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One of the theories which explain, why gastroesophageal reflux disease (GORD) may provoke cough, is the occurrence of aspiration of gastric content into the airways. The aim of the study was to assess the presence of aspiration markers: pepsin and bile acids (BA) in induced sputum in gastroesophageal reflux-related (GOR-related) chronic cough (CC) patients. Forty-one CC patients and 20 healthy controls were enrolled in the study. GORD as cause of CC was diagnosed by presence of GORD-related symptoms, gastroscopy and/or improvement of cough upon treatment with proton pump inhibitors (PPI). Patients were divided into two groups based on the response to PPI treatment. In all patients and healthy controls induced sputum was obtained and differential cell counts were calculated. Levels of pepsin and BA were measured in sputum supernatants. Pepsin was detectable in 48.8% samples in CC patients and in 60% healthy controls (p = NS). In pepsin positive samples no significant difference in pepsin concentration could be found between CC patients and control subjects. Pepsin levels in pepsin positive samples were significantly decreased in patients treated with PPI compared to non-treated patients. BA were detectable in 56% samples of CC patients and in 70% healthy controls (p = NS). BA concentration in BA positive samples in CC group was not different from healthy controls. There was also no difference when comparing patients who took PPI and those who did not. Patients characterized as PPI-responders and PPI-non-responders had similar pepsin and BA concentrations. Airway cellularity was not significantly different between groups of patients with or without pepsin or BA in induced sputum. Our results demonstrated the lack of differences in gastric content aspiration between patients with probable GOR-related CC and healthy control subjects. This might imply that the reflex cough theory may be more relevant than the reflux-associated aspiration theory in the pathophysiology of GORinduced chronic cough., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Introduction: Measurement of peak nasal inspiratory flow (PNIF, peak nasal inspiratory flow) seems to be a cheap and simple method to assess nasal patency. Unfortunately, due to the lack of reference values a single measurement does not take any information about the degree of nasal obstruction. Therefore, the purpose of this study was to establish parameters useful for estimating PNIF reference values., Material and Methods: 221 respondents, from Wrocław, answered a questionnaire based on ECRHS II and ISAAC. Sample was randomized based on the personal number, stratified and representative of age and sex. Subjects were divided into three groups on the basis of their age (6-7, 13-14 and 20-45 years). The PNIF was measured using an In-Check portable nasal inspiratory flow meter (In-Check's Clement-Clark). The highest of the five PNIF values was used as the measure of PNIF for each subject in subsequent analyses (PNIF MAX). Patients with rhinitis and/or asthma were withdrawn from the study., Results: Repeated measurements of PNIF were performed in 221 healthy volunteers. PNIF values were higher in males compared to women and this difference was statistically significant. There was a statistically significant correlation between height and PNIF MAX, and there was no such correlation between age and PNIF MAX. Stepwise linear regression that included gender, height, age revealed that only sex and height were independent significant predictors of PNIF. Obtained dependence PNIF MAX = -137.7 - 22.5 x + 1.7 y, where x is the sex (a woman, 0 - male) and the y - height. Coefficient of determination (R(2)) was 0.45 which means that regression equation explains about 45% of the observed PNIF MAX variability., Conclusions: A correlation was found between PNIF value and sex and height of the patients, while age is irrelevant in this regard. Difficulty of establishing standards for the PNIF parameter are probably due to anatomical differences in the construction of the nose.

Introduction: Assessment of nitric oxide (NO) concentration in exhaled air is broadly used to monitor the airway inflammation in asthma. High level of NO are also observed in paranasal sinuses and gastrointestinal tract (GT). The intact esopahageal sphincters are responsible for maintain the NO within the GT. It is not known how much the GT and especially esophageal motility disorders can affect the FeNO measurements. The aim of the study was to assess if the gastroesophageal reflux disease has any impact on level of NO in exhaled air in patients who do not suffer from any airway disease., Material and Methods: In 51 patients, in whom asthma, nasal polyps or atopy were excluded, gastroscopy with biopsy was performed. In 13 of them no esophageal pathology was found and they were considered as the control group. In the other 38 patients the esophagitis was diagnosed based on Los Angeles classification., Results: The concentration of NO in exhaled air in patients with endoscopical gastro-esophageal changes did not differ significantly from the NO concentration in patients without inflammatory changes in stomach and esophagus (p = 0.68). Moreover, the presence of hiatal hernia did not affect the FeNO (p = 0.67). There was also no significant dependence between NO level and infection with Helicobacter pylori (p = 0.18)., Conclusions: The gastroesophageal pathologies did not significantly affect NO concentration in exhaled air.

