High Total IgE Levels Research Articles

From phenotype to biological treatment of severe asthma

Severe asthma is considered a complex and heterogeneous disease, which includes different phenotypes, defined in terms of both clinical and molecular characteristics and different underlining endotypes. According to different studies, there are several clinical phenotypes of severe asthma in children. Most children are allergic to multiple aeroallergen sensitization (house dust mites, pollen, molds) and have high levels of total and specific IgE, reversible airflow obstruc- tion and early signs of remodelation. A small subgroup of children has persistent airflow limitation (FEV1 <80% predicted). There are two major underlining functional or pathophysiologic mechanisms for different phenotypes of asthma and severe asthma accord- ing to the immune mechanism: Type 2 asthma (Th2-high asthma, eosinophils in serum and sputum, high IgE levels, high FeNO; key cytokines IL-4, IL-5, IL-13) and non-Type 2 asthma (Th2-low asthma, neutrophilic, paucigranulocytic and mixed granulocytic inflam- mation; key cytokines IL-8, IL-17, IL-22). The type 2 asthma endotype is more common in children, while biomarkers involved in the pathogenesis, such as IgE and IL-5 have become targets for biological therapy. The non-type 2 asthma endotype, less frequent in children with severe asthma, has fewer therapeutic options. The effect of azithromycin is still under investigation. Severe asthma, although uncommon, is a complex and high-risk phenotype of childhood asthma. Close monitoring of the patient and precise definition of underlying endotype during evaluation enables identification and use of personalized, endotype-targeted treatment.

The prevalence of ultra-low total IgE level among Egyptian population: impact of age, sex, and socioeconomic class

BackgroundImmunoglobulin E (IgE) is the least prevalent antibody type; it plays a key role in host immunity against parasitic infections and allergic diseases. Association between IgE deficiency and higher malignancy rates has been suggested in many studies.ObjectivesThe goal of our study was to determine the prevalence of ultra-low total IgE levels and their variations according to sex and age among the Egyptian population.MethodologyThis multicenter retrospective cross-sectional study included serum total IgE and CBC records of 1099 children and 993 adults recruited from private and public hospitals in Egypt between 2015 and 2021. Total IgE levels were classified into ultra-low, normal, high, and very high.ResultsOf all included subjects, 0.8% had ultra-low IgE levels and 74.4% had normal IgE levels. High and very high serum total IgE levels were 24.1% and 0.7%, respectively. IgE levels were significantly higher among adults than children 45 (16.5–113.25) IU/ml vs. 20 (10–75) IU/ml; p < 0.001and among private hospital’s patients than the public one (40 (15–98.4) IU/ml vs. 25 (10–98.4) IU/ml; p = 0.002. No significant difference between total IgE serum levels regarding gender (p = 0.825). Total IgE levels were higher among young adults, with a gradual decline among older patients and a peak among the 50 s and 60 s patients. Pearson correlation between IgE and absolute eosinophilic count showed positive correlation but did not reach significant level r = 0.04, p = 0.367.ConclusionAge and socioeconomic class have impacts on total IgE levels with a relatively low prevalence of ultra-low IgE among the Egyptian population.

Значення поліморфізму тол-подібного рецептора-2 в розвитку сенсибілізації до кліщів домашнього пилу в дітей із атопічним дерматитом

Atopic dermatitis is a chronic recurrent inflammatory skin disease that affects 5-20% of children. Airborne allergens derived from house dust mites can cause atopic dermatitis. TLR2 play an important role in the recognition of house dust mite allergens. Purpose - to investigate the prevalence of sensitization to house dust mites in children with atopic dermatitis and the role of TLR2 rs4696480 polymorphism in the development of sensitivity to house dust mites. Materials and methods. The study included 100 patients with atopic dermatitis. Genotyping of the polymorphism TLR2 rs4696480 was performed in the patient group using real-time PCR. Measurements of sIgE to dust mites were performed by Western blotting according to the manufacturer’s protocol (Simesta-Medivis, Ukraine-Germany). Results. Sensitization to house dust mites was found in 48% of children. Children with elevated levels of specific IgE to dust mites had a significantly higher SCORAD index than patients without sensitization (p&lt;0.001). In the group of children sensitized to house dust mites, there were significantly higher levels of total IgE (p&lt;0.001) and a longer course of the disease (p&lt;0.05). There was no statistically significant difference in the distribution of genotypes depending on the presence of sensitization to dust mites (OR=1.250 (0.481-3.245) for AA and AT; OR=2.125 (0.715-6.315) for AA and TT). Conclusions. This study showed that the susceptibility to dust mites among children with atopic dermatitis is 48%. The presence of susceptibility to house dust mites affects the severity of the disease. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author. Key words: TLR2, house dust mites, atopic dermatitis, children.

