H.Alice Orgel

Genetics of IgE and allergy: Serum IgE levels in twins

Abstract Serum IgE levels are an important risk factor in allergic disease resulting from immediate-type hypersensitivity. IgE levels of middle-aged male monozygous twins (54 pairs) and dizygous twins (39 pairs) were measured and a significant genetic effect on IgE levels was observed (H = 0.592). A significant genetic effect was also noted in twin children (H = 0.789). The statistical relationship between IgE levels and atopic disease, as well as aspects of the methods of analysis of twin data, is discussed.

Ipratropium bromide aqueous nasal spray for patients with perennial allergic rhinitis: A study of its effect on their symptoms, quality of life, and nasal cytology☆

Ipratropium bromide is an anticholinergic agent with topical activity that has been studied as a freon-propelled aerosol spray for therapy of nonallergic rhinitis. This is the first report of its use both as an aqueous nasal spray and in perennial allergic rhinitis. In this study 123 patients who had symptoms of perennial allergic rhinitis were randomized to receive ipratropium bromide 21 micrograms or 42 micrograms or placebo, one spray per nostril three times a day for 4 weeks. Patients maintained daily diaries of duration and severity of nasal symptoms and were evaluated weekly. Mean duration and severity of rhinorrhea was decreased in both ipratropium bromide treatment groups by comparison with placebo, with consistently greatest improvement in the group treated with ipratropium bromide 42 micrograms per nostril three times a day. No statistically significant differences occurred among treatment groups in duration or severity of postnasal drip, congestion, or sneezing. Seventy percent of patients treated with 42 micrograms of ipratropium bromide thought it had good or excellent effect on rhinorrhea (p less than 0.05 vs placebo); significantly more patients thought that it had improved the quality of life (p = 0.02). No changes occurred in nasal cytology, and no significant local or systemic adverse events occurred. These data indicate that ipratropium bromide significantly decreases the rhinorrhea of perennial allergic rhinitis.

The safety of egg-containinq vaccines for egg-allergic patients

Forty-two patients with a history of egg sensitivity were evaluated for receiving avian-grown vaccines. After giving a history and undergoing physical examination, each patient was skin-tested with egg antigens and six egg-propagated vaccines, given an oral egg challenge, and finally, when possible, given a vaccine challenge. Thirty-seven of the 42 patients (88%) were ultimately given one or more of the vaccines with no reactions or only minimal ones to both egg protein and vaccine; they had mild reactions consisting of pruritus, headache, and apprehension. Immunization was withheld from three patients who had a history of severe reactions after egg ingestion and strongly positive skin reactivity to both egg and vaccine. A history of egg intolerance should not, by itself, disqualify a patient from receiving one of these vaccines. However, a history of exquisite sensitivity to egg protein indicates that a severe vaccine reaction is likely. An intradermal skin test utilizing 0.02 ml of a 1:100 dilution of the vaccine and resulting in a wheal of greater than 5 mm was found to be the test that most reliably predicted those patients who should not receive the vaccine.

A dose-response study of the bronchodilator action of azelastine in asthma

Azelastine is an orally effective inhibitor of mediator activity in allergic reactions and has also been demonstrated to have bronchodilator activity. In this randomized, double-blind, placebo-controlled, multicenter study, 150 patients, aged 12 to 60 years, with moderate to severe asthma, received a single oral dose of 2, 4, 8, 12, or 16 mg of azelastine or placebo. Theophylline was stopped 24 hours and other bronchodilators at least 8 hours before the study day. Patients were evaluated for 8 hours after dose by spirometry and were monitored for adverse effects. All doses of azelastine produced bronchodilation with 4 mg greater than 2 mg greater than placebo; higher doses did not increase magnitude or duration of effect. We conclude that azelastine produces significant bronchodilation of long duration. The optimal dose appears to be 4 mg for adolescent and adult patients with asthma.

Efficacy of azelastine in perennial allergic rhinitis: Clinical and rhinomanometric evaluation

Azelastine is a chemically novel medication that has been demonstrated to be clinically effective for asthma and seasonal allergic rhinitis. In a 10-week, multicenter, double-blind, placebo-controlled, crossover study, the efficacy and safety of azelastine, 1 mg and 2 mg twice daily, were evaluated in 192 patients with symptoms of perennial allergic rhinitis. Patients maintained daily symptom and adverse-experience diaries and were evaluated every 2 weeks by the investigators. Pseudoephedrine, 30 mg, was provided as backup medication. Amelioration of most individual symptoms and a decrease in the total symptom scores were observed with both dosages of azelastine; greater improvement with 2 mg twice daily than with 1 mg twice daily, was observed. Nasal congestion, as a symptom and as reflected by rhinomanometric assessment, was the least improved parameter. Backup decongestant medication decreased during treatment with azelastine and increased during the placebo regimen. There were no major adverse effects.

