[Measurement of mediators in drug allergies. Preliminary study]

Drug allergy is still a region where diagnosis remains difficult. It relies on clinical history, sometimes skin tests and lymphoblast transformation tests, though only when the antigen is soluble. Provocation tests may, if there is a doubt, prove the involvement of the drug. It may be made objective by the measurement of mediators: ECD and tryptase, thus showing the involvement of eosinophils and mastocytes. Should change in these mediators be associated with a syndromic reaction or is it on its own, a diagnostic factor? A complementary study with a reference group, on a sufficient number of patients has allowed, with the assistance of a statistical analysis, better objectivity from the results.

[Multitest Fx5 in food allergy]

A comparative study was made of three in vivo and in vitro diagnostic methods for food allergy: Fx5 multitest (Pharmacia); Measurement of specific IgE CAP (Pharmacia); Skin tests (Prick Tests). 20 patients, from 3 to 71 years (mean 24.4 years), were selected by clinical suggestion (asthma, rhinitis, atopic dermatitis, urticaria and/or Quincke's oedema). The Fx5 test used six food allergens: wheat, egg, cow's milk, soya, peanut and fish. The Cap Rast for each substance was evaluated, as was Fx5, by a radio-immunological method. The Prick Tests made with the six allergens used were considered to be positive when the diameter of the weal was greater than that produced by a reference test with histamine. The results were considered as a comparison between Fx5 and Cap Rast to each of the foods, between Fx5 and prick Test with five foods and finally between CAP RAST and Prick Test. Correlation Fx5--Cap rast was better and more useful in the diagnosis of food allergy than skin tests.

[Phadiatop in the diagnosis of skin allergy to pneumoallergens]

Usually, Phadiotop is presented as an in vitro multitest to pneumoallergens that are indicated in respiratory allergy. Now, in skin allergy atopic dermatitis and reaginic urticaria-Quincke's oedema, the responsibility of pneumoallergens, particularly mites, is clear. 47 Subjects were studied. Clinical history, skin test nd specific IgE gave confirmation of allergy to pneumoallergens. This was proved by the subsequent clinical development, with, in most cases, spectacular improvement after desensitization.8 section. We have compared Phadiotop with these different clinical criteria, skin tests and Cap Rast IgE. The results favour Phadiotop and confirm its value and indication in skin allergy to pneumoallergens.

[Allergy to heparin. Particular problems in the pregnant woman]

Oral anti-coagulants are always contra-indicated for pregnant women. Only anti-coagulants of the types of heparin or its derivatives may be used. However, some patients have an allergy to Heparin. In this article the correct action to take both for diagnosis and prevention is studied. We present 2 observations of heparin-allergic pregnant women with, in the first case a tentative addiction to heparin which created a check and in the second case there was success in a second pregnancy with low-molecular weight heparin.

[The rebirth of the H1-antagonists]

Anti H1s of the third generation, of which the first was Terfenadine, possess not only blocking effects on H1 receptors to histamine, but also have a "cromone-like" action on the membranes of cells that have been, or not, activated by specific stimuli (antigens). They act on the early phase of immediate hypersensitivity. These anti H1s of the new generation also have wider indications: asthma, perennial or pollen rhinitis, dermatoses such as urticaria and atopic dermatitis. Their tolerance has been remarkably improved with regard to the central effect (very reduced), such as absence of an atropine effect.

[Current ideas on hay fever and its treatment]

Etiological treatment of atopic dermatitis cannot be considered without taking account of all the data of the syndrome: Search for the etiological; mechanism; Treatment of the cause and skin changes; Preventative treatment of infection; Above all, treatment of pruritus that determines the final state of the skin by the consequent scratching and the future psychological condition from the implicated prolonged suffering. Even though it may be difficult, responsible allergens must be detected and the entire range of allergy treatments tried. The local treatments to give a good skin condition must be understood. Finally, it is essential to educate the parents for the best possible family effort.

[Diversity of antigenic fractions of allergenic extracts and importance of the Western blot technique]

The Phast-system groups together the techniques of electrophoresis and transfer. When applied to allergen extracts it allows identification of the allergenic protein fractions and shows their reactivity against sera from allergic patients. The Phast-system is indicated for the choice of the appropriate allergen for specific immunotherapy. If it is not possible to do it systematically, it should be done whenever there is a check to specific immunotherapy.

