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In a multicentric study by the European Study Group for Drug Allergy 58 patients suffering from an immediate type reaction after intake of pyrazol analgetics were examined with regard to allergy or pseudoallergy. Besides the scratch tests with the original substance we performed cutaneous tests with pyrazol conjugates and determined IgE and IgG antibodies by means of modified radioallergosorbent (RAST) method. Three groups could be distinguished: (1) pseudoallergic reactions to nonsteroidal analgetics of the aspirin type (15 cases); (2) IgE-mediated pyrazolone allergy verified by skin tests and/or IgE-RAST (21 cases), and (3) pyrazolone idiosyncrasy (26 cases).

5 patients with alopecia areata were treated with local application of DNCB in acetone over a period of 3–9 months. 9 of these had alopecia areata totalis, 3 had alopecia areata fere totalis, and 3 had common alopecia areata. The results are comparable with those of other authors. The response did not depend upon the duration of the disease but upon its extension. In all patients with alopecia areata and alopecia areata fere totalis, hair growth was induced, while only 2 of the 9 patients with alopecia areata totalis responded satisfactorily. One third of the latter were children in whom the treatment may be less effective than in adults. Contact allergy was induced in all but 1 case in which no hair growth occurred. Since the mutagenic effect of DNCB has been demonstrated in the Ames test, DNCB ought to be replaced by other haptens, but its possible cancerogenic effect must be tested in other in vivo models.

A mother and her son are described who both suffer from hereditary angiooedema. Both were treated with Danazol, a synthetic derivative of ethisterone. The prophylactic clinical effect seemed obvious, and also the serum concentration of the complement component C4, which had regularly been lower before treatment, became normal. However, no change of the serum concentration of the C1 esterase inhibitor could be demonstrated; this is in contrast to observations of other authors.

The relationship of C1-inhibitor (C1-INH) concentration and apparent functional activity was investigated in 111 plasma samples from 21 patients with the common form of hereditary angioedema (HAE). Functional C1-INH was analyzed by means of a modified version of immunodiffusion assay. Down to a C1-INH level of approximately 0.075 g/l (38% of normal) apparent C1-INH functions were found within the normal range, while below this level functional adequacy of C1-INH could no longer be ascertained. When C4 concentrations, considered to reflect approximately functional C1-INH, were related to C1-INH antigen levels of individual samples, a relationship emerged which was identical to that between C1-INH concentration and apparent function. No attacks of edema could be associated with C1-INH concentrations above 0.075 g/l, while it was possible to associate attacks with concentrations below this level. In experiments where patient plasma and normal plasma were mixed in various ratios or where HAE plasma was replaced by purified C1-INH, an increase in C1-INH antigen to concentrations of 0.06-0.08 g/l was followed by a sharp rise in apparent functions to normal values. The rise of functional C1-INH became moderate when C1-INH antigen further increased. The results supported the idea of a functionally critical level of C1-INH in the common form of HAE.

Summary Skin tests and RAST determinations with breed-specific dog allergen extracts and a cat allergen preparation were made on forty-four atopic patients divided into three groups. Group 1 were twenty dog-owning atopic patients without clinical signs of dog sensitivity. Group 2 contained twenty-one patients with a clinical history that suggested allergy to dogs, and Group 3 contained ten atopic patients who were sensitive to cats. In neither the in vivo nor the in vitro tests was there any evidence for dog breed specificity, nor was dog albumin found to be a major allergen in the population studied, though a few individuals showed strong RAST activity to albumin. Furthermore, a cat fur extract inhibited the reaction between dog hair and anti-dog serum, and a dog hair extract inhibited the reaction between cat fur extract and anti-cat serum.

Sera from 159 adult asthmatic outpatients (extrinsic, n = 82, intrinsic, n = 65 and acetylosalicylic acid (ASA)-sensitive, n = 12) and from 100 controls were tested for total levels of IgG, IgM, IgA, IgE, complement factors C3, C4, C1-inhibitor, alpha 1-antitrypsin and circulating immune complexes. The following results were observed: (1) a marked increase of IgE in extrinsic asthma; (2) a slight increase of IgM, and (3) an equal increase of complement C4 levels in all three asthma groups; (4) normal mean values of C3 levels with a significantly larger standard deviation of the mean in all three asthma groups; (5) an equally slight decrease of protease inhibitors, such as C1-inhibitor and alpha 1-antitrypsin, and (6) the presence of circulating immune complexes in 22% of extrinsic, in 8% of intrinsic and 13% of ASA-sensitive asthmatics. Circulating immune complexes can be found in all three asthma groups and may correlate with complement deviation.

