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Pituitary macroadenoma presenting with rhinitis
S294
899 Fumigatus Correlation of Serum Precipitins and IgG Anti Aspergillus (IgG-Af) Determined by Fluoroenzymeimmunoassay P. S. Hutcheson, R. G. Slavin; Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, RATIONALE: The presence of serum precipitins against Aspergillus fumigatus (Af) and IgG-Af are considered part of the diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA). There is no data available on the specific lgG UniCAP assay, so we compared serum precipitins to Af and IgG-Af. METHODS: Precipitin determinations consisted of sera placed in gel surrounded by 5 different antigen Af preparations and were scored 0-5 depending on how many antigens were positive. IgG-Af was determined by UniCAP 100 fluoroenzymeimmunoassay (Pharmacia) with results in mg/l. The determinations were done on 161 patient samples: (group 1) 35 CF Af sensitive (skin test +) non-ABPA; (group 2) 47 CF Af non-sensitive nonABPA; (group 3) 40 asthmatic ABPA; (group 4) 37 CF ABPA. RESULTS: The majority of precipitin scores were either 0 or 5, and there was a trend toward higher IgG-Af with increased numbers of precipitins, but this was not statistically significant. The mean for each of the four groups with 0 and 5 precipitin scores respectively was: group 1-32.8, 125.9; group 2-25.6, 122.1; group 3-64.8, 122.9; and group 4-53.4, 129.0. The range in nonABPA patients with 0 precipitins never exceeded 105, whereas the range in ABPA patients with 5 precipitins never fell below 30. CONCLUSION: The presence of precipitins did not significantly correlate with increased IgG-Af, although there was a trend toward higher IgGAf associated with higher precipitin scores. It would appear that both serum precipitins and IgG-Af determinations should be done as part of the serology to establish the diagnosis of ABPA.
Funding: NIH and CF Foundation
900
J ALLERGY CLIN IMMUNOL FEBRUARY 2003
Abstracts
"""'" . . o , . , . . o . ,,.so.,,., w.,
,A. L. Darter l, D, A. Khan2; lAllergy & Immunology, UTSouthwesteru, Dallas, TX, 2Allergy & Immunology, UT Southwestern, Dallas, TX. RATIONALE: To report a case of a pituitary macroadenoma presenting with rhiuitis. METHODS: A 49 year old African American female who presented with 1 year of progressive nasal congestion most severe on the left, minimal rhinorrhea with occasional blood clots. She denied sneezing, nasal itch, but did relate hyposmia. Second generation antihistamines, nasal steroids, and oxymetazoline failed to relieve the congestion. She denied fevers, chills, night sweats, or headache. She did have an intentional twenty pound weight loss recently. Physical exam was notable for a large polypoid mass on the left medial to the inferior turbinate. RESULTS: Rhinoscopy demonstrated narrowing of the nasal vault on the right, and on the left a large polypoid mass with active bleeding along the floor of the nasal cavity obscuring most of the middle turbinate. Magnetic resonance imaging demonstrated a 5.0 cm enhancing mass involving the sphenoid sinus, the pituitary fossa, the suprasellar cistern, and impinged upon the optic chiasm. The mass extended into the nasal fossa involving the hard palate and inferior turbinate on the left. A biopsy demonstrated a pituitary adenoma. Endocrinologic studies were negative. She underwent a subtotal resection and her residual disease is being followed by serial imaging. CONCLUSIONS: A pituitary adenoma is a rare cause of nasal tumors, and rarely presents with rhinitis or other nasal symptoms as the initial manifestation. Symptoms of unilateral congestion, hyposmia, bleeding, or pain should alert the physician to structural abnormalities, including tumors and warrant a thorough physical examination of the nose with rhinoscopy.
