RESUMEN
Elevated serum IgE levels are associated with allergic disorders, parasitosis and specific immunologic abnormalities. In addition, epidemiological and mechanistic evidence indicates an association between IgE-mediated immune surveillance and protection from tumour growth. Intriguingly, recent studies reveal a correlation between IgE deficiency and increased malignancy risk. This is the first review discussing IgE levels and links to pathological conditions, with special focus on the potential clinical significance of ultra-low serum IgE levels and risk of malignancy. In this Position Paper we discuss: (a) the utility of measuring total IgE levels in the management of allergies, parasitosis, and immunodeficiencies, (b) factors that may influence serum IgE levels, (c) IgE as a marker of different disorders, and d) the relationship between ultra-low IgE levels and malignancy susceptibility. While elevated serum IgE is generally associated with allergic/atopic conditions, very low or absent IgE may hamper anti-tumour surveillance, indicating the importance of a balanced IgE-mediated immune function. Ultra-low IgE may prove to be an unexpected biomarker for cancer risk. Nevertheless, given the early stage of investigations conducted mostly in patients with diseases that influence IgE levels, in-depth mechanistic studies and stratification of malignancy risk based on associated demographic, immunological and clinical co-factors are warranted.
Asunto(s)
Asma/diagnóstico , Linfocitos T CD8-positivos/inmunología , Ruidos Respiratorios/diagnóstico , Subgrupos de Linfocitos T/inmunología , Linfocitos T Reguladores/inmunología , Asma/inmunología , Separación Celular , Preescolar , Femenino , Citometría de Flujo , Humanos , Lactante , Recién Nacido , Recuento de Linfocitos , Masculino , Pronóstico , Ruidos Respiratorios/inmunologíaRESUMEN
Gaucher disease (GD), the most common lysosomal storage disorder, demonstrates an autosomal recessive pattern of inheritance. The genetic defect in GD leads to decreased production of the lysosomal enzyme glucosylceramide hydrolase, thereby resulting in the deposition of glucosylceramide sphingolipids within multiple organ systems. Although the precise mechanisms remain unclear, GD is usually associated with chronic antigenic stimulation and hyperimmunoglobulinaemia. We report a novel case of type I GD coexisting with relatively low serum immunoglobulins, impaired antibody production, and recurrent bacterial infections in a 62-year-old male. The patient had been diagnosed with GD 30 years previously and had subsequently started enzyme replacement therapy. Since being diagnosed with GD, the patient had suffered from repeated episodes of acute bronchitis and a recent severe bout of community-acquired pneumonia that required a lengthy hospitalization. On our initial evaluation, the patient had laboratory testing that demonstrated: decreased serum IgG, IgG2, and IgA levels; reduced absolute CD3(+)/CD4(+), CD3(+)/CD8(+), and lymphocyte counts; low IgG titres to pneumococcal polysaccharide vaccine; and decreased anti-tetanus antibodies. Lymphocyte function analysis demonstrated a normal response to phytohaemagglutinin, and decreased responses to concanavalin A and pokeweed mitogen. Repeat testing after 6 months revealed normal serum immunoglobulin levels and mitogenic responses. Although the explanation for our observed transient hypogammaglobulinaemia remains unclear, this patient's clinical constellation (i.e. repeated infections, hypogammaglobulinaemia and lymphopenia, decreased post-vaccination titres, and impaired responses to some mitogens) shares overlapping features with common variable immunodeficiency (CVID).
