RESUMEN
OBJECTIVE: A pilot study to assess the efficacy and safety of a novel specs device developed to alleviate chronic dizziness using eyeglasses with referential marks fixed on the lenses. MATERIALS AND METHODS: Forty patients with stable symptoms of chronic dizziness for more than 3 months participated in a 4-week, double-blind, randomized treatment with Active-Specs or Sham-Specs. Efficacy was assessed using validated semiquantitative scales and questionnaires of vertigo, dizziness and anxiety. Safety evaluation included monitoring of any adverse event. RESULTS: Thirty-six participants were included in the efficacy analysis, 18 in each group. Twelve of 18 subjects (67%) treated with Active-Specs reported substantial improvement of symptoms compared to six (33%) with Sham-Specs showing a significant improvement on Clinical Global Impressions scale (P = .017). The Active-Specs group showed significant reduction in the Vertigo Visual Analogue Scale (P = .017) and a nonsignificant but consistent trend of improvement measured by the Dizziness Handicap Inventory and Beck Anxiety Inventory. There were no adverse events related to the treatment. CONCLUSIONS: This novel specs device seems to be a safe and promising novel treatment for chronic dizziness. We hypothesize that marks in specific zones of the peripheral visual field could strengthen information of real head motion counteracting the mismatch sensory and locomotor information causing chronic dizziness. The results of this pilot study should be followed up by additional studies aimed at confirming the present encouraging findings.
Asunto(s)
Mareo/diagnóstico , Mareo/terapia , Anteojos/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/diagnóstico , Ansiedad/epidemiología , Ansiedad/terapia , Enfermedad Crónica , Mareo/epidemiología , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Encuestas y Cuestionarios , Vértigo/diagnóstico , Vértigo/epidemiología , Vértigo/terapiaRESUMEN
BACKGROUND: In allergic conditions, the degree of skin test reactivity does not always correlate with the severity of clinical symptoms. Additional factors may contribute to the reported symptom severity. OBJECTIVES: To investigate the association between the magnitude of the skin prick test (SPT) response and the reported symptom severity in patients with allergic rhinitis and the possible modifying role of psychological factors. METHODS: One hundred four patients with allergic rhinitis and 23 with non-allergic rhinitis, classified according to their SPT response to 19 aeroallergens, were asked to rate the severity of five symptoms and to indicate whether their symptoms intensified on exposure to five common aeroallergens. They also completed a psychological questionnaire. Results Reported symptom severity of allergic rhinitis did not correlate with weal size for any of the aeroallergens tested or with the number of positive responses on SPT. It was not related to patient age, sex, or education. The reported symptoms severity correlated positively (0.29, P < 0.01) with reported symptom intensification on exposure to allergens. Moreover, both outcomes were positively associated with the psychological factors of hypochondriasis (0.20, P < 0.05 and 0.18, P < 0.05, respectively), and somatic awareness (0.24, P < 0.05 and 0.33, P < 0.01, respectively), but not with neuroticism. CONCLUSIONS: The severity of symptoms experienced by patients with allergic rhinitis is apparently not related to the magnitude of SPT response, but rather to psychological factors of hypochondriasis and somatic awareness. Physicians should be aware of the contribution of psychological factors to patient perceptions of the intensity of symptoms and of the intensification of symptoms on their exposure to allergens.
Asunto(s)
Hipocondriasis/psicología , Rinitis/psicología , Trastornos Somatosensoriales/psicología , Adulto , Alérgenos/inmunología , Análisis de Varianza , Animales , Gatos , Exposición a Riesgos Ambientales , Femenino , Humanos , Hipocondriasis/diagnóstico , Inmunoglobulina E/inmunología , Pruebas Intradérmicas/métodos , Masculino , Persona de Mediana Edad , Poaceae , Polen , Pruebas Psicológicas , Rinitis/diagnóstico , Rinitis Alérgica Perenne/diagnóstico , Rinitis Alérgica Perenne/psicología , Rinitis Alérgica Estacional/diagnóstico , Rinitis Alérgica Estacional/psicología , Trastornos Somatosensoriales/diagnóstico , Encuestas y Cuestionarios , ÁrbolesRESUMEN
There is evidence that the incidence and severity of asthma are increasing worldwide, but there are limited data on asthma in Israel. The aim of this study was to investigate the prevalence and severity of asthma and asthma symptoms in 13-14 yr-old schoolchildren in Israel. The self-completed questionnaire used was a modified version of that developed by the International Study of Asthma and Allergies in Childhood (ISAAC), and was administered to a national sample of 12,918 children. The prevalence of asthma ever, wheezing ever and wheezing in the last 12 months were 13.7, 23.8 and 17.9% respectively. Significantly higher rates of a history of asthma and asthma symptoms were observed in Jews compared with Arabs. Although asthma ever was more prevalent in males than in females, asthma symptoms were significantly more common in females. The type of area of residence had no effect on the prevalence of wheezing. The ethnic differences in the prevalence of asthma persisted after controlling for sex, district of residence and level of urbanization. The prevalence of both asthma and asthma symptoms in Israel are slightly above the mean reported from 10 other countries in Europe and the Far-East.
