[Safety and efficacy of treatment for severe atopic dermatitis with cyclosporin A and transfer factor]. / Seguridad y eficacia en el tratamiento de la dermatitis atópica severa con ciclosporina A y factor de transferencia.

BACKGROUND: The atopic dermatitis is a chronic skin disease that appears in patients with a personal or family history of allergic asthma and rhinitis. It is associated to the specific activation of a gene group. In most instances, the response to the conventional treatment is adequate. The are cases, though, know as refractory, where that is not the case. The study of two therapeutic alternatives, Transfer Factor (TF) and Cyclosporin A (CyA), was elaborated for this type of patients. MATERIAL AND METHODS: Patients with severe refractory AD were studied, being admitted to the Allergic Service to the ISSSTE Lic. Adolfo López Mateos, ISSSTE, between September 1997 and june 1998. They were randomly divided in two groups. The first one was subjected to CyA, on a 4 mg/kg/day dosage, with monthly surveillance of kidney and hepatic functions and blood pressure twice a week. Group two was subjected to TF, as follows: one unit every third day for the first week, two units per week for the next three weeks and one monthly unit to complete six months. Initial and final clinical and immunologic testing was performed on both groups (eosinophils, total IgE, CD4 and CD8). RESULTS: Six patients included group A, and 12 patients in group B. Both groups showed a significant statistic reduction in the total eosinophils count, without an statistic difference between them. None showed changes in the total IgE. CyA reduced the CD4 levels, while the TF increased the levels of CD8 cells, both with a p < 0.05. Both groups showed clinical improvement satistically significant, but no differences with a p > 0.05 appeared between them. Tolerance to the treatments was adequate, and there was not need to suspend the treatment in any case. Only three patients showed hypertricosis and other one presented headaches, with CyA. CONCLUSION: Both treatments showed therapeutic benefits in the treatment of patients with severe refractory AD, with similar immunologic improvement. Both drugs present different action mechanisms, so their joint application could offer clinical benefit to the patient (synergetic action), cost reduction, and long term treatments with reduced adverse effects.

[Transference factor in moderate and severe atopic dermatitis]. / Factor de transferencia en dermatitis atópica moderada y severa.

We did a prospective, comparative, experimental study with 30 patients with moderate to severe atopic dermatitis from the allergy section from September 1994 to March, 1995. The test laboratory examination was performed in all patients: complete blood cell count, immunoglobulins A, G, M and E determination, lymphocyte subpopulations CD3, CD4, CD8, CD4-CD8 proportion, CD25, rosette formation for B and T lymphocytes, coproparasitoscopic examination, throat and nose cultures, nasal cytology, skin tests of cellular immunity to PPD, thrichophytin, candidine, varidasa; skin prick test to poliens, fungi, inhalants and foods. All patients underwent to a sign and symptom grading score system as follows: the parameters were erythema, pruritus, eczema, papule valorated on a scale from 0 a 4+( O = no symptoms, + = mild, ++ = moderate, + ++= severe, ++ ++ = very severe). Initially all patients received one placebo unit every 15 days orally 3 times, then one after 30 days. Laboratory examination was performed and then treatment with transfer factor was initiated, initially 1 unit every 15 days three times and the fourth 30 days after. 15 days after the last dose a new immunological valoration was done. Results demonstrate a CD4 cell decrement, blood eosinophil and lgE dissemination although they're not statistically significative. There was a statistically significative improvement in the 4 clinical parameters: erythema, eczema, pruritus and populous with the use of Transfer Factor.

Immunotherapy with transfer factor of recurrent herpes simplex type I.

This clinical trial of Transfer Factor, an immunomodulator, in the treatment of herpes simplex type I, proved this agent to be more effective as regards duration of acute phase recurrences as well as the frequency of the reappearance of relapses of this disease. The evaluation was made in 20 patients whose disease had been treated before with other therapeutic agents (including acyclovir) which permitted them to be their own controls for the comparative data obtained and submitted to statistical analysis of the two parameters mentioned, duration of the acute phase and frequency of relapses. Patients with compromised cellular immunity or with any additional disease were excluded from the study. Transfer factor, one unit, was administered subcutaneously daily for 3 to 4 days during the acute phase of the disease, and subsequently at 15-day intervals for the first 6 months; followed by a continuation of monthly injections until the termination of the study period. In six of the 20 patients there was a recurrence of the disease while receiving maintenance dosages of TF. These patients were again given the full initial dosage schedule and reinstated again with the maintenance dosage. In the initial eight patients, an immune status profile was obtained, and all results were found to be in the normal range. This was considered sufficient evidence that the criteria for the selection of patients excluded any with detectable variations in the profile of the immune status, and it was decided to eliminate this as a prerequisite for participating in the study. The results showed an important improvement in the response to transfer factor immune modulation therapy. A statistically significant reduction in the frequency of recurrences within a one month period, the Student t test gave a p = 0.0001 in TF treated patients. The average duration in days of the acute phase also showed an important difference in favor of the TF treatment. The U Mann-Whitney test gave a p = 0.0005. These results suggest that, at present, TF may be considered the therapeutic agent of choice in the treatment of herpes simplex type 1 disease.

Antimycobacterial antibodies in diffuse lepromatous leprosy detected by counterimmunoelectrophoresis.

By using the counterimmunoelectrophoresis (CIE) technic it was possible to demonstrate the presence of antimycobacterial antibodies in the sera of patients suffering from lepromatous leprosy. The antigen was prepared from isolated Mycobacterium lepraemurium. The technic was more reliable and quicker than Ouchterlony's classical double diffusion in gel. Clinical application of the method is therefore recommended.