Late cutaneous allergic responses in isolated IgE-dependent reactions

Late cutaneous reactions in patients with delayed pressure urticaria

Late cutaneous reactions ( LCRs ) have been described in patients after allergen skin testing, skin testing with heterologous anti-human IgE, autologous skin-blister fluid, and, variably, after 48/80 injection. We report our results of skin testing patients with delayed pressure urticaria ( DPU ), chronic urticaria, and normal volunteers with histamine and 48/80. All patients with DPU had LCRs after 48/80. No patients in either of the other groups developed LCRs . This may be a clue to pathogenic mechanisms involved in DPU .

Inhibition of the late phase reaction to anti-human IgE in man by oral tranexamic acid

Pharmacological modulation of the immediate and late phase reaction (LPR) to anti-human IgE was further investigated in a double-blind cross-over study. Tranexamic acid (AMCA) 1 g t.i.d. 24 h prior to and following intradermal injection of anti-IgE produced an approximate 40% inhibition of the LPR (P less than 0.01) without affecting the early response as compared with placebo in 10 volunteers. Antagonistic effect on activation of fibrinolysis and possibly the complement system is suggested as a possible mode of action.

Suppression of immediate and late anti-IgE-induced skin reactions by topically applied alcohol/onion extract

In a double blind study, alcohol/onion extract (5% ethanol) was injected simultaneously with 20 IU and 200 IU rabbit anti-human-IgE intradermally in 12 adult volunteers (6 atopics, 6 non-atopics). Diameters of wheals and flares were measured 10 min after and compared with control sites challenged with 20 IU and 200 IU anti-IgE in a 5% ethanol solution. The skin sites were then treated epidermally with 45% alcohol/onion extract and 45% ethanol under occlusion. Diameters of late cutaneous reactions were measured hourly. Oedema formation was clinically estimated according to an arbitrary scale and skin thickness measured with a calliper. In the onion-treated skin sites the wheal areas were significantly reduced (20 IU: control: 108 +/- 53 mm2; onion 69 +/- 42 mm2, P less than 0.05; 200 IU anti-IgE: control: 152 +/- 25 mm2, onion: 138 +/- 26 mm2, P less than 0.02). The oedema formation during the late phase skin reaction was markedly depressed (P less than 0.005 at 2 h, P less than 0.01 at 4 and 6 h, P less than 0.02 at 8 h). The extent of late skin reactions was slightly, but not significantly reduced. Obviously, onions contain pharmacologically active substances with anti-inflammatory and/or allergic properties.

Platelet-activating factor: a possible mediator of the dual response to allergen?

Certain allergic asthmatic patients exhibit a dual response in the lung following bronchial challenge with the appropriate allergen. Often this is paralleled by a cutaneous dual response when the antigen is injected intradermally. The mechanisms underlying such phenomena are not established, but some evidence suggests that the late response is a consequence of the early response. Since platelet activation has been observed following antigen challenge in asthmatic subjects, we have studied the ability of platelet activating factor (PAF-acether, AGEPC) to induce cutaneous inflammatory responses in man. In a time course study over 24 hr, PAF-acether produced a biphasic response: an immediate weal and flare reaction, which resolved within 1-2 hr and was followed some 3-6 hr later by a delayed reaction in which erythema associated with hyperalgesia was evident. These observations suggest that PAF-acether should be considered in the context of allergic asthma as a possible mediator of the dual response to allergen.

Late-phase reactions in ocular anaphylaxis in the rat

We assessed whether anaphylactic stimulation of rat ocular tissue produces a late-phase reaction at the histologic level. Clinical changes of swelling and redness started within minutes, peaked at about 20 min, and then subsided. Neutrophils increased at 1/2 hr after stimulation, peaked at 6 hr, and subsided to normal at 24 hr. Eosinophils reached a significant increase at 6 hr. Compaction of vessel contents was present at 1/2 hr; vessels were normal thereafter. Extravasated red blood cells and debris in the tissue were prominent at 6 hr. Macrophages had accumulated significantly at 6 hr and maintained that level at 24 hr. Any effect of anaphylaxis on macrophage accumulation was masked because control-injected ocular tissue also showed an accumulation of macrophages at 24 hr. Our results demonstrate that in ocular tissue, as in skin, the early acute phase of immediate hypersensitivity is but one stage of a multiphasic reaction.