Intrinsic asthma: myth or reality?

Asthma is a multifactorial syndrome with different etiologies, both allergic and non-allergic. Response to an allergen may be moderate and may often be shown only by provocation tests, not by skin tests or RAST. Food allergy is a significant cause of asthma. There are many non-allergic causes, from gastro-oesophageal reflux to aspirin-intolerant asthma, to sulphites...the list is far from exhaustive. Often there is an association of allergic and non-allergic causes.

[Allergy survey in genital contact dermatitis]

Contact eczema is one of the most frequent dermatological affections, regardless of age and sex. In typical cases, the diagnosis is usually easy, but it may be less so where there are atypical factors, in particular locations and with complications or unusual etiological data. In fact, the first condition in making a diagnosis is to suspect that there is the possibility of contact allergy. As an example, it should be remembered that allergy to benzalkonium can be diagnosed after a mean time of 87 months of evolution. The present availability of standardised allergens for testing for contact allergens has greatly changed the diagnostic possibilities. The allergens that are most often the cause in the genital region are perfumes, chlorhexidine, hexamidine, benzylalkonium chloride and latex. Only recognition of the allergen and its removal are used and sufficient to obtain recovery.

[Immunological causes of male infertility]

Sperm (spermatozoa and the various secretions of the accessory glands) with its very complex antigenic system is only produced from puberty and thus at a time when the body has already had a for a long time the facility to respond to an antigenic stimulation with an immune reaction. Because of this, the spermatozoa, in contrast to other cells of the organism, are considered as strangers and may behave as auto-antigens. However, the existence of a haemato-testicular barrier, that prevents all contact between the sperm and the immune system must be recognized in man, its rupture has the consequence of formation of anti-spermatozoa antibodies. It is estimated that 5% of cases of sterility are of immunological origin and linked to the presence in man and/or woman of anti-sperm antibodies. The production is greater in man than in women because of the roles, in the first of macrophages and in the second of polynuclear neutrophils in the destruction of the spermatozoa. Anti spermatozoal antibodies play a part in sterility by: Spontaneous agglutination in ejaculation, thus preventing their progression in the female genital tract. Free spermatozoa, charged with antibody are retained at the level of the cervical secretion = SHAKING phenomenon. The anti-spermatozoal antibodies mask some antigens, so preventing penetration of the spermatozoa into the ovule. Contact of spermatozoa with antibody fixed to the uterine tissue is followed by secretion of histamine and this encourages the expulsion of an implanted egg. This is before the existence of: Spontaneous agglutination in ejaculation, Oligospermatosis, Indeterminate cause sterility, Immobilisation of the spermatozoa in the cervical secretion, Failure of repetition.

[General considerations on desensitization by the sublingual route]

A favourable action by a new method of therapy and in particular desensitization by the sub-lingual route is sometimes difficult to confirm. To make a sensible study requires a maximum of prior knowledge and this is not easy to acquire. How to select the patients? What method of administration is possible? What should be the dose adopted? What might be the secondary effects? Desensitization by the sub-lingual route seems to us to be a technique for the future. Impressions and thoughts on the new method route for desensitization must lead to controlled studies, very objective, which will confirm or invalidate it.

[Specific immunotherapy using Alpha-Fraction-Retard-D. pteronyssinus. Double-blind study in asthma]

A multicenter, double blind clinical study on two homogeneous, treated and untreated groups, has allowed an objective appreciation of the results of specific immunotherapy using the alpha-fraction of D. pteronyssinus in asthma. A statistically significant difference was seen of the consumption of drugs in the treated group and in infants of less than 5 years (p = 0.047). Tolerance, evaluated as a function of local and secondary effects was excellent and comparable in the two groups.

[Post-exercise asthma]

Atopy is frequently found in isolated APE (post exercise asthma) and in AIE (exercise induced asthma). These two syndromes are more frequent in men (85.5% of cases) than in women and are especially found in young subjects (62.5%) between 10 and 20 years old. There is an analogy between the study of isolated APE and the bronchospasm associated with AIE. Food allergy is found in both cases. The food allergens are the same, with wheat flour the most important foodstuff.

