| 2008 | A prospective, randomized comparison of cobra perilaryngeal airway and laryngeal mask airway unique in pediatric patients. | Anesth Analg | The Cobra Perilaryngeal Airway (PLA) provides better sealing pressure than the Laryngeal Mask Airway Unique (LMAU) during positive-pressure ventilation in adults. We compared the performance of the CobraPLA and LMAU in infants and children.Two-hundred pediatric patients were randomly assigned to a CobraPLA or an Laryngeal Mask Airway (LMA). We measured airway sealing at cuff inflation pressures of 40 and 60 cm H2O; ease and time of insertion; device stability; efficacy of ventilation; number of insertion attempts; incidence of postoperative sore throat, dysphonia, laryngospasm, bronchospasm, and gastric gas insufflation. Steady-state end-tidal(CO2) was measured at the head of the CobraPLA and at the "Y-piece" piece of the anesthetic circuit. For the major outcomes, the airway groups were subdivided post hoc into small and large CobraPLA and small and large LMA subgroups. Results are presented as means +/- sds; P < 0.05 was considered statistically significant.Airway sealing pressure with the cuff inflated to 60 cm H2O in the large CobraPLA subgroup (22 +/- 7 cm H2O) was significantly more than that of the small CobraPLA subgroup (18 +/- 5 cm H2O) and large LMA subgroup (16 +/- 5 cm H2O; P < 0.001). The CobraPLA was more stable than the LMA (same anatomic fit score before and after surgery) and produced less gastric insufflation. Head CobraPLA end-tidal(CO2) values were 6.4 +/- 6 mm Hg more than those of the Y piece of the circle circuit.The CobraPLA airway performed as well as the LMAU during anesthesia in pediatric patients for a large range of outcomes and was superior for some. |
| 2003 | Limpet anaphylaxis: cross-reactivity between limpet and house-dust mite Dermatophagoides pteronyssinus. | Allergy | Limpet is a mollusc that is frequently found along the shores of warm seas. Few allergic reactions to limpet have been described, and cross-reactivity with house-dust mites has not been established.We report five patients with anaphylactic reactions due to limpet ingestion. A limpet extract was prepared and skin prick tests (SPT), radioallergosorbent assays (RAST), sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE), and IgE-immunoblotting were performed. In order to evaluate cross-reactivity, an immunoblotting inhibition assay with Dermatophagoides pteronyssinus was also done.All patients were asthmatics sensitized to house-dust mites. In each case, severe bronchospasm was evidenced, and three required mechanical ventilation. Positive SPT with limpet extract was found in the four patients tested. RAST showed specific IgE on each patient's sera. Immunoblotting showed several allergenic fractions with a wide molecular weight range (15-250 kDa). D. pteronyssinus inhibited IgE-binding molecules above 50 kDa in the limpet extract, particularly one molecule of 75 kDa.We describe five patients with IgE-mediated limpet allergy. Severe bronchospasm was the most important symptom. Cross-reactivity with D. pteronyssinus was demonstrated. |
| 1998 | Occurrence of exercise induced bronchospasm in elite runners: dependence on atopy and exposure to cold air and pollen. | Br J Sports Med | To study factors affecting the occurrence of exercise induced bronchospasm (EIB) in elite runners.Fifty eight elite runners, 79% of them belonging to Finnish national teams, volunteered. The athletes answered a questionnaire on respiratory symptoms. Skin prick tests were used to investigate atopy, and spirometry to examine lung function at rest and after an exercise challenge test (ECT) at subzero temperature in the winter and after a similar ECT in the summer at the end of the birch pollen season.Definitive EIB (a post-exercise reduction of 10% or more in forced expiratory volume in one second (FEV1) was observed in five (9%) of the 58 runners. A subgroup consisting of 19 non-atopic symptom-free runners with no family history of asthma was used to establish a normal range for post-exercise reduction in FEV1. When this group's mean exercise induced change in FEV1 minus 2 SDs (a reduction of 6.5% or more in FEV1) was taken as the lower limit of the reference range, 15 (26%) of the runners had probable EIB in either the winter or the pollen season. The occurrence of probable EIB depended on atopy (odds ratio increased with number of positive skin prick test reactions, p < 0.05). Nine (22%) of the 41 runners, challenged in both the winter and the pollen season, had probable EIB only in the winter, and three (7%) had it only in the pollen season. Only one runner (2%) had EIB in both tests.Mild EIB is common in Finnish elite runners and is strongly associated with atopy. Seasonal variability affects the occurrence of EIB, and thus exercise testing should be performed in both cold winter air and the pollen season to detect EIB in elite runners. |