Complement receptor enhancement as evidence of neutrophil activation after exercise-induced asthma

To determine whether neutrophils are activated after exercise-induced asthma, increases in neutrophil complement receptor numbers (complement receptor enhancement) were measured by the rosette technique. In twelve asthmatic patients there was a time-dependent rise in complement receptor numbers for up to 60 min after treadmill exercise. This enhancement of complement receptors was preceded by a rise in plasma neutrophil chemotactic activity and a reduction in the peak expiratory flow rate. These changes could be inhibited by prior administration of disodium cromoglycate. The changes were not observed in seven asthmatic patients in whom asthma was not induced by an identical exercise task. Complement receptor enhancement was also observed in vitro when partially purified neutrophil chemotactic activity from a patient with exercise-induced asthma was incubated with normal neutrophils. These findings suggest that inflammatory cells are activated after exercise-induced asthma, possibly as a result of the release of neutrophil chemotactic activity and other mast-cell-associated mediators.

Immunological studies in asthmatic children undergoing antigen provocation in the skin, lung and nose

In children with perennial asthma, dual (immediate and late) reactions in the skin to D. pteronyssinus and Timothy grass pollen were more frequent with high doses of antigen and were associated with large immediate reactions. The frequency of dual bronchial or nasal reactions was not related to the size of the immediate reaction and dual reactions were commonly elicited to the lowest antigen dose which would elicit an immediate reaction. Serum IgG, IgA, IgM or IgE concentrations, IgE or IgG antibodies to the antigens and defective yeast opsonization did not differ in children with dual or immediate only reactions in skin, nose or lung. In five patients undergoing bronchial provocation tests with D. pteronyssinus there was no fever, no fine crepitations in the lungs and no significant change in the levels of C3.

Histamine H-1 binding site on human polymorphonuclear leukocytes

Neutrophilic polymorphonuclear leukocytes (PMN) infiltrate the sites of allergic reactions and may respond to histamine, one of the major mediators of allergy. In order to characterize histamine interactions with PMN, the binding of [3H]pyrilamine was studied. Human PMNs bind [3H]pyrilamine in a specific, saturable, and reversible fashion and demonstrate specificity (H-1 antagonists greater than histamine greater than H-2 antagonists) for the competitive binding agents studied. Human PMNs have a homogeneous population of H-1 receptors of moderate affinity (Kd = 52 nM) in large number (265 X 10(3)/cell) which do not demonstrate cooperativity. Thus PMNs attracted to sites of allergic inflammation have H-1 binding sites which may respond to histamine stimulation.

Basophils in human disease

Hypersensitivity reactions containing significant infiltrates of basophils occur in a large proportion of allergic diseases such as contact dermatitis, atopic dermatitis, and allergic rhinitis, and are quite deleterious. However, the potential usefulness of such responses can be recognized in similar reactions in guinea pigs responding to tissue invasion by complex multicellular parasites in which interactions occur between thymic-derived T lymphocytes, antibodies, and basophils in immune resistance responses. Perhaps inappropriate and deleterious allergic responses to pollens, chemicals, and insects is the price that we must pay for the ability to reject complex parasites.

Mechanism of perennial allergic asthma

The early (immediate) allergic asthmatic response does not account for the clinical features of perennial asthma. However, the late response--now thought to be due to allergen-IgE reaction-and the increase in non-allergic bronchial reactivity that is seen in allergen-sensitive asthmatics and that follows the late response do suggest an explanation. If the increased non-allergic bronchial reactivity somehow enhances bronchial responsiveness to allergen there would, in perennial allergic asthma, be a vicious circle. It will not be easy to test, in the laboratory or clinically, the validity of this hypothesis, but there are important implications for diagnosis, treatment, and prevention.

