Elevated Immunoglobulin E Research Articles

Anemia and intestinal parasite infection in school children in rural Vietnam.

This study hypothesized that besides iron deficiency, intestinal parasites infection is also a determinant of anemia in schoolchildren in rural Vietnam. 400 primary schoolchildren from 20 primary schools in Tam Nong district, a poor rural area in Vietnam, were randomly selected from enrollment lists. Venous blood (5ml) was collected in a cross sectional study and analyzed for hemoglobin (Hb), serum ferritin (SF), serum transferrin receptor (TfR), serum C-reactive protein (CRP) and total immunoglobulin E (IgE). Stools samples were examined for hookworm, Trichuris, and Ascaris infection. Logistic regression was used to assess the effect of intestinal parasites on anemia. The prevalence of anemia (Hb < 115g/l) was 25%. Iron deficiency (TfR > 8.5mg/L) occurred in 2% of the children. The prevalence of intestinal parasites was 92% with the highest prevalence for Trichuris (76%) and Ascaris (71%). More than 30% and 80% of the children showed an elevated CRP (> or = 8 mg/L) and IgE (> 90 IU/ml) concentration. Anemia status was borderline significantly associated with SF and not associated with TfR and CRP. The prevalence odds ratio for Trichuris infection was 1.96 (95% CI 1.07-3.59) and 2.00 (95% CI 1.08-3.65) with iron deficiency reflected by TfR and SF, respectively. Anemia is highly prevalent among schoolchildren in Vietnam but may not be associated with iron deficiency. Trichuris infection is associated with a doubled risk of anemia, not mediated through iron deficiency. Chronic infection may play a role in anemia, but needs further investigation.

Immunoglobulin E Antibodies to Rocuronium

Diagnosis of allergy from neuromuscular blocking agents is not always straightforward. The objectives of the current study were to investigate the value of quantification of immunoglobulin E (IgE) by ImmunoCAP (Phadia AB, Uppsala, Sweden) in the diagnosis of rocuronium allergy and to study whether IgE inhibition tests can predict clinical cross-reactivity between neuromuscular blocking agents. Twenty-five rocuronium-allergic patients and 30 control individuals exposed to rocuronium during uneventful anesthesia were included. Thirty-two sera (total IgE > 1,500 kU/l) were analyzed for potential interference of elevated total IgE titers. Results were compared with quantification of IgE for suxamethonium, morphine, and pholcodine. Cross-reactivity between drugs was assessed by IgE inhibition and skin tests. Sensitivity of IgE for rocuronium, suxamethonium, morphine, and pholcodine was 68, 60, 88, and 86%, respectively. Specificity was 100% for suxamethonium, morphine, and pholcodine IgE and 93% for rocuronium IgE. ROC analysis between patients and control individuals changed the threshold to 0.13 kUa/l for rocuronium, 0.11 kUa/l for suxamethonium, 0.36 kUa/l for morphine, and 0.43 kUa/l for pholcodine. Corresponding sensitivity was 92, 72, 88, and 86%, respectively. Specificity was unaltered. Interference of elevated total IgE with quantification of IgE was demonstrated by the analysis in sera with a total IgE greater than 1,500 kU/l. IgE inhibition did not predict clinical relevant cross-reactivity. The rocuronium ImmunoCAP constitutes a reliable technique to diagnose rocuronium allergy, provided an assay-specific decision threshold is applied. IgE assays based on compounds bearing ammonium epitopes are confirmed to represent reliable tools to diagnose rocuronium allergy. High total IgE titers were observed to affect specificity of the assays.

Immunoglobulin E-Mediated Allergies in Lung-Transplanted Adults

Immunoglobulin E (IgE)-mediated allergy has repeatedly been reported after solid organ transplantation, apparently affecting approximately 10% of pediatric organ transplant recipients. Interestingly, type 1 allergy has not been described in transplanted adults, suggesting a particular propensity in childhood. The present cross-sectional study assessed the prevalence of type 1 allergy in 42 adult lung transplant recipients aged 25 to 50 years. Instruments included standardized interviews, skin prick tests, and serum IgE measurements. Ten of 42 patients (23.8%) displayed elevated specific IgE levels or positive skin prick test results against one or more allergens. Five individuals (11.9%) additionally reported corresponding clinical symptoms of type 1 allergy. No statistically significant association of sensitization or allergy prevalence with patient age, kind of immunosuppressive therapy, and time since transplantation was found. The phenomenon of transplantation-associated allergy is not age-restricted and thus should be assessed more thoroughly in all age groups.

