Factors effecting natural course of egg allergy.

Summary: Background. There is limited data about the natural course of egg allergy in the literature. We aimed to analyze the factors that can affect the tolerance or persistence of egg allergy. Methods. A total number of 126 IgE- mediated egg allergic patient who had data about tolerance gaining were included in the study. Demographic and laboratory data were recorded retrospectively. Kaplan-Meier curves was used for estimation of resolution and the factors related to resolution by Cox regression model. Results. Among 126 patients 81 (64.2%) had gained tolerance with a median survival time of 48 months (min 12- max 121). Tolerance was gained in 22.2% (28) of these patients in the first 2 years, in 46.8% (49) 2-6 years, 3.1% (4) between 7-12 years. In univariate analysis, no history of anaphylaxis (at initiation or during OFC) (Hazard ratio 2.193; 95%CI 1.309-3.674, p = 0.003), baseline sIgE level less than 8.2 (Hazard ratio 11.292; 95%CI 2.766-46.090, p = 0.001) and baseline egg SPT less than 11 mm (Hazard ratio 2.906; 95%CI 1.424-5.930, p = 0.003) were found to be related to earlier resolution of egg allergy. In multivariate analysis only anaphylaxis was significantly related to later resolution (Hazard ratio: 6.547; 95%CI 15.80-27.434, p = 0.01). Conclusions. Higher levels of egg sIgE, skin prick test induration and anaphylaxis at onset or during oral food challenge, can give hint about persistence of egg allergy.

GSK3 is a regulator of RAR-mediated differentiation.

Acute myeloid leukemia (AML) is the most common form of leukemia in adults. Unfortunately, the standard therapeutic agents used for this disease have high toxicities and poor efficacy. The one exception to these poor outcomes is the use of the retinoid, all-trans retinoic acid (ATRA), for a rare subtype of AML (APL). The use of the differentiation agent, ATRA, in combination with low-dose chemotherapy leads to the long-term survival and presumed cure of 75-85% of patients. Unfortunately ATRA has not been clinically useful for other subtypes of AML. Though many non-APL leukemic cells respond to ATRA, they require significantly higher concentrations of ATRA for effective differentiation. Here we show that the combination of ATRA with glycogen synthase kinase 3 (GSK3) inhibition significantly enhances ATRA-mediated AML differentiation and growth inhibition. These studies have revealed that ATRA's receptor, the retinoic acid receptor (RAR), is a novel target of GSK3 phosphorylation and that GSK3 can impact the expression and transcriptional activity of the RAR. Overall, our studies suggest the clinical potential of ATRA and GSK3 inhibition for AML and provide a mechanistic framework to explain the promising activity of this combination regimen.

''Air-bubble'' signs in the CT diagnosis of perforated pulmonary hydatid cyst: three case reports.

Computed tomography is an important imaging modality in the evaluation of hydatid cyst. However, diagnosis of perforated hydatid cyst is very difficult and for this reason some radiological findings have been defined. An important finding is the ''air bubble'' sign. As a consequence of cyst rupture, secondary bacterial infections like bronchopneumonia or lung abscess may develop which complicate the clinical picture further. In the literature, the ''air bubble'' sign which is a relatively newly discovered radiological sign is reported to be very sensitive in establishing diagnosis. For this reason, in suspected cases of hydatid cyst, the air bubble sign may aid physicians in establishing diagnosis.

A patient with rubella encephalitis and status epilepticus.

