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714 HIV attitudes & practices of Northern California allergists
318
ALLEHGY
Abstracts
713
BRONCHIAL HYPERREACTIVITY IN PATIENTS WITH ACQUIRED ICIYUHODEFICIENCY SVNDROWE (AIDS). S. Schnipper. M.D.. J. Grizzanti. ~2.0.. C.B. Small, M.D., O.L. Rosenstreich. M.D. Ox, NY We previously reported a high incidence of bronchial hyperreactivity, as determlned by peak expiratorv flow rates and methacholine challenaes in'patienis with acute pneumocystls pneumonia (PCP). The present investigation was performed to determine whether this hyperreactivity was secondary to th*. acute PCP or to the underlying HIV infection itself. Thirty-one HIV-infected outpatients were studied. The group Included asymptomatic. AIDS-related complex (ARC), and AIDS patients, both with and without histories of past PCP. A matched group of non-HIV infected cigarette smokers. and a new cohort of patfents with acute PCP were tested as well. Peak flow measurements were made, before and after inhaled an bronchodilator. As previously noted. 84% (31/37) of acute PCP patients had low peak flow rates 1~80% of nl\ and 74% exhibited a significant bronchodilator response (>15%). In contrast, flow rates were low in only 17-29% of HIV infected individuals without a history of PCP (asymptomatic or ARC) and only 10% exhibited a positive bronchodilator response. Seventy five (75%) of patients with AIDS who had recov&ed'from‘PCP also had normal flow rates and no patient in this group exh'bited a positive bronchodilator response. Peak flow rates were normal in all the non-infected cigarette smokers. These results indicate that bronchial hyperreactivity is secondary to acute PCP. and not to the HIV infection or to cigarette smoking. In addition, they suggest that bronchial hyperreactivity reverses after resolution of acute PCP.
715
714
HIV ATTITUDES & PRACTICES OF NORTHERN CALIFORNIA ALLERGISTS &Am As a pilot to a national survey, Allergy Assn. of No. California members were anonymously questioned by mail. 60/I 18 in active practice replied. 49/59 arc ABA1 certified. 53/60 (88%) felt allergists should seeHIV+ pts in specialty consultation only. 9/60 said they should do primary HIV care also & 7 were actually doing so. 41/58 (7 1%) have had known HIV+ ots in their oractices. 24/48 &sohy knew HIV+ non-p& 8/56 (14%) considered themselves at risk for HIV, 7 due to occupational exposures. Of those n risk, 5/7 (71%) ask their pts’ Ab status, vs. only 21/44 (48%) who were not at risk. 48/56 thought HIV+ pts should have allergy skin tests if indicated. IO/56 supported in-vitro testing only. 33 used infection precauti& universally, 14 -for -known or suspected HIV+ pts only, including 2 MD’s who had an occupational exposure 10HIV. Asked if giving systemic steroids to HIV+‘s is dangerous, 29/44 (66%) said yes, 4 (9%) uncertain, 11 (25%) no. Regarding danger in immunotherapy for HIV+‘s, 16151(28%) said yes, 10 (20%) unsure, 31 (54%) no. 40/58 wanted more HIV information, via conferences, national meetings, mailings and newsletters. HIV pts are prevalent in the practices of No. CA allergists, a surprising no. of whom have had occupational HIV exposures. Not all allergists ask pts’ Ab status or use universal precautions. Those at risk tend to ask Ab status and observe universal precautions more frequently. There is no consensus on the safety of systemic steroids or immunotherapy in HIV+ pts.
716
i:!k
,MMUNVL !ANUARY 19L’l
OCCURRENCE OF MITE ALLERGENS IN THE HOME OF Dpt ALLERGIC PATIENT: AND MATCHED CONTR(K SUBJECTS. Ph.D., A. Vdrot, E. Quoix, M.D., G. Hedelin, A. Dletmnn, M.D., J.C. Bessot, M.D., G. Paull, . D . . Strasboura. France. yite allergex exposure of 70 patients wi:b rhinitis asthma or sensitized was to Dpt compared with mite allergen exposure of control subjects. Matched control subjects were immediate neighbors (n = 70) and patients arbitrarlly selected from a list of hospitalized nonrespiratory patients (n = 54) : they were matched according to age (+ 5 years) and sex. Dust from mattresses was collected during the same season for each patient and his controls (2 mn/d ; same technician and vacuum cleaner:. Both Acarex testR and Der p1 and Def fl determinations uere performed. Univariate and multivariate analysis were used. Relative risks were calculated by non-conditional and conditional logistic regression for matched sets. Mean values of Der pl and Der il did not differ significantly for patients (28.2 pg/g and respectively), neighbor control 18.2 ps/g, subjects (22.68 pg/g and 16.15 pg/g, respectively), or hospital controls (21.1 pg/g and 12 pg/g, respectively). Acare class distributicn of the house dust samples uas not significantly different for patients and matched controls. The calculated odds ratios associated with expostire to mite allergens did not differ significantly from 1. These results suggest that genetic background is an important factor besldes environment allergen exposure. Nevertheless the high level of Dp allergens in our area increases the risk of sensitization in atopii subjects.