Immunoglobulin E (IgE)-mediated cross-reactivity between mesquite pollen proteins and lima bean, an edible legume

Immunoglobulin E (IgE)-mediated food allergy often develops as a consequence of allergic sensitization to pollen proteins. Mesquite (Prosopis juliflora) tree pollen is reported to be cross-reactive with other pollen species, but little has been reported on its cross-reactivity with plant-derived foods belonging to the same/different families. The present study investigates the in vitro cross-reactivity of mesquite pollen and lima bean (Phaseolus lunatus), an edible seed belonging to the Leguminosae family. Of 110 patients (asthma, rhinitis or both) tested intradermally, 20 showed marked positive reactions with Prosopis pollen extract. Of these, 12 patients showed elevated specific IgE to Prosopis pollen extract alone and four to both Phaseolus and pollen extract. In vitro cross-reactivity was investigated using inhibition assays [enzyme-linked immunosorbent assay (ELISA) inhibition, immunoblot inhibition], histamine release and lymphoproliferation. P. lunatus extract could inhibit IgE binding to P. juliflora in a dose-dependent manner, requiring 400 ng of protein for 50% inhibition in ELISA assay. Immunoblot and immunoblot inhibition demonstrated the presence of 20, 26, 35, 66 and 72 kDa as shared IgE binding components between the two extracts. Histamine release, peripheral blood mononuclear cells proliferation and interleukin (IL)-4 levels also suggested allergenic cross-reactivity. In conclusion, there is humoral and cellular cross-reactivity between Prosopis pollen and Phaseolus seed allergens.

Hypogammaglobulinaemia secondary to cow‐milk allergy in children under 2 years of age

Symptomatic hypogammaglobulinaemia in children younger than 2 years of age was studied to rule out a primary immunodeficiency. Thirty-four patients were referred to the Immunology Service to study the hypogammaglobulinaemia-associated clinical picture. Food allergy was documented in 10 patients by personal and familial history, presence of specific immunoglobulin E (IgE) and elevated total serum IgE levels. Coeliac disease and human immunodeficiency virus infection were also ruled out. Protein loss through stools was assessed by clearance of alpha1-antitrypsin (AAT). Serum immunoglobulin levels were determined by nephelometry and functional antibodies were studied by enzyme-linked immunosorbent assay. The cellular immune response was assessed by in vitro lymphocyte proliferation in response to mitogens and cell subsets were analysed by flow cytometry. In five patients of the 10 patients we suspected a protein loss through the mucosa. Four of these five patients showed an increased AAT and the other showed an extensive cutaneous lesion. Immunological studies revealed normal antibody function, in vitro lymphoproliferative responses and cell numbers in four of the 5 patients. One patient showed abnormally low numbers of CD4(+) T cells as well as a defective proliferative response to mitogens. After diagnosis of cow milk allergy, milk was replaced with infant milk formula containing hydrolysed proteins. Recovery of immunoglobulin values and clinical resolution were achieved. Hypogammaglobulinaemia during early childhood in some children may be secondary to cow milk allergy, and immunoglobulins and cells may leak through the inflamed mucosa. Resolution of symptoms as well as normalization of immunoglobulin values may be easily achieved by avoidance of the offending allergen.

Novel intraoral phenotypes in hyperimmunoglobulin‐E syndrome

Hyperimmunoglobulin-E syndrome (HIES) is a primary immunodeficiency characterized by eczema, recurrent skin and lung infections with pneumatocoele formation, and extremely elevated serum immunoglobulin-E. The precise immunologic defect and genetic etiology remain unknown. Non-immunologic findings include characteristic facial features (prominent forehead, fleshy nasal tip, and increased interalar distance); skeletal involvement (pathological fractures, scoliosis, and craniosynostosis); and retention of primary teeth. This study aims to characterize intraoral soft tissue findings in HIES patients. Sixty HIES patients (4-54 years, 27 males, 33 females) received intraoral and radiographic evaluations. Chronological dental development was also assessed. Lesions of the hard palate and dorsal tongue were found in 55% and 60% of patients, respectively. Palatal lesions ranged from a generalized surface keratosis to a midline sagittal fibrotic bridge. Tongue lesions consisted of multiple fissures and a midline cleft. On the lip and buccal mucosa, keratotic plaques and/or surface fissures were found in 8% and 23% of patients, respectively. Manifested in 76.7% of patients, the intraoral lesions were significantly more prevalent than the characteristic facial traits (P=0.0013). Alterations in oral mucosa and gingiva were present in the majority of HIES patients. These novel intraoral findings may facilitate the diagnosis of HIES.

