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63. Canine tissue culture rubella vaccine in dog-sensitive children
VOLUME 47 NUMBER 2
Abstracts of papers
115
Before immunotherapy, the following antibody activities could be demonstrated in the nasal secretions: HA, 13/20 (65 per cent); P-K, 16 (80 per cent); IgGr binding, 14 (70 per cent); IgA, 11 (55 per cent); and IgE, 1 (5 per cent). In sera, the following activities were present prior to immunotherapy: HA, 18/20 (90 per cent); P-K and IgG binding, 20 (100 per cent); IgA, 14 (70 per cent); and IgE, 10 (50 per cent). The change in activity following immunotherapy is outlined in the table below. TABLE I. Increase in antibody activity following immunotherapy 20 Sera
20 Secretions No. HA P-K
5 3
1
%
No.
%
25 15
7 12
35 60
5 15 5
15 1 8
75 5 40
RadioMnding IgG IgA IgE
1 3 1
The changes in the nasal secretions showed no correlation to the amount of immunotherapy or to the patients' clinical response. These data would indicate that parenteral immunotherapy afifects antibodies in secretions to a much lesser degree than antibodies in serum.
62. Familial occurrence of asthma, nasal polyps, and aspirin intolerance. Bichard P . Lockey, M.D., Donald L. Eucknagel, M.D., Ph.D., and Neal A. Vanselow, M.D., Ann Arbor, Mich. Four members of a Mennonite family (Family A), including three first cousins, had asthma, nasal polyps, and aspirin-induced wheezing (A8A-triad). One of the cousins had a daughter with ASA-triad and an identical twin sister with allergic rhinitis and extrinsic asthma. The husband of the twin with A8A-triad was also a member of the isolate, although close direct relationship with his wife could not be established. Ninety of over 200 additional family members were examined. While none had ASA-triad, 43 per cent had a possible history of rhinitis, asthma, or eczema. Two siblings of an unrelated family (Family B) had ASA-triad. A third sibling had intrinsic asthma alone. The parents were unrelated and said to be unaffected. Four of 5 patients with ASA-triad had normal levels of IgE; a fifth had a high titer. The identical twin with extrinsic asthma and allergic rhinitis had high normal levels of IgE. The presence of ASA-triad in siblings in Family B and in counsins of Family A suggests, but does not prove, this trait is recessively inherited. Although close inbreeding did not occur in Family A, the population may be derived from a relatively small number of founders. Therefore, the husband of the affected twin may also carry the gene, explaining the apparent mother-daughter transmission. The absence of the triad in the other twin suggests environmental factors may also play a role. To our knowledge, familial occurrence of ASA-triad has not previously been reported.
63. Canine tissue culture rubella vaccine in dog-sensitive children. Sumio Go, M.D., and "Wallace E. Moore, Jr., M.D., Denver, Colo. It is routinely recommended that vaccines prepared in canine tissue culture be avoided by persons allergic to dogs or dog dander. This study was undertaken to determine whether or not rubella vaccine prepared in canine renal cell culture is safe for use in dog-sensitive children and to evaluate skin testing with the vaccine. The study group consisted of 15
116
American Academy of Allergy
J. ALLERG. FEBRUARY 1971
dog-sensitive children with at least two of the following: (1) history of dog allergy, (2) postive skin test to dog extract, and (3) positive bronchial inhalation test to dog extract. Tifteen children who were not dog-sensitive served as a control group. Three children in the dog-sensitive group had positive immediate skin tests to the vaccine. Other children in this group with equal or greater skin reactivity to dog extract had negative vaccine skin tests, reflecting a lack of correlation between the two skin tests. No positive vaccine skin tests were noted in the control group and no delayed skin reactions occurred in either group. All children (including the 3 with positive vaccine skin tests) were given the vaccine under carefully monitored conditions and none had an adverse reaction of either an allergic or nonallergic nature. These results provide preliminary evidence that rubella vaccine prepared in canine renal cell culture is safe for dog-sensitive children and suggest that little, if any, dog-allergenie material contaminates the final vaccine product. A postive skin test to the vaccine is indication for caution in its administration but does not appear to be an absolute contraindication to its use.
