Massive polyclonal hyperimmunoglobulinemia E, eosinophilia and increased IgE-bearing lymphocytes

A patient (E.M.) with marked eosinophilia and hyperimmunoglobulin E (IgE) has been followed for 4 years. Peripheral blood eosinophilia reached levels in excess of 18,000 cells/mm3 and serum IgE concentration increased to more than 210,000 units/ml (about 0.48 mg IgE/ml). The IgE has both lambda and kappa light chains and is therefore considered polyclonal. The patient has an increase in peripheral blood lymphocytes which stain for surface IgE. Transfer of the patient's plasma (plasmsEM) to a rhesus monkey did not induce peripheral boood eosinophilia. The half life of IgEEM in a rhesus monkey was 2.2 days, which is similar to the half life of myeloma IgE in human subjects. The condition was not associated with defined morbidity except for mild persistent pruritus. Various studies revealed no evidence for atopic parasitic, immune deficiency or neoplastic disease.

3-Methoxy-4-hydroxy-phenylglycol sulfate (MOPEG-SO4) in ventricular and cisternal cerebrospinal fluid of dogs

Cerebrospinal fluid was collected from the lateral ventricles and cisternal space from beagle dogs under light pentobarbital anesthesia. Homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenylglyco-sulfate (MOPEG-SO4) levels in the liquor taken from these two regions were evaluated, and the ventricular-cisternal ratio (V/C) was calculated for each monoamine metabolite. A marked similarity in the V/C ratio of 6:1 for 5-HIAA and 5:1 for MOPEG-SO4, as compared to a much higher V/C ratio of 18:1 for HVA, perhaps reflects the more diffuse distribution of norepinephrine and serotonin, precursor amines, as compared to dopamine in the CNS and also emphasizes the probable existence of an active transport mechanism for the removal of MOPEG-SO4, as has been well documented for 5-HIAA and HVA.

Respiratory immune response to aerosolized keyhole limpet hemocyanin in primate lungs

Methodology for delivery of antigen to the lower respiratory tract of rhesus monkeys and the recovery of respiratory secretions (RS) by bronchial lavage has been evaluated and has been done on repeated occasions without apparent risk to animals. Rhesus immunoglobulin (Ig)G, IgM, and IgA were identified in RS by their cross-reactivity with human IgG, IgA, and IgM, and relative concentrations of rhesus IgA and IgG could be evaluated in sequential samples of RS and serum (S) by radial immunodiffusion analysis using antiserum specific for human gamma and alpha chains. Administration of keyhole limpet hemocyanin (KLH) by aerosol was compared with intravenous administration of KLH. The aerosol route of administration resulted in IgG, IgM, and IgA antibodies detectable by radio-immunodiffusion in RS but only IgG antibodies in serum. After separate sequences of exposure to KLH delivered to the lung, a secondary type of immune response in the lung appeared as indicated by time of appearance and height of antibody titers. Antibody titers against KLH were estimated by passive hemagglutination of tanned sheep red cells coated with KLH, and anti-KLH titers were comparatively higher in RS of animals immunized by the respiratory route. Treatment of RS and S with 2-mercaptoethanol resulted in reduction of hemagglutination titers of both S and RS, but the degree of reduction varied in different samples and was independent of whether or not the S and RS were collected simultaneously. These results indicate that at least part of the antibody response to aerosolized KLH in rhesus monkeys occurs in the lung and that antibodies may appear in all three immunoglobulin classes in this response.

Solitary sclerosing plasma-cell myeloma of the spine. Case report

✓ A case is reported in which spinal cord compression was caused by a solitary sclerosing plasma-cell myeloma involving the T-9 vertebra.

IgE and IgG antibodies against Aspergillus fumigatus in sera of patients with bronchopulmonary allergic aspergillosis

Studies of sera from patients with bronchopulmonary allergic aspergillosis (BPAA) confirm a previous report that serum IgE concentrations are elevated. Both IgE and IgG antibodies against <i>Aspergillus fumigatus</i> antigen (AF Ag) can be detected <i>in vitro</i> using a solid phase radioimmunoadsorbent technique. Sera were studied by several techniques to determine if the elevated serum IgE concentrations in BPAA were composed primarily of IgE antibodies directed against AF Ag. The results indicated that the opposite is more likely: that most of the IgE in the sera obtained from patients with BPAA and used in these studies is not directed against AE Ag.

Immunologic Reactions Against Insulin

Immediate or anaphylactic type hypersensitivity to insulin may be detected by in vitro analysis of IgE antibodies against insulin antigenic determinants. A solid phase immunoadsorbent prepared with polystyrene tubes and an IgE anti-IgE matrix provides the method of fixation of serum IgE against radiolabeled insulin. The degree of insulin binding by IgE correlates with the clinical allergic state and declines in parallel with the Prausnitz-Küstner titers of patient's sera. A more rapid decline in IgE-binding capacity of insulin occurred after therapeutic insulin desensitization or continuous insulin therapy. The occurrence of insulin allergy and immunologic insulin resistance in the same patients was associated with the presence of both IgE and IgG antibodies against insulin. The immunoadsorbent system for detection of IgE antibodies against insulin was used to evaluate cross-reactivity of heterologous insulins or insulin fragments with bovine insulin and is applicable to other IgE-mediated systems.