D. H. Bryant

The correlation between skin tests, bronchial provocation tests and the serum level of IgE specific for common allergens in patients with asthma.

Cutaneous and bronchial immediate allergic reactivity and the serum level of IgE specific for each of four common inhalant allergens were determined for 153 asthmatic patients. Positive bronchial reactivity to an extract was not detected in any of the patients with a negative prick test reaction to that extract but did occur in 9% of the patients in whom the serum tests results for IgE specific to that allergen fell within the range regarded as negative. Highly significant correlation coefficients between the degree of bronchial and cutaneous allergic reactivity to the allergen extracts were found and these were slightly but significantly less than the correlation between the serum level of allergen specific IgE and the degree of bronchial allergic reactivity to the allergen extracts. These findings indicate that the results both of prick testing with appropriate extracts and estimation of the serum level of allergen specific IgE can be used to predict not only the presence of detectable bronchial reactivity to inhalant allergens but also the degree of this reactivity. However, for the routine investigation of asthmatic patients measurement of the serum level of allergen specific IgE would appear to have little advantage over properly performed prick tests.

New Type of Allergic Asthma due to IgG “Reaginic” Antibody

This study was undertaken to examine the possibility that IgE is not the only immunoglobulin responsible for immediate allergic reactions. A group of asthmatics were investigated in whom immediate allergic reactivity of the bronchi to common inhalant allergens had been confirmed by provocation tests. Their sera were fractionated and the reaginic activity of the immunoglobulin classes was studied by passive cutaneous anaphylaxis testing in monkeys. The results showed that the immediate allergic reactions were due to IgE antibodies in most patients, but there was a group with reactions due to short-term anaphylactic IgG antibodies. It was not possible to inhibit the IgG-mediated responses with disodium cromoglycate. As these two groups had clearly different serum IgE levels the estimation of IgE provided an important guide to the management of these patients.

Radiation-Induced Lung Injury: A Hypersensitivity Pneumonitis?

Radiation pneumonitis occurs 6 to 12 weeks after thoracic irradiation, and is thought to be due to direct radiation-induced lung injury. Four patients who developed pneumonitis after unilateral thoracic irradiation for carcinoma of the breast were studied with bronchoalveolar lavage, gallium scan of the lung, and respiratory function tests. On the irradiated side of the chest, all four patients showed an increase in total cells recovered from the lavage fluid and a marked increase in the percentage of lymphocytes. When results for the unirradiated lung were compared with results for the irradiated lung, there was a comparable increase in total cells and percentage of lymphocytes. Gallium scans showed increases for both irradiated and unirradiated lungs. Prompt improvement was seen after corticosteroid therapy in all patients. The fact that abnormal findings occur equally in irradiated and unirradiated lung is inconsistent with simple direct radiation-induced injury and suggests an immunologically mediated mechanism such as a hypersensitivity pneumonitis.

Bronchial histamine reactivity: its relationship to the reactivity of the bronchi to allergens

The aim of this study was to examine the proposal that the magnitude of the response of the bronchi to an immediate allergic reaction depends not only on the degree of sensitization of the bronchi by allergen specific IgE antibody but also on the reactivity of the bronchi to the vasoactive mediators which are released during immediate allergic reactions. This was done by determining the bronchial reactivity to Dermatophagoides pteronyssinus and to histamine of both symptomatic and asymptomatic groups of atopic subjects who had comparable serum levels of D. pteronyssinus specific IgE. Positive bronchial responses to the D. pteronyssinus extract were recorded with both the symptomatic and asymptomatic subjects, the mean bronchial threshold dose of allergen being significantly higher in the asymptomatic than in the asthmatic patients. There was a highly significant correlation between the serum level of allergen specific IgE and the bronchial threshold dose of allergen extract and also between the bronchial threshold dose of allergen extract and of histamine in all groups of subjects. The ability to predict bronchial reactivity to the allergen from the serum level of allergen specific IgE within each group was significantly better if the bronchial reactivity to histamine was included in the correlation analysis. This supports the hypothesis that whether a particular subject who is producing specific IgE antibody will develop symptoms on the inhalation of that allergen depends not only on the amount of allergen which he inhales and on the degree of sensitization of his bronchi but also on the reactivity of his bronchi to the vasoactive mediators which are released by allergen–IgE interaction.

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 characteristic 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 aero‐allergens giving positive prick test reactions.

Drinking Water Hardness and Urolithiasis

Excerpt Urolithiasis was the discharge diagnosis for 7.1 per 1000 general hospital separations between 1948 and 1952 in the United States (1). In 1952, 9.5 per 10 000 population required hospitaliz...

Cutaneous eosinophil accumulation in atopic and non-atopic individuals: the effect of an ECF-A tetrapeptide and histamine.

The numbers of eosinophils recruited locally to abraded human skin were measured in eight atopic and eight non‐atopic volunteers, at time intervals over 24 hr, following the application of an ECF‐A tetrapeptide (Val‐Gly‐Ser‐Glu) or histamine. In all subjects the higher doses of the peptide (10‐4 and 10‐6 mol/1) or histamine (10‐3 and 10‐5 mol/1) produced significantly greater counts than the Tyrodes diluent alone. The counts produced with the lowest dose of peptide (10‐8 mol/1) or histamine (10‐7 mol/1) were not significantly different from the control. The peptide or histamine evoked a greater local eosinophilia in the atopics than the non‐atopics. This effect was probably independent of the peripheral blood eosinophil counts since at the time of study the numbers of circulating eosinophils between the two groups were not significantly different. In the atopics, histamine in doses of 10‐3 and 10‐5 mol/1 were required to give the same eosinophil response as that obtained with 10‐4 and 10‐6 mol/1 of the peptide, respectively.

Histamine content of sputum from patients with asthma and chronic bronchitis.

Studies using the guinea pig ileum bioassay technique have previously shown that patients with either asthma or chronic bronchitis have increased amounts of histamine in their sputum. Because of the limitations of this assay technique, a spectrofluorometric method for measuring the histamine content of sputum was developed. Using this technique it was found that the mean histamine concentration of sputum from patients with bronchogenic carcinoma or pneumonia was not significantly different from the mean value for sputum collected during a remission phase from patients with either chronic bronchitis or asthma. However, the mean values in patients with asthma or chronic bronchitis during an exacerbation were significantly higher and returned to basal values as the airways obstruction improved. There was no significant difference in sputum histamine concentration between those patients with extrinsic atopic asthma and those with late onset cryptogenic asthma during an exacerbation although the value in patients with an exacerbation of chronic bronchitis was significantly less.

Smoking in hospitalised patients

A survey was conducted in a large inner-city hospital to examine the extent of overt and covert smoking being carried out by patients while they were in hospital. There were 311 patients studied. Twenty percent of all patients tested admitted to smoking during their admission, and another 8% showed expired carbon monoxide levels indicative of recent smoking, but denied they had smoked. The percentage of any one ward that were smoking varied from 4% to 41%. Patients with cardiac and respiratory disease were much more likely to lie about their smoking than those with other diseases. Smokers were more than twice as likely to be readmitted for the same condition than nonsmokers.

Extension of pulmonary tuberculosis after fibreoptic bronchoscopy

Two cases are described in which the diagnosis of pulmonary tuberculosis was suspected on both clinical and radiological grounds. Sputum smear and culture were negative for acid fast bacilli. Consequently a bronchoscopy and bronchial washings from the affected lobe were undertaken. While this procedure achieved a positive diagnosis of pulmonary tuberculosis, it also resulted in a significant extension of the disease.