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396 IgG4 levels in patients with IgE RAST positive and RAST negative adverse reactions to peanut (PN), cow's milk (M) and egg (E)
396
IGG4 LEVELS IN PATIENTS WITH IGE RAST POSITIVE AND RAST NEGATIVE ADVERSE REACTIONS TO PEANUT (PN), COW'S MILK (M) AND EGG (E). L. Perelmutter, Ph.D., J.W. Gerrard, D.M., Ottawa and Saskatoon, Canada The purpose of this study was to determine whether IgG4 RASTs could identify subjects with non-IgE mediated adverse reactions to foods. IgG4 RAST levels to PN, M and E were studied in Fourteen had RAST positive, severe 34 subjects. IgE-mediated reactions to foods, all were allergic to PN, 4 were also sensitive to M andE, had adverse reactions and 1 to E. Twenty-four to foods to which they were prick and IgE RAST negative, 18 reacted to M only, and 3 to M and to the foods, and E. Twenty had no reaction The above were prick and RAST IgE negative. groups were not mutually exclusive. The mean IgG4 RASTs, measured as percentage bound, were higher to M than to PN or E, but levels to PN did not differ significantly between those with IgE-mediated allergy and those with none and in the cases of M and E did not differ significantly between those with IgEthose non-IgE-mediated mediated allergy, reactions and those with no reactions. I&2, between norRASTs do not appear to distinguish IgE and non-IgE-mediated mals and those.with reactions to foods.
PN M E
397
;;zATE
IgE-mediated allergy 4.73+1.97 9.7 T2.69 4.4 fL.48
IgG4 RAST No allergy 5.63+4.12 11.25T5.99 8.02z3.95
398
COMPARISON BETWEEN RIA-MAST AND RIA-RAST IN DETECTING IgE ANTIBODIES TO FOODS. John E. Firestone, Jr., M.D. and Sami L. Bahna, M.D.; New Orleans, Louisiana Several tests have been recently available for measuring specific IgE abs but they have not been adequately compared. The RIA methods of MAST (Irmnunosystems, Inc.) & RAST (Pharmacia Diagnostics) have the same immunochemical principle & are scored similarily, but MAST uses autoradiography instead of scintillation countfor abs to multiple allergens ing & can test We used these 2 tests in measimultaneously. suring IgE abs to 5 foods (cow's milk, eggwhite, peanut, crab & shrimp) in sera of 58 patients respiratory or G.I. symptoms with dermatologic, Oral challenges suspected to be from foods. were performed in double-blind manner using food in capsules or hidden in elemental formula (Vivonex). MAST & RAST scores were similar in 65% of cases & differed by 1 in 24%, by 2 in 9% moderate & by 3 in 2%. There was a significant overall correlation between MAST & RAST scores; r=0.74 (0.70-0.81 for individual foods). EAST was 5-fold more sensitive than MAST for eggwhite but the reverse was noted in the other foods (2-4 folds). The overall concordance with challenge was 44% for MAST & 45% for RAST, with a tendency to be higher for MAST in case of crab but higher for RAST in cases of peanut & shrimp. The 2 tests correlated satisfactorily with each other but both had suboptimal correlation with challenge. Sensitivity & specificity of the 2 tests varied from one food to another, possibly due to differences in the allergens used. Further studies are needed to include larger numbers & to compare material from different batches.
399
ALTERED SPECIFIC IgG TO SPECIFIC IgE RLTIPISQE) IN CHILDREN WITH FOOD IINTIGEN HVPERSENSITIVITV. B.B.HOLSEN,J.J.HERHAN,C.L.LERNER,J.JACOBITZ, L.JONES,R.SCHNEIDERHAN,K.RUBINER HOUSTON,TX & CHICAQO,IL. Food rntigen hypersensitivity is eediJted thru Jn IgE eechJnisnIsubsequent protection or loss of
Non-IgE-mediated reactions -8.54+5.37 4.98z1.78
OF RAST IN FOOD SENSITIVITY. Sami L. , . ., Dr.P.H. and Mohan D. Gandhi, M.D.; New Orleans, Louisiana The usefulness of WT in the diagnosis of food sensitivity was investigated in 61 allergy patients (32 M & 29 F) at ages 2 mo-38 yr (x 8.2 yr) and whose symptoms were respiratory in 42, dermatologic in 40, G.I. in 15, and anaphylaxis in 6. All patients had histories highly suggestive of food sensitivity. Oral challenge was carried out in a double-blind fashion with the suspected food in capsules or hidden in Vivonex. Serum samples were obtained for determination of IgE antibodies (Phadebas EAST--Pharmacia Diagnostics) to 11 foods (cow's milk, crab, eggwhite, fish, orange, peanut, shrimp, soybean, strawberry, tomato 6 wheat). BAST was scored 0 to 4+, and was considered positive if score challenges were positive. > 1. 36 of 92 total GST was concordant with challenge in 55% of all instances; being highest for orange & fish and lowest for eggwhite. In the positive challenge group, BAST was positive in 58% which was not significantly different from 47% in the negative challenge group, however the figures varied from one food to another. RAST was "falsely" negative in 42% of all positive challenges; being highest for tomato and lowest for fish, peanut & crab. The discrepancy between challenge and EAST to certain foods or in certain manifestations is worth considering in clinical practice and calls for further investigations to increase the BAST specificity and to define its reliability in various allergic manifestations.
