Provocation Testing in Clinical Practice (Clinical Allergy and Immunology)

1555 Pages·1994·10.06 MB·English

by  Sheldon Spector

Cover

Provocation Testing in Clinical Practice
CLINICAL ALLERGY AND IMMUNOLOGY
Series Editor
MICHAEL A. KALINER, M.D.
Medical Director
Institute for Asthma and Allergy
Washington, D. C.

1. Sinusitis: Pathophysiology and Treatment, edited by Howard M.
Druce
2. Eosinophils in Allergy and Inflammation, edited by Gerald J. Gleich
and A. Barry Kay
3. Molecular and Cellular Biology of the Allergic Response, edited by
Arnold I. Levinson and Yvonne Paterson
4. Neuropeptides in Respiratory Medicine, edited by Michael A.
Kaliner, Peter J. Barnes, Gert H. H. Kunkel, and James N.
Baraniuk
5. Provocation Testing in Clinical Practice, edited by Sheldon L.
Spector
ADDITIONAL VOLUMES IN PREPARATION
Mast Cell Proteases in Immunological Responses, edited by George H.
Caughey

Provocation Testing in Clinical Practice
title:
Clinical Allergy and Immunology ; 5
author: Spector, Sheldon L.
publisher: Informa Healthcare
isbn10 | asin: 0824792491
print isbn13: 9780824792497
ebook isbn13: 9780585377964
language: English
Provocation tests (Medicine) , Bronchial
provocation tests, Allergy--Diagnosis,
subject Hypersensitivity, Bronchial Provocation
Tests, Nasal Provocation Tests,
Immunologic Tests.
publication date: 1995
lcc: RC587.P76P74 1995eb
ddc: 616.97/075
Provocation tests (Medicine) , Bronchial
provocation tests, Allergy--Diagnosis,
subject: Hypersensitivity, Bronchial Provocation
Tests, Nasal Provocation Tests,
Immunologic Tests.
Immunologic Tests.
Page i
Provocation Testing in Clinical Practice
edited by
Sheldon L. Spector
Allergy Medical Clinic and Allergy Research Foundation
Los Angeles, California
Page ii
Library of Congress Cataloging-in-Publication Data
Provocation testing in clinical practice / edited by Sheldon L. Spector.
p. cm. — (Clinical allergy and immunology; 5)
Includes bibliographical references and index.
ISBN 0-8247-9249-1 (alk. paper)
1. Provocation tests (Medicine) 2. Bronchial provocation tests.
3. Allergy—Diagnosis. I. Spector, Sheldon L. II. Series.
[DNLM: 1. Hypersensitivity. 2. Bronchial Provocation Tests. 3. Nasal
Provocation Tests. 4. Immunologic Tests. W1 CL652 v. 5 1995 / QW 900 P968
1995]
RC587.P76P74 1995
616.97’075—dc20
DNLM/DLC
for Library of Congress 94-
33912
CIP
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Copyright © 1995 by Marcel Dekker, Inc. All Rights Reserved.
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Current printing (last digit):
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PRINTED IN THE UNITED STATES OF AMERICA
PRINTED IN THE UNITED STATES OF AMERICA
Page iii
Preface
There are a multitude of books dealing with general topics such as
asthma, eye conditions, rhinitis, or skin diseases; however, there are very
few, if any, dealing with provocative challenges to various organs in the
body. My interest in provocative challenges has led me to seek out
experts who could provide background information as well as details
regarding the challenges themselves. This book will therefore serve as a
rather unique reference work.
Many articles have appeared on scientific programs regarding
pharmacological challenges such as methacholine and histamine, and
the number of such challenges continues to increase. Adenosine and
leukotriene challenges were virtually unheard of only a few years ago.
Some of the challenges discussed in this volume are induced from
natural sources such as air pollution and infectious agents. In vitro
studies and animal models that have helped us understand mechanisms
are also included in this book.
The main thrust of this work, however, represents details regarding
challenges in humans. This means that guidelines must be utilized for the
proper performance of such challenges to be done in a scientific and
moral way. Humans are not as homogeneous as many of the animals
that are studied, so it is not unusual for a paradoxical or unpredictable
response to occur. This is an even greater reason for precautions to be
taken, since quantification becomes important. The dose of metabisulfite
or aspirin administered to someone with asthma must be tailored to the
potential disease as well as the heterogeneous patient. As new data
emerge, so dose the breadth of the discussion on challenges. Even a few
years ago it was not
Page iv
appreciated that certain loop diuretics might protect against provocative
challenge. Medications such as adenosine or one of the products of the
arachidonic acid pathway were also not mentioned because they had not
been isolated or purified to the point of giving a challenge. Many
procedures described in this volume are of practical value to the
practicing physician since skin tests in both immediate, delayed, and
contact sensitivity are discussed.
This book will prove important to clinical researchers, interested in the
various aspects of allergy, clinical immunology, and pulmonary medicine.
There is an in-depth discussion of the background as well as the practical
aspects of performing these challenges for those who are interested in
state-of-the-art procedures. In this respect, the volume will be a reference
guide for serious investigators as well as a guide to the practicing
allergist/immunologist. In addition, there is an international character to
this compendium, with authors from such places as England, Australia,
France, and Canada. I sincerely wish that the information provided in this
book will serve the physician well in understanding the mechanisms,
diagnosis, and even treatment when normal physiological mechanisms
are challenged.
Sheldon L. Spector
Page v

