IgE Mediated Wheat Allergy Associated with Resistant and Severe Forms of Allergic Conjunctivitis.

Objective: This study aimed to determine the prevalence and criteria of wheat allergy (WA) among patients with resistant allergic conjunctivitis (AC). Methods: A prospective comparative study was conducted on 100 patients with resistant AC. Skin prick-tests (SPTs), total and sIgE against a panel of inhalant and food allergens were performed in all patients' sera. They were divided into 2 groups according to skin prick test (SPT) and specific IgE (sIgE) level, namely the wheat sensitive group (WSG) and wheat tolerant group (WTG). Total ocular symptom scores (TOSS) and 4-point sign scales were correlated for both groups. Results: Ten patients out of 100 with IgE-mediated resistant AC were wheat sensitive, and the other 90 were wheat tolerant patients. WSG included patients of significantly younger age. Positive family history of atopy was proven in 100% of WSG vs. 67% of WTG. A significantly higher frequency of multiorgan allergy was detected in 100% of WSG vs. 20% in WTG (P = 0.0001). Thirty (30%) of WSG had associated allergic rhinitis (AR) and bronchial asthma (BA). Another 30% had an associated AR only, 10% had an associated BA only, and another 20% had an associated skin allergy. TOSS, 4- point sign scale, and total IgE level were significantly higher in WSG. Conclusion: This study provides novel evidence that wheat allergy is responsible for some severe forms of AC.

Prevalence and Predictors of Metabolic Syndrome among Patients with Bronchial Asthma: A Cross Sectional Study.

BACKGROUND: Recent studies have reported the epidemiological link between Metabolic Syndrome (MS) and asthma, but it has rarely been studied in Egypt. The study aimed to investigate the prevalence of MS and its predictors among asthma patients in Egypt. METHODS: In total, 320 patients with bronchial asthma were included. The following were assessed: spirometric evaluation, anthropometric indices, blood pressure, fasting blood sugar and serum lipid profile. We analyzed the correlation between metabolic scores and patient characteristics. Predictors of MS were identified using logistic regression analysis. RESULTS: The prevalence of MS was 57.5% in asthma patients. For asthma patients, low High-Density Lipoprotein (HDL) and abdominal obesity were the commonest metabolic abnormality. Waist circumference, Fasting Blood Sugar (FBS) and triglyceride correlated significantly with asthma (P < 0.05). FBS and DBP were the best predictors of MS. CONCLUSION: MS is frequent in asthma patients in Egypt. Obesity and lipid abnormalities were the commonest metabolic abnormality. Screening of these patients for components of metabolic syndrome should be a part of routine workup.

Food and Aeroallergen Sensitization in IgE -Mediated Asthma in Egypt.

Purpose: Identifying the distribution of allergens is valuable to the effective diagnosis and treatment of allergic disease. So, our aim is to explore the sensitization of food and aeroallergens in Egyptian patients with atopic asthma. Methods: Cross-sectional study recruited 268 Egyptian patients with atopic asthma. Asthmatic patients were assessed by the enzyme allegro sorbent test (EAST) method for specific IgE to a panel of 19 common regional inhaled allergens and 15 food allergens. Results and Discussion: One hundred percent of the patients were sensitive to at least one allergen. Allergy to food allergens only was 2.9%; inhaled allergens only were 26.2% and both were70.9%. Fungi (62%) were the most frequent sensitizing aeroallergen amongst our asthmatic patients, followed by the pollen allergens (42.5%) and house dust mites (HDMs) (26%). Cows' milk (30.5%) was the most frequent sensitizing food amongst our asthmatic patients, followed by eggs (22.4%) and fish (21.6%). Mono-sensitized patients accounted for 6.7% of all cases, while polysensitized was 93.3%. Moderate and severe asthma showed a significantly higher frequency of polysensitization compared to mild asthma. Conclusion: Fungi and cow's milk are the chief sensitizing allergens in Egyptian patients with atopic asthma. This study represents the first report of sensitization in atopic adult asthma using a large extract panel in Upper Egypt.

One-year evaluation of clinical and immunological efficacy and safety of sublingual versus subcutaneous allergen immunotherapy in allergic conjunctivitis.

