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181 Antibody against ethylene oxide — Human serum albumin in patients with anaphylactic reactions to dialysis
ANTIBODY AGAINST ETHYLENE OXIDE - HUMAN SERUM IN CNS TO DIALYSIS. ar &ttereon,.M;D..&C Gz
183
ROLE OF THE QUATERNARYAMMONIUM IONS IN THE MECHANISMS OF ANAPHYLACTIC REACTIONS TO SUCCINYLCHOLINE (Sch). D. Cador, M.D., J.D. M. Senft. P. Bongrand. Fourneron; P.H.D., g. Furstos, .P.H.D., MD. Marseille. France. D. Vervloet, Recently antibodies to muscle W relaxants were found in the sera of patients who experienced an anaphylactic shock during general anesthesia. We studied the cross reactivity of I@ antibodies to Sch, one of the most with relaxants, widely used muscle choline and with synthetized di-ammonium salts of different chain length with the following formula : (""la); N+-(CH2),-N+(CH$j (n = 2, 4, 6, the action of 8. . and we studied these salts on leukocytes of patients with positive skin tests and positive histamine release (HR) to sch. In 5 separate experiments Sch and the diammonium salts could inhibit the binding of IgE antibodies to choline sepharose. HR could be induced specifically from 6 patient's leukocytes in presence of Sch or di-ammonium salts if the length of the chain linkiag the two ammonium groups was >c 6.2 A (n = 4). No significant HR could ,be obtained with a chain length of 3.8 A (n = 2). The data clearly indicated that the ammonium groups with IgE are the determinants reacting antibodies and are responsible for mediator release in patients who experienced an anaphylactic shock with Sch.
184
ANAPHYLACTIC REACTIONS TO SUCCINYLCHOLINE. PREVENTION OF MEDIATORS RELEASE BY CHOLINE. D. Vervloet, M.D., P. Dor, M.D. A. Arnaud, M.D., M. Senft, M. Alazia, M.D., J. Charpin, M.D. Marseille France. Choline (Ch) which is a monovalent part of the Succinylcholine (Sch) one of the most commonly used muscle relaxant in general anesthesia could be coupled on epoxy-sepharose. cross I&G antibodies reacting with Ch and Sch, were found in the sera of 15 out of 22 patients with anaphylactic shock to Sch. In such sera uptakes of lz51 anti IgE were 21% of the total added radioactivity. Uptakes recorded with 19 control sera were 60.4% in 15 and between 0.4 and 1xi.n 4. Preincubation of the sera with free Ch or Sch inhibited the binding of IgE antibodies to the Ch sepharose compleCh could act as an xes. Furthermore hapten inhibitor. In vitro, preincubation for 30mn of leukocytes from 6 patients with 20, 200 and 2000 mcg/ml Ch inhibited maximal histamine release (HR) induced by Sch (lOmcg/ml) : mean maximal HR of 40%f4 was reduced to 3128, 14?5 and 824 respectively (p < 0.001). In vivo, Ch (lmg/ml) when mixed with Sa (10mcg/ml) could inhibit the positive skin tests induced by Sch in patients (N = 5). Ch did not decrease HR or skin tests induced by unrelated agents as anti IgE or mite extracts. These results prove the IgE mechanisms of allergic reactions to Sch and suggest a possible way of preventing such reactions.