64. An immunological study of Ascaris-infested individuals. J. A. Philk, M.D., M.Sc, A. J. Harrold, M.D., Montreal, Quebec, and L. Perelmutter, Ph.D., Ottawa, Ontario, Canada. A study was performed on 4 individuals who had accidentally ingested a large number of "live" Asoaris suum ova and developed a clinical syndrome including massive pulmonary infiltrates, marked eosinophilia, asthma, urticaria, and fever. Ascaris larvae were found in the sputum, stomach washings, and in the stools. The clinical symptoms and presence of larvae persisted for several weeks after exposure. Serum IgG and IgA levels were normal in these individuals. However, IgM levels were elevated in two patients (D. V. and E. D.) mainly due to the presence of IgM-precipitating antibodies to ascaris. In addition, serum IgE levels were also elevated in the same two individuals (D. F. and E. D.), whereas the IgE levels were normal for the other two patients. There was a correlation between the concentration of IgM antibodies to Ascaris, level of IgE globulin, intensity of pulmonary infiltrates, bronchial spasm, and urticaria reactions in these 4 individuals. Thus, although all four patients possessed ascaris larvae several weeks after exposure, only those individuals with circulating IgM antibodies and elevated IgE levels had the most severe clinical symptoms, suggesting that perhaps antigen-antibody complexes involving IgM and to some extent IgE antibodies were responsible for these symptoms. Furthermore, the results of these studies indicate that ascaris infestation in humans may not necessarily lead to an increase in serum IgE levels.
65. Intestinal parasites in asthma. Eichard G. Van Dellen, M.D., and John H. Thompson, Jr., Ph.D., Rochester, Minn. To confirm or refute the report by Tullis (New Eng. J. Med. 282: 370, 1970) that 198 of 201 patients with bronchial asthma had one of three intestinal parasites, we looked for parasites in 258 stool specimens from 123 patients (ages 16 to 80 years) with both allergic and nonallergic asthma. Stools were collected in the parasitology laboratory from 82 outpatients who had taken % ounce of Epsom salts; these were examined immediately. Stools were collected in the hospital from 41 hospitalized patients without purgation. Each stool was examined by an eosin-saline wet preparation and after acid-ether centrifugal sedimentation. All stools from all patients were negative for Ascaris Iwnbricoides, Strongyloides stercoralis, and Necator americanus, the three parasites found by Tullis. In 49 of our patients, at least three stools were negative. Therefore, if a much larger number of patients had been examined, we estimate (upper 95 per cent confidence limit from: [l-p]49 ;= 0.05) that not more than 6.0 per cent of persons from our asthma population would show these intestinal parasites in the first three stools by our test procedure. Since Tullis found parasites in 49 per cent of his patients after examination of three stools.
Abstracts of papers
115
Before immunotherapy, the following antibody activities could be demonstrated in the nasal secretions: HA, 13/20 (65 per cent); P-K, 16 (80 per cent); IgGr binding, 14 (70 per cent); IgA, 11 (55 per cent); and IgE, 1 (5 per cent). In sera, the following activities were present prior to immunotherapy: HA, 18/20 (90 per cent); P-K and IgG binding, 20 (100 per cent); IgA, 14 (70 per cent); and IgE, 10 (50 per cent). The change in activity following immunotherapy is outlined in the table below. TABLE I. Increase in antibody activity following immunotherapy 20 Sera
20 Secretions No. HA P-K
5 3
1
%
No.
%
25 15
7 12
35 60
5 15 5
15 1 8
75 5 40
RadioMnding IgG IgA IgE
1 3 1
The changes in the nasal secretions showed no correlation to the amount of immunotherapy or to the patients' clinical response. These data would indicate that parenteral immunotherapy afifects antibodies in secretions to a much lesser degree than antibodies in serum.
62. Familial occurrence of asthma, nasal polyps, and aspirin intolerance. Bichard P . Lockey, M.D., Donald L. Eucknagel, M.D., Ph.D., and Neal A. Vanselow, M.D., Ann Arbor, Mich. Four members of a Mennonite family (Family A), including three first cousins, had asthma, nasal polyps, and aspirin-induced wheezing (A8A-triad). One of the cousins had a daughter with ASA-triad and an identical twin sister with allergic rhinitis and extrinsic asthma. The husband of the twin with A8A-triad was also a member of the isolate, although close direct relationship with his wife could not be established. Ninety of over 200 additional family members were examined. While none had ASA-triad, 43 per cent had a possible history of rhinitis, asthma, or eczema. Two siblings of an unrelated family (Family B) had ASA-triad. A third sibling had intrinsic asthma alone. The parents were unrelated and said to be unaffected. Four of 5 patients with ASA-triad had normal levels of IgE; a fifth had a high titer. The identical twin with extrinsic asthma and allergic rhinitis had high normal levels of IgE. The presence of ASA-triad in siblings in Family B and in counsins of Family A suggests, but does not prove, this trait is recessively inherited. Although close inbreeding did not occur in Family A, the population may be derived from a relatively small number of founders. Therefore, the husband of the affected twin may also carry the gene, explaining the apparent mother-daughter transmission. The absence of the triad in the other twin suggests environmental factors may also play a role. To our knowledge, familial occurrence of ASA-triad has not previously been reported.
