John E. Salvaggio

New Orleans asthma: V. Relationship between Charity Hospital asthma admission rates, semiquantitative pollen and fungal spore counts, and total particulate aerometric sampling data

Abstract A 2 year study of the relationship between climatologic variables, semiquantitative rotoslide pollen and fungal spore aerometric sampling data, and emergency room asthma admission rates at New Orleans Charity Hospital was made. An interrelationship between certain climatologic factors, high airborne spore and pollen concentrations, and asthma admission rates was noted. Large asthma epidemics (above 40 asthma admissions per 24 hours) occurred almost exclusively from June through December and in greater magnitude during September, October, and November. High summer asthma admission rates were significantly associated with high total spore and pollen, basidiospore-like, and small spore rotoslide counts. Asthma epidemics occurring during the peak September and October local Ambrosia pollination season were not necessarily associated with sudden influxes of Ambrosia pollen, but there was a significant relationship between high daily asthma admission rates (above 20 daily asthma admissions) and 24 hour rotoslide Ambrosia counts during September and early October. Asthma epidemics of considerable magnitude occurred in late October and November immediately following the peak Ambrosia pollination season. High total and basidiospore-like rotoslide spore concentrations plus heavy deposits of amorphous chitinous material resembling plant debris were noted on slide samples during these episodes. We currently postulate that New Orleans epidemic asthma does not involve a point source chemical or particulate pollutant but rather results from sensitization of the local atopic population by diverse natural inhalant allergens acting in seasonal patterns.

New Orleans asthma. I. Characterization of individuals involved in epidemics.

Abstract As a group, the involved subjects appear to be a homogeneous group, strongly resembling the uninvolved asthmatics and characterized by a strong personal and family history of atopic disease with pronounced immediate skin reactivity to many local inhalant allergens.

New Orleans asthma: II. Relationship of climatologic and seasonal factors to outbreaks

Abstract Outbreaks of obstructive pulmonary disease in the city of New Orleans, which occur in epidemic proportions, are generally seasonal, occurring with greater frequency and magnitude during the months of September, October, and November. These fall outbreaks are associated with minimum temperatures and minimum humidities. Involved individuals are not symptomatic exclusively during outbreaks, and previously observed similarities between involved and noninvolved asthmatic subjects are due to the overlap of these groups. In light of previous observations that New Orleans asthma affects a homogeneous group of allergic individuals and is not related to measurable increases in specific chemical pollutants, the observed climatological and seasonal variations suggest that it does not differ from conventional extrinsic bronchial asthma.

Bagassosis: I. Precipitins against extracts of crude bagasse in the serum of patients.

Excerpt Bagassosis is an acute respiratory disease that primarily affects workers who handle bales of bagasse or dried sugar cane fiber. The disease was first recognized by Blitz in 1937 (1), and...

Nonspecificity of the bronchoconstricting effect of histamine and acetyl-beta-methylcholine in patients with obstructive airway disease

Abstract Several reports comparing the response of normal and atopic individuals to histamine and Mecholyl demonstrated evidence of marked bronchoconstriction among atopic subjects and minimal response in normal persons. To test the specificity of this effect, responses of normal and asthmatic individuals and patients with idiopathic obstructive pulmonary disease to parenteral histamine and Mecholyl challenge were compared. Although asthmatic and normal subjects could be easily differentiated because of the bronchoconstriction produced in the former, the idiopathic obstructive pulmonary disease group also developed significant airway obstruction. This suggests that the bronchoconstricting effect of histamine and Mecholyl cannot be used to differentiate persons with asthma from those with other types of obstructive pulmonary disease and that the bronchoconstricting response may represent a non-specific phenomenon related to many diverse factors.

Immunologic response of atopic and normal individuals to keyhole limpet hemocyanin

Abstract Groups of atopic and normal individuals were immunized intranasally with aerosolized keyhole limpet hemocyanin (KLH), a purified high-molecular weight protein known to be highly immunogenic in man. A high percentage of atopic, as opposed to normal, individuals demonstrated immediate wheal and flare skin reactivity to KLH during the process of patient selection prior to initiation of the study. We divided 65 subjects with negative KLH wheal and flare skin tests into normal, atopic, and family history groups. KLH was administered: (1) by weekly nasal aerosol (0.3 mg. per week for 2 months followed by a 0.6 mg. aerosol booster); (2) by monthly intracutaneous injection of 22 μg. At 2 months, wheal and flare skin reactivity appeared with greater frequency in atopic individuals irrespective of immunization route. By 212 months, group differences were no longer evident. Many subjects developed large delayed skin reactions to KLH after one month, and these were usually followed by the appearance of immediate reactions at the 2 month testing. Low level mercaptoethanol (ME) — sensitive (IgM) anti-KLH hemagglutinating antibody coincided with appearance of delayed skin reactions early in the course of the study and was followed sequentially by wheal and flare skin reactivity and IgG hemagglutinating antibody. IgG anti-KLH titers and wheal and erythema skin reactivity were greatest at the termination of the study.

