Evolutive phases of experimental prehepatic portal hypertension

Partial portal vein ligation is the experimental model most frequently used to study prehepatic portal hypertension. Different systemic and splanchnic biochemical and histological alterations in short-term (28-45 days) and long-term (12-14 months) evolutive phases which has been described in this experimental model suggest the existence of different pathophysiological mechanisms involved in their production. The enteropathy produced could develop in three phases: an early or acute phase with vasomotor hemodynamic alterations (ischemia-reperfusion associated with intestinal hyperemia, edema and oxidative stress); an intermediate phase with immunological alterations (mesenteric lymphadenopathy, increased mucosal infiltration by mast cells and the hepato-intestinal release of pro- and anti-inflammatory mediators); and a late or chronic phase with intestinal remodeling (vascular and epithelial). The alterations which are produced in these three evolutive phases make it possible to propose an inflammatory etiopathogeny for hypertensive portal enteropathy.

Evaluation by the skin prick test of Anisakis simplex antigen purified by affinity chromatography in patients clinically diagnosed with Anisakis sensitization

Anisakis simplex crude extracts (CE) (IPI, ASAC and ALK-ABELLÓ), A. simplex larval antigens purified using a column of IgG anti-A. simplex (PAK) or a column of IgG anti-Ascaris suum (PAS), antigen eluted from columns of IgG anti-A. suum (EAS) and an A. suum adult CE were assayed by the skin prick test. Thirty percent of assayed patients showed a negative reaction in the Anisakis skin prick test. Of 70% positives, two patients had a weal greater than that produced by histamine with the A. simplex extract from ABELLÓ and IPI. The A. suum skin prick test was positive in 35% of patients, with a lower reaction than that observed with the A. simplex extract from IPI in 57% of the sera and a higher reaction in 28% of the sera. All patients with positive reactions with the crude extract also showed positive weals with the two purified antigens, PAK and PAS. All patients, except three, with a reaction to A. suum antigen, were positive to the EAS antigen. In five patients the weal size produced by PAS was greater than that observed with PAK, whereas in another six patients the contrary was observed. Only one of these six patients did not react to EAS antigen, coincident with the patient showing only a slight increase (7%) in the weal size induced by PAK vs. PAS. When the EAS antigen was tested on patients positive to both PAK and PAS, six patients presented a weal size of >30% and only three patients who were positive to PAS did not react to the EAS antigen. These three patients were also negative against the A. suum CE. Purification by affinity chromatography eliminates from the PAS antigen the proteins responsible for producing cross-reactions with Ascaris (present in the EAS antigen).

Enzyme-linked immunosorbent assay and Western blot antibody determination in sera from patients diagnosed with different helminthic infections with Anisakis simplex antigen purified by affinity chromatography

An evaluation of the sensitivity and the specificity of the Anisakis simplex antigens purified by affinity chromatography was performed using sera from patients diagnosed with Anisakis sensitisation and sera from patients previously diagnosed with different helminthic infections. Only the sera of the patients diagnosed with Schistosoma mansoni or Onchocerca volvulus parasitic infections were negative against the A. simplex antigen and its purified fractions (PAK antigen: A. simplex antigen purified using columns prepared with anti-A. simplex rabbit IgG and PAS antigen: PAK antigen purified using columns prepared with anti-Ascaris suum rabbit IgG). However all the sera were positive against the A. suum antigen. In all the sera from the patients diagnosed with Anisakis sensitisation, the antibody levels detected using the purified antigens (PAK and PAS antigens) were lower than the observed using the A. simplex crude extract with the highest diminution in the case of the IgG. When these same sera were tested against the A. simplex crude extract by Western blot, several bands of high molecular masses were observed as well as, intense bands at 60 and/or 40 kDa. A concentration of these last proteins was observed in the PAK and the PAS antigens. When the sensitivity and the specificity determinations were performed, only seven of the 38 patients diagnosed of Anisakis sensitisation were positive, as well as, the sera from the patients diagnosed with parasitisms by Echinococcus granulosus or Fasciola hepatica.

