ABSTRACT
BACKGROUND: Environmental fungi have been linked to TH2 cell-related airway inflammation and the TH2-associated chronic airway diseases asthma, chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), and allergic fungal rhinosinusitis (AFRS), but whether these organisms participate directly or indirectly in disease pathology remains unknown. OBJECTIVE: To determine the frequency of fungus isolation and fungus-specific immunity in patients with TH2-associated and non-TH2-associated airway disease. METHODS: Sinus lavage fluid and blood were collected from sinus surgery patients (n = 118) including patients with CRSwNP, patients with CRS without nasal polyps, patients with AFRS, and non-CRS/nonasthmatic control patients. Asthma status was determined from medical history. Sinus lavage fluids were cultured and directly examined for evidence of viable fungi. PBMCs were restimulated with fungal antigens in an enzyme-linked immunocell spot assay to determine total memory fungus-specific IL-4-secreting cells. These data were compared with fungus-specific IgE levels measured from plasma by ELISA. RESULTS: Filamentous fungi were significantly more commonly cultured in patients with TH2-associated airway disease (asthma, CRSwNP, or AFRS: n = 68) than in control patients with non-TH2-associated disease (n = 31): 74% vs 16%, respectively (P < .001). Both fungus-specific IL-4 enzyme-linked immunocell spot (n = 48) and specific IgE (n = 70) data correlated with TH2-associated diseases (sensitivity 73% and specificity 100% vs 50% and 77%, respectively). CONCLUSIONS: The frequent isolation of fungi growing directly within the airways accompanied by specific immunity to these organisms only in patients with TH2-associated chronic airway diseases suggests that fungi participate directly in the pathogenesis of these conditions. Efforts to eradicate airway fungi from the airways should be considered in selected patients.
Subject(s)
Antibodies, Fungal/biosynthesis , Asthma/microbiology , Mycoses/microbiology , Nasal Polyps/microbiology , Rhinitis/microbiology , Sinusitis/microbiology , Th2 Cells/immunology , Adult , Antigens, Fungal/immunology , Aspergillus/immunology , Asthma/complications , Asthma/immunology , Asthma/pathology , Case-Control Studies , Cells, Cultured , Chronic Disease , Female , Humans , Immunoglobulin E/blood , Inflammation/complications , Inflammation/immunology , Inflammation/microbiology , Inflammation/pathology , Interleukin-4/metabolism , Leukocytes, Mononuclear , Male , Middle Aged , Mycoses/complications , Mycoses/immunology , Mycoses/pathology , Nasal Polyps/complications , Nasal Polyps/immunology , Nasal Polyps/pathology , Rhinitis/complications , Rhinitis/immunology , Rhinitis/pathology , Sinusitis/complications , Sinusitis/immunology , Sinusitis/pathology , Th2 Cells/microbiology , Th2 Cells/pathology , Therapeutic IrrigationSubject(s)
Milk Hypersensitivity/diagnosis , Milk/adverse effects , Adult , Animals , Child, Preschool , Female , Fetal Growth Retardation , Goats , Humans , Infant, Newborn , Maternal-Fetal Exchange , Pregnancy , SheepABSTRACT
Echinacea, believed by herbal practitioners to enhance the immune system, is one of the most widely used herbal supplements in the United States. Like most herbal products, it lacks strict FDA regulation and more information is needed about its potential adverse reactions. Here, we report the case of a patient with eosinophilia of unclear etiology whose condition resolved after cessation of this supplement. We feel this likely represents an IgE-mediated allergic process to echinacea.
Subject(s)
Drug Hypersensitivity/etiology , Echinacea/adverse effects , Hypereosinophilic Syndrome/chemically induced , Phytotherapy/adverse effects , Plant Preparations/adverse effects , Humans , Male , Middle AgedABSTRACT
Hereditary angioedema (HAE) is a rare and potentially fatal disease that is important to recognize early. It is usually associated with low levels or impaired function of C1 inhibitor, which is involved in several inflammatory pathways. The treatment of HAE is very different from other causes of angioedema, emphasizing the importance of early and accurate diagnosis. The authors report the case of a patient who had symptoms starting in his teens but was not diagnosed until the age of 57 years. They also review the consequences of delayed diagnosis of HAE.
Subject(s)
Angioedemas, Hereditary/diagnosis , Delayed Diagnosis , Angioedemas, Hereditary/drug therapy , Complement C1 Inhibitor Protein/analysis , Danazol/therapeutic use , Estrogen Antagonists/therapeutic use , Humans , Male , Middle AgedABSTRACT
Psoriasis rebound after efalizumab discontinuation is well-documented in the literature. We report the case of a patient who experienced psoriasis rebound 2 months after efalizumab discontinuation, despite being on more than 5 mg/kg/day of cyclosporine. This case illustrates an instance where high doses of a very efficacious antipsoriasis therapy were not sufficient to prevent efalizumab-associated rebound. In addition to describing this case, we also propose a theoretical mechanism to explain how rebound after efalizumab discontinuation comes about.