| 1995 | Passive immunization with an anti-substance P antibody prevents substance P- and neurokinin A-induced bronchospasm in anesthetized guinea-pigs. | Life Sci | In a guinea-pig model of asthma, active immunization against substance P (SP) prevented the development of airways' hyperresponsiveness and reduced bronchospastic responses to SP (i.v.). The rat-mouse heterohybridoma NC1/34 secretes a specific, rat IgG1, anti-substance P antibody (alpha-SP Ab) which was isolated and purified by passing supernatant from cultures through thiophilic gel. Purity of antibody was about 50% (SDS-PAGE). The relative affinities of the alpha-SP Ab for SP, neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) were estimated by ELISA using a constant amount of SP coupled (glutaraldehyde) to bovine serum albumin (BSA) to capture the antibody, alone and in the presence of increasing concentrations of the neuropeptides. At alpha-SP Ab dilutions of 1 in 5,000 to 1 in 32,000, CGRP did not prevent antibody binding to SP-BSA conjugate bound to the plates, but both SP and NKA prevented binding. In this system, the relative affinity of the alpha-SP Ab, at dilutions of 1 in 5,000 and 1 in 10,000, was about 50 times greater for SP than NKA. Whether passive immunization with alpha-SP Ab prevented bronchospastic responses to SP and NKA (i.v.), in vivo, was determined in groups of anesthetized guinea-pigs by recording pulmonary flow resistance (RL) and dynamic pulmonary elastance (EL). Injection of alpha-SP Ab (i.v., 5:1 molar ratio: alpha-SP Ab:SP total dose) did not alter baseline values of RL and EL, but markedly inhibited increases in RL and EL induced by SP and NKA (i.v.) without affecting responses to methacholine (i.v.). A control, "irrelevant" rat IgG-type antibody at a similar concentration had no effect on responses to SP or NKA. These findings indicate that passive immunization with a monoclonal alpha-SP Ab can prevent the bronchospastic effects of exogenous SP and NKA in guinea-pigs. |
| 1991 | Basidiomycete allergy: identification and characterization of an important allergen from Calvatia cyathiformis. | Int Arch Allergy Appl Immunol | Basidiomycetes were not considered as major aeroallergen sources until spore traps revealed the prevalence of basidiospores, which were in some cases associated with epidemic outbreaks of asthma. More recently, we established that approximately one third of subjects with respiratory allergic disease were skin prick test positive to basidiospore extracts. Bronchial challenge with these extracts induced reversible immediate and late phase bronchospasm in sensitive subjects. Screening individual RAST-positive sera for reactivity to immunoprinted Calvatia cyathiformis spore extract indicated that a basic component with pI 9.3 reacted with 63% of test sera. Further analysis by RAST and immunoprint (IP) inhibition showed that this component, Cal c Bd9.3, appeared to cross-react with spore extracts from 3 of 5 other species tested. To isolate this component for additional analysis, a protocol was used with two sequential stages of preparative isoelectric focusing (IEF) followed by hydrophobic interaction chromatography. This yielded purified Cal c Bd9.3 that retained IgE-binding activity by IP, was a single band by IEF and SDS-PAGE (16 kD) analysis when stained with Coomassie blue. Double diffusion in gel with rabbit antiserum to Cal c BD9.3 demonstrated a single precipitin band in crude extract that was identical to that obtained with purified Cal c Bd9.3. By IP this antiserum recognized pure Cal c Bd9.3 and the 9.3 band in crude extracts from C. cyathiformis and 3 other species, corroborating the cross-reactivity. However, other bands were also recognized. These studies indicate that basidiospores are major fungal aeroallergens, many of which contain a common basic allergen to which most sensitized subjects react. |