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PubMed1994

Modified par j I allergen from P judaica pollen and its rate of absorption in rats.

Polymerized allergens (allergoids) have been introduced in the immunotherapy of allergic disease in order to reduce the risk of side effects. However, their high molecular weight can be a limit, particularly when they are administered by a route involving passage through the mucosal barrier. We describe a simple procedure aimed at developing an original modified allergen with significantly less allergenic potential (intended as human IgE-binding capacity) but preserving the monomeric nature of the molecule. Par j I, the major allergen of Parietaria judaica pollen, was purified by a combination of monoclonal antibodies and affinity chromatography. Par j I allergen was then modified by reaction with potassium cyanate (KCNO), and compared with the native allergen to evaluate its allergenic potency (RAST-inhibition) and molecular weight (SDS-PAGE). Modified allergen showed significantly lower allergenic potency but kept its original molecular weight, making it particularly suitable for buccal (sublingual) administration. To study the adsorption profile, modified Par j I was radiolabeled and administered intravenously and sublingually to normal rats. The prospects for clinical application of the modified allergen are discussed.

Absorption↗
PubMed2006

Effect of allergen-specific immunotherapy on platelet secretory activity in patients with grass-pollen allergy.

Platelet may become activated following antigen challenge to participate then actively in the immune-inflammatory response. Moreover, some evidence proves that specific immunotherapy induces changes in the platelet function. The objective of this study was to determine circulating platelet activity during the early phase of allergen-specific immunotherapy (SIT) in patients with grass pollen-sensitive allergic rhinitis. Twelve grass-pollen allergic patients (seven men and five women) with intermittent allergic rhinitis were treated with specific subcutaneous allergoid preparation. SIT was received by six weekly injections, the vaccine dose increasing until the maintenance level was reached. Blood was sampled at four different time points: before and directly before SIT, 30 min and 24 h after the maximum dose injection of the vaccine. Plasma level of beta-thromboglobulin (beta-TG), marker of platelet activation in vivo was measured using ELISA method. Baseline beta-TG level did not differ significantly among the patients and healthy subjects. Moreover, no significant differences were observed in the degree of platelet activity between the different times of this study in the patients group. We failed to detect any significant changes in circulating platelet activity, the measure of plasma level of beta-TG, in patients with grass-pollen induced intermittent rhinitis during the course of the dose increase phase of grass pollen SIT. In particular, it seems that both early (after 30 min) and late (after 24 h) changes in plasma level of this marker do not occur following the maximum dose administration of the allergen vaccine during the early SIT phase.

Adolescent↗
PubMed1998

Future directions for allergen immunotherapy.

Over the last 30 years several approaches to modify immunotherapy have been tested, including allergoids, alum precipitation, and most recently peptides. However, none of these have replaced the traditional regimens. Over the same period our scientific understanding of allergic disease has been transformed. Today it is possible to identify and monitor changes occurring during treatment and to target many different aspects of the immune system. Recombinant technology provides a powerful technique both for sequencing proteins and producing allergens in commercial quantities. The recombinant proteins can be modified by site-directed mutagenesis so as to decrease their reactivity with IgE antibodies while maintaining reactivity with T cells. Knowledge of the tertiary structure of allergens will make it simpler to identify and change surface epitopes. A completely different approach is to use plasmids to introduce the genes for an allergen. The strength of this technique is that the plasmid can be designed to control expression and also to influence the cytokine profile of the response or the isotype of antibodies produced. Finally, different adjuvants can be used with proteins to alter the response. These include IL-12, immunostimulatory sequences of DNA, and bacterial proteins such as those used in HibVax. It is now possible to identify the cells that control the immune response to allergens and to design treatments that will either downregulate or change the response of T cells. The challenge is to transform this information into an effective treatment for allergic disease.

Allergens↗
PubMed1988

Comparison of atracurium and vecuronium during anaesthesia for laparoscopy.

Atracurium 0.3 mg kg-1 and vecuronium 0.06 mg kg-1 were compared directly in a double-blind randomized trial during anaesthesia for laparoscopy in 57 healthy young women. The effects of the drugs were monitored using a portable electromyograph. Both drugs provided adequate intubating conditions at 3 min, and prompt antagonism of paralysis after administration of neostigmine, but recovery was significantly faster with vecuronium (mean time to 20% recovery of control electromyographic response: vecuronium 15.1 min; atracurium 20.6 min (P less than 0.001)). Atracurium caused a higher frequency of clinically observed allergoid reactions (21%) compared with vecuronium (3%).

