Demonstration of Reactivity to Airborne and Food Allergens in Cutaneous Vasculitis by Variations In Fibrinopeptide A and Other Blood Coagulation, Fibrinolysis and Complement Parameters

Summary

In a 32-year-old woman and a 40-year-old man with cutaneous vasculitis, etiological allergic responses to foods and airborne allergens were found. During provocation tests, observations were made on blood levels of fibrinopeptide A( FPA) and coagulation factors, fibrinogen degradation products (FDP) and serum complement components. Skin biopsies were taken for microscopic and immunofluorescence analysis.

In case 1, anaphylactoid allergy to milk and reaginic and anaphylactoid hypersensitivity to grass pollens were found. Dermal provocations with grass pollens gave arthralgia, hematomas, serum C3 fluctuation, factor VII reduction and fibrinolysis. During peroral milk challenge, transient increases in FPA and FDP levels were observed before symptoms appeared.

In case 2, anaphylactoid hypersensitivity responses to bacteria, animal danders, foods and pollens were found. Two inhalations with sheep-wool extract resulted in a typical skin eruption. The first also gave an early reduction of C3 and then FPA liberation. Nasal birch-pollen test gave an increase of FPA in the latent period and then typical nodules. At least no low molecular weight FDP were detected during provocations.

In patients with vasculitis reactions to exogenous allergens, FPA and FDP estimations after provocations may discriminate harmful from innocuous allergens and reveal individual response patterns in coagulation and fibrinolysis systems.

• References

• 1 Bachmann F, Duckert F, Koller F. 1958; The Stuart-Prower factor assay and its clinical significance. Thrombosis et Diathesis Haemorrhagica 2: 24.
• 2 Denson K. W. 1961; The specific assay of Prower-Stuart factor and factor VII. Acta Haematologica 25: 105.
• 3 Dixon F. J, Vazquez J. J, Weigle W. O, Cochrane C. G. 1958; Pathogenesis of serum sickness. Archives of Pathology 65: 18.
• 4 Gell P. G. H, Coombs R. R. A, Lachmann P. J. 1975. Clinical Aspects of Immunology. 3rd edn.. Blackwell Scientific Publications; Oxford:
• 5 Handel D. W, Roenigk Jr H. H, Shainoff J, Deodhar S. 1975; Necrotizing vasculitis. Etiologic aspects of immunology and coagulopathy. Archives of Dermatology 111: 847.
• 6 Harkavy J. 1963. Vascular Allergy and Its Systemic Manifestations. Butterworths; Washington:
• 7 Johansson S. A. 1967 Platelets, coagulation factors and 5-hydroxytryptamine in sensitization, anaphylaxis and burn injuries. Acta Medica Scandinavica. Suppl. 471 (Thesis).
• 8 Kockum C. 1976; Radioimmunoassay of fibrinopeptide A-clinical applications. Thrombosis Research 8: 225.
• 9 Kristenson A. 1922; A new method for the direct counting of the so-called blood platelets in man. Acta Medica Scandinavica 57: 301.
• 10 Lansbury J. 1958; Report of a three-year study on the systemic and articular indexes in rheumatoid arthritis: theoretic and clinical considerations. Arthritis and Rheumatism 1: 505.
• 11 Laurell A. B, Sjöholm A, Johnson U. 1970; Quantitation of the fourth complement component by electrophoresis in agarose gel containing antibodies. Clinical and Experimental Immunology 7: 423.
• 12 Laurell C. B. 1972; Electroimmunoassay. Scandinavian Journal of Clinical and Laboratory Investigation 29 suppl. 124 21.
• 13 Lundh B, Hedberg H, Laurell A. B. 1970; Studies on the third component of complement in synovial fluid from arthritic patients. I. Immunological quantitation and relation to total complement. Clinical and Experimental Immunology 6: 407.
• 14 Mancini G, Carbonara A. O, Heremans J. F. 1965; Immunochemical quantitation of antigens by single radial immunodiffusion. Immunochemistry 2: 235.
• 15 Merskey C, Lalezari P, Johnson A. J. 1969; A rapid, simple, sensitive method for measuring fibrinolytic split products in human serum. Proceedings of the Society for Experimental Biology and Medicine 131: 871.
• 16 Movat H. Z. 1973; Chemical mediators of the vascular phenomena of the acute inflammatory reaction and of immediate hypersensitivity. Symposium on Clinical Immunology . Medical Clinics of North America 56: 2541 (Review).
• 17 Nilsson I. M, Blombäck M, von Francken I. 1957; On an inherited autosomal hemorrhagic diathesis with antihemophilic globulin (AHG) deficiency and prolonged bleeding time. Acta Medica Scandinavica 159: 35.
• 18 Nilsson I. M, Olow B. 1962; Fibrinolysis induced by streptokinase in man. Acta Chirurgica Scandinavica 123: 247.
• 19 Norén I, Blombäck M. 1971; A quick method for the assay of factor VIII with use of standardized reagents in a thrombin generation system. Coagulation 4: 119.
• 20 Nossel H. L, Yudelman I, Canfield R. E, Butler Jr V. P, Spanondis K, Wilner G. D, Qureshi G. D. 1974; Measurement of fibrinopeptide A in human blood. The Journal of Clinical Investigation 54: 43.
• 21 Owren P. A, Strandli O. K. 1969; Normotest. Farmakoterapi 1-11: 14.
• 22 Owren P. A. 1959; Thrombotest. A new method for controlling anticoagulant therapy. Lancet 2: 754.
• 23 Pitcher P. M. 1971 Preparation of a rapid slide test for the detection of fibrinogen degradation products (FDP) in serum and a preliminary report on its use as a clinical screening test. 2nd Congress of the International Society on Thrombosis and Haemostasis. Oslo 1971. Abstr. 282.
• 24 Proceedings of the International Symposium on Immune Complex Diseases. Milan: 1970. Carlo Erba Foundation;
• 25 Rich A. R, Gregory H. J. E. 1943; Experimental demonstration that Periarteritis Nodosa is manifestation of hypersensitivity. Bulletins of the Johns Hopkins Hospital 72: 65.
• 26 Robbins J, Stetson Jr C. A. 1959; An effect of antigen-antibody interaction on blood coagulation. Journal of Experimental Medicine 109: 1.
• 27 Schroeter A. L, Copeman P. W. M, Jordon R. E, Saws W. M, Winkelmann R. K. 1971; Immunofluorescence of cutaneous vasculitis associated with systemic disease. Archives of Dermatology 104: 254.
• 28 Simpson J. G, Robertson A. J, Stalker A. L. 1973. The effect of immune complexes on coagulation and fibrinolysis in vivo. In: Lewis D. H, Ditzel J. (eds) Proceedings of the 7th European Conference on Microcirculation. Part II 260 S. Karger; Basel.:
• 29 Slaastad R. A, Godal H. C. 1972; Discrepancy between Thrombotest and Normotest – an indicator of disseminated intravascular coagulation (DIC)?. Scandinavian Journal of Haematology 9: 411.
• 30 Theorell, H. H. To be published.
• 31 Winkelmann R. K, Ditto W. B. 1965; Cutaneous and visceral syndromes of necrotizing or “allergic” angiitis. A study of 38 cases. Medicine 2: 59.