allergy
The effectiveness of a peripatetic allergy nurse practitioner service in managing atopic allergy in general practice--a pilot study.

Brydon M.

Norfolk Allergy Diagnostic and Advisory Service, Norwich, UK.

The effectiveness of an allergy nurse practitioner service operating within community health care was evaluated in terms of symptom improvement and reduction in allergy related general practitioner consultations and prescribed medication. A postal questionnaire survey of 53 allergy patients, identified from three general practices in the Norwich area during a pilot scheme, was carried out concurrently with a survey of the patients' case records at the surgeries. The questionnaire included questions concerning allergy status, general practitioner visits and the number of prescribed medications supplied. The main outcome measures were the number of general practitioner consultations and prescribed medications before and after the allergy nurse practitioner consultation and the patient's reported level of symptoms. The results showed that the intervention of an allergy nurse practitioner consultation produced significant reductions in the outcome measures. The number requiring a general practitioner consultation fell by 40% (from 133 to 80, P < 0.001) and the number of prescribed medications fell by 42% (from 153 to 89, P < 0.001). Twenty-seven (69%) of the 39 patients who responded to the questionnaire reported an improvement in symptoms, whilst 26% (n = 10) remained the same and 5% (n = 2) were worse. An additional study of 23 of the +ve skin-tested patients, over an extended period, showed greater reductions in general practitioner consultations and prescribed medication (71%, P < 0.001 and 59%, P < 0.004 respectively). In conclusion, it is apparent that the application of developed skills and expertise in allergy assessment by a nurse coupled with time can lead to improvement in symptom level in allergy patients. Such a service also has the possibility of providing savings within the National Health Service. Simply prescribing drugs without a system of self-management and avoidance measures is unlikely to improve the care available to allergy patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10779298&dopt=Abstract allergy medicine



allergy
Immune complexes IgE/IgG in airborne allergy: increase during pollen season.

Jarzab J, Gawlik R.

Department and Clinic of Internal and Allergic Diseases, Silesian University School of Medicine, Zabrze, Poland.

In the present study we addressed the question of IgE/IgG immune complex serum level in 92 patients with respiratory allergy in relation to their clinical status. Twenty patients with allergy to insect stings and 22 healthy volunteers were also investigated. IgE/IgG immune complexes and IgG anti-IgE antibodies were estimated using double antibody solid-phase immunoassays in IgG serum fractions isolated by protein A affinity chromatography or in fractions obtained by Sephacryl S-300 gel filtration. Three people (14%) from the control group, two patients (10%) with insect allergy and 41 patients (45%) from the group with airborne allergy exhibited an increased serum level of IgE/IgG immune complexes (chi2, p <0.05). IgG anti-IgE serum level was also significantly higher in the examined group of patients with airborne allergy than in the control group. None of the factors analyzed, including the kind of allergic disease, the type of inhalant allergen (pollen or house dust antigens), the severity of allergy judged from the frequency and intensity of symptoms for 1 year preceding blood sampling and the symptoms exhibited during blood sampling, showed a statistically significant relation to the level of IgE/IgG immune complexes or IgG anti-IgE, when the whole group of patients with respiratory allergy was analyzed. A distinct difference between patients investigated during and outside of the pollen season was found in patients with isolated pollen allergy. The latter exhibited an increase of IgE/IgG immune complexes (57% vs. 29%) significantly more often, which indicates the possible involvement of IgE/IgG immune complexes in the pathogenesis of pollen allergy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10780796&dopt=Abstract allergy medicine



allergy
Different serum interleukin-12 and sCD30 levels in food- and pollen-sensitized children.

Blanco Quiros A, Arranz E, Hoyos C, Carrasco JA, Andion R.