Asunto(s)
Agammaglobulinemia/inmunología , Formación de Anticuerpos , Enfermedad de Gaucher/inmunología , Inmunoglobulinas/sangre , Linfocitos/inmunología , Enfermedad Aguda , Agammaglobulinemia/diagnóstico , Agammaglobulinemia/tratamiento farmacológico , Bronquitis/inmunología , Bronquitis/microbiología , Infecciones Comunitarias Adquiridas/inmunología , Infecciones Comunitarias Adquiridas/microbiología , Regulación hacia Abajo , Terapia de Reemplazo Enzimático , Enfermedad de Gaucher/diagnóstico , Enfermedad de Gaucher/tratamiento farmacológico , Enfermedad de Gaucher/enzimología , Glucosilceramidasa/deficiencia , Glucosilceramidasa/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Pruebas Inmunológicas , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/inmunología , Neumonía Bacteriana/microbiología , RecurrenciaRESUMEN
BACKGROUND: Exposure to indoor allergens is associated with asthma morbidity. Nationally, asthma morbidity disproportionately affects socially disadvantaged populations, but it is unclear whether exposure to indoor allergens follows a similar pattern. OBJECTIVE: We sought to examine the national prevalences and demographic correlates of sensitivity to indoor allergens related to asthma. METHODS: Analysis of a cross-sectional survey of a representative sample of 4164 United States children aged 6 to 16 years who participated in allergen testing in the Third National Health and Nutrition Examination Survey from 1988 to 1994 was performed. The main outcome measures were sensitivity reactions to cockroach, dust mite, cat, and Alternaria alternata, as measured via skin prick testing. RESULTS: Multivariate models, including sex, age, race-ethnicity, education, poverty, family history, region of country, housing age, crowding, and urban residence, revealed significant racial-ethnic disparities in sensitivity. Compared with white children, African American children had higher odds ratios (ORs) of cockroach or dust mite sensitivity (cockroach OR, 2.5 [95% CI, 1.9-3.2]; dust mite OR, 1.3 [95% CI, 1.0-1.7]), as did Mexican American children (cockroach OR, 1.9 [95% CI, 1.3-2.8]; dust mite OR, 1.6 [95% CI, 1.2-2.2]). African American children also had significantly higher odds of sensitivity to A alternata (OR, 2.1 [95% CI, 1.5-2.8]). CONCLUSIONS: African American and Mexican American children are substantially more likely than white children to be sensitized to allergens important in asthma. Differences in indoor allergen sensitivity are consistent with racial differences in asthma morbidity. Along with other data, these findings suggest that racial disparities in housing, community, or both environmental factors play a role in determining national patterns of asthma morbidity.
Asunto(s)
Contaminación del Aire Interior/efectos adversos , Alérgenos , Asma/epidemiología , Adolescente , Alternaria/inmunología , Animales , Antígenos Dermatofagoides , Asma/diagnóstico , Asma/etiología , Niño , Cucarachas/inmunología , Estudios Transversales , Demografía , Femenino , Glicoproteínas , Humanos , Masculino , Oportunidad Relativa , Prevalencia , Pruebas Cutáneas , Factores Socioeconómicos , Estados Unidos/epidemiología , Salud UrbanaRESUMEN
OBJECTIVE: To determine the accuracy of parent report and the accuracy of the medical record in documenting physician performance of elements of pediatric asthma care in the primary care setting. METHODS: A convenience sample of 79 English-speaking parents of 4--12-year old children with asthma presenting to medical center--affiliated inner-city primary care pediatric clinics in the Bronx, Dallas, and Chicago was enrolled, and the office visit was audiotaped. Parents were interviewed 1--16 days after the visit by telephone. OUTCOME MEASURES: Accuracy of parent report was the primary outcome. The "reference standard" was an independent evaluation of the audiotaped record of the primary care visit. The National Asthma Education and Prevention Program was used as a guide to select data elements to assess quality of pediatric asthma care during primary care visits. RESULTS: Sufficient documentation was significantly (P <.001) less likely to be present in the medical record than in the follow-up interview for each element of care. When these elements were combined into a cumulative score, 71% of parent interviews but only 37% of medical records scored > or = 5 (out of a possible 6), with 29% of medical records scoring < 3. Parents were able to accurately report (concordance of parent data with audiotape reference standard) whether or not the visit had included performance of 5 of the 6 elements of care. CONCLUSIONS: Our study suggests that parent telephone interview within 2 weeks after the visit is more accurate than the medical record for documentation of the quality of asthma care in pediatric primary care visits. The medical record was not sufficient to assess the quality of primary care related to asthma, primarily because of missing data. Therefore, our data suggest that assessing quality of care using the medical record will not only bias the findings in the direction of more deficient care but will also make improvement in care more difficult. Further validation of our strategy for using parent report to assess the quality of care in primary care visits will require its application in a variety of other primary care settings.