IgE and atopy in perinatally HIV‐infected children

Elevated serum immunoglobulin E (IgE) and increased prevalence of atopy is reported in patients infected with human immunodeficiency virus (HIV). The elevated serum IgE may be attributed to polyclonal stimulation of B cells or IgE production against allergens, viruses, fungi and bacteria. This study investigates the prevalence of atopy in perinatally HIV-infected children, and the relationships between serum IgE (and other serum immunoglobulins) with atopy, CD4+ cell count and HIV-disease stage. Serum immunoglobulin levels, epicutaneous skin test for common aeroallergens, clinical Centers for Disease Control and Prevention (CDC) classification, CD4+ cell counts and allergy history were extracted from the charts of perinatally HIV-infected children on highly active antiretroviral therapy. The prevalence of atopy (52%) and the pattern of aeroallergen sensitivity were comparable with the US pediatric population. Serum IgE levels did not correlate with clinical disease stage. However, in non-atopic patients, serum IgE levels increased with disease progression (p = 0.02). There was an inverse relationship between the prevalence of elevated serum IgE levels and atopy with progression of disease (p = 0.019). Serum IgE did not correlate with atopy, CD4+ cell count, or duration of HIV infection or levels of serum immunoglobulins. This is the first study to show no increased prevalence of atopy in perinatally HIV-infected children compared with the general population. In advanced stages of HIV, elevated serum IgE may be specific for antigens other than those known as allergens.

Reference Values of Total Serum IgE and Their Significance in the Diagnosis of Allergy in Young European Adults

Allergic sensitization mediated by immunoglobulin E (IgE) is the basis of allergic diseases, and elevated total IgE, in spite of some well-known limitations, is frequently included as a diagnostic criterion for allergic diseases. The reference value of total IgE (IgE-t) in the literature (1.5–144 kU/l) was established almost 2 decades ago. The aim of this study was to establish IgE-t reference values, establishing an updated cutoff value able to identify atopic subjects, defined as a positive CAP-radioallergosorbent test to at least one of a panel of common allergens, among young European adults. The study included 6,670 subjects from 10 Western European countries within the framework of the European Community Respiratory Health Survey II. IgE-t and specific IgE (IgE-s) were measured for the main inhalant allergens; IgE-s in class 0 for all allergens (66.2%) characterized non-atopy. The reference values were estimated by means of linear regression using a 50% random subsample of non-atopic subjects. Two non-atopic subsamples were examined so that one subsample could be used to establish reference IgE-t values, and these values were compared to those in the second non-atopic subsample to validate the findings. Sensitivity and specificity for atopy were assessed on the other 50% of non-atopic and on all atopic subjects. The 95th percentile of IgE-t reference values in non-smokers was 148 kU/l in women and 169 kU/l in men, while it was 194 and 220 kU/l in female and male smokers, respectively: serum IgE-t above the 95th percentile identifies <32% and above the 99th percentile <20% of atopic adults (low sensitivity), but a serum IgE-t below the 95th percentile identifies >90% and below the 99th percentile identifies >95% of non-atopic adults (good specificity). Due to the adequate specificity, IgE-t values exceeding the normal limits confirm a suspected atopic status; however, because of the low sensitivity, values below the cutoff seem not to exclude an atopic status with sufficient accuracy.

Immunoglobulin E (IgE) and Lymphocyte Subsets in Relation to Vitamins C and E in Cord Blood

