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Our aim was to investigate the usefulness of circulating levels of adrenocorticotropic hormone (ACTH) and also salivary cortisol to monitor cortisone substitution in patients with Addison's disease. 13 patients with primary adrenal insufficiency (8 women and 5 men, age 44 ± 11 years) received 12.5 mg cortisone acetate orally at 16:00 h and 25 mg at 07:00 h. Blood samples for cortisol and ACTH analysis were drawn every hour for 24 h, and also every half hour between 07:00 and 12:00 h. Samples for salivary cortisol were collected in parallel. Total ACTH levels showed large inter-individual variations and a diurnal rhythm with a nadir in the early evening at 19:00 (median 19 ng/l, range 2-434 ng/l) and high levels in the early morning, with a peak around 07:30 (median 844 ng/l, range 45-2,249 ng/l). Plasma cortisol concentrations showed 2 peaks distinct in time, but variable in height, 1-2 h after intake of cortisone. Plasma cortisol correlated significantly with ln(ACTH) at 17:00 h (r=-0.56), at 10:00 h (r=-0.51), and at 10.30 h (r=-0.57). When tested at different time points, ln(ACTH) at 10:00 to 12:00 h was negatively correlated with plasma cortisol between 08:30 and 12:00 h. Plasma cortisol was highly correlated to ln(salivary cortisol) most of the time points measured, but 30-60 min after intake of cortisone acetate the correlation disappeared. In conclusion, the large interindividual variation in ACTH levels most likely indicates varying sensitivity to cortisol with a need for individualized dosing schemes. Furthermore ACTH-determinations may be useful for dose titration of cortisol., (© Georg Thieme Verlag KG Stuttgart · New York.)

The aim of this study was to investigate if unsupervised measurement of saliva secretion could be used instead of supervised measurement at the dental clinic. One hundred patients attending a dental clinic for regular dental care were asked to participate (group A). A control group of 40 subjects was recruited (group B). Saliva samples were collected and stimulated saliva secretion rates were determined. After instruction, subjects in both groups collected the first sample at day 1 at the dental clinic. Subjects in group A continued to collect 2 more samples at day 1 and 3 samples at each of day 3 and day 5 outside the clinic. Subjects in group B did 3 saliva samplings at day 1, day 3, and day 5 under supervision at the dental clinic. In total 9 samples from each subject were collected. Median secretion rates in group A were, in day 1, 2.1 ml/min (range: 0.1-5.1); day 3, 1.9 ml/min (range: 0.1-5.3); and day 5, 1.9 ml/min (range: 0.1-5.5). Corresponding rates in group B were, in day 1, 2.1 ml/min (range: 0.6-4.4); day 3, 2.0 ml/min (range: 0.7-4.6); and day 5, 2.0 ml/min (range: 0.9-4.1). No significant difference in secretion rates appeared between groups A and B at day 1, 3, and 5 or during the 5 days of observations. Analysis of intra-individual differences in secretion rates showed that in group Athere was a significant difference between measurements, while in group B measurements did not differ significantly. The intra-individual variation expressed as mean coefficient of variation during the 5-day period was 20.4% in group A and 17.3% in group B. In conclusion, measurement of saliva secretion capacity under unsupervised conditions may be a feasible method to judge saliva secretion capacity in clinical practice.

Knowledge of the determinants of use of formal home-based services among older people is of particular importance for predicting the need for and cost of care in the future. The aim of this study was to estimate the frequency of formal and informal help among community-dwelling older people and to assess the determinants of home-based formal help, with a special emphasis on the frequency of help from spouse, from children and other relatives and friends. We used nationally representative cross-sectional data from 1,166 community-dwelling Finnish persons aged 70-99. Determinants of formal help were assessed with logistic regression models. Receiving formal help was most strongly related to need factors such as age and functional capacity. Adjusted for need factors, receiving help from spouse or living with someone else than the spouse decreased the odds of receiving formal help. In contrast, the more frequently the children helped, the larger were the odds of receiving formal home-based help. Help from other informal sources did not affect receipt of formal help. Our results thus suggest that intra-household help from spouse or from other co-residents may partly offset expected cost increases in the formal care sector brought about by an aging population. The results further suggest that help from children and help from formal sources is likely to be concomitant and that children may act as agents seeking formal help also in a welfare state based on the universal and equal care services.