Implication of serum Nitric oxide and IgE in urinary schistosomiasis: The case of Bamendjing, Cameroon

BackgroundUrinary schistosomiasis (US), also known as bilharziasis is a waterborne parasitic infection most common in rural areas of developing countries. The infection is associated with haematuria but little or nothing is known about its association with other urinary parameters, induction of Nitric Oxide (NO) and IgE production around the Bamendjing Dam an area highly suspected of Schistosoma haematobium infections. The study sought to address this problem for possible future interventions and control. Materials and methodsUrine samples were collected from 301 randomly selected participants and analysed for the presence of S. haematobium using the syringe filtration concentration method. Sera from patients infected with S. haematobium and also from some uninfected individuals were analysed for IgE and NO using ELISA and colorimetric methods respectively. FindingsThe results showed a prevalence of 16.9% (51/301). Sixty percent of the 49 patients with nitrite in their urine, were infected with urinary schistosomiasis (US) (30/49; p = 0.00). Meanwhile only 40% of the 15 patients with bilirubinuria were infected with US (6/15; p = 0.0241). The risk of patients with US having leucocytes and nitrites was high (OR of 1.3 and 1.7 respectively). Total IgE serum levels were significantly higher in patients with US (648.872 ± 223.142) compared to uninfected individuals (275.682 ± 181.674) (p = 0.00). Infected persons had heightened mean NO levels (2,583,617.647 ± 1,100,678.786) than non-infected participants (1,689,766.667 ± 1,163,084.729). Urinary Schistosomiasis in association with urinary parameters had a significant impact on mean IgE levels (F = 4.248, p = 0.022). Patients infected with Urinary Schistosomiasis alone had significantly higher mean total IgE levels than non-infected participants (p = 0.004). ConclusionApart from haematuria, this study has demonstrated that Urinary Schistosomiasis is prevalent among inhabitants around the Bamendjing Dam and results in an increase of other urine parameters such as leucocytes and nitrates and high levels of serum NO and total serum IgE in patients. These parameters are important in the screening of patients for treatment and control of urinary schistosomiasis.

The Predictive Value Of Umbilical Cord Blood Total IgE Levels In Allergic Diseases

Allergic diseases in children have increased significantly. In recent years, it affects up to 35% of children. The current study aimed to investigate the value of the umbilical cord blood total IgE levels in the prediction of the development of allergic diseases during 8 years of follow-up. Methods — In cross-sectional study included 500 infants who were born in the obstetrics department at Tishreen and Al-Assad University Hospitals during the period 2007-2015. Questionnaires were administered after the birth included gender, gestational age, birth weight, mode and season of delivery, smoking during pregnancy, and family history of allergic diseases. Umbilical cord blood total IgE levels were measured. The infants were followed up for eight years for subsequent development of allergic disorders. Results — 214 (42.8%) of 500 newborns had high umbilical cord blood total IgE levels. We followed 143 of 214 newborns for 8 years; there was an allergic family history in 51.7% of newborns. During the following period, allergic diseases developed in 76.22% of the children with high umbilical cord blood total IgE levels. Allergic symptoms in children varied between nasal allergy (19.6%), skin allergy (eczema and urticarial) (25.2%), childhood asthma (31.5%). The rate of allergic symptoms development in the presence of two factors (family history and high umbilical cord blood total IgE) was 51.7%. Conclusion — We found a high prevalence of allergic diseases in children with high umbilical cord blood total IgE. The current study could be used as a preventative strategy to reduce the risk of allergic diseases by predictive of subsequent.