Asunto(s)
Asma/terapia , Servicios de Salud del Niño/normas , Padres , Atención Primaria de Salud/normas , Garantía de la Calidad de Atención de Salud/métodos , Chicago , Niño , Preescolar , Humanos , Entrevistas como Asunto , Registros Médicos , Ciudad de Nueva York , Reproducibilidad de los Resultados , Grabación en Cinta , TexasRESUMEN
BACKGROUND: Cockroach allergen is important in asthma. Practical methods to reduce exposure are needed. OBJECTIVE: We sought to evaluate the effectiveness of house cleaning and professional extermination on lowering cockroach antigen levels in inner-city dwellings. METHODS: As part of the National Cooperative Inner-City Asthma Study intervention, 265 of 331 families with asthmatic children who had positive skin test responses to cockroach allergen consented to a professional home extermination with 2 applications of a cockroach insecticide (Abamectin, Avert) combined with directed education on cockroach allergen removal. On a random subset of 48 homes undergoing cockroach extermination in the intervention group, Bla g 1 was measured in settled dust from the kitchen, bedroom, and TV/living room. The first sample was collected 1 week before extermination, with additional samples after the exterminations at approximately 2, 6, and 12 months after the first sample. Self-reported problems with cockroaches were collected at baseline and after 12 months of follow-up in both the intervention and control group. RESULTS: The geometric mean kitchen level of Bla g 1 decreased at 2 months (33.6 U/g) relative to preextermination levels (68.7 U/g, P <.05). The percent of kitchens with over 8 U/g of Bla g 1 followed a similar pattern, but only the decrease from preextermination to 6-month levels was significant (86.8% vs 64.3%, P <.05). By the 12-month visit, the allergen burden had returned to or exceeded baseline levels. Except for an increase in the bedroom at 2 months (8.9 U/g vs 11.1 U/g, P <.05), no other significant change was seen. Only about 50% of the families followed the cleaning instructions; no greater effect was found in these homes. Self-reported problems with cockroaches showed no difference between the intervention and control group after 1 year of follow-up. CONCLUSIONS: Despite a significant, but short-lived, decrease the cockroach allergen burden remained well above levels previously found to be clinically significant.
Asunto(s)
Alérgenos/efectos adversos , Asma/prevención & control , Cucarachas/inmunología , Polvo/análisis , Vivienda , Control de Insectos , Proteínas de Insectos/efectos adversos , Alérgenos/análisis , Animales , Antígenos de Plantas , Asma/epidemiología , Asma/etiología , Estudios Transversales , Exposición a Riesgos Ambientales , Humanos , Proteínas de Insectos/análisis , Evaluación de Programas y Proyectos de Salud , Estados Unidos/epidemiología , Población UrbanaRESUMEN
We describe a case of a hypersensitivity reaction to intravenous hydrocortisone in a 64-year-old female with asthma, and briefly review other cases.
