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The behaviour of some serological aspects of autoimmunity was studied in patients with inflammatory bowel disease (IBD) by determining the incidence and levels of serum IgM, IgG and IgA rheumatoid factors (RF) and of circulating immune-complexes (IC) in 67 patients suffering from ulcerative colitis (UC) and 53 from Crohn's disease (CD). Sera from 40 young healthy subjects were included as controls. RF were detected by an enzyme linked immuno-assay (ELISA) and IC by the CIC-conglutinin and the CIC-C1q assays. ELISA detected a higher incidence of IgM RF in both UC and CD groups than the routine agglutination tests, although the mean levels were non significantly higher than in controls. Mean IgG RF levels were significantly above normal in UC and CD patients, the latter showing a greater incidence of elevated values and higher mean levels. IgA RF were significantly elevated only in CD patients; mean values for the UC group were within the normal range. The CIC-conglutinin test did not detect a significant incidence or high mean levels of IC and the CIC-C1q assay turned up a sizeable number of positive samples only in the CD group. Although still only preliminary, these overall findings suggest that RF activity is somehow present in patients with IBD. The greater prevalence of IC in CD patients, together with the patterns of IgG and IgA RF support the concept that this disease possibly involves autoimmune phenomena more than ulcerative colitis.

A study of some complement functions was performed in two patients affected with hereditary angioneurotic edema (HAE) - mother and daughter - from a Southern Italy family (Apulia) and in three of their relatives. A decreased level of the C1 esterase plasma inhibitor was found in both the patients, who were treated with tranexamic acid with a slight, but definite improvement. However, the disease could not be traced beyond two generations in the pedigree and a couple of ascendants was found who were free from HAE both from the clinical standpoint and from that of the laboratory evaluation of complement functions. The possibility that HAE arose in the family through a mutational event is discussed.

In 15 subjects immunized with two doses of purified adjuvant-free tetanus toxoid, the behaviour of specific IgE and hemoagglutinative antibodies was studied. In the majority of the subject the presence of specific IgE and hemoagglutinative antibodies was observed upon a control carried out 15 days after immunization. After reintroduction of antigen an increase both of specific IgE and hemoagglutinative antibodies was observed. No subject who had presented specific IgE in the serum after the first inoculation of tetanus toxoid showed local or general reaction after reintroduction.

The aim of this prospective study was to evaluate the incidence of allergic reactions to drugs compared to other kinds of medical emergencies admitted to the main Hospital in Milan during a 6 months period. At the same time we drew a list of drugs most frequently involved in allergic reactions, and a list of the most frequent symptoms. Using special forms, the medical staff collected patients' data: age, history of atopy, identification of the drug causing the reaction, and any previous reactions. Among 11,407 cases of medical emergencies, we found 163 (1.43%) patients showing drug reactions: the mean age was 27.3; 58.90% were female; atopy was present in 16.56%. The drugs most frequently involved were: pyrazon group (22%); ASA (20.86%); penicillin and derivatives (9.20%); sulfa drugs (6.14%); group B vitamins (4.30%); tetanus toxoid (4.30%); hyposensitizing extracts (3.68%); propionic acid derivatives (2.46%); paracetamol (1.84%); indomethacin (1.23%); rifampicin (1.23%); erythromycin (1.23%); glafenine (1.23%); others (17.80%). Urticaria and/or angioedema were the most frequent symptoms (86.51%), then anaphylactic shock (9.81%) and asthma (3.68%) with regard to anaphylactic shock only 6.20% of the patients had had a previous reaction to the same drug. From these data we can see that the incidence of drug reactions is very low compared to other medical emergencies; penicillin evidenced fewer reactions than expected, while the pyrazon group and ASA confirmed the data from literature.

Persistent unexplained lymphadenopathy with intermittent fever, weight loss, night sweats and malaise was observed in the period from March 1983 to April 1984 in 66 intravenous drug addicts living in Milan. A high percent of these subjects showed cellular immunity alterations, with significant decrease of total lymphocyte count (p less than 0.001) and of OKT4+ cells (percent and absolute number) (p less than 0.001) OKT8+ cells were augmented in percent, but not in absolute count. OKT4/OKT8 cell ratio were inverted, with significant reduction versus the healthy controls (p less than 0.001). IgG mean concentrations were significantly higher than the normal (p less than 0.001). Anergy or hypoergy to recall skin testing were evidenced in 58/66 patients. Cases of persistent unexplained lymphadenopathy associated with abnormalities of cellular immunity are considered as a possible prodrom of AIDS and were frequently observed in high risk populations. The occurrence of this clinical syndrome in a urban area may be premonitory of further progression to the epidemic. It will be necessary to assess whether this clinical and immunological picture will result in some of these patients in full blown acquired immunodeficiency syndrome.

Peripheral blood mononuclear cells (PBMC) from 40 normal individuals, 20 men and 20 women, divided according to age were evaluated for their ability to mediate natural killer (NK) cytotoxicity, using the K562 erythroleukemic cells as target. The results of a specific 51Cr release assay demonstrated that NK activity was greater in men than in women. There was a significant correlation between NK activity and the percentages of Leu 11a+ cells in younger women, but not in the other groups and no correlation between NK activity and Leu 7+ cells.

