Morphology of delayed-type hypersensitivity reactions in man

Anti-Inflammatory Effects of Cold Thermal Therapy on Allergic Skin Inflammation Induced by Trimellitic Anhydride in BALB/c Mice

Cold and hot thermal therapies are widely used as a traditional therapy in many cultures and are often prescribed in the treatment of various musculoskeletal and neurological conditions which present themselves to primary care physicians. However, there are no reports that investigated either the effects of cold and hot thermal therapies on the skin inflammation of trimellitic anhydride- (TMA-) induced dermatitis-like contact hypersensitivity (CHS) mouse model, or the mechanism of thermal therapy on allergic skin inflammation. Therefore, in this study, to reveal the anti-inflammatory effect of thermal therapy and its mechanism on TMA-induced CHS, we analyzed ear-swelling response (ear edema), vascular permeability, serum IgE levels, histological examination, and histamine and Th2 cytokine levels. Cold thermal therapy reduced the ear-swelling response, the vascular permeability, the serum IgE levels, and the infiltration of eosinophils and mast cells as well as the mast cell degranulation. To determine the mechanism by which cold thermal therapy inhibits allergic skin inflammation, detailed studies were carried out revealing that cold thermal therapy suppressed IL-4 and IL-5 secretion and mast cell activation. These results indicated that cold thermal therapy cures skin inflammation of TMA-induced CHS by decreasing Th2 cytokine release, especially IL-4 and IL-5, and mast cell activation. These data suggest that new insight into the mechanism of robust therapeutic effects of cold thermal therapy against allergic dermatitis, and cold thermal therapy may prove to be a useful therapeutic modality on allergic inflammatory diseases as traditional use as well as Th2- or mast cell-mediated allergic responses.

Role of mast cell in the late phase of contact hypersensitivity induced by trimellitic anhydride

Mast cells are known as effector cells of IgE-mediated allergic responses, but role of mast cells in contact hypersensitivity (CHS) has been considered controversial. In this study, we investigated role of mast cell in trimellitic anhydride (TMA)-induced CHS. The mice were sensitized to TMA on the back and repeatedly challenged with TMA on the left ear at 1-week intervals. The ear after challenge showed biphasic responses. The repetition of TMA challenge shifted in time course of ear response and enlarged the extent of early and late phase reactions in proportion to the frequency of TMA challenges in C57BL/6 mice. In late phase reaction, peak of ear response by single challenge showed at 24 hours after challenge, but the peak by repeat challenges at 8 hours after the last challenge. Number of mast cells and eosinophils per unit area increased in proportion to frequency of TMA challenges. However, mast cell-deficient WBB6F1/J-Kit^W/Kit^W-v mice developed the late phase reaction without the early phase reaction. The repetition of TMA challenge shifted in time course of ear response and enlarged the extent of ear response and the infiltration of eosinophils. The magnitude of these responses observed according to the frequency of the TMA challenge in mast cell-deficient WBB6F1/J-Kit^W/Kit^W-v mice was significantly lower than that in C57BL/6 mice. Also TMA elicited mast cell degranulation and histamine release from rat peritoneal mast cells in a concentration-dependent manner. Conclusively, TMA induces the early and late phase reactions in CHS, and mast cells may be required for TMA-induced CHS.

Mast cell: an emerging partner in immune interaction

Mast cells (MCs) are currently recognized as effector cells in many settings of the immune response, including host defense, immune regulation, allergy, chronic inflammation, and autoimmune diseases. MC pleiotropic functions reflect their ability to secrete a wide spectrum of preformed or newly synthesized biologically active products with pro-inflammatory, anti-inflammatory and/or immunosuppressive properties, in response to multiple signals. Moreover, the modulation of MC effector phenotypes relies on the interaction of a wide variety of membrane molecules involved in cell–cell or cell-extracellular-matrix interaction. The delivery of co-stimulatory signals allows MC to specifically communicate with immune cells belonging to both innate and acquired immunity, as well as with non-immune tissue-specific cell types. This article reviews and discusses the evidence that MC membrane-expressed molecules play a central role in regulating MC priming and activation and in the modulation of innate and adaptive immune response not only against host injury, but also in peripheral tolerance and tumor-surveillance or -escape. The complex expression of MC surface molecules may be regarded as a measure of connectivity, with altered patterns of cell–cell interaction representing functionally distinct MC states. We will focalize our attention on roles and functions of recently discovered molecules involved in the cross-talk of MCs with other immune partners.