Rubella is an important childhood disease that was historically widespread but is now very infrequent. It is an acute viral infection ordinarily characterized by mild constitutional symptoms. Complications are relatively uncommon in childhood. Encephalitis similar to that seen with measles occurs in about 1 in 6,000 cases. The severity is highly variable, and there is an overall mortality rate of 20%. Symptoms in survivors usually resolve within 1-3 week without neurologic sequelae. An 8.5-year-old boy presented with rubella encephalitis and status epilepticus. Five days before admission the patient had erythematous maculopapular rash on the face, spreading to the trunk and extremities. On the admission day, he had a generalized tonic-clonic seizure with loss of consciousness. Microscopic and cytologic examinations of cerebrospinal fluid showed nonspecific. Electro-encephalography (EEG) showed diffuse slowing. An enzyme linked immunosorbent assay (ELISA) revealed that rubella IgM antibody titer was positive in serum and in cerebrospinal fluid. One day later, the patient became conscious with normal physical condition. As a conclusion, it is possible to prevent the complications of rubella infection, especially the congenital rubella syndrome and encephalitis with a rapid and efficient vaccination program.

The efficacy of bronchodilatators on respiratory functions undergoing dental treatment in asthmatic children.

AIM: The aim of this study was to compare the effects of dental treatments on respiratory functions in moderate asthmatic children in comparison to healthy controls as well as to determine the need for bronchodilatator treatment before dental procedures. METHODS: Twenty-six children with moderate asthma aged between 7-14 years who had peak expiratory flowmeter (PEF) values above 80% were selected for the study group. Control group consisted of 28 healthy children of the same age group. Before dental procedures, patients' dental anxiety levels were scored with Corah's Dental Anxiety Scale. The asthmatic group had their dental treatments in 2 sessions. At the first appointment, they were treated without administering a bronchodilatator therapy. After 2 weeks, at the second appointment the children administered bronchodilatator therapy before their dental treatments. PEF values were recorded in both asthmatic groups and in control group prior to, just after and 30 min after dental therapy. RESULTS: PEF values in asthmatic patients recorded just after dental treatment were significantly lower than control group (P<0.05). When we compared the asthmatic groups who received and who did not receive bronchodilatator treatment, a statistically significant difference was found between PEF values before, just after and 30 min after dental treatment in who didn't receive bronchodilatator treatment (P<0.05). CONCLUSIONS: Administration of bronchodilatator treatment as a premedication before dental procedures may be useful in asthmatic patients.

Successful desensitization of a case with desferrioxamine hypersensitivity.

Thalassaemia major is a severe chronic hemolytic disease, resulted with iron overload mainly due to regular blood transfusions. Iron overload may lead to serious organ toxicity and even fatal complications, if no iron excretion is achieved by a chelating agent. First introduced in 1976 as s.c. treatment for thalassaemia major, desferrioxamine (DFO) has substantially improved the life expectancy in the disease. While DFO can cause local allergic reactions including redness, itching, pain and lumps, on rare occasion anaphylactic reactions can occur. The mechanism of anaphylaxis like reactions is not well understood. In this case report, we presented a 10 years-old girl with thalassaemia major who had to stop DFO therapy after appearing of systemic allergic reactions with hypotension, tachycardia, pruritus and urticaria against this drug. Serum IgE level was normal, specific IgE and skin prick tests were negative. Intradermal test was resulted with positive reaction to DFO. The patient was hospitalized and desensitization protocol was initiated with rapid s.c. infusions per 15 min. The protocol was stopped at the 17th cycle because of local reaction reappeared. After that, DFO was further diluted and was restarted with lower dosage and longer infusion period. Then, DFO dosage was increased and the dilutions and infusion times were decreased gradually. By this desensitization programme, the patient would continue to use DFO chelation safely for 10 months.

Urticaria and angioneurotic edema due to the temporary henna tattoo.

Temporary henna tattoo, which has become popular among young people, is obtained from the mixture of the plants Lawsonia alba or Lawsonia inermis and paraphenylenediamine (PPD). In forming reactions frequent development of anti-PPD substance is noticed. A 13-year old boy who started itching, erythema, enduration on the application area, increasingly urticarial rash, conjunctivitis and swelling of the lips 48 h after being applied the temporary henna tattoo was hospitalized. He had a local reaction to henna tattoo when he was 5-year old. He was treated with parenteral corticosteroids and oral antihistaminic drugs. Skin reactions persisted for 18 days. The patient showed no early reaction to henna 10% and PPD 1% concentration in saline solution but did late reaction (after 48 h) to PPD in diameter of 12x13 mm in prick test in 3 weeks after the reaction. A case who developed angioneurotic edema and urticaria to temporary henna tattoo noticed that the henna tattoo is not an innocent application and young people need to be informed on this subject.

