[Food and food additives hypersensitivity in adult asthmatics. I. Skin scratch test with food allergens and food challenge in adult asthmatics].

OBJECTS: The aim of this study was to investigate in adult asthmatics, which kinds of food allergen can cause a positive reaction by skin scratch test and cause symptoms when administered as a food challenge. SUBJECTS AND METHOD: Three thousand one hundred and two adult asthmatic patients were submitted to skin scratch tests with housedust mite. Japanese cedar extracts and 33 types of food. Sixty one adult asthmatic patients with a history of immediate, adverse reactions after food ingestion underwent open food challenge. RESULT: Six hundred and twenty five of 3102 subjects (20.1%) had a positive test to one or more food allergens. The commonest food allergens were shrimp (27.7%), crab (27.7%), yeast (23.8%) and buckwheat (15.8%). The positive tests of shrimp, egg and cow's milk were highest in patients under 20 years and decreased with age, however the test rates of crab and soybean were not influenced by age. Positive food challenge responses occurred in 30/60 subjects (50%). The foods, which most of ten provoked a reaction, were buckwheat, shrimp, crab and bread. CONCLUSION: Skin scratch test results in adult asthmatics were different from those in atopic children where the commonest foods with positive tests were egg, cow's milk and soybean. Except for patients with a previous life-threatening reaction. Food allergy should be diagnosed by food challenge where a patient's history of adverse reaction to food, positive skin test and RAST strongly support specific food reactivity.

Correlation between antigen-specific IL-2 response test and provocation test for egg allergy in atopic dermatitis.

BACKGROUND: The antigen-specific interleukin-2 response (AIR) test using lymphocytes is effective in searching for the antigen which causes allergic diseases and understanding their disease activity. OBJECTIVE AND METHODS: The correlation between the raw egg oral provocation test and egg white antigen-specific interleukin-2 (IL-2) response test was investigated in 123 children with infantile atopic dermatitis and 13 children with bronchial asthma. RESULTS: Among the 83 who showed positive reactions to provocation, 75 also reacted positively to the AIR test (sensitivity, 90.4%), while among the 53 children who showed negative responses to antigen provocation, 45 produced negative responses to the AIR test (specificity, 84.9%). The specificity of egg white IgE RAST score and skin-prick test are 88.7 and 81.3% which are comparable to that of the AIR test. However, their sensitivity was low (38.6 and 66.7%). In the patterns of symptom developed in the provocation AIR displayed late and delayed type allergic responses in addition to the immediate type which RAST reflected. The RAST-negative group composed of 98 patients included 51 (52.0%) who exhibited positive reactions to the provocation test. Among these 44 responded positively to the AIR test (86.3%). CONCLUSION: The AIR test is effective for screening egg white antigen as part of the tests for antigens responsible for allergic diseases and as a test to ascertain the relevant antigens, and that the conditions that could not be diagnosed by RAST can be detected by the AIR test.

T cell mediation of abnormally low production of ovalbumin-specific immunoglobulin A in patients allergic to eggs.

Cells producing IgA specific to ovalbumin (OVA) were detected with an assay of plaque-forming cells (PFC). Non-T cells were separated on a polystyrene resin column and were further depleted of B cells that bound sheep erythrocytes (SRBC) by SRBC-rosette sedimentation. The cells were recombined with T cells separated on a polystyrene resin column, stimulated with OVA antigen, and then cultured for 5 d. The number of OVA-specific IgA-PFC from the lymphocytes of infants allergic to hen's eggs (7 +/- 5 per 7 x 10(4) non-T cells, n = 9) was significantly less than that of PFC from lymphocytes of age-matched controls (110 +/- 18 per 7 x 10(4) non-T cells, n = 7) and from those of children with atopic dermatitis who were not allergic to hen's eggs (90 +/- 30 per 7 x 10(4) non-T cells, n = 4). Patients' B cells added to the culture supernatant from OVA-stimulated normal T cells (82 +/- 18 per 7 x 10(4) non-T cells, n = 4) were able to produce the specific IgA to levels comparable to those of normal B cells (92 +/- 9 per 7 x 10(4) non-T cells, n = 6), but the patients' T cells did not cause normal B cells to produce the antibody (8 +/- 2 per 7 x 10(4) non-T cells, n = 4). This indicates that the patients' T cells were less able than were normal T cells to promote the production of OVA-specific IgA-PFC. Until the age of 6 y, the ability of the patients' lymphocytes to produce specific IgA was abnormally low; from that age on, it was normal. At the stage of allergen entry, this transiently low production of OVA-specific IgA may contribute to the onset of allergy to hen's eggs.

