Immunoglobulin- and complement-bearing lymphocytes in allergic contact dermatitis and atopic dermatitis (eczema)

Haemolytic streptococcus infection of chronic maxillary sinusitis. An immunological study using the skin window test

The SWT was performed on 30 patients with chronic haemolytic streptococcus maxillary sinusitis, and 5 controls with no streptococcus in their nose and throat. Foreign and patient's own organism were used as antigen. The lymphoblastic transformation was higher in control streptococcus free patients than in chronic maxillary sinusitis, more when using foreign than patient's own organism. The failure of cellular immune response as a contributory factor to chronicity of maxillary sinusitis is discussed. The possible value of prepared foreign streptococcus vaccine in prevention and treatment is mentioned.

T and B lymphocytes in patients with nickel sensitivity

Peripheral blood mononuclear cells from altogether 45 nickel-sensitive patients and 37 controls were assayed for various T and B cell variables. All the patients, but none of the controls, fulfilled our in vitro criteria for a positive response to nickel sulphate (NiSO4). We report normal T and B lymphocyte counts, normal spontaneous plaque-forming cell (PFC) numbers, normal serum immunoglobulin levels, and no demonstrable specific cytotoxic T lymphocyte activity associated with nickel sensitivity. We could detect only a slight increase in the number of PFC and in the number of cytoplasmic immunoglobulin positive (cIg+) cells following stimulation of the patients' cells with NiSO4 for 6 days in culture. Apart from a transient increase in the [3H]thymidine uptake by patients' cells stimulated with NiSO4 in vitro, and a transient drop in the OKT4/OKT8 ratio, there were no major differences in the values of the above variables before and after in vivo challenge of 3 patients with NiSO4. Blood from only 2 of the latter 3 patients was tested in the DNA synthesis test. We conclude that apart from the DNA synthesis test, none of these tests is of any use as an aid to diagnosis in patients with nickel sensitivity. A careful attitude towards patch testing should be maintained.

Quantitative analysis of T-lymphocyte subsets in atopic eczema, using monoclonal antibodies and flow cytofluorimetry

An analysis of T-lymphocyte subpopulations was performed on thirty-eight consecutive patients with atopic eczema, using monoclonal antibodies and flow cytofluorimetry. The total T-lymphocyte and helper T-cell numbers did not differ significantly from those of a matched control group, but there was a highly significant reduction in suppressor T-cell numbers among the atopic group. Both suppressor T-cell deficiency and circulating IgE elevation were found to correlate positively with disease activity. Food specific IgE levels to milk and egg were ascertained by radioallergosorbent (RAST) studies. These proved positive in seven out of thirty-five atopics (20%).

Increase of lymphocytes with Fc receptors for IgE in patients with allergic rhinitis during the grass pollen season

