RESUMO
BACKGROUND: Many patients with common variable immunodeficiency (CVID) have a clinical history suggestive of allergic respiratory disease. However, in such individuals, the prevalence of asthma and the role of atopy have not been well established. The objective of this study was to evaluate pulmonary function and identify asthma in patients with CVID. We also investigated the role of IgE as a trigger of asthma in these patients. METHODS: Sixty-two patients diagnosed with CVID underwent spirometry, as well as skin prick testing and in vitro determination of serum-specific IgE levels for aeroallergens, together with bronchial provocation with histamine and allergen. RESULTS: The most common alteration identified through spirometry was obstructive lung disease, which was observed in 29 (47.5%) of the 62 patients evaluated. Eighteen (29.0%) of the 62 patients had a clinical history suggestive of allergic asthma. By the end of the study, asthma had been diagnosed in nine (14.5%) patients and atopy had been identified in six (9.7%). In addition, allergic asthma had been diagnosed in four patients (6.5% of the sample as a whole; 22.2% of the 18 patients with a clinical history suggestive of the diagnosis). CONCLUSION: In this study, CVID patients testing negative for specific IgE antibodies and suspected of having allergic asthma presented a positive response to bronchial provocation tests with allergens. To our knowledge, this is the first such study. When CVID patients with a history suggestive of allergic asthma test negative on traditional tests, additional tests designed to identify allergic asthma might be conducted.
Assuntos
Asma/complicações , Asma/imunologia , Imunodeficiência de Variável Comum/complicações , Imunodeficiência de Variável Comum/imunologia , Adolescente , Adulto , Idoso , Asma/epidemiologia , Imunodeficiência de Variável Comum/epidemiologia , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Prevalência , Testes de Função Respiratória , Testes Cutâneos , Adulto JovemRESUMO
Objetivo: A nefropatia primária da IgA (NIgA) e adeficiência de IgA (DIgA) constituem as formas maiscomuns de glomerulonefrite e de deficiência primáriade anticorpos, respectivamente, despertando interesseespecial o fato de ambas envolverem distúrbios contrastantes da produção da IgA. O objetivo deste trabalho foi comparar os níveis de citocinas possivelmente implicadas na produção da IgA (IL-4, IL-5, IL-6, IL-10) em pacientes com NIgA ou DIgA. Casuística e Métodos: Foram estudados 18 pacientes com NIgA (hematúria microscópica e proteinúria persistente ou intermitente e biópsia renal percutânea com depósito de IgA em mesângio glomerular detectado por imunofluorescência), sendo nove do gênero masculino e nove do feminino, com média de idade de 33,2 anos; 17 pacientes com DIgA (níveis séricos de IgA menores do que 7 mg/dL e níveis normais ou elevados de IgG e IgM), sendo 13 do gênero masculino e quatro do feminino, com média de idade de 25,5 anos; dez voluntários sadios (dois do gênero masculino e oito do feminino com média de idade de 30,7 anos). As citocinas foram quantificadas por método imunoenzimático em sobrenadante de cultura de PMBC após 48 horas de estímulo com fitohemaglutinina . Resultados: Foram observados: 1) níveis elevadosde IL-5 e de IL-10 e baixos de IL-6 em pacientes com NIgA em relação aos pacientes com DIgA e controlessadios; 2) níveis semelhantes de IL-4 em ambos gruposde pacientes e mais elevados na NIgA em comparaçãoaos controles sadios; 3) níveis similares de todasas citocinas testadas em pacientes com DIgA e controlessadios. Conclusões: Os níveis elevados de IL-5 encontrados na NIgA reforçam a importância desta citocina na síntese de IgA, cujos níveis séricos estão aumentados em aproximadamente 50 per cent dos casos; os níveis elevados de IL-4 e IL-5 encontrados nestes pacientes sugerem que estas duas citocinas possam estar envolvidas na glicosilação da IgA e seu conseqüente depósito em mesângio renal; os níveis elevados de IL-10 e baixos de IL-6 observados em pacientes com NIgA reforçam a hipótese de que a IL-10 esteja implicada na síntese da IgA em humanos e sugerem que esta citocina possa desempenhar um papel regulador sobre a produção deIL-6.
Assuntos
Humanos , Masculino , Feminino , Adulto , Testes Imunológicos de Citotoxicidade , Glomerulonefrite por IGA , Técnicas In VitroRESUMO
Patients with Humoral immunodeficiency syndromes frequently present recurrent infections, mainly of the digestive and respiratory tracts. This study carried out a clinical and laboratorial evaluation in 15 humoral immunodeficiency patients presenting chronic gastrointestinal symptoms. Out results emphasize the relevance of immunodeficiency syndromes in the differential diagnosis of chronic diarrhea.
Assuntos
Diarreia/etiologia , Síndromes de Imunodeficiência/complicações , Síndromes de Malabsorção/etiologia , Adulto , Criança , Pré-Escolar , Doença Crônica , Feminino , Gastroenteropatias/etiologia , Gastroenteropatias/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (P < 0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membranoproliferative glomerulonephritis. In both histological types immunofluorescence showed IgM and C3 granular deposits in the glomeruli. The data in this study suggests that mesangial proliferative and membranoproliferative glomerulonephritis, with glomerular granular IgM and C3 deposits, represent the renal lesions of the schistosomiasis associated nephropathy.