[Environment of the asthmatic child]

This work is in the purview of epidemiological studies that concern the environment of asthmatic children. Infantile asthma is found especially in children who live in the country, in an electrically-heated house and who sleep in a badly orientated room. The environment is composed of feather-bedding, soft-toy animals and animals from the countryside. The role of tobacco and insufficient aeration has been shown in this enquiry. School attendance is not disturbed by development of asthma. The majority of teachers do not understand infantile asthma. This study is to emphasize the importance of the environment in the development of allergic infantile asthma and the possibilities of its prevention. Information to the teachers, as well as the treating physicians, is also necessary for prevention.

[Food allergy in childhood asthma]

Food allergy is responsible for asthma in 6% of cases, all ages together, with the same etiology. As in a adults, the influence of atopy is indisputable and is proved by the presence of familial and personal antecedents and rise in total IgE. Proof of food allergy is based only on tests of exclusion and reintroduction and/or provocation tests, under control of spirometry and plasma histamine. Eggs, milk, wheat, fish, potato, pork meat are the foods most frequently associated. A comparative study of food allergy in adult asthma shows that cow milk and eggs are most frequently responsible, as in children. For diagnosis, specific IgE RAST is more often correlated (65%) with the clinical condition than skin tests (60%).

[Astemizole: its pharmacokinetics and pharmacologic properties]

Astemizole (Hismanal) is a chemically novel compound selected from a series of piperidinylaminobenzimidazoles. Further preclinical pharmacological investigations were initiated by experiences with other drugs in the same field. The aim of this review is to illustrate new pharmacological data on astemizole. Astemizole showed the lowest ED50 and the longest duration in mast cell-mediated shock. Binding characteristics to histamine H1 receptors were specificity, selectivity and long duration. Lack of effects on the wakefulness-sleep cycles was evidenced. An equal bioavailability of the drug was demonstrated with different formulations, dosing and food intake. High plasma levels of desmethylastemizole, the major metabolite, and longer half-life than for astemizole, contribute partly to the antihistamine activity. On chronic administration relative amounts of both molecules in the peripheral compartment are most likely responsible for the expected pharmacological effect. The time-course of kinetics shows, the peak plasma levels of the unchanged astemizole followed by a gradual take-over by desmethylastemizole. In patients with hepatic or renal insufficiency the pharmacokinetic background was similar to healthy volunteers.

[Evolution of in vivo and in vitro tests during specific immunotherapy against hymenoptera venoms]

In this study, on a population of 26 patients with systemic reactions after hymenoptera stings, different immunobiological tests have been used to confirm the sensitivity to hymenoptera venom. These 26 patients were divided into two groups according to the stage of their immunotherapy: group 1 (n = 8) included all assessments from day 0 (before IT) and group 2 (n = 16) the assessments at 1 and 2 years during IT. In general, there was a good correlation between skin tests, RAST and histamine release. The results show that the IgE level seems to be more informative than histamine release and that measurement of the specific IgE level is more sensitive with Allerbio allergen compared with other allergens. However these preliminary results must be confirmed on a statistically significant number of patients. HL by Agf is less sensitive than that done with Ags.

[The Pharmacia CAP system as a new measure of specific IgE. Application in the diagnosis of hypersensitivity to the venom of the Vespula wasp]

Every improvement can make the measurement of specific IgE more effective. This is the case with the CAP system, a new solid phase technique which uses an Immunocap made from hydrophilic polymer, encased in a capsule, for the fixation of anti-IgE or allergen. The Immunocap fixes 3 times more protein than paper discs. Another improvement is that of calibration of the CAP System by the WHO standard for IgE, with the results expressed in KUI/I: 0.35 to 100 KUI/I for specific IgE and 2 to 2,000 KUI/I for total IgE. The study was of patients who had an anaphylactic or systemic reaction after wasp stings. The subjects were divided into two groups A and B and compared with a reference Groupe C. The study also included subjects who were sensitive to mites, grass pollens and egg. Finally, the technique itself was submitted to a reproducibility test. The results confirm that the sensitivity and specificity of the test were both equal to unity. The CAP System therefore offers the possibility of detecting the lowest amounts of IgE.