Human placental pericytes poorly stimulate and actively regulate allogeneic CD4 T cell responses

OBJECTIVE

Cell-mediated immune responses in peripheral tissues begin with T cell infiltration through endothelial cell (EC) microvessels and accumulation in the perivascular space occupied by pericytes (PC). Here, we investigate how human T cells interact with PC.

METHODS AND RESULTS

We compared human placental PC with autologous umbilical vein EC. Cultured PC express lower levels of major histocompatibility complex (MHC) and positive costimulatory molecules but higher levels of negative costimulatory molecules than do EC. Unlike EC, interferon-γ-treated MHC class II-positive PC (PC(+)) cannot stimulate resting allogeneic CD4 T cell proliferation or cytokine production. Instead, coculture of resting CD4 T cells with PC(+) induces CD25 expression and renders T cells unresponsive to restimulation by EC(+) from the same donor. PC cultured across a semi-permeable membrane decrease alloreactive CD4 T cell proliferation to EC(+), an effect enhanced by pretreatment of PC with interferon-γ and partially reversed by interleukin-10 and transforming growth factor-β neutralization, but do not induce anergy.

CONCLUSIONS

Human placental PC are poorly immunogenic and negatively regulate CD4 T cell responses through contact-dependent and contact-independent mechanisms.

Mast cells as "tunable" effector and immunoregulatory cells: recent advances

This review focuses on recent progress in our understanding of how mast cells can contribute to the initiation, development, expression, and regulation of acquired immune responses, both those associated with IgE and those that are apparently expressed independently of this class of Ig. We emphasize findings derived from in vivo studies in mice, particularly those employing genetic approaches to influence mast cell numbers and/or to alter or delete components of pathways that can regulate mast cell development, signaling, or function. We advance the hypothesis that mast cells not only can function as proinflammatory effector cells and drivers of tissue remodeling in established acquired immune responses, but also may contribute to the initiation and regulation of such responses. That is, we propose that mast cells can also function as immunoregulatory cells. Finally, we show that the notion that mast cells have primarily two functional configurations, off (or resting) or on (or activated for extensive mediator release), markedly oversimplifies reality. Instead, we propose that mast cells are "tunable," by both genetic and environmental factors, such that, depending on the circumstances, the cell can be positioned phenotypically to express a wide spectrum of variation in the types, kinetics, and/or magnitude of its secretory functions.

Food hypersensitivity and irritable bowel syndrome

Irritable bowel syndrome is a common condition but its pathophysiology remains poorly understood. Many irritable bowel syndrome patients give a history of food intolerance, but data from dietary elimination and re-challenge studies are inconclusive. Multiple aetio-pathological mechanisms have been postulated. The gut has an extensive immune system but current understanding of processing of food antigens in health and disease is limited. There is no clinically useful marker available to test for food hypersensitivity in irritable bowel syndrome. Researchers have employed both skin tests and serum immunoglobulins (IgG and IgE) as markers of food hypersensitivity in various disorders including irritable bowel syndrome, but published data are equivocal. In this article, the evidence for the role of food hypersensitivity in irritable bowel syndrome is reviewed and, based on the available data, a possible pathophysiological hypothesis has been formulated.

Lymphohistiocytic and granulomatous phlebitis in penile lichen sclerosus

Lichen sclerosus (LS) is a chronic inflammatory disease of unknown etiology that may affect the genital and/or extragenital skin of individuals of either sex at all ages. In boys, the prepuce is the most common site of involvement. The diagnostic criteria of LS include the presence of inflammatory infiltrates mainly composed of T lymphocytes. We report on two cases of LS of the prepuce because of the unusual feature of lymphocytic (CD45RO+ and CD20+), histiocytic (CD68+), and granulomatous phlebitis. This lesion was not present in a group of another 18 cases of childhood penile LS. We have not been able to find any references describing and illustrating inflammatory involvement of the dermal vein walls in LS. Unlike the data reported in the literature, the dermal inflammatory infiltrates of these two cases showed a similar proportion of B and T lymphocytes in addition to frequent CD68+ histiocytes.

