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The results are reported of an immunological study conducted on 37 cases of active sarcoidosis, in which some in vivo and in vitro tests related to the cell-mediated immunitary response were effected. The results are discussed, with relation to the clinical use of the immunological tests adopted, and their immunopathogenetic significance. In particular, the occurrence of false-positive and false-negative results in the in vitro Kveim antigen test (LMT) using the antigen preparations currently available, limit its use in clinical practice.

Bronchoalveolar lavage (BAL) was performed in a group of 25 patients with pulmonary sarcoidosis in order to monitor variations in alveolar lymphocytes (AL) in comparison to the clinical evolution of the disease. Two BAL were performed in each patient, the second 6-12 months after the first (8.9 +/- 3, M +/- SD). Twelve patients were classified as improved and 13 as unimproved on the basis of a score of changes in the clinical picture, x-ray, respiratory function, immunological and biochemical tests. There was a significant decrease (p less than 0.001) of the percentage of AL in 66% of cases in the improved group, but not in the unimproved group, where, on the contrary, it was possible to observe an increase in the percentage of AL in 46% of these cases (n.s.). In 9 of 11 patients followed for 1-5 years with at least 3 BAL, AL behaviour correlated with clinical evolution. On the basis of the parameters studied, it was possible to show a correlation between lymphocytes, alveolitis and clinical evolution, especially in patients with an improved course. While a single BAL does not seem to be sufficient to show the course of the disease, repeated long-term washings allow a more accurate staging of sarcoidosis and can give early warning of relapses even when the conventional parameters (clinical, radiological and functional) are unchanged. Our aim was to look for a simpler parameter, which could be used routinely by even unspecialized laboratories, who are not able to type lymphocytes.

Circulating immune complexes (CIC) were found in 47% of 71 patients before treatment, in a horizontal study of the presence of CIC in primary lung cancer (PLC). The precipitation technique in PEG was used, and C1q, IgG and IgM fractions in the precipitate were assayed. Especially in epidermoid carcinoma, CIC were found in 1/6 cases with stage 1, 2/9 with stage II and 21/34 with stage III. The frequency was significantly higher in stage III cases, and showed a significant tendency to increase with progression of the clinical stage. If stage parameters are considered separately, this tendency correlates significantly (p less than 0.002) with the amount of lymph node involvement (N) but not to the tumor (T) size nor to the presence of metastases (M). Analysis of CIC behavior in comparison with the single fractions showed that C1q and/or IgG were elevated in 40% of cases. The presence of C1q and/or IgG associated with IgM is more characteristic of stage N2, while the presence of CIC with the fractions C1q and/or IgG not associated with IgM is more frequent in stage N1. There was a lower survival rate at 12 months in patients with CIC as compared to those without (p less than 0.05).

Eight hundred and two consecutive symptomatic outpatients (with asthma and rhinitis) were studied to evaluate the incidence of prick test positivity to cat and dog danders and the association of exposure to these animals in the home, as revealed by a standard questionnaire. 14.3% were found to be skin positive to cat and/or dog danders. The incidence of cutaneous hypersensitivity to cat and/or dog danders was 25% in the 216 subjects who kept animals, significantly higher (p less than 0.0005) than the 10.4% of 586 subjects who did not keep animals. In the 57 subjects who owned both dogs and cats, a significantly higher incidence of skin hypersensitivity was found compared to the other subjects. Our data does not demonstrate a greater incidence in sensitivity to cat danders compared to dog danders, or increased sensitization to dermatophagoides pteronyssinus, nor a different incidence of clinical manifestations (asthma and rhinitis) between those with animals in the house and those without.