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Eosinophil inflammation is essential in many cases of allergic and non-allergic rhinitis. Activated eosinophils release toxic granule proteins. In this study, we compared the degree of local nasal and systemic eosinophil activation by the determination of eosinophil cationic protein (ECP) in serum and native nasal fluid from 119 patients. We found no significant differences in serum ECP levels of the various patient groups. In all patient groups, except in the vasomotor rhinitis group, nasal fluid ECP levels differed significantly from normal controls. We found a nasal fluid ECP (mean +/- SEM) of 32.6 +/- 8.1 ng/ml for normals, 106 +/- 39.7 for non-rhinitic atopics, 87.6 +/- 20.8 ng/ml for patients with chronic non-allergic sinusitis, 101.3 +/- 40.4 ng/ml for patients with a history of pollinosis, 150.5 +/- 35.1 ng/ml for patients with acute pollinosis, 84.7 +/- 24.7 ng/ml for individuals with perennial allergic rhinitis and 112.9 +/- 25.6 ng/ml for patients with both perennial and seasonal allergy. Patients with nasal polyps had mean nasal ECP levels of 146.9 +/- 57.7 ng/ml in absence of allergy and 147.9 +/- 54.9 ng/ml in the presence of allergy. Nasal ECP was 67.0 +/- 22.4 for patients with hyperreactive rhinitis. We found a significant correlation of 0.95 between nasal eosinophils and nasal ECP. Nasal ECP and a subjective symptom score only correlate significantly for chronic sinusitis. We conclude that monitoring native nasal fluid ECP levels may be useful in the diagnosis and management of nasal inflammation. Elevated ECP in nasal secretion may originate from upregulated eosinophil degranulation and thus is a marker for local inflammation although not specific for any particular nasal disease.

In the last years, the role of nasal mast cells and the eosinophils in the immediate hypersensitivity reaction of allergic rhinitis has been well documented. Tryptase and the eosinophil cationic protein (ECP) are specific activation markers for mast cells and esosinophils respectively. To determine the possible diagnostic value of these markers in allergic rhinitis we measured the levels in both serum and native nasal fluid using sandwich RIA-assays. Twenty eight seasonal allergic patients (16 with active allergy and 12 with extraseasonal allergy) and 11 patients with chronic sinusitis were studied. Twenty one normal healthy donors served as controls. We could not detect increased levels of tryptase and ECP in the serum of all patients and healthy donors. In contrast, patients with active allergy showed very higher levels of ECP than patients of the three other groups. Similarly, nasal ECP was higher in patients with nasal pathology than in healthy subjects. The highest levels were found in the patients with active allergic rhinitis. Our results show that both native nasal fluid tryptase and ECP can be used as markers of local inflammation and that the assessment of their levels can be useful in the diagnosis and follow up of mucosal inflammation in the nose.

Tryptase, a neutral protease, is selectively concentrated in the secretory granules of human mast cells, and its release into the circulation serves as a clinical marker of mast cell activation. The current study describes a new, more sensitive ELISA utilizing a newly developed, mouse monoclonal IgG1 antibody for capture called B12 and capable of detecting tryptase in normal plasma and serum. The greater sensitivity of the new immunoassay results in part from a greater portion of tryptase being detected. Mean levels of tryptase in serum from normal subjects from Richmond, Virginia (4.9 ng/ml; n = 56), Munich, Germany (3.8 ng/ml; n = 19), and Amersfoort, The Netherlands (1.9 ng/ml; n = 8) were as indicated. In 62 subjects with ongoing allergic rhinitis, tryptase levels were no different in serum than for 19 normal controls, indicating that local mast cell activation is not necessarily reflected in the circulation. In 61 subjects sensitive to honey bee or yellow jacket venom by history, the 17 destined to have a severe, hypotensive response to a sting challenge had higher levels of tryptase at baseline than mild reactors, nonreactors, and controls, suggesting that baseline levels of tryptase may predict the severity of the clinical response to allergen in sensitive subjects.