Resume Le celeri est un antigene alimentaire frequent. Sa consommation sous forme crue, cuite ou comme condiment peut entrainer des reactions allergiques de type immediat allant d'une simple urticaire de contact jusqu'au choc anaphylactique. Une pollinose et une sensibilisation cutanee au pollen d'armoise et/ou de bouleau de meme qu'une allergie associee aux carottes et a certaines epices semblent relativement frequentes. Le collectif de nos patients comprend 27 individus chez qui l'ingestion de celeri provoquait diverses manifestations allergiques de type immediat. Des tests cutanes avec des preparations variees de celeri, avec d'autres legumes et epices, avec les pollens d'armoise et de bouleau ainsi que des dosages d'anticorps specifiques au moyen du RAST ont ete entrepris. Ces derniers ont montre trois groupes differents de patients allergiques au celeri quant a leur sensibilisation pollinique : sensibilisation a l'armoise dans 5 cas, au bouleau seul dans 7 cas et a l'armoise et au bouleau dans 15 cas. Des RAST positifs ont ete obtenus pour plusieurs epices, surtout l'anis (12 cas sur 27), le cumin et le curry. Ainsi cette etude clinique et serologique confirme l'association entre l'allergie au celeri et l'allergie aux epices qui semble constituer une nouvelle et interessante entite clinique.

The problem of skin tests for allergy to ingested substances is discussed. The authors tested intradermally (using 0.02 ml of the antigen) their patients using raw, boiled and heat-denatured extracts of milk and egg-white. They also used extracts obtained by enzymic and chemical hydrolysis. A total of 18 patients were tested. Nearly all patients gave positive skin tests of the immediate type (Type I) to the crude extracts but only about 50% reacted to the hydrolysates. The test results are discussed in relation to the clinical manifestations.

ZusammenfassungEs werden die Resultate einer offenen Studie mit Dinatrium cromoglicicum (Lomudal ®) in der Behandlung des Asthma bronchiale bei 53 ambulanten Patienten mitgeteilt. Die Beurteilung des

kann gesagt werden, das die modernen immunologischen Untersuchungsmethoden sehr interessante Anderungen einiger Serum-Faktoren gezeigt haben, die einerseits, wie Erhohung von IgG und IgE zum Ausfall der Hautteste, Beteiligung der Respirationstraktus und Schweregrade des Verlaufs in Beziehung stehen, anderseits von der Erkrankung des Respirationssystems unabhangig sind, wie Erhohung des Coeruloplasmins, Erniedrigung des Haptoglobins, Erniedrigung des Komplementfaktors Beta 1-A (C′3), sowie des Alpha 1-Antitrypsins. Diese Veranderungen konnen einstweilen lediglich vermerkt, und in ihrer immunologischen Bedeutung noch nicht interpretiert werden. Moglicherweise sind sie Ausdruck einer polyfaktoriellen genetischen Storung.

So-called biologically active detergents may produce direct toxic skin changes by causing the release of pharmacologically active substances (kinins). They also give rise to true contact eczema by their protease content. The significance of positive patch tests to these detergents in eczematous subjects who had not been exposed previously to enzyme containing detergents is discussed.

