Specific immunoglobulin E for staphylococcal enterotoxins in nasal polyps from patients with aspirin-intolerant asthma

BACKGROUND

Nasal polyps infiltrated with eosinophils are commonly found in chronic asthmatic patients, more frequently in those with aspirin-intolerant asthma (AIA) than aspirin-tolerant asthma (ATA). Some studies have suggested a contribution of superantigens derived from Staphylococcus sp to nasal polyposis and eosinophilia, but their relative importance in AIA and ATA subjects is unknown.

OBJECTIVE

We investigated whether local production of specific IgE to staphylococcal enterotoxins A and B (SEA and SEB) and relationships with markers of eosinophilic inflammation differ in the nasal polyps of AIA and ATA subjects.

METHODS

Fifteen AIA subjects with positive responses to lysine-aspirin bronchoprovocation and 15 ATA subjects underwent polypectomy. Immunoassays were used to quantify eosinophil cationic protein (ECP), IL-5, mast cell tryptase, soluble IL-2 receptors (sIL-2R), total IgE, and specific IgE for SEA and SEB.

RESULTS

ECP levels in nasal polyp homogenates were higher in AIA subjects than in ATA subjects (P < 0.02), with no significant differences in tryptase, IL-5 or sIL-2R. Total IgE, and specific IgE to both SEA and SEB, were detectable in some nasal polyps from both subject groups, but median levels were markedly higher in AIA subjects than in ATA subjects (P = 0.04, 0.01, 0.05, respectively). Levels of specific IgE to SEA and SEB correlated significantly with levels of ECP and IL-5, but not those of tryptase or sIL-2R.

CONCLUSION

These findings suggest that staphylococcal superantigens may drive local eosinophilic inflammation in nasal polyp tissue, and that this is exacerbated in subjects with AIA.

Increased levels of circulating autoantibodies to cultured human bronchial epithelial cell in adult patients with nonatopic asthma

The pathogenetic mechanism of nonatopic asthma has not yet been defined. The idea of a possible involvement of autoimmunity in the pathogenesis of nonatopic asthma has been proposed by earlier studies. To evaluate the possible involvement of autoimmune response against bronchial epithelial cell in the pathogenesis of nonatopic asthma, we measured circulating autoantibodies to cultured human bronchial epithelial cell (BEAS-2B cell line) using enzyme-linked immunosorbent assay. We used stored serum samples form 38 age-matched healthy controls, 26 adult patients with atopic asthma, 16 adult patients with nonatopic asthma, and 12 adult patients with systemic lupus erythematosus. Levels of IgG autoantibodies to bronchial epithelial cell were significantly higher in patients with nonatopic asthma (mean+/-SD of absorbance values; 0.135+/-0.030) and systemic lupus erythematosus (0.293+/-0.181) than in healthy controls (0.112+/-0.016) and patients with atopic asthma (0.116+/-0.031) (p<0.05). This study showed that levels of circulating IgG autoantibodies to bronchial epithelial cell were increased in adult patients with nonatopic asthma. Further studies are needed to evaluate the possible involvement of autoimmune mechanism in the pathogenesis of nonatopic asthma.

Anaphylaxis caused by the new ant, Pachycondyla chinensis: demonstration of specific IgE and IgE-binding components

BACKGROUND

There have been no reports dealing with the pathogenic mechanism and IgE-binding components in patients with anaphylaxis caused by a sting from Pachycondyla chinensis.

OBJECTIVES

This study was conducted to observe the clinical features of patients with P chinensis -induced anaphylaxis. The roles of specific (s) IgE and sIgG4 antibodies were evaluated, and IgE-binding components were identified.

METHODS

Seven patients with P chinensis -induced anaphylaxis and 15 unexposed control subjects were enrolled. P chinensis ants were collected at the patients' homes, and venom was prepared as P chinensis extract. Five patients complained of bee venom-induced anaphylaxis and had positive sIgE levels to yellow jacket venom, wasp venom, or both as well. Serum sIgE and sIgG4 were detected by means of ELISA. To identify IgE-binding components within P chinensis extracts, 12% SDS-PAGE with immunoblot analysis was applied.

RESULTS

All patients had positive skin prick test responses to P chinensis antigen and positive sIgE levels. Five (71%) patients had positive sIgG4 levels. Eight IgE-binding components (58, 46, 3l, 29, 27, 25, 22, and 12 kd) were noted, and the component at 12 kd was the most frequently found allergen (85%). IgE ELISA inhibition tests were performed on 2 groups of sera: one from patients with anaphylaxis induced by both P chinensis and bee venom (group A) and the other from patients with anaphylaxis induced by P chinensis venom alone without bee venom allergy (group B). ELISA inhibition tests with serum from group A showed significant inhibitions with addition of P chinensis extract, partial inhibitions with yellow jacket antigen, and minimal inhibitions with wasp or imported fire ant antigens. However, ELISA inhibition tests with serum from group B showed significant inhibitions with P chinensis antigen but no inhibition with wasp, yellow jacket, or imported fire ant antigens.

CONCLUSIONS

IgE-mediated reactions contributed to the development of P chinensis -induced anaphylaxis. Eight IgE-binding components and one major allergen (12 kd) were identified. Further studies will be needed to clarify the role of sIgG4 and to identify allergenic relationships with major bee and wasp allergens.

Clinical and immunologic changes after allergen immunotherapy with Hop Japanese pollen

BACKGROUND AND OBJECTIVE

Hop Japanese (Hop J) pollen has been reported as one of the major causative pollen allergens in the autumn season. There have been no published data regarding the clinical and immunologic effects of Hop J pollen immunotherapy in sensitized patients. In this study, we evaluated clinical and immunologic effects of Hop J immunotherapy.

PATIENTS AND METHODS

Pollens were collected in our area, and "Depo-Hop J" was prepared in the laboratory of Allergopharma (Reinbek, Germany). Fifteen asthmatic patients who had Hop J immunotherapy for > 1 year were enrolled. Their clinical parameters, such as asthma symptom scores, were monitored. Skin reactivity to Hop J and degree of airway hyperresponsiveness to methacholine were measured before and 1 year after the immunotherapy. Sera were collected before the immunotherapy, at the end of initial therapy, and 1 year after the therapy. Serum total IgE levels were compared by radioimmunoassay. Serum-specific IgE, IgG1, and IgG4 levels to Hop J were compared by ELISA. To evaluate the changes of cellular mechanisms, soluble CD30 (sCD30), soluble interleukin (IL)-2 receptor (sIL-2R), soluble CD23 (sCD23), and IL-10 levels were measured by ELISA.

RESULTS

Specific IgG1 and IgG4 levels began to increase at the end of the initial therapy (P < 0.05) with significant decreases in symptom scores (P < 0.05), whereas total and specific IgE levels showed variable responses during the immunotherapy with no statistical significance (P > 0.05). Serum sIL-2R and sCD30 levels decreased significantly (P < 0.05) 1 year after immunotherapy. No significant changes were noted in sCD23, IL-10, skin reactivity to Hop J, or airway responsiveness to methacholine (P > 0.05).

CONCLUSIONS

We are certain that Hop J allergen immunotherapy, if carried out properly according to suitable indications, can favorably influence asthma. Thus, an increase in specific IgG4 and IgG1 antibodies and reduction of a possible Th2 lymphocyte marker (sCD30) may be associated with symptomatic improvements.

