[Evaluation of the concentration of proinflammatory/Pro Th1 Cytokines IFN-gamma and TNF-alpha and anti inflammatory/Pro Th2 cytokines IL-13 and IL-4 in breast milk and their relationship to atopic dermatitis]

Atopic dermatitis [AD] is one of the most common chronic, highly pruritic and inflammatory skin diseases. The exclusive influence of breastfeeding in the prevention of inflammatory diseases is a matter of debate. In this study, we aimed to determine the concentration of interferon-gamma [IFN-gamma], tumor necrosis factor-alpha [TNF-alpha], interleukin-13 [IL-13] and interleukin-4 [IL-4] cytokines as anti Th2 or anti Th1 cytokines in breast milk and their relationship with atopic dermatitis in breastfed infants. This study carried out in Afzalipour Hospital of kerman during one year from 2010 to 2011, we selected 50 breastfed infants with AD as cases and 50 healthy infants without AD or any other allergic disease as the controls. The concentrations of pro- and anti-inflammatory cytokines were measured by ELISA in the mothers' milk. The demographic characteristics were recorded in a data collection form. Moreover, severity of the disease was determined by SCORAD index. T-test and logistic regression were used for assessment of the correlation among study variables. The concentrations of IFN-gamma and IL-13 were significantly higher [respectively, P=0.04, and P=0.02] in the case group. However, logistic regression revealed that only IFN-gamma significantly increased the risk for atopic dermatitis [P=0.02]. Concentration of TNF-alpha was similar in the milk from mothers belonging to the two groups. The results indicate that the concentrations of IFN-gamma, IL-13 and IL-4 cytokines are higher in the milk of mothers whose infants have AD. However, the risk for atopic dermatitis increases by 49% by every ten-unit [in pg/mL] increase in the level of IFN-gamma

Relationship between duration of breastfeeding and development of atopic dermatitis

Earlier studies on breastfeeding [BF] and atopy in infants have yielded contradictory results. To evaluate the relationship between duration of BF and developing of AD. Seven hundred fifty infants between 2 to 3 years old from kindergartens of Kerman, Iran were enrolled in this cross-sectional study. Data were obtained by questionnaires. Diagnosis of atopic dermatitis [AD] was made according to UK Working Party criteria. There was a significant association between duration of BF and the risk of AD [OR=0.93, 95% CI=0.90-0.96]. Early supplement feeding increased the risk of AD [OR=0.69, 95% CI=0.52-0.92]. The adjusted odds ratios of variables show that a positive family history of atopy, contact with smoke during pregnancy, suffering from asthma and rhinoconjunctivitis increased the risk of AD in infants. On the other hand, having elder siblings and taking oral contraceptive pills by mother decreased the risk of AD. Our results suggest that duration of BF has a protective effect against developing AD in infants. We recommend prolonged BF in all infants for protection against AD

Cutaneous manifestations of primary immunodeficiency diseases in children

Primary immunodeficiency diseases [PIDs] are rare but include severe conditions found predominantly in children, Most PIDs have cutaneous manifestations that may be important as early diagnostic features. The purpose of this study was to determine the frequency and nature of cutaneous alterations associated with PIDs. This article is a cross-sectional study at the department of allergy and clinical immunology of children's medical center conducted between December 5, 2001 and April 20, 2002. The subjects included pediatric patients with a diagnosis of PID and dermatological diagnoses were made by a dermatologist. Two hundred and ten patients were studied They consisted of 68 cases of humoral deficiency, 22 cases of cellular and combined deficiencies, 57 cases of phagocytic defects and 63 cases of other PIDs. In 67 cases [31.8%] the cutaneous alterations preceded and were the basis for clinical immunological diagnosis. Overall cutaneous alterations were infections in 99 cases and eczematous dermatitis in 27 cases. Our findings support the results of other studies that most PIDs have cutaneous features which being their typical aspects are highly suggestive for the diagnosis of PIDs

Mortality in primary immunodeficient patients, registered in Iranian primary immunodeficiency registry