Budesonide ameliorates early portal hypertension in the rat: possible antiexudative splanchnic action

Major portal pressure increase occurs on the second day post-stenosing-ligation of the portal vein in the rat and it is associated with pancreatic edema, intraperitoneal free exudate, hypoalbuminemia and hypoproteinemia. All this suggests the development of a regional exudative inflammatory response. In order to verify this hypothesis the steroid budesonide, whose antiinflammatory activity could prevent these alterations, was administered to rats with prehepatic portal hypertension. Wistar male rats were divided into the following groups: Control rats that were administered saline solution (CS; n = 10), Control rats that were administered budesonide (36 mg/kg per day; CB; n = 10), triple stenosing ligation of portal vein (TSLP) with saline solution (n = 10) and triple stenosing ligation of portal vein with budesonide (36 mg/kg per day; n = 10). In rats with prehepatic portal hypertension at 48 h of postoperative evolution, budesonide decreases the incidence of pancreatic edema, of peritoneal free exudate, of mesenteric adenopathies and prevents hypoproteinemia, hypoalbuminemia and hyper-beta-globulinemia. Some of the macroscopic intra-abdominal alterations and some of the changes in the electrophoretic pattern found in portal hypertensive rats could have an inflammatory etiopathogeny because budesonide shows an effective prophylaxis.

Living & learning with allergy: a European perception study on respiratory allergic disorders

BACKGROUND

Knowledge of allergy patients' perception of own disease is inadequate, and understanding of the impact of local environment, including family and health-care system, on patients' management of disease is insufficient. We examined the potential of telephone-based survey techniques for establishing this knowledge in 10 European countries.

METHODS

A two-phased questionnaire developed by use of focus groups in seven countries was translated into 10 languages. To ensure that the true values of the populations were restored in randomly selected populations, 75,343 telephone numbers selected for screening represented balanced national distributions of households.

RESULTS

Eight thousand two hundred and sixty-eight respiratory allergy sufferers were identified by the telephone screening process. 85.4% accepted to participate in the survey and 89.6% completed both phases comprising 34 questions and rating of 49 statements. Data for each country were weighted in terms of age, sex and the recorded allergy prevalence within age intervals.

CONCLUSIONS

The telephone survey technique allowed for establishment of random representative samples, and application of mathematical weighting procedures assured that the true national values were restored in the data set. As all interviews were performed in a standardised manner we conclude that the telephone-based survey methodology enables national representative data set to be established and compared.

National prevalence of respiratory allergic disorders

BACKGROUND

Many epidemiological studies have assessed the prevalence of respiratory allergic disorders in confined geographical locations. However, no study has yet established nationally prevalence data in a uniform manner representing whole countries and, thus, enabling cross-national comparisons.

METHODS

In 10 European countries, screening of random, representative samples of telephone numbers identified the target population aged 16-60. The inclusion criteria were a positive reporting of respiratory allergy to named allergens and, concomitantly, an unassisted description of appropriate symptoms. To obtain a truly representative, national prevalence of each country, the data were weighted against the actual sex and age composition.

RESULTS

31,065 screening interviews were performed. The nationally balanced prevalence varied significantly among the 10 countries (P<0.001) from 11.7% in Spain to 33.6% in Italy. The overall weighted prevalence for Europe was 24.4%. Comparing males and females, overall, the odds-ratio was 0.874 (P<0.001). For age intervals of 16-29, 30-49, and 50-60 years, the odds-ratios for males were 1.104 (P<0.088), 0.827 (P<0.001), and 0.658 (P<0.001), respectively. The prevalence correlated inversely with age.

CONCLUSIONS

Respiratory allergic disorders constitute a huge health problem in Europe, and the impact may be increasing as the prevalence is highest among young people.

Cross-reactivity between Anisakis simplex sensitization and visceral larva migrans by Toxocara canis

The aim of this work was to study cross-reactivity in the diagnosis of two related ascaridosis. Nineteen patients diagnosed with recidivous acute urticaria (RAU) caused by Anisakis simplex and 26 patients diagnosed with visceral larva migrans (VLM) caused by Toxocara canis were studied employing commercial diagnostic kits and "in house" assay kits. Cross-reactivity observed was greater when using "in house" assay kits, suggesting that T. canis excretory-secretory antigens were not only recognized by antibodies from patients with RAU but with greater intensity compared to the A. simplex excretory-secretory antigens.

