High IgE Research Articles

Low-dose peanut challenges can facilitate infant peanut introduction regardless of skin prick test size

The Learning Early About Peanut Allergy (LEAP) trial and other studies recommend early peanut introduction to prevent peanut allergy in at-risk infants. 1 Du Toit G. Roberts G. Sayre P.H. et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015; 372: 803-813 Crossref PubMed Scopus (1239) Google Scholar ,2 Perkin M.R. Logan K. Tseng A. et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016; 374: 1733-1743 Crossref PubMed Scopus (497) Google Scholar In addition, peanut oral immunotherapy (OIT) shows increased rates of sustained unresponsiveness in children younger than 5 years with known peanut allergy, 3 Vickery B.P. Berglund J.P. Burk C.M. et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. J Allergy Clin Immunol. 2017; 139: 173-181.e8 Abstract Full Text Full Text PDF PubMed Scopus (219) Google Scholar suggesting better outcomes with early exposure. The LEAP trial excluded infants with skin prick tests (SPTs) greater than 4 mm. 1 Du Toit G. Roberts G. Sayre P.H. et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015; 372: 803-813 Crossref PubMed Scopus (1239) Google Scholar The guidelines recommend peanut introduction or oral food challenge (OFC) only in infants who have SPTs less than or equal to 7 mm and do not specifically address management of infants with SPTs greater than 7 mm (or high peanut IgE levels). 4 Togias A. Cooper S.F. Acebal M.L. et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017; 139: 29-44 Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar Data suggest that patients with peanut SPT greater than 7 mm are likely to react, 4 Togias A. Cooper S.F. Acebal M.L. et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017; 139: 29-44 Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar ,5 Roberts G. Lack G. Diagnosing peanut allergy with skin prick and specific IgE testing. J Allergy Clin Immunol. 2005; 115: 1291-1296 Abstract Full Text Full Text PDF PubMed Scopus (227) Google Scholar but most reference values for SPT and peanut IgE levels are not standardized for infants. 5 Roberts G. Lack G. Diagnosing peanut allergy with skin prick and specific IgE testing. J Allergy Clin Immunol. 2005; 115: 1291-1296 Abstract Full Text Full Text PDF PubMed Scopus (227) Google Scholar ,6 Hill D.J. Heine R.G. Hosking C.S. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol. 2004; 15: 435-441 Crossref PubMed Scopus (201) Google Scholar It is unknown whether infants with SPT greater than 7 mm may tolerate and benefit from early peanut exposure. Given the potential long-term benefits of tolerating peanut, we sought to offer peanut OFCs to a wider population of sensitized infants.

The Effects of Smoking on IgE, Oxidative Stress and Haemoglobin Concentration.

Background:Smoking is a well-known related factor for many health problems in a human being through different ways of exposure. Objectives:Thie aim of the study was to examine the effects of different types of cigarette smoking on hemoglobin level, high sensitive C-Reactive Protein (hsCRP), Malondialdehyde (MDA), and IgE levels in healthy adult subjects. Methods:One hundred seventy-one healthy adult females and males were included in this study. They divided into four groups: cigarette, shisha, passive smokers, and non-smokers groups. Serum samples from all groups analyzed for hemoglobin, hsCRP, IgE, and malondialdehyde level. Results:The mean MDA, IgE, and hemoglobin levels significantly increased in both smokers (cigarette and Shisha groups) and passive smokers than in non-smokers group (p<0.05). The hsCRP levels were significantly increased (p<0.05) in cigarette and Shisha smokers compared to non-smokers. At the same time, there was a non-significant relationship between passive smoker in comparison to non-smokers (p>0.05). Conclusion:This study concluded that smoking, including cigarette and shisha, even passive smoking harmed health through increasing Malondialdehyde, serum IgE and hs-CRP levels in the body.

Effect of brimonidine tartrate on basophil activation in glaucoma patients.