Drug-induced hypersensitivity syndrome (DIHS) is characterized by fever, rash and internal organ involvement, mostly in form of hepatitis, myocarditis, nephritis or pneumonitis, which may occur 1-8 weeks after medicine exposure. Fever is an early feature, usually preceding a widespread erythematous skin eruption, but the severity of the skin-related changes does not correlate with the extent of internal organ involvement. It is considered that anticonvulsants (particularly carbamazepine), antibiotics, allopurinol are the most frequent causative agents of DIHS. The underlying mechanisms causing DIHS are poorly understood--defective detoxification of the reactive drug's metabolites or genetic predisposition have been implicated. Diagnosis of DIHS is based on clinical presentation connected with drug intake, supported by a finding of eosinophilia, increased concentration of inflammation markers and abnormal biochemical parameters, mainly liver function tests. Treatment consists of immediate withdrawal of all suspected medicines, followed by supportive systemic corticosteroids. We describe a case of a 72-years-old female who developed symptoms of drug-induced hypersensitivity syndrome after approximately 4 weeks of taking anticonvulsant (Amizepin) due to sensual axonal polyneuropathy. Withdrawal of drug and treatment with systemic corticosteroids caused clinical improvement rapidly.

The aim of the study was to evaluate the sensitivity and specificity of allergen-induced basophil CD164 upregulation in patients with seasonal allergic rhinitis caused by allergy to grass pollens. This study was performed in 24 patients with allergy to grass pollens, and in 25 healthy controls. The protocol for allergen-induced basophil CD164 upregulation consisted of whole blood samples processing and staining with anti-CCR3/anti-CD164 antibodies added to a buffer at the beginning of stimulation. We observed dose-dependent allergen-induced basophil CD164 upregulation with 100% of specificity in both used allergen concentrations (12 and 1.2 ng/ml). Higher allergen concentration resulted in 100% and lower concentration in only 70.83% sensitivity. We have observed in the patients statistically significant correlations between anti-IgE stimulation and both allergen concentrations (for 12 ng/ml, r = 0.71, p < 0.0001; and for 1.2 ng/ml, r = 0.64, p < 0.001). We conclude that assessment of allergen-induced basophil CD164 upregulation is a very useful method for in vitro determination of allergy to grass pollens. This method seems to be a very promising tool in laboratory testing of allergies to other allergens.

We present a case of a 27-years-old female who experienced several episodes of food-dependent exercise-induced anaphylaxis (FDEIA). Besides two typical episodes of FDEIA triggered by a postprandial physical exercise, she also experienced atypical episodes in which the sequence of the causative stimuli was clearly reversed-clinical symptoms which appeared after a prolonged exercise, followed by ingestion of the sensitizing food. This unusual clinical picture entitled us to extend the routine recommendations- avoidance of the coincidence of food allergens intake and exercise accordingly to her history.

The phenomenon of population aging has led to a significant rise in the chronic disease rate compared to other human pathologies. Elderly people are usually affected by > or =2 chronic diseases concomitantly, mainly cardiovascular, pulmonary, and central nervous system diseases, metabolic disturbances and cancer. Chronic comorbidities in elderly patients may worsen their clinical status, making both the diagnosis and treatment more difficult. Meanwhile, contemporary medicine is focused on its subspecialties, thus turning away from the tradition of great, academic-based, general internal medicine. Clinical practice is dominated by a specific approach to a single disease rather than a patient with comorbidities. Therefore, an accurate diagnosis, ensuring effective treatment in the case of a complex and ambiguous clinical picture, is based on an attempt to combine multiple expert consultations rather than make a holistic evaluation, so characteristic of traditional internal medicine. For that reason, pathophysiology and clinical picture of a chronic disease in the elderly requires the revival of internal medicine, which is also essential to the development of geriatrics.

Objective: The aim of our study was to determine the diagnostic usefulness of a newly developed basophil activation test (BAT) in patients allergic to Dermatophagoides pteronyssinus and pollens. We also analyzed the influence of cetirizine on CD63 upregulation. This popular antihistamine strongly inhibits skin tests, but its impact on BAT sensitivity remains unknown and deserves at least preliminary determination., Methods: The study sample comprised 22 patients allergic to house dust mite and pollens and 19 healthy controls. All participants underwent skin prick testing and the newly developed flow-cytometric basophil activation test. The protocol for allergen-induced basophil CD63 upregulation consisted of whole blood samples that were processed and stained with anti-CCR3/CD63 antibodies added to the buffer at the beginning of stimulation. Skin prick tests and BAT were performed twice--before and 2 hours after ingestion of 10 mg of cetirizine., Results: The new BAT is characterized by its short processing time, easy basophil gating, and strong CD63 upregulation with very high sensitivity and excellent specificity. Our results suggest that allergen-induced CD63 upregulation by higher doses of allergens is not inhibited 2 hours after administration of cetirizine (unlike skin prick tests)., Conclusion: The BAT is a very useful and precise method for the diagnosis of allergy to aeroallergens. It is not influenced by cetirizine.

Increased in vitro basophil activation in buffers of slightly elevated osmolarity in 2 cases of food-dependent exercise-induced anaphylaxis is presented. These data may suggest the importance of basophil activation degree in pathogenesis of this life threatening syndrome.

