Jose Luis Subiza

Allergenic pollen and pollinosis in Madrid

Abstract Objective: A 15-year pollen count was performed in the atmosphere of Madrid, Spain, to determine the months in which the highest concentrations of allergenic pollens occur. Methods: Pollen counts were done with a Burkard spore trap (Burkard Manufacturing, Rickmansworth, Herst., U.K.). The results were subsequently compared with results of skin tests in patients with pollinosis born and living in and around Madrid. Results: The highest airborne presence (percent of total yearly pollen counts, mean of counts from 1979 to 1993) was for Quercus spp. (17%); followed by Platanus spp. (15%), Poaceae (15%), Cupressaceae (11%), Olea spp. (9%), Pinus spp. (7%), Populus spp. (4%), and Plantago spp. (4%). The most predominant pollens from January to April are tree pollens (Cupressaceae, Alnus, Fraxinus, Ulmus, Populus, Platanus, and Morus ), although these are also abundant in May and June ( Quercus, Olea, and Pinus spp.). The grass pollination period shows a double curve: the first peak occurs from February to April (8% of yearly grasses), and the second peak occurs from May to July (90% of yearly grasses). Among allergenically significant weeds, the most notable is Plantago ; in contrast, Rumex , Urticaceae, Cheno-Amaranthaceae, and Artemisia spp. have very low concentrations (≤2% yearly total pollens). The most significant allergenic pollen is that of grasses, with a prevalence of positive prick test results of 94%, followed by Olea europaea (61%), Plantago lagopus (53%), Platanus hybrida (52%), and Cupressus arizonica (20%). Conclusion: The population of Madrid is exposed to high concentrations of allergenic pollen from February to July, although the most intense period is from May to June. Grass pollens are the most important cause of pollinosis in this area. (J Allergy Clin Immunol 1995;96:15-23.)

Platanus pollen as an important cause of pollinosis

OBJECTIVE The existence of Platanus pollinosis is not generally accepted despite the production of very large quantities of airborne Platanus pollen in many cities of the United States and Europe. The aim of this study was to investigate if Platanus pollen really contributes to the symptoms of the patients with pollinosis in the Madrid area. METHODS We carried out systematic skin prick testing with Platanus pollen extract on 47 patients seen in our allergy center with spring-summer pollinosis symptoms. Each patient maintained symptom score diaries before, during, and after the Platanus pollination season. The average symptom scores were calculated and compared with the Platanus pollen counts. Measurements of specific IgE by ELISA and immunoblotting also were performed in each patient. RESULTS The Platanus skin tests were positive in 33 of the 39 patients first seen with seasonal symptoms during Platanus pollen season and only in three of the eight patients without symptoms during Platanus exposure (Fishers exact test; p < 0.05). Twenty-two of the 33 Platanus-positive skin test patients also had a positive ELISA result. Furthermore, the average 24-hour rhinitis symptom scores of the 39 patients first seen with seasonal symptoms during March through April showed significant correlation with Platanus pollen counts (r(s) = 0.57, p < 0.05). The immunoblot results suggest that a 17 kd pollen protein could be a major allergen in patients with Platanus pollinosis. CONCLUSIONS Platanus pollen is an important cause of pollinosis in Madrid. A protein with a molecular weight of 17 kd appeared to be its major allergen.

Cyclophosphamide Induces the Development of Early Myeloid Cells Suppressing Tumor Cell Growth by a Nitric Oxide-Dependent Mechanism

Adoptive immunotherapy with cyclophosphamide (Cy) increases the host resistance against tumor growth. The precise mechanism(s) by which this therapy enhances tumor suppression is unclear. Cy induces the development of early myeloid cells that may be strongly antiproliferative through NO production. These cells are similar to the natural suppressor cells found in normal bone marrow with a potential antitumor effect. Here we have addressed whether the development of NO-producing cells may be involved in this tumor resistance in Cy-treated mice. The results show a synergism between Cy treatment and tumor-specific lymphocytes transferred systemically (i.v.) or locally (Winn’s assay) that results in a strong tumor suppression. Inhibition of NO production by NG-monomethyl-l-arginine at the site of tumor inoculation results in a loss of the protection achieved by the combined therapy. Cy-treated mice develop splenic early myeloid (CD11b, Gr-1, CD31 (ER-MP12), ER-MP20, ER-MP54) cells producing large amounts of NO upon T cell-derived signals (IFN-γ plus CD40 ligation) able to inhibit tumor cell growth in vitro. Early myeloid cells (ER-MP54+) and cells expressing inducible NO synthase are increased at the site of tumor challenge in mice treated with the combined therapy, but not in those treated with Cy or immune cell transfer alone. Thus, Cy induces the expansion of early myeloid cells, inhibiting tumor cell growth by a mechanism involving NO. Both the recruitment and the activation of these myeloid cells at the site of tumor challenge appear to be dependent on the presence of tumor-specific lymphocytes.

