[Per os desensitization in nickel contact eczema: a double-blind placebo-controlled clinico-biological study]. / Désensibilisation per os dans l'eczéma de contact au nickel: étude clinico-biologique en double insu contre placebo.

BACKGROUND: Ingestion of nickel (Ni) has been demonstrated to induce a specific state of tolerance in the guinea pig and mouse. In a pilot study conducted in 10 patients, we demonstrated that per os administration of Ni leads to reduced proliferation of specific lymphocytes and a lower number of responding lymphocytes in blood. The aim of this study was to evaluate the clinical and biological changes induced by the ingestion of Ni in a double-blinded placebo-controlled study. PATIENTS AND METHODS: Patients with nickel contact hypersensitivity were given a capsule of nickel sulfate containing 5 mg Ni (group A) or an identical placebo (group B) once a week for 7 weeks. Clinical criteria were assessed 49 days after study onset: objective measurement of lesion extent and intensity and quantitative patch tests at concentrations 2.4-0.8-0.2 and 0.05 p. 100. Likewise stimulation of specific lymphocyte proliferation and the number of circulating lymphocytes responding to Ni at limit dilutions were determined. RESULTS: Thirty patients with nickel contact eczema were included in the study, 28 women and 2 men. There was no statistical difference between the two groups for the intensity of skin lesions or their clinical course, quantitative patch tests and lymphocyte stimulation tests. Conversely, the number of circulating lymphocytes responding to Ni was significantly lower in group A than in group B at study end (p < 0.05). DISCUSSION: This double-blind placebo-controlled study confirmed that per os nickel can induce a significant reduction in the number of circulating lymphocytes responding to Ni. No other effect could be demonstrated for the clinical and biological parameters studied. These preliminary results should prompt a multicentric controlled trial including a larger number of patients with more severe lesions at inclusion and with a longer treatment duration.

The Flutter VRP1: a new personal pocket therapeutic device used as an adjunct to drug therapy in the management of bronchial asthma.

Respiratory physiotherapy is essential to the treatment of all acute or chronic respiratory disorders in which expectoration difficulties are a major problem. A new personal pocket therapeutic device that looks like a small pipe, the Flutter VRP1, combines safe endobronchial positive expiratory pressure, varying between 10 and 20 cm of water, with oscillations of both the intrabronchial pressure and the flow of exhaled air. We have tested this device in 20 patients (12 males and 8 females) suffering from hyperproductive asthma, presenting in common, among other factors, hypersensitivity to acarids as a major allergen. Patients used the device a minimum of 5 x 5 min daily for 30-45 days as the sole physiotherapy and did not take any mucolytics during the study period. The forced expiratory volume in one second (FEV1), the vital capacity (VC) and the peak expiratory flow (PEF) were measured immediately before and after 1 month of treatment with the Flutter VRP1. All three parameters were significantly improved by the daily use of this therapeutic device. Both objective and subjective improvement was evidenced in 18 of 20 patients.

PAF acether release on antigenic challenge. A method for the investigation of drug allergic reactions.

This study describes an in vitro method to evaluate a PAF acether release test (PART) from white blood cells after antigenic challenge. PAF acether activity of the supernatant was tested by platelet aggregation. The aggregating power was abolished by using SRI 63-441 (Sandoz), a PAF acether inhibitor. This method was applied to 57 patients with allergic or pseudo-allergic reactions to drugs by using different drug protein conjugates. The results of PART were evaluated in relation to the clinical history (score of imputability) and to other tests (skin tests, lymphocyte transformation tests (LTT), IgE-RAST). A good correlation was found between the release of PAF acether and a high predictability score: sensitivity 75%, specificity 83.8%. PART also correlated with skin tests (75% agreement, n = 60), with LTT (67.7% agreement, n = 74) and in 65.6% of cases with positive penicillin IgE-RAST (n = 32). This method brings a new possibility for the investigation of drug-allergic and pseudo-allergic reactions.

[Hyposensitization in pollinosis. Results of a 3-year controlled study with 2 depot-allergoid grass pollen extracts: aluminum hydroxide-adsorbed allergoid and tyrosine-adsorbed allergoid]. / Zur Hyposensibilisierung der Pollinose. Ergebnisse einer kontrollierten Studie über drei Jahre mit zwei Depotallergoid-Graspollenextrakten: Aluminiumhydroxid-adsorbiertes Allergoid (AGD) und Tyrosin-adsorbiertes Allergoid (TA).

For controlled hyposensitization treatment over a period of three years 36 patients with confirmed grass pollen sensitization had been selected in 1986 and randomly distributed to receive preseasonal injection therapy: 23 patients were treated with an average of seven AGD (aluminium-adsorbed allergoid) injections, and 13 patients had received six TA (tyrosine-adsorbed allergoid) injections. Evaluation of the trial data collected during three years of preseasonal treatment showed the following results of tolerance and efficacy: Systemic side-reactions registered during therapy were only mild and transient and occurred in the average after 3% of the AGD injections and after 10% of the TA injections. Local reactions over 5 cm diameter were registered after 7% in the AGD group and after 9% in the TA group. Before therapy there was no significant difference (p greater than 0.05) between the groups; after three years of therapy the AGD injections had resulted in a mean net rise of specific IgG of 220% (significant, p = 0.001); during the same time, TA injections had resulted in a final net increase of 10% (not significant, p greater than 0.05). Both treatment forms did not lead to any statistically relevant changes of specific IgE values. After three years of hyposensitization treatment, patients of both groups had improved; but an advantage was documented for patients treated with AGD on the basis of scores for objective assessment as well as for registered symptom and medication scores.