Funding: Self-funded
901 Wheezy Faecal Microflora in Atopic Wheezy and Non-Atopic NonChildren M. A. Simon l, C. S. Murray ~, G. W. Tannock I, H. J. M. Harmsen 3, G. W. Welling 3, A. Custovic 2, A. Woodcock2; tDepartment of Microbiology, University of Otago, Otago, NEW ZEALAND, 2North West Lung Centre,
Manchester, UNITED KINGDOM, 3Department of Medical Microbiology, University of Groningen, Groningen, NETHERLANDS. RATIONALE: Differences have been suggested in the composition of intestinal microflora from allergic and non-allergic children. METHODS: Within the context of a prospective birth cohort (Manchester Asthma and Allergy Study) we conducted a nested case-control study in children aged 3-5 years. Faecal microflora in atopic children with a history of recurrent wheeze (cases-AW) was compared to that of non-atopic children who had never wheezed (controls-NANW). Cases and controls were matched for age, sex, parental atopy, indoor allergen exposure and pet ownership. We identified bacteria in the faeces by PCR amplification and denaturing gradient gel electrophoresis, and enumerated any bifidobacteria by fluorescent in situ hybridization. RESULTS: 33 cases (mean age 4.4 yrs, 20 male) and 33 controls provided stool samples for analysis. Comparison of total bacterial community profiles showed a unique microflora for each child (mean Dice's similarity coefficient 22%, range 3.3-60.8%). There was no difference in the frequency of detection of lactic acid bacteria between cases and controls or the frequency of detection of bifidobacteria between cases (30/33) and controls (31/33, p=l.00 Fisher's exact test). The range of bifidobacteria species detected was similar in both groups. The percentage of bifidobacteria in the total faecal microflora was no different between cases (median 1.71%, range 0-20.83%) and controls (median 1.88%, range 0-18.23%, p=0.728, Wilcoxon Signed Ranks Test). CONCLUSIONS: We found no differences in faecal flora composition between atopic children aged 3-5 years with a history of recurrent wheeze and non-atopic, non-wheezy controls using molecular biology techniques.
Funding: GSK Respiratory Research Award
902 inRespiratory SyncytialVirus(RSV)S,imuia,ion of |nterleukin-11 Human Alveolar Epithelial Cells--Inhibition by Montelukast B. I". Leyko, J. Zimmermann, H. Shah, G. Joseph, Y. Huang, M. Frieri; Nassau University Medical Center, East Meadow, NY. RATIONALE: RSV is a major trigger of pediatric broncholitis, reactive airway disease (RAD) and asthma. Alveolar macrophages harbor RSV damaging airway epithelium leading to RANTES and cytokine release. IL-I 1 is an important mediator of RAD associated with RSV. A549 cells reflect distal small airways containing leukotriene receptors, which are important targets for RAD or asthma and Montelukast has been demonstrated to clinically improve RSV bronchiolitis and RAD. METHODS: We evaluated A549 human alveolar epithelial cells in the presence of 256 [tg/ml RSV antigen and IL-II~ for 1L-I 1 and RANTES production by ELISA at 6-20 hrs intervals with 10 [aM of montelukast. RESULTS: RSV stimulated IL-I 1 and RANTES at 6 hrs (57-91 pg/ml, p=.08 and 1-207 pg/ml, p<.05) and at 17 hrs (162-232 pg/ml and 0-83 pg/mi, p<.05) significantly enhanced with IL-I~ at both time points (p<.05) Montelukast inhibited IL-II levels both with RSV and IL-I alone (91-71 pg/ml and I 17-102 pg/ml, NS) and in combination ( 186-127 pg/ml, p=0.08) at 6 hrs. CONCLUSIONS: IL-11 and RANTES is stimulated in the presence of RSV antigen and is synergistically enhanced by addition of [L-I~. Montelukast reduced IL-11 in combination with RSV and IL-1[~, approaching significance at 6 hours. Thus, Montelukast may have an anti-inflammatory effect in preventing RAD due to RSV via cytokine inhibition.
