronary heart disease (49 smokers and 21 non-smokers) intradermal tests and specific precipitation tests with four different extracts of tobacco were performed. Skin tests with tobacco extracts were positive in 41 smokers and 7 nonsmokers. In both groups the immediate and delayed type reactions were weak and of rather doubtful specificity, while the late type reaction was usually more frequent and stronger in smokers (in 14 patients it was positive with all preparations). Specific precipitins against tobacco antigens were found in the sera of 13 smokers but never in nonsmokers. The positive precipitation test correlated well with the positive late skin reactions to tobacco extracts. Such correlation with Ag 1 was observed in 9 out of 13 patients, with Ag II in four cases, with Ag IV and Ag V in 2 and 2 patients respectively. The coincidence of strongly positive late skin reactions and positive precipitation tests with tobacco extracts seems to indicate that tobacco allergy really exists and resembles, in a number of patients with coronary artery disease, type III hypersensitivity reactions to tobacco antigens. It is postulated that immune complexes of precipitins and tobacco antigens may be formed in some patients and initiate pathological processes in coronary arteries leading to their occlusion.

Adult↗

Allergens of Epicoccum nigrum grown in different media for quality source material.

BACKGROUND: The Epicoccum nigrum (EN) extract used in allergy disorders exhibits batch-to-batch variations in protein composition and allergenic potency. In this study, the allergens of EN grown in different media were investigated. METHODS: EN was grown in five different nutrient media as stationary cultures at 25 degrees C for 5-23 days. The growth pattern was characterized by measuring dry weight, protein and carbohydrate content. The antigenic and allergenic content of EN extract was evaluated with EN-positive patients' sera and antibodies raised in rabbit. RESULTS: The growth of EN in Czapeck Dox medium yielded insufficient material, while Sabouraud's broth with yeast extract (SBY) gave maximum spore-mycelial mass and protein content. Potato dextrose broth (PDB) and potato dextrose agar (PDA) showed higher dry weight and protein in 7-9-day cultures. SDS-PAGE resolved 26, 22, and 21 protein bands in EN extracts from cultures of day-13 SBY, day-7 PDB, and day-9 PDA, respectively. IgE/IgG immunoblots showed more allergenic (25)/antigenic (25) bands in EN cultured in SBY than in the others. Specific IgE ELISA and intradermal tests showed EN extract from day-13 culture in SBY to be the most potent. CONCLUSIONS: The day-13 culture of EN in SBY was the most potent and may be selected for preparing EN extracts for diagnosis of allergy and future studies.

Adolescent↗

Skin reaction in Callithrix jacchus penicillata to phytohemagglutinin.

Sixty marmosets (Callithrix jacchus penicillata) were intradermally tested with phytohemagglutinin. It was possible to classify this population into three groups on the basis of the reactions: 1. negatives, 2. those which showed just local hemorrhage, and finally 3. a group which developed a wheal as well as hemorrhage. The biopsy at the site of the reaction demonstrated several microscopic foci. This finding contrasted with the homogeneous cellular infiltration found in the human controls.

Animals↗

[The course of Jones-mote reaction in guinea pigs after the sensitization with mycobacteria (author's transl)].

Mycobacterial antigens induce of JONES-MOTE reaction, which is well stated in 7 to 9 days after being intracutaneously sensitized (Tab. 1). The reaction is adjuvant independent; Al(OH)3 as an adjuvant stabilizes and enlarges the reaction in the interval between 7 and 9 days after the sensitization (Tab 2). The erythema size, read 6, 24 and 48 hours after the intradermal testing shows no significant differences (Tab. 3). The maximal intensity of the JONES-MOTE reaction was found after 24 hours (Tab. 4). The sensitization with 0.2 mg of bacterial mass is sufficient (Tab. 5, Fig. 1). The size of erythema increases when 0.5 mug to 10 mug of homologous sensitin are used (Tab. 6, Fig. 2). An oral application of M. fortuitum increased the total count of basophilic leukocytes and caused cross reactions (Fig. 3).