The mast-cell-specific proteolytic enzymes tryptase and chymase were identified in and isolated from cholesteatoma in a ratio similar to that found in human skin. We assume that this ratio reflects a similar distribution of tryptase-containing and tryptase/chymase-containing mast cells in both these tissues. It seems conceivable that mechanisms able to trigger excessive and/or continuous mast cell degranulation in the middle ear might be causative for the formation of cholesteatoma either directly or via primed chronic inflammatory reactions. By their ability to amplify degranulation of mast cells, mast cell proteinases, in particular chymase, may contribute to the chain of events leading to the formation of cholesteatoma.

Nasal allergy is due to a change in the immunoreactivity of an individual. B-lymphocytes produce allergen-specific IgE antibodies after the antigen is presented to T-helper cells. IgE bound to mast cells leads to mast cell activation in the case of antigen contact. Mast cells release mediators and induce local inflammation. The symptoms of allergic rhinitis are caused by various factors and are different in individuals, and hence therapy must be in accordance with the necessities in the individual. There are four principles of therapy in allergic rhinitis. The first and best is allergen avoidance. It is the first choice in animal allergy and important in mite allergy. It is difficult for mold allergy and impossible for pollen allergy. The second is immunotherapy. Immunotherapy is a specific form of controlled allergen admission that changes immunoreactivity into allergen tolerance in a major part of patients. Immunotherapy is a very important tool if performed by a physician with experience. The third principle is drug therapy. With todays drugs, it is still symptomatic. alpha-sympathomimetic vasoconstrictors administered systemically (and, still better, locally) relieve nasal stuffiness. Parasympatholytic drugs can abort pathological secretions. Cromoglycate (DNCG) is a local prophylactic drug improving all symptoms of allergic rhinitis. DNCG is the first choice in pollinosis. Antihistamines are usually given systemically, and the modern drugs have no sedative effect. Clinical effects are comparable to DNCG, and there are new substances available for local therapy. Steroids given systematically improve all symptoms of allergy and inflammation after a certain delay. Due to side effects, local steroids are preferred today.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic rhinometry is a method to analyse nasal airway geometry. Almost every antigen-induced allergic reaction in the nasal cavity leads to morphologic changes known as nasal obstruction. Therefore a study in 8 patients suffering from allergic rhinitis was conducted. Patients were challenged with 1,000 Biological Units (BU) of grass pollen or D. pteronyssinus extract in one nostril. Acoustic rhinometry (AR) was performed before and 10, 20, 30, 45 and 60 minutes and then 2 to 8 hours after allergen exposure. 4 of the patients developed a late phase reaction. Changes were seen in the minimal cross-sectional area (MCA) and even better in a newly induced volume parameter called volume A (V-A). Volume A is calculated by integration of the distance/area graph surrounding the anterior part of the lower turbinate. Thus we can get information on more than one point of a graph in the important region of the anterior nose. Early phase reaction leads to a decrease in both MCA and V-A from 30% to 10% of the baseline value whereas late phase reaction gives only a third of this effect. The contralateral V-A and MCA are only slightly affected in the early phase, but there is an almost symmetric reaction of both sides in the late phase reaction. All changes were more pronounced in V-A compared to MCA. Therefore we propose to add V-A to MCA in describing the results of AR. Acoustic rhinometry is a suitable method for measuring local changes following nasal allergen challenge.

Tryptase is a mast cell-specific marker of degranulation. To investigate the possible diagnostic value of tryptase in allergic rhinitis, we measured the levels in both serum and native nasal fluid with a sandwich RIA-assay (Pharmacia). Twenty-three allergic patients and five patients with chronic ethmoidal sinusitis were included. Eighteen of the 23 allergic patients were tested within the pollen season or had perennial rhinitis; the remainder were tested at least 1 month out of the pollen season. None of the patients had detectable serum tryptase (> 0.1 ng/ml). Also patients with chronic ethmoidal sinusitis showed no tryptase in nasal fluid. One of seven allergic patients tested out of season had slightly increased nasal tryptase of 1.8 ng/ml. In patients with active nasal allergy, the tryptase in nasal fluid ranged from 6.4 ng/ml to 640 ng/ml with a mean of 101 ng/ml and SD 173. These results show a clear distinction between active and non-active nasal allergy and other non-mast-cell-related nasal disease. Further, nasal tryptase release by natural allergen exposure is even higher than that observed in allergen challenge tests.

