Sublingual immunotherpay as a relevant alternative in the treatment of allergic rhinitis: an intervention study

It is well known that, specific immunotherapy, together with avoidance of the allergen and symptomatic treatment forms part of the treatment of allergy. The best known and most studied form is subcutaneous immunotherapy [SCIT], whose efficacy was demonstrated in numerous studies. However, in spite of having been shown to be safe, it is not free of adverse effects and must be administered under the supervision of medical personnel. Sublingual immunotherapy [SLIT] may be used as an alternative treatment in allergy. This study was conducted to assessthe efficiency of sublingual immunotherapy as a relevant alternative for treatment of allergic rhinitis. The study included 50 patients with allergic rhinitis; diagnosis was based on clinical manifestations and confirmed by presence of eosinophilia in nasal smear. Their mean age was 22 years ranging from 16 to 60 years, 22 of them were males and 28 were females. All patients were subjected to clinical examination, nasal smear examination for eosinophile count, skin prick test, initial assessment for total IgE and IgE specific allergens [RAST], after receiving sublingual immunotherapy patients were followed up by total IgE and RAST after 24 months, staloral 10ml of a 10,100 iu/ml solution of an allergen extract was used as sublingual solution for desensitization, which specially prepared for each individual,doses are adminisrereted daily at increasing doses until the maintenance dose is reached.Doses of extract were delivered by puffs directly under tongue and kept under tongue for 2 minutes before being swallowed. Results showed that the cause of allergic rhinitis in this study was found to be dust mites in 44% of cases and fungus allergens in 12% of them while it was mixed in 44% of the studied cases. There was a statistically significant improvement in the mean total IgE from 789.24 IU/ML before treatment to 341.24 IU/ML after treatment [P<0.001], according to RAST it revealed changes from a mean of 2.95 IU/ML to 1.09 IU/ML after treatment in fungus and from a mean of 3.1 to 1.21 IU/ML after treatment in mites as well as from a mean of 5.6 to 2.6 IU/ML after treatment in the mixed group, in addition to a significant decrease in the mean diameter of skin prick test reactions after immunotherapy in all types of allergens and amelioration of symptoms in all cases. The follow up of these patients by total IgE and [RAST] revealed much improvement. It is concluded that sublingual immunotherapy [SLIT] is safe and may be considered as a relevant alternative to subcutaneous immunotherapy [SCIT], for the treatment of allergic rhinitis.

outbreak of hepatitis a associated with treated waste water used for irrigation

Hepatitis A virus [HAV] infection is endemic in developing countries and remains a public health problem elsewhere. This study was conducted to investigate an outbreak of HAV infection, which occurred during a period of almost 5 months [January-May 1996] in the National Guard Iskan [Housing Authority] in Jeddah, Saudi Arabia. Ninety four cases were found to be positive for IgM antibody to HAV. A case control study was done to identify possible risk factors. For every case, 3 controls have been selected from the same household matched for age and sex. Information about reported cases was obtained by attending physicians through an interview questionnaire from adult cases and parents of young cases and controls [<12 y]. It included questions regarding symptoms, demographics and possible source of the infection. Results showed that the attack rate of the whole population was 1.03%, while that for children <10 years was twofold higher [2.05%] than the total population. The risk of acquiring infection among them was found to be five times that among those aged 40 years and higher [R.R=5.32]. There was a lack of association between developing hepatitis A and any of the food items or milk used in the studied area during the time of the outbreak. On the other hand exposure to irrigation water among cases was found to be significantly higher than among controls especially among children below 10 years [O.R=2.26]. Analysis of the available data suggests a strong association between illness and exposure to waste water used for irrigation of gardens through playing with it, or through occasional drinking especially among children below 10 years. The prolonged course of the outbreak [5 months] may be attributed to subsequent person to person transmission from index cases to intimate contacts especially among the same household

Blood lead and blood pressure in occupationally exposed workers

The association of increased blood lead concentration to elevated blood pressure was investigated in 184 male workers occupationally exposed to inorganic lead and in 51 non-exposed male workers matched for age as a control group. The study participants received complete medical examinations, including standard measurement of blood pressure and body weight. Occupational exposure to lead was detected by history taking and by measuring blood lead level, urinary delta aminolevulinic acid [delta-ALA] and hemoglobin level. Exposed workers had comparatively higher blood lead concentrations [46.08 +/- 6.54 microg/dl] than the control [26.29 +/- 5.47 microg/ dl] [P<0.001]. Similarly, urinary delta-ALA was higher than controls [P<0.001]. Both systolic and diastolic blood pressure [SBP, DBP] were higher among exposed than controls [P<0.001] for both and correlated positively with blood lead concentrations and urinary delta-ALA. The hemoglobin level was lower in the exposed group compared with the control group [P<0.01]. These data may support the existence of a causal association between higher blood lead concentrations and elevated blood pressure among occupationally exposed workers