ABSTRACT
BACKGROUND: Women have an increased prevalence of severe asthma compared with men. IL-17A is associated with severe asthma and requires IL-23 receptor (IL-23R) signaling, which is negatively regulated by let-7f microRNA. OBJECTIVE: We sought to Determine the mechanism by which 17ß-estradiol (E2) and progesterone (P4) increase IL-17A production. METHODS: IL-17A production was determined by using flow cytometry in TH17 cells from women (n = 14) and men (n = 15) with severe asthma. Cytokine levels were measured by using ELISA, and IL-23R and let-7f expression was measured by using quantitative PCR in TH17-differentiated cells from healthy women (n = 13) and men (n = 14). In sham-operated or ovariectomized female mice, 17ß-E2, P4, 17ß-E2+P4, or vehicle pellets were administered for 3 weeks before ex vivo TH17 cell differentiation. Airway neutrophil infiltration and CXCL1 (KC) expression were also determined in ovalbumin (OVA)-challenged wild-type female recipient mice with an adoptive transfer of OVA-specific TH17 cells from female and male mice. RESULTS: In patients with severe asthma and healthy control subjects, IL-17A production was increased in TH17 cells from women compared with men. IL-23R expression was increased and let-7f expression was decreased in TH17-differentiated cells from women compared with men. In ovariectomized mice IL-17A and IL-23R expression was increased and Let-7f expression was decreased in TH17 cells from mice administered 17ß-E2+P4 compared with those administered vehicle. Furthermore, transfer of female OVA-specific TH17 cells increased acute neutrophil infiltration in the lungs of OVA-challenged recipient mice compared with transfer of male OVA-specific TH17 cells. CONCLUSIONS: 17ß-E2+P4 increased IL-17A production from TH17 cells, providing a potential mechanism for the increased prevalence of severe asthma in women compared with men.
Subject(s)
Asthma/immunology , Estrogens/immunology , Gene Expression Regulation/immunology , Interleukin-17/immunology , Interleukin-23/immunology , MicroRNAs/immunology , Progesterone/immunology , Receptors, Interleukin/immunology , Signal Transduction/immunology , Th17 Cells/immunology , Adolescent , Adult , Animals , Asthma/pathology , Female , Humans , Male , Mice , Middle Aged , Th17 Cells/pathologySubject(s)
Anti-Asthmatic Agents/therapeutic use , Asthma/drug therapy , Exhalation/physiology , Forced Expiratory Volume/physiology , Nitric Oxide/analysis , Adolescent , Black or African American , Breath Tests , Child , Child, Preschool , Disease Progression , Emergency Medical Services , Female , Humans , Male , White PeopleSubject(s)
Asthma/diagnosis , Asthma/metabolism , Nitric Oxide/metabolism , Adolescent , Asthma/epidemiology , Asthma/physiopathology , Biomarkers/metabolism , Breath Tests , Child , Child, Preschool , Female , Forced Expiratory Volume , Humans , Male , Prospective Studies , Severity of Illness IndexABSTRACT
OBJECTIVES: After completing this article, readers should be able to: 1. List the etiologic agents that commonly cause urticaria, angioedema, and anaphylaxis. 2. Recognize the signs and symptoms of anaphylaxis and be able to deliver rapid,effective treatment for anaphylaxis. 3. Distinguish between acute and chronic urticaria, and recognize the differences in their evaluation and treatment. 4. List the causes of papular urticaria. 5. Discuss the acute management of stinging insect anaphylaxis.
Subject(s)
Anaphylaxis/diagnosis , Angioedema/diagnosis , Urticaria/diagnosis , Anaphylaxis/drug therapy , Anaphylaxis/etiology , Angioedema/drug therapy , Angioedema/etiology , Humans , Urticaria/drug therapy , Urticaria/etiologyABSTRACT
Systemic loxoscelism is a constitutional illness resulting from the bite of the brown recluse spider. In severe form, it may cause hemolysis, acute renal failure, and disseminated intravascular coagulation. More rarely, it may result in death. We report an unusual case of systemic loxoscelism resulting in death less than one day following envenomation. We also discuss screening algorithms and contemporary management of systemic loxoscelism.
Subject(s)
Brown Recluse Spider , Spider Bites/diagnosis , Child, Preschool , Emergency Service, Hospital , Fatal Outcome , Female , Humans , Spider Bites/therapy , TennesseeABSTRACT
BACKGROUND: Kawasaki disease (KD) is an acute multisystem vasculitis of unknown etiology that typically affects young children. KD presenting as a retropharyngeal inflammatory process is very rare. OBJECTIVES: To report a case of KD initially presenting as a retropharyngeal edema mimicking a deep neck infection, and to review previously published reports in the literature. CASE REPORT: We report a case of KD in a previously healthy 3-year-old child who presented with acute onset of fever and cervical adenitis, along with computed tomography scan findings of retropharyngeal edema and inflammation. KD was suspected due to persistent fever and no improvement in the patient's condition despite appropriate antibiotic therapy; and other classic findings of KD eventually developed. An echocardiogram obtained on the 10th day of illness revealed pericardial effusion but no coronary ectasia or aneurysm. Treatment with high-dose intravenous immunoglobulin resulted in dramatic clinical improvement. Follow-up echocardiograms obtained 2 and 8 weeks after discharge revealed a small left coronary artery aneurysm (CAA). Nine months later, the CAA had resolved and the patient was well with no sequelae. CONCLUSIONS: Although unusual, physicians should be aware of retropharyngeal edema as an atypical presentation of KD.