Occupational asthma and rhinitis caused by multiple herbal agents in a pharmacist

BACKGROUND

Herb agents have been widely used for centuries in the Orient and they have been cultivated throughout Asia. There have been a few cases of occupational allergy caused by herb materials. We report a case of occupational asthma and rhinitis caused by six herb materials in a pharmacist working at a pharmacy.

OBJECTIVE

We sought the role of immediate hypersensitivity in herbal agent-induced asthma in a pharmacist.

METHODS AND RESULTS

The patient had strong positive responses on skin prick test to extracts of six herb materials: Chunkung (Cnidii rhizoma), Banha (Pinellia ternata), Sanyak (Dioscorea radix), Kangwhal (Ostericum koreanum), Danggui (Angelica radix), and Kunkang (Zingiberis rhizoma). Bronchoprovocation tests showed an early asthmatic response to Danggui extract. Serum specific IgE antibodies to Chunkung, Banha, and Sanyak were detected by ELISA with no specific IgE bindings to Kangwhal, Danggui, and Kunkang extracts. Twelve percent sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and IgE immunoblotting revealed one IgE binding component (60 kD) within Chunkung extract, two (10, 25 kD) in Banha, and four (33, 34, 65, 98 kD) in Sanyak. Basophil histamine release test revealed that Danggui extract could release a greater amount of histamine from basophils in the patient than in a healthy control.

CONCLUSIONS

Chunkung, Banha, and Sanyak may induce IgE-mediated bronchoconstriction in an exposed worker, and Danggui can cause bronchoconstriction by direct histamine-releasing effect from mast cells in a sensitized patient.

Diverse profiles of specific IgE response to toluene diisocyanate (TDI)-human serum albumin conjugate in TDI-induced asthma patients

The prevalence studies on specific IgE to toluene diisocyanate (TDI)-human serum albumin (HSA) conjugate in TDI-induced asthma have shown variable results. In this study, we attempted to compare specific IgE bindings to TDI-HSA conjugate and its specificity using 3 different conjugates. Sera were collected from 20 TDI-induced asthma and 10 controls. Specific IgE were measured by ELISA using three TDI-HSA conjugates; two from Carnegie Mellon (CM; 98 and 99 CM conjugates) and one from Ajou University. To evaluate specificity and cross-reactivity, ELISA inhibition tests were applied. Positive and negative predictive values between Ajou conjugate and 98 CM conjugate were 75% and 100%. Those between Ajou and 99 CM were 100% and 93.8%. One patient showed an isolated positive response to the Ajou with negative responses to the other two conjugates. ELISA inhibition test using this patient's serum revealed the significant inhibitions by the Ajou and minimal inhibitions by the others. On the other hand, another patient showed an isolated positive response to 99 CM with negative responses to the others, and ELISA inhibition test showed significant inhibition by 99 CM with minimal inhibitions by the others. These results suggest that specific IgE bindings to a new antigenic determinant of TDI-HSA conjugate can be heterogeneous and differ from one individual to another.

Identification of IgE-binding components of citrus red mite in sera of patients with citrus red mite-induced asthma

BACKGROUND

Our previous investigations demonstrated that citrus red mite (CRM) antigen could cause IgE-mediated bronchoconstriction in exposed farmers working on citrus farms.

OBJECTIVE

This study was performed to confirm IgE-binding components and major allergens within the CRM antigens.

METHODS

Ten subjects who had been diagnosed as having CRM-induced asthma were enrolled. Serum-specific IgE antibodies to CRM antigens were measured by using an ELISA. To identify IgE-binding components and major allergens, SDS-PAGE, 2-dimensional PAGE, IgE-immunoblot analysis, and amino acid sequencing of major allergens were performed.

RESULTS

All the asthmatic subjects had high specific IgE antibodies to CRMs. Twelve percent SDS-PAGE analysis showed more than 10 protein bands ranging from 6 to 64 kd. SDS-PAGE and IgE-immunoblot analysis with each individual serum showed 5 IgE-binding components (11, 24, 35, 40, and 64 kd), with 2 (24 and 35 kd) of them bound in more than 50% of the study subjects. Two-dimensional PAGE and IgE-immunoblot analysis demonstrated that the major allergen at 24 kd had 2 bands with different isoelectric points of 4.75 and 5.1. Thirty-five kilodaltons had one band with an isoelectric point of 4.75. All amino acid sequencing of the 2 major allergens was performed, which was not homologous with any previously characterized allergens.

CONCLUSION

Five IgE-binding components and 2 major allergens (24 and 35 kd) were identified within the CRM antigen. The N-terminal amino acid sequence of the 2 major allergens (24 and 35 kd) was determined.

Are there any links between Hop Japanese pollen and other weed pollens or food allergens on skin prick tests?

Recent investigations suggest that the importance of Hop Japanese pollen, which has been known as one of the major causative weed pollens, is increasing in this country. There have been few data dealing with the allergenic relationship between Hop J pollen and other food or inhalant allergens. Among 2909 patients who visited the Allergy Clinic of Ajou University Hospital, Suwon, Korea, 471 patients sensitized to Hop J, mugwort, or ragweed pollens on skin-prick test were enrolled. Positive rates to common inhalant or food allergens and their allergenic relationships with other pollens or food allergens were analyzed based upon skin-prick test results. The positive rates to sunflower, fat hen, nettle, grass (Bermuda, Orchard) and tree (alder, birch, and poplar) pollen were significantly higher in those sensitized to Hop J pollen than in those of negative responders (p < 0.05, respectively). No significant associations were noted with ragweed or mugwort pollen (p > 0.05, respectively). In regard to food-related allergens, an association was noted between Hop (Humulus lupulus) or celery allergens in those sensitized to Hop J pollen (p < 0.05, respectively). Hop J pollen may have possible links with celery, Hop, and sunflower pollens on skin-prick test. Further in vitro investigations will be needed to evaluate the possibility of cross-reacting components between them.

Presence of circulating autoantibodies against bronchial epithelia cell in patients with nonatopic asthma

Allergic response to common environmental agents has been regarded as a main pathogenetic mechanism of bronchial asthma. However, allergic sensitization (atopy) can not be detected in a siginificant number of adult asthmatic patients. The etiology of nonatopic asthma has not yet been defined. To evaluate the possible involvement of autoimmune response against bronchial mucosa in the pathogenesis of nonatopic asthma, we performed indirect immunofluorescence staining of fresh frozen human bronchial mucosa tissue using serum samples from patients with atopic and nonatopic asthma, healthy controls, and patients with systemic lupus erythematosus. On immunostaining, circulating IgG autoantibodies against bronchial mucosa were detected in 2 (9.1%) of 22 patients with nonatopic asthma and in none of 22 patients with atopic asthma and of 22 healthy controls. IgG autoantibodies from the two patients with nonatopic asthma predominantly stained the cytoplasmic membrane of basal cells in bronchial epithelium. Serum samples from 10 patients with systemic lupus erythematosus immunostained the nucleus of epithelial cells in whole layer of bronchial epithelium. This study showed the presence of circulating IgG autoantibodies against the bronchial epithelial cell in a small portion of patients with nonatopic asthma. Further studies may be necessary to evaluate the possible involvement of autoimmune mechanism in the pathogenesis of nonatopic asthma.

Hypersensitivity pneumonitis caused by Fusarium napiforme in a home environment

BACKGROUND

We report a case of hypersensitivity pneumonitis (HP) in a 17-year-old male student caused by Fusarium napiforme found in his home environment.

