Liisa Räsänen

Comparison of diagnostic methods in latex surgical glove contact urticaria

Surgical rubber gloves contain allergens derived from natural rubber latex which may sensitize, causing contact urticaria and even systemic reactions. We examined 15 hospital employees allergic in latex surgical gloves, using various skin tests and RAST, to determine the most reliable diagnostic method and to investigate coexistent allergy to glove powder and rubber chemicals. Prick testing using a stock solution made from one brand of latex glove yielded positive (2+ to 4+) reactions in all 15 employees; 8 retained positive reactions at a 1/10 dilution, 1 at 1/100 and 4 at 1/1000. A prick test using rubber‐tree sap (Hevea brasiliensis) was positive in 12/15 employees and a scratch‐chamber test using crushed rubber‐tree leaf was positive in 13/l5. A latex glove use test was positive in 12/13 employees and a latex RAST detected measurable amounts of specific IgE in 8/15. No positive prick lest reactions were obtained using glove powder. On patch testing, 2/15 employees showed delayed allergy to rubber chemicals but no immediate reactions were detected, The present results indicate that in addition to the use test, prick testing with a stock solution prepared from latex surgical gloves is an adequate test method for routine practice when diagnosing latex glove contact urticaria The correlation between prick tests and whole glove me tests was good, but latex RASTs yielded some negative results.

Allergy to ingested cereals in atopic children

Clinical features, hypersensitivity mechanisms, and differential diagnosis of cereal allergy or intolerance were investigated in children with atopic dermatitis (AD). On oral provocation, 18 children exhibited a positive response to wheat, three to rye, one to barley, and one to oats. Cereal‐induced symptoms were dermatologic, gastrointestinal, or oropharyngeal, and their onset after provocation was immediate (eight cases), delayed (14 cases), or both immediate and delayed (one case). A combination of type I allergy tests (prick test, RAST, and histamine‐release test) detected all immediate reactors and 9/14 delayed reactors. Of the five subjects remaining negative in these tests, three were positive in the patch or lymphocyte‐proliferation tests. Subjects with cereal allergy or intolerance frequently possessed IgE, IgA, and IgG antibodies against gliadin, but only one of these children was HLA‐DR3‐positive, and none had reticulin antibodies typical of celiac disease. Combining tests of immediate and delayed hypersensitivity can confirm allergy to cereals in a more reliable way. The coexistence of cereal allergy and celiac disease seems to be rare.

Diagnostic value of skin and laboratory tests in cow's milk allergy/intolerance.

The applicability of a panel of five skin and laboratory tests in the diagnosis of cows milk allergy/intolerance (CMAI) was investigated. The tests used were prick and patch tests, RAST, basophil histamine release test (BHRT) and lymphocyte proliferation test (LPT). Twenty‐two atopic children who had experienced either immediate or delayed cutaneous symptoms upon challenge with cows milk (CM), and 12 non‐milk‐allergic controls with atopic dermatitis (AD) were included in the study. RAST, prick test, BHRT and LPT to CM and patch test to α‐casein were positive in the CMAI group and non‐milk‐allergic atopic controls as follows: 59% and 33%, 57% and 0%, 55% and 17%, 77% and 17%, 33% and 0%. RAST, prick test and BHRT were more often positive in children exhibiting immediate reactions, and patch test and LPT more often positive in those having delayed reactions to CM. The panel of five tests detected 21/22 children with CMAI and gave false‐positive results in 5/12 of non‐milk allergic controls. The sensitivity and specificity of the panel in the diagnosis of CMAI were 95% and 58%, respectively.

Basophil histamine release and lymphocyte proliferation tests in latex contact urticaria. In vitro tests in latex contact urticaria.

Basophil histamine release and lymphocyte proliferation tests were examined with latex allergen prepared from surgical gloves in 15 patients with latex contact urticaria. The basophil histamine release test (BHRT) yielded positive results in 13/14 (93%) patients, whereas commercial latex RAST was positive in only 9/15 (60%) patients. Lymphocyte proliferation test (LPT) was positive in 3/15 (20%) patients, suggesting that cell‐mediated immune reactions may also occur in latex allergy. However, patch tests to latex were negative and neither were epidermal Langerhans cells able to present latex antigen to T lymphocytes in vitro.

Immunology and treatment of mosquito bites

Cutaneous reactions to mosquito bites are usually pruritic weals and delayed papules. Arthus‐type local and systemic symptoms can also occur but anaphylactic reactions are very rare. Both clinical and experimental evidence suggest that the various bite reactions result from sensitization to the mosquito saliva injected into the skin during feeding. Recent immunoblot studies have shown both IgG‐ and IgE‐class anti‐mosquito antibodies, but their species‐specificity and clinical importance is at present unknown. In addition to an Arthus‐type mechanism, both cutaneous late‐phase reactivity and cell‐mediated immunity may be involved in the pathophysiology of delayed mosquito‐bite lesions. Cutaneous sensitization to mosquito bites can be divided into five different stages ranging from the stages of immediate wealing and delayed bite papules, to the stage of non‐reactivity. No desensitization treatment is generally available for mosquito allergy but it has recently been shown that cetirizine, a potent non‐sedating antihistamine, is effective against the wealing and pruritus caused by mosquito bites.