sensitivity
iu uncleJr.PJtients Were studied for of hintory, prick test, and orrl double bind Jntigen chrllengelspecific IgE&IgG were detereined by ELISAIlymphocyte Jrrkers Jnd responses were deternined. Patients(40,30 children,eeJn 2.4yrs.,tlO Jdults,eean 21.2)were correlrted with COmplaintn Of UrtiCJriJ/JngioedeeJ-129JCUtOi<2 hrs) rhinitis /COnjUnCtiVitis,2,Jsthnr-8 JCUtl leesiS/diJrrheJ -b,rnJphylJxis-121 Non-correlrted complrinta were heJdJChe-2,b10JtingW2,JCUte diarrhea-2,rhinitis Jt P-bhrr-2,Jnd irritrbility-2.Correlation represents pos history, prick test, Jhd challenge while non-correlrtion eeJns neg chJllenge.Neg history&prick testfSlJnd neg history,poe skin test(SlindividuJlr hJd nlg control ChJllenges. lntigens studied were cow’e milk proteins-14, pernut-8,roy-4,189 white-14{Jlt 40 prtients Jnd 13 controls received J plJceb0 chellenge. Positive chrllenge ptsf3Olhad elevrted specific IgE Jnd low wpecific Igh(25), Igh (2) Jnd Ig8~/Ig6~(SlItheir SBE WJS decrersed fo.s~g.2lCOepJred t0 CootrOls,(4.g~g.6lIeost (85Xlhad decreased T-Helper cell nueber Jnd a 30% decrerse T-Helper cell response to specific rntigen.Children thJt lont clinical food sensitivity ovw 12-36 l os had Jn increrse in WE. Thun, Jlt@red BQE WJS deeonrtrrted in patients with food antigen hypersensitivity.
corrslrtion
204
IGG4 LEVELS IN PATIENTS WITH IGE RAST POSITIVE AND RAST NEGATIVE ADVERSE REACTIONS TO PEANUT (PN), COW'S MILK (M) AND EGG (E). L. Perelmutter, Ph.D., J.W. Gerrard, D.M., Ottawa and Saskatoon, Canada The purpose of this study was to determine whether IgG4 RASTs could identify subjects with non-IgE mediated adverse reactions to foods. IgG4 RAST levels to PN, M and E were studied in Fourteen had RAST positive, severe 34 subjects. IgE-mediated reactions to foods, all were allergic to PN, 4 were also sensitive to M andE, had adverse reactions and 1 to E. Twenty-four to foods to which they were prick and IgE RAST negative, 18 reacted to M only, and 3 to M and to the foods, and E. Twenty had no reaction The above were prick and RAST IgE negative. groups were not mutually exclusive. The mean IgG4 RASTs, measured as percentage bound, were higher to M than to PN or E, but levels to PN did not differ significantly between those with IgE-mediated allergy and those with none and in the cases of M and E did not differ significantly between those with IgEthose non-IgE-mediated mediated allergy, reactions and those with no reactions. I&2, between norRASTs do not appear to distinguish IgE and non-IgE-mediated mals and those.with reactions to foods.
PN M E
397
;;zATE
IgE-mediated allergy 4.73+1.97 9.7 T2.69 4.4 fL.48
IgG4 RAST No allergy 5.63+4.12 11.25T5.99 8.02z3.95
398
COMPARISON BETWEEN RIA-MAST AND RIA-RAST IN DETECTING IgE ANTIBODIES TO FOODS. John E. Firestone, Jr., M.D. and Sami L. Bahna, M.D.; New Orleans, Louisiana Several tests have been recently available for measuring specific IgE abs but they have not been adequately compared. The RIA methods of MAST (Irmnunosystems, Inc.) & RAST (Pharmacia Diagnostics) have the same immunochemical principle & are scored similarily, but MAST uses autoradiography instead of scintillation countfor abs to multiple allergens ing & can test We used these 2 tests in measimultaneously. suring IgE abs to 5 foods (cow's milk, eggwhite, peanut, crab & shrimp) in sera of 58 patients respiratory or G.I. symptoms with dermatologic, Oral challenges suspected to be from foods. were performed in double-blind manner using food in capsules or hidden in elemental formula (Vivonex). MAST & RAST scores were similar in 65% of cases & differed by 1 in 24%, by 2 in 9% moderate & by 3 in 2%. There was a significant overall correlation between MAST & RAST scores; r=0.74 (0.70-0.81 for individual foods). EAST was 5-fold more sensitive than MAST for eggwhite but the reverse was noted in the other foods (2-4 folds). The overall concordance with challenge was 44% for MAST & 45% for RAST, with a tendency to be higher for MAST in case of crab but higher for RAST in cases of peanut & shrimp. The 2 tests correlated satisfactorily with each other but both had suboptimal correlation with challenge. Sensitivity & specificity of the 2 tests varied from one food to another, possibly due to differences in the allergens used. Further studies are needed to include larger numbers & to compare material from different batches.
