Riassunto
Impressive progress has been made in the general field of immunology which has made possible new understanding and pragmatic approaches to the patient with allergic disease. Indeed, one working in the field of immunology senses a major revolution of immunobiologic thinking, much of which has relevance to the clinical practice of allergy. To the practicing allergist, pediatrician, or internist who must deal with allergic patients, the surging new information may seem confusing and bewildering. As part of our comprehensive series on modern immunobiology which aims to digest this progress, we believe it is appropriate to devote an entire volume to the fundamental principles, new knowledge, and clinical lore on which the modern practice of allergy must be based. In the present volume we strive to bring together relevant contributions from leaders in the field of immunobiology with those whose work stands at the forefront of clinical practice. The advancing understanding has in numerous instances reached the point of clinical application, and we have tried to encompass in this volume the entire scope of modern allergy.
Contenuti
1 Basophils and Mast Cells: Structure, Function, and Role in Hypersensitivity.- 1. Introduction.- 2. Origin, Distribution, and Morphology.- 2.1. Origin and Normal Distribution.- 2.2. Morphology.- 2.3. Phylogenetic Considerations.- 3. Chemical Mediators of Hypersensitivity Reactions.- 3.1. Histamine and Histamine-Synthesizing Capacity.- 3.2. Proteoglycans.- 4. Role in Immediate Hypersensitivity Reactions.- 4.1. Introduction.- 4.2. Homocytotropic Antibody.- 4.3. Mechanisms of IgE-Mediated Histamine Release.- 4.4. Other Factors That Induce Degranulation.- 5. Morphological Features of Basophil Degranulation.- 5.1. Basophil Anaphylactic Degranulation.- 5.2. Degranulation of Basophils Participating in Delayed-Onset Hypersensitivity Reactions.- 5.3. Model of Basophil Degranulation.- 5.4. Mast Cell Degranulation.- 6. Roles in Hypersensitivity Reactions of Delayed Onset.- 6.1. Introduction.- 6.2. Homocytotropic Antibody-Mediated Reactions with Delayed Components.- 6.3. Basophils in Delayed-Onset Immunological Reactions.- 6.4. Mast Cells in Delayed-Onset Immunological Reactions.- 6.5. Role of Basophils and Mast Cells in Delayed-Onset Immunological Reactions.- 7. Summary.- 8. References.- 2 Participation of Eosinophils in Immunological Systems.- 1. Introduction.- 2. Description of the Eosinophilic Leukocyte.- 2.1. History.- 2.2. Structure.- 2.3. Enzyme Content.- 2.4. Surface Receptors.- 3. Eosinophilopoiesis.- 3.1. Normal Production and Distribution of Eosinophils.- 3.2. T-Lymphocyte Involvement in Accelerated Eosinophilopoiesis and Eosinophilia.- 4. Regulation of Eosinophil Migration and Localization.- 4.1. Complement-Generated Factors.- 4.2. Mast-Cell-Derived Factors.- 4.3. Neutrophil-Derived Factors.- 4.4. Lymphocyte-Derived Factors.- 4.5. Other Chemotactic Substances.- 5. Functional Roles of Eosinophils and Clinical Relationships.- 5.1. Atopic Allergies.- 5.2. Immune-Complex-Mediated Disorders.- 5.3. Syndromes of Varied or Unknown Etiologies.- 5.4. Neoplasias.- 5.5. Infectious Diseases.- 6. Concluding Statement.- 7. References.- 3 Lymphocyte Subpopulations and Functions in Hypersensitivity Disorders.- 1. Introduction.- 2. Development of Thymus and T Lymphocytes.