Nasal ECP patterns and specific immunotherapy in mite-allergic rhinitis patients.

BACKGROUND: Specific immunotherapy (SIT) is an effective treatment in allergic rhinitis and it has been shown to decrease nasal ECP rise after allergen challenge. AIMS: To evaluate if the kynetics of nasal ECP release after specific nasal challenge could be changed by SIT and if these changes were related to the dose of allergen administered. MATERIAL AND METHODS: 75 allergic rhinitis patients, monosensitized to house dust mites were included: 25 controls and 50 SIT-treated patients. These patients were divided in two groups: one receiving a high dose of the allergenic extract (Group 2) and other receiving a lower dose (Group 1). Nasal challenges were performed at the beginning of the study (T0), after 6 (T1) and after 12 months (T2). Nasal ECP values were measured in nasal lavages before challenge and one and four hours after obtaining a positive reaction. Patients were also asked in every visit to evaluate on a visual analog scale the intensity of their disease in the previous month. RESULTS: SIT was effective in improving subjective (visual analog scale) and objective parameters (nasal allergenic reactivity). Both SIT groups had significant differences between T0 and T2 values and comparing with control patients. SIT reduced significantly mean post-provocation ECP values in both groups and reduced the number of patients that showed increase in nasal ECP > 100% of basal values in each of the SIT-treated groups. The changes in nasal ECP values and particularly in nasal ECP patterns were more pronounced in Group 2 than in Group 1 but the differences did not reach statistical significance. CONCLUSIONS: SIT can inhibit nasal ECP increase after allergen challenge, frequently present in non SIT-treated patients. This effect is more pronounced and reaches statistical significance earlier in patients receiving higher doses of the allergenic extract used in SIT.

Heat-shock proteins and atherosclerosis.

In this review the authors focus on the possible role of heat-shock proteins (hsp) in the immune pathogenesis of the atherosclerotic process. The authors discuss evidence showing increased expression of these proteins in the vascular wall of stressed and atherosclerotic vessels and the immune mechanisms which could justify some of the inflammatory aspects that are now currently recognized in atherosclerosis, namely some of the possible hsp immune activating properties and also the possibility of hsp representing an innocent auto-antigen which could be the unwanted target of an immune response, initially directed against microbial heat-shock proteins. Epidemiological evidence linking atherosclerosis and cardiovascular diseases to soluble hsp levels as well as the intensity of anti-hsp immune response is also reviewed.

Atopy and helminths.

In this article, the authors review current and latest evidence linking helminth infections and the development of atopy. Although there is intense ongoing investigation and debate on this issue, the review of experimental, clinical and epidemiological data apparently shows that helminth infections can have beneficial aspects in regard to the pathogenesis of atopy and allergic diseases. Despite the fact that simplistic views are not recommended, it seems that polyclonal IgE production and mainly the stimulation of host immunoregulatory networks leading to synthesis of anti-inflammatory cytokines (IL-10, TGF-beta and others) can provide new insights into how mechanisms that helminths have developed throughout their evolution and that are useful for parasite evasion and persistence, could also be used in humans in order to provide new approaches in atopy prevention.

Laboratory diagnosis of hymenoptera venom allergy: comparative study between specific IgE, western blot and allergen leukocyte stimulation (CAST).

Allergy to hymenoptera venom is a classical IgE mediated disease with a potentially fatal course. Specific venom immunotherapy (SIT) is the most effective mean of treating this serious condition, after the diagnosis has been clearly established by a clinical history, in-vivo and in vitro tests. We have evaluated the usefulness of a cellular test (CAST) which is a recently developed ELISA method based on the evaluation of sulfidoleukotriene secretion by leukocytes stimulated with specific antigen. We also evaluated the correlation of CAST with skin tests, specific IgE (sIgE) and western blot for sIgE for hymenoptera venom sIgE. We have included in this study 14 patients, with a clinical history suggestive of hymenoptera venom allergy. None of them had previously been subjected to immunotherapy. A good correlation was obtained between skin tests, sIgE and western blot. However, there was no correlation between these methods and CAST. We conclude that the positivity of CAST method raises some questions about other mechanisms, which maybe non-IgE dependent. Although the number of patients in this study is quite small, the immunoblot analysis may be a valuable additional method in insect venom allergy.

Capillary leakage syndrome: a case report and a review.

Capillary leakage Syndrome (CLS) is a rare clinical syndrome, that was first described in 1960, characterized by acute episodes of generalized edema, hemoconcentration, hypoproteinemia and monoclonal gammopathy, in the vast majority of cases. We describe a 39-year-old man with anasarca, bilateral pleural and pericardial effusions, ascites and diffuse alveolo-intersticial edema. Clinical and laboratory findings were consistent with an acute episode of CLS. Treatment with prednisone, furosemide and aminophylline was started, which lead to a gradual improvement in 48 hours. Pathophysiologically there is an increase in capillary permeability with the extravasation of fluid and plasmatic proteins to the extravascular space that can lead to hypovolaemic shock. In the second phase there is a reentry of the fluid overload leading to pulmonary edema. The etiology of this hyperpermeability still remains unclear. The role of cytokines has become central in the comprehension of pathophysiology of CLS. Adhesion molecules are probably also involved in the genesis of capillary leakage. CLS treatment remains empirical. However, at present it seems that the association of steroids with furosemide, aminophylline and terbutaline are capable of controlling the clinical manifestation of the acute episodes in most cases. To our knowledge no prophylatic therapy has clearly proven its efficacy. There are only a few series analyzing the long-term evolution of patients with CLS. Further studies are necessary with the objective to collect enough patients with CLS to observe natural history of the disease and evaluate the efficacy of empiric treatments.