Allergic Rhinitis and Sinusitis

Allergic rhinitis may often be satisfactorily managed by antihistamines, decongestants, and topical corticosteroids. When these simple methods fail, specific diagnosis and injection treatment (immunotherapy) by the specialist in allergy and immunology are in order.

IgE antibody measurements in ragweed hay fever. Relationship to clinical severity and the results of immunotherapy

Specific IgE anti-ragweed antibodies (IgEAR) were measured over two years in two groups of highly sensitive patients treated (immunized) with either ragweed extract or placebo and in a third group of placebo-treated, relatively insensitive patients. The IgEAR on the patients' basophils were assessed by ragweed antigen E (AgE)-induced histamine release; blocking (IgG) antibodies were measured by their ability to inhibit AgE induced histamine release. These data were evaluated against the clinical severity of ragweed hay fever in each patient. WE FOUND THAT: (a) In placebo treated patients IgEAR usually declined gradually prior to the ragweed season and were boosted by environmental exposure to ragweed pollen. (b) In immunized patients the IgEAR rose at the beginning of treatment, but fell as immunotherapy proceeded; by the end of the second year the levels had decreased in 18/19 patients. (c) The increase in blocking antibody during immunotherapy correlated significantly (P < 0.05) with the decrease in serum IgEAR. (d) Judged by their sensitivity to AgE induced histamine release, IgEAR on basophils correlated significantly with IgEAR in the serum of untreated patients (P < 0.01). (e) The highly sensitive placebo treated patients' symptom scores were significantly correlated with their IgEAR in serum (P < 0.01) and with the sensitivity of their basophils to AgE-induced histamine release (P < 0.01). Neither correlation was observed in the relatively insensitive patients. (f) In the treated group the IgEAR measurements predicted neither the degree of their illness nor their clinical improvement We conclude tha IgE antibody measurements may be useful in the assessment of the severity of reaginic allergy in highly sensitive patients. Its use in modestly sensitive patients requires patients requires further study, as does the inverse association between IgE and IgG antiragweed antibodies.

Induction of IgE-mediated immediate hypersensitivity to group I rye grass pollen allergen and allergoids in non-allergic man

The major (Group I) allergen of rye grass pollen and two of its allergoids, adsorbed on alumina gel, were injected into three groups of non-allergic humans. In addition to inducing the anticipated blocking antibody (IgG) response, all individuals developed immediate skin hypersensitivity to the allergen and its allergoids characteristic of reaginic antibody-(IgE-)mediated reactions. At some time during the course of the study, virtually every individual's peripheral blood leucocytes were also found to release histamine when challenged in vitro with low concentrations of allergen and allergoids. Quantitatively, each person's skin and leucocyte sensitivities were not as well correlated as in naturally allergic people. Leucocyte responsiveness was generally shortlived, but could be restored by antigenic restimulation. Allergoid: allergen sensitivity ratios were greater in allergen-than allergoid-immunized individuals, but less than in naturally allergic individuals. Unexpectedly, allergoid-immunized individuals' leucocytes were more sensitive to allergen than allergoid. Despite the observed skin and leucocyte reactivities, none of the people showed clinical manifestations of hay fever following natural exposure to pollen.

The skin sensitivity of the artificially sensitized individuals could be passively transferred to non-allergic humans by intradermal injection of serum (P-K Test), thereby implicating the involvement of IgE antibody. Further proof of the role of IgE was obtained by blocking the P-K test, either by heating the serum or by adsorbing it using an anti-IgE immunosorbent.

Nasal secretory antibody to inhalant allergens in allergic and non-allergic patients

Nasal washings were obtained from normal and ragweed allergic (immunized and non-immunized) subjects. All specimens contained `blocking' antibodies as measured by their ability to inhibit antigen E induced histamine release from human leucocytes. The antibody was largely of the IgA class (secretory antibody). There was little difference between the blocking activity of normal, allergic and immunized allergic subjects. All patients also had blocking secretory antibody against grass pollen group I antigens to which they were not clinically sensitive. There was no correlation between the level of anti-grass and anti-ragweed activity; moreover, no antibody activity was demonstrated against an allergen (pitressin) to which the subjects had not been exposed. A modest but significant rank correlation was found between the level of serum and nasal anti-ragweed activity in the allergic immunized patients, but no relationship obtained between the clinical severity of symptoms referable to ragweed exposure and the level of nasal antibody. It is concluded that all subjects environmentally exposed to pollen allergens develop nasal blocking antibodies; the level of this antibody bears little relationship to parenteral immunization and no detectable relationship to the clinical severity of ragweed hay fever.