Myocardial ischemia due to severe amoxicillin allergy.

A patient suffered a myocardial injury as a manifestation of anaphylactic reaction to amoxicillin-clavulanic acid administration. A cardiologic study (ergometry and catheterization) showed no obstructive coronary disease and prick test to amoxicillin was positive. Anaphylaxis may cause myocardial injury and the mechanism is likely to be vasospasm induced by mast cells and basophil mediators.

Impaired type-1 activity and increased NK cells in Gleich's syndrome.

BACKGROUND: An altered production of cytokines has been described in Gleich's syndrome. Our aim was to study the cytokine production at the single-cell level in a patient with Gleich's syndrome and to determine whether it changed during a flare episode. METHODS: Blood samples were obtained from a 30-year-old woman diagnosed with Gleich's syndrome before and during the subsequent flare of edema of trunk and arms and weight gain. The major lymphoid subsets (CD4+, CD8+, and CD19+) and natural killer (NK) cells were measured by flow cytometry. Cytokine-producing T cells (IL-2, IFN-gamma, and IL-4) were quantified in whole blood by intracellular staining with specific monoclonal antibodies and flow cytometry analysis after polyclonal stimulation with phorbol 12-myristate 13-acetate and ionomycin. RESULTS: Increased numbers of immature CD4+CD8+ T cells and NK cells were observed in peripheral blood during the asymptomatic period. The latter population significantly decreased during the flare. Type-1 cells were decreased in both asymptomatic and, more markedly, during the attack with respect to healthy subjects. CONCLUSIONS: The decreased type-1 response demonstrated in this patient might be the basis of the hypereosinophilia of Gleich's syndrome. Besides, the NK cells might play a role in the pathogenesis of these inflammatory episodes.

Immunotherapy with bacterial ribosomal antigens in bronchial asthma. II. Immunological study.

A newly developed mode of vaccination with bacterial ribosomal antigens was evaluated in 83 patients with bacterial bronchial asthma. The response of the immune system to two years of immunotherapy was studied by serial determinations, every six months, of the following parameters: E; Ea and EAC rosettes; B-cell surface immunoglobulins; PHA-induced blast transformation, and IgG, IgA, IGM, IgD and IgE immunoglobulins. At basal conditions, patients showed a slight depression in the function of cell-mediated immunity, an increase in Ea rosette formation and decreased values of IgA. After vaccination with ribosomal antigens, an enhanced T-cell response to PHA was observed, followed by normal values of Ea rosettes and increased values of IgA. A statistically significant correlation (p less than 0.001) was evident between Ea rosettes and IgA. Nearly half of the bacterial asthmatic patients in our series presented elevated levels of IgE (greater than 125 U/ml) that remained unchanged even after specific treatment. The immunomodulating action of bacterial ribosomal therapy is discussed.

Lepromatous leprosy and contact dermatitis.

The rare association of lepromatous leprosy and allergic contact dermatitis due to chromium in cement was confirmed clinically and biologically in a male patient. The apparent lack of influence of lepromatous leprosy on the development and maintenance of this dermatitis dependent upon cell-mediated immune mechanisms is discussed.

Frequency of sensitization to different pollen groups and results of specific immunotherapy.

Of all the diseases produced by the inhalation of allergens, it is perhaps pollinosis in which specific immunotherapy with pollen antigens is most indicated. For this reason, the present work studies the symptoms and the results of skin tests, before and after the completion of a correct and specific course of immunotherapy for three years. We selected 345 patients with a clear history of pollinosis, suffering from rhinitis (90.7%), conjunctivitis (71%), bronchial asthma (51%) and urticaria (4.3%). The most sensitizing pollens were those of grasses, which affected 97.68% of the patients, followed by flowers (70.14%), shrubs (59,13%) and trees (47.82%). Multiple pollen sensitizations were found in 88.2%, but only 27.24% were sensitive to grass pollens alone. After specific polyvalent treatment with aqueous extract a notable improvement was found in the results of the skin tests (73.8%) and in clinical symptoms (87%). On the other hand, we found a deterioration in the skin test results in 5.9% and a worsening of symptoms in 1.5%. These unfavourable results were probably due to the failure to include all sensitizing pollens in the immunotherapy extract. These results suggest to us that the only worthwhile treatment for pollinosis is immunotherapy based on a polyvalent and specific extract individually prepared, whether aqueous or depot type, according to the skin test results.

Evaluation of total IgE in diverse allergosis. Comparative study with other techniques. Part II.

A total of 181 allergic patients were studied and classified according to the causal antigen, 92 patients were sensitized to the mixed grass pollen, 55 to house dust, 28 to Candida albicans, 31 patients with egg allergy and 25 with milk allergy. All of them presented strong positivity to anamnesis, intracutaneous tests and exposition tests. In all of them the serum total IgE was determined using the radioimmunoassay (RIST) and the antigen specific IgG, following Boyden's passive hemagglutination technique. In 31 patients with pollinosis, 55 with house dust allergy and 25 with sensitization to Candida albicans, the determination of the antigen specific IgG was also carried out following the quantitative precipitation method. The results showed a greater reliability on the hemagglutination as opposed to the determination of total IgE with grass pollen. The hemagglutination was positive in 90.20% and the total IgE was increased in 59.78% of the cases. In patients with house dust allergy the total IgE was elevated in 69.08% of the cases and the hemagglutination was increased in 60.71% of the cases. In those cases of sensitivity to Candida albicans, the total IgE presented higher values in 63.84% of the cases, while the hemagglutination was increased in 21.43% of the cases. In egg allergy,, the IgE was increased in 56.83% of the cases and the hemagglutination in 87.09% of all of the 31 cases studied. In the cases of milk allergy the IgE presented increases in 32% of the cases and the hemagglutination gave higher titers in 56% of all of the 25 cases studied. The results make evident that the hemagglutination should be included in the rutinary diagnosis of allergic diseases as well as the determination of total IgE or antigen specific IgE.

Evaluation of total IgE in diverse allergosis. Comparative study with other techniques. Part I.

Three hundred patients whose ages ranged between 10 and 50 years were studied. They were classified, according to the number of sensitizing allergens, their sensitization frequency, the clinical syndrome diagnosed, and the therapy followed by each one of them. Intracutaneous tests with twenty-nine groups of allergens and the determination of total IgE, were carried out on each of them. A statistical evaluation was performed on the results obtained, for the purpose of proving mathematically the certainty of these values. The results obtained lead to the following conclusions: 1) The mean values of IGE found coincide with those discovered by other authors, except in the cases of parasytosis and atopic dermatitis. 2) The expression "mean value of IgE" is incorrect for comparative effects with respect to normal levels, since a great diffusion of individual values with respect to this mean value, were observed in all the circumstances studied. 3) A different reaginic response is noticed in the patients studied: from 50 to 70% presented extremely elevated values of serum IgE. Points 1) and 3) are being submitted to an exhaustive re-examination.