[The etiologies of asthma]

Asthma may have several etiologies. It is well-known that there are allergic subjects with low IgE bound to mast cells, with negative specific RAST and with weakly positive skin tests, but with a positive provocation test with pneumo-allergens. Food allergy, isolated or associated is also not a negligible cause. Non-allergic subjects often respond to triggering factors: Gastro-oesophageal reflux Neuro-endocrine origin Infectious origin Physical origin (exercise). In our study, we place the emphasis on two types of extremely severe asthma, linked to intolerance of aspirin and metabisulphites and often associated.

[Mercury--is it a respiratory tract allergen?]

Mercury is a well-known allergen in dermato-allergology, often manifesting as delayed type hypersensitivity contact eczema. Immediate hypersensitivity reactions (urticaria, anaphylactic shock) have also been described for this allergen, most frequently seen in patients with the delayed type contact eczema. To our knowledge this allergen has not been implicated in production of respiratory symptoms. We describe a patient who had aggravation of asthma by mercury contained in dental amalgam. When the dental amalgam was removed there was a great improvement in his asthma. This observation suggests that mercury in the form of dental amalgam may also be an allergen of the respiratory tract, which should not be surprising, bearing in mind the work that shows the existence of mercury vapours from dental amalgam.

[The environment and perennial rhinitis in the child]

In assessing the importance of the "allergen eviction" factor in the treatment of infantile allergies, the authors begin an inventory of those elements in the environment that concern perennial rhinitis. From 200 observations of allergic children (all mixed diagnoses) they found 21 observations of rhinitis alone, predominantly boys. The environments of two groups (all allergics--rhinitis alone) were compared. No difference for: Home, country, town heating allergens found. Found significant differences for the type of house new-old those elements of domestic comfort (carpets, feather beds, aeration, soft toys) agreement between the results of tests and the environment domestic animals or permanent proximity. Found fundamental differences for psychological environmental factors (absent in rhinitis). It seems that perennial rhinitis probably arises from abundance of domestic antigens more than for the other allergic manifestations, as the nose is the first filter to receive foreign particles.

[Rhinomanometry: indications, limitations and results]

The aim of this study was to present briefly the different techniques for measurement of nasal resistance and to show the importance that we attribute to this measurement. Within the framework of the allergological investigation rhinamometry is a parameter that allows evaluation of the results of allergenic nasal provocation. Nasal provocation is in the framework as a complementary examination that is often indespensable to confirm with most possible certainty the involvement of an allergen in the ORL pathology. Positive etiological diagnosis is a fundamental basis for therapeutic advice.

[Fernand Widal syndrome and sulfite intolerance. Therapeutic problems in general and ORL problems in particular]

Asthma from intolerance of sulphites has been the subject of clinical work by our team since 1984. In 1986, we advised that asthma from sulphite intolerance was more frequent in patients who presented with illness from aspirin or the Fernand Widal syndrome. So it has emerged that there are clear therapeutic problems since sulphites as preservatives are present in other forms in some anti-allergy drugs, anti-histamines used for ORL.

[Physiopathology and therapeutic considerations for rhinitis]

Rhinitis affects about 10% of the global population. Whatever is the cause of the rhinitis, allergic or not, the physio-pathology is the same, with intervention of mediators as the origin of the nervous stimulation of the epithelium and mucosae. This innervation is threefold: parasympathetic (ACH), sympathetic (Nor ADR), non-adrenergic, non cholinergic system: neuropeptides: VIP. Rhinitis is therefore linked with imbalance of these systems. Treatment of rhinitis must be composed not only of anti H1 which are effective against secretions and sneezes, but also the anti-inflammatory steroids, which are effective against inflammation. Cromoglycate, ketotifen... should be obligatory as membrane stabilizers.

[Allergic rhinitis in the horse: first case]

The responsibility of the artificial environment in the development of respiratory allergy in horses is well known as the most important factor for the development of asthma, chronic dry cough and pulmonary emphysema. One case of allergy to the natural environment could be observed. One allergic rhinitis with asthma could be explored. Pathology, cause, tests and specific immuno-therapy are presented.