TAB3-PD-02 Background: Epidemiologic studies have demonstrated beneficial effects of foods rich in antioxidants or antioxidant supplements on ventilatory function, respiratory symptoms, and atopy in children and adults. One plausible mechanism by which vitamin levels may influence health is through immunomodulation. Objective: To determine whether concentrations of vitamins C and E in cord blood are associated with alterations in immune parameters at birth. Methods: Mothers delivering in 2 districts in the Czech Republic between 1994 and 1998 were enrolled in the Immune Biomarker Study. Cord blood samples (n = 1397) were analyzed by flow cytometry to determine lymphocyte phenotypes (T lymphocytes: CD3+, CD4+, CD8+; B lymphocytes: CD19+; and natural killer cells: CD16+CD56+). Cord IgE was determined by Carrier-Polymer-System and maternal IgE by nephelometry for 463 births. Vitamin C was determined using spectrophotometry (n = 763) and vitamin E by high pressure liquid chromatography with UV detection (n = 642). Multiple linear regression was used to quantify the relations between vitamins C and E and lymphocyte proportions adjusting for questionnaire information (lifestyle, sociodemographic, reproductive) as well as delivery and meteorologic variables. Elevated cord serum IgE (>0.9 IU/mL) was predicted by multiple logistic regression models adjusting for district, year of birth, and elevated levels of maternal IgE (>100 IU/mL) as a proxy for maternal atopy (other covariates were not predictive). Results: Mean cord blood levels (μg/mL, ± SD) for vitamins E and C were 3.2 ± 2.0 and 13.9 ± 4.8, respectively. For a 1-μg (about half the SD)/mL increase in cord vitamin E, the percentage of cord CD19+ cells decreased −2.8% (95% CI, −5.4% to −0.3%) in a model adjusted for 45-day average ambient temperature. Models alternatively adjusting for 3-day temperature showed similar results. Associations were attenuated after control for season of delivery. Other lymphocyte subsets were not associated with cord vitamin E levels. For a 1-μg/mL increase in cord vitamin E, the odds of having an elevated cord IgE increased slightly (OR = 1.3; 95% CI, 1.0 to 1.6). Adjustment for maternal atopy, a strong predictor of cord IgE, had no impact here. Vitamin C levels were not associated with lymphocytes or IgE. Conclusion: Fetal vitamin E levels may affect the relative production of B cells and the concentrations of circulating IgE at birth. Other seasonal factors, such as pollen exposures or additional nutritional factors, may confound the association with lymphocytes. Further work is needed to clarify the independent and joint effects of these exposures.

Latex allergy in health care workers in Taiwan: prevalence, clinical features

Latex allergy is becoming a major health concern among healthcare workers, of whom approximately 2.8 to 18% are reportedly sensitized. The purpose of this study was to analyze the results of a natural rubber latex (NRL) allergy screening program to identify sensitized hospital employees. Nurses (n = 130) assigned to operating theaters and intensive care units were evaluated using a written questionnaire for symptoms of atopy (asthma, rhinoconjunctivitis, and atopic eczyma), possible reactions to latex gloves, other medical devices and previous surgery. Serological testing for total immunoglobulin E (IgE), latex-specific IgE, and specific-IgE to melon, banana, kiwi, tomato, and chestnut were performed using Pharmacia CAP radioallergosorbent tests. Skin pick test (SPT) for latex allergen was also performed. Elevated serum total IgE was found in 22(16.9%) of the 130 nurses, 3(16.7%) of whom had increased latex-specific IgE further confirmed by SPT. The overall prevalence of latex allergy was 2.3% (3/130). No cross reactive fruit-allergy was found among the latex-sensitized nurses. This study supports the existence of other forms of atopy are related to an increased risk of latex sensitization. The NRL screening program used in this study is feasible for use in identifying latex-sensitized employees.

The Bronchial Lavage of Pediatric Patients With Asthma Contains Infectious Chlamydia

Purpose of the Study. To examine the frequency of Chlamydia pneumoniae infections in pediatric patients with asthma. Study Population. Seventy pediatric patients undergoing flexible fiber-optic bronchoscopy as a part of their ongoing clinical care. Methods. Bronchoaveolar lavage (BAL) fluid and blood were examined for the presence of C pneumoniae by smear examination and culture. The BAL and blood samples were cultured on human or mouse macrophages to determine infectivity. Polymerase chain reaction (PCR) amplification of BAL samples was performed to confirm specificity of the culture technique. Blood was examined for total immunoglobulin E (IgE). Blood samples from 70 matched, nonrespiratory control patients were cultured for Chlamydia. Results. Forty-two patients undergoing bronchoscopy had asthma and 28 had various other respiratory diseases. Thirty-eight (54%) BAL samples were positive for Chlamydia by PCR and 22 (31%) samples were positive for Chlamydia by culture. Of the positive BAL samples, 28 (74%) of 38 PCR-positive and 14 (64%) of 22 culture-positive samples were from children with asthma. Culture-positive blood samples were found in 24 (34%) of 70 respiratory patients and 8 (11%) of 70 nonrespiratory controls. In the blood culture–positive respiratory group, 17 (71%) of 24 were from children with asthma. Elevated total serum IgE was associated with BAL culture–positive results, and this relationship was stronger than total IgE and asthma diagnosis. Conclusions. Viable C pneumoniae organisms are frequently present in the lung lavage in a cohort of predominately asthmatic pediatric patients. Reviewer Comments. Results from this study suggest that infectious C pneumoniae may be common in BAL fluid of children with asthma. Historically, C pneumoniae has been associated with exacerbation and increased incidence of respiratory conditions in adults, but studies to examine similar associations in children have not been performed. This is the first investigation to report viable and infectious C pneumoniae in the BAL fluid of children with asthma. These findings are intriguing and should encourage investigators to examine the clinical implications of Chlamydia infection among pediatric patients with asthma.