Study of Hypersensitivity to Malassezia furfur in Patients with Atopic Dermatitis with Head and Neck Pattern: Is It Useful as a Biomarker and Therapeutic Indicator in These Patients?

Atopic dermatitis (AD) is one of the most prevalent chronic inflammatory diseases. Head and neck (H&N) involvement, also known as the picture-frame pattern, can be a diagnostic and even therapeutic challenge. Sensitization to the fungus Malassezia furfur seems to be implicated in this clinical presentation. To investigate the role of Malassezia furfur in H&N dermatitis, we performed an observational single-centre study. Serum-specific IgE levels for Malassezia furfur were determined in a total of 25 patients with AD (15 receiving dupilumab treatment, 10 not receiving dupilumab), 14 patients with seborrheic dermatitis, and 19 healthy controls. Reactivity to Malassezia furfur, in terms of serum-specific IgE levels (>0.35 Ku.arb./L), was found in 80% of patients with AD. Risk factors to consider include high total IgE levels, sensitization to multiple pneumoallergens, and elevated LDH and CRP levels. Prescription of topical antifungals, oral antifungals, or a combination of both showed good response in 100% of cases in the H&N AD group treated with dupilumab. The most appropriate treatment seems to be the use of oral itraconazole and/or ketoconazole cream. The median treatment time was 3 weeks. Localized dermatitis in H&N significantly affects the patient’s life. We present a study of sensitization to Malassezia furfur in patients with H&N AD. It is important to know the differential diagnosis and to approach the study correctly. Sensitization to Malassezia furfur may be one of the main reasons, especially in patients being treated with dupilumab. The use of antifungals allows for adequate control, avoiding treatment changes and improving the patient’s quality of life.

Эозинофильный гастрит у ребенка. Как заподозрить? Критерии диагностики

Objective of the Review: To analyze current data on eosinophilic lesions of the stomach in children with the analysis of a clinical case. Key points. Diseases of the gastrointestinal tract associated with primary tissue eosinophilia are a heterogeneous group of changes characterized by inflammation, with predominantly eosinophilic tissue infiltration in the absence of other known causes. Clinical manifestations of allergic inflammatory diseases of the gastrointestinal tract are most often nonspecific. Depending on the level of the lesion, eosinophils are distinguished: gastritis (EoG), enteritis, and colitis. In recent years, more and more attention of experts has been directed to research in this area, but so far there are no general epidemiological data on the prevalence of this pathology in the population, both adults and children. Conclusion. Currently, there are no clear morphological criteria for diagnosing eosinophilic lesions of the stomach, small and large intestine in children, and clinical manifestations, especially in young children, are nonspecific. When making a diagnosis of EoG, it is necessary to take into account a family allergic history, a set of laboratory diagnostic data (eosinophilia in a clinical blood test and a high level of total IgE) and a morphological study of a biopsy of the gastric mucosa. Keywords: children, eosinophilic gastritis, eosinophilia, tissue eosinophilia, food allergy.

A2 adenosine receptor contributes to the development of cow's milk protein allergy via regulating regulatory T cells.

Objective(s):A2 adenosine receptor (A2AR) is a novel promising target for the treatment of inflammatory and allergic diseases. However, its role in the development of cow’s milk protein allergy (CMPA) has not been elucidated. The present study was designed to investigate the function of A2AR in CMPA development.Materials and Methods:BALB/c mice were sensitized and challenged with ovalbumin (OVA) to induce allergic responses. The model was assessed by detecting allergic responses and plasma-specific IgE levels. The levels of A2AR were measured by PCR and flow cytometry. The subpopulation of Treg cells was analysed.Results:The mice sensitized and challenged with OVA showed classic allergic symptoms, such as acute allergic skin responses, increased anaphylactic shock symptom scores, and higher levels of total IgE, OVA-specific IgE, IgG1 and IgG2a. OVA-sensitized mice and CMPA patients showed decreased levels of A2AR and Treg cells. Interestingly, we observed a positive correlation between A2AR expression and Treg levels in CMPA patients. Further study showed that the A2AR agonist CGS21680 blocked OVA-induced allergic reactions, and the A2AR antagonist KW-6002 amplified allergic responses. Interestingly, CGS21680 not only activated the A2AR-mediated signalling pathway but also caused an increase in the population of Treg cells. In contrast, KW-6002 therapy decreased the levels of Tregs in allergic mice.Conclusion:A2AR expression is downregulated in CMPA. The A2AR-mediated pathway negatively regulates the development of CMPA, at least in part, by amplifying the differentiation of Tregs.