Parapsoriasis with poikiloderma and transformation in mycosis fongoides Parapsoriasis poikilodermique avec transformation en mycosis fongoide

The Radio Allergo Sorbent Test (Phadebas-RAST) is a recently developed radioimmunological in-vitro test for determining IgE specific serum antibodies in reaginic allergy. The overall correspondence between RAST and skin tests in 1,128 tests with a total of 19 allergens was 70.2%. The agreement between positive RAST and skin tests was 22.1%. In instances of disagreement the combination of a positive skin test and a negative RAST was much more frequent (24.1%) than the reverse (5,7%). The agreement between RAST and skin tests was 94.5% for cat epithelium, 89.3% for egg white, 86.2% for timothy pollen, 84.2% for milk, 80.3% for mite Dermatophagoides pteronyssinus, 78.8% for birch pollen, 71.9% for dog epithelium, 67.7% for horse dandruff, 57.3% for moulds and only 40.3% for house dust. Positive RAST results for atopic patients with respiratory allergy usually indicate a clinically relevant sensitization (positive case history or positive provocation test), while negative results do not rule out the possibility of significant sensitization. Circulating reagins were detected in 9.4% of the mite and 12.7% of the mould RAST, although the skin tests were negative. The greatest discrepancy between RAST and inhalation test results occurred with house dust (47% agreement, only 12% positive correlation). The RAST was negative in 53% of the cases with positive provocation tests. The first step in the diagnosis of allergy is still a thorough case history combined with careful prick and intracutaneous testing. When the case history and skin tests are in disagreement, RAST may be helpful as a supplementary test. In addition, the RAST may be useful in clarifying cases in which the patient is on continuous steroid or antihistamine therapy, as well as for children who are frightened of skin tests. If house dust asthma is suspected, it is advisable in all but a few instances to utilize the bronchial provocation test to confirm the diagnosis and for initiation of specific desensitization.

From the end of 1979 to June 1985 an inhalative allergy to silk wastes was diagnosed in the allergy station of the Dermatological Clinic of the University of Zurich in 118 patients, 54,2% of whom were women. Usually, bed quilts advertised as filled with "wild silk" were the cause of the sensitization. Occupational exposure to silk materials was found in only 4 cases. Average age at the time of first appearance of symptoms was 30.5 years, and sensitization time from first exposure to appearance of symptoms was 8.5 months. Monovalent sensitization was found in 44.1%. In most cases exposure prophylaxis sufficed to avoid symptoms. "Wild silk", unlike cultivated (mulberry Bombyx mori) silk, is the product of wild silk moths of the genus Antheraea feeding on oak leaves. Silk wastes are a byproduct of silk manufacturing, consisting of short silk threads (e.g. the end or the beginning of the cocoons), and make highly suitable filling material. During further silk processing the allergenic components, especially sericin, are eliminated by boiling off and degummed. For closer identification of the allergen(s), various kinds of raw and cleaned mulberry and wild silk were tested in sensitized patients by skin and RAST tests. The filling content of different bed quilts was investigated by the Swiss Textile Industry Test Institute. None consisted entirely or mainly of wild silk, and all contained a predominant portion of cultivated silk. The aggressive potency of the "wild silk" bed quilts is due to the insufficiently cleaned and degummed mulberry and wild silk wastes. Contamination of the silk wastes by an insect of the genus Anthrenus was also found.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors report 7 cases of allergic respiratory diseases such as asthma, allergic rhinitis and bronchitis, induced by non-occupational contact with pet-fish food. Food for pet fish contains proteins of a variety of arthropod species (larvae and adult forms) --e.g. Chironomus, Daphnia, brine shrimps and others --as well as fresh-water worms such as Tubifex, Enchytraea etc. Thus far only hemoglobins of Chironomus have been well studied with regard to their antigenic role; sensitization against Chironomus was noticed in most of our patients. Daphnia is also known to be a specific allergen. Atopic patients often become sensitized against further respiratory allergens (5 out of the 7 patients had a previous allergy against pollen). Accordingly, patients with respiratory diseases of already known allergic origin should, in our opinion, give up not only mammals or birds as household pets but also an aquarium.

Atopic dermatitis is a multifactorial skin disease with complex aspects and a wealth of abnormal immunological and nonimmunological findings. Abnormalities of skin morphology and function, disturbances of the essential fatty acids metabolism and in the cyclic AMP system as well as immunological abnormalities are shortly described. In analogy to asthma and rhinitis, the author propose to divide atopic dermatitis according to the presence or not of an associated respiratory allergy and specific IgE sensitization in 3 groups, namely in an "extrinsic", an "intrinsic" and a "mixed" type.