Pattern of cytokine production by T cells from adolescents with asthma in remission, after stimulation with Dermatophagoides farinae antigen.

Children with asthma usually become asymptomatic by the time they reach age 20 y. To clarify the immunologic mechanisms responsible for this phenomenon, we studied patients in remission and others who still had frequent asthma attacks. Patients were grouped by clinical status, and three variables were measured: serum levels of IgE, production of IL4 and interferon (IFN)-gamma, and the activation of T cells induced by Dermatophagoides farinae (Df) antigen. Df-induced activation of T cells (as measured by antigen-induced IL2 responsiveness) or IL2 synthesis itself was induced in patients with active asthma but not in normal subjects. These responses were much weaker in patients in remission. When stimulated by Df antigen in vitro, lymphocytes from patients with active asthma produced much more IL4 than did the cells from normal subjects, and cells from patients in remission produced only a small amount. In contrast, under similar conditions lymphocytes from patients with active asthma produced less IFN-gamma than did the cells from normal subjects. Production of IFN-gamma stimulated by Df antigen was high in patients in remission but not in normal subjects. Thus, upregulated IFN-gamma production after exposure to Df antigen might reduce IL4 secretion, which would suppress IgE production and would improve clinical status. Df antigen may suppress Df-induced allergic responses in patients with asthma in remission.

[Spontaneous IgE production in asthmatic children].

In this study, we demonstrated spontaneous IgE production by peripheral blood mononuclear cells of asthmatic children. In 26 asthmatic children, the level of spontaneous IgE ranged 0.1-15.0 IU/ml and in 5 healthy normal children showed under 0.051 IU/ml. In 5 of asthmatic children, specific antibody of Dermatophagoides farinae was detected from PBMC by CAP RAST. In healthy normal children, specific antibody of Df was not detected. Spontaneous IgE production by PBMC and serum IgE level showed well correlation (gamma = 0.835, p < 0.001). Spontaneous IgE production and specific antibody of Df by PBMC also showed well correlation (gamma = 0.717, p < 0.001) IgE production of asthmatic children was inhibited by IFN-gamma.

Ovalbumin-specific induction of IL2 responsiveness in lymphocytes from patients with hen egg allergy and its regulation by the culture supernatant of normal lymphocytes.

Interleukin 2 (IL2) responsiveness of ovalbumin (OVA)-stimulated lymphocytes from patients with hen-egg allergy was studied. The number of viable cells of 5-day cultured lymphocytes stimulated with OVA was increased by an additional three days incubation with recombinant IL2. This phenomenon was not observed when the lymphocytes of patients allergic to OVA but not to Dermatophagoides farinae extract antigen (Df) were stimulated with Df. Normal lymphocytes stimulated with OVA expressed Tac antigen (low affinity IL2 receptor) but, in contrast to those from the allergic patients, did not absorb nor respond to IL2. The induction of OVA-specific IL2 responsiveness in patient lymphocytes was markedly suppressed on the addition of culture supernatant from OVA-stimulated normal T cells, but Df-specific IL2 responsiveness of the lymphocytes from Df-sensitized patients with bronchial asthma was not suppressed by the same supernatant. The supernatant of lymphocytes from allergic patients did not show such suppressive effect. The patient lymphocytes whose IL2 responsiveness was suppressed with the supernatant from normal lymphocytes still expressed Tac antigen. These observations suggest that the culture supernatant of normal T lymphocytes stimulated with OVA contained an antigen-specific factor suppressing the induction of IL2 responsiveness of OVA-stimulated patient lymphocytes. The production of such a suppressive factor was impaired in the patient, and further, the factor may have inhibited the triggering signal of IL2 receptors having absorbed IL2. The existence of some allogeneic barrier between the factor(s) and patient lymphocytes was suggested, since the supernatant from OVA-stimulated normal T cells did not necessarily suppress the response of all patients tested.