Adult↗
PubMed1990

Effects of one-year hyposensitization in allergic rhinitis. Comparison of two house dust mite extracts.

In an open study, 21 patients suffering from chronic non-seasonal rhinitis and allergic to house mites (HDM) have been treated for 1 year with either a new extract (Pharmalagen; n = 10) or an allergoid, pyridine denatured, extract (Alavac; n = 11), both precipitated with AlOH3 (depot). The following investigations were performed before and after therapy: clinical scoring (for 4 weeks), quantified skin prick tests (SPT) and nasal provocation tests (NPT) with HDM, and determination in serum of HDM-specific IgE and IgG. Both groups were compared with six patients who remained untreated and underwent the same investigations. Hyposensitization with either extract induced an improvement in clinical scores (P less than 0.05), a decrease in SPT reactivity (Pharmalgen: P less than 0.001; Alavac: P less than 0.01), a marked increase in the nasal tolerance to HDM (P less than 0.001) and in HDM-specific IgG (P less than 0.001). In the group of untreated patients, all these parameters remained unchanged. Compared with the Alavac extract, the Pharmalgen extract was more active in decreasing SPT reactions (P less than 0.05) and inducing a HDM-specific IgG rise (P less than 0.05). Although both extracts induced some untoward allergic reactions, no adrenaline was used at any time during the study. These data suggest that hyposensitization with depot extracts of HDM can be considered a safe and active adjunct to the treatment of allergic rhinitis.

Adolescent↗
PubMed2005

Safety and tolerability of ultra-rush induction, less than one hour, of sublingual immunotherapy in children.

BACKGROUND: The safety and tolerability of sublingual immunotherapy (SLIT) has been documented in allergic patients both in the build-up phase as well as during maintenance, but only two studies have evaluated the occurrence of adverse reactions with an ultra-rush regimen of SLIT induction in a mixed paediatric/adult population. Moreover one of these two studies used a chemically modified extract (allergoid). The aim of the present study was to evaluate the occurrence of immediate or late adverse reactions in allergic children after a very fast (40 min) ultra-rush SLIT induction with two different allergen extract solutions. METHODS: We studied 100 children (64 boys, mean age of 9.6 years, range 3.5-16.8), with a history of intermittent/persistent rhinitis and/or intermittent/mild persistent asthma due to inhalant allergens. The ultra-rush build-up phase involved the administration, every 10 min, of increasing doses of the highest-concentration vial of SLIT of two different manufacturers (Anallergo and Stallergènes). RESULTS: All patients completed the treatment, side-effects have been recorded in 19% of the cases: 10% within 1 h after the build-up phase, 7% within 48 h and 2% mixed. A major difference (p = 0.0001) was recorded between Anallergo (6 patients, 8.7%) and Staloral (13 patients, 41.9%), but all the reactions were mild: principally oral symptoms, in 1 case rhinorrhoea and cough, and delayed abdominal pain and diarrhoea in another patient. CONCLUSIONS: No severe adverse reactions were observed with this ultra-rush SLIT induction also in the paediatric age; statistical differences have been documented between the two different extracts.

Administration, Sublingual↗
PubMed1988

Induction of allergen-specific T cells by conjugates of N-formyl-methionyl-leucyl-phenylalanine and rye grass pollen extract.

A conjugate of the biologically active peptide N-formyl-methionyl-leucyl-phenylalanine and rye grass pollen extract (F-MLP/rye), previously shown to react with rye grass pollen extract-specific T cells, induced the formation of allergen-specific T cells in mice. Lymph node cells prepared from mice immunized with either native extract or F-MLP/rye gave an enhanced response to unmodified rye grass pollen allergens in vitro. Syngeneic spleen macrophages were able to present the unmodified allergens to T cells obtained from both groups of mice causing their proliferation in vitro. Conjugation of the peptide into the extract brought about an extensive reduction in its reactivity with grass pollen-specific human IgE, and a loss of its ability to induce specific IgG antibody in guinea-pigs. A state of delayed hypersensitivity specific for rye grass pollen extract was produced in guinea-pigs by immunization with either the F-MLP/rye or unmodified extract. It is concluded that conjugates such as F-MLP/rye or other T' allergoids could be used as probes to investigate whether changes in T cell activity are important in immunotherapy.

Allergens↗
PubMed1988

Retained T-cell reactivity of rye grass pollen extract following cleavage with cyanogen bromide and nitrothiocyanobenzoic acid.

