Cellular histamine release, specific and total serum IgE levels in hay fever patients and controls.

The amount of histamine released from blood leucocytes by allergen, the amount of allergen required to release 50% histamine and the total IgE and IgE specific for Dactylis glomerata are compared in nine hay fever patients and five control individuals. The variation with time of total IgE, of specific IgEe and of the percentage of histamine released at a fixed allergen concentration, corresponding to the cellular sensitivity, is shown for one control individual with positive in vitro and skin tests, but without clinical symptoms. For four patients with a low total IgE level the evolution of these parameters during a 1 year treatment period is presented.     

Early-onset hay fever in Israeli children

In order to investigate the influence of climate and vegetation on the age of onset and clinical picture of hay fever (HF), we examined 116 children with typical HF living in a single climatic area: fifty-four were from rural farming settlements and sixty-two from towns and cities. Overall age of onset was low; 72% of rural children developed HF between the ages of 2 years and 4 years compared to only 24% of urban children (P less than 0.005). At the same time, 57% of rural children had positive skin tests to more than three pollen extracts out of nineteen allergens tested, compared to 19% of urban children (P less than 0.005). There were no significant differences between the rural and urban groups with regard to the incidence of asthma as part of their HF, nor were there differences in total IgE levels. The results of this study suggest that Israeli children develop hay fever earlier than generally reported in the literature, and that this is most marked in the rural areas. This can be explained by their specific environment, which consists of a basically dry, desert-like climate where lawns, crops and trees are extensively irrigated, leading to the dissemination into the environment of large amounts of pollen grains, which are not washed away because of the lack of rain.     

Allergy shots for hay fever

Although allergy shots have been used for many years, immunotherapy for symptoms of allergic rhinitis has only recently been clearly shown to be effective. Standardization of allergens will provide even better results in the diagnosis and treatment of allergic rhinitis in the future. Success in an individual patient depends on appropriate application. Immunotherapy should be reserved for patients who have allergy to airborne allergens, have significant symptoms after exposure to them, have sensitivity that has been proven by a skin or in vitro test, and cannot avoid the allergen or control symptoms with drugs. Thus, allergy shots are generally not used for allergy to pet dander or food. Immunotherapy is begun with a very dilute concentration of allergen, which is gradually increased to the maximum dose that is safely tolerated. The interval between shots is then increased gradually to once a month. Duration of treatment is usually 3 years in children and longer in adults. Treatment usually fails if the patient cannot free the environment of large amounts of known allergens, if the allergen was not correctly determined during initial evaluation, or if the allergen dose is inadequate. The patient must have realistic expectations: Allergy shots often do not totally eliminate symptoms, and improvement takes time.     

Comparative trial of two dose regimens of terfenadine in patients with hay fever

Eighty patients with hay fever took part in a double-blind study to compare the efficacy of two doses of terfenadine, namely 60 mg b.d., the standard recommended dose, and 120 mg b.d. Thirty-nine patients received 60 mg b.d. and thirty-eight received 120 mg b.d., each given over 1 week. Symptoms were assessed at the start and end of treatment and were also recorded in diary cards. Over-all efficacy was determined by doctor and patient at the end of treatment. Onset of relief of symptoms after the first dose was recorded. The results showed no significant differences between the two treatments. Symptom relief was good for both (54%-63% experiencing good or complete relief) and the target symptoms of hay fever (i.e. those most commonly reported) were relieved particularly well. Average onset of symptom relief was 72 minutes for 60 mg and 59 minutes for 120 mg. Side-effects were few for both doses, only three patients in total reporting sedation.     

Histocompatibility-antigens in hay fever (author's transl)]

HL-A antigens have been determined in 110 not related Caucasian patients from southwest Germany suffering from hay fever and in 353 blood donors from the same area. Gene-frequencies and haplotype-frequencies of these 2 groups were compared, deviations within various specific allergy groups were investigated taking into consideration associated diseases. Patients suffering from hay fever showed a significant increase in frequency of W 19 and a significant decrease in HL-A8. Increase of W 19 was most evident in persons who became sick before the 16th year of age and in those who showed asthmatic symptoms in addition to those of hay fever. HL-A8 is significantly decreased only in persons who became sick after the 16th year of age. Found differences in haplotype-frequencies need further confirmation in larger studies. A relationship between changes of HL-A frequencies in hay fever due to special pollen allergies could not be determined.     

Nasal challenge with ragweed pollen in hay fever patients. Effect of immunotherapy.

Challenge of the nasal mucosa of allergic subjects with specific allergen induces not only the expected sneezing and rhinorrhea, but also the appearance in nasal secretions of mediators commonly associated with activation of mast cells or basophils: histamine, leukotrienes, prostaglandin D2 (PGD2), kinins, and TAME ([3H]-N-alpha-tosyl-L-arginine methyl ester)-esterase. To determine whether specific immunotherapy alters mediator release in vivo, nasal pollen challenge was used to compare 27 untreated highly sensitive ragweed (RW)-allergic subjects with 12 similarly sensitive patients receiving long-term immunotherapy (3-5 yr) with RW extract (median dose, 6 micrograms RW antigen E). The two groups were equally sensitive based on skin tests and basophil histamine release. The immunized group had a diminished response as demonstrated by (a) the treated group required higher pollen doses to excite sneezing or mediator release; (b) significantly fewer subjects in the treated group released mediators at any dose (TAME-esterase [P = 0.005], PGD2 [P = 0.04]), and (c) the treated group released 3-5-fold less mediator (TAME-esterase [P = 0.01], and histamine [P = 0.02]).     

Challenge tests and specific IgE in hay fever sufferers

The relationship between challenge tests, specific IgE and seasonal effects in hay fever sufferers was studied. There were significant relationships between nasal challenge, conjunctival challenge and skin-prick test threshold doses, although the skin and conjunctiva tended to be less sensitive than the nose. A seasonal effect was apparent on nasal challenge, but not conjunctival challenge or skin-prick testing, with lower threshold doses recorded after the pollen season than in midwinter. There was a significant relationship between specific IgE and nasal challenge, but not conjunctival or skin-prick test threshold doses.     

Multi-centre double-blind comparison of terfenadine once daily versus twice daily in patients with hay fever

This double-blind, randomized multi-centre study was designed to compare efficacy and tolerability of 120 mg terfenadine taken once daily (in the morning) with the established regimen of 60 mg terfenadine taken twice daily in the treatment of seasonal rhinitis. Two comparable groups, a total of 191 hay fever patients, were treated for 1 week. Symptom severity was assessed by the investigators before and at the end of the treatment (visual analogue scale), and daily by the patient (four-point rating scale). All symptoms improved to a similar degree in both groups. Differences between the two groups were not statistically significant, except for nasal symptoms in three cases as assessed by the visual analogue scale in one centre (better relief in the group given 120 mg terfenadine once daily). Tolerability was good and similar in both groups. The data presented show that in the treatment of hay fever 120 mg terfenadine given once daily is an effective, convenient and well tolerated alternative to the regimen of 60 mg terfenadine given twice daily.     

Pneumoparotitis: an unusual manifestation of hay fever

This case concerns bilateral parotitis apparently caused by increased intraoral pressure generated by sneezing and forceful clearing of the nares during an attack of hay fever. This was accompanied by painful anterior cervical lymphadenopathy. The condition responded well to an oral cephalosporin and increased fluid intake along with an analgesic agent. The patient recovered without sequelae.