Effect of natural seasonal pollen exposure and repeated nasal allergen provocations on elevation of exhaled nitric oxide.

BACKGROUND: Exhaled nitric oxide (FENO) is a marker for allergic airway inflammation. We wondered whether in patients with intermittent allergic rhinitis only (i) natural pollen exposure and (ii) artificial pollen exposure by repeated nasal allergen provocations may lead to an elevation of FENO. METHODS: In two prospective studies, we compared the FENO of nonatopic controls with the FENO of nonasthmatic individuals with mild intermittent rhinitis to tree and/or grass pollen. Study I: 13 atopic individuals and seven controls had measurements of FENO, blood eosinophils and eosinophilic cationic protein (ECP) before, during and after pollen season. Study II: 16 atopic individuals and 12 controls had nasal allergen provocations on four following days out of pollen season, with daily measurements of FENO before, 2 and 6 h after provocation, and determination of blood eosinophils, ECP and FEV1 at baseline, on days 5 and 10-12. RESULTS: Natural pollen exposure (study I) caused a significant elevation of FENO in allergic individuals. Nasal allergen provocations (study II) did not elicit a statistically significant rise neither of FENO nor of blood eosinophils between baseline and day 5. However, a subgroup of four individuals with a rise of blood eosinophils during nasal allergen provocations showed also a rise of FENO. CONCLUSIONS: We suppose that in allergic rhinitis a concomitant reaction of the bronchial system is dependent on a strong local inflammation leading to a generalized immune stimulation.

The butterbur extract petasin has no effect on skin test reactivity induced by different stimuli: a randomized, double-blind crossover study using histamine, codeine, methacholine, and aeroallergen solutions.

BACKGROUND: Petasin (Ze 339) was recently introduced on the market as a potent herbal antiallergic drug for treatment of respiratory allergies such as hay fever. Few clinical studies have been performed so far addressing the clinical effectiveness of Ze 339. OBJECTIVE: To evaluate the antiallergic properties of Ze 339 using skin prick tests with different stimuli, such as codeine, histamine, methacholine, and a relevant inhalant allergen. METHODS: A randomized, double-blind, placebo-controlled study was performed in which Ze 339 was compared to acrivastine, a short-acting antihistamine, in 8 patients with respiratory allergy and in 10 nonatopic, healthy volunteers. Antiallergic activity of Ze 339 was determined by analyzing inhibitory potency in skin prick tests with codeine, histamine, methacholine, and an inhalant allergen. Wheal-and-flare reactions were assessed 90 minutes after a double dose of Ze 339, acrivastine, or placebo. An interval of at least 3 days was left between the skin tests. RESULTS: Acrivastine was identified as the only substance that significantly inhibited skin test reactivity to all solutions analyzed in all study subjects. In contrast, no significant inhibition could be demonstrated for Ze 339 with any test solution. Moreover, the results of Ze 339 did not differ significantly from placebo. CONCLUSIONS: In this study we found no antiallergic, particularly antihistaminic, effect of Ze 339 in skin tests using a variety of stimuli often used to evaluate immediate skin test reactivity. The mechanism by which Ze 339 is effective in the treatment of seasonal allergic rhinitis still needs to be elucidated.

Effect of tree pollen specific, subcutaneous immunotherapy on the oral allergy syndrome to apple and hazelnut.

BACKGROUND: The efficacy of specific immunotherapy (SIT) in pollen allergy is well established. However, its effect on pollen associated food allergy particularly the oral allergy syndrome (OAS) is not definitely ascertained. OBJECTIVE: The purpose of this controlled prospective study was to investigate whether SIT with tree pollen, mainly birch, has an effect on OAS induced by apple or hazelnut in birch pollen-allergic individuals. METHODS: Twenty-seven birch pollen-allergic subjects with OAS induced by apple or hazelnut underwent open oral provocation tests (OPT) with increasing doses (1 to 128 g) of fresh apple or ground hazelnut 1 year apart. Fifteen of 27 subjects were treated with SIT and 12 were not. Skin-prick test with birch pollen, apple and hazelnut, and specific serum IgE, IgG and IgG4 to rBet v 1, apple and hazelnut were determined. RESULTS: Thirteen of 15 (87%) SIT-treated subjects could eat significantly (P <0.001) more of apple or hazelnut without any symptoms/signs. The average tolerated quantity increased from 12.6 to 32.6 g apple after 1 year in this group. In contrast, only one of 12 (8%) individuals without SIT was able to consume a higher amount without symptoms. On evaluating laboratory parameters, only IgG4 antibodies to rBet v 1 were found to be significantly (P <0.01) increased in the SIT-treated group after 1 year. CONCLUSIONS: The study shows that SIT with extracts containing birch pollen has a positive impact on OAS to apple or hazelnut in birch pollen-allergic individuals. In spite of this outcome, the amount of apple/hazelnut tolerated is still small. Thus, the effect of SIT on the patients' management of OAS remains limited.