- 3. Development of B Lymphocytes.- 4. Lymphocyte Markers.- 4.1. Surface Immunoglobulin.- 4.2. Receptors for IgG Fc.- 4.3. Complement Receptors.- 4.4. Receptors for Mouse Erythrocytes.- 4.5. Epstein-Barr Virus (EBV) Receptor.- 4.6. Receptors for Spontaneous Rosette Formation with Macaca Monkey RBC.- 4.7. Human “Ia-like” Alloantigens.- 4.8. Human Thymic Lymphocyte Antigens (HTLA).- 4.9. Receptor for Sheep Erythrocytes.- 4.10. Receptors for Rhesus Monkey Erythrocytes.- 4.11. Receptors for Helix promatia Hemagglutinin.- 4.12. Receptors for Spontaneous Autorosette Formation.- 4.13. ?-Naphthyl-acetate Esterase.- 4.14. Distribution of Lymphocyte Subpopulations in Peripheral Blood, Tissues, and Extravascular Fluids.- 5. Functional Properties of Human T, B, and Third-Population Cells.- 6. Proliferative Responses to Mitogens, Antigens, and Allogeneic Cells.- 7. Lymphocyte Mitogenic Factor (LMF).- 8. Migration Inhibition Factor (MIF).- 9. Interferon Production.- 10. Chemotactic Factors.- 11. Cell-Mediated Lympholysis (CML).- 12. Antibody-Dependent and Spontaneous Cell-Mediated Cytotoxicity.- 13. Precursor Cells among the So-Called Third Population of Lymphocytes.- 14. Human T-Cell Subpopulations.- 14.1. Specificity of Immunoglobulin Receptors on T-Cell Subpopulations.- 14.2. Histamine Receptors.- 14.3. Morphology of T? and T? Cells.- 14.4. Sensitivity of T-Cell Subpopulations.- 14.5. RNA Content of T? and T? Cells.- 14.6. Compartmental Distribution of T-Cell Subsets.- 14.7. Response of T-Cell Subpopulations to Mitogens and Allogeneic Cells.- 14.8. Leukocyte Migration Inhibition Factor Production.- 14.9. Locomotor Properties of T-Cell Subpopulations.- 14.10. Suppressor and Helper Functions of T-Cell Subsets.- 14.11. Antibody-Dependent (ADCC), Spontaneous (SLMC), and Mitogen-Induced (MICC) Cytotoxicity.- 15. Atopic Dermatitis.- 16. Cellular Immunity.- 16.1. T Lymphocytes.- 16.2. Lymphocyte Transformation.- 16.3. Delayed-Type Hypersensitivity.- 16.4. Humoral Immunity.- 16.5. B Lymphocytes.- 16.6. Serum Immunoglobulins.- 17. Bronchial Asthma and Allergic Rhinitis.- 17.1. Cell-Mediated Immunity: T Lymphocytes.- 17.2. Lymphocyte Transformation and Mediator Production in Response to Mitogens and Antigens.- 17.3. Humoral Immunity: B Lymphocytes.- 17.4. Serum Immunoglobulins.- 17.5. Antibody-Dependent Cell-Mediated Cytotoxicity (ADCC).- 17.6. Cyclic Nucleotides in Leukocytes of Atopic Subjects.- 17.7. Polymorphonuclear Leukocyte and Monocyte Chemotaxis in Atopic Disease.- 18. Drug Hypersensitivity.- 19. Summary.- 20. References.- 4 Molecular Properties of Allergens.- 1. Allergens or Antigens.- 2. Types of Antigenic Determinants.- 3. B-Cell-Specific Antigenic Determinants.- 3.1. Experimental Approaches.- 3.2. Antigenic Determinants Reacting with IgG Antibodies: Size, Structure, and Conformation.- 3.3. Antigenic Determinants Reacting with IgM Antibodies.- 3.4. Antigenic Determinants Reacting with IgE Antibodies.- 4. T-Cell-Specific Antigenic Determinants.- 4.1. Experimental Approaches.- 4.2. Size, Structure, and Conformation.- 5. Concluding Remarks.- 6. References.- 5 Immunoglobulin E: Biosynthesis and Immunological Mechanisms of IgE-Mediated Hypersensitivity.- 1. Introduction.- 2. Mechanisms of IgE-Mediated Hypersensitivity.- 2.1. Immunological Properties of IgE Antibody.