High IgE Levels Research Articles

Anaphylaxis: An Infrequent Presentation of Hydatid Disease

Background: Hydatid disease in humans is caused by the taeniid Echinococcus. It usually presents as an asymptomatic hepatic cyst. Its manifestation as anaphylactic shock is exceptional. Aim: To present a clinical case of anaphylaxis due to hydatidosis. Material and Methods: A 32-year-old farmer man was admitted as emergency with pruritus in the hands, feet and armpits associated with erythema, facial edema and generalized habonasal lesions. He referred feeling of respiratory distress. The examination revealed a hypotensive and tachycardia patient, with a baseline oxygen saturation of 90%. Blood analysis revealed leukocytosis stands, without other notable findings as a normal liver profile. During hospital care, he presented a single episode of fever of 38ºC without focality. After 48 hours of close monitoring, the patient remains asymptomatic, so discharge home is decided. Results: The study by allergology showed eosinophilia, high levels of IgE with low C4 and positive serology for E. granulosus stand out. A thoraco-abdominopelvic computed tomography showed a lesion of a cystic nature in the right hepatic lobe, corresponding to a CE3 transitional hydatid cyst (WHO classification). After treatment with Albendazol, a closed cystopericystectomy is performed using a right subcostal laparotomy that proceeds without incident. Conclusion: Despite the fact that anaphylaxis secondary to hydatid disease is rare, it should always be included in the differential diagnosis of an episode of anaphylactic reaction of unknown cause due to the severity of the disease and the specificity of the required treatment.

A075 THE FOOD SENSITIZATION RELATED TO A-896G GENE POLYMORPHISM OF TLR-4 IN ADULTS WITH ATOPIC DERMATITIS

Polymorphism of the TLR-4 gene can be associated with high levels of IgE and positivity of skin prick tests in patients with asthma, rhinitis and atopic dermatitis.

Association of Cotinine-Verified Cigarette Exposure with Chronic Rhinosinusitis in Korean Adults.

Chronic rhinosinusitis is known to be influenced by cigarette exposure; however, this relationship is based on the presence of nasal polyps, and objective measurements of cigarette exposure in chronic rhinosinusitis are not well established. This study aimed to estimate the association between chronic rhinosinusitis and smoking status based on self-reported questionnaires and urinary cotinine levels according to the presence of nasal polyps. We analyzed a total of 23,621 participants who participated from the fifth Korea National Health and Nutrition Examination Survey (2010–2012). Serum total and specific IgE level were measured. Higher prevalence of chronic rhinosinusitis with nasal polyps was associated with current smoking status (OR = 1.43, 95% CI = 1.00–2.03). This association was prevalent in participants aged ≤ 50 years (OR = 1.76, 95% CI = 1.01–3.05), and higher urinary cotinine level showed correlation with higher prevalence of chronic rhinosinusitis with nasal polyps in this age group (OR = 1.04, 95% CI = 1.00–1.08). In addition, positive correlation between serum total IgE and urinary cotinine levels was greater in patients with chronic rhinosinusitis (β = 0.493, 95% CI = 0.071–0.916) than in controls (β = 0.062, 95% CI = 0.021–0.103). Aggressive smoking interventions should be performed in patients with chronic rhinosinusitis with nasal polyp, especially in cases of young adults or high serum IgE levels.

The Prevalence of Hypersensitivity Reactions to Antirheumatic Biological Agents and Results of the Skin Tests: Experience of a Tertiary Referral Allergy Center in Turkey