Department of Paediatrics and Immunology, University of Valladolid, Spain. ablanco ped.uva.es

It has been proposed that a down-regulation of interleukin (IL)-12 and interferon (IFN)-gamma might be related to susceptibility to allergy in early life. The aim of this study was to assess serum IL-12 levels in food-sensitized and pollen-sensitized children and to compare these with another activation marker, sCD30. Twenty children with pollen allergy and 22 food-sensitized children were included. The diagnosis of immunoglobulin (Ig)-E-mediated allergy, suggested by clinical symptoms, was based on skin-prick tests, serum IgE antibodies and total IgE levels. Samples from 24 non-allergic children were used as controls. IL-12 and sCD30 levels were measured by ELISA. It was found that pollen-sensitized patients had normal IL-12 and higher sCD30 levels than controls (114 vs. 63 U/ml, p = 0.028), but, surprisingly, food-sensitized infants showed normal sCD30 and increased serum IL-12 levels (323 vs. 118 pg/ml, p = 0.0001). No differences were found in patients suffering from asthma or allergic dermatitis. Levels of sCD30 and IL-12 determined in May showed a strong correlation with those obtained in November. Interleukin-12 and IgE levels had an inverse correlation (r = -0.494, p = 0.0001) whereas no correlation was found between sCD30 and IgE. Age had a strong negative influence on IL-12 levels in allergic (Z = 4.834, p < 0.0005) and in normal children (Z = 3.00, p < 0.002); by contrast, sCD30 levels were not significantly age-dependent. When IL-12 levels from the food-allergy group were compared with those from normal controls younger than 4 years of age, the difference remained significant (p = 0.001), ruling out an age-bias. The conclusions made in this study were that serum IL-12 and sCD30 showed different behaviors in children with food or pollen allergy. We found IL-12 and sCD30 levels in pollen-allergic patients that agree with the classical T-helper (Th) 1/Th2 paradigm of allergy. In contrast, serum IL-12 levels were increased in food-sensitized children, suggesting a different immunologic pathogenesis.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10678718&dopt=Abstract allergy medicine



allergy
Prevention of latex allergy by selection of low-allergen gloves.

Mahler V, Fischer S, Fuchs T, Ghannadan M, Valent P, Fartasch M, Kraft D, Schuler G, Valenta R.

Institute of General and Experimental Pathology, AKH, University of Vienna, Austria.

BACKGROUND: In recent years the prevalence of type I allergy to latex has continuously increased, in particular among healthcare workers, to about 10%. While most forms of type I allergy caused by other environmental allergens can be treated by pharmacotherapy or specific immunotherapy, minimizing exposure to latex proteins may represent an effective preventive measure for latex allergy. OBJECTIVE: To investigate whether it is possible to select by in vitro and in vivo testing low-allergen latex gloves for prevention of latex allergy. METHODS: We obtained separate extracts by standard aqueous extraction from the inner and outer surfaces of 15 different commonly used (10 examination, five surgical) glove brands. The extracts were analysed by quantitative (bicinchoninic protein assay, immunoglobulin [Ig] E-ELISA, ELISA competition) and qualitative (SDS-PAGE, silver staining, IgE immunoblotting) methods for their protein and allergen contents. In addition, the glove extracts were analysed for their capacity to induce basophil histamine release and immediate skin reactions. RESULTS: Extracts from different glove brands contained cross-reactive IgE epitopes. However, IgE binding studies, basophil histamine release and skin testing showed that different glove brands and their inner and outer surfaces contained widely varying protein and allergen contents. While the determination of total protein contents was not sufficient to identify low-allergen gloves, IgE measurements, basophil histamine release and skin testing were in good agreement and allowed to select low-allergen products. CONCLUSION: We suggest the use of low-allergen latex products identified by IgE binding, basophil histamine release assays and skin testing as a feasible preventive measure for latex allergy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10718848&dopt=Abstract allergy medicine



allergy
O-glycans as a source of cross-reactivity in determinations of human serum antibodies to Anisakis simplex antigens.

Lorenzo S, Romaris F, Iglesias R, Audicana MT, Alonso JM, Leiro J, Ubeira FM.

Laboratorio de Parasitologia, Facultad de Farmacia, Universidad de Santiago de Compostela, Spain.

