Eighty-one Indian patients received immunotherapy for allergic diseases during 109 pregnancies. Their allergy clinic records were analysed retrospectively and this revealed an incidence similar to or less than the general population with regard to abortion, perinatal mortality, prematurity, toxaemia and congenital malformation. A control group of 60 contemporary Indian patients (82 pregnancies) who refused immunotherapy were also analysed retrospectively and this revealed a higher incidence of abortion, prematurity and toxaemia as compared with those treated with immunotherapy. It is concluded that immunotherapy for allergic diseases is safe in pregnancy. Immunotherapy is safe even when it is initiated for the first time in a pregnant patient, an aspect not reported in any study until now.
Although this was an open trial, it could be concluded that relief with inhaled corticosteroids in bronchial asthma is more rapid than immunotherapy; however the decline in benefit on cessation of inhaled corticosteroid is even more rapid, a phenomenon not seen with immunotherapy.
Summary
Papain is a proteolytic enzyme with elastolytic activity, which produces emphysemalike lesions when introduced into the airways of animals. It is encountered by humans in numerous occupations, medications and domestic products.
Sensitization to papain in two subjects in different occupations was confirmed with skin tests with chemical‐grade papain and radioallergosorbent tests (RAST), with a papain which had been chemically inactivated by selective active site blockade. Skin tests and RAST were negative in non‐symptomatic co‐workers. Withdrawal from occupational exposure to papain resulted in an improvement in symptoms.
In a survey of 330 subjects at the time they were receiving routine allergy skin tests, seven reacted to papain. Sensitization was confirmed by the RAST. Serum IgG antibodies to papain were detected among sensitized individuals and also in five out of 266 sera obtained from a clinical hospital laboratory.
The findings illustrate immune responses to papain in humans in the form of atopic sensitization and serum IgG antibodies. Moreover, recurrent respiratory symptoms in the presenting persons served to illustrate that they and their co‐workers were repeatedly exposed to air‐borne papain. In view of the potential danger from the proteolytic effects of papain, these observations illustrate the need for further investigations of the effects of human exposure to air‐borne papain.
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