METHODS

The patient was diagnosed according to history, chest radiograph, spirometry, high-resolution chest CT, and transbronchial lung biopsy. To identify the causative agent, cultured aeromolds were collected by the open-plate method. From the main fungi cultured, fungal antigens were prepared, and immunoblot analysis with the patient's serum and each fungal antigen was performed.

RESULTS

Five fungal species were isolated from the patient's home. Immunoblotting analysis with the patient's serum demonstrated more than 10 IgG-binding fractions to F. napiforme extract only, while little binding was noted with the other fungal antigens.

CONCLUSIONS

We should be aware that HP may be caused by F. napiforme in the home environment.

Specific IgG1 and IgG4 antibodies to citrus red mite in citrus farmers: a study of their relationship to respiratory symptoms

Citrus red mite (CRM) is known as the most common sensitizing allergen in subjects with asthma and rhinitis working on citrus farms. The aim of this study is to evaluate the role of specific IgG1 (slgG1) and specific IgG4 (slgG4) to CRM in citrus farmers. Questionnaire survey and skin prick test including CRM antigen was done by 136 workers. Specific IgE (slgE), slgG1 and slgG4 to CRM were detected by enzyme-linked immunosorbent assay (ELISA). CRM-sensitive-asthma was diagnosed upon presence of asthmatic symptoms by questionnaire, airway hyperresponsiveness to methacholine and slgE to CRM. CRM-sensitive rhinitis was diagnosed upon presence of rhinitis symptoms and slgE to CRM. Eleven (8.1%) had CRM-sensitive asthma and 25 (18.4%) had CRM-sensitive rhinitis. Significant association was noted between presence of asthmatic symptoms and slgE or slgG4 (p<0.05, respectively), while no significant association was noted in slgG1 (p>0.05). Significant association was noted in the prevalence between slgG4 and slgE (p<0.05), while no significant association was noted between slgG1 and slgG4 or slgE (p<0.05, respectively). There was a significant correlation between slgE and slgG4 level (r=0.39, p<0.05). These findings suggest that the presence of slgG1 to CRM is response to CRM exposure, and further studies will be needed to evaluate the role of slgG4.

House dust mite-specific IgE antibodies in induced sputum are associated with sputum eosinophilia in mite-sensitive asthmatics

BACKGROUND

Although allergen-specific IgE antibodies have been considered to play an important role in the pathogenesis of atopic asthma, the role of IgE antibodies in the development of airway inflammation is not well defined.

OBJECTIVE

To evaluate the association between allergen-specific IgE antibodies and inflammation of the asthmatic airway.

METHODS

We measured house dust mite (HDM; Dermatophagoides farinae)-specific IgE antibodies in both serum and induced sputum from 16 HDM-sensitive asthmatic patients, and evaluated their association with sputum eosinophilia and eosinophil cationic protein (ECP) levels in induced sputum.

RESULTS

Levels of HDM-specific IgE antibodies in induced sputum were significantly higher in asthmatic patients than in controls (P < .01). In asthmatic patients, levels of HDM-specific IgE antibodies were significantly higher in induced sputum samples with eosinophilia (sputum eosinophil count > or = 5% of 200 counted non-squamous cells) than in those without eosinophilia (P < .05). There were no significant differences in serum levels of HDM-specific IgE antibodies between asthmatic patients with sputum eosinophilia and asthmatic patients without sputum eosinophilia. In asthmatic patients, sputum ECP levels were significantly correlated with levels of HDM-specific IgE antibodies (r = 0.60, P = .01) in induced sputum but not with those in serum.

CONCLUSION

We conclude that allergen-specific IgE antibodies in induced sputum from atopic asthmatics are associated with sputum eosinophilia. This result suggests that IgE-dependent mechanisms are involved in eosinophilic inflammation of the airway in atopic asthmatics.

Specific IgG, but not specific IgE, antibodies to toluene diisocyanate-human serum albumin conjugate are associated with toluene diisocyanate bronchoprovocation test results

BACKGROUND

The role of specific IgG to toluene diisocyanate (TDI) in the pathogenesis of TDI-induced asthma still remains unclear.

OBJECTIVE

We sought to evaluate the clinical significance of serum-specific IgG to TDI-human serum albumin (HSA) conjugate in subjects with TDI-induced asthma compared with specific IgE antibody.

METHODS

One hundred three subjects were enrolled and divided into 4 groups according to specific bronchoprovocation test (BPT) results: 50 subjects with TDI-induced asthma with positive results on TDI BPT were defined as group 1, 13 symptomatic workers exposed to TDI with negative results on TDI BPT were defined as group 2, 20 unexposed patients with allergic asthma were defined as group 3, and 20 unexposed healthy control subjects were defined as group 4. Serum-specific IgG and IgE antibodies to TDI-HSA conjugate were detected by means of ELISA.

RESULTS

The prevalence of specific IgG antibody to TDI-HSA conjugate was significantly higher in group 1 than in group 2 (46% vs 7.7%, P =.01) or group 3 (0%, P <.01). No significant difference was noted between group 2 and group 3 (P >. 05). However, the prevalence of specific IgE antibody to TDI-HSA conjugate was not significantly different between group 1 and group 2 (14% vs 7.7%, P >.05) or group 2 and group 3 (7.7% vs 0%, P >.05). There was no significant difference in prevalence of specific IgE or specific IgG according to the type of asthmatic response during the TDI BPT (P >.05). Overall, statistically significant association was noted between the prevalence of specific IgE and IgG antibodies in 103 subjects (P <.05), but no difference was noted within group 1 subjects only (P >.05).

CONCLUSION

These findings demonstrate that the presence of serum-specific IgG is closely related to TDI BPT results, and it may contribute to the development of TDI-induced asthma.

Anti-T antibodies and peanut-agglutinin-binding glycoproteins in sera of patients with gastric cancer

Agglutinating antibodies to neuraminidase-treated red blood cells (anti-T agglutinins) are known to be reduced in patients with gastric cancer. The antigenic determinant of anti-T agglutinin is known to have a disaccharide structure [Gal(beta1-3)GalNAc], the same specificity as peanut agglutinin (PNA). We examined sera of 27 patients with gastric cancer and 30 controls for anti-T agglutinins, anti-T antibodies and PNA-binding glycoproteins. Anti-T agglutinins were titrated by a microtiter hemagglutination method. Levels of anti-T antibodies were determined by enzyme immunoassay using synthetic glycoconjugate [Gal(beta1-3)GalNAc O-alpha-linked to human serum albumin] as an antigen. Levels of PNA-binding glycoproteins in sera were measured by sandwich enzyme-linked lectin assay using wheat germ agglutinin and peroxidase-conjugated PNA. Titers of anti-T agglutinins were significantly lower in patients with gastric cancer than in controls (P = 0.041). Levels of anti-T antibodies were not significantly different in patients with gastric cancer and controls; however, decreased levels of anti-T antibodies were more frequent in patients with gastric cancer than in controls (P = 0. 001). Levels of PNA-binding glycoproteins were significantly higher in sera of patients with gastric cancer than in controls (P = 0.001). The levels of anti-T antibodies inversely correlated with the levels of PNA-binding glycoproteins in sera of patients with gastric cancer (r = -0.44, P = 0.021). These results suggest that the decrease in anti-T antibodies in sera of patients with gastric cancer might be due to immune complex formation between circulating PNA-binding glycoproteins and anti-T antibodies.