Asunto(s)
Antiinflamatorios/efectos adversos , Asma/tratamiento farmacológico , Hidrocortisona/efectos adversos , Hipersensibilidad Inmediata/inducido químicamente , Antiinflamatorios/administración & dosificación , Asma/inducido químicamente , Hipersensibilidad a las Drogas/diagnóstico , Exantema/inducido químicamente , Femenino , Fiebre/inducido químicamente , Humanos , Hidrocortisona/administración & dosificación , Inyecciones Intravenosas/efectos adversos , Persona de Mediana EdadRESUMEN
BACKGROUND: It is important to understand the relationship between environmental allergen exposure dose and the risk of atopic individuals becoming sensitized to that allergen if we are to change the risk of sensitization and morbidity from allergic disease. OBJECTIVE: The objective of these studies was to determine whether there was a dose response between current exposure to mite, cockroach, and cat allergen in inner-city children and to determine the prevalence of sensitization to these allergens. METHODS: A sample of 500 children was selected from the 1528 children enrolled in the National Cooperative Inner City Asthma Study. Children were selected who had a sample of home dust and valid skin test responses performed with a MultiTest skin test device. The samples of home dust were collected from the floor and furniture in the kitchen, bedroom, and television/living room and were assayed for Der p 1, Der f 1, Bla g 1, and Fel d 1 allergens. RESULTS: Each allergen level correlated significantly between rooms in individual homes. Mite (Der p 1 and Der f 1) and cat (Fel d 1) allergen levels were frequently below the detection limit of the assay. Cockroach allergen (Bla g 1) concentrations in the child's bedroom were related to the prevalence of positive skin test responses to cockroach allergen extract among the children, with an odds ratio for sensitization of 1.45 (1.11-1.92). Positive skin test responses to cockroach allergen were seen in 15% of children exposed to bedroom dust with a Bla g 1 concentration below the level of detection compared with a rate of 32% in bedrooms with Bla g 1 levels of 1 to 2 U/g and 40% to 44% among those in rooms with 4 U/g or greater. The relationship between exposure and positive skin test responses was clearly stronger among atopic children with a greater number of positive skin test responses. CONCLUSIONS: Despite widespread exposure to household allergens, the strongest relationship between exposure and sensitization was seen in the bedroom. The dose response between exposure to cockroach allergen and sensitization suggested that exposure to low doses of allergen, 2 U/g or less, was a risk factor and that the risk plateaus above 4 U/g. Atopy modified the relationship of exposure to sensitization.
Asunto(s)
Contaminación del Aire Interior/efectos adversos , Alérgenos/inmunología , Asma/inmunología , Hipersensibilidad/inmunología , Salud Urbana , Alérgenos/efectos adversos , Animales , Asma/etiología , Gatos , Niño , Preescolar , Cucarachas , Polvo , Vivienda , Humanos , Hipersensibilidad/etiología , Ácaros , Áreas de Pobreza , Pruebas CutáneasRESUMEN
BACKGROUND: Increased serum IgE levels are associated with advanced HIV infection. The magnitude of the increase has varied greatly between studies which generally did not assess potential confounding factors. OBJECTIVE: To determine whether the increased serum IgE levels reported with HIV infection is affected by demographic or behavioral factors, we studied injection drug users, women, and minority ethnic and racial groups with HIV infection, for whom little data now exist. METHODS: A prospective cross-sectional study of ambulatory patients with or at risk for HIV infection was performed. We enrolled 83 injection drug users and 56 non-drug users seropositive for HIV and 43 seronegative at-risk individuals from an Infectious Diseases clinic and a longitudinal study of HIV infection in injection drug users in the Bronx, New York City. Fifteen HIV-seronegative non-atopic controls were also studied. Total serum IgE levels were measured by a solid phase fluorescent assay and lymphocyte phenotypes were measured by monoclonal antibodies. RESULTS: On multiple linear regression analysis, HIV infection (P=.01) and advanced HIV disease (P < or =.01) were independently associated with increased serum IgE levels, controlling for gender, race, age, and use of injection drugs. In both HIV-seronegative and seropositive individuals, female gender was independently associated with lower IgE levels (P < or = .001). We did not find an independent effect of race or injection drug use on IgE levels. CONCLUSIONS: Increased serum IgE levels were associated with HIV infection, the highest levels existing in those with advanced HIV disease. Women had lower IgE levels than men, independent of HIV status. Active or past drug use, race, and age were not found to be independently associated with serum IgE levels. Further studies are necessary to elucidate the mechanisms underlying the increased serum IgE levels seen with HIV infection and its associated immunodeficiency, and to substantiate and explore the decreased levels found in women.
