Test IgE Research Articles

Rinitis alérgica

ConceptRhinitis is defined as nasal conditions characterised by sneezing, nasal itching, rhinorrhoea and nasal obstruction or congestion, which makes it a risk factor for potential respiratory complications. EpidemiologyIt is an underestimated cause for morbidity, originating high costs for those who suffer from it, both economic and social ones, affecting their quality of life. AR is the most frequent allergic disease and one of the most frequent conditions worldwide, particularly in developed countries. ClassificationIt is classified as allergic rhinitis (AR) or nonallergic rhinitis, and they are subdivided according to their frequency into persistent (more than 4 days a week and more than 4 consecutive weeks) or intermittent (does not meet previous criteria), and according to their severity into moderate-severe (if it affects sleep, daily routine or of symptoms are unpleasant) or mild (if it does not meet the criteria for moderate-severe). DiagnosisDiagnosis is reached by analysing medical records, conducting skin and/or specific IgE tests, as well as other useful complementary tests. TreatmentMany patients remain untreated, undertreated or treated incorrectly. Starting an adequate treatment for patients with AR would make significant savings in indirect costs.

Dissociation between skin test reactivity and anti-aeroallergen IgE: Determinants among urban Brazilian children.

BackgroundThe dissociation between specific IgE and skin prick test reactivity to aeroallergens, a common finding in populations living in low and middle-income countries, has important implications for the diagnosis and treatment of allergic diseases. Few studies have investigated the determinants of this dissociation. In the present study, we explored potential factors explaining this dissociation in children living in an urban area of Northeast Brazil, focusing in particular on factors associated with poor hygiene.MethodsOf 1445 children from low income communities, investigated for risk factors of allergies, we studied 481 with specific IgE antibodies to any of Blomia tropicalis, Dermatophagoides pteronyssinus, Periplaneta americana and Blatella germanica allergens. Data on demographic, environmental and social exposures were collected by questionnaire; serum IgG and stool examinations were done to detect current or past infections with viral, bacterial, protozoan and intestinal helminth pathogens. We measured atopy by skin prick testing (SPT) and specific IgE (sIgE) to aerollergens in serum (by ImmunoCAP). SIgE reactivity to B. tropicalis extract depleted of carbohydrates was measured by an in-house ELISA. Total IgE was measured by in house capture ELISA. SNPs were typed using Illumina Omni 2.5.ResultsNegative skin prick tests in the presence of specific IgE antibodies were frequent. Factors independently associated with a reduced frequency of positive skin prick tests were large number of siblings, the presence of IgG to herpes simplex virus, Ascaris lumbricoides and Trichuris trichiura infections, living in neighborhoods with infrequent garbage collection, presence of rodents and cats in the household and sIgE reactivity to glycosylated B. tropicalis allergens. Also, SNP on IGHE (rs61737468) was negatively associated with SPT reactivity.ConclusionsA variety of factors were found to be associated with decreased frequency of SPT such as unhygienic living conditions, infections, total IgE, IgE response to glycosylated allergens and genetic polymorphisms, indicating that multiple mechanisms may be involved. Our data, showing that exposures to an unhygienic environment and childhood infections modulate immediate allergen skin test reactivity, provide support for the “hygiene hypothesis”.

Association of Clinical Reactivity with Sensitization to Allergen Components in Multifood-Allergic Children