Primary Immun Deficiency in Patients with Non-Cystic Fibrosis Bronchiectasis and Its Relationship with Clinical Parameters.

Bronchiectasis is characterized by chronic respiratory infection. The role of immunodeficiency in this disease is poorly studied in relation to clinical indices. The primary aim of this study was to determine the frequency of these neglected altered immune status by evaluating immunoglobulins, lymphocyte subsets, complement levels, and neutrophil function, and to assess its relationship with clinical parameters in adult patients with non-cystic fibrosis bronchiectasis (NCFB). A total of 74 (30 men and 44 women with a mean age of 47±17 years) adult patients with stable NCFB were enrolled in this study. The bronchiectasis severity index (BSI) and FACED (F:FEV1, A: Age, C: Chronic colonization, E: Extension, D: Dyspnea) scores were assessed. Peripheral blood samples were collected for the detection of total IgG, IgA, IgM, IgE, and IgG subclasses and C3 and C4 levels. The counts of CD3, CD4, CD8, CD19, CD16/56 expressing peripheral blood lymphocytes and neutrophil oxidative function were evaluated. In the study population, BSI and FACED severity index scores increased with longer duration of the disease (p=0.01 and p=0.040, respectively). Of the 74 patients, 27 (37%) showed humoral aberrations. The number of male patients were higher in this group (p=0.03). High serum total IgE levels were associated with high scores in BSI (moderate-severe group versus mild group, p=0.030). Patients with bronchiectasis demonstrated lower CD3+ T cell count, lower CD4+ T helper cell percentage, and lower CD4+ T cell count (p=0.031, p=0.030, p=0.029, respectively) than healthy subjects. A significant negative correlation was found between the percentage and count of CD16/56+ natural killer (NK) cells and the number of exacerbations within the past year (r=-0.230, p=0.049 and r=-0.264, p=0.023, respectively). Humoral aberrations in adult patients with NCFB were found to be frequent. IgE levels were related to high scores for disease severity indices. Furthermore, patients with low percentage and counts of NK cells had higher rates of exacerbations. These results emphasize the importance of immune function assessment in adult patients with NCFB.

A PATIENT WITH ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (ABPA) WHO HAD UNDERGONE TUBERCULOSIS TREATMENT TWICE

The case subject was a 19-year-old exchange student from Thailand who had undergone tuberculosis (TB) treatment twice. Upon observing a shadow in the right upper lung, the patient was referred for examination; however, acid-fast bacteria test results were negative. Furthermore, high levels of total IgE and anti-aspergillus IgE and IgG antibodies were found. Bronchoscopy revealed inflammation with stenosis in the right superior lobar bronchus, and there was an outflow of yellow viscous sputum upon suctioning. After applying a localized steroid spray, the patient expectorated a large amount of sputum containing Aspergillus fumigatus. Upon administration of steroids and itraconazole, the conglomerate mass shadow's inner portion disappeared, and dilated bronchi appeared. Even though the diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) of Rosenberg and Patterson were not strictly satisfied, ABPA was diagnosed in conjunction with the course of treatment. It was determined that prior tubercle bacilli test results were negative, and thus the patient must have had ABPA from the onset. The symptoms eased, and the patient returned to Thailand. Although pulmonary tuberculosis and ABPA are different illnesses, they share similarities in symptoms and clinical findings. Therefore, past medical history should not be believed blindly, and it is imperative to diagnosis the condition accurately by performing appropriate tests. Furthermore, we had the opportunity to view the computed tomography images of the chest 18 years after the initial examination. In the entire lung region, findings of significant bronchiectasis were presented.

