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Choi DM, Pyun JE, Yim HE, Yoo KH, Shim JO, Lee EJ, Won NH. Eosinophilic gastroenteritis in an 18-year-old male with prolonged nephrotic syndrome. KOREAN JOURNAL OF PEDIATRICS 2016; 59:S72-S75. [PMID: 28018451 PMCID: PMC5177718 DOI: 10.3345/kjp.2016.59.11.s72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/18/2014] [Accepted: 10/03/2014] [Indexed: 11/27/2022]
Abstract
Eosinophilic gastroenteritis is a rare disease characterized by prominent eosinophilic tissue infiltration of the gastrointestinal tract. Here, we report a case of eosinophilic gastroenteritis in an 18-year-old patient with prolonged nephrotic syndrome who presented with abdominal pain and peripheral hypereosinophilia. During the previous 2 years, he had visited local Emergency Department several times because of epigastric pain and nausea. He had been treated with steroid-dependent nephrotic syndrome since 3 years of age. Tests ruled out allergic and parasitic disease etiologies. Gastroduodenoscopy with biopsy revealed marked eosinophilic infiltration in the duodenum. Renal biopsy findings indicated minimal change disease spectrum without eosinophilic infiltration. The oral deflazacort dosage was increased, and the patient was discharged after abdominal pain resolved. To our knowledge, this is the first report of eosinophilic gastroenteritis in a patient with minimal change disease.
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Affiliation(s)
- Da Min Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jung Eun Pyun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Hyung Eun Yim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Yoo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jung Ok Shim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Pathology, Korea University College of Medicine, Seoul, Korea
| | - Nam Hee Won
- Department of Pathology, Korea University College of Medicine, Seoul, Korea
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Ito J, Fujiwara T, Kojima R, Nomura I. Racial differences in eosinophilic gastrointestinal disorders among Caucasian and Asian. Allergol Int 2015; 64:253-9. [PMID: 26117257 DOI: 10.1016/j.alit.2015.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/04/2015] [Accepted: 02/15/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although there is an increasing number of eosinophilic gastrointestinal disorders (EGID) cases including eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE), being reported globally, no systematic reviews have been conducted to elucidate the racial differences in these disorders. We aimed to show the racial differences, especially among Caucasians and Asians, in the risk of EoE and EGE. METHODS We conducted a systematic review using PubMed in September 2012. All case reports and case series on EGID that involved human subjects and described race or ethnicity, as well as pathological findings, were included. For the comparison of reported cases between Caucasians and Asians, a chi-squared test was used. RESULTS Among the 687 studies found in PubMed, 121 studies fulfilled the eligibility criteria. In total, 2621 patients were reviewed. Among Caucasian EGID patients, 94% had EoE; while among Asian EGID patients, 72% had EGE (p < 0.001). Among EoE, Asians were significantly less likely to have dysphagia and heartburn, but more likely to have vomit and abdominal pain, compared to Caucasians (p < 0.001). Further, among EGE, Asians were significantly more likely to have eosinophil-infiltrated colon than Caucasians (OR: 3.22, 95% confidence interval [CI]: 1.60-7.04), but were less likely to have eosinophil-infiltrated stomach (OR: 0.29, 95% CI: 0.17-0.49). CONCLUSIONS We found that EoE occurs more frequently in Caucasian EGID patients than Asian EGID patients, while the reverse is true for EGE. Also, racial disparities in symptoms and eosinophil-infiltrated tissues were observed. Our findings suggest further genetic and environmental studies to elucidate the etiology of EGID.
