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Varney VA, Nicholas A, Warner A, Sumar N. IgE-Mediated Systemic Anaphylaxis And Its Association With Gene Polymorphisms Of ACE, Angiotensinogen And Chymase. J Asthma Allergy 2019; 12:343-361. [PMID: 31632094 PMCID: PMC6790349 DOI: 10.2147/jaa.s213016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 09/05/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The renin-angiotensin system (RAS) protects the circulation against sudden falls in systemic blood pressure via generation of angiotensin II (AII). Previously, we demonstrated that patients with anaphylaxis involving airway angioedema and cardiovascular collapse (AACVS) had significantly increased "I" gene polymorphisms of the angiotensin-converting-enzymes (ACE). This is associated with lower serum ACE and AII levels and was not seen in anaphylaxis without collapse nor atopics and healthy controls. OBJECTIVES To examine the angiotensinogen (AGT-M235T) and chymase gene (CMA-1 A1903G) polymorphisms in these original subjects. METHOD 122 patients with IgE-mediated anaphylaxis, 119 healthy controls and 52 atopics had polymorphisms of the AGT gene and chymase gene examined by polymerase chain reactions and gel electrophoresis. Their previous ACE genotypes were included for the analysis. RESULTS AGT-MM genes (associated with low AGT levels) were significantly increased in anaphylaxis (Terr's classification). When combined with ACE, anaphylaxis showed increased MM/II gene pairing (p<0.0013) consistent with lower RAS activity. For chymase, there was increased pairing of MM/AG (p<0.005) and AG/II and AG/ID (p<0.0073) for anaphylaxis consistent with lower RAS activity. A tri-allelic ensemble of the 6 commonest gene combinations for the healthy controls and anaphylaxis confirmed this difference (p=0.0001); for anaphylaxis, genes were predominately MM/AG/II or ID, while healthy controls were DD/MT/AG or GG patterns. CONCLUSION Our gene polymorphisms show lower RAS activity for anaphylaxis especially AACVS. Animal models of anaphylaxis are focused on endothelial nitric oxide (eNO) which is shown to be the mediator of fatal shock and prevented by eNO-blockade. The interaction of AII and eNO controls the microcirculation in man. High serum AII levels reduce eNO activity, so higher RAS-activity could protect against shock. Our data shows low RAS activity in anaphylaxis especially AACVS, suggesting the influence of these genes on shock are via AII levels and its effects on eNO.
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Affiliation(s)
- VA Varney
- Department of Medicine, St Helier Hospital, Carshalton, SurreySM5 1AA, UK
- Department of Allergy and Immunology, St Helier Hospital, Carshalton, SurreySM5 1AA, UK
| | - A Nicholas
- Department of Allergy and Immunology, St Helier Hospital, Carshalton, SurreySM5 1AA, UK
| | - A Warner
- Department of Allergy and Immunology, St Helier Hospital, Carshalton, SurreySM5 1AA, UK
| | - N Sumar
- Department of Allergy and Immunology, St Helier Hospital, Carshalton, SurreySM5 1AA, UK
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Varney VA, Quirke G, Kearon C, Adeyemo S, Parnell H. P219 The use of oral modafinil in chronic obstructive pulmonary disease patients with chronic hypercapnic respiratory failure. Sleep Breath 2017. [DOI: 10.1136/thoraxjnl-2017-210983.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Varney VA, Parnell H, Quirke G. The Benefits of Identifying and Treating Adrenal Suppression in Adult Difficult Asthmatics: A Case Series. Health (London) 2016. [DOI: 10.4236/health.2016.87067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Varney VA, Evans J, Bansal AS. Successful treatment of reactive airways dysfunction syndrome by high-dose vitamin D. J Asthma Allergy 2011; 4:87-91. [PMID: 22034572 PMCID: PMC3196486 DOI: 10.2147/jaa.s19107] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Indexed: 11/23/2022] Open
Abstract
Reactive airways dysfunction syndrome is a controversial and poorly understood condition produced by inhalational injury from gas, vapors, or fumes. The symptoms mimic asthma, but appear unresponsive to asthma treatments. If symptoms persist for more than 6 months, there is a risk that they can become chronic. For these cases, effective treatments are lacking and quality of life is poor. We describe the first use of high-dose vitamin D in a patient with this condition, who fulfilled the 1995 American College of Chest Physicians criteria for this syndrome. The patient we describe presented an extremely difficult management problem and was refractory to conventional treatments, but responded to high-dose oral vitamin D supplements.