DIFFERENCES IN BIOLOG!CAL FINDINGS :N HOUSES 5' ALLERGIC PATIENTS IN RELATION TO CLINICAL HESULTS OBTAINED IN A DOUBLE BLIND STUDY WITH 10 MATCHED PAIRS. H.S.M.Kort, -B.S., F.M.Kniest, Ph.D., J.E.M.H. van Bronswijk M.D., E. Bischoft Ph . D ., U hoven, The Netherlinds and Mainz FR(; The problem: In a I year double :,lind contr. study (DB) with rhinitic patients of the Llnl/. Clinic of Utrecht a signif. amelloratlon cli daily symptom scores was found, starting I;!-lb weeks after Acarosan(A) treatment (r:. Compared to control (Cl, symptom score decreased 474 Ip-0.025) more in the A group. This g'obal result was not based on homogenous pair-b,eiults pairs showed extensive difference‘,, i other.: 1n c only small ones. In total 8 01~1 : f patients improved more than their :ontroI. '.! understand this we extended biO!fJa. inve?: Mat. and meth.: a) LIB: Determin. cc ‘cictus~~ dui! mites (HOM) and other mites ir! dust r,amcl?: (vat. cleaning; 4 times/yr.;lmin!m'l afterflotation, assessment of guanine contef;t: (Acare,~Test); calculation of exposure scores related to contact time with textiles. a(ilriclda! (benzyl benzoatel two times. Patierlts: da1 ;y symptom scores, medical examinations. b) supol. biolog. examinations: and storage mites(SM) fungi(F) on inner walls and room pa;.titions. Results: In 3 out of 5 pairs with weak results in DB presence of SM cl-12/mZ) ana c nn humid walls (3 dwellings with A, 3 with Cl. Sens;tiration against SM allergens was assessed in :i patients with A and 2 with C. r.onclusion;, Symptom scores in patients depend not only 011 exposure to allergens of HDM, but 41s~. of $9 In such dwellings supplementary 1 :. '!“(.(!~5zr:'
ALLEHGY
Abstracts
713
BRONCHIAL HYPERREACTIVITY IN PATIENTS WITH ACQUIRED ICIYUHODEFICIENCY SVNDROWE (AIDS). S. Schnipper. M.D.. J. Grizzanti. ~2.0.. C.B. Small, M.D., O.L. Rosenstreich. M.D. Ox, NY We previously reported a high incidence of bronchial hyperreactivity, as determlned by peak expiratorv flow rates and methacholine challenaes in'patienis with acute pneumocystls pneumonia (PCP). The present investigation was performed to determine whether this hyperreactivity was secondary to th*. acute PCP or to the underlying HIV infection itself. Thirty-one HIV-infected outpatients were studied. The group Included asymptomatic. AIDS-related complex (ARC), and AIDS patients, both with and without histories of past PCP. A matched group of non-HIV infected cigarette smokers. and a new cohort of patfents with acute PCP were tested as well. Peak flow measurements were made, before and after inhaled an bronchodilator. As previously noted. 84% (31/37) of acute PCP patients had low peak flow rates 1~80% of nl\ and 74% exhibited a significant bronchodilator response (>15%). In contrast, flow rates were low in only 17-29% of HIV infected individuals without a history of PCP (asymptomatic or ARC) and only 10% exhibited a positive bronchodilator response. Seventy five (75%) of patients with AIDS who had recov&ed'from‘PCP also had normal flow rates and no patient in this group exh'bited a positive bronchodilator response. Peak flow rates were normal in all the non-infected cigarette smokers. These results indicate that bronchial hyperreactivity is secondary to acute PCP. and not to the HIV infection or to cigarette smoking. In addition, they suggest that bronchial hyperreactivity reverses after resolution of acute PCP.
