Comparison between sensitivity of autologous skin serum test and autologous plasma skin test in patients with chronic idiopathic urticaria for detection of antibody against IgE or IgE receptor [FcepsilonRIalpha]

Intradermal injection of autologous serum and plasma elicit a cutaneous reactivity in almost 45-60% of patients with Chronic Idiopathic Urticaria [CIU]. This reactivity is associated with the presence of auto antibodies against IgE or IgE receptors. This study was carried out to compare the cutaneous reactivity of autologous serum and plasma skin tests in a series of patients with CIU for diagnosis of auto antibodies against IgE or IgE receptor. Fifty eight patients with CIU were injected intradermally with autologous serum and plasma [anticoagulated by citrate]. Histamine was used as positive control and normal saline as negative control. The study group was checked by routine laboratory tests [CBC, U/A etc], allergens with skin prick tests, and serum IgE level, and auto antibodies against thyroid as well. Duration of urticaria was another factor which was assessed. There was no significant difference between positive ASST and positive APST patients for the above mentioned tests. 77.6% of the patients were Positive for APST and 65.5% were ASST positive. Duration of urticaria was longer in patients with positive ASST and APST than ASST and APST negative patients, although the difference was not statistically significant. Autologous serum skin test [ASST] and autologous plasma skin test [APST] could be used for estimation of duration and severity of urticaria and planning for the treatment

Autoantibodies to the high-affinity IgE receptor in patients with asthma.

Autoimmune diseases have been implicated as a cause of intrinsic asthma; however, there is little data on the role of autoimmunity in the pathogenesis of asthma. The purpose of this study was to investigate circulating autoantibodies against the high-affinity IgE receptor Fc(epsilon)RI in patients with asthma. Seventy-eight patients with asthma and 32 healthy individuals as control subjects were included. All subjects were tested with basophil histamine releasing assay and immunoblotting to assess for the potential presence of receptor Fc(epsilon)RI autoantibodies. Of the 78 asthma patients total subjects, 25 (32.1%) had a positive by basophil histamine releasing assay and 23 (29.5%) by immunoblotting. Both of them were significant higher than the positive rate, 9.4% (p < 0.05) and 9.4% (p < 0.05), respectively. Our data demonstrated that aberrant autoantibodies against the high-affinity IgE receptor Fc(epsilon)RI were found in some patients with asthma implies that the autoimmunity may be one factor in intrinsic asthma pathogenesis.

Anaphylaxis: an analysis of cases evaluated at the Puerto Rico Medical Center over a ten-year period

OBJECTIVE: To examine the clinical characteristics of patients with anaphylactic reactions evaluated at the Puerto Rico Medical Center over a ten year period. BACKGROUND: Anaphylaxis, an immunologic reaction classically initiated by the combination of an antigen and a mast cell fixed antibody (usually IgE), still carries a fatality rate of 500 to 1000 cases per year in the United States. It constitutes a medical emergency that needs to be identified promptly in order to install appropriate treatment. No studies of this condition have been conducted in Puerto Rico, specifically to assess the clinical presentation, main causes and outcome. METHODS: Eighty-three records of patients with a diagnosis of anaphylaxis were screened by retrospective and concurrent analysis. Of these, only 51 fulfilled the diagnostic criteria of anaphylaxis. Specific data gathered from those records assessed the clinical characteristics of each case, precipitating factors, severity of the reaction and outcome. A standard form was used for data gathering. A grading system was utilized to classify the severity of the clinical episodes. RESULTS: Cutaneous features were the most commonly found manifestations of anaphylactic reactions in the studied group. Only reactions graded 2 and 3 were identified. Reactions to medications were the most frequent identifiable causes of the entity. Multiple sensitivities to different allergens were not predictive of this clinical condition. CONCLUSIONS: The identification in this study that only cases with the more severe grades of anaphylaxis were evaluated and treated at our center, the inability to recognize an inciting cause in about one third of the patient sample and the fact that a minority of the treated patients received subsequent follow-up by an allergist, reflect the need to promote the training of physicians in the field of allergy in Puerto Rico and the continued education of all physicians in the Island regarding this clinical disorder.

Increased circulating Fe[epsilon] RII-bearing b-lymphocytes and serum levels of IL-4 in non - autoreactive chronic idiopathic urticaria

The exact pathophysiology of chronic idiopathic urticaria [CIU] is not well understood. The concept of autoreactivity has evolved to explain the disease in up to 50% of cases, while the search for other mechanisms is still needed to explain the disease, at least among the remaining subpopulation of non-autoreactive CIU. Therefore, we thought to investigate some aspects of the IgE-dependent, lymphocyte-mediated late-phase response [LPR] of anaphylaxis. We searched for percentages of Fc[epsilon]RII-bearing [CD23[+]] B and T lymphocytes and correlated this with total IgE serum levels, IL-4 serum levels and the disease severity scores. Twenty-five patients with non-autoreactive CIU and ten healthy control subjects participated in this study. CD23[+] B- and T-cells were assessed by flow cytometry, total IgE serum levels were estimated by enzyme linked fluorescent assay [ELFA], IL-4 serum levels were estimated by Enzyme Amplified Sensitivity Immunoassay [EASIA], while disease severity was determined by a daily self-assessment urticaria activity and itching score. Our results showed that the mean values for percentages of CD23[+] B-cells [6.7 +/- 2.3%], total IgE serum levels [139.6 +/- 103.9 micro g/dl] and IL-4 serum levels [18.3 +/- 14.7ng/ml] for patients were statistically significant [p=0.002, 0.013 and 0.008, respectively], when compared with the corresponding values for controls [4.0 +/- 1.7%, 51.5 +/- 25.1 micro g/dl, and 5.1 +/- 4.1ng/ml, respectively], while the difference between the mean percentage of CD23[+] T-cells for patients [2.8 +/- 2%] and that for controls [2.1 +/- 0.6%] was nonsignificant [p=0.267]. Strong positive correlations were detected between percentages of CD23[+] B-cells and severity scores [r= 0.678, p= 0.0001], total IgE serum levels [r= 0.756, p= 0.0001] and IL-4 serum levels [r= 0.709, p= 0.0001], while no correlation was detected between CD23[+] B-cells and CD23[+]T-cells [r= 0.188, p= 0.368]. It is concluded, that CD23[+] B-cells, regulated by IL-4, may contribute in the pathogenesis of non-autoreactive CIU, by producing high levels of IgE and possibly lymphokines, while CD23[+] T-cells may be involved in early antigen recognition. This may have a future therapeutic ramification in this distinct subset of CIU by targeting low-affinity IgE receptors

Tabaquismo: alteraciones producidas por el uretano en los receptores de macrófagos y el sistema del complemento / Smoking: alterations by urethano in macrophages, complement system

Se comunican los resultados de un análisis de la acción del uretano sobre las células inmunocompetentes (macrófagos), el sistema del complemento y también en los enterocitos. El estudio de los receptores de macrófagos por medio de la formación de rosetas puso de manifiesto que concentraciones altas de uretano destruyen a los macrófagos y disminuyen la unión con IgG y el tercer componente del complemento. Los resultados obtenidos experimentalmente in vitro sugieren que de acuerdo con el grado y tiempo de la exposición al humo de tabaco se puede romper el equilibrio del sistema inmunitario y de otras poblaciones celulares que desembocan en los procesos patológicos que se relacionan con tabaquismo