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Abstract
Chylous effusions in adults are commonly associated with malignant disease. Although the condition is rare, their occurrence presents a significant management problem. A review of the literature demonstrates the high mortality of this condition in the past from cachexia and infection or after surgical attempts at correction. The first report of somatostatin use in chylous effusions was a decade ago. Since 2000, case reports of successful treatment in infants and neonates with intravenous somatostatin or octreotide have been published. For adults, few reports exist. We describe a case series of seven patients, all with malignancy. In each case, there was a systematic approach to treatment using subcutaneous octreotide and a fat-free diet, resulting in complete resolution of the condition. Although no guidelines are available for the management of chylous effusions, our non-invasive approach avoided lymphangiogram, surgery and allowed early discharge.
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Varney VA, Warren M, Palmer M. Amiodarone - induced pulmonary nodules mimiking metastatic lung disease - investigation by somatostatin radio peptide scanning. Acute Med 2005; 4:63-65. [PMID: 21655520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 61 year old former paramedic presented to A&E complaining of palpitations. He was found to be in atrial fibrillation, which reverted spontaneously to sinus rhythm. A chest x-ray taken at that time showed multiple pulmonary nodules consistent with metastatic malignancy (Figure 1). In the past he had been treated with amiodarone 200mg daily for 6 years following a previous diagnosis of atrial fibrillation, which had been attributed to alcoholic cardiomyopathy. He had discontinued the drug 8 months earlier, after self diagnosing hypotension and bradycardia. A previous chest x-ray, taken before starting amiodarone, was normal.
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Affiliation(s)
- V A Varney
- Department of Respiratory Medicine, St Helier Hospital, Wrythe Lane, Carshalton, Surrey
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Varney VA, Tabbah K, Mavroleon G, Frew AJ. Usefulness of specific immunotherapy in patients with severe perennial allergic rhinitis induced by house dust mite: a double-blind, randomized, placebo-controlled trial. Clin Exp Allergy 2003; 33:1076-82. [PMID: 12911781 DOI: 10.1046/j.1365-2222.2003.01735.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of specific immunotherapy (SIT) in patients with severe house dust mite (HDM)-induced perennial allergic rhinitis using diary cards and objective endpoints. PATIENTS AND METHODS Thirty-six adult patients were selected with moderate to severe allergic rhinitis due to HDM allergy uncontrolled by regular anti-allergic drugs. Twenty-eight patients completed the study, 22 of these patients also had mild asthma. Subjects were stratified for HDM sensitivity on the basis of their 4-week diary card score and the size of their immediate and late-phase skin reaction to HDM. The groups were well matched for all relevant parameters. Patients were randomized to receive active preparation (Alutard(R)-SQ, ALK, Dermatophagoides pteronyssinus extract) or an identical placebo preparation. Increasing doses were administered until the maintenance dose was reached. This dose was then given once a month for 12 months. RESULTS Clinical efficacy was evaluated by symptom medication diary cards recorded for 4 weeks after 12 months of continuous treatment and compared with pre-treatment scores. Skin test reactivity was re-measured after 12 months of treatment to HDM, cat dander and codeine phosphate. After 1 year of treatment, the actively treated group showed a 58% reduction in diary card symptom scores (P<0.002) and a 20% reduction in the use of rescue medication. The placebo group had a 32% reduction in symptom scores (P=NS), but no reduction in rescue medication requirements. The active group showed 36% reduction in skin prick test sensitivity to D. pteronyssinus (P=0.006), while the placebo group values were unchanged. Skin reactivity to codeine was unchanged in both groups. No significant adverse reactions to SIT were encountered. CONCLUSIONS One year of SIT for D. pteronyssinus in patients with poorly controlled rhinitis (+/-mild asthma) produced clinically useful improvement as shown by symptom-medication diary cards and reductions in immediate skin reactions compared with placebo treatment.
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Affiliation(s)
- V A Varney
- RCMB Research Division, University Medicine, Southampton General Hospital, Southampton, UK.