Rye grass pollen extract was fragmented by sequential treatments with cyanogen bromide and 2-nitro-5-thiocyanobenzoic acid, and a fraction containing fragments of molecular weight greater than 10,000 Mr was isolated. The in vitro reactivity of the extract with specific IgE was extensively reduced by fragmentation. Less reduction in activity was shown either by skin testing or by inhibition of an extract-specific IgG-binding assay. Reactivity with, and ability to induce, extract-specific mouse T cells were retained by the fragment preparation, and the ability to cause transformation of lymphocytes from atopic donors was unchanged. Fragments did not induce extract-specific IgG antibody in mice, were unable to stimulate the production of T-helper cells which could collaborate in an adoptive cell-transfer system, and did not induce delayed hypersensitivity reactions in guinea pigs. The possibility that such T-cell-reactive modified allergens (T'allergoids) might be used to stimulate selectively T-cell subsets and, therefore, could be used to advantage in immunotherapy is discussed.

Animals↗
PubMed2004

Allergy vaccines--new approaches to an old concept.

Allergy vaccination (AV) consists of injecting increasing amounts of offending allergens into sensitive patients with the intention of reducing their level of sensitivity to allergens. This form of therapy was first used over one hundred years ago and until recently had not changed in principle. The vaccines themselves are now far better characterised and standardised, according to new regulatory requirements. The therapy is believed to exert its effects by a combination of means: by the induction of blocking antibodies; a switch from a T helper (Th)2 to a more Th1 allergen-specific immune response; and induction of anergy, probably via the development of allergen-specific regulatory T cells. New allergen forms and formulations are being designed with these targets in mind. Allergoids (allergens chemically modified to reduce allergenicity, but to retain immunogenicity) are becoming employed more frequently. More modern depot forms, such as those containing tyrosine or calcium phosphate, are replacing aqueous extracts and older depot adjuvants such as alum. T cell-reactive peptides and recombinant allergens or their muteins are also being studied as replacements for whole extracts and have shown some potential. Immunomodulators, such as monophosphoryl lipid A (MPL), designed with defined targets in mind are now included in some vaccines and help to accelerate the process. All these measures have led to a reduction in the need for the traditional long injection schedules. The authors are very familiar in particular with the background to the use of MPL as an adjuvant. They have been personally involved in the development of this approach, which has led to a product being available for use on a regular basis in some European countries. Hence, this work is reported in considerable detail. Other similar immunomodulators, such as CpG motifs, are in development, while new targets, such as the Notch protein/receptor interaction, are exciting new developments that may eventually bear fruit. The excellent safety profile of the sublingual route of administration of allergy vaccines could lead to the wider use of AV, and locally active immunomodulators could make AV a therapy of choice for many more patients than at present.

Adjuvants, Immunologic↗
PubMed2002

Peptide-based vaccines in the treatment of specific allergy.

The efficacy of conventional allergen-specific immunotherapy (SIT) for allergic conditions and venom hypersensitivity is well documented. However it's use is limited due allergic side effects including anaphylaxis and the difficulty of standardising proteins in complex allergenic mixtures. The aim of new therapeutic strategies is to circumvent these limitations and approaches include allergen non-specific therapy, such as anti-IgE and anti-cytokine therapy and other allergen specific techniques including the peptide based vaccines (PBV), modified allergens (allergoids) and DNA vaccines. PBV are small linear peptide fragments containing T cell epitopes which are designed to reduce the ability to cross link antigen-specific IgE. Studies in animal models have confirmed proof of principle demonstrating the induction of hyporesponsiveness using high doses of peptides. However, the principle limitation to clinical use of PBV is the polymorphism of HLA class II molecules. There are ongoing clinical studies using peptide-based vaccines for cat, bee and grass allergies--looking at both immunological mechanisms and clinical outcome measures. The mechanisms underlying the efficacy of PBV appear to be similar to those described for classical immunological tolerance. Thus, the peptides may induce anergy due to absence of co-stimulation, activation-induced cell death, a switch from a Th2 to a Th1 cytokine profile, the induction of regulatory T cells or combinations of these mechanisms. Successful immunotherapy, in bee sensitive individuals, is associated with the elaboration of IL-10. Clonal deletion is unlikely as an overall mechanism as there is evidence that the subsequent in vitro response to associated, non-injected, peptides can be suppressed. Mechanistic studies continue to provide insight into the mode of action of whole allergen and peptide-based immunotherapy. Clinical studies designed on the basis of these observations hold the promise of safer vaccines with improved efficacy. Whether this strategy can be used for allergy to complex allergen mixtures such as dust mites will need further evaluation.

