Nausea in bulimic women in response to palatable food

Nausea in response to an appetizing food stimulus was assessed in bulimic women and healthy control subjects. Nausea was assessed via subjects' self-report and changes in levels of plasma arginine vasopressin (AVP), a hormonal correlate of nausea. Converging evidence was obtained indicating that bulimic women experienced nausea in response to the sight, smell, or taste of the palatable food stimulus. The possibility that the observed nausea is a learned response that may contribute to the bulimic binge/purge pattern is discussed.

Assessment of airway hyperresponsiveness in chronic stable asthma

Airway reactivity and disease severity were investigated in 24 subjects with stable chronic bronchial asthma. Disease severity was determined by assigning a disease severity score (DSS) representing six clinical and therapeutic parameters. Airway hyperresponsiveness was assessed in two ways: airway reactivity score (ARS) based on the number of positive responses to a question concerning exposure to 22 nonspecific inhaled irritants and methacholine challenge testing and determining the cumulative dose causing a 20% reduction in FEV2 (CMD20). A significant correlation between DDS and CMD20 (r = 0.57; p less than 0.003) and DSS and ARS (r = 0.67; p less than 0.0003) attested to the important influence of airway hyperresponsiveness on disease severity. Significant correlations for ARS with CMD20 (r = -0.60; p less than 0.002) suggested the consistency with which the ARS estimated methacholine hyperresponsiveness. We found no statistically significant correlations between DSS, ARS, or CMD20 and the age of subject, duration of asthma, or other host characteristics. There was not a significant correlation between the degree of airway obstruction and DSS or ARS noted. The results of this investigation demonstrate the value of the use of clinical information for assessing airway hyperresponsiveness and disease severity in patients with chronic stable asthma. Both ARS and DSS are useful clinical tools for estimating methacholine reactivity.

Conditioned responses to a taste conditioned stimulus paired with lithium chloride administration

The present experiments examined whether behavioral conditioned responses (CRs) develop to lithium chloride (LiCl)-paired tastes and whether these CRs are similar to the behaviors that follow administration of the drug. Rats were exposed to a saccharin solution via intraoral infusions before being injected with either LiCl or saline. CRs were assessed after conditioning when the saccharin conditioned stimulus was delivered alone. The unconditioned response to LiCl delivery is a very distinctive posture that has been termed "lying-on-belly." The present study indicates that this behavior pattern also occurs after the delivery of a LiCl-paired taste solution. The similarity between these unconditioned and conditioned behaviors is consistent with the hypothesis that responses are conditioned during taste aversion acquisition and that CRs are similar to those that are generated by the drugs used in conditioning.

Antibodies to morphine in workers exposed to opiates at a narcotics manufacturing facility and evidence for similar antibodies in heroin abusers

According to the International Narcotics Control Board, over 45,000 kg of morphine and 54,000 kg of codeine were ethically manufactured in 1986 at three facilities in the United States. Little information exists about possible adverse health effects associated with workplace exposure to opiate compounds in this industry. Because there are no specific federal standards for workplace exposure to narcotic dusts, exposure-control defaults to the nuisance dust standard (10 mg/m3, as an 8 hr time-weighted average). Narcotics manufacturing workers were evaluated for anti-morphine IgG before and 10 mo. after the implementation of an improved respiratory protection program (RPP). Significantly elevated IgG levels were measured before the improved RPP (P less than 0.005). After the improved RPP, a significant reduction was observed (P less than 0.001), suggesting that specific antibody levels could be used as biomarkers of exposure. Inhibition studies showed that the antibodies were specifically directed against morphine with some cross reactivity with morphine derivatives. Preliminary results are also shown which indicate that similar anti-morphine antibodies are present in the sera of intravenous heroin abusers. Elevated levels (P less than 0.05) of anti-morphine antibodies were detected in sera from heroin abusers, providing evidence that similar antibodies may be produced from non-occupational exposure to opiates. These finding have potentially far-reaching implications for addiction research and drug testing.

Preabsorptive insulin release in bulimic women and chronic dieters

Preabsorptive insulin release was examined in bulimic women and in matched controls who diet. A palatable food was presented to subjects after an overnight fast and plasma insulin and glucose were measured at baseline, during presentation of the food and after it had been tasted. Food presentation and consumption were associated with significant elevations in plasma insulin levels prior to elevations in blood glucose, but not prior to actual tasting and consumption of the food. Insulin levels of bulimic and dieting women did not differ significantly at any time. The results indicate that when dietary restraint and body weight are controlled, bulimics do not display abnormal patterns of insulin release in response to foods.