Occupational asthma and IgE sensitization to cellulase in a textile industry worker

BACKGROUND

Although there have been a few reports of occupational asthma due to cellulase in several occupational settings, this is the first case of cellulase-induced occupational asthma in an employee working in the textile industry. Its pathogenetic mechanism remains to be further clarified.

OBJECTIVE

It is important to alert physicians to the possibility of occupational asthma caused by cellulase in workers of the textile industry.

METHODS AND RESULTS

The patient had atopy and strong positive responses to cellulase extract on skin prick tests. Bronchoprovocation test showed an early asthmatic response to cellulase extract. Serum specific IgE and specific IgG4 antibodies to cellulase were detected by enzyme-linked immunosorbent assay (ELISA). In order to further characterize the allergenic component of the extract, sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were performed. Eight IgE binding components ranging from 6 to 97.5 kD were detected within the cellulase extract.

CONCLUSION

These findings suggest that inhalation of cellulase can induce IgE-mediated bronchoconstrictions in employees working in the textile industry.

Presence of specific IgG antibody to grain dust does not go with respiratory symptoms

A high prevalence of work-related symptoms in relation to grain dust exposure has been reported in grain dust workers, but the role of the specific IgG antibody is unknown. To study the possible role of specific IgG (sIgG) and specific IgG4 (sIgG4) in the development of work-related symptoms, sIgG and sIgG4 subclass antibodies against grain dust antigens were determined by ELISA in sera from 43 workers and 27 non-exposed controls. They were compared with results of specific IgE antibodies, exposure intensity and the presence of respiratory symptoms. SIgG and sIgG4 antibodies were detectable in almost all sera of exposed workers, and the prevalence were significantly higher than those of controls (p<0.05). Higher sIgG4 was noted in workers with specific IgE (p<0.05). The correlation between sIgG and exposure duration was significant (p<0.05). There was no association between the prevalence of sIgG and sIgG4 and the presence of respiratory symptoms, or work stations. In conclusion, these results suggest that the existence of sIgG and sIgG4 might represent a response to grain dust exposure and may unlikely play a role in the etiology of respiratory symptoms.

The presence of atopy does not determine the type of cellular infiltrate in nasal polyps

BACKGROUND AND OBJECTIVES

Any relationship between atopy and nasal polyposis remains to be further studied to determine the contribution of atopy to the pathogenesis of nasal polyps.

MATERIALS AND METHOD

We have compared the inflammatory cellular infiltrate in nasal polyp tissue taken during resection from 10 atopic and 11 non-atopic subjects. We have used immunohistochemistry to enumerate the individual inflammatory cell types using monoclonal antibodies against tryptase (AA1) to identify mast cells, the secreted forms of eosinophil cationic protein (EG2) to identify activated eosinophils, neutrophil elastase (NE+) to demonstrate neutrophils, and T cell surface markers (CD3) to identify pan T cells.

RESULT

The number of AA1+ and NE+ cells tended to be higher in atopics, but no statistical significance was found (p = 0.06, p = 0.12). Eosinophil numbers (EG2) were abundant in both groups and found to be not different between them (p = 0.65). Some subjects had CD3+ cells with no significant difference between atopic and non-atopic subjects (p = 0.21). Significant correlation was found between NE+ and AA1+ or EG2 cells (r = 0.59, r = 0.63, p < 0.05, respectively).

CONCLUSION

These results suggest that the presence of atopy does not determine either the type of extent of cellular infiltration of nasal polyps.

Oilseed rape allergy presented as occupational asthma in the grain industry

BACKGROUND

There have been several reports on respiratory allergic symptoms induced by pollen of oilseed rape. To the best of our knowledge, this is the first report dealing with oilseed rape dust mainly composed of seeds, as an occupational allergen in the grain industry. In this paper, we present a case of occupational asthma caused by oilseed rape dust from the Animal Feed Industry, which proved to be induced by an IgE-mediated reaction.

METHODS AND RESULTS

The patient displayed positive responses to Dermatophagoides farinae as well as oilseed rape dust extract. The bronchoprovocation test showed an early asthmatic response to oilseed rape dust extract. Serum specific IgE antibody to oilseed rape antigen was detected by enzyme-linked immunosorbent assay (ELISA). ELISA inhibition test showed significant inhibitions with addition of oilseed rape antigen. In order to further identify the allergenic components of extract, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblot analysis were performed. Fourteen IgE-binding components ranging from 10 to 160kDa were detected within the oilseed rape extract.

CONCLUSION

These results suggest that the inhalation of oilseed rape dust, not pollen, can cause IgE mediated bronchoconstriction in an exposed worker of the grain industry.

Immunohistochemical characterization of cellular infiltrate in nasal polyp from aspirin-sensitive asthmatic patients

BACKGROUND

The immunopathologic mechanism of nasal polyp in aspirin-sensitive asthma remains to be further defined.

OBJECTIVE

To characterize the features of the inflammatory cellular infiltrate in the nasal polyp tissue from aspirin-sensitive asthmatic patients.

METHODS

We have taken nasal polyp tissue during nasal polyp resection from 13 aspirin-sensitive asthma, 6 allergic, and 12 non-allergic subjects. Immunohistochemistry was employed to stain and enumerate the individual inflammatory cell types using monoclonal antibodies against tryptase (AA1) to identify mast cells, against secreted forms of eosinophil cationic protein (EG2), to identify activated eosinophils, against neutrophil elastase (NE) for neutrophils and against T cell surface markers (CD3) to identify total T cells.

RESULTS

There were no significant differences in AA1 + cells among three groups (P>.05). EG2 + cells tended to be higher in ASA-sensitive asthmatic patients than in allergic and non-allergic subjects, but no statistical significance was observed. NE+ cells were found in most subjects of the three groups and their numbers were significantly higher in allergic subjects than in aspirin-sensitive asthma (P<.05). Some patients had CD3+ cells with no statistical significance among the three groups. Significant correlation was found in numbers between NE+ cell and AA1+ cell (r=.44, P=.01), and between NE+ cell and EG2+ cell (r=.40, P=.02).

CONCLUSION

These findings suggested that major effector cells such as mast cells and eosinophils might be placed in the center of the inflammatory response of nasal polyps, regardless of their association with aspirin sensitivity.

Elevation of specific immunoglobulin A antibodies to both allergen and bacterial antigen in induced sputum from asthmatics

The antigenic specificity and pathogenetic significance of immunoglobulins in airway secretion from asthmatic patients have not been established. Elevated levels of B-cells and immunoglobulin (Ig)A antibodies have been reported in sputum of asthmatics and these levels correlated with the eosinophil counts and levels of degranulated cytotoxic proteins from eosinophils. This study aimed to investigate the antigen specificity and possible pathogenetic significance of antibodies in airway secretion from asthmatic patients. Specific IgA and IgG antibodies to both allergen (Dermatophagoides farinae) and bacterial antigen (capsular polysaccharide antigen from Streptococcus pneumoniae) were measured in sputum from 16 atopic asthmatic patients sensitized to D. farinae and 12 nonatopic, nonasthmatic controls by enzyme-linked immunosorbent assay. Sputum was induced by inhalation of hypertonic saline. Eosinophil cationic protein (ECP) levels in sputum from asthmatic patients were measured by the Pharmacia CAP system. Levels of IgA to both D. farinae and S. pneumoniae and IgG to D. farinae in the sputum from asthmatic patients were significantly higher than those from controls (p<0.005). No significant difference was found in the levels of IgG to S. pneumoniae between the two groups. In asthmatic patients, there were significant correlations between IgA to D. farinae and S. pneumoniae (r=0.76, p=0.003). Sputum ECP levels correlated significantly with IgA to D. farinae (r=0.55, p=0.03) and S. pneumoniae (r=0.56, p=0.03) and IgG to D. farinae (r=0.52, p=0.04), but not with IgG to S. pneumoniae in asthmatic patients. In conclusion, specific immunoglobulin A antibodies to both allergen and bacterial antigen were elevated in induced sputum from atopic asthmatics and their possible involvement in eosinophil degranulation was suggested.