Allergens↗
PubMed2006

Modified recombinant allergens for safer immunotherapy.

Molecular cloning and recombinant production of allergens offered new perspectives for the increasing problem of allergies. A variety of preparations are being developed aiming to increase safety and improve efficacy of specific immunotherapy. Recombinant-based approaches are mostly focused on genetic modification of allergens to produce molecules with reduced allergenic activity and conserved antigenicity, i.e. hypoallergens. Studies dealing with genetic modifications of allergen genes reported the production of site-directed mutants, deletion mutants, allergen fragments and oligomers, and allergen chimeras. An alternative to genetic engineering is the chemical modification of pure recombinant allergens. It has been shown that allergens modified with immunostimulatory DNA sequences (allergen-ISS conjugates), which masks IgE epitopes and adds a desirable Th1-inducing character to the allergen molecule. Other chemical modifications include oligomerization by aldehydes (allergoids) and maleylation, which seems to target allergens to particular antigen presenting cells. Several of these modified allergen preparations have been already evaluated for their safety in clinical provocation studies. So far, clinical trials showed the efficacy and safety of immunotherapy with an Amb a 1-ISS conjugate for ragweed pollen-allergic patients. In addition, a preparation consisting of hypoallergenic fragments of Bet v 1 was evaluated for immunotherapy of birch pollen-allergic patients. In parallel, several animal studies have now demonstrated the potential of genetic immunization for allergy treatment in the future.

Allergens↗
PubMed2005

Full-body cardiovascular and tumor MRI for early detection of disease: feasibility and initial experience in 298 subjects.

OBJECTIVE: High diagnostic accuracy, emerging whole-body concepts, and lack of side effects combine to render MRI a natural candidate for screening purposes. The aim of this study was to evaluate the technical feasibility of a comprehensive multiorgan-targeting MRI examination and determine the frequency of findings in subjects without a history of serious disease. SUBJECTS AND METHODS: The study group was composed of 331 subjects. The MRI protocol (mean examination time, 63 min) encompassed the target organs: the brain, arterial system, heart, and colon. Diagnoses were deemed relevant if the physician had to inform the subject about the findings. Subjects with a history of serious illnesses were excluded from subsequent analysis (n=33). All analyses were performed for the resulting subgroup of 298 subjects (247 men, 51 women; mean age, 49.7 years). RESULTS: All 298 examinations were diagnostic excluding eight MR colonography components in which remaining stool hampered reliable diagnosis. Follow-up or radiologic confirmation could be obtained in 75% of all cases with relevant findings (128/169); only one false-positive result was encountered. Of the study group, 21% exhibited signs of atherosclerotic disease. Two cerebral infarctions and one myocardial infarction, previously unknown, were encountered; 12% had peripheral vascular disease. Twelve colonic polyps and nine pulmonary lesions were correctly detected. Of all MRI examinations, 29% revealed relevant additional findings in nontargeted organs. Only one minor allergoid reaction was encountered. CONCLUSION: The presented data point toward an increased use of MRI for screening in the future, but to date screening MRI should not be performed outside a research setting because the cost-benefit relation is unclear.

Adult↗
PubMed2000

[Allergen-specific immune therapy in the treatment of asthma].