Funding: Self-funded
903 Antibiotic Use During Early Infancy Increases the Risk for Atopy C. Cole Johnson L, D. R. Ownby 2, S. L. Havstad 3, S. Hensley Alford L, E. M. Zoratti 4, E. L. Peterson 3, C. L. M. Joseph3; ICancer Epidemiology, Prevention and Control, Henry Ford Health System, Detroit, MI, 2Allergy/Immunology, Medical College of Georgia, Augusta, GA, 3Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, MI, 4Allergy/Immunology, Henry Ford Health System, Detroit, MI. RATIONALE: Increases in pediatric allergy and asthma parallel the rise in antibiotic use. Antibiotic (AB) use has been suggested as a risk factor
899 Fumigatus Correlation of Serum Precipitins and IgG Anti Aspergillus (IgG-Af) Determined by Fluoroenzymeimmunoassay P. S. Hutcheson, R. G. Slavin; Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, RATIONALE: The presence of serum precipitins against Aspergillus fumigatus (Af) and IgG-Af are considered part of the diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA). There is no data available on the specific lgG UniCAP assay, so we compared serum precipitins to Af and IgG-Af. METHODS: Precipitin determinations consisted of sera placed in gel surrounded by 5 different antigen Af preparations and were scored 0-5 depending on how many antigens were positive. IgG-Af was determined by UniCAP 100 fluoroenzymeimmunoassay (Pharmacia) with results in mg/l. The determinations were done on 161 patient samples: (group 1) 35 CF Af sensitive (skin test +) non-ABPA; (group 2) 47 CF Af non-sensitive nonABPA; (group 3) 40 asthmatic ABPA; (group 4) 37 CF ABPA. RESULTS: The majority of precipitin scores were either 0 or 5, and there was a trend toward higher IgG-Af with increased numbers of precipitins, but this was not statistically significant. The mean for each of the four groups with 0 and 5 precipitin scores respectively was: group 1-32.8, 125.9; group 2-25.6, 122.1; group 3-64.8, 122.9; and group 4-53.4, 129.0. The range in nonABPA patients with 0 precipitins never exceeded 105, whereas the range in ABPA patients with 5 precipitins never fell below 30. CONCLUSION: The presence of precipitins did not significantly correlate with increased IgG-Af, although there was a trend toward higher IgGAf associated with higher precipitin scores. It would appear that both serum precipitins and IgG-Af determinations should be done as part of the serology to establish the diagnosis of ABPA.
Funding: NIH and CF Foundation
900
J ALLERGY CLIN IMMUNOL FEBRUARY 2003
Abstracts
"""'" . . o , . , . . o . ,,.so.,,., w.,
,A. L. Darter l, D, A. Khan2; lAllergy & Immunology, UTSouthwesteru, Dallas, TX, 2Allergy & Immunology, UT Southwestern, Dallas, TX. RATIONALE: To report a case of a pituitary macroadenoma presenting with rhiuitis. METHODS: A 49 year old African American female who presented with 1 year of progressive nasal congestion most severe on the left, minimal rhinorrhea with occasional blood clots. She denied sneezing, nasal itch, but did relate hyposmia. Second generation antihistamines, nasal steroids, and oxymetazoline failed to relieve the congestion. She denied fevers, chills, night sweats, or headache. She did have an intentional twenty pound weight loss recently. Physical exam was notable for a large polypoid mass on the left medial to the inferior turbinate. RESULTS: Rhinoscopy demonstrated narrowing of the nasal vault on the right, and on the left a large polypoid mass with active bleeding along the floor of the nasal cavity obscuring most of the middle turbinate. Magnetic resonance imaging demonstrated a 5.0 cm enhancing mass involving the sphenoid sinus, the pituitary fossa, the suprasellar cistern, and impinged upon the optic chiasm. The mass extended into the nasal fossa involving the hard palate and inferior turbinate on the left. A biopsy demonstrated a pituitary adenoma. Endocrinologic studies were negative. She underwent a subtotal resection and her residual disease is being followed by serial imaging. CONCLUSIONS: A pituitary adenoma is a rare cause of nasal tumors, and rarely presents with rhinitis or other nasal symptoms as the initial manifestation. Symptoms of unilateral congestion, hyposmia, bleeding, or pain should alert the physician to structural abnormalities, including tumors and warrant a thorough physical examination of the nose with rhinoscopy.
