Asthma and allergy in Albania.

BACKGROUND: The risk of allergic disease may be influenced by the degree of "westernization". A survey was conducted to ascertain whether the prevalence of allergy was lower in Albania than elsewhere in Europe, as it has been the most isolated European country. METHODS: The subjects were residents of Tirana aged 20-44 years. A screening questionnaire was completed by 2653 subjects. A more detailed questionnaire was administered to a random sample of 564 respondents, together with skin prick tests and serum IgE assay. RESULTS: The prevalence of wheeze in the last year, and of wheeze without a cold, was lower in Albania than in any country that participated in the European Community Respiratory Health Survey. Nasal allergy and atopy (as indicated by serum specific IgE) were also uncommon in Albania, although serum total IgE concentrations were high. CONCLUSIONS: The findings confirmed the hypothesis of a low prevalence of allergy in Albania. Possible reasons include the recent economic isolation of Albania, the infrequency of smoking by women, the lack of domestic pets, and the high incidence of childhood infection and parasitic infestation. The prevalence of allergy and its potential determinants should be monitored in Albania as that country acquires the characteristics of other parts of Europe.

Diagnostic allergy laboratory external proficiency testing in Europe.

As with all diagnostic laboratory testing, some form of external proficiency testing is required both for the laboratory undertaking the testing and for the safety of the requesting clinician and his patient. Allergen Specific immunoglobulin E antibody testing in serum can produce different results depending on the method. Originally External Quality Assessment schemes in Europe were run on a National basis but 5 years ago a cooperation scheme was adopted whereby each National scheme adopted common serum pools for distribution, common distribution dates, and a common report format. The EUROEQAS circulates a common report to each of the participants throughout Europe. This article describes the organization of such a scheme and the results produced over the past 12 months.

Tryptase and IgE concentrations in the respiratory tract of infants with acute bronchiolitis.

It has been proposed that a specific IgE response contributes to the immunopathology of acute respiratory syncytial virus (RSV) bronchiolitis but previous work has been difficult to replicate. Indirect evidence that might support this contention was sought by measuring total IgE concentrations in bronchoalveolar lavage (BAL) samples obtained from intubated infants and by attempting to detect mRNA for IgE in cells obtained from both the upper and lower respiratory tract. Evidence of significant mast cell activation was sought by measuring tryptase concentrations in BAL fluid and serum. Detectable concentrations of IgE were found in two of seven BAL samples obtained more than five days after intubation and mRNA for IgE was demonstrated in three of six BAL samples and three of six samples obtained from the upper respiratory tract. Tryptase was detectable in 11 of 12 BAL samples with the two highest values detected on day 1. These values were raised compared with control samples but were not such to suggest that mast cell degranulation is the major contributor to the inflammatory process. These results suggest that IgE may be produced in the airways of infants in response to RSV infection. The relationships between IgE production, RSV infection, and symptoms of acute bronchiolitis remain obscure.

Inter-laboratory external quality assessment schemes for specific IgE antibodies. The results of a European scheme for 1992.

External quality assessment programmes for specific IgE have been organised for some years in the United Kingdom, Belgium and the Netherlands but independently. This paper describes a co-operation scheme whereby the same samples were circulated simultaneously from each of the three countries and subsequent results combined to produce a single "EURO EQAS" report. Serum pools were prepared each containing antibodies, at differing concentrations, to 4 different allergens. The allergens surveyed represented the 10 most commonly encountered in Northern Europe. Results were submitted in grades (or classes) and in quantitative units and they showed some similarity by grade regardless of method used but differed greatly in units probably due to method differences. This paper shows how results could be treated to produce statistical data for the participants to help them be aware of their performance internally and also in comparison to other users.

Temperature and risk factors for ischaemic heart disease in the Caerphilly prospective study.

OBJECTIVE: To examine the associations between air temperature and risk factors for ischaemic heart disease. METHOD: Data on risk factors are available from up to 2036 men in the Caerphilly Prospective Heart Disease Study. Daily temperatures were obtained from the Meteorological Office. Relations between these were examined by regression. RESULTS: The coldest month of the year has a mean temperature that is 16 degrees C lower than that in the warmest month. A fall in temperature of this magnitude is associated with higher blood pressures (by 3-5 mm Hg) and a lower concentration of high density lipoprotein cholesterol (by 0.08 mmol/l). The most important effects however, seem to be on the haemostatic system. Fibrinogen is 0.34 g/l higher in the coldest month than in the warmest (p < 0.001) and alpha 2 macroglobulin, a protein that inhibits fibrinolysis, is also raised. Platelet count is increased by 30% of a standard deviation and the sensitivity of platelets in whole blood to adenosine diphosphate is increased by cold. CONCLUSIONS: These effects on haemostasis, together with the effect on blood pressure, could explain a large part of the increase in ischaemic heart disease in the winter but are unlikely to explain much of the difference in mortality within different areas of England and Wales.