Objective: The use of biological agents (BAs) has increased dramatically for inflammatory diseases and this increase has led to a rise in hypersensitivity reactions (HSRs). The symptoms and diagnostic tools for HSRs are not standardized. We aimed to analyze the prevalence of HSRs to anti-rheumatic BAs and to evaluate the usefulness of skin tests (STs) as a diagnostic tool. Materials and Methods: Our study was conducted at the Ege University Medical Faculty, Department of Internal Medicine, Division of Allergy and Clinical Immunology and Division of Rheumatology, Izmir, Turkey. Four hundred sixty patients who received BAs between Jan 1st, 2015, and Jan 1st, 2016, were reviewed in this retrospective cross-sectional study. The prevalence of HSRs was retrospectively evaluated. Ten patients with HSRs were evaluated with STs containing commercially available culprit drugs. The data was collected from hospital records. The age, sex, atopic diseases, primary rheumatic diseases, and anti-rheumatic therapies of the patients were recorded. Results: Two hundred fifty patients were treated with rituximab (RTX), 45 with infliximab, 40 with tocilizumab (TOC), 36 with golimumab, 35 with etanercept, 34 with abatacept, 15 with certolizumab, and 5 with adalimumab. Fifty reactions with RTX and two reactions with TOC were infusion-related (IRRs). Ten HSRs were observed. Eight patients had immediate (7 immediate systemic reactions and 1 local injection site reactions), and 2 had late-onset cutaneous reactions. We detected the ratio of IRRs as 11.3%, immediate HSRs as 1.73%, IgE-mediated reactions as 1.08%, and anaphylaxis as 0.86%. STs were positive in 5 of 8 patients with immediate HSRs. Four of them had anaphylaxis, and remarkably, 3 of these had positive STs. None of the ten patients had high levels of specific IgE and only four had atopic diseases. Total IgE levels were not high and specific IgE levels were not positive in the presence of HSR to BAs (p=0.039). Conclusion: Five of the 8 (62.5%) patients with immediate reactions had positive STs, which suggested IgE-mediated reactions. The prevalence of HSRs to BAs was less than the ones mentioned in the literature.

Identification of peroxidase-1 and beta-glucosidase as cross-reactive wheat allergens in grass pollen-related wheat allergy

BackgroundSome patients with wheat-dependent exercise-induced anaphylaxis (WDEIA) or wheat allergy showed negative ω-5 gliadin-specific IgE test and high level of grass pollen-specific IgE. It was presumed that these patients developed allergic reaction upon cross-reaction of their IgE antibodies raised against grass pollen allergens to wheat allergens. This study aimed to clarify clinical characteristics and wheat allergens of this phenotype of WDEIA/wheat allergy, which were tentatively diagnosed as grass pollen-related wheat allergy (GPWA). MethodsA total of six patients with GPWA were enrolled, and controls were 17 patients with grass pollen allergy but no episode of wheat allergy, and 29 patients with other wheat allergies: 18 with conventional WDEIA and 11 with hydrolyzed wheat protein allergy. Sensitization to wheat proteins was determined by basophil activation test (BAT). IgE-binding proteins in wheat flour were identified by immunoblotting followed by mass spectrometry. Wheat allergen-specific IgE tests were established by CAP-FEIA system. ResultsAll the six patients with GPWA were sensitized to water-soluble wheat proteins in BAT and IgE-immunoblotting, and peroxidase-1 (35 kDa) and beta-glucosidase (60 kDa) were identified as specific IgE-binding wheat proteins. The binding of patient IgE to these proteins was inhibited by pre-incubation of patient sera with grass pollen. The peroxidase-1- and beta-glucosidase-specific IgE tests identified three and four of six patients with GPWA, respectively, but only two of 29 controls, indicating high specificity of these tests. ConclusionsPeroxidase-1 and beta-glucosidase are specific wheat allergens for GPWA among grass pollen allergy and other types of wheat-induced food allergies.

Chronic Rhinosinusitis with Nasal Polyps and Asthma

Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) characterized by a type 2 immune signature often have severe and recurrent disease. Lower airway conditions such as asthma are common comorbidities and share similar pathophysiology. CRSwNP with asthma is characterized by tissue eosinophilia and high local IgE levels. Clinically, CRSwNP with comorbid asthma is associated with more severe sinonasal symptoms and worse quality of life, and it is more difficult to treat both medically and surgically. Asthma in the presence of nasal polyposis is also more difficult to control, being more exacerbation prone, with increased airway obstruction and more extensive eosinophilic inflammation. Aspirin/nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (AERD) is a recognized phenotype of CRSwNP with comorbid asthma. Patients with CRSwNP with comorbid AERD are among those with the most severe and difficult-to-treat disease, and tend to have severe NP. The shared pathophysiology of the upper and lower airways has important implications for both the diagnosis and management of respiratory comorbidities. However, in clinical practice, the nose and lungs are often treated as separate entities. The underlying systemic inflammatory link between CRSwNP and asthma provides a compelling rationale for systemic treatment with novel biologics targeting shared underlying type 2 inflammatory pathways.