Clinical and immunologic studies of rapid venom immunotherapy in Hymenoptera-sensitive patients

A 2- to 5-hour regimen of rapid venom immunotherapy (RVIT) was administered to 33 patients with anaphylactic sensitivity to Hymenoptera venom in a hospital setting in which full emergency resuscitation equipment was available. The RVIT was administered as 10 increasing doses of each treatment venom every 10 to 15 minutes to achieve a final dose on day 1 of 58.55 micrograms per venom. Patients returned for booster venom injections of 60 micrograms on day 3, 70 micrograms on day 7, 80 micrograms on day 21, and 100 micrograms on day 35 after RVIT. Serial antigen-induced leukocyte histamine release studies were performed on day 1 in 10 patients before and after RVIT, as well as 3 1/2 months after initiation of RVIT. Of 33 patients, 32 achieved a cumulative venom dose on day 1 of at least 50 micrograms, and the entire group received a mean dose of 95.46 micrograms. Local reactions during RVIT occurred in 18 (55%) patients. Four patients (12%) experienced mild systemic reactions during or after completion of RVIT. Subsequent booster venom doses administered to 29 patients were well tolerated. A decrease in venom-induced leukocyte-histamine release from baseline was detected in three (30%) patients immediately after RVIT and in seven (70%) patients months after achieving maintenance doses. Cutaneous sensitivity decreased by at least one log10 concentration in eight (32%) of 25 patients. Twenty-two natural re-sting events occurred in 12 (50%) of 24 patients surveyed after successful completion of RVIT, of whom seven identified the insect as one for which they had been treated. No systemic reactions were reported. Results of this study indicate that RVIT is a safe, alternative method of venom administration for patients who are at immediate risk for re-sting anaphylactic episodes.

Guidelines for the clinical evaluation of hypersensitivity pneumonitis. Report of the Subcommittee on Hypersensitivity Pneumonitis

In general, a history of exposure to "moldy" hay, birds, or other incriminated occupational or environmental inhalants in a patient with clinical and radiologic features consistent with HSP should lead to the demonstration of serum precipitins to the suspected antigen and an established diagnosis, confirmed by avoidance of the agent involved. Occasionally, other diagnostic procedures are required. The diagnosis is often difficult in domestic exposures, such as humidification and air conditioning systems. A careful environmental history is essential, and at times the physician must inspect the patient's environment personally. In most cases, the diagnosis is established if (1) the history and physical findings and pulmonary function tests indicate an interstitial lung disease, (2) the x-ray film is consistent, (3) there is exposure to a recognized cause, and (4) there is antibody to that antigen. In other exceptional circumstances, bronchoalveolar lavage may help. Biopsy is rarely needed. Special environmental studies and identification of new antigens require research facilities. Provocation tests are research procedures, not necessary for the diagnosis, and not needed in contested workmen's compensation adjudications.

Guidelines for the clinical evaluation of occupational asthma due to high molecular weight (HMW) allergens. Report of the Subcommittee on the Clinical Evaluation of Occupational Asthma due to HMW Allergens

Sensitization to HMW allergens is a relatively common immunopathogenic factor in occupational asthma. The mechanism of sensitization is an IgE-mediated, type I reaction. High molecular weight allergen refers to proteins and polymers of organic compounds over 5 kd and usually in the 20 to 50 kd range. In most cases diagnosis requires: 1. A high index of suspicion of job-related asthma. 2. Exposure to HMW compounds and clinical findings associated with such an exposure. 3. Confirmation of sensitization by appropriate in vitro or in vivo tests. 4. Confirmation of a pathogenic role by physiologic measurements in either a natural setting or during laboratory-controlled challenges.

