Individual allergens as risk factors for bronchial responsiveness in young adults

BACKGROUND: Bronchial responsiveness is known to be related to atopy, but the relative contribution of sensitisation to individual allergens in the UK, or whether serum total IgE is an independent risk factor, is unknown. METHODS: A random sample of 1864 men and women aged 20-44 years, drawn from family health service registers in Cambridge, Ipswich and Norwich, was invited to answer a detailed questionnaire, undergo skin prick tests and methacholine bronchial challenge, and provide a serum sample for measurement of total and specific IgE. The relation of bronchial responsiveness to risk factors was studied in 749 subjects (40.2%) with complete data. RESULTS: Bronchial responsiveness was increased in those sensitised to cat, D pteronyssinus, Timothy grass and Cladosporium, but decreased in subjects also positive to birch allergen. Additional skin prick tests added little information. Serum total IgE was not significantly related after adjustment for specific IgE to the five allergens. Increasing titres of specific IgE to D pteronyssinus were associated with increasing bronchial responsiveness. Specific IgE to Cladosporium had a prevalence of around 3%, but was associated with greatly increased responsiveness. Decreased baseline lung function was related (p < 0.001) to increased responsiveness. There was an interaction between age and smoking status, with lower responsiveness in older non-smokers. CONCLUSION: Atopy is the most important risk factor for bronchial responsiveness in this age group, but effects are not additive across all allergens. Research in reducing exposure to house dust mite should also address the role of Cladosporium sensitisation and exposure to indoor moulds.     

The prevalence of atopy and hypersensitivity to latex in medical laboratory technologists

Members of the Alberta Society of Medical Laboratory Technologists were invited to take part in a study of sensitivity to latex gloves. A total of 230 persons volunteered; 108 (47%) had no problems with gloves, and 122 (53%) reacted to latex gloves. A history was obtained regarding atopy, smoking, years in laboratory medicine, and the nature of the problem with latex gloves. Serum was assayed for the total IgE level and the presence of IgE with specificity to common inhalant allergens and to latex. The affected group had an increased population of subjects with an atopic history and a higher incidence of a raised IgE level and a positive screen for inhalant allergens. In the affected group, there was no relationship between the total IgE level and severity of skin reaction. However, smoking was related to severity of reaction and was more common in the groups with a more severe reaction. Three subjects were positive for IgE specific for latex; there were no other data distinguishing them from latex-negative subjects.     

Infection prophylaxis in complex limb trauma through immediate definitive reconstruction via a free tissue transfer

Levels of specific IgE antibodies to three kinds of venom (honeybee, wasp and yellow jacket) were followed up for two years in five male pest control operators (age: 24 to 50 years) with Hymenoptera sting within the latest six months. At the first examination, all subjects had a positive reaction for venom-specific IgE but their levels were varied in the range from class 2 to 5 (0.70 approximately 99.9 UA/ml), and a positive reaction was observed in the case of unoffending Hymenoptera. A subject who was re-stung during the two-year follow-up period showed increase in all of the venom-specific IgE levels. Of four subjects without re-stung during the two years, three subjects had a logarithmic decrease in all the specific IgE levels time-dependently, but one subject with a high total serum IgE level showed an increase and decrease alternately in the specific IgE The total serum IgE level may be a factor which influences the change in the venom-specific IgE level. In the four subjects without a high total serum IgE level, the biological half-life of venom-specific IgE was estimated to be 6 to 12 months based on the decreased level during the follow-up period.     

Distribution of total serum IgE and specific IgE to common aeroallergens by sex and age, and their relationship to each other in a random sample of the Dutch general population aged 20-70 years. Dutch ECRHS Group, European Community Respiratory Health Study

To describe the distribution of serum total IgE and specific IgE to common aeroallergens by sex and age and to study their relationship to each other, we measured serum total IgE and specific IgE (CAP) to house-dust mite, timothy grass, cat, birch, and Cladosporium in a random sample of 2496 subjects, aged 20-70 years from the Dutch general population. We found that total IgE was higher in men, independently of smoking, and that total IgE had no relationship with age after adjustment for specific IgE and smoking in linear regression analysis. At least one positive specific IgE test was found in 32% in both sexes. Men had higher prevalences of specific IgE to house-dust mite and lower prevalences of specific IgE to birch than women. The proportion with positive specific IgE decreased with age. The mean total IgE increased with the number of positive specific IgE tests. Thus, total IgE is higher in men and has no relationship with age if specific IgE is taken into account. The prevalences of specific IgE to aeroallergens are high and decrease with increasing age. We suggest that sex differences in total IgE should be considered when using total IgE.     