Peripheral blood lymphocytes from 10 nonallergic donors and 7 patients suffering from seasonal allergic rhinitis and receiving desensitization therapy were analyzed by rosette assays for Fc receptors for IgE (Fc epsilon R) and IgG (Fc gamma R) before, during and after the grass pollen season. Six of seven patients had moderately elevated IgE levels (330 +/- 268 IU/ml), all had high titers of skin sensitizing antibodies to grass pollens and serum IgE antibodies as measured by radio-allergosorbent tests (RAST). Seven of the nonallergic donors had 2-30 IU/ml IgE and negative RAST, whereas three had 91-267 IU/ml IgE and two were RAST positive to the grass pollens. In March, when the patients were asymptomatic, the mean +/-SD of the Fc epsilon R+ lymphocytes did not significantly differ from the nonallergic control group: nonallergic Fc epsilon R+ 1.2 +/- 0.9% (29 +/- 20/,mm3), allergic Fc epsilon R+ 2.0 +/- 3.1% (48 +/- 52/mm3). In contrast, during the grass pollen season in May and June, when the patients developed symptoms of allergic rhinitis, they had significantly (P less than 0.01) more Fc epsilon R+ lymphocytes than the controls: nonallergic Fc epsilon R+ 1.7 +/- 1.9% (40 +/- 46/mm3), allergic Fc epsilon R+ 4.7 +/- 1.2% (134 +/- 69/mm3). In the postpollen period, August-October, most of the patients again had low numbers of Fc epsilon R+ lymphocytes: nonallergic Fc epsilon R+ 1.4 +/- 0.9% (26 +/- 13/mm3), allergic Fc epsilon R+ 2.1 +/- 1.9% (62 +/- 82/mm3). The nonallergic control donors with elevated IgE levels and positive RAST always had low numbers of Fc epsilon R+ lymphocytes. In contrast, two other nonallergic donors, who had a 2-7 IU/ml IgE and negative RAST, showed significant increases of Fc epsilon R+ lymphocytes over several weeks during the grass pollen season. No statistically significant changes in Fc gamma R+ lymphocytes occurred in both nonallergic and allergic donors. The total and specific IgE serum levels did not vary much in the nonallergic donors and patients during the period of study and any changes that did occur did not correlate with the changes in Fc epsilon R+ lymphocytes. The data demonstrate that Fc epsilon R+ peripheral blood lymphocytes increase in allergic patients during natural antigen exposure and active disease in the absence of measurable increases of total and specific serum IgE. Because two nonallergic control donors also had temporary increases of Fc epsilon R+ lymphocytes, an increase of peripheral blood Fc epsilon R+ lymphocytes may be a sensitive indicator of an ongoing IgE immune response.

Subpopulations of lymphocytes and lymphocyte transformation tests in atopic dermatitis: evaluation of a systemic treatment with a new chromone compound and comparison with a normal group

In 28 adults patients with atopic dermatitis participating in a double-blind controlled clinical trial of systemic treatment with a new chromone compound, immune monitoring were performed with a number of in vitro tests. The parameters were phytohemagglutinin, pokeweed mitogen, concanavalin A, purified protein tuberculin derivative, Escherichia coli, Staphylococcus aureus, streptokinase/streptodornase, and allogene lymphocytes in a one-way mixed lymphocyte culture. No benefit could be proven for the drug in the clinical investigation or any change in the immunological tests during the trial. There was no demonstrable differences in the applied immunoparameters between mild and severe atopic dermatitis. The study group was compared with an age- and sex-matched control group and a general tendency to decreased T-cell function in the PHA, PWM, PPD and MLC tests together with a slightly increased HEAC percentage was found in the patients with atopic dermatitis.

Immunofluorescence studies on eosinophilic granulocytes

Immunofluorescence techniques were used to find out whether immunoglobulins (Ig) and complement (C3) determinants are present on the membrane of eosinophilic granulocytes in atopic patients and in patients with an allergic contact dermatitis. Normal healthy individuals served as controls. The studies were performed with eosinophilic granulocytes in suspension and in thin cell layers. The demonstration of the presence of cytoplasmic Ig and C3 in eosinophilic granulocytes was carried out in skin specimens taken 20-30 min after injection of the antigen and in specimens taken from positive patch tests 48 h after application of the antigen. No immunoglobulins or C3 determinants could be demonstrated on the membrane of eosinophilic granulocytes in the patients or the healthy controls, when the suspension methods were used. However, in thin cell layers and in skin sections the eosinophilic granulocytes showed a positive fluorescence of the cytoplasm after having been exposed to various conjugates and a FITC solution. It is concluded that the commonly used immunofluorescence techniques tend to give non-specific staining results, most likely due to reactivity of the FITC marker of the conjugates with basic proteins present in the cytoplasm of the eosinophilic granulocyte.

The recruitment of inflammatory cells using the skin-window technique

The chemotaxis of inflammatory cells induced by the skin-window technique using IgD as cytotaxigen or cytotaxinogen was studied in 16 patients with allergic contact dermatitis. Six patients with leg ulcer served as controls. By means of this method the recruitment of inflammatory cells with receptors for IgD could be shown.

