Topical acetylsalicylic acid in the treatment of allergic pollinosic conjunctivitis

The pharmacological treatment of allergic conjunctivitis includes the use of topical antiinflammatory drugs, i.e. steroids and NSAIDs (nonsteroidal antiinflammatory drugs), such as acetylsalicylic acid (ASA). However, steroids are not suitable in prolonged treatment, as well as in pollinosis in the Mediterranean area, because of their side effects. The present double-blind study evaluates the topical use of acetylsalicylic acid eye drops (1% solution) compared to placebo in the treatment of patients with seasonal allergic conjunctivitis during the period June-July 1990. The patients were randomized and treated with ASA eye drops or placebo eye drops, both applied as one drop in each eye q.i.d. for 14 days. The severity of symptoms was evaluated before and after treatment by the investigator and the patient. An overall judgement of therapeutic response was expressed independently by the patient and the investigator at the end of the treatment. The ASA-treated group improved significantly compared to the placebo-treated group. No serious side effects were observed. The results confirm the clinical efficacy and safety of topical ASA in the treatment of pollen-induced allergic conjunctivitis.

Expression of very late activation antigen-1 on intrathyroid lymphocytes in autoimmune thyroid disease

Very late activation antigen-1 (VLA-1) is a beta 1-integrin implied in interaction with extracellular matrix components. It is expressed by T lymphocytes upon prolonged activation in vitro. In this work we have evaluated VLA-1 expression in thyroid infiltrates and peripheral blood of patients with autoimmune thyroid disease (AITD), by immunofluorescence on dispersed cells and by in situ analysis on frozen tissue sections. The results obtained showed increased proportions of VLA-1 positive lymphocytes in thyroid infiltrates, similarly to that observed with "early" activation antigens. No positivity of thyroid follicular cells was observed. Given the role of the VLA-1 molecule in lymphocyte adhesion, the increased VLA-1 positivity of infiltrating lymphocytes is consistent with intrathyroidal homing of long-term activated cells, possibly relevant to AITD pathogenesis.

Comparative effects of terfenadine and loratadine in the treatment of hay fever

This double-blind, double-dummy, parallel-group study was undertaken in 40 patients with seasonal allergic rhinoconjunctivitis during the 1990 hay fever season. The patients were randomized and treated for seven days with either 120 mg terfenadine or 10 mg loratadine, each drug taken once daily in the morning. The severity of nasal congestion, rhinorrhea, sneezing, nasopharyngeal itching, and itchy, watery, red eyes was evaluated before and at the end of treatment. The global severity of symptoms was ranked daily by the patient on a diary card. Both treatment groups experienced a significant improvement of symptoms after treatment (p < 0.01), without any significant difference between the two study drugs. Terfenadine and loratadine significantly improved symptom severity by 69 and 55% compared with the baseline values, respectively. Headache and fatigue were reported in three loratadine-treated patients, and sedation in one patient. No side effects were observed in patients receiving terfenadine. This study confirmed that terfenadine 120 mg once daily is a safe and effective treatment for hay fever.

Two screening methods for detection of specific IgE to inhalant allergens. Comparison with skin prick test and RAST

We analyzed the technical features of two new screening methods for detection of specific IgE to inhalant allergens. Moreover, their diagnostic accuracy was evaluated comparing the results obtained from the procedures with those from RAST and skin prick test (SPT) in a group of 30 symptomatic allergic patients. The procedures employ a classic ELISA method, where the presence of IgE is revealed by a colored reaction. These two assays appeared to be quick, inexpensive and easy to use. The results obtained showed significant correlations with both RAST and SPT, in particular for Dermatophagoides pteronyssinus, Parietaria officinalis and grasses, which are the allergens chiefly responsible for respiratory atopy in our area.

A multicentric study on sensitivity and specificity of a new in vitro test for measurement of IgE antibodies

The sensitivity and specificity of the Pharmacia CAP System, a new in vitro assay for measuring IgE antibodies, were evaluated in a multicentric study on 286 allergic patients and 243 normal subjects. Sensitivity was 95.5%, with results significantly better than RAST for some allergens, and specificity was excellent, 98.1%.

