Immunotherapy of atopic disorders. Present state of the art and future perspectives

A new method, distribution-analyzing latex immunoassay (DALIA), to measure specific immunoglobulin G against mite and wheat allergen in human sera

A distribution-analyzing latex immunoassay (DALIA), based on the agglutination of latex particles coupled with mite or wheat allergen, was developed to determine allergen-specific IgG in human sera. The immune complex between chemically coupled-allergen latex and specific IgG was agglutinated specifically and efficiently by employing an IgM-type monoclonal second antibody with strong amplification activity. The extent of agglutination was evaluated by determining the relative ratio of volumes (RV) of agglutinates to residual nonagglutinating particles with a particle counter. This method exhibited a high sensitivity (detection limit < or = 5 units/ml) in the determination of allergen-specific IgG, and no influence of inhibitory factors such as competitive antibodies (specific-IgA, -IgM) and nonspecific IgG (< or = 320 mg/ml) was observed. The concentrations of specific IgG against mite allergen in the sera of 130 allergy patients with atopic dermatitis and 52 normal subjects were 22.3 +/- 12.3 and 16.5 +/- 4.2 units/ml, respectively, and the concentrations of specific IgG against wheat allergen in the same two groups were 5.4 +/- 4.2 and 2.1 +/- 2.2 units/ml, respectively. The coefficients of variation of intra- and interassay ranged from 3.4% to 11.2% in both cases. The present method is an excellent homogeneous immunoassay which may be used as a routine assay that can measure 50 samples per hour without prior treatment.

Increased ciliary beating frequency of nasal mucosa following immunotherapy for allergy

The present study was designed to elucidate the effect of immunotherapy on the beating frequency of nasal cilia in patients with nasal allergy. Of 40 patients with nasal allergy due to Dermatophagoides farinae, 20 were treated with immunotherapy by the use of D farinae extracts, and 20 control patients were treated with antihistamine tablets. Mucosal pieces were taken from the right inferior turbinate before and 1 year after the initiation of treatment, and the ciliary beating frequency (CBF) was examined by a photoelectric method. The use of antihistamine tablets did not increase CBF even when it relieved the nasal symptoms. Immunotherapy, on the other hand, increased CBF in 66.7% of patients when it alleviated their nasal symptoms. The CBF before immunotherapy of patients who showed an increase CBF after treatment was statistically higher than that of patients who did not.

Bronchial asthma. Mechanisms and management of a complex obstructive airway disease

Airway hyperreactivity to physical, chemical, and pharmacologic stimuli is a hallmark of bronchial asthma. In patients with extrinsic (allergic) asthma, in whom an immunologic mechanism of the IgE type can be demonstrated, specific sensitivity develops to a variety of common environmental substances, including pollen, fungus spores, house dust mites, and animal danders. Persons with intrinsic asthma, in whom immunologic mechanisms are hard to demonstrate, often have chronic sinus disease and nasal polyps and manifest clinical intolerance to nonsteroidal antiinflammatory agents. Evaluation of asthma includes a history and complete physical examination, skin tests, radioallergosorbent tests, pulmonary function tests, blood gas determination, and inhalation challenge tests. Treatment is focused on environmental control, pharmacotherapy, and immunotherapy.

House dust mite-specific IgE, IgG1, and IgG4 antibodies in patients with perennial rhinitis

Serum samples were obtained from patients with house dust mite-sensitive nasal allergies before and 6 months after immunotherapy, and the level of immunoglobulin (Ig)E, IgG1, and IgG4 antibodies in those sera was determined by the enzyme-linked immunosorbent assay. The present data showed that the mite-specific IgG4 antibodies increased in patients who responded well to immunotherapy but not in those who responded poorly. It was suggested from the present study that IgG4 antibodies seem to act as "blocking antibodies" to reduce the allergic reaction in the target organ, and that an increase of allergen-specific IgG4 antibodies following immunotherapy can be of clinical benefit to patients suffering from mite-specific nasal allergy.