Mast cell degranulation results in the release of serine class proteinases with trypsin- and chymotrypsin-like specificity. While looking for natural protein inhibitors of these enzymes, we studied their reactions with the double-headed Kunitz-type inhibitor, bikunin, and the human bronchial secretion inhibitor (BSI), which are the only known low-molecular-mass proteinase inhibitors of the human respiratory tract. Both trypsin and chymotrypsin can be inhibited by these inhibitors. However, human BSI is unable to inhibit human tryptase and is the physiological counterpart of chymase in the upper respiratory tract. Human bikunin is unable to inhibit human chymase and human tryptase. Furthermore, human tryptase is also not inhibited by a fragment that consists only of the trypsin-specific C-terminal inhibitor domain of human bikunin. This finding contradicts reports that claim the occurrence of a tryptase-specific proteinase inhibitor in rat mast cells.

Although total IgE determination in the diagnosis of allergic rhinitis has been proposed for screening, specific tests seem to be more efficient. In this study, Magic Lite SQ Allergy Screen Inhalant (ML) and CAP-FEIA Phadiatop (CF) were compared in serum in a group of 101 patients with allergic rhinitis (41 women, 60 men, mean age 31.4 years, range 7-69) and 37 controls (17 women, 20 men, mean age 38.3 years, range 6-68). All patients were suffering from nasal disease. The diagnosis based on case history, skin prick test, total and specific IgE determination and nasal challenge tests. ML was found to have a sensitivity of 96% and a specificity of 83.8% while CF achieved a sensitivity of 94.1% and a specificity of 94.6%. Efficiency was 92.8% for ML and 94.2% for CF. A positive predictive value of 94.2% for ML and of 97.9% for CF was calculated while the negative predictive value was 88.6% for ML and 85.4% for CF. It is concluded, that both ML and CF are suitable allergy screening tests able to give a 100% diagnostic security in combination with further examinations, especially regarding the case history.

Diagnosis of allergic diseases is based on medical history, clinical and specific tests. Although the role of specific IgE-determination used for allergy diagnosis is cleared, the technique might be expensive for routine screening. The development of a new dip-stick screening device (Visagnost Inhalationsallergien, in U.S. Quidel allergy screen) gives us the possibility of fast and easy screening without laboratory equipment. For the evaluation of the diagnostic value of Visagnost we compared the device with two modern standard laboratory techniques, Magic Lite SQ (Ciba-Corning) and CAP-FEIA (Pharmacia). We tested the most relevant allergens in Germany, in detail birch, grass, rye, ragweed, alternaria, cat, dog and the housedust mites D. pteronyssinus and D. farinae. We found a mean "RAST"-class of 1.55 (SD 1.25) for Magic Lite SQ, a mean of 1.24 (SD 1.62) for Visagnost and a mean of 1.93 (SD 1.70) for CAP-FEIA. Plotting the results for each of the examined methods, Magic Lite SQ seems to be more sensitive in lower specific IgE-levels, while CAP-FEIA gives more results of high IgE-levels, Visagnost ranging in between in general. Dividing the "RAST"-class results in the negative group of class 0 and 1 and in the positive group of class 2 and more, Visagnost revealed a sensitivity of 57% compared to CAP-FEIA and 63% to Magic Lite SQ, respectively. Specificity was 95.8% for CAP-FEIA and 90.7% for Magic Lite, while the positive predictive value for Magic Lite SQ was 87.9% and 95.7% for CAP-FEIA. Magic Lite gave a negative predictive value of 69.5% while 58.7% for CAP-FEIA.(ABSTRACT TRUNCATED AT 250 WORDS)

Purpose: Malignant neoplasms of the salivary glands are extremely unusual in the pediatric age group., Methods: We report an 11-year-old boy who presented with a mass in the left submandibular region and a second mass in the jugularfacial venous angle., Results: Histologic evaluation determined that this was a squamous cell carcinoma of the submandibular gland with metastasis to a cervical node. Review of the literature was undertaken to identify the rate of malignant salivary gland tumors in children. Malignant salivary gland tumors are extremely rare in children. When malignancy does occur, nearly 90% are present in the parotid gland. The submandibular gland is effected in 7.7% of cases. The most common malignancy in salivary glands of children is the mucoepidermoid carcinoma. Squamous cell carcinoma occurs in less than 2% of cases., Conclusions: Salivary gland tumors are very rare in children in contrast to adults. The proportion of malignant tumors in children is higher than that observed in adults; however, it is not possible to draw conclusions concerning treatment from the few case reports that exist. A higher rate of local recurrence and cervical lymph node metastasis may be expected in children.