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SUTO A, SUTO Y, ONOHARA N, TOMIZAWA Y, YAMAMOTO-SUGAWARA Y, OKAYAMA T, MASUDA K. Food allergens inducing a lymphocyte-mediated immunological reaction in canine atopic-like dermatitis. J Vet Med Sci 2015; 77:251-4. [PMID: 25728252 PMCID: PMC4363033 DOI: 10.1292/jvms.14-0406] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/09/2014] [Indexed: 11/23/2022] Open
Abstract
Canine atopic-like dermatitis (ALD) is suspected to be associated with food allergies, particularly those mediated by lymphocytes. In this study, 54 cases were included as ALD dogs, based on the negative IgE test results. In the dogs, the percentage of activated cells in helper-T lymphocytes was measured by flow cytometry using cultured peripheral lymphocytes under food allergen stimulation. We observed that 49 of the 54 ALD dogs (90.7%) had positive lymphocyte reactions against one or more food allergens. The most common food allergen was soybean, showing positive results in 21 dogs (42.9%), while the allergen to cause the lowest number of reactions was catfish (only 5 dogs, 10.2%). These results may be useful in considering elimination diets for ALD dogs.
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Affiliation(s)
- Akemi SUTO
- Suto Animal Hospital, 2–29–8 Horie, Urayasu-city, Chiba 279-0041, Japan
| | - Yukinori SUTO
- Suto Animal Hospital, 2–29–8 Horie, Urayasu-city, Chiba 279-0041, Japan
| | - Nozomi ONOHARA
- Suto Animal Hospital, 2–29–8 Horie, Urayasu-city, Chiba 279-0041, Japan
| | - Yu TOMIZAWA
- Suto Animal Hospital, 2–29–8 Horie, Urayasu-city, Chiba 279-0041, Japan
| | - Yukiko YAMAMOTO-SUGAWARA
- Animal Allergy Clinical Laboratories Inc., SIC-2 #301, 5–4–30 Nishihashimoto, Midori-ku, Sagamihara-city, Kanagawa 252-0131, Japan
| | - Taro OKAYAMA
- Animal Allergy Clinical Laboratories Inc., SIC-2 #301, 5–4–30 Nishihashimoto, Midori-ku, Sagamihara-city, Kanagawa 252-0131, Japan
| | - Kenichi MASUDA
- Animal Allergy Clinical Laboratories Inc., SIC-2 #301, 5–4–30 Nishihashimoto, Midori-ku, Sagamihara-city, Kanagawa 252-0131, Japan
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Copelovitch L, Sam Ol O, Taraquinio S, Chanpheaktra N. Childhood nephrotic syndrome in Cambodia: an association with gastrointestinal parasites. J Pediatr 2010; 156:76-81. [PMID: 19683254 DOI: 10.1016/j.jpeds.2009.06.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 05/28/2009] [Accepted: 06/24/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe childhood nephrotic syndrome (NS) in Cambodia and to evaluate whether initial presentation or relapse is associated with gastrointestinal parasitic infection. STUDY DESIGN We reviewed the records of 112 children with NS. A retrospective cross-sectional study compared 99 stool exams from 63 children with NS with 12 365 stool exams from 9495 controls. RESULTS The male-to-female ratio was 1.7; the mean age of presentation was 8.95 years--44% were hypertensive, 44% had microscopic hematuria, 40% had eosinophilia, and 41% had acute renal failure; 92.7% were steroid sensitive, 12.7% were steroid dependent, and 8.9% were frequent relapsers. Peritonitis and death were rare outcomes. Giardia lamblia (OR, 3.62; 95% CI, 2.0 to 6.1), Strongyloides stercoralis (OR, 3.59; 95% CI, 1.3 to 8.2), and Hookworm species (OR, 2.57; 95% CI, 1.0 to 5.5) were more likely to be isolated from the children with NS than the controls. CONCLUSIONS The clinical course of childhood NS in Cambodia is similar to the developed world. Differences at presentation included older age and increased prevalence of microscopic hematuria, hypertension, eosinophilia, and acute renal failure. This study demonstrates an association between G lamblia, S stercoralis, and possibly Hookworm species and the onset of NS.
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Affiliation(s)
- Lawrence Copelovitch
- Department of Pediatrics, Angkor Hospital for Children, Samdech Tep Vong Street, Siem Reap, Cambodia.
