1
|
Pacheco GA, Rao V, Yoo DK, Saghaei S, Tong P, Kumar S, Marini-Rapoport O, Allahyari Z, Moghaddam AS, Esbati R, Alirezaee A, Parnes A, Patil SU, Wesemann DR. Origins and diversity of pan-isotype human bone marrow plasma cells. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.08.592267. [PMID: 38766053 PMCID: PMC11100731 DOI: 10.1101/2024.05.08.592267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Bone marrow plasma cells (BMPCs) produce durable, protective IgM, IgG, and IgA antibodies, and in some cases, pro-allergic IgE antibodies, but their properties and sources are unclear. We charted single BMPC transcriptional and clonal heterogeneity in food-allergic and non-allergic individuals across CD19 protein expression given its inverse correlation to BMPC longevity. Transcriptional and clonal diversity revealed distinct functional profiles. Additionally, distribution of somatic hypermutation and intraclonal antibody sequence variance suggest that CD19low and CD19high BMPCs arise from recalled memory and germinal center B cells, respectively. Most IgE BMPCs were from peanut-allergic individuals; two out of 32 from independent donors bound peanut antigens in vitro and in vivo. These findings shed light on BMPC origins and highlight the bone marrow as a source of pathogenic IgE in peanut allergy.
Collapse
Affiliation(s)
- Gaspar A. Pacheco
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| | - Vishal Rao
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| | - Duck Kyun Yoo
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| | - Shahab Saghaei
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| | - Pei Tong
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| | - Sachin Kumar
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| | - Orlee Marini-Rapoport
- Food Allergy Center and Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital; Boston, MA 02115, USA
| | - Zahra Allahyari
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| | - Ali S. Moghaddam
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| | - Romina Esbati
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| | - Aida Alirezaee
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| | - Aric Parnes
- Department of Medicine, Division of Hematology, Brigham and Women’s Hospital; Boston, MA 02115, USA
| | - Sarita U. Patil
- Food Allergy Center and Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital; Boston, MA 02115, USA
| | - Duane R. Wesemann
- Department of Medicine, Division of Allergy and Clinical Immunology, Division of Genetics, Brigham and Women’s Hospital; Boston, MA 02115, USA
- Harvard Medical School; Boston, MA 02115, USA
- The Broad Institute of MIT and Harvard; Cambridge, MA 02124, USA
- The Ragon Institute of MGH, MIT and Harvard; Cambridge, MA 02139, USA
- Massachusetts Consortium on Pathogen Readiness; Boston, MA 02115, USA
| |
Collapse
|
2
|
Horino S, Yamaguchi Y, Miyabayashi H, Aki H, Nanjo Y, Onuma M, Rikiishi T, Yabe H, Imaizumi M, Sato A, Miura K. Topical therapy and skin care for transplant-associated atopic dermatitis in children and adolescents. Pediatr Transplant 2024; 28:e14653. [PMID: 37990976 DOI: 10.1111/petr.14653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/11/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND New-onset allergic diseases, such as food allergy or atopic dermatitis, can develop after allogeneic transplantation. There are limited reports of new-onset atopic dermatitis after allogeneic hematopoietic stem cell transplantation in children and adolescents, and its treatment is yet to be established. The pathogenesis may differ from typical atopic dermatitis in terms of alloimmunity including graft-versus-host disease. METHODS We present five children and adolescents with new-onset atopic dermatitis after allogeneic hematopoietic stem cell transplantation. The characteristics and clinical profiles of skin treatment after hematopoietic stem cell transplantation are summarized. RESULTS Graft-versus-host disease prophylaxis included systemic tacrolimus for all patients. After hematopoietic stem cell transplantation, all patients achieved complete donor chimerism of the bone marrow and had acute graft-versus-host disease of the skin. After engraftment, all patients had skin lesions that met the international consensus diagnostic criteria for atopic dermatitis. None of the patients met the diagnostic criteria for chronic graft-versus-host disease. Topical therapy and skin care based on atopic dermatitis guidelines improved skin condition and atopic dermatitis severity scores in all patients. In addition, type 2 inflammatory markers improved accordingly. CONCLUSION Topical therapy and skin care may be effective for transplant-related atopic dermatitis after hematopoietic stem cell transplantation. When extensive dermatitis is observed after hematopoietic stem cell transplantation, this treatment may avoid excessive immunosuppressive therapy if it meets the diagnostic criteria for atopic dermatitis.
Collapse
Affiliation(s)
- Satoshi Horino
- Department of Allergy, Miyagi Children's Hospital, Miyagi, Japan
| | - Yuki Yamaguchi
- Department of Allergy, Miyagi Children's Hospital, Miyagi, Japan
| | | | - Haruka Aki
- Department of Allergy, Miyagi Children's Hospital, Miyagi, Japan
| | - Yuka Nanjo
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
| | - Masaei Onuma
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
| | - Takeshi Rikiishi
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
| | - Hiromasa Yabe
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Masue Imaizumi
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
| | - Atsushi Sato
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
| | - Katsushi Miura
- Department of Allergy, Miyagi Children's Hospital, Miyagi, Japan
| |
Collapse
|
3
|
Hoh RA, Thörnqvist L, Yang F, Godzwon M, King JJ, Lee JY, Greiff L, Boyd SD, Ohlin M. Clonal evolution and stereotyped sequences of human IgE lineages in aeroallergen-specific immunotherapy. J Allergy Clin Immunol 2023; 152:214-229. [PMID: 36828082 DOI: 10.1016/j.jaci.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/22/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Allergic disease reflects specific inflammatory processes initiated by interaction between allergen and allergen-specific IgE. Specific immunotherapy (SIT) is an effective long-term treatment option, but the mechanisms by which SIT provides desensitization are not well understood. OBJECTIVE Our aim was to characterize IgE sequences expressed by allergen-specific B cells over a 3-year longitudinal study of patients with aeroallergies who were undergoing SIT. METHODS Allergen-specific IgE-expressing clones were identified by using combinatorial single-chain variable fragment libraries and tracked in PBMCs and nasal biopsy samples over a 3-year period with antibody gene repertoire sequencing. The characteristics of private IgE-expressing clones were compared with those of stereotyped or "public" IgE responses to the grass pollen allergen Phleum pratense (Phl p) 2. RESULT Members of the same allergen-specific IgE lineages were observed in nasal biopsy samples and blood, and lineages detected at baseline persisted in blood and nasal biopsy samples after 3 years of SIT, including B cells that express IgE. Evidence of progressive class switch recombination to IgG subclasses was observed after 3 years of SIT. A common stereotyped Phl p 2-specific antibody heavy chain sequence was detected in multiple donors. The amino acid residues enriched in IgE-stereotyped sequences from seropositive donors were analyzed with machine learning and k-mer motif discovery. Stereotyped IgE sequences had lower overall rates of somatic hypermutation and antigen selection than did single-chain variable fragment-derived allergen-specific sequences or IgE sequences of unknown specificity. CONCLUSION Longitudinal tracking of rare circulating and tissue-resident allergen-specific IgE+ clones demonstrates persistence of allergen-specific IgE+ clones, progressive class switch recombination to IgG subtypes, and distinct maturation of a stereotyped Phl p 2 clonotype.
