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Specific immunotherapy (SIT) is probably the only causative treatment in allergic diseases including pollinosis. It is capable of changing the natural history of the disease.Present study has been designed to estimate the effectiveness and safety of multi-seasonal immunotherapy with grass-pollen-allergoid-containing vaccines.Twenty seven patients with pollinosis entered the study. They were randomly assigned to two groups receiving two different but absolutely comparable vaccines (Allergovit, Pollinex). Cards of patient's self-evaluation (including nasal, eye and bronchial symptoms) as well as anti-allergic drug consumption were evaluated.Significant amelioration of symptoms was noticed already after first season of SIT 3.4 +/- 0.29 vs 7.54 +/- 0.35 points before SIT (control)(p0.05). The respective value after third SIT was 2.1 +/- 0.26 (p0.001). Also anti-allergic drug consumption felt from 2.12 +/- 0.12 points before SIT to 0.86 +/- 0.11 and 0.37 +/- 0.11 after first and third SIT, respectively (p0.001 and p0.00005). Few side reactions were observed, only one mild systemic reaction.Our study confirms that pre-seasonal SIT is a clinically effective and safe therapeutic method in patients with pollinosis. It's effect seems to be time-related.

The case of chylomicronemia syndrome in 45 year old man, previously misdiagnosed as hypercholesterolemia is described. Secondary causes of hyperlipoproteinemia were excluded. No symptoms, characteristic of familial lipoprotein lipase deficiency were observed. We concluded that the diagnosis of hyperlipoproteinemia has to be based on determination of all plasma lipids concentrations (total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol). Otherwise a false diagnosis is quite possible. In rare cases additional laboratory tests are needed.

The aim of this study was to asses the importance of the most frequently observed signs and symptoms, as well as commonly used laboratory tests for differentiation between bronchial asthma and chronic obturative pulmonary disease (COPD). Sensitivity(Se) and specificity (Sp) indices were calculated for 140 analysed variables. Sixty one patients diagnosed as having COPD and 89 as suffering from asthma were analysed. For each patient the modified ATS-DLD-75-C questionnaire was filled out, and laboratory tests results were collected. Laboratory findings included: basic spirometry, diurnal PEF variation, bronchodilator tests with salbutamol, ipratropium bromide and corticosteroids, challenges with histamine and exercise, blood gas analysis, skin tests, chest X ray, ECG, blood cell count, blood and sputum eosinophilia. The results obtained have shown that there is no single parameter characterised by specificity and sensitivity that enable to differentiate between the diseases of interest with sufficient accuracy. Sputum expectoration for et least 3 months of the year (Se = 84%, Sp = 69%), smoking index (cigarettes number per day x years of smoking)or = 200 (Se = 89%, Sp = 74%), have appeared to have the highest sensitivity and specificity for COPD. Most typical of asthma are: intermittent episodes of wheezing (Se = 89%, Sp = 69%), positive bronchodilator tests: with salbutamol (Se--73%, Sp--93%), with ipratropium bromide and with corticosteroids (Se--66%, Sp--94%) and diurnal variation of PEFor = 20% predicted (Se--64%, Sp--92%). Challenge test with histamine is of limited value for differentiation bronchial asthma from COPD (Se--96%, Sp--40%), while blood eosinophilia, resting spirometry or blood gases are useless for this purpose.

Authors compared efficacy of high Atrovent doses and Salbutamol on pulmonary ventilation. Examinations were performed in 20 patients with BA and 20 patients with COPD. Each drug was given on separate days in increasing doses (0.04; 0.25 and 0.5 mg) of Atrovent and 0.2 mg of Salbutamol. Bronchodilatation was assessed by measurement of FEV1; FEF25%, FEF50%, FEF75%. Maximal effect in patients with COPD was reached with doses of 0.25 and 0.5 mg of Atrovent (delta FEV1(%) +22). Salbutamol and 0.04 mg of Atrovent were significantly less effective. In patients with BA Salbutamol (delta FEV1(%) +49) are likely to be more effective bronchodilator an Atrovent (delta FEV1(%) +26).

Bronchial asthma is a chronic condition with an inflammatory background--allergic inflammation. In recent years several observations have been published documenting activity of low molecular weight heparin (LMWH) in chronic inflammatory diseases of respiratory tract. This study was set up to evaluate the effect of nebulized LMWH on spirometric parameters and selected markers of allergic inflammation in bronchial asthma. Twenty patients diagnosed with mild or moderate asthma entered the study. At the beginning and at the end of the experiment every patient underwent bronchoscopy with BAL and in 15 of them bronchial biopsy was performed. Blood was drawn for ECP evaluation. LMWH was administered in nebulization in a dose 5000 U Xa/day for two weeks. BALf cellularity was evaluated as well as BALf IL-5 concentration. Further ELAM-1 and VCAM-1 expression in bronchial mucosa was examined in immunohistochemistry. We demonstrated that heparin treatment significantly enhanced FEV1 from 76.02 +/- 21.7% nominate value before to 92.4 +/- 21.8% after treatment (p0.005). Cellular profile of BALf changed, showing significant drop in percentages of eosinophils--from 7% to 6% (p0.05), macrophages--38 to 32% (p0.05) and neutrophils--32 to 28% (p0.05). Surprisingly we did not notice any change in ECP concentration in blood serum or IL-5 in BALf. Also adhesion molecules expression in bronchial mucosa remained unchanged. We conclude that chronic LMWH nebulization is a valuable treatment ameliorating asthmatic condition clearly due to anti-inflammatory properties of heparin. Both dose of LMWH used and the time of therapy have to be further investigated in order to develop treatment able to influence more of the elements of allergic inflammation.