Funding: Self-funded
901 Wheezy Faecal Microflora in Atopic Wheezy and Non-Atopic NonChildren M. A. Simon l, C. S. Murray ~, G. W. Tannock I, H. J. M. Harmsen 3, G. W. Welling 3, A. Custovic 2, A. Woodcock2; tDepartment of Microbiology, University of Otago, Otago, NEW ZEALAND, 2North West Lung Centre,
Manchester, UNITED KINGDOM, 3Department of Medical Microbiology, University of Groningen, Groningen, NETHERLANDS. RATIONALE: Differences have been suggested in the composition of intestinal microflora from allergic and non-allergic children. METHODS: Within the context of a prospective birth cohort (Manchester Asthma and Allergy Study) we conducted a nested case-control study in children aged 3-5 years. Faecal microflora in atopic children with a history of recurrent wheeze (cases-AW) was compared to that of non-atopic children who had never wheezed (controls-NANW). Cases and controls were matched for age, sex, parental atopy, indoor allergen exposure and pet ownership. We identified bacteria in the faeces by PCR amplification and denaturing gradient gel electrophoresis, and enumerated any bifidobacteria by fluorescent in situ hybridization. RESULTS: 33 cases (mean age 4.4 yrs, 20 male) and 33 controls provided stool samples for analysis. Comparison of total bacterial community profiles showed a unique microflora for each child (mean Dice's similarity coefficient 22%, range 3.3-60.8%). There was no difference in the frequency of detection of lactic acid bacteria between cases and controls or the frequency of detection of bifidobacteria between cases (30/33) and controls (31/33, p=l.00 Fisher's exact test). The range of bifidobacteria species detected was similar in both groups. The percentage of bifidobacteria in the total faecal microflora was no different between cases (median 1.71%, range 0-20.83%) and controls (median 1.88%, range 0-18.23%, p=0.728, Wilcoxon Signed Ranks Test). CONCLUSIONS: We found no differences in faecal flora composition between atopic children aged 3-5 years with a history of recurrent wheeze and non-atopic, non-wheezy controls using molecular biology techniques.
Funding: GSK Respiratory Research Award
902 inRespiratory SyncytialVirus(RSV)S,imuia,ion of |nterleukin-11 Human Alveolar Epithelial Cells--Inhibition by Montelukast B. I". Leyko, J. Zimmermann, H. Shah, G. Joseph, Y. Huang, M. Frieri; Nassau University Medical Center, East Meadow, NY. RATIONALE: RSV is a major trigger of pediatric broncholitis, reactive airway disease (RAD) and asthma. Alveolar macrophages harbor RSV damaging airway epithelium leading to RANTES and cytokine release. IL-I 1 is an important mediator of RAD associated with RSV. A549 cells reflect distal small airways containing leukotriene receptors, which are important targets for RAD or asthma and Montelukast has been demonstrated to clinically improve RSV bronchiolitis and RAD. METHODS: We evaluated A549 human alveolar epithelial cells in the presence of 256 [tg/ml RSV antigen and IL-II~ for 1L-I 1 and RANTES production by ELISA at 6-20 hrs intervals with 10 [aM of montelukast. RESULTS: RSV stimulated IL-I 1 and RANTES at 6 hrs (57-91 pg/ml, p=.08 and 1-207 pg/ml, p<.05) and at 17 hrs (162-232 pg/ml and 0-83 pg/mi, p<.05) significantly enhanced with IL-I~ at both time points (p<.05) Montelukast inhibited IL-II levels both with RSV and IL-I alone (91-71 pg/ml and I 17-102 pg/ml, NS) and in combination ( 186-127 pg/ml, p=0.08) at 6 hrs. CONCLUSIONS: IL-11 and RANTES is stimulated in the presence of RSV antigen and is synergistically enhanced by addition of [L-I~. Montelukast reduced IL-11 in combination with RSV and IL-1[~, approaching significance at 6 hours. Thus, Montelukast may have an anti-inflammatory effect in preventing RAD due to RSV via cytokine inhibition.
Funding: Self-funded
903 Antibiotic Use During Early Infancy Increases the Risk for Atopy C. Cole Johnson L, D. R. Ownby 2, S. L. Havstad 3, S. Hensley Alford L, E. M. Zoratti 4, E. L. Peterson 3, C. L. M. Joseph3; ICancer Epidemiology, Prevention and Control, Henry Ford Health System, Detroit, MI, 2Allergy/Immunology, Medical College of Georgia, Augusta, GA, 3Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, MI, 4Allergy/Immunology, Henry Ford Health System, Detroit, MI. RATIONALE: Increases in pediatric allergy and asthma parallel the rise in antibiotic use. Antibiotic (AB) use has been suggested as a risk factor