Evaluation of Banana Hypersensitivity Among a Group of Atopic Egyptian Children: Relation to Parental/Self Reports

PURPOSE: To evaluate the frequency of banana sensitization and allergy among a group of atopic Egyptian children in relation to parental/self reports. METHODS: This is a case-control study included 2 groups of allergic children with and without history of banana allergy, each included 40 patients. They were subjected to skin prick test (SPT) using commercial banana allergen extract and prick-prick test (PPT) using raw banana, in addition to measuring the serum banana-specific IgE. Oral banana challenge was performed in suspected cases. RESULTS: Banana allergy was diagnosed in 3 (7.5%) patients based on positive history of allergy on exposure to banana, positive SPT/PPT and elevated banana-specific IgE. The 3 patients had bronchial asthma with exacerbation upon banana exposure. The PPT results conform with those of SPT both in diagnosis of banana allergy and in the skin reactivity to banana. Serum banana-specific IgE was detectable in the whole studied sample with higher serum level among those without history of banana allergy (P=0.005). Oral banana challenge was negative for 20 patients with history of banana allergy and positive serum banana-specific IgE but negative SPT and PPT. CONCLUSIONS: Self/parental reports of banana allergy is high while the actual banana allergy is uncommon. The PPT seems as reliable as SPT in diagnosis of banana allergy unlike specific IgE which reflects sensitization rather than allergy. Oral food challenge remains the most helpful tool for diagnosis of food allergy in suspected cases.

HLA-DRB1 in Egyptian rheumatoid arthritis patients and its association with anti-CCP antibody and disease activity

Rheumatoid arthritis [RA] is a multifactorial disease involving environmental and genetic components. A complex group of human leucocyte antigen [HLA] class II alleles are associated with an increased risk of developing RA, but their exact role in its pathogenesis remains unclear. Many studies examined the hypothesis that shared epitope [SE]-containing HLADRBl alleles can account for these associations. The presence of anti-cyclic citrullinated peptide antibody [anti-CCP] has been associated with RA development. We aimed to assess presence of HLADRBl in RA patients and its association with anti CCP and disease activity. Forty rheumatoid arthritis patients were assessed clinically with disease activity score [DAS]. Serum rheumatoid factor [RF] and anti CCP antibodies level were assessed. HLA-DRBl typing was done with sequence specific oligonucleotide probe [SSOP] technique and was compared with normal Egyptian population. HLA-DRBl 04 were the most frequent allele followed by HLADRBl 10 in RA patients [30.2%, 7.9% respectively]. HLA-DRBl 03 and HLA-DR Bl 02 were found to be protective alleles as they are less frequent in the patients than the controls. HLA-DRBl 04 showed a significant positive association with both positive anti-CCP antibodies and RF level. Concerning the disease activity, HLA-DRBJ 04, HLA-DRBl 08 and HLA-DRBl 01 showed a significant association with higher disease activity. HLA-DRBl 04 gene may be not only an indicator for the development of rheumatoid arthritis but also associated with positive anti-CCP antibody production and higher disease activity

Thymus and activation-regulated chemokine in children with systemic lupus erythematosus

Systemic Lupus Erythematosus [SLE] is an autoimmune rheumatic disease and glomerulonephritis is a challenging complication of SLE which is more frequent in children. Thymus and activation - regulated chemokine [TARC] is a hemostatic chemokine and TARC production is induced rapidly thus providing an important link between early innate immune responses and adaptive immunity. The aim of the present work was to measure serum TARC in SLE patients and correlate it with disease activity in patients with clinically evident lupus nephritis versus patients without lupus nephritis. This study was conducted on thirty patients [26 females and 4 males] with SLE, regularly attending the Pediatric Allergy and lmmunology Clinic Children's Hospital, Ain Shams University. Their ages ranged between 9-16 years [mean +/- SD = 13.6 +/- 2.68 years]. Lupus patients were categorized into two groups according to lupus nephritis [LN]: Group I a [with LN] and Group I b [without LN]. Results of the previous two groups were compared to a control group comprised of 40 [27 females and 13 males] age and sex matched apparently healthy subjects whose ages ranged between 10 and 16 years [mean + SD= 12.95 +/- 2.68 years]. All participants were subjected to full history taking, thorough clinical examination, urine analysis, assessment of ESR, creatinine, C3, ANA Abs, anti-dsDNA Abs and serum TARC. All SLE patients were seropositive for ANA. Serum TARC levels were statistically highly significantly [p=<0.001] elevated in all lupus patients, in Group Ia, in Group lb all respectively compared to controls and also in Group Ia versus Group lb. As regards indicators of LN, serum TARC showed statistically highly significant [p<0.001] elevated levels in patients with hematuria, edema, hypertension and anti-dsDNA positivity than in those with negative indicators of LN. Serum TARC showed statistically significant [p<0.05] positive correlation with ESR and SLEDAT score in all lupus patients, statistically highly significant [p=<0.001] positive correlation with ESR [in group I a], 24 hrs urinary proteins [in all lupus patients and group I b] and serum creatinine [in all lupus patients, group I a and group I b]. In conclusion, serum TARC levels were statistically significantly higher in all lupus patients versus healthy controls being statistically significantly higher in LN patients with versus lupus patients without nephritis. Also, serum TARC had significant positive correlation to SLEDAI score and ESR indicating its correlation with disease activity