In a survey carried out between January and April 1985 covering all of Switzerland except the Canton of Ticino and including 2524 males and females (49% and 51% respectively) aged 15 to 74 years, the subjects were interviewed regarding pollinosis symptoms during the pollen season of 1984 and in previous years, and questioned about other allergic symptoms. Individuals with pollinosis or with family members suffering from pollinosis received an additional questionnaire. This first extraterritorial survey of Switzerland showed that every tenth Swiss aged 15 or over suffers from hay fever (incidence 9.6%). In addition, 3% had suffered from pollinosis previously. In the 15-24 age group the incidence was 16%. It fell with advancing age and was only 4.2% in the over-60 age group. No statistically significant differences were found between incidences in town (9%) and country (10%) and between the sexes. Hay fever morbidity in individuals with higher education (14.5%) and in certain occupations (student, apprentice - 21%) and among job levels "manager, senior civil servant, senior employee" (13.8%) was higher than in other categories. This representative survey confirmed that in Switzerland hay fever is commoner than in 1926 and 1958. The symptoms of pollen allergy are known: symptoms predominate in May (53%) and June (62%) including rhinitis in 94%, conjunctivitis in 82% and asthma in 24%. In 11% pollen allergy was already manifest in the first four years of life, in 62% before puberty and in 80% before the age of 20.(ABSTRACT TRUNCATED AT 250 WORDS)

The case is reported of a 19-year-old patient with recurrent Quincke edema with systemic symptoms. Based on observations of the course, diary entries and specific skin tests (scratch), sensitization to malt extract from germinated barley was diagnosed. The allergic reactions usually occurred after consumption of malt-containing chocolate drinks and malt-containing snack products. In cooperation with Prof. S. G. O. JOHANSSON, Stockholm, we have for the first time identified specific serum IgE antibodies against malt extract.

The urticaria is a common skin disease, characterized by evanescent, pruritic, erythematous and oedematous wheals and sometimes by giant hives (angio-edema). Its pathogenesis is related to the activation of tissue mast cells by many immunologic or non-immunologic mechanisms, resulting in a release of biologically active products. The cause of chronic urticaria remains unknown in 75 to 80% of the cases. This form is rare in childhood. More of 50% of children with acute urticaria are atopic with preexisting dermatitis of pollinosis. A papular urticaria (prurigo strophulus), an urticaria pigmentosa, and, in case of angioedema, the hereditary form due to functional inactivity of the C1-inhibitor must be excluded. The therapeutic possibilities in the praxis are briefly discussed.

After a short historical review, the clinical symptomatology of the pseudoallergic reactions (PAR) after intake of acetylsalicylic acid (ASS) is examined. An intolerance to ASS mostly becomes manifest as bronchial asthma--sometimes up to a status asthmaticus: it is frequently combined with vasomotoric rhinopathia and nasal polyps (so-called "aspirin triad") or as urticaria and angio-edema, seldom as a shock reaction. These symptoms can - in contrast to an allergy--appear at the first intake of the drug. Changes in the arachidonic acid metabolism are of pathogenetic importance, as all substances that inhibit the cyclooxygenase pathway [e.g., most of the nonsteroidal anti-inflammatory drugs (NSAIDs)] are not tolerated by ASS-sensitive patients. Generally, a typical clinical history is sufficient for the diagnosis. Due to the fact that the ASS and NSAID pseudoallergy so far cannot be proved by in vitro methods, oral or inhalative provocation tests are needed when the tolerance situation to the drugs is unknown. However, these tests present high risks. A research group working with Capron (Lille) has recently been able to prove that washed platelets from patients with an analgetic asthma syndrome show an abnormal in vitro response to ASS or NSAID - like indomethacin and fluriprufen - which is characterized by liberation of cytocydal supernatants against parasites, as well as of free O2 radicals, which can be detected by chemiluminescence. Therefore, a platelet anomaly of arachidonic acid metabolism seems to be pathognomonic for ASS asthma. It is not yet known whether or not this is also related to ASS urticaria.(ABSTRACT TRUNCATED AT 250 WORDS)