High-dose therapy with peripheral blood stem cell (PBSC) support using an innovative mobilization regimen in patients with high-risk primary or chemoresponsive metastatic breast cancers

BACKGROUND: Epidemiologic studies are necessary to determine the prevalence of allergic diseases. This varies widely depending on allergen preparations and patients studied. OBJECTIVE: To investigate the prevalence of atopic disease, skin test reactivity, total and specific IgE to common allergens, and other variables in a sample of students from Málaga, southern Spain. METHODS: Three hundred sixty-five students (age 17.9 +/- 1.18) were interviewed by an allergist. Skin prick tests were performed with Dermatophagoides pteronyssinus, Artemisia vulgaris, Plantago lanceolata, Chenopodium album, Olea europaea, Phleum pratense, Parietaria judaica, Cynodon dactylon, Alternaria tenuis, and cat dander. Total and specific IgE to D. pteronyssinus, Olea, and Parietaria were determined. RESULTS: Of all subjects studied, 19.9% suffered from rhinoconjunctivitis, 4.1% rhinoconjunctivitis plus asthma, 3.1% asthma alone, and 0.8% atopic dermatitis; 46.4% had a positive skin test to at least one allergen (28.2% to D. pteronyssinus, 20.4% to Olea, 13.8% to Phleum); and 43% had total IgE > 100 kU/L and 44.7% a family history of atopy. Allergic symptoms were strongly associated with skin test positivities and family allergic history. Patients with asthma or skin prick test positive had higher total IgE values than others (P < .01). There was a significant correlation between specific IgE values and wheal size in skin test. CONCLUSIONS: Our findings confirm the high prevalence of atopic diseases, and the close relationship of skin tests reactivity (or presence of specific IgE) to allergens with symptoms of asthma and rhinitis. The presence of a family history of allergic diseases influences the development of positive skin tests and atopic illness. Dermatophagoides pteronyssinus and pollen of Olea europaea were found to be the most common allergens.     

Differences in detection of alcohol use in a prenatal population (on a Northern Plains Indian Reservation) using various methods of ascertainment

Although Fetal Alcohol Syndrome (FAS) rates have been reported to be higher in American Indian populations, no screening tool has been validated for alcohol use in American Indian women. The objectives of this study were to compare the detection of prenatal alcohol use by a self-administered questionnaire to detection by clinical interview; and to ascertain whether the screening tool would increase detection of pregnant women who are abusing alcohol. The hospital records of the women were reviewed for any history of alcohol-related illnesses or injuries to compare with results obtained from the questionnaire. Seventy women attending their first prenatal clinic visit on a reservation were screened for alcohol use. There was a wide range in detection of prenatal alcohol use (20%-71% of the sample detected) depending on the method used. There was a large variation in sensitivities (7%-93%) of the individual questions in identifying patients detected as "high risk" by the clinicians. The T-ACE screening questions significantly increased detection of alcohol use compared to detection by the clinicians (p = 0.04 Fisher's exact test). Due to the large variation between different methods of detection, it is recommended that screening tools that increase detection of alcohol use should be combined with methods of higher specificity such as using questions about quantity and frequency of alcohol intake, medical chart review and clinical interview. We also found that various interpretations of the screening questions by the patients highlighted the need to tailor the wording of individual questions to the particular patient population.     

