499 Phenotype cell analysis of venom allergic patients on immunotherapy

PHENOTYPE CELL ANALYSIS OF VENOM ALLERGIC PATIENTS ON IMMUNOTHERAPY. Lewis Perelmutter, Ph.D. and Michael Gentlesk, M.D., Philadelphia, Pa. Various immune parameters were examined from a group of venom allergic patients at various stages of immunotherapy (IT)(O-8 years). Six patients were on post IT and three on pre-IT. Phenotype analysis utilizing a flow cytometer indicated that B cell levels representing early intermediate (B2) or late (Bl) antigen (B4), specific responses were elevated on all patients whether on IT or not, compared to a group of normal individuals. There was a greater number of Bl cells after compared to pre-IT, however, the level of serum IgG antibody (against honeybee or yellow jacket) was unrelated to the number of Bl cells. Eight of nine patients showed elevated Ia (I3 marker) with no distinction to being on IT or not. T helper/suppressor ratios were normal in all and there was no difference these patients, compared to the non-allergic group for the helper-inducer (4B4) and inducer-suppressor (2H4) T cell subsets. One patient on IT for 8 years had slightly elevated B cell levels (Bl, B2 and B4) and produced serum IgG antibody responses indicating that there was no B cell tolerance observed in this patient. Another patient on IT for a short time (0.9 years) had elevated early and intermediate, but normal late B cell responses. These results suggest that the B cell markers may be useful in determining activation of the immune system at various stages of venom IT.

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EVOLUTION OF SPECIFIC IgG AND IgG4, AND BLOCKING ACTIVITY DURING MITE RUSH IMMUNOTHERAPY'. Margarita Murietta, MD ; Patrick Natta, MD ; Francisque Leynadier, MD ; Albert Priftanji, MD; Jacques Dehaussy ; Claude L&y, MD ; Corinne SCgalen, MD ; Jean Dry, MD. Paris - France. The development of blocking activity (BA) due to IgG after rush immunotherapy to mites has been demonstrated (1). We simultaneously measured the BA (by inhibition of basophil degranulation) and specific IgG and IgG4 (Pharmacia IgG and Ig$4 RASTF) in 16 asthmatic patientsCAge = (30,6 10,031 years ; M/F (sex ratio) = 7191 who had undergone rush immunotherapy with Dermatophagoides Pteronyssinus and Dermatophagoides Farinae on days 0, 4, 7, 15, 30 and 180. All samples were measured blind in the same run. Our results show a significant rise (p< 0,001) of the BA, specific IgG and IgG4 with time, as well as significant correlations between specific IgG and the BA (n = 79 ; r = 0,46 ; p< 0,001) and between specific IgG4 and the BA (n= 77 ; r = 0,68 ; p< 0,001). These results suggest that specific IgG4 could be involved in the BA. (1) Leynadier F., Abuaf N., Halpern G.M, Murrietta M., Garcia-Duarte C., Dry J. : Blocking IgG antibodies after rush immunotherapy with mites. Ann. Allergy ; 57 : 325-329

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MONITORING OF ALLERGEN SPECIFIC IgG AND IgG SUBCLASSES IN PATIENTS UNDERGOING IMMUNOTHERAPY (IT). T. Ldfkvist, G. Svensson, B. Agrell, S. Drejorg, R..Einarsson, L. Hammar~en~und, Hud inge, Linkdping and Uppsala, Thirty-two mite-sensitive patients with rhinoconjunctivitis were randomized in a treatment group (2& p) and in a control group (11 p). Pharmalgen D. farinae was given weekly to the treatment group. The maintainance dose ranged from 20 000 - 100 000 BU/ml and the patients were followed during one year. There was a significant improvement in the group on therapy regarding subjective evaluation (p < O.Ol), skin prick test (p < 0.0001) and conjunctival provocation test (p < 0.001). The effect of IT was assessed by determination of mite allergen specific IgG (IgG-RAST with specially prepared paper discs) and by enzyme-linked immunosorbent assay for IgG subclass response towards a major mite allergen (Ag 19/20). The IgG and IgG were measured using a microtitration \3ell coatsd with the major allergen and subclass specific monoclonal mouse antihuman antibodies. A marked increase of mite specific IgG was detected in the patients on IT but not in the control. The level of Ag 19/20 specific IgG4 increased rapidly initially in most treated patients and was well above the pretreatment value after 1 year. The content of Ag 19/20 specific IgG just showed a tendency to increase in thk treatment group. IgG subclasses remained constant at the pretreatment level in the control.

ELEVATION OF SERUM IgG4 DURING PERENNIAL RYE GRASS (PRG) I~rnur4oTHEtxAPv(IT): CLINICAL CORRELATIONS. A.Motamedi..N.Bhat,M.D..N.Horris,Phd, J.Scott,Phd, Concord, California. One of the porometers of isnnunomodulation during IT with allergen extracts is rise in allergen specific serum IgG4(spG4). The purpose of this study was to evaluate the changes in sp-IgG4 and specific IgE(spE) in relation to clinical response in patients receiving IT for PRG

sensitivity. study group consisted of 11 patients with and asthmo.Of these 8 patients were assigned in double blind random fashion to study group(SG) and 3 patients to placebo group(PB). All patients had positive scratch skin tests to PRG and positive PRG specific RAST tests. IT with standardized PRG extrract was given to SG and albumin saline to PG.Baseline and follow up data included daily symptom scores,weekly physical exam and pulmonary functions and monthly spG4 ond spE. The doctors, nurses, patients or the lob did not know which group a given individual belonged to. The study lasted for two years. The results showed that in 7 of SG patients spG4 was below Pug/ml at baseline which increased after two years to 4.4, 13.2. 40. 3.4, 10. 3.2, 22, and 4ug/ml. In one SG patient spG4 increased from 13 to 17.4ug/ml. PG patients showed no change in spG or levels. The spG4 spE changes corresponded to fall in spE levels, decrease in symptom scores and other clinical findings. COnCluSlOnS: This study confirms that standardized PRG antigen IT results in rise of spG4 and fall in spE for PRG. These changes are assoicated with parallel cllnicol improvements of hay fever and asthma. hay

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