The effect of aging on host defences. Implications for therapy

Immunosenescence is a well known physiological phenomenon resulting from reduced efficiency of the immune system in the elderly. It has been studied both in animal models and in humans. In this review attention is focused on T cell responsiveness, since this cell type is both a marker of the immune response and one of the main targets of several drugs. For this latter reason, most studies of the effect of drugs on the immune system have been performed with reference to the effects on T lymphocytes. In the second part of the article experimental data concerning several drugs and drug classes [steroids, calcium antagonists, theophylline, histamine H1- and H2-receptor antagonists, sodium cromoglycate (cromolyn sodium), pirenzepine, rosaprostol, beta 2-mimetics, antibiotics and antibacterials] and immune responsiveness are reviewed. Lastly, the clinical perspectives of pharmacological treatment in aged subjects in relation to immunosenescence are evaluated.

Non-steroidal treatment of pollen-induced conjunctivitis: comparison of different pharmacological protocols

Pharmacological treatment of allergic conjunctivitis may be based on the therapeutic use of topical steroids; however, because of the side effects, steroids are not clinically suitable in either prolonged treatment, or pollinosis. Because non-steroidal topical drugs are suitable in prolonged treatment, this single-blind study evaluated the following topical drugs: cromoglycate plus chlorphenamine, cromoglycate plus tetryzolin and imidazolin plus nafazolin, compared with placebo. The results confirm significant clinical efficacy of these drugs on signs and symptoms compared with placebo. Thus, "non-steroidal" topical drugs should be the preferred choice in prolonged forms of pollen-induced (e.g. Parietaria and/or grasses) conjunctivitis.

Comparative study between two immunoassays for detection of allergen-specific IgG4

In the present work two commercially available immunoassays for allergen-specific IgG4 detection were compared, IgG4 FAST Test and ALLERBLOCK-MS IgG4 EIA Kit. For this purpose 30 serum samples were tested for IgG4 antibodies (Abs) specific to Dermatophagoides pteronyssinus (Dp) by the two immunoassays. Eleven serum samples were collected from normal subjects, 6 from Dp-atopic patients never treated by specific immunotherapy (ITS) and 13 from Dp-atopic patients previously treated by ITS. Pearson's linear correlation analysis showed a significant correlation of results from the two immunoassays. However, a better discrimination of Dp-specific IgG4 values between ITS-treated and untreated patients or normal subjects was obtained by FAST than ALLERBLOCK-MS method; moreover, the former showed a better intra-assay coefficient of variation than the latter.

Expression of intercellular adhesion molecule-1 (ICAM-1) on thyroid epithelial cells in Hashimoto's thyroiditis but not in Graves' disease or papillary thyroid cancer

In order to study the possible role of antigen-independent adhesion systems in thyroid autoimmunity, we evaluated by indirect immunofluorescence the expression of lymphocyte functional antigen-1 (LFA-1) and its ligand ICAM-1 on mononuclear cell infiltrates (when present) and thyroid follicular cells of four patients with Hashimoto's thyroiditis, 30 with Graves' disease, five with papillary cancer, two with follicular adenoma, and two normal thyroid specimens. The expression of MHC class I and class II antigens was also evaluated. Most mononuclear infiltrates were LFA-1 positive, as expected. A positivity for ICAM-1 on follicular cells was observed in three out of four Hashimoto's thyroiditis specimens; such a phenomenon was totally absent in Graves' disease or any other pathological condition, or in normal tissue. MHC class II expression on thyrocytes was observed in all the patients with Hashimoto's thyroiditis, in 27 out of 30 with Graves' disease and in three out of five papillary cancer specimens.

Protective effect of loratadine on specific conjunctival provocation test

The protective effect of loratadine (anti-H1 antagonist) on clinical and cellular processes following the early phase of specific conjunctival provocation test was assessed in 20 patients affected by seasonal allergic rhinoconjunctivitis, in a double-blind, randomized, placebo-controlled, parallel-group study. Patients were randomly assigned to two treatment groups, each being given a single daily dose of loratadine 10 mg or placebo, for 7 days, out of pollen season. Pretreatment with Loratadine resulted in a significant higher allergen threshold dose than placebo (p less than 0.01). Patients treated with loratadine experienced a significant reduction (p less than 0.01) in conjunctival symptom severity as compared with placebo, following conjunctival challenge. Finally, the number of inflammatory cells was lower in the loratadine-treated patients compared to the placebo group (p less than 0.01). In conclusion, loratadine exerts a significant protective effect on the early phase cellular and clinical events of conjunctival reaction induced by allergen challenge in atopic patients.