Immune status in atopic eczema: a survey

We have searched the literature for data on the in vitro assessment of immune status in atopic eczema patients, and have found much confusion. The major findings are tabulated. It is concluded that atopic eczema is a form of immune deficiency, although it is unclear whether this is a primary or secondary defect. Most authors find a T-lymphocyte deficit while eosinophils, B lymphocytes and serum IgE are increased. Serum IgE levels appear to correlated with severity of eczema symptoms. We have previously suggested that T-lymphocyte levels are overestimated in eczema when fetal calf serum is used in the E-rosette assay. Analysis of the literature for the effect of this serum in the assay confirms that there is a T-lymphocyte deficit in atopic eczema, but that the serum masks it. Thus, much of the confusion surrounding this issue can be resolved.

Complement and immunoglobulin deposits in the skin of patients with atopic dermatitis

The immunofluorescent patterns of uninvolved and involved skin biopsies from eight patients with atopic dermatitis were studied, using direct immunofluorescence techniques to identify deposits of the immunoglobulins G, A and M as well as the complement factors C1q, C3, C4, C5, factor B and properdin. Immunoglobulin deposits (mainly IgG) were found in five patients, complement deposits in three patients in the basement membrane zone. In three patients the immunofluorescence was positive for C3, in two patients for C1q, C4 and C5. Regarding the factors of the alternative pathway of the complement system, two patients showed deposits of properdin, one of factor B. The changes were not confined to the eczematous lesions, but were found in uninvolved skin too. The most prominent changes were observed in patients with severe disease.

T-cell function in atopic dermatitis. Controlled examination of concanavalin A dose-response relations in cultured lymphocytes

The Concanavalin A (Con A) stimulation response of peripheral lymphocytes in vitro was found to be decreased statistically significant (alpha = 0.005) in patients with light atopic dermatitis, Strictly matched pairs were examined. Using ten graded concentrations of Con A, dose-response relations of the pairs were demonstrated, differences were more evident at lower suboptimal concentrations. Background DNA-synthesis of the patients was elevated.

Immunofluorescence studies across the leprosy spectrum

Forty biopsies from skin lesions of untreated (24) and treated (16) leprosy patients, representing the whole leprosy spectrum, were examined by means of immunofluorescence (IF) methods. Only few or no cells staining with FTC-labelled antihuman immunoglobulin antisera were found in the lesional skin of all patients examined. Sparse IgM-deposits along the basement membrane of the epidermis were observed in a few borderline lepromatous and lepromatous patients. Complement deposits along the basement membrane of the epidermis and in the vessel walls were found in tuberculoïd as well as in lepromatous patients. Complement and in a lesser number IgG-deposits were observed around sweat glands and sometimes around sweat gland ducts and other skin appendages. Autofluorescing macrophages were noted in patients at the lepromatous side of the leprosy spectrum; approximately half of these patients showed complement deposits in an around these cells.

Influence of specificity of reagents and of behaviour of cell surface Ig on the detection and enumeration of immunoglobulin-bearing lymphocytes in humans

Some parameters likely to influence detection and classification of human B-lymphocytes using anti-immunoglobulin (Ig) sera have been investigated. Of 20 separate mono- and polyspecific native or conjugated anti-Ig sera analysed by a passive haemagglutination technique, 13 exhibited non-specific reactivity. This technique showed no consistent correlation between the titre of individual sera against Fab2 and whole IgG respectively. The indirect immunofluorescence (IF) method applied to detect surface Ig on blood lymphocytes seemed to detect Fc-bearing rather than Ig-bearing cells. The direct method generally yielded fewer reacting cells (5%) than the indirect (10-25%), suggesting that Fc-bearing cells are more numerous than Ig-bearing cells. The Ig-bearing blood lymphocytes seemed to belong preferentially to the IgM class. Passively adsorbed Ig did not appear to contribute significantly to the number of Ig-bearing cells detected. Anti-Ig sera induced redistribution and some endocytosis of surface Ig but this did not markedly affect detection of Ig-bearing cells.

