Plasma separation in patients with bronchial asthma, atopic dermatitis and hyperimmunoglobulinaemia E

The effect of intensive plasma separation performed eight times within 5 weeks in four patients with atopic dermatitis, bronchial asthma and hyperimmunoglobulinaemia E was followed as regards clinical symptoms and changes in the concentrations of serum (S) IgE, S IgG, S IgA, S IgM, plasma complement C3 split products, S transferrin, blood eosinophils, chemotaxis of neutrophil cells and histamine metabolites in urine in samples obtained consecutively during the period of observation. The occurrence of circulating immune complexes (IC) was analysed by a polyclonal rheumatoid factor (pRF) agglutination inhibition assay and an IgE IC specific technique. IgE 1C were demonstrated in three of the patients prior to plasma separation, complexed IgE was 2–3 % of the total concentration of S IgE. In one patient complexes were detected by the pRF agglutination inhibition assay, also. In the three patients with IgE 1C, the complexes disappeared during treatment, but recurred in two of the patients shortly after the last plasma separation. Shortly after eight separations the S IgE was reduced in all patients to a mean level of 46% of the pre-exchange concentrations. During the following 3 weeks the relative increase of S IgE in three of the patients was similar to the values obtained for S IgG. Serum IgG was subnormal in all patients during the period of treatment. Increasing numbers of eosinophils were observed in three of the patients after the fifth separation procedure. The histamine metabolite 1,4-methylimidazoleacetic (1,4-MIAA) in urine was increased in all patients, but no significant changes were observed during the treatment. The increase of complement C3c split product in two of the patients during the separation procedure indicated that complement activation took place. Questionable clinial improvement of dermatitis and asthma was observed during the period of plasma separation, and the effect was short lasting. For the time being plasma separation in patients with combined hyperimmunoglobulinaemia E, asthma and atopic dermatitis cannot be recommended as a tool in the management of the disease.