OBJECTIVES: 1. To identify all published randomised controlled trials of allergen specific immunotherapy in asthma. 2. To estimate the overall efficacy of allergen specific immunotherapy upon asthmatic symptoms, medication requirements, lung function, nonspecific bronchial hyperreactivity (BHR) and allergen specific BHR. SEARCH STRATEGY: A search of the asthma database by the Cochrane Airways Group at St. Georges Hospital Medical School, London identified 660 nonunique citations with the keywords Immunotherapy* or Hyposensitive or Desensiti*. This database included all studies published up to 1997 with the keywords Asthma or Wheez* from the Medline, Embase and Cinahl databases, together with other studies identified by handsearching. SELECTION CRITERIA: The review was restricted to randomised controlled trials (RCT). Only studies which focussed upon asthma were included. Allergen specific immunotherapy was defined as the subcutaneous administration of extracts of house dust mites, pollens, animal danders or moulds, chemically modified allergoids or antigen-antibody complexes. Although placebo controlled trials were methodologically stronger, studies which administered house dust or other relatively antigenically inactive preparations to the control group were also considered. Double blinded trials were preferred, but single blind and open studies were also reviewed for possible inclusion. At least one of the following clinical outcomes had to be reported: asthmatic symptoms, asthma medication requirements, lung function, nonspecific BHR or allergen specific BHR. Inclusion of studies in the review was decided by a simple majority of all three reviewers, who independently read the methods sections of papers identified by the search strategy and applied the stated criteria. Quality assessment was performed by 2 reviewers, who independently assessed the concealment of allocation. DATA COLLECTION AND ANALYSIS: The comparisons were: Allergen immunotherapy v placebo, Allergen immunotherapy v antigenically inactive control, House dust v placebo and Allergen immunotherapy v untreated control. These comparisons were performed separately for each outcome, whenever these results were reported. Outcome data were extracted and entered into RevMan 3.0.1 for statistical analysis. Categorical outcomes were analysed as odds ratios (OR) and 95% confidence intervals (95% CI) calculated by Peto's method. Continuous outcomes were analysed as standardised mean differences (SMD). Fixed effects models were used to obtain summary statistics for the overall efficacy of allergen immunotherapy and x2 tests were performed to assess heterogeneity between studies. MAIN RESULTS: Fifty four randomised controlled trials published between 1954 and 1997 satisfied the inclusion criteria. There were 25 studies reporting immunotherapy for mite allergy, 13 studies of pollen allergy, eight studies of animal dander allergy, two studies of allergy to the mould Cladosporium and six studies which attempted simultaneous immunotherapy for multiple aeroallergens. Concealment of allocation was assessed as clearly adequate in only 11 studies. The adequacy or otherwise of 40 studies could not be determined from the details published in the papers. Only three studies used a clearly inadequate method for concealment of allocation. There was a significant overall improvement in asthma symptom scores following immunotherapy (combined SMD -0.52; 95% -0.70 to -0.35). Patients randomised to immunotherapy were also significantly less likely to report a deterioration in asthma symptoms than those randomised to placebo (OR 0.27; 95% CI 0.21 to 0.35). Asthma medication requirements were significantly reduced (SMD -0.51; 95% CI -0.74 to -0.28). Patients randomized to immunotherapy were also significantly less likely to require medication than those randomised to placebo (OR 0.28; 95% CI 0.19 to 0.42). There was no overall improvement in lung function following immunotherapy and marked hete

Asthma↗
PubMed2001

[Evaluation of effectiveness and safety of three year immunotherapy with mixed grass pollen allergens].

BACKGROUND: Specific immunotherapy (SIT) is probably the only causative treatment in allergic diseases including pollinosis. It is capable of changing the natural history of the disease. GOAL: Present study has been designed to estimate the effectiveness and safety of multi-seasonal immunotherapy with grass-pollen-allergoid-containing vaccines. MATERIAL AND METHODS: Twenty seven patients with pollinosis entered the study. They were randomly assigned to two groups receiving two different but absolutely comparable vaccines (Allergovit, Pollinex). Cards of patient's self-evaluation (including nasal, eye and bronchial symptoms) as well as anti-allergic drug consumption were evaluated. RESULTS: Significant amelioration of symptoms was noticed already after first season of SIT 3.4 +/- 0.29 vs 7.54 +/- 0.35 points before SIT (control)(p < 0.05). The respective value after third SIT was 2.1 +/- 0.26 (p < 0.001). Also anti-allergic drug consumption felt from 2.12 +/- 0.12 points before SIT to 0.86 +/- 0.11 and 0.37 +/- 0.11 after first and third SIT, respectively (p < 0.001 and p < 0.00005). Few side reactions were observed, only one mild systemic reaction. CONCLUSIONS: Our study confirms that pre-seasonal SIT is a clinically effective and safe therapeutic method in patients with pollinosis. It's effect seems to be time-related.

Adolescent↗
PubMed2002

[The influence of a three-year preseasonal specific immunotherapy on selected parameters of allergic inflammation in pollinosis patients].