An early component of delayed-type hypersensitivity mediated by T cells and mast cells

In four different systems it was shown that murine delayed-type hypersensitivity (DTH) responses at 18-48 h were preceded by early 2-h responses. CBA mice immunized with picryl chloride, BDF1 mice immunized with oxazolone, BALB/c mice immunized with dinitrofluorobenzene, and C57BL/6 mice immunized with L5178Y lymphoma cells, and challenged with the appropriate specific antigen, all gave rise to expected 18-48 h delayed-in-time hypersensitivity reactions, but all of these responses were preceded by early hypersensitivity reactions that peaked at 2 h. These early 2-h reactions are transferable with T cells or with a T cell-derived, antigen-binding factor and are antigen-specific. The early and late components of DTH reactions are mast cell dependent since neither are elicited in mast cell deficient W/Wv or Sl/Sld mice. The T cell activity mediating the early component of DTH is demonstrable as early as 24 h after immunization, while the classical late component of DTH is not demonstrable until days 3-4. The difference in onset after immunization of the early and late components of DTH, and the different kinetics of these components in recipients of cell transfers that were challenged immediately or 24 h after transfer, led to the hypothesis that immunization for DTH leads to rapid induction in lymphoid organs of a certain population of T cells to produce an antigen-binding factor. This factor sensitizes peripheral tissues, probably mast cells, and local challenge with appropriate antigen leads to mast cell activation and release of the vasoactive amine serotonin, resulting in increased permeability of the local vasculature. This allows other circulating antigen-specific T cells, which are induced later after immunization, to enter the tissues and interact with antigen, resulting in production of chemoattractant lymphokines that recruit accessory leukocytes such as monocytes and polymorphs to enter the tissues via gaps between endothelial cells. These inflammatory cells, that are recruited to the site via two different T cell activities, constitute the characteristic infiltrate of DTH responses. Identification of an early 2-h component of DTH that is T cell- and mast cell-dependent provides evidence that the tissue-sensitizing, antigen-binding, T cell factor probably functions in vivo in the early phases of DTH responses.

A reagin-like antibody in horse serum. II. Anti-human IgE induced reversed cutaneous anaphylaxis-like responses in horse skin

Fc specific anti-human IgE serum induced prolonged reversed cutaneous anaphylaxis (RCA)-like reactions in horse skin. Morphologically and histologically, these reactions resembled passively induced late cutaneous anaphylaxis responses in human skin, but differed from reversed passive Arthus responses induced in horse skin using anti-horse IgG serum. The induction of RCA-like responses in horse skin by anti-human IgE indicates shared Fc antigenic determinants on human IgE and a horse homocytotropic or reagin-like antibody.

A reagin-like antibody in horse serum: 1. Occurrence and some biological properties

The demonstration of a reagin-like antibody against Culicoides pulicaris extract in the serum of horses and ponies affected with recurrent seasonal dermatitis (sweet itch) is reported. This antibody can confer Prauznitz-Küstner (P-K) sensitivity on homologous skin for up to 5 days and, like human IgE, is thermolabile and susceptible to 2-mercaptoethanol reduction. It is eluted on diethylaminoethyl dextran-52 anion exchange chromatography independently of IgG, IgG(T) and IgM, and its elution characteristics indicate similarity in net molecular charge to human IgE. The P-K response observed in horse skin is biphasic, and is morphologically similar to the late cutaneous anaphylactic response in man. Both phases of the P-K response are dependent upon the reagin-like antibody, although other serum factors appear involved in the delayed phase of the response.

Bronchial asthma and the neutrophil chemotactic factor

Neutrophil chemotactic factor (NCF) is a slight acidic macromolecule which is released into the circulation of asthmatic individuals following antigen provocation and an exercise task. It also appears in late asthmatic reactions with a time course of appearance which precedes the second fall in FEV1. The release of NCF was inhibited by prior administration of disodium cromoglycate (DSCG) suggesting its possible mast cell origin.