Association of HLA class-II genes and anti-neutrophil cytoplasmic antibodies in Chinese patients with inflammatory bowel disease

BACKGROUND: Occupational respiratory allergy to green coffee beans (GCB) and to castor beans (CB) was studied in 112 workers in a modern coffee manufacturing plant of Trieste (Italy), where the process is completely automatic, the environmental conditions are good and where exposure to CB can be considered absent because since 1970, only new sacks have been used for coffee transportation. METHODS: All subjects were interviewed by a trained doctor using a questionnaire to investigate allergic symptoms and predisposing factors. Sensitization to GCB and to common allergens (pollens, molds, house dust mites) were evaluated by the skin-prick test. The serum of subjects with a positive skin-prick test to CGB or who had symptoms at work was tested for specific IgE (RAST) for GCB and CB. Lung function was evaluated by a Ponigraph spirometer. RESULTS: Sensitization to GCB was found in 25.8% of green coffee workers (31 cases), in 2.7% of roasted coffee workers (37 cases) and in 4.5% of the clerks (44 cases), p < 0.01. The evaluation of IgE specific for CB gave positive results only in 3 of 10 subjects sensitized to GCB. A total of 20% of GCB workers (6 cases) complained of work-related respiratory symptoms (asthma and/or rhinitis) compared with only one subject in the roasted coffee group and one in the control group (p < 0.01). Asthma was reported by 2/31 of the green coffee workers and by 1/44 of roasted coffee workers. CONCLUSIONS: There was a significant correlation between sensitization to GCB and work related symptoms (p < 0.01), common allergic symptoms (p < 0.05) and atopy by prick test (< 0.01). These results point to the need to evaluate atopic status in workers and identify the most susceptible subjects, with the aim of informing them of their at-risk status and monitoring their progress. This makes it possible to diagnose sooner those symptoms possibly indicative of a work-related disease, because even in presence of good environmental conditions and even when symptoms are mild, it is almost always the atopic subjects who are affected.     

ALATOP-RIA in the screening of atopy in a non Caucasian population

ALATOP is an "in vitro" radioimmunoassay screening test for atopy, previously validated in a caucasian population. The aim of the study was to assess the usefulness of a screening test of atopy in a non caucasian population. We select a non caucasian population (n = 208), from hospital immunoallergy consultations, Cape Verde Republic (Africa). It was determined the sensitivity, specificity and predictive values comparing with skin prick tests (SPT) results for the 208 patients, and with clinical data (Clin) in 115 patients. It was also determined the levels of total IgE, done by IRMA. RESULTS: Using different corrections factors, 0.85 gives the best results: ALATOP/SPT-Sensitivity-88.5% +/- 4.34; Specificity-73.8% +/- 8.41; Positive predictive value-66.9%; Negative predictive value-91.4%; Efficiency of the test-79.3%. ALATOP/CLIN-Sensitivity-95.2% +/- 3.89; Specificity-71.2% +/- 12.07; Positive predictive value-65.6%; Negative predictive value-96.2%; Efficiency of the test-80.0%. The mean values of total IgE were-406 IU/ml. CONCLUSIONS: The mean value of total IgE was significantly increased even in the ALATOP-/SPT-not saw in caucasian populations. The use of a different correction factor (0.85) for ALATOP, optimize the test, showing a good negative predictive value, but raises the question of adapted compositions of screening tests for different populations.     

Age of entry to day nursery and allergy in later childhood

BACKGROUND: Infections in early childhood may prevent allergies in later life. If this hypothesis is true, early exposure to childcare outside the home would protect against atopy by promotion of cross infections. We investigated whether children who attend a nursery at a young age have a lower rate of atopy and fewer allergies than children who attend from an older age. METHODS: In a cross-sectional study carried out in 1992-93, we examined 2471 children in three age-groups (5-7, 8-10, and 11-14 years) from the towns of Bitterfeld, Hettstedt, and Zerbst in eastern Germany. The children's parents answered a questionnaire about allergies and symptoms, attendance at day care, and related factors. Sensitisation was assessed by skin-prick tests and measurement of allergen-specific IgE antibodies in serum. FINDINGS: In 669 children from small families (up to three people), the prevalence of atopy was higher among children who started to attend day nursery at an older age than in those who started to attend at a younger age (p<0.05). Compared with children who first attended at age 6-11 months, the adjusted odds ratios for a positive skin-prick test were 1.99 (95% CI 1.08-3.66) for children who attended at age 12-23 months and 2.72 (1.37-5.40) for those who attended at age 24 months and older. In 1761 children from large families (more than three people), age of entry to day nursery had no effect on atopy. INTERPRETATION: Our findings accord with the hypothesis that early infection may protect against allergies in later life.     