Thirty percent of children with food allergies have multiple simultaneous allergies; however, the features of these multiple allergies are not well characterized serologically or clinically. We comprehensively evaluated 60 multifood-allergic patients by measuring serum IgE to key allergen components, evaluating clinical histories and medication use, performing skin tests, and conducting double-blind, placebo-controlled food challenges (DBPCFCs). Sixty participants with multiple food allergies were characterized by clinical history, DBPCFCs, total IgE, specific IgE, and component-resolved diagnostics (IgE and IgG4) data. The food allergens tested were almond, egg, milk, sesame, peanut, pecan, walnut, hazelnut, cashew, pistachio, soy, and wheat. Our data demonstrate that of the reactions observed during a graded DBPCFC, gastrointestinal reactions occurred more often in boys than in girls, as well as in individuals with high levels of IgE to 2S albumins from cashew, walnut, and hazelnut. Certain food allergies often occurred concomitantly in individuals (ie, cashew/pistachio and walnut/pecan/hazelnut). IgE testing to components further corroborated serological relationships between and among these clustered food allergies. Associations of certain food allergies were shown by DBPCFC outcomes as well as by correlations in IgE reactivity to structurally related food allergen components. Each of these criteria independently demonstrated a significant association between allergies to cashew and pistachio, as well as among allergies to walnut, pecan, and hazelnut.

Airway hyperresponsiveness to mannitol and methacholine and exhaled nitric oxide in children with asthma

ABSTRACTObjective: Asthma is characterized by airway hyperresponsiveness (AHR), inflammation, and obstruction. AHR to stimuli that indirectly cause bronchial smooth muscle (BSM) contractions via release of endogenous mediators is thought to better reflect airway inflammation than AHR to stimuli that act directly on BSM. Fractional exhaled nitric oxide (FeNO) is a useful parameter for noninvasive clinical airway inflammation assessments. Accordingly, this study aimed to examine the relationships of mannitol and methacholine challenge test outcomes with FeNO and the influence of inhaled corticosteroid treatment in children with asthma. Methods: One hundred thirty-four asthmatic children (89 males; ages: 5–17 years, median: 9 years) underwent spirometry, FeNO measurement, serum total/specific IgE testing, and blood eosinophil count. All subjects were challenged with mannitol dry powder (MDP; AridolH, Pharmaxis, Australia) and methacholine at 7-day intervals. Data of steroid-treated and steroid-naïve children were compared. Results: Positive responses to MDP and methacholine challenge tests were observed in 74.6% and 67.2% of total subject group, respectively, and 72 children had positive response to both challenge tests. The median FeNO level, response-dose ratio (RDR) of PC20 methacholine, and RDR of PD15 MDP were significantly higher in the steroid-treated group than in the steroid-naïve group (p < 0.001, 0.226, and 0.004, respectively). FeNO levels associated significantly with PD15 MDP and RDR PD15 MDP in total subject populations (p = 0.016 and 0.003, respectively); however, a significant correlation between FeNO and RDR PD15 MDP was observed only in the steroid-naïve group. Conclusions: Compared with AHR to methacholine, AHR to MDP more closely reflected the level of FeNO in steroid-naïve asthmatic children.

Relevance of nasal provocation testing in house dust mite allergy

Patients with house dust mite allergies frequently exhibit very different symptoms to those allergic to other inhalant allergens. The frequency of comorbid allergic asthma in these patients is increased. Therefore, diagnosing patients with suspected house dust mite allergies can be difficult. It is important to distinguish between sensitization to an allergen and aclinically relevant allergy. Nasal provocation testing (NPT) is areliable method to identify patients suitable for a causal treatment (specific immunotherapy). Position papers on methodology and interpretation of NPT data are available. Skin prick and allergen-specific IgE tests reveal areasonable correlation with NPT results, although this is inexact to some extent. Performance of NPT in patients with suspected house dust mite allergy is important in individuals with questionable symptoms and unclear skin and blood test results, particularly prior to initiation of allergen immunotherapy.