Salivary IgA antigliadin antibody as a marker for coeliac disease.

In recent years, serum antibodies to gliadin (AGA) have been reported to be useful markers of coeliac disease. IgA AGA have also been found in intestinal secretions and saliva in coeliac disease and may offer a convenient, non-invasive screening test. In order to test this hypothesis, salivary and serum AGA were measured in children with coeliac disease proved by biopsy and compared with several control groups. Measurement of salivary IgA AGA provided excellent discrimination between those children with coeliac disease and the control groups, and our study suggests that it may provide a rapid, non-invasive method of screening for this disease before intestinal biopsy.

Sequential serological responses to Aspergillus fumigatus in patients with cystic fibrosis. Use of antigen 'stretching' to delineate IgG and IgE activity.

Immunogens from Aspergillus fumigatus were fractionated on the basis of molecular weight. Nine fractions ranging from 900 to 10 kDa were used in ELISA and in a radioallergosorbent test (RAST) with sera from cases of allergic bronchopulmonary aspergillosis (ABPA) and from cystic fibrosis (CF) patients with ABPA or other Aspergillus involvement and compared with control subjects. The profile of IgG reactivity to the nine fractions did not vary substantially for all Aspergillus-involved groups producing peaks at greater than 900 kD and 170 kD whereas the profile for control subjects had a peak at greater than 900 kD only. The IgE profile for CF patients with ABPA did not differ from the profile of the RAST-positive CF patients without ABPA and provided only one peak of activity at 24 kD. Recovery from an episode of ABPA in CF patients was accompanied by a fall in both IgG and IgE antibody levels to all nine fractions, whereas increases in IgG and IgE to all fractions were seen during an episode of ABPA. Although there was an exaggerated IgG increase to antigens in the 43-170 kD range during ABPA, a meaningful increase was also observed to unfractionated A. fumigatus antigen preparations. With IgE in one detailed study the 24-kD fraction provided a better indication of Aspergillus involvement than the unfractionated A. fumigatus antigens. Sequential studies of IgG and IgE levels were not able to predict an episode of ABPA but were useful in conjunction with clinical assessment in following the course of the illness.

An immunochemical evaluation for the identification and typing of monoclonal proteins.

Using automated measurements of kappa (kappa) and lambda (lambda) light chain and IgG, IgA and IgM concentrations we assessed the ability of the kappa/lambda ratio and the heavy/light chain ratio to identify and type monoclonal components which had been previously identified by serum protein electrophoresis and immunoelectrophoresis. We examined 1151 samples, of which 277 contained monoclonal components; 90% of the monoclonal proteins could be identified by this approach, of which 95% were correctly typed. In addition 19 of 874 samples without monoclonal components showed an abnormal kappa/lambda ratio. We assessed the ability of the immunochemical evaluation to calculate monoclonal component concentration and then compared the results to the scanning densitometry of serum protein electrophoresis.

Ispaghula sensitization in workers manufacturing a bulk laxative.

Exposure to ispaghula dust in a pharmaceutical factory resulted in chest tightness/wheeze, nasal, and ocular or skin symptoms in 48 of 92 exposed workers. Whilst symptoms were not incapacitating in the majority (44) of these, one worker required antihistamines and three others experienced severe respiratory symptoms when exposed to the dust. These three were atopic, had a positive RAST and skin test to ispaghula; a combination unique to them. There was a significant relationship between work-related symptoms and atopic status, however, smoking did not influence symptoms, total serum IgE and specific anti-ispaghula IgE. We conclude that handling ispaghula produces an irritant effect in most exposed people, however, sensitization to the dust can occur with severe respiratory symptoms.

Seasonal variation in suppressor T cell subsets and non-specific suppressor cell function in hay fever sufferers.

The helper/suppressor T cell ratio, as defined by monoclonal antibodies, was significantly higher in hay fever sufferers compared with controls (P less than 0.05), but only during or shortly after the pollen season. This was due to a reduction in the suppressor subset, which returned to control values in the winter. There was no significant difference in the non-specific concanavalin A-induced suppressor cell function compared with controls. The mean summer value was significantly lower than the winter value (P less than 0.05), but we cannot be sure that this was not the result of changes in laboratory conditions. No relationship was found between T cell subsets or suppressor cell function and total or specific IgE levels, or between T cell subsets and suppressor cell function. Our findings suggest that in hay fever, reduction in suppressor cell numbers and function is a secondary phenomenon.

Can the risk of peritonitis be predicted for new continuous ambulatory peritoneal dialysis (CAPD) patients?