The diagnosis of allergic airway diseases, especially allergic rhinitis, is based on medical history, clinical examination and further tests. Since the detection of IgE, total IgE in serum has become a major tool in the diagnosis of immediate allergy. Although in-vivo-tests like skin prick test are performed in almost every allergologist's practice, the capability of determining IgE was restricted to special laboratories. As shown for semiquantitative glucose dipsticks, a rapid and easy method has advantages for both patient and doctor. A recently developed dipstick test (Visagnost, in U.S. Quidel allergy screen) for allergy screening now enables every practitioner to determine total IgE levels within less than one hour. For the evaluation of the diagnostic value of this dipstick test, we compared the total IgE levels in the sera of 56 patients with two modern methods (Magic Lite, Ciba-Corning, and Cap-FEIA, Pharmacia). Visagnost is an enzyme-immuno-assay with the solid phase on the dipstick. It can be performed in serum, plasma or whole blood, in this study the test was performed in serum. Magic lite is a combined solid-liquid-phase immuno-assay with a final chemiluminescent reaction, the incubation time is about two hours. Cap-FEIA is a solid phase sandwich ELISA with a fluorescent reaction and an incubation time of at least four hours. Patient's sera were shock-frozen in liquid nitrogen and stored at -80 degrees C until examination. Visagnost gave results in four ranges of minor 20 U/ml, 21-50 U/ml, 51-100 U/ml and more than 100 U/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

In the past 15 years, storage mites became more common as an agent in allergic airway disease. Sensitization to storage mites has been reported in farmers and grain workers. There were some studies investigating local populations, especially in the north of Europe. The sensitization to storage mites in a rural population seems to be similar to the rate found for Dermatophagoides. The main diseases caused by storage mites are allergic rhinitis and asthma. Although there is a cross-reactivity between Dermatophagoides pteronyssinus and storage mites, most of the antigens were distinct from house dust mite antigens. In our study, we analysed sera obtained from patients with known house dust mite allergy. Patients with a RAST class 2, 3 or 4 for Dermatophagoides pteronyssinus were tested for specific IgE-antibodies against storage mites. The test was performed using the Melja EAST-technique. We obtained a sensibilization rate of 7% for Acarus siro (d70), 17% for Lepidoglyphus destructor (d71), 3% for Tyrophagus putrescentiae (d72) and 13% for Glycyphagus domesticus (d73). According to our results we can conclude that storage mites are relevant allergens in allergic rhinitis, especially in the rural population in Bavaria. Therefore, routine testing in patients with perennial rhinitis is proposed.

We report on a 45-year-old male patient with the signs of exophytic, obstructive and painless tumour of the right external auditory canal developed within a period of about 3 months. The tumour was completely removed in local anaesthesia and histologically found to be a leiomyosarcoma. The only possible origin of this lesion might be the smooth muscle cells of the local blood vessels or the mm. arrectores pilorum.

An acid-resistant trypsin inhibitor was released from goat serum inter-alpha-trypsin inhibitor and isolated by affinity chromatography. The primary structure of the inhibitor was established and the inhibitory properties were estimated. The inhibitor designed gIK-14 was characterized as a serine proteinase inhibitor from the family of the double-headed Kunitz-type inhibitors as suggested.

The amino-acid sequence of the inhibitory part of the sheep serum inter-alpha-trypsin inhibitor (ITI) was determined. The inhibitor is composed of two covalently linked Kunitz-type domains. The reactive site of the C-terminal antitryptic domain contains arginine in position 71 (P1) and glycine in position 73 (P'2), whereas ITI derived inhibitors hitherto investigated contain phenylalanine in these positions. The reactive site of the N-terminal elastase inhibiting domain contains leucine in position 15 (P1) and methionine in position 17 (P'2), as in ITI-derived inhibitors of pig and horse.