Collapse
Affiliation(s)
- Ramona A Hoh
- Department of Pathology, Stanford University, Stanford, Calif
| | | | - Fan Yang
- Department of Pathology, Stanford University, Stanford, Calif
| | | | - Jasmine J King
- Department of Pathology, Stanford University, Stanford, Calif
| | - Ji-Yeun Lee
- Department of Pathology, Stanford University, Stanford, Calif
| | - Lennart Greiff
- Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Scott D Boyd
- Department of Pathology, Stanford University, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, Calif
| | - Mats Ohlin
- Department of Immunotechnology, Lund University, Lund, Sweden
| |
Collapse
|
4
|
Ramonell RP, Brown M, Woodruff MC, Levy JM, Wise SK, DelGaudio J, Duan M, Saney CL, Kyu S, Cashman KS, Hom JR, Fucile CF, Rosenberg AF, Tipton CM, Sanz I, Gibson GC, Lee FEH. Single-cell analysis of human nasal mucosal IgE antibody secreting cells reveals a newly minted phenotype. Mucosal Immunol 2023; 16:287-301. [PMID: 36931600 DOI: 10.1016/j.mucimm.2023.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/27/2022] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
Immunoglobulin (Ig) E is central to the pathogenesis of allergic conditions, including allergic fungal rhinosinusitis. However, little is known about IgE antibody secreting cells (ASCs). We performed single-cell RNA sequencing from cluster of differentiation (CD)19+ and CD19- ASCs of nasal polyps from patients with allergic fungal rhinosinusitis (n = 3). Nasal polyps were highly enriched in CD19+ ASCs. Class-switched IgG and IgA ASCs were dominant (95.8%), whereas IgE ASCs were rare (2%) and found only in the CD19+ compartment. Through Ig gene repertoire analysis, IgE ASCs shared clones with IgD-CD27- "double-negative" B cells, IgD+CD27+ unswitched memory B cells, and IgD-CD27+ switched memory B cells, suggesting ontogeny from both IgD+ and memory B cells. Transcriptionally, mucosal IgE ASCs upregulate pathways related to antigen presentation, chemotaxis, B cell receptor stimulation, and survival compared with non-IgE ASCs. Additionally, IgE ASCs have a higher expression of genes encoding lysosomal-associated protein transmembrane 5 (LAPTM5) and CD23, as well as upregulation of CD74 (receptor for macrophage inhibitory factor), store-operated Calcium entry-associated regulatory factor (SARAF), and B cell activating factor receptor (BAFFR), which resemble an early minted ASC phenotype. Overall, these findings reinforce the paradigm that human ex vivo mucosal IgE ASCs have a more immature plasma cell phenotype than other class-switched mucosal ASCs and suggest unique functional roles for mucosal IgE ASCs in concert with Ig secretion.
Collapse
Affiliation(s)
- Richard P Ramonell
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Matthew C Woodruff
- Emory Autoimmunity Center of Excellence, Emory University, Atlanta, Georgia, USA; Department of Medicine, Division of Rheumatology, Lowance Center for Human Immunology, Emory University, Atlanta, Georgia, USA
| | - Joshua M Levy
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Sarah K Wise
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - John DelGaudio
- Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Meixue Duan
- Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Celia L Saney
- College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Shuya Kyu
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, Georgia, USA
| | - Kevin S Cashman
- Emory Autoimmunity Center of Excellence, Emory University, Atlanta, Georgia, USA; Department of Medicine, Division of Rheumatology, Lowance Center for Human Immunology, Emory University, Atlanta, Georgia, USA
| | - Jennifer R Hom
- Emory Autoimmunity Center of Excellence, Emory University, Atlanta, Georgia, USA; Department of Medicine, Division of Rheumatology, Lowance Center for Human Immunology, Emory University, Atlanta, Georgia, USA
| | - Christopher F Fucile
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA; Informatics Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alexander F Rosenberg
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA; Informatics Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher M Tipton
- Emory Autoimmunity Center of Excellence, Emory University, Atlanta, Georgia, USA; Department of Medicine, Division of Rheumatology, Lowance Center for Human Immunology, Emory University, Atlanta, Georgia, USA
| | - Ignacio Sanz
- Emory Autoimmunity Center of Excellence, Emory University, Atlanta, Georgia, USA; Department of Medicine, Division of Rheumatology, Lowance Center for Human Immunology, Emory University, Atlanta, Georgia, USA
| | | | - F Eun-Hyung Lee
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, Georgia, USA.
| |
Collapse
|
5
|
Shi L, Liu C, Xiong H, Shi D. Elevation of IgE in patients with psoriasis: Is it a paradoxical phenomenon? Front Med (Lausanne) 2022; 9:1007892. [PMID: 36314037 PMCID: PMC9606585 DOI: 10.3389/fmed.2022.1007892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin E (IgE) elevation is a hallmark of allergic conditions such as atopic dermatitis (AD). The pathogenesis of AD is typically associated with high levels of IL-4 and IL-13 produced by activated T helper 2 (Th2) cells. Psoriasis, on the other hand, is an inflammatory skin disease mainly driven by Th17 cells and their related cytokines. Although the immunopathologic reactions and clinical manifestations are often easily distinguished in the two skin conditions, patients with psoriasis may sometimes exhibit AD-like manifestations, such as elevated IgE and persistent pruritic lesions. Given the fact that the effective T cells have great plasticity to re-differentiate in response to innate and environmental factors, this unusual skin condition could be a consequence of a cross-reaction between distinct arms of T-cell and humoral immunity. Here we review the literature concerning the roles of IgE in the development of AD and psoriasis, showing that elevated IgE seems to be an important indicator for this non-typical psoriasis.
Collapse
Affiliation(s)
- Leyao Shi
- The Second Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China,The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Chen Liu
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China
| | - Huabao Xiong
- Basic Medical School, Institute of Immunology and Molecular Medicine, Jining Medical University, Jining, China,Huabao Xiong
| | - Dongmei Shi
- The Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, China,Department of Dermatology, Jining No.1 People's Hospital, Jining, China,*Correspondence: Dongmei Shi
| |
Collapse
|
6
|
Xie M, Fajt ML. Development of New White Fish Allergy after Bone Marrow Transplantation from a Non-atopic Donor. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2020; 93:679-683. [PMID: 33380929 PMCID: PMC7757063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Transplant-acquired food allergy has become increasingly recognized in solid organ and bone marrow transplantation. As food allergy has no cure and causes considerable impact on the lives of patients who require strict avoidance of foods to avoid potentially severe or fatal reactions, it is crucial for physicians to better understand the risk factors and mechanisms driving development of food allergy post-transplant. We report a case of new food allergy to whitefish in an elderly patient post-bone marrow transplant in which neither donor nor recipient had a history of atopy. Methods: A 70-year-old man experienced an anaphylactic reaction to Swai whitefish (Pangasius hypophthalmus) 6 months post-transplant that he had previously tolerated on multiple occasions both pre-transplant and in the preceding months post-transplant. This allergy was investigated by commercial serum specific IgE testing and fresh prick-to-prick skin test to Swai whitefish. Results: Fresh prick-to-prick demonstrated large positive reaction to the Swai whitefish with wheal of 10 mm and flare of 22 mm compared to positive histamine control with a wheal/flare of 5x8mm. Serum specific IgE testing to commercial whitefish was negative (specific IgE <0.10kU/L). The patient continues to strictly avoid Swai whitefish but tolerates all other fish and shellfish. Conclusions: The unique development of specific Swai whitefish allergy in an elderly man after bone marrow transplant where both donor and recipient had no prior history of atopy strongly supports transplant-related immunomodulation as a major mechanism for transplant-acquired allergy and suggests that that absence of atopy or advanced age may not necessarily be protective.
Collapse
Affiliation(s)
- Maylene Xie
- Fellow-Allergy-Immunology, Division of Pulmonary,
Allergy, and Critical Care, Department of Medicine, University of Pittsburgh
Medical Center, Pittsburgh, PA
| | - Merritt L. Fajt
- Assistant Professor of Medicine, Division of
Pulmonary,Allergy, and Critical Care, Department of Medicine, Associate Program
Director-Allergy-Immunology Fellowship, University of Pittsburgh Medical Center,
Pittsburgh, PA,To whom all correspondence should be addressed:
Merritt L. Fajt, MD, UPMC Montefiore Hospital, NW 628, 3459 Fifth Avenue,
Pittsburgh, PA 15213; Tel: 412-864-3199, Fax: 412-692-2260, Email address:
| |
Collapse
|
7
|
Whiteside S, Chin A, Tripathi G, Dharmani-Khan P, Markova M, Keslova P, Sedlacek P, Geddes MN, Lewis V, Modi M, Kalra A, Dabas R, Akhter A, Larratt L, van Slyke T, Brandwein J, Spellman SR, Leigh R, Daly A, Khan FM, Storek J. Curability and transferability of atopy with allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2020; 55:1282-1289. [PMID: 32231249 DOI: 10.1038/s41409-020-0876-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/07/2020] [Accepted: 03/16/2020] [Indexed: 12/29/2022]
Abstract
Atopy is excessive production of IgE in response to allergens. We evaluated in patients undergoing allogeneic hematopoietic cell transplantation (HCT) the following hypotheses: (1) Atopy is "curable" in atopic patients receiving HCT from a nonatopic donor (D-R+), and (2) Atopy is transferable from atopic donors to nonatopic recipients (D+R-). Atopic patients with atopic donors (D+R+) and non-atopic patients with non-atopic donors (D-R-) served as controls. We measured levels of multiallergen-specific IgE (A-IgE, atopy defined as ≥0.35 kUA/L) in sera from 54 patients and their donors pre HCT and from the patients at ≥2 years post HCT. Only 7/12 (58%) D- R+ patients became nonatopic after HCT. Only 1/11 (9%) D+R- patients became atopic. Eleven of 13 (85%) D-R- patients remained nonatopic. Unexpectedly, 11/18 (61%) D+R+ patients became nonatopic. In conclusion, contrary to our hypothesis and previous reports, the "cure" of atopy may occur in only some D-R+ patients and the transfer of atopy may occur rarely. The "cure" may not be necessarily due to the exchange of atopic for nonatopic immune system, as the "cure" may also occur in D+R+ patients.