Immunofluorescence studies in reactional leprosy with relevance to treatment

Twenty-three biopsies of skin lesions of patients with various types of leprosy, showing a recent reaction, were examined by means of immunofluorescence (IF) methods. The patients were divided into two groups according to the number of inflammatory cells, staining with various FTC-labelled anti-immunoglobulin antisera, in representative areas of the biopsies. It was found that the presence of these cells was correlated with a good response to thalidomide treatment.

Lymphocyte subpopulations, serum immunoglobulins and complement factors in patients with atopic dermatitis

The percentages of lymphocytes carrying different classes of membrane-bound Ig, and lymphocytes forming rosettes with sheep erythrocytes (E-RFC), as well as lymphocytes with receptor for the Fc-part of IgG (EA-RFC) were determined in 19 patients with atopic dermatitis. Lymphocyte suspensions were also stained with a specific rabbit anti-human T-lymphocyte antiserum. Furthermore, the serum concentration of IgG, IgA, IgM and IgE and the complement factors C3 and C4 were measured. A small but significant increase in lymphocytes with membrane-bound IgE and an increase in the serum concentration of IgE and complement factor C4 were observed. A decrease in the percentages of lymphocytes with receptors for sheep erythrocytes (E-RFC) was also found. The percentages of lymphocytes that stained with the anti-T antiserum correlated well with the percentages of lymphocytes forming rosettes with sheep erythrocytes. In one patient we found increased IgE positive lymphocytes, increased IgE serum concentration and a decreased T-cell number.

T and B lymphocytes in contact and atopic dermatitis

Twenty patients with contact dermatitis, eighteen with atopic dermatitis, two with mixed dermatitis, and 20 controls were examined for the number of T and B lymphocytes, and serum concentrations of IgD and IgE. Significantly higher counts of B lymphocytes bearing IgE and high serum IgE values were found in the atopic group. No other significant differences were found. In particular, we found a normal frequency of IgD bearing lymphocytes in contact dermatitis, and normal T lymphocyte counts in both groups of patients.

Immunofluorescent patterns in the skin in Besnier's prurigo. The eczema asthma syndrome

The immunofluorescent patterns in the skin of eighteen patients with Besnier's prurigo were studied at different stages of eczematous lesions. The presence, distribution pattern, and numbers of immunoglobulin and complement-positive lymphocytes in twenty-nine biopsies are reported. In all cases IgE-positive lymphocytes were present in both clinically uninvolved and involved skin. IgG, IgM and IgE-positive lymphocytes showed a characteristic distribution pattern in the dermis. In the acute stages IgM deposition was prominent in the basement membrane zone and it is suggested that damage to the basement membrane results in diffusion of immunoglobulin and complement into the epidermis. These features were not present in a control group of normal skin and of other dermatoses.

Diagnostic procedures in immunodermatology

Most immunologic diseases are caused by the derailment of the humoral or cellular pathways of the immunologic defense system. This derailment results from numerous factors such as the inability of the patient to remove the pathogen; the consumption, defect, or deficiency in any component of these pathways, and the overproduction of any of the components. To diagnose these immunologic disorders one has to detect the pathogen and the reactions caused by it and to determine the cause of its nonclearance. The immunofluorescence techniques has been invaluable in detecting both the antigen that causes the disease and the reactions initiated by the antigen, such as the production of antibodies and the activation of the complement system. The immunoperoxidase technique has also been used for these purposes in certain instances. For detecting the circulating immune complexes which occur as intermediates in the chain of reactions initiated by the antigen, various physiochemical and biologic techniques have been used. However, none of these tests seems to be totally reliable for determining whether circulating immune complexes are present. The consumption of complement was detected by hemolytic estimations and radial immunodiffusion or rocket electrphoresis. These techniques were also useful in detecting the hereditary deficiencies in immunoglobulins and components of classical and alternative pathways of complement activation. Since these techniques cannot be used to estimate IgE, the radioallergosorbent test was used to measure such levels in the atopic patients. Cellular hypersensitivity was detected with skin tests together with methods which assess the ability of lymphocytes to produce mediators in response to antigen. Many of these mediator assays, however, are not suitable for this purpose. A satisfactory substitute appears to be to determine the factor in antigen-stimulated, lymphocyte culture supernatants which activates macrophages to take up radiolabeled colloidal gold or radiolabeled glucosamine. In contact allergic dermatitis, an increase in the IgD-bearing lymphocytes and granulocytes has also been correlated with cellular hypersensitivity. Lymphocytes and polymorphonuclear leukocytes coated with antibodies mainly directed against nuclear antigens of the basal layer cells of the noninvolved epidermis have invariably been encountered in psoriasis. The use of these findings for diagnostic purposes and for understanding the mechanisms of certain diseases is being explored.