Identification and partial characterization of an exercise-induced neutrophil chemotactic factor in bronchial asthma

A heat-stable neutrophil chemotactic factor (NCF) has been identified in the serum of 13 atopic asthmatic subjects after treadmill exercise. Peak activity was detected at 10 min and returned to prechallenge values by 1 h. No NCF activity was detected in the sera of three nonasthmatic atopic or four normal nonatopic individuals performing the same task. NCF produced by exercise (NCFEX) had a similar time-course of release to NCF provoked by specific antigen (NCFAG). The appearance of circulating NCFEX and NCFAG closely paralleled the fall in peak expiratory flow rate/forced expiratory volume in 1 s (PEFR/FEV1). Histamine challenge in atopic asthmatics at concentrations giving a comparable change in PEFR/FEV1 to that evoked by exercise or inhaled antigen was not associated with the appearance of circulating NCF. In seven subjects NCFEX release was inhibited by prior administration of disodium cromoglycate. NCFEX and NCFAG eluted as single peaks of activity when applied separately to columns of Sephadex G-200, and both were an estimated 750,000 daltons. NCFEX and NCFAG also eluted as single peaks of activity, at between 0.15 and 0.30 M NaCl, following anion exchange chromatography on DEAE-Sephacel (pH 7.8). The isoelectric points of NCFEX and NCFAG were virtually identical (between pH 6.0 and 6.5) as determined by chromatofocusing on Polybuffer Exchanger 94. The activities of NCFEX and NCFAG were substantially reduced, in both a time- and dose-dependent fashion, after incubation with trypsin and chymotrypsin. Partially purified NCFEX and NCFAG promoted both stimulated random migration (chemokinesis) as well as directional migration (chemotaxis). These experiments indicate that NCFEX and NCFAG might be identical substances and raise the possibility that mediators by hypersensitivity are released during exercise-induced asthma in atopic subjects.

Neutrophil chemotactic activity in antigen-induced late asthmatic reactions

Nine patients with bronchial asthma who had early and late falls in forced expiratory volume in one second (FEV1)(10 minutes and six hours, respectively) after inhalational challenge with specific antigens were studied for the presence of circulating neutrophil chemotactic activity (NCA). NCA was detected during both the early and the late asthmatic responses; the time course of appearance of NCA in the circulation paralleled that of the falls in FEV1. In contrast, five patients with asthma who had early reactions had only a single early peak of NCA, with no further rise for up to 24 hours. The NCA detected during early and late reactions eluted with macromolecules of an estimated molecular weight greater than 500,000 daltons when applied separately to columns of Sephadex G-200. Since high-molecular-weight NCA is believed to be associated with mast cells, these observations support the view that mediators of hypersensitivity are released in both the late and the early asthmatic responses.

Basophils in allergen-induced patch test sites in atopic dermatitis

Atopic dermatitis often occurs in patients who have high IgE levels and positive immediate skin tests to several common allergens. However, there is considerable doubt about the role played by allergens in this disease. Patch testing for 48 h at superficially abraded skin sites revealed that allergens could induce eczematous lesions in atopic dermatitis patients but only in those who also gave a positive immediate skin reaction to the same allergen. Lesions induced by the purified house dust mite antigen, antigen P1 contained mononuclear cells, basophils, eosinophils, and neutrophils. These patients also had raised specific serum IgE against antigen P1, and their leucocytes released histamine upon exposure to the same antigen. Thus an acute eczematous lesion can be induced by the application of inhalant allergens to the skin.

Cellular inflammatory response to fungal antigen studied with the skin window technique--correlation of the exudate with the evolution of the mycotic infection

The skin window technique, using a coverslip, was applied to study the inflammatory exudate induced by killed pathogenic yeasts in patients with mycotic infections. The presence of eosinophils in the specific exudate after 3 hours seems to indicate specific IgE fixed in the tissues. This was demonstrated by the correlation of this specific eosinophilia with the eosinophilia induced by an anti-IgE serum and with the positive immediate intradermal reactions and by the correlation with serum-specific IgE detected with an immunoenzymatic technique. Increased eosinophilia is related to the active phase of the disease. The eosinophilia in the specific exudate seems to be more reliable than an in vitro technique for the detection of the specific IgE against fungal antigen. In this material, the eosinophilia demonstrated that yeast-specific IgE may be responsible for both immediate and delayed intradermal reactions.

