prevalence of lupus anticoagulant in normal pregnancy and in women with recurrent fetal loss-recommendations for laboratory testing for lupus anticoagulant

There is wide disagreement in the literature on the rate of detection of lupus anticoagulant [LA] in women with recurrent fetal loss [RFL]. The aim of this study was to determine the prevalence of LA using four phospholipid-dependant coagulation tests in a large population of Saudi women. We determined the prevalence of LA in women with RFL [n=925], normal pregnancy [n=663], and in healthy blood donors [n=204], at the King Khalid University Hospital, Riyadh. The following coagulation tests were employed: the activated partial thromboplastin time [APTT], platelet neutralization procedure [PNP], kaolin clotting time [KCT] and the dilute Russel's viper venom test [dRVVT]. In RFL patients, positive APTT was 10.2%, APTT+PNP 3.6%, KCT 10.5%, and dRVVT 10.9%. In normal pregnancy, the corresponding figures were 12.8%, 3.1%, 10.8%, and 5.6%. Three positive tests occurred in 2.3% of RFL patients, including APTT+KCT 3.5%, APTT+dRVVT 3.9%, and KCT+dRVVT 4.1%. The corresponding figures for normal pregnancy were 1.6% for three positive tests, and 3.0%, 1.8%, 2.4%, respectively. The dRVVT was the only test that showed a rate of positive results almost double that seen in normal pregnancy. If only one or even two screening tests were performed, a significant number of LA positive cases would have been missed. This could make a difference to treating physicians as to the possible etiology and management of RFL. It is therefore advisable to routinely use the three tests [APTT, KCT and dRRVT] when screening for LA

Foods and food allergy: the prevalence of IgE antibodies specific for food allergens in Saudi patients

The intent of this study is to determine the prevalence and pattern of sensitivity to food allergens in Saudi patients. Subjects: The subjects included in this study were 58 patients with asthma, 47 patients with rhinitis and 112 patients with urticaria. They all gave clinical history suspecting food as causing or aggravating their symptoms. Specific IgE antibodies to different food allergens were measured in the patients serum by using the Pharmacia CAP Radioaller gosorbent [RAST] Fluoroimmunoassay [FEIA] test. IgE-antibodies specific for different foods were detected in 38 [17.5%] out of 217 patients. Most positive reactions were detected in urticaria patients [9-7%] followed by asthmatic patients [5.5%] and allergic rhinitis [2.3%]. Reactions to peanut [22.6%], egg white [14.5] and cow's milk [12.9%] were very prominent. The prevalence rate of food allergy seems to be high in Saudi patients when compared to studies from other regions. The pattern of food reactions, detected in this study, can be utilized in diagnosis of patients with suspected food allergy. Further studies will be required to obtain more information about the prevalence and incidence rates among different patient groups

Nickel sensitivity: a clinical and allergic study of 100 patients in Riyadh, Saudi Arabia

The aim of this study is to present some of the clinical and allergic features of nickel sensitivity in patients from the Riyadh area and to compare the data with similar studies from other regions. Out of 320 patients, 100 patients gave a positive patch test to nickel sulfate alone or in association with other allergens. These were included in this analysis. The patients were patch-tested with the European standard series which included nickel sulfate 5% in petrolatum. Of the 320 patients, 100 [31.3%] showed a positive reaction to nickel sulfate either alone [43=13.4%] or in association with other allergens [57=17.8%]. In the first group who reacted to nickel sulfate alone, there were 6 men and 27 women [ratio 1:6.2]. In the second group there were 17 men and 40 women [ratio 1:2.4]. Nickel appeared to be the most common cause of contact dermatitis in this region. This is in agreement with reports from other parts of the world. Women are more commonly affected with a tendency to show single sensitivities. We suggest that all patients with hand and foot dermatitis should be tested for nickel sensitivity. Since prevention is difficult, early diagnosis seems to be the only practical measure at the present time

Overwhelming respiratory failure associated with Legionella pneumophila

Four patients were admitted to the medical intensive care unit at King Khalid University Hospital [KKUH] with overwhelming respiratory failure. Extensive investigations revealed serological evidence of Legionella infection. Three patients required intubation and mechanical ventilation. All patients received erythromycin; rifampin was added to two patients. Two patients survived and two patients died. We report, for the first time in Saudi Arabia, four cases of Legionella pneumophila with severe respiratory failure