Effect of Avoiding Cow's Milk Formula at Birth on Prevention of Asthma or Recurrent Wheeze Among Young Children

Children with food allergies may develop asthma or recurrent wheeze. To evaluate whether asthma or recurrent wheeze among children were changed by avoiding supplementing breastfeeding (BF) with cow's milk formula (CMF) in the first 3 days of life. This randomized, unmasked, clinical trial was conducted at 1 university hospital in Japan beginning October 2013 with follow-up examinations occurring until January 2020. A total of 312 newborns at risk for atopy were randomized and assigned to either BF with or without amino acid-based elemental formula (EF) or BF with CMF, with follow-up examinations for participants showing signs of atopy conducted at 24 months. Follow-up examinations ran through January 2020. Immediately after birth, newborns were randomly assigned (1:1 ratio) to either breastfeeding with or without amino acid-based elemental formula for at least the first 3 days of life (no CMF group) or breastfeeding supplemented with CMF (≥5 mL/d) from the first day of life to 5 months of age (CMF group). Asthma or recurrent wheeze diagnosed by the pediatric allergy specialists of this trial; subgroups were stratified by serum levels of 25-hydroxyvitamin D and IgE. Of 312 infants (156 [50.0%] randomized to the no CMF group), 302 (96.8%) were followed up at their second birthday: 77 of 151 (51.0%) in the no CMF group and 81 of 151 (53.6%) in the CMF group underwent extended follow-up because of having atopic conditions. Asthma or recurrent wheeze developed in 15 (9.9%) of the children in the no CMF group, significantly less than the children in the CMF group (27 [17.9%]; risk difference, -0.079; 95% CI, -0.157 to -0.002). In participants with vitamin D levels above the median at 5 months of age, asthma or recurrent wheeze developled in 5 (6.4%) children in the no CMF group, significantly less than in the children in the CMF group (17 [24.6%]; risk difference, -0.182; 95% CI, -0.298 to -0.067; P for interaction = .04). In the highest quartile group of total IgE at age 24 months, asthma or recurrent wheeze developed in 2 children (5.3%) in the no CMF group, significantly less than the children in the CMF group (14 [43.8%]; risk difference, -0.385; 95% CI, -0.571 to -0.199; P for interaction = .004). The findings of this study suggest that avoiding CMF supplementation in the first 3 days of life has the potential to reduce the risk of asthma or recurrent wheeze in young children, especially among those with high vitamin D or high IgE levels. umin.ac.jp/ctr Identifier: UMIN000011577.