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Abdel-Hafez M, Shimada M, Lee PY, Johnson RJ, Garin EH. Idiopathic nephrotic syndrome and atopy: is there a common link? Am J Kidney Dis 2009; 54:945-53. [PMID: 19556042 DOI: 10.1053/j.ajkd.2009.03.019] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 03/20/2009] [Indexed: 11/11/2022]
Abstract
Numerous reports during the last 60 years have reported a strong association between idiopathic nephrotic syndrome and atopic disorders. Idiopathic nephrotic syndrome can be precipitated by allergic reactions and has been associated with both aeroallergens (pollens, mold, and dust) and food allergies. Patients with idiopathic nephrotic syndrome also may show increased serum immunoglobulin E (IgE) levels. A review of the literature suggests that although some idiopathic nephrotic syndrome cases may be associated with allergies, evidence that it is a type of allergic disorder or can be induced by a specific allergen is weak. Rather, it is likely that the proteinuria and increased IgE levels in patients with idiopathic nephrotic syndrome are caused by increased levels of interleukin 13 observed in these patients. Recent studies suggest that interleukin 13, a known stimulator of IgE response, may mediate proteinuria in patients with minimal change disease because of its ability to directly induce CD80 expression on the podocyte.
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Affiliation(s)
- Maher Abdel-Hafez
- Division of Pediatric Nephrology, University of Florida, Gainesville, FL 32610, USA
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Rostoker G, Delchier JC, Chaumette MT. Increased intestinal intra-epithelial T lymphocytes in primary glomerulonephritis: a role of oral tolerance breakdown in the pathophysiology of human primary glomerulonephritides? Nephrol Dial Transplant 2001; 16:513-7. [PMID: 11239024 DOI: 10.1093/ndt/16.3.513] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is increasing evidence that some organ-specific and generalized autoimmune diseases in humans might be related to a breakdown of oral tolerance. We explored this hypothesis in human primary glomerulonephritides. We prospectively counted intraepithelial T lymphocytes in the duodenal mucosa (as a marker of rupture of oral tolerance), together with IgA1 and IgA2 mucosal plasma cells, in patients with primary glomerulonephritides. METHODS We investigated eight adults with immune-complex glomerulopathy (membranous nephropathy+membranoproliferative glomerulonephritis), 16 adults with an idiopathic nephrotic syndrome, and 25 adults with IgA nephropathy. Patients with glomerulonephritides were compared to two control groups: group 1 consisted of nine healthy adults; group 2 comprised five adults with coeliac disease before dietary gluten withdrawal or during a clinical relapse related to gluten ingestion. (The latter disease is associated with increased numbers of intraepithelial T lymphocytes, and a breakdown of oral tolerance to gliadins is involved in the pathogenesis of coeliac disease). Duodenal fibroscopy was performed under neuroleptanalgesia. Four to six endoscopic biopsy specimens were taken from the second duodenum. Intraepithelial T lymphocytes were blindly counted on paraffin sections stained with haematein-eosin-saffron (HES), within the epithelium of a villus in a zone with at least 100 cells. Mucosal IgA1 and IgA2 plasma cells were blindly counted in a mucosal tissue unit by using specific mouse monoclonal antibodies directed against IgA1 and IgA2, with alkaline phosphatase anti-alkaline phosphatase (APAAP) revelation. As values were not normally distributed, we used non-parametric analysis of variance with the Kruskal-Wallis test, and compared median values by using the non-parametric Mann-Whitney test. RESULTS Intraepithelial T lymphocytes were significantly more abundant in patients with primary glomerulonephritides and coeliac disease than in healthy controls (P < 0.0001 in the Kruskal-Wallis test): healthy controls, median 11 (range 4.65-16); immune complex glomerulopathy, 27.45*** (15-93); idiopathic nephrotic syndrome, 16.5** (9-26.5); IgA nephropathy, 26.10*** (11.3-47.5); coeliac disease, 55*** (20-80) (*P <0.05; **P <0.01; ***P < 0.005, Mann-Whitney test). No difference was found in the number of duodenal IgA1 and IgA2 plasma cells between controls and patients with primary glomerulonephritides. IgA1 and IgA2 plasma cells were increased in patients with coeliac disease. CONCLUSION The significant increase in intestinal intraepithelial T lymphocytes in primary glomerulonephritides suggests a pathophysiological role of oral tolerance breakdown.