BACKGROUND: Anisakis simplex is a seafood-borne parasite that may both infect humans and cause allergy. Serodiagnosis of anisakiasis and allergy caused by this nematode is difficult since most Anisakis antigens show cross-reactivity problems. OBJECTIVE: To analyse the possible role of sugar epitopes contained in Anisakis simplex antigens as causes of false-positive results in serodiagnostic assays. METHODS: The antigens UA2R and UA3R recognized by two anti-Anisakis monoclonal antibodies were used in this study. Capture ELISA techniques were used to compare the reactivities with native or O-deglycosylated antigens of sera from Anisakis-free children (most of them infected by several other parasites) and from Anisakis allergy patients. O-deglycosylation was done by mild alkali treatment with NaOH. SDS-PAGE and immunoblotting were used to characterize the effects of NaOH or N-glycanase F treatment on UA3R. RESULTS: Native UA2R was recognized by IgG1 and IgM antibodies in the sera of both Anisakis-free subjects and allergy patients. Native UA3R was recognized by most sera from allergy patients (92% considering immunoglobulin (Ig) G1, 100% considering IgE), but also by a significant proportion of sera from Anisakis-free subjects (36% considering IgG1, 14% considering IgE). O-deglycosylation of UA3R greatly improved specificity: none of the sera from Anisakis-free patients showed either IgG1 or IgE reactivity with O-deglycosylated UA3R, while the proportion of sera from allergy patients showing IgE reactivity with this antigen was practically unaffected. O-deglycosylation of UA2R did not improve the specificity of assays using this antigen. Our results also show that the protein core of glycoproteins may be altered by even very mild alkali treatment, depending on the nature of the protein. CONCLUSION: Native glycoproteins of A. simplex should not be used for diagnostic purposes. O-deglycosylated UA3R seems to be an excellent candidate for use as target antigen in the serodiagnosis of anisakiasis and A. simplex allergy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10718853&dopt=Abstract allergy medicine



allergy
[Allergy effect on migraine course in older children and adolescents]

[Article in Polish]

Wendorff J, Kamer B, Zielinska W, Hofman O.

Klinika Neurologii Instytutu, Centrum Zdrowia Matki Polki.

The interaction between allergy and migraine has been discussed since many years. The aim of the present study was the evaluation of: 1. allergy prevalence in the studied children with migraine, 2. allergy effect on the clinical course of migraine. MATERIAL AND METHOD: The studied group comprised 30 children and adolescents aged 11-17 years with the diagnosis of migraine with or without aura by IHS criteria. In each case the migraine index was determined and symptoms of allergy were sought. Skin prick test and tests for immunoglobulin E in serum were done. The analysis of results showed the presence of allergy in 12 cases (40%), and on this basis two groups were isolated: with and without allergy. The allergic children were given antiallergic treatment for 6 months (pharmacological or diet restriction). RESULTS: In the allergy group the migraine index decreased significantly from 2.45 to 0.33. Headache intensity decreased as well. CONCLUSIONS: 1. In 40% of cases migraine was associated with allergy. 2. Treatment results suggest that allergy and antiallergic treatment may influence the course of migraine attacks.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10719688&dopt=Abstract allergy medicine



allergy
Latex allergy in adults with spinal cord injury: a pilot investigation.

Monasterio EA, Barber DB, Rogers SJ, Able AC, Fredrickson MD.

Spinal Cord Injury Center, South Texas Veterans Health Care System, Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, 78229-3900, USA.

Latex allergy is a well-known complication of repeated exposure to natural rubber latex (NRL) products. The medical literature is replete with studies investigating the prevalence of NRL allergy in myelodysplastic children. However, the prevalence of NRL allergy in adults with spinal cord injury (SCI) has received little attention. Patients with a history of NRL exposure secondary to long-term indwelling urinary catheter usage were recruited as subjects. The presence of NRL allergy was established using the radioallergosorbent assay technique (RAST). Serum from 15 subjects who had been injured an average of 23.8 +/- 11.9 years and who had used an indwelling urinary catheter an average of 17.1 +/- 11.5 years was obtained. RAST for NRL was positive in 7 of the 15 (47%). Of note, serum obtained in a control group of 4 subjects who had been injured an average of 54.4 +/- 3.1 years and had no significant history of long-term indwelling urinary catheter usage were all RAST negative. This study suggests that adults with SCI and significant NRL exposure via long-term indwelling urinary catheter usage may be at risk for the development of NRL allergy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10752867&dopt=Abstract allergy medicine