OVERLAPPING ACUTE AND CHRONIC EOSINOPHILIC PNEUMONIA: A CASE REPORT

SESSION TITLE: Medical Student/Resident Diffuse Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lung limited eosinophilic diseases include acute eosinophilic pneumonia (AEP) and chronic eosinophilic pneumonia (CEP) which are regarded as two different diseases that differ in severity and timeline.[1] We present a case labeled as idiopathic AEP with features suggestive of a chronic pathology and overlap with CEP. CASE PRESENTATION: An 81 year-old caucasian non-smoking female presented with three days of shortness of breath and non-productive cough. She denied any sick contacts, recent travel or contact with farm animals. Her initial exam showed tachycardia, hypoxia and decreased breath sounds on auscultation with diffuse crackles. Labs showed leukocytosis of 17.5 K/uL with 21% eosinophils and an absolute eosinophil count of 3.7 K/uL. Her computed tomography (CT) of the chest showed extensive ground glass infiltrates with interlobular septal thickening and a crazy paving pattern.(Images A, B, C) Bronchoscopy and bronchoalveolar lavage showed total nucleated cell count of 2,783 with 78% eosinophils, negative cytology and normal flow cytometry. Serologies were negative for parasitic and fungal infections. AEP was diagnosed and the patient was started on a prednisone taper. During her outpatient follow up after two months, she was symptom free. Given no identified inciting factors with resolution of symptoms in less than two weeks, she was labeled as idiopathic AEP. Her labs though showed continued peripheral eosinophilia of 8% and high IgE level. Her prednisone taper was prolonged with eventual normalization of her eosinophilia and IgE level. Pulmonary function tests were normal and repeat CT chest showed minimal residual ground glass infiltrates. DISCUSSION: AEP and CEP don’t have clear diagnostic criteria but there is an overlap between their symptoms, different radiologic findings and eosinophils on BAL being the cornerstone for diagnosis.[2] In AEP, symptoms usually resolve in less than 4 weeks, with higher incidence and severity of respiratory failure and lower incidence of peripheral eosinophilia. Our case shows an overlap between AEP and CEP with peripheral eosinophilia and high IgE levels despite steroid therapy and the resolution of symptoms. Carmi Barta, et al, propose that AEP and CEP may be a spectrum of the same underlying pathological pathway with a difference in clinical presentation.[3] It appears that duration of symptoms may be a discriminating factor between the two entities, but the diagnosis is less clear when symptoms resolve with persistence of lab abnormalities. Our case demonstrates such clinical and laboratory discordance; thus, we suggest that AEP and CEP may in some cases be the same disease process with AEP being an exacerbation or an inciting event. CONCLUSIONS: Our case highlights the need for additional investigations and understanding of eosinophilic lung diseases. Reference #1: Evans R., et al. Eosinophilic lung diseases. Med Clin North Am 2011;95:1163–118. Reference #2: Yuzo Suzuki, Takafumi Suda, Eosinophilic pneumonia: A review of the previous literature, causes, diagnosis, and management, Allergology International, Volume 68, Issue 4, 2019, Pages 413-419. Reference #3: Bartal, Carmi et al. “Drug-induced eosinophilic pneumonia: A review of 196 case reports.” Medicine vol. 97,4 (2018): e9688. DISCLOSURES: No relevant relationships by Youssef Abouleish, source=Web Response No relevant relationships by Elise Stephenson, source=Web Response No relevant relationships by Sami Tahhan, source=Web Response

Molecular characterization of a Trichinella spiralis serine proteinase

The aim of this study was to investigate the biological characteristics and functions of a Trichinella spiralis serine proteinase (TsSerp) during larval invasion and development in the host. The full-length TsSerp cDNA sequence was cloned and expressed in Escherichia coli BL21. The results of RT-PCR, IFA and western blotting analyses showed that TsSerp was a secretory protein that was highly expressed at the T. spiralis intestinal infective larva and muscle larva stages and primarily located at the cuticle, stichosome and intrauterine embryos of the parasite. rTsSerp promoted the larval invasion of intestinal epithelial cells (IECs) and the enteric mucosa, whereas an anti-rTsSerp antibody impeded larval invasion; the promotion and obstruction roles were dose-dependently related to rTsSerp and the anti-rTsSerp antibodies, respectively. Vaccination of mice with rTsSerp elicited a remarkable humoral immune response (high levels of serum IgG, IgG1/IgG2a, IgE and IgM), and it also triggered both systemic (spleen) and local intestinal mucosal mesenteric lymph node (MLN) cellular immune responses, as demonstrated by a significant elevation in Th1 cytokines (IFN-γ) and Th2 cytokines (IL-4) after the spleen and MLN cells from vaccinated mice were stimulated with rTsSerp. Anti-TsSerp antibodies participated in the killing and destruction of newborn larvae via ADCC. The mice vaccinated with rTsSerp exhibited a 48.7% reduction in intestinal adult worms and a 52.5% reduction in muscle larvae. These results indicated that TsSerp participates in T. spiralis invasion and development in the host and might be considered a potential candidate target antigen to develop oral polyvalent preventive vaccines against Trichinella infection.

Enhancement of Anti-allergic Effect of Diethylcarbamazine Citrate in Asthmatic Mouse Model: Testing of Anti-drug Antibodies and Quercetin.