Defective T cell function in atopic dermatitis

The cellular immune system of 37 patients with atopic dermatitis (AD) was assessed by measuring peripheral blood T and B cells and the in vitro lymphocyte response to graded doses of phytohemagglutinin (PHA) (background and 6 concentrations of PHA from 100 to 1.6 mug). These were then correlated with clinical severity, ecosinophil counts, and serum IgE levels. The IgE levels (1,482 IU +/- 252 SEM), eosinophil counts (977 +/- 143), and absolute number of B cells (958 +/- 123) were significantly (p less than 0.05) higher than in age-matched controls (70 IU +/- 28, 182 +/- 79, and 480 +/- 60, respectively), and each significantly (p less than 0.05) correlated with the clinical severity. By contrast, percent B lymphocytes (20 +/- 1), percent (51 +/- 2) and total (2,357 +/- 217) T cells did not differ from controls. Eleven patients had low percent T cells (less than 40%); clinical and laboratory evaluation in these patients did not differ from the remaining 26. Lymphocytes from AD patients had higher background deoxyribonucleic acid (DNA) synthesis than controls (suggestive of increased number of B cells) and significantly depressed responses at the low PHA concentrations (6.3, 3.1, and 1.6 mug), which significantly correlated (p less than 0.05) inversely with IgE levels. These studies suggest a subtle defect in T lymphocyte function leading to increased B cells and increased IgE production.

[Investigations of the T and B cells and the hemopexin-carrying lymphocytes in cases of porphyria cutanea tarda (author's transl)]

The immunoglobulins and hemopexin carrying cells have been determined in 14 patients having Porphyria cutanea tarda and in 15 healthy volunteers. At the same time, the stimulating effect of phytohemaglutinine and the leucocytesmigration inhibition by purified tuberculine proteins, were measured. In the 14 cases of Porphyria cutanea tarda, the IgG content and the number of hemopexin carrying lymphocytes was significantly increased, while the amounts of the other immunoglobuline carrying cells, and of T lymphocytes, was unchanged. Phytohemaglutinine stimulation and inhibition of leukocytes migration by purified tuberculine proteins were found to be identical in both patients and control groups.

Immunoglobulin and complement bearing polymorphonuclear leukocytes in allergic contact dermatitis and psoriasis vulgaris

Immunofluorescence techniques were used to demonstrate the presence of immunoglobulin (Ig) and complement (C) bearing polymorphonuclear leukocytes (PMNL) in specimens of skin from the lesions of ten patients with allergic contact dermatitis and of ten with psoriasis vulgaris. The distribution patterns of these Ig- and C-coated cells in the peripheral blood of the twenty patients were also studied. Ten normal healthy controls were included. In cases of allergic contact dermatitis, IgD was the predominant class of Ig on the PMNL. The percentage of C-bearing PMNL were also significantly increased, suggesting that both molecules might be present on the cell memebrane of these cells at the same time. In psoriasis vulgaris, the predominant class of Ig on the PMNL was IgG. The percentage of PMNL coated with C were not signficantly raised. These results suggest that in allergic contact dermatitis the PMNL can be coated with both Ig and C which may render them cytophilic; they also show that in psoriasis vulgaris PMNL can bind Ig. In the ten healthy controls, it was possible to distinguish between those PMNL which are and those which are not bearing immunoglobulin.