Asunto(s)
Infecciones por VIH/inmunología , Inmunoglobulina E/sangre , Adulto , Recuento de Linfocito CD4 , Linfocitos T CD8-positivos , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: Advanced HIV infection is associated with increased serum IgE levels, which in turn have been associated with a poor prognosis. Our preliminary data revealed that serum IgE levels were significantly elevated in HIV seropositive injection drug users compared with HIV seropositive non-injection drug users. Since viral hepatitis is common among injection drug users and is itself associated with elevated serum IgE levels, we studied whether there was an association between increased serum IgE levels and positive hepatitis serology in HIV-seropositive patients. METHODS: A retrospective cross-sectional analysis was performed. The medical records of ambulatory HIV-infected patients in an ongoing study were reviewed. Forty-five patients had hepatitis A, B, and C serology performed. The associations between serum IgE levels and hepatitis A, B and C antibodies, CD4 and CD8 lymphocyte percentages, injection drug use, and sex were analyzed by univariate and multiple regression analyses. RESULTS: On univariate analyses, hepatitis B antibody was significantly associated with increased serum IgE levels in HIV-infected subjects (P = .013), especially in those with AIDS (P = .015). Multiple regression analyses controlling for CD4 lymphocyte percentages, sex, and drug use, confirmed that hepatitis B antibody status remained significantly associated with increased serum IgE levels (P = .05). There was no association of serum IgE levels with hepatitis A or C serology. CONCLUSION: Prior hepatitis B infection is significantly associated with increased serum IgE levels in advanced HIV infection. The clinical implications of this finding deserve further study.
Asunto(s)
Anticuerpos Anti-VIH/análisis , Infecciones por VIH/inmunología , VIH-1/inmunología , Anticuerpos contra la Hepatitis B/análisis , Hepatitis B/inmunología , Inmunoglobulina E/análisis , Relación CD4-CD8 , Estudios Transversales , Femenino , Seropositividad para VIH/inmunología , Antígenos de Superficie de la Hepatitis B/inmunología , Humanos , Inmunoglobulina G/análisis , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: It has been hypothesized that asthma-related health problems are most severe among children in inner-city areas who are allergic to a specific allergen and also exposed to high levels of that allergen in bedroom dust. METHODS: From November 1992 through October 1993, we recruited 476 children with asthma (age, four to nine years) from eight inner-city areas in the United States. Immediate hypersensitivity to cockroach, house-dust-mite, and cat allergens was measured by skin testing. We then measured major allergens of cockroach (Bla g 1), dust mites (Der p 1 and Der f 1), and cat dander (Fel d 1) in household dust using monoclonal-antibody-based enzyme-linked immunosorbent assays. High levels of exposure were defined according to proposed thresholds for causing disease. Data on morbidity due to asthma were collected at base line and over a one-year period. RESULTS: Of the children, 36.8 percent were allergic to cockroach allergen, 34.9 percent to dust-mite allergen, and 22.7 percent to cat allergen. Among the children's bedrooms, 50.2 percent had high levels of cockroach allergen in dust, 9.7 percent had high levels of dust-mite allergen, and 12.6 percent had high levels of cat allergen. After we adjusted for sex, score on the Child Behavior Checklist, and family history of asthma, we found that children who were both allergic to cockroach allergen and exposed to high levels of this allergen had 0.37 hospitalization a year, as compared with 0.11 for the other children (P=0.001), and 2.56 unscheduled medical visits for asthma per year, as compared with 1.43 (P<0.001). They also had significantly more days of wheezing, missed school days, and nights with lost sleep, and their parents or other care givers were awakened during the night and changed their daytime plans because of the child's asthma significantly more frequently. Similar patterns were not found for the combination of allergy to dust mites or cat dander and high levels of the allergen. CONCLUSIONS: The combination of cockroach allergy and exposure to high levels of this allergen may help explain the frequency of asthma-related health problems in inner-city children.
