Alpha 1-antitrypsin in tropical pulmonary eosinophilia

Serum alpha-antitrypsin (A1AT) was measured in 36 patients (group A) with tropical pulmonary eosinophilia (TPE) and 30 patients with pulmonary eosinophilia with associated worm infestation (group B). Serum A1AT level was also measured in 42 healthy subjects (group C). In 28 patients (group A, 15 and group B, 13), the serum A1AT level was below 60 percent of the mean A1AT value of the control group. The A1AT-deficient patients had a more severe form of illness with recurrence and relapse, and they were generally refractory to treatment. In these deficient patients, a significant negative correlation (p < 0.02) between A1AT and absolute blood eosinophil counts (AEC) was observed. In 21 patients (group A, B and group B, 13), the effect of therapy with either diethylcarbamazine or deworming or both was observed. This showed a significant posttreatment rise of A1AT level with a significant fall in AEC (p < 0.02) as compared to their respective pretreatment levels. Serum A1AT levels in either or both parents of 11 patients (group A, 5 and group B, 6) were found to be within normal levels. The significant rise in A1AT levels with a significant fall in AEC levels in the patients following therapy and the absence of A1AT deficiency in the parents examined indicate that the A1AT deficiency observed in TPE is probably acquired.