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Abstract
Chylous effusions have an identical appearance to milk and occur when the thoracic duct is blocked. Since chyle represents direct absorption of fat from the small intestine lacteals, it is rich in fat, calories, vitamins and immunoglobulins. Drainage of this milk-like fluid from any cavity (chest or abdomen) results in rapid weight loss and profound cachexia. The recognition of this milk-like fluid as chyle is urgent for the implementation of the correct treatment. In adults, lymphoma is one of the commonest malignancies to cause blockages in the thoracic duct. Once the diagnosis is made, conservative treatment with strict dietary adjustment often fails to prevent weight loss or resolve the underlying cause. Since the condition is uncommon, no guidelines exist. Many surgeons recommend early surgical intervention before the patient becomes too weak. Surgery may also fail. We report the case of a 62-year-old man with chylous effusions and a weight loss of 30 kg. The nature of the effusion was unrecognized for the first 16 weeks. Upon diagnosis, dietary adjustment was made and a lymphangiogram organized with a view to surgery. Literature searches revealed two cases in which somatostatin was used after surgical procedures failed. We therefore used octreotide (a synthetic analogue of somatostatin). We report complete resolution of the condition within 72 h leading to the resumption of a normal diet and discharge within 2 weeks.
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Affiliation(s)
- J Evans
- Department of Haematology and Respiratory Medicine, St Helier Hospital, Carshalton, Surrey, UK
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Abstract
BACKGROUND Allergen injection immunotherapy is effective for summer hay fever and reduces cutaneous sensitivity to grass pollen. OBJECTIVE We have addressed whether this effect of immunotherapy may be due to a decrease in mast cell numbers in the skin. METHODS Total mast cells and mast cell subtypes in the dermis were measured by dual immunocytochemistry in 40 adult patients who had received either 'active' grass pollen immunotherapy or placebo injections for 9 months in a double-blind clinical trial. RESULTS Clinical improvement in hay fever was accompanied by a greater than 10-fold reduction in the immediate cutaneous response to grass pollen (P = 0. 0002) and a sevenfold decrease in mast cell numbers in the skin (P = 0.0001). The number of mast cells after immunotherapy correlated with the clinical response in terms of seasonal symptoms (r = 0.61, P = 0.001) and rescue medication use (r = 0.75, P = 0.0001). Specific double immunostaining showed that the majority of mast cells (greater than 60%) were tryptase/chymase-positive (MCTC) and the remainder tryptase-only (MCT) cells. Following immunotherapy both subtypes were equally reduced. CONCLUSION One mechanism by which immunotherapy may act is to reduce mast cell numbers with a consequent reduction in immediate allergic sensitivity.
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Affiliation(s)
- S R Durham
- Upper Respiratory Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London, UK
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Varney VA, Edwards J, Tabbah K, Brewster H, Mavroleon G, Frew AJ. Clinical efficacy of specific immunotherapy to cat dander: a double-blind placebo-controlled trial. Clin Exp Allergy 1997. [PMID: 9291281 DOI: 10.1111/j.1365-2222.1997.tb01225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the efficacy of specific immunotherapy with standardized cat dander extract, using objective endpoints and simulated 'natural' exposure to cats. DESIGN Double-blind, randomized, placebo-controlled study carried out at a UK Allergy research clinic. SUBJECTS Twenty-eight patients with moderate to severe allergic rhinoconjunctivitis with asthma due to cat allergy. Subjects were stratified for cat sensitivity, cat ownership and asthma, and the groups were well matched for all relevant parameters. MAIN OUTCOME MEASURES Symptom scores and peak flow rate during and after exposure to cats in a cat-room. Skin tests and conjunctival provocation thresholds. RESULTS The actively treated group showed a marked reduction in symptoms during the cat exposure (mean score 61.6-17.1; P < 0.001) with no change in the placebo group (64.7 vs 62.1). The active group also showed a reduced peak flow response to cat exposure (mean fall of 85 L/min pretreatment, 29 L/min after treatment, P < 0.005) as well as reductions in conjunctival provocation sensitivity, skin sensitivity to cat extract and skin sensitivity to house dust mite (D.pteronyssinus). Skin reactivity to histamine and codeine were unaltered. No significant adverse reactions were encountered. CONCLUSIONS Specific immunotherapy seems to be an effective treatment for cat allergy. Allergy to cats is common and often poorly controlled on conventional pharmacotherapy. Although cat allergy has not traditionally been considered as a valid indication for immunotherapy in the UK, it should now be considered as a legitimate treatment, especially for those who are unable to avoid exposure.
