Parker W A, Whisman B A, Apaliski S J, Reid M J
Division of Medicine, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas.
J Allergy Clin Immunol. 1989 Nov;84(5 Pt 1):667-77. doi: 10.1016/0091-6749(89)90294-7.
Mountain cedar (MC) (Juniperus ashei) causes a significant and isolated seasonal allergic rhinitis in south-central Texas during the winter months. Retrospective studies have indicated that patients segregate into two categories based on skin test reactions: single positive skin test to MC only and multiple positive skin tests. These two populations differed in age, personal and family history of atopy, levels of both IgE and total MC-specific IgE (sIgE), and symptomatology. It has been speculated that the subjects with only a single positive skin test may actually be nonatopic and develop an IgE response to MC because of some peculiarity of the antigen. In a prospective, randomized, controlled trial, we tested the efficacy of immunotherapy (IT) with MC extract in 51 subjects, 12 single positive skin tests and 39 multiple positive skin tests, to determine if these differences indeed exist and if IT is equally effective in both groups. We failed to demonstrate significant differences in age, sex, MC sIgE, total IgE, initial immediate cutaneous response, initial late cutaneous response, or personal or family history of atopy. IT was equally effective in both groups of subjects with no significant differences noted in response to MC sIgE, MC sIgG1, MC sIgG4, or with suppression of the late cutaneous response. In addition, we found that suppression of the late cutaneous response correlated significantly with cumulative dose of MC extract, postseasonal level of MC sIgG1 and MC sIgG4, and improvement of symptomatology. Suppression of the late cutaneous response may be a clinically useful parameter to follow in monitoring patients during IT. Caution is advised because this procedure may result in systemic reactions.
山地雪松（MC）（杜松）在冬季会在得克萨斯州中南部引发严重且独立的季节性过敏性鼻炎。回顾性研究表明，根据皮肤试验反应，患者可分为两类：仅对MC皮肤试验呈单一阳性和多项皮肤试验呈阳性。这两类人群在年龄、特应性个人和家族史、IgE以及总MC特异性IgE（sIgE）水平和症状表现上存在差异。据推测，仅皮肤试验呈单一阳性的受试者实际上可能并非特应性体质，而是由于抗原的某些特性而对MC产生了IgE反应。在一项前瞻性、随机、对照试验中，我们对51名受试者（12名单一阳性皮肤试验者和39名多项阳性皮肤试验者）进行了MC提取物免疫疗法（IT）的疗效测试，以确定这些差异是否确实存在，以及IT在两组中是否同样有效。我们未能证明在年龄、性别、MC sIgE、总IgE、初始即刻皮肤反应、初始迟发性皮肤反应或特应性个人或家族史上存在显著差异。IT在两组受试者中同样有效，在对MC sIgE、MC sIgG1、MC sIgG4的反应或迟发性皮肤反应的抑制方面均未发现显著差异。此外，我们发现迟发性皮肤反应的抑制与MC提取物的累积剂量、季节后MC sIgG1和MC sIgG4水平以及症状改善显著相关。迟发性皮肤反应的抑制可能是IT期间监测患者的一个临床有用参数。建议谨慎操作，因为此程序可能会导致全身反应。