Collapse
Affiliation(s)
| | - Alex Chin
- University of Calgary, Calgary, AB, Canada.,Alberta Public Laboratories, Calgary, AB, Canada
| | - Gaurav Tripathi
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | - Poonam Dharmani-Khan
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | - Marketa Markova
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Petra Keslova
- 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Sedlacek
- 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michelle N Geddes
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | - Victor Lewis
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | | | - Amit Kalra
- University of Calgary, Calgary, AB, Canada
| | - Rosy Dabas
- University of Calgary, Calgary, AB, Canada
| | | | - Loree Larratt
- Alberta Health Services, Calgary and Edmonton, AB, Canada.,University of Alberta, Edmonton, AB, Canada
| | - Tiffany van Slyke
- Alberta Health Services, Calgary and Edmonton, AB, Canada.,University of Alberta, Edmonton, AB, Canada
| | - Joseph Brandwein
- Alberta Health Services, Calgary and Edmonton, AB, Canada.,University of Alberta, Edmonton, AB, Canada
| | - Stephen R Spellman
- Immunobiology Research, Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA
| | - Richard Leigh
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | - Andrew Daly
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| | - Faisal M Khan
- University of Calgary, Calgary, AB, Canada.,Alberta Public Laboratories, Calgary, AB, Canada
| | - Jan Storek
- University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary and Edmonton, AB, Canada
| |
Collapse
|
8
|
Tracing IgE-Producing Cells in Allergic Patients. Cells 2019; 8:cells8090994. [PMID: 31466324 PMCID: PMC6769703 DOI: 10.3390/cells8090994] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/13/2019] [Accepted: 08/21/2019] [Indexed: 12/11/2022] Open
Abstract
Immunoglobulin E (IgE) is the key immunoglobulin in the pathogenesis of IgE associated allergic diseases affecting 30% of the world population. Recent data suggest that allergen-specific IgE levels in serum of allergic patients are sustained by two different mechanisms: inducible IgE production through allergen exposure, and continuous IgE production occurring even in the absence of allergen stimulus that maintains IgE levels. This assumption is supported by two observations. First, allergen exposure induces transient increases of systemic IgE production. Second, reduction in IgE levels upon depletion of IgE from the blood of allergic patients using immunoapheresis is only temporary and IgE levels quickly return to pre-treatment levels even in the absence of allergen exposure. Though IgE production has been observed in the peripheral blood and locally in various human tissues (e.g., nose, lung, spleen, bone marrow), the origin and main sites of IgE production in humans remain unknown. Furthermore, IgE-producing cells in humans have yet to be fully characterized. Capturing IgE-producing cells is challenging not only because current staining technologies are inadequate, but also because the cells are rare, they are difficult to discriminate from cells bearing IgE bound to IgE-receptors, and plasma cells express little IgE on their surface. However, due to the central role in mediating both the early and late phases of allergy, free IgE, IgE-bearing effector cells and IgE-producing cells are important therapeutic targets. Here, we discuss current knowledge and unanswered questions regarding IgE production in allergic patients as well as possible therapeutic approaches targeting IgE.
Collapse
|
9
|
Caruso C, Pinter E, Poli E, Ferri F, Merli M, Colantuono S, Mennini G, Melandro F, Rumi G, Galandrini R, Ginanni Corradini S. Acquired cow's milk sensitization after liver transplant in an adult: "clinical implications" and future strategies. Allergy Asthma Clin Immunol 2019; 15:11. [PMID: 30828351 PMCID: PMC6385433 DOI: 10.1186/s13223-019-0326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background Identifying the mechanisms responsible for the development of food allergy in liver transplant recipients is more complex as there are several different clinical scenarios related to the immunological function of the liver. Case presentation We describe the first case of Transplant Acquired Food Allergy (TAFA) to cow milk in an adult following LT from a donor dead because of anaphylactic shock. A 67-year-old woman with primary biliary cirrhosis was referred to the Transplant Center of our hospital because of an acute-on-chronic liver failure. The donor was a 15-year-old girl deceased for anoxic encephalopathy due to food induced anaphylaxis after eating a biscuit. In the donor's history food allergies to cow milk and eggs were present. Conclusion This case emphasizes the need for a standardized assessment of both solid-organ donors and recipients including donor allergy history in order to detect recipients at risk for anaphylaxis due to passive IgE transfer. Despite several reports of TAFA after solid organ, especially liver, an appropriate protocol to avoid risk for the recipient doesn't exist at the moment. The SPT (skin prick test) or specific IgE level are not enough to ensure a correct management in these cases and a correct education of the patients and the medical staff involved is absolutely necessary. It is the first case of milk allergy sensitization after solid organ transplant by passive transfer of IgE.
Collapse
Affiliation(s)
- C Caruso
- Allergy Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli, IRCSS, Rome, Italy
| | - E Pinter
- 3Clinical Immunology, Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - E Poli
- 5Gastroenterology Unit, Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - F Ferri
- 5Gastroenterology Unit, Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - M Merli
- 5Gastroenterology Unit, Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - S Colantuono
- Allergy Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli, IRCSS, Rome, Italy.,3Clinical Immunology, Department of Clinical Medicine, Sapienza University, Rome, Italy
| | - G Mennini
- 2Dipartimento di Chirurgia Generale e Trapianti d'Organo, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy
| | - F Melandro
- 2Dipartimento di Chirurgia Generale e Trapianti d'Organo, "Sapienza" Università di Roma, Policlinico Umberto I, Rome, Italy
| | - G Rumi
- Allergy Unit, Presidio Columbus, Fondazione Policlinico A. Gemelli, IRCSS, Rome, Italy
| | - R Galandrini
- 4Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Ginanni Corradini
- 5Gastroenterology Unit, Department of Clinical Medicine, Sapienza University, Rome, Italy
| |
Collapse
|
10
|
Take N, Nakahara T, Kido-Nakahara M, Furue M. Three cases of adult-onset atopic dermatitis after hematopoietic stem cell transplantation. Allergol Int 2018; 67:529-531. [PMID: 30007511 DOI: 10.1016/j.alit.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/02/2018] [Accepted: 04/05/2018] [Indexed: 10/28/2022] Open
|
11
|
Affiliation(s)
- Andrea R Waldman
- Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA
| | - Jusleen Ahluwalia
- Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA
| | - Jeremy Udkoff
- Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA
| | - Jenna F Borok
- Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA
| | - Lawrence F Eichenfield
- Pediatric and Adolescent Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA
| |
Collapse
|
12
|
Abstract
Atopic dermatitis is characterized by the interplay of skin barrier defects with the immune system and skin microbiome that causes patients to be at risk for infectious complications. This article reviews the pathogenesis of atopic dermatitis and the mechanisms through which patients are at risk for infection from bacterial, viral, and fungal pathogens. Although these complications may be managed acutely, prevention of secondary infections depends on a multipronged approach in the maintenance of skin integrity, control of flares, and microbial pathogens.
Collapse
Affiliation(s)
- Di Sun
- Department of Pediatrics, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Peck Y Ong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA; Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 75, Los Angeles, CA 90027, USA.
| |
Collapse
|
13
|
Abstract
Mechanisms that regulate the tolerance to dietary proteins or the loss of this and subsequent development of disease are poorly understood. In food allergy, there is growing awareness of the urgency in understanding these events to aid in the development of next-generation therapies and interventions. This review focuses on the accumulating evidence related to food allergy that develops after transplantation. This intriguing immunological phenomenon has been described in several different types of transplant settings and to variety of different foods. We outline these studies and the evidence from them that support transplant-acquired food allergy being a process regulated by both the donor allergic status and the recipient genetics and treatments. A number of key risk factors seem prevalent throughout transplant-acquired food allergy and include type of transplant, age and general health of the recipient, modality of immunosuppression and potentially the genetics of both donor and recipient. Importantly, these studies provide a window into better general understanding of food allergy, and facilitate clearer understanding of the critical immunological and epidemiological factors needed to allow the adoptive transfer of a food-specific allergic disease from one individual to another.