A few studies have reported data on the prevalence of exercise-induced bronchospasm in high school and university athletes. Recently published data suggest that exercise-induced bronchospasm may affect up to 39% of American university athletes. To date, no data describing this pathology in athletes from Central Europe have been published. The aim of the present study was to establish the prevalence of exercise-induced bronchospasm in pupils attending sports mastership classes in secondary school as well as students of the University of Physical Education in Wroclaw. The participants were 77 athletes (30 women and 47 men) aged 16-27 years (mean 17.3 years). Only one athlete (1.29%) diagnosed with atopic asthma before testing experienced a fall in forced expiratory volume in one second (12.9% FEV(1)) compared with baseline, which showed that the exercise test result was positive. From a clinical point of view, the ventilation disturbance was asymptomatic. In the other participants, there were slight but statistically significant rises in FEV(1) (P < 0.02). The results of our study indicate a very low prevalence of exercise-induced bronchospasm in the population of athletes examined.

Introduction: Chronic inflammation in asthmatic airways leads to bronchial hyper-responsiveness (BHR) and the development of structural changes. Important features of remodeling include the formation of subepithelial fibrosis due to increased collagen deposition in the reticular basement membrane. Transforming growth factor (TGF)-beta might be a central mediator of tissue fibrosis and remodeling., Materials and Methods: Immunohistochemistry was used to measure collagen III deposition and TGF-beta(1) expression in biopsies from patients with long-standing asthma treated with inhaled corticosteroids, patients with recently diagnosed asthma, and control subjects. Computer-assisted image analysis was used to evaluate total basement membrane (TBM) thickness., Results: Asthmatics, particularly those with long-standing asthma, had thicker TBMs than healthy subjects. Collagen III deposition was comparable in the studied groups. BHR was not correlated with features of mucosal inflammation and was lower in steroid-treated patients with long-standing asthma than in subjects with newly diagnosed asthma untreated with steroids. Epithelial TGF-beta(1) expression negatively correlated with collagen III deposition and TBM thickness., Conclusions: The study showed that TBM thickness, but not collagen III deposition, could be a differentiating marker of asthmatics of different disease duration and treatment. The lack of correlation between BHR and features of mucosal inflammation suggests the complexity of BHR development. Corticosteroids can reduce BHR in asthmatics, but it seems to be less effective in reducing subepithelial fibrosis. The role of epithelial TGF-beta(1) needs to be further investigated since the possibility that it plays a protective and anti-inflammatory role in asthmatic airways cannot be excluded.

In developed countries, the population aged 65 and over has been increasing. Asthma is a common disease among older persons and it may appear de novo above the age of 65. The prevalence of the disease in elderly people is estimated to be between 6.5% and 17%. Available data about older asthma patients are limited by a small numbers of studies reports. Asthma beginning late during the lifetime seems to be more severe, but the natural history of this disease appears to be variable. The characteristics of asthma in older patients is being complicated by the changes related to aging. Aging of the respiratory system is a natural process associated with its structural and functional changes. These changes may influence the expression of asthma. Differentiating physiological ageing from pathological changes related to disease can be difficult. Interactions of some of these mechanisms in asthma in the elderly are analyzed in this article.

We present a case of anaphylactic shock induced by exercise following celery ingestion. The possible mechanism of food-dependent exercise-induced anaphylaxis (FDEIA) and the laboratory tests for its diagnosis are discussed. We evaluated spontaneous, celery-allergen-induced, and anti-FcepsilonRI-antibody-induced histamine release from basophils obtained from the patient, 2 celery-allergic controls, and 3 healthy controls. Buffers of increasing osmolarity were used to mimic conditions of vigorous physical exercise. Only the patient's basophils showed an increase in spontaneous, anti-FcepsilonRI antibody-induced and allergen-induced histamine release under physiological conditions and with slightly increased medium osmolarity. To our knowledge, this is the first report on the possible role of increased histamine releasability in the pathogenic mechanism of FDEIA. We suggest that FDEIA results from increased histamine releasability triggered by physical effort after exposure to a sensitizing food allergen.

Asthma is a common disease among elderly persons. The prevalence of asthma in subjects aged over 65 years is 6.5-17%. The diagnosis of asthma is based on typical symptoms with confirmatory information gained from physical examination and laboratory studies. Respiratory symptoms are less specific in older people. Additionally the clinical manifestations of asthma is complicated by co-morbidities, polypragmasy, underreporting of symptoms, cognitive impairment. Moreover, elderly patients are sometimes unable to perform pulmonary function tests. Consequently, discriminating asthma from chronic obstructive pulmonary disease is difficult in this group of patients. The difficulties in differential diagnosis of asthma in older adults entails that disease in the elderly is often underdiagnosed and inadequately treated.