Histamine content and secretion in basophils and mast cells

Biochemical determinations of the histamine content and secretion from basophils and mast cells have been available for some time, and much of the complex anatomy of these cellular populations and their release reactions has been documented using the electron microscope. The ultrastructural analyses led to the description of vesicular transport between secretory granules and the plasma membrane as a mechanism for secretion from basophils and mast cells--a process termed piecemeal degranulation. Proof of concepts incorporated in a general degranulation model put forth in 1975 (DVORAK, H.F. and DVORAK, A.M.) requires high magnification imaging of a granule constituent in trafficking vesicles in the process of a stimulated release reaction in which the constituent release is monitored biochemically. Development and application of a new enzyme-affinity method to detect histamine at high magnifications in well-preserved ultrastructural samples have provided the necessary means to establish proof that appropriate secretagogues can stimulate the vesicular transport of histamine in basophils and mast cells during release reactions monitored biochemically. The background information necessary to the understanding of this result is presented here, as well as the development and verification of the diamine oxidase-gold method to image histamine in human mast cell granules as the test system. Also presented are applications using this technology to examine histamine stores and secretion in vitro, in vivo, and ex vivo in human basophils and mast cells and in mouse mast cells. Specifically examined are histamine stores developing in maturing mast cells induced to develop de novo from cultured human cord blood cells, secretagogue-stimulated release and recovery of histamine stores from isolated, purified human lung mast cells ex vivo, cytokine-stimulated degranulation of human skin mast cells and their histamine stores in vivo, piecemeal degranulation of human gut mast cells and their histamine stores in inflammatory bowel disease in vivo, piecemeal degranulation of mouse skin mast cells and their histamine stores in inflammatory eye disease in an interleukin-4 transgenic mouse model in vivo, and the stimulated secretion and recovery of histamine from human basophils ex vivo.

Cell biology of the basophil

The cell biology of basophils, based on published studies spanning 1990-1997, is reviewed. These rarest cells of granulocyte lineages are now available in sufficient numbers for such studies to be done, based on new methods for isolating and purifying the cells from peripheral blood and organ sources and for their derivation in growth factor-containing cultures from their precursors de novo. These studies are dependent on electron microscopy for the accurate identification of basophils, studies which have recently established the presence of basophils in two new species--mice and monkeys. Secretory, endocytotic and storage properties of basophils constitute their mechanistic role(s) in human disease; their role(s) in health is, however, obscure. Development of immunoaffinity and enzyme-affinity ultrastructural labeling techniques to image the Charcot-Leyden crystal protein and histamine in human basophils, coupled with ultrastructural analysis of kinetic samples of cells obtained after stimulation with diverse secretogogues, has provided insight into the role of vesicles in secretory transport mechanisms in human basophils as well as the definition of key ultrastructural phenotypes of secreting basophils.

Persistent immune tolerance to nickel and chromium by oral administration prior to cutaneous sensitization

Oral administration of allergens, foreign proteins, or cell-bound antigens may induce systemic suppression of subsequent humoral and cell-mediated immune responses ("oral tolerance"). The induction of specific immune tolerance provides a potential strategy for treatment of T-cell-dependent immune diseases. Therefore, in depth studies into preconditions for optimal and persistent tolerance induction are mandatory. Here we report on such studies in a guinea pig model using the non-cross-reactive contact allergens nickel and chromium. Feeding per os of nickel sulfate or potassium dichromate did not trigger systemic TDTH-effector functions. Instead, short feeding periods led to a dose-dependent, and metal-specific, suppression of subsequently induced allergic contact hypersensitivity. Administration of the allergens onto the oral mucosa was most effective in the induction of immune tolerance. When first sensitizing attempts were delayed until 1 year after feeding, the degree of unresponsiveness was reduced. In contrast, with cutaneous contacts starting shortly after the feeding period, tolerance was fully stable and undiminished for at least 2 years. Thus, in orally treated guinea pigs cutaneous contacts provide boosting tolerogenic signals, supporting the view that oral tolerance does not result from clonal deletion but from active antigen-specific immunosuppression. Indeed, unresponsiveness to cutaneous immunization could be transferred by lymphoid cells from fed guinea pigs in a metal-specific way.