To evaluate the mechanism of which brimonidine tartrate 0.15% causes clinical hypersensitivity. A prospective case-control study comparing 8 glaucoma patients with clinical hypersensitivity to brimonidine to a control group consisting 13 healthy volunteers. Blood samples were stimulated with brimonidine 0.15%, timolol 0.5% or brimonidine tartrate/timolol maleate 0.2%/0.5%. Premixed antibodies (CD63/FITC and aIgE/PE) were added for direct staining and whole-blood samples were lysed, fixed and analyzed by a flow cytometer. The basophil population was defined by high IgE cell expression. Degranulation was identified by the expression of the activation molecule CD63. Basophil activation was not significant when comparing percent of activated basophils of patients and healthy controls after exposure to brimonidine (2.58%, 2.45%, respectively, P=0.72). There was a significant suppression of basophil activation when a combination of brimonidine-timolol (0.87%) was compared to timolol (2.27%; P=0.012) and to brimonidine alone (2.58%; P=0.017). The results of our study do not support the hypothesis that brimonidine induces an immediate allergic reaction. Basophil activation was suppressed by the presence of β-blockers in patients hypersensitive to brimonidine and in healthy individuals. This finding indicates that timolol suppress brimonidine drug reaction by a different mechanism.

Cell-bound IgE and plasma IgE as a combined clinical diagnostic indicator for allergic patients

Allergic responses are mainly caused by IgE, which is often located on the cell surface. The current diagnostic method detects both allergen-specific IgE and total IgE levels, but a number of allergic patients have a normal serum IgE level, which is a poor clinical correlate for allergy. Here, we developed a simple method to detect the level of cell-bound IgE by dissociating it from blood cells with lactic acid. Dissociated cell-bound IgE and plasma IgE levels were detected using the same ELISA kit at the same time. We established two clinical cohorts: an allergic patient group and a healthy participant group. In general, cell-bound IgE correlated well with plasma IgE; however, some patients exhibited high cell-bound IgE levels but low plasma IgE levels. We recommended 350 ng/mL peripheral blood total IgE (cell-bound IgE + plasma IgE) as the cut-off value for allergy diagnosis. Using this indicator, 90.32% of our allergic patients were correctly diagnosed. The peripheral blood total IgE level is a promising clinical diagnostic indicator in allergic patients and will provide more guidance for allergy diagnosis and therapeutic evaluation.

Clinical relevance of eosinophils, basophils, serum total IgE level, allergen-specific IgE, and clinical features in atopic dermatitis.

BackgroundAtopic dermatitis (AD) is an inflammatory disease with diverse clinical features. Although AD is diagnosed mainly by clinical features, the laboratory abnormalities can be found in most patients and may be of diagnostic value. However, few studies have been performed on the clinical significance of laboratory abnormalities in adult and adolescent AD.MethodsAdult and adolescent patients with AD were included in this study. The questionnaire and dermatological examination were completed by investigators. Laboratory tests included complete blood count, serum total IgE, and allergen‐specific IgE.ResultsA total of 473 patients were recruited and 396 of them were diagnosed as AD. Increased serum total IgE level, peripheral eosinophils, and basophils were seen more frequently in AD patients than in non‐AD patients (P < .05). Positive aeroallergens were seen more in AD patients than in non‐AD patients (P < .05). Both total serum IgE level (R = .286, P < .001) and peripheral eosinophils (R = .444, P < .001) significantly correlated with EASI score. Serum total IgE level and extrinsic type AD decreased with age. Patients with elevated serum total IgE are more likely to have a personal history of atopic diseases (P = .014). AD‐associated symptoms (such as flexural dermatitis, white dermographism, and anterior neck folds) are more frequently observed in AD patients with high serum IgE or eosinophilia (P < .05).ConclusionThe serum total IgE level, allergen‐specific IgE, peripheral eosinophils, and basophils are important for the diagnosis of AD. And they are associated with the severity, age groups, and clinical manifestations.

Differences in the Clinical Characteristics of Early- and Late-Onset Asthma in Elderly Patients.

Differences between early-onset and late-onset asthma in elderly subjects have not been comprehensively described in China. We conducted a cross-sectional study to determine the phenotypic differences between early-onset asthma (EOA) and late-onset asthma (LOA) in elderly patients. We collected clinical and physiological data from 176 elderly patients with asthma. Participants were divided into two groups: EOA group and LOA group. Demographics, comorbidities, inflammatory parameters, lung function, severity, asthma control, and medication use among EOA and LOA elderly patients were compared. Elderly subjects with EOA had more atopic disease, a stronger positive family history of asthma, higher IgE, and exhaled nitric oxide levels as compared to those with LOA. In contrast, elderly subjects with LOA had lower lung function and more marked fixed airflow obstruction (FAO). Elderly subjects with LOA had a higher incidence of chronic obstructive pulmonary disease (COPD). No differences were observed in age, gender, BMI, history of smoking, severity, and asthma control between the two groups. Both similarities and differences exist between elderly subjects with EOA and those with LOA in China. Further work is required to determine the pathophysiological, clinical, and therapeutic implications for different asthma phenotypes in elderly subjects.