Collapse
Affiliation(s)
- Shweta S Hosakoppal
- Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul J Bryce
- Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
14
|
Moutsoglou DM, Dreskin SC. B cells establish, but do not maintain, long-lived murine anti-peanut IgE(a). Clin Exp Allergy 2016; 46:640-53. [PMID: 27021119 DOI: 10.1111/cea.12715] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/25/2015] [Accepted: 01/05/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Peanut allergy (PNA) has been reported to be transferred to tolerant recipients through organ and bone marrow (BM) transplantation. The roles T and B cells play in establishing, and the roles B cell subsets play in maintaining lifelong anti-peanut IgE levels are unknown. OBJECTIVES To determine the cellular requirements for the transfer of murine PNA and to determine the role CD20(+) cells play in maintaining long-lived anti-peanut IgE levels. METHODS We developed a novel adoptive transfer model to investigate the cellular requirements for transferring murine PNA. We also treated peanut-allergic (PA) mice with anti-CD20 antibody and measured IgE levels throughout treatment. RESULTS Purified B220(+) cells from PA splenocytes and purified CD4(+) cells from naïve (NA) splenocytes are the minimal requirements for the adoptive transfer of PNA. Prolonged treatment of allergic mice with anti-CD20 antibody results in significant depletion of B cell subsets but does not affect anti-peanut IgE levels, symptoms, or numbers of IgE antibody secreting cells (ASCs) in the BM. Adoptive transfer of BM and spleen cells from allergic donors treated with anti-CD20 antibody does not result in the transfer of PNA in NA recipients, demonstrating that anti-CD20 antibody treatment depletes B cells capable of differentiating into peanut-specific IgE ASCs. CONCLUSIONS AND CLINICAL RELEVANCE Peanut allergy can be established in a NA hosts with B220(+) cells from PA donors and CD4(+) cells from peanut-NA donors. However, long-term depletion of B220(+) cells with anti-CD20 antibody does not affect anti-peanut IgE levels. These results highlight a novel role for B cells in the development of PNA and provide evidence that long-lived anti-peanut IgE levels may be maintained by long-lived ASCs.
Collapse
Affiliation(s)
- D M Moutsoglou
- Division of Allergy and Clinical Immunology, Departments of Medicine and Immunology, University of Colorado Denver, Aurora, CO, USA
| | - S C Dreskin
- Division of Allergy and Clinical Immunology, Departments of Medicine and Immunology, University of Colorado Denver, Aurora, CO, USA
| |
Collapse
|
15
|
Nahm DH. Personalized Immunomodulatory Therapy for Atopic Dermatitis: An Allergist's View. Ann Dermatol 2015; 27:355-63. [PMID: 26273148 PMCID: PMC4530142 DOI: 10.5021/ad.2015.27.4.355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 01/06/2023] Open
Abstract
The current standard medical therapy for atopic dermatitis (AD) mainly focuses on symptomatic relief by controlling skin inflammation with topical corticosteroids and/or topical calcineurin inhibitors. However, the clinical efficacy of pharmacological therapy is often disappointing to both patients and physicians. The terminology of AD contains a historical meaning of eczematous dermatitis caused by hypersensitivity reaction to environmental inhalant or food allergen. Complex interrelationships among genetic abnormalities, environmental triggers, skin barrier defects, and immune dysfunction resulting in a vicious domino-circle seem to be involved in the development and maintenance of AD. In the viewpoint of AD as an allergic disease, complete avoidance of clinically relevant allergen or induction of specific immune tolerance through administrations of allergen (allergen immunotherapy) can provide clinical remission by breaking the vicious domino-circle maintaining a chronic disease state. In recent clinical studies, monoclonal antibodies including the anti-interleukin-4 receptor antibody and anti-B cell antibody induced significant clinical improvements in patients with AD. The detailed characteristics of immune dysfunction are heterogeneous among patients with AD. Therefore, a personalized combination of immunomodulatory therapies to reduce hypersensitivity (allergen immunotherapy) and correct immune dysfunction (monoclonal antibody therapy) could be a reasonable therapeutic approach for patients with AD. Future immunomodulatory therapies for AD should be developed to achieve long-term treatment-free clinical remission by induction of immune tolerance.
Collapse
Affiliation(s)
- Dong-Ho Nahm
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
16
|
Gauvreau GM, Harris JM, Boulet LP, Scheerens H, Fitzgerald JM, Putnam WS, Cockcroft DW, Davis BE, Leigh R, Zheng Y, Dahlén B, Wang Y, Maciuca R, Mayers I, Liao XC, Wu LC, Matthews JG, O'Byrne PM. Targeting membrane-expressed IgE B cell receptor with an antibody to the M1 prime epitope reduces IgE production. Sci Transl Med 2015; 6:243ra85. [PMID: 24990880 DOI: 10.1126/scitranslmed.3008961] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Elevated serum levels of both total and allergen-specific immunoglobulin E (IgE) correlate with atopic diseases such as allergic rhinitis and allergic asthma. Neutralization of IgE by anti-IgE antibodies can effectively treat allergic asthma. Preclinical studies indicate that targeting membrane IgE-positive cells with antibodies against M1 prime can inhibit the production of new IgE and significantly reduce the levels of serum IgE. We report results from two trials that investigated the safety, pharmacokinetics, and activity of quilizumab, a humanized monoclonal antibody targeting specifically the M1 prime epitope of membrane IgE, in subjects with allergic rhinitis (NCT01160861) or mild allergic asthma (NCT01196039). In both studies, quilizumab treatment was well tolerated and led to reductions in total and allergen-specific serum IgE that lasted for at least 6 months after the cessation of dosing. In subjects with allergic asthma who were subjected to an allergen challenge, quilizumab treatment blocked the generation of new IgE, reduced allergen-induced early and late asthmatic airway responses by 26 and 36%, respectively, and reduced allergen-induced increases in sputum eosinophils by ~50% compared with placebo. These studies indicate that targeting of membrane IgE-expressing cells with anti-M1 prime antibodies can prevent IgE production in humans.
Collapse
Affiliation(s)
| | | | - Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec G1V 4G5, Canada
| | | | - J Mark Fitzgerald
- University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada
| | | | | | - Beth E Davis
- University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada
| | - Richard Leigh
- University of Calgary, Calgary, Alberta T2N 4Z6, Canada
| | - Yanan Zheng
- Genentech Inc., South San Francisco, CA 94080, USA
| | - Barbro Dahlén
- Karolinska University Hospital, Stockholm S-141 86, Sweden
| | - Yehong Wang
- Genentech Inc., South San Francisco, CA 94080, USA
| | | | - Irvin Mayers
- University of Alberta, Edmonton, Alberta T6G 2G3, Canada
| | | | - Lawren C Wu
- Genentech Inc., South San Francisco, CA 94080, USA
| | | | | |
Collapse
|
17
|
Ponnampalam A, Growe G, Loftus P, Chipperfield K, Bigham M. Acquired peanut hypersensitivity following platelet transfusion. Transfus Med 2014; 24:426-7. [DOI: 10.1111/tme.12148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/14/2014] [Accepted: 07/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- A. Ponnampalam
- Department of Pathology; University of Manitoba; Winnipeg MB Canada
| | - G. Growe
- Department of Pathology; University of British Columbia
- BC and Yukon Centre; Canadian Blood Services
| | - P. Loftus
- BC and Yukon Centre; Canadian Blood Services
| | | | - M. Bigham
- BC and Yukon Centre; Canadian Blood Services
- School of Population and Public Health; University of British Columbia; Vancouver BC Canada
| |
Collapse
|
18
|
Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R, Bernstein D, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles SA, Wallace D, Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, Nadeau K, Nowak-Wegrzyn A, Oppenheimer J, Perry TT, Randolph C, Sicherer SH, Simon RA, Vickery BP, Wood R. Food allergy: a practice parameter update-2014. J Allergy Clin Immunol 2014; 134:1016-25.e43. [PMID: 25174862 DOI: 10.1016/j.jaci.2014.05.013] [Citation(s) in RCA: 508] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/02/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology (JCAAI). The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Food Allergy: A practice parameter update-2014." This is a complete and comprehensive document at the current time. The medical environment is a changing one, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, ACAAI, and JCAAI. These parameters are not designed for use by pharmaceutical companies in drug promotion.