Serum and overnight dialysate samples were obtained from 36 adult uraemic patients at the end of their continuous ambulatory peritoneal dialysis (CAPD) training. The samples were analysed for albumin, IgG, C3, and antistaphylococcal peptidoglycan antibody. None of the dialysate measurements correlated with the risk of peritonitis during up to one year's CAPD treatment. Nineteen of the 36 patients were retested 6 to 20 months after starting CAPD. There were significant rises in serum C3 (p less than 0.02) and albumin (p less than 0.001) and a significant fall in dialysate IgG (p less than 0.02). Eight further patients were sampled at the end of training and three weeks later. They had a significant fall in dialysate IgG (p less than 0.05). During CAPD training peritoneal permeability appears to be transiently increased. Analysis of overnight dialysate samples during training does not allow prediction of those at risk of subsequent peritonitis.

Platelet number and size in relation to serum orosomucoid concentration in Crohn's disease.

The relationship between platelet size and platelet count was investigated in 41 patients with Crohn's disease. A high platelet count was associated with a decrease in platelet size, but an overall increase in the platelet crit. There was also a significant correlation between the patient's platelet count and serum orosomucoids, which have traditionally been used to assess disease activity.

Immunological changes associated with a successful outcome of pollen immunotherapy.

Changes in immunological measurements thought to be important in the mechanism of immunotherapy for hay fever were related to objective measurements of treatment outcome. Antigen-specific IgE and IgG, and T suppressor cell status, using monoclonal antibodies and a specific functional assay, were measured before and after immunotherapy. Treatment outcome was assessed using nasal and conjunctival challenge tests. Seventeen subjects received immunotherapy for 6 months. Nine showed a decrease in nasal and/or conjunctival sensitivity, compared with 2 of 13 control subjects (P less than 0.05). Subjects responding to immunotherapy had a significantly higher post treatment IgE level and a higher pre- and post-treatment IgG level than non-responders and controls. Immunotherapy had no effect on suppressor cell status.

Use of immunoglobulin heavy- and light-chain measurements compared with existing techniques as a means of typing monoclonal immunoglobulins.

Using automated measurements of kappa and lambda light chains and IgG, IgA, and IgM, we assessed the utility of the kappa/lambda ratio and the heavy chain/light chain ratio in characterizing monoclonal immunoglobulins previously identified by sensitive electrophoresis on agarose gel and typed by immunofixation or immunoelectrophoresis. We examined 348 selected samples, of which 165 contained monoclonal components, finding that 93.4% were detected and 89% correctly typed by this approach. Eight samples were shown to contain monoclonal light chains that were not visible as bands on electrophoresis but demonstrated abnormalities of the kappa/lambda or heavy chain/light chain ratio.

Overestimation of immunoglobulins in the presence of rheumatoid factor by kinetic immunonephelometry and rapid immunoturbidimetry.

The United Kingdom External Quality Assessment Scheme for Specific Proteins has demonstrated that one method group, comprised of kinetic immunonephelometric assays, gives significantly higher results for immunoglobulins in certain pathological sera containing rheumatoid factor. Using IgM as a model, we have compared kinetic immunonephelometry and a rapid (5 min incubation) immunoturbidimetric assay with radial immunodiffusion (RID) on seven sera. Compared with RID significantly higher results were obtained by kinetic nephelometry on all five sera positive for rheumatoid factor, and by turbidimetry on three of the four of these studied. In a serum with IgM increased due to primary biliary cirrhosis lower results (P0.005) were obtained by nephelometry than by RID. The remaining serum was normal, and no significant intermethod differences were found. The possible causes for these discrepancies are discussed.

Challenge tests and specific IgE in hay fever sufferers.

The relationship between challenge tests, specific IgE and seasonal effects in hay fever sufferers was studied. There were significant relationships between nasal challenge, conjunctival challenge and skin-prick test threshold doses, although the skin and conjunctiva tended to be less sensitive than the nose. A seasonal effect was apparent on nasal challenge, but not conjunctival challenge or skin-prick testing, with lower threshold doses recorded after the pollen season than in midwinter. There was a significant relationship between specific IgE and nasal challenge, but not conjunctival or skin-prick test threshold doses.

Total IgE and allergen-specific IgE assays: guidelines for the provision of a laboratory service.

The Analytical Methods Working Party of the Association of Clinical Biochemists (ACB) established this Task Force to consider the measurement of total serum IgE and specific IgE. The aims were to give general guidance on available methods of assay; to survey commercial kits and 'in-house' methods; to investigate performance based on external Quality Assessment and independent evaluation, and to advise on criteria laboratories should consider before setting up IgE and specific IgE assays.