Primary immunodeficiencies [PID] are a group of disorders, characterized by an unusual susceptibility to infections. Delay in diagnosis results in increased morbidity and mortality in affected patients. The purpose of this study was to determine the mortality rate of Iranian immunodeficient patients referred to Children Medical Center Hospital affiliated to Tehran University of Medical Sciences over a period of 20 years. In this study, records of 235 [146 males, 89 females] patients with immunodeficiency who were diagnosed and followed in our center, during 22 years period [1979 2001] were reviewed. The diagnosis of immunodeficiency was based on the standard criteria. The cause of death was determined by review of death certificates. Antibody deficiency was the most common diagnosis made in our patients. The overall five-year survival rate was 22.7% in our studied patient group; this was greatest in antibody deficiency. During the 22 year period of study, 32 patients died. As some of the patients could not be located, the true mortality rate ranged between 13.6% and 17.5%. The main leading cause of death were lower respiratory tract involvement in 14 cases [44%]. The most common pathogenic microorganisms causing fatal infections were psudomonas and staphylococcus in 9 cases [28.1%] followed by E. coli in 7 [21.9%], tuberculosis in 13 [40.6%] and salmonella in 1 [3.1%]. Based on our study, delay in diagnosis in patients with PID results in tissue and organ damage and several complications. Mortality and morbidity are increased in undiagnosed patients

Neutropenia in patients with primary antibody deficiency disorders

Neutropenia is characterized by decrease in the absolute number of circulating neutrophils and an increase susceptibility to infections. The current study was performed in order to explain the clinical and laboratory findings of patients with antibody deficiency disorders associated neutropenia. The patients' records of 19 neutropenic cases out of 207 patients with antibody deficiencies, who had been referred to Children's Medical Center and enrolled in Iranian primary immunodeficiency registry, were reviewed. Nineteen cases [14 male and 5 female], with a mean age of 10.7 +/- 5.7 years, were associated with neutropenia [9.2%]. The disorders with associated neutropenia were Hyper IgM syndromes [3 of 8], Common variable immunodeficiency [13 of 109], and X-linked agammaglobulinemia [3 of 45]. The median age for the onset of disease and diagnosis age were 15 months [1-134] and 3.8 years [6 months-13 years], respectively. The most common infections during the course of illness were pneumonia [13 cases], diarrhea [12 cases], oral candidiasis [9 cases], otitis media [6 cases], sinusitis [6 cases], cutaneous infections [5 cases], and abscess [5 cases]. Other less frequent infections were: conjunctivitis, oral ulcers, meningitis, and osteomyelitis. Three neutropenic patients died because of recurrent infections. Neutropenia may occur in any of the primary immunodeficiency disorders. Persistent or severe infections always pose a supposition, which deserves further evaluation for detecting an underlying immune deficiency syndrome and neutropenia, since a delay in diagnosis may result in a serious organ damage or even death of the patient

Gastrointestinal manifestations of patients with Chronic Granulomatous Disease

Chronic Granulomatous Disease [CGD] represents a group of inherited disorders of phagocytic system, manifesting recurrent infections at different sites. The present study was accomplished in order to determine the gastrointestinal manifestations of CGD patients. Fifty-seven patients [38 males and 19 females] with CGD, who had been referred to three immunodeficiency referral centers in Iran, were studied during a 24-year period [1980-2004]. The median age at the time of study was 14.5 years old [1-56 years]. The median onset age of symptoms was 5 months [1 month - 13.75 years], and that of diagnostic age was 5 years [2 months- 54.1 years], with a diagnostic delay of 33 months, on average. Seven patients were presented with acute diarrhea, 3 with oral candidiasis, and 2 with liver abscesses as the first chief complaints. Twenty-four cases [42.1%] had been complicated by gastrointestinal manifestations during their course of the disease. Of those, 12 cases [21.1%] had diarrhea, 7 [12.3%] oral candidiasis, 5 [8.8%] hepatitis, 4 [7.0%] hepatic abscess, and 2 cases [3.5%] gastric outlet obstruction. Also, failure to thrive was detected in 6 patients [10.5%]. Four patients died [7%]. CGD should be excluded in any patient with gastrointestinal manifestations especially chronic diarrhea, hepatic abscess, and gastric outlet obstruction