An Immunoepidemiological Approach to Asthma: Identification of in-Vitro T-Cell Response Patterns Associated With Different Wheezing Phenotypes in Children

Purpose of the Study. To determine if variations in clinical asthma phenotypes are the result of differences in underlying T-cell immune responses to inhalant allergens. Study Population. One hundred forty-seven children (aged 8.6–13.5 years) and 25 of their siblings (aged 7.4–17.4 years) were recruited from 194 members of a birth cohort studied prospectively for asthma development. Methods. Wheeze and asthma were defined by parental questionnaire. Atopy was defined as at least 1 positive skin-prick test for environmental or food allergens. Increased bronchial hyperreactivity (BHR) was defined as a ≥20% drop in forced expiratory volume in 1 second after inhaled histamine up to 7.8 μmol/L. T-cell responses to allergens and mitogens, blood eosinophils, and immunoglobulin E (IgE) were measured and compared with clinical phenotypes. Results. Ninety-five (55.2%) of the children were atopic, sensitized predominantly to house dust mite (42.4%). Asthma was present in 26 (15.1%) children, of whom 22 (85%) were atopic; BHR was present in 62 (35.9%) children, of whom 45 (73%) were atopic. Atopy was associated with T-helper 2 (Th2) cytokine responses (interleukin-4 [IL-4], IL-5, IL-9, IL-13), whereas Th1 responses (IL-10, interferon-γ [IFN-γ], tumor necrosis factor-α [TNF]) occurred in all children. Skin-prick test wheal size was positively associated with house dust mite allergen-induced IL-5 (P &amp;lt; .0001) and IFN-γ (P = .003) and negatively associated with IL-10. Asthma was associated with eosinophilia and elevated house dust mite–specific IL-5, IL-9, IL-13, and IgE. BHR was associated with eosinophilia, elevated allergen-specific IL-5 and IgE, increased total IgE, and a polyclonal cytokine response (IL-5, IL-13, IFN-γ, and TNF-α). In atopics, current asthma or wheeze was associated with house dust mite allergen-specific IL-5 and IL-13; BHR was associated with IL-5 and IgE. In nonatopics, BHR was associated with increased house dust mite allergen-specific and polyclonal IL-10 and polyclonal IFN-γ and TNF-α. Conclusions. In atopic and nonatopic children, distinctive immune-response patterns were identified for asthma and BHR. Immunologic Th1 and Th2 hyperresponsiveness was identified as a hallmark of BHR. Reviewer Comments. Modification of T-cell responses has become an increasingly important focus in the investigation of treatments for atopic disease. Although this study further highlights the prominence of Th2-driven responses in atopic individuals, the results also demonstrate allergen-specific and polyclonal Th1 responses associated with BHR in atopic and nonatopic children. These findings suggest a nonantagonistic interaction between Th1 and Th2 pathways in the production of asthma symptoms. Further understanding of the associations between T-cell response patterns and clinical wheezing phenotypes in children may lead to future asthma therapies in this population.

Immunoglobulin E: a new diagnostic clue for Behçet’s disease?