Collapse
|
19
|
Wu LC, Scheerens H. Targeting IgE production in mice and humans. Curr Opin Immunol 2014; 31:8-15. [PMID: 25156315 DOI: 10.1016/j.coi.2014.08.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/01/2014] [Accepted: 08/04/2014] [Indexed: 11/26/2022]
Abstract
Immunoglobulin E (IgE) is pathogenic in allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergy. Recent studies using genetically modified IgE reporter mice indicate that the majority of serum IgE in mice is produced by short-lived IgE plasma cells, with minor contributions from long-lived IgE plasma cells, and implicate IgG1 and IgE memory B cells as potential sources of IgE memory. Clinical studies using antibodies against IL-13 or the IL-4 and IL-13 receptor subunit IL-4Rα, as well as an antibody against the M1 prime domain of human membrane IgE, indicate that, similar to mice, a proportion of IgE in humans is derived from ongoing IgE immune responses and short-lived plasma cells. Targeting IgE production may lead to new therapies for the treatment of allergic diseases.
Collapse
Affiliation(s)
- Lawren C Wu
- Department of Immunology, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
| | - Heleen Scheerens
- Department of Pharmacodynamic Biomarkers, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
| |
Collapse
|
20
|
Gordon J, Damstetter E, Nardone B, Mehta J, West DP, Cotliar J. Drug allergy in haematopoietic stem cell transplantation. Allergol Immunopathol (Madr) 2014; 42:375-7. [PMID: 23537592 DOI: 10.1016/j.aller.2013.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/14/2013] [Indexed: 11/20/2022]
Affiliation(s)
- J Gordon
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - E Damstetter
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - B Nardone
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - J Mehta
- Department of Medicine, Division of Hematology/Oncology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - D P West
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - J Cotliar
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
21
|
Wu LC, Zarrin AA. The production and regulation of IgE by the immune system. Nat Rev Immunol 2014; 14:247-59. [PMID: 24625841 DOI: 10.1038/nri3632] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IgE not only provides protective immunity against helminth parasites but can also mediate the type I hypersensitivity reactions that contribute to the pathogenesis of allergic diseases such as asthma, allergic rhinitis and atopic dermatitis. Despite the importance of IgE in immune biology and allergic pathogenesis, the cells and the pathways that produce and regulate IgE are poorly understood. In this Review, we summarize recent advances in our understanding of the production and the regulation of IgE in vivo, as revealed by studies in mice, and we discuss how these findings compare to what is known about human IgE biology.
Collapse
Affiliation(s)
- Lawren C Wu
- Department of Immunology, Genentech Inc., 1 DNA Way, South San Francisco, California 94080, USA
| | - Ali A Zarrin
- Department of Immunology, Genentech Inc., 1 DNA Way, South San Francisco, California 94080, USA
| |
Collapse
|
22
|
Hsu E, Horslen S. The emergence of eosinophilic disorders in pediatric transplant recipients. Pediatr Transplant 2013; 17:713-5. [PMID: 24164823 DOI: 10.1111/petr.12164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Evelyn Hsu
- Pediatric Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, WA, USA.
| | | |
Collapse
|
23
|
Eckl-Dorna J, Niederberger V. What is the source of serum allergen-specific IgE? Curr Allergy Asthma Rep 2013; 13:281-7. [PMID: 23585215 DOI: 10.1007/s11882-013-0348-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Immunoglobulin E (IgE), the key effector element in the induction and propagation of allergic diseases, is the least abundant antibody class. In allergic patients, class switch recombination to IgE in B cells is induced by allergen contact in conjunction with T cell interaction and a Th2 cytokine environment. With regard to future therapeutic approaches, the sites of IgE production in human subjects and the nature and characteristics of IgE-producing cells are of great interest. In this context, it has been shown that allergen-specific IgE levels can be boosted by contact with allergens via the respiratory mucosa of the nose. Also, it has been proposed that allergy effector organs (e.g., the nasal mucosa and the lung) may be important sites of IgE production in allergic patients. IgE-producing cells have also been found in the blood, but their numbers are extremely low. Transfer of specific sensitization during bone marrow transplantation indicates the presence of IgE-producing B memory cells or plasma cells also in the bone marrow. This review summarizes data on the induction of IgE production, IgE memory and the sites of IgE production in human allergic patients.
Collapse
Affiliation(s)
- Julia Eckl-Dorna
- Department of Otorhinolaryngology, Medical University of Vienna, General Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | | |
Collapse
|
24
|
Wei J, Zhang Y, Xu H, Jin J, Zhang J. Atopic dermatitis-like presentation of graft-versus-host disease: a novel form of chronic cutaneous graft-versus-host disease. J Am Acad Dermatol 2013; 69:34-9. [PMID: 23375455 DOI: 10.1016/j.jaad.2012.12.970] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 12/10/2012] [Accepted: 12/16/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Graft-versus-host disease (GVHD) is a systemic disease, and skin is often one of the target organs. An atopic dermatitis (AD)-like presentation has never to our knowledge been reported. OBJECTIVE We sought to describe an AD-like presentation of cutaneous GVHD. METHODS Data on 11 patients with an AD-like presentation of GVHD were collected. The clinical and laboratory findings were retrospectively studied. RESULTS All 11 patients developed skin lesions after hematopoietic stem-cell transplantation. The skin lesions occurred between 2 to 12 months after transplantation. Eight patients received their transplant from a first-degree family member; 3 received their transplant from an unrelated donor. The skin lesions were pruritic and suggestive of AD, whereas the histology showed features of AD and GVHD. The lesions responded to topical and systemic anti-inflammatory and immunosuppressive therapy and phototherapy. LIMITATIONS The number of patients is small and the study is retrospective. CONCLUSIONS AD-like GVHD might represent a novel form of chronic cutaneous GVHD and responds well to treatment.
Collapse
Affiliation(s)
- Jin Wei
- Department of Dermatology, Peking University People's Hospital, Beijing, China
| | | | | | | | | |
Collapse
|
25
|
Eckl-Dorna J, Pree I, Reisinger J, Marth K, Chen KW, Vrtala S, Spitzauer S, Valenta R, Niederberger V. The majority of allergen-specific IgE in the blood of allergic patients does not originate from blood-derived B cells or plasma cells. Clin Exp Allergy 2012; 42:1347-55. [DOI: 10.1111/j.1365-2222.2012.04030.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- J. Eckl-Dorna
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna; Austria
| | - I. Pree
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna; Austria
| | - J. Reisinger
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna; Austria
| | | | - K.-W. Chen
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna; Austria
| | - S. Vrtala
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna; Austria
| | - S. Spitzauer
- Institute of Medical and Chemical Laboratory Diagnostics; Medical University of Vienna; Vienna; Austria
| | | | - V. Niederberger
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna; Austria
| |
Collapse
|
26
|
Dullaers M, De Bruyne R, Ramadani F, Gould HJ, Gevaert P, Lambrecht BN. The who, where, and when of IgE in allergic airway disease. J Allergy Clin Immunol 2011; 129:635-45. [PMID: 22168998 DOI: 10.1016/j.jaci.2011.10.029] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 10/18/2011] [Accepted: 10/19/2011] [Indexed: 02/07/2023]
Abstract
Allergic asthma and allergic rhinitis/conjunctivitis are characterized by a T(H)2-dominated immune response associated with increased serum IgE levels in response to inhaled allergens. Because IgE is a key player in the induction and maintenance of allergic inflammation, it represents a prime target for therapeutic intervention. However, our understanding of IgE biology remains fragmentary. This article puts together our current knowledge on IgE in allergic airway diseases with a special focus on the identity of IgE-secreting cells ("who"), their location ("where"), and the circumstances in which they are induced ("when"). We further consider the therapeutic implications of the insights gained.