[Perennial rhinitis from food allergy]

Food allergy (AA) is involved in a third of subjects with perennial rhinitis (RPA). The majority of the patients are polysensitized. Isolated food allergy was only seen in 6 of 261 cases, which indicates an association of food allergy with other allergens, essentially pneumo-allergens. Immediate diagnosis of AA in RPA is difficult as it is essentially based on tests of elimination and re-introduction of the food, skin tests and RAST.

[Anaphylaxis induced by exercise]

Exercise-induced anaphylaxis EIA is a syndrome most often initiated by food allergy. Objective or diagnostic proof of the condition is shown by a provocation test from ingestion of a food before or after exercise, according to clinical history, with assay of plasma histamine and spirometry or rhinamometry. The original part of this work is evidence of EIA linked to food allergy to wheat, with cross reactivity to grass pollens.

[Preliminary study of the comparison of histamine liberation performed using an antigen bound to a disc and a soluble antigen]

Histamine release was done by the RIA method with soluble allergen and with allergen fixed to a disc, on 26 subjects who were sensitized to hymenoptera venoms. The correlation was statistically significant (r = 0.58) between the two allergens and between RAST and fixed antigen.

[Specific immunotherapy using the slow alpha fraction of Dermatophagoides pteronyssinus. Efficacy; tolerance]

This open study was made on 126 patients (72 men, 54 women). Specific immunotherapy (IT) commenced in 1988 with the Dermatophagoides pteronyssinus alpha fraction (alpha -F Dpt) a new standardised, purified allergen, of better quality, but more reactive. The patient were aged between 4 and 66 years (mean 23.1 years) the subjects were young and the majority were male. Most (93.6%) showed at least respiratory symptoms (asthma, rhinitis). In about a quarter of the patients there were also dermatological and ocular symptoms. The patients were usually desensitized according to the classical technique (76.6%) we recorded semi-accelerated IT in only one case. Overall, IT with alpha-F Dpt was efficacious (54.7% O and well tolerated (74.5%). Efficacy and tolerance were better with the "accelerated" technique than the classic (respectively 73.9% against 60.6% and 86.9%). In contrast, efficacy and tolerance were not influenced by age or sex. Finally, we believe that IT has more chance of being efficacious if the initial biological values are more significant.

[Hereditary angioedema]

Hereditary angio-oedema (AOH) is a familial affliction that is most often hereditary, but sometimes acquired and linked to a deficiency of C1 esterase inhibitor. 8 cases have been examined, amongst which there was one attack in a young girl, without any clinical signs. Amongst the other 7, one had acquired AOH. The diagnosis was confirmed by the deficiency of C1 esterase inhibitor, associated with a significant reduction of the other fraction of complement c3-c4 and also total haemolytic complement. Strong doses of corticosteroids were used in 4 patients for urgent treatment. Basic treatment with DANAZOL was commenced in 3 patients.

[Role of food allergy in atopic dermatitis]

Food allergy is one of the main causes of atopic dermatitis. Its frequency was established at 41.3% in our study. Eggs, cows milk and wheat were the foods most often responsible for DA. Proof by elimination-reintroduction is the best diagnostic criterion in food allergy, leading to suppression of the food if its nutritional importance permits this. This food suppression leads to 84% clinical improvement of DA.

[Significance of anti-gluten IgA levels for detection and monitoring of celiac disease]

Diagnosis of coeliac disease rests in jejunal biopsy. This is recognised as a traumatic examination which today may perhaps be replaced by a biological test produced by Pharmacia in which the anti-gluten IgA is measured by the ELISA method. The sensitivity of the test reaches 100% and the specificity to 96%. This biological test makes it possible to follow the development of the coeliac illness under diet, since the anti-gluten IgA diminishes significantly, often to the normal level.

[Must the concept of intrinsic asthma be supported?]

Intrinsic asthma, defined as asthma which is not from allergy to pneumo-allergens, of cause unknown, may show several etiologies. Allergics, remembering that there in some subjects there may be small amounts of IgE on the mastocytes, with specific RAST IgE negative, skin tests only weakly positive, but with a positive provocation test to pneumo-allergens. Food allergy, isolated and associated, may also contribute a not-negligible cause. Non-allergics, responding to the frequent triggering factors: Gastro-oesophageal reflux; Neuro-endocrine origin; Infections; Physical origin (exercise). In our study, we quote two types of extremely severe asthma, linked to intolerance to aspirin and metabisulfites with others that are associated.