Asunto(s)
Alérgenos/efectos adversos , Asma/inmunología , Cucarachas/inmunología , Hipersensibilidad Inmediata/complicaciones , Alérgenos/análisis , Animales , Asma/fisiopatología , Gatos/inmunología , Niño , Preescolar , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/análisis , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hipersensibilidad Inmediata/diagnóstico , Hipersensibilidad Inmediata/inmunología , Masculino , Ácaros/inmunología , Áreas de Pobreza , Estados Unidos , Salud UrbanaAsunto(s)
Antihipertensivos/efectos adversos , Compuestos de Bifenilo/efectos adversos , Espasmo Bronquial/inducido químicamente , Imidazoles/efectos adversos , Enfermedades Profesionales/inducido químicamente , Tetrazoles/efectos adversos , Administración por Inhalación , Antihipertensivos/administración & dosificación , Compuestos de Bifenilo/administración & dosificación , Estudios Cruzados , Método Doble Ciego , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Imidazoles/administración & dosificación , Losartán , Tetrazoles/administración & dosificaciónRESUMEN
BACKGROUND: Atopic symptoms such as sinusitis, eczema, and wheezing are common in human immunodeficiency virus (HIV)-infected children. OBJECTIVE: To determine whether IgE levels are increased in HIV-seropositive children, and to determine whether there is a relationship between IgE, stage of disease, and atopic symptoms. METHODS: Levels of serum IgE and parameters of HIV infection, including absolute CD4 and CD8 T lymphocyte counts, and serum levels of neopterin, beta 2 microglobulin and HIV P24 antigen were measured. Clinical parameters including stage of disease, opportunistic infections, and atopic symptoms were recorded. RESULTS: IgE was increased prior to 1 year of age and mean levels remained elevated through age 6 years but regressed to the normal mean in children ages 7 to 9. There was a strong association between increased IgE and the presence of secondary disseminated or systemic diseases including pulmonary lymphoid hyperplasia, Pneumocystis carinii pneumonia, or disseminated cytomegalovirus infection. There was no correlation between CD4 levels and IgE levels (r = .03). The relationship between IgE and serum P24 antigen, beta 2 microglobulin, and neopterin levels was also analyzed. A weak positive correlation was found only with serum p24 antigen levels (r = .24). Atopic symptoms were found in a subpopulation of these children, with wheezing occurring in 27% of all patients, atopic dermatitis in 5%, drug reactions in 7% and sinusitis in 8% but IgE levels were not significantly elevated in patients with atopic symptoms. CONCLUSIONS: These findings demonstrate that serum IgE is increased in children very early after HIV infection and that IgE levels increase in association with HIV-associated systemic disease. Increased IgE is not associated with atopic symptoms in children.
Asunto(s)
Infecciones por VIH/inmunología , VIH-1/inmunología , Inmunoglobulina E/sangre , Biomarcadores/sangre , Niño , Preescolar , Femenino , Infecciones por VIH/clasificación , Infecciones por VIH/diagnóstico , Humanos , Hipersensibilidad Inmediata/inmunología , Hipersensibilidad Inmediata/virología , Lactante , MasculinoRESUMEN
Pulmonary eosinophilic granuloma is a disorder caused by localized collections of proliferating histiocytes in the lung. Little is known about its etiology except that the majority (58 to 97%) of patients are current or ex-smokers, making the potential etiologic role of tobacco products an important area for research. Tobacco glycoprotein (TGP) is a potent immunostimulator that has been isolated from cigarette smoke. TGP-specific lymphocyte proliferation, and cytokine production in vitro, were measured in three patients with pulmonary eosinophilic granuloma in remission and in three closely matched normal subjects with similar smoking histories. One patient with eosinophilic granuloma of bone and a matched control subject were also studied. Peripheral blood mononuclear cells were cultured with TGP, the recall antigen streptokinase (SK), and the mitogen concanavalin A (Con A). All three of the patients with pulmonary eosinophilic granuloma exhibited significant decreases in lymphocyte stimulation to TGP, despite normal responses to SK and Con A. In contrast, the response of the patient with eosinophilic granuloma of bone was higher than her matched control. The mean responses of the patients with pulmonary eosinophilic granuloma to TGP was significantly lower than the mean of nondiseased smokers or of normal nonsmokers. Twenty-four-hour culture supernatants were collected and assayed for cytokine levels (IL-1, IL-2, and IL-6). TGP-stimulated IL-2 production was significantly lower in the patients with pulmonary eosinophilic granuloma than in the normal subjects, confirming the reduced T-cell proliferative response.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Granuloma Eosinófilo/sangre , Glicoproteínas/farmacología , Enfermedades Pulmonares/sangre , Linfocitos/efectos de los fármacos , Nicotiana , Plantas Tóxicas , Adulto , Análisis de Varianza , División Celular/efectos de los fármacos , Células Cultivadas , Granuloma Eosinófilo/etiología , Femenino , Humanos , Interleucinas/sangre , Enfermedades Pulmonares/etiología , Linfocitos/citología , Masculino , Persona de Mediana Edad , Fumar/sangre , Estadísticas no ParamétricasRESUMEN
Two patients with advanced multiple myeloma were treated with oral low-dose cyclosporin A. one without other therapy and one in conjunction with chemotherapy to which the patient had been previously unresponsive. Both patients had objective laboratory and clinical responses. In the patient treated with cyclosporin A alone, decreasing serum IL-6 and beta-2-microglobulin levels fell as the clinical response evolved. Cyclosporin A deserves further evaluation in the therapy of multiple myeloma.
