Primary Immunodeficiency: Specific antibody deficiency with normal IgG.

Specific antibody deficiency (SAD) is a common primary immunodeficiency disorder that should be considered in older children and adults with recurrent and/or severe sinopulmonary infections. The diagnosis is characterized by inadequate antibody response to polysaccharide vaccine, specifically, pneumococcal, with normal responses to protein antigens and normal levels of serum immunoglobulins as well as immunoglobulin G (IgG) subclasses. The underlying mechanism for SAD is not completely elucidated. It is understood that young children have limited polysaccharide responsiveness, which develops with increased age. Due to this phenomenon, the consensus is that there is adequate immune maturity after age 2 years, which is the earliest for the SAD diagnosis to be established. There remains a lack of consensus on thresholds for polysaccharide nonresponse, and there are several commercial laboratories that measure a range of serotypes, with the recommendation for patients to have their diagnostic evaluation with serotype testing both before vaccination and after vaccination to be conducted by the same laboratory. Once a diagnosis has been made, the management of SAD is based on the clinical severity. Clinicians may consider prophylactic antibiotics as well as immunoglobulin replacement. These patients should be closely followed up, with the possibility of discontinuation of IgG replacement after 12 to 24 months. Children are more likely to demonstrate resolution of SAD than are adolescents and adults. Patients with SAD may also progress to a more severe immunodeficiency; therefore, continued monitoring remains a crucial principle of practice in the care of patients with SAD.

Delayed Pressure Urticaria Associated With Altitude Chamber Training Responsive to Cyclosporine and Omalizumab.

Delayed pressure urticaria (DPU) is a subset of chronic inducible urticaria. It is characterized by the formation of wheals anytime between 30 minutes and 24 hours after stimulus exposure of localized pressure application. In this case report, we discuss a military flight crew member with no significant past medical history who developed DPU following rapid decompression in an altitude chamber. The chamber training included an uneventful ascent to 45,000 feet, higher than he had been previously, and a rapid decompression. About 16 hours later, he developed pruritic swelling of his hands and feet, along with diffuse deep nodular swelling, erythematous plaques, and erythematous nodules. His DPU was refractory to monotherapy treatment with antihistamines, and he continued to develop lesions in weight-bearing areas. Control of symptoms was achieved through combination treatment of a second-generation antihistamine, a leukotriene receptor antagonist, and an immunosuppressant (cyclosporine). His waiver to return to flight status was denied while on cyclosporine. He was transitioned to a monoclonal antibody that binds free immunoglobin E (omalizumab) with resolution of symptoms and was cleared to return to active duty.

Neural activity in catecholaminergic populations following sexual and aggressive interactions in the brown anole, Anolis sagrei.

Social behaviors in vertebrates are modulated by catecholamine (CA; dopamine, norepinephrine, epinephrine) release within the social behavior neural network. Few studies have examined activity across CA populations in relation to social behaviors. The involvement of CAs in social behavior regulation is especially underexplored in reptiles, relative to other amniotes. In this study, we mapped CA populations throughout the brain (excluding retina and olfactory bulb) of the male brown anole lizard, Anolis sagrei, via immunofluorescent visualization of the rate-limiting enzyme for CA synthesis, tyrosine hydroxylase (TH). Colocalization of TH with the immediate early gene product Fos, an indirect marker of neural activity, also enabled us to relate activity in TH-immunoreactive (TH-ir) neurons to appetitive and consummatory sexual and aggressive behaviors. We detected most major TH-ir cell populations that are present in other amniotes (within the hypothalamus, midbrain, and hindbrain), although the A15 population was entirely absent. We also detected a few novel or rare cell clusters within the amygdala, medial septum, and inferior raphe. Many CA populations, especially dopaminergic groups, showed increased TH-Fos colocalization in association with appetitive and consummatory sexual behavior expression, while a small number of regions showed increased colocalization in relation to solely consummatory aggression (biting of an opponent). In conclusion, we here map CA populations throughout the brown anole brain and demonstrate evidence for catecholaminergic involvement in appetitive and consummatory sexual behaviors and consummatory aggressive behaviors in this species.

Aggression- and sex-induced neural activity across vasotocin populations in the brown anole.

Activity within the social behavior neural network is modulated by the neuropeptide arginine vasotocin (AVT) and its mammalian homologue arginine vasopressin (AVP). However, central AVT/AVP release causes different behavioral effects across species and social environments. These differences may be due to the activation of different neuronal AVT/AVP populations or to similar activity patterns causing different behavioral outputs. We examined neural activity (assessed as Fos induction) within AVT neurons in male brown anole lizards (Anolis sagrei) participating in aggressive or sexual encounters. Lizards possess simple amniote nervous systems, and their examination provides a comparative framework to complement avian and mammalian studies. In accordance with findings in other species, AVT neurons in the anole paraventricular nucleus (PVN) were activated during aggressive encounters; but unlike in other species, a positive correlation was found between aggression levels and activation. Activation of AVT neurons within the supraoptic nucleus (SON) occurred nonspecifically with participation in either aggressive or sexual encounters. Activation of AVT neurons in the preoptic area (POA) and bed nucleus of the stria terminalis (BNST) was associated with engagement in sexual behaviors. The above findings are congruent with neural activation patterns observed in other species, even when the behavioral outputs (i.e., aggression level) differed. However, aggressive encounters also increased activation of AVT neurons in the BNST, which is incongruous with findings in other species. Thus, some species differences involve the encoding of social stimuli as different neural activation patterns within the AVT/AVP network, whereas other behavioral differences arise downstream of this system.