Role of specific IgE, IgG and IgG4 antibodies to corn dust in exposed workers

BACKGROUND AND METHODS

To evaluate the role of specific antibodies to corn dust (CD) and their relationship to respiratory dysfunction, we detected serum specific IgE(slgE) and IgG4(slgG4) antibodies by ELISA in 42 employees working in the animal feed industry and 27 unexposed controls.

RESULTS

Our survey revealed that 15 (34.9%) subjects had work-related respiratory dysfunction associated with or without nasal symptoms. Among these subjects, eight had airway hyper-responsiveness to methacholine. Significant differences were noted in slgE and slgG4 between exposed and unexposed groups (p = 0.04, p = 0.00 respectively), but no difference was noted in slgG (p = 0.1). Although there was no significant differences in the prevalence of specific IgE antibody between symptomatic (29%) and asymptomatic groups (19%, p = 0.55), the specific IgE levels were significantly higher in symptomatic workers than in asymptomatic workers (p = 0.03). Specific IgG antibody was detected in 1 (6%) symptomatic and 4 (15%) asymptomatic workers (p = 0.46). Specific IgG4 antibody was detected in 11 (73%) of symptomatic and 21 (78%) of asymptomatic workers (p = 0.90). The higher prevalence of slgG4 antibody was noted in workers with slgE antibody (p = 0.001). The correlation between slgG and exposure duration was significant (r = 0.36, p = 0.02). There was no association between the prevalence of slgE, slgG, and slgG4 to exposure intensity, smoking or atopic status.

CONCLUSION

These results suggested that the existence of slgG and slgG4 might represent a response to CD exposure, and that some unexposed subjects had slgG to CD. Specific IgE might play a role in the development of respiratory symptoms.

IgE production from the nasal polyp tissue: comparison between atopic and non-atopic subjects

OBJECTIVES AND METHODS

To confirm the local production of IgE antibody from the nasal polyp tissue, and to evaluate the difference between atopics and non-atopics, nasal polyp tissues were taken from both 10 atopic and 10 non-atopic subjects. The tissue total IgE (tlgE) level was measured by enzyme-linked immunosorbent assay (ELISA) and serum tlgE level by radio-immunoassay. The tissue albumin level was measured by nephelometry, and serum albumin level by Bromocresol green method.

RESULTS

The polyp tissue tlgE/albumin as well as serum tlgE/albumin ratio were significantly higher in atopics than in non-atopics (p < 0.05), with no difference in the albumin level between the two groups (p > 0.05). Three non-atopic subjects had high polyp tissue tlgE/albumin (> 10). A significant correlation was noted between serum tlgE/albumin and polyp tlgE/albumin (r = 0.46, p = 0.04). The ratio of polyp tlgE/albumin to serum tlgE/albumin was greater than 1 in all of the non-atopic subjects and 7 of 10 atopic subjects.

CONCLUSION

These findings support the hypothesis that IgE antibody could be locally produced from the nasal polyp tissue of non-atopic subjects as well as atopic subjects. The possibility of an isolated local production of IgE antibody was suggested.

Neutrophil infiltration and release of IL-8 in airway mucosa from subjects with grain dust-induced occupational asthma

BACKGROUND

The immuno-pathological mechanism for occupational asthma induced by grain dust (GD) remains to be clarified. There have been few reports suggesting the involvement of neutrophils inducing bronchoconstriction after inhalation of GD.

OBJECTIVE

To further understand the role of neutrophil in the pathogenesis of GD-induced asthma.

MATERIALS AND METHODS

We studied the phenotype of leucocytes of the bronchial mucosa in patients with GD-induced asthma. Bronchial biopsy specimens were obtained by fibreoptic bronchoscopy from six subjects with GD-induced asthma. Six allergic asthma patients sensitive to house dust mite were enrolled as controls. Bronchial biopsy specimens were examined by immunohistochemistry with a panel of monoclonal antibodies to tryptase-containing mast cell (AA1), activated eosinophil (EG2), pan T-lymphocyte (CD3) and neutrophil elastase (NE). Induced sputum was collected before and after the GD-bronchoprovocation test. The IL-8 level in the sputum was measured using ELISA.

RESULTS

There was a significant increase in the number of AA1+ and NE+ cells in bronchial mucosa of GD-induced asthma, compared with those of allergic asthma (P=0.01, P=0.01, respectively). No significant differences were observed in the number of EG2+ and CD3+ cells (P = 0.13, P=0.15, respectively). IL-8 was abundant in the sputum of all GD-induced asthma patients and significantly increased after the bronchial challenges compared with the baseline value (P = 0.03).

CONCLUSION

These findings support the view that neutrophil recruitment together with mast cells may contribute to the bronchoconstriction induced by GD. A possible involvement of IL-8 was suggested.

Analysis of induced sputum for studying allergen-specific IgE antibodies in airway secretion from asthmatic patients

BACKGROUND

Allergen-specific IgE antibodies have been considered to play an important role in the pathogenesis of atopic asthma. However, studies on allergen-specific IgE antibodies in airway secretion from asthmatic patients are very rare compared with those in serum.

OBJECTIVES

The present study was undertaken to determine whether induced sputum might provide a useful method for analysing allergen-specific IgE antibodies in airway secretions from asthmatic patients.

METHODS

Specific IgE antibodies to house dust mite (HDM) antigen were measured in induced sputum from 10 HDM-sensitive asthmatic patients and 12 non-allergic controls by enzyme-linked immunosorbent assay. HDM-specific IgE was regarded as positive when the absorbance value was higher than mean + 2SD of controls. Their antigen-binding characteristics were determined by immunoblot analysis.

RESULTS

HDM-specific IgE was positive in induced sputum from seven of 10 HDM-sensitive asthmatics. The IgE binding to HDM antigen could be inhibited by fluid phase HDM antigen in a dose-dependent manner, not by mugwort antigen. Treatment of induced sputum with dithiothreitol decreased the antigen-specific bindings, and increased the non-specific bindings on the measurement of HDM-specific IgE. These effects were significant in a concentration of dithiothreitol greater than 0.05%. Immunoblot analysis revealed that HDM-specific IgE antibodies in induced sputum recognized the HDM antigens with molecular weights of 42, 34, 32, 25 and 14 kDa. These antigen binding characteristics were similar to those in serum.

CONCLUSION

We conclude that analysis of induced sputum is a useful non-invasive method for studying allergen-specific IgE antibodies in airway secretion from asthmatic patients.