We studied whether migration influences the relationship between area socioeconomic structure and mortality. We used data on Finns aged 25-64 that are linked to information on proportions of manual workers in 85 functional regions in 1987 and 1997, and on deaths in 1998-2004. Participants aged 25-44 moving to areas with a lower proportion of manual workers had lower mortality and those moving to areas with a higher proportion of manual workers had mortality similar to those residing in these areas at both time points. Among the 45-64-year-olds, all migrants between areas had increased mortality. However, because these mortality differences and the migratory flows were relatively small, their effects on area socioeconomic differences in mortality were also small.

Objectives: To estimate changes in the total and independent effects of education and occupational social class on mortality over 30 years, and to assess the causes of changes in the independent effects., Methods: Census records linked with death records for 1971-2000 for all Finns aged 30-59 years were studied. The total and independent effects of education and social class on mortality were calculated from relative risks in nested Poisson regression models., Results: Among men and women, the model shows that the total effects of education, and particularly occupational social class on mortality, have increased over time. Among 40-59-year-old people, the effects of education are currently less independent of social class than in the 1970s, but among younger Finns the independent effects have remained stable. The effects of social class on mortality that are independent of education have grown among people of older ages, particularly among men., Conclusions: Changes in the independent effects of socioeconomic measures on mortality are determined by changes in their associations with mortality, and distributional changes that affect the strength of the associations between these measures. Distributional changes are driven by changes in educational systems and labour markets, and are of major importance for the understanding of socioeconomic inequalities in mortality.

In recent years, an increasing number of applications involving fast neutrons have been developed or are under consideration, e.g. radiation treatment of cancer, neutron dosimetry at commercial aircraft altitudes, soft-error effects in computer memories, accelerator-driven transmutation of nuclear waste and energy production and determination of the response of neutron detectors. Data on light-ion production in light nuclei such as carbon, nitrogen and oxygen are particularly important in calculations of dose distributions in human tissue for radiation therapy at neutron beams, and for dosimetry of high-energy neutrons produced by high-energy cosmic radiation interacting with nuclei (nitrogen and oxygen) in the atmosphere. When studying neutron dose effects, it is especially important to consider carbon and oxygen, since they are, by weight, the most abundant elements in human tissue. Preliminary experimental double-differential cross sections of inclusive light-ion (p, d, t, (3)He and alpha) production in carbon induced by 96-MeV neutrons have been presented. Energy spectra were measured at eight laboratory angles: 20, 40, 60, 80, 100, 120, 140 and 160 degrees. Measurements were performed at The Svedberg Laboratory (TSL), Uppsala, using the dedicated MEDLEY experimental setup. The authors have earlier reported experimental double-differential cross sections of inclusive light-ion production in oxygen. In this paper, the deduced kerma coefficients for oxygen has been presented and compared with reaction model calculations.

The European Commission is funding within its Sixth Framework Programme a three-year project (2005-2007) called CONRAD, COordinated Network for RAdiation Dosimetry. The organisational framework for this project is provided by the European Radiation Dosimetry Group EURADOS. One task within the CONRAD project, Work Package 6 (WP6), was to provide a report outlining research needs and research activities within Europe to develop new and improved methods and techniques for the characterisation of complex radiation fields at workplaces around high-energy accelerators, but also at the next generation of thermonuclear fusion facilities. The paper provides an overview of the report, which will be available as CERN Yellow Report.

The present status of neutron beam production techniques above 20 MeV is discussed. Presently, two main methods are used; white beams and quasi-monoenergetic beams. The performances of these two techniques are discussed, as well as the use of such facilities for measurements of nuclear data for fundamental and applied research. Recently, two novel ideas on how to produce extremely intense neutron beams in the 100-500 MeV range have been proposed. Decay in flight of beta delayed neutron-emitting nuclei could provide beam intensities five orders of magnitudes larger than present facilities. A typical neutron energy spectrum would be essentially monoenergetic, i.e., the energy spread is about 1 MeV with essentially no low-energy tail. A second option would be to produce beams of (6)He and dissociate the (6)He nuclei into alpha particles and neutrons. The basic features of these concepts are outlined, and the potential for improved nuclear data research is discussed.

A liquid scintillation detector aimed for neutron energy and fluence measurements in the energy region <20 MeV has been calibrated using monoenergetic and white spectrum neutron fields. Careful measurements of the proton light output function and the response matrix have been performed allowing for the application of unfolding techniques using existing codes. The response matrix is used to characterise monoenergetic neutron fields produced by the T(d,n) at a low-energy deuteron accelerator installed at the Swedish Defense Research Agency (FOI).

