Heinz J. Wittig

Age-related serum immunoglobulin E levels in healthy subjects and in patients with allergic disease

Serum IgE levels were measured by a paper-disc radioimmunoassay technique (PRIST) in 425 nonallergic subjects and in 570 patients with asthma, 244 with allergic rhinitis, 48 with asthma and eczema (atopic dermatitis), 49 with eczema but without asthma, and 57 with chronic urticaria. The data are presented for age groups in geometric means and standard deviations and by modal distribution. Normal mean IgE levels for the total sample were 32 IU/ml with highest levels (mean of 51 IU/ml) in school-age children. The highest IgE levels were found in patients with both asthma and eczema (mean of 985 IU/ml), followed by asthma alone (305 IU/ml), eczema alone (273 IU/ml), and allergic rhinitis (171 IU/ml). The values for our United States population were higher than those reported from Scandinavian countries but lower than those reported from Canada. The geometric mean plus 1 SD (64 IU/ml for infants, 150 IU/ml for schoolchildren, and 100 to 120 IU/ml for all other age groups) appears to be the most useful limit of normalcy. Overlaps with normal values are largest for urticaria, eczema, and allergic rhinitis and least for patients with allergic asthma.

Degree and duration of skin test suppression and side effects with antihistamines: A double blind controlled study with five antihistamines*

The ability of antihistamines to suppress the wheal response of an intradermal skin test is well recognized, but the degree and duration of this suppression have not previously been adequately studied. This double blind study employed five commonly used antihistamines in recommended therapeutic doses. Wheal suppression was recorded immediately after completing a 3 day course of the respective drug and was followed for up to 7 days or until the wheal regained control levels. Mean suppression ranged from 30.7 per cent to 62.7 per cent and required from 1.89 to 4.31 days to re-establish control levels. Incidence and degree of side effects from each antihistamine are also discussed.

Treatment of perennial allergic rhinitis with cromolyn sodium. Double-blind study on 34 adult patients.

A double-blind crossover study was performed on 34 adult patients with perennial allergic rhinitis, using an aqueous solution of 4% cromolyn sodium or a placebo substance six times daily over a 4-wk period with daily documentation of both symptoms and use of symptomatic medications. All patients had markedly positive skin test reactions to at least one antigen. Chemistry screens and IgE serum levels were determined. Significant reductions occurred in the symptom-scores for runny nose, stuffy nose, sneezing, and nose blowing while patients were on cromolyn treatment (p less than 0.005). Likewise, while on treatment, there was a significant reduction in the consumption of antihistamines. In an attempt to differentiate between good and poor cromolyn responders by clinical and laboratory parameters, we found that (1) patients with high IgE levels responded better than those with low IgE levels, (2) patients with markedly positive skin test reactions to epidermoids and to foods responded better than those with pollen allergy, and (3) females appeared to have a significantly better drug response than males. Age did not play a role in drug response, nor did drug sequence (placebo-active or active-placebo).

Suppression of histamine-induced pruritus by three antihistaminic drugs

A double-blind crossover study of inhibition of histamine-induced pruritus by three commonly prescribed antihistamines was conducted on 28 normal subjects. Drugs used included diphenhydramine HCl (Benadryl), cyproheptadine (Periactin), hydroxyzine HCl (Atarax), and a lactose placebo in identical capsules. Intradermal histamine dose-response thresholds of pruritus were obtained before and after pretreatment with the three antihistamines and placebo in each subject. Analysis of data revealed a fivefold increase above baseline of the histamine dose required to produce pruritus following both cyproheptadine and placebo. This compared to a tenfold increase following diphenhydramine and a 750-fold increase following hydroxyzine HCl. The most common side effect was drowsiness, which occurred with all three drugs.

Hypersensitivity to the imported fire ant: A report of 49 cases

Two South American species of the fire ant group, Solenopsis richteri and Solenopsis invicta, now occupy more than 150 million acres in 13 southern states and cause systemic allergic reactions to their stings. We report 49 cases of such reactions with case reports and documentation. Specificity of the sting was documented by either typical pustule formation or positive skin tests. Of 37 patients treated with hyposensitizing injections, 10 have subsequently been restung. Only one suffered a systemic reaction. Problems of cross-reactivity with other insects are discussed and the literature is reviewed. Hypersensitivity to the imported fire ant continues to be a serious problem in the southern United States and appears to be amenable to properly instituted hyposensitization therapy.

Lymphocyte transformation with bacterial antigens in intrinsic asthma

Abstract Chronic infection of the respiratory tract is often thought to play an important role in intrinsic asthma. To study this further, the response of lymphocytes from patients with intrinsic asthma was investigated by in vitro challenge with various bacterial antigens and assayed by liquid scintillation counting of 3 H-thymidine uptake. Lymphocytes from normal individuals were run in an identical manner for comparison. The mean of the unstimulated background counts from all patients with intrinsic asthma was 250 per cent above the mean of the normal control values. Upon challenge with mixed bacterial antigen, the majority of both patients and control subjects and a 300 per cent or greater increase in counts. Response to H. influenzae antigen seemed to be dose related, with some suppression of 3 H-thymidine uptake at high antigen concentration. It would appear that lymphocytes from intrinsic asthmatic patients respond to challenge with mixed bacterial antigens and also H. influenzae antigen in the same manner and degree as do controls. However, lymphocytes from some patients with intrinsic asthma seem to have a significantly higher unstimulated rate of transformation than do those from normal control subjects. The reasons for this are unknown, and further investigation is indicated.