Asunto(s)
Asma/epidemiología , Adolescente , Distribución por Edad , Asma/diagnóstico , Asma/fisiopatología , Intervalos de Confianza , Femenino , Encuestas Epidemiológicas , Humanos , Israel/epidemiología , Masculino , Análisis Multivariante , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Muestreo , Distribución por Sexo , EstudiantesRESUMEN
The objective of this study was to investigate the impact of allergy to hymenoptera venom on the occupational activities of patients undergoing immunologic treatment for insect sting anaphylaxis. The design was a cross-sectional study conducted in a sample of 500 out of 1,500 patients undergoing venom immunotherapy for insect sting reaction in 13 allergy clinics in Israel. A self-administered questionnaire was used to collect data about demographic characteristics of patients, severity of the allergic reaction and adverse effects on occupational activities. Of the 204 respondents who were part of the labour force, 48.5% reported adverse effects on routine occupational activities. The factors with a significant influence on the probability of adverse occupational effects were: (1) patient's type of work (blue collar vs. white collar: OR = 3.22, p < 0.001: army vs. white collar: OR = 5.28, p = 0.001); (2) severity of the allergic reaction (severe reaction vs. mild/moderate reaction: OR = 2.34, p = 0.007). Our findings suggest that severe insect sting allergy has an adverse impact on patients' occupational activities. This factor requires special attention by the medical community. Social workers and occupational physicians should collaborate in the assessment and management of these patients.
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Anafilaxia/etiología , Costo de Enfermedad , Himenópteros , Mordeduras y Picaduras de Insectos/complicaciones , Salud Laboral , Adolescente , Adulto , Anciano , Anafilaxia/rehabilitación , Anafilaxia/terapia , Animales , Estudios Transversales , Femenino , Humanos , Inmunoterapia , Israel , Masculino , Persona de Mediana Edad , OcupacionesRESUMEN
Differences in IgE binding and skin responses to pollen extracts of four species of Pistacia, and some immunochemical characteristics of this pollen were investigated. The incidence of positive SPT among atopic patients varied between 31.5% to the pollen extracts of P. vera and 24.6% to P. palaestina. The antigens are located on the exine of the grains as well as in their cytoplasm. Some of the antigens are common to all four species, whereas others seem to be specific. Cross-reactivity was found among the four species of Pistacia and between them and Schinus terebintifolious. Five conspicuous IgE-binding bands were observed in the immunoblots of the four examined species, the bands of 49, 57, 64, 68, and 79 kDa. The 36-37-kDa band of P. lentiscus and the 60- and 84-kDa bands of P. atlantica and P. vera were also noticeable. As the flowering seasons of Pistacia and Schinus do not overlap, the patients are exposed to such pollen for more than 4 months a year. Apparently, Pistacia pollen is a major source of allergy.
Asunto(s)
Polen/inmunología , Sitios de Unión de Anticuerpos , Western Blotting , Humanos , Inmunoglobulina E/metabolismo , Focalización Isoeléctrica , Pruebas CutáneasRESUMEN
To evaluate risk factors associated with the severity of systemic insect sting reaction and to determine the type of insect responsible for systemic anaphylaxis, we conducted a cross-sectional study of 498 patients undergoing venom immunotherapy for insect sting reaction in 13 allergy clinics in Israel. Data were collected by questionnaire and review of patient records. Eighty percent of the patients were treated with honeybee venom, which was used as a single therapy in 60% of the group. In a multivariate logistic model the major factors identified as significantly influencing the probability of a more severe systemic reaction were short time of onset of reaction after stinging (<30 min), high number of prior stings (> or = 4), and age (> or = 18 years). A total of 79.3% of the patients had been stung outdoors, and 50% had lived all their lives in rural areas as compared to 10% in the general Israeli population. This study reports clinically valuable risk factors for the severity of systemic sting reaction. A practical finding was that the honeybee is the insect mostly responsible for sting reactions in Israel, but the type of insect is not a significant predictor of the severity of the reaction.