Double-differential cross-sections for light-ion production (up to A = 4) induced by 96 MeV neutrons have been measured for Fe, Pb and U. The experiments have been performed at The Svedberg Laboratory in Uppsala, using two independent devices, MEDLEY and SCANDAL. The recorded data cover a wide angular range (20 degrees -160 degrees ) with low energy thresholds. The data have been normalised to obtain cross-sections using np elastic scattering events. The latter have been recorded with the same setup, and results for this measurement are reported. The work was performed within the HINDAS collaboration with the primary aim of improving the database for three of the most important nuclei for incineration of nuclear waste with accelerator-driven systems. The obtained cross-section data are of particular interest for the understanding of the so-called pre-equilibrium stage in a nuclear reaction and will be compared with model calculations.

A new quasi-monoenergetic neutron beam facility has been constructed at The Svedberg Laboratory (TSL) in Uppsala, Sweden. Key features include a neutron energy range of 11-175 MeV, high fluxes, user flux control, flexible neutron field size and shape, and spacious and easily accessible user area. The first results of the beam characterisation measurements are reported.

Elastic neutron scattering from (12)C, (14)N, (16)O, (28)Si, (40)Ca, (56)Fe, (89)Y and (208)Pb has been studied at 96 MeV in the10-70 degrees interval, using the SCANDAL (SCAttered Nucleon Detection AssembLy) facility. The results for (12)C and (208)Pb have recently been published, while the data on the other nuclei are under analysis. The achieved energy resolution, 3.7 MeV, is about an order of magnitude better than for any previous experiment above 65 MeV incident energy. A novel method for normalisation of the absolute scale of the cross section has been used. The estimated normalisation uncertainty, 3%, is unprecedented for a neutron-induced differential cross section measurement on a nuclear target. Elastic neutron scattering is of utmost importance for a vast number of applications. Besides its fundamental importance as a laboratory for tests of isospin dependence in the nucleon-nucleon, and nucleon-nucleus, interaction, knowledge of the optical potentials derived from elastic scattering come into play in virtually every application where a detailed understanding of nuclear processes is important. Applications for these measurements are dose effects due to fast neutrons, including fast neutron therapy, as well as nuclear waste incineration and single event upsets in electronics. The results at light nuclei of medical relevance ((12)C, (14)N and (16)O) are presented separately. In the present contribution, results on the heavier nuclei are presented, among which several are of relevance to shielding of fast neutrons.

In fast neutron cancer therapy, approximately 50% of the cell damage is caused by recoil protons from neutron-proton (np) scattering. In the intermediate energy region, there is a need for unambiguous np scattering data with good precision in both the shape of the angular distribution and the absolute normalisation. The normalisation techniques have been reviewed for np scattering measurements as well as recent experimental results, particularly the data obtained at The Svedberg Laboratory at 96 and 162 MeV. In addition, to what extent systematic uncertainties in the np differential cross section might affect the determination of proton recoil kerma coefficients is investigated.

Recently, many new applications of fast neutrons are emerging or under development, like dose effects due to cosmic ray neutrons for airplane crew, fast neutron cancer therapy, studies of electronics failure induced by cosmic ray neutrons and accelerator-driven incineration of nuclear waste and energy production technologies. In radiation treatment, the kerma (Kinetic energy release in matter) coefficient, which describes the average energy transferred from neutrons to charged particles, is widely used. The kerma coefficient can be calculated from microscopic nuclear data. Nuclear data above 20 MeV are rather scarce, and more complete nuclear data libraries are needed in order to improve the understanding of the processes occurring on a cellular level. About half the dose in human tissue due to fast neutrons comes from proton recoils in neutron-proton (np) scattering, 10-15% from nuclear recoils due to elastic and inelastic neutron scattering and the remaining 35-40% from neutron-induced emission of light ions. Experimental data on elastic and inelastic neutron scattering at 96 MeV from (12)C and (16)O have been obtained recently at The Svedberg Laboratory in Uppsala, Sweden. These data are shown to be relevant for the determination of nuclear recoil kerma coefficients from elastic and inelastic neutron scattering at intermediate energies.

We describe a double-scattering experiment with a novel tagged neutron beam to measure differential cross sections for np backscattering to better than +/-2% absolute precision. The measurement focuses on angles and energies where the cross section magnitude and angle dependence constrain the charged pion-nucleon coupling constant, but existing data show serious discrepancies among themselves and with energy-dependent partial-wave analyses. The present results are in good accord with the partial-wave analyses, but deviate systematically from other recent measurements.