Sinopulmonary aspergillosis in children with hematological malignancy.

Invasive pulmonary aspergillosis is a serious infectious complication in immunocompromised especially neutropenic patients. Despite improvements in early diagnosis and effective treatment, invasive pulmonary aspergillosis is still a devastating opportunistic infection. These infections also interfere with the anticancer treatment. We report our experience in the diagnosis and therapeutic management of sinopulmonary aspergillosis in 4 children with hematologic malignancy. All patients except the first were neutropenic when sinopulmonary aspergillosis was diagnosed. Clinical signs included fever, cough, respiratory distress, swallowing difficulty, headache, facial pain-edema and hard palate necrosis. Radiodiagnostic methods showed bilateral multiple nodular infiltrations, soft tissue densities filling all the paranasal sinuses, and bronchiectasis. Diagnosis of aspergillosis was established by bronchoalveolar lavage in one case, tissue biopsy, positive sputum and positive cytology, respectively, in the other 3 cases. One patient was treated with liposomal amphotericin B and other 3 cases were treated with liposomal amphotericin B + itraconozole. Outcome was favorable in all cases except the one who died due to respiratory failure. Early diagnosis, appropriate treatment and primary disease status are important factors on prognosis of Aspergillus infections in children with hematological malignancy.

A de novo t (X;8)(p11.2;q24.3) demonstrating Cornelia de Lange syndrome phenotype.

Cornelia de Lange syndrome is a rare syndrome of hitherto unknown etiology. We present a 9-months old female patient with de novo t (X;8) (p11.2;q24.3) and Cornelia de Lange Syndrome phenotype. De novo t (X;8)(p11.2;q24.3) was not reported so far in Cornelia de Lange syndrome.

Immediate adverse reactions to immunotherapy.

BACKGROUND: Immunotherapy, which has been used since the beginning of this century, has potential adverse reactions. The purpose of this study was to evaluate immediate local and systemic reactions to allergen immunotherapy and to compare rates of adverse reactions to aluminum-adsorbed versus calcium-adsorbed allergen vaccines. METHODS: 108 cases (38 girls and 70 boys) were given allergen immunotherapy between 1997 and 2001. The following data were recorded for each patient: primary disease being treated (allergic rhinitis, asthma, or allergic rhinitis and asthma), allergic sensitivities (dust mite or grass pollen), number of injections, the stage of immunotherapy (buildup or maintenance), dilution of allergen vaccine, and type of allergen vaccine (calcium- or aluminum-adsorbed). Adverse reactions were classified as systemic or local. Local reactions were classified as hyperemia and induration less than 5 cm, more than 5 cm, itching, and pain. RESULTS: 4783 injections were evaluated in 108 subjects with allergic rhinitis (44%), asthma (40%), allergic asthma, and rhinitis (16%). Frequency of immediate systemic reaction was 0.13%. Frequency of immediate local reactions were: hyperemia and induration less than 5 cm 3%, greater than 5 cm 0.16%, local itching 0.15%, and local pain 0.2%. There was no significant difference in systemic and local reactions between calcium- and aluminum-adsorbed vaccines. Immediate local reactions were more frequent during maintenance therapy compared to buildup. Subjects were more likely to have local reactions during maintenance therapy if they had allergic rhinitis (p < 0.05) or were receiving grass pollen vaccine (p < 0.01). CONCLUSION: Immediate adverse reactions were uncommon when given to children with asthma and allergic rhinitis. Aluminium- and calcium-adsorbed allergen vaccines showed similar rates of systemic and local reactions.