Specific IgE against staphylococcal enterotoxin [superantigens] in allergic rhinitis: An independent risk factor for severe bronchial asthma

Objective: The study aimed to investigate whether IgE to Staphylococcus aureus enterotoxins might be relevant to disease severity in adult asthmatic patients

Materials and Methods: Specific IgE antibody concentrations in serum against enterotoxins, grass pollen [GP], and house dust mite [HDM] allergens and total IgE levels were measured in 69 adult control subjects, 152 patients with non-severe asthma, and 166 patients with severe asthma. Severe asthma was defined as inadequately controlled disease despite high-dose inhaled corticosteroids plus at least 2 other controller therapies, including oral steroids

Results: Statistical analysis demonstrated Enterotoxin IgE positivity which was significantly greater in patients with severe asthma [59.67%] than in healthy control subjects [13% P< .001]. Twenty-one percent of patients with severe asthma showing positive enterotoxin IgE were considered non atopic. Also statistical analyses demonstrated significantly increased risks for enterotoxin IgE-positive subjects to have severe asthma [95%] versus enterotoxin IgE-negative subjects

The presence of GP or house dust IgE antibodies was not associated with either significantly increased risk for asthma or severity. Oral steroid use and hospitalizations were significantly increased in patients with positive enterotoxin IgE and non-atopic asthma. GP IgE was associated with a higher FEV1 percent predicted value and enterotoxin IgE was associated with a lower FEV1 percent predicted value

Conclusion: Staphylococcal enterotoxin IgE antibodies, but not IgE against inhalant allergens, are risk factors for asthma severity. We hypothesize that the presence of enterotoxin IgE in serum indicates the involvement of staphylococcal superantigens in the pathophysiology of patients with severe bronchial asthma

Korner's septum; clinical, radiological and cadaveric studies

To describe the anatomy of the Korner's septum [KS] or petrosquamosal suture [PSS], its incidence, variations in normal and inflamed middle ears, and to evaluate its clinical importance. Review of 100 CT scans temporal bones were done to determine the degree of visualization of Korner's septum [KS]. Cadaveric dissection of 100 temporal bones were done in temporal bone dissection laboratory of Ain Shams University Specialzied hospital in addition to 100 mastoidectomies performed in the ENT inpatient department. KS or PSS is not only a bony plate dividing the mastoid cells at the level of the antrum, but is also a lamina starting from the posterior aspect of the glenoid fossa that extends above the middle ear cavity and courses inferiorly lateral to facial canal and proceeds to mastoid apex. Korner's septum was seen radiologically in 26% of CT scans of temporal bones, and in 25% of temporal bone specimens. Clinically "KS" was seen in [29%] of cases with COM and in [24%] in cases without COM with a total incidence of [28%]. Frequently there was a hidden cholesteatoma or cholesterol graunloma behind the septum. Rarely the cog [anterior part of the septum] may extend to fix the ossicels. KS is an imporatn anatomic observation in patients with chronic otitis media, it may contribute to middle ear infection and it may hide cholesteatoma or cholesterol granunloma behind it which may be missed if superficial compartment was sclerosed

Cellular phenotypes and immunity in acquired aural cholesteatoma

Middle ear cholesteatoma is characterized by the presence or a keratinizing squamous epithelium with proliferative features and associated with marked bone destruction. Aims of this study to detect the cellular phenotypes and their immunological functional state in aquired aural cholesteatoma. So, cellular membranous expression of CD4, CD8 and HLA-DR antigens on the infilterated mononuclear cells in cholesteatoma were studied through immunohistochemical method. Nine formalin-fixed cholesteatoma specimens were obtained from patients of chronic otitis media during their ear surgery. The patients' ages ranged between 11 to 43 years [mean age=22 yrs. and SD +/- 6.5] and they involved 15 males and 12 females. All patients had dry ears with no signs of bacterial infections for at least 2 weeks preoperatively. Also, three normal skin specimens from external auditory canals of these patients were taken as a control. All tissue specimens were subjected to Hematoxylin and Eosin staining and immunohistochemical [strept-avidin-peroxidase] method staining. The results showed CD4 positive [=T- helper or inducer] lymphocytes in 24 out of 27 specimens [88.8%] with subepithelial distribution and at the periphery of lymphoid follicles in 15 cases [55.5%].While, CD 8 positive [=T-suppressor or cytotxic] lymphocytes were seen only in 6 out of 27 specimens [22.2%] with diffuse distribution pattern. On the other hand, HLA-DR expression was observed in both cholesteatoma matrix and perimatrix cellular components indicating their immunocompetent activity. Keratinocytes of cholesteatoma matrix were HLA-DR positive in 18 specimens [66.6%] while, "epidermal Langerhans" cells were positive in 12 specimens [44.4%]. In the perimatrix of all specimens, infilterated lymphocytes and macrophages were positive for HLA-DR expression. Also, [either intact or degranulated mast cells] were demonstrated in all specimens scattered in the cholesteatoma perimatrix. Active T-helper cells are directly correlated to the expression HLA-DR has a certain playing. Role in epithelial proliferation and participating in bone resorption rather than cytotoxic T-lymphocytes. Also, activated keratinocytes and Langerhans' cells and sensitized mast cells contribute to the biologic features of cholesteatoma