Diethylcarbamazine citrate (DEC) is known as an effective treatment for bronchial asthma because of its ability to reduce eosinophil trafficking to the lung tissue. The current study aimed to potentiate the anti-allergic effect of the drug by passive immunization of the asthmatic model with anti-DEC antibody or prior treatment with quercetin (Qur). Eight mice groups were categorized into control, the model of lung asthma, treated with DEC, passively immunized with anti(α)-bovine serum albumin Ab, anti-DEC Ab, prior exposure to 10, 20, or 40 mg Qur/Kg. b.wt. Both eosinophil peroxidase (EPO) and eotaxin2 in the lung tissues were performed. Serum levels of cytokines, bronchoalveolar lavage fluid (BALF) IgE, rabbit anti-bovine serum albumin (anti-BSA), and DEC IgG in lung tissue homogenates were assayed by ELISA. Regarding the effect of anti-DEC Ab and Qur on DEC-induced recovery of histopathological alterations showed that the Ova group had peri-bronchial hyperplasia, mononuclear leukocyte infiltration, thickening in the wall of alveoli, and congested blood vessels. However, the reduction of inflammatory cells and thickened alveolar walls was dependent on the Qur dose. Qur40 enhanced the anti-allergic effect of DEC. Moreover, the present data revealed high levels of Th2 cytokines (IL-4 and IL-5) and IgE in the Ova group. An increased leukocyte infiltration/thickening of the alveolar wall and lung tissue EPO/eotaxin2 were also observed. Qur-40 could show an enhancement effect on DEC for the reduction of IL-4, IL-5, IgE, EPO, and eotaxin 2. Consequently, the IFN-γ/IL-4 ratio was increased. Qur at 40 mg/Kg could be recommended to enhance the DEC effect suggesting a novel approach for treatment.

IgE AND IgG antibody responses to Dermatophagoides pteronyssinus in dogs with demodicosis and atopic dermatitis

Canine demodicosis is a common inflammatory parasitic skin disease caused by Demodex mites. House dust mites, such as Dermatophagoides spp., play an important role in the pathogenesis of canine atopic dermatitis (AD). The goal of this experimental work was to investigate whether demodectic dogs could be previously exposed/sensitized to house dust mites’ antigens. First the prevalence of demodicosis in a southeastern region of Brazil was investigated by analyzing clinical files of dogs that were admitted to a Veterinary Hospital. Subsequently, the IgG responses to Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df) and IgE to D. pteronyssinus (Dp) were evaluated in two groups, AD or demodicosis dogs. Additionally, the major IgE-binding Dp proteins that are recognized by sera from dogs with demodicosis and AD were evaluated. A total of 2,599 clinical files were analyzed to identify the major parasitic skin diseases in dogs from this region, considering the age, sex and breed of the animals. The epidemiological study identified 111 animals with skin diseases; from these 20.7% presented demodicosis. Afterwards, serum samples were obtained from another groups of demodicosis, AD, and healthy dogs, and analyzed for Dp and Df-specific IgG, and IgE antibody levels, Dp IgG avidity by ELISA and IgE-binding Dp-specific proteins by immunoblot. IgG and IgE antibodies to Dp were detected in sera from additional groups of dogs with AD, demodicosis or healthy, with higher IgE levels to Dp in AD than demodectic or healthy dogs. IgG to Df was detected, despite with smaller levels compared to Dp in sera from demodectic dogs, and also in healthy dogs. Immunoblot showed IgE-binding to Dp proteins in sera of dogs with demodicosis and AD; with strong reactivity for the 72 and 116 kDa antigens detected by sera from demodicosis dogs. However, sera from healthy dogs >12 months old also presented reactivity to these bands. In conclusion, the detection of Dp-IgG and IgE antibodies in sera from demodectic dogs indicates previous exposure and sensitization to the house dust mite, respectively, more than cross-reactivity between demodex mites and Dp antigens detected by canine antibodies. Additionally, higher Dp-specific IgE levels were found in dogs with AD compared with those with demodicosis or healthy, suggesting that Dp-specific IgE could better discriminate dogs with AD from healthy ones or even those with demodicosis.

Seropositivity and risk factors of Toxocara canis infection in adult asthmatic patients.