Occupational asthma and IgE sensitization to grain dust

To evaluate type I hypersensitivity to grain dust (GD), its prevalence and relationship to respiratory dysfunction, we studied clinical and immunologic features, including skin prick tests (SPT), serum specific IgE, and bronchoprovocation tests of 43 employees working in the animal feed industry. To further characterize IgE-mediated reaction, SDS-PAGE and electroblot studies were performed. Our survey revealed that 15 (34.9%) subjects had work-related skin response (> or =2+ of A/H ratio) to GD, thirteen (30.2%) had high specific IgE antibody against GD. The specific IgE antibody was detected more frequently in symptomatic workers (40%) than in asymptomatic workers (11%). Significant association was found between specific IgE antibody and atopy or smoking (p<0.05). The ELISA inhibition test of GD revealed significant inhibitions by GD extract and minimal inhibitions by the house dust mite, storage mite and corn dust. Immunoblot analysis showed 8 IgE binding components within GD ranging from 13.5 to 142.5 kDa. Two bands (13.5, 33 kDa) were bound to the IgE from more than 50% of the 14 sera tested. In conclusion, these findings suggest that GD inhalation could induce IgE-mediated bronchoconstriction in exposed workers.

Seasonal variation of IgG subclass antibodies to house dust mite in sera from mite-sensitive asthmatic patients

BACKGROUND

House dust mite is an important cause of bronchial asthma. Seasonal variation of environmental house dust mite allergen levels and the specific IgE antibody to house dust mite have been reported.

OBJECTIVE

We studied the changes in IgG subclass antibodies to house dust mite associated with seasonal variation of house dust mite allergen levels in houses of mite-sensitive asthmatic patients.

METHODS

In 14 mite-sensitive asthmatic patients, house dust mite allergen (Der f 1) contents in bedding were measured monthly, and IgG subclass antibodies to house dust mite, Dermatophagoides farinae (D. farinae), were determined by enzyme-linked immunosorbent assay (ELISA) every 3 months from July to December.

RESULTS

The concentration of Der f 1 in dust from bedding reached maximum levels in August and September, and significantly decreased in November and December compared with August and September (P < .05). Levels of D. farinae-specific IgG4 antibodies significantly decreased in December compared with September (P < .05) with no statistically significant change between September and June (P > .05). Levels of D. farinae-specific IgG2 antibodies decreased significantly in December compared with June (P < .05). The levels of IgG1 and IgG3 antibodies to D. farinae showed no significant differences during the study period.

CONCLUSION

These findings suggest that seasonal changes in natural exposure to house dust mite allergen might lead to concurrent changes in specific IgG4 antibodies to house dust mite in mite-sensitive asthmatic patients and each IgG subclass antibodies to house dust mite might have a different kinetics.

Immunohistochemical characterization of the cellular infiltrate in airway mucosa of toluene diisocyanate (TDI)-induced asthma: comparison with allergic asthma

Toluene diisocyanate (TDI) is the most prevalent agent in occupational asthma (OA) in Korea. The immuno-pathologic mechanism for TDI-induced bronchoconstriction remains to be clarified. We studied the immunohistochemical finding of inflammatory cells in bronchial mucosa in subjects with TDI-induced asthma. Fiberoptic bronchial biopsy specimens were obtained from nine subjects with TDI-induced asthma. Six allergic asthma sensitive to house dust mite were enrolled as controls. Bronchial biopsy specimens were examined by immunohistology with a panel of monoclonal antibodies to mast cell tryptase (AA1), secretary form of eosinophil cationic protein (EG2), pan T-lymphocyte (CD3) and neutrophil elastase (NE). There was a significant increase in the number of AA1+, EG2+ and NE+ cells in TDI-induced asthma compared to those of allergic asthma (p=0.02, p=0.04, p=0.03, respectively). No significant differences were observed in the number of CD3+ cells (p=0.27). These findings support the view that neutrophil recruitment together with eosinophil and mast cell, may contribute to the bronchoconstriction induced by TDI.

Role of circulating immune complex in aspirin-sensitive asthma

BACKGROUND & OBJECTIVES

The pathogenic mechanism of aspirin-sensitive asthma (ASA-BA) remains to be further defined. To evaluate the role of circulating immune complex (CIC) in ASA-BA.

SUBJECTS & METHODS

We measured IgG- and IgA-IC level by ELISA using anti-C3 antibody in 33 ASA-BA patients whose sensitivity was confirmed by lysine-aspirin bronchoprovocation test, and compared with those of 14 allergic, 14 intrinsic asthma patients and 7 healthy controls.

RESULTS

There was no significant difference in IgG-IC level among the four groups (p > 0.05), while IgA-IC levels of aspirin-sensitive asthma were higher than those of other groups (p = 0.0035). Patients with nasal polyp had significantly higher IgG-IC than those without it (p = 0.02). No differences were found according to medication and symptom scores, and presence of atopy, rhino-sinusitis, urticaria or concurrent sensitivity to sulfite (p > 0.05). Insignificant correlation was found between IgG-IC level and asthma duration, total IgE level, or circulating eosinophil count.

CONCLUSION

These findings suggest a possible contribution of IgG-IC to the development of nasal polyp in ASA-BA. Further study will be needed to clarify the role of IgA-IC in the pathogenesis of ASA-BA.

Prognostic factors for toluene diisocyanate-induced occupational asthma after removal from exposure

BACKGROUND

The outcome of isocyanate-induced occupational asthma remains to be further defined. There have been few studies on the role of specific antibodies in prognosis of toluene diisocyanate (TDI) induced occupational asthma. Moreover, to the best of our knowledge, there have been no studies on the improvement pattern of airway hyperresponsiveness (AH). We analysed the prognostic factors that affected the outcome of 35 toluene diisocyanate-induced occupational asthma.

OBJECTIVES

To define clinical and laboratory parameters predicting favourable prognosis for TDI-induced occupational asthma.

METHODS AND RESULTS

After confirmation of bronchial sensitivity by TDI bronchoprovocation test (BPT), 35 patients were recommended to avoid exposure to TDI; they were also given anti-asthmatic medications including inhaled steroids and monitored for 2 years. Seventeen (49%) recovered completely with disappearance of airway hyperresponsiveness (AH) to methacholine during the follow-up period (mean duration: 12 months, range of 3-30 months). Eleven (31%) showed a significant improvement in AH for first year, which improvement stabilized in the next year with mild symptoms. Seven (20%) patients did not show any evidence of improvement in AH and had persistent symptoms. Favourable prognosis was associated with a short duration of asthmatic symptoms before diagnosis (P < 0.05), immediate cessation of exposure after diagnosis (P < 0.05), milder degree of AH at diagnosis (P < 0.05), and the presence of specific IgE antibodies to TDI-human serum albumin conjugate (0.05 < P < 0.1). No association was found with atopic and smoking status, age, exposure duration, or length of latent period (P > 0.05).

CONCLUSION

These data suggest that early detection of TDI-induced asthma and immediate cessation of exposure are important factors for a favourable prognosis.

Evidence of Hop Japanese pollinosis in Korea: IgE sensitization and identification of allergenic components

BACKGROUND

Hop Japanese (Hop J) pollens are abundant in the air of Korea during the autumn season. Their significance as a source of allergic sensitization is still unclear.

OBJECTIVES

We sought to detect the sensitization rate to Hop J pollen as an inhalant allergen and to identify its allergenic components.