Progesterone-responsive urticaria and eosinophilia

A 30-year-old black albino woman was first observed with a 4-year history of monthly urticarial episodes associated with hypereosinophilia. Hives consistently began at the end of menses and lasted for 1 to 2 weeks. A comprehensive evaluation excluded underlying malignancy and infection. There was no evidence of extracutaneous visceral involvement consistent with the primary hypereosinophilic syndrome. A 6-month prospective evaluation was performed, during which daily hive symptoms were recorded and weekly determinations of eosinophils, serum total IgE, progesterone, estradiol, and 24-hour urine histamine were obtained. Eosinophil counts (range, 4002 to 37,350 cells per cubic millimeter) increased in association with the onset of hives and decreased to baseline levels after their resolution. The 24-hour urine histamine peaked at the onset of each urticarial episode. When serum progesterone levels increased, the hives were quiescent and peripheral eosinophils decreased to baseline levels. Progesterone caused in vitro dose-related inhibition of antihuman IgE-induced histamine release from peripheral basophils of this patient. Treatment with oral medroxyprogesterone resulted in remission of urticaria and a decrease in eosinophil counts. This patient represents a unique case of chronic cyclic urticaria and hypereosinophilia that appears to be modulated by the effects of progesterone.

Cephalic insulin release in anorexic women

Cephalic phase insulin release (CPIR) was examined in women with anorexia nervosa and in lean, age matched controls. Following an overnight fast, a palatable food was presented to subjects and plasma insulin was measured at baseline and every minute for a 10 minute period following the presentation of the food. Elevation in plasma insulin occurred five minutes after food presentation in the anorexic group only. The finding of a significant CPIR in anorexics but not controls was unexpected and tends to rule out a deficient cephalic insulin response as a contributor to the self-starvation observed in anorexia nervosa.

Prednisone pretreatment leads to histaminic airway hyporeactivity soon after resolution of the immediate allergic response

We assessed the effect of prednisone pretreatment (50 mg/day for three days) on the development of the early increase in histamine reactivity that occurs soon after resolution of the immediate response in allergic humans. Four allergic subjects who were known to develop only isolated immediate responses upon Kentucky bluegrass inhalation, as well as four mild allergic asthmatic subjects known to develop typical dual phase responses, were evaluated. All testing was done more than nine weeks after the grass pollen season had ended. Allergen inhalation produced an immediate response in all subjects. However, upon resolution of the immediate response to allergen in these pretreated subjects, the PC200His in all dual responding asthmatics and in three of the four isolated immediate responders had substantially increased above baseline values. We conclude that prednisone pretreatment leads to histaminic hyporeactivity soon after resolution of the immediate allergic response in both dual responding asthmatics and isolated immediate responders. It would seem that this prednisone effect is independent of its potential influence on the influx of inflammatory cells into diseased airways.

Acute airway narrowing in monkeys from challenge with 2.5 ppm formaldehyde generated from formalin

Nine adult male Cynomolgus monkeys (Macaca fascicularis) were exposed for 10 min to 2.55 +/- 0.03 ppm formaldehyde (HCHO; mean +/- standard error of the mean, SEM) generated from formalin with a newly developed HCHO challenge system. The generation system was capable of producing highly stable HCHO vapor concentrations with fluctuations of HCHO concentrations of less than +/- 5%. The experimental design included pre-exposure methacholine challenge to determine if responses to HCHO were associated with pre-existing bronchial hyperreactivity. Significant changes in average pulmonary flow resistance (RL) were observed (compared to control RL values) at 2 (p less than 0.01), 5 (p less than 0.01), and 10 min (p less than 0.005) post-HCHO challenge. Pre-challenge RL values (mean +/- SEM) were 11.3 +/- 1.4 cm H2O.l/s, while at 2, 5, and 10 min after HCHO challenge, values were 16.1 +/- 2.1, 16.9 +/- 2.8 and 20.0 +/- 3.4 cm H2O.l/s, respectively. Methacholine challenge data suggest that reactions to HCHO tend to be greater in monkeys hyperreactive to methacholine, but the relationship does not reach statistical significance in this small series of animals. These data indicate that significant pulmonary function deficits occur immediately after challenge with 2.55 ppm HCHO vapor in monkeys.

