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A one year study of the efficacy of the antifungal agent ketoconazole in non-invasive pulmonary aspergillosis was carried out. Ten patients, seven with allergic bronchopulmonary aspergillosis and three with mycetoma, were studied. They were randomly allocated to receive 400 mg daily or placebo orally in a double blind fashion. In the treated group (n = 6), concentrations of serum IgG specific for Aspergillus fumigatus fell significantly during treatment (mean reduction 42% (SEM 2.2%) compared with determinations preceding the study). This effect was evident by three months and continued for the 12 months of treatment. Patients receiving placebo (n = 4) showed no significant change in serum IgG concentration (mean change + 10% (SEM 5.3%]. Asthmatic patients treated with ketoconazole (n = 4) had significantly lower symptom scores than those receiving placebo (n = 3) (+0.45%/month (SEM 6.9%) versus +27%/month (SEM 6.5%); p less than 0.001). None of the patients treated with ketoconazole reported any adverse effects. Ketoconazole may cause serious liver damage but its use may be justified in bronchopulmonary aspergillosis if further experience confirms its ability to alter the course of a potentially serious disease. [ABSTRACT FROM AUTHOR]

Six subjects with budgerigar fancier's lung, pigeon breeder's lung, or mushroom worker's lung underwent identical paired inhalation provocation tests of 20 minutes to five hours duration (mean 2.3 hours) using a natural method of antigen exposure. For one test of each pair, the subjects were protected by the use of industrial dust respirators that incorporate electrostatically charged, resin-impregnated merino wool filters. The unprotected challenges provoked late responses of mild to moderate severity, that were characteristic of extrinsic allergic alveolitis. These were monitored by methods described previously, using four subjective and six objective monitoring tests. A score of 1 was allowed for each monitoring test showing a significant change. A combined monitoring score of 32/57 was associated with the unprotected challenges-that is, 56% of the maximum score possible. The respirators successfully protected four of the subjects from any suspicion of a positive response. The remaining two subjects reported symptoms of minimal severity, but there was no independent confirmatory evidence of positive reactions. The combined monitoring score associated with all six protected challenges was 2/60 (3%), while that associated with corresponding control challenges was 3/73 (4%). We conclude that respirators of this type can offer substantial, and in most cases complete, protection against single exposures to environmental dusts that may provoke extrinsic allergic alveolitis. [ABSTRACT FROM AUTHOR]

The validity of inhalation tests in the investigation of extrinsic allergic alveolitis was assessed from the results of 144 antigen and control tests in 31 subjects. A definitive pattern of positive late responses was observed. Reactions to nebulised bird serum and droppings in subjects with bird fancier's lung were identical to reactions after "natural" exposures in aviaries or lofts, and to reactions after "occupational" challenges in subjects with farmer's lung and mushroom worker's lung. In general, positive tests were easily recognised subjectively from symptoms and signs appropriate to an influenza-like illness and undue respiratory effort on exercise. They were associated with significant changes in six readily available objective monitoring measurements--exercise minute ventilation (greater than or equal to +15%), body temperature (> 37.2 degrees C), circulating neutrophils (greater than or equal to +2500/mm3), exercise respiratory frequency (greater than or equal to +25%), circulating lymphocytes (greater than ore equal to -500/mm3 with lymphopenia), and forced vital capacity (greater than or equal to -15%). These confirmatory monitoring tests had specificities of approximately 95% and sensitivities of 85-48%. Measurement of diffusing capacity, lung volume subdivisions, or resting minute ventilation/respiratory frequency proved to be too insensitive to be useful, as did auscultation and chest radiography. We conclude that responses that do provoke significant changes in these less sensitive tests are unnecessarily distressing and, presumable, unnecessarily hazardous. [ABSTRACT FROM AUTHOR]

Precipitin responses to different avian serum antigens occur in bird fancier's lung (BFL) and coeliac disease. Failure to distinguish between them could encourage an erroneous diagnosis of BFL in patients with coeliac disease, and the recent suggestion that these two disorders are strongly associated may be questioned, partly for this reason. In the present study small bowel biopsy specimens were obtained from 12 of a series of 14 patients proved to have BFL by inhalation provocation tests. None was suggestive of coeliac disease. Of a further 61 patients with biopsy-proved coeliac disease, seven were found to be exposed currently and 33 formerly to birds. As a result of clinical evaluation, BFL was considered a possible cause of undue breathlessness reported by three of the current bird fanciers only, and all underwent inhalation provocation tests. One alone gave positive results. We conclude that if a real association does exist between these two disorders, its clinical importance has been greatly exaggerated. [ABSTRACT FROM PUBLISHER]

Peripheral blood lymphocytes of twenty-three subjects with grass pollen allergy were cultured with grass pollen antigen for 3 days. After harvesting, the culture supernatants were added to fresh autologous lymphocytes which were maintained in culture for 6 days. Cellular uptake of [³H]thymidine was measured during the sixth day of culture, and revealed that the lymphocyte culture supernatants stimulated greater thymidine uptake than expected from the lymphocyte transformation response to corresponding amounts of antigen. The supernatant factor which mediated this effect was termed `lymphocyte mitogenic factor' by analogy with a similar response of lymphocytes in clinical and experimental delayed hypersensitivity. Lymphocyte culture supernatants were also tested for migration- inhibition factor by their ability to inhibit the migration of guinea-pig macrophages. [ABSTRACT FROM AUTHOR]

Family studies of IgE responses to common inhaled antigens have suggested dominant inheritance of atopy. Molecular genetic linkage analysis was used to confirm this proposal. In seven families the transmission of atopy was linked, with a maximum lod score of 5.58, to a DNA polymorphism defined by p lambda MS.51, which confirms dominant inheritance and assigns the gene locus to chromosome 11. [ABSTRACT FROM AUTHOR]

Investigates differences between paternal and maternal patterns of transmission of atopy at the 11q13 locus. Study of the genetics of atopy; Atopy as a common familial state underlying allergic asthma and rhinitis; Study methods, results and discussion.

Introduction: The aim of this study was to assess faecal immunochemical test (FIT) negativity in terms of its effect on cancer risk in the local symptomatic two-week wait (2WW) population. FIT was introduced to the colorectal 2WW pathway at the start of the pandemic. This study analyses the FIT-negative (<10µg Hb/g) cohort and calculates the relative risk and odds ratio associated with a negative FIT test., Methods: FIT tests were sent to symptomatic 2WW patients without rectal bleeding, iron-deficient anaemia or palpable mass. Where FIT was <10µg Hb/g investigations were moved to a radiology protocol., Results: The test return rate was 91% with a FIT-negative (<10µg Hb/g) rate of 82%. The FIT-negative group in the symptomatic referral pathway in Cornwall have a low (1.4%) risk of colon cancer but a significant risk (6.6%) when all cancer types are considered. The impact of a negative quantitative FIT changes the odds ratio of a patient having a luminal cancer by 0.26. The odds ratio for 'all cancer' risk was affected by 0.83., Conclusion: A negative FIT test within the local NG12 symptomatic patient group signifies a low risk of colon cancer and identifies patients who can be initially investigated with cross-sectional imaging. However, when all cancer types are considered, cancer prevalence in this group remains above 6%. In relative risk terms a negative FIT represents a small change in overall risk and this patient group still qualify for investigation through 2WW pathways.