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Affiliation(s)
- G Rostoker
- Service de Néphrologie et de Dialyse, Hôpital Claude Galien, Quincy sous Sénart, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
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Juncos LI, Muiño JC, García NH, Ferrer CI, Romero M, Sambuelli RH, Beltramo D. Renal tubular acidosis and vasculitis associated with IgE deposits in the kidney and small vessels. Am J Kidney Dis 2000; 35:941-9. [PMID: 10793031 DOI: 10.1016/s0272-6386(00)70267-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We report a woman with a history of allergies, polyuria, polydipsia, proteinuria, renal loss of electrolytes, renal tubular acidosis, nephrocalcinosis, and palpable purpura. A proximal defect was excluded by a normal bicarbonate reabsorption curve, and a distal tubular defect was shown because urine pH did not decrease to less than 6.4 despite ammonium chloride-induced systemic acidosis. Moreover, furosemide failed to improve urinary acidification. Urine-to-blood PCO(2) gradient was less than 14 mm Hg, although the urine bicarbonate level reached values as high as 89 mEq/L. Combining bicarbonate and neutral phosphate infusions increased the urine-to-blood PCO(2) gradient to only 20 mm Hg. These subnormal PCO(2) gradient values point to proton-pump dysfunction in the collecting tubule. Histological evidence of tubulointerstitial disease accompanied the tubular defects. The striking histological feature was the presence of immunoglobulin E (IgE) deposits in glomeruli, tubuli, and vessels. Concurrent with these findings, she had high serum IgE titers and CD23 levels. IgE antibodies from her serum were reactive against human renal tubuli, with binding to two regions that matched two different proteins present in cortex and medulla. One of these proteins corresponded to carbonic anhydrase II (31 kd); the second, to an unidentified protein that seems attached to cell membranes. We suggest that these IgE antibodies could have had a pathogenic role in this patient's glomerular, tubular, and small-vessel disease.
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Affiliation(s)
- L I Juncos
- IV Department of Internal Medicine, National University of Cordoba and Instituto Privado de Especialidades Medicas, Argentina.
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Werfel SJ, Cooke SK, Sampson HA. Clinical reactivity to beef in children allergic to cow's milk. J Allergy Clin Immunol 1997; 99:293-300. [PMID: 9058683 DOI: 10.1016/s0091-6749(97)70045-9] [Citation(s) in RCA: 138] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cow's milk is one of the most common food allergens in children. Limited information is available on the prevalence of reactivity to a related food source, beef. The purposes of this study were to examine the prevalence of symptomatic sensitivity to beef in a selected pediatric population and to determine the frequency of concomitant reactivity to cow's milk and beef. METHODS Children referred for assessment of atopic dermatitis and possible food hypersensitivity were evaluated for symptomatic reactivity to beef by double-blind placebo-controlled food challenges (DBPCFCs) and subsequent open feedings of beef. Sodium dodecyl-sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblot, and immunodot blot analyses were performed with patients' sera on preparations of beef extracts subjected to different cooking conditions: raw (no heating), medium, and well-cooked. RESULTS Eleven of 335 children referred for evaluation of atopic dermatitis and possible food hypersensitivity were found to have symptomatic sensitivity to beef; eight were also sensitive to milk, as demonstrated in previous DBPCFCs. Eight patients reacted to beef during DBPCFC, and three tolerated beef in a DBPCFC and well-cooked beef in an open challenge but reacted to ingestion of less well-cooked beef. SDS-PAGE of raw beef revealed at least 24 protein fractions. Several protein bands in raw beef appeared to denature with heating. Bovine serum albumin and bovine gamma globulin were heat-labile in the beef extract, but six protein fractions persisted even after heating the beef extract for 2 hours at 85 degrees C. IgE from patients reacting to rare and well-cooked beef bound up to six of these heat-resistant fractions, but IgE from patients reacting only to rare beef failed to bind any of these fractions with one exception. In addition, patients reacting to rare and well-cooked beef had specific IgE to a 17.8 kd fraction, which was only weakly recognized by one patient reacting only to rare beef. CONCLUSIONS Specific IgE antibodies to heat-labile beef proteins might explain why some patients can tolerate well-cooked beef but not medium-rare and rare beef. Patients reacting only to rare beef may not need to maintain a complete beef elimination diet.