Role of gut microbiota in children with allergic rhinitis with high serum total IgE level

Objective:To study the role of gut microbiota in children with allergic rhinitis with high serum total IgE level. Method:A total of 17 cases of children in Shanghai Children's Medical Center of Shanghai Jiao Tong University School of Medicine, who suffered from perennial allergic rhinitis of grade 5-6, were enrolled in this study. Baseline information were collected from all participants. Peripheral blood was collected to test the level of serum total IgE and specific IgE. Fecal samples were collected for bacterial DNA extraction and sequenced by 16S rDNA high-throughput sequencing. R, Mother and LEfSe softwares were used for diversity analysis, relative abundance calculation and differential species detection. Result:Twenty-three fecal samples were collected in total, including thirteen in attack period（attack group） and ten in control period（control group）. In the attack group, six cases were serum total IgE positive（positive group） and seven were negative（negative group）. Compared with the control group, there was no significant difference in either Alpha diversity or Beta diversity of Weighted Unifrac in the attack group（P>0.05）. The relative abundance of odoribacteraceae and odoribacter were significantly increased in the attack group（LDA score>2）. The relative abundance of Porphyromonadaceae in positive group were significantly lower than that in negative group, while family Dethiosulfovibrionaceae genus Pyramidobacter was definitely higher on the contrast（LDA score>2）. Conclusion:Children with allergic rhinitis have different characteristics of intestinal flora during the attack and control period. Gut microbiota is associated with high serum total IgE level in children with allergic rhinitis. Specific microbial alterations play a potential role in disease pathophysiology.

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.

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.

Distinct type 2-high inflammation associated molecular signatures of chronic rhinosinusitis with nasal polyps with comorbid asthma

BackgroundPatients with chronic rhinosinusitis with nasal polyps (CRSwNP) and comorbid asthma have more severe disease and are difficult to treat. However, the molecular endotypes associated with CRSwNP with comorbid asthma (CRSwNP + AS) are not clear. This study aimed to investigate the characteristics of type 2 inflammation and the molecular signatures associated with CRSwNP + AS.MethodsA total of 195 subjects; including 65 CRSwNP + AS patients, 99 CRSwNP-alone patients, and 31 healthy control subjects; were enrolled in the study. Nasal tissues from patients with CRSwNP + AS, CRSwNP-alone and control subjects were assessed for infiltration of inflammatory cells and concentrations of total IgE. Whole-transcriptome sequencing was performed and differentially expressed (DE) mRNAs and long non-coding RNAs (lncRNAs) and their associated pathways were analyzed. The correlations between type 2 cytokines and local eosinophils, tissue IgE, and transcriptome signatures were evaluated.ResultsSignificantly higher local eosinophil infiltration and higher levels of total IgE were found in nasal tissues from CRSwNP + AS patients than in nasal tissues from CRSwNP-alone patients. Furthermore, atopy and recurrence were significantly more frequent in patients with CRSwNP + AS than in patients with CRSwNP-alone (62.5% vs 28.6% and 66.7% vs 26.9%, respectively). RNA sequencing analysis identified 1988 common DE-mRNAs, and 176 common DE-lncRNAs shared by CRSwNP + AS versus control and CRSwNP-alone versus control. Weighted gene coexpression network analysis (WGCNA) identified LINC01146 as hub lncRNA dysregulated in both subtypes of CRSwNP. Overall, 968 DE-mRNAs and 312 DE-lncRNAs were identified between CRSwNP + AS and CRSwNP-alone. Both pathway enrichment analysis and WGCNA indicated that the phenotypic traits of CRSwNP + AS were mainly associated with higher activities of arachidonic acid metabolism, type 2 cytokines related pathway and fibrinolysis pathway, and lower activity of IL-17 signalling pathway. Furthermore, the expression of type 2 cytokines; IL5 and IL13, was positively correlated with local eosinophil infiltration, tissue IgE level, and the expression of DE-mRNAs that related to arachidonic acid metabolism. Moreover, WGCNA identified HK3-006 as hub lncRNA in yellow module that most positively correlated with phenotypic traits of CRSwNP + AS.ConclusionsPatients with CRSwNP + AS have distinct type 2-high inflammation-associated molecular signatures in nasal tissues compared to patients with CRSwNP-alone.