Asunto(s)
Ciclosporina/uso terapéutico , Mieloma Múltiple/tratamiento farmacológico , Administración Oral , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclosporina/administración & dosificación , Dexametasona , Doxorrubicina/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Vincristina/administración & dosificaciónRESUMEN
The majority of patients with human immunodeficiency virus (HIV) infection will develop acute sinusitis. This may be a single episode, or may be the beginning of a long course of recurrent sinusitis, of which the etiology is not yet well understood. A retrospective study of cultures from antral washings was conducted to determine the organisms that were more commonly isolated in patients with HIV infection and sinusitis. Forty-seven organisms were isolated from the sinus cultures of 41 HIV-positive patients. The most common organisms isolated were Streptococcus pneumoniae (19%), Streptococcus viridans (19%), and Pseudomonas aeruginosa (17%). Pseudomonas aeruginosa is an atypical cause of acute sinusitis in the general population but was found to be an important pathogen in our HIV-infected patients. Other atypical organisms were also isolated, including Listeria monocytogenes and Candida albicans. It is important to recognize that atypical organisms must be considered if an HIV-infected patient with sinusitis does not respond to initial antibiotic therapy. A discussion follows emphasizing the need for prompt diagnosis and treatment of sinusitis in HIV infection.
Asunto(s)
Seropositividad para VIH/complicaciones , Listeria monocytogenes/aislamiento & purificación , Senos Paranasales/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Sinusitis/complicaciones , Sinusitis/microbiología , Streptococcus pneumoniae/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Femenino , Humanos , Masculino , Estudios Retrospectivos , Sinusitis/tratamiento farmacológicoRESUMEN
Serum immunoglobulin class and IgG subclasses were measured in 30 adult patients with chronic sinusitis documented by CT scans of the paranasal sinuses. Results were compared to 30 age-and-sex matched patients with chronic rhinitis who had normal sinus CT scans, and a matched group of asymptomatic, healthy subjects. None of the patients was taking oral corticosteroids and none had ever received allergen immunotherapy. IgA deficiency was present in 3% (2/60) of the patients with chronic rhinitis or sinusitis and IgG deficiency was seen in another two (3%). None of the normals had low IgA or IgG. Low levels of IgG1 or IgG3 were found in some patients in all three groups, while none had low IgG2 levels. Serum levels of IgG, IgA, IgM, IgG1, IgG2, and IgG4 were not significantly different between the groups. Mean serum IgG3 levels, however, were significantly lower in the chronic sinusitis group than the chronic rhinitis group (P < .003) or the normals (P < .0005). The incidence of below normal levels of IgG3 was also more frequent in chronic sinusitis than in chronic rhinitis (P < .04) or normals (P < .002). Patients in the chronic sinusitis group had a high incidence of asthma (57%) and atopy (45%) but there was no difference in immunoglobulin class or IgG subclass levels in matched asthmatics compared with nonasthmatic patients with chronic sinusitis. Atopic patients with chronic sinusitis had a higher frequency of IgG3 subclass deficiency than nonatopics (P = .04). Normalization of low immunoglobulin class or IgG subclass levels that coincided with clinical improvement was documented in two patients with sinusitis.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Inmunoglobulina G/clasificación , Inmunoglobulinas/sangre , Sinusitis/sangre , Sinusitis/inmunología , Adolescente , Adulto , Anciano , Enfermedad Crónica , Femenino , Humanos , Hipersensibilidad Inmediata/sangre , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Rinitis/sangreRESUMEN
Coloring agents are frequently added to drugs, foods, and cosmetics. If approved by the FDA, these additives may be added or substituted without notifying physicians. A patient developed angioedema, wheezing, urticaria, and dizziness one hour after taking the first Premarin tablet from a new refill. She had previously tolerated Premarin daily for 7 months without any adverse reactions. The new tablets were noted to be a slightly different shade of maroon and subsequent investigation revealed that the dye formulation had been changed (FD&C red #3 and FD&C yellow #6 were changed to FD&C red #40 and D&C #27). Puncture skin testing with a suspended tablet from the new Premarin batch was positive but was negative to a different drug (dye-free). Premarin skin testing in two normal volunteers was negative. The patient has since tolerated transdermal estrogen without any adverse reactions. These findings suggest that an additive in the Premarin tablet, most likely one of the new dyes, and not the estrogen, was the cause of the anaphylaxis. Physicians need to be aware that inactive ingredients can be changed without warning and these new constituents may cause sudden and potentially very severe allergic reactions to previously tolerated medication.