120 patients with acne vulgaris had to undergo an intracutaneous allergen test with 23 of the most important food allergens. The skin test results of 83 patients (69.2%) were negative, only 9 (7.4%) showed a distinct immediate reaction on four or more food extracts. Almonds showed the most positive reactions (11.6%), then malt (10%), cheese, mustard, red pepper (8.3% each), and wheaten flour (7.5%). Thereupon the patients were instructed to either keep no diet at all, or to follow an acne diet, or a special elimination diet based on the results of the skin test. Moreover, all the patients had to undergo the same mild acne local therapy. After 3 months treatment (with monthly controls) 45 patients could be evaluated. No statistical difference was found within the three groups with regard to the success of treatment. Diet prescriptions for acne vulgaris are generally not very significant, although they are possibly useful in individual cases.

The case of a 58-year-old employee of an antibiotic-producing factory with occupationally related disorders (asthmatic dyspnea, episodic fever in the evening and malaise) is presented. A change of workplace did not completely relieve the patient. The further course was complicated by nephrolithiasis with urinary infection requiring nephroureterotomy. The extensive allergological investigation resulted in absolutely negative skin tests of the immediate and delayed type with environmental allergens including moulds and antibiotics. The serological examinations showed a high total IgE level and positive specific IgE to benzylpenicilloyl (BPO). The arterial blood gas analyses at rest showed that the patient hyperventilated massively. Consecutive inhalation of lactose, tetracycline, ampicillin and chloramphenicol dust administered by Spinhaler turboinhaler produced a delayed asthmatic reaction with an FEV1 a fall of 42% five hours after provocation, accompanied by general symptoms identified by the patient as here former disorders. Circulating immunocomplexes (C1q-binding test) were now positive, as was anti-BPO-IgG, while anti-BPO-IgE decreased slightly.

Celery is a frequent food allergen: not only raw, but also cooked and as a spice it can produce various reactions of immediate type, from oral contact urticaria to anaphylactic shock. Most celery-allergic patients suffer from hay fever and show a skin sensitization to mugwort. An associated allergy to several spices is quite common, and therefore the term "celery-mugwort-spice-syndrome" has been proposed. The authors have investigated 35 patients, 85% of them women, in whom a current celery allergy of varying severity was diagnosed during the first 8 months of 1984. A positive skin test to celery was seen in 16 patients who denied any symptoms from it. Thorough skin testing and RAST screening with different celery preparations, other foodstuffs and mugwort-pollens were performed on all patients. The modified prick test with native celery-root proved to be the best method for detecting celery sensitization, showing a positive result in 88.6%. The scratch test with celery-salt was positive in 70.5%, intracutaneous testing with commercial extract in 63.5% and the RAST with celery-sticks in 66% of the patients. Sensitization to mugwort was absent in 8 patients only. The mugwort-sensitive group frequently showed a positive test to ragweed-pollens, a common plant in North America, and this appears to indicate cross-reactivity amongst the family of the Asteraceae. Cross-reactivity amongst the Apiaceae is the cause of the many positive results obtained with carrot, parsely, anise, fennel and caraway, the carrot allergy being of clinical importance in 50% of cases, including one with a history of anaphylactic shock after ingestion of raw carrots.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of localized urticaria in an otherwise healthy young woman, produced only by direct contact of the skin with heat, is described. The minimal temperature of urtication was 44 degrees C (immersion of the forearm in hot water for 5 min). Redness and painful oedema immediately developed without reflex flare. Total serum IgG, IgA, IgM, IgE, complement factors C3 and C4, and alpha1-antitrypsin were in the normal range, whereas the C1-inhibitor level was slightly decreased. There was no evidence of circulating immune complexes in the serum. A skin test and a RAST with house dust were positive, but there were no signs of respiratory atopy. An attempt for passive transfer of heat urticaria into the abdominal skin of a rhesus monkey failed, but was successful for house dust. A treatment trial with ketotifen, a new, perorally acting anti-allergic drug, was poorly effective, but dexchlorpheniramine maleate, a classical antihistaminic, in a dose of 12 mg daily completely suppressed the swelling evoked by heat, but not the erythema, suggesting that other tissue or plasma factors than histamine may be involved in the mechanism of heat urticaria in this patient.