This cross-sectional study involving 86 adult asthmatic patients aimed to determine the relationship between Toxocara seropositivity and severity of asthma in adult asthmatics and investigate the risk factors for Toxocara infection. In all cases, T. canis IgG level was measured using an anti-Toxocara IgG enzyme-linked immunosorbent assay kit. Total serum IgE and eosinophil count were also determined. The anti-Toxocara IgG seropositivity was 68.6% among asthmatic patients. There were no statistically significant associations between Toxocara seroprevalence and other risk factors, clinical symptoms of asthma and high level of total serum IgE and eosinophilia. Pet ownership could be an important risk factor for Toxocariasis. Having a pet at home and wheezing were significantly associated with Toxocara seropositivity in adult asthmatic patients.

Complement C3 and allergic asthma: a cohort study of the general population.

Complement C3 plays a role in asthma development and severity. We tested the hypothesis that high plasma complement C3 concentration is associated with high risks of asthma hospitalisation and exacerbation.We prospectively assessed the risk of asthma hospitalisation in 101 029 individuals from the Copenhagen General Population Study with baseline measurements of plasma complement C3, and genotyped for rs1065489, rs429608 and rs448260 determining levels of complement C3. Risk of asthma exacerbation was further assessed in 2248 individuals with allergic asthma.The multivariable adjusted hazard ratio of asthma hospitalisation was 1.23 (95% CI 1.04-1.45) for individuals in the highest tertile (>1.19 g·L-1) of plasma complement C3 compared with those in the lowest tertile (<1.03 g·L-1). The C3 rs448260 genotype was associated with risk of asthma hospitalisation with an observed hazard ratio of 1.17 (95% CI 1.06-1.28) for the CC genotype compared with the AA genotype. High plasma complement C3 was associated with high levels of blood eosinophils and IgE (p for trends ≤6×10-9), but only the SKIV2L rs429608 genotype was positively associated with blood eosinophil count (p=3×10-4) and IgE level (p=3×10-4). In allergic asthma, the multivariable adjusted incidence rate ratio for risk of exacerbation was 1.69 (95% CI 1.06-2.72) for individuals in the highest plasma complement C3 tertile (>1.24 g·L-1) versus the lowest (<1.06 g·L-1).In conclusion, a high concentration of plasma complement C3 was associated with a high risk of asthma hospitalisation in the general population and with a high risk of asthma exacerbation in individuals with allergic asthma. Our findings support a causal role of the complement system in asthma severity.

Increased Malignancy Rate in Children With IgE Deficiency: A Single-center Experience.

Immunoglobulin (Ig) E-deficient adults (IgE<2.5 kU/L) have increased susceptibility for developing malignancy. We evaluated the association between IgE deficiency and cancer diagnosis in children (age younger than 18 y), compared with those non-IgE-deficient (IgE≥2.5 kU/L). Information about malignancy diagnosis were compared between 4 cohorts of children who had IgE levels measured at our institution: IgE-deficient (IgE<2.5 kU/L), normal IgE (2.5<IgE≥100 kU/L), high IgE (100≥IgE<1000 kU/L), very high IgE (IgE≥1000 kU/L). Overall, 94/4586 (2%) children had IgE deficiency. A significantly higher malignancy rate was found in IgE-deficient children (3/94, 3.2%) compared with non-IgE-deficient cohort (13/4492, 0.3%, P<0.0001). Analysis of the groups with different IgE levels revealed a significantly higher rate of cancer in IgE-deficient children (3.2%) compared with those with normal (0.5%; odds ratio [OR]=7.84; 95% confidence interval [CI]: 1.94-31.61, P=0.004), high (0.2%; OR=25.80; 95% CI: 4.94-134.54, P=0.002), and very high IgE levels (0.2%; OR=42.17; 95% CI: 3.84-463.02, P<0.0001). All 3 IgE-deficient children had lymphoma. Malignancies in the other groups included lymphoma, leukemia, brain, liver, ovarian cancers. Malignancy rate was higher in IgE-deficient children compared with those with normal, high, or very high IgE levels, supporting the hypothesis that IgE deficiency may be a marker for malignancy susceptibility in children. Larger, prospective studies are necessary to further evaluate this association.