Asunto(s)
Anafilaxia/etiología , Mordeduras y Picaduras de Insectos/complicaciones , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Venenos de Artrópodos , Niño , Preescolar , Estudios Transversales , Desensibilización Inmunológica , Femenino , Humanos , Mordeduras y Picaduras de Insectos/terapia , Israel , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
We report the expression cloning and characterization of GDNFR-alpha, a novel glycosylphosphatidylinositol-linked cell surface receptor for glial cell line-derived neurotrophic factor (GDNF). GDNFR-alpha binds GDNF specifically and mediates activation of the Ret protein-tyrosine kinase (PTK). Treatment of Neuro-2a cells expressing GDNFR-alpha with GDNF rapidly stimulates Ret autophosphorylation. Ret is also activated by treatment with a combination of GDNF and soluble GDNFR-alpha in cells lacking GDNFR-alpha, and this effect is blocked by a soluble Ret-Fc fusion protein. Ret activation by GDNF was also observed in cultured embryonic rat spinal cord motor neurons, a cell type that responds to GDNF in vivo. A model for the stepwise formation of a GDNF signal-transducing complex including GDNF, GDNFR-alpha, and the Ret PTK is proposed.
Asunto(s)
Proteínas de Drosophila , Proteínas del Tejido Nervioso/genética , Proteínas Proto-Oncogénicas/genética , Proteínas Tirosina Quinasas Receptoras/genética , Receptores de Factor de Crecimiento Nervioso/genética , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Células Cultivadas/efectos de los fármacos , Clonación Molecular , Relación Dosis-Respuesta a Droga , Feto/citología , Factor Neurotrófico Derivado de la Línea Celular Glial , Receptores del Factor Neurotrófico Derivado de la Línea Celular Glial , Glicosilfosfatidilinositoles/metabolismo , Proteínas de la Membrana/metabolismo , Ratones , Ratones Endogámicos C57BL , Datos de Secuencia Molecular , Neuronas Motoras/metabolismo , Factores de Crecimiento Nervioso/genética , Factores de Crecimiento Nervioso/metabolismo , Factores de Crecimiento Nervioso/farmacología , Proteínas del Tejido Nervioso/metabolismo , Proteínas del Tejido Nervioso/farmacología , Fosforilación , Proteínas Proto-Oncogénicas c-ret , Ratas , Ratas Sprague-Dawley , Proteínas Recombinantes/metabolismo , Retina/citología , Médula Espinal/citología , Tirosina/metabolismoRESUMEN
Thirty-six symptomatic patients, with positive skin reactions to Cupressus sempervirens pollen extract were skin-tested with pollen extracts of Podocarpus gracilior and Callitris verrucosa, of these 17 (47%) had positive responses to P. gracilior, nine (25%) to C. verrucosa, and six (17%) to both. None of the non-atopic healthy controls had positive reactions to either of the extracts. Radioallergosorbent test (RAST)-inhibition studies were performed with pooled sera from three patients. Fifty per cent inhibition was obtained with 11 micrograms protein of C. sempervirens, 54 micrograms of P. gracilior, and 71 micrograms of C. verrucosa; however, when pollen extract of Olea europaea, an unrelated allergen, was tested, 265 micrograms protein were needed to obtain 50% inhibition. One-dimension sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) analysis of pollen extracts from the three species revealed that they had several very similar protein bands. Using Western blot analysis, several closely related IgE binding proteins were identified in the three species. It was concluded that the pollen grains of P. gracilior and of C. verrucosa are potentially allergenic. The presence of common allergenic proteins indicate partial crossreactivity with C. sempervirens.