Characterization of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis

Hair-bearing, transitional, and alopecic scalp from three males and one female with progressive pattern alopecia were examined. Ultrastructural studies disclosed measurable thickening of the follicular adventitial sheaths of transitional and alopecic zones compared with those in the non-alopecic zones. This finding was associated with mast cell degranulation and fibroblast activation within the fibrous sheaths. Immunohistochemically, control biopsies were devoid of follicular inflammation (n = 3), while transitional regions consistently showed the presence of activated T-cell infiltrates about the lower portions of follicular infundibula. These infiltrates were associated with the induction of class II antigens on the endothelial linings of venules within follicular adventitia and with apparent hyperplasia of follicular dendritic cells displaying the CD1 epitope. Inflammatory cells infiltrated the region of the follicular bulge, the putative source of stem cells in cycling follicles. The data suggest that progressive fibrosis of the perifollicular sheath occurs in lesions of pattern alopecia, and may begin with T-cell infiltration of follicular stem cell epithelium. Injury to follicular stem cell epithelium and/or thickening of adventitial sheaths may impair normal pilar cycling and result in hair loss.

Degranulation of cystic fibrosis nasal polyp mast cells

The ultrastructure of nasal polyps from cystic fibrosis (CF) patients was compared with non-CF nasal polyps in this study. Morphometric analysis showed that CF nasal polyps contained greater numbers of mast cells, endothelial cells, lymphocytes, and plasma cells compared with the non-CF specimens. Morphologic evidence of degranulation was seen in approximately 30 per cent of the CF mast cells but was not observed in the non-CF mast cells. Increased numbers of small granules, vacuolated granules, and lipid bodies were noted in the CF compared with the non-CF nasal polyp mast cells. Also observed was a decrease in collagen in the extracellular space of the CF nasal polyps compared with the non-CF specimens. Although eosinophils were observed in the non-CF nasal polyp tissue, these leukocytes were absent in the CF nasal polyps. These data indicate that striking morphologic differences exist between CF and non-CF nasal polyps with mast cell degranulation, a salient feature of CF specimens.

Intercellular adhesion molecule expression in the evolving human cutaneous delayed hypersensitivity reaction

Intercellular adhesion molecule-1 (ICAM-1), putatively expressed by antigen-presenting or target skin cells, is a ligand for the lymphocyte function-associated antigen (LFA-1) present on circulating lymphocytes. Immunohistochemistry of normal adult human skin using monoclonal antiserum to ICAM-1 demonstrated focal reactivity restricted to endothelium lining the dermal microvasculature. Delayed hypersensitivity responses elicited with dinitrochlorobenzene in the skin of the same subject were evaluated sequentially over a 96 h period using immunohistochemical and ultrastructural techniques. The first alteration observed consisted of mast cell degranulation within perivenular foci in the superficial dermis at 4 h after antigen challenge. Sparse superficial perivascular T-cell infiltrates were present by 24 h. Progressive staining for ICAM-1 was observed in microvascular endothelium and in dermal dendritic cells between 24 and 48 h. ICAM-1 expression was documented focally within the lower epidermis at 48 h and diffusely within the lower and upper epidermal layers at 96 h. ICAM-1 expression by keratinocytes was consistently associated with T-cell migration into the epidermis, whereas migration was never observed in the absence of ICAM-1 reactivity. Immunoelectron microscopy confirmed ICAM-1 to be exclusively present on endothelial cells, dermal dendritic cells, mononuclear cells, and keratinocytes, and permitted characterization of the patterns of membrane reactivity. ICAM-1 expression by epidermal cells appears to be closely linked to the progressive migration of T cells from the dermis into the epidermis that characterizes cutaneous delayed hypersensitivity.

Degranulation of human mast cells induces an endothelial antigen central to leukocyte adhesion

To understand better the role of mast cell secretory products in the genesis of inflammation, a system was developed for in vitro degranulation of human mast cells in skin organ cultures. Within 2 hr after morphine sulfate-induced degranulation, endothelial cells lining microvessels adjacent to affected mast cells expressed an activation antigen important for endothelial-leukocyte adhesion. Identical results were obtained when other mast cell secretagogues (anti-IgE, compound 48/80, and calcium ionophore A23187) were used. Induction of this antigen was abrogated by preincubation with cromolyn sodium, an inhibitor of mast cell secretion, and by antiserum to tumor necrosis factor alpha. These findings indicate that degranulation of mast cells activates dermal endothelium through tumor necrosis factor-dependent mechanisms. This event may be critical to the elicitation phase of cutaneous inflammation.

Patch testing in prurigo nodularis

32 patients with prurigo nodularis evaluated at the Mayo Clinic from 1975 to 1987 have been patch tested for sensitivity to appropriate allergen series; 25 of these had relevant positive reactions and subsequent follow-up to 5 to 14 years was available for 11. 6 patients had persistent disease and 5 had resolution or marked improvement. 3 of these latter patients noted a strong positive correlation between improvement and avoidance of contact allergens. Screening for contact sensitivity may be helpful in the management of this refractory dermatosis, particularly if there is a coexistent dermatitis.