- 2.2. Mechanisms of Sensitization.- 2.3. Immunological Mechanisms of IgE-Mediated Reactions.- 3. IgE Antibody Response and Regulation.- 3.1. Precursor B Lymphocytes of IgE-Forming Cells.- 3.2. Requirement of T-Helper Cells in IgE Response.- 3.3. Regulation of IgE Antibody Response by Suppressor T Cells.- 3.4. Experimental Model of Immunotherapy.- 4. References.- 6 Mediators of Immediate Hypersensitivity.- 1. Introduction.- 2. Physicochemical Characteristics, Metabolism, and Pharmacological Actions of Mediators.- 2.1. Preformed Mediators.- 2.2. Newly Generated Mediators.- 3. Mast Cell Degranulation: Biochemical Mechanisms and Controls.- 3.1. Agents Which Initiate Mast Cell Degranulation.- 3.2. Biochemical and Morphological Aspects of Degranulation.- 3.3. Modulating Agents.- 3.4. A Conceptual Model for Cell Activation.- 4. Interaction of the Mediators of Immediate Hypersensitivity with Humoral and Cellular Elements of the Immune System.- 4.1. Interaction with Humoral Elements.- 4.2. Interaction with Cellular Elements.- 4.3. Regulation of the Immediate Hypersensitivity Response in Tissue.- 5. References.- 7 The Genetics of Allergy.- 1. Introduction.- 2. Immunogenetics.- 2.1. Transplantation Biology.- 2.2. Cell Cooperation and Genetic Restriction.- 2.3. Antibody Diversity.- 2.4. Polymorphisms to Complex Antigens.- 3. Cognitive Function.- 3.1. Nutrient Recognition.- 3.2. Pollen Biology.- 3.3. The Immune System.- 3.4. The Central Nervous System.- 4. Problem Solving in Clinical Immunogenetics.- 4.1. Multifactorial Diseases.- 4.2. Clinical Phenotypes.- 4.3. Environmental Interactions.- 4.4. Antigens.- 4.5. Sampling Problems.- 4.6. Models and Solutions.- 4.7. Multivariate Analysis.- 5. HLA-Associated Diseases.- 5.1. Disease Associations.- 5.2. Hypothetical Mechanisms.- 5.3. Predictions and Prevention.- 6. Human Immune Response Genes.- 6.1. Allergic Diseases.- 6.2. Immunoglobulin E.- 6.3. Allergen Response Polymorphisms.- 6.4. Infectious Diseases.- 7. References.- 8 Urticaria and Angioedema.- 1. Introduction.- 2. Mediator Pathways of Urticaria and Angioedema.- 3. Causes of Urticaria and Angioedema.- 4. Physical Urticarias and Angioedema.- 4.1. Cold Urticaria.- 4.2. Cholinergic Urticaria.- 4.3. Dermographism.- 4.4. Pressure Urticaria (Angioedema).- 4.5. Solar Urticaria.- 4.6. Aquagenic Urticaria.- 5. Hereditary Forms of Urticaria and Angioedema.- 5.1. Familial Cold Urticaria.- 5.2. Hereditary Vibratory Angioedema.- 5.3. C3b Inactivator Deficiency.- 5.4. Urticaria and Amyloidosis.- 5.5. Hereditary Angioedema.- 6. Vasculitis and Urticaria.- 7. Chronic Idiopathic Urticaria and Idiopathic Angioedema.- 8. References.- 9 Food Hypersensitivity.- 1. Introduction.- 2. Plan of Presentation.- 3. Basic Immunology.- 3.1. Local Components.- 3.2. Systemic Components.- 3.3. Developmental Features.- 3.4. Genetic Factors.- 3.5. Components of Immunological Reactions.- 3.6. Types of Immunological Reactions.- 4. Clinical Immunology.- 4.1. The Mucosal Barrier and the Immune System.- 4.2. Detection of Reaginic Sensitization.- 4.3. Detection of Nonreaginic Sensitization.- 5. Clinical Manifestations.- 5.1. Adverse Reactions to Foods.- 5.2. Unproven “Syndromes”.- 5.3. Immunological Reactions to Foods.- 5.4. Reagin-Mediated Reactions.- 5.5. Reactions Not Reagin Mediated.- 6. Clinical Applications.- 6.1. History and Physical Examination.