METHOD

We carried out skin prick tests with Hop J pollen extract in 1287 patients with respiratory allergy who visited our hospital over the course of 1 year. The serum-specific IgE antibody to Hop J pollen antigen was detected by ELISA, and its binding specificity was confirmed by the ELISA inhibition test. To confirm the respiratory sensitization, bronchoprovocation tests were performed in 16 asthmatic patients sensitive to this pollen. To characterize allergenic components, Hop J pollen extract was analyzed by means of sodium dodecylsulfate-polyacrylamide gel electrophoresis followed by IgE immunoblotting.

RESULTS

A positive result on the skin prick test (> or = 2+ of the antigen to histamine ratio) was noted in 79 (6.1%) patients. The serum-specific IgE antibody was detected in 18 (41.9%) patients among 43 positive reactors tested. The ELISA inhibition test with the addition of Hop J pollen extract showed a dose-dependent response. Minimal inhibitions were noted with addition of ragweed and mugwort pollen extracts. Nine asthmatic patients showed significant bronchoconstriction after inhalation of the Hop J pollen extract (five early and four dual asthmatic responders), and all of them had high specific IgE binding. Immunoblot analysis revealed 12 IgE-binding components ranging from 13 to 89 kd. Three bands (13 kd, 74 kd, and 80 kd) were bound to the IgE among the sera tested from more than 50% of the patients.

CONCLUSION

We believe that the Hop J pollen should be considered as a relevant allergen during the autumn season and thus included in skin test batteries in Korea. Some patients diagnosed as having "intrinsic" asthma or rhinitis might be sensitized to this pollen and other previously unknown allergens.

Identification of IgE-binding components in occupational asthma caused by corn dust

BACKGROUND

There have been some reports of corn dust-induced occupational asthma that suggest nonimmunologic mechanism. In this paper, we present a case of occupational asthma and rhinitis caused by corn dust where bronchoconstriction was induced by an IgE-mediated reaction.

METHODS AND RESULTS

The patient had positive responses to weed and grass pollens as well as corn dust extracts. The bronchoprovocation test elicited an early asthmatic response to corn dust extracts. Serum-specific IgE and IgG4 antibodies to corn dust extracts were detected by enzyme-linked immunosorbent assay (ELISA). In order to identify further the allergenic component of the extracts, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were performed. Ten IgE-binding components (9 to 140 kD) were detected within the corn dust extracts.

CONCLUSION

These results suggest that inhalation of corn dust can cause IgE-mediated bronchoconstriction in an exposed worker.

Correlation between IgA antibody and eosinophil cationic protein levels in induced sputum from asthmatic patients

BACKGROUND

Eosinophils are known to be main effector cells in allergic inflammation and IgA antibody has been shown to be a potent stimulus for eosinophil degranulation in in vitro conditions.

OBJECTIVE

To evaluate the possible role of IgA antibodies on eosinophil degranulation in lower respiratory mucosa of asthmatics, we tried to find a correlation between total IgA and eosinophil cationic protein (ECP) levels in induced sputum from asthmatics.

METHODS

We measured total IgA and albumin levels by nephelometry, and eosinophil cationic protein levels by Pharmacia CAP system in induced sputum from 23 atopic asthmatics and 12 healthy controls.

RESULTS

IgA and albumin levels in induced sputum from asthmatics with sputum eosinophilia (sputum eosinophil count > or = 5% of 200 counted non-squamous cells) were significantly higher (P < 0.05) than those from controls. However, IgA and albumin levels in induced sputum from asthmatics without sputum eosinophilia were not significantly different with those from controls (P > 0.05). In induced sputum from asthmatics, ECP levels were significantly correlated with albumin (r = 0.44, P = 0.04) and IgA levels (r = 0.67, P = 0.002). ECP/albumin ratio was also significantly correlated with IgA/ albumin ratio (r = 0.61, P = 0.004).

CONCLUSION

Our results support the hypothesis that IgA antibodies in tracheobronchial secretion may be involved in eosinophil degranulation in asthma, and further study is needed to prove this hypothesis.

Seasonal variation of skin reactivity and specific IgE antibody to house dust mite

BACKGROUND

House dust mite is an important cause of bronchial asthma worldwide. While the allergen is present all year-round, a seasonal variation of house dust mite allergen levels has been found. There have been few reports, however, on seasonal variation of specific immune response to house dust mite.

OBJECTIVE

We studied the changes in skin reactivity and specific IgE antibody to house dust mite associated with seasonal variation of house dust mite allergen levels in houses of mite-sensitive asthmatic patients.

METHODS

In 14 mite-sensitive asthmatic patients, house dust mite allergen (Der f 1) contents in bedding were measured monthly. Skin reactivity on prick test and specific IgE antibody to house dust mite, Dermatophagoides farinae (D. farinae), were determined every 3 months from july to December.

RESULTS

The concentration of Der f 1 in dust from bedding reached maximum levels in August and September, and significantly decreased in November and December compared with August and September (P < .05). Skin reactivity (a ratio of mean wheal diameter of allergen to histamine) to D. farinae decreased significantly in December compared with September (P < .05). Serum levels of total IgE and specific IgE antibody to D. farinae decreased significantly in December compared with September (P < .05).

CONCLUSION

These findings suggest that seasonal changes in natural exposure to house dust mite allergen might lead to concurrent changes in skin reactivity and specific IgE antibody to house dust mite in mite-sensitive asthmatic patients.

New occupational allergen in a pharmaceutical industry: serratial peptidase and lysozyme chloride

BACKGROUND

Serratial peptidase and lysozyme are often used as anti-inflammatory agents. There have been very few documented cases of occupational allergy caused by these substances. We report a case of a pharmaceutical industry worker who developed occupational asthma and rhinitis caused by both serratial peptidase and lysozyme chloride.

OBJECTIVE

It is important to alert physicians to the possibility of occupational asthma when dealing with workers in the pharmaceutical industry.

METHOD AND RESULT

The patient had strong positive responses to peptidase and lysozyme extracts on skin-prick tests. Bronchoprovocation tests showed a dual asthmatic response to peptidase and an early asthmatic response to lysozyme. Serum specific IgE antibodies to peptidase and lysozyme were detected by enzyme-linked immunosorbent assay (ELISA). In order to further characterize the allergenic component of these extracts, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were also performed. More than ten components ranging form 7.3 to 83.1 kD were found in peptidase extracts, and two IgE binding components (67, 10.9 kD) were detected within the lysozyme extracts.

CONCLUSION

These findings suggest that inhalation of peptidase and lysozyme can induce IgE-mediated bronchoconstrictions in an exposed worker.

Isocyanate-induced occupational asthma: challenge and immunologic studies

Isocyanate is the most prevalent agent in occupational asthma(OA) in Korea. We analyzed 43 toluene diisocyanate(TDI) induced OA patients of whom 81% were found to be spray painters. The bronchial sensitivity of all subjects was confirmed by TDI-bronchial challenge test. Serum-specific IgE antibodies to isocyanate-human serum albumin(HSA) conjugate were detected by RAST technique(Pharmacia, Sweden). Bronchial challenge test results revealed 21(57%) early, 5 late only, 4 dual, and 12 atypical responders(5 prolonged immediate, 6 square-shaped, 1 progressive). Four(9%) subjects had negative results on the methacholine bronchial challenge test. High levels of serum specific IgE antibody to isocyanate-HSA were found in 17(40%) patients. The prevalence of a specific IgE antibody was not associated with a type of TDI-bronchial challenge test response, smoking and atopic status, presence of rhino-sinusitis and systemic symptoms, or a degree of airway hyperresponsiveness to methacholine(p > 0.05). The period of latency, ranging from 3 to 132 months, was significantly longer in high specific IgE responders (p < 0.05). These data suggest that 40% of isocyanate-induced occupational asthma patients had high specific IgE antibody to isocyanate-HSA conjugate. The presence of specific IgE antibody does not seem to correlate with clinical parameters.