Collapse
Affiliation(s)
- Melissa Dullaers
- Laboratorium of Immunoregulation and Mucosal Immunology, Department of Pulmonary Medicine, University Hospital Ghent, Ghent, Belgium.
| | | | | | | | | | | |
Collapse
|
27
|
Atkins D, Malka-Rais J. Food allergy: transfused and transplanted. Curr Allergy Asthma Rep 2010; 10:250-7. [PMID: 20425005 DOI: 10.1007/s11882-010-0110-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The inadvertent transfer of food allergy from an allergic donor to an unsuspecting recipient by transfusion or organ donation is a relatively rare but intriguing event with potentially catastrophic consequences. Additionally, the development of food allergy in the recipient of a transplant from a donor who was not food allergic poses questions about why this occurs, why it is observed more frequently in some situations than others, and the mechanisms that may be involved. In this review, the transfer of food allergy by transfusion, bone marrow transplantation, and the transplantation of different solid organs is explored, and potential mechanisms in addition to the importance of careful monitoring are discussed.
Collapse
Affiliation(s)
- Dan Atkins
- National Jewish Health, Denver, CO 80206, USA.
| | | |
Collapse
|
28
|
Successful treatment of young-onset adult T cell leukemia/lymphoma and preceding chronic refractory eczema and corneal injury by allogeneic hematopoietic stem cell transplantation. Int J Hematol 2009; 90:397-401. [PMID: 19705056 DOI: 10.1007/s12185-009-0406-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 07/29/2009] [Accepted: 07/29/2009] [Indexed: 10/20/2022]
Abstract
Only some carriers of human T cell lymphotropic virus type I (HTLV-1) develop adult T cell leukemia/lymphoma (ATLL) after a long latency period, and an association has been reported between chronic refractory eczema, known as infective dermatitis, and young-onset ATLL. A 25-year-old female developed ATLL and underwent allogeneic hematopoietic stem cell transplantation (HSCT) in non-remission. She had chronic refractory eczema and corneal injury at the onset of ATLL. Remission of ATLL was achieved, and the HTLV-1 proviral load decreased after HSCT. In addition, her pre-existing eczema and corneal injuries almost disappeared. More than a year has passed since the transplantation was performed, and she has had no recurrence of either ATLL or lesions in the skin and eye. Her clinical course suggests a possible association between skin and eye lesions and HTLV-1 infection. Changes in the immunological condition after HSCT might play a key role. Special attention is needed when HTLV-1 carriers develop eye or skin lesions.
Collapse
|
29
|
|
30
|
Levy Y, Davidovits M, Cleper R, Shapiro R. New-onset post-transplantation food allergy in children--is it attributable only to the immunosuppressive protocol? Pediatr Transplant 2009; 13:63-9. [PMID: 18179638 DOI: 10.1111/j.1399-3046.2007.00883.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
New-onset post-transplantation food allergy has been described mainly after liver transplantation, and its pathogenesis was attributed to the immunomodulatory effects of tacrolimus therapy. The aim of the present study was to evaluate the association of food allergy with solid organ transplantation in our center. The medical records of children who underwent kidney transplantation and children who underwent liver or liver and kidney transplantation from 1986 to 2005 were reviewed. A total of 189 children (124 after kidney transplantation, 65 after liver or liver and kidney transplantation) received tacrolimus as part of the immunosuppressive regimen. New-onset post-transplantation food allergy was documented in four of them: two with liver transplants and two with combined kidney and liver transplants. The absence of new-onset food allergy in the children with isolated kidney transplants is compatible with other reports in the literature. This study supports the concept that the functioning liver itself, and not only tacrolimus immunosuppression, is a main contributor to food allergy in this patient population.
Collapse
Affiliation(s)
- Yael Levy
- Kipper Institute of Immunology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
| | | | | | | |
Collapse
|
31
|
Tabbara KF, Nassar A, Ahmed SO, Al Mohareb F, Aljurf M. Acquisition of vernal and atopic keratoconjunctivitis after bone marrow transplantation. Am J Ophthalmol 2008; 146:462-5. [PMID: 18614131 DOI: 10.1016/j.ajo.2008.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Revised: 05/05/2008] [Accepted: 05/07/2008] [Indexed: 12/30/2022]
Abstract
PURPOSE Vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) result from genetic and environmental factors. We present patients who had no history of atopic disorders before bone marrow transplantation (BMT) and who seem to have acquired VKC or AKC from their donors, who had atopic disorders. DESIGN Observational case series. METHODS The patients in this study were part of a cohort of patients who had undergone allogeneic hemapoietic stem cell transplantation (HSCT) from January 1997 through December 2007. Of 621 HSCT recipients, four recipients who were free of allergic disorders acquired VKC or AKC from their afflicted donors after HSCT. Each patient underwent complete ophthalmologic examination, determination of the total serum immunoglobulin (Ig) E, and conjunctival scrapings. RESULTS Four (0.64%) of 621 patients who had undergone HSCT acquired VKC or AKC after BMT. The donors had VKC or atopic dermatitis. In addition, in two of these four patients, asthma developed. One patient had elevated total serum IgE. Conjunctival scrapings of all four patients revealed the presence of eosinophils. One patient had concurrent graft-versus-host disease. CONCLUSIONS VKC and AKC are systemic allergic disorders characterized by local ocular manifestations. This report suggests the possibility of the acquisition of VKC or AKC after BMT by adoptive transfer.
Collapse
|
32
|
Is allergic disease curable or transferable with allogeneic hematopoietic cell transplantation? Blood 2008; 113:279-90. [PMID: 18469199 DOI: 10.1182/blood-2008-01-128686] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In the pathogenesis of allergic asthma/rhinitis, 2 main types of cells play a role: hematolymphatic cells (mast cells, eosinophils, T cells, B cells) and nonhematolymphatic cells (airway smooth muscle cells, epithelial cells). It is not known which one of the 2 cell types plays the primary role. Here we review the literature on allergic disease transfer and potential cure with allogeneic hematopoietic cell transplantation (HCT), as transferability and curability would support a primary role of hematolymphatic cells and have implications for donor selection for HCT and possible future treatment of severe allergic disease with HCT. A total of 18 nonallergic recipients were reported to develop allergic disease after transplantation; however, conclusive information for transfer was available for only 5 cases. Allergic disease was reported to abate in 3 allergic recipients; however, conclusive information for "cure" was available for only 2 cases. Problems in interpreting the reports include incomplete data on allergic disease in the donor or recipient before transplantation, not knowing the denominator, and the lack of controls. In summary, review of the literature generates the hypothesis that allergic disease is transferable and curable with HCT. A prospective study, including appropriate controls, is needed to evaluate this hypothesis.
Collapse
|
33
|
Lee JH, Park HY, Choe YH, Lee SK, Lee SI. The development of eosinophilic colitis after liver transplantation in children. Pediatr Transplant 2007; 11:518-23. [PMID: 17631020 DOI: 10.1111/j.1399-3046.2007.00693.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Tacrolimus-based immunosuppression in pediatric liver transplant recipients is known to be associated with EGID. Our goal was to determine the incidence, risk factors, and characteristics of EGID in our pediatric liver transplantation program. This study was a retrospective analysis of 38 pediatric liver transplant recipients. Rectal mucosal biopsy was performed to evaluate for gastrointestinal PTLD and eosinophilic colitis. There were 14 patients (37%) who were diagnosed with eosinophilic colitis. The mean age at transplantation was 10.8 +/- 1.8 months. Those with eosinophilic colitis had a higher incidence of peripheral eosinophilia (p = 0.003) during the first two months following transplantation and had a higher EBV infection rate. Symptoms, such as diarrhea, hematochezia, and abdominal pain, became apparent after an average of three months; diagnoses were made at 6.9 +/- 2.0 months after transplantation. There were eight patients (57%) with elevated food-specific IgE levels. With food restriction treatment, the symptoms of patients improved. EGID should be considered when clinical symptoms are present, because symptoms of this disorder are similar to those of gastrointestinal PTLD. It should also be considered when peripheral eosinophila is detected or when EBV seroconversion develops during the first two months following transplantation.
Collapse
Affiliation(s)
- Jee Hyun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong Gangnam-Gu, Seoul 135-710, South Korea
| | | | | | | | | |
Collapse
|
34
|
Abstract
Vitiligo is an autoimmune condition in which T cells recognize and destroy melanocytes. We present a case of a 20-year-old male who developed generalized vitiligo 4 years after allogeneic bone marrow transplantation (BMT) for Fanconi anemia. Although other autoimmune conditions have been well characterized as post-BMT complications, vitiligo is very rare. We review the 9 previously reported cases of post-BMT vitiligo.