Behçet's disease (BD) is a multisystemic inflammatory disorder of unknown etiology. Hyperimmunoglobulinemia has been demonstrated in BD; however, its clinical importance has not yet been discovered. In a few reports, an association between BD and plasma immunoglobulin E (IgE) has been noted. In this study, we had three objectives: (1) to investigate plasma levels of IgE and their association with levels of acute phase reactants, (2) to determine whether treatment has any effect upon IgE levels, and (3) to assess whether higher serum levels of IgE provide a clue for the diagnosis of BD. Fifty-two patients with BD, without any accompanying disease or condition that might lead to a rise in IgE, were compared with 51 age-matched healthy controls. Plasma levels of IgE, IgA, IgG, and IgM were analyzed by means of nephelometric analysis. Results showed that among the 52 patients, 23 (44%) had IgE levels that were higher than the upper limits of normal. IgE was not correlated with age, erythrocyte sedimentation rate, or C-reactive protein (p=0.59, p=0.57, and p=0.757, respectively). These relationships remained nonsignificant when multiple regression analysis was performed, with R (2) of 0.187 and p=0.057. Moreover, treatment of patients with elevated IgE did not produce any predictable IgE response. We conclude that Behçet's patients commonly exhibit elevated plasma IgE levels. However, elevated IgE levels are not correlated with levels of acute phase reactants or disease activity. We suggest that IgE levels might be an independent diagnostic clue in Behçet's patients.

Atopic dermatitis or hyper-IgE syndrome?

A case of atopic dermatitis (AD), recurrent infections, and elevated immunoglobulin E (IgE) level is presented. Clinical characteristics, pathophysiology, diagnosis, and management in this patient are reviewed. Clinical pearls and pitfalls include the following: (1) deep-seeded Staphylococcus aureus infections occur rarely in AD and should raise the possibility of immunodeficiency syndromes such as hyper-IgE syndrome (HIES); (2) HIES is characterized by a clinical triad consisting of elevated serum IgE levels, recurrent staphylococcal skin abscesses, and pneumonia with pneumatocele formation; (3) although serum IgE levels in AD have been noted to be as high as 10,000 IU/mL, severe cases of AD such as that presented here can exceed this range; (4) the efficacy of anti-IgE therapy in AD or HIES is unknown and may be limited by dosing requirements.

Clinical Impact of the Swollen Duodenal Papilla in Autoimmune Pancreatitis

Background: Although autoimmune pancreatitis (AIP) sometimes shows a swollen duodenal papilla, the significance of duodenal papilla of AIP has not been fully elucidated. Aim: To evaluate the clinical significance of the main duodenal papilla in AIP from the view point of endoscopic features and immunohistochemical findings. Patients and Methods: Sixteen patients (9 male, 7 female, age 54-76 years) were consecutively enrolled from April 2001 to October 2005. Patients with AIP that underwent ERCP as well as endoscopic biopsies were studied. AIP was diagnosed if all of the following criteria were met: a) irregular narrowing of the main pancreatic duct on ERCP, b) sausage-shaped pancreas on CT, c) histopathological findings of lymphoplasmacytic sclerosing pancreatitis, d) elevated serum immunoglobuline. Both the endoscopic features and the immunohistochemical findings of the duodenal papilla using IgG4 antibodies were retrospectively reviewed. These findings of the patients with AIP were compared to those of 13 patients with alcoholic pancreatitis. IgG4-positive plasma cell infiltration cell count of over 10 per high-power field was regarded as positive in all histopathological specimens. Results: Swollen main duodenal papilla was observed in 12 (85.7%) patients with AIP and 3 (18.8%) patients with alcoholic pancreatitis. Significant differences were found in the swelling of the main duodenal papilla between AIP and alcoholic pancreatitis (p < 0.05). The swollen main duodenal papilla in 12 (85.7%) patients with AIP improved in response to treatment with corticosteroids. In 4 patients without elevated serum IgG4, the swollen pancreas without swollen duodenal papilla improved spontaneously without corticosteroids. As for ERCP findings, the main pancreatic duct just proximal to the duodenal papilla (within 10 to 15 mm) had a normal caliber in 12 (85.7%) AIP patients with swollen duodenal papilla, but not in patients with alcoholic pancreatitis. Although in 14 of 16 AIP patients infiltration of IgG4-positive plasma cells was detected in the duodenal papilla as well in its pancreatic tissues, there was no infiltration of IgG4 in alcoholic pancreatitis patients. Significant differences were found in the IgG4 positive plasma cell in the duodenal papilla between AIP and alcoholic pancreatitis (p < 0.05). Conclusions: These results suggest that a swollen main duodenal papilla with IgG4 positive plasma cell infiltration and preserved segment of the main pancreatic duct just proximal to the duodenal papilla are characteristic findings in patients with AIP. We propose these novel findings are useful in the diagnosis of AIP as well as the choice for corticosteroids.