Trends in Provider Management of Patients with Food Protein–Induced Enterocolitis Syndrome

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. To better understand provider-level variation in FPIES knowledge and management. A 23-question online survey was administered to AAAAI members during the spring and summer of2014. Among 470 respondents, 64% reported "full understanding" of FPIES diagnosis/management; 78.8% reported managing 1 or more patient with FPIES; and 80.4% correctly identified an FPIES case vignette. FPIES was correctly differentiated from infantile colic or food protein-induced allergic proctocolitis by 82.5% and 71.3%, respectively. Among providers currently managing patients with FPIES, 47.5% indicated soy formula, 73.8% breast milk, and 94.5% elemental formula as appropriate substitutes in cow milk (CM)-FPIES. Skin testing is performed by 73.4%; 62.2% obtain serum food-specific IgE testing, 12.7% patch testing, 36.8% oral challenge,and 28% perform no tests. Eighty-four percent provide patients with FPIES with allergy action plans, 72.8% provide a personalized action plan, and 21% prescribe epinephrine autoinjectors. Odds of prescribing epinephrine were lower among those reporting "full understanding" of FPIES (odds ratio [OR], 0.41; 95% CI, 0.21-0.79). Academic providers had higher odds of providing an action plan (OR, 2.4; 95% CI, 1.17-4.98) and performing diagnostic oral food challenge (OR, 1.99; 95% CI, 1.99-3.25), but not of correct vignette differentiation of FPIES from other conditions, correct identification of appropriate CM-FPIES substitutes, or timing for food reintroduction. More years in practice wereassociated with lower odds of reporting full understanding of FPIES diagnosis/management (OR, 0.96; 95% CI, 0.94-0.99). Nearly one-third of respondents reported poor familiarity with FPIES. Considerable variation exists in the use of diagnostic tests, management, and choice of "safe" nutrition, indicating a strong need for FPIES practice guidelines.

Diagnosis of red meat allergy with antigen-specific IgE tests in serum

Red meat allergy is a tick-associated hypersensitivity reaction to galactose-α-1,3-galactose (α-gal) and is characterized by anaphylaxis, angioedema, urticaria and/or gastrointestinal symptoms occurring 3–6 hours after ingesting red meat such as beef, pork, or lamb. Diagnosis of red meat allergy is challenging due to the unusually long delay in symptom onset and poor sensitivity of skin prick tests with commercial meat extracts. The primary diagnostic tools available for this disease are quantification of α-gal-, beef-, pork-, and/or lamb-specific IgE in serum, however the diagnostic performance of these tests has not been reported. Using patient data for n=135 patients with red meat allergy and n=37 controls, we found that measurement of α-gal-specific IgE using the bovine thyroglobulin (bTG) ImmunoCAP method had the best overall sensitivity (100%) and specificity (92.3%) for diagnosis of red meat allergy. Measuring α-gal-specific IgE using the streptavidin (SA)-CAP technique or beef- or pork-specific IgE using ImmunoCAP were also effective tests with high sensitivities (89–92%) and variable specificities (65–82%). Lamb-specific IgE and total IgE had essentially no diagnostic value for red meat allergy. Positive and negative predictive values mirrored these trends. Taken together, these findings indicate that the α-gal-specific IgE test by bTG ImmunoCAP is the most useful for establishing a diagnosis of red meat allergy, although α-gal-specific IgE by SA-CAP and beef- and pork-specific IgE by ImmunoCAP are also effective tests.

Analysis and dynamic observation of inhaled and food allergens for people in Pearl River Delta

Objective:To investigate the distribution of allergens in patients with suspected allergic diseases in Pearl River Delta, analysis the changes of allergens with seasons and years, and provide clinical references for management strategies with regional character.Method:Patients from 9 hospitals in Pearl River Delta, with suspected clinical symptoms and signs of allergic disease, were given serum specific IgE test from September 2012 to April 2016. The positive rate was compared with genders, ages, the dynamic changes of seasons, and years.Result:In 30 003 patients, the positive rate of dust mites, house dust, tree, mugwort, mold, animal dander were 39.3%, 26.1%, 16.9%, 26.1%, 9.0%, 6.0% respectively. In 22748 patients, the positive rate of egg, milk, fish, seafood, meats, fruits, nuts were 13.5%, 14.5%, 10.3%, 14.5%, 10.9%, 15.4%, 10.9%. The positive rate of female patients are higher than male patients in both inhaled and food allergens (P< 0.01). The positive rate of minor group was obviously higher than that of the adult group (P< 0.01). The highest positive rate of dust mite, mold, animal dander, egg, fish occurs in the spring, while trees, mugwort, house dust, milk, seafood, meats, fruits, nuts in summer (P< 0.01). There was an upward trend in the positive rate of dust mite, while the positive rate of house dust, mugwort, mold, egg, milk was on the decline, and positive rate of other allergens changed in volatility from 2013 to 2015 (P< 0.01).Conclusion:The dust mites, house dust, seafood and fruits were the main allergens in Pearl River Delta and should be the key for prevention and treatment of allergic diseases. More attention should be paid to the patients of allergic diseases of minors and major seasonal allergens in clinical prevention and treatment. The changes of allergens with the years and dietary habit in local area for the prevention and control of allergic diseases are also not allowed to be ignored.