BACKGROUND: The aim of this study is to evaluate the clinical and immunological efficacy and safety of allergen immunotherapy (AIT) in patients with allergic conjunctivitis (AC) and to compare between sublingual and subcutaneous routes of administration. METHODS: A prospective comparative case series study was performed on 100 patients with IgE-mediated AC. Patients were referred to allergy clinics for skin prick test (SPT) and AIT. Patients with positive SPT and high-serum IgE level were enrolled in this study. Patients were divided into two groups: sublingual immunotherapy (SLIT) group (50 patients) and subcutaneous immunotherapy (SCIT) group (50 patients). Both groups were followed for 1 year. Efficacy was assessed clinically by comparing pre- and post-treatment symptoms and medication scores and assessed immunologically by comparing pre- and post-treatment serum IgE level and wheal diameter of SPT. Safety of the therapy was assessed by the occurrence of adverse reactions and patient tolerability to the therapy. RESULTS: Patients were either mono- or polysensitized to different allergens. Aeroallergens were significantly more common than food allergens (P = 0.00). The most prevalent aeroallergens were pollens (40%) and house dust (30%). At 12-month follow-up, both routes SLIT and SCIT led to a statistically significant clinical and immunological improvement (P < 0.05). This improvement was evident in all follow-up parameters including total ocular symptom score (TOSS), medication score, total serum IgE level, and wheal diameter of skin prick test (SPT). There was no significant difference between the two routes of administration (SLIT & SCIT) in any of the follow-up parameters (P > 0.05). Patients were able to tolerate the allergen therapy without developing any serious adverse events. CONCLUSION: Aeroallergen polysensitization is common among patients with AC. SPT should be included in the diagnostic workup of those patients. AIT is a safe and effective treatment option for patients with AC as it has the potential to achieve significant reduction in symptom and medication scores without ocular or systemic side effects. There is no significant difference between both routes of administration either SLIT or SCIT in achieving clinical and immunologic improvement; so the patient can choose his preferred method for therapy.

Methylation and expression profiles of MGMT gene in thymic epithelial tumors.

OBJECTIVES: A key challenge in diagnosis and treatment of thymic epithelial tumors (TET) is in improving our understanding of the genetic and epigenetic changes of these relatively rare tumors. METHODS: Methylation specific PCR (MSP) and immunohistochemistry were applied to 66 TET to profile the methylation status of DNA repair gene O6-methylguanine DNA methyltransferase (MGMT) and its protein expression in TET to clarify the association between MGMT status and clinicopathological features, response to chemotherapy and overall survival. RESULTS: MGMT methylation was significantly more frequent in thymic carcinoma than in thymoma (17/23, 74% versus 13/44, 29%; P<0.001). Loss of expression of MGMT protein was significantly more frequent in thymic carcinoma than in thymoma (20/23, 87% versus 10/44, 23%; P<0.0001). There is a significant correlation between of MGMT methylation and loss of its protein expression (P<0.0003). MGMT methylation and loss of expression were significantly more frequent in advanced thymic epithelial tumors (III/IV) than in early tumors (I/II). CONCLUSION: MGMT methylation plays a soul role in development of TET, especially in thymic carcinoma. Therefore, translation of our results from basic molecular research to clinical practice may have important implication for considering MGMT methylation as a marker and a target of future therapies in TET.

Aberrant DNA methylation of some tumor suppressor genes in lung cancers from workers with chromate exposure.

Our previous studies revealed a variety of genetic changes in lung cancers from chromate-exposed workers (chromate lung cancer). In the present study, we examined epigenetic changes in chromate lung cancers. Nested-methylation-specific PCR was employed in studying the methylation of CpG islands in the APC, MGMT, hMLH1 genes in 36 chromate lung cancers and 25 nonchromate lung cancers. Methylation in chromate lung cancers was detected at 86% for APC, 20% for MGMT, and 28% for hMLH1. Whereas, it occurred at lower frequencies in nonchromate lung cancers, particularly in APC (44%) and hMLH1 (0%) genes. Our previous study showed that methylation of p16 gene in chromate lung cancer and nonchromate lung cancer was 33% and 26%, respectively. The mean methylation index (MI), a reflection of the overall methylation status, was significantly higher in chromate lung cancers than nonchromate lung cancers (0.41 vs. 0.21, P=0.001). Methylation of multiple genes (particularly hMLH1, p16, and APC genes) had experienced more than 15 yr of chromate exposure in chromate lung cancer (MI: <15 yr; 0.19, ≥ 15 yr, 0.42). There is a significant correlation of p16 and hMLH1 methylation with the expressional decrease or loss of the corresponding gene products (P=0.037 and 0.024) respectively, and an inverse correlation between APC and MGMT methylation (P = 0.014). This study provides a novel evidence for the chromium carcinogenesis that chromate lung cancer is linked to the progressive methylation of some tumor suppressor genes, which may be related to genomic instability.