Boletus edulis: a digestion-resistant allergen may be relevant for food allergy.

BACKGROUND: Fungal components can cause allergic symptoms either through inhalation, ingestion or contact. Whereas respiratory allergy is thought to be induced by spores, allergic reactions following ingestion are attributed to other parts of the mushroom. Reports of food-related allergic reactions due to the edible mushroom Boletus edulis have occasionally been reported. OBJECTIVE: The aim of the study was to investigate whether separate allergens may be detected in alimentary allergy to Boletus edulis. METHODS: Sera of two subjects, one with recurrent anaphylaxis and the other with a predominantly oral allergy syndrome following ingestion of Boletus edulis, have been analysed by a time-course digestion assay using simulated gastric fluid and by SDS-PAGE immunoblotting. Sera of four Boletus edulis skin prick test-negative subjects and all without clinical symptoms to ingested Boletus edulis served as controls. RESULTS: In lyophilized Boletus edulis extract, at least four water-soluble proteins were detected, the most reactive at 55 kDa and at 80 kDa. Following the time-course digestion assay, IgE binding was found to a 75-kDa protein, but only if the sera of the subject with recurrent anaphylaxis was used. CONCLUSION: The data indicate that Boletus edulis can cause an IgE-mediated food allergy due to a digestion-stabile protein at 75 kDa. No IgE immune response to this protein was detected in the serum of a subject with respiratory allergy and oral allergy syndrome to Boletus edulis nor in control sera.

Reduced in vivo allergenicity of Bet v 1d isoform, a natural component of birch pollen.

BACKGROUND: The major allergen of birch pollen, Bet v 1, is present in structurally slightly different isoforms. It has been postulated that certain isoforms show a distinct ability to bind birch pollen-specific IgE, although the T-cell response remains similar. OBJECTIVE: We verified the hypothesis of a distinct allergenicity but similar T-cell immunogenicity of 2 isoforms in birch pollen-allergic subjects by in vivo tests and an in vitro assay for T-cell stimulation. METHODS: Forty-eight birch pollen-allergic, 11 grass pollen-allergic, and 10 nonatopic control individuals were tested with 10-fold increasing concentrations (0.01 to 10.0 microg/mL) of recombinant (r) Bet v 1a and rBet v 1d by skin prick test (SPT), intradermal test (IDT), and conjunctival provocation test (CPT). An allergen-specific proliferation assay was performed on 21 patients with the 2 recombinant and the natural birch pollen allergens. RESULTS: In each test system only birch pollen-allergic subjects but no controls reacted to the recombinant allergens. A positive in vivo response to 10 microg/mL of rBet v 1a was observed in 21 of 48 by SPT, in 48 of 48 by IDT, and in 33 of 48 by CPT. In contrast, the IDT response to 10 microg/mL of rBet v 1d was reduced by a factor of 100 because it was equivalent to the response to 0.1 microg/mL of rBet v 1a. rBet v 1d failed to elicit a positive reaction in SPT and CPT. The proliferative response of T cells was similar for both recombinant isoforms because 8 of 21 individuals reacted to rBet v 1a and 6 of 21 to rBet v 1d. Only 1 subject had a positive reaction to rBet v 1d alone. CONCLUSION: The natural isoforms rBet v 1a and rBet v 1d differ in their ability to bind IgE but are similar in their immunogenicity for T cells. Thus rBet v 1d might be a promising candidate for use in immunotherapy of birch pollen-allergic individuals.

Reactivity of carrot-specific IgE antibodies with celery, apiaceous spices, and birch pollen.

Although carrot allergy is not well recognized in North America, the celery-carrot-mugwort-spice syndrome is well known in Europe. In the current study, cross reactivity of carrot, stalk celery, and spices, all members of the Apiaceae and birch pollen was assessed with serum from a patient reporting raw carrot-induced, raw stalk celery-induced, or spice-induced laryngeal edema and bronchospasm. By RAST inhibition, some cross-reactivity was demonstrated between raw carrot and stalk celery and other members of the Apiaceae. Immunoprint inhibition revealed common allergic epitopes on a 17-kD band shared by carrot, celery, and birch pollen. The results suggest that subjects sensitized to carrot may also have allergic reaction to other vegetables of spices of the Apiaceous family. Furthermore, carrot hypersensitivity can be associated with birch pollen allergy.