Clinical and allergological analysis of ocular manifestations of sick building syndrome.

PurposeThe disease concept of sick building syndrome (SBS) is still unclear. Ocular mucous membrane irritation is one of the major symptoms of SBS. However, the immunological aspects of the ocular complications of SBS are not yet clarified. The clinical and allergological aspects of SBS cases with ocular disorders with special reference to allergic conjunctival diseases (ACD) were analyzed, especially with respect to local immunological features.MethodsTwelve cases of SBS with ocular findings and 49 cases of ACD (allergic conjunctivitis [AC], atopic keratoconjunctivitis [AKC], and vernal keratoconjunctivitis [VKC]) for comparison were evaluated. The clinical findings in SBS and ACD were scored, and tear film breakup time (BUT) was measured. Cytokine (interferon-γ [IFN-γ], interleukin [IL]-2, IL-4, IL-5, IL-6, IL-8, and IL-13) concentrations in tears were analyzed by cytometric bead arrays. Eosinophil count in peripheral blood, total IgE in serum, and multiple allergen simultaneous test (MAST) for antigen-specific IgE were also measured.ResultsIn SBS, conjunctival lesions were observed in all cases, and corneal abnormalities were found in two-thirds of the cases. Limbal lesions were observed in 2 pediatric cases. Mean serum total IgE level in SBS was significantly higher than that in AC; however, it was significantly lower than that in AKC and VKC. Eosinophil count in peripheral blood and number of positive allergens in MAST were significantly lower in SBS than in AKC and VKC. Significant elevation of tear IL-4 was observed in SBS and ACD. However, in contrast to ACD, elevation of other cytokines in tears was not observed in SBS. Mean tear BUT in SBS was in the normal range.ConclusionFrom these results, SBS is thought to be partially induced by an allergic response. However, clinical dissociation of the ocular clinical findings and local immunological features in tear cytokines may suggest that SBS belongs to a different entity from ACD.

Accuracy of immunoblotting assay for detection of specific IgE compared with ImmunoCAP in allergic patients.

Background and aimStandardized techniques help us to better diagnosis and follow up of allergic diseases. In this study, we determined the sensitivity, accuracy, and specificity of an Immunoblotting test compared to ImmunoCAP as the reference in vitro test for detection of specific IgE in allergic patients.MethodsIn this cross-sectional study, specific IgE level was determined in patients with allergic symptoms who referred to the Immunology, Asthma and Allergy Research Institute, Tehran, Iran from 2010–2016, by two techniques. Eleven different allergens (six aeroallergens and five food allergens) were determined, and 303 specific IgE tests were performed for the patients by each method. The Immunoblotting test is a multiplex assay on a nitrocellulose membrane coated with 20 selected allergens. ImmunoCAP is considered as the reference method for determination of in vitro specific IgE. Its principle is an automated sandwich immunoassay, and allergens were bound to the solid phase, covalently. Finally, the fluorescence of elute was determined. Specific IgE more than 0.35 KU/L was considered as a positive test. Sensitivity, specificity, accuracy, kappa coefficient, positive and negative likelihood ratio (+/− LR), and correlation coefficient (calculated with Spearman test) between two tests were determined using statistical analysis (SPSS software, version 18).ResultsOne hundred and thirty five patients entered this study. The median age of the patients was 3.75 years with the males constituting 54.8% of the population. The most common cheif complaints were respiratory (51.6%), skin (41.8%) and gastrointestinal (27.9%) symptoms, respectively. The sensitivity, specificity, accuracy, +LR and −LR were 83%, 97%, 92%, 27.66 and 0.17, respectively. The kappa coefficient of the immunoblotting test was 0.81 compared to the reference technique. The correlation coefficient for positive tests between the two methods was 0.71 (p<0.001).ConclusionRegarding the presence of 20 allergens in a RIDA allergy panel and according to our findings, this immunoblotting test with high sensitivity could be used as a fast and cost-efficient screening test. However, ImmunoCAP is recommended when the accurate level of specific IgE is required. ImmunoCAP findings are particularly helpful for immunotherapy and the elimination diet.

