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A 4-week multicenter, double-blind, placebo-controlled, parallel-group trial was carried out with 416 adults with ragweed allergic rhinitis to compare 200 micrograms of fluticasone propionate once daily and 100 micrograms of fluticasone propionate twice daily with placebo. Compared with placebo, both groups receiving fluticasone propionate had greater number of symptom free days (P < .01), lower median symptom scores (P < .01), and greater number of days not requiring rescue medications (P < .001). No significant differences for individual symptoms were found between the two fluticasone propionate groups except that those taking the twice daily dosage used less antihistamine (P < .01) and had greater number of days free of rescue medications (P < .05). Adverse events were comparable between the three groups. These results indicate that topical intranasal fluticasone propionate 200 micrograms once daily and 100 micrograms twice daily are both efficacious and well tolerated.

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We report a case of angioimmunoblastic lymphadenopathy in a child followed for 13 years. Unusual features include prolonged course, cold urticaria, nonthrombocytopenic purpura, poor wound healing, transfusion reactions, and possible neurologic involvement with cerebritis and epileptic seizures. The patient's serum contained a monoclonal cryoglobulin, immunoglobulin G, kappa light chain type, that activated the classic complement pathway in vitro and mediated passive transfer of the cold urticaria. The patient responded well to corticosteroids and has been in clinical remission for 8 years without specific treatment. There is immunologic evidence of persistent residual disease activity. This case illustrates the remarkable diversity of clinical and immunologic features and the variable prognosis of this disorder.

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The serum from 112 patients with systemic lupus erythematosus (SLE) was examined to compare serologic reactivity among anti-Ro positive and anti-Ro negative patients. While hypergammaglobulinemia, rheumatoid factor (RF) and elevated Clq binding were significantly more frequent among the anti-Ro positive group there was no increase in the frequency of anti-dsDNA antibody measured by the Farr assay or antibodies to ssDNA, dsDNA, poly dG . poly dC, poly (dA-dT) and cardiolipin measured by ELISA. Patients with the highest levels of anti-DNA antibody by the Farr assay did not have any increased frequency of anti-Ro antibodies. We concluded that anti-Ro and anti-DNA antibodies are independently regulated. The frequent occurrence of RF in anti-Ro positive SLE patients may provide a useful screening assay for this autoantibody among pregnant SLE patients.

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Agglutinating antisera were induced in rabbits against a purified genetic variant of human albumin and against normal albumin. These antisera had different specificities, as determined by inhibition experiments with the purified variant and normal albumin. The results suggest that genetic variants of human albumin differ antigenically from the normal protein. It is conceivable that antibodies against normal human albumin could be induced following albumin administration to individuals homozygous for an albumin variant.

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Twelve patients with systemic lupus erythematosus and biopsy-proved diffuse proliferative glomerulonephritis were randomly allocated to a control group (to continue receiving conventional therapy only) or to a plasmapheresis group (to receive conventional therapy along with one 4-I plasma exchange a month). The six patients treated with plasmapheresis had better preservation of renal function, reduced disease activity, fewer admissions to hospital and less need for steroid and immunosuppressive therapy than the six control patients. The patients treated with plasmapheresis also showed evidence of reduced immunologic activity and had no side effects attributable to the plasma exchange. These results suggest that monthly plasma exchange should be assessed in a controlled randomized trial as a possible therapeutic adjunct in patients with systemic lupus erythematosus and diffuse proliferative glomerulonephritis.

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Serum immunoglobulins, complement and alpha 1-antitrypsin were assayed in forty-eight patients with chronic urticaria. Thirteen cases had chronic cold urticaria and thirty-two had chronic idiopathic urticaria. Elevated mean serum IgM was found in chronic cold urticaria. Seven patients had partial immunoglobulin deficiencies. IgE was elevated in sixteen cases of chronic idiopathic and in two with chronic cold urticaria. Eight patients had depressed serum total haemolytic complement activity. Low C3 and normal C4 serum protein concentrations in four cases suggested alternative complement pathway activation. Twenty of forty-six patients were atopic, although specific allergies responsible for the urticaria were not identified in any of them. alpha 1-antitrypsin levels were normal in all patients. The data suggest that the aetiology and pathogenesis of chronic urticarias in this study are heterogeneous. No evidence of abnormality of the protease inhibitor system in either chronic idiopathic or chronic cold urticaria was found.

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Two hundred and eighty-four patients with various rheumatic diseases were studied for the prevalence of antibodies to extractable nuclear antigen (anti-ENA) using an improved haemagglutination technique. Anti-ENA rarely occurred in patients with rheumatoid arthritis, scleroderma, polymyositis, dermatomyositis and Sjögren's syndrome. Seventeen per cent (13/72) of patients fulfilling at least four preliminary ARA criteria for systemic lupus erythematosus (SLE) demonstrated anti-ENA. The predominant antibody was directed at ribo-nuclease-resistant ENA (anti-Sm). Antibodies to ribo-nuclease-sensitive ENA (anti-RNP) occurred in the minority of patients with SLE (2/72) and the mixed connective tissue disease syndrome (MCTD). A trend toward an increased incidence of renal disease in SLE patients with anti-Sm was present. Sequential analysis of anti-Sm in patients with SLE showed a fall in titre paralleling the normalization of anti-DNA antibody titres and serum complement values. No case of unrecognized MCTD was uncovered in our rheumatic disease population.

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Skin tests have been used for many years to detect reaginic antibodies in the investigation of allergic patients. Recently in vitro assays of allergic reagins, including the radioallergosorbent test (RAST) and the rat mast cell test (RMCT) have become available. A comparison of the clinical usefulness of these tests suggested that skin tests and the RAST are of comparable diagnostic accuracy and reliability. The RMCT was found to be poorly reproducible and unreliable. For routine cases skin tests should continue to be the procedure of choice. The RAST may reasonably be used when skin tests are unreliable, impractical or contraindicated. The RAST may also be helpful in some cases in resolving discrepancies between skin test results and the clinical history.

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