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Various authors have linked IgG4 antibodies to biological activities that are apparently contradictory in different studies. On one hand, it has been confirmed that during immunotherapy with inhalant and Hymenoptera venom antigens, an increase is produced in specific IgG4 levels. On the other hand, it has been suggested that these antibodies can intervene in hypersensitivity reactions, basically when these are directed against food antigens. We studied IgG4 levels against milk and egg fractions in patients with atopic dermatitis (AD) (n = 23), and in healthy individuals (n = 20). Patients with AD had significantly much higher IgG4 levels against egg white (24.16 micrograms/ml), egg yolk (9.96 micrograms/ml) and beta-lactoglobulin (10 micrograms/ml) than those found in healthy individuals (6.75, 3.12, 3.35 micrograms/ml, respectively), with no significant differences for alpha-lactalbumin and casein. Patients with AD without hypersensitivity to egg and milk, at the moment of the study, also had significantly higher levels than those of control individuals, against egg white (27.11 micrograms/ml), egg yolk (12 micrograms/ml) and beta-lactoglobulin (11.72 micrograms/ml). There were no differences in IgG4 levels against alpha-lactalbumin, beta-lactoglobulin and casein, when comparing patients with AD and hypersensitivity to milk, and patients with AD without present hypersensitivity to milk. We concluded that patients with AD presented high IgG4 levels against egg and milk fractions, in relation to the healthy population, and that the fraction of milk with the highest antigenic potency was beta-lactoglobulin.

Among the rare foods capable of producing food allergies is the snail (Helix terrestre). The snail is a delicacy eaten in Spain, France and Portugal. This study presents the findings of an allergic study of 10 patients with this infrequent food allergy during the past 10 years. The shock organ in the majority (80%) of these patients was the bronchial tree. Six of them did not have any digestive or skin symptoms which are usually seen in cases of food allergy. All patients manifested the symptomatology after ingestion of Helix terrestre. Two also had reactions after eating Patella vulgata (limpet). The snail and the limpet are within the phylogenetic line of molluscs, i.e. of gastropods. All patients tolerated the ingestion of cephalopods and bivalves which belong to two other phylogenetic lines. Skin tests to seafoods (squids, prawns, lobsters and clams) were negative for all patients. This suggests that the sensitizing antigen is probably a protein found only in gastropod molluscs. Skin tests along with the histamine release test were valid diagnostic methods for this food allergy. The limited bibliography on this subject is probably due to the fact that the consumption of snails as well as limpets is limited to specific geographical areas.

One hundred and forty four patients, with dermal reactions to different drugs, were chosen from our clinic. The selection criteria was based on a detailed and careful anamnesis in order to be certain of the specific drug responsible for the reaction. We tried to establish a drug-specific reaction pattern for each of the drugs studied. Intradermal skin tests were performed with all drugs to be studied, except with pyrazolones and aspirin, for which patch tests were applied. The drug concentrations were established prior to the tests in order to avoid unwanted unspecific reactions. In every case, immediate and delayed reaction readings were carried out. A three crosses reaction (+++) was considered positive. The skin tests were positive in 44% of the cases, a value higher than those referred to by most authors. The delayed reactions to skin tests and the chloramphenicol-mediated delayed-type "dermatitis-like" manifestations are compared. It is noteworthy to mention that positive delayed reactions were observed more frequently with chloramphenicol than with any of the other studied drugs. The same applies for those patients with a positive history to chloramphenicol. The most common reaction pattern to penicillin and streptomycin in our series (20%) were urticaria and Quincke's edema. Penicillin, pyrazolones and streptomycin were the most common drugs responsible for urticarial patterns, being the pyrazolones related to fixed erythema in many cases. The age group 25-50 was the most frequently involved. No sex predominance was observed. The value of the classic skin tests is discussed, so are history recording and the in vitro tests.

We selected 38 symptomatic pollen-sensitive rhinitic patients without bronchial pathology and with normal pulmonary functional study (volume flow curve). A control group consisting of 10 individuals was studied adjacently. The study was performed within the pollen season. The determination of Raw value was carried out through increasing doses of histamine challenge employing the Apta-Jaeger apparatus. The results were expressed in PC20 wherein 26% of the pollen-affected patients presented bronchial hyperreactivity (positive histamine bronchial provocation test). In this group the values of basal Raw were found to be increased with respect to the control group (p less than 0.025) and pollen-sensitive patients with negative histamine bronchial provocation test (p less than 0.01). On the other hand, the pollen-sensitive group with negative response to histamine bronchial challenge presented Raw values which were similar to the control group.