Purification of Anisakis simplex antigen by affinity chromatography

In order to improve the specificity and sensitivity of the techniques for the diagnosis of human anisakidosis, a method of affinity chromatography for the purification of species-specific antigens from Anisakis simplex third-stage larvae (L3) has been developed. New Zealand rabbits were immunized with A. simplex or Ascaris suum antigens or inoculated with Toxocara canis embryonated eggs. The IgG-specific antibodies were isolated by means of protein A-Sepharose CL-4B bead columns. IgG anti-Anisakis simplex, anti-Ascaris suum and anti-T. canis were coupled to CNBr-activated Sepharose 4B. For the purification of the larval Anisakis simplex antigens, it was loaded into the anti-A. simplex column and bound antigens were eluted. For the elimination of the epitopes responsible for the cross-reactions, the A. simplex-specific proteins were loaded into the anti-Ascaris suum and anti- T. canis columns. To prove the specificity of the isolated proteins, immunochemical analyses by polyacrylamide gel electrophoresis and immunoblotting were carried out. Likewise, immunoaffinity columns were prepared using specific IgG from patients with Anisakis simplex sensitization, previously diagnosed by fluoro-enzymo-immunoassay. The protein patterns of antigen after purification by the human columns were similar to those obtained using the rabbit columns.

Specific and total IgE in patients with recurrent, acute urticaria caused by Anisakis simplex

Titres of parasite-specific IgE were investigated in 19 patients thought to have recurrent, acute urticaria caused by sensitization to Anisakis simplex (Dujardin, 1845), before and after they were placed on a fish-free diet. Patients with other allergic disease and those being treated with corticosteroids or antihistaminics were excluded. Skin-prick tests were carried out with A. simplex extract, and blue- and white-fish extracts. The CAP system (Pharmacia), a commercial test kit developed for the assay of food-specific IgE, was used to monitor serum concentrations of total IgE and antigen-specific IgE against Anisakis, Ascaris, Echinococcus, Toxocara, tuna, salmon, shrimp, mussel and cod. Before going on a fish-free diet, the 19 patients had CAP scores against A. simplex of 5 (three cases), 3 (seven) or 2 (nine). After a mean of 120 days on the diet, the scores against A. simplex were unchanged in 15 of the cases, reduced in three [from 5 to 4 (one case) or from 2 to 0 (two cases)] and increased in one (from 2 to 3). Most (16) of the patients no longer had any urticaria and the others reported significant reductions in the intensity and frequency of their symptoms.

Recidivous acute urticaria caused by Anisakis simplex

This study aimed to determine the cause of acute recidivous urticaria in patients who usually eat fish or other seafood. Twenty-five patients were studied. The skin prick test with larval Anisakis simplex extract was performed; total and specific IgE against A. simplex was measured with the CAP System; specific antibodies to A. simplex were determined by ELISA; and immunorecognition patterns of the sera were studied by Western blot. Nineteen patients showed specific IgE to A. simplex, but specific IgE to Ascaris was demonstrated in only two patients. No patients reacted to Toxocara canis or Echinoccocus granulosus antigens with the same test. The skin prick test was positive in 16 patients, in two of them persisting for 48 h. Five patients showed neither skin reaction nor specific IgE to A. simplex. Sera showed specific immunoglobulin levels against A. simplex larval crude extract, by both ELISA and Western blot. Likewise, specific immunoglobulin levels against excretory-secretory antigen were also measured by ELISA. Only one patient showed sensitization to fish. A. simplex was found to be the main cause of acute recidivous urticaria in patients who usually eat fish and are not sensitized to it.

Clinical tolerance, parasitological efficacy and environmental effects of dehumidifiers in stable asthmatics sensitized to house dust mites

Dehumidifiers (DH) are potentially effective appliances as coadjuvant therapy in the treatment of bronchial asthma caused by sensitization to house dust mites. The aims of this study were to analyze DH tolerance in asthmatic patients, to assess the parasitological effects and to analyze the environmental effects produced by the use of these appliances in the bedrooms of asthmatic patients sensitized to house dust mites. 10 stable asthmatic patients sensitized to house dust mites were studied. DH appliances (CD-300) were installed in their bedrooms. Each patient was given symptom scoring tables and a portable peak expiratory flow (P.E.F.) during a period of 5 months, 1 month before installing the DH and 4 months afterwards. To study the parasitological efficacy of the DHs, we analyzed dust samples from the bedrooms and determined the Der p I, Der f I and Der II allergens by means of a modified ELISA based on monoclonal antibodies. Dust samples were collected before installing the DHs and after they had been working for 2 and 4 months. Dry temperature and relative humidity measurements at three time intervals (7-9, 15-17 and 22-24 h) were carried out. The 1st measurement was done prior to installation of the DHs in the patients' bedrooms and the 2nd and 3rd were achieved 2 and 4 months respectively after the installation. Statistical analysis was done by comparison of paired means. No significant differences were detected in the patients' symptoms nor in the P.E.F. measurements in the course of the study. Decreases in the house dust mite allergens were observed in 4 bedrooms. A significant decrease in relative humidity in the bedrooms of mite asthma patients after use of dehumidifier appliances was observed (p < 0.01). Significant differences between the measurements of the bedrooms with and without DH were detected (p < 0.01). In summary, DHs were well tolerated by stable asthmatic patients, produced a significant decrease in the relative humidity level and showed some parasitological efficacy.