[Bibliographic review of antihistaminics H2 in the treatment of chronic (or recurrent) idiopathic urticaria]

Cimetidine alone has not been shown conclusively to be effective in the treatment of urticaria. Cimetidine in combination with an H1 antihistamine has been shown to be effective in studies of patients who could not be controlled by H1 antihistamine alone. In that section of the patient population with "untreatable" chronic urticaria, the use of an H2 antagonist in conjunction with an H1 antagonist should be considered as a possible treatment.

[Local and general experimental anti-anaphylactic effect of 554 L, a synthetic antihistaminic]

554 L, a synthetic histamine depressant, was first made in September 1956. In spite of the age of this compound, it seemed to us that it may be of interest to examine it for possible experimental general and localised bronchial antianaphylactic activity. In the first experiments, the results showed an anti-anaphylactic effect in guinea pigs that had been sensitised to cow milk. The second study proved that there was an anti-anaphylactic effect locally on the bronchii by an aerosol of 554 L or Hypostamine on guinea pigs that were sensitive to OVA. These results may produce development of this old compound in delayed release and aerosol presentations.

[Type I hypersensitivity to latex]

Allergy to latex causes serious accidents that are often unrecognised. These accidents are perfectly predictable by a simple interrogation, together with skin and biological tests. Populations at risk can be identified: persons undergoing treatment, particularly the disabled and also housewives. There is a risk of further increases in the number of cases of hypersensitivity to latex due to the expanding use of preservatives. The study undertaken at the CHU at Angers has shown that allergy to fruits is frequent in patients who are sensitive to latex. The exact nature of allergy to Hevea is not yet well understood: it is not possible at present to decide whether there is "crossed allergy" or whether it is one part of a larger syndrome.

[Cell-mediated immunity using anti-influenza vaccine (AIV) and an immunostimulant (R)]

21 infected asthmatics were involved in this study, divided into three groups: Group 1 (G1): 7 subjects who received Ribomunyl. Group 2 (G2): 7 subjects who received anti-influenza vaccine, replaced on the 8th day by Ribomunyl. Group 3 (G3): 7 subjects who received the anti-influenza vaccine. Every patient had a IMC assessment on days 0, 8 and 30 that was composed of: 1. An RE test to show the Ly T11 receptors. 2. A study of the lymphocyte sub-populations CD3, CD4 and CD8, that respectively exhibit the LyT, T-helper and T-suppressor receptors. 3. Lymphocyte function was studied by stimulation of the lymphocytes by lectins, PHA (Ly T), Con A (Ly Ts) PKWM (Ly 8): by TB co-operation). 4. Measurement of total IgE. Only the lymphocyte stimulation tests by lectins showed a significantly raised response in the subjects of G1, who received Ribomunyl. IAV and Ribomunyl (G2) or IAV alone (G3) showed lymphocytes responses that were statistically less than G1. It seemed as though the IAV retarded the Ribomunyl response in IMC. The RE test and the study of the sub-populations did not show any significant differences between the groups. No differences between the total IgE levels could be seen in the groups. This study indicates the possibilities in the treatment of super-infected asthmatics with Ribomunyl alone, since the anti-influenza vaccine had a tendency to retard cell-mediated immunity.

[Comparative study of ELISA and RIA technics for the detection of specific IgG4]

The assay of IgG4 was done by an ELISA method that has been perfected in our laboratory over two years, or by the RIA (Pharmacia technique). Assay of IgG4 is an objective element in the control of specific immunotherapy (IT) to hymenoptera venoms and grass pollens. There is an excellent correlation between the two techniques of ELISA and RIA, that shows an increase in IgG4 titre after around 3 to 4 years of IT.

[Antihistaminic or anti-degranulating activity of pregnancy serum]

From observation of women who had anaphylactic accidents to hymenoptera venoms, with positive histamine release, we have noticed that these same patients lose their histamine release during pregnancy. Measurement of histamine release to pollens confirms the existence of a histaminase, which develops from the third month of the pregnancy and which is the origin of the loss of histamine release. This study makes eliminates a possible anti-degranulation ability of pregnancy sera.