Reliable mite-specific IgE testing in nasal secretions by means of allergen microarray

Reliable mite-specific IgE testing in nasal secretions by means of allergen microarray

Personalized Medicine in Allergic Asthma: At the Crossroads of Allergen Immunotherapy and "Biologicals".

Major allergic disease can be viewed as clinical syndromes rather than discrete disease entities. Emerging evidence indicates that allergic asthma includes several disease phenotypes. Immunological deviation toward high T helper cell type 2 cytokine levels has been demonstrated for a subgroup of pediatric asthma patients, and now, several novel monoclonal antibodies have been approved for treatment of this subgroup as a stratified approach of “personalized” medicine in allergy. Introduction of component-based IgE testing before allergen immunotherapy (AIT), i.e., testing for IgE cross-reactivity before initiation of AIT, has also brought stratified medicine into allergy therapy. Improved responder criteria, which identify treatment-responders previous to therapy, might foster this stratification and even individualized AIT might have an impact for tailor-made therapy in the future. Furthermore, combining antibody-based treatment with AIT could help to establish more rapid AIT protocols even for allergens with a high risk of anaphylactic reactions. Efforts to advance such “personalized” medicine in pediatric allergy might be challenged by several issues including high costs for the health-care system, increasing complexity of allergy therapy, the need for physician allergy expertise, and furthermore ethical considerations and data safety issues.

Food Protein-Induced Enterocolitis Syndrome.

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-, cell-mediated food allergy of unknown prevalence and pathophysiology. Onset is typically during the first year of life; seafood-induced FPIES may start in adulthood. Acute FPIES manifests within 1-4 hours after ingestion with repetitive emesis, pallor, and lethargy progressing to dehydration and hypovolemic shock in 15% of cases. Chronic FPIES manifests with intermittent emesis, watery diarrhea, and poor growth progressing to dehydration and hypovolemic shock over a period of days to weeks. Chronic FPIES has been only reported in infants aged less than 3 months fed with cow milk (CM) or soy formula. The most common triggers are CM, soy, rice, and oat. Diagnosis of FPIES relies on recognition of a pattern of clinical symptoms and may be missed owing to the absence of typical allergic symptoms (eg, urticaria, wheezing) and delayed onset in relation to food ingestion. Physician-supervised food challenge is recommended if diagnosis or the trigger food is not clear and to evaluate for resolution. Testing for food-specific IgE is usually negative, although a subset of patients, usually with CM-induced FPIES may develop sensitization to foods. Such atypical FPIES tends to have a more prolonged course. Despite the potential severity of the reactions, no fatalities have been reported, and FPIES has a favorable prognosis. In most cases, FPIES resolves by age 3-5 years, although persistence of CM-induced FPIES and soy FPIES into adulthood has been reported. The first international consensus guidelines on diagnosis and management of FPIES were published in 2017. Given that the pathophysiology of FPIES is poorly understood, there are no diagnostic biomarkers and no therapies to accelerate resolution. These unmet needs warrant future investigations to improve the care of patients with FPIES.