Asunto(s)
Alérgenos/inmunología , Polen/inmunología , Árboles , Alérgenos/análisis , Western Blotting , Reacciones Cruzadas , Electroforesis en Gel de Poliacrilamida , Humanos , Inmunoglobulina E/metabolismo , Polen/química , Unión Proteica , Proteínas/análisis , Proteínas/inmunología , Prueba de Radioalergoadsorción , Rinitis/sangre , Rinitis/etiología , Rinitis/inmunología , Pruebas Cutáneas , Dodecil Sulfato de SodioRESUMEN
We investigated the relationship between disease activity and total IgE concentration in the sera of patients with active systemic lupus erythematosus (SLE). In addition, the prevalence of personal and family history of allergic rhinitis and asthma were examined with a questionnaire and immediate skin tests for common inhalant allergens in 24 patients in remission. In the 20 patients with active disease, we found that IgE concentration was significantly higher during the periods of active disease than the periods of remission. This elevation was not associated with an elevation in total serum IgG concentrations. The increase in IgE concentration during disease activity in patients with active nephritis was significantly higher than in patients without nephritis. Of the 24 patients in remission, only one reported allergic rhinitis, and two had positive skin tests for inhalant allergens. We concluded that, although patients with SLE do not have an increased rate of atopic disorders, serum IgE rises during disease activity and is associated with active nephritis. This phenomenon suggests that IgE may be involved in the pathogenesis of SLE, particularly in patients with nephritis.
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Hipersensibilidad/complicaciones , Inmunoglobulina E/análisis , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/complicaciones , Adulto , Femenino , Humanos , Lupus Eritematoso Sistémico/fisiopatología , Masculino , Persona de Mediana Edad , Nefritis/complicaciones , Concentración OsmolarRESUMEN
Date palm (Phoenix dactylifera) and pecan (Carya illinoensis) trees are commonly planted in Israel for fruit, for shade, or as ornamental plants. Pollen grains of both species are allergenic; however, the extent of exposure to such pollen and the incidence of allergic response have not been studied here. We therefore investigated skin-test responses to pollen extracts of 12 varieties of palm and 9 of pecan in 705 allergic patients living in 3 cities and 19 rural settlements. Sensitivity to the pollen extracts of both species was much higher among residents of rural than of urban communities. Moreover, there was a definite relationship between the abundance of these trees in a region and the incidence of skin responders to their pollen. Sensitivity was frequent in settlements rich in these 2 species, such as those with nearby commercial date or pecan plantations. In general, sensitivity to date pollen extracts was lower than to pecan. However, differences in skin responses to pollen extracts of various clones were substantiated. Air sampling revealed that pollen pollution decreased considerably with distance from the trees. At approximately 100 m from a source concentrations of airborne pollen were low. Since planting of male palm and pecan trees in population centers would increase pollen pollution, it should be avoided.
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Hipersensibilidad/epidemiología , Polen , Demografía , Frutas , Hipersensibilidad/diagnóstico , Incidencia , Israel/epidemiología , Nueces , Pruebas Cutáneas , ÁrbolesRESUMEN
IgE levels in sera of patients with multiple myeloma (MM) were found to be similar to those of patients with monoclonal gammopathy of unknown significance (MGUS) and to normal controls. This is in contrast to the significant depression in the level of the other polyclonal isotypes in patients with MM. Immediate skin test response to common environmental allergens was also preserved in patients with MM as compared with normal nonatopic controls. One-year treatment of MM patients with alkylating agents caused a significant decrease in the monoclonal immunoglobulin level and induced a tendency toward decreasing IgE level but had no effect on the polyclonal immunoglobulin concentrations. These findings suggest that IgE production and immediate skin test response is not impaired by the pathologic process in MM patients, in contrast to the production of other polyclonal immunoglobulins. This demonstrates the dissociation between the response of the IgE antibody and the other isotypes.
