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Perennial rhinitis, treated with astemizole
69
INCREASED CELL MEDIATED IMMUNITY IN PATIENTS WITH CHRONIC CUTANEOUS TRICHOPKYTON DERMATOPHYTOSIS Zeb Dyer,A.P.A., Richard Hammond,M.D., M[ron Liebhaber, M . D . , S a n t a B a r b a r a , CA. B o n n i e J Ank, A.B.,E.Richard Stiehm,M.D. Los Angeles Immunologic responsiveness was evaluat e d i n ii p a t i e n t s w i t h c h r o n i c T r i c h o p h y t o n r u b r u m (CTR) d e r m a t o p h y t o s i s , and compared to 8 noninfected subjects (cont r o l s ) . T h e C T R p a t i e n t s w e r e a s k e d to verify a history of allergies. T.rubrum was cultured on mycobiotic agar; IgE was determined by P.R.I.S.T. assay, immunoglobulins and precipitins were determined by radial immunodiffusion, IgEmediated sensitivity was determined by prick and intradermal-methods, cell mediated immunity (CTR) w a s d e t e r m i n e d by p a t c h a n d i n t r a d e r m a l testing and in vitro lymphocyte stimulation to T.rubrum antigen. All CTR patients had positive lymphocyte stimulation r e s p o n s e to T. r u b r u m . These lymphocyte stimulation indices were significantly greater than controls. C M I s k i n t e s t r e s p o n s e to T. r u b r u m i n C T R p a t i e n t s w a s 73% c o m p a r e d t o 50% of controls. Immunoglobulins were normal a n d a n t i T. r u b r u m p r e c i p i t i n s n o t detected. O n l y 27% o f C T R p a t i e n t s h a d a positive allergy history, blood eosinophilia or increased IgE. We demonstrated an increased CMI responsiveness to T.rubrum in predominately n o n - a t o p i c p a t i e n t s w i t h d e r m a t o phytosis.
70
PERENNIAL RHINITIS, TREATED WITH ASTEMIZOLE Richard Brobyn~ M.D.s.Michael Benoit, M.D., Nan Mader, Bainbridge Island, Washington Kenneth Cleaver, New Brunswick, New Jersey Astemizole (AST), a new long-acting H I blocking agent, was evaluated versus placebo in a double-blind trial, which was followed by open drug treatment. Sixty patients with positive skin tests, moderate to severe symptoms and a history of sedation with other antihistamines were entered into the 4 week double-blind phase. Patients received a single tablet (i0 mg. AST or placebo) daily, before breakfast. Fifty-six patients completed the initial portion, and the investigators' global evaluations at week 4 follow: Excellent Good Fair Poor Total AST 8 16 12 i 37 Placebo 0 3 I0 6 19 Total 8 19 22 7 56 These results yield a p value of 0.0004 by the Wilcoxen Method. All 56 continued on open astemizole; the placebo patients received a short loading dose followed by the regular i0 mg/day. After 3 to 4 months, 43/56 continue on therapy. Only one patient discontinued treatment for side effects, that being edema after 2 months. The only reported case of sedation was handled by administering AST at night. Blood level determinations indicate saturation by about 2 months, and a level of 6 ng/ml corresponds to excellent results. Astemizole is a useful agent to treat perennial allergic rhinitis.
71 PROSPECTIVEMULTICENTRIC STUDY OF CLINICAL PRACTICE EXPERIENCE WITH BECLOMETHASONE DIPROPIONATE INHALE (BDP) Drug Committee American Academy of Allergy Richard A. Krumholz, M.D., Chairman A group of 386 asthmatic patients were monitored prospectively for one year to evaluate the incidence, nature and consequences of adverse reactions related to the continuous use of BDP, together with a global evaluation of effectiveness. This study is a continuation of the study reported in 1981 on 279 subjects. Of the 386 patients, 376 had moderate to severe asthma; median age was 31 years (4-77); 194 were male and 192 were female. The dose of BDP ranged from one inhalation (puff) once-a-day to four inhalations (puffs) four times-a-day and follow-up visits were at approximately four month intervals. Results of the analysis of the 386 patients treated for one year showed that 40 patients experienced adverse effects. There were five cases of thrush, 25 cases of hoarseness and 17 cases of other side effects. All adverse experiences will be reported.