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Affiliation(s)
- V A Varney
- University of Medicine, Southampton General Hospital, UK
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Varney VA, Holgate ST. Allergy testing in respiratory medicine. Br J Hosp Med (Lond) 1996; 56:406-8. [PMID: 8909715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Durham SR, Ying S, Varney VA, Jacobson MR, Sudderick RM, Mackay IS, Kay AB, Hamid QA. Grass pollen immunotherapy inhibits allergen-induced infiltration of CD4+ T lymphocytes and eosinophils in the nasal mucosa and increases the number of cells expressing messenger RNA for interferon-gamma. J Allergy Clin Immunol 1996; 97:1356-65. [PMID: 8648033 DOI: 10.1016/s0091-6749(96)70205-1] [Citation(s) in RCA: 282] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Grass pollen injection immunotherapy is effective in patients with summer hay fever, although efficacy must be balanced against possible side effects. The mechanism of immunotherapy is unknown but may be related to its ability to inhibit allergen-induced late responses, which are known to be characterized by infiltration of T lymphocytes, eosinophils, and cells with messenger RNA for so-called TH2-type cytokines (IL-4 and IL-5). OBJECTIVE This study was designed to observe the effect of grass pollen immunotherapy on late nasal responses and associated cellular infiltration and cytokine mRNA expression. METHODS We performed local nasal provocation with grass pollen (and a control challenge) in 28 patients after a 12-month double-blind, placebo-controlled trial of immunotherapy. Nasal biopsy specimens were obtained at 24 hours and processed for immunohistology and in situ hybridization studies. RESULTS Grass pollen immunotherapy inhibited allergen-induced immediate (0 to 60 minutes) increases in sneezing (p < 0.02) and nasal blocking (p < 0.01) and late (0 to 24 hours) nasal symptoms (p < 0.05). Immunotherapy also inhibited the associated infiltration of the nasal mucosa by CD4+ T lymphocytes and total (major basic protein-containing) and "activated" (cationic protein-secreting) eosinophils (all p = 0.03). There was a significant (p = 0.04) increase in cells expressing mRNA for interferon-gamma at 24 hours after allergen challenge, which correlated inversely with patients' seasonal symptoms (r = -0.65, p < 0.05) and medication requirements (r = -0.75, p < 0.02) during the pollen season. CONCLUSION The results suggest that successful grass pollen immunotherapy for summer hay fever may act by inhibiting allergen-induced T lymphocyte and eosinophil recruitment and eosinophil activation in the target organ, possibly through a mechanism involving protective local increases in TH1-type cells.
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Affiliation(s)
- S R Durham
- Department of Allergy and Clinical Immunology, Royal Brompton Hospital and National Heart & Lung Institute, Imperial College, London
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13
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Abstract
Grass pollen immunotherapy is effective, although efficacy must be balanced against side-effects. In a double-blind, placebo-controlled trial of 40 adult patients with summer hay fever, immunotherapy with a depot grass pollen extract (Phleum pratense, Alutard SQ) reduced symptoms and medication requirements with an acceptable minimal level of side-effects (31). The original placebo group, as well as the actively treated group, have now received active immunotherapy in an open fashion for a further 3 years. An important question was whether continued injection treatment was accompanied by maintained clinical improvement. By analysis of diary symptoms, rescue medication, and visual analogue scores during the pollen season, we show that efficacy was maintained throughout the 3-4-year study period. Clinical improvement was accompanied by a sustained and marked decrease in immediate conjunctival allergen sensitivity and a further significant decrease in the size of the allergen-induced late cutaneous response. In contrast, an initial decrease in the allergen-induced immediate cutaneous response was not maintained at 3-4 years. Of the patients, 37/40 completed the first year, 33/40 the second year, and 32/40 the third year of treatment. Patients dropped out for reasons other than the outcome of immunotherapy. During a total of 2598 injections, five immediate systemic reactions were observed, all during the induction (not maintenance) phase, and all occurred within 10 min of injection and responded promptly to adrenaline. Grass pollen immunotherapy is effective and safe, provided it is performed on carefully selected patients by trained physicians with immediate access to resuscitative measures.