Management of autoimmune pancreatitis

The article contains modern data on such a chronic pancreatic disease as autoimmune pancreatitis (AIP). Statistical data on the prevalence and incidence of AIP are presented, the current international classification of this pathology is considered, the main features of type 1 AIP (lymphoplasmacytic sclerosing pancreatitis, LPSP) and type 2 AIP (idiopathic duct centric pancreatitis, IDCP) are put forward. The clinical manifestation of these types is different: obstructive jaundice develops more often in patients with LPSP, while patients with IDCP mostly have acute pancreatitis. The presence and variety of extrapancreatic manifestations of the disease with extremely frequent concomitant development of ulcerative colitis is emphasized. The features of serological diagnosis of AIP and the role of IgG4 level in determining the type of disease are considered. The proper techniques of AIP instrumental diagnostics are listed, the typical changes detected during computed tomography and the distinctive histological characteristics of LPSP and IDCP are considered. The feasibility of a differential diagnosis between AIP and pancreatic cancer is indicated by analyzing the results of serological, imaging, and histological studies. The algorithm of management of AIP patients depending on the type of disease is described, as well as the tactics of prescribing corticosteroids, immunomodulators upon LPSP and IDCP. Immunomodulators of choice (mycophenolate mofetil, azathioprine) are indicated, and rituximab administration features are considered. Possible signs of AI recurrence are listed (IgG4-sclerosing cholangitis, high IgE level).

The intestinal milieu influences the immunoproteome of male and female Heligmosomoides polygyrus bakeri L4 stage.

The gastrointestinal nematode Heligmosomoides polygyrus bakeri shows enhanced survival in mice with colitis. As the antibody response plays an important role in antiparasitic immunity, antibodies against male and female L4 H. polygyrus were examined in mice with and without colitis. Levels of specific antibodies in the mucosa and serum were determined by enzyme-linked immunosorbent assay and immunogenic proteins of male and female parasites were identified using 2D electrophoresis and mass spectrometry. The function of identified proteins was explored with Blast2Go. Nematodes in mice with colitis induced higher levels of specific immunoglobulin G (IgG1) and IgA, a lower level of IgE in the small intestine and a higher level of IgE in serum against female L4. Infected mice with colitis recognized 12 proteins in male L4 and 10 in female L4. Most of the recognized proteins from male L4 were intermediate filament proteins, whereas the proteins from female L4 were primarily actins and galectins. Nematodes from mice with colitis were immunogenically different from nematodes from control mice. This phenomenon gives new insights into helminth therapy as well as host-parasite interactions.

Serum IgE against galactose-alpha-1,3-galactose is common in Laotian patients with snakebite envenoming but not the major trigger for early anaphylactic reactions to antivenom.

Snake antivenom is the only specific treatment for snakebite envenoming, but life-threatening anaphylaxis is a severe side effect and drawback for the use of these typically mammalian serum products. The present study investigates the hypotheses whether serum IgE antibodies against the epitope galactose-alpha-1,3-galactose (α-gal) located on the heavy chain of non-primate mammalian antibodies are a possible cause for hypersensitivity reactions to snake antivenom. Serum samples from 55 patients with snakebite envenoming were obtained before administration of snake antivenom and tested for serum IgE (sIgE) against α-gal and total IgE. Early anaphylactic reactions (EARs) during the first 3 h after antivenom administration were classified into mild, moderate or severe and correlated with the presence of sIgE against α-gal. Fifteen (27%) out of 55 patients (37 male, 18 female, median 34 years, range 9–90 years) developed EARs after antivenom administration. Eleven, three and one patients had mild, moderate and severe EARs, respectively. Serum IgE against α-gal was detected in 17 patients (31%); in five (33%) out of 15 patients with EARs and in 12 (30%) out of 40 patients without EAR (Odds Ratio = 1.2; 95%-confidence interval: 0.3–4.2) with no correlation to severity. Although the prevalence of serum IgE against α-gal was high in the study population, very high levels of total IgE in the majority of patients question their clinical relevance and rather indicate unspecific sIgE binding instead of allergy. Lack of correlation between α-gal sIgE and EARs together with significantly increased total IgE levels suggest that sIgE against α-gal is not the major trigger for hypersensitivity reactions against snake antivenom.