The immunology of contact dermatitis. A review with special reference to the pathophysiology of eczema

This review summarizes current knowledge of the pathophysiological events which lie behind the development of contact dermatitis. The clinical distinction between allergic and irritant eczema is discussed. New observations are evaluated on our understanding of how allergic and irritant eczema may in many respects be similar, evolving through common physiological pathways of immune inflammation.

Experience with percutaneous titanium implants in the head and neck: a clinical and histological study

Percutaneous implants have been associated with numerous problems. However, by using skin-penetrating, bone-anchored titanium implants, developed by Professor Brånemark at the Department of Anatomy, University of Göteborg, good long-term results have been observed. These implants have been in clinical use for anchorage of bone-conducting hearing aids and facial prostheses since 1977 and 1979, respectively. The total number of implants is approximately 700. Less than 4% of the observations have shown significant irritation. Biopsies from 33 patients were collected for histological studies. In the irritated skin there was an increased number of inflammatory cells, mainly polymorphonuclear cells, B-cells, and plasma cells but not T-cells. This suggests a response directed against exogenous agents rather than an allergic reaction against the implant per se.

Evidence for circulating IgE complexes in food allergy

Antigen entry and the formation of immune complexes occur in atopic subjects after food ingestion. We have studied patients with asthma, eczema and arthralgia and we were able to detect the presence of IgE immune complexes and the antigen entry from the gut before and after food challenge. Food allergic subjects showed, after food challenge, the presence of IgE and IgG immune complexes, which correlates with the subsequent occurrence of symptoms. Both the symptoms and the appearance of IgE immune complexes could be prevented by pretreatment with oral sodium cromoglycate (SCG). IgE immune complexes were isolated by an isokinetic ultracentrifugation gradient and the components were analyzed for antigen-specific IgE and IgG as well as free antigen levels. The observation that SCG reduces antigen entry, the appearance of IgE immune complexes and the occurrence of symptoms point to the central role of IgE in the intestinal mucosa.

The role of basophils in the immunopathogenesis of hypersensitivity to fleas (Ctenocephalides felis) in dogs

Biopsies taken of skin test sites from 10 dogs allergic to fleas were fixed in Karnovsky's fixative and embedded in methacrylate. One micron sections were stained with acid Giemsa for identification of basophils. This cell was identified in most biopsies taken at intervals from 1 hour to 48 hours post-injection. The proportion was highest between 4 hours and 18 hours and had substantially fallen by 48 hours. The highest number of basophils recorded as a percentage of the inflammatory infiltrate was 22.1%, with biopsies from 7 of the 10 dogs showing in excess of 10% basophils at some point. The results suggest that cutaneous basophil hypersensitivity may play an immunopathogenic role in flea-bite hypersensitivity in dogs.

Ultrastructure of the immediate, histamine-mediated microvascular response in human skin with urticaria pigmentosa

The immediate microvascular response in the skin of adults with urticaria pigmentosa after activation of mast cells was examined with the electron microscope. Mast cell degranulation was activated by gently rubbing the cutaneous lesion, and biopsy material was removed 5 to 10 min following stimulation. Aspects of mast cell degranulation were found in all the samples. Several indications of the effects produced by histamine release upon permeability of the small upper dermal venules were evident: (1) Scattered endothelial contraction, which resulted in alternation of contracted and dilated portions of the endothelial wall. Deep nuclear indentations in the contracted endothelial cells occurred in a proportion of 53%. (2) Marked dilation and congestion of some venules. (3) Randomly distributed interendothelial gaps, with platelets or red blood cells traversing the gap. The open junctions of small diameter were numerous, whereas the large gaps were numerically few. (3) The presence of a dense material consistent with plasma protein beneath and external to the vascular basement membrane. Vessels showing aspects similar to those occurring after mild thermal injury were noticed. The possibility exists that several mediators and mechanisms superimpose during the early histamine-mediated phase of the vascular response in urticaria pigmentosa following activation of mast cells.

