Recurrent Staphylococcal Abscesses Associated with Defective Neutrophil Chemotaxis and Allergic Rhinitis

Abstract

Four patients with recurrent staphylococcal furonculosis and deep abscess formation were evaluated to determine if a defect in the host defense mechanism could account for the unusual incidence of infection. Each also suffered repeated allergic rhinitis, often preceding the onset of infection. A marked defect in neutrophil granulocyte chemotaxis occurred when the patients were symptomatic with rhinitis and abscess formation. Their mean chemotactic index (+/- SD) was 16 +/- 6, while that of 25 control subjects was 70 +/- 11. Neutrophil random migration, phagocytosis, bactericidal activity, and lymphocyte T-cell populations were normal, as were serum concentrations of IgA, IgG, IgM, and IgE. Serial neutrophil function tests revealed normal chemotactic responsiveness when the patients were symptom-free of allergic rhinitis and no longer having abscesses. Abnormal function returned, however, when symptoms recurred. These studies suggest that defective neutrophil function associated with allergic phenomena need not be accompanied by hyperimmunoglobulinemia E. Such defects may be intermittent, appearing when allergic symptomatology and infections develop.

Granulocyte Migration Abnormality in Patients Suffering from Seasonal Allergic Rhinitis: Failure of Treatment with Cimetidine

“…The defect was modest in degree which could explain the absence of associated recurrent infections in 4 of the 5 patients studied. These findings are similar to that reported by Hill et al [1] in allergic patients without staphylococ cal infections. Only 1 of our patients suffered from minor infections that occurred yearly in spring.…”

“…The association of allergic rhinitis, defective gran ulocyte chemotaxis, and recurrent staphylococcal skin abscesses has been reported [1], The mechanism of the granulocyte dysfunction in these patients is not known, but one possibility is that the IgE-mediated histamine release may be responsible. This is based upon in vitro studies showing binding of histamine to leukocytes and their displacement with antihista mines [2], induction of increased intracellular cyclic AMP and diminished chemotactic responses in gran ulocytes incubated with histamine, and the preven tion of these effects in granulocytes protected with burimamide, an histamine Hs-receptor blocker [3].…”

“…To examine this question further in vivo, we stud ied granulocyte migration in patients with sympto matic allergic rhinitis and then attempted to correct the noted granulocyte defect with cimetidine, a widely available histamine H2-receptor blocker. 1 We thank Dr. Edward Conway for performing the skin tests.…”

Infections in patients with abnormal granulocyte chemotaxis

“…Patients with atopic disease and recurrent staphylococcal furunculosis may have transiently abnormal granulocyte locomotion. Hill et al [34] found depressed chemotaxis during allergic symptomatology but normal granulocyte chemotactic responsiveness when staphylococcal furuncles were being treated.…”

Evaluation of the Host Defense System in Asthmatic Patients

“…Low levels of secretory IgA or of the second component of com plement and defects of the alternative pathway of complement are much more frequent among atopic children than in the general population [Soothill and Har vey, 1976;Siccardi et al, 1980Siccardi et al, , 1981, Moreover, defective neutrophil chemotaxis has been described in patients with marked allergic diseases and recurrent infections [Hill et al, 1976]. Recently, quantitative and qualitative changes in T cells have been described in atopic derma titis and respiratory allergy with increased IgE levels.…”