[Experiences with a combination therapy of methylprednisolone and troleandomycin in severe bronchial asthma requiring high-dose corticoids]

Although treatment comprising a combination of methylprednisolone (MP) and troleandomycin (TAO) has been employed to treat cases of severe bronchial asthma requiring high doses of corticosteroids, for about 20 years, now, it has always been associated with major adverse reactions (1). A new protocol avoids these adverse effects by a rapid reduction in the dose of MP to alternating administrations and low TAO dosage (250 mg). Nineteen patients were treated using this protocol, 16 of whom for more than two months (maximum 21, minimum 4 months). Three patients were taken out of the study as early non-responders in the initial phase. Five patients must be considered to be late non-responders, or were discharged from the study on account of pathological liver parameters. In 8 patients who showed good tolerance, an appreciable reduction in the dose of steroids, with stabilisation of the asthma, was observed.

[Is sodium salicylate suitable as a protective agent in the analgesic-induced asthma syndrome?]

The protective effect of NaS in analgetic-induced asthma (AIA) was investigated in patients with AIA. In none of the patients was the asthmatic reaction to acetylsalicylic acid (ASS) completely inhibited by the oral administration of NaS. In a single patient, an intolerance reaction occurred after oral ingestion of the substance. In several patients, induction of tolerance towards acetylsalicyclic acid was facilitated after prior ingestion of NaS.

[Comparison of salivary with serum levels of retard theophylline under steady-state conditions]

In 86 asthmatic children, the theophylline levels in the serum and saliva were compared. A pronounced (r = 0.95) and statistically highly significant (p less than 0.001) relationship was observed to exist between the theophylline concentrations in serum and saliva.

[Neopterin in phases of exacerbation of bronchial asthma and in experimental asthma conditions]

In conditions associated with stimulation of cellular immunity and enhanced macrophage activity, for example, in viral infections, neopterin is elevated. Acute exacerbations of bronchial asthma--in particular in the case of intrinsic asthma--are frequently precipitated by viral infections of the upper airways. In both extrinsic and intrinsic asthma, neopterin is normal in the stable phases. In the exacerbation phase with signs of infection of the upper airways, however, neopterin in significantly elevated both in the serum and in the urine. In contrast, during and following positive inhalative provocation testing with histamine, allergens and aspirin, no increase in neopterin is to be observed.

Immunoprint pattern in patients with allergic bronchopulmonary aspergillosis in different stages

Individual immunoprint patterns of sodium dodecylsulfate-polyacrylamide gel electrophoresis-separated Aspergillus fumigatus (Af) allergens/antigens were evaluated in 28 patients with allergic bronchopulmonary aspergillosis in stages II to V. It could be demonstrated that active disease (stage III) is characterized by a very strong IgE response against a variety of Af components, whereas the IgE antibody pattern in corticosteroid-treated patients who have demonstrated improvement is much weaker. In patients in remission (stage II), it is minimal. In contrast, many patients in stage V without corticosteroid treatment demonstrated a strong reactivity of IgE antibodies, indicating persisting active disease. The pattern of IgG antibodies with individual Af components resembles, in general, that of IgE antibodies; however, discrimination between different stages and between treated patients is much weaker. Our results indicate that a certain relationship between the different stages of allergic bronchopulmonary aspergillosis and Af immunoprint patterns exists.

Intolerance to tartrazine in aspirin-induced asthma: results of a multicenter study

One hundred and fifty-six German, Italian and Polish patients with confirmed aspirin-induced asthma underwent open oral challenges with increasing doses of tartrazine up to 25 mg. All positive challenges were repeated under double-blind conditions. Only 4 of 156 patients (all Polish) had positive reactions in a double-blind test, as evidenced by a fall in FEV1 greater than 25% from baseline and corresponding clinical symptoms. Sixty-five patients who tolerated 25 mg tartrazine well received 50-3,000 mg tartrazine and none showed adverse reactions. Thus, intolerance to tartrazine appears to be rare among Central-European and South-European patients with aspirin-induced asthma, its frequency amounting to about 2.6%.

IgE antibodies to house dust, mite, animal allergens and moulds in house dust hypersensitivity

Fifty-three patients were investigated by intradermal tests and Phadebas RAST and, in most cases, the serum IgE level was determined. They were tested for sensitivity to house dust, Dermatophagoides pteronyssinus, cat, dog, horse and mould allergens. All cases with IgE antibodies to house dust were found to have specific IgE to other tested allergens as well. Eighty-nine per cent of the patients being RAST positive for house dust were also positive for D. pteronyssinus and in the majority of those cases IgE antibodies to other allergens were detected. The results reaffirm previous findings that the mite is not the only allergen in house dust and that extract of house dust is a mixture of several allergenic substances, which make it less suitable for differential testing. It is concluded that serum IgE determination is of value as a screening procedure in the diagnosis and that the use of a number of specific allergens in RAST is valuable in pinpointing the offending allergen in house dust hypersensitivity.

[Beclomethasonedipropionate for corticoid inhalation therapy in bronchial asthma]

Beclomethasone dipropionate, a new corticosteroid for inhalation in the form of a pressurised aerosol with a daily dosage of 300-400/mug, has been given to 130 adult asthmatics. In 56% of the steroid-dependent asthmatics, oral or parenteral corticosteroids were reduced and in a further 28% discontinued entirely. In 16% of patients a reduction of systemic corticosteroids could not be achieved. 12 patients suffering from an obstructive airway disease who had not previously been on systemic corticosteroids were treated successfully with inhalation of beclomethasone dipropionate alone. The reduced dosage of systemic corticosteroids as a result of the use of beclomethasone dipropionate was 4.24 mg of prednisone daily. Side effects, in the form of mouth candidiasis, were noted in only 2 patients.

IgE levels in external secretions

IgE levels were measured in serum and various external secretions from normals and patients with respiratory, intestinal, gynecological and dermatologic diseases. No IgE was detected in cervicovaginal secretions. The small intestinal secretions also had no detectable IgE, but did have a substance that inhibited the precipitation of IgE – anti-IgE, and was possibly a degradation product of IgE. The IgE:IgG ratio in sputum, nasal washings and saliva was greater than that of serum, suggesting that IgE is a secretory immunoglobulin. IgE levels were highest in these secretions and in serum of patients with extrinsic asthma and neurodermatitis.