DRoxe.9, hl
MI;:, PT Ivanovich, M.D., C Brown, Nicholls, M.D., R Patterson, M.D.,
M.D., AJ Chicago,
Tllinois
Total antibody and IgE directed against ethylene oxide altered human serum albumin (ETO-HSA) were measured in the sera of 24 patients who have had an anaphylactic reaction while undergoing hemodialysis and 41 dialysis patients who have not had this reaction. A polystyrene tube radioimmunoassay was used to quantitate specific IgE, and a modification of the ammonium sulfate technique of Lidd and Farr was used to measure total antibody binding. The geometric meanwas 0.9 ng of ETO-HSA bound by IqE per ml of serum for reactors and 0.1 ng for-non-reactors (p * 0.0001). Sixteen of 24 reactors had detectable levels of IgE,to ETO-HSA while only 3 of 41 non-reactors did (p < 0.0001). The geometric mean of total antibody bound by ETO-HSA per ml of serum was also significantly different between reactors and nonreactors, 270 ng vs. 31 ng respectively (p < 0.0001). Fourteen of 24 reactors had detectable total ETO-HSA binding while only 4 of 39 nonreactors had such binding (p < 0.0001). These in vitro assays implicate IgE against ET0 alteredproteins as a likely explanation for many instances of dialysis anaphylaxis in this patient population.
182
FOOD SKIN TESTING IN PATIENTS WITH "IDIOPATHIC ANAPHYLAXIS." W. E. Stricker, M.D., E. AnorveLopez, M.D., and C. E. Reed, M.D., Rochester, Minnesota. Most cases of anaphylaxis are due to allergy to foods or drugs, but some occur in the absence of allergy and are designated as idioathic. Because if an allergen exists, avoidance is the key treatment. We have evaluated 102 patients with the initial diagnosis of idiopathic anaphylaxis with a battery of 79 food antigen skin prick tests selected to include foods reported or suspected of provoking anaphylasix. Only those patients whose. episodes consisted of at least two of the following were included in the study: angioedema with or without hives, laryngeal edema leading to severe dyspnea, hypotension, or loss of consciousness. Detailed history, physical examination, and conventional laboratory tests ruled out any known food sensitivities or other etiologies of anaphylaxis. Thirty-two patients (31%) had Positive tests to one or more'food antigens. In'7 of these, subsequently eating a food that elicted a positive test provoked an anaphylactic reaction. Positive clinical correlation in the 7 patients was found with 10 different antigens: aniseed, cashew nut, celery, flaxseed, hops, mustard, mushroom, shrimp, sunflower, and walnut. We conclude that a battery of selected food antigen skin prick tests provides a useful method for identifying an offending antigen in these patients, and that not all (7% in our series) cases of idiopathic anaphylaxis by history are truly idiopathic.
150
183
ROLE OF THE QUATERNARYAMMONIUM IONS IN THE MECHANISMS OF ANAPHYLACTIC REACTIONS TO SUCCINYLCHOLINE (Sch). D. Cador, M.D., J.D. M. Senft. P. Bongrand. Fourneron; P.H.D., g. Furstos, .P.H.D., MD. Marseille. France. D. Vervloet, Recently antibodies to muscle W relaxants were found in the sera of patients who experienced an anaphylactic shock during general anesthesia. We studied the cross reactivity of I@ antibodies to Sch, one of the most with relaxants, widely used muscle choline and with synthetized di-ammonium salts of different chain length with the following formula : (""la); N+-(CH2),-N+(CH$j (n = 2, 4, 6, the action of 8. . and we studied these salts on leukocytes of patients with positive skin tests and positive histamine release (HR) to sch. In 5 separate experiments Sch and the diammonium salts could inhibit the binding of IgE antibodies to choline sepharose. HR could be induced specifically from 6 patient's leukocytes in presence of Sch or di-ammonium salts if the length of the chain linkiag the two ammonium groups was >c 6.2 A (n = 4). No significant HR could ,be obtained with a chain length of 3.8 A (n = 2). The data clearly indicated that the ammonium groups with IgE are the determinants reacting antibodies and are responsible for mediator release in patients who experienced an anaphylactic shock with Sch.