[Open trial on the tolerance to Rhinaaxia in allergic rhinitis]

Forty-four patients, most of them with strong symptoms, were included in this study of the tolerance and efficacy of Rhinaaxia in the treatment of allergic rhinitis. Thirty two patients had good or very good tolerance. Others reported nasal irritation and sneezes after the sprays and one left the study for this reason. The efficacy on nasal symptoms is also very clear. On the third day of treatment the decrease of the nasal trouble was already significant.

[The human basophil degranulation test. Attempt at determining its reliability]

A single-blind assay was made between a laboratory in Paris and our own, in order to assess objectively the Human Basophil Degranulation test (TDBH). The study was made on 28 subjects. They presented with anaphylactic or systemic reactions to hymenoptera venom. The samples from these patients were sent to Paris without any other diagnostic information. Agreement of results between ANGERS and PARIS was very poor, at around 38.5%. Agreement between the TDBH at ANGERS and PARIS with other biological parameters and skin tests was also weak, at 41.7 to 55% in ANGERS and 45.8 to 58.3% in PARIS. The techniques used at ANGERS and PARIS were the same. Overall, TDBH does not seem to be either reliable or reproducible between two laboratories, in the special case of hypersensitivity to hymenoptera venoms.

[Cell-mediated immunity in antibiotic therapy]

Should antibiotic therapy required in the treatment of acute infection be administered frequently in patients at risk with clinical conditions involving recurrent superinfection? The results of our ongoing investigations initiated in 1967 and the present study indicate that macrolides, particularly erythromycin depress the host defense system. In contrast in a study performed in subjects treated for 8 days using cell-immunity tests, we found that cefaclor and amoxicillin may have an enhancing effect on host defenses.

[Determination of specific IgE by chemiluminescence. The IgE DHS-CLA system]

The DHS-CLA IgE system (MAST immunosystems) allows simultaneous determination of specific IgE for 35 different allergens. The method here described is compared with RAST and results are in good agreement with allergic etiology. CLA testing appears to be a good alternative when anamnesis does not permit a clear diagnostic orientation.

[Determination of histamine]

Introduction of the radio-immunological technique (IMMUNOTECH, Marseille) for the measurement of histamine will in the future facilitate measurement of this mediator and this will be specially interesting during provocation tests for food and drug allergies and for histamine release in anaphylactic accidents caused by hymenoptera venom. The technique is more sensitive than that of the automated fluorimetric analysis.

[Epidemiologic survey on the living conditions of asthmatic patients]

Study of the living conditions of asthmatic subjects in comparison to a reference group showed that orientation of rooms to the East or North is much more frequent in asthmatics than in the reference group. This may explain the resistance to desensitization to mites found in some asthmatics.

[Intolerance to metabisulfites in asthma induced by aspirin]

38% of subjects who presented with aspirin (Acetyl-salicylic acid AAS)-included asthma were also found to be intolerant to metabisulphites (MBS). The diagnosis was based on interrogation and an oral provocation test (TPO), to which the majority of the responses were similar, immediate and/or delayed. Atopy and other immunological tests are not involved in this type of asthma, which like AAS is has an intolerance mechanism.

[Determination of specific IgG4 in allergy]

Measurement of the titre of specific IgG4 by the ELISA method may provide objective assistance to the control of specific immunotherapy (IS) to hymenoptera venom and grass pollens. A marked increase of the specific IgG4 titre in the first 3 months of IS or a titre already raised before the start of IS correlated with poor clinical results. Specific IgG4 can not be considered to be a diagnostic indicator in food allergy since we have frequently found this type of antibody in control subjects. Specific IgG4 in food allergy expresses a mucosal marker rather than a pathological reaction.

[ImmunoComb--reliability and reproducibility]

ImmunoComb is a solid phase in vitro immunological test for the measurement of serum or plasma total IgE. The technique was compared with PRIST for measurement of total IgE. The study also included reproducibility, on a test serum dilution both on a complete plate and plate sections. Statistically the conclusion is that ImmunoComb is a colourimetric test that gives the exact total IgE titre with good reproducibility. Use of a photometer greatly improves the sensitivity of assessing the results.