Causative agents, mediators and histomorphology of inflammation

The purpose of this survey on the interrelationship of causative agents, mediators and the histomorphology of inflammation is to show to what extent endogenous biochemical factors determine the inflammatory reaction. There is overwhelming evidence, today, that such factors are involved in the manifestation of acute as well as chronic, non-specific as well as well as specific inflammation. In fact, the histomorphological pattern of many inflammatory reactions more directly reflects the activity of the mediators than of the causative agents involved. Therefore, knowledge of the properties of mediators of inflammation does not only provide new insights into the underlying pathomechanisms but may also help in the understanding and interpretation of the histomorphology of inflammatory lesions.

Tissue mast cells in health and disease

Mast cells (MC) are regular constituents of soft tissue and occur with varying frequency in nearly every organ. They derive from monocytic cells occurring in the adhering mononuclear fraction of the peripheral blood. Their subsequent evolution into mature MCs is primed by a MC generating lymphokine released by sensitized T-cells on restimulation by the antigen. MC granules contain preformed heparin histamine and eosinophil chemotactic factors. Other factors such as leukotriene B4 can be produced by MCs following stimulation. This is the case during the initial phase of nonspecific inflammations, when MCs are stimulated by complement activation. In the immediate type hypersensitivity reaction giving rise to IgE, MC degranulation occurs independent from complement. In IgG and IgM mediated reactions, however, MC involvement is effected by complement consumption and C5 a generation. In delayed type hypersensitivity MCs increase locally. Their functional significance remains obscure. MC neoplasias are rare and generally confined to the dermis. Cutaneous mastocytoses are called benign mastocytoma when localized and urticaria pigmentosa when disseminated. Generalized mastocytosis involves extracutaneous tissue irrespective of skin involvement. Those associated with urticaria pigmentosa-like skin lesions, present at the onset of the disease, have a significantly higher survival rate than those lacking a primary skin involvement. The term urticaria pigmentosa should be reserved for cases of cutaneous mastocytosis without extracutaneous involvement. Cases of mastocytoses lacking primary skin lesions assume a malignant course and are additionally aggravated by high incidence of myeloproliferative disorders and MC leukemia. MC sarcoma is an extremely rare neoplasia of MCs which may also terminate as a MC leukemia.

A reliable rat model of the delayed hypersensitivity skin test response

A model of the delayed type hypersensitivity response (DTH) has been developed in Sprague-Dawley rats. The sensitizing and skin test antigen is keyhole limpet hemocyanin (KLH). This antigen produces 99% sensitization and the response is maintained in 98% of the animals for up to 3 months. In four animals the DTH response was maintained greater than 1 year. The response can be abrogated with protein deprivation and restored with refeeding. The skin test method of DTH assessment correlates with an alternate technique of radiolabeled cell accumulation in the ear (r = 0.95, P less than 0.001). This model should prove useful in evaluating the role of the DTH response in measuring host resistance to infection.

Histamine-releasing activity. IV. Molecular heterogeneity of the activity from stimulated human thoracic duct lymphocytes

Previous studies with the lymphokine, histamine-releasing activity (HRA), showed that HRA consisted of a heterogeneous group of molecules. The possibility of using thoracic duct lymphocytes (TDL) as a source of large quantities of HRA has been investigated. Antigen-stimulated TDL synthesize and release HRA in quantities similar to an equivalent number of peripheral blood lymphocytes (PBL). Streptokinase (SK) antigen routinely caused TDL to produce HRA approximately 15,000 Da. In contrast, staphylococcus enterotoxin B (SEB) induced the formation of a heterogeneous mixture of HRAs with apparent molecular weights of 50,000 and 15,000. Two peaks of activity (HRA I and II) were recovered when the supernatant from SK-stimulated TDL was subjected to ion-exchange chromatography. Interestingly, basophil chemotactic activity (BCA) was also eluted in these two peaks. Although interferon (IFN) is also released by antigen-stimulated TDL, the nonidentity of IFN and HRA was established by fundamental differences in chromatographic properties and specific antisera to IFN. In contrast, these studies suggest that HRA and BCA may be present on the same molecular entity.

An assay to measure antigen-specific immune complexes in food-allergy patients

An allergen- and isotype-specific assay to quantify the presence of serum immune complexes is described. This assay is based on a two-site recognition system so that only molecular complexes containing both antigen and antibody are counted. In this study affinity-purified antibodies to egg and milk whey were used on paper discs in conjunction with a soluble, labeled anti-immunoglobulin (IgE or IgG specific). To evaluate the assay, immune complexes were prepared in vitro by mixing antigen at different concentrations with serum from a patient with high levels of antibody. Complexes were detectable over a 5 log range of antigen concentration. The lower limit of sensitivity of the assay was estimated to be 5.8 ng of complexed IgE per milliliter of patient serum. To determine if the assay could detect natural in vivo-formed complexes, sera from patients with positive RAST scores to egg white or milk were selected for a preliminary study. Three of the nine egg white-positive sera and two of the nine milk-positive sera were found to contain significant levels of IgE immune complexes. The versatility and sensitivity of the assay should now make it feasible to design experiments to elucidate the role, if any, of circulating immune complexes in the etiology of food allergy.