Introduction: Asthmatic inflammation is responsible for vital features of the disease, including bronchial hyperresponsiveness (BHR). At present we do not have precise markers for monitoring asthmatic inflammation. C-reactive protein (CRP), a marker of systemic inflammation, seemed to be a factor which could also reflect the level of asthmatic inflammation expressed by BHR. Therefore the relationship between CRP concentration and BHR was evaluated., Materials and Methods: One hundred and two patients entered the study. A skin prick test with a broad spectrum of common aeroallergens as well as baseline spirometry and a histamine bronchoprovocation test were performed in each subject. Blood samples for high-sensitivity CRP (hsCRP) measurement were taken before the bronchial challenge tests., Results: Serum hsCRP concentrations ranged from 0.20 to 14.5 mg/l (median: 1.2 mg/l, 25-75% quartiles: 0.6-2.4). Positive skin prick tests were found in 26 subjects. Bronchial hyperresponsiveness was confirmed in 42 patients (first subgroup), while 60 subjects did not demonstrate BHR (second subgroup). Among the patients with BHR, asthma was diagnosed in 33 cases and Corrao syndrome in 9. In both subgroups, serum hsCRP concentrations had similar levels (median: 1.4 mg/l, 25-75% quartiles: 0.8-2.4 and median: 0.9 mg/l, 25-75% quartiles: 0.5-2.8, respectively; p=0.297). There was no statistically significant correlation (r = -0.163, p = 0.302) between serum hsCRP concentration and the level of BHR expressed as the 20% provocative concentration for histamine. In addition, hsCRP serum concentration, after adjustment for age, atopy, body mass index, and gender, was not a significant predictor of positive histamine bronchoprovocation test results (p = 0.22,, Conclusions: Serum hsCRP concentration is not a good marker of BHR, which is mainly dependent on asthmatic inflammation and is measured during bronchial challenge with histamine. This finding is important for interpreting and discussing results obtained from epidemiological and population-based studies on relationships between either CRP concentration and BHR or local and systemic inflammation.

A population aged 65 and over has been increasing in the developed countries. The prevalence of asthma in elderly patients is estimated between 6.5 and 17%. Asthma is an important cause of morbidity and mortality in the elderly. Moreover, death due to asthma occurs mostly in elderly patients. Only a few studies have reported the characteristics of asthma in the elderly patients. Two distinct clinical presentations of asthma have been described in the elderly. There are differences both in the pathophysiology and the clinical manifestation of asthma between elderly patients with a long-standing disease and those with late-onset disease. Additionally, aging of the respiratory system influences the asthma presentation. Asthma has been presented for many years may lead to persistent obstructive ventilatory defect and can mimic chronic obstructive pulmonary disease. Irreversible obstruction is commonly observed in elderly patients with asthma. The differential diagnosis of asthma is difficult in older adults and asthma is underrecognized and undertreated in the older population. Undertreatment is common in elderly asthmatics which largely is related to diagnostic issues.

Introduction: The patients' acceptance of the treatment scheme and their readiness to stick to the prescribed dosing is considered to be the most important condition on which successful treatment of asthma and COPD depends. With regard to this assumption, a study was designed whose aim was to find out how patients assess a particular powder inhaler, cyclohaler and to what degree they approve of its physical and technical features., Material and Methods: The study consisted in completing an anonymous questionnaire. The study group was recruited from asthmatic and COPD patients treated in outpatient units in Wroclaw and Lublin, Poland. 230 persons passed the recruitment stage, 220 completed the study., Results: 96.4 and 94.5% of the patients ranked small size and low weight of the inhaler, respectively, as its most positive features, ranking the features higher than the device's colour (respectively p = 0.003 and p = 0.02). Other features, like dust protection and comfortable mouthpiece won almost equally high evaluation (respectively 97.3 and 98.2%). Most patients assessed these features as more important than discretion and easy handling and transportation (respectively p = 0.015 and p = 0.028). A high percentage of the study group praised the inhaler's technological efficacy. 94-96% at the least gave positive opinions about such features as: clear instruction, certainty of a dose's intake, the possibility of checking the amount of inhaled doses., Conclusion: The inhaler that was the object of the study enjoyed a high degree of acceptance mostly due to its features facilitating easy and efficient inhalation.

Background: Airway remodeling has recently emerged as a major problem in an increasing percentage of patients with asthma. Reasons for great diversity in the progression of irreversible bronchoconstriction among asthmatics remain unclear., Objective: The aim of this study was to assess whether the potential ability of leukocytes to produce cysteinyl leukotrienes in response to various stimuli is correlated with magnitude of irreversible airway obstruction in asthmatics., Materials and Methods: The study sample comprised 76 asthmatics (34 males, mean +/- SD age 52 +/- 13 years), and 35 healthy controls (18 males, 38.2 +/- 15 years). Each subject underwent 2 pulmonary function tests: before and after bronchodilator administration. In addition, approximate annual decline in forced expiratory volume in 1 second (FEV1) (% of predicted) was calculated. Leukotriene C4 (LTC4) production was assessed combining a cellular antigen stimulation test and enzyme-linked immunosorbent assay using Bulhmann Laboratories AG kits. Leukocytes isolated from peripheral blood were stimulated with anti-FcepsilonRI antibody, N-formyl-methionyl-leucyl-phenylalanine (fMLP) and phorbol 12-myristate 13-acetate (PMA). In separate tubes each subject's leukocytes were tested for spontaneous LTC4 production. Finally, stimulated LTC4 production was expressed in pg/mL after subtraction of values of spontaneous production., Results: In asthmatics, baseline FVC% and FEV% values ranged from 24.4% to 122.4% (mean, 75.5%) and from 23.4% to 126.6% (mean, 74.4%), respectively. There were no significant differences between asthmatics and controls in LTC4 production stimulated by anti-FcepsilonRI antibody (P = .79), fMLP (P = .33) or PMA (P = .86). We found no correlation between stimulated LTC4 production and spirometric parameters at baseline or after bronchodilator administration or annual decline in FEV1%., Conclusion: Our results do not confirm the hypothesis that airway remodeling in asthma might be related to enhanced ability of leukocytes to produce cysteinyl leukotrienes in response to various stimuli.