184
ANAPHYLACTIC REACTIONS TO SUCCINYLCHOLINE. PREVENTION OF MEDIATORS RELEASE BY CHOLINE. D. Vervloet, M.D., P. Dor, M.D. A. Arnaud, M.D., M. Senft, M. Alazia, M.D., J. Charpin, M.D. Marseille France. Choline (Ch) which is a monovalent part of the Succinylcholine (Sch) one of the most commonly used muscle relaxant in general anesthesia could be coupled on epoxy-sepharose. cross I&G antibodies reacting with Ch and Sch, were found in the sera of 15 out of 22 patients with anaphylactic shock to Sch. In such sera uptakes of lz51 anti IgE were 21% of the total added radioactivity. Uptakes recorded with 19 control sera were 60.4% in 15 and between 0.4 and 1xi.n 4. Preincubation of the sera with free Ch or Sch inhibited the binding of IgE antibodies to the Ch sepharose compleCh could act as an xes. Furthermore hapten inhibitor. In vitro, preincubation for 30mn of leukocytes from 6 patients with 20, 200 and 2000 mcg/ml Ch inhibited maximal histamine release (HR) induced by Sch (lOmcg/ml) : mean maximal HR of 40%f4 was reduced to 3128, 14?5 and 824 respectively (p < 0.001). In vivo, Ch (lmg/ml) when mixed with Sa (10mcg/ml) could inhibit the positive skin tests induced by Sch in patients (N = 5). Ch did not decrease HR or skin tests induced by unrelated agents as anti IgE or mite extracts. These results prove the IgE mechanisms of allergic reactions to Sch and suggest a possible way of preventing such reactions.
DRoxe.9, hl
MI;:, PT Ivanovich, M.D., C Brown, Nicholls, M.D., R Patterson, M.D.,
M.D., AJ Chicago,
Tllinois
Total antibody and IgE directed against ethylene oxide altered human serum albumin (ETO-HSA) were measured in the sera of 24 patients who have had an anaphylactic reaction while undergoing hemodialysis and 41 dialysis patients who have not had this reaction. A polystyrene tube radioimmunoassay was used to quantitate specific IgE, and a modification of the ammonium sulfate technique of Lidd and Farr was used to measure total antibody binding. The geometric meanwas 0.9 ng of ETO-HSA bound by IqE per ml of serum for reactors and 0.1 ng for-non-reactors (p * 0.0001). Sixteen of 24 reactors had detectable levels of IgE,to ETO-HSA while only 3 of 41 non-reactors did (p < 0.0001). The geometric mean of total antibody bound by ETO-HSA per ml of serum was also significantly different between reactors and nonreactors, 270 ng vs. 31 ng respectively (p < 0.0001). Fourteen of 24 reactors had detectable total ETO-HSA binding while only 4 of 39 nonreactors had such binding (p < 0.0001). These in vitro assays implicate IgE against ET0 alteredproteins as a likely explanation for many instances of dialysis anaphylaxis in this patient population.
182
FOOD SKIN TESTING IN PATIENTS WITH "IDIOPATHIC ANAPHYLAXIS." W. E. Stricker, M.D., E. AnorveLopez, M.D., and C. E. Reed, M.D., Rochester, Minnesota. Most cases of anaphylaxis are due to allergy to foods or drugs, but some occur in the absence of allergy and are designated as idioathic. Because if an allergen exists, avoidance is the key treatment. We have evaluated 102 patients with the initial diagnosis of idiopathic anaphylaxis with a battery of 79 food antigen skin prick tests selected to include foods reported or suspected of provoking anaphylasix. Only those patients whose. episodes consisted of at least two of the following were included in the study: angioedema with or without hives, laryngeal edema leading to severe dyspnea, hypotension, or loss of consciousness. Detailed history, physical examination, and conventional laboratory tests ruled out any known food sensitivities or other etiologies of anaphylaxis. Thirty-two patients (31%) had Positive tests to one or more'food antigens. In'7 of these, subsequently eating a food that elicted a positive test provoked an anaphylactic reaction. Positive clinical correlation in the 7 patients was found with 10 different antigens: aniseed, cashew nut, celery, flaxseed, hops, mustard, mushroom, shrimp, sunflower, and walnut. We conclude that a battery of selected food antigen skin prick tests provides a useful method for identifying an offending antigen in these patients, and that not all (7% in our series) cases of idiopathic anaphylaxis by history are truly idiopathic.
150