Evaluation of rubella screening in pregnant women

BACKGROUND: The rationale for rubella vaccination in the general population and for screening for rubella in pregnant women is the prevention of congenital rubella syndrome. The objective of this study was to evaluate the effectiveness of the prenatal rubella screening program in Quebec. METHODS: A historical cross-sectional study was designed. Sixteen hospitals with obstetric services were randomly selected, 8 from among the 35 "large" hospitals in the province (500 or more live births/year) and 8 from among the 50 "small" hospitals (fewer than 500 live births/year). A total of 2551 women were randomly selected from all mothers of infants born between Apr. 1, 1993, and Mar. 31, 1994, by means of stratified 2-stage sampling. The proportions of women screened and vaccinated were ascertained from information obtained from the hospital chart, the physician's office and the patient. RESULTS: The overall (adjusted) screening rate was 94.0%. The rates were significantly different between large and small hospitals (94.4% v. 89.6%). Five large hospitals and one small hospital had rates above 95.0%. The likelihood of not having been screened was statistically significantly higher for women who had been pregnant previously than for women pregnant for the first time (4.8% v. 1.4%; p < 0.001). Of the 200 women who were seronegative at the time of screening (8.4%), 79 had been vaccinated postpartum, had a positive serological result on subsequent testing or did not require vaccination, and 59 had not been vaccinated postpartum; for 62, subsequent vaccination status was unknown. INTERPRETATION: Continued improvement in screening practices is needed, especially in small hospitals. Because vaccination rates are unacceptably low, it is crucial that steps be taken to address this issue.     

Focal lesion in the splenium of the corpus callosum in epileptic patients: antiepileptic drug toxicity?

Although the prevalence of asthma has risen significantly during the last 30 yr, it is not clear whether this has occurred primarily in persons with a strong genetic predisposition to asthma and atopy or in other sections of the population. We have investigated outcomes in children of nuclear families selected through probands previously characterized by studies in 1964 and 1989 as having histories of persistent childhood onset atopic asthma, transient childhood wheezy bronchitis, and no respiratory symptoms or atopy. Children of wheezy bronchitic probands had a significantly better symptomatic outcome in adolescence, irrespective of the atopic status of the parent proband, than do children of either asthmatic or asymptomatic probands, suggesting that this may be a syndrome that shows familial aggregation and is distinct from asthma. Total serum IgE levels were significantly lower in children of nonatopic asymptomatic probands, including those with wheezing symptoms. In contrast children of nonatopic asymptomatic probands had an unexpectedly high prevalence of wheezing (33%), positive skin prick tests (56%), and positive specific serum IgE to common allergens (48%) that was similar to that found in children of atopic asthmatic probands. Our findings support the concept that wheezy bronchitis is a separate syndrome from atopic asthma. High total serum IgE levels within our population appear to be an important marker of genetic predisposition to atopy. Our data also suggest that much of the increase in asthma prevalence is associated with specific IgE sensitization and is occurring in persons previously considered to be at low risk of developing asthma or atopy.     