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Affiliation(s)
- S M Walker
- Allergy Clinic, Royal Brompton Hospital, London, UK
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Varney VA, Cumberworth V, Sudderick R, Durham SR, Mackay IS. Rhinitis, sinusitis and the yellow nail syndrome: a review of symptoms and response to treatment in 17 patients. Clin Otolaryngol 1994; 19:237-40. [PMID: 7923847 DOI: 10.1111/j.1365-2273.1994.tb01222.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A total of 17 patients with yellow nail syndrome are described. Their symptoms, age of onset and severity are examined with particular reference to the presence of rhinosinusitis. Fourteen of the patients (83%) suffered severe rhinosinusitis, which pre-dated nail changes in four, coincided with yellow nails in six, and occurred later in the remaining patients. In general, patients responded poorly to conventional medical and surgical treatment, with the exception of functional endoscopic sinus surgery (FESS) which may be of value in these patients. The frequent association of rhinosinusitis with yellow nails may warrant its recognition as part of the syndrome. Careful inspection of the fingernails in all patients presenting with severe rhinosinusitis is warranted.
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Affiliation(s)
- V A Varney
- Nose Clinic, Royal Brompton Hospital, London, UK
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Varney VA, Hamid QA, Gaga M, Ying S, Jacobson M, Frew AJ, Kay AB, Durham SR. Influence of grass pollen immunotherapy on cellular infiltration and cytokine mRNA expression during allergen-induced late-phase cutaneous responses. J Clin Invest 1993; 92:644-51. [PMID: 8349803 PMCID: PMC294897 DOI: 10.1172/jci116633] [Citation(s) in RCA: 355] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We have studied the influence of grass pollen immunotherapy on cellular infiltration and cytokine mRNA expression during allergen-induced late-phase cutaneous responses. In a double-blind, placebo-controlled trial of immunotherapy in 40 adult hay fever sufferers, clinical improvement was accompanied by a decrease in the size of the late-phase skin response. When the immunotherapy-treated group was compared with the placebo group, analysis of skin biopsies obtained 24 h after intradermal allergen revealed a significant reduction in the number of infiltrating CD3+ (P = 0.04) and CD4+ (P = 0.009) cells and a trend for a decrease in EG2+ eosinophils (P = 0.08). Treatment did not influence allergen-induced recruitment of CD8+ cells, neutrophils, or macrophages. Unexpected increases in expression of CD25 (P = 0.006) and HLA-DR (P = 0.007) were observed in the actively treated group. In situ hybridization using a panel of riboprobes demonstrated "TH2-type" (IL-4, IL-5) cytokine mRNA responses in both groups of patients. In contrast, significant hybridization for IL-2 (8/16 patients, P = 0.02) and for interferon-gamma (6/16 patients, P = 0.04) was observed only in the actively treated group. These findings indicate that immunotherapy is associated with suppression of allergen-induced CD4+ T lymphocyte infiltration, but among the cells that are recruited, there is upregulation of CD25 and HLA-DR. At least in this model, immunotherapy does not appear to affect expression of TH2-pattern cytokines in response to allergen exposure, but expression of mRNA for Th1-type cytokines was enhanced in half of the patients. The results support the view that immunotherapy may possibly be working through induction of T cell tolerance.