Anaphylactic reaction after the ingestion of chamomile tea: A study of cross-reactivity with other composite pollens

We report a case of an 8-year-old atopic boy in whom ingestion of a chamomile-tea infusion precipitated a severe anaphylactic reaction. The patient suffers from hay fever and bronchial asthma caused by a variety of pollens (grass, olive, and mugwort). This severe reaction was developed after his first ingestion of chamomile tea. Studies revealed the presence of immediate skin test reactivity and a positive passive transfer test to chamomile-tea extract. Moreover, both specific antichamomile-tea extract and anti-Matricaria chamomilla-pollen extract IgE antibodies were detected by an ELISA technique. Cross-reactivity among chamomile-tea extract and the pollens of Matricaria chamomilla, Ambrosia trifida (giant ragweed), and Artemisia vulgaris (mugwort), was demonstrated by an ELISA-inhibition study. These findings suggest a type I IgE-mediated immunologic mechanism as being responsible for the patients anaphylactic symptoms and also suggest that the patient cross-reacted the pollens of Matricaria chamomilla contained in the chamomile tea because he was previously sensitized to Artemisia pollen.

Seasonal asthma caused by airborne Platanus pollen

This work describes three patients suffering from bronchial asthma after being naturally exposed to airborne plane‐tree pollen. The three patients gave immediate response in skin tests and dual response in bronchial provocations using Platanus hybrida extract. There was specific seric IgE activity against this/these antigen(s) with the CAP system. The three patients also showed significant correlation (P < 0·001) between their rhinitis and asthma symptom‐scores registered on their diary cards and plane‐tree pollen counts, collected using the Burkard spore trap. Among 187 patients living in Madrid and who came to our centre with a history of rhinitis and/or seasonal asthma, we found a prevalence of positive skin‐prick tests to Platanus of 56%, only surpassed by gramineous pollen (Dactylis glomerata and/or Trisetum paniceum) 92% and Olea europaea 63%. The aerobiological sampling of the pollen content of the air in Madrid, carried out between 1 January 1979 and 31 December 1993 revealed an airborne presence (per cent of total yearly pollen count, mean of 1979–1993) of 14·9% for the Platanus, 14·8% for grasses, 9·8% for Olea and 3·6% for Plantago. The Platanus is one of the most frequently found pollens in the atmosphere over Madrid. At present, in this geographical area, a high percentage of patients with pollinosis are sensitive to this pollen. At least in some of these patients Platanus pollen is capable of inducing rhinitis and bronchial asthma.

Prediction of annual variations in atmospheric concentrations of grass pollen. A method based on meteorological factors and grain crop estimates

We performed an aerobiologic observation of the grasses present in Madrid for 14 years (1978–1991), using volumetric air samplers. The counts obtained show that the major grass pollen release period (average daily grass pollen counts >50 grains/m3 of air) occurs in the months of May and June, although lower counts can occur some days from the end of January onward. There are wide year‐to‐year variations in total atmospheric grass pollen counts, expressed as the total sum of the mean daily concentrations from April 1st to July 30th (ranging from 2568 to 6624). A strong, statistically significant correlation, based on Spearmans rank test and/or simple and multiple linear regressions, was found between the total grass seasonal count and preseasonal rainfall from October to March (R2= 0.64; P= 0.0429). The meteorological variable which gave the correlation with greatest statistical significance (R2= 0.97; P= 0.0016) was the average monthly preseasonal humidity from October to March. A good correlation was also found between March estimates of wheat, rye and barley crops and the total grass count (R2= 0.73; P= 0.006). A model was designed from the above mentioned humidity variable through a multilinear regression analysis, and it was possible to predict, at the beginning of April, total seasonal counts for 1989 (predicted = 5468; actual = 4410; average error = 24%), 1990 (5033; 6090; – 17%)and 1991 (3930; 2568; 53%). These data may help clinicians to predict and prepare themselves for the intensity of the grass pollen season and to explain yearly variations in the severity of symptoms.