Allergic children with extremely high total IgE but no allergen identified in the initial screening panel.

High serum IgE level in atopic children usually implies a highly sensitized condition. However, there is a subgroup of atopic children for whom a specific allergen cannot be identified. In this study, we analyzed follow-up data from these children. From March 2014 to July 2017, we recruited 14 atopic children with serum total IgE level higher than 500 Ku/L, but with no specific allergen identified by repeated MAST tests initially. Follow-up studies of specific IgE were conducted by the OPTIGEN MAST Allergy test and ImmunoCAP assays (Thermo Fisher Scientific/Phadia), while total IgE and specific IgG were measured by ImmunoCAP. The patients were aged from 2 to 17y/o. The follow-up MAST tests showed significantly positive results in 10 patients. There were no significant differences in any of the clinical characteristics between the MAST-positive and MAST-negative groups. In the MAST-negative group, five allergen-specific IgE antibodies, including those for cockroach, Euroglyphus maynei, Blomia tropicalis, shrimp, and crab, were strongly predictive of negative ImmunoCAP results, according to ROC (Receiver operating characteristic curve) analysis of the AUC (Area under the Curve of ROC) (0.70-0.95), with significance set at p<0.05. In two thirds of atopic children with a high serum IgE whose specific allergen had yet to be identified, it was possible to identify the specific MAST allergen(s) after an average follow-up of 33.2 months. For patients who still had negative results in follow-up MAST, mite DP, DF, and DM may be suitable choices for further allergen identification by ImmunoCAP.

Association of Nasal Polyposis with Bronchial Asthma

Objective: To find out association between Nasal polyposis and bronchial asthma. Methods: This was a cross sectional study which was carried out in the departments of Otolaryngology and Head-Neck surgery of Bangabondhu Sheikh Mujib Medical University and Dhaka Medical College Hospital during the period of February 2014 to July 2014. A Total 230 patients were selected according to selection criteria among which 30 subjects had nasal polyposis (designated as group A or cases) and 200 subjects had no nasal polyposis (designated as group B or control group). Results: In group (A), asthma was found in 30.0% cases. On the other hand, asthma was found in 2.5% of control group (B). The association of nasal polyposis with bronchial asthma was highly significant (p&lt;.05). In both group 40.0% patients were within the 38-47 year’s age group. In case group, 80.0% patients had any sorts of allergic history on the other hand, only 15.0% patients had allergic history in control group. High eosinophil count was found 66.7% patients suffering from nasal polyposis with bronchial asthma and in comparison to patients suffering from nasal polyposis without bronchial asthma had high eosinophil count 42.85%. In group A High IgE level was found 66.7% patients suffering from nasal polyposis with bronchial asthma, on the other hand, 42.85% had IgE level among patients suffering from nasal polyposis without bronchial asthma. Conclusion: Patients with nasal polyposis and asthma are significantly associated. Both serum IgE and total circulating eosinophil count are significant associated with nasal polyposis and bronchial asthma. Bangladesh J Otorhinolaryngol; April 2017; 23(1): 11-18

Using Precisely Defined in vivo Microbiotas to Understand Microbial Regulation of IgE.

Early life exposure to microbes plays an important role in immune system development. Germ-free mice, or mice colonized with a low-diversity microbiota, exhibit high serum IgE levels. An increase in microbial richness, providing it occurs in a critical developmental window early in life, leads to inhibition of this hygiene-induced IgE. However, whether this inhibition is dependent solely on certain microbial species, or is an additive effect of microbial richness, remains to be determined. Here we report that mice colonized with a combination of bacterial species with specific characteristics is required to inhibit IgE levels. These defined characteristics include the presence in early life, acetate production and immunogenicity reflected by induction of IgA. Suppression of IgE did not correlate with production of the short chain fatty acids propionate and butyrate, or induction of peripherally induced Tregs in mucosal tissues. Thus, inhibition of IgE induction can be mediated by specific microbes and their associated metabolic pathways and immunogenic properties.