Immunotherapy with honeybee venom and yellow jacket venom is different regarding efficacy and safety.

Venom immunotherapy (VIT) for Hymenoptera allergy is accepted as safe and effective. However, widely varying success rates and frequencies of side effects are reported. Differences between various Hymenoptera species could account for these diverging results. We therefore analyzed 205 patients with a history of systemic allergic reactions to either honeybee (148 patients) or yellow jacket stings (57 patients) during VIT. All patients had a positive skin test to the respective venom before VIT, were monitored for side effects of VIT, and submitted to a sting challenge while they were receiving VIT. Patients with honeybee-venom allergy had a higher sensitivity in both skin tests (p less than 0.05) and RAST (p less than 0.001) than patients with yellow jacket-venom allergy. They developed systemic side effects to VIT injections significantly more often (41% versus 25%; p less than 0.01) and also reacted more frequently to the sting challenge (23% versus 9%; p less than 0.01) than patients with yellow jacket-venom allergy. We conclude that results obtained from studies on the allergy to one Hymenoptera venom cannot be extrapolated to allergies to other Hymenoptera venoms.

Allergy to honey: relation to pollen and honey bee allergy.

To identify the allergenic components of honey we studied 22 patients with a history of systemic allergic symptoms following honey ingestion. The group of honey-allergic patients was compared with three control groups: 10 subjects sensitized to artemisia, 10 with honey bee venom allergy and 10 without a history of atopy or bee sting reactions. The allergological tests included skin tests and RAST with three different kinds of Swiss honey (dandelion, forest and rape), pollen of compositae species, celery tuber, extract of bee pharyngeal glands, honey bee venom and bee whole body extract. The results show that 3/4 of honey-allergics are sensitive to dandelion honey and 13 of 22 also to compositae pollen. Nine of the honey allergic patients were sensitized to honey bee venom, 3 also to bee pharyngeal glands and to bee whole body extract. Analysis of diagnostic tests and RAST inhibition studies suggest that besides compositae pollen other allergens, most likely of bee origin are important. In honey allergics primary sensitization may be due either to the honey itself, to airborne compositae pollen or even to cross-reacting bee venom components.

[The incidence of hay fever in leading Swiss athletes]. / Häufigkeit von Heuschnupfen bei Schweizer Spitzensportlern.

This enquiry covers 2961 active Swiss athletes of national or international standing in 68 different sports. Of these, 2060 (70%; 1507 males, 552 females) answered the questionnaire. 347 athletes (16.8%) indicated they suffered from hay fever, 204 of them (59%) needing medication during the pollen season. 25% took antihistamines, 20% various nasal decongestants, 19% Similasan, a homeopathic drug, and 11% various eye drops. 6% received injections of depot corticosteroid preparations. 50% of the athletes obtained these medications on prescription. 146 athletes (7.1%) complained of lower respiratory tract symptoms, 77 of them mentioning asthma attacks and 47 continuous dyspnea. The enquiry shows that the incidence of hay fever in highly trained athletes is as high as in the general Swiss population. The same is true of asthma. A considerable proportion of allergic athletes are inadequately informed as to both antiallergic therapy and doping regulations.

[Pollinosis. IV. Which pollens should be tested in allergology practice? Results of determinations of allergy-causing pollens in the Zurich air 1981-1984, with reference to threshold concentrations]. / Pollinosis. IV: Welche Pollen sollten in der Allergie-Praxis getestet werden? Ergebnisse der Bestimmungen von allergie-erzeugenden Pollen in der Luft von Zürich in den Jahren 1981-1984 unter Berücksichtigung von Schwellenkonzentrationen.

The most important pollens causing pollinosis in Zurich include hazel (Corylus), alder (Alnus) and birch (Betula) in spring, grasses--including rye--in summer, and mugwort (Artemisia) in autumn. Investigations on airborne pollen of Zurich were conducted from 1981 to 1984, and assessed with special reference to threshold concentrations. The results show that sorrel (Rumex) and plantain (Plantago) also belong to the most important pollens and should therefore be included in the test spectrum for allergological examinations. The pollen of ash (Fraxinus), oak (Quercus), beech (Fagus) and plane tree (Platanus) was regularly found in high percentages during these years. Hence the clinical relevance of these tree pollens should not be underestimated, because successful diagnosis and therapy depends mainly on the use of the relevant strain of pollen.