715
714
HIV ATTITUDES & PRACTICES OF NORTHERN CALIFORNIA ALLERGISTS &Am As a pilot to a national survey, Allergy Assn. of No. California members were anonymously questioned by mail. 60/I 18 in active practice replied. 49/59 arc ABA1 certified. 53/60 (88%) felt allergists should seeHIV+ pts in specialty consultation only. 9/60 said they should do primary HIV care also & 7 were actually doing so. 41/58 (7 1%) have had known HIV+ ots in their oractices. 24/48 &sohy knew HIV+ non-p& 8/56 (14%) considered themselves at risk for HIV, 7 due to occupational exposures. Of those n risk, 5/7 (71%) ask their pts’ Ab status, vs. only 21/44 (48%) who were not at risk. 48/56 thought HIV+ pts should have allergy skin tests if indicated. IO/56 supported in-vitro testing only. 33 used infection precauti& universally, 14 -for -known or suspected HIV+ pts only, including 2 MD’s who had an occupational exposure 10HIV. Asked if giving systemic steroids to HIV+‘s is dangerous, 29/44 (66%) said yes, 4 (9%) uncertain, 11 (25%) no. Regarding danger in immunotherapy for HIV+‘s, 16151(28%) said yes, 10 (20%) unsure, 31 (54%) no. 40/58 wanted more HIV information, via conferences, national meetings, mailings and newsletters. HIV pts are prevalent in the practices of No. CA allergists, a surprising no. of whom have had occupational HIV exposures. Not all allergists ask pts’ Ab status or use universal precautions. Those at risk tend to ask Ab status and observe universal precautions more frequently. There is no consensus on the safety of systemic steroids or immunotherapy in HIV+ pts.
716
i:!k
,MMUNVL !ANUARY 19L’l
OCCURRENCE OF MITE ALLERGENS IN THE HOME OF Dpt ALLERGIC PATIENT: AND MATCHED CONTR(K SUBJECTS. Ph.D., A. Vdrot, E. Quoix, M.D., G. Hedelin, A. Dletmnn, M.D., J.C. Bessot, M.D., G. Paull, . D . . Strasboura. France. yite allergex exposure of 70 patients wi:b rhinitis asthma or sensitized was to Dpt compared with mite allergen exposure of control subjects. Matched control subjects were immediate neighbors (n = 70) and patients arbitrarlly selected from a list of hospitalized nonrespiratory patients (n = 54) : they were matched according to age (+ 5 years) and sex. Dust from mattresses was collected during the same season for each patient and his controls (2 mn/d ; same technician and vacuum cleaner:. Both Acarex testR and Der p1 and Def fl determinations uere performed. Univariate and multivariate analysis were used. Relative risks were calculated by non-conditional and conditional logistic regression for matched sets. Mean values of Der pl and Der il did not differ significantly for patients (28.2 pg/g and respectively), neighbor control 18.2 ps/g, subjects (22.68 pg/g and 16.15 pg/g, respectively), or hospital controls (21.1 pg/g and 12 pg/g, respectively). Acare class distributicn of the house dust samples uas not significantly different for patients and matched controls. The calculated odds ratios associated with expostire to mite allergens did not differ significantly from 1. These results suggest that genetic background is an important factor besldes environment allergen exposure. Nevertheless the high level of Dp allergens in our area increases the risk of sensitization in atopii subjects.
DIFFERENCES IN BIOLOG!CAL FINDINGS :N HOUSES 5' ALLERGIC PATIENTS IN RELATION TO CLINICAL HESULTS OBTAINED IN A DOUBLE BLIND STUDY WITH 10 MATCHED PAIRS. H.S.M.Kort, -B.S., F.M.Kniest, Ph.D., J.E.M.H. van Bronswijk M.D., E. Bischoft Ph . D ., U hoven, The Netherlinds and Mainz FR(; The problem: In a I year double :,lind contr. study (DB) with rhinitic patients of the Llnl/. Clinic of Utrecht a signif. amelloratlon cli daily symptom scores was found, starting I;!-lb weeks after Acarosan(A) treatment (r:. Compared to control (Cl, symptom score decreased 474 Ip-0.025) more in the A group. This g'obal result was not based on homogenous pair-b,eiults pairs showed extensive difference‘,, i other.: 1n c only small ones. In total 8 01~1 : f patients improved more than their :ontroI. '.! understand this we extended biO!fJa. inve?: Mat. and meth.: a) LIB: Determin. cc ‘cictus~~ dui! mites (HOM) and other mites ir! dust r,amcl?: (vat. cleaning; 4 times/yr.;lmin!m'l afterflotation, assessment of guanine contef;t: (Acare,~Test); calculation of exposure scores related to contact time with textiles. a(ilriclda! (benzyl benzoatel two times. Patierlts: da1 ;y symptom scores, medical examinations. b) supol. biolog. examinations: and storage mites(SM) fungi(F) on inner walls and room pa;.titions. Results: In 3 out of 5 pairs with weak results in DB presence of SM cl-12/mZ) ana c nn humid walls (3 dwellings with A, 3 with Cl. Sens;tiration against SM allergens was assessed in :i patients with A and 2 with C. r.onclusion;, Symptom scores in patients depend not only 011 exposure to allergens of HDM, but 41s~. of $9 In such dwellings supplementary 1 :. '!“(.(!~5zr:'