Specific IgE-dependent sensitization, atopy, and bronchial hyperresponsiveness in apprentices starting exposure to protein-derived agents

Atopy, specific IgE sensitization, and bronchial hyperresponsiveness (BHR) were examined in a cohort of 769 apprentices starting career programs in animal health or veterinary medicine (Group 1), pastry making (Group 2), and dental hygiene (Group 3). The hypothesis were that: (1) a proportion of subjects can be "sensitized" although no significant specific occupational exposure has occurred; and (2) there is a relationship between baseline specific sensitization to work-related antigens and host characteristics. Skin tests were administered using 11 common inhalants and specific allergens, including six laboratory animal extracts, three cereal antigens, alpha-amylase, and latex. Methacholine challenge tests were performed. The prevalence of atopy was 54.4% in Group 1, 58.1% in Group 2, and 52.5% in Group 3. Skin reactivity to work-specific proteins was as follows: laboratory animal proteins, 13.8% in Group 1, 14.0% in Group 2, and 15.6% in Group 3. No subject was sensitized to alpha-amylase, whereas 1.2% in Group 1, 5% in Group 2, and 4.1% in Group 3 were sensitized to flour. Five subjects reacted to latex. BHR (PC20 < or = 8 mg/ml) was present in 17.6%, 21.2%, and 14.8% of subjects in Groups 1, 2, and 3, respectively. Specific sensitization was associated with positive skin reactions to common allergens, work-related symptoms, and BHR. These results suggest that students starting career programs with exposure to high-molecular-weight allergens have a low but substantial frequency of specific sensitization to work-related allergens that is related to atopy and BHR.     

The relationship between bronchial histamine reactivity and atopic status

It has been proposed that increased production of IgE, a feature of atopy, is a cause of the non-specific bronchial hyper-reactivity that is characterisitc of asthma. This hypothesis was examined by selecting groups of subjects with asthma or rhinitis and a group of healthy control subjects and studying the relationship between their bronchial histamine reactivity and their atopic status. In none of the groups tested was there a significant association between the degree of bronchial histamine reactivity and either the serum level of total IgE or the number of extracts of aeroallergens giving positive prick test reactions.     

Amplified rhinovirus colds in atopic subjects

Evidence suggests that atopic individuals may be predisposed to more severe rhinoviral colds coupled to a worsening of existing airway disease than those with asthma. The role of atopy and IgE levels, as well as their relationship to clinical disease expression have not been defined. We hypothesized that an allergic diathesis modulates rhinoviral colds and have initiated studies of normal, atopic and asthmatic subjects employing experimental rhinoviral infection, with measurements of symptom scores, viral shedding and cultures, albumin in nasal washes and serological responses. Twenty-two subjects (11 normal, 5 atopic, 6 atopic and asthmatic) participated and were inoculated with human rhinovirus serotype 16 (HRV 16). Measurements of neutralizing antibody and viral culture were performed at screening, pre-inoculation, during the cold and at 8-10 weeks convalescence. Daily symptoms were noted, nasal washes done, IgE measured and atopy was diagnosed by skin tests. Seventeen volunteers developed clinical colds as assessed by symptom scores, virus shedding was demonstrated (with positive culture) in all subjects and a fourfold or higher seroconversion occurred in 11/22. Neutralizing HRV antibody developed unexpectedly in 10 subjects between screening and inoculation and the presence of absence of this pre-inoculation antibody determined subsequent severity of colds in normal but not in atopic subjects. Atopic antibody positive individuals developed severe clinical colds that were independent of preinoculation antibody in contrast to normal subjects who developed mild colds in the presence of a neutralizing antibody (P = 0.01). Both atopic and normal antibody negative subjects developed severe colds.(ABSTRACT TRUNCATED AT 250 WORDS)     

Efficiency of mixed RASTs in serological screening of possibly allergic patients

OBJECTIVE: To determine the age distribution of results of serological allergy screening using mixed-allergen radioallergoabsorbent tests (RASTs), and to determine the cost-effectiveness of mix RASTs. DESIGN: Retrospective. SETTING: University Hospital of Rotterdam; Dijkzigt Hospital and Sophia Children's Hospital, the Netherlands. METHODS: An analysis was made of the results of all determinations requested in a period of 3 years with use of the CAP Phadiatop test (aimed at IgE against a mixture of inhalant allergens) and the CAP f x 5 food mix test (aimed at IgE against a mixture of food allergens). RESULTS: The CAP Phadiatop test was positive most strongly and most frequently in patients aged 7 to 30 years. From the age of 2 years, there was a sharp rise of the number of positive CAP Phadiatop tests, but IgE against inhalant allergens was also found in over 10% of the children aged 0 and 1 year. Up to and including the age category of 6 years, over one-third of the sera submitted had a positive CAP f x 5 food mix test. From a budget point of view, preliminary screening with a mix RAST is the more advantageous the lower the allergy prevalence and the higher the mean number of CAP-RASTs to be requested per serum. CONCLUSION: A substantial saving of laboratory costs can be achieved by having mix RASTs such as CAP Phadiatop and CAP f x 5 food mix tests precede determinations of specific IgE against separate allergens; these savings will be the higher the smaller the proportion of positive results and the higher the mean number of separate RASTs to be requested per serum.     