Intranasal fluocortin butyl in patients with perennial rhinitis: A 12-month efficacy and safety study including nasal biopsy

Fluocortin butyl (FCB) is a recently developed topical intranasal corticosteroid that is inhaled as a powder and has been demonstrated to be well tolerated and to improve symptoms and signs of perennial rhinitis in previous short-term studies. This multicenter, open-label study evaluated the efficacy and safety of FCB during a 12-month treatment period in patients with perennial rhinitis. Treatment was initiated with one inhalation of FCB in each nostril three times a day (total dosage, 3 mg/day). In subsequent months, one third of the patients was maintained at the dosage of 3 mg/day, one third at a lower dosage of 2 mg/day, and the remaining one third of the patients at a larger dosage of 4 to 8 mg/day. Of 109 patients enrolled in the study, 90 patients (82.6%) completed all 12 months of treatment. Symptom and sign scores decreased significantly (p less than 0.001) at the 2-month evaluation compared to scores at baseline, and the improvement was maintained throughout the 12-month study period. After 12 months, greater than 80% of the patients had substantial control of symptoms. Specimens of nasal biopsies, performed at the beginning and end of treatment, revealed a decrease in eosinophils and other cellular infiltrates, a slight tendency of an increase in mast cell counts, and a trend toward normalization of the nasal mucosa. There were few adverse effects. Mean plasma cortisol levels were normal before and after corticotropin stimulation at baseline and after 12 months of FCB therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum IgG, IgA, IgM, and IgE levels and allergy in Filipino children in the United States

Abstract The serum levels of IgE, IgG, IgA, and IgM of 27 American-born Filipino children 5 to 17 years of age were measured and found to be significantly higher than those of a control group of 24 Caucasian children of similar age distribution and attending the same general pediatric clinics. The geometric mean of serum IgE of the Filipinos was 227 U. per milliliter and of the Caucasians, 69 U. per milliliter (p

Ipratropium Nasal Spray in Children with Perennial Rhinitis

OBJECTIVE To compare the efficacy and safety of ipratropium nasal spray and placebo administered twice each day for 4 weeks in pediatric patients with perennial rhinitis who had rhinorrhea as a major complaint. METHODS This was a multicenter, double-blind, parallel group study. Patients aged 6 to 18 years with symptoms of perennial nonallergic (PNAR) or perennial allergic rhinitis (PAR) were randomized to receive ipratropium (42 micrograms per nostril) or placebo nasal spray, double-blind, twice each day for 4 weeks. Efficacy was evaluated by nasal symptoms, especially anterior rhinorrhea, and quality of life. Previous caregivers for rhinitis and medications used in the past were also evaluated. RESULTS A total of 202 patients were empanelled, 162 with PAR, 40 with PNAR; of these 151 with mild-severe rhinorrhea were evaluated for efficacy. Treatment with ipratropium reduced symptoms of rhinorrhea primarily in patients with PNAR. In patients with PAR this response was less pronounced, and was seen as a modest decrease in the severity of rhinorrhea noted in the first 2 weeks of treatment. Quality of life assessments confirmed that rhinorrhea was bothersome to these pediatric patients, and suggested that treatment with ipratropium nasal spray was associated with an improvement, especially in the patients with PNAR. There were few adverse events; these were similar in the two treatment groups. CONCLUSIONS Ipratropium nasal spray 0.03% administered at a dose of 42 micrograms/nostril bid is a safe and effective new therapy for control of anterior rhinorrhea in pediatric patients with PNAR. Twice daily administration is adequate for patients with PNAR, but patients with PAR might benefit from more frequent administration (e.g., tid).

Genetic and Developmental Aspects of lgE

The main purpose of this review is to discuss the genetic control of IgE levels and lgE antibody production in humans, and the way in which IgE levelschange with age. The relation between IgE and atopy in infants and young children is also examined.

Bitolterol and albuterol metered-dose aerosols: Comparison of two long-acting beta2-adrenergic bronchodilators for treatment of asthma

In this double-blind, parallel, single-dose study, bitolterol mesylate aerosol (three sprays, 1.11 mg) and albuterol aerosol (two sprays, 180 mcg) were compared for efficacy of bronchodilation in 120 adolescent and young adult patients with moderate to severe asthma. All patients required regular medications for asthma control. None was steroid dependent. Both medications gave effective bronchodilation within 5 min with maximum effect at 30 to 60 min. Mean percent increase in forced expiratory volume in 1 sec (FEV1) over baseline was higher for bitolterol than for albuterol at all test times up to 8 hr after a dose at which time 20% mean percent increase of FEV1 over baseline was still present in the bitolterol-treated patients. With albuterol mean percent increase in FEV1 fell to 15% over baseline at 5 hr after a dose. Differences in FEV1 increase between the two treatment groups were statistically significant at 4 to 8 hr after a dose. Patients with baseline FEV1 less than 50% of predicted normal had a response to bitolterol that was higher than that observed with albuterol treatment (p less than 0.1). Mean maximum percent increase in FEV1 and median duration of bronchodilation were greater with bitolterol than with albuterol, but the differences were not statistically significant. Both bitolterol aerosol and albuterol aerosol were demonstrated to be safe, effective, and long-acting bronchodilating agents. Both bitolterol and albuterol administered by aerosol had a rapid onset, and the maximum degree of bronchodilation was comparable. However, at the doses studied, bitolterol produced significantly higher increase in FEV1 over baseline at longer times after medication than did albuterol.