Allergic reactions, "spillover' reactions, and T-cell subsets

A strong positive, allergic patch-test reaction was elicited in 15 patients with an established allergy for a particular allergen. Patches with a marginally irritating concentration of sodium lauryl sulfate (SLS) were applied at fixed distances. The SLS patch situated adjacent to the allergic reaction was significantly enhanced in 12 of 15 patients (P less than 0.01) compared to more distant SLS reactions ("spillover'). Only quantitative differences were observed in the histologic pictures of the different types of reaction. The infiltrate consisted of lymphocytes and histiocytes, mainly located perivascular in the upper dermis. T-cell subsets were assessed with monoclonal antibodies using an immunoperoxidase technique. The distribution of the different T cells was the same for both reaction types. T cells located outside the perivascular infiltrates (e.g., in the epidermal vesicles) were OKT-8-positive (cytotoxic/suppressor T lymphocytes). Immunofluorescence examination did not show different patterns for the allergic or "enhanced toxic' reactions with regard to the presence of immunoglobulins and complement. The "spillover' phenomenon may cause false-positive patch-test reactions.

Cutaneous basophil hypersensitivity in the guinea pig conjunctiva

Cutaneous basophil hypersensitivity (CBH) is an immunologic reaction extensively studied in the guinea pig. We elicited this reaction in the conjunctiva by systemically sensitizing guinea pigs to ovalbumin in incomplete Freund's adjuvant. Skin tests showed basophils in the skin one week after sensitization when challenged with ovalbumin. However, the conjunctiva showed an eosinophilic reaction with few basophils. This is compatible with other extracutaneous manifestation of the CBH reaction.

Cutaneous basophil hypersensitivity in atopic dermatitis

The infiltration by basophils into delayed hypersensitivity skin test sites was examined in patients with atopic dermatitis, contact dermatitis and in normal healthy persons. Atopic dermatitis patients, with large amounts of IgE, injected intradermally with staphylococcal antigens showed reactions that were more transient and erythematous than those of normal persons. On histological examination there were numerous, degranulating basophils among the perivascular mononuclear cells. Normal persons, with small amounts of IgE showed typical mononuclear cell infiltration and few basophils. Patients with contact dermatitis, one with much IgE, responded to patch tests to potassium dichromate or to nickel sulphate by delayed type reactions, but on histology, two of the four patients showed a significant infiltration by basophils. It is considered that the erythematous response to the antigen in atopic dermatitis patients is related to the basophil infiltration.

Granuloma annulare

Granuloma annular (GA) is a benign inflammatory skin disease usually localized to the distal extremities, although generalized, perforating, and subcutaneous variants have also been identified. A regular histopathologic feature is the presence of mononuclear cells, often in palisading array, around foci of altered collagen. The clinical and histologic features of each subtype of GA are discussed along with a differential diagnosis. A variety of remedies have been used to treat GA, but efficacy is hard to define in a disease in which spontaneous resolution is usual outcome. GA has not been conclusively linked either to diabetes or solar radiation. Recent data suggest a role for vascular injury or delayed-type hypersensitivity in the pathogenesis, but the cause of GA remains obscure.

The pathomorphology of malignant catarrhal fever. II. Multisystemic epithelial lesions

Epithelia from 18 Holstein-Fresian calves with experimentally induced malignant catarrhal fever and two calves with naturally occurring disease had severe destructive inflammatory epithelial lesions. Calves were necropsied at early, mid and late clinical stages. Multifocal, degenerative and necrotic epithelial lesions were associated with lymphoid cells. Ultrastructurally, numerous lymphocytes, lymphoblasts and macrophages were accumulated between epithelial cells and in lamina propria, vessels and perivascular tissues. Epithelial cells in such lesions had variably severe degenerative changes or were necrotic but there was no proliferative response. Lesions were widespread in all calves and affected oral, ocular, gastrointestinal, ductal, urinary tract, choroid plexus and other epithelial tissues. Calves killed in late clinical stages had more severe lesions than those killed early. The predominantly lymphocytic, invasive-destructive pattern seen in tissues of cattle with malignant catarrhal fever was similar to that seen in such conditions as contact hypersensitivity and graft versus host disease. Viral structures were not seen.