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Inmunoglobulina E/sangre , Mieloma Múltiple/inmunología , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Melfalán/uso terapéutico , Persona de Mediana Edad , Mieloma Múltiple/tratamiento farmacológico , Paraproteinemias/sangre , Paraproteinemias/tratamiento farmacológico , Paraproteinemias/inmunología , Pruebas CutáneasRESUMEN
We report our experience of adverse reactions to immunotherapy (IT) in patients with insect venom allergy and inhalant respiratory allergy. Adverse reactions included large local reactions, generalized cutaneous reactions or systemic reactions. Among 87 patients treated for venom allergy, 43% had adverse reactions during the course of IT, averaging 2.5 reactions per patient and per course of IT. Nine had systemic reactions, of which 7 required adrenaline administration. Among 52 patients treated with inhalant allergen extracts, 40% had adverse reactions averaging 3 reactions per patient per course of treatment. Ten patients had systemic reactions but only 2 required adrenaline administration. There was no difference between the rate of adverse reactions in the venom and the inhalant treatment groups. IT has an inherent risk which has to be weighed against its benefits.
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Hipersensibilidad Inmediata/terapia , Inmunoterapia/efectos adversos , Adolescente , Adulto , Anciano , Anafilaxia/etiología , Venenos de Abeja/inmunología , Niño , Femenino , Humanos , Hipersensibilidad Inmediata/inmunología , Masculino , Persona de Mediana Edad , Rinitis/terapia , Venenos de Avispas/inmunologíaRESUMEN
Falls among the elderly are a major concern of those caring for them. We studied the incidence of falls in institutionalized elderly, as well as the characteristics of those who fell and the causes of the falls, to determine how to prevent falling. A 2-month survey was conducted in Mishan, an institution in Raanana, and included 144 falls in 108 patients (447 women and 162 men, mean age 84) out of a total of 609 elderly. The prevalence of falls was 1426 per 1000 per year. Most cases of falls were first seen in the emergency room or wards for demented patients. The prevalence of falls among those receiving physiotherapy was only 1/3 that of those who did not. Old institutionalized patients tend to fall mainly while getting in and out of bed. Falls may result from medication such as sleeping pills and psychotropic drugs, but not diuretics. Falls are not inevitable, and measures can be applied to prevent them and thus reduce their frequency.
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Accidentes por Caídas/estadística & datos numéricos , Institucionalización , Accidentes por Caídas/prevención & control , Anciano , Anciano de 80 o más Años , Causalidad , Femenino , Humanos , MasculinoRESUMEN
We provide evidence that olive pollen extract can induce asthmatic response. The pattern of airway response to olive pollen is investigated. Nineteen patients with seasonal allergic rhinitis and asthma, suspected to be due to olive pollen, all of whom had positive skin-prick test, were investigated. Bronchial challenge with olive pollen extract were performed and the peak flow rate was followed for 20 hr. Eight patients developed dual asthmatic response (DAR), six patients developed early asthmatic response (EAR) and five patients had no asthmatic response. The early maximal fall in FEV1 and the PD15 were not different between the group with DAR and the group with EAR only. We conclude that olive pollen can induce dual asthmatic response.
Asunto(s)
Asma/inmunología , Polen , Árboles , Adolescente , Adulto , Pruebas de Provocación Bronquial , Niño , Femenino , Volumen Espiratorio Forzado , Humanos , Hipersensibilidad Tardía/inmunología , Hipersensibilidad Inmediata/inmunología , Masculino , Persona de Mediana Edad , Capacidad VitalRESUMEN
The inhibitory effect of prostaglandin E2, histamine, isobutylmethylxanthine, and 1,25-dihydroxyvitamin D3 (1,25-[OH]2D3) on the mitogenic stimulation of peripheral blood lymphocytes from normal and atopic subjects was studied. We found that lymphocytes from atopic patients were less susceptible to inhibition by the three agents that elevate intracellular cyclic adenosine monophosphate (cAMP) concentrations and by the active metabolite of vitamin D (inhibition of 27%, 14%, 12%, and 36% for the atopic patients as compared with 40%, 20%, 22%, and 46% for the normal donors, by the four agents, respectively; p less than 0.02). The inhibitory effect of the cAMP-elevating agents was potentiated by the addition of 1,25-(OH)2D3 to the lymphocyte cultures. The potentiation was more pronounced on lymphocytes from the atopic donors, increasing their responsiveness to levels comparable to levels of lymphocytes from normal donors. The synthetic corticosteroid, dexamethasone, had a similar potentiating effect on the inhibitory action of prostaglandin E2. In view of the beneficial action of beta-agonists, phosphodiesterase inhibitors, and corticosteroids in the treatment of allergy, the potentiating effect of 1,25-(OH)2D3 on the action of cAMP-elevating agents may be of therapeutic interest.