Magnesium deficiency is a common electrolyte disorder in patients with acute severe asthma, but intracellular magnesium content better reflects its homeostasis than does its serum concentration. Magnesium takes part in many metabolic processes in the organism, including energy metabolism, protein and nucleic acid synthesis, cell cycle, the binding of substances to the plasma membrane, and maintenance of cytoskeletal and mitochondrial integrity. It also modulates ion transport and influences intracellular calcium concentration. Maintenance of the cells' transmembrane gradient depends on the presence of magnesium, and hypomagnesemia may result in an increase in neuromuscular cell excitability. Magnesium is a cation modulating the smooth muscle contractility of different tissues: hypomagnesemia causes their contraction and hypermagnesemia their relaxation. Suggestions of a positive influence of magnesium in the treatment of asthma exacerbation have been known for a long time, but research results differ. A single dose of intravenous magnesium sulfate given to patients with acute asthma exacerbation has been shown to be safe, but its efficiency is still under discussion. According to the Global Initiative for Asthma GINA-2005, magnesium sulfate administration is not recommended for routine treatment, but it is permitted in patients with severe asthma exacerbation not responding to treatment (evidence category A). Recommendations of the British Thoracic Society allow one dose of magnesium sulfate to patients with acute severe asthma exacerbation and inadequate initial response to broncho-dilating inhalation treatment (evidence category A). Future investigations should help to establish the indications for magnesium use in the treatment of acute asthma exacerbations as well as the magnesium dose and the scheme of its administration.

The introduction of induced sputum, as the diagnostic and research tool allowed to define nonasthmatic eosinophilic bronchitis characterized as a chronic cough in patients with no symptoms or objective evidence of variable airflow obstruction, with normal airway hyperresponsiveness and sputum eosinophilia. Eosinophilic bronchitis is an important cause of chronic cough. Studies in which the assessment of airway inflammation has been undertaken in chronic cough patients have shown that nonasthmatic eosinophilic bronchitis accounts for 10 to 30% of cases referred for specialist investigation. Eosinophilic bronchitis, like asthma, is characterized by eosinophilic airway inflammation, but unlike asthma, there is no airway hyperresponsiveness or bronchoconstriction. The airway immunopathology of asthma and eosinophilic bronchitis are almost identical. An obvious question is why an apparently similar pattern of airway inflammation is associated with different functional abnormalities in patients with nonasthmatic eosinophilic bronchitis and asthma. The differences in functional association may be related to differences in the localization of mast cells within the airway wall, with airway smooth muscle infiltration occurring in patients with asthma, and epithelial infiltration in patients with nonasthmatic eosinophilic bronchitis.

Introduction: Drugs used in asthma or COPD exacerbation are delivered to the lungs by inhalation. This is facilitated, among other factors, by the use of dry powder inhalers (DPIs). Lung deposition from DPI depends predominantly on peak inspiratory flow (PIF). The aim of the study was to asses the variability of PIF generated by patients using different types of DPI inhalers during asthma or COPD exacerbation and to trace possible relationships between PIF value and some spirometric values., Material and Methods: There were 28 patient fulfilling inclusion criteria, among them 17 (4 women) were suffering from COPD and 11 (8 women) from asthma. Spirometry, PEF and PIF measurements were performed in the first and the last day of hospitalisation. Peek inspiratory flow was obtained using In-Check DIAL - a device which simulated airflow resistances equivalent to Turbuhaler, Diskus and Aeroliser respectively., Results: The significant improvement in PIF was observed only in patients with COPD. There were no statistically significant correlations between PIF and both FEV1 and PEF except those in the first day of hospitalization in COPD patients (r = 0.66-0.81). Optimal PIF was achieved in all patients only with Diskus., Conclusions: Measurements of peek inspiratory flow are useful in choosing the most suitable DPI for patients with COPD and asthma exacerbations. We conclude that in those patients, PIF measurement should complement a standard spirometry.

