Subcutaneous and sublingual immunotherapy versus conventional therapy in atopic dermatitis

Subcutaneous immunotherapy [SCIT] has been shown to improve eczema in patients with atopic dermatitis [AD]. Recently, a sublingual route with a more satisfactory safety profile has emerged, as an effective alternative to SCIT. To date, there are only a few studies regarding the efficacy and safety of sublingual immunotherapy [SLIT] in patients with AD. The aim of the study was to compare the clinical efficacy of SCIT and SLIT in patients with AD, as compared to conventional therapy. In addition, the efficacy of SLIT using food allergens was assessed. This study was conducted on 60 AD patients with a positive skin prick test [SPT] reaction to inhalant allergens. Immunotherapy using inhalant allergens was given subcutaneously in 20 patients [group A], and sublingually in 20 patients [group B]. In group B, patients who also showed a positive SPT reaction to a food allergen received additional SLIT using that food allergen. 20 patients received conventional therapy only for AD [group C]. All groups received therapy for six months. We assessed the following outcomes: severity of atopic dermatitis by SCOR.AD, SPT reactivity, and total serum IgE levels at baseline, and after 6 months of therapy. After 6 months, the mean SCORAD decreased significantly in all 3 groups. Both immunotherapy groups showed a comparable percent of change in SCORAD, which was significantly higher than in group C. A marked reduction in the use of topical corticosteroids and oral antthistamines was detected among groups A and B. A negativization of skin tests, as well as a decreased reactivity to inhalant allergens occurred almost only among groups A and B. 58% of patients in group B, who were given SLIT for food allergens showed a negativization or a decreased reactivity of SPT reactions to food allergens. A substantially higher proportion of patients receiving SCIT reported side effects as compared to those receiving SLIT, Total serum IgE levels did not change significantly among any of the 3 groups. Both SCIT and SLIT are effective in AD, but the ease of administration and the lower incidence of side effects with SLIT encourage its use. SLIT with food allergens was effective in a substantial proportion of patients, and its clinical usefulness deserves additional studies

Transferrin and the prediction of spontaneous bacterial peritonitis

Patients with advanced liver disease are particularly susceptible to spontaneous bacterial peritonitis [SBP]. Pathogenic micro-organisms could survive and become more virulent in the presence of free iron. Thus, iron binding proteins provide protection against these organisms. The present study was conducted to evaluate the role of determining transferrin levels in serum and ascitic fluid, as well as its serum: ascitic fluid ratio [mg/mg] in differentiating between SBP and SA [sterile ascites] in cirrhotic patients. Moreover, the role of the ratio between ascitic fluid transferrin: ascitic fluid total protein [mg/g], as a marker for SBP was tested. Our study included 50 patients. Twenty five patients had SBP [according to Runyon's and Hoefs criteria] while the other 25 patients had SA. Our results revealed that patients with advanced liver impairment had higher susceptibility for SBP than SA. They had significantly higher serum total bilirubin [p<0.001] and significantly lower serum albumin and transferrmn [p<0.001, respectively]. More over, SBP group had significant prolongation of the prothrombin time [p<0.001]. Ascitic fluid aspirated from the SBP patients showed significantly lower transferrin and total protein values [p<0.05 and <0.001, respectively]. Serum: ascitic fluid transferrin ratio [mg/mg] was significantly lower in patients with SBP [p<0.001]. The best cut off level giving the highest diagnostic sensitivity and specificity was 3.5 yet, at this level poor diagnostic sensitivity and specificity in differentiating between the two clinical conditions [76% and 28%, respectively] was found. Ascitic fluid transferrin: ascitic fluid total protein ratio [mg/g] was significantly higher in patients with SBP [p<0.001] and had a diagnostic sensitivity and specificity of 100%, respectively in differentiating between both clinical conditions at a cut-off level of 22.26. Patients with advanced liver disease are more liable for the occurrence of SBP than SA. Ascitic fluid transferrin: ascitic fluid total protein ratio, at a cut-off level of 22.26, can differentiate between the two clinical conditions with a diagnostic sensitivity and specificity of 100%, respectively

role of 99m Tc-sulphur colloid in detecting the relationship between hepatic kupffer cells dysfunction and intrinsic asthma

This study was carried out at both Departments of Medicine and Radiotherapy and Nuclear Medicine Ain Shams University Hospitals between January, 1992 and February 1993. It included 2 groups. The first group consisted of 20 patients having criteria suggestive of intrinsic asthma [6 males and 14 females], their ages varied between [31 and 55 years]. The second group [controls] consisted of 20 volunteers who were not complaining of any allergic manifestations. The study showed that there was a positive correlation between total half life of plasma clearance of 99mTc-sulphur colloid and Forced expiratory volume in one second [FEVl] among intrinsic asthmatic patients but there was no significant difference between intrinsic asthmatic patients and control group as regard total half life of plasma clearance of 99mTc-sulphur colloid denoting that hepatic macrophages Kupffer cells are functionally active in the intrinsic asthmatic patients