Contents

Editors In Memoriam Foreword Preface Contributing , Authors 1 , .Review., of., .Immunology 2. Evaluation .and. Management .of. Immune D.e.f'c. .e.n.c.y.jn A e.rgy Pracii.ce 3. Immunology. of IgE mediaied and .O.t.her ,Hype,rsensitiv,ity States.,, C. Raymond Zeiss and Jacob J. Pruzansky 4. .Biochemical, Mediators. of. . Allergic . .Reactions 6. .A erge.ns and., .OtherFactor Important in Atopic Disease 7 .Airborne Pollen Prevalencejn the. United. states 8. .Diagnosis. .oLImmediate,...

Immunologic Screening Tests

Initial laboratory tests that may indicate that a patient has an immune deficiency can be done in most regional laboratories and community hospitals, and the results should be available in a few days. These should include measurement of the major immunoglobulins and IgG subclasses. In adults, serum protein electrophoresis should also be included because patients with monoclonal gammopathy, multiple myeloma, or chronic lymphocytic leukemia (CLL) may have antibody deficiency with a normal total...

Indications For An Immunologic Workup

Although many immune-deficient patients present with a clear history of distinct episodes of infection, the allergist is frequently called on to see patients with less severe, nonspecific symptoms such as nasal stuffiness, chronic and recurrent rhinorrhea, or cough, which may be due to infection, allergy, or other factors. The first step in sorting out such complaints is to try to distinguish whether the symptoms are, in fact, due to infection. Inciting factors, such as seasonality, and clearly...

Autoimmunity

Autoimmune diseases involve the development of antibody or cell-mediated immune responses directed against self antigens ( 88,92). In many autoimmune diseases, an individual's risk is affected by his or her HLA genes (2,3 and 4,93,94). There are several possible scenarios under which such undesirable responses might be initiated. Autoimmune responses may arise when antigens that have been normally sequestered from the immune system (e.g., in immunologically privileged sites) are exposed as a...

Documenting The History Of Infection

A major goal in questioning the patient and reviewing the medical records is to develop a firm impression of the types of infections that the patient has suffered so that subsequent laboratory tests can be targeted to analyze specifically those components of the immune system whose defects would most likely explain the patient's symptoms. This will be best served by keeping in mind general patterns of infection that might be caused by defects in specific immunologic defense mechanisms. Thus,...

Detailed Immunologic Laboratory Evaluation

Although frank hypogammaglobulinemia, neutropenia, and complete deficiency of a component of the classic complement pathway can be detected by the screening laboratory tests described previously, more detailed testing is necessary to detect more subtle immune deficiencies. This level of testing is also frequently necessary to characterize severe defects more completely. Because of the possibility that clinically significant antibody deficiency may be present even when the total serum...

House Dust And Dust Mites

House dust has been recognized as an allergen for many centuries. In 1921, Kern (153) demonstrated that house dust extracts produced positive skin test results in many patients with asthma. In 1964, Voorhorst and co-workers reexamined and subsequently expanded the knowledge of the relationships among house dust, mites, and human allergic disorders (154). These Dutch workers are to be credited with sparking the worldwide interest in mites as allergens. Miyamoto and associates in Japan...

Grasses Poaceae

Grasses are monocotyledons of the family Poaceae (or Gramineae). The flowers usually are perfect ( Fig 6,7. and Fig, 6,8) Pollen grains of most allergenic grasses are 20 to 25 pm in diameter, with one germinal pore or furrow and a thick intine (Fig.B.S) Some grasses are self-pollinated and therefore noncontributory to allergies. The others are wind pollinated, but of the more than 1,000 species in North America, only a few are significant in producing allergic symptoms. Those few, however, are...

Chapter References

Innate immune recognition mechanisms and pathways. Immunol Rev 2000 173 89. 2. Klein J, HorejSi V. Immunology. Malden, MA Blackwell Scientific, 1997. 3. Roitt I. Essential immunology. 9th ed. Malden, MA Blackwell Scientific, 1997. 4. Janeway CA, Travers P, Walport M, et al. Immunobiology the immune system in health and disease. 4th ed. New York Garland, 1999. 5. Audibert FM, Lise LD. Adjuvants current status, clinical perspectives and future prospects. Immunol Today...

Trees Gymnosperms

Trees may be gymnosperms or angiosperms. The gymnosperms include two orders, the Coniferales (conifers) and the Ginkgoales. Neither are of particular importance in allergy, but because of the prevalence of conifers and the incidence of their pollens in surveys, some comments are in order. Conifers grow mainly in temperate climates. They have needle-shaped leaves. The following three families are germane to this discussion. Pinaceae (Pines, Spruces, Firs, and Hemlocks) Pines are monoecious...

Insects

Insects were recognized as inhalant allergens long before mites (which are arachnids, not insects) came to the foreground. Cockroaches have been described as allergens based on skin test data in allergic persons ( 217). Kang and associates (218) extended this work to include RASTs and bronchoprovocation studies to further implicate cockroach-associated materials as asthmagenic. Asthmatics with positive skin-prick test results to cockroach extracts have been reported to have higher total serum...

Epithelial And Other Animal Allergens

The category of animal allergens includes animal emanations hair, dander, feathers, saliva, and urine. Because domestic animals are widespread in our society and some of their emanations are potent allergens, the topic is important for the allergist. Occupational exposure of farmers, veterinarians, and laboratory workers has economic importance. Social and family interactions may be strained severely when one person becomes allergic to a beloved family pet. The allergist often is called on to...

The Atopic State and the TH2 Paradigm

Extensive evidence has accumulated that may define the underlying immunologic basis for the atopic phenotype, that is, individuals with allergic asthma, allergic rhinitis, and atopic eczema (24). The atopic condition can be viewed as a TH2 lymphocyte-driven response to allergens of complex genetic and environmental origins (36). The reciprocal action of IL-4 and IFN-g on IgE production led to several studies on the T-cell origin of these cytokines. Mosmann and Coffman ( 37) described two...

Industrial And Occupational Chemicals And Air Pollutants

The isocyanates are used in the manufacture of polyurethane and are often found in the paint and printing industries. Isocyanates are the most common cause of occupational asthma in the world. Toluene diisocyanate causes asthma in some workers (5 -10 ) in the plastics and electronic industries, but it does not affect members of the general public who use polyurethane. The mechanism of toluene diisocyanate asthma has been studied extensively. There is some evidence for an immune reaction, but...

In Memoriam W James Metzger Jr MD October 30 1945November 17 2000

Jim was a fellow at Northwestern University from 1974 to 1976 and spent his career in academic medicine at the University of Iowa and East Carolina Medical School where he was Division Chief of Allergy Asthma and Immunology and Vice-Chair of the Department of Medicine. He moved to Denver to the National Jewish Hospital in the months before he became ill. He was an author in three editions of Allergic Diseases. Jim had many accomplishments in Allergy-Immunology including the early discovery that...