Mast cells (MCs) are both central effectors and signaling cells in allergic reactions. Their key role in the immunopathology of asthma and other allergic diseases has been well documented. Molecular events leading to MC activation have not been yet fully established, however. Recent studies emphasize the key role of the protein tyrosine kinases Lyn and Fyn in MC signal transduction. The finding that Lyn kinase negatively regulates MC degranulation and that Fyn kinase enhances this effector response is of great importance. This creates new possibilities for therapeutic intervention in asthma and other allergic diseases. This review summarizes current knowledge on MC intracellular signaling and discusses the most recent strategies for the treatment of allergic diseases based on MC signaling pathway inhibition.

Transient pancytopenia as an adverse hematologic reaction due to ticlopidine. We present a case of transient pancytopenia due to ticlopidine in 66-year-old woman who was administrated with ticlopidine as a primary prevention of heart failure. The first sign was a skin rush which was followed by ticlopidine cessation. Two days later she developed septic shock, pneumonia and neutropenia (600 cells/mm3) with decrease of platelats, erytrocytes count and hemoglobin. Blood transfusions were not required. After treatment with antibiotics according to antibiogram the patient recovered and was dismissed after 38 days with normal blood morphology. We conclude that ticlopidine was the most probable cause of transient pancytopenia. Severe adverse hematological effects due to ticlopidine occur in 0.8-2.3% cases. Thus treatment with ticlopidine should be cerfully considered.

Current point of view on patho-mechanism, diagnosis, clinical features and prevention of contact urticaria syndrome was presented, especially with emphasis on systemic symptoms existing in this disease. The importance of allergic and non-allergic reaction in pathogenesis of this syndrome was also discussed. Special attention was paid to possibility of life threatening symptoms appearing during the contact of allergens or other physical agents with the skin. In addition the principles of prophylaxis in such cases were described.

The complex relationship between the local inflammatory response and the spread of airway mycosis during prolonged glucocorticoid therapy in bronchial asthma patients remains unclear. We assessed the ability of airway leukocytes to produce nitric oxide (NO) in relation to differential inflammatory cell counts, levels of asthma severity, and coexisting airway mycotic infections. The study was carried out on leukocytes from the induced sputa (IS) of 14 patients with asthma complicated by mycotic airway infections undergoing prolonged glucocorticoid therapy (group FcA). Three groups of subjects without airway fungal infections were also studied: 18 glucocorticoid-treated asthmatics (group cA), 11 steroid-free asthmatics (group A), and 13 healthy control subjects (group H). In group FcA, both the level of spontaneous production of NO and the percentages of neutrophils in the IS were significantly higher than in all the remaining groups. Additionally, a significant positive correlation was noticed between the NO levels and both the percentages of neutrophils in the IS and the symptom intensity scores. The results suggest a possible predominant role of neutrophils in the overproduction of NO related to asthma severity and coexisting fungal infections in glucocorticoid-treated patients.

Urticaria and angioedema are one of the most frequent skin diseases, nevertheless no etiologic factors have been found in a large number of cases. This review summarizes the available medical literature from Medline regarding Helicobacter pylori and mentioned disease. Different studies have shown a high prevalence of Helicobacter pylori infection in patients with chronic urticaria, and occasional remission of the skin lesions after eradication therapy. However there are several papers, which support lack of relationship between H. pylori infection and the course of urticaria and angioedema. Thus we need further randomized, double-blind and placebo controlled studies including adequate diagnostic schedules, sufficient eradication treatment protocols, confirmation of eradication, and adequate control groups to establish a role of H. pylori in urticaria and angioedema.

Molecular mechanisms of actions, pharmacokinetics and anti-inflammatory potency of inhaled glucocorticosteroids (ICS) are described. Differences in clinical effectiveness of ICS in asthma and chronic obstructive pulmonary disease (COPD) therapy and up-to-date recommendations for treatment with ICS in asthma and COPD patients are discussed. Finally there are presented data on safety of long-term treatment with ICS, specially in asthmatic children.

A case of angioedema caused by enalapril, undiagnosed for 5 years was presented. Enhanced blood and tissue eosinophilia shown in nasal smear was observed. In addition increased activity of coagulation system was shown manifested by enhance of concentration of Hageman factor and cardiolipin antibodies IgM and IgA isotype. The role of coagulation, complement and fibrinolysis systems in pathogenesis of ACE-inhibitors induced angioedema was discussed. The influence of bradykinin on activity of eosinophils was analyzed.

Current concepts on the diagnosis and treatment of urticaria and angioedema concerning allergic, non-allergic, idiopathic and symptomatic aetiology of this very complex disease were discussed. Much attention was paid to the necessity of multidrug therapy in which antihistamines play the most important role in chronic forms of the disease. The possibility of occurrence of life-threatening conditions was emphasised and the rules of their treatment and early prevention of intensification of symptoms typical of anaphylaxis.