Circulating DNA has been extracted from plasma of 6 patients with pulmonary embolism; it appears of low molecular weight (about 400 base pairs) and of uniform size; its staining sensitivity to ethidium bromide suggests it is mainly double stranded. DNA circulates linked with proteins.

Serum IgE levels were measured in two groups of healthy elderly subjects: a first group of 18 with circulating autoantibodies (sign of a probable deficit of suppressor T lymphocytes) and a second group of 15 without circulating autoantibodies. The IgE levels in the first group (average 1032 U/ml) resulted significantly higher than those in the second group (average 103 U/ml), P less than 0.05. This result can be related to a deficit of suppressor T lymphocytes functionality, present in these subjects, which would cause, besides the appearance of autoantibodies, also an increase of serum IgE levels. Moreover, this phenomenon seems to confirm that in man, too, as in experimental animals, IgE synthesis is under the control of suppressor T lymphocytes specific for IgE. From a clinical viewpoint, the two populations studied do not differentiate and no symptoms of atopy were observed in subjects with high IgE levels.

In human one-way mixed lymphocyte reactions we have observed an increase in the percentage of sIgD bearing lymphocytes, detected by direct membrane immunofluorescent staining. This increase does not seem to be attributable either to the synthesis of sIgD receptor molecules by previously negative T or null cells or to a non specific stimulation of B cells by a factor released in the course of the MLR.

We referred the data on association between M.S. patients and HLA complex in the different populations. Then we discussed the different aetiopathogenetic hypothesis that centre on the disease. We considered also viral and autoimmunity theory and the possibility that these two hypothesis don't wrangle but complete them.

To determine the diagnostic value and precision of the quantitative skin test (QST), RAST, specific nasal (NPT) and conjunctival (CPT) provocation tests, we studied 91 patients, suffering from allergic rhinoconjunctivitis with positive skin prick tests (SPT) to common allergens, among whom sixty-nine of them had symptoms related to the positive SPT, and 22 had no clinical correspondence. In these two groups, by comparing the threshold of positivity, we investigated whether there was any parallelism between responses to the tests considered. We also compared the level of specific IgE (RAST) to the wheal-areas evoked by preliminary SPT for the corresponding allergen in order to detect any quantitative relationship between these investigations. Increasing concentrations of standardized allergen extracts (from 10 to 100,000 BU/ml) were used in all in vivo tests. NPT was evaluated on the basis of multiple recordings of nasal resistances by anterior passive rhinomanometry. QST proved to correlate well with RAST and its easier method ensures it a major role in assessing the levels of allergic sensitization. SPT wheal-areas and RAST vales correlated well only for grass and birch, presumably because of better standardization of these allergen extracts. When provocation tests, especially NPT, were positive, patients were almost always symptomatic for the allergen tested (high positive predictive value). Likewise, 21 out of the 22 asymptomatic subjects had negative NPT (high specificity). These results suggested the utility of standardized provocation tests in order to restrict diagnosis to the truly causative allergens in patients with multiple positive SPT results.

Plasma and isolated cryoglobulins from ten patients with mixed cryoglobulinemia were studied for the presence of DNA using the diphenylamine reagent test. DNA-like material was detected in all the plasmas tested and it was also present in nine of the isolated cryoglobulins. IgM and IgG components of three cryoglobulins were purified by gel-filtration: anti-DNA activity was detected in IgG fraction (two cases), in IgM and IgG (one case); antigammaglobulin activity was always found in IgM fraction.

Circulating immune-complexes (ICs) and complement system (C) were studied in sera from 10 patients with malignant skin melanoma. The presence of ICs was demonstrated in all of them by three distinct methods. Moreover, ICs were purified in all the patient sera. The fact that ICs were detected in each serum and that the results of the analysis obtained by the different methods were not overlapping is discussed. It is stressed that the differences among the intrinsic characteristic of each technique are responsible for these discrepancies. The C profile was altered if compared with normal values, but it was not strictly characteristic for an ICs disease. In the purified ICs C3, C4, IgM, IgC1, and IgG3 were demonstrated; C1q, C1s, IgA, IgG2, and IgG4 never. It is noteworthy that a rheumatoid activity was found in the purified material and that this activity was significantly correlated with serum immuno-conglutinins (IKs) titre.

We have studied the effects of the immunosuppressive agent Cyclosporin A (CsA) on the allogenic stimulation of human lymphocytes from 10 patients with progressive systemic sclerosis (PSS) and 10 healthy controls, when activated in vitro during 1ry and 2ry MLR. CsA markedly suppressed 1ry MLR in both PSS subjects and controls. In contrast to the marked suppression of 2ry MLR observed for most of the PSS subjects and all control subjects, lymphocytes from 3 out of 10 PSS patients had paradoxically amplified allogenic responses when primed in the presence of CsA. The possibility is discussed that in these patients the recruitment of suppressor-effector cells by CsA-resistant suppressor-inducer lymphocytes is impaired.