Relative Value of Skin Prick, Specific Peanut Specific IgE and Component Tests in Predicting the Outcome of Oral Peanut Challenge

Relative Value of Skin Prick, Specific Peanut Specific IgE and Component Tests in Predicting the Outcome of Oral Peanut Challenge

Food-Specific IgE Testing in Children: Current Practices Among Primary Care Pediatricians and a Web-Based Educational Intervention

Food-Specific IgE Testing in Children: Current Practices Among Primary Care Pediatricians and a Web-Based Educational Intervention

Effects of food allergens on asthma exacerbations in schoolchildren with atopic asthma

ABSTRACTAlthough the prevalence with which food causes asthma is not well known, food allergy is implicated in a variety of respiratory symptoms. Eighty-two asthmatic children aged 6–16 years with doctor-diagnosed sensitization to inhalants and presenting with asthma exacerbation participated in this study of food allergies linked to asthma exacerbations. The diagnosis of food allergy was established using a questionnaire, clinical criteria, serum-specific IgE antibody measurements, and an atopy patch test. Asthma exacerbation was determined using fractional exhaled nitric oxide management after the children were admitted to the hospital. On the basis of questionnaire data, suspected food allergy was identified in 59.8% children. The positive and negative rates of serum food-specific IgE tests were 54.9% and 45.1%, respectively. The results of atopy patch tests in radioallergosorbent-positive participants were 88.9% positive and 12.5% negative. Food allergy is a risk factor for asthma exacerbation, and evaluation of food allergy in selected patients with asthma is indicated.

Occupational asthma caused by sensitization to a cleaning product containing triclosan

A recent consensus statement has highlighted the increased risk of developing asthma after exposure to workplace and domestic cleaning products. [1] Siracusa A. De Blay F. Folletti I. et al. Asthma and exposure to cleaning products: a European Academy of Allergy and Clinical Immunology task force consensus statement. Allergy. 2013; 68: 1532-1545 Crossref PubMed Scopus (122) Google Scholar Specific cleaning agents, such as benzylalkonium chloride, have been recognized as causes of occupational asthma by sensitization and now comprise a significant burden of work-related asthma. European Respiratory Society guidelines recommend that sensitizer-induced occupational asthma should be diagnosed by identifying the workplace as the cause and confirming sensitization to an asthmagen by specific inhalation challenge (SIC) in the absence of any available specific IgE tests. [2] Baur X. Sigsgaard T. Aasen T.B. et al. ERS Task Force on the Management of Work-Related AsthmaGuidelines for the management of work-related asthma [published correction appears in Eur Respir J. 2012;39:1553.]. Eur Respir J. 2012; 39: 529-545 Crossref PubMed Scopus (147) Google Scholar We present the first case of occupational asthma caused by the biocide triclosan, commonly used in cleaning and personal care products.

Serum Leptin Level among School Children with Atopic Dermatitis

Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition. The pathogenesis of AD is still not fully understood. The association between obesity and AD suggests a potential role for adipocytes hormones, mainly leptin, which had variable immunological functions. Objective: The aim of the present study was to assess serum leptin concentrations in children with AD and to evaluate the relationship between serum leptin levels and various demographic and clinical parameters. Material and Methods: A case control study included 90 school age children (54 cases and 36 controls) conducted at Al-Azhar University Hospital (New Damietta), from January 2016 to April 2017. The diagnosis of AD was based on ISAAC questionnaire. Enrolled children completed scoring of severity of AD (SCORAD), blood tests for total IgE, eosinophil counts. Serum leptin was measured by ELIZA. Results: There was no significant difference between cases and controls as regard age, sex and BMI. Serum leptin was significantly (P=0.015) higher among patients than healthy control. This difference was apparent between both boys (P=0.043) and girls (P=0.026). In addition, serum leptin was significantly higher among atopic girls (P=0.017) than boys. Regarding type of AD, there was no significant difference between patients with intrinsic AD and patients with extrinsic AD considering variable clinical parameters. Serum leptin was higher among intrinsic AD patients but it was not significant (P=0.062). Correlation analysis revealed significant negative correlation between leptin and total IgE (P=0.004). Also, non-significant negative correlation between serum leptin level and SCORAD value (P=0.062). Conclusion: There was significant association between serum leptin levels and atopic dermatitis, which was apparent among both atopic boys and girls. However, serum leptin was significantly higher among atopic girls than boys. Thus, leptin might play a role in the pathogenesis of AD. The tendency of leptin to increase among girls and with intrinsic AD suggests complex pathological mechanisms.