Allergy in laboratory animal workers

179 people working with small laboratory animals were studied by questionnaire, lung-function tests, skin tests with common allergen extracts and extracts of the serum and urine of five animal species, and serology. 49 people had symptoms related to animal contact, most commonly rhinitis but also asthma and skin rashes. Skin reactivity to animal extracts was related to symptoms, particularly asthma, but many people with rhinitis only had negative skin tests. Positive skin tests without symptoms were rare. 3 people had additional late skin reactions. Atopic individuals were no more likely than non-atopics to have animal-related symptoms but were more likely to have asthma. Gel diffusion revealed no precipitating antibodies, and no specific IgG was detected with the ELISA technique. Lung-function measurements were normal. Sensitisation to laboratory animals may involve heavy antigen exposure, so that relatively unreactive individuals can be affected. Exclusion of atopic individuals from work with laboratory animals will not eliminate the problem.

Effect in man of anti-allergic drugs on the immediate and late phase cutaneous allergic reactions induced by anti-IgE

Wheal and flare reactions as well as a late cutaneous allergic reaction (LCAR) were induced by anti-human IgE in healthy subjects. The effect of the beta 2-adrenoceptor stimulant terbutaline, the histamine-1 (H1) receptor blocking agent mepyramine and the synthetic glucocorticoid betamethasone on these reactions was studied. All administrations were given intradermally (i.d.). The immediate reaction to anti-IgE was inhibited by 3 micrograms terbutaline and 30 micrograms mepyramine (P less than 0.01) whereas 50 micrograms betamethasone had no effects. Terbutaline had no effect on the flare response induced by i.d. injected histamine but a slight effect on whealing. Terbutaline and mepyramine weakly reduced the LCAR throughout the observation period of 24 h (P less than 0.01). In contrast, betamethasone almost completely abolished the LCAR. It is concluded that the two phases of the skin reaction to anti-IgE are interrelated since an inhibition of the early phase was followed by an attenuation of the LCAR. The mechanism of action of steroids seems to differ fundamentally from that of other anti-allergic drugs since inhibition of the early step in the reaction is not essential to the action on the late step. It is further suggested that terbutaline inhibits anti-IgE-mediated cutaneous reactions by inhibition of the mast cell release reaction.

Correlation between lymphocyte responses and immediate hypersensitivity to purified allergens

Seventy-nine unrelated subjects were selected for high allergic sensitivity to ragweed and/or grass pollens. Sensitivities to ragweed antigens E and Ra5 and rye grass group 1 were measured by intradermal skin testing and by histamine release in vitro. Lymphocyte responses were determined by incorporation of 3H-thymidine in vitro in the presence of antigen. Skin-test and histamine-release sensitivities were significantly correlated with lymphocyte response in the case of antigen E, but not for group 1 and Ra5. In addition, lymphocyte response to antigen E was significantly correlated with total serum IgE level. Six antigen E-sensitive individuals had marked delayed, but no immediate, reactions to Ra5 and almost all showed lymphocyte responses to Ra5. We conclude that immediate sensitivity and lymphocyte responses of allergic individuals to antigen E are significantly correlated, and that lymphocyte responses and delayed reaction to an antigen without immediate sensitivity or IgG antibody are possible even in allergic subjects.

Effect of topical indomethacin on allergen-induced dual skin reactions

Twelve asthmatics with dual bronchial and skin reactions after allergen challenge received topical treatment with a 5%-indomethacin cream half an hour before and up to 7 h after intradermal allergen and histamine injections. The erythema during the first 20 min of the wheal and flare reaction (WFR) was not affected, neither were the diameters of wheals and flares. 40 to 60 min after injection we observed a marked reduction of the erythema in histamine- and allergen-tested skin areas of 10 patients. This effect lasted up to the 5th h after injection of high allergen doses. During the fully developed late cutaneous reactions (LCR) no effect of indomethacin on the erythema was observed, the edema of LCR was only insignificantly reduced. These results suggest that the erythema in LCR between the 1st and 4th h is caused, at least in part, by local formation of prostaglandins.