Serum levels of eosinophil cationic protein and eosinophil protein x in pollen atopic patients with stable asthma and its relation with bronchial hyperresponsiveness

Eosinophils are important effector cells in allergic inflammation described in allergic rhinitis (AR) and allergic bronchial asthma (BA). During the pollen season serum levels of eosinophil cationic protein (ECP) and eosinophil X protein/eosinophil-derived neurotoxin (EPX/EDN) are increased in BA. The aim of the present study was to evaluate the serum levels of ECP and EPC in pollen atopic patients with AR and BA during the winter. 92 patients were studied. They were divided into three groups: I 29 patients with AR, II 51 patients with BA and III 12 healthy subjects. Allergic rhinitis and bronchial asthma were diagnosed by routine clinical tests: clinical history, skin tests, total IgE and specific IgE. In addition ECP and EPX were determined in serum. All patients were asymptomatic, stable and without medical treatment. Methacholine challenge test (MCT) was performed in all patients. MCT were positive in 4 patients of group I and 45 patients of group II. ECP levels (ug/l) were: 21 (I), 24 (II) and 7 (III). EPX levels (ug/l) were 35 (I), 45 (II) and 21 (III). Statistical differences (p < 0.01) were observed both in ECP and EPX levels in patients with MCT positive in relation to patients with MCT negative, and in allergic patients (I and II) in comparison with the healthy subjects (III) (p < 0.01). ECP and EPX serum levels are increased in patients with a positive MCT in the winter, out of the pollen season, when patients are asymptomatic, stable and without treatment. This fact suggests that eosinophils play an important role in the pathogenesis of bronchial asthma.

Anaphylaxis induced by ingestion of a pollen compound

We report on the case of a 32-year-old atopic patient who showed a severe anaphylactic reaction due to the ingestion of a pollen compound prepared in an herbalist's. A few minutes after ingestion, generalized pruritus, difuse erythema, facial edema, cough, hoarseness and dysphonia appeared, and the emergency administration of subcutaneous epinephrine and intravenous methylprednisolone was necessary. Skin tests with a battery of inhalants and food allergens were performed. The patient only showed sensitization to Artemisia vulgaris, Taraxacum officinalis and Salix alba. Specific IgE levels were evaluated by FEIA-CAP giving a seric level of CAP class 3 to Artemisia vulgaris and class 2 to Taraxacum officinalis and Salix alba. Samples of the pollen compound were shown in the microscopical analysis to be 93% pollens and 6% fungi. In the qualitative study Taraxacum officinalis (15%), Artemisia vulgaris (5%) and Salix alba (15%) were the main elements identified. In summary, this case study describes a food-induced systemic reaction due to a pollen compound in an atopic patient with a history of allergic rhinitis. Pollinic patients must be informed on the risks that the consumption of these compounds might cause.

The clinical value of neuron-specific enolase as a tumor marker in bronchoalveolar lavage

BACKGROUND

Neuron-specific enolase (NSE) is used in the staging and monitoring of responses to therapy and the detection of recurrences in lung cancer. The diagnostic value of NSE has been under discussion. This may be because NSE usually has been studied in the sera of patients with bronchogenic carcinoma and not in the bronchoalveolar lavage (BAL).

METHODS

The NSE levels in the BAL of three groups--control subjects, patients with chronic bronchitis, and patients with tumors--were analyzed. The fluid obtained was centrifuged. The NSE was analyzed in the supernatant of the BAL (NSE, Pharmacia, Columbia, MD). Its concentrations were calculated in relation to milligrams of total protein.

RESULTS

A significant difference was noted in the level of NSE in the BAL of the tumor group compared with those of the other two groups. No differences were observed between the other two groups or between healthy smokers and nonsmokers. No correlation was found with the histologic type of pulmonary carcinoma and NSE levels in BAL. The NSE levels were higher in the lavages of patients with primary pulmonary carcinomas than in those with metastases.

CONCLUSIONS

Neuron-specific enolase could be of aid in the early diagnosis of solitary pulmonary nodules and lung cancer. More studies would be required to identify a correlation between NSE levels in BAL and those in serum, or between NSE levels in BAL and tumor size and location and disease stage of lung cancer.