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Usefulness of Inmunoglobulin E Antibody Levels to Recombinant Fel d 1 in Predicting the Cat Specific Bronchial Provocation Test Results
S8 Abstracts
SATURDAY
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Determining the Influence of Washing on the Aerosol Performance of a New Valved Holding Chamber (VHC) S. Somaraju1, H. Wu1, D. von Hollen2; 1Next Breath, LLC, Baltimore, MD, 2Respironics, Inc., Parsippany, NJ. RATIONALE: An earlier study examined the aerosol performance of a pre-production washed OptiChamber Advantage II (OCA II, Respironics, Inc.), a charge neutral (anti-static) VHC, with HFA albuterol and HFA fluticasone pressurized metered dose inhalers (pMDIs).[1] Washing VHCs can affect aerosol performance. This study compared the prior results with test results from a pre-production unwashed OCA II. METHODS: Three OCAII VHCs were tested in an unwashed Ôout-of-theboxÕ condition using HFA albuterol (90mg/actuation) and HFA fluticasone (110mg/actuation) pMDIs. The pMDIs were primed, shaken and fired into the VHC 10 times. Fine particle dose (FPD;mg < 4mm) and mass median aerodynamic diameter (MMAD) were determined using a Next Generation Impactor at 30L/min flow and drug was analyzed by HPLC. RESULTS: The OCA II FPD values in the unwashed condition were 44.44mg with albuterol and 75.44mg with fluticasone. The FPD values in the washed condition were 43.44mg with albuterol and 70.56mg with fluticasone. The MMAD values from the OCA II in the unwashed condition were 2.38mm with albuterol and 2.63mm with fluticasone. The MMAD values in the washed condition were: 2.27mm with albuterol and 2.57mm with fluticasone. The washed and unwashed results were substantially equivalent. CONCLUSIONS: The OCA II offers consistent and reliable drug delivery whether washed or unwashed. These findings demonstrate that an Ôout of the boxÕ OCA II delivers a dependable output of medication without the extra step of washing. 1] Somaraju, S et al. Comparison of Aerosol Performance Output from Anti-Static Valve Holding Chambers using HFA Metered Dose Inhaler Formulations. Proceedings of AARC2008 Annual congress. In-Press.
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Usefulness of Inmunoglobulin E Antibody Levels to Recombinant Fel d 1 in Predicting the Cat Specific Bronchial Provocation Test Results J. C. Jaramillo, M. J. Sa´nchez-Gonza´lez, N. Blanca-Lo´pez, M. A. Jime´nez, J. Rodrı´guez, P. Daroca, C. Ferna´ndez; Hospital 12 de Octubre, Madrid, Spain. RATIONALE: Recombinant Fel d 1(rFel d 1) could be a good candidate for replacing cat dander extracts in diagnostics for cat allergy. We analyze this topic in asthmatic patients sensitized to cat using the specific bronchial provocation test (BPT) results as reference. METHODS: Thirty-nine asthmatic patients (mean age 31.2 6 8.4 years) with positive results for skin prick testing (SPT) and/or detectable cat allergens serum specific IgE (CAP -System FEIA) underwent a BPT with cat epithelium. In addition, sera were tested for specific IgE to rFel d 1 (InmunoCAP PHADIA). The cut off point for a positive result of both in vitro tests was 0.35 kUA/l. Statistical analysis of results was carried out by Receiver Operating Characteristics (ROC) curves. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were also calculated for both in vitro tests. RESULTS: Cat epithelium BPT was positive in 24 subjects. The area under the curve for rFel d 1 was 0.839 (CI 0.70-0.97), and 0.836 (CI 0.70-0.96) (p 5 0.959) for cat allergen specific IgE. For rFel d 1 91.6% sensitivity, 40% specificity, 70% PPV and 75% NPV were obtained, for cat specific IgE 100% sensitivity, 6.67% specificity, 63% PPV and 100%NPV. CONCLUSIONS: Cat epithelium and rFel d 1 serum-specific IgE are useful tests in predicting the outcome of cat specific BPT. Both tests have similar efficacy; however rFel d1 seems to be more accurate to rule out specific bronchial hyperreactivity.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
15
Serum Tryptase levels in Aspirin-Exacerbated Respiratory Disease (AERD) J. Park, J. Lee, S. Park, D. Kim, A. Jang, C. Park; Soonchunhyang University Bucheon Hospital, Bucheon, Gyeonggi Do, Republic of Korea. RATIONALE: Tryptase, a serine protease, is major secretory products of mast cell. Intrinsic differences in mast cell activation have been suggested to predispose some individuals to anaphylaxis and airway inflammation. We investigated the relation of tryptase with AERD. METHODS: The asthmatics (n 5 61) underwent the oral aspirin challenge (OAC). OAC reactions were categorized into 2 groups as follows: 20% or greater decreases in FEV1 or 15% to 19% decreases in FEV1 with extrarbronchial reactions(naso-ocular or cutaneous) (Y, n 5 32) and 15% less decreases in FEV1 (N, n 5 15). Y (n 5 32) group were treated with leukotriene modifier drug daily followed by OAC after 12 weeks later. All patients underwent asthma treatment according to GINA guideline.We measured serum tryptase at the day of OAC, before ingestion of aspirin and the last time. RESULTS: 1) The mean of serum tryptase levels before ingestion of aspirin at the day of OAC were no significantly differences between Y group and N group(11.8 6 3.8 vs 4.9 6 1.0 (ug/l), P 5 0.232). 2) The patients with relatively high serum tryptase levels before ingestion of aspirin (n 5 6) were in Y group and serum tryptase levels of them significantly decreased at the last time of OAC (p 5 0.028). 3) In Y group, the patients with relatively high serum tryptase levels (n 5 6) showed more increased serum tryptase levels at the day of OAC after 12 weeks than did the others (n 5 26) and more pronounced decrease in FEV1% after OAC at 12 weeks later than did the others (23.3 6 6.8% vs 7.9 6 1.9%, p 5 0.016). CONCLUSIONS: The serum tryptase was related to aspirin induced bronchospasm and progression of AERD.