Collapse
Affiliation(s)
- Shelley Cathcart
- Department of Dermatology, Memorial Hospital, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | |
Collapse
|
35
|
Niederberger V, Ring J, Rakoski J, Jager S, Spitzauer S, Valent P, Horak F, Kundi M, Valenta R. Antigens drive memory IgE responses in human allergy via the nasal mucosa. Int Arch Allergy Immunol 2006; 142:133-44. [PMID: 17057411 DOI: 10.1159/000096439] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 06/20/2006] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Natural allergen contact induces an increase of IgE levels and sensitivity but the mechanisms underlying the allergen-specific memory responses are poorly understood. Furthermore, it has not been studied whether allergen exposure affects the molecular reactivity profiles in patients. The aim of this study was to analyze the influence of nasal allergen encounter on the molecular profile and magnitude of memory IgE responses and on systemic sensitivity. METHODS We investigated allergen-specific IgE, IgG subclass and IgM responses to defined allergen molecules (grass pollen: Phl p 1, Phl p 2 and Phl p 5; birch pollen: Bet v 1 and Bet v 2) in allergic patients in response to natural as well as to controlled nasal and dermal allergen exposure. Changes in systemic sensitivity were monitored by skin prick testing and by basophil histamine release experiments. RESULTS Respiratory antigen exposure boosted IgE levels to a pre-established profile of allergen molecules without inducing significant IgM responses or new IgE specificities in allergic individuals. The importance of the route of allergen contact is demonstrated by an increase of systemic IgE levels and sensitivity after nasal exposure. In vitro sensitisation of basophils with pre- and post-seasonal serum samples suggests an allergen-induced elevation of specific IgE as a cause for the increased allergen-specific sensitivity. CONCLUSION The characteristics of the allergen-driven antibody responses indicate a direct activation of an established pool of IgE memory cells with defined specificities as an underlying mechanism. Our finding that nasal allergen contact is a major factor for the boosting of memory IgE and systemic sensitivity may open new therapeutic possibilities.
Collapse
Affiliation(s)
- Verena Niederberger
- Department of Otorhinolaryngology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Granot E, Yakobovich E, Bardenstein R. Tacrolimus immunosuppression - an association with asymptomatic eosinophilia and elevated total and specific IgE levels. Pediatr Transplant 2006; 10:690-3. [PMID: 16911492 DOI: 10.1111/j.1399-3046.2006.00542.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
De novo development of food allergy is an infrequent but potentially serious complication of transplantation. An increased prevalence of food allergy noted specifically in children receiving tacrolimus immunosuppression supports the hypothesis that selective suppression of Th1 lymphocytes by the IL-2 inhibitor immunosuppressants CsA, and the more potent drug, tacrolimus , promotes Th2 lymphocytes and an allergic immune response. This study was undertaken to characterize the IgE-mediated immune response, in CsA and tacrolimus-treated, post-OLT children. Thirty children and adolescents aged 1.9-21 yr, mean: 10.6 yr, (6.4 yr post-tx.) were studied. Immunosuppression-CsA: 10 patients, tacrolimus; 20 patients. Blood eosinophils, total IgE levels and specific IgE antibodies (Immulite 2000 Allergy; Diagnostic Products Corp., Los Angeles, CA, USA) to a panel of food and inhaled allergens were measured and correlated with clinical symptoms of allergy. Eosinophilia (>500/mm(3)) range: 599-3125, mean: 1294, was present in 10/20 of patients treated with tacrolimus and 1/10 treated with CsA. IgE levels were elevated in eight of these 10 tacrolimus-treated patients and in two CsA patients ; five were <3 yr of age and IgE levels ranged from 54 to 111 IU/mL (mean: 83), normal for age <45 IU/mL and five were > or =9 yr and IgE levels ranged from 134 to 1606 IU/mL (mean: 557), normal for age <87 IU/mL. Specific IgE levels to a wide panel of food allergens were positive in five tacrolimus-treated patients and to both food and inhaled allergens in three patients (two tacrolimus-treated, one CsA). Four children (tacrolimus-treated) had symptoms of food allergy . None had a family history of allergy. Eosinophilia is present in up to 50% of children and adolescents receiving tacrolimus immunosuppression. The majority of these patients also have elevated levels of total and specific (mainly to food allergens) IgE antibodies. Most patients are asymptomatic and do not manifest food allergy or asthma.
Collapse
Affiliation(s)
- E Granot
- Pediatric Liver Unit, Division of Pediatrics, Kaplan Medical Center, Rehovot, Israel.
| | | | | |
Collapse
|
37
|
|
38
|
Abstract
Tens of thousands of patients undergo hematopoietic stem cell transplantation (HSCT) each year, mainly for hematologic disorders. In addition to the underlying diseases, the chemotherapy and radiation therapy that HSCT recipients receive can result in damage to multiple organ systems. Pulmonary complications develop in 30% to 60% of HSCT recipients. With the widespread use of prophylaxis for certain infections, the spectrum of pulmonary complications after HSCT has shifted from more infectious to noninfectious complications. This article reviews some of the noninfectious, chronic pulmonary complications.
Collapse
Affiliation(s)
- Bekele Afessa
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
| | | |
Collapse
|
39
|
Koharazawa H, Kanamori H, Takabayashi M, Yamaji S, Taguchi J, Fujimaki K, Ishigatsubo Y. Resolution of atopic dermatitis following allogeneic bone marrow transplantation for chronic myelogenous leukemia. Bone Marrow Transplant 2005; 35:1223-4. [PMID: 15880131 DOI: 10.1038/sj.bmt.1704990] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
40
|
Niemeier V, Passoth PR, Krämer U, Bauer J, Oschmann P, Kupfer J, Gieler U. Manifestation of atopic eczema in children after heart transplantation in the first year of life. Pediatr Dermatol 2005; 22:102-8. [PMID: 15804295 DOI: 10.1111/j.1525-1470.2005.22203.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Children undergoing heart transplantation in the first year of life appear in clinical observation to develop atopic eczema at an above-chance frequency despite immunosuppressive therapy with cyclosporine A. A clinical study was undertaken to clarify the extent to which those children develop atopic eczema with above-chance frequency. In this cross-sectional study, we examined 41 consecutive children after heart transplantation. Twenty-seven underwent heart transplantation in the first year of life, seven after the first birthday, and seven had cardiac surgery other than heart transplantation in the first year of life and served as a control group. Atopic eczema was diagnosed in 11 out of 27 children with heart transplant in the first year of life. No atopic eczema was diagnosed in the other two groups. Children undergoing heart transplant prior to the first birthday apparently develop atopic eczema more frequently than children whose surgery was performed after the first birthday, and also more frequently than children undergoing organ-preserving procedures, despite immunotherapy. It remains an open question whether a surgical procedure within the first months of life with subsequent immunosuppression causes an alteration in the reactivity of the immune system in these children compared to older children which promotes the occurrence of atopic eczema despite immunosuppression.
Collapse
Affiliation(s)
- Volker Niemeier
- Department of Dermatology and Andrology, Justus-Liebig-University Giessen, Germany
| | | | | | | | | | | | | |
Collapse
|
41
|
Niederwieser D, Gentilini C, Hegenbart U, Lange T, Moosmann P, Pönisch W, Al-Ali H, Raida M, Ljungman P, Tyndall A, Urbano-Ispizua A, Lazarus HM, Gratwohl A. Transmission of donor illness by stem cell transplantation: should screening be different in older donors? Bone Marrow Transplant 2005; 34:657-65. [PMID: 15334048 DOI: 10.1038/sj.bmt.1704588] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With increasing donor age, the potential of transmitting diseases from donor to recipient reaches new dimensions. Potentially transmittable diseases from donors include infections, congenital disorders, and acquired illnesses like autoimmune diseases or malignancies of hematological or nonhematological origin. While established nonmalignant or malignant diseases might be easy to discover, early-stage hematological diseases like CML, light-chain multiple myelomas, aleukemic leukemias, occult myelodysplastic syndromes and other malignant and nonmalignant diseases might not be detectable by routine screening but only by invasive, new and/or expensive diagnostic tests. In the following article, we propose recommendations for donor work-up, taking into consideration the age of the donors. In contrast to blood transfusions, stem cells from donors with abnormal findings might still be acceptable for HCT, when no other options are available and life expectancy is limited. This issue is discussed in detail in relation to the available donor and stem cell source. Finally, the recommendations presented here aim at harmonized worldwide work-up for donors to insure high standard quality.