Assuntos
Hepatomegalia/complicações , Síndrome Nefrótica/etiologia , Esquistossomose mansoni/complicações , Adolescente , Adulto , Biópsia por Agulha , Distribuição de Qui-Quadrado , Complemento C3/metabolismo , Feminino , Hepatomegalia/epidemiologia , Hepatomegalia/imunologia , Hepatomegalia/patologia , Humanos , Imunoglobulina M/metabolismo , Rim/imunologia , Rim/patologia , Masculino , Microscopia de Fluorescência , Pessoa de Meia-Idade , Síndrome Nefrótica/epidemiologia , Síndrome Nefrótica/imunologia , Síndrome Nefrótica/patologia , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/imunologia , Esquistossomose mansoni/patologiaRESUMO
Schistosomal nephropathy has long been related to the hepatosplenic form of schistosomiasis. In the last few years, 24 patients with hepatointestinal schistosomiasis and the nephrotic syndrome were studied. Aiming at evaluating a possible etiologic participation of schistosomiasis in the development of the nephropathy, this group was comparatively studied with a group of 37 patients with idiopathic nephrotic syndrome. Both groups had a different distribution of the histologic lesions. In the group with schistosomiasis there was a statistically significant prevalence of proliferative mesangial glomerulonephritis (33.3%), whereas in the control group there was prevalence of membranous glomerulonephritis (32.4%). On immunofluorescence, IgM was positive in 94.4% of the patients with schistosomiasis versus 55.0% in the control group (P < 0.01). In the group with schistosomiasis, 8 patients evidenced mesangial proliferative glomerulonephritis and 5, membranoproliferative glomerulonephritis. In both histological types immunofluorescence showed IgM and C3 granular deposits in the glomeruli. The data in this study suggests that mesangial proliferative and membranoproliferative glomerulonephritis, with glomerular granular IgM and C3 deposits, represent the renal lesions of the schistosomiasis associated nephropathy
Assuntos
Humanos , Masculino , Feminino , Hepatomegalia/complicações , Síndrome Nefrótica/etiologia , Esquistossomose mansoni/complicações , Adolescente , Adulto , Biópsia por Agulha , Distribuição de Qui-Quadrado , Complemento C3/metabolismo , Hepatomegalia/epidemiologia , Hepatomegalia/imunologia , Hepatomegalia/patologia , Imunoglobulina M/metabolismo , Rim/imunologia , Rim/patologia , Microscopia de Fluorescência , Pessoa de Meia-Idade , Síndrome Nefrótica/epidemiologia , Síndrome Nefrótica/imunologiaRESUMO
Comparison of the clinical significance and allergenic cross-reactivity of Blomia kulagini (B. kulagini) and Lepidoglyphus destructor (L. destructor) was made on sera from Sweden and Brazil using the radio-allergo-sorbent test (RAST) and the RAST inhibition technique. RAST-positive sera were obtained from 53 allergic Swedish farmers and 31 allergic subjects from Brazil who were positive to B. kulagini and/or L. destructor. B. kulagini was shown to be a common cause of sensitization especially in Brazil. There was a fairly high correlation between positive RAST results to L. destructor and B. kulagini based on sera from both Sweden and Brazil. The highest RAST scores were found against L. destructor in Swedish sera and against B. kulagini in Brazilian sera. The RAST inhibition studies showed that the L. destructor extract was able to inhibit the B. kulagini system (a positive RAST to B. kulagini allergen disc) in Swedish but not in Brazilian sera. In contrast, the B. kulagini extract was only able to inhibit the L. destructor system in sera from Brazil and not in sera from Sweden. This study shows that results obtained with RAST inhibition are not entirely dependent on the overall specificity of the IgE antibodies in the patient's sera, since the more subtle specificity of the primarily sensitizing allergen will dominate. Thus, conclusions drawn regarding allergenic cross-reactivity are dependent on the populations tested, and conclusions on the existence or absence of cross-reactivity, e.g. between two species of mites may be contradictory.
Assuntos
Alérgenos/imunologia , Ácaros/imunologia , Adolescente , Adulto , Agricultura , Animais , Brasil , Criança , Pré-Escolar , Reações Cruzadas/imunologia , Poeira/efeitos adversos , Humanos , Imunoglobulina E/análise , Imunoglobulina E/imunologia , Pessoa de Meia-Idade , Teste de Radioalergoadsorção , Inquéritos e Questionários , SuéciaRESUMO
The immune responses to the non-pyroglyphid mite Blomia kulagini and the pyroglyphid mite Dermatophagoides pteronyssinus were compared in 440 Swedish farmers and 34 allergic subjects from Brazil using the radioallergosorbent test (RAST). Both B. kulagini and D. pteronyssinus were shown to be a common cause of sensitization, particularly in Brazil. The highest RAST scores were found against D. pteronyssinus in sera from both countries. Allergenic cross-reactivity between the two mites was studied by the RAST inhibition technique. Both B. kulagini and D. pteronyssinus possess their own unique allergens as well as allergens in common. Thus, besides mites belonging to the Dermatophagoides genus, other pyroglyphid and non-pyroglyphid mites in different countries should be taken into consideration before starting hyposensitization treatments.
Assuntos
Hipersensibilidade/etiologia , Ácaros/imunologia , Adolescente , Adulto , Animais , Brasil , Criança , Pré-Escolar , Reações Cruzadas , Humanos , Pessoa de Meia-Idade , Teste de Radioalergoadsorção , SuéciaRESUMO
The occurrence of chronic mucocutaneous candidiasis accompanying polyglandular autoimmune syndrome type I is reported in a female aged 13. Apart the candidiasis, since the age of 3, she had convulsions beginning at 6, cataract at 9, teeth abnormalities, and basal ganglia calcifications. Laboratory data confirmed the diagnosis of hypoparathyroidism. This picture was accompanied by intestinal malabsorption, leading to a state of progressive malnutrition, with intense hypoalbuminemia and anemia. Although the pathophysiology of malabsorption, in these cases, is still not clear, the therapeutic response to pancreatin, in the present case, suggested pancreatic insufficiency, reinforced by the normal d-xylose test and the small intestinal biopsy with inexpressive result.