Levocabastine versus cromolyn sodium in the treatment of pollen-induced conjunctivitis

Thirty patients with allergic conjunctivitis, caused by Parietaria or grass pollens, participated in a double-blind parallel study comparing levocabastine to cromolyn sodium, both given as eye drops. Symptom and sign scores were recorded during a 4-week period. The patients received only these drugs during the time of observation. The evaluation of the clinical signs and symptoms by the clinicians and by the patients revealed a significant improvement of conjunctivitis in all patients. The intergroup comparison was equal in the two groups treated respectively with levocabastine and cromolyn. Therefore, levocabastine and cromolyn are effective in the treatment of pollen-induced allergic conjunctivitis.

Functional involvement of the LFA-1/ICAM-1 adhesion system in the autologous mixed lymphocyte reaction

The integrin surface molecule termed lymphocyte functional antigen-1 (LFA-1), and its physiological ligand intercellular adhesion molecule-1 (ICAM-1), have been proven to play a relevant role in several immune reactions where cell-to-cell contact is required: these reactions include allogeneic mixed lymphocyte reaction (MLR) and direct cytotoxicity. In the present study, we show that monoclonal antibodies (mAbs) directed to LFA-1 as well as to ICAM-1 molecules are able to inhibit T cell proliferation in autologous MLR (AMLR). Such an in vitro reaction is generally considered a functional model of Ia-mediated immunocompetent cell cooperation, and is impaired in several pathological conditions. It is noteworthy that the LFA-1 molecule is largely represented on the T cell surface, whereas ICAM-1 is poorly expressed on resting T cells: autologous stimulation slightly increases ICAM-1 expression. Pretreatment studies indicate that the inhibitory effect of anti-ICAM-1 mAb on T cell proliferation in AMLR is exerted on responder T cells.

The effect of methimazole on the immune system is unlikely to operate directly on T lymphocytes

It has been shown that the antithyroid drug methimazole (MMI) may affect B cells and possibly accessory cell function. In the present study we investigated in detail the effects of MMI on T cell in vitro proliferation. The following variables were evaluated: T cell proliferation following stimulation with phytohemagglutinin (PHA), and anti-CD3 or anti-CD2 monoclonal antibodies; interleukin-2 (IL-2) and gamma-interferon (gamma-IFN) production by PHA-stimulated T cells in bulk culture and by T cell clones; PHA-induced IL-2 receptor expression; LPS-induced interleukin-1 production by accessory cells. The results obtained failed to demonstrate any effect of MMI on T cells in vitro proliferation, whatever the activation pathway considered. In addition, IL-2 and gamma-IFN productions were substantially unaffected by the drug, as well as IL-1 production by accessory cells. However, a slight reduction of PHA-induced IL-2 receptor expression was observed. Although the hypothesis of an effect of MMI on some specialized T cell functions cannot be ruled out, it is likely that the supposed "immunosuppressive" effect of the drug does not concern primarily the T lymphocyte.

Phenotypic and functional analysis at the clonal level of infiltrating T lymphocytes in papillary carcinoma of the thyroid: prevalence of cytolytic T cells with natural killer-like or lymphokine-activated killer activity

