alpha-chymotrypsin and Urticaria

We occasionally see egg-allergic children who develop contact urticaria to hen's egg despite the absence of the overt symptoms on ingestion. The mechanisms remain to be elucidated.. Twenty-one subjects with positive reactions to 20-min patch tests for egg-white antigens were divided into subgroups with positive (n = 10) and negative (n = 11) results to oral challenge tests by the same antigens. We measured IgE antibody for egg white and its components, and IgE-binding activities to digestive enzyme-treated ovomucoid by RAST inhibition.. There were no significant differences in IgE antibody titers to egg white (positive vs negative: 30.3% vs 15.3%, P=0.130), ovomucoid (21.5% vs 10.2%, P= 0.078), ovotransferrin (9.9% vs 3.7%, P = 0.105), and lysozyme (3.4% vs 2.9%, P=0.944), except ovalbumin (16.8% vs 5.6%, P=0.024), between the positive and negative subjects in the provocation tests. In contrast, the concentration (1.93 microg/ml) of pepsin-treated ovomucoid needed for 50% RAST inhibition in the challenge-positive subjects was significantly (P=0.0003) lower than that (114.9 microg/ml) of negative subjects. Similar but less significant differences were obtained when ovomucoid fragments treated with chymotrypsin (0.91 microg/ml vs 6.86 microg/ml, P=0.014) and trypsin (0.75 microg/ml vs 4.67 microg/ml, P= 0.041) were used as inhibitors.. We suggest that IgE antibodies from subjects showing contact urticaria despite the absence of reactions to the ingestion of egg white recognize the epitope(s) unstable to digestive enzymes.

Topics: Administration, Oral; Allergens; Animals; Child; Child, Preschool; Chymotrypsin; Conalbumin; Double-Blind Method; Egg White; Eggs; Female; Food Hypersensitivity; Humans; Immunoglobulin E; Infant; Male; Muramidase; Ovalbumin; Ovomucin; Pepsin A; Placebos; Radioallergosorbent Test; Trypsin; Urticaria

25 patients with chronic urticaria suspected to be of 'alimentary origin', were studied for a quantitative or qualitative deficiency of pancreatic enzyme secretion. All showed a normal fecal chymotrypsin excretion and 23/25 a normal bentiromide (PABA) and pancreolauryl test. In 2 females the urinary PABA and pancreolauryl tests were borderline pathological. This does not support the hypothesis that a pancreatic deficiency (of the kind which could be identified with the methods used) is associated with chronic urticaria in patients in whom improvement of urticaria occurs under a hydric or low antigenic diet.

Topics: 4-Aminobenzoic Acid; Chronic Disease; Chymotrypsin; Feces; Female; Fluorescein; Fluoresceins; Humans; Pancreas; Pancreatic Function Tests; para-Aminobenzoates; Urticaria

The hypothesis that deficiencies of plasma protease inhibitors might play a role in the pathogenesis of chronic urticaria was evaluated. Plasma levels were measured in patients with urticaria and a matched control group for alpha1-antitrypsin, alpha2-macroglobulin, total trypsin-inhibiting capacity, kallikrein-inhibiting capacity, and the complement factors C1 esterase inhibitor, C3, and C4. A total of 92 patients with chronic urticaria or more than three months' duration was studied. Patients with acquired cold urticaria had significantly decreased levels of alpha1-antitrypsin and total antitrypsin activity. In patients with acquired angioneurotic edema, alpha1-antitrypsin levels and antichymotrypsin activities were lowered, with less significant decreases in anti-trypsin and antikallikrein activities. Levels of C1 esterase inhibitor , C3, and C4 were normal in all groups. There was no correlation between the increased sensitivity to intracutaneously administered kallikrein injection and deficiencies of of protease inhibitors.

Topics: Adolescent; Adult; Aged; alpha 1-Antitrypsin; alpha-Macroglobulins; Angioedema; Child; Chronic Disease; Chymotrypsin; Complement C1 Inactivator Proteins; Complement C3; Complement C4; Esterases; Female; Humans; Kallikreins; Male; Middle Aged; Protease Inhibitors; Skin Tests; Urticaria

Topics: Adolescent; Adult; alpha 1-Antitrypsin; Alpha-Globulins; Child; Chymotrypsin; Cold Temperature; Complement System Proteins; Female; Genes, Dominant; Genetic Linkage; Humans; Kallikreins; Leukocytosis; Macroglobulins; Male; Middle Aged; Netherlands; Pedigree; Protease Inhibitors; Trypsin Inhibitors; Urticaria

Topics: Adolescent; Adult; Child; Chymotrypsin; Cold Temperature; Female; Humans; Kinins; Male; Middle Aged; Peptide Hydrolases; Protease Inhibitors; Trypsin; Urticaria