- 6.2. Confirmation of Reported Adverse Reaction to Food.- 6.3. Differential Diagnosis.- 6.4. Evidence of Specific Immunological Sensitization.- 6.5. Reactions Reagin Mediated.- 6.6. Reactions Not Reagin Mediated.- 6.7. Management.- 7. Envoi.- 8. References.- 10 Drug Allergy.- 1. Introduction.- 2. Clinical Manifestations of Drug Allergy.- 2.1. Anaphylactic Shock.- 2.2. Serum Sickness Syndrome.- 2.3. Cutaneous Manifestations.- 2.4. Hematological Manifestations.- 2.5. Vasculitis and Connective Tissue Damage.- 2.6. Hepatic Damage.- 2.7. Fever.- 2.8. Nephropathy.- 2.9. Pulmonary Manifestations.- 2.10. Miscellaneous.- 3. Immunochemistry and Immunopathology of Drug Reactions.- 3.1. Chemical Properties Involved in the Allergenic Potential of Drugs.- 3.2. Induction of Immune Responses to Drugs: Main Factors Involved.- 4. Principal Allergenic Drugs.- 4.1. Penicillins and Cephalosporins.- 4.2. Other Antibiotics.- 4.3. Sulfonamides.- 4.4. Aspirin.- 4.5. Antipyretic and Analgesic Drugs.- 5. Diagnosis of Drug Allergy.- 5.1. Case History.- 5.2. Skin Tests.- 5.3. In Vitro Tests.- 5.4. Provocation Tests.- 6. Therapy.- 6.1. Prophylaxis.- 6.2. Hyposensitization.- 7. References.- 11 Insect Allergy: Stinging and Biting Insects.- 1. Introduction.- 2. Stinging Insects: “Winged” Hymenoptera.- 2.1. Clinical Aspects.- 2.2. Immunopathogenesis.- 2.3. Diagnosis.- 2.4. Therapy.- 3. Fire Ant.- 4. Biting Insects.- 5. References.- 12 Nasal Hypersensitivity.- 1. Introduction.- 2. Common Syndromes of Nasal Disease.- 2.1. Seasonal Allergic Rhinitis.- 2.2. Perennial Allergic Rhinitis.- 2.3. Nonatopic or Infectious Rhinitis.- 2.4. Vasomotor Rhinitis.- 2.5. Rhinitis Medicamentosa.- 2.6. Anatomical Lesions as a Cause of Rhinitis.- 2.7. Neurogenic Rhinitis.- 2.8. Food Intolerance as a Cause of Rhinitis.- 2.9. Hormonal Rhinitis.- 2.10. Atrophic Rhinitis.- 2.11. Chemical Rhinitis.- 2.12. Rhinitis Associated with Nasal Polyps.- 2.13. Psychosomatic Rhinitis.- 3. Incidence of the Syndromes of Nasal Disease.- 4. Histological Classification of Nasal Disease.- 4.1. Normal Histology of the Nasal Membrane.- 4.2. Abnormal Histological Features Suggesting Nonimmunological Causes of Nasal Disease.- 4.3. Abnormal Infiltrates Suggesting Nonimmunological Causes of Nasal Disease.- 4.4. Abnormal Infiltrates Suggesting Immunological Causes of Nasal Disease.- 5. Summary.- 6. References.- 13 Pathogenesis of Bronchial Asthma.- 1. Introduction.- 2. Clinical Classification and Pathology.- 2.1. Classification.- 2.2. Pathology.- 3. Normal Anatomy and Innervation.- 3.1. Cells of the Pulmonary Airways.- 3.2. Nerve Supply of the Lung.- 3.3. Control Mechanisms.- 3.4. Bronchial Airways.- 4. Allergic Asthma (Extrinsic).- 4.1. Immunological Basis.- 4.2. Allergens.- 4.3. Chemical Mediators.- 4.4. Cholinergic Reflex Pathways.- 5. Idiopathic Asthma (Intrinsic).- 5.1. Hyperresponsive Cholinergic Receptors.- 5.2. Partial ?-Adrenergic Blockade.- 5.3. Hyperresponsive a-Adrenergic Receptors.- 5.4. Alternative Hypotheses.- 5.5. Aspirin Sensitivity.- 5.6. Exercise-Induced Asthma.- 5.7. Viral Infections Inducing Asthma.- 5.8. Emotions and Bronchial Asthma.- 6. References.- 14 Immunological Features of Infiltrative Pulmonary Disease.- 1. Introduction.- 2. Hypersensitivity Pneumonitis (Extrinsic Allergic Alveolitis).- 2.1. Etiology.