Pegelow K O, Jonsson J
Acta Allergol. 1975 Dec;30(6):339-62. doi: 10.1111/j.1398-9995.1975.tb01671.x.
Two comparable groups of asthmatics each with 10 patients were treated during 2 years at scheduled intervals with either natural or synthetic ACTH up to a total dose of 2000-95-- IU. All patients had previously been given the natural but never the synthetic hormone. Intradermal tests with natural and synthetic ACTH were performed before treatment and after 1, 12 and 24 months. Serum samples were also taken on these occasions and analysed for antibodies against ACTH, vasopressin and porcine gamma-globulin. No sign of clinical allergy to ACTH was noted in any of the patients during the 2-year period. The incidence of intradermal reactions against natural ACTH was high at the onset of treatment but was not increased by treatment with either synthetic or natural ACTH, while the reactivity rate against synthetic ACTH was increased after both types of treatment. The incidence of IgE reactions against synthetic ACTH at the 20 U/ml level was significantly increased after 12 months' treatment with either natural or synthetic hormone. A high incidence of low-titered agglutinating antibodies against natural or synthetic ACTH was demonstrated before treatment in both the groups, but no significant change in incidence or mean titre against natural or synthetic ACTH or porcine gamma-globulin was noted during treatment with the natural or the synthetic preparation. A few patients, however, did display an increased agglutinating titre against ACTH after 12 months' treatment. Rather unexpectedly, most sera reacting with ACTH were found to react also with vasopressin and a significant increase of the incidence of these reactions and of the titres occurred during the treatment with synthetic as well as with natural ACTH. Two cases have been examined in detail, one because of a fulminant shock after synthetic ACTH and the other because of very high antibody titres without clinical symptoms of ACTH allergy.
两组各有10名哮喘患者的可比组，在两年内按预定间隔接受天然或合成促肾上腺皮质激素治疗，总剂量达2000 - 95国际单位。所有患者此前均接受过天然促肾上腺皮质激素治疗，但从未接受过合成激素治疗。在治疗前以及治疗1个月、12个月和24个月后，分别进行天然和合成促肾上腺皮质激素的皮内试验。在这些时间点还采集血清样本，分析抗促肾上腺皮质激素、抗血管加压素和抗猪γ球蛋白抗体。在这两年期间，未观察到任何患者对促肾上腺皮质激素有临床过敏迹象。治疗开始时，针对天然促肾上腺皮质激素的皮内反应发生率较高，但无论是接受合成还是天然促肾上腺皮质激素治疗，该发生率均未增加，而针对合成促肾上腺皮质激素的反应率在两种类型的治疗后均有所增加。在用天然或合成激素治疗12个月后，针对20 U/ml水平合成促肾上腺皮质激素的IgE反应发生率显著增加。两组在治疗前均显示出针对天然或合成促肾上腺皮质激素的低滴度凝集抗体发生率较高，但在用天然或合成制剂治疗期间，针对天然或合成促肾上腺皮质激素或猪γ球蛋白的发生率或平均滴度均未观察到显著变化。然而，有少数患者在治疗12个月后针对促肾上腺皮质激素的凝集滴度有所增加。相当出乎意料的是，发现大多数与促肾上腺皮质激素反应的血清也与血管加压素反应，并且在用合成以及天然促肾上腺皮质激素治疗期间，这些反应的发生率和滴度均显著增加。对两例病例进行了详细检查，一例是因为使用合成促肾上腺皮质激素后发生暴发性休克，另一例是因为抗体滴度非常高但无促肾上腺皮质激素过敏的临床症状。