C3-containing IgE immune complexes in asthmatic patients

Higher levels of IgE-containing immune complexes (IC) have been reported in sera from patients with allergic diseases than in sera from controls. To evaluate the possibility of an IC-mediated mechanism in the pathogenesis of bronchial asthma, we measured circulating C3-containing IgE IC (C3-IgE IC) using anti-C3 ELISA from 20 house dust mite (HDM)-sensitive asthmatics, 20 non-atopic asthmatics, and 14 non-atopic controls. C3-IgE IC levels were significantly higher in HDM-sensitive asthmatics (mean +/- S.D.: 12.2 +/- 7.8 AU/ml) than in non-atopic asthmatics (6.5 +/- 7.5 AU/ml) or controls (5.8 +/- 4.4 AU/ml). C3-IgE IC levels were significantly correlated with HDM-specific IgE levels (r = 0.50, p < 0.05), but not with total IgE levels (r = 0.36, p > 0.05) in HDM-sensitive atopic asthmatics. C3-IgE IC levels in sera did not significantly change during HDM-bronchoprovocation test in six HDM-sensitive asthmatics who showed positive reaction. Part of C3-IgE IC could be precipitated by protein G coupled beads. In conclusion, C3-IgE IC levels were elevated in sera from HDM-sensitive asthmatics; moreover IgG antibodies might be a component of C3-IgE IC. Our results suggest that an IgE IC-mediated mechanism could be involved in the pathogenesis of atopic asthma.

Occupational asthma due to deer dander

BACKGROUND

The literature on allergy to deer is limited. The allergenic component remains to be identified.

METHODS

We report a case of occupational asthma and rhinitis caused by deer dander. A 44-year-old male farmer had raised three red deer on his farm for 2 years, prior to occurrence of asthmatic symptoms. Dander extract was prepared from the patient's deer.

RESULTS

Skin-prick test elicited positive reactions to dander extracts from goat, sheep, camel, and cow as well as to deer dander extract. Bronchoprovocation test with deer dander extract elicited an early asthmatic response. Serum-specific IgE antibody to the deer dander extract was detected by enzyme-linked immunosorbent assay (ELISA). Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblot analysis showed five IgE binding components (110, 72, 59, 45, and 21 kilodalton) within the deer dander extract.

CONCLUSIONS

These results suggest that deer dander can induce occupational asthma through an IgE-mediated mechanism in a farmer raising deer.

Buckwheat flour hypersensitivity: an occupational asthma in a noodle maker

BACKGROUND

There have been very few reports of occupational allergies caused by inhalation of buckwheat flour. In this paper, we present a case of occupational asthma and rhinitis caused by buckwheat flour inhalation.

METHODS AND RESULTS

The patient had strong positive responses to grass and ragweed pollens as well. The bronchoprovocation test showed early asthmatic response to buckwheat flour extracts. Serum specific IgE antibody to buckwheat flour was detected by enzyme-linked immunosorbent assay (ELISA). In order to further identify the allergenic component of the extracts, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were performed. Eight IgE binding components (9-55 kDa) were detected within the buckwheat flour extracts.

CONCLUSION

These results suggest that inhalation of buckwheat flour can caused IgE mediated bronchoconstriction.

Effects of autologous sera on immediate and late skin reaction to the house dust mite in atopic individuals

To evaluate the in vivo effect of autologous serum including antibodies to house dust mite in atopic individuals, we observed the immediate (15 mins) and late (6 hours) skin reactions (ISR, LSR) on intradermal (ID) test of serially diluted Dermatophagoides farinae antigens (DFa, Allergopharma, Germany) mixed with autologous sera (DFa-S) and diluent alone (DFa-D). We tested 34 DFa-skin reactive atopic individuals including 12 asthmatics (BA), 8 asthmatics on immunotherapy with DFa (IT), and 14 healthy atopic controls (AC). We observed complete inhibition of ISR in the lowest allergen dose of DFa-S in 7 (58.3%) of 12 BA, 3 (37.5%) of 8 IT, and 2 (14.3%) of 14 AC. In BA, the inhibition of ISR was more frequent than AC (p < 0.05). We observed larger late reactions in half of LSR positive cases on ID test by DFa-S than by DFa-D (> or = 1.5 X size; accentuation of LSR). Accentuation of LSR were shown more frequently by DFa mixed with larger amount of serum (25% in 1:1 mix; 80% in 1:3 mix, p < 0.05). But there were no differences of DFa-specific IgE and IgG subclass antibodies regardless of the inhibition of ISR or the accentuation of LSR. In conclusion, some autologous sera from DFa-sensitive individuals showed the inhibition of ISR and the accentuation of LSR on DFa-ID test.

Measurement of IgE and IgG subclass antibodies to whole body antigen and two major allergens (Der fI & Der fII) of Dermatophagoides farinae in normal subjects and asthmatics

House dust mites have been known as the most important allergen in respiratory allergic diseases. Among several mite allergens, group I and group II antigens were recognized as major allergens. We measured specific IgE and IgG subclass antibodies against whole body antigen (WBA) and two major allergens of Dermatophagoides farinae (Der fI and Der fII) in sera from 66 adults with asthma (asthma group) and 34 normal subjects (healthy group) by ELISA. The mean O.D. values of WBA-specific IgE and IgG subclass antibodies in 100 studied sera were significantly higher than those of the two major allergens (p < 0.001) and the level of Der fII- IgG1, IgG4 and IgE were higher than those of Der fI but IgG2 of Der fI was higher than that of Der fII (p < 0.001). The level of IgG4 of WBA were significantly higher in the atopic group than in the nonatopic group (1.280 +/- 0.634 v.s. 0.8290 +/- 0.388, p < 0.001), but the WBA- IgG1, IgG2, IgG3 were not different between the two groups. Among IgG subclass antibodies of Der fI, IgG2 was significantly higher in the nonatopic group than in the atopic group (1.7770 +/- 0.255 v.s. 1.636 +/- 0.390, p < 0.05) but there were no differences in IgG1, IgG3, and IgG4. Among IgG subclass antibodies of Der fII, IgG2 (1.534 +/- 0.380 v.s. 1.3010 +/- .431, p < 0.05) and IgG4 (1.09650 +/- .567 v.s. 0.708 +/- 0.146, p < 0.001) were significantly higher in the atopic group than in the nonatopic group. IgE antibodies to WBA, Der fI and Der fII were significantly higher in the atopic group (p < 0.001). There were significant correlationships between the levels of IgE and IgG4 of WBA (r = 0.60), Der fI (r = 0.33) and Der fII (r = 0.72). Even though there were no differences in the levels of allergen specific IgE and IgG subclass antibodies between nonatopic healthy and nonatopic asthmatic groups, the number of sera with prominent level of IgG2 of WBA were more common in the nonatopic asthmatic group (69% in nonatopic asthma group v.s. 28% in nonatopic healthy group, X2-test, p < 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)