Asunto(s)
Anafilaxia/inducido químicamente , Colorantes/efectos adversos , Estrógenos Conjugados (USP)/administración & dosificación , Adulto , Femenino , Humanos , Pruebas CutáneasRESUMEN
Intact cell mediated immunity (CMI) requires a complex interaction between lymphocytes, macrophages, and cytokines. The presence of functional CMI can be easily tested in vivo by delayed hypersensitivity (DTH) skin testing. Delayed hypersensitivity skin testing has been commonly used in three ways; anergy screening, testing for infection with intracellular pathogens, and testing for sensitivity to contact allergens. Accurate anergy screening requires intradermal testing with four or more common recall antigens such as Candida albicans, tetanus toxoid, mumps, and purified protein derivative. Problems of antigen potency and availability can be overcome by using a multiple time test-like device that contains seven different recall antigens (Multitest CMI). Although testing for infection was once common, it is now only recommended for tuberculosis screening because most other antigens are either not predictive of infection or not commercially available. Accurate testing for contact allergy requires careful attention to technique, and limitation of allergens to the 20 antigens that are approved by the American Academy of Dermatology.
Asunto(s)
Alérgenos , Hipersensibilidad Tardía/diagnóstico , Enfermedades del Sistema Inmune/diagnóstico , Infecciones/diagnóstico , Plantas Tóxicas , Pruebas Cutáneas/métodos , Toxicodendron , Tuberculina , Antígenos Bacterianos , Antígenos Fúngicos , Anergia Clonal , Humanos , Hipersensibilidad Tardía/inmunología , Enfermedades del Sistema Inmune/inmunología , Inmunidad Celular , Infecciones/inmunología , Mitógenos , Pruebas del Parche/métodosRESUMEN
Sixty-three adults with symptomatic chronic rhinosinusitis had computerized tomographic (CT) scans of the paranasal sinuses, which were used to quantify disease severity. These patients were divided into three closely age- and sex-matched groups: a CT scan-negative group (chronic rhinitis only), a mild sinusitis group and a severe sinusitis group. Serum dust mite-specific IgG levels were found to be significantly elevated in the sinusitis patients compared with a matched group of asymptomatic normal individuals. Levels were highest in the more severe sinusitis group, in which the mean titre was 559 U/ml and the incidence of titres greater than 400 U/ml was 48%, as compared with a mean titre of 139 U/ml and only a 10% incidence of titres greater than 400 U/ml in the normal subjects (P < 0.005 and < 0.01). In contrast, although the frequency of immediate hypersensitivity to dust mite, as assessed by intradermal skin tests, tended to be higher in patients with sinusitis, it was not significantly different from normal individuals. The association between mite IgG and disease was most striking in the patient sub-group with negative mite skin tests. In this group, mite IgG levels were significantly higher than normal, even in those patients with only chronic rhinitis. These findings demonstrate that increased serum levels of IgG against dust mites are strongly associated with chronic rhinosinusitis, especially in the sub-group of patients who are not allergic to mites.