The diagnostic utility of Serum IgE and Absolute eosinophil count in cases of Allergic Rhinitis

Introduction: Allergic rhinitis is the commonest allergic disease in India. Eosinophils have been long associated with allergies. Serum IgE levels are also used as a parameter to support the diagnosis of the same. Both absolute eosinophil count (AEC) and serum IgE are a part of basic investigation panel for allergies and are known to be positively related with it. Thus, this study was taken up to determine the diagnostic utility of Serum IgE and absolute eosinophil count in cases of Allergic rhinitis. Methodology: This was a two-year prospective study conducted on 105 cases, clinically diagnosed as allergic rhinitis. Absolute eosinophil count and total serum IgE were recorded for all the cases. Diagnostic utility of each parameter was determined using appropriate statistical tests. Results were tabulated and assessed. Results: Among 105cases, 44.8% were females and 55.2% were males, with mean age of 29.8years. Peripheral blood eosinophils &gt;6% were seen in 42% cases. Of the total cases, Absolute eosinophil count was increased&gt;450cells/cu mm in 49 (46.6%) cases and Serum IgE was elevated &gt;120IU/ml in 73(69.5%) cases. Both AEC and Serum IgE together were raised only in 39(37.1%) cases. Conclusion: Thirty-nine (37.1%) cases showed simultaneous increase in AEC and Serum IgE. The outcomes of both tests when considered together did not significantly affect the diagnosis of Allergic rhinitis. However, individually, 49 (46.6%) cases had a high absolute eosinophil count and Serum IgE was raised in 73(69.5%) cases. Although not significant, testing for Serum IgE levels were found to be more accurate with a better diagnostic utility.

Effect of Enterobius vermicularis parasite on IgE antibody levels among children in Al- Diwaniyah City, middle Iraq.

The aim of this study was to detect the concentration of IgE antibody in children infected with Enterobius vermicularis and healthy children as a control group by using Enzyme linked immunosorbent assay (ELISA) technique. The results indicated that there was an increase in the concentration of IgE antibody levels in people with E. vermicularis parasite with an average of (227.08 IU) compared to the control group, and the study of elevation ratios for age, where the results showed that the lowest increase in IgE antibody was recorded in the age group 1-3 years. The highest increase was recorded in the age group between 7-9 years with an average of (306.84 IU). The results of the statistical analysis showed very significant differences indicating a higher level of IgE among people with E. vermicularis parasite compared to the control group at a probability level of 0.05. The results of the statistical analysis through the use of the F-test showed no significant differences between the high antibody IgE in children with E. vermicularis parasite depending on age groups.

Use of mepolizumab in adult patients with cystic fibrosis and an eosinophilic phenotype: case series

BackgroundCystic fibrosis (CF) is characterized by inflammation, progressive lung disease, and respiratory failure. Although the relationship is not well understood, patients with CF are thought to have a higher prevalence of asthma than the general population. CF Foundation (CFF) annual registry data in 2017 reported a prevalence of asthma in CF of 32%. It is difficult to differentiate asthma from CF given similarities in symptoms and reversible obstructive lung function in both diseases. However, a specific asthma phenotype (type 2 inflammatory signature), is often identified in CF patients and this would suggest potential responsiveness to biologics targeting this asthma phenotype. A type 2 inflammatory condition is defined by the presence of an interleukin (IL)-4high, IL-5high, IL-13high state and is suggested by the presence of an elevated total IgE, specific IgE sensitization, or an elevated absolute eosinophil count (AEC). In this manuscript we report the effects of using mepolizumab in patients with CF and type 2 inflammation.ResultsWe present three patients with CF (63, 34 and 24 year of age) and personal history of asthma, who displayed significant eosinophilic inflammation and high total serum IgE concentrations (type 2 inflammation) who were treated with mepolizumab. All three patients were colonized with multiple organisms including Pseudomonas aeruginosa and Aspergillus fumigatus and tested positive for specific IgE to multiple allergens. We examined the effect of mepolizumab on patients’ lung function (FEV1), blood markers of type 2 inflammation, systemic corticosteroid use and frequency of CF exacerbations. One patient had a substantial increase in lung function after starting mepolizumab and all three patients had a substantial benefit in regards to reduced oral CCS use. While none of the patients showed significant changes in the exacerbation rates there was markedly reduced requirements for oral CCS with exacerbations. In addition, mepolizumab had a positive effect on type 2 inflammatory markers, reducing markers of allergic inflammation in all 3 patients.ConclusionsMepolizumab appears to have a positive effect on clinical course in patients with CF presenting with a type 2 phenotype characterized by allergic sensitization and hyper-eosinophilia.

Deficiency of immunoglobulin E protects mice from experimental abdominal aortic aneurysms.