- 2.2. Clinical Features: Disease Presentation.- 2.3. Diagnosis.- 2.4. Therapy.- 2.5. Pathogenesis.- 3. The Eosinophilic Pneumonias.- 3.1. Eosinophilic Pneumonias with Asthma.- 3.2. Eosinophilic Pneumonias without Asthma.- 4. Pulmonary Fibrosis.- 4.1. Connective Tissue Diseases.- 4.2. Occupational Diseases.- 4.3. Infectious and Idiopathic Diseases.- 5. References.- 15 Augmented Immunglobulin E Synthesis in Primary Immunodeficiency.- 1. Introduction.- 2. Potential Mechanisms for Augmented IgE Synthesis in Immunodeficiency.- 3. Excessive IgE Synthesis in Primary Immunodeficiency Disorders.- 3.1. The Wiskott-Aldrich Syndrome.- 3.2. DiGeorge’s Syndrome.- 3.3. Nezelof’s Syndrome.- 3.4. Selective IgA Deficiency.- 3.5. The Hyper-IgE Syndrome.- 4. References.- 16 Hypersensitivity Vasculitis: The Acute Phase of Leukocytoclastic (Necrotizing) Lesions.- 1. Properties of Complexes and Immune-Complex-Mediated Responses.- 1.1. Introduction: Arthus-Like Responses and Vasculitis.- 1.2. Properties of Immune Complexes in Relation to Tissue Damage.- 1.3. Increased Vascular Permeability and Deposition of Complexes.- 1.4. Sequence of Changes in Arthus-Type Reactions.- 2. Investigations of Human Vasculitis.- 2.1. Detection of Immunoglobulins and Complement C3 in Various Forms of Vasculitis.- 2.2. Comments on the Significance of Immunoglobulins in Lesions.- 2.3. Partial “Immune Deficiency” and Weak-Affinity Antibodies in Immune Complex Disorders.- 2.4. Histamine-Mediated Vasculitis.- 3. Identification of Antigens Possibly Forming Immune Complexes in Patients with Cutaneous Vasculitis.- 3.1. Bacterial Antigen in Immune Complexes and Vasculitis Lesions.- 3.2. Virus as Antigen in Immune Complexes.- 3.3. DNA as Antigen in Immune Complexes.- 3.4. Cryoglobulins as Immune Complexes in Vasculitis.- 4. Possible Contribution of Rheumatoid Factors to Vasculitis.- 4.1. Serum Rheumatoid Factors.- 4.2. Tissue-Bound, Possibly Locally Formed, Rheumatoid Factors.- 5. Role of C-Reactive Protein in Vasculitis.- 6. Summary of Investigations on Human Vasculitis.- 7. References.- 17 Laboratory Diagnosis of Immediate Hypersensitivity Disorders.- 1. Introduction.- 1.1. Clinical Indication.- 1.2. Standardization of Major Allergens.- 2. Skin Testing.- 2.1. Introduction.- 2.2. Test Procedures.- 2.3. Clinical Interpretation.- 3. Determination of Total and Specific IgE.- 3.1. Introduction.- 3.2. Measurement of Total IgE.- 3.3. Measurement of Specific IgE.- 4. Measurement of Specific IgG.- 4.1. Double Antibody Technique.- 4.2. Clinical Significance.- 5. Auxiliary Procedures.- 5.1. Histamine Release from Leukocytes in Vitro.- 5.2. Passive Sensitization.- 5.3. Bronchial and Conjunctival Challenge.- 6. Summary.- 7. References.- 18 Immunological and Pharmacological Management of Allergic Diseases.- 1. Allergic Rhinitis.- 1.1. Immunological Management.- 1.2. Pharmacological Management.- 2. Asthma.- 2.1. Definition.- 2.2. IgE-Triggered Asthma.- 3. Anaphylaxis.- 3.1. Immunological Management.- 3.2. Pharmacological Management.- 4. Urticaria and Angioedema.- 4.1. Immunological Management.- 4.2. Pharmacological Management.- 5. Allergic Bronchopulmonary Aspergillosis (ABPA).- 5.1. Diagnosis.- 5.2. Management.- 6. Hypersensitivity Pneumonitis.- 6.1. Recognition.- 6.2. Management.- 7. References.
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