The use of radioactive isotopes for analysis of cutaneous allergic responses

Local exudation at the sites of allergic and histamine-induced cutaneous reactions, was measured with an in vivo double-labelling procedure, based upon local serial simultaneous measurements of indium-113 m (113mIn) labelled transferrin and technitium-99m labeled red blood cells (99mTc RBC). Analyses depended upon the reaction index i.e. comparison of the ratio of 113mIn/99mTc counts at the reaction site with the ratio of 113mIn/99mTc at the corresponding unreacted site in the skin of the opposite arm. Reaction indices were initially significantly elevated at the sites of histamine and allergic reactions. After the first hour, there was a progressive reduction at histamine sites indicating a tapering of the local accumulation of indium-labelled transferrin. By contrast allergic reaction sites showed a continuing increase in the reaction index after one hour. During the first hour the curves were comparable, but they diverge and were significantly different after one hour (0.05 greater than P greater than 0.02). This is consistent with the known occurrence of late cutaneous reponses at the site of allergic but not histamine reactions.

Hypersensitivity pneumonitis in a technician using Pauli's reagent

A technician working in a medical laboratory used a spray of sodium diazobenzenesulphate (Pauli's reagent) in chromatography. She developed a respiratory illness with both airways obstruction and radiographic and physiological evidence of interstitial pneumonitis. An occupational type of challenge test was followed by both immediate and late bronchial obstructive responses, by a fall in arterial oxygen tension, and by increased radiographic shadowing. Histology of a lung biopsy specimen, a low serum C3, and a postive skin prick test to the reagent suggested that the illness was a hypersensitivity reaction to Pauli's reagent.

Production of IgE complexes by allergen challenge in atopic patients and the effect of sodium cromoglycate

Specific IgE complexes and symptoms of asthma and eczema were produced in two allergic patients by oral challenge with food allergen. Both symptoms and IgE complexes could be prevented by pre-treatment with oral sodium cromoglycate. The IgE complexes can fix complement and may therefore provide the vehicle of the "late" responses seen in immediate hypersensitivity. The central role of gut sensitivity is emphasised by the protection afforded by sodium cromoglycate both when given acutely, against the effects of an oral challenge, and when given continuously for asthma and eczema due to food allergy.

Effects of ketotifen and clemastine on passive transfer of reaginic reaction

Passive transfer (PK) tests were performed with a reaginic serum on a recipient reacting with an immediate and a more prolonged reaction when specificity challenged. Both reactions are thought to be mediated by IgE immunology. Ketotifen, a cycloheptathiophene derivative, and clemastine, given to the recipient in maximal clinical doses for 3 days, inhibited the immediate reaction. Ketotifen had a very slight effect also on the prolonged reaction. The results indicate that the in vivo effects of ketotifen in the human system are due not so much to mast cell inhibitory mechanisms, but more to post-release antihistaminic and some anti-inflammatory properties.

Allergic and nonallergic rhinitis. Diagnosis and management

The causes of rhinitis are many. Allergic rhinitis is mediated by IgE, and immunotherapy in selected patients is very effective. Immunoglobulins do not seem to play a role in nonallergic rhinitis, and immunotherapy is ineffective. Correct diagnosis spares the patient needless expense, inconvenience, and eventual disappointment.

[Allergy diagnosis in patients with bronchial asthma (bronchial provocation test, skin test and RAST) (author's transl)]

87 patients with bronchial asthma underwent skin test, RAST and measurment of airway resistance before and after inhalation of control solution as well as at least 10 times after each of one to four bronchial provocations (making up a total of 171 tests) with extracts of house dust, house dust mite, animal dander, mould spores and pollen in increasing concentrations. An actual clinical significance of the skin test reactions was found in 60% of all cases and of the RAST results in 66% of all cases. The overall agreement between skin test results and RAST results was 61%. The correlations between the different tests depended on the degree of hypersensitivity, on the tested allergen and on whether the results of skin test and RAST, respectively, were positive or negative. There existed a good correlation between the results of all three test methods and case history only for pollen allergens and animal dander. Noticeably often negative RAST results with house dust and mould spores, as well as positive skin tests with house dust mite and mould spores could not be confirmed by the provocation test. Important indications for a bronchial provocation test in asthmatics are doubtful case history, doubtful skin test or RAST results with the problem-allergens house dust, house dust mite and mould spores; the bronchial provocation test is especially commendable when drastic or cumbersome therapeutic measures (immunotherapy, change of home, change of job) are to follow or if late asthmatic reactions are expected.