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Affiliation(s)
- V A Varney
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, United Kingdom
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Varney VA, Jacobson MR, Sudderick RM, Robinson DS, Irani AM, Schwartz LB, Mackay IS, Kay AB, Durham SR. Immunohistology of the nasal mucosa following allergen-induced rhinitis. Identification of activated T lymphocytes, eosinophils, and neutrophils. Am Rev Respir Dis 1992; 146:170-6. [PMID: 1626799 DOI: 10.1164/ajrccm/146.1.170] [Citation(s) in RCA: 179] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We have studied the immunohistology of the nasal mucosa in allergen-induced rhinitis. Sixteen grass pollen-sensitive patients were challenged twice by randomly allocated allergen or control solutions applied on filter paper disks to the inferior turbinate. All had immediate nasal responses, but late-phase responses were equivocal and only evident as nostril blockage. When cell counts in the nasal submucosa were compared with control values 24 h after allergen, there were no changes in CD45+ (total leukocytes), CD3+, or CD8+ cells. Significant increases were found in the numbers of CD4+ T-helper cells (p less than 0.05) and CD25+ [interleukin-2 receptor (IL-2R+)] cells (p less than 0.02). Increases in eosinophils (anti-major basic protein, p less than 0.01) and neutrophils (antineutrophil elastase, p less than 0.01) were also observed. There were increases in tissue macrophages and HLA-DR-positive immunostaining and a reduction in mast cells (tryptase positive), but none of these changes was statistically significant. No significant changes in epithelial thickness, cross-sectional area, or integrity were observed. There was a significant correlation between CD4+ and CD25+ cells (r = 0.61, p less than 0.01) but not between macrophages and CD25+ cells (r = 0.18). The changes in the nasal submucosa were not merely a reflection of alterations in circulating cell populations since it was shown that a significant increase in the lymphocyte CD4/CD8 ratio (p less than 0.05) was observed in nasal biopsies but not in peripheral blood after allergen challenge.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- V A Varney
- Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, United Kingdom
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Durham SR, Ying S, Varney VA, Jacobson MR, Sudderick RM, Mackay IS, Kay AB, Hamid QA. Cytokine messenger RNA expression for IL-3, IL-4, IL-5, and granulocyte/macrophage-colony-stimulating factor in the nasal mucosa after local allergen provocation: relationship to tissue eosinophilia. J Immunol 1992; 148:2390-4. [PMID: 1560199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Tissue eosinophilia is characteristic of human atopic allergic inflammation, although the mechanism is largely unknown. In this study we test the hypothesis that eosinophil infiltration during allergen-provoked rhinitis in hayfever sufferers may occur as a consequence of activation of a population of cells having a characteristic cytokine profile equivalent to the murine Th lymphocyte Th2 subset. Biopsies of the nasal inferior turbinate were obtained from 10 grass pollen-sensitive patients 24 h after local nasal provocation with allergen and after a control challenge with the allergen diluent. Biopsies were divided into two and subsequently processed for in situ hybridization using 35S-labeled RNA probes for selected cytokines and for immunohistology using an eosinophil granule mAb (EG2) which recognizes secreting eosinophils. At allergen-challenged sites compared with control sites there were significant increases in mRNA+ cells for IL-3 (p less than 0.04), IL-4 (p = 0.01), IL-5 (p = 0.02) and granulocyte/macrophage-CSF (p = 0.03). In contrast, only occasional hybridization signals were observed for IL-2 and IFN-gamma at both allergen and control sites. After allergen there was an increase (p = 0.01) in EG2+ eosinophils and significant correlations were observed between EG2+ cells and mRNA expression for "Th2-type" cytokines, particularly IL-5 (r = 0.90, p less than 0.0001). These results demonstrate that recruitment of eosinophils during human allergen-induced rhinitis is associated with cells expressing mRNA for IL-3, IL-4, IL-5, and granulocyte/macrophage-CSF.
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Affiliation(s)
- S R Durham
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England, U.K
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18
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Durham SR, Ying S, Varney VA, Jacobson MR, Sudderick RM, Mackay IS, Kay AB, Hamid QA. Cytokine messenger RNA expression for IL-3, IL-4, IL-5, and granulocyte/macrophage-colony-stimulating factor in the nasal mucosa after local allergen provocation: relationship to tissue eosinophilia. The Journal of Immunology 1992. [DOI: 10.4049/jimmunol.148.8.2390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Tissue eosinophilia is characteristic of human atopic allergic inflammation, although the mechanism is largely unknown. In this study we test the hypothesis that eosinophil infiltration during allergen-provoked rhinitis in hayfever sufferers may occur as a consequence of activation of a population of cells having a characteristic cytokine profile equivalent to the murine Th lymphocyte Th2 subset. Biopsies of the nasal inferior turbinate were obtained from 10 grass pollen-sensitive patients 24 h after local nasal provocation with allergen and after a control challenge with the allergen diluent. Biopsies were divided into two and subsequently processed for in situ hybridization using 35S-labeled RNA probes for selected cytokines and for immunohistology using an eosinophil granule mAb (EG2) which recognizes secreting eosinophils. At allergen-challenged sites compared with control sites there were significant increases in mRNA+ cells for IL-3 (p less than 0.04), IL-4 (p = 0.01), IL-5 (p = 0.02) and granulocyte/macrophage-CSF (p = 0.03). In contrast, only occasional hybridization signals were observed for IL-2 and IFN-gamma at both allergen and control sites. After allergen there was an increase (p = 0.01) in EG2+ eosinophils and significant correlations were observed between EG2+ cells and mRNA expression for "Th2-type" cytokines, particularly IL-5 (r = 0.90, p less than 0.0001). These results demonstrate that recruitment of eosinophils during human allergen-induced rhinitis is associated with cells expressing mRNA for IL-3, IL-4, IL-5, and granulocyte/macrophage-CSF.