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Induced Sputum In Chronic Cough. N. Lukan1, O. Racz1, R. Pullmann2, J. Petrovicova1; 1Safarik University, Kosice, Slovakia, 2Commenius University, Martin, Slovakia. RATIONALE: Induced sputum is one of basic non-invasive procedures allowing to estimate the intensity of inflammation. Sputum contains beside cells also proteins as eosinophilic cationic protein (ECP) and many others. The aim of presented work was to estimate which parameter could be more sensitive in assessment of inflammation intensity in chronic dry cough. METHODS: Fifty-eight patients (mean age 41.6 6 15.1 years; range 16-75 years; F/M:43/15) with chronic dry cough lasting more than eight weeks were included in this study. Patients with cardiogenic, postinfectious cough and GERD were eliminated. Presence of eosinophiles and neutrophiles in induced sputum, ECP and oxidative stress as free radicals (FR) were estimated. RESULTS: Eosinophil white cells were present in sputum of 33 (56.9%) patients, whereas neutrophiles almost in all of them (54 patients-93.1%). ANOVA analysis showed significant difference between patients without eosinophiles and those with high number of eosinophiles. On the other side ECP concentration was also elevated (19.0 6 27.51 mg/l) in patients without eosinophiles in induced sputum. Free radical concentration was also elevated in the group with high number of eosinophiles but did not show any association with the presence and number of neutrophiles in the sputum. CONCLUSIONS: Complex analysis of parameters of induced sputum can be helpful in assessment of airway inflammation. Our results show that eosinophilic cationic protein is a more sensitive parameter than the presence of cells in induced sputum. The estimation of free radicals in sputum provides little added value.
SATURDAY
13
Determining the Influence of Washing on the Aerosol Performance of a New Valved Holding Chamber (VHC) S. Somaraju1, H. Wu1, D. von Hollen2; 1Next Breath, LLC, Baltimore, MD, 2Respironics, Inc., Parsippany, NJ. RATIONALE: An earlier study examined the aerosol performance of a pre-production washed OptiChamber Advantage II (OCA II, Respironics, Inc.), a charge neutral (anti-static) VHC, with HFA albuterol and HFA fluticasone pressurized metered dose inhalers (pMDIs).[1] Washing VHCs can affect aerosol performance. This study compared the prior results with test results from a pre-production unwashed OCA II. METHODS: Three OCAII VHCs were tested in an unwashed Ôout-of-theboxÕ condition using HFA albuterol (90mg/actuation) and HFA fluticasone (110mg/actuation) pMDIs. The pMDIs were primed, shaken and fired into the VHC 10 times. Fine particle dose (FPD;mg < 4mm) and mass median aerodynamic diameter (MMAD) were determined using a Next Generation Impactor at 30L/min flow and drug was analyzed by HPLC. RESULTS: The OCA II FPD values in the unwashed condition were 44.44mg with albuterol and 75.44mg with fluticasone. The FPD values in the washed condition were 43.44mg with albuterol and 70.56mg with fluticasone. The MMAD values from the OCA II in the unwashed condition were 2.38mm with albuterol and 2.63mm with fluticasone. The MMAD values in the washed condition were: 2.27mm with albuterol and 2.57mm with fluticasone. The washed and unwashed results were substantially equivalent. CONCLUSIONS: The OCA II offers consistent and reliable drug delivery whether washed or unwashed. These findings demonstrate that an Ôout of the boxÕ OCA II delivers a dependable output of medication without the extra step of washing. 1] Somaraju, S et al. Comparison of Aerosol Performance Output from Anti-Static Valve Holding Chambers using HFA Metered Dose Inhaler Formulations. Proceedings of AARC2008 Annual congress. In-Press.