Adjuvants, Immunologic↗

[Incidence, diagnosis, prevention and treatment of insulin allergy].

In the Scientific Institute for Endocrinology, Geriatrics and Gerontology, Sofia, 1723 diabetic patients were treated with insulin during the last 3 years. In 150 of them insulin allergy was supposed. The patients sensitivity toward the various insulin preparations was determined by intradermal test. Insulin allergy was found in 29 patients (1.68%). Insulin allergy was found more frequently in patients using acid insulin preparations and by frequent changes of the type of preparation. It is recommended that in special categories of diabetic patients--such as growing up, pregnant women, with complications of insulin treatment--only neutral, swine and purified insulin preparation should be used.

Adolescent↗

Bezafibrate-induced anaphylactic shock: unusual clinical presentation.

We report a case of a patient who suffered generalized urticaria, chest tightness, wheezing, nausea, vomiting, hypotension, and loss of consciousness. Two hours earlier she had taken Eulitop Retard following lunch. She had tolerated all the implicated food after the reaction. Allergy evaluation revealed intense positive responses to intradermal tests with bezafibrate active component and Eulitop Retard (skin tests in control subjects were negative). Specific IgE tests (RAST) to Eulitop Retard were negative. An IgE mechanism is suggested to be responsible for this adverse reaction on the basis of the positive skin tets. The delayed onset (two hours) of this anaphylactic shock is unusual. Although infrequent, it may be caused by the specific pharmacokinetic characteristics of this drug, which is a slow releasing agent, mainly absorbed in the gut. The drug was taken just after lunch, and this concomitant food ingestion could also have produced a delay in gastric drainage and a retarded drug absorption. An IgE-mediated accelerated type reaction could also explain this delay. Apparently the patient reacted after the first contact to the drug, and the absence of a sensitization period is not usual in this type of immune reponse. Finally, we recommend the performance of prick and intradermal skin tests prior to any systemic challenge when allergic reactions to fibric acid derivatives are suspected.

Anaphylaxis↗

The cutaneous reaction to staphylococcal protein A in normal subjects and patients with atopic dermatitis or psoriasis.

Intradermal testing with the staphylococcal cell wall component, protein A, in healthy volunteers and in patients with atopic dermatitis and psoriasis produced a range of responses but in all groups there was an immediate weal and flare response. There was marked individual variation in subsequent erythema, but the patients with atopic dermatitis had less erythema at 15 min and 24 h than normal or psoriatic individuals. The greatest erythematous reaction at 48 h was seen in patients with psoriasis.

Adult↗

[Histoplasmin and paracoccidioidin reactions in Serra de Pereiro. (Ceara State--Brazil)].

Intradermal tests using histoplasmin and paracoccidioidin antigens were performed in 138 persons from Pereiro, Ceará, Brazil. The results were positive in 61.5% and 32.5% with histoplasmin and paracoccidioidin antigens respectively. These results suggest infection by H. capsulatum and P. brasiliensis in the people living in the studied area. New studies are necessary to detect histoplasmosis and paracoccidioidomycosis as clinical diseases in that region.

Adolescent↗

Histoplasmin reaction. Comparison of a polysaccharide antigen to the filtrate antigen.

This work was planned by taking into account all the knowledge accumulated from the immunological study of paracoccidioidomycosis. It aimed at comparing a polysaccharide antigen from Histoplasma capsulatum to a classic histoplasmin with the help of intradermal tests of delayed type of hypersensitivity. Tests were applied to 115 individuals in Santo Amaro, a town in the State of São Paulo. Positive results using classic histoplasmin were obtained in 46.0% cases whereas positive results using the polysaccharide antigen at its highest concentration were obtained in 51.30% cases. The major conclusion in this investigation is that it is possible to use the polysaccharide antigen as histoplasmin instead of the filtrate antigen.

Adolescent↗