Bagassois III. Isolation of Thermophilic and Mesophilic Actinomycetes and Fungi from Moldy Bagasse

Summary and Conclusion Industrial workers who grind raw sugar cane fiber from which the sucrose content has been extracted and which has been stored in bales under high environmental temperature develop a characteristic respiratory illness called bagassosis. Precipitins against unknown antigens in crude bagasse have been detected in the sera of many patients with this disorder, and thermophilic microorganisms are suspected as likely sources of bagasse antigen. This report describes the most common thermophilic actinomycetes and fungi isolated from the “bagasse” fiber. These include M. vulgaris, S. thermoviolaceus, S. griseoflavus, S. fradiae, S. thermovulgaris, S. olivaceus, and H. lanuginosa. The sera of many patients with bagassosis contained precipitins against cellular extracts of M. vulgaris. Since bagassosis results almost exclusively from inhalation of dried stored sugar cane fiber and M. vulgaris has been the most common isolate from this type of bagasse, it is postulated that M. vulgaris is the main source of “moldy bagasse” antigens.

Bagassosis: IV. Precipitins against extracts of thermophilic actinomycetes in patients with bagassosis☆

Abstract Precipitating antibodies against extracts of crude moldy bagasse have previously been detected in the serum of patients with bagassosis and to a lesser extent in the serum of unaffected sugar cane workers. In this report serum specimens obtained from patients with bagassosis and appropriate control groups were analyzed for precipitins against thermophilic fungi and actinomycetes isolated from bagasse. The thermophilic actinomycete Micromonospora vulgaris was found to be an important source of bagassosis antigens. Sixty-four per cent of those with bagassosis of recent onset demonstrated precipitins against this organism and eight M. vulgaris antigens were identified using rabbit antiserum. Patients with bagassosis also demonstrated elevated levels of IgG and IgA and normal IgM levels. Only an occasional unaffected bagasse industry worker or unexposed Louisiana resident demonstrated precipitin arcs against the battery of actinomycete extracts employed and these arcs were generally not as well defined or intense as those developed by serum of patients with overt bagassosis. Precipitin arcs tended to decrease in number and intensity with clinical improvement. A positive precipitin reaction to M. vulgaris in a case of suspected active or recent onset bagassosis was considered to be of presumptive diagnostic significance.

New Orleans asthma: IV. Semiquantitative airborne spore sampling, 1967 and 1968

Abstract A semiquantitative survey of atmospheric spore concentrations in the city of New Orleans with the use of automatic intermittent rotoslide samplers was performed during the years 1967 and 1968. In comparison with our previous rotoslide pollen survey, spores were invariably detected in excess of pollen grains by a factor of 10 to 100. Relatively large spores of the deuteromycetes (fungi imperfecti) were easily identified morphologically. Identification of small spores was uncertain because of considerable group overlap and interspecies variation. Spores in this category were detected in highest quantity. Spores resembling large basidiospores were included in a third general category. Many myxomycete spores were also likely included in this category because of similar morphology. In all morphological categories, semiquantitative atmospheric spore counts were comparatively low in January and February. Counts increased sharply in March and April and increased variably throughout the summer and late fall months. Noticeable decreases were recorded in late November at or near the usual onset of local killing frosts. Petri plate colony identification, although performed only sporadically, was not as helpful as anticipated. Analysis of one typical large asthma epidemic (December, 1968) revealed high rotoslide catches in all major spore categories but no sharp increase in total cultural colony count or obvious change in colony composition.

The Effect of Prolonged Plasmapheresis on Immunoglobulins, other Serum Proteins, Delayed Hypersensitivity and Phytohemagglutinin-Induced Lymphocyte Transformation

Serum protein concentrations and lymphocyte function, were determined in prisoner volunteers undergoing prolonged biweekly plasmapheresis and appropriate control subjects. Prolonged biweekly removal o