Functional gastrointestinal disorders: psychological, social, and somatic features

BACKGROUND: Helminthic infections induce an IL-4-dependent polyclonal stimulation of IgE synthetization. It is still unclear, however, what role helminths play in allergic sensitization. OBJECTIVE: We sought to determine the relationship between Ascaris-specific IgE and allergic sensitization in a nontropical country. METHODS: In 2 consecutive cross-sectional surveys in 1992-1993 and 1995-1996, data from school entrants (age range, 5 to 7 years), third graders (age range, 8 to 10 years), and sixth graders (age range, 11 to 14 years) were collected. The 2 younger groups were reexamined in the second survey. Data for about 2300 children, including a cohort of 700 subjects, were analyzed. Ascaris IgE and total and specific IgE to inhalant allergens were measured, and skin prick tests were performed. Information about asthma and allergic rhinitis was collected by a questionnaire. RESULTS: Children who were Ascaris-IgE seropositive (>0.35 IU/mL) in both surveys had 10-fold higher levels of total IgE (451 IU/mL vs 45 IU/mL, P < .001) and higher prevalence rates of allergen-specific IgE seropositivity (56.3% vs 26.6%, P < .001). They also had a higher prevalence of allergic rhinitis (12.6% vs 3.7%, P < .001) and asthma (5.7% vs 1.6%, P < .05). In subjects who were Ascaris-seronegative in the first survey but seropositive in the second survey, total and specific IgE increased markedly. Sensitization to Dermatophagoides pteronyssinus increased nearly 3-fold in this group. In contrast, in children who became Ascaris-seronegative, total and specific IgE decreased. CONCLUSIONS: Contact with low doses of helminthic antigen is associated with an increase of total and specific IgE production. Helminthic infections in East German children are not the cause for a low prevalence of allergies in the former East Germany.     

Association of respiratory symptoms and lung function in young adults with use of domestic gas appliances

BACKGROUND: There is evidence from some studies that people living in homes with gas stoves and other unvented gas appliances experience more respiratory symptoms than those who use other fuels for cooking and heating, but other studies have found no such association. We have investigated whether the use of gas appliances is associated with an increased risk of respiratory symptoms and whether sensitisation to common environmental allergens modifies any such association. METHODS: A stratified random sample of 15,000 adults aged 20-44 years, living in three towns in East Anglia, UK, were sent a questionnaire on asthma and hayfever. From those who responded, a random sample of 1864 were invited to complete an extended questionnaire that included questions on use of gas appliances, to give blood samples for measurements of total IgE and specific IgE to common allergens, and to undergo tests of respiratory function, 659 women and 500 men agreed to an interview. The association of the use of gas appliances with respiratory symptoms, total IgE, specific IgE, and respiratory function was assessed by logistic and multiple regression models. FINDINGS: Women who reported they mainly used gas for cooking had an increased risk of several asthma-like symptoms during the past 12 months including wheeze (odds ratio 2.07 [95% CI 1.41-3.05]), waking with shortness of breath (2.32 [1.25-4.34]), and asthma attacks (2.60 [1.20 -5.6]). Gas cooking increased the risk of symptoms more in women who were atopic than in non-atopic women but the difference did not reach significance (p . 0.05). Women who used a gas stove or had an open gas fire had reduced lung function (forced expiratory volume in 1 s [FEV1]) and increased airways obstruction (FEV1 as a percentage of forced vital capacity) compared with women who did not. These associations were not observed in men. INTERPRETATION: In East Anglia, the use of gas cooking is significantly associated with subjective and objective markers of respiratory morbidity in women but not in men. Women may be more susceptible than men to the products of gas combustion or they may have greater exposure to high concentrations of these products because they cook more frequently than men.     