This clinical entity described for the first time by Osler in 1888 presented a great therapeutic problem during many decades because of its severity. Landerman and later on Donaldson and Evans established the pathogenic mechanisms of this disease finding a deficiency in the inhibitor of the first activated component of complement, an alpha 2 aminoglycoprotein, to be the mechanism responsible of the same. More concretely, alterations in the plasmin, kinin and kallikrein systems are those that will lead to a change in vascular permeability with resultant tissue alterations. Four cases of hereditary angioneurotic edema are studied in female patients aged between 15 and 50 years and with family history consistent with angioneurotic familiar edema in which there were six cases of death due to edema of the glottis. Once the diagnosis had been made the patients were subjected to treatment with EACA at doses of 2.5 gm every 6 hours. The determinations of complement were similar in the four cases, with marked decreases in C4 and C1 inhibitor with a decrease in total complement in three cases. Regarding secondary effects, vomiting was found only in one cases, which as the dose was reduced did not necessitate termination of treatment. In summary, considering the results obtained in the cases above, we believe that due to its good tolerance and moderate cost, epsilon-amino-caproic acid at the abovementioned dosage is an excellent pharmacological agent in the treatment of Osler's hereditary angioneurotic edema.

We decided in this work to evaluate the prophylactic value of carbuterol in exercise-induced asthma (EIA), comparing this drug to salbutamol and DSCG in order to describe its usefulness in exercise-induced asthma, while employing the closing-pressure method for the early detection of airway constriction. The study involved 44 bronchial asthmatics with prior histories of EIA. Only 10 patients had noticeable symptoms after exercise. All patients were asymptomatic and without any medication for at least one week prior to the commencement of the study. A continuous running treadmill was chosen for the exercise test, and a 10 minute time-period with a maximum heart rate of 180 beats/min. was the limit. Measurements of the FEV1, PEF and Raw were also done. Drug therapy was carried out by administering 10.5 mg of carbuterol, or 4 mg of salbutamol orally, 1.5 hours, before the exercise, or a 20 mg DSCG capsule, 30 minutes also prior to exercise. We concluded that: DSCG is the drug of choice in the control of EIA, while salbutamol results were somewhat less effective. Orally administered carbuterol did not provide any protection effect as expected. Raw measurements enter as a new parameter for consideration in this type of disease, being entirely compatible with FEV1 and PEF values during assessment.

One hundred and seventy eight healthy individuals, smokers and non-smokers of both sexes were studied, grouping them according to the parameters of age, height, weight and body surface, with the aim to prepare a standard table of airway resistance. The method was performed with the apparatus APTA (Jaëger) based upon the closing pressure technique. Regarding resistance, the average value obtained was 0.66790 Kpc/L/sec-1 with a standard deviation of 0.26773. With respect to the statistical study, no significant correlations were found among the parameters of sex, age, weight, body surface and smoking habits in relation with airway resistance. Nevertheless, we obtained an inverse significant correlation between variables of height and airway resistance. As a consequence, a study of linear correlation was done between height and airway resistance, bringing about the correlation coefficient such as the equation of linear regression wherein we obtained the lines of regression and the formula of the equation.

Following the acceptance of the interrupter technique as one of the most sensitive in determining airway resistance, we decided to conduct a comparative study between healthy subjects and those patients with respiratory illness, in the varieties rhinitis and bronchial asthma. The study included 125 patients with respiratory illness, 42 diagnosed as having rhinitis and 83 with bronchial asthma with or without associated rhinitis. These groups were divided into symptomatic and asymptomatic at the time of the study. Hundred and eighty individuals were selected as a control group. A significant difference can be seen between the values for airway resistance of the control group (means = 0,651 7 kpc/l./sec.-1) and those with symptomatic rhinitis (means = 0,7732 kpc/l./sec.-1) or symptomatic bronchial asthma (means = 1,2602 kpc/l./sec-1). Values for airway resistance in asymptomatic patients (rhinitis and bronchial asthma) are similar to the control group. The rhinitis group which was clinically symptomatic at the beginning of the study was divided into two groups according to whether the airway resistance was within +/- 1 standard deviation of the mean or elevated analysis showed a statistical difference between the two groups. This makes us think that we are dealing here with distinct groups.

A newly developed mode of vaccination with bacterial ribosomal antigens was evaluated in 83 patients with bacterial bronchial asthma. The response of the immune system to two years of immunotherapy was studied by serial determinations, every six months, of the following parameters: E; Ea and EAC rosettes; B-cell surface immunoglobulins; PHA-induced blast transformation, and IgG, IgA, IGM, IgD and IgE immunoglobulins. At basal conditions, patients showed a slight depression in the function of cell-mediated immunity, an increase in Ea rosette formation and decreased values of IgA. After vaccination with ribosomal antigens, an enhanced T-cell response to PHA was observed, followed by normal values of Ea rosettes and increased values of IgA. A statistically significant correlation (p less than 0.001) was evident between Ea rosettes and IgA. Nearly half of the bacterial asthmatic patients in our series presented elevated levels of IgE (greater than 125 U/ml) that remained unchanged even after specific treatment. The immunomodulating action of bacterial ribosomal therapy is discussed.