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Affiliation(s)
- S J Werfel
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Verdaguer J, Corominas M, Bas J, Valls A, Mestre M, Romeu A, Gonzalez L, Massip E, Buendia E. IgE antibodies against bovine serum albumin in a case of eosinophilic gastroenteritis. Allergy 1993; 48:542-6. [PMID: 8238812 DOI: 10.1111/j.1398-9995.1993.tb01112.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Eosinophilic gastroenteritis is a disease characterized histologically by an eosinophilic infiltration of the gut. The cause of this disease remains unclear, although both food allergy and food intolerance have been implicated in its pathogenesis. We report the case of a 22-year-old man in whom gastrointestinal symptoms first appeared in childhood, with involvement of mucosa and muscularis layers of stomach and bowel. He presented high IgE blood levels, and his prick test was positive to bovine, pig, and lamb sera. Immunoblots from calf, pig, and lamb sera, incubated with the patient's serum and revealed by autoradiography, demonstrated the presence of a 65-kDa protein band that was recognized by IgE antibodies but not by IgG. This band corresponded to bovine serum albumin, while IgE did not show reactivity with human albumin. These data suggest a possible role for IgE-mediated hypersensitivity mechanisms in the pathogenesis of eosinophilic gastroenteritis.
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Affiliation(s)
- J Verdaguer
- Immunology Service, Hospital Duran i Reynals, Barcelona, Spain
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Gozalo A, Dagle G, Montoya E, Weiler R, Málaga CA. Spontaneous cardiomyopathy and nephropathy in the owl monkey (
Aotus
sp.) in captivity. J Med Primatol 1992. [DOI: 10.1111/j.1600-0684.1992.tb00592.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- A. Gozalo
- Center for Reproduction and Conservation of Nonhuman PrimatesInstituto Veterinario de Investigaciones Tropicales y de AlturaUniversidad Nacional Mayor de San MarcosIquitosPeru
| | - G.E. Dagle
- Battelle Northwest LaboratoriesBiology and Chemistry DepartmentRichlandWAU.S.A
| | - E. Montoya
- Center for Reproduction and Conservation of Nonhuman PrimatesInstituto Veterinario de Investigaciones Tropicales y de AlturaUniversidad Nacional Mayor de San MarcosIquitosPeru
| | - R.E. Weiler
- Battelle Northwest LaboratoriesBiology and Chemistry DepartmentRichlandWAU.S.A
| | - CA. Málaga
- Battelle Northwest LaboratoriesBiology and Chemistry DepartmentRichlandWAU.S.A
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Hoedemaeker PJ. Glomerular antigens in experimental glomerulonephritis. INTERNATIONAL REVIEW OF EXPERIMENTAL PATHOLOGY 1988; 30:159-229. [PMID: 3061961 DOI: 10.1016/b978-0-12-364930-0.50008-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- P J Hoedemaeker
- Department of Pathology, University of Leiden, The Netherlands
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