Specific immunotherapy (SIT) can in some cases influence the course of allergic inflammation (eosinophilia and ECP concentration in peripheral tissue). This study was set up to evaluate the efficacy of three-year pre-seasonal SIT with grass pollen allergoid. We measured NALf eosinophilia and ECP concentration both in NALf and blood serum after subsequent SITs. Twenty seven patients aged 26.7 +/- 7.4 (range 18-45) entered this study. They were randomly assigned to treatment with either Pollinex or Allergovit. We observed a progressive fall in NALf eosinophilia in subsequent years: 24.1 +/- 2.4%; 20.2 +/- 4.6%; 9.8 +/- 1.9% vs. 30.4 +/- 3.0% before treatment (p < 0.05, p < 0.05 and p < 0.001, respectively). Also ECP concentration fell after second and third SIT to 15.6 +/- 1.5 ng/ml i 12.96 +/- 1.75 ng/ml vs 23.3 +/- 3.7 ng/ml before SIT (p < 0.05). A significant drop in serum ECP concentration was recorded only after the third SIT season--2.5 +/- 1.23 micrograms/ml vs 5.8 +/- 1.3 micrograms/ml before treatment, p < 0.01. NALf eosinophilia correlated positively with NALf ECP concentration--R2 = 0.92, p < 0.05. Hence, SIT ameliorates allergic inflammation decreasing significantly activity of eosinophils in nasal mucosa measured as NALf eosinophilia and ECP concentration. This effect seems to be time-depended.

Adult↗
PubMed2002

[Use of conjugated allergen-polymer vaccines (pollen allergens of new generation) for allergen-specific immunotherapy].

AIM: To assess effectiveness of new pollen allergotropins for allergen-specific immunotherapy (ASI). MATERIAL AND METHODS: The allergotropins were produced basing on conjugation of pollen allergoids (timothy, birch, mugwort pollen) and polyelectrolite (polyoxidonium) with immunomodulating properties. Pollen allergotropins (timpol, berpol) were designed to treat pollenosis caused by sensitization to timothy and birch pollen. Pollen allergotropins were studied in ASI given to 140 patients with pollenosis and 10 patients with bronchial asthma. RESULTS: In the group of pollenosis patients with hypersensitivity to birch pollen the response to berpol was excellent in 55% patients (the disease symptoms disappeared, antihistamine drugs intake was stopped), good--in 33%, satisfactory--in 12%. Timpol produced a marked response in all the patients treated for hypersensitivity to timothy pollen. CONCLUSION: Pollen allergotropins have a high therapeutic effect under low risk of provoking reactions of anaphylactic type in patients on ASI.

Adult↗
PubMed1992

Recombinant pollen allergens from Dactylis glomerata: preliminary evidence that human IgE cross-reactivity between Dac g II and Lol p I/II is increased following grass pollen immunotherapy.

We previously described the isolation of three identical complementary DNA (cDNA) clones, constructed from Orchard/Cocksfoot grass (Dactylis glomerata) anther messenger RNA (mRNA), expressing a 140,000 MW beta-galactosidase fusion protein recognized by IgE antibodies in atopic sera. Partial nucleotide sequencing and inferred amino acid sequence showed greater than 90% homology with the group II allergen from Lolium perenne (Lol II) indicating they encode the group II equivalent, Dac g II. Western blot immunoprobing of recombinant lysates with rabbit polyclonal, mouse monoclonal and human polyclonal antisera demonstrates immunological identity between recombinant Dac g II, Lol p I and Lol p II. Similar cross-identity is observed with pollen extracts from three other grass species: Festuca rubra, Phleum pratense and Anthoxanthum odoratum. Recombinant Dac g II was recognized by species- and group-cross-reactive human IgE antibodies in 33% (4/12) of sera randomly selected from grass-sensitive individuals and in 67% (14/21) of sera from patients receiving grass pollen immunotherapy, whilst 0/4 sera from patients receiving venom immunotherapy alone contained Dac g II cross-reactive IgE. Cross-reactive IgG4 antibodies were detectable in 95% of sera from grass pollen immunotherapy patients. These preliminary data suggest that conventional grass pollen allergoid desensitization immunotherapy may induce IgE responses to a cross-reactive epitope(s) co-expressed by grass pollen groups I and II (and possibly group III) allergens.

Allergens↗
PubMed1991

[Acute adverse effects and complications of central venous digital subtraction angiography (DSA). Results of 2,600 studies].

Side-effects and complications from 2,600 intravenous digital-subtraction-angiographies (IV-DSA) are reported. All studies were performed in a standardized technique using a non-ionic contrast agent (Iopromid 370 mg J/ml). Side-effects or complications were noted in 2.5% of all IV-DSA. Most often nausea (0.92%), urticaria (0.5%), angina pectoris (0.5%) and symptomatic alterations of blood-pressure (0.27%) were recorded. 8.4% of all reactions occurred with a delay of at least one hour. All side-effects and complications resolved, partly under symptomatic therapy. In one (0.04%) out of 2,600 studies a severe allergoid reaction occurred, affording intensive-care therapy. With proper patient selection and a suitable technique, IV-DSA may be regarded--within the angiographic methods--as a procedure of relatively low risk.

Aged↗