Rudolph M. Franklin

Allergy to insect stings. II. Phospholipase A: the major allergen in honeybee venom.

In order to determine the proteins of major allergenic importance in honeybee venom (Apis mellifera) it was chromatographed on G-50 Sephadex. The four major protein peaks eluted were identified as hyaluronidase, phospholipase, melittin, and apamin. Testing these preparations on the leukocytes of 6 honeybee-sensitive patients, with the in vitro method of histamine release, revealed that all individuals were most sensitive to phospholipase A. IgE antibodies against phospholipase A (RAST) were found in the sera of honeybee-sensitive patients and IgG antibodies to this venom component were found in the sera from beekeepers and venom-treated patients. Melittin appeared to be allergenic in several patients, but the results were variable and were possibly due to contamination with phospholipase. All patients were insensitive to the hyaluronidase and apamin preparations. We conclude that phospholipase A is the major allergen of honeybee venom and, since this protein is readily available, it should be useful for diagnostic and therapeutic studies as well as for the standardization of materials used in the management of honeybee-sensitive patients.

Transfer of Bacterial Infection By Donor Cornea in Penetrating Keratoplasty

A 45-year-old man died of Hogdkins disease complicated by peritonitis and possible septicemia. His corneas were used for transplant in a 26-year-old man with advanced keratoconus and a 42-year-old man with vascularized central leukoma of old herpetic keratitis. Both recipients developed a fulminating endophthalmitis with Pseudomonas aeruginosa. We believe that the donor corneas, although clinically normal, were heavily infected, with signs of inflammation possibly suppressed by the Hodgkins disease.

Leber's Idiopathic Stellate Retinopathy

Three patients with Lebers idiopathic stellate retinopathy-a 16-year-old girl, a 26-year-old man, and a 7-year-old girl-also had acute multifocal chorioretinitis. The second patient also had an associated idiopathic peripheral seventh nerve palsy. Extensive neurologic testing and viral cultures gave no explanation of the origin of the retinopathy. However, each of the patients had had an upper respiratory or gastrointestinal illness shortly before the onset of the condition, suggesting an infectious origin. In all three patients the optic disk swelling resolved spontaneously and the stellate exudate gradually faded.

Conjunctivitis and Keratoconjunctivitis Associated with Primary Immunodeficiency Diseases

Nineteen patients with a variety of well-defined primary immunodeficiency diseases were examined for ocular abnormalities. Eight patients with low levels, or absence, of all the major serum immunoglobulins had conjunctivitis or keratoconjunctivitis associated with bacterial infection. The remaining 11 patients, who had at least one immunoglobulin class present in normal concentration in the serum, showed no inflammatory ocular lesion. Absence of only IgA, the major tear immunoglobulin, did not predispose the eye to these lesions.