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Usefulness of Inmunoglobulin E Antibody Levels to Recombinant Fel d 1 in Predicting the Cat Specific Bronchial Provocation Test Results J. C. Jaramillo, M. J. Sa´nchez-Gonza´lez, N. Blanca-Lo´pez, M. A. Jime´nez, J. Rodrı´guez, P. Daroca, C. Ferna´ndez; Hospital 12 de Octubre, Madrid, Spain. RATIONALE: Recombinant Fel d 1(rFel d 1) could be a good candidate for replacing cat dander extracts in diagnostics for cat allergy. We analyze this topic in asthmatic patients sensitized to cat using the specific bronchial provocation test (BPT) results as reference. METHODS: Thirty-nine asthmatic patients (mean age 31.2 6 8.4 years) with positive results for skin prick testing (SPT) and/or detectable cat allergens serum specific IgE (CAP -System FEIA) underwent a BPT with cat epithelium. In addition, sera were tested for specific IgE to rFel d 1 (InmunoCAP PHADIA). The cut off point for a positive result of both in vitro tests was 0.35 kUA/l. Statistical analysis of results was carried out by Receiver Operating Characteristics (ROC) curves. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were also calculated for both in vitro tests. RESULTS: Cat epithelium BPT was positive in 24 subjects. The area under the curve for rFel d 1 was 0.839 (CI 0.70-0.97), and 0.836 (CI 0.70-0.96) (p 5 0.959) for cat allergen specific IgE. For rFel d 1 91.6% sensitivity, 40% specificity, 70% PPV and 75% NPV were obtained, for cat specific IgE 100% sensitivity, 6.67% specificity, 63% PPV and 100%NPV. CONCLUSIONS: Cat epithelium and rFel d 1 serum-specific IgE are useful tests in predicting the outcome of cat specific BPT. Both tests have similar efficacy; however rFel d1 seems to be more accurate to rule out specific bronchial hyperreactivity.
J ALLERGY CLIN IMMUNOL FEBRUARY 2009
15
Serum Tryptase levels in Aspirin-Exacerbated Respiratory Disease (AERD) J. Park, J. Lee, S. Park, D. Kim, A. Jang, C. Park; Soonchunhyang University Bucheon Hospital, Bucheon, Gyeonggi Do, Republic of Korea. RATIONALE: Tryptase, a serine protease, is major secretory products of mast cell. Intrinsic differences in mast cell activation have been suggested to predispose some individuals to anaphylaxis and airway inflammation. We investigated the relation of tryptase with AERD. METHODS: The asthmatics (n 5 61) underwent the oral aspirin challenge (OAC). OAC reactions were categorized into 2 groups as follows: 20% or greater decreases in FEV1 or 15% to 19% decreases in FEV1 with extrarbronchial reactions(naso-ocular or cutaneous) (Y, n 5 32) and 15% less decreases in FEV1 (N, n 5 15). Y (n 5 32) group were treated with leukotriene modifier drug daily followed by OAC after 12 weeks later. All patients underwent asthma treatment according to GINA guideline.We measured serum tryptase at the day of OAC, before ingestion of aspirin and the last time. RESULTS: 1) The mean of serum tryptase levels before ingestion of aspirin at the day of OAC were no significantly differences between Y group and N group(11.8 6 3.8 vs 4.9 6 1.0 (ug/l), P 5 0.232). 2) The patients with relatively high serum tryptase levels before ingestion of aspirin (n 5 6) were in Y group and serum tryptase levels of them significantly decreased at the last time of OAC (p 5 0.028). 3) In Y group, the patients with relatively high serum tryptase levels (n 5 6) showed more increased serum tryptase levels at the day of OAC after 12 weeks than did the others (n 5 26) and more pronounced decrease in FEV1% after OAC at 12 weeks later than did the others (23.3 6 6.8% vs 7.9 6 1.9%, p 5 0.016). CONCLUSIONS: The serum tryptase was related to aspirin induced bronchospasm and progression of AERD.
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Induced Sputum In Chronic Cough. N. Lukan1, O. Racz1, R. Pullmann2, J. Petrovicova1; 1Safarik University, Kosice, Slovakia, 2Commenius University, Martin, Slovakia. RATIONALE: Induced sputum is one of basic non-invasive procedures allowing to estimate the intensity of inflammation. Sputum contains beside cells also proteins as eosinophilic cationic protein (ECP) and many others. The aim of presented work was to estimate which parameter could be more sensitive in assessment of inflammation intensity in chronic dry cough. METHODS: Fifty-eight patients (mean age 41.6 6 15.1 years; range 16-75 years; F/M:43/15) with chronic dry cough lasting more than eight weeks were included in this study. Patients with cardiogenic, postinfectious cough and GERD were eliminated. Presence of eosinophiles and neutrophiles in induced sputum, ECP and oxidative stress as free radicals (FR) were estimated. RESULTS: Eosinophil white cells were present in sputum of 33 (56.9%) patients, whereas neutrophiles almost in all of them (54 patients-93.1%). ANOVA analysis showed significant difference between patients without eosinophiles and those with high number of eosinophiles. On the other side ECP concentration was also elevated (19.0 6 27.51 mg/l) in patients without eosinophiles in induced sputum. Free radical concentration was also elevated in the group with high number of eosinophiles but did not show any association with the presence and number of neutrophiles in the sputum. CONCLUSIONS: Complex analysis of parameters of induced sputum can be helpful in assessment of airway inflammation. Our results show that eosinophilic cationic protein is a more sensitive parameter than the presence of cells in induced sputum. The estimation of free radicals in sputum provides little added value.