399
ALTERED SPECIFIC IgG TO SPECIFIC IgE RLTIPISQE) IN CHILDREN WITH FOOD IINTIGEN HVPERSENSITIVITV. B.B.HOLSEN,J.J.HERHAN,C.L.LERNER,J.JACOBITZ, L.JONES,R.SCHNEIDERHAN,K.RUBINER HOUSTON,TX & CHICAQO,IL. Food rntigen hypersensitivity is eediJted thru Jn IgE eechJnisnIsubsequent protection or loss of
Non-IgE-mediated reactions -8.54+5.37 4.98z1.78
OF RAST IN FOOD SENSITIVITY. Sami L. , . ., Dr.P.H. and Mohan D. Gandhi, M.D.; New Orleans, Louisiana The usefulness of WT in the diagnosis of food sensitivity was investigated in 61 allergy patients (32 M & 29 F) at ages 2 mo-38 yr (x 8.2 yr) and whose symptoms were respiratory in 42, dermatologic in 40, G.I. in 15, and anaphylaxis in 6. All patients had histories highly suggestive of food sensitivity. Oral challenge was carried out in a double-blind fashion with the suspected food in capsules or hidden in Vivonex. Serum samples were obtained for determination of IgE antibodies (Phadebas EAST--Pharmacia Diagnostics) to 11 foods (cow's milk, crab, eggwhite, fish, orange, peanut, shrimp, soybean, strawberry, tomato 6 wheat). BAST was scored 0 to 4+, and was considered positive if score challenges were positive. > 1. 36 of 92 total GST was concordant with challenge in 55% of all instances; being highest for orange & fish and lowest for eggwhite. In the positive challenge group, BAST was positive in 58% which was not significantly different from 47% in the negative challenge group, however the figures varied from one food to another. RAST was "falsely" negative in 42% of all positive challenges; being highest for tomato and lowest for fish, peanut & crab. The discrepancy between challenge and EAST to certain foods or in certain manifestations is worth considering in clinical practice and calls for further investigations to increase the BAST specificity and to define its reliability in various allergic manifestations.
sensitivity
iu uncleJr.PJtients Were studied for of hintory, prick test, and orrl double bind Jntigen chrllengelspecific IgE&IgG were detereined by ELISAIlymphocyte Jrrkers Jnd responses were deternined. Patients(40,30 children,eeJn 2.4yrs.,tlO Jdults,eean 21.2)were correlrted with COmplaintn Of UrtiCJriJ/JngioedeeJ-129JCUtOi<2 hrs) rhinitis /COnjUnCtiVitis,2,Jsthnr-8 JCUtl leesiS/diJrrheJ -b,rnJphylJxis-121 Non-correlrted complrinta were heJdJChe-2,b10JtingW2,JCUte diarrhea-2,rhinitis Jt P-bhrr-2,Jnd irritrbility-2.Correlation represents pos history, prick test, Jhd challenge while non-correlrtion eeJns neg chJllenge.Neg history&prick testfSlJnd neg history,poe skin test(SlindividuJlr hJd nlg control ChJllenges. lntigens studied were cow’e milk proteins-14, pernut-8,roy-4,189 white-14{Jlt 40 prtients Jnd 13 controls received J plJceb0 chellenge. Positive chrllenge ptsf3Olhad elevrted specific IgE Jnd low wpecific Igh(25), Igh (2) Jnd Ig8~/Ig6~(SlItheir SBE WJS decrersed fo.s~g.2lCOepJred t0 CootrOls,(4.g~g.6lIeost (85Xlhad decreased T-Helper cell nueber Jnd a 30% decrerse T-Helper cell response to specific rntigen.Children thJt lont clinical food sensitivity ovw 12-36 l os had Jn increrse in WE. Thun, Jlt@red BQE WJS deeonrtrrted in patients with food antigen hypersensitivity.
corrslrtion
204