Respiratory allergy in laboratory animal workers: a retrospective cohort study using pre-employment screening data

OBJECTIVES: To study the role of exposure, atopy, and smoking in the development of laboratory animal allergy (LAA) in a retrospective cohort study. METHODS: Between 1977 and 1993, 225 people received a pre-employment screening when they started a job at a Dutch research institute where they were going to work with laboratory animals. After active follow up 136 of them (60.4%) could be traced and were sent a questionnaire with extensive questions on allergic symptoms, smoking habits, and job history. 122 people (89.7%) sent back a completed questionnaire. Those who were accepted for a job at the institute and did not have allergic symptoms at the start of the job were selected as cohort members. After selecting people with complete data on start and end date of jobs, exposure intensity, atopy, and smoking, the cohort consisted of 99 people with an average time of follow up of 9.7 years. LAA was defined as a positive response to a set of questions in the questionnaire. The mean number of hours a week a person was exposed to laboratory animals at entry of the cohort was used as a surrogate for exposure, and was divided into four categories. RESULTS: 19 cohort members (19.2%) reported LAA. More people with asthmatic symptoms were found in the high exposure categories. More atopic than non-atopic people reported asthmatic symptoms (13% v 6%). The mean time until development of symptoms of LAA was about 109 months in non-atopic people (n = 9), and 45 months in atopic people (n = 10) (t test; P < 0.05). Time until development of symptoms of LAA was shorter at a higher intensity of exposure, except for those exposed for less than two hours a week. A proportional hazard regression analysis showed that exposure and atopy were significant determinants of LAA. An increased relative risk (RR) was found for non-atopic people exposed to laboratory animal allergens for more than two hours a week. Atopic people had an even higher risk when exposed to laboratory animals for more than two hours a week (RR above 7.3). Sex, smoking, and age were not risk factors. More atopic than non-atopic people were absent from work or transferred because of allergies. CONCLUSIONS: This study showed that exposure and atopy are significant predictors of LAA and that the risk of developing LAA remained present for a much longer period (> 3 y) than considered before.     

Pathogenicity and lethality of a minute intestinal fluke, Neodiplostomum seoulense, to various strains of mice

Atopy is a genetically determined disorder that affects 10%-20% of the population. Many symptoms of patients with atopy (allergic rhinitis, conjunctivitis, asthma, and anaphylaxis) result from events occurring after crosslinking of cell-bound IgE by per se innocuous environmental antigens. The frequently raised hypothesis that autosensitization can also be a pathogenetic factor in atopy, gained support by our recent demonstration of IgE antibodies against human proteins in atopic dermatitis patients. To unravel the molecular nature of IgE-defined autoantigens, we used serum IgE from atopic dermatitis patients to screen a human epithelial cDNA expression library. One of the cDNA-encoding IgE-reactive products contained 1501 bp of a 2274 bp open-reading frame finally identified by sequence analysis of two additional cDNA clones resulting from oligonucleotide screening. The IgE-defined autoantigen, designated Hom s 1, exhibited an almost complete sequence identity with a recently described antigen recognized by cytotoxic T cells of a squamous cell carcinoma patient. Purified recombinant Hom s 1 specifically bound IgE from patients with severe atopy. When used as immunogen in rabbits, recombinant Hom s 1 gave rise to an anti-serum that reacted with a cytoplasmic protein exhibiting a broad cellular and tissue reactivity (skin, lung > gastrointestinal tract > muscle, brain) and identified a 55 kDa protein in blotted serum IgE preparations. The attractive possibility remains that the Hom s 1-triggered IgE response contributes to the events resulting in allergic tissue inflammation. If so, the respective recombinant molecule may serve as a paradigmatic tool for the diagnosis and treatment of patients with "intrinsic" atopy.