The optimization test in the guinea pig in relation to other predictive sensitization methods

The allergenicity of various compounds was tested by means of the optimization procedure in the guinea-pig. Results with antibiotics, preservatives, fragrance raw materials and miscellaneous contactants are reported. Their relevance is critically discussed in relation to other animal sensitization methods (Draize, Bühler, open epicutaneous and maximization tests). Predictive animal tests are compared with those used in human allergy (Shelanski & Shelanski; maximization test). The importance of animal methods entailing the use of adjuvants is underlined.

The effects of malnutrition on secretory and cellular immune processes

About 15 million children under 5 years of age die each year due to suppressed immunity and the resulting increased infection. In severely malnourished children and animals some immune systems such as T-cell function, secretory IgA and complement are significantly suppressed. Other systems, such as the serum IgG or IgA, are normal or even elevated. Some of these changes are apparently caused by nutritional stress while others may be due to stimulation by increased incidence of infection and antigen load. On the other hand, marginal malnutrition stimulates increased phagocytosis and T-cell function with increased immunity to cancer but decreased resistance to certain microbial agents. The mechanisms of immune suppression by malnutrition, persistence of these effects after renutrition, and the effect of maternal malnutrition on newborn immunity are critically reviewed. Possible non-nutritional means of rapid immunological restoration of malnourished children are described.

Immunological skin testing and interpretation: a plea for uniformity

Immunological skin tests are one of the major methods used for the assessment of one's immune status. A review of the literature clearly reveals that there is no uniform methods for the administration and interpretation of skin tests. Without uniformity, it is obvious that data are not comparable. Contradictory conclusions may be reached from the same skin test data, depending upon the method of interpretation used. Precedent, rather than rationale, has often determined the method of interpretation. There are studies which suggest that slight induration or erythema, often considered negative, are significant immunologic events. The various methods of skin test administration and interpretation are reviewed. Recommendations for application and interpretation are presented so that uniformity may exist.

Histologic aspects of patch test reactions in allergic contact dermatitis

Twenty subjects with allergic contact dermatitis were patch tested with the responsible allergen applied to four fixed points on the back. Skin biopsies of the four sites were obtained after 6, 12, 24 and 48 hours, fixed in neutral formalin and stained with hematoxylin-eosin, Giemsa and toluidine blue. Sections were examined and lymphomonocytes, mast cells, eosinophils and basophils counted. In all cases the infiltrate consisted mainly of lymphomonocytes (80-82%); mast cells (5%) and basophils (0.2%) do not present clear variations within the given time. Eosinophils showed a definite numerical increase in six cases out of 20.

Effect of histamine H2-receptor antagonists on delayed hypersensitivity

The delayed skin-test response to four antigens was assessed before and after 6 weeks' cimetidine therapy in patients with duodenal-ulcer disease. In the eight patients who received cimetidine there was a significant increase in both erythema and induration after six weeks' cimetidine therapy. In contrast, the intensity of delayed-hypersensitivity reactions at 6 weeks was not increased in eight control patients who did not receive cimetidine. These studies indicate that therapy with an H2-receptor antagonist may be associated with an augmentation of delayed hypersensitivity responses.

The ultrastructure of granuloma annulare

Nine cases of granuloma annulare at different stages of development were investigated electron microscopically. Special attention was given to collagen changes, to the cellular infiltrate, and to vascular changes. The necrobiotic changes of the collagen were: loosening of the fibers at the borders of the bundles; swelling and loss of cross-striation of the fibrils; and complete degradation of the collagen, with precipitation of mucinous and fibrin material and of glycogen. In 2 cases "cross-banded filamentous aggregations" were present. In later stages new collagen synthesis occurred. In the infiltrate, histiocytes/macrophages were seen developing into epithelioid and giant cells. In addition, numerous active lymphocytes and, at later stages, some neutrophils were found. Vascular changes consisted of endothelial swelling and duplications of the basal lamina. A perivascular infiltrate was present, but no distinct vasculitis was seen. Our results indicate that the necrobiosis of the collagen without primary vasculitis may be an initial event in granuloma annulare. A delayed hypersensitivity mechanism is discussed with regard to pathogenesis.