Early myeloid cells are high producers of nitric oxide upon CD40 plus IFN‐γ stimulation through a mechanism dependent on endogenous TNF‐α and IL‐1α

Bone marrow contains nonadherent low‐density wheat germ agglutinin‐positive (Fr3‐WGA+) cells that release large amounts of NO and show natural suppressor activity if stimulated with activated T cells. We have assessed the involvement of CD40‐derived signals in NO production and their cytokine requirements. Production of NO by Fr3‐WGA+ cells in co‐culture with activated T cells is inhibited by a competing CD40 soluble fusion protein. Fr3‐WGA+ cells express the inducible NO synthase (iNOS) and release NO following CD40 plus IFN‐γ activation. Production of NO through CD40 is strictly dependent on endogenous TNF‐α and / or IL‐1α, since it is inhibited by neutralizing these cytokines or blocking the TNF receptor (p55). Both cytokines are transcribed when Fr3‐WGA+ cells are stimulated by CD40 signaling plus IFN‐γ, although TNF‐α remains below detection limits in stimulated Fr3‐WGA+ cell cultures. Phenotypic studies combined with data on intracellular iNOS expression and cell sorting indicate that NO‐producing cells are CD40, CD31 (ER‐MP12), CD11b (Mac‐1)low, ER‐MP20 (Ly‐6C) and Gr‐1 (Ly‐6G) positive, consistent with myeloid progenitors. The results point to early myeloid cells as an important cell source of NO once triggered by activated T cells through CD40 and IFN‐γ‐derived signals, in a mechanism involving the production of TNF‐α and / or IL‐1α.

Bronchial asthma, rhinoconjunctivitis, and contact dermatitis caused by onion

CASE REPORTS Patient 1 is a nonsmoking, 45-year-old homemaker. For years she had been experiencing episodes of rhinoconjunctivitis, dyspnea, and coughing when chopping onions. In the last few years, eczematous dermatitis had been appearing, mainly on the fingertips, which became worse when she was chopping onions. Total serum IgE was 182 IU/ml. Patient 2 is a 37-year-old female office worker and homemaker in whom rhinoconjunctivitis and bronchial asthma caused by sensitivity to pollen were diagnosed. Over the past 15 years, she had noticed intense rhinoconjunctival symptoms and slight dyspnea when chopping onions. Total serum IgE was 162 IUlml. In order to study the prevalence of allergy to onion, skin prick tests were performed on 106 subjects, randomly chosen in our clinic: 39 subjects were atopic. In eight (7.5%) immediate positive reactions were noted. Of these eight, all were sensitive to grass pollen; two of them (patients 3 and 4) had intense rhinoconjunctivitis, and one of the two also had chest tightness, wheezing, and dyspnea after being exposed to the aerosols emanating from onions. Patient 3 was a 31-year-old, nonsmoking man, in whom pollen-induced rhinoconjunctivitis and asthma

Occupational asthma caused by Brazil ginseng dust

The inhalation of different substances of plant origin can cause immediate and late onset asthma. The list of these agents responsible for such reactions is continuously increasing. We discuss a patient who developed symptoms of asthma after exposure to Pfaffia paniculata root powder used in the manufacturing of Brazil ginseng capsules. Airway hyperreactivity was confirmed by a positive bronchial challenge to methacholine. Sensitivity to this dust was confirmed by immediate skin test reactivity, a positive bronchial challenge (immediate response), and the presence of specific IgE detected by ELISA technique to an aqueous extract. The bronchial response was inhibited by sodium cromoglycate. Unexposed subjects did not exhibit reactivity to this ginseng extract with any of the tests referred to above. The same study performed with Korean ginseng (Panax ginseng) elicited negative results. This study is the first, to our knowledge, that links ginseng-root dust to occupational asthma.

Cluster immunotherapy with a glutaraldehyde‐modified mixture of grasses results in an improvement in specific nasal provocation tests in less than 2.5 months of treatment

Background Cluster immunotherapy is becoming increasingly used. It allows for a rapid build up phase and the administration of higher doses of allergen in a shorter period of time.