63. Canine tissue culture rubella vaccine in dog-sensitive children. Sumio Go, M.D., and "Wallace E. Moore, Jr., M.D., Denver, Colo. It is routinely recommended that vaccines prepared in canine tissue culture be avoided by persons allergic to dogs or dog dander. This study was undertaken to determine whether or not rubella vaccine prepared in canine renal cell culture is safe for use in dog-sensitive children and to evaluate skin testing with the vaccine. The study group consisted of 15
116
American Academy of Allergy
J. ALLERG. FEBRUARY 1971
dog-sensitive children with at least two of the following: (1) history of dog allergy, (2) postive skin test to dog extract, and (3) positive bronchial inhalation test to dog extract. Tifteen children who were not dog-sensitive served as a control group. Three children in the dog-sensitive group had positive immediate skin tests to the vaccine. Other children in this group with equal or greater skin reactivity to dog extract had negative vaccine skin tests, reflecting a lack of correlation between the two skin tests. No positive vaccine skin tests were noted in the control group and no delayed skin reactions occurred in either group. All children (including the 3 with positive vaccine skin tests) were given the vaccine under carefully monitored conditions and none had an adverse reaction of either an allergic or nonallergic nature. These results provide preliminary evidence that rubella vaccine prepared in canine renal cell culture is safe for dog-sensitive children and suggest that little, if any, dog-allergenie material contaminates the final vaccine product. A postive skin test to the vaccine is indication for caution in its administration but does not appear to be an absolute contraindication to its use.
64. An immunological study of Ascaris-infested individuals. J. A. Philk, M.D., M.Sc, A. J. Harrold, M.D., Montreal, Quebec, and L. Perelmutter, Ph.D., Ottawa, Ontario, Canada. A study was performed on 4 individuals who had accidentally ingested a large number of "live" Asoaris suum ova and developed a clinical syndrome including massive pulmonary infiltrates, marked eosinophilia, asthma, urticaria, and fever. Ascaris larvae were found in the sputum, stomach washings, and in the stools. The clinical symptoms and presence of larvae persisted for several weeks after exposure. Serum IgG and IgA levels were normal in these individuals. However, IgM levels were elevated in two patients (D. V. and E. D.) mainly due to the presence of IgM-precipitating antibodies to ascaris. In addition, serum IgE levels were also elevated in the same two individuals (D. F. and E. D.), whereas the IgE levels were normal for the other two patients. There was a correlation between the concentration of IgM antibodies to Ascaris, level of IgE globulin, intensity of pulmonary infiltrates, bronchial spasm, and urticaria reactions in these 4 individuals. Thus, although all four patients possessed ascaris larvae several weeks after exposure, only those individuals with circulating IgM antibodies and elevated IgE levels had the most severe clinical symptoms, suggesting that perhaps antigen-antibody complexes involving IgM and to some extent IgE antibodies were responsible for these symptoms. Furthermore, the results of these studies indicate that ascaris infestation in humans may not necessarily lead to an increase in serum IgE levels.
65. Intestinal parasites in asthma. Eichard G. Van Dellen, M.D., and John H. Thompson, Jr., Ph.D., Rochester, Minn. To confirm or refute the report by Tullis (New Eng. J. Med. 282: 370, 1970) that 198 of 201 patients with bronchial asthma had one of three intestinal parasites, we looked for parasites in 258 stool specimens from 123 patients (ages 16 to 80 years) with both allergic and nonallergic asthma. Stools were collected in the parasitology laboratory from 82 outpatients who had taken % ounce of Epsom salts; these were examined immediately. Stools were collected in the hospital from 41 hospitalized patients without purgation. Each stool was examined by an eosin-saline wet preparation and after acid-ether centrifugal sedimentation. All stools from all patients were negative for Ascaris Iwnbricoides, Strongyloides stercoralis, and Necator americanus, the three parasites found by Tullis. In 49 of our patients, at least three stools were negative. Therefore, if a much larger number of patients had been examined, we estimate (upper 95 per cent confidence limit from: [l-p]49 ;= 0.05) that not more than 6.0 per cent of persons from our asthma population would show these intestinal parasites in the first three stools by our test procedure. Since Tullis found parasites in 49 per cent of his patients after examination of three stools.