72
lIE ~NALYTICAL ACOJRACY OF SPECIFIC IgE ANTIBODY RESULTS DETERMINED BY A BLIND PROFICIiNCY SURVEY. G. L. Jacob, B.S. and H. A. Homburger, M.D., Rochester, MN The effects of analytical variability on the accuracy of specific IgE antibody (IgE ~b) measurements are not well documented. We have monitored the accuracy of the results generated in our laboratoryby testing aliquots of positive serum pools and a negative serum pool submitted blindly for measurement of IgE A5 to 15 different allergens, including foods; weed, grass ald tree pollens; mites, molds and epithelia; and H>menoptera venoms. Positive serum pools were prepared to contain moderate amounts of IgE ~b. Tests were performed by sandwich radioimmonoassayswith microcystalline cellulose-allergen conjugates. ~ e results were classified as negative (NEG), borderline (BD) or positive (POS) by calculating the ratio in percent of total cccmts hotrod (% TCB) for eadl test aliquot divided by the % TCB of a standard negative control serum as follo~s: ~ <150% control, BD 150 to 400% control, and POS >400% control. Aliquots of each positive pool and the negative pool were assayed on at least 17 occasiors for IgE Ab to each allergen during a 12 month period. 7he results of all tests are tabulated below: True Results; n,(%) False Results; n,(%) POS NEC POS BD NEG Positive Pools 279 (94) --16 (5) 2 (i) Negative Pool -250 (87) 0 39 (13) - We conclude that frank false POS and false NEG IgE ~b results are very uncommon with microcyrstalline celluloseallergen reagents. Results in the BD category are equivocal and may or may not indicate the presence of low levels of IgE ~b.
110
INCREASED CELL MEDIATED IMMUNITY IN PATIENTS WITH CHRONIC CUTANEOUS TRICHOPKYTON DERMATOPHYTOSIS Zeb Dyer,A.P.A., Richard Hammond,M.D., M[ron Liebhaber, M . D . , S a n t a B a r b a r a , CA. B o n n i e J Ank, A.B.,E.Richard Stiehm,M.D. Los Angeles Immunologic responsiveness was evaluat e d i n ii p a t i e n t s w i t h c h r o n i c T r i c h o p h y t o n r u b r u m (CTR) d e r m a t o p h y t o s i s , and compared to 8 noninfected subjects (cont r o l s ) . T h e C T R p a t i e n t s w e r e a s k e d to verify a history of allergies. T.rubrum was cultured on mycobiotic agar; IgE was determined by P.R.I.S.T. assay, immunoglobulins and precipitins were determined by radial immunodiffusion, IgEmediated sensitivity was determined by prick and intradermal-methods, cell mediated immunity (CTR) w a s d e t e r m i n e d by p a t c h a n d i n t r a d e r m a l testing and in vitro lymphocyte stimulation to T.rubrum antigen. All CTR patients had positive lymphocyte stimulation r e s p o n s e to T. r u b r u m . These lymphocyte stimulation indices were significantly greater than controls. C M I s k i n t e s t r e s p o n s e to T. r u b r u m i n C T R p a t i e n t s w a s 73% c o m p a r e d t o 50% of controls. Immunoglobulins were normal a n d a n t i T. r u b r u m p r e c i p i t i n s n o t detected. O n l y 27% o f C T R p a t i e n t s h a d a positive allergy history, blood eosinophilia or increased IgE. We demonstrated an increased CMI responsiveness to T.rubrum in predominately n o n - a t o p i c p a t i e n t s w i t h d e r m a t o phytosis.