A comparative tolerance study of terfenadine-pseudoephedrine combination tablets and pseudoephedrine tablets in patients with allergic or vasomotor rhinitis

In this multicentre, double-blind, randomized, parallel group study, 315 patients with allergic or vasomotor rhinitis were treated on a twice daily dosing schedule with either a 60 mg terfenadine-120 mg pseudoephedrine hydrochloride combination or 120 mg pseudoephedrine hydrochloride (extended release) for 2 weeks. No clinically significant differences between the two groups were noted in body weight, temperature, respiration rate or blood pressure following the treatment period. An increase in mean heart rate of approximately 5 beats/min from entry to the final clinic visit was noted in both treatment groups. No clinically significant changes were noted in either treatment group when pre- and post-treatment electrocardiograms were compared. There were also no clinically significant alterations in laboratory values, which included serum chemistry, haematology and urinalysis, within or between either group. The adverse events profiles for both groups were similar. The most frequent adverse event was insomnia, in 40 (25.3%) patients given the terfenadine-pseudoephedrine combination and in 42 (26.8%) of those given pseudoephedrine. No unusual or unexpected adverse events were reported.

Development of salt aversion in the Fischer-344 rat

Adult Fischer-344 (F-344) rats fail to prefer NaCl solutions of any concentration to water and, in fact, avoid NaCl at solution concentrations which other strains of rats reliably prefer. In contrast, immature rats of a number of strains have been reported to express an elevated salt preference relative to adults. The present studies examine the development of the F-344 rat's salt aversion by testing salt preference in the preweaning (Day 10) and weanling (Days 20-24) F-344 rat. At Day 10, F-344 rats ingested significantly more 1% and 2% NaCl solutions than water during "towel testing" and their preference was comparable to that displayed by other strains at this age. By the time of normal weaning (Days 20-24) significant avoidance of NaCl solutions in the isotonic range was displayed by F-344 rats, and their preference was strikingly different from other rat strains. This was evident in a 24-hr 2-bottle preference test as well as a 25 min "towel test." Since NaCl preference of F-344 rats is comparable to other rat strains at Day 10 but dramatically different by Day 20, a change must occur during this time which reverses the hedonic value of NaCl stimulation. Identification of factors responsible for this reversal may provide insight into the causes both of the F-344 rat's dislike of salt and the immature rats elevated salt preference.

Strain differences in taste reactivity to NaCl

The taste reactivity test was used to determine whether strain differences in response to NaCl revealed by preference tests were attributable to taste or postoral factors. Taste reactivity data revealed significant differences between sodium-replete Fischer 344 (F-344) and Wistar strains in response to NaCl for both aversive and ingestive oral motor behaviors. Because the taste reactivity test analyzed the immediate response to orally applied chemical stimuli, these data support a strain difference based on taste factors. Taste reactivity data also indicate strain differences in ingestive but not aversive scores to other normally ingested chemical stimuli, water, and two sucrose concentrations. In response to normally avoided quinine, F-344 and Wistar strains did not differ in either ingestive or aversive score. To investigate whether strain differences revealed when rats were tested while sodium replete would persist in the sodium-deficient state, both strains were treated with the diuretic furosemide. Taste reactivity tests revealed that in response to sodium deficiency both F-344 and Wistar strains shift their oral motor response profile to NaCl; strains did not differ in either ingestive or aversive score when sodium deficient. NaCl intake and preference measures also support the fact that both strains demonstrate a sodium appetite. Interpretive limitations based on ceiling and floor effects within taste reactivity and preference data were discussed.

Prevention of chymopapain anaphylaxis by screening chemonucleolysis candidates with cutaneous chymopapain testing

With chymopapain at a concentration of 10 mg/ml, the authors skin tested 540 chemonucleolysis candidates; six were positive, and 534 were negative. None of the positive patients received therapeutic injections of chymopapain. There were no instances of unequivocal anaphylaxis to chymopapain in the patients with negative skin tests treated with chymopapain. When this 0% incidence of systemic reactions in skin test negative patients is compared with the historical rate of 1%, this difference is statistically significant (p less than 0.05). Restriction of chymopapain treatment to patients with negative prick tests can reduce the incidence of systemic reactions.