We conclude that it is possible to successfully extract teeth without interrupting or reducing the dose of anticoagulant medication with warfarin. We also conclude that patients with anticoagulant medication are treated differently depending on where they have their dental treatment done.

The aim of this study is to assess to what extent selected characteristics of functional regions affect alcohol-related mortality among men in Finland after adjusting for individual-level characteristics. The study was conducted as a multilevel Poisson regression analysis, with individuals (n = 1.1 million) as the first level and functional regions of Finland (n = 84) as the second level. The analysis covered men aged 25-64. The data are based on the 1990 census records, which were linked to death records in 1991-1996. The outcome measure was alcohol-related mortality, which was defined using information on the underlying and contributory causes of death. The individual-level covariates included age, education, socioeconomic status, marital status and mother tongue. The area-level variables considered were the proportion of manual workers, unemployment level, median household income, Gini coefficient of income, family cohesion, voting turnout, level of urbanisation and proportion of Swedish-speaking inhabitants. A high proportion of manual workers and of unemployed and low social cohesion (family cohesion and voting turnout) were found to produce adverse effects on alcohol-related mortality, and the independent effects of these variables remained after adjustment for all individual-level and area-level characteristics. The protective effect of high level of urbanisation was revealed after adjustment for other individual- and area-level characteristics. Neither mean income nor income inequality were related to alcohol-related mortality. Adjusting for individual-level variables diminished the average relative deviation of alcohol-related mortality among the functional regions by 41%. The inclusion of area-level characteristics in the model resulted in a total diminution of variation of 79%. The area characteristics considered in this study had a notable effect on alcohol-related mortality, although these effects were smaller than those of the individual-level characteristics. Fuller understanding of the mechanisms underlying the effects of area measures of social structure and cohesion on risky alcohol consumption and alcohol-related mortality is needed.

Background: In 2 prior uncontrolled studies, nebulized lidocaine reduced oral glucocorticoid use in patients with severe glucocorticoid-dependent asthma., Objective: We tested the safety and efficacy of nebulized lidocaine in a randomized, placebo-controlled study in patients with mild-to-moderate asthma., Methods: We recruited 50 subjects (25 receiving lidocaine and 25 receiving placebo); all had a prebronchodilator FEV(1) of 64% to 125% of predicted normal value and were treated with daily inhaled glucocorticoids (but not systemic glucocorticoids) and bronchodilators for at least 2 months. Before treatment, subjects monitored their symptoms and peak flow values and maintained their medications for 2 weeks. At initiation, subjects inhaled either nebulized placebo (saline) or lidocaine (4%, 100 mg) 4 times daily. All subjects were instructed to reduce their inhaled glucocorticoid dosage by one half each week for 3 weeks and to discontinue glucocorticoid treatment at week 4. The subjects continued the nebulized lidocaine or placebo for a total of 8 weeks, monitored their symptoms, and used bronchodilators to control symptoms., Results: Indicators of asthma severity showed benefit for the lidocaine-treated group: changes in FEV(1) (P < or =.001), nighttime awakenings (P < or =.02), symptoms (P < or =.010), bronchodilator use (P < or =.010), and blood eosinophil counts (P < or =.020). Subjects in both groups reduced use of inhaled glucocorticoids comparably. Subjects receiving nebulized placebo showed increases in their symptom scores, bronchodilator use (P < or =.05 for both), and blood eosinophil counts (P < or =.01) and decreases in FEV(1) (P < or =.001)., Conclusion: Nebulized lidocaine provided effective and safe therapy in subjects with mild-to-moderate asthma.