Lymphocyte proliferation test as a diagnostic aid in chromium contact Sensitivity

We investigated the clinical applicability of the lymphocyte proliferation test (LPT) in chromium contact sensitivity, 6 out of 8 chromium‐sensitive patient were positive in the LPT, whereas none of 8 non‐chromium‐sensitive controls responded in vitro to tri‐ or hexavalem chromium compounds. LPT thus appeared to offer an additional diagnostic tool in chromium sensitivity. We also studied cellular interactions in 4 of our chromium‐sensitive patients. Sensitized T‐lymphocytes could he activated to proliferate only in the presence of accessory cells, of which epidermal Langerhans cells (LC) appeared more efficient than blood adherent cells.

Comparison of immunologic tests in the diagnosis of occupational asthma and rhinitis

In this study, three immunologic tests, skin prick test, RAST, and basophil histamine‐release test (BHRT), were compared by provocation in the diagnosis of occupational asthma and rhinitis. Twenty‐three positive bronchial or nasal challenges were performed on 16 patients (six farmers, six bakery workers, and four food industry workers) and asthma or rhinitis was diagnosed as caused by cereal flour or grain, cow epithelium, storage mites, garlic, or soy dust. A control group consisted of 12 patients, of whom four (two bakery workers, one food industry worker, and one farmer) were challenge‐negative, and the rest suffered from pollen allergy and seasonal rhinitis and were not challenged. The sensitivity and specificity of the prick test, RAST, BHRT, and a panel of them were as follows: 74 and 89%, 57 and 86%, 78 and 93%, and 91 and 71%, respectively. The overall concordance among these three type I allergy tests or between immunologic tests and challenge was relatively good.

Persistent cutaneous pseudolymphoma after intradermal gold injection

After intradermal testing with goldsodiumthiomalate (GSTM), 5 out of 8 patients developed skin papules at the test sites, which persisted up to 20 months. The lesions were surgically excised. Histology revealed pseudolymphoma of B and T cell type containing follicular structures and occasional small granulomas. The amount of histiocytic cells among B and T lymphocytes was pronounced, including acid cysteine proteinase inhibitor (ACPI) positive follicular dendritic cells, CD68 positive macrophages, factor XUIa positive dermal dendrocytes and S‐100 positive cells. By electron microscopy, the macrophages contained endosomes loaded with crystalloid material which contained gold in X‐ray microanalysis. Atomic absorption spectrophotometry also confirmed the presence of gold in one specimen. Thus GSTM seemed to accumulate in tissue macrophages leading to constant immunologic activation with lymphoid proliferation and histiocytic response.

Elaboration of leukocyte migration inhibitory factor by human lymphocyte subpopulations stimulated with mitogens.

Abstract This paper describes experiments to determine whether human lymphocyte sub-populations stimulated with a variety of mitogens, leucoagglutinin (LA), concanavalin A (con A), pokeweed mitogen (PWM), protein A (prot A), and anti-β2-microglobulin (anti-β2m), synthesize lymphokines. T and B lymphocytes as well as unseparated mononuclear cells were stimulated with the mitogens, and the presence of leukocyte inhibitory factor (LIF) in the culture supernatants was tested by an agarose migration method. Culture supernatants stimulated with LA or prot A were also fractionated on Sephadex G-100 columns, and LIF-containing fractions were tested for heat stability and the effect of monosaccharides. The results indicated that LA and con A caused LIF synthesis only in T-cell populations, while PWM stimulated both T and B lymphocytes and prot A and anti-β2mm were B-cell stimulants. Furthermore, LIF from LA-and prot-A-stimulated cultures behaved similarly upon physicochemical characterization.

Decreased monocyte production of interleukin-1 and impaired lymphocyte proliferation in atopic dermatitis.

SummaryWe studied lymphocyte proliferation and subsets in ten atopic dermatitis (AD) patients and ten healthy controls. In addition, monocyte production of interleukin 1 (IL-1) was investigated. Mean numbers of total T cells, T-cells subsets, and B cells did not significantly differ between AD patients and controls even though the patients had slightly decreased amounts of suppressor T lymphocytes. Proliferative responses of AD patients to purified protein derivative of tuberculin (PPD), concanavalin A (ConA), or allogeneic cells did not significantly differ from those of healthy controls at optimal stimulant concentrations. In contrast, at suboptimal concentrations, AD patients showed a diminished response to all of these stimulants. Monocytes from AD patients elaborated clearly less IL-1 than those from healthy controls.