We investigated the phenotype and function of thyroid tumor-, metastatic lymph node-, and peripheral blood-derived T lymphocytes of four patients with papillary thyroid cancer. Both phenotypic analysis of freshly isolated cells and clonal analysis, using a high efficiency cloning technique, were performed. For comparison, intrathyroid and peripheral blood T lymphocytes derived from patients with autoimmune thyroid diseases (Graves' disease and Hashimoto's thyroiditis) have been studied. In papillary cancer, the phenotype of thyroid and lymph node-derived T lymphocytes did not differ from that of peripheral blood lymphocytes of the same patients or lymphocytes from normal peripheral blood. At variance with respect to autoimmune thyroid disease, activation markers were poorly represented. The functional analysis of T cell clones showed similar proportions of interleukin-2-producing (helper-inducer) clones in thyroid, lymph node, and peripheral blood, slightly lower than in Hashimoto's thyroiditis and slightly higher than in Graves' disease. With regard to effector function, we found lower proportion of clones with cytolytic activity in a lectin-dependent assay compared to that in Hashimoto's thyroiditis. Interestingly, however, the proportions of cytolytic clones displaying cytolytic activity against the neoplastic cell line K562 (natural killer-like activity) or fresh unrelated tumor cells (lymphokine-activated killer activity) were relatively high in thyroid cancer infiltrates.

Pirenzepine treatment in urticaria-angioedema syndrome caused by adverse reactions to foods

An increased gastroenteric mucosal permeability is generally considered a pathophysiological mechanism in the urticaria-angioedema syndrome caused by adverse reactions to foods. Since pirenzepine, an antimuscarinic receptor drug, exerts a cytoprotective activity on digestive mucosa, the authors evaluated the clinical efficacy of pirenzepine and terfenadine (antihistamine), alone or associated, in the treatment of patients with urticaria-angioedema syndrome due to food allergy. Furthermore, additional endoscopy and biopsy studies were performed in order to provide experimental evidence about the cytoprotective activity of this treatment. The results of the present investigation confirm the clinical efficacy, with improvement of histological parameters, of pirenzepine treatment in adverse reactions to foods, as previously demonstrated by our group, and suggest further investigations on the functional mucosal impairment hypothesized in this pathological condition.

Immunologic and clinical evaluation of a 12-month course of specific immunotherapy

Allergen specific immunoglobulins (IgE, IgG, IgG1, and IgG4) were evaluated during the course of a 12-month specific immunotherapy (ITS) in 27 allergic subjects: 12 Dermatophagoides pteronyssinus (DP)-, 9 Parietaria officinalis (W19)-, six perennial and timothy rye grass (G5 and G6)-sensitive cases. Further, the modifications of the specific Ig levels were compared with the significant improvement in symptoms and drug consumption observed after 12 months of ITS. IgE levels significantly decreased after 6 and 12 months, while IgG1 significantly increased in the early phases of ITS (3rd month), and IgG4 significantly and progressively increased during the course of ITS. No modification was observed in specific total IgG. Regression analysis test among the various Ig levels revealed a strict correlation only between IgE and IgG4 (high levels of IgE before ITS correlated with high levels of IgG4 after 12 months of ITS). No correlation was observed between total Ig changes and improvement of clinical status or drug consumption.

Effects of tetroxoprim and sulfadiazine on T lymphocyte proliferation and gamma-interferon production

The in vitro effects exerted by tetroxoprim and sulfadiazine on T lymphocyte proliferation were evaluated at drug concentrations equal to and twice the plasmatic peak level of each drug. The two drugs did not exert any significant effect on spontaneous and mitogen (PHA) or monoclonal antibody (MAb anti-CD3) induced T lymphocyte proliferation at the studied concentrations, both when tested separately and combined. In addition the two compounds did not significantly interfere in gamma-interferon (IFN-gamma) production.

Functional study of T lymphocyte responsiveness in patients with dementia of the Alzheimer type

The autologous mixed lymphocyte reaction (AMLR) was used to study T lymphocytes in a group of patients with dementia of the Alzheimer type (DAT) in order to confirm the observation that their T cell proliferation in AMLR was greater than in age-matched controls, and to investigate other pathways of T cell activation, searching for correlations between immunologic and clinical findings in DAT. The mean proliferative response in AMLR was increased in patients with DAT. No differences between patients and age-matched controls were detected when other pathways of T cell activation were investigated. The degree of response in the AMLR varied among patients with DAT. This fits with the suggestion that the disorder may be a heterogeneous syndrome.