Allergic asthma with high plasma IgE levels is a significant risk factor of human abdominal aortic aneurysm (AAA). This study tests a direct role of IgE in angiotensin-II (Ang-II) perfusion- and peri-aortic CaCl2 injury-induced AAA in mice. In both models, IgE-deficiency in Apoe-/- Ige-/- mice blunts AAA growth and reduces lesion accumulation of macrophages, CD4+ and CD8+ T cells, and lesion MHC class-II expression, CD31+ microvessel growth, and media smooth muscle cell loss, compared with those from Apoe-/- control mice. Real time-PCR reveals significant reductions in expression of neutrophil chemoattractants MIP-2α and CXCL5 in AAA lesions or macrophages from Apoe-/- Ige-/- mice, along with reduced lesion Ly6G+ neutrophil accumulation. Consistent with reduced lesion inflammatory cell accumulation, we find significant reductions of plasma and AAA lesion IL6 expression in Apoe-/- Ige-/- mice. Immunofluorescent staining and FACS analysis show that AAA lesion neutrophils express FcεR1. Mechanistic study demonstrates that IgE induces neutrophil FcεR1 expression, activates MAPK signaling, and promotes IL6 production. This study supports a direct role of IgE in AAA by promoting lesion chemokine expression, inflammatory cell accumulation, MAPK signaling, and cytokine expression. IgE inhibition may represent a novel therapeutic approach in AAA management.

The antioxidant and antidiabetic activity of the Arabian balsam tree “Commiphora gileadensis” in hyperlipidaemic male rats

The leaf and twig aqueous extracts of Arabian balsam tree (Commiphora gileadensis) were tested to protect against alloxan-induced hyperglycaemia in hypercholesterolemic male rats. The antioxidants, high density lipoproteins, IgE and α-Amylase were decreased, whereas kidney function indices, liver function enzymes, triglycerides, cholesterol, low density lipoproteins and all immunoglobulins except IgE were increased as a result of alloxan administration. Moreover, the renal, hepatic and pancreatic tissue showed a drastic pathological damage. In G3 and G4, treating the diabetic rats with C. gileadensis leaf and twig extracts, respectively greatly ameliorated all biochemical parameters and the injured tissues and restored them nearly to the normal. In G4, the aqueous extract of C. gileadensis twig was more efficient in treating the diabetic rats than the leaf aqueous extract in G3. Both C. gileadensis leaf and twig aqueous extracts succeeded in adjusting the glucose levels of diabetic rats under hypercholesterolemic condition due to their antioxidant activity.

Allergic sensitization in nasobronchial allergy patients and its correlation with total immunoglobulin E level

INTRODUCTION: Bronchial asthma (BA) and allergic rhinitis (AR) are immunoglobulin (Ig) E-mediated hypersensitivity phenomena. The objective of the study is to assess the association between total serum IgE level and skin prick test (SPT) in Indian patients who presented with different nasobronchial allergy symptoms. MATERIALS AND METHODS: This was an observational prospective study conducted in the Allergy and Asthma Clinic, Motihari, Bihar. A total of 183 patients diagnosed as BA and AR undergo SPT against different allergens between January 2017 and July 2018. Serum total IgE was measured in all patients. All statistical analyses were performed using statistical software SPSS version 20 (SPSS Inc., Chicago, IL, USA). P RESULTS: The study patients included 95 males and 88 females (total 183) with a mean age of 27.15 ± 12.64 years. SPT was positive in 99 out of 183 (54.09%) study patients. BA and AR were associated with skin sensitization in 30.60% and 15.30% of patients, respectively, while 54.09% of patients were associated with both AR and asthma. Forty-four out of 99 (44.44%) patients were sensitized to single allergen, while 40.40% and 15.15% of patients were sensitized to 2–5 allergens and >5 allergens, respectively. Except 11 patients, all the study patients had high total IgE level (>150 IU/ml). More than half of the study patients (51.36%) were associated with more than 1000 serum total IgE level. Total IgE level was not affected with the number of allergen sensitization. SPT-positive patients had higher IgE value than SPT-negative patients but statistically not significant (P > 0.05), and there was also poor correlation between SPT result and serum total IgE level (r = 0.102). CONCLUSION: SPT should be performed in all clinical allergic patients irrespective of serum total IgE level.

