Effect of allerglobuline injection on serum immunoglobulin levels in ENT patients.

Allerglobuline is a human gammaglobulin preparation which has been reported to have a protective effect against Type I allergic diseases and chronic infection of the upper respiratory tract both in adults and children. This study included 64 patients suffering from perennial allergic rhinitis and/or chronic infection of the nose, paranasal sinuses and pharynx. All patients received Allerglobuline 10 ml intramuscular injection once a week for 5 times then once a month for another 3 times. Blood samples were taken before the first and after the last injections to assay for the levels of Igs G, A, M and E. The therapeutic responses were evaluated after the fifth injections by dividing into 5 grades (from Grade I = excellent to Grade V = no response). Statistical analysis revealed that there was no significant difference between the pre- and post-treatment levels of Igs, G, A and M. But the level of IgE decreased significantly after 8 injections (p less than 0.001). There was no correlation between the level of immunoglobulins and grade of therapeutic responses. But the number of patients who respond satisfactorily to Allerglobuline treatment increased from 62.26% after 5 injections to 77.36% after 8 injections. This difference does not reach the statistically significant level but is noteworthy.

A study on CNS-side effects of mequitazine, an H1-specific antihistamine in healthy Thai volunteers.

Mequitazine is a potent, non-sedative, long-acting H1-specific antihistamine proven to be a better therapeutic drug than other conventional antihistamines. It is also reported by many authors that the drug produces less sedative or other depressive actions on the central nervous system than other antihistamines. In order to evaluate the advantage of this drug in Asian people, an assessment of side effects of mequitazine, in comparison with chlorpheniramine, on the central nervous system was done in 20 healthy Thai volunteers, 10 males and 10 females 23-39 years of age, using a double blind crossover placebo controlled trial. Various subjective tests: alertness scale rating, visual analogue scale rating as well as objective tests: card sorting, glassbead picking and estimation of reaction time, were performed. There were no significant differences in side effects on the central nervous system between mequitazine and the placebo, whereas chlorpheniramine did produce side effects.

Study of mechanisms of post-transfusion hypertension in thalassaemic patients.

Post-transfusion hypertension, convulsion and cerebral haemorrhage is a serious complication that may occur in the thalassaemias. In this study we evaluated the effect of blood transfusion on blood pressure, plasma renin activity (PRA), blood viscosity, and urinary vanillylmandelic acid (VMA) and catecholamines in 11 beta-thalassaemia/haemoglobin E patients. The results showed that after each unit of blood transfusion the blood viscosity was increased and correlated with the increased in haematocrit level. At the same time the PRA level was significantly decreased and tended to return to the normal level in a few days after the transfusion. There was no alteration in the urinary VMA and catecholamine levels. During the study two patients developed hypertension and headache. Their PRA were still lower than the pre-transfusion levels and the blood pressure returned to the normal pre-transfusion levels within 30-90 minutes after the intravenous injection of furosemide.

A preliminary study of circulating immune complexes during allergen immunotherapy in Thai patients.

Circulating immune complexes are suspected as a potentially serious adverse effect after prolonged allergen immunotherapy. This study was undertaken to determine whether there were any significant immunological differences between 32 subjects with allergic rhinitis/asthma treated with immunotherapy of various durations and 13 subjects with similar diagnosis who had never been treated by immunotherapy. All patients were carefully examined for symptoms and signs of immune-complex diseases with negative results. The presence of circulating immune complexes was evaluated by the modified 125I-C1q binding test, the solid phase conglutinin (K) binding test and determination of C3, C4 and C3d levels. In addition, urinalysis, and quantitative determination of serum IgG, IgA, IgM and IgE were also performed. The overall results suggested that prolonged allergen immunotherapy did not result in an increase of circulating immune complexes or other adverse immunological consequences.

Ferns and their allergenic importance: skin and nasal provocation tests to fern spore extract in allergic and non-allergic patients.

In our recent survey, fern spores were found to be the third most common airborne air spora in the Bangkok atmosphere; therefore, the significance of fern spores as a causative allergen was assessed in patients with allergic rhinitis. By using the extract from the spores of Acrostichum aureum Linn, which is a widespread fern, an intracutaneous test was done in 226 allergic rhinitis patients and 61.5% of these patients reacted positively. Nasal provocation test by using the same kind of fern spore extract was also performed in 24 allergic rhinitis patients and the positive reaction occurred in 70.8%. When skin tests and nasal provocation tests were performed in a group of 20 nonallergic ENT patients, only 20% gave weakly positive skin test reactions and 15% gave mild reactions to the nasal provocation test. The authors concluded that fern spores are potentially allergenic and allergists should be aware that ferns could be an important aeroallergen.

Intranasal budesonide for the treatment of perennial rhinitis in Thai patients.

The efficacy and tolerability of a new intranasal glucocorticosteroid, budesonide, was evaluated in 28 Thai adult patients with perennial rhinitis. After one week pre-treatment observation period, the nasal spray was given as two puffs into each nostril twice daily (400 micrograms/day) for four weeks. The severity of all nasal symptoms decreased significantly after 1 week treatment reaching a minimal level after 2 weeks. The amounts of antihistamine tablets taken by the patients were also significantly reduced during the treatment with budesonide. Three patients reported adverse effects which were mild and easily tolerated. Morning plasma cortisol levels measured before and after four-week treatment in 15 patients revealed no significant changes. This study suggests that intranasal budesonide is an effective and well-tolerated treatment for perennial rhinitis.

A study of the skin reaction to bacterial vaccine in perennial rhinitis.

Immediate and late skin reactions to a bacterial vaccine test were studied in perennial rhinitis patients. The incidence of late skin response was 17.6% when 0.1 ml of bacterial vaccine was tested. The incidence of positive immediate reaction was similar to the late reaction but there was no significant association between these two types of reaction. There was no correlation between the skin reaction to bacterial extract and the presence of pathogenic and microflora in the nose and throat of the patient. Statistical analysis also showed that there was no significant correlation between the results of the skin test to bacterial vaccine and to common allergenic extracts.

A comparative study of the incidence of indoor and outdoor mold spores in Bangkok, Thailand.

The culture plate method was used in this survey of the indoor and outdoor incidence of the atmospheric molds in Bangkok Metropolis in the year 1977. The over-all sampling showed the prevalence of yeasts, Aspergillus, Hermodendrum and non-sporulated white fungi as the frequency of occurrence; each of them was over 50%. In general the incidence was high in the winter months and low in the rainy season except for Aspergillus, Fusarium and Curvularia which did not decline during the rainy period. Observations indicated that there are only slight differences between the incidence and the types of airborne fungi recovered from the exposed plates in the bedrooms and outside the houses in and around Bangkok Metropolis.

Histamine content in 24-hour urine in patients with dengue haemorrhagic fever.

Twenty-four hour urinary histamine in 12 patients with DHF compared to 12 normal subjects in the comparable age and sex were studied. The results revealed significantly increased urinary excretion in patients with DHF than in normal subjects in both free and total forms. This finding suggests that histamine may be one, if not all, of the mediators released during the course of the disease, especially in the severe cases. Histamine may play an important role for the leakage of intravascular fluid to the various serous spaces resulting in hypovolemia and shock.