Assuntos
Alérgenos/uso terapêutico , Bevacizumab/uso terapêutico , Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/terapia , Neoplasias Ovarianas/tratamento farmacológico , Administração Intravenosa , Adulto , Alérgenos/imunologia , Bevacizumab/efeitos adversos , Bevacizumab/imunologia , Protocolos Clínicos , Hipersensibilidade a Drogas/imunologia , Dispneia , Feminino , Humanos , Tolerância Imunológica , Neoplasias Ovarianas/complicações , Urticária , Fator A de Crescimento do Endotélio Vascular/imunologiaAssuntos
Acetazolamida/imunologia , Inibidores da Anidrase Carbônica/imunologia , Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/terapia , Sulfonamidas/efeitos adversos , Acetazolamida/efeitos adversos , Antibacterianos/efeitos adversos , Antibacterianos/imunologia , Inibidores da Anidrase Carbônica/efeitos adversos , Hipersensibilidade a Drogas/imunologia , Feminino , Humanos , Pseudotumor Cerebral/tratamento farmacológico , Sulfonamidas/imunologia , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Combinação Trimetoprima e Sulfametoxazol/imunologia , Adulto JovemRESUMO
Although severe reactions to immunoglobulin preparations have been frequently reported, IgE antibodies against IgA are usually not investigated; and occur predominantly in previously sensitized patients. The purpose is to report anaphylaxis to IGIV during initial infusion in a patient with common variable immunodeficiency with absent IgA without prior sensitization and in the absence of detectable IgG anti-IgA antibodies, and positive skin tests for immediate hypersensitivity to four different preparations of IGIV, one subcutaneous immunoglobulin preparation, and to purified IgA. Patient was treated without side effects with IGIV preparation depleted of IgA to which immediate hypersensitivity skin test was negative. This case demonstrates that patients with CVID with no IgA and without prior exposure to immunoglobulin or plasma may develop anaphylaxis following initial infusion of IGIV, which appears to be due to IgE anti-IgA, and independent of IgG anti-IgA antibodies. Since there is no good correlation between anaphylaxis/anaphylactic reactions and IgG anti-IgA antibodies, and IgE anti-IgA antibody test is commercially unavailable, we suggest that the patients with CVID with absence of IgA might be skin tested for immediate hypersensitivity prior to initiation of immunoglobulin administration. However, such recommendation may require studies on a large number of patients with CVID with no detectable IgA.
RESUMO
Cutaneous non-disseminated, non-tuberculous mycobacterial infections have been reported in both immunocompetent and immunocompromised subjects. Systemic Mycobacterium avium intracellulaire (MAI) have been reported in non-HIV patients with Idiopathic CD4 lymphocytopenia. We report a comprehensive immunological analysis in syndrome of selective IgM deficiency and T lymphocytopenia (both CD4+ and CD8+) with disseminated cutaneous MAI infection. Naïve (TN) and Central memory (TCM) subsets of both CD4+ and CD8+ T cells were decreased, whereas terminally differentiated effector memory (TEMRA) subset of CD4+ and CD8+ T cells were markedly increased. IFN-γ producing T cells were markedly decreased. Although CD14(high)CD16- proinflammatory monocytes were modestly increased, IFN-γR+ monocytes were markedly decreased. The expression of TLR3, TLR5, TLR7, and TLR9 on monocytes was decreased. Germinal center B cells (CD19+IgD-CD38+CD27(lo)) and B1 cells (CD20+CD27+CD43+CD70-) were markedly decreased. A role of immune alterations, including B cells and antibodies in disseminated cutaneous MAI infection is discussed.