Synonym— Laurell antigen‐antibody crossed electrophoresis (82) ad modum Clarke & Freeman (29).

Synonyms: —antigen electrophoresis in antibody‐containing agarose gel (84) —electroimmuno assay (85).

PrefaceThe only real argument for establishing a specific diagnosis in allergic diseases is the institution of a specific treatment. Allergen avoidance and immunotherapy represent the only specific treatments we are able to offer allergic patients. The capacity of drug treatment is limited to the elimination or diminishing of symptoms, and no studies have been able to show that pharmacologic treatment of allergic diseases, not even corticosteroids, modifies the spontaneous, long-term course of the disease. Costbenefit studies of immunotherapy present problems, and we recommend that immunotherapy be an integrated part of the treatment of allergic disorders, thus reducing the disease severity, improving the quality of life of allergics, and diminishing the risk and cost of pharmacotherapy.The first EAACI Immunotherapy Position Paper was published in 1988. New insights into the pathogenesis of allergic diseases and recent publications on immunotherapy have called for a revision of the Immunotherapy Position Paper. However, allergenspecific immunotherapy is a controversial treatment, and drafting this 1992 revised Position Paper is difficult since: 1) We intend to recommend that immunotherapy be performed in the most scientific way, but supportive data are not always sufficient. 2) Although clinical experience is encouraging, particularly with recent high-quality extracts, a further reduction in the number of patients treated by immunotherapy, while we wait for further scientific data, will make improvements more difficult, and eventually lead to a halt in the production of allergen extracts. Our Position Paper, therefore, aims at reaching a consensus, balancing science, theory, and current practice in most European countries, at the same time intending to improve the scientific value of the 1992 revised EAACI Immunotherapy Position Paper .The outlines of the 1992 revised EAACI Immunotherapy Position Paper were debated at a one-day meetingin February 1991, in Copenhagen, Denmark, sponsored by ALK, Denmark. The first edition was drafted at a three-day meeting in May 1991, in Madrid, Spain, organized by Dr Emilio Alvarez-Cuesta and kindly sponsored by Abell6, Spain. The final revised edition of the Position Paper represents the opinion of the members of the EAACI Immu-notherapy Subcommittee and includes comments from the EAACI associate European national societies of allergology. Hans-Jrargen Malling Bent Weeke aluminium-containing allergen extracts. Allergy 1985: 40: 59. FROSTAD AB, GRIMMER 0, SANDVIK L, MOXNES A. AAS K. Clinical effects of hyposensitization using a purified allergen preparation from timothy pollen as compared to crude aqueous extracts from timothy pollen and a four-grass pollen mixture respectively. Clin Allergy 1983: 13: 337-57. 60. FURIN MJ. NORMAN PS. CRETICOS PS, et al. Immunotherapy decreases antigen-induced eosinophil cell migration into the nasal cavity. J Allergy Clin Imrnunol 1991: 88: 27-32. 61. GEHA RS. Use of IgE-derived peptides to treat allergy. Ann Allergy 1991: 66: 359-60. 62. GEORGIT...

SummaryA method for biological equilibration (BE) of allergen reference preparations using the skin‐prick test (SPT) method and histamine HCl 10 mg/ml as reference substance (reference method), was evaluated. The precision was low for weals less than 10 mm2. The slope (log weal area/log concentration) of allergen and histamine did not vary significantly between investigators and allergens. The median slopes were 0.39 (n= 384) and 0.34 (n= 397), for allergen and histamine, respectively (P < 0.01). The concentration of allergen eliciting a weal of the same size as that of histamine HCl 1 mg/ml (Chl) in the median sensitive patient, 1000 Biological Units/ml (BU/ml), did not vary significantly between clinics/geographical regions (grasses, mites and moulds). As BE is repeatable between regions. BUs estimated by this method are generally valid. A high correlation (r= 0.91, P < 0.001) was found between the median Chl as estimated with histamine 1 and 10 mg/ml as reference substance, respectively. Thus, this reference method for BE is valid. The precision of the SPT method with histamine HCl 1 mg/ml is not as good as with 10 mg/ml, which is therefore recommended as the reference concentration.

Background-High dose inhaled glucocorticosteroids are increasingly used in the management of patients with moderate to severe asthma. Although effective, they may cause systemic side effects. Fluticasone propionate is a topically active inhaled glucocorticosteroid which has few systemic effects at high doses. Methods-Fluticasone propionate, 1.5 mg per day, was compared with beclomethasone dipropionate at the same dose for one year in patients with symptomatic moderate to severe asthma; 142 patients received fluticasone propionate and 132 received beclomethasone dipropionate. The study was multicentre, double blind and of a parallel design. For the first three months patients attended the clinic every four weeks and completed daily diary cards. For the next nine months they were only seen at three monthly intervals in the clinic. Results-During the first three months diary card peak expiratory flow (PEF) rate and lung function measurements in the clinic showed significantly greater improvement in patients receiving fluticasone propionate (difference in morning PEF 15 Vmin (95% CI 6 to 25)), and these differences were apparent at the end of the first week. The improved lung function was maintained throughout the 12 month period and the number of severe exacerbations in patients receiving fluticasone propionate was reduced by 8% compared with those receiving beclomethasone dipropionate. No significant differences between the two groups were observed in morning plasma cortisol levels, urinary free cortisol levels, or response to synthetic ACTH stimulation. In addition, both the rates of withdrawal and of adverse events were low, and there were fewer exacerbations of asthma with fluticasone propionate than beclomethasone dipropionate.Conclusions-This study shows that fluticasone propionate in a daily dose of 15 mg results in a significantly greater increase in PEF and asthma control than the same dose of beclomethasone dipropionate, with no increase in systemic or other side effects.