We describe a case of fatal asthmatic attack in 27-year-old woman with type II brittle asthma and pollinosis. Despite recurrent episodes of severe asthmatic attacks she refused prolonged therapy with the exception of beta 2-agonists used when needed. The day prior to the fatal attack she was intensively exposed to pollens. She ineffectively tried to manage the attack with high doses of beta 2-agonists administered by MDI and jet nebulizer. After being intubated and transferred to the hospital, she was ventilated mechanically and treated intensively with high doses of corticosteroids, beta 2-agonists, both intravenously and in nebulisation, and nebulised with anticholinergics, but remained unresponsive to the therapy. She gradually deteriorated and died after nine hours of treatment. We conclude that the unresponsiveness to the treatment was mainly due to down-regulation of beta 2-receptors and point out the necessity of regular treatment with inhaled corticosteroids in patients with brittle asthma type II, even in the absence of symptoms.

Bronchoalveolar lavage (BAL) or induced sputum (IS) techniques may provide leukocytes for the evaluation of airway inflammatory response in bronchial asthma. The aim of the present study was to compare features of leukocyte populations obtained by the two different methods regarding the cell types and their activity in patients with bronchial asthma. The nitric oxide (NO) level released from the cells was measured as a marker of their activity. Pulmonary leukocytes were obtained from the BAL and IS of 11 asthmatic patients in stable condition at the time of the study. The BAL and IS leukocyte populations varied in cell count and NO production. Macrophages were the predominant leukocyte population in BAL (median (Me) = 83.0%, range 67.9-88.4%), whereas sputum sediments were found to consist mainly of neutrophils (Me = 55.7%, range 29.0-64.9%). The IS leukocytes released much more NO (p = 0.0022) than the BAL leukocytes. In spite of these quantitative differences, a similar pattern of NO production was observed in BAL and in IS cells. Both BAL and IS leukocyte populations produced almost the same amounts of NO before and after lipopolysaccharide stimulation (p = 0.9063, p = 0.4801, respectively). Furthermore, a slight positive correlation Spearman's rank (RS) = 0.5578, p = 0.0594) was noticed between the neutrophil percentages and NO levels produced by BAL cells, whereas in IS a statistically significant correlation between the percentage of neutrophils and the levels of NO (RS = 0.6643, p = 0.0184) was observed. In conclusion, the BAL and IS leukocyte populations are different in cell type, their size and activity. Depending on the asthma severity and the type of cells needed in a study, either BAL or IS specimens may be chosen as a source of pulmonary leukocytes. The use of IS as a noninvasive technique is supposed to be potential value particularly in the study of the airway inflammatory response mediated mainly by neutrophils, i.e. during and/or after exacerbation of the disease. Based on our results, a possible contribution of neutrophils in the production of NO in the airways of asthmatic patients can be proposed apart from other cells such as macrophages.

Airway fungal infections are often associated in asthmatics with the exacerbation of asthma symptoms. However, the pathomechanism of this phenomenon has not been fully understood. The aim of our study was to assess whether antimycotic treatment can influence the capacity of bronchoalveolar (BAL) leukocytes to release proinflammatory cytokines, which could contribute to increase in asthma severity. Ten patients with bronchial asthma complicated by airway fungal infections (Candida albicans and/or Aspergillus fumigatus) were included in the study. Seven asthmatics were treated with systemic and inhaled corticosteroids, whereas the remaining three with inhaled ones only. All subjects underwent several courses of therapy with antibiotics due to respiratory infections. BAL leukocytes obtained from the patients were cultured in the absence or presence of lipopolysaccharide E.coli (LPS) or Newcastle disease virus (NDV). The BAL procedure and measurement of the levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (II-6), interferon-gamma (IFN-gamma), and interferon-alpha (IFN-alpha) by specific bioassays were performed twice: before antimycotic treatment and after 3 weeks of therapy with 8 mg of nebulized fluoconazole and 400 mg of oral ketoconazole per day. The elimination of fungi from respiratory tract resulted in an apparent clinical improvement. This coincided with diminished production of TNF-alpha in response to LPS and the production of IFN-alpha in response to NDV, which were initially high and subsided significantly after antimycotic therapy (p = 0.035, and 0.011, respectively). Such changes were not observed in the case of IFN-gamma and IL-6. This may suggest that TNF-alpha as well as IFN-alpha are secreted by fungi-prestimulated leukocytes from the lower respiratory tract and may be involved in the processes of exacerbation of asthma complicated by fungal infections. Further analyses of relationships between changes in cytokine levels and clinical parameters indicated that IFN-alpha seems to be of particular interest in fungal stimulation of asthma.

The aim of the study was to evaluate the activation of eosinophils in an unique case of a young man with atopy manifested as chronic pollen contact urticaria. In order to reveal the role of eosinophils in that case, the study was performed by means of monoclonal antibodies EG2 and chemiluminescence. In addition, comparative electron microscopic study of peripheral blood and skin infiltrating eosinophils were performed for which the name ultrastructural morphometric analysis of intracytoplasmic eosinophil granules has been proposed. The results indicated, that 40% of peripheral blood eosinophils were activated spontaneously and they were more active than those in skin infiltrates. Specific pollen allergen caused activation of 100% of peripheral blood eosinophils. The study suggests presence of a systemic pattern of eosinophil activation in atopy.

