Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis

BACKGROUND: Rush immunotherapy (RIT) presents an attractive alternative to standard immunotherapy. However, RIT carries a much greater risk of acute allergic reactions, including anaphylaxis. OBJECTIVES: We hypothesized that omalizumab, a humanized monoclonal anti-IgE antibody, would be effective in enhancing both safety and efficacy of RIT. METHODS: Adult patients with ragweed allergic rhinitis were enrolled in a 3-center, 4-arm, double-blind, parallel-group, placebo-controlled trial. Patients received either 9 weeks of omalizumab (0.016 mg/kg/IgE [IU/mL]/mo) or placebo, followed by 1-day rush (maximal dose 1.2-4.0 mug Amb a 1) or placebo immunotherapy, then 12 weeks of omalizumab or placebo plus immunotherapy. RESULTS: Of the 159 patients enrolled, 123 completed all treatments. Ragweed-specific IgG levels increased >11-fold in immunotherapy patients, and free IgE levels declined >10-fold in omalizumab patients. Patients receiving omalizumab plus immunotherapy had fewer adverse events than those receiving immunotherapy alone. Post hoc analysis of groups receiving immunotherapy demonstrated that addition of omalizumab resulted in a 5-fold decrease in risk of anaphylaxis caused by RIT (odds ratio, 0.17; P = .026). On an intent-to-treat basis, patients receiving both omalizumab and immunotherapy showed a significant improvement in severity scores during the ragweed season compared with those receiving immunotherapy alone (0.69 vs 0.86; P = .044). CONCLUSION: Omalizumab pretreatment enhances the safety of RIT for ragweed allergic rhinitis. Furthermore, combined therapy with omalizumab and allergen immunotherapy may be an effective strategy to permit more rapid and higher doses of allergen immunotherapy to be given more safely and with greater efficacy to patients with allergic diseases.     

Human mast cells present antigen to autologous CD4+ T cells

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Proinflammatory Cytokine Gene Polymorphisms among Iranian Patients with Asthma

Introduction  Asthma is one of the most common respiratory diseases caused by acute and chronic inflammation of airways. Proinflammatory cytokines could contribute to this inflammatory process. This study was performed in order to analyze the genetic profile of proinflammatory cytokines in Iranian asthmatic patients. Patients and Methods  The allele and genotype frequencies of a number polymorphic genes coding for tumor necrosis factor (TNF)-α, interleukin (IL)-1α, IL-1β, IL-1 receptor (IL-1R), IL-1RA, and IL-6 were investigated in 60 patients with asthma in comparison with 140 controls using polymerase chain reaction with sequence-specific primers. Results  The most frequent genotypes in our patients were TNF-α GA at position −308 (P = 0.001), TNF-α AA at position −238 (P = 0.01), IL-1α TC at position −889 (P = 0.0001), IL-1β TC at position −511 (P = 0.0001), and IL-1RA TC at position Mspa-I 11100 (P = 0.001). In contrast, the frequencies of the genotypes TNF-α GG at position −308 (P = 0.001), IL-1α CC at position −889 (P = 0.005), IL-1β CC at position −511 (P = 0.0001), and IL-1RA TT at position Mspa-I 11100 (P = 0.0001) in the patient group were significantly lower than controls. The most frequent haplotypes for TNF-α (positions 308, −238) was A/A in the patient group in comparison with controls (P = 0.0001). Conclusion  While environmental factors are important in the development of asthma, genetic factors could have a critical role in the expression of the disease. Considering the high frequency of presence of TNF-α AG genotype (−308), it seems that the production of TNF-α in the asthmatic patients could be higher than normal subjects.     

Brucella canis-induced anterior uveitis in companion dogs in Ahvaz,Iran

Canine brucellosis, caused by Brucella canis, is an important cause of abortions, stillbirths, uveitis, epididymitis, orchitis, and sperm abnormalities in dogs. Anterior uveitis is one of the most common ocular diseases in dogs. The aim of this study was to describe the clinical and diagnostic features of anterior uveitis in dogs affected with B. canis in the Ahvaz district, southwestern Iran. A total of 243 blood samples were obtained from urban dogs between 2006 and 2010 and examined by immuno-chromatography assay (Anigen Rapid C. Brucella Ab Test Kit). Prevalence to B. canis antibodies was 6.58 % (16 out of 243) in the studied dogs. B. canis-induced anterior uveitis was seen in two German Shepherd dogs (12.5 %; 2 out of 16), the first was a 3.5-year-old male and the second was a 2.5-year-old female. Clinical ophthalmologic abnormalities included moderate anterior uveitis, mild conjunctival hyperemia, and iris hyperpigmentation. Following routine treatment (a median of 9 weeks from the onset of therapy), ocular inflammation resolved and serological tests were negative. The present study shows that ocular inflammation due to B. canis is present among the urban dog population in the Ahvaz district, Iran. B. canis infection should be included in the differential diagnosis for dogs with intraocular inflammation, regardless of previous history.     

Prevalence of hepatitis B and hepatitis D coinfection in asymptomatic blood donors in Iran

Hepatitis delta virus (HDV) is a satellite virus that needs hepatitis B virus (HBV) surface antigen for amplification and transition. HDV appears in HBsAg carriers as acute coinfection and superinfection in patients with chronic hepatitis B. This coinfection leads to chronic hepatitis, cirrhosis, and liver carcinoma. The aim of this study was to detect the prevalence of coinfection and superinfection of HBVs and HDVs in blood donor individuals in Iran. Sera from 854 asymptomatic blood donors from the Bank of positive samples storage at the National Blood Transfusion Organization of Iran that were positive for hepatitis B surface antigen were analysed. The presence of antibody against HDV in blood donors was detected using ELISA followed by conventional PCR, seminested PCR and real‐time PCR to determine coinfection and/or superinfection. Restriction fragment length polymorphism was used for HDV genotyping. All 854 samples were HBsAg and anti‐HBc positive whereas only 18 (2%) of them were positive for anti‐HDV. Of the 854 samples, 154 (18%) were HBV‐DNA positive. HDV‐RNA was detected in 0.6% of the total samples by seminested PCR and real‐time PCR and the two PCR methods produced similar results. Moreover, 16.6% and 83.4% of anti‐HDV‐positive samples exhibited coinfection and superinfection with HBV, respectively. Genotype I of HDV was determined in positive samples.