Antiallergic drugs and the immune response. Interactions and possible clinical relevance

Since the pharmacological treatment of allergic diseases is used in patients with alteration of the immune response due to atopy and possible concomitant infections, we have investigated the possible effects of such drugs as cromolyn, theophylline, ketotifen, oxatomide, astemizole, fenoterol, pirenzepine, and rosaprostol on the in vitro immune response, in order to obtain experimental data and, as a consequence, clinical conclusions. In a series of investigations by our group and other authors the following immunological parameters have been considered: T cell activation induced by different pathways (i.e. autologous stimulation, PHA, anti-CD3, -CD2 and -CD28 monoclonal antibodies), and lymphokine production (i.e. IL-1, IL-2 and gamma-IFN). For a more detailed experimental model the experiments have been performed both in bulk culture and by using T cell clones derived from the peripheral blood. The results show cromolyn to have an enhancing effect, theophylline and ketotifen a suppressing effect, whereas the remainder show no effect on the immune response. These data are considered and discussed from the aspect of their possible clinical relevance and also in light of the in vivo data previously reported.

Incidence of digestive diseases in patients with adverse reactions to foods

Adverse reactions to foods may occur when the balance between defensive mechanisms (such as enteric and gastric secretions, digestive enzymes, enteric barrier, etc) and aggressive factors (ie, gastroenteric mucosal damage, constipation, sIgA deficiency, etc) is altered. We therefore analyzed a group of patients with urticaria/angioedema syndrome due to food ingestion evaluating the association with digestive diseases. Our data provide clear evidence for high incidence of concomitant gastroenteric disorders in patients affected by adverse reactions to foods. We consider that these pathologic conditions may promote adverse reactions to foods.

Theophylline and the immune response: in vitro and in vivo effects

We analyzed the in vitro and in vivo effects of theophylline on various immunological parameters including proliferation of peripheral mononuclear cells (PMNC) in response to phytohemagglutinin (PHA), anti-T3 and anti-T11 monoclonal antibodies (MAb), PHA-induced interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) production by PMNC, interleukin-1 (IL-1) production by accessory cells, PHA-induced IL-2 production by T-cell clones, and PHA- and anti-T3 MAb-induced DNA synthesis by T cell clones. Results showed that theophylline inhibited PHA- and anti-T3-induced proliferation of both PMNC and T-cell clones, whereas the PMNC proliferation induced by MAb anti-T11 was not affected. The inhibition appeared to be dose-dependent and strictly related to the presence of the drug in the culture. Moreover, PHA-induced IL-2 production by both PMNC and T-cell clones also appeared to be reduced by theophylline. IL-1 production by accessory cells was not affected. These data suggest that the immunological inhibition exerted by theophylline is confined to the T-cell compartment, mainly by acting on structure(s) related to the T3/Ti complex, the primary site for T-cell activation. The alternative pathway of T-cell activation (i.e., via T11 site) seems unaffected. In addition, these results suggest possible clinical relations between the inhibition of the immune response and the plasma levels of the drug reached after a "once daily" or "twice daily" oral ingestion of slow-release theophylline products.

Cytoprotective drugs: a new perspective in the treatment of adverse reactions to foods

Food allergy (FA) and food intolerance (FI) are complex syndromes caused by adverse reactions to foods. Since mucosal permeability of the digestive tract is often increased during this pathology, we evaluated the clinical efficacy of two different cytoprotective drugs in patients with urticaria-angioedema due to FA and FI. These drugs were pirenzepine, an anti-muscarinic (anti-MI) receptor antagonist, and rosaprostol, a synthetic prostaglandin. Further, the results obtained by these schedules of treatment were compared with those achieved by the previously described polyantihistaminic treatment (ie, the association of anti-H1 plus anti-H2 receptor blockers). The present investigation suggests that the cytoprotective drugs are more effective than the antisecretive ones (ie, the anti-H2). Recently, anti-H2 drugs and ketotifen were shown to be in vitro inhibitors of the immune response and cromolyn was demonstrated capable of exerting an enhancing effect on T cell proliferation. In the present study we tested the effect of pirenzepine on several immunologic parameters, such as lymphocyte proliferation (through different activation pathways) and lymphokine (interleukin-2 and interferon-gamma) production. Since we found that pirenzepine does not affect the immune response and in consideration of its clinical efficacy, we consider this cytoprotective drug a valuable tool in the treatment of adverse reactions to foods.