Collapse
Affiliation(s)
- D Niederwieser
- Department of Internal Medicine II, Division of Hematology and Oncology, University of Leipzig, Philipp Rosenthalstr. 23-25, Leipzig D-4103, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Hallstrand TS, Sprenger JD, Agosti JM, Longton GM, Witherspoon RP, Henderson WR. Long-term acquisition of allergen-specific IgE and asthma following allogeneic bone marrow transplantation from allergic donors. Blood 2004; 104:3086-90. [PMID: 15280196 DOI: 10.1182/blood-2004-05-1775] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Adoptive transfer of allergen-specific immunoglobulin E (IgE) from atopic donors to nonatopic recipients occurs during the first year following bone marrow transplantation (BMT). Mature B- and T-cell clones with allergen-specific memory and hematopoietic progenitor cells are transferred through BMT. The objective of this study was to characterize the long-term rate of allergic sensitization and development of clinical allergic diseases following BMT from atopic donors. A long-term follow-up study was conducted in a cohort of donor and recipient pairs with moderate-to-severe allergic disease in the donor prior to BMT. Assessments of allergen-specific IgE, clinical rhinitis, and asthma were made in the donors prior to BMT and in the recipients with a mean follow-up of 15.5 years after BMT. From an initial cohort of 12 bone marrow transplant recipients who received marrow from allergic donors, 5 long-term survivors were identified. Allergen-specific IgE transferred from donor to recipient following BMT frequently persisted, and a high rate of de novo allergic sensitization was observed between 1 and 14 years after BMT. These events were associated with elevation in total IgE, and development of allergic rhinitis and asthma at long-term follow-up. We conclude that marrow-derived immune cells from allergic donors can transfer the predisposition to allergy and asthma.
Collapse
Affiliation(s)
- Teal S Hallstrand
- Department of Medicine, University of Washington, BB-1333 Health Sciences, Box 356523, 1959 NE Pacific St, Seattle, WA 98195-6523, USA
| | | | | | | | | | | |
Collapse
|
43
|
Chehade M, Nowak-Wegrzyn A, Kaufman SS, Fishbein TM, Tschernia A, LeLeiko NS. De novo food allergy after intestinal transplantation: a report of three cases. J Pediatr Gastroenterol Nutr 2004; 38:545-7. [PMID: 15097447 DOI: 10.1097/00005176-200405000-00017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Mirna Chehade
- Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, Mount Sinai School of Medicine, New York, New York, USA
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
Allogeneic bone marrow transplantation is an established treatment modality for leukemia, hematologic disorders and inborn errors of metabolism. while the focus of attention is the transplant recipient, the bone marrow donor (often a sibling) is both physically and emotionally involved in the process. Few reports have been written from the donor's perspective, however. One of the authors of this report (G.P.) was a marrow donor as a child, and he reflects on this experience at the completion of his first year of training in medical school.
Collapse
Affiliation(s)
- Gurpreet Parmar
- School of Medicine, The University of Western Ontario, London, Ontario, Canada
| | | | | |
Collapse
|
45
|
Dermatitis espongiótica y enfermedad de injerto contra huésped. ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
46
|
Shalit M, Amar A, Or R. Allergy development after bone marrow transplantation from a non-atopic donor. Clin Exp Allergy 2002; 32:1699-701. [PMID: 12653158 DOI: 10.1046/j.1365-2222.2002.01511.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transfer of allergy from atopic bone marrow donors to recipients is known to occur. Development of allergy in a non-atopic patient transplanted from a non-atopic donor is an unfamiliar phenomenon in clinical practice. OBJECTIVES To clarify the course of events causing a bone marrow recipient to acquire an allergic disease in such non-conducive circumstances. METHODS Full medical history, prick and intradermal skin tests, and serum IgE levels were obtained from both donor and recipient patients. DNA and red blood cell phenotype analyses were used to detect the degree of chimerism. RESULTS Only the recipient patient showed positive specific IgE antibodies and skin tests to house dust mite. The recipient patient displayed 100% donor chimera, based on all engraftment markers sought. CONCLUSION Full engraftment after allogeneic bone marrow transplantation may be associated with modulation of T and B cell function, which in turn could cause the onset of allergic disease after bone marrow transplantation.
Collapse
Affiliation(s)
- M Shalit
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah-Hebrew University Hospital, Jerusalem 91120, Israel.
| | | | | |
Collapse
|
47
|
|
48
|
Kelso JM. Recurrence of allergic rhinitis, previously alleviated with allergen immunotherapy, after autologous bone marrow transplant. Ann Allergy Asthma Immunol 2002; 89:316-8. [PMID: 12269654 DOI: 10.1016/s1081-1206(10)61961-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several associations between immunoglobulin E and bone marrow transplantation (BMT) have been reported. OBJECTIVE A patient whose allergic rhinitis (AR) resolved after allergen immunotherapy (AIT) but recurred after the patient received an autologous BMT is reported. METHODS Allergy skin tests were performed before AIT began and after 4 years of therapy. Skin tests were repeated after a recurrence of symptoms 6 years later after an autologous BMT for breast cancer. RESULTS Six years of AIT led to a near complete resolution of AR symptoms. Skin tests showed a marked reduction in reactivity to allergens in the AIT. After an additional 6-year symptom-free interval off AIT, symptoms returned after the BMT. Repeat skin tests showed a marked increase in reactivity. CONCLUSIONS Patients reconstituting their immune systems after autologous BMT may have a recurrence of AR previously suppressed with AIT.
Collapse
MESH Headings
- Adult
- Allergens/therapeutic use
- Bone Marrow Transplantation/adverse effects
- Desensitization, Immunologic
- Female
- Humans
- Recurrence
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/etiology
- Rhinitis, Allergic, Perennial/therapy
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/etiology
- Rhinitis, Allergic, Seasonal/therapy
- Skin Tests
Collapse
Affiliation(s)
- John M Kelso
- Department of Internal Medicine, Naval Medical Center, San Diego, California 92134-1005, USA.
| |
Collapse
|
49
|
Abstract
Atopy, allergy, or asthma rarely can complicate organ transplantation. We identified two patients who developed asthma following bone marrow transplantation. Neither patient had a documented history of allergy, atopy, or asthma, but their donors were human leukocyte antigen-identical siblings who had a history of asthma. Pulmonary function testing revealed decreased airflow. Investigation of the bronchial biopsy specimens revealed eosinophilia and histologic features that were compatible with asthma. No infectious pathogens were identified. Both patients received therapy with bronchodilators and inhaled corticosteroids with symptomatic improvement. A diagnosis of asthma should be entertained in the differential diagnosis of pulmonary complications in bone marrow transplant recipients.
Collapse
Affiliation(s)
- Heather Rietz
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | | |
Collapse
|
50
|
Alajlan A, Alfadley A, Pedersen KT. Transfer of vitiligo after allogeneic bone marrow transplantation. J Am Acad Dermatol 2002; 46:606-10. [PMID: 11907519 DOI: 10.1067/mjd.2002.117215] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adoptive transfer of donor immunity has been demonstrated in animals after bone marrow transplantation (BMT). In humans, several autoimmune diseases have been similarly transferred. Although BMT may, per se, be associated with a modulation of the recipient's immune system, which could trigger or even cause autoimmune diseases, both animal experiments and experience with humans show the likeliness of adoptive transfer of donor immunity to the recipient. We describe a patient with multiple myeloma in whom generalized vitiligo developed within 3 months after allogeneic BMT from his HLA-matched sister with vitiligo. We believe that a form of adoptive transfer of donor immunity to the recipient might play a role in the development of vitiligo. In spite of this, neither de novo development of vitiligo in a genetically predisposed patient nor autoimmune phenomena associated with graft-versus-host disease can be completely excluded as a contributing factor for development of vitiligo in our patient. To our knowledge, this is the first case report of transfer of vitiligo after BMT from a donor with vitiligo.
Collapse
Affiliation(s)
- Abdulmajeed Alajlan
- Section of Dermatology, Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | | | | |
Collapse
|