Case report: An unusual presentation of atopic dermatitis in an elderly female

Rationale Atopic dermatitis (AD) usually presents during childhood and rarely in the elderly. AD is characterized by pruritus, erythematous papules, excoriations, lichenification and at times prurigo nodularis. It is also associated with other atopic diseases and elevated serum immunoglobulin E (IgE). Methods A 72 year-old woman developed diffuse pruritus 14 months prior to presentation. She developed worsening eczematous erythematous papules throughout her body with excoriations, which waxed and waned. Pruritus was intermittently controlled with hydroxyzine, a potent topical corticosteroid, and over-the-counter skin lotions. She denied any history of allergies or asthma. Results Laboratory data were remarkable for blood eosinophils of 1896 cells/mcL, serum IgE of 7120 kU/L and mildly elevated IgE to multiple foods and environmental allergens such as egg white, peanut, ragweed, and dust mites. Skin biopsy revealed dermatitis with eosinophils consistent with AD. Immunohistochemical analysis for inflammatory cells was positive for CD4, CD8, and CD25; and negative to CD23, CD30, CD56, and CD57. One month later, with almost complete resolution of her skin lesions, blood eosinophils normalized to 480 cells/mcL but serum IgE had increased to 13540 kU/L. The patient continues to be monitored for development of disorders such as parapsoriasis, cutaneous T cell lymphoma or other lymphoproliferative disease. Conclusion Adult onset of AD with an extremely elevated serum IgE in an elderly individual without prior history of atopy may occur rarely.

Respiratory Allergy to Trimellitic Anhydride in Rats: Concentration-Response Relationships During Elicitation

The present study investigated whether airway responses of sensitized rats to trimellitic anhydride (TMA) were concentration dependent and whether these were related to irritation by TMA. Groups of BN and Wistar rats were sensitized by two dermal applications of TMA (50% w/v, followed by 25% w/v in vehicle). Controls received vehicle (acetone–olive oil 4:1, v/v). All animals were challenged 3 wk after the first sensitization by inhalation of one of a range of concentrations of TMA (0.2–61 mg/m3 for BN rats, 15–250 mg/m3 for Wistar rats). Breathing pattern, breathing frequency, and tidal volume were measured before, during, and after challenge to assess allergic and irritative airway responses. One day after challenge, nonspecific airway responsiveness to a range of concentrations of methacholine was measured. At necropsy on the same day, blood was withdrawn for measuring total serum immunoglobulin E (IgE) and organs were weighed. Larynx, trachea and lungs were examined histopathologically. In BN rats, TMA sensitization elevated total IgE levels; subsequent inhalation challenge with 2 mg/m3 of TMA and higher caused laryngeal inflammation with squamous epithelial metaplasia, and pulmonary hemorrhages. Concentration-related decreases in breathing frequency and alterations in breathing pattern, which differed from the irritation-induced pattern, were also observed at these levels. Inhalation challenge with TMA concentrations of 12 mg/m3 and higher increased lung weight. Increased nonspecific airway responsiveness was observed at the 2 next higher tested concentrations of 46 and 61 mg/m3. In unsensitized BN rats, only laryngeal squamous metaplasia was observed, albeit at higher challenge concentrations of TMA, and decreased breathing frequency, a typical breathing pattern characteristic of irritation. Identically sensitized Wistar rats showed airway inflammation and pulmonary hemorrhages upon challenge with TMA, but no functional changes, even at distinctly irritating concentrations of TMA up to 250 mg/m3. In conclusion, TMA challenge of sensitized BN rats caused challenge concentration-related allergic airway inflammation, asthmalike changes in breathing pattern, and increased nonspecific airway responsiveness. The lowest no-observed-effect level (NOEL) based on the most sensitive endpoint investigated was 0.2 mg/m3, a value that is well below the irritation concentration. The presence of a NOEL in the sensitized BN rat suggests that assessment of safe human exposure levels is feasible.

Association between polymorphisms in the SPINK5 gene and atopic dermatitis in the Japanese.