Steroid-sparing effect of omalizumab in stage IV (corticosteroid dependent) allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) consists of five stages ranging from the acute stage (pulmonary infiltrate, eosinophilia, and increased total Immunoglobulin-E [IgE]) to pulmonary fibrosis. Our patients were diagnosed as Stage IV (corticosteroid dependent) ABPA, in which treatment with systemic corticosteroids cannot be discontinued as symptoms worsen after discontinuation of oral corticosteroids. Omalizumab is a humanized recombinant, monoclonal antibody that selectively binds to IgE to inhibit the immune response to an allergen. It forms immune complexes which not only lower the level of free IgE antibody, but also serve as an allergen buffer, even in cases of markedly high serum IgE >1000 IU/ml in ABPA. In this article, we report three cases of (Stage IV) corticosteroid-dependent ABPA with poor clinical response even after effective treatment with antifungal therapy and courses of corticosteroids (>3 exacerbations/year). After the start of injection omalizumab, the three patients have experienced significant and sustained clinical improvement and improved quality of life with low-dose prednisolone 5 mg every alternate day. The dose of systemic corticosteroids was reduced by 50% in the 1st year and by 70% in the 2nd year although lung function failed to improve.

A Pediatric Patient with Prolonged Retention of Deciduous Teeth Caused by High IgE Syndrome: A Case Report

A Pediatric Patient with Prolonged Retention of Deciduous Teeth Caused by High IgE Syndrome: A Case Report

Allergic Fungal rhino-sinusitis frequency in chronic rhino-sinusitis patients and accuracy of fungal culture in its diagnosis.

Objective:To determine the frequency of Allergic Fungal Rhino-sinusitis (AFRS) in Chronic Rhino-sinusitis (CRS) patients and the accuracy of fungal culture in diagnosing AFRS.Methods:Immunocompetent patients with CRS and without invasive fungal rhino-sinusitis presenting over a period of 3 years in ENT department of Mayo Hospital, from April 2014 to September 2017 were included in the study. AFRS was diagnosed clinically and on Bent and Kuhn diagnostic criteria. All patients underwent endoscopic sinus surgery. Removed tissue histopathology and fungal culture was done. Diagnostic accuracy of fungal culture in AFRS patients was determined.Results:Out of 216 patients of CRS, 45 (20.8%) had AFRS. Mean age of patients diagnosed with AFRS was 29.49±9.16. Out of 45 patients, 26 were male and 19 were female. Nasal polyps were present in 45 (100%) patients, fungal stain was positive in 39(86.7%). CT scan showed sinus expansion in 28(62.2%) patients, heterogeneous opacity in 45(100%) patients and bone destruction in 13(28.9%). Presence of Allergic Mucin was seen in 45(100%) patients, high IgE levels in 36(80.0%), eosinophilia in 21(46.7%), presence of Charcot Leyden crystals in 27(60.0%). Asymmetrical involvement of sinuses was seen in 30 (66.7%) and co-existent asthma was seen in 18(40.0%). Fungal culture positive patients were 25(55.6%). Diagnostic accuracy of fungal culture was 91.6%.Conclusion:Fungal culture has a key role in confirming diagnosis of AFRS. We also noted that frequency of AFRS is increasing in CRS patients.

Risk factors of zinc deficiency in children with atopic dermatitis.

Background and objectives. Zinc deficiency increases risk of infections, allergies and autoimmunity. We wished to determine risk factors in severe atopic dermatitis (AD) and identify of hypozincemia rate. Materials and methods. Retrospective study done on AD children (≤ 14 years) with serum zinc test. Data included demographic and laboratory tests (serum zinc level, IgE, food-specific IgE), and skin tests. Results. 168 AD children, aged 38.9 months with concomitant allergies in 47 (28%), family history of allergies in 131 (80%), and parental consanguinity in 134 (79.9%). AD was mild in 12 (7.2%, SCORAD 15.8) children, moderate in 41 (24.5%, SCORAD 30.4), and severe in 115 (68.3%, SCORAD 69.4). Hypozincemia was observed in 42 (25%, zinc 8.6 ± 1.1 µmoI/L) children and associated only with severe AD (p = 0.0418) and elevated IgE (p = 0.001). Conclusions. Hypozincemia is rather prevalent in AD, and severe AD and high IgE increase its risk. An adjunct oral zinc may help reducing severe poorly responsive AD.

Defining the biological responses of IL-6 by the study of a novel IL-6 receptor chain immunodeficiency

We describe immunodeficiency arising from ablation of IL6R expression that is characterized by recurrent infections, eczema, high IgE titers, and absent CRP acute-phase response.