A case of the mixed disease of the connective tissue (MCTD) in male patient occupationally exposed to PVC and other toxic agents is presented. Clinical symptoms consisted of the typical signs of SLE, rheumatoid arthritis and lupoid hepatitis. MCTD diagnosis was confirmed serologically by the presence of autoantibodies anti-RNP. Prednisone administered in the daily dose of 60 mg produced remission.

Clinical study on efficiency of the nedocromil sodium (Tilade, Fisons) was performed in 20 patients with atopic and nonatopic bronchial asthma. The drug was administrated in dose of 8 mg per day for 2 months which allowed to renounce regular using of Beclocort forte after 7 days of the treatment. In both types of bronchial asthma the positive effect of nedocromil sodium was confirmed, causing increase of pulmonary ventilation and decrease of bronchial hyperactivity. Especially profitably effect was noticed in atopic bronchial asthma in which statistically important increase of peak expiratory flow (PEF) was obtained and decrease of bronchial hyperreactivity by PC20 for histamine was observed (p < 0.05). Mentioned above spirometric parameters did not differ in statistically important pattern in patients with nonatopic bronchial asthma, when Beclocort forte group with Tilade group compared. Neither important differences in general number of cells nor percentage composition of cell smears were observed in bronchoalveolar lavage fluid.

Gasometric parameters were performed before, during and after bronchoalveolar lavage (BAL) in 21 patients with mild bronchial asthma. In addition, spirometric parameters were performed before and after BAL. Decrease of pO2, SaO2 and increase of pCO2 which kept within the limits of normal values were observed. After BAL gasometric parameters returned to baseline values. Bronchoalveolar lavage caused statistically significant fall in FEV1 and PEF. BAL was well tolerated and did not worse the clinical state of patients.

A case of a 27-year patient with a clinical syndrome of Coxsackie B viral infection is presented. The symptoms included pleurodynia, myocarditis and the acute gastritis. The diagnosis was confirmed with serological tests which showed high titre of antibodies neutralizing Coxsackie B3. The symptoms of myocardial infarction dominated in both clinical course and autopsy. The authors suggest that serological tests specific for Coxsackie B infection should be performed in the young patients with the symptoms of myocardial infarction.

Thirteen patients with clinical diagnosis of hay fever, were examined. T lymphocytes subpopulation was determined by the E rosette test. The present study is concerned with the effect of histamine on the ability of T lymphocytes for E rosette formation after blockade of the histamine H2 receptor with its inhibitor cimetidine. It has been found that histamine effect is expressed by the histamine H2 receptor, as its blockade with cimetidine leads to the failure of histamine to inhibit rosette formation by T lymphocytes.

Effect of isoproterenol and propranolol on the production of hemocytotropic antibodies and degranulation of peritoneal mast cells from sensitized mice was studied. It was demonstrated that stimulation with large doses of the antigen caused degranulation of peritoneal mast cells and that additional administration of a beta antagonist propranolol failed to increase the degranulation phenomenon. Marked inhibition in degranulation of mast cells was seen in mice sensitized with large and small doses of antigen after isoproterenol. In 2h PCA test in animals immunized with large doses of the antigen a higher activity of PCA reaction illustrating the concentration of IgG1 antibodies was noted. With higher doses of the antigen and propranolol the titers of the antibodies were markedly higher. The inhibiting effect of isoprenaline on the passive cutaneous anaphylaxis was observed only in the 72 h-test, mostly in the group of mice immunized with small doses of the antigen.

In 20 patients with hay fever and 19 control subjects the rosette formation test was carried out to determine T and B lymphocyte subpopulations. T and B lymphocyte subpopulations are expressed by the percentage of E, EA and EAC rosettes, respectively. Statistical analysis revealed a significant reduction in the number of E rosettes (p < 0.001), and a slight, but statistically significant decrease in the number of EAC rosettes (p < 0.05) in hay fever patients.

Electron microscopic studies provided evidence that a patient with cow's milk allergy, manifested as bronchial asthma, has prominent eosinophil granule discharge, attributable to the release of cytotoxic major basic protein (MBP). This finding illustrates a critical role of eosinophil MBP in anaphylactic injury induced by food allergen. Patient white blood cells pretreated with Ketotifen revealed intact ultrastructure of eosinophils granules and cytoplasm. Inhibition of eosinophils degranulation by Ketotifen demonstrates a new pharmacologic mode of action of this anti-allergic, anti-anaphylactic agent.

Eight persons with clinically diagnosed hay fever were examined. The control group consisted of ten subjects without any signs of allergy. T lymphocyte subpopulation was evaluated by E rosette test. The effect of histamine was studied adding various concentrations of histamine (from 10(-9) to 10(-4) M) to the suspension of lymphocytes. A proportional drop in the percentage of the formed E rosettes could be seen at histamine concentrations ranging between 2 x 10(-9) and 2 x 10(-6) M. At 10(-6) up to 10(-4) M there was both an increase and further reduction in the percentage of the E rosette formation. A question arises whether there exists any correlation between the decreased number of T lymphocytes and elevated content of histamine in atopic persons?