70
PERENNIAL RHINITIS, TREATED WITH ASTEMIZOLE Richard Brobyn~ M.D.s.Michael Benoit, M.D., Nan Mader, Bainbridge Island, Washington Kenneth Cleaver, New Brunswick, New Jersey Astemizole (AST), a new long-acting H I blocking agent, was evaluated versus placebo in a double-blind trial, which was followed by open drug treatment. Sixty patients with positive skin tests, moderate to severe symptoms and a history of sedation with other antihistamines were entered into the 4 week double-blind phase. Patients received a single tablet (i0 mg. AST or placebo) daily, before breakfast. Fifty-six patients completed the initial portion, and the investigators' global evaluations at week 4 follow: Excellent Good Fair Poor Total AST 8 16 12 i 37 Placebo 0 3 I0 6 19 Total 8 19 22 7 56 These results yield a p value of 0.0004 by the Wilcoxen Method. All 56 continued on open astemizole; the placebo patients received a short loading dose followed by the regular i0 mg/day. After 3 to 4 months, 43/56 continue on therapy. Only one patient discontinued treatment for side effects, that being edema after 2 months. The only reported case of sedation was handled by administering AST at night. Blood level determinations indicate saturation by about 2 months, and a level of 6 ng/ml corresponds to excellent results. Astemizole is a useful agent to treat perennial allergic rhinitis.
71 PROSPECTIVEMULTICENTRIC STUDY OF CLINICAL PRACTICE EXPERIENCE WITH BECLOMETHASONE DIPROPIONATE INHALE (BDP) Drug Committee American Academy of Allergy Richard A. Krumholz, M.D., Chairman A group of 386 asthmatic patients were monitored prospectively for one year to evaluate the incidence, nature and consequences of adverse reactions related to the continuous use of BDP, together with a global evaluation of effectiveness. This study is a continuation of the study reported in 1981 on 279 subjects. Of the 386 patients, 376 had moderate to severe asthma; median age was 31 years (4-77); 194 were male and 192 were female. The dose of BDP ranged from one inhalation (puff) once-a-day to four inhalations (puffs) four times-a-day and follow-up visits were at approximately four month intervals. Results of the analysis of the 386 patients treated for one year showed that 40 patients experienced adverse effects. There were five cases of thrush, 25 cases of hoarseness and 17 cases of other side effects. All adverse experiences will be reported.
72
lIE ~NALYTICAL ACOJRACY OF SPECIFIC IgE ANTIBODY RESULTS DETERMINED BY A BLIND PROFICIiNCY SURVEY. G. L. Jacob, B.S. and H. A. Homburger, M.D., Rochester, MN The effects of analytical variability on the accuracy of specific IgE antibody (IgE ~b) measurements are not well documented. We have monitored the accuracy of the results generated in our laboratoryby testing aliquots of positive serum pools and a negative serum pool submitted blindly for measurement of IgE A5 to 15 different allergens, including foods; weed, grass ald tree pollens; mites, molds and epithelia; and H>menoptera venoms. Positive serum pools were prepared to contain moderate amounts of IgE ~b. Tests were performed by sandwich radioimmonoassayswith microcystalline cellulose-allergen conjugates. ~ e results were classified as negative (NEG), borderline (BD) or positive (POS) by calculating the ratio in percent of total cccmts hotrod (% TCB) for eadl test aliquot divided by the % TCB of a standard negative control serum as follo~s: ~ <150% control, BD 150 to 400% control, and POS >400% control. Aliquots of each positive pool and the negative pool were assayed on at least 17 occasiors for IgE Ab to each allergen during a 12 month period. 7he results of all tests are tabulated below: True Results; n,(%) False Results; n,(%) POS NEC POS BD NEG Positive Pools 279 (94) --16 (5) 2 (i) Negative Pool -250 (87) 0 39 (13) - We conclude that frank false POS and false NEG IgE ~b results are very uncommon with microcyrstalline celluloseallergen reagents. Results in the BD category are equivocal and may or may not indicate the presence of low levels of IgE ~b.
110