Immune responses of cynomolgus monkeys to phthalic anhydride

Four groups of four Macaca fascicularis monkeys were administered 10 consecutive weekly subcutaneous injections of 2 mg aluminum hydroxide plus one of the following: 200 micrograms of phthalic anhydride (PA)-monkey serum albumin (PA-MSA, group 1); 200 micrograms of PA dissolved in ethanol-saline (EtOH-sal, group 2); 200 micrograms of MSA (group 3); or EtOH-sal alone (group 4). Direct intracutaneous tests to PA-MSA, PA-EtOH-sal, MSA, and EtOH-sal were applied at biweekly intervals throughout the course of the immunization. Serum-specific IgG to PA-MSA and specific IgE to PA-MSA were determined at 2-week intervals according to the ELISA and RAST methods, respectively. The prevalence of cutaneous sensitivity to PA-MSA in the PA-MSA-immunized group (group 1) was significantly greater after 4 and 6 (p less than 0.01) and 8 and 10 (p less than 0.05) weeks, compared with the other treatment groups. Significantly elevated (p less than 0.01) PA-MSA-specific IgG was also observed in monkeys in group 1 compared with the other treatment groups. No significant changes in PA-MSA RAST or total IgE were observed in any group during the study. These results indicate that parenteral sensitization to PA in subhuman primates requires the presence of new antigenic determinants formed by PA on protein carriers.

Pulmonary and immunologic evaluation of foundry workers exposed to methylene diphenyldiisocyanate (MDI)

A cross-sectional evaluation was performed of workers in a steel foundry in which methylene diphenyldiisocyanate (MDI) was used as a component of a binder system used to make cores and molds. Preshift and postshift spirometry and clinical evaluations were performed on 26 currently exposed (group I), on six formerly exposed (group II), and on 14 nonexposed workers to MDI (group III). Serum samples were assayed for total antibody binding, specific IgG by ELISA, and specific IgE by the RAST method to MDI-human serum albumin (HSA). Symptoms compatible with occupational asthma were elicited from seven (27%) of 26 group I workers and from three of six group II workers. No symptoms were reported by group III workers. Intrashift change in FEV1 (a mean decrease of 0.049 L) in group I workers was significantly decreased compared to that in unexposed group III workers (a mean increase of 65 ml; p = 0.043). Specific IgG and total antibody responses to MDI-HSA were detected only in workers with current or former exposure to MDI. Only one worker was identified with IgE-mediated occupational asthma exhibiting a positive prick test and elevated RAST to MDI-HSA of 25.5% bound. In this occupational setting, polyclonal immune responses to MDI-HSA and clinical sensitization to MDI were demonstrated to occur.

An open study of auranofin in the treatment of steroid-dependent asthma

To determine the efficacy of oral gold in asthma, 20 patients with steroid-dependent asthma received auranofin at a dose of 3 mg by mouth, twice daily, in a 24-week open clinical trial. Prospective evaluation of bronchial responsiveness to methacholine was determined before and 8 and 16 weeks after initiation of auranofin therapy. Serial spirometry (FEV1 and FVC), lung volumes, and diffusing capacities (single breath carbon monoxide diffusing capacity of the lungs) were measured before and at 10 and 20 weeks after treatment. All subjects were required to record concomitant medications, symptom scores, and morning and evening peak expiratory flow rates. In vitro immunologic studies performed before and after 8 and 20 weeks of auranofin therapy included leukocyte histamine release in response to antihuman IgE, lymphocyte blast transformation in response to concanavalin A and phytohemagglutinin, and leukocyte inhibitory factor activity in response to Candida albicans and tetanus toxoid antigens. In 18 patients evaluated, there were no significant differences between baseline and posttreatment spirometry, single breath carbon monoxide diffusing capacity of the lungs, and lung volumes. At week 16 of treatment, the steroid cumulative dose or the total prednisone dose administered from 7 days before through 10 days after each methacholine test day decreased from a mean of 293 +/- 125 mg at baseline to 192 +/- 115 mg. At week 16, nine of 18 patients (50%) exhibited decreased methacholine responsiveness as defined by a more than one-half log10 increase in the concentration of methacholine causing a 20% decrease in FEV1. A significant correlation (r = 0.60) was observed between the increase in the concentration of methacholine causing a 20% decrease in FEV1 and the decrease in steroid cumulative dose after 16 weeks of treatment. Leukocyte histamine release to anti-IgE exhibited significant reductions from baseline at week 20 to 10(-2) (p less than 0.002) and at 10(-3) (p less than 0.005) dilutions. At week 20, leukocyte inhibitory factor activity in response to Candida increased from baseline at the 0.1 mg per well (p = 0.025) and 1 mg per well (p = 0.05) concentrations; similarly, the responses to tetanus toxoid increased at the 1 mg per well (p less than 0.05) and 0.1 mg per well (p less than 0.01) concentrations.(ABSTRACT TRUNCATED AT 400 WORDS)