Objective: To assess the usefulness of measuring plasma cortisol profiles in growth hormone-treated hypopituitary adults and to compare these with cortisol levels in healthy controls., Methods: Eleven ACTH-deficient adult patients received 12.5 mg cortisone-acetate orally at 16.00 h and 25 mg at 07.00 h. The patients arrived in the ward at 12.00 h. After tablet intake at 16.00 h, samples for serum cortisol were taken at hourly intervals for the next 24 h, except between 07.00 and 12.00 h when samples were drawn every half hour; 24-h urinary free cortisol (24-h-UFC) excretion was collected simultaneously. For comparison, 8 healthy controls were investigated., Results: The patients had circulating cortisol levels with very low plasma cortisol at 07.00 h before their morning dose of cortisone acetate. At the same time period, controls had their highest plasma cortisol levels. After tablet intake the patients had a rapid initial absorption of cortisol, but a marked variability in the morning peak levels (Cmax), and the Cmax was in general higher and occurred 90 min later than the Cmax in the controls. The 24-h-UFC excretion and 24-h area under the curve (24-h-AUC) did not differ between patients and controls. The female patients had higher 24-h-AUC for plasma cortisol (p=0.032) and tended to have higher plasma cortisol peaks in the morning, but had levels of 24-h-UFC similar to those of the male patients., Conclusions: Conventional cortisone substitution with a twice-daily replacement regimen in hypopituitary adults results in abnormal circulating cortisol profiles with low or non-measurable morning values and variable individual peaks. This suggests that the present dosing schemes have to be improved and that cortisone substitution should be individualized.

Presently, many new applications of fast neutrons are emerging or under development, like dose effects due to cosmic-ray neutrons for airplane crew, fast-neutron cancer therapy, studies of electronics failures induced by cosmic-ray neutrons, and accelerator-driven incineration of nuclear waste and energy production technologies. All these areas would benefit from improved neutron dosimetry. In this paper, the present rapid progress on measurements of double-differential neutron-induced nuclear reaction data are described. With such data at hand, the full response of, in principle, any system, including human tissue, can be calculated in detail. This could potentially revolutionise our understanding of biological effects in tissue due to fast neutrons.

The aim of this pilot study was to investigate the secretion rate from minor salivary glands in 16 patients (mean age 62 years) with myeloma, lymphoma or other malignant haematological diseases receiving chemotherapy (study group). An age- and sex-matched control group (n = 16) was recruited. The secretion rate from the minor salivary glands on the inside of the lower lip, measured using the Periotron method, was in mean 2.8 microliters/cm2/min in the study group compared with 4.5 microliters/cm2/min in the control group (p < 0.01). No difference was found in the secretion rate of paraffin-stimulated whole saliva. There were more individuals who experienced dry mouth in the study group (n = 7) than in the control group (n = 2). The conclusion from this pilot study is that the secretion rate from the minor salivary glands might be reduced in cancer patients treated with chemotherapy.

Background: Allergic rhinitis is traditionally defined as an IgE- and mast cell-mediated hypersensitivity reaction. Allergen challenge models suggest that cytokines and eosinophil mediators may also play roles. However, the causal relationship among inflammatory cells, their products, and patients' symptoms during natural allergen exposure has not been established., Objective: We sought to elucidate the mechanisms of seasonal allergic rhinitis and the beneficial effects of topical glucocorticoids., Methods: Thirty patients with ragweed-induced hay fever and a strongly positive serologic test response for ragweed IgE antibody received budesonide nasal spray or placebo in a randomized, parallel, double-blind study. Nasal wash fluids and sera were collected before and during the hay fever season. The levels of inflammatory mediators and allergen-specific immunoglobulins were measured by immunoassay. The activation markers on blood eosinophils were quantitated by flow cytometry., Results: Compared with placebo-treated patients, budesonide-treated patients had strikingly reduced symptoms. In the placebo group, nasal symptoms correlated with nasal lavage fluid eosinophil-derived neurotoxin and IL-5 levels. At the season peak, the budesonide-treated group had significantly lower nasal fluid eosinophil-derived neurotoxin, IL-5, and soluble intracellular adhesion molecule-1 levels. In the treated group eosinophil expression of CD11b was suppressed at the season peak. In contrast, levels of IL-4 and IL-6 in nasal fluid and the seasonal increases in serum ragweed-specific IgE and nasal fluid IgA antibodies did not differ between groups., Conclusion: Eosinophilic inflammation plays a critical role in seasonal allergic rhinitis symptoms. One of the therapeutic effects of glucocorticoids is to suppress this inflammation.

