'Entopy': local allergy paradigm.

Allergy is defined as an immediate hypersensitivity type I immunological disease, which can be IgE or non-IgE driven, and in the latter case may be antibody or cell mediated. Atopy is a term used to describe individuals with a genetic predisposition for developing IgE-mediated allergic disease. But more recently, it has become evident that IgE-mediated disease can occur in non-atopic subjects. While it is now generally accepted that mucosal local IgE has a role in the expression of atopic allergic disease, the concept of 'local allergy' in non-atopic subjects has been proposed, with the term 'entopy' given to this condition. Although there is increasing evidence supporting this paradigm, entopy is only applicable to a proportion of non-atopic patients, suggesting that other disease mechanisms exist to explain non-atopic disease. This review considers the evidence for local mucosal allergy in atopic and non-atopic individuals with an emphasis on diseases affecting the upper airways and eye. Furthermore, the diagnosis, treatment and relationship between local allergy and conventional (systemic) allergy are discussed, and alternative disease mechanisms predominantly involving antibodies or their sub-components (free light chain Igs) are postulated to explain the 'entopy' paradigm. This review is intended to provide an improved understanding of the mechanisms and causes of local mucosal hypersensitivity.

Sarcoidosis: unusual cause of a rectal mass.

We have reported the case of a patient who had a rectal mass 3 years after the diagnosis of sarcoidosis. A malignancy was suspected, but biopsy of the rectal mass showed epithelioid granulomas with giant cells, consistent with sarcoidosis. Therefore, sarcoidosis should be considered as a rare cause of a rectal mass.

Complement factor I deficiency with recurrent aseptic meningitis.

Patients with deficiency of the complement regulatory protein factor I typically present with systemic pyogenic bacterial infections, including meningitis. We report a novel case with total deficiency of factor I in serum and plasma; the patient experienced nine consecutive episodes of aseptic meningitis within a 2-year period. There was no history of previous bacterial sepsis. Aseptic meningitis recurred despite attempted penicillin prophylaxis. Each episode resolved rapidly without sequelae, with or without antibiotic treatment. Serum complement profiles showed persistently low levels of C3, factor B, and factor H and undetectable factor I protein. Family complement studies could not be performed. Except for a minimally increased titer of antinuclear antibody, no other immunologic abnormality was detected. Results of an oral ibuprofen challenge were negative. We conclude that deficiency of factor I may predispose to aseptic, as well as pyogenic bacterial, meningitis.

Repeated inhalation of nebulized albuterol did not induce arrhythmias in a patient with Wolff-Parkinson-White syndrome and asthma.

It has been assumed that in asthmatic patients with Wolff-Parkinson-White (WPW) syndrome, ablative therapy for the condition is necessary for the safe treatment of the asthma with beta 2-adrenergic drugs. The following case report illustrates that inhaled albuterol was safely administered to an asthmatic patient with electrocardiographic evidence of preexcitation, without the need of an ablative procedure. This case report is, to our knowledge, the first in the literature in which the cardiac rhythm of a patient with WPW syndrome was monitored during repeated inhalations of a beta 2-agonist.

Association of cigarette smoking with elevated serum IgE levels in Hispanic Puerto Rican men.

Unexplained elevation of serum IgE concentrations occurs in cigarette-smoking Caucasian males from temperate zones. To determine whether race or geography might be factors, we measured serum IgE concentrations in 94 Puerto Rican Hispanic patients, including smokers and nonsmokers. Mean serum IgE levels were elevated in our total patient population compared with Caucasian Americans. Geometric mean IgE was significantly increased in total smokers (157 IU/mL) compared with nonsmokers (78 IU/mL) and in male smokers greater than age 55 years (335 IU/mL) compared with male nonsmokers (41 IU/mL). Serum IgE was not significantly increased in female smokers. Among patients older than 55 years, persistent elevation of serum IgE occurred in male smokers. Our findings in a Puerto Rican Hispanic population are similar to those in studies of Caucasian smokers in temperate zones.