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Affiliation(s)
- S R Durham
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England, U.K
| | - S Ying
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England, U.K
| | - V A Varney
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England, U.K
| | - M R Jacobson
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England, U.K
| | - R M Sudderick
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England, U.K
| | - I S Mackay
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England, U.K
| | - A B Kay
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England, U.K
| | - Q A Hamid
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England, U.K
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Gaga M, Frew AJ, Varney VA, Kay AB. Eosinophil activation and T lymphocyte infiltration in allergen-induced late phase skin reactions and classical delayed-type hypersensitivity. The Journal of Immunology 1991. [DOI: 10.4049/jimmunol.147.3.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
T lymphocyte infiltration is a well documented feature of classical delayed-type hypersensitivity (DTH) reactions. Recently, we have shown that T lymphocytes and activated (EG2+) eosinophils accumulate in the allergen-induced late phase skin reaction (LPR). To compare the kinetics and phenotypic composition of these T lymphocyte responses, LPR and DTH reactions of comparable induration size were induced in atopic subjects. In addition, DTH and LPR were compared between atopic and nonatopic subjects. In atopic individuals, allergen challenge elicited a perivascular influx of T lymphocytes that was predominantly CD4+. Eosinophil accumulation and activation were also prominent. There was no cellular response to allergen challenge in the nonatropic group. In both groups, DTH responses showed an intense T cell infiltrate which was more dense and dispersed than in the LPR. CD4+ T cells predominated but at 48 h CD8+ numbers were also significantly increased. In DTH, total leukocyte numbers (CD45+) were increasing at 48 h, whereas in the LPR, cell numbers reached a plateau between 24 and 48 h. T cell activation (shown by expression of IL-2R) was more prominent in DTH. Endothelial expression of HLA-DR was increased in both LPR and DTH, implying the local release of inflammatory cytokines in both reactions. Small but significant numbers of activated eosinophils (EG2+) were detected in atopics and non-atopics at 24 h in DTH but not at 48 h. These findings suggest that the allergen-induced LPR induced in atopic subjects is, at least in part, a form of cell-mediated hypersensitivity but with T cell kinetics that differ from classical DTH.
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Affiliation(s)
- M Gaga
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England
| | - A J Frew
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England
| | - V A Varney
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England
| | - A B Kay
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England
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Gaga M, Frew AJ, Varney VA, Kay AB. Eosinophil activation and T lymphocyte infiltration in allergen-induced late phase skin reactions and classical delayed-type hypersensitivity. J Immunol 1991; 147:816-22. [PMID: 1830598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
T lymphocyte infiltration is a well documented feature of classical delayed-type hypersensitivity (DTH) reactions. Recently, we have shown that T lymphocytes and activated (EG2+) eosinophils accumulate in the allergen-induced late phase skin reaction (LPR). To compare the kinetics and phenotypic composition of these T lymphocyte responses, LPR and DTH reactions of comparable induration size were induced in atopic subjects. In addition, DTH and LPR were compared between atopic and nonatopic subjects. In atopic individuals, allergen challenge elicited a perivascular influx of T lymphocytes that was predominantly CD4+. Eosinophil accumulation and activation were also prominent. There was no cellular response to allergen challenge in the nonatropic group. In both groups, DTH responses showed an intense T cell infiltrate which was more dense and dispersed than in the LPR. CD4+ T cells predominated but at 48 h CD8+ numbers were also significantly increased. In DTH, total leukocyte numbers (CD45+) were increasing at 48 h, whereas in the LPR, cell numbers reached a plateau between 24 and 48 h. T cell activation (shown by expression of IL-2R) was more prominent in DTH. Endothelial expression of HLA-DR was increased in both LPR and DTH, implying the local release of inflammatory cytokines in both reactions. Small but significant numbers of activated eosinophils (EG2+) were detected in atopics and non-atopics at 24 h in DTH but not at 48 h. These findings suggest that the allergen-induced LPR induced in atopic subjects is, at least in part, a form of cell-mediated hypersensitivity but with T cell kinetics that differ from classical DTH.
