Lowell L. Henderson

Effect of immunotherapy on immunoglobulin E and immunoglobulin G antibodies to ragweed antigens: A six-year prospective study

The effect of immunotherapy with aqueous short ragweed (SRW) extract on IgE and IgG antibodies was tested over a 6 yr period in 47 adults with ragweed hay fever. Sera were collected each year in July and October from 1973 through 1979. In May 1976, 23 patients began immunotherapy with a lyophilized standardized SRW extract. From 1976 through 1979, treated patients received an average total dose of 4.8 × 103 protein nitrogen units (1039 μg of AgE). IgE antibodies to SRW and ragweed AgE were measured by the radioallergosorbent test (RAST) in antigen excess using allergens bound to Sepharose. Blocking antibodies primarily of the IgG class were measured by RAST interference. In response to inhalation of ragweed pollen, untreated patients showed seasonal rises (July to October) and postseasonal falls (October to July) of IgE antibodies during the entire study period. IgE antibody levels in the untreated patients decreased with time and from 1974 to 1979 fell 41% (p < 0.003) for an average halftime of 6.2 yr. Before immunotherapy, treated patients also showed seasonal rises and postseasonal falls. Treatment with SRW extract in 1976 produced an abrupt increase in IgE and IgG antibodies and a clear-cut suppression of seasonal rises of IgE antibodies without an effect on postseasonal falls through 1978. From 1974 to 1979, IgE antibodies to AgE and SRW decreased more in the immunized group than in the control group, and by 1979 these levels showed a mean fall of 73%. Blocking antibodies increased in the treated patients and reached maximal levels by July 1978. In 1978 and 1979, the levels of IgG blocking antibodies to AgE were inversely related to the IgE antibody levels to AgE. These results indicate that adults with ragweed hay fever show regular seasonal and postseasonal changes in IgE antibodies and that IgE antibodies spontaneously decrease with time. Immunotherapy magnifies these decreases by suppression of the seasonal rises, but it does not affect the postseasonal falls.

Measurement of the absolute levels of IgE antibodies in patients with ragweed hay fever: Effect of immunotherapy on seasonal changes and relationship to IgG antibodies☆

Abstract The effect of immunotherapy with aqueous ragweed pollen extract on changes in IgE antibody was analyzed in 40 untreated patients with ragweed hay fever and compared to changes in 63 treated patients. Treated patients received cumulative doses prior to and during treatment ranging from 1.4 × 10 5 to 4.8 × 10 6 protein nitrogen units (PNU). IgG antibody to ragweed antigen E (AgE) was measured by radioimmunoprecipitation, while IgE antibody to allergens in crude ragweed extract was measured by the radioallergosorbent test (RAST). The RAST procedure was calibrated using a serum whose content of IgE antibody in nanograms per milliliter had been determined by immunoabsorption, and with this method the absolute quantities of IgE antibodies to ragweed allergens could be measured. Control experiments indicated that the IgG antibodies in the sera of the treated patients did not interfere with the measurements of IgE antibodies. The levels of IgE antibody in serum varied from less than 5 ng/ml to approximately 3,000 ng/ml. IgE antibodies decreased from October, 1973, to July, 1974, and rose sharply from July to October, 1974, following the pollination season. In both untreated and treated patient groups the magnitudes of the decreases were related (p

Maximal rise in IgE antibody following ragweed pollination season

Patients allergic to ragweed pollen who did not receive immunotherapy had an increase in ragweed-specific IgE antibodies associated with seasonal exposure. Of 17 such patients, 15 reached peak levels between mid-September and mid-October. Two had peak values after mid-October; the levels were only slightly higher than earlier values. Our study shows that serum obtained in mid-October reflects approximately the maximal IgE antibody level attained 0y ragweed-sensitive patients in our area and that this value can be used as a baseline in monitoring the subsequent decline in antibodies. In addition, our data support an earlier observation that the magnitude of seasonal rise in IgE antibody is related to the preseasonal value. The significantly positive correlation of the results of carefully performed skin tests (end point titration) with radioallergosorbent test (RAST) values suggests the possibility that the RAST can be employed as a reliable diagnostic aid, perhaps even replacing the skin test.

Evaluation of IgE tests in an allergy practice

Abstract We measured serum IgE in 264 patients seen in the course of an allergy practice during the summer of 1970. IgE values were elevated in 21 per cent of patients who had idiopathic asthma and 10 per cent of patients who had idiopathic rhinitis. The elevated IgE was of no immediate clinical help in this idiopathic group because we were unable to detect hidden allergenic factors on further review of the history and skin tests. The finding of such an elevation, however, will prompt us to a continuing search for an allergic etiology or other condition associated with elevation of IgE. In patients who had hypersensitivity to stinging insects, IgE was elevated in 9 of 29 (31 per cent), and in patients with asthma and aspirin intolerance it was elevated in one of 5. Results in small numbers of patients with several other conditions including cold urticaria, chronic urticaria, and drug allergy are also presented.

Urinary excretion of histamine in patients having asthma and hay fever: observations on changes produced by administration of cortisone.

Abstract Children excreted normal amounts of free and conjugated histamine in the urine in the intervals between attacks of allergy. During acute attacks, the excretion of free histamine tended to be decreased, suggesting that free histamine may be retained in the body. The administration of adrenocortical hormones to five patients having acute attacks of allergy resulted in an increased elimination of free histamine in the urine; in two of the patients who had severe attacks, this elimination was abnormally great. The effect of these hormones on conjugated histamine was variable.

Effect of corticosteroids on seasonal increases in IgE antibody

Abstract We analyzed seasonal changes in IgE antibodies to ragweed antigens in 28 patients with ragweed hay fever during the 1972 pollination season. Thirteen patients were treated with an injection of 60 mg. of triamcinolone acetonide suspension and 16 mg. of methylprednisolone orally on 3 successive days shortly after the onset of their symptoms in late August. Fifteen patients were untreated and served as controls. Serum samples were obtained in July (control group) or just prior to steroid treatment in August, and from both groups in mid-September and finally in mid-October. Initially, IgE antibody levels did not differ between the groups. IgE antibody increased after pollen exposure in both groups, but there was no significant difference in the increases. In contrast, symptom scores were significantly less in patients treated with steroids (P

Acute Reaction to Insect Sting

For most people, insect stings are among lifes little hurts but are nota cause for concern. This is not so for someone hypersensitive to the sting of a bee or other insect. A severe reaction can be fatal in moments. Hyposensitization plus instruction in what to do when stung can be lifesaving.

Treatment of Acute Asthma in the Elderly

The treatment of asthma in the elderly is similar in many ways to that in younger patients, but it also differs in many respects. The elderly patient is more likely to have associated diseases that also require treatment. He is less adaptive to modifications in his program of living. Thus the regular therapeutic management of asthma must be modified to take into account the patients advanced age and his special needs. The purpose of this paper is to present such a therapeutic program.