Immediate-Type allergy against human insulin associated with marked eosinophilia in type 2 diabetic patient

We describe a type 2 diabetic patient who showed immediate-type allergy against human insulin associated with marked eosinophilia at initial insulin therapy. Three months after initiation of insulin therapy, he noticed itchy skin wheals at the site of the insulin injection. Laboratory data at that time showed marked eosinophilia (2,512 /mm3) and progression of renal dysfunction. Skin test with semisynthetic human insulin and protamine sulfate resulted in local immediate skin reactions such as itchy erythema and wheals. Histopathology of the biopsy specimen from skin showed perivascular infiltration of lymphocytes and numerous eosinophils in the dermis and subcutaneous fat. Although the titer of total IgE antibody was within normal range, that of insulin-specific IgE antibody was high. Insulin administration was discontinued to preserve his insulin secretion, and stable control of his hyperglycemia was obtained by initiating nateglinide treatment (360 mg/day). His itchy skin lesions disappeared within two weeks after cessation of the insulin therapy and both eosinophilia and renal dysfunction gradually improved. Although the widespread use of human insulin in diabetic patients has greatly reduced the incidence of insulin allergy, the possibility of human insulin allergy should be kept in mind when initiating such therapy.     

实验性自身免疫性肝炎小鼠的口服耐受诱导研究

口服耐受是一种治疗全身性炎症疾病的潜在手段。在一些动物模型中,口服自身抗原可抑制自身免疫反应。目的:观察在实验性自身免疫性肝炎(EAH)小鼠中诱导口服耐受对肝脏病变的影响。方法:在实验第1天和第7天,将新鲜制备的蛋白质浓度为0.5-2 g/L的肝抗原S-100 0.5 ml和等体积的弗氏完全佐剂(CFA)充分乳化后,予C57BL/6小鼠腹腔注射,以诱导EAH的产生。诱导:EAH前5天起,每天分别予小鼠插管喂饲1 mg和10mg的肝抗原S-100、肝抗原S-100第1峰、第2峰和第3峰,对照组以PBS 1 ml灌胃。结果:仅肝抗原S-100第1峰抗原高剂量组小鼠的肝组织学病变程度较对照组显著减轻(P<0.05),血清丙氨酸转氨酶(ALT)水平也较对照组显著下降(P<0.05)。肝抗原S-100总抗原高剂量组的血清.ALT水平较对照组显著下降(P<0.05),肝组织学病变程度呈下降趋势,但与对照组的差异无显著性。结论:口服肝抗原S-100第1峰抗原可诱导EAH小鼠的免疫耐受。     

Red-Cell Sensitization in Myelofibrosis

Using an enzyme-linked immunosorbent assay (ELISA), elevated RBC-Ig of the IgG and IgM class were found in 8 of 14 patients with idiopathic myelofibrosis. In 2 patients with high levels of RBC-Ig the direct Coombs' test was positive. It is supposed that immune haemolysis may contribute to the anaemia in some patients with idiopathic myelofibrosis.     

Suppression of Early Rhesus Sensitization by Passive Anti-D Immunoglobulin:Suppression of Early Rhesus Sensitization

Anti-D immunoglobulin is an effective prophylactic against rhesus isoimmunization. It is generally regarded as ineffective once antibody production has developed though there have been a number of inconclusive reports suggesting it may suppress early sensitization. Anti-D (100μg) was given after delivery of a rhesus (D) positive child to a rhesus (D) negative mother who was shown to have anti-D antibodies at that time by five tests on two separate specimens in two different laboratories and by a weakly positive direct anti-globulin test on the cord blood. In a further pregnancy with a rhesus (D) positive child no antibody was detected by multiple tests including enzyme technique.     

Severe Asthma with Fungal Sensitization

A new phenotype of asthma has been described recently, namely severe asthma with fungal sensitization (SAFS). SAFS can be conceptualized as a continuum of fungal sensitization, with asthma at one end and allergic bronchopulmonary aspergillosis at the other. It is diagnosed by the presence of severe asthma, fungal sensitization, and exclusion of allergic bronchopulmonary aspergillosis. Because of the paucity of data and ambiguity in diagnostic criteria, SAFS is currently more of a diagnosis of exclusion than a specific entity. Treatment of SAFS initially should be similar to that of severe asthma, including the use of omalizumab. The potential role of itraconazole as a specific therapy in SAFS requires more evidence before it can be incorporated in routine practice. An urgent need exists for data regarding the prevalence, natural history, and clinical relevance of SAFS so that its exact characterization and importance as a specific subtype of asthma can be clearly defined. This review summarizes the current understanding of the pathogenesis, diagnosis, and management of SAFS.     

Role of Allergen Sensitization in Older Adults

There is a common perception among physicians and patients that allergic diseases are not relevant in older adults. There is also recognition that innate and adaptive immune functions decline with aging. It is the function of a variety of immune cells in the form of allergic inflammation that is a hallmark of allergic diseases. In fact, there is a fairly consistent observation that measures of allergic sensitization, such as skin prick testing, specific IgE, or total IgE, decline with age. Nonetheless, the association between allergic sensitization and allergic diseases, particularly asthma and allergic rhinitis, remains robust in the older adult population. Consequently, an appropriate evaluation of allergic sensitivities is warranted and indicated in older asthma and rhinitis patients to provide optimal care for the individual and minimize any resultant morbidity and mortality.     

Component Resolved Testing for Allergic Sensitization

Component resolved diagnostics introduces new possibilities regarding diagnosis of allergic diseases and individualized, allergen-specific treatment. Furthermore, refinement of IgE-based testing may help elucidate the correlation or lack of correlation between allergenic sensitization and allergic disease. Novel tools to predict severe outcomes and to plan for allergen-specific treatment are necessary, and because only a small amount of blood is needed to test for a multitude of allergens and allergenic components, component resolved diagnostics is promising. A drawback is the risk of overdiagnosis and misinterpretation of the complex results of such tests. Also, the practical use and selection of allergenic components need to be evaluated in large studies including well-characterized patients and healthy, sensitized controls and with representation of different geographical regions.