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Affiliation(s)
- M Gaga
- Department of Allergy and Clinical Immunology, National Heart & Lung Institute, London, England
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Kay AB, Varney VA, Durham SR. Immunotherapy and hay fever: Authors' reply. West J Med 1991. [DOI: 10.1136/bmj.302.6775.531-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Varney VA, Gaga M, Frew AJ, Aber VR, Kay AB, Durham SR. Usefulness of immunotherapy in patients with severe summer hay fever uncontrolled by antiallergic drugs. BMJ 1991; 302:265-9. [PMID: 1998791 PMCID: PMC1668945 DOI: 10.1136/bmj.302.6771.265] [Citation(s) in RCA: 301] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of immunotherapy (hyposensitisation) in patients with severe summer hay fever. DESIGN A randomised, double blind, placebo controlled study of a biologically standardised depot grass pollen extract. SETTING Allergy clinic, Royal Brompton and National Heart Hospital, London. PATIENTS 40 adults (mean age 35 years) with a history of severe grass pollen allergy uncontrolled by standard antiallergic drugs. Patients with perennial asthma were specifically excluded. INTERVENTION Patients were randomised to receive either an active preparation (Alutard SQ, a grass pollen (Phleum pratense) extract) or placebo at a rate of two subcutaneous injections a week in increasing doses until a maintenance dose was reached. This maintenance dose was given once a month. MAIN OUTCOME MEASURES Clinical efficacy was evaluated by symptom and drug diary cards, visual analogue scores during the grass pollen season, and a postseasonal assessment by the patients and a doctor. Conjunctival and skin sensitivity to local allergen provocation was measured before and after eight months of treatment. RESULTS There was a highly significant decrease (median Alutard SQ v median placebo (95% confidence interval for difference between medians] in total symptom scores (p=0.001) in the Alutard SQ treated group (360 v 928 (238 to 825]. Significant differences were also found in total drug use (p=0.002, 129 v 627 (178 to 574]. Visual analogue symptom scores were also reduced in the active group (p=0.02, 2.2 v 5.5 (-4.8 to -0.5]. The postseasonal assessment, by either the doctor or the patients, showed a large improvement (p less than 0.001) in favour of Alutard SQ. Provocation tests showed a greater than 10-fold reduction for the active group in immediate conjunctival allergen sensitivity (p=0.001), a 40% decrease in early phase response (p=0.02), and a 57% decrease in the late phase (p=0.001) cutaneous response after intradermal allergen. A total of 523 active injections were given. There was one systemic reaction at 10 minutes after injection, which was rapidly reversed with intramuscular adrenaline. There was one mild delayed urticarial reaction at 2 1/2 hours. CONCLUSION Immunotherapy is effective in patients with severe summer hay fever, but immediate anaphylactic reactions limit its use to specialised centres. Patient selection is extremely important, and chronic perennial asthma should be specifically excluded. As serious reactions occur within minutes a two hour wait for all patients after each injection seems unnecessary.
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Affiliation(s)
- V A Varney
- Department of Allergy, Clinical Immunology, National Heart and Lung Institute, Royal Brompton Hospital, London
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Abstract
Human late-phase allergic skin reactions (LPSR) are characterised histologically by a mixed infiltrate of granulocytes and mononuclear cells. Quantitative immunohistology reveals a correlation between the numbers of CD4+ T-cells and the number of activated eosinophils at LPSR sites. These CD4+ T-cells are predominantly CD45RO+ and belong to the 'memory' T-cell subset. Immunofluorescence studies indicate that type III (immune complex) mechanisms make no significant contribution to the LPSR. On the other hand, the LPSR and classical delayed-type hypersensitivity (DHT) both have a marked CD4+ T-cell component. T-cell infiltration is a more diffuse process in DTH than in the LPSR; between 24 and 48 h, DTH sites show a further increase in T-cell numbers with the appearance of CD8+ T-cells and an influx of monocytes. Activated eosinophils are present in the early stages of both LPSR and DTH, but are more prominent in the LPSR. These different patterns of cellular infiltration and activation are probably due to differences in the cytokine secretion pattern of the infiltrating T-cells. Detailed analysis of this hypothesis will require the use of in situ hybridization techniques.
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Affiliation(s)
- A J Frew
- Department of Allergy and Clinical Immunology, National Heart and Lung Institute, London, UK
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