The impact of age on Pru p 3 IgE production in Italy.

BackgroundPollen allergy may be frequently associated with fruit-vegetables: the so-called pollen food syndrome. Pru p 3 is the most relevant peach allergen. Previously, it has been reported that serum specific IgE level to Pru p 3 depends on age in a limited geographic area.ObjectiveThis study aimed to to test the hypothesis about the differences of Pru p 3 sensitization across Italy, mainly concerning the impact of age.MethodsThe current study was retrospective and multicentre, involving 2 labs in Northern Italy (709 subjects), 1 in Genoa (1,040 subjects), and 1 in Southern Italy (2,188 subjects). All of them referred to labs for IgE testing because of suspected food allergy. Serum IgE to Pru p 3 was assessed in all subjects.ResultsSixteen point seven percent (16.7%) of subjects were sensitized to Pru p 3. Sensitization percentage sigificantly decreased over time. The serum IgE levels increased up to young adulthood and then decreased until aging.ConclusionOur experience demonstrates that Pru p 3 sensitization and production are closely age-dependent phenomena.

POLYGLANDULAR AUTOIMMUNE SYNDROME ASSOCIATED WITH MULTIPLE AUTOIMMUNE CONDITIONS AND ATOPIC DERMATITIS - AN UNUSUAL MANIFESTATION OF A POLYAUTOIMMUNITY PHENOTYPE.

The polyglandular autoimmune syndrome (PAS) type III is a rare condition defined as the coexistence of autoimmune thyroid disorder with other endocrine autoimmune diseases, including type 1 diabetes, without adrenal dysfunction. PAS may associate with other non-endocrine autoimmune diseases, overlapping with the multiple autoimmune syndromes (MAS). We present a case of PAS III/ MAS type 3, including autoimmune thyroiditis, autoimmune diabetes, vitiligo, lupus erythematosus, associated with adult-onset atopic dermatitis, a combination not reported previously. A 40 years old woman, registered as nurse working in dialysis unit, previously diagnosed with vitiligo, euthyroid autoimmune thyroiditis and disseminated granuloma annulare, with personal and familial history of atopic disorders, presented in our clinic for disseminated eczematous and lichenoid cutaneous rashes. She was tested positive for antinuclear, anti-double stranded DNA and anti-histone antibodies, with inflammatory syndrome and marginal lymphopenia and she was diagnosed with systemic lupus erythematosus (SLE). Subsequently, moderate hyperglycemia, positive anti-glutamic acid decarboxylase antibodies and low C-peptide level prompted the diagnosis of autoimmune diabetes. Recurrent flexural eczematous rashes, with negative epicutaneous tests but positive specific IgE tests for common allergens fulfilled the clinical criteria for the diagnosis of atopic dermatitis. The clinical, immunological and glycemic status were controlled with low doses of oral prednisone (<0.5 mg/kg), methotrexate (10mg/week), antimalarials, metformin, emollients and photoprotection. After changing her workplace, the immunosuppressive treatment could be discontinued, and the patient maintained normal immunological and biochemical profile at 6 months follow-up.This case brings a unique perspective on the evolution, associations spectrum and the management challenges of endocrine polyautoimmunity associated with atopic diathesis.