The role of basophils in inflammatory reactions

This review demonstrates that basophils reflect skin and lung mast cell reactivity and show characteristic changes in mediator release associated with clinical disease. Although the numbers of IgE molecules and IgE receptors on basophils have been enumerated, these have, in most instances, little influence on the release of histamine after challenge. There is, rather, a parameter of "releasability" that may be a major variable in allergic disease states. Basophils contain and release histamine, the eosinophil chemotactic factor of anaphylaxis (ECFA), a slow reacting substance of anaphylaxis (SRS-A), and a kallikrein. The release process is controlled by hormone-basophil receptor interactions that determine the cyclic AMP level; plasma and tissue adenosine levels appear prominent in this control. Histamine feeds back to negatively modulate basophil and mast cell release through a specific histamine 2-receptor; it also inhibits lymphocyte and neutrophil function. Like neutrophils, basophils contain beta-glucuronidase while neutrophils contain SRS-A and a low-molecular-weight ECF. The stimuli for primary basophil and neutrophil release are, however, quite different, although phagocytic stimuli, which fail to cause basophil mediator release, potentiate the IgE response. It is concluded that basophols play a significant in vivo role in inflammation by acting as an interface between foreign antigens, the serum cascade systems, and other inflammatory cells.

Levels of complement components during allergen-induced asthma

The levels of circulating complement components C3 and C4, total haemolytic complement, CH50, as well as evidence of complement activation, have been studied in peripheral blood samples during allergen-induced asthma. No evidence of activation of the complement system was detected in these studies.

Sensitization following Hymenoptera whole body extract therapy

Treatment of an insect-sensitive patient with Hymenoptera whole body extracts (WBE) led, on five occasions, to a serum sickness--like syndrome which did not recur after therapy was stopped. The patient was found to be sensitive by skin test, histamine release, and radioallergosorbent test (RAST) to both venom and WBE as well as to venomless bee body preparations. Subsequent therapy with honeybee and yellow jacket venoms was without sequelae, and after treatment the patient did not react to a sting. In order to assess the frequency of sensitivity to irrelevant body proteins in patients treated with WBE we carried out WBE RASTs on sera from 15 such patients and compared them with those from 15 nontreated insect-allergic patients who had similar venom-specific IgE antibody levels. None of the patients allergic to insects who had not been treated with WBE had detectable IgE anti-WBE antibodies, while about 50% of those treated with WBE had developed IgE antibodies against these proteins. It appears that sensitization to nonvenom WBE proteins in terms of the development of IgE antibody is a common result of this therapy, and, rarely, repeated challenge with this complex antigenic mixture can also lead to clinical illness.

Relative refractory state for late cutaneous allergic responses

The late cutaneous allergic response (LCAR) is a usual sequel to the wheal-and-flare (early) response in sufficiently intense cutaneous allergic reactions. Allergic reactions with early and late components were produced in the skin of the forearm by the intracutaneous injection of anti-IgE or allergen. One week later, these sites, which were normal in gross appearance, and separate control sites on the opposite forearm, were injected. At the sites of repeat reactions, the wheal diameter of the early response was the same but the LCAR was considerably smaller than at simultaneously injected control sites. This local relative refractory state for LCAR is immunologically nonspecific in the sense that it was manifest even when the antigen injected the second time had no evident immunologic relationship with the antigen injected initially. The refractory state for LCAR was present at 2 wk after the initial reaction, but it was no longer demonstrable after 3 wk. This local relative refractory state for LCAR may represent an inhibitory control mechanism for allergic reactions in man.