Identification of Specific IgE Antibodies and Asthma Control Interaction and Association Using Cluster Analysis in a Bulgarian Asthmatic Children Cohort.

(1) Background: Asthma is a complex heterogeneous disease that likely comprises several distinct disease phenotypes, where the clustering approach has been used to classify the heterogeneous asthma population into distinct phenotypes; (2) Methods: For a period of 1 year, we evaluated medical history data of 71 children with asthma aged 3 to 17 years, performing pulmonary function tests, drew blood for IgE antibodies against inhalation and food allergies detection, and Asthma Control Questionnaire (ACQ); (3) Results: Five distinct phenotypes were determined. Cluster 1 (n = 10): (non-atopic) the lowest IgE level, very low ACQ, and median age of diagnosis. Cluster 2 (n = 28): (mixed) the highest Body mass index (BMI) with the latest age of diagnosis and high ACQ and bronchodilator response (BDR) levels and median and IgE levels. Cluster 3 (n = 19) (atopic) early diagnosis, highest BDR, highest ACQ score, highest total, and high specific IgE levels among the clusters. Cluster 4 (n = 9): (atopic) the highest specific IgE result, relatively high BMI, and IgE with median ACQ score among clusters. Cluster 5 (n = 5): (non-atopic) the earliest age for diagnosis, with the lowest BMI, the lowest ACQ score, and specific IgE levels, with high BDR and the median level of IgE among clusters; (4) Conclusions: We identified asthma phenotypes in Bulgarian children according to IgE levels, ACQ score, BDR, and age of diagnosis.

Understanding the significance of cytokines and chemokines in the pathogenesis of alopecia areata.

Alopecia areata has basically been understood as a type 1 inflammatory disease. Activated NKG2D+ CD8+ cells produce the Th1 cytokine interferon-γ, which leads to the disruption of immune tolerance of hair follicles and the exposure of self-antigens. This results in dense inflammatory cell infiltration and apoptosis around hair follicles, inducing hair loss. A well-known complication of alopecia areata is atopic dermatitis, a typical type 2 inflammatory disease. Hair scientists have shied away from confronting and understanding how alopecia areata, a type 1 inflammatory disease, and atopic dermatitis, a type 2 inflammatory disease, can occur together. This review summarizes the research on the cytokine balance in alopecia areata and then focuses on the classification of the cytokine balance in alopecia areata, including the classification of atopic dermatitis into extrinsic and intrinsic types. Dupilumab reportedly showed dual efficacy in a patient with concomitant atopic dermatitis and alopecia areata, supporting our own experience. Elevated Th2 cytokine levels have also been reported in patients with alopecia areata, with increased serum IL-4, IL-5, IL-6 levels, high IgE levels and elevated eosinophil levels. Because local immunotherapy is a treatment that induces Th2-type inflammation, it may worsen the condition of alopecia areata patients with extrinsic atopic dermatitis. It is desirable to select appropriate treatments with consideration of the cytokine balance.

A Study on Serum Immunoglooubin E levels as a marker in childhood asthma

Background: Asthma is a chronic inflammatory of the lungs which causes bronchial hyperresponsiveness and reversible airway obstruction. The disease predominantly affects the children. Bronchial asthma is manifested in response to external trigger of allergens. The most important risk factor is atopy, which produces high amount of IgE, the aim of this study is to evaluate serum IgE levels as a marker for the disease activity and study the correlation with the severity of bronchial asthma. Methods: A prospective study was conducted in peadiatrics department of the tertiary care hospital from March 2019 to February 2019. Children between 6-12yrs admitted with clinical features of asthma as per GINA guidelines was included in the study. IgE levels were taken at the time of the initial presentation. Results: The study showed that all the participants 100% who presented with clinical features suggestive of asthma had high IgE levels irrespective of age, sex and severity of asthma. The mean IgE levels in females were more than males. As the severity of asthma increased the mean IgE levels also increased. Conclusion: The study conclude that the IgE levels are independent of age and sex. IgE levels are directly proportional to severity of asthma.