Serum vitamin D levels of atopic dermatitis in adolescents and its clinical significance

Objective To investigate the relationship between the serum level of vitamin D and severity of atopic dermatitis (AD) in adolescents. Methods From March 2016 to February 2017, 102 adolescents with AD(AD group) and 100 healthy adolescents(control group) were selected.The distribution and serum levels of vitamin D in the two groups were compared.According to SCORing atopic dermatitis (SCORAD) score, AD patients were divided into mild group, moderate group and severe group.The levels of 25-(OH)D3, total IgE (TIgE) and peripheral blood eosinophil cells percentage(EOS%) were detected in the three groups. Results There was no statistically significant difference in the proportion of patients with vitamin D deficiency, insufficiency and sufficiency between the AD group and control group(χ2=2.718, P=0.257). The serum level of 25(OH)D3 in the AD group was lower than that in the control group[(18.43±3.73)μg/L vs.(19.47±3.27)μg/L, t=2.112, P=0.036]. The mean values of vitamin D deficiency, insufficiency and sufficiency in the AD group were (11.11±1.65)μg/L, (17.49±1.69)μg/L, (21.73±1.17)μg/L, respectively, which in the control group were (12.86±1.47)μg/L, (17.55±1.34)μg/L, (22.05±1.32)μg/L, respectively.The level of vitamin D deficiency in the AD group was significantly lower than that in the control group (t=2.588, P=0.017), but there were no statistically significant differences in vitamin D insufficiency and sufficiency between the AD group and control group.In 102 AD patients, 40 cases were mild, 29 cases were moderate and 33 cases were severe.The levels of 25-(OH)D3, TIgE and peripheral blood EOS% had statistically significant differences among the three groups (F=6.315, 35.813, 31.285, all P 0.05). Regarding the TIgE level and EOS%, severe group>moderate group>mild group(t=8.318, 8.788, all P<0.01; t=4.322, 4.784, all P<0.01). The value of 25-(OH)D3 was negatively correlated with the TIgE level(r=-302, P<0.01) and EOS%(r=-508, P<0.01) in the AD group. Conclusion Vitamin D deficiency or insufficiency exists in adolescents with AD.Low level of vitamin D is correlated with high TIgE level and EOS%.The severity of AD is closely correlated with increased serum levels of TlgE and EOS%, as well as decreased serum levels of vitamin D. Key words: Dermatitis, atopic; Adolescents; Vitamin D; Severity of illness index; IgE; Eosinophilia cell

SNPs of Thymic stromal lymphopoietin (TSLP) in Colombian chronic spontaneous urticaria patients.

Thymic stromal lymphopoietin (TSLP) is an epithelial cell-derived and Th2-initiating cytokine. Previous studies have shown an increasing number of TSLP+ cells in the dermis of lesional skin of patients with chronic spontaneous urticaria (CSU). Single nucleotide polymorphisms (SNP) in TSLP could be influencing these findings on the skin of those patients; besides that, other dermato-allergopaties had been associated with SNPs of TSLP. In this first study, we described the distribution of SNPs of TSLP in chronic spontaneous urticaria patients. We performed an exploratory descriptive study with 102 CSU-patients from the Colombian Caribbean coast. The SNPs: rs1837253, rs17551370, rs3806933, rs2289276 of TSLP were genotyped by qPCR. Clinical characteristics and serum total IgE [normal values <100 IU/ml] were also evaluated. We estimated allelic, genotypic, and haplotypic frequencies; also Hardy-Weinberg equilibrium and linkage disequilibrium. Eighty-two percent of CSU-patients were female gender. 25.7% (n: 19/74) of patients had high levels of total IgE, and the angioedema was present in 69.5% of them (n: 66/95). The less frequent alleles were T-rs1837253 (27.5%), A-rs17551370 (12.5%), T-rs3806933 (50%), and T-rs2289276 (32.4%). Only rs3806933 was not in H-W equilibrium. The more frequent haplotypes were C/G/T/C (18%) and C/G/C/C (18%). These SNPs were not in linkage disequilibrium D´:0.592, LOD: 1.5, R2:0.063. Our results showed the distribution of SNPs of TSLP gen in this multi-ethnic group. We are planning to continue this study comparing these findings with a control group (healthy-individuals) in order to establish the influence of these SNPs with CSU.

