[New in vitro procedures in allergy diagnosis]. / Neue in-vitro-Verfahren zur Allergiediagnostik.

The diagnosis of IgE-mediated allergies is mainly based on anamnesis, skin test and antigen challenge. In some situations however, described in the text, skin test keeps in the background and serological antibody-identification becomes more and more important. This development is clearly illustrated by the example of patients suffering from neurodermatitis: since the introduction of appropriate screening-methods atopic organ manifestations of the patients are noticed significantly more often than before. All laboratory for the serological diagnoses of allergies, including completely new methods, are described and checked up for useful criteria of interpretation. For this purpose the statistical data of more than 20,000 persons, suffering from atopy were reviewed. Finally, both the variations of the IgE-level, including possible consequences, and the increased occurrence of cross-sensitivities between inhalational and ingestive antigens are discussed.

Studies on bacterial hypersensitivity in man. Interrelationship between skin reactions to bacterial peptidoglycan and serum peptidoglycan antibody titers.

The nature and extent of bacterially induced allergies are difficult to define. Since peptidoglycan, the main component of the cell wall of almost all bacteria, has been available in a highly purified, chemically and immunologically well-defined form, investigation of the allergological significance of this cell component is feasible. Intracutaneous tests were carried out on 181 test subjects with five different peptidoglycan (PG) preparations from Staphylococcus aureus, Staphylococcus epidermidis and Streptococcus Pyogenes. The results of the investigation were compared with the result of determination of serum PG antibodies and serum IgE concentrations. It was shown that test subjects with dual and later reactions to three different staphylococcal PGs displayed significantly higher PG antibody titers than test subjects with negative reactions. Such a relationship could not be found with the cutaneous reactions to streptococcal PG. The total serum IgE values were very much higher in test subjects with immediate reactions to staphylococcal PG than in test subjects with a negative reaction. Typical Arthus reaction or late granulomatous reactions were not observed. Humoral antibodies are involved at least in part in the elicitation of dual and late reactions. Thus, there are interesting parallels to allergy to fungal spores and organic dusts.

[Skin reactions to isolated bacterial cell wall components, bacterial peptidoglycan in particular]. / Hautreaktionen gegen isolierte bakterielle Zellwand-komponenten, insbesondere bakterielle Peptidoglycane.

To elucidate the pathogenetic mechanism of bacterial-allergical diseases and of reactions provoked by bacterial test substances (e.g. the intracutaneous test), it is necessary to analyse carefully various factors involved in these reactions. To try to separate toxic from immunological reactions minute amounts of peptidoglycan in four different preparations were applied to humans by intracutaneous injections. Peptidoglycan, an immunologically well defined wall components of almost all bacteria and which is therefore ubiquitous, was isolated from staphylococci and streptococci. The skin reactions were evaluated by macroscopical, microscopical and immunohistological observations, as well as by electromicroscopy and statistical means. Several findings indicate the involvement of immunological factors in the observed skin reactions. In some cases no measurable reaction was seen, whereas in others typical skin reactions occurred. Similar reactions were produced by the antigenically related peptidoglycans isolated from Staphylococcus aureus and Staphylococcus epidermis. These reactions differed, however, from those elicited by peptidoglycan preparations from Streptococcus pyogenes type A. Patients with chronic bacterial infections and who were injected by four bacterial preparations demonstrated a significant increase in delayed hypersensitivity reaction compared with two other groups of patients (atopic patients without chronic infection). Because of the very low test dose, necrotic skin reactions, which occur in animal experiments, were not observed.

[Treatment of seasonal asthmatic symptoms. A multicentre trial to compare the effects of ketotifen and disodium cromoglycate (author's transl)]. / Behandlung saisonaler asthmatischer Beschwerden. Multizentrischer Vergleich von Ketotifen und Dinatrium cromoglicicum (DNCG).

A randomized multicentre trial was done to investigate the protective effects of ketotifen and disodium cromoglycate (DSCG) in the therapy of bronchial asthma. 236 patients with seasonal asthmatic symptoms were treated and controlled in the summer of 1978. Both drugs showed a significant improvement of the lung function and a marked reduction of asthmatic symptoms, cough and expectoration.

[Pre-seasonal treatment of hayfever with a pollen depot extract (author's transl)]. / Zur präsaisonalen Behandlung des Heuschnupfens mit einem Depot-Pollenextrakt (L-Tyrosin-Adsorbat).

90 patients with "hayfever" - that means pollenallergic diseases of the respiration tract and the eyes - were treated in spring 1974 and 1975 with a tyrosinabsorbed grass and rye depot extract with three injections before the pollen-season. Only 16 patients had an isolated grass-rye-pollen-allergy in skin test, all the other patients had additional extrinsic allergies. These results were proved by RAST. One third of the patients had bad side-effects (27 out of 90) during the treatment. 17 patients showed general reactions and ten patients very strong local reactions. We think that these side-effects were caused by contact with antigens (hairs of animals, foods, flowers of trees) during therapy and acute or chronic infections. The results of therapy were asked by a questionnaire one year after the series of injections, there were 37 improved, 32 unchanged and/or worsened in pollen-season after treatment. Nevertheless the results encouraged to continue this treatment with the grass-rye-pollen-extract. It could be used as an "initial treatment" in pollinosis patients with a wide spread allergy just before the beginning of the pollen-season. It is necessary to fullfill all procedures of precaution which are in use in hyposensitizationtherapy to prevent stronger side-effects.