Atopy, which is characterized by increased levels of immunoglobulin E (IgE) against common environmental allergens, is considered the strongest predisposing factor for asthma and atopic dermatitis (AD). Mutations in the gene encoding serine protease inhibitor Kazal-type 5 (SPINK5) are responsible for Netherton syndrome, a rare skin disorder characterized by greatly elevated IgE levels with atopic manifestations. A recent study of Caucasian AD families showed that maternally derived alleles of the SPINK5 gene are associated with development of AD and asthma, suggesting the parent-of-origin effect for the development of atopic diseases in the SPINK5 gene. We studied the possible association of the SPINK5 gene for the development of atopic diseases by determining the genotypes of five polymorphisms in a Japanese population. Ttransmission disequilibrium tests revealed an association of SPINK5 polymorphisms with AD but not with asthma. Our data indicate that the SPINK5 gene is associated with AD across ethnicities.

Immunoglobulin E production in chronic pancreatitis

Objectives Serum immunoglobulin E (IgE) was investigated in patients with chronic pancreatitis in order to elucidate possible disease mechanisms linking pancreatitis, adverse reaction to foods and allergy. Design and methods Serum IgE was analysed in 86 nonatopic patients with advanced chronic pancreatitis and 54 non-atopic controls. IgE detection was performed by enzyme-linked immunofluorescence. Results Mean IgE levels (± standard error of mean) in chronic pancreatitis patients (286.1 ± 49 kU/l) were found to be significantly elevated compared to controls (67.7 ± 11 kU/l; P < 0.0001). Normal IgE levels (< 100 kU/l) were present in 40/54 control patients (74.1%), but only 39/86 pancreatitis patients (45.3%). Of the patients with chronic pancreatitis, 47/86 (54.6%) had clearly elevated IgE levels of > 100 kU/l and their IgE values did not show a Gaussian distribution. However, nine-fold higher IgE levels were found in chronic pancreatitis patients with alcohol consumption of > 25 g/day and exocrine insufficiency (915.5 ± 240 kU/l) than in pancreatitis patients with normal exocrine function and no alcohol consumption (103.4 ± 43 kU/l; P < 0.001). Moreover, acute episodes of chronic pancreatitis were found to increase serum IgE levels. Conclusions In patients with chronic pancreatitis, serum IgE production is markedly enhanced, especially during acute inflammatory episodes or when alcohol is consumed. Since abstinence from alcohol and pancreatic enzyme substitution are associated with clearly lower IgE levels, it may be concluded that pancreatic insufficiency with reduced nutrient digestion and alcohol consumption stimulate IgE production. This finding gives rise to the speculation that, apart from pancreatic inflammation, cross-linking of IgE with alimentary or other antigens might be involved in the pathophysiology of a subpopulation of patients with chronic pancreatitis and manifest pancreatic insufficiency.

Immunoglobulin E production in chronic pancreatitis.

Serum immunoglobulin E (IgE) was investigated in patients with chronic pancreatitis in order to elucidate possible disease mechanisms linking pancreatitis, adverse reaction to foods and allergy. Serum IgE was analysed in 86 non-atopic patients with advanced chronic pancreatitis and 54 non-atopic controls. IgE detection was performed by enzyme-linked immunofluorescence. Mean IgE levels (+/- standard error of mean) in chronic pancreatitis patients (286.1+/-49 kU/l) were found to be significantly elevated compared to controls (67.7+/-11 kU/l; P<0.0001). Normal IgE levels (<100 kU/l) were present in 40/54 control patients (74.1%), but only 39/86 pancreatitis patients (45.3%). Of the patients with chronic pancreatitis, 47/86 (54.6%) had clearly elevated IgE levels of >100 kU/l and their IgE values did not show a Gaussian distribution. However, nine-fold higher IgE levels were found in chronic pancreatitis patients with alcohol consumption of >25 g/day and exocrine insufficiency (915.5+/-240 kU/l) than in pancreatitis patients with normal exocrine function and no alcohol consumption (103.4+/-43 kU/l; P<0.001). Moreover, acute episodes of chronic pancreatitis were found to increase serum IgE levels. In patients with chronic pancreatitis, serum IgE production is markedly enhanced, especially during acute inflammatory episodes or when alcohol is consumed. Since abstinence from alcohol and pancreatic enzyme substitution are associated with clearly lower IgE levels, it may be concluded that pancreatic insufficiency with reduced nutrient digestion and alcohol consumption stimulate IgE production. This finding gives rise to the speculation that, apart from pancreatic inflammation, cross-linking of IgE with alimentary or other antigens might be involved in the pathophysiology of a sub-population of patients with chronic pancreatitis and manifest pancreatic insufficiency.