The efficacy of oral fluconazole versus nystatin was evaluated as a treatment modality for oral candidosis. Of the included patients (n = 60), two-thirds presented with an erythematous candidosis, and the others showed clinical signs compatible with a pseudomembranous candidosis. Predisposing factors were xerostomia (n = 18), HIV (n = 5), immunosuppression in conjunction with organ transplantation (n = 10), and wearing of dentures (n = 14). For the remaining patients no specific predisposing factors were found. One patient who was treated with nystatin was excluded owing to nausea that was related to the antifungal treatment. After 7 days of treatment with fluconazole (50 mg/day), the affected oral mucosa, assessed by the investigator, was cured or showed considerable improvement in 87% of the patients (n = 30). The corresponding figure for the nystatin group (n = 30), rinsing with 1 mL 4 times a day for 21 days, was 80%. Following treatment with fluconazole, 20 of 22 patients with symptoms at the start (91%) reported improvement. The comparable figures for the nystatin group were 10 of 12 patients (83%). Half of the patients in the nystatin group reported inconvenience from taking the medication (mean value = 25.9) compared with 23% of the patients in the fluconazole group (mean value = 6.6). Eight patients in the fluconazole group and 12 patients in the nystatin group exhibited a relapse within 6 months. These differences were not found to be statistically significant. The patients in the fluconazole group reported less inconvenience from taking the medication, a finding that may have clinical implications for compliance.

Cytokines active on eosinophils are important in the pathogenesis of allergic diseases. A study was conducted to determine if nasal eosinophilia in allergic rhinitis is associated with an increase in eosinophil-active cytokines in nasal secretions and to compare the effects of fluticasone propionate aqueous nasal spray with astemizole and placebo on the levels of these cytokines. Forty-five patients with moderately severe ragweed allergic rhinitis were randomly assigned to receive 2 weeks of treatment with fluticasone propionate aqueous nasal spray 200 micrograms once daily, astemizole 10 mg once daily, or placebo. Nasal lavage was performed in July (preseason), August (peak season), September (after 2 weeks of treatment), and October (postseason). The number of eosinophils, the amount of eosinophil-derived neurotoxin (EDN), and the amount of eosinophil survival-enhancing activity were measured. Total mean nasal symptom scores, concentrations of nasal eosinophils and EDN, and eosinophil survival-enhancing cytokine activity in nasal secretions were significantly lower after 2 weeks of treatment with fluticasone propionate compared with astemizole or placebo. Survival-enhancing activity was detected in the nasal secretions of 25 patients. By blocking activity with monoclonal antibodies, specific cytokines were identified (granulocyte macrophage-colony stimulating factor, 3 samples; interleukin-3, 2 samples; interleukin-5, 5 samples). In conclusion, eosinophil-active cytokine concentrations parallel the nasal symptoms of patients with ragweed allergic rhinitis. Unlike astemizole, fluticasone propionate significantly lowers cytokine activity in nasal tissue, which may contribute to the therapeutic efficacy of the drug.

The first case of oral hairy leukoplakia in an HIV-negative patient with multiple myeloma is reported. The patient is a 56-year old man who has had monoclonal gammopathy of undetermined significance since 1986 and has been treated for a symptomatic multiple myeloma since 1993. The clinical and histopathologic findings are typical for oral hairy leukoplakia, and Epstein-Barr virus was demonstrated with polymerase chain reaction technique. Although a relatively large number of cases of oral hairy leukoplakia has been reported in HIV-negative patients, both immunocompromised and immunocompetent, only a few of these patients have had a malignant hematologic disease.

This is a descriptive study of patients with symptomatic lichenoid-like reactions of the lips in contact with composite restorations (n = 12). Clinically, the lesions appeared as symptomatic single or multiple erythematous areas that included white papules. Candida was found by cultivation or histopathological examination in 7 of the lesions. Patch testing (n = 7) did not reveal any reactions to composite components, except for one patient who showed a delayed hypersensitivity reaction to formaldehyde. Replacement of existing dental materials parallel to antifungal treatment resulted in healing or significant improvement in 7 of 9 patients. This study shows that resin components can be associated with adverse reactions in the oral mucosa of the lips and that these reactions may be accompanied by an infection with Candida.

Because the secretions of asthma and rhinitis contain toxic eosinophil granule proteins and because secretory IgA is the most potent immunoglobulin stimulus for eosinophil degranulation, we measured eosinophil-derived neurotoxin and ragweed-specific IgA and IgE antibodies in nasal lavage before and during the ragweed pollen season in 44 hay fever patients. We found IgA antibody in nanogram/milliliter concentrations before the season and rising 20-fold by the end of the season. IgE antibody was present in picogram/milliliter concentrations and did not change. Eosinophils and eosinophil-derived neurotoxin also increased. We conclude that IgA is the predominant antibody in allergic nasal secretions and increases with allergen exposure. The hypothesis that secretory IgA antibody-allergen complexes contributes to allergic inflammation by stimulating eosinophil degranulation warrants further study.