Understanding the asthmatic response to an experimental rhinovirus infection: Exploring the effects of blocking IgE

Rhinovirus frequently causes asthma exacerbations among children and young adults who are allergic. The interaction between allergen and rhinovirus-induced symptoms and inflammation over time is unclear. Our aim was to compare the response to an experimental inoculation with rhinovirus-16 in allergic asthmatics with the response in healthy controls and to evaluate the effects of administrating omalizumab before and during the infection. Two clinical trials were run in parallel. In one of these trials, the response to an experimental inoculation with rhinovirus-16 among asthmatics with high levels of total IgE was compared to the response in healthy controls. The other trial compared the effects of administering omalizumab versus placebo to asthmatics in a randomized, double-blind placebo-controlled investigation. The primary outcome for both trials compared lower respiratory tract symptoms (LRTSs) between study groups over the first 4 days of infection. Frequent comparisons of symptoms, lung function, and blood eosinophil counts revealed differences that were more pronounced among allergic asthmatics than among controls by days 2 and 3 after virus inoculation. Additionally, an augmentation of upper respiratory tract symptom scores and LRTS scores occurred among the atopic asthmatics versus the controls during the resolution of symptoms (P< .01 for upper respiratory symptom tract scores and P< .001 for LRTS scores). The beneficial effects of administering omalizumab on reducing LRTSs and improving lung function were strongest over the first 4 days. LRTSs and blood eosinophil counts were augmented and lung function was reduced among allergic asthmatics early after rhinovirus inoculation but increased late in the infection during symptom resolution. The effect of administering omalizumab on the response to rhinovirus was most pronounced during the early/innate phase of the infection.

Spontaneous regression of maligan breast neoplasia in a female patient with high level of immunoglobulin ig e

M.C.V., aged 54, born in Presidente Bernardes, Minas Gerais, was admitted on 09/10/2018 with a palpable alteration in the right breast, having a 15mm heterogeneous lobed nodule at the junction of the upper quadrant of the right breast (BI-RADS 5) with mammography having focal asymmetry in the same position (BI-RADS 0), being submitted to core-biopsy by ultrasound with resulting Infiltrating Ductal Carcinoma – Grade 3. Immunohistochemical pattern reveals positivity of the estrogen and progesterone hormone receptors, C-ERB B2 with a score of +2 and Ki67‒positive by 20%. Negative Fish test. She refused treatment, returning to the service on 14/08/2019 with normal physical examination, an 8 mm ultrasound lesion at the junction of the upper quadrants of the right breast (BI-RADS 6) and regression in mammography of focal asymmetry. Staging study performed with chest X-rays, total abdomen ultrasound and normal bone scintigraphy. Laboratory study was normal, except for the high level of total IgE in 4,290. She underwent segmental and sentinel lymph node resection in the right breast on 17/08/2019 at Hospital São Vicente de Paula, Ubá, Minas Gerais, with histological result, infiltrating lobular carcinoma, 9 mm in size, free margins and study of the negative sentinel lymph node. Radiotherapy and use of Tamoxifen 20mg for 5 years were indicated. It was possible to conclude that there is something different, possibly associated with the high level of IgE, which we continue to study to further understand.

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.

Allergy promotes alopecia areata in a subset of patients.

In this commentary, we focus on allergy as a facilitating factor in the pathogenesis of alopecia areata (AA). From previous studies on AA, it is well known that subsets of patients can have one or more of; seasonal relapse, comorbid atopic rhinitis, asthma and dermatitis, lesion infiltrating eosinophils and plasma cells, high levels of total IgE, specific IgE for house dust mites (HDMs), and/or disrupted skin barrier function by the evaluation of filaggrin. Allergy and AA share a similar genetic background; both contributing to an immune reaction imbalance. Furthermore, adjunctive treatment with antihistamines, or desensitization for HDM, can reduce the severity of alopecia in atopic AA patients. Therefore, allergies may contribute to the onset and relapse of AA. Identification of an allergic or atopic immune component in AA patient subsets may indicate adjunctive treatment intervention measures against allergies should be taken which may improve the success of conventional AA treatment.