Contents
Preface iii
Contributors ix
Allergenic Extracts
1 1
John W. Yunginger
Standardization of Allergens
2 15
Jean Bousquet and François-B. Michel
Use of the Skin Blister Model and Intradermal Testing to Explore the
Pathogenesis and Pharmacological Control of Cutaneous Allergic
3 51
Inflammation
William A. Massey and Lawrence M. Lichtenstein
Experimental Provoked Viral Respiratory Infections in Human Adult
4Volunteers 69
Philip Fireman
The Effects of Respiratory Infections on Airway Function
5Nizar N. Jarjour, Robert F. Lemanske, Jr., Elliot C. Dick, William J. 83
Calhoun, and William W. Busse
Air Pollutants as a Provocative Challenge in Humans
6 109
Henry Gong, Jr.
Page vi

Deposition and Fate of Inhaled Pharmacological Aerosols
7 157
Joseph D. Brain and James D. Blanchard
Methodologies of Aerosol Delivery
8 215
Richard R. Rosenthal
Bronchial Challenge Testing: In Vivo–In Vitro Correlations
9 231
Carol A. Hirshman
The Use of Nonisotonic Aerosols for Evaluating Bronchial
Hyperresponsiveness
10 249
Sandra D. Anderson, Christine M. Smith, Leanne T. Rodwell, Jacqueline
I. du Toit, Josef Riedler, and Colin F. Robertson
Inhalation Challenges with Lipid Mediators (Leukotrienes, Prostaglandins,
11and PAF-Acether) and Adenosine 279
Jonathan P. Arm and Tak H. Lee
Airway Challenges with Inhaled Constrictor Mediators
12 311
Paul M. O’Byrne and Noe Zamel
Allergen Inhalation Challenges
13 325
Sheldon L. Spector
Environmental Challenges to Animal Allergens
14 369
Robert A. Wood and Peyton A. Eggleston
Genetic Aspects of Asthma and Bronchial Hyperresponsiveness
15 383
Robert G. Townley, Russell J. Hopp, A. K. Bewtra, and Nicki M. Nair
Protective Effect of Inhaled Loop Diuretics on Experimentally Induced
Bronchoconstriction
16 411
S. Bianco, M. G. Pieroni, R. M. Refini, P. Sestini, M. Robuschi, and A.
Vaghi
Provocative Challenge by Exercise or Hyperventilation
17 425
J. F. Souhrada and M. Souhrada
Inhalation Bronchoprovocation in Children
18 451
Paul V. Williams and Gail Shapiro
Use of Inhalation Bronchial Challenge for Occupational Diseases
19 479